Socioeconomic status and health: The role of subjective social status

Abstract

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.

Low-intensity physical activity is associated with reduced risk of incident type 2 diabetes in older adults: evidence from the English Longitudinal Study of Ageing

“…Previous studies have shown that physical activity remained significantly related to incident diabetes after adjustment for a single measure of SES (typically education [16][17][18] but also occupational class [19]). Our study has accounted in a fuller way for SES by adjusting models for both education and total wealth, which is one of the best measures of SES for older people [20], and thus has more convincingly shown that the significant association between physical activity and incident diabetes is not an artefact of residual confounding because of inadequate adjustment for SES.…”

Subjective socioeconomic status and health in cross-national comparison

“…Health outcomes linked to subjective socioeconomic position included self-rated health (SRH; Demakakos et al, 2008;Singh-Manoux et al, 2005), depression (Demakakos et al, 2008;Sakurai et al, 2010;Singh-Manoux et al, 2003), nurse-rated health (Nobles et al, 2013), cortisol (Adler et al, 2000;Wright and Steptoe, 2005), and mortality rates (Kopp et al, 2004). While some studies showed that the association between subjective socioeconomic status and health was explained when accounting for objective markers of SES, at least for some outcomes (Singh-Manoux et al, 2003), the majority of studies suggest that subjective SES is associated with health even after controlling for objective SES.…”

“…Terms that are sometimes used synonymously are perceived social position (Garbarski, 2010) and subjective social status (Adler et al, 2000;Demakakos et al, 2008). The great recent interest in subjective SES among public health researchers has two reasons.…”

Subjective Social Status and Functional Decline in Older Adults

“…16 In studies of adults of all ages, lower SSS is associated with worse baseline self-rated health and health status. [11][12][13][14][17][18][19] While some studies find that the associations between subjective social status and health remain after accounting for objective measures of SES, 11,18 others do not. 19 To our knowledge, the only longitudinal study of subjective social status and health was conducted in British civil servants ages 35-55 years 10 and found that SSS was significantly associated with worse 3-year scores in psychological distress, the SF-36, and self-rated health.…”