Association between subjective social status and cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis

Tang, Karen; Rashid, Ruksana; Godley, Jenny; Ghali, William A.

doi:10.1136/bmjopen-2015-010137

Cited by 140 publications

(125 citation statements)

References 42 publications

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“…First, socioeconomic position is a complex construct and a variety of indicators may be utilized, like income, wealth, occupation and other individual and contextual markers and indexes [42–44]. Our analyses were based exclusively on the level of education, with several intrinsic limitations, such as the differential economic and social returns across gender and race strata, over time and geopolitical context, and the lack of information about the quality of education.…”

Section: Discussionmentioning

confidence: 99%

Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil

Alves

Faerstein

2016

Int J Equity Health

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BackgroundHypertension is a major public health issue worldwide, but knowledge is scarce about its patterns and its relationship to multiple axes of social disadvantages in Latin American countries. This study describes the educational inequality in the prevalence of hypertension in Brazil, including a joint stratification by gender and race.MethodsWe analyzed interview-based data and blood pressure measurements from 59,402 participants aged 18 years or older at the 2013 Brazilian National Health Survey (PNS). Sociodemographic characteristics analyzed were gender (male, female), racial self-identification (white, brown, black), age (5-years intervals), and educational attainment (pre-primary, primary, secondary, tertiary). Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or self-reported use of antihypertensive medications in the last 2 weeks. We used logistic regression to evaluate the age-adjusted prevalences of hypertension (via marginal modeling), and pair-wise associations between education level and odds of hypertension. Further, the educational inequality in hypertension was summarized through the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). All analyses considered the appropriate sampling weights and intersections with gender, race, and education.ResultsAge-adjusted prevalence of hypertension was 34.0 % and 30.8 % among men and women, respectively. Black and brown women had a higher prevalence than whites (34.5 % vs. 31.8 % vs. 29.5 %), whereas no racial differences were observed among men. White and brown, but not black women, showed graded inverse associations between hypertension and educational attainment; among men, non-statistically significant associations were observed in all racial strata. The RII and SII estimated inverse gradients among white (RII = 2.5, SII = 18.1 %) and brown women (RII = 2.3, SII = 14.5 %), and homogeneous distributions of hypertension in educational subgroups among black women and among men.ConclusionIn this representative sample of Brazilian adults, the association between educational attainment and hypertension was influenced by gender and race – a topic still poorly understood. Our findings highlight the importance of assessing intersections of multiple sociodemographic characteristics in health inequalities research. The use of comprehensive measures of inequality, such as RII and SII, provide useful insights for monitoring health inequalities in an intersectional perspective.

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Section: Discussionmentioning

confidence: 99%

Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil

Alves

Faerstein

2016

Int J Equity Health

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“…According to a prospective cohort study, SSS is a strong predictor of ill health, irrespective of education, occupation and income (15). Lower SSS is also associated with increased risk of hypertension, dyslipidemia, coronary artery disease, diabetes and obesity (16, 18). Such associations between SSS and health outcomes may be due to the effects of perceived social status on the underlying physiology of feeding behavior, which may impact body size and body fatness (12, 19–22).…”

Section: Introductionmentioning

confidence: 99%

Subjective social status is associated with compensation for large meals – A prospective pilot study

et al. 2019

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“…This subjective social standing or class is largely based on perceived relative possession of material and social resources (wealth, education, occupational prestige) compared with others, given the role of such resources in signifying and reifying status. Cross-sectional investigations and metaanalysis on the relationship between subjective socioeconomic status and health outcomes have suggested that individuals who report lower levels of subjective socioeconomic status and rank are more likely to be at risk for weight gain, adiposity, diabetes, and overweight/obesity even when controlling for objective indicators of socioeconomic status (11)(12)(13)(14). One pilot feasibility study using a small sample has implied that people placed into disadvantaged social roles subsequently consume more calories, but under circumstances where those in disadvantaged roles are exposed to greater stress and potential aggression from those in dominant roles (15).…”

mentioning

confidence: 99%

Mere experience of low subjective socioeconomic status stimulates appetite and food intake

Cheon

Hong

2016

Proc. Natl. Acad. Sci. U.S.A.

126

121

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Among social animals, subordinate status or low social rank is associated with increased caloric intake and weight gain. This may reflect an adaptive behavioral pattern that promotes acquisition of caloric resources to compensate for low social resources that may otherwise serve as a buffer against environmental demands. Similarly, diet-related health risks like obesity and diabetes are disproportionately more prevalent among people of low socioeconomic resources. Whereas this relationship may be associated with reduced financial and material resources to support healthier lifestyles, it remains unclear whether the subjective experience of low socioeconomic status may alone be sufficient to stimulate consumption of greater calories. Here we show that the mere feeling of lower socioeconomic status relative to others stimulates appetite and food intake. Across four studies, we found that participants who were experimentally induced to feel low (vs. high or neutral) socioeconomic status subsequently exhibited greater automatic preferences for high-calorie foods (e.g., pizza, hamburgers), as well as intake of greater calories from snack and meal contexts. Moreover, these results were observed even in the absence of differences in access to financial resources. Our results demonstrate that among humans, the experience of low social class may contribute to preferences and behaviors that risk excess energy intake. These findings suggest that psychological and physiological systems regulating appetite may also be sensitive to subjective feelings of deprivation for critical nonfood resources (e.g., social standing). Importantly, efforts to mitigate the socioeconomic gradient in obesity may also need to address the psychological experience of low social status.

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Association between subjective social status and cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis

Cited by 140 publications

References 42 publications

Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil

Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil

Subjective social status is associated with compensation for large meals – A prospective pilot study

Mere experience of low subjective socioeconomic status stimulates appetite and food intake

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