Examining cultural, psychosocial, community and behavioural factors in relationship to socioeconomic inequalities in limiting longstanding illness among the Arab minority in Israel

Background: Few studies have examined the explanatory pathways to social inequalities in health within ethnic minorities. The current study examined the relative contributions of specific pathways explaining the associations between socioeconomic status (SES) and limiting longstanding illness (LLI) among the Arab minority in Israel. Methods: A cross-sectional study of a random sample of 902 individuals aged 30-70 selected in a multistage sampling procedure. SES was measured by education, land ownership and relative family income. Five-stage logistic regressions assessed the attenuations in the odds of LLI among those with lower SES compared to higher SES after including relevant groups of explanatory factors: psychosocial, behavioural and community, and their integration. Results: Rates of LLI were significantly higher in participants with lower SES. Inclusion of groups of explanatory variables attenuated all SES-LLI associations in a similar pattern: psychosocial factors played a main explanatory role, yielding 15-40% attenuation in odds ratios (OR). The contribution of community indicators was modest (10-21%); health behaviours had a marginal contribution (6-7%). Cultural factors were not associated with SES or LLI. The integrative model contributed up to 49% reduction in the OR. Conclusions: The significant associations between SES and LLI suggest that formative policy to reduce SES-LLI disparities should emphasise creating opportunities for economic development to improve SES, which was the main predictor of inequalities. Combining strategies of community capacity building and reinforcement of individual inner resources might be complementary. Such conclusions might apply to other minorities in a similar context, for which future studies are required.