Relationship Between Subjective Social Status and Measures of Health in Older Taiwanese Persons

Hu, Peifeng; Adler, Nancy E.; Goldman, Noreen; Weinstein, Maxine; Seeman, Teresa E.

doi:10.1111/j.1532-5415.2005.53169.x

Cited by 167 publications

(167 citation statements)

References 32 publications

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“…This evidence suggests that SSS and wealth, regardless of their overlap, were important correlates of older people's health independent of one another. This conclusion coincides with recent suggestions that objective and subjective measures of SES are related but not interchangeable (Hu et al, 2005) and indicates that SSS and wealth reflect cumulative SES but probably different dimensions of it.…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, we found that the associations of SSS with waist circumference and CRP in women and with fibrinogen in men became non-significant only in models that adjusted for all objective SES measures. These findings accord with the existing literature suggesting that SSS is related to self-rated health (Franzini & Fernandez-Esquer, 2006;Hu et al, 2005;Operario et al, 2004;Ostrove et al, 2000;Singh-Manoux et al, 2005) and mental health (Franzini & FernandezEsquer, 2006;Singh-Manoux et al, 2005). However, they are not consistent with evidence suggesting that SSS is not related to diabetes in women over and above education (SinghManoux et al, 2003).…”

Section: Discussionsupporting

confidence: 76%

“…Evidence on SSS as a correlate of health in old age is scarce, with only one such study identified in our literature review (Hu, Adler, Goldman, Weinstein, & Seeman, 2005). Nevertheless, an increasing body of research, mostly cross-sectional, indicates that SSS (measured as a ladder score) relates over and above objective SES markers to self-rated health (Franzini & FernandezEsquer, 2006;Hu et al, 2005;Operario, Adler, & Williams, 2004;Ostrove et al, 2000;SinghManoux, Marmot, & Adler, 2005), mental health (Franzini & Fernandez-Esquer, 2006;SinghManoux et al, 2005), heart rate and sleep latency (Adler, Epel, Castellazzo, & Ickovics, 2000), cortisol levels (Wright & Steptoe, 2005), and dental outcomes (Sanders, Slade, Turrell, Spencer, & Marcenes, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, an increasing body of research, mostly cross-sectional, indicates that SSS (measured as a ladder score) relates over and above objective SES markers to self-rated health (Franzini & FernandezEsquer, 2006;Hu et al, 2005;Operario, Adler, & Williams, 2004;Ostrove et al, 2000;SinghManoux, Marmot, & Adler, 2005), mental health (Franzini & Fernandez-Esquer, 2006;SinghManoux et al, 2005), heart rate and sleep latency (Adler, Epel, Castellazzo, & Ickovics, 2000), cortisol levels (Wright & Steptoe, 2005), and dental outcomes (Sanders, Slade, Turrell, Spencer, & Marcenes, 2006). Also, there is evidence that SSS relates to adolescent health (Goodman, Adler, Daniels, Morrison, Slap, & Dolan, 2003;Goodman, Adler, Kawachi, Frazier, Huang, & Colditz, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…Also, there is evidence that SSS relates to adolescent health (Goodman, Adler, Daniels, Morrison, Slap, & Dolan, 2003;Goodman, Adler, Kawachi, Frazier, Huang, & Colditz, 2001). In contrast, research has shown that SSS is not related at all to body mass index, sleep quality, and resting systolic blood pressure in women , angina and respiratory illness in women (Singh-Manoux et al, 2003), and difficulties in Activities of Daily Living (Hu et al, 2005). Also, studies have shown that adjusting for objective indicators of SES attenuates the associations of SSS with perceptions of physical health (Franzini & Fernandez-Esquer, 2006), diabetes, self-rated health, and depression in both sexes, and angina and respiratory illness in men (Singh-Manoux et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic status and health: The role of subjective social status

Demakakos

Nazroo

Breeze

et al. 2008

Social Science & Medicine

586

519

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Studies have suggested that subjective social status (SSS) is an important predictor of health. This study examined the link between SSS and health in old age and investigated whether SSS mediated the associations between objective indicators of socioeconomic status and health. It used crosssectional data from the second wave (2004-05) of the English Longitudinal Study of Ageing, which were collected through personal interviews and nurse visits. The study population consisted of 3368 men and 4065 women aged 52 years or older. The outcome measures included: self-rated health, long-standing illness, depression, hypertension, diabetes, central obesity, high-density lipoprotein cholesterol, triglycerides, fibrinogen, and C-reactive protein. The main independent variable was SSS measured using a scale representing a 10-rung ladder. Wealth, education, and occupational class were employed as covariates along with age and marital status and also, in additional analyses, as the main independent variables. Gender-specific logistic and linear regression analyses were performed. In age-adjusted analyses SSS was related positively to almost all health outcomes. Many of these relationships remained significant after adjustment for covariates. In men, SSS was significantly (p≤0.05) related to self-rated health, depression, and long-standing illness after adjustment for all covariates, while its association with fibrinogen became non-significant. In women, after adjusting for all covariates, SSS was significantly associated with self-rated health, depression, long-standing illness, diabetes, and high-density lipoprotein cholesterol, but its associations with central obesity and C-reactive protein became non-significant. Further analysis suggested that SSS mediated fully or partially the associations between education, occupational class and self-reported and clinical health measures. On the contrary, SSS did not mediate wealth's associations with the outcome measures, except those with self-reported health measures. Our results suggest that SSS is an important correlate of health in old age, possibly because of its ability to epitomize life-time achievement and socioeconomic status.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Socioeconomic status and health: The role of subjective social status

Demakakos

Nazroo

Breeze

et al. 2008

Social Science & Medicine

586

519

View full text Add to dashboard Cite

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Associations Between Subjective Social Status andDSM-IVMental Disorders

et al. 2014

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IMPORTANCE The inverse social gradient in mental disorders is a well-established research finding with important implications for causal models and policy. This research has used traditional objective social status (OSS) measures, such as educational level, income, and occupation. Recently, subjective social status (SSS) measurement has been advocated to capture the perception of relative social status, but to our knowledge, there have been no studies of associations between SSS and mental disorders.OBJECTIVES To estimate associations of SSS with DSM-IV mental disorders in multiple countries and to investigate whether the associations persist after comprehensive adjustment of OSS. DESIGN, SETTING, AND PARTICIPANTS Face-to-face cross-sectional household surveys of community-dwelling adults in 18 countries in Asia, South Pacific, the Americas, Europe, and the Middle East (N = 56 085). Subjective social status was assessed with a self-anchoring scale reflecting respondent evaluations of their place in the social hierarchies of their countries in terms of income, educational level, and occupation. Scores on the 1 to 10 SSS scale were categorized into 4 categories: low (scores 1-3), low-mid (scores 4-5), high-mid (scores 6-7), and high (scores 8-10). Objective social status was assessed with a wide range of fine-grained objective indicators of income, educational level, and occupation. MAIN OUTCOMES AND MEASURESThe Composite International Diagnostic Interview assessed the 12-month prevalence of 16 DSM-IV mood, anxiety, and impulse control disorders. RESULTSThe weighted mean survey response rate was 75.2% (range, 55.1%-97.2%). Graded inverse associations were found between SSS and all 16 mental disorders. Gross odds ratios (lowest vs highest SSS categories) in the range of 1.8 to 9.0 were attenuated but remained significant for all 16 disorders (odds ratio, 1.4-4.9) after adjusting for OSS indicators. This pattern of inverse association between SSS and mental disorders was significant in 14 of 18 individual countries, and in low-, middle-, and high-income country groups but was significantly stronger in high-vs lower-income countries.CONCLUSIONS AND RELEVANCE Significant inverse associations between SSS and numerous DSM-IV mental disorders exist across a wide range of countries even after comprehensive adjustment for OSS. Although it is unclear whether these associations are the result of social selection, social causation, or both, these results document clearly that research relying exclusively on standard OSS measures underestimates the steepness of the social gradient in mental disorders.

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