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Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

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  • Macleod, John
  • Davey Smith, George
  • Metcalfe, Chris
  • Hart, Carole

Abstract

Both subjective and objective measures of lower social position have been shown to be associated with poorer health. A psychosocial, as opposed to material, aetiology of health inequalities predicts that subjective social status should be a stronger determinant of health than objective social position. In a workplace based prospective study of 5232 Scottish men recruited in the early 1970s and followed up for 25 years we examined the association between objective and subjective indices of social position, perceived psychological stress, cardiovascular disease risk factors and subsequent health. Lower social position, whether indexed by more objective or more subjective measures, was consistently associated with an adverse profile of established disease risk factors. Perceived stress showed the opposite association. The main subjective social position measure used was based on individual perceptions of workplace status (as well as their actual occupation, men were asked whether they saw themselves as "employees", "foremen", or "managers"). Compared to foremen, employees had a small and imprecisely estimated increased risk of all cause mortality, whereas managers had a more marked decreased risk. The strongest predictors of increased mortality were father's manual as opposed to non-manual occupation; lack of car access and shorter stature, (an indicator of material deprivation in childhood). In the fully adjusted analyses, perceived work-place status was only weakly associated with mortality. In this population it appears that objective material circumstances, particularly in early life, are a more important determinant of health than perceptions of relative status. Conversely, higher perceived stress was not associated with poorer health, presumably because, in this population, higher stress was not associated with material disadvantage. Together these findings suggest that, rather than targeting perceptions of disadvantage and associated negative emotions, interventions to reduce health inequalities should aim to reduce objective material disadvantage, particularly that experienced in early life.

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  • Macleod, John & Davey Smith, George & Metcalfe, Chris & Hart, Carole, 2005. "Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men," Social Science & Medicine, Elsevier, vol. 61(9), pages 1916-1929, November.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:9:p:1916-1929
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    9. Wolff, Lisa S. & Subramanian, S.V. & Acevedo-Garcia, Dolores & Weber, Deanne & Kawachi, Ichiro, 2010. "Compared to whom? Subjective social status, self-rated health, and referent group sensitivity in a diverse US sample," Social Science & Medicine, Elsevier, vol. 70(12), pages 2019-2028, June.
    10. Jerneja Farkas & Majda Pahor & Lijana Zaletel-Kragelj, 2011. "Self-rated health in different social classes of Slovenian adult population: nationwide cross-sectional study," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(1), pages 45-54, February.
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    14. Emma Zang & Anthony R. Bardo, 2019. "Objective and Subjective Socioeconomic Status, Their Discrepancy, and Health: Evidence from East Asia," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 143(2), pages 765-794, June.
    15. Billingsley, Sunnee, 2012. "Intragenerational mobility and mortality in Russia: Short and longer-term effects," Social Science & Medicine, Elsevier, vol. 75(12), pages 2326-2336.
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    17. Leu, Janxin & Yen, Irene H. & Gansky, Stuart A. & Walton, Emily & Adler, Nancy E. & Takeuchi, David T., 2008. "The association between subjective social status and mental health among Asian immigrants: Investigating the influence of age at immigration," Social Science & Medicine, Elsevier, vol. 66(5), pages 1152-1164, March.
    18. Karen Clay & Werner Troesken, 2006. "Deprivation and Disease in Early Twentieth-Century America," NBER Working Papers 12111, National Bureau of Economic Research, Inc.
    19. Gebreab, Samson Y. & Diez-Roux, Ana V. & Hickson, DeMarc A. & Boykin, Shawn & Sims, Mario & Sarpong, Daniel F. & Taylor, Herman A. & Wyatt, Sharon B., 2012. "The contribution of stress to the social patterning of clinical and subclinical CVD risk factors in African Americans: The Jackson Heart Study," Social Science & Medicine, Elsevier, vol. 75(9), pages 1697-1707.
    20. Clougherty, Jane Ellen & Eisen, Ellen A. & Slade, Martin D. & Kawachi, Ichiro & Cullen, Mark R., 2009. "Workplace status and risk of hypertension among hourly and salaried aluminum manufacturing employees," Social Science & Medicine, Elsevier, vol. 68(2), pages 304-313, January.
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    23. Kroenke, Candyce, 2008. "Socioeconomic status and health: Youth development and neomaterialist and psychosocial mechanisms," Social Science & Medicine, Elsevier, vol. 66(1), pages 31-42, January.

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