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Logo of bmcphBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Public Health
BMC Public Health. 2012; 12: 46.
Published online Jan 18, 2012. doi:  10.1186/1471-2458-12-46
PMCID: PMC3293707
Health inequalities in the Netherlands: a cross-sectional study of the role of Type D (distressed) personality
Marja JH van Bon-Martens,corresponding author1,2 Johan Denollet ,3 Lambertus ALM Kiemeney ,4 Mariël Droomers,5 Monique JA de Beer,6 Ien AM van de Goor,1 and Hans AM van Oers1,7
1Academic Collaborative Centre Public Health Brabant, Tranzo, Tilburg School of Social and Behavioral Sciences, University of Tilburg, Tilburg, the Netherlands
2Department of Health Promotion, Regional Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands
3CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, the Netherlands
4Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
5Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
6Department of Local Health Policy, Regional Health Service West-Brabant, Breda, the Netherlands
7Centre for Public Health Status and Forecasts, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
corresponding authorCorresponding author.
Marja JH van Bon-Martens: M.J.H.vanBon/at/; Johan Denollet : J.Denollet/at/; Lambertus ALM Kiemeney : B.Kiemeney/at/; Mariël Droomers: M.Droomers/at/; Monique JA de Beer: M.Beer/at/; Ien AM van de Goor: L.vandeGoor/at/; Hans AM van Oers: Hans.van.Oers/at/
Received November 5, 2011; Accepted January 18, 2012.
In the Netherlands, as in many European countries, inequalities in health exist between people with a high and a low socioeconomic status (SES). From the perspective of the 'indirect selection hypothesis', this study was designed to expand our understanding of the role of Type D personality as an explanation of health inequalities.
Data came from two cross-sectional Dutch surveys among the general population (aged between 19 and 64 years, response 53.7%, n = 12,090). We analyzed the relative risks of low SES, assessed using education and income, and Type D personality, assessed using the Type D Scale-14 (DS14), for different outcomes regarding lifestyle-related risk factors and health, using multivariate Generalized Linear Models.
Results showed that Type D personality was significantly associated with low SES (OR = 1.7 for both low education and low income). Moreover, the relative risks of Type D personality and low SES were significantly elevated for most adverse health outcomes, unconditionally as well as conditionally.
The cross-sectional design hinders the making of definite etiological inferences. Nevertheless, our findings suggest that Type D personality does not explain the socioeconomic health inequalities, but is a risk factor in addition to low SES. Prevention of adverse health outcomes in low SES populations may have more effect when it takes into account that persons with a low SES in combination with a Type D personality are at highest risk.
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