Occupational Mobility and Coronary Heart Disease

Abstract

Using prevalence data of white men in Evans County, Ga, this paper studies the relationship between coronary heart disease (CHD) and social mobility. Two basic findings are (1) that in both types of mobility, intragenerational and intergenerational, persons in the two lower social classes are more at risk if upwardly mobile than the stable populations; and (2) that upwardly mobile persons among the upper social classes show lower rates than the stable, a reversal of the other finding.One of the striking findings of the cardiovascular incidence study conducted in Evans County, Georgia, between 1960-1962 was the changing relationship between coronary heart disease (CHD) and social class that had oc¬ curred during this time period (Cassel et al, 901). Social class was assessed by the McGuire-White scale' (a rural version of the Warner scale), which uses occupation, education, and source of income to derive a social class in¬ dex score. Social class analysis was re¬ stricted to white men. In 1960 those in the upper half of the range of social class scores were found to have age adjusted rates of CHD that were more than twice as high as those with scores in the lower half of the range.By 1967, however, this social class dif¬ ference had disappeared with the "lower" social class men having the same rates as the "higher." Various analyses have convinced us that these changing relationships represent a change in incidence by social class rather than being the effects of selec¬ tive survival or migration (Cassel et al, 901). Furthermore, it would ap¬ pear that the equality in rates in the two social class groups has been achieved by an increase in the rates for the "lower" social class men (par¬ ticularly younger men), rather than a decrease in the "higher" social class.This increase in the rates of CHD in the lower social class is occurring at a time when Evans County is un¬ dergoing a fairly rapid transition from a rural agrarian to a more "modern" industrialized economy.Until comparatively recently the only people participating in this change of "style of life" to any large extent were the "higher" social class men. It was the clinical impression of one of us (Hames, 883), based upon a life¬ time of experience in this county, that in recent years "lower" social class men were beginning to partici¬ pate in these changes to an ever in¬ creasing extent. Thus, in microcosm Evans County may be recapitulating the changes in style of life and ac¬ companying CHD rates that have characterized the urban developed countries over the past half century.What those particular styles of life are, particularly those which may be relevant to the risk of developing CHD, is a matter of speculation. There is no evidence that major changes in diet have occurred. Changes in cigarette smoking and physical activity surely have occurred, but as shown elsewhere (Cassel, 890), these are unlikely to have ac¬ counted for all of these social class findings. An additional possibility that requires exploration is that some of the psychosocial fact...

Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review

“…Six of 11 studies evaluated adult CVD risk factors as outcomes [49,64,72,73,75,77]; seven evaluated CVD mortality or CHD [38,44,75-79]. Four adjusted only for age [38,49,76,80]. …”

Socioeconomic status and coronary heart disease risk factor trends. The Minnesota Heart Survey.

“…[6][7][8][9] Early studies beginning in the 1930s in the United Kingdom and United States indicated a positive association between CHD and SES, with the highest SES groups having the most disease.10'11 More recently, an inverse association has been observed in those countries, with similar patterns in New Zealand, Aus-tralia, and the Scandinavian countries.12-15 The lowest SES groups now have the highest CHD rates. Correspondingly, lower SES groups also have the least favorable health characteristics, including obesity, cigarette smoking, hyperlipidemia, hypertension, and lack of physical activity.…”

Health Consequences of the Experience of Migration

“…The early work of Syme and colleagues (69,70) was seen as supportive of the hypothesis; however, this was at the cost of ignoring certain fi ndings (e.g. lower CHD rates if the father's nativity was foreign vs US) that didn't seem to fi t. Other studies (67,71) did not replicate the relationships observed earlier; the effects of upward mobility were seen either to increase or to lower CHD risk, depending on the social class level of the study subjects (68,72 ). In fact, the whole literature on occupational mobility and health (73) presents a confusing and inconclusive picture.…”

“…One area of research within the US setting that has had some popularity is the work linking CHD to sociocultural mobility (e.g. [67][68][69][70][71]. Geographical or occupational moves and intergenerational status mobility are thought to create sociocultural discontinuity, which in tum may lead to conflict, unpredictability, and inadequacy of existing skills in short, an analogue to migration.…”