Class — The Ignored Determinant of the Nation's Health

Isaacs, Stephen L.; Schroeder, Steven A.

doi:10.1056/nejmsb040329

Cited by 324 publications

(221 citation statements)

References 28 publications

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“…Traditionally, race/ethnicity as well as education and incomes have been the focus of health disparities research (Isaacs & Schroeder, 2004). Given recent concerns that individual education and incomes may not adequately reflect social class (Marmot, 2000), there is a growing emphasis on the roles of occupation, social capital, and social context, all difficult parameters to capture in epidemiologic studies.…”

Section: Discussionmentioning

confidence: 99%

Disparities in obesity rates: Analysis by ZIP code area

Drewnowski

Rehm

Solet

2007

Social Science & Medicine

138

103

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Obesity in the USA has been linked to individual income and education. Less is known about its geographic distribution. The goal of this study was to determine whether obesity rates in King County, Seattle, Washington state, at the ZIP code scale were associated with area-based measures of socioeconomic status and wealth. Data from the Behavioral Risk Factor Surveillance System were analyzed. At the ZIP code scale, crude obesity rates varied six-fold. In a model adjusting for covariates and spatial dependence, property values were the strongest predictor of the area-based smoothed obesity prevalence. Geocoding of health data provides new insights into the nature of social determinants of health. Disparities in obesity rates by ZIP code area were greater than disparities associated with individual income or race/ethnicity.

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Section: Discussionmentioning

confidence: 99%

Disparities in obesity rates: Analysis by ZIP code area

Drewnowski

Rehm

Solet

2007

Social Science & Medicine

138

103

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“…Further, because patient activation is positively related to socio-economic status (SES) 13 , and there is a large literature documenting that SES is a strong predictor of health outcomes 27,28 , it is important to assess whether patient activation is consistently associated with health outcomes for people of differing SES. Prior studies have found patient activation to be a valid measure in a number of population subgroups (e.g.…”

Section: Introductionmentioning

confidence: 99%

Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes

2011

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BACKGROUND: There is a growing awareness that patients should be more active and effective managers of their health and health care. Recent studies have found patient activation-or having the knowledge, skills, and confidence to manage one's health, to be related to health-related outcomes. These studies have often relied on self-reported outcomes and often have used small samples. OBJECTIVE: To examine the degree to which patient activation is related to a broad range of patient health and utilization outcomes in a large, insured population. DESIGN: Cross-sectional study of patients at Fairview Health Services in Minnesota. Data on patient activation and patient outcomes were derived from the electronic health record, abstracted in December 2010. PATIENTS: A total of 25,047 adult patients were included in the analysis. They all had a primary care visit in the prior six months and completed the patient activation measure as part of an office visit. MAIN MEASURES: The key independent measure was the Patient Activation Measure. We examined 13 patient outcomes across four areas: prevention, unhealthy behaviors, clinical indicators, and costly utilization. RESULTS: In multivariate models, patient activation was related to 12 of 13 patient outcomes in the expected direction. For every additional 10 points in patient activation, the predicted probability of having an ED visit, being obese, or smoking was one percentage point lower. The likelihood of having a breast cancer screen or clinical indicators in the normal range (A1c, HDL, and triglycerides) was one percentage point higher. CONCLUSIONS: This cross sectional study finds that patient activation is strongly related to a broad range of health-related outcomes, which suggests improving activation has great potential. Future work should examine the effectiveness of interventions to support patient activation.KEY WORDS: patient activation; patient engagement; health care quality.

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“…[1][2][3][4][5] This association has been demonstrated for over a century and for numerous objective measures of SES, including net worth or wealth, income, educational attainment, and occupation. [6][7][8] Recently, there has been an emerging interest in the relationship between subjective social status (SSS) and health.…”

Section: Introductionmentioning

confidence: 99%

“…However, longitudinal studies have not been conducted to examine whether older persons who view themselves at the lowest rungs of social status are at most risk for poor health outcomes. Since decline in functional status is one of the greatest predictors of poor quality of life, morbidity, health care utilization and mortality 20,21 among older adults, the goals of this study were (1) to assess the association between subjective social status, and baseline functional and health status in older adults, and (2) to determine whether older adults with lower subjective social status are more likely to experience fouryear functional decline or death.…”

Section: Introductionmentioning

confidence: 99%