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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Effect of Family Factors on Health
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Kevin Fiscella, Rochester Dept of Family Medicine, University of Rochester
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Ferrer et al make creative use of the Community Tracking Study to examine the extent to which the physical and mental health status of family members are associated with each other. The study represents a first step towards quantifying the impact of families on health and raise some provocative questions. The results show significant associations for most configurations of families (note: the results in Tables 2 and 3 do not correspond exactly with the results reported in the text). Effects seem to be stronger for families without children. The authors interpret this to mean that families grow more alike with age because adjustment for age reduces the family effect more for families without children. However, this may be an artifact of the non-linear relationship between age and health status. This problem might be addressed by deriving age-adjusted health status scores for each family member. The familial associations are diminished after controlling for other family factors including age, income and health insurance. It is not clear why education was not also included in the multilevel regression model. SES is a multilevel dimensional construct and control for only one dimension will result in residual confounding. However, as the authors correctly acknowledge, there are a number of other factors that also mediate these effects besides income. The finding that health insurance contributes, albiet modestly, to familial assocations is consistent with evidence that the presence of health insurance affects health status and survival. I agree that genetic factors probably play a relatively modest role for the reasons cited by the authors (though use of age-adjusted health status might help to highlight these effects better. The authors do not mention another factor - assortive mating - spouses (and partners) tend to select others with characteristic similar to their own. This phenomena has been well documented in the social psychological literature. However, the finding that age is associated with stronger associations suggest that couples health does begin to converge with time. Further research is needed to determine what factors moderate and mediate these relationships. Competing interests: None declared |
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