Statistical challenges in modelling the health consequences of social mobility: the need for diagonal reference models

OBJECTIVES: Various studies on the health consequences of socio-economic position address social mobility. They aim to uncover whether health outcomes are affected by: (1) social mobility, besides, (2) social origin, and (3) social destination. Conventional methods do not, however, estimate these three effects separately, which may produce invalid conclusions. We highlight that diagonal reference models (DRMs) overcome this problem, which we illustrate by focusing on overweight/obesity (OWOB). METHODS: Using conventional methods (logistic-regression analyses with dummy variables) and DRMs, we examine the effects of intergenerational educational mobility on OWOB (BMI ≥ 25 kg/m(2)) using survey data representative of the Dutch population aged 18–45 (1569 males, 1771 females). RESULTS: Conventional methods suggest that mobility effects on OWOB are present. Analyses with DRMs, however, indicate that no such effects exist. CONCLUSIONS: Conventional analyses of the health consequences of social mobility may produce invalid results. We, therefore, recommend the use of DRMs. DRMs also validly estimate the health consequences of other types of social mobility (e.g. intra- and intergenerational occupational and income mobility) and status inconsistency (e.g. in educational or occupational attainment between partners).