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PubMed1984

Nutritional status of the social class groups.

There is a marked increase in mortality and morbidity with decreasing social class status so that the death rate of adult males in social class V is twice that of men in social class I. Differences in nutritional status between the social classes could account for this phenomenon. In this survey the nutritional status of 254 consecutive adult admissions to a teaching hospital was assessed by anthropometric and biochemical measurements and delayed hypersensitivity skin tests. No significant difference in nutritional status was detected between the five social class groups. There was no significant difference between the combined social class groups I and II compared with IV and V. A similar result was obtained with the same assessment of 167 fit adult individuals of comparable age and sex distribution living in the community. There is no significant difference in nutritional status between the social classes when they are well or ill and therefore the differences in mortality and morbidity in lower social classes are unlikely to be caused by inadequate nutrition.

Adolescent↗

PubMedDate not supplied

Social class and chronic illness in Dublin.

Information on the social class distribution of illness is scarce in Ireland. The aim of this study was to document the social class distribution of 12 common chronic conditions in middle-aged persons in Dublin. Data were collected on 3,111 individuals attending three large general practices over the course of a calendar year, and 1,024 individuals living in the same areas. Ten out of the 12 conditions studied were significantly more common in those from social classes five and six, than those from social classes one and two. Persons from social classes three and four, classes five and six, had an overall excess morbidity rate of 21% and 70% respectively. The distribution of chronic illness in middle-aged residents of Dublin is social class related.

Chronic Disease↗

PubMed2000

[Inequalities in health according to social class in Catalonia, 1994].

OBJECTIVE: To study social inequalities in health in Catalonia. DESIGN: Cross-sectional survey of a representative sample of the population of Catalonia, Spain (Catalan Health Interview Survey, 1994). PARTICIPANTS: Responses from 5641 males and 6604 women aged 15 years or over were included for analysis. MEASUREMENTS AND MAIN RESULTS: We analysed the information about self-perceived health, restriction of activity, and presence of chronic conditions according to social class by means of logistic regression models. The proportion of subjects that rated their health as fair or poor was higher in social classes IV-V than in classes I-II (men: 25.0% vs. 14.5%; OR, 1.8, 95% CI, 1.5-2.3; women: 34.4% vs. 21.5%; OR, 1.7, 95% CI, 1.4-2.1). There were differences by social class in respect to restriction of activity and presence of chronic conditions. CONCLUSIONS: Despite the decrease of social inequalities in accesibility and use of health services due to the universalisation of health coverage, differences by social class remain in the perception of health status. These inequalities should be addressed by the health system within the framework of broad public and social policies.

Adolescent↗

PubMed1987

Social class differences in mental retardation and subnormality.

Social class and regional differences in mental retardation were studied in a birth cohort of 12,000 children followed up until the age of 14. The incidence of severe mental retardation IQ less than 50 was significantly higher in farming families and in less developed areas, which is in agreement with the fact that a greater part of the population in these areas belong to social class IV and farmers. The obvious explanation for the higher incidence of severe mental retardation among farmers is an excess of older mothers in this group. In the group of severe mental retardation, paternal unemployment was also statistically, significantly more frequent than among the others. Mild mental retardation, IQ 50-70, was significantly higher in all classes other than I + II and mental subnormality, IQ 71-85 was higher in social classes III and IV. The other less favourable social conditions, which were statistically more frequent in the families of the mentally subnormal, were that: the father had died, was unemployed, on sick leave or receiving a pension and the mother was not living at home, was unemployed, or was on sick leave or receiving a pension. The incidence of mental subnormality was significantly higher in more developed areas, in spite of the fact that the members of social class IV were less and those of classes I + II more numerous than elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

Complicating race: the relationship between prejudice, race, and social class categorizations.

Although racial stereotyping and prejudice research have received considerable attention, the important element of social class has been largely excluded from social psychological research. Using the Statement Recognition Procedure, two experiments investigated social categorization along race and social class dimensions, the influence of racial and social class prejudice on these categorizations, and differences between White and Black perceivers. Analyses conducted at the subtype of race and social class memberships demonstrated differing patterns of categorization based on subtype membership. For example, lowerclass Black targets were primarily categorized by race, whereas middle-class Black targets were primarily categorized by social class. The results demonstrate the importance of considering social class membership independent of and in conjunction with race. Theoretical and methodological implications regarding the study for race and social class categorizations are discussed.

Adult↗

PubMed1977

Psychiatric hospitalization. II. Effect of social class and delivery systems.

The effects of social class and delivery system on admission and behavioral variables, diagnosis, treatment, and length of hospitalization were studied by comparing patients admitted over a one-year period to the psychiatric services of a public and a private general hospital, staffed by the same Department of Psychiatry. Patients were of similar age and sex and were matched by social class. Crisis-precipitated admissions and affective-disorder diagnoses varied with social class irrespective of treatment facility. Patients diagnosed as schizophrenic were more common in the upper classes at the private facility and the lower classes at the public facility. Somatic treatments and length of hospitalization also varied according to social class as well as delivery system. The results of this study imply that economic differences between public and private delivery systems operate to select patients for admission and affect expeditiousness of treatment, perhaps to the detriment of patients in both systems.

Adult↗

PubMed1992

Social class and colon cancer survival in Finland.

METHODS. Social class differences in colon cancer survival were studied in 3147 patients with colon cancer diagnosed in Finland from 1979-1982. Of these patients, 2969 were eligible for survival analysis. RESULTS. A clear social class gradient in colon cancer survival was detected. The difference in the age-adjusted relative risk of death due to colon cancer between the highest (I) and lowest (IV) social class was 19%. Stage of disease at diagnosis accounted for a substantial proportion of differences in survival, and treatment accounted for the rest of them. Differences in treatment by social class were most apparent among patients with advanced or unknown stage of disease at diagnosis. Controlling for the place of residence had little effect on the survival differences. Delay in diagnosis did not account for the observed differences in survival by social class.

Aged↗

PubMed2002

Social class gradients in health during adolescence.

STUDY OBJECTIVE: To review existing data on social class gradients in adolescent health and to examine whether such gradients exist in new data concerning US adolescents. DESIGN: Review of relevant publications and unpublished data; regression analyses using adolescent self reported health status data to determine whether there are gradients by social class, using three classes categorised by adolescent reported parental work status and education. PARTICIPANTS: Adolescents of ages 11-17. MAIN RESULTS: Findings from the literature indicate the presence of social class gradients in some but not all aspects of adolescent health. Results from new data showed social class gradients in several domains of health and in profiles of health. The likelihood of being satisfied with one's health, of being more resilient (better family involvement, better problem solving, more physical activity, better home safety), having higher school achievement, and of being in the best health profiles were significantly and progressively greater as social class rose. Moreover, the probability of being in the poorest health profile type group was progressively higher as social class declined. CONCLUSIONS: The review of existing data and the new findings support the existence of social class gradients in satisfaction with one's health, in resilience to health threats, in school achievement, and in being in the best health overall (as manifested by the health profiles composed of four major domains of health). The study had two especially notable findings: (1) the paucity of studies using the same or similar indicators, and (2) the consistent existence of social class gradients in characteristics related to subsequent health, particularly intake of nutritional foods and physical activity. The sparseness of existing data and the different aspects of health investigated in the relatively few studies underscore the need for (1) the development of conceptual models specifically focused on adolescent health and social class; (2) additional inquiry into the measurement of social class and adolescent perceptions of class; (3) inclusion of contextual variables in study design; and (4) longitudinal cohort studies to better understand the specific determinants of health during adolescence.

Adolescent↗

PubMed2006

Low social class is linked to upper gastrointestinal symptoms in an Australian sample of urban adults.

OBJECTIVE: The epidemiology of gastrointestinal (GI) symptoms has been described in population surveys, yet their distribution by socio-economic (social) class remains largely uninvestigated. The aim of this study was to evaluate the influence of social class on GI symptoms in an urban sample of Australian adults. MATERIAL AND METHODS: The prevalence of 25 GI symptoms was determined by postal questionnaire. Five latent symptom groups were identified by a principal components analysis (PCA) (Esophageal, Dysmotility-like, Nausea/vomiting, Constipation and Diarrhea). These components were used to model the association between GI symptoms and adult social class. Social class was assigned according to a census-based measure of area disadvantage, and to highest level of completed education. Age- and sex-adjusted odds ratios - as identified by unconditional logistic regression - were used to describe the relationship between symptom groups and adult social class. RESULTS: The effects of area disadvantage and education on Esophageal and Dysmotility-like symptoms were pronounced, with persistent trends for elevated symptom rates amongst the lower social classes (all p<0.01 on age- and sex-adjusted effects). When defined by area disadvantage, the odds ratios for Nausea/vomiting were significantly elevated among the lowest social class group (p=0.01), whereas the odds for Constipation were significantly elevated among the upper-middle social class when defined by education (p=0.001). Diarrhea was not associated with social class whether defined by area disadvantage or education. CONCLUSIONS: Low social class is a risk factor for upper GI complaints.

Adult↗

PubMed2002

Social class differences in overweight of prepubertal children in northwest Germany.

OBJECTIVES: To assess social class differences in overweight and health-related behaviours in 5-7-y-old German children. DESIGN: Cross-sectional study. SETTING: Twenty-nine primary schools in Kiel (inhabitants: 248000), northwest Germany. SUBJECTS: A total of 1350 German 5-7-y-old children and their parents. MAIN OUTCOME MEASURES: Body mass index (BMI), fat mass and health-related behaviours of the children. Self-reported height and weight of their parents, parental school education as a measure of social class. RESULTS: The prevalence of overweight (> or = 90th percentile of reference) was 18.5%. There was an inverse social gradient (P < 0.01): the highest fat mass was observed in children from low social class. The odds ratios for overweight reached 3.1 (CI 1.7-5.4) in boys and 2.3 (CI 1.2-4.3) in girls, respectively (low vs high social class). Overweight parents (BMI > or = 25 kg/m2) were more likely to have overweight children. Parental overweight enhanced the inverse social gradient. The prevalence of overweight was 37.5% (low social class) vs 22.9% (high social class) in children from overweight parents, respectively. There was an inverse social gradient in unhealthy behaviours. Parental BMI and physical inactivity were independent risk factors of overweight in children. CONCLUSIONS: In 5 to 7-y-old children overweight and health-related behaviours are inversely related to social class. Parental overweight enhanced the risk of childhood overweight. The familial effect on body weight is most pronounced in children with low social class. Preventive measures should specifically tackle 'overweight families' from low social class.

Behavior↗

PubMed1990

Modeling heart disease mortality with census tract rates and social class mixtures.

The relationship between social class and 1980 heart disease (HD) mortality in eight urban U.S. counties was examined by regressing age and sex adjusted census tract specific HD rates (N = 1211) on tract social class characteristics. The regression model indicated that lower middle class residents experienced a HD mortality rate 1.9 (95% CI = 1.3, 2.8) times the rate in the upper middle/middle class, while the working poor experienced a HD rate 4.4 (95% CI = 3.5, 5.7) times the rate in the referent class. Similar class effects were seen for both black and nonblack residents. The crude race effect (1.3 with 95% CI = 1.2, 1.4) was explainable by the concentration of blacks in the lower classes. The methods illustrate the ecologic regression of mixtures of mortality rates on mixtures of exposure in the presence of random tract effects which eliminates some of the problems associated with small denominators or zero rates in some tracts.

Coronary Disease↗

PubMed1999

Social support at age 33: the influence of gender, employment status and social class.

This paper investigates the conceptualisation and operationalisation of social support and it's relationship to gender, employment status and social class. Clarification of these relationships is sought in order to better understand associations between social support and health. We used data from the 33-year survey of the 1958 British birth cohort study. Individual items and subscales of practical and emotional support were examined. In general, men had lower support than women and social classes IV and V had lower support than classes I and II. Emotional support, either from personal (for example, from friends or family), or combined with organisational sources of support (such as from a church or a financial institution), showed consistent gender and social class patterns. This suggests that emotional support is a robust concept across socio-demographic groups. Less consistent trends were found for practical support, in that socio-demographic trends depended on how practical support was measured. In particular, it depended on whether both personal and organisational sources of support were examined. Gender differences in social support were large and might therefore be expected to contribute to gender differences in health, whereas social class differences in social support were modest, suggesting a minor explanatory role for this factor in accounting for inequalities in health.

Adult↗

PubMed1990

Social class as a prognostic factor in breast cancer survival.

The effect of social class on survival of female breast cancer patients was studied by linking the patient files of the Finnish Cancer Registry (FCR) with the information on patient's social status, obtained from the 1970 Population Census of Finland. The material consisted of 10,181 patients 25 to 69 years of age at diagnosis, whose cancer was diagnosed between 1971 and 1980. The classification of social class was based on occupation. The effects of social class, age, period of diagnosis, and stage of disease on survival were evaluated using the Cox proportional hazards model; mortality from causes of death other than breast cancer was taken into account using the exact causes of death. Those in the lowest social class had about 1.3 times higher relative excess risk of dying than those in the highest social class. The older the patients, the greater was the difference in survival by social class. Differences in stage distribution explained only a minor proportion of the variation in survival by social class. The Finnish legislation guarantees everyone fairly equal accessibility to health care. The results suggest that more determined efforts should be undertaken to reduce inequity in survival.

Adult↗

PubMed1991

Influence of birth weight on differences in infant mortality by social class and legitimacy.

OBJECTIVE: To investigate the influence of birth weight on the pronounced social class differences in infant mortality in Britain. DESIGN: Analysis of routine data on births and infant deaths. SETTING: England and Wales. SUBJECTS: All live births and infant deaths, 1983-5. MAIN OUTCOME MEASURE: Mortality in infants by social class, birth weight, and legitimacy according to birth and death certificates. RESULTS: Neonatal and postneonatal mortality (deaths/1000 births) increased with social class. Neonatal and postneonatal mortality was 4.2/1000 and 2.3/1000 respectively for social class I and 6.8/1000 and 5.6/1000 respectively for social class V. Mortality was lower among births registered within marriage (postneonatal 3.5/1000; neonatal 5.2/1000) than among those jointly registered outside marriage (5.1/1000; 6.4/1000); mortality was highest in those solely registered outside marriage (7.2/1000; 7.0/1000). For neonatal mortality the effect of social class varied with birth weight. Social class had little effect on neonatal mortality in low birthweight babies and increasing effect in heavier babies. For postneonatal mortality the effect of social class was similar for all birth weights and was almost as steep as for all birth weights combined. CONCLUSION: Birth weight mediates little of the effect of social class on postneonatal mortality.

Birth Weight↗

PubMed2006

Does ambivalence about becoming pregnant explain social class differentials in use of contraception?

BACKGROUND: Manual social class background has consistently been associated with markers of poorer sexual health. This study of adults examines contraceptive use across social classes and the role of ambiguity towards pregnancy in non-use. METHOD: A nationally representative sample of Irish men and women aged 18-45 years were surveyed (n = 3317). Use of contraception in the last year and at the last occasion of vaginal sexual intercourse was queried. Reasons for non-use were examined. RESULTS: The consistency of contraceptive use in the last year was higher among women than men with lower use in unskilled manual social classes for both sexes. 'Not having planned for sex' was the most commonly cited reason for non-use (47% of men and 40% of women). 'Not caring if pregnancy occurred' was cited by 11% of women and 12% of men, while 'took a chance' was cited by 8% of both men and women. Results showed semi and unskilled manual women more likely to report that sex was unplanned or that they 'took a chance'. Among men, all other classes were more likely to report each of the ambivalence statements than the professional and managerial class. CONCLUSIONS: The study provides evidence of social class differentials in use of contraception among adults, and shows that these may be due, in part, to higher levels of ambivalence about pregnancy among working class women. The article adds to the socio-demographic literature on class differentials in unwanted pregnancy and extends research on adolescents to cover patterns for adult women and men.

Adolescent↗

PubMed2001

Trends in cigarette smoking in Spain by social class.

OBJECTIVE: . The aim of this study was to evaluate smoking trends among Spanish men and women by social class between 1987 and 1997. METHODS: We used secondary analysis of the National Health Interview Surveys of 1987, 1993, 1995, and 1997. The main outcome measures were prevalence of smoking, smoking cessation activity (quit ratio), and smoking initiation in the manual and nonmanual social class in each year and smoking prevalence ratio, smoking cessation ratio, and smoking initiation ratio in 1997 versus 1987 in each social class. RESULTS: Among men ages 25 years and older the prevalence of smoking in both the manual and the nonmanual social class decreased between 1987 and 1997 in all age groups, and the relative magnitude of the decrease was always greater in the nonmanual social class. In contrast, among women the prevalence of smoking increased in both social classes: in the 25- to 44-year age group the smoking prevalence ratios in 1997 versus 1987 were 1.20 in the nonmanual social class and 1.61 in the manual social class, while in the 45- to 64-year age group the prevalence ratios were 2.52 and 2.15, respectively. The quit rate among men increased in both social classes in all age groups between 1987 and 1997; in contrast, among women the quit rate increased only among those ages 25 to 44 years in the nonmanual social class. Smoking prevalence for people ages 16 to 24 years--smoking initiation--decreased among men and women between 1987 and 1997 in both social classes. CONCLUSIONS: Smoking trends in Spain by social class have differed among men and women. The findings are considered in the context of policies and programs aimed at reducing smoking.

Adolescent↗

PubMed2003

[Education and occupational social class: their relationship as indicators of socio-economic position to study social inequalities in health using health interview surveys].

AIM: To analyse the relationship between social class based on occupation and level of education in the study of social inequalities in health and use of health services. DESSIGN: Cross-sectional study (health interview survey). SETTING: General population of the city of Cornellà de Llobregat (Spain). PARTICIPANTS: Representative sample of subjects aged 14 years old or over (1043 men and 1101 women) who personally answered the questionnaire. MEASUREMENTS: We analyse the association between social class and level of studies and different independent variables (self-perceived health, smoking, medical visits) by means of logistic regression. RESULTS: The proportion of men who declare their self-perceived health as poor is higher among those who have low education (45.4%) than among those who have primary education level or higher (25.9%). The prevalence of smoking shows a similar pattern (54.2% versus 41.5%), with a gradient effect, which is statistically non-significant. However, these differences are no longer evident if social class is used to group the individuals. No clear association is observed between the use of health services and socio economic level. CONCLUSIONS: We need to use several indicators of socioeconomic position to evaluate social inequalities In this disadvantaged population, level of education seems to be a good indicator to study social inequalities in health.

Cross-Sectional Studies↗

PubMed1980

[Social class and bronchial cancer. Quantitative and qualitative aspects of cigarette smoking].

The social class distribution of 400 male lung cancer patients differs significantly from the distribution in 280 controls (more lower-class people among lung cancer patients). Lung cancer patients showed a similar distribution of smokers in all social classes, who had the same tar exposure. Controls showed a similar distribution of smokers in all social classes but a significant difference between the tar exposure of smokers in different social classes. Tar exposure of smokers increases with the decrease of social class, comprising a higher lung cancer risk in the lower social classes, which equals the class distribution of lung cancer patients found in the study.

Humans↗