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PubMed2004

[Social classes and poverty].

Social classes and poverty are two key social determinants fundamental to understand how disease and health inequalities are produced. During the 90's in Spain there has been a notable oscillation in the inequality and poverty levels, with an increase in the middle of the decade when new forms of social exclusion, high levels of unemployment and great difficulties in accessing the labour market, especially for those workers with less resources, emerged. Today society is still characterized by a clear social stratification and the existence of social classes with a predominance of high levels of unemployment and precarious jobs, and where poverty is an endemic social problem much worse than the EU average. To diminish health inequalities and to improve the quality of life will depend very much on the reduction of the poverty levels and the improvement of equal opportunities and quality of employment. To increase understanding of how social class and poverty affect public health, there is a need to improve the quality of both information and research, and furthermore planners and political decision makers must take into account those determinants when undertaking disease prevention and health promotion.

Employment↗
PubMed2004

Gender differences in the relationship of partner's social class to behavioural risk factors and social support in the Whitehall II study.

In most countries health inequality in women appears to be greater when their socio-economic position is measured according to the occupation of male partners or spouses than the women's own occupations. Very few studies show social gradients in men's health according to the occupation of their female partners. This paper aims to explore the reasons for the differences in social inequality in cardiovascular disease between men and women by analysing the associations between own or spouses (or partners) socio-economic position and a set of risk factors for prevalent chronic diseases. Study participants were married or cohabiting London based civil servants included in the Whitehall II study. Socio-economic position of study participants was measured according to civil service grade; socio-economic position of the spouses and partners according to the Registrar General's social class schema. Risk factors were smoking, diet, exercise, alcohol consumption, and measures of social support. In no case was risk factor exposure more affected by the socio-economic position of a female partner than that of a male study participant. Wives' social class membership made no difference at all to the likelihood that male Whitehall participants were smokers, or took little exercise. Female participants' exercise and particularly smoking habit was, in contrast, related to their spouse's social class independently of their own grade of employment. Diet quality was affected equally by the socio-economic position of both male and female partners. Unlike the behavioural risk factors, the degree of social support reported by women participants was in general not strongly negatively affected by their husband or partner being in a less advantaged social class. However, non-employment in the husband or partner was associated with relatively lower levels of positive, and higher negative social support, while men with non-working wives or partners were unaffected. Studying gender differences in health inequality highlights some of the problems in health inequality research more broadly. We are brought face to face with the fact that the development of conceptual models that can be applied consistently to aetiology in both men and women are still at an early stage of development. Closer attention is needed to the different processes behind material power and 'emotional power' within the household when investigating gender differences in health and risk factors.

Adult↗
PubMed1979

[Social class and bronchial cancer: the social structure in comparison to the total population].

400 male lung cancer patients were analysed according to their social class distribution and compared with the relevant age group of the Austrian population. There are significantly more lower class people among lung cancer patients than in the general population. The higher lung cancer risk in lower social classes, therefore, may be associated with social factors. These may influence smoking habits, the main cause of lung cancer: lower class people are more often cigarette smokers, less exsmokers and prefere high tar cigarettes.

Age Factors↗
PubMed2001

Anorexia nervosa and social class.

OBJECTIVES: (1) To examine social class status of female patients with anorexia nervosa presenting over a 33-year period; (2) to identify any differences in clinical features between the social classes. METHOD: Retrospective survey using comprehensive clinical database of patients referred to a national specialist center for the assessment and treatment of anorexia nervosa. Social class was defined using UK Registrar General's classification of father's occupation. Statistical methods included initial univariate analyses and subsequent ordinal logistic regression. RESULTS: (1) Social class distribution was consistently weighted toward social classes 1/2. (2) Possible clinical indicators examined included low body weight, binge eating, and consequent weight-regulatory behaviors such as vomiting and laxative and diuretic misuse. These clinical features and their distribution proved to be similar across the social groups. Clinically rated quality of family relationships and types of family constellations were also consistent across the social classes. (3) Dieting prodromata and onset of the disorder occurred at younger ages in social classes 1/2. (4) A modest shift in social class distribution over time was apparent, with slightly more patients presenting post-1985 likely to come from lower social classes. Claims that the social class distribution is a product of referral patterns and acceptances are disputed. CONCLUSION: We suggest that the social class bias reflects a sociocultural influence; a product of the disorder significantly often arising as an avoidant response to the conflict between social class-related family values/attitudes and adolescent turbulence within that family.

Adult↗
PubMed1990

Social class, mental illness, and social mobility: the social selection-drift hypothesis for serious mental illness.

The assumptions and methods of previous studies of the social selection-drift hypothesis for serious mental illness are examined by using comtemporary log-linear methods for social mobility analysis. The null hypothesis of no difference in intergenerational social mobility between seriously mentally ill and general population control groups cannot be rejected in previous studies by Birtchnell (1971), Goldberg and Morrison (1963), Langner and Michael (1963), and Turner and Wagenfeld (1967). The findings of this study suggest that previous empirical support for intergenerational social mobility differences is an artifact of not controlling for group differences in origins and destinations when collapsed origin-by-destination tables are analyzed. This study suggests that intergenerational social mobility differences between seriously mentally ill and general population groups in previous studies provide very little, if any, empirical support for social selection-drift processes in serious mental illness.

Female↗
PubMed1993

Re-thinking the analysis of intergenerational social mobility: a comment on John W. Fox's "Social class, mental illness, and social mobility".

The method of analyzing social mobility described by Fox (1990) is flawed in its adjustment for between-group differences in destination status when estimating the extent of the mentally ill's mobility as compared with the general population. Use of the recommended model with hypothetical data sets resulted in a significant finding when no overall upward or downward mobility occurred, and a non-significant result when the downward mobility of a psychotic group was contrived to be massive. An alternative model for the test of group differences in mobility is suggested within the framework of log-linear analysis commended by Fox (1990). This method indicated significantly more downward and less upward mobility in mentally ill groups when data from four studies were re-analyzed. We conclude that the weight of evidence from published studies supports the notion of social selection-drift, although this does not imply the inconsequence of social factors in the aetiology of schizophrenia (and other psychoses) or in its prognosis and occupational consequences.

Humans↗
PubMed1981

Smoking and drinking by middle-aged British men: effects of social class and town of residence.

In 7735 men aged 40-59, selected at random from general practices in 24 towns throughout Britain, pronounced differences were noted in the prevalences of smoking and drinking between the social classes. Social class differences also existed for frequency and quantity of drinking, type of beverage, and several aspects of smoking behaviour. Increasing amounts of smoking were associated with higher prevalences of moderate to heavy drinking, particularly in daily rather than weekend drinkers. Between drinking groups, however, the relation with smoking was more U-shaped, with light and heavy drinkers smoking more than moderate drinkers. The lowest rates of moderate to heavy smoking were observed in frequent light drinkers, particularly in the nonmanual workers. The proportion of moderate to heavy drinkers was no higher among ex-cigarette smokers than among current smokers. When the data were examined by town of residence social class differences persisted. Controlling for social class still showed pronounced differences between towns in both smoking and drinking behaviour. These data confirm that town of residence and social class have independent effects on smoking and drinking. The established regional and social class differences in cardiovascular disease may be due in part to the independent influences of town and social class on smoking and drinking behaviour.

Adult↗
PubMed1987

Is social class standardisation appropriate in occupational studies?

Social class standardisation has been proposed as a method for separating the effects of occupation and "social" or "lifestyle" factors in epidemiological studies, by comparing workers in a particular occupation with other workers in the same social class. The validity of this method rests upon two assumptions: (1) that social factors have the same effect in all occupational groups in the same social class, and (2) that other workers in the same social class as the workers being studied are free of occupational risk factors for the disease of interest. These assumptions will not always be satisfied. In particular, the effect of occupation will be underestimated when the comparison group also has job-related exposures which cause the disease under study. Thus, although adjustment for social class may minimise bias due to social factors, it may introduce bias due to unmeasured occupational factors. This difficulty may be magnified when occupational category is used as the measure of social class. Because of this potential bias, adjustment for social class should be done only after careful consideration of the exposures and disease involved and should be based on an appropriate definition of social class. Both crude and standardised results should be presented when such adjustments are made.

Data Collection↗
PubMed1997

Possible explanations for social class differences in cancer patient survival.

Social class differences in cancer patient survival have been reported for most cancer types and for a number of countries. The etiology of these differences has been studied less thoroughly and less systematically than social class differences in cancer occurrence. Stage of disease at diagnosis appears to be the most important factor contributing to the social class differences in cancer patient survival. This has been observed most clearly for gastrointestinal and gynaecological cancers. Social class differences in survival are generally wider for patients diagnosed with cancer at local stages than for those diagnosed with cancer at advanced stages. The reasons why cancers are more frequently diagnosed at a local stage in high than in low social classes in not properly understood at the moment. Of other potential contributing factors, the role of treatment and psychosocial factors has scarcely been studied. Biological indicators of tumour aggressiveness have failed to explain the social class differences.

Biomarkers, Tumor↗
PubMed1991

Undiminished social class mortality differences in New Zealand men.

Social class mortality differences in New Zealand men aged 15-64 years have previously been examined for the period 1975-7. It was found that the lower social classes had mortality rates higher than the upper social classes with the mortality rate of the lowest class being approximately twice that of the highest class on a six category scale. The greatest relative social class differences were in men aged less than 35 years. The analysis has now been repeated for the period 1985-7. Mortality declined by 15% between 1975-7 and 1985-7, but the social class mortality differences were undiminished, and the mortality slope was actually slightly greater in the more recent time period. The primary significance of social class analyses is that they identify groups in the community which have an excess mortality that is potentially preventable. The findings of this study indicate that this potential has not been fully realised in New Zealand, since social class differences are undiminished despite the continuing decline in overall mortality.

Adolescent↗
PubMed1993

Endometriosis and social class: an Asian experience.

The social class distribution in 147 patients confirmed to have endometriosis at laparoscopy was done to see if the disease was associated with affluence. Two hundred and eighty-one patients confirmed not to have endometriosis was used as controls. The patients were derived from a background population for which the social class characteristics was known. Endometriosis was significantly (p < 0.001) associated with social class 1 and 2. However there was no association between social class distribution and the severity of the disease developed.

Adult↗
PubMed1996

Relationships between social class, nutrient intake and dietary patterns in Edinburgh schoolchildren.

Social class may have an important influence on dietary intakes and health. Information on specific nutrient differences between children of high and low social classes may help explain health inequalities and identify target areas for nutrition education. In this study, energy and nutrient intakes were estimated in 136 7-8-year-olds, from a range of social backgrounds, using 7-day weighed inventories. A structured questionnaire was used to establish social class. Lower social class children had significantly lower daily intakes of many micronutrients, which nevertheless met dietary reference values, and a higher percentage energy from fat. In addition, lower social class children consumed less breakfast cereal, more full fat milk, were more likely to take school meals and received a greater proportion of energy and nutrients from snacks than higher social class children. Lower social class children were significantly shorter, but this association was independent of diet. The results suggest that lower social class children are a vulnerable group nutritionally. Nutrition education should focus on influencing the dietary patterns of lower social class children to favour a decrease in percentage energy from fat.

Body Height↗
PubMed1990

Nutrient intakes during pregnancy: observations on the influence of smoking and social class.

The influence of smoking and social class on dietary intake in pregnancy was investigated in a random sample of smokers (greater than or equal to 15 cigarettes/d) and nonsmokers. A total of 206 subjects (94 smokers and 112 nonsmokers) completed a 7-d weighed dietary intake at 28 wk gestation and 178 completed a second assessment at 36 wk. Nonsmokers had higher intakes of almost all nutrients than did smokers and the nutrient density of their diet was greater. Energy intake was nonsignificantly higher in nonsmokers. Women in higher social classes had the highest nutrient intakes. Smokers were shorter than nonsmokers and tended to be of lower social class. After maternal height and social class were controlled for, smoking had a significant effect on intake of many micronutrients. Dietary intake was reduced in late pregnancy, particularly in smokers. These data suggest that smokers in all social classes have a poorer quality of diet.

Adult↗
PubMed2004

Assessing the social class of children from parental information to study possible social inequalities in health outcomes.

PURPOSE: When the subjects are children, the assessment of social class must be made indirectly from parental data. We propose correspondence analysis as a method for combining parental information. METHODS: Four assessment methods were used: father's occupation, mother's occupation, dominant occupation of both, and both combined by means of a correspondence analysis. The results were used to explore social inequalities in dental health. We used data from a survey performed on school children (12- and 15-16-year olds) in the Comunitat Valenciana (Spain). Dental health was measured through prevalence of caries, number of teeth with caries, number of caries in permanent teeth, decayed, missing, and filled teeth score (DMF-T), decayed, missing, and filled surface score (DMF-S), prevalence of DMF>0, community periodontal index of treatment needs (CPITN) and prevalence of CPITN>0. RESULTS: Correspondence analysis methods reflect the impact of social class on health indicators. They were able to assign a social group to all individuals. The association between social class and oral health was found to be sensitive to the method used. CONCLUSIONS: Pooling information from both parents is important. Evidence of social inequalities in oral health may or may not be obtained depending on the method used.

Adolescent↗
PubMed1997

Social class variation in place of cancer death.

The aim of this research was to describe the distribution of place of death for cancer. An analysis of place of death for all 831 cancer deaths in 1995 among Doncaster Health Authority's residents was carried out. The data were extracted using the Public Health Mortality File. It was found that there is statistically significant evidence that place of death is associated with social class. Social class I and II with 15% of all cancer deaths contributed 24% of hospice deaths, 14% of hospital deaths and 12% of home deaths. Social class III with 24% of all cancer deaths contributed 58% of hospice deaths, only 9% of hospital deaths and 35% of home deaths. Social classes IV and V with 61% of cancer deaths contributed only 18% of hospice deaths, 77% of hospital deaths and 53% of home deaths. The reasons for these differences may be to do with access to services, perceptions of different services by patients and general practitioners and the availability of social support within different sections of the community.

England↗