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At least 109 records · Page 6Linked to original sources
PubMed1999

Do the rich really die young? Alcohol-related mortality and social class in Great Britain, 1988-94.

AIMS: To determine whether social class is a major influence on alcohol-related mortality in the general, economically active population of Great Britain. DESIGN AND PARTICIPANTS: Poisson regression of rates of mortality known to be directly caused by alcohol consumption by age, sex and social class in England, Wales and Scotland. MEASUREMENTS: The measure of alcohol-related mortality is total deaths from ICD-9 categories 291; 303; 357.5; 425.5; 535.3; 305; 790.3; and 571.0-571.3 over the 7-year period 1988-94. (It excludes deaths for which alcohol-attributable fractions would need to be calculated.) The measure of social class is the British Registrar General's six-fold occupational classification, used to code census and death certification data. FINDINGS: Alcohol-related mortality rates are higher for men in the manual occupations than in the non-manual occupations, but the relative magnitude depends on age. Men aged 25-39 in the unskilled manual class are 10-20 times more likely to die from alcohol-related causes than those in the professional class, whereas men aged between 55 and 64 in the unskilled manual class are only about 2.5-4 times more likely to die. For women in paid employment there is no consistent class gradient; younger women in the manual classes are more likely to die from alcohol-related causes, but for older women it is those in the professional class who suffer elevated mortality. CONCLUSIONS: Social class is a risk factor for alcohol-related mortality in Britain, although it is mediated by age and sex. Alcohol appears to be similar to other psychoactive substances, therefore, in that problem use is linked to social structural factors such as poverty, disadvantage and social class. This suggests that social interventions aimed at reducing poverty and inequality have the potential to reduce current levels of alcohol-related harm among the poorest groups in the community.

Adolescent↗
PubMed1997

[Aggressiveness and social status in the class social structure].

Both aggressive behavior and an outsider position in the peer group can be regarded as risk factors for the social development and long-term adjustment of children. The aim of the present investigation was to analyze the influence of these two factors on the social experiences of students in secondary school. The presence of aggressive behavior was determined by means of peer ratings and self-ratings. Classroom climate, i.e. the quality of the sense of community in a class, was considered as a modifying factor. In a first step, from 96 classes in the first and third grades of secondary school two extreme groups of 24 classes each were formed on the basis of student evaluations of the cohesion in the class and the frequency of aggressive arguments between students. At this time the students also rated other aspects of their social experiences at school. In a second step, sociometric data were obtained in the selected classes on the most liked and least liked classmates and on certain behaviors to determine the social position of the students in their peer group and their involvement in aggressive arguments. The social experiences attitudes and values of the students were highly correlated with the frequency of their involvement in aggressive arguments. There were some marked discrepancies between peer ratings and self-ratings of behavior, but both types of rating appear to have some clinical relevance. Beside the social status in the peer group the classroom climate had considerable impact on the social experiences of aggressive children. In addition, there were indications that the classroom climate plays a role in the social status of aggressive students in the class.

Adolescent↗
PubMed1992

A comparison of 3-year-olds' caries experience in 1973, 1981 and 1989 in a Hertfordshire town, related to family behaviour and social class.

The teeth of three samples of 3-year-old children were examined in the same fashion over two 8-year periods in a predominantly 'middle-class' town in Hertfordshire. After correcting for the changing social class structure of the town, mean dmft fell by 60% over the first period and by 29% over the second period, so the rate of improvement is decreasing. Improvements in caries levels have taken place in all the social classes except for a slight deterioration in social classes IV + V between 1981 and 1989. Ninety-six per cent of social class I + II children, but only 72% of social class IV + V children were caries-free. After falling from 8% to 1% between 1973 and 1981, the proportion of children with rampant labial caries increased to 4% in 1989. More children now visit a dentist for a check-up before the age of 4 years, more start toothbrushing at an earlier age and with greater frequency, and more are given fluoride supplements. Generally, infant feeding practices have continued to improve, although more mothers reported using a comforter bottle. Some of these practices are still strongly class-related, with manual social class families adopting less favourable behaviour. In inner city areas, family preventive behaviour and dental health is likely to be poorer.

Bottle Feeding↗
PubMedDate not supplied

[Pseudo-correlation between neurotic somatic diseases and social class].

The hypothesis that neurotic bodily complaints are dependent on social class, sex, and age, was tested using a representative sample of size N=1549. It is shown that bodily complaints are dependent on age and sex, but independent of social class. Correlations of -.41 between age and education and of -.22 between education and sex were obtained, suggesting that the correlation found in earlier investigations between social class and neurotic bodily complaints were in fact due to the common dependence on sex. It is shown, however, that psychosomatic conceptions of bodily complaints are dependent on social class. People from higher social classes interpret their complaints significantly more frequently as being due to psychological factors. The consequences for the doctor-patient-relationship, which may be drawn from these results, are discussed.

Adolescent↗
PubMed1992

Social factors mediating social class differences in blood pressure in a Jamaican community.

Research on the factors mediating social class differences in blood pressure was carried out in a Jamaican community. It was found in a previous report that higher social class is related to lower blood pressure for females, while for males higher social class is related to higher blood pressure. These differences are examined in greater detail here, especially in terms of the historical context of the specific community studied, which is on the fringe of the Kingston urban area, and in terms of the continuing importance of a social class system established under colonial rule. In the current study it is shown that social class differences in blood pressure for males are mediated by perceptions of social support. Social class differences in blood pressure for females are mediated by perceptions of economic stress. It is suggested that specific patterns of the growth of the city, and the historically-based social class system, have resulted in the juxtaposition of lower and middle class Jamaicans within this community, who in turn are influenced by different factors affecting blood pressure.

Adult↗
PubMed2002

Persistent social class mortality differences in New Zealand men aged 15-64: an analysis of mortality during 1995-97.

OBJECTIVE: Social class mortality differences in New Zealand men aged 15-64 years have previously been examined for the periods 1975-77 and 1985-87 using the Elley-Irving social class scale. The objective was to repeat these analyses for 1995-97 in order to examine time trends, and to assess current social class patterns of mortality. METHODS: Age-standardised mortality rates were calculated for each social class and a weighted estimate of the social class mortality gradient was obtained. RESULTS: Male mortality declined 21% between 1985-87 and 1995-97, but the social class mortality differences have not diminished and may have even increased. The Relative Index of Inequality has increased from 1.8 in 1975-77 to 2.1 in 1985-87 and 2.3 in 1995-97. Unlike previous analyses, the relative social class mortality gradient was just as strong in the older age groups as in the younger age groups, indicating that the possible increase in social class gradient has largely occurred in the older age groups. CONCLUSIONS: These findings indicate that the potential to address the excess preventable mortality caused by socio-economic factors has not been fully realised in New Zealand. IMPLICATIONS: Social class analyses identify groups in the community that have an excess mortality that is potentially preventable. There are still major social class differences in mortality in New Zealand, and these differences may even have increased. It is important that these patterns are taken into account in public health planning and that further research is conducted to identify the mechanisms by which these differences occur.

Adolescent↗
PubMed2003

Social class, ethnicity and attendance for antenatal care in the United Kingdom: a systematic review.

BACKGROUND: Evidence from outside the United Kingdom points to several socio-demographic factors associated with late initiation of antenatal care or fewer antenatal visits, but it is not clear how generalizable these studies are to the UK context. This systematic review addresses the question of whether there are social or ethnic inequalities in attendance for antenatal care in the United Kingdom. METHODS: We identified and reviewed UK studies assessing attendance for antenatal care according to any measure of social class, social deprivation or ethnicity. A wide range of electronic databases was searched for published and unpublished studies. Further studies were identified from reference lists, citation searches and key organizations. RESULTS: From over 1300 identified papers, 20 were potentially relevant. Nine were included in the review. Most studies were of poor quality, with only one study controlling for the effect of potential confounders such as age, parity and clinical risk factors. All but one were based on data collected around 20 years ago. Three of the five studies looking at antenatal attendance and social class found that women from manual classes were more likely to book late for antenatal care and/or make fewer antenatal visits than other women. All four studies reporting on antenatal attendance and ethnicity found that women of Asian origin were more likely to book late for antenatal care than white British women. CONCLUSIONS: There is little good quality evidence on social and ethnic inequalities in attendance for antenatal care in the United Kingdom. Recommendations for further research are suggested.

Female↗
PubMed2004

Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour?

Social class understood as social relations of ownership and control over productive assets taps into parts of the social variation in health that are not captured by conventional measures of social stratification. The objectives of this study are to analyse the association between self-reported health status and social class and to examine the role of work organisation, material standards and household labour as potential mediating factors in explaining this association. We used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. This was a stratified sample, strata being the 10 districts of the city. The present study was conducted on the working population, aged 16-64 years (2345 men and 1874 women). Social class position was measured with Erik Olin Wright's indicators according to ownership and control over productive assets. The dependent variable was self-reported health status. The independent variables were social class, age, psychosocial and physical working conditions, job insecurity, type of labour contract, number of hours worked per week, possession of appliances at home, as well as household labour (number of hours per week, doing the housework alone and having children, elderly or disabled at home). Several hierarchical logistic regression models were performed by adding different blocks of independent variables. Among men the prevalence of poor reported health was higher among small employers and petit bourgeois, supervisors, semi-skilled (adjusted odds ratio-aOR: 4.92; 95% CI: 1.88-12.88) and unskilled workers (aOR: 7.69; 95%CI: 3.01-19.64). Work organisation and household material standards were associated with poor health status with the exception of number of hours worked per week. Work organisation variables were the main explanatory variables of social class inequalities in health, although material standards also contributed. Among women, only unskilled workers had poorer health status than the referent category of manager and skilled supervisors (aOR: 3.25; 95%CI: 1.37-7.74). All indicators of work organisation and household material standards reached statistical significance, excepting the number of hours worked per week. In contrast to men, among women the number of hours per week of household labour was associated with poor health status (aOR: 1.02; 95% CI: 1.01-1.03). Showing a different pattern from men in the full model, household material deprivation and hours of household labour per week were associated with poor health status among women. Our findings suggest that among men, part of the association between social class positions and poor health can be accounted for psychosocial and physical working conditions and job insecurity. Among women, the association between the worker (non-owner, non-managerial, and un-credentiated) class positions and health is substantially explained by working conditions, material well being at home and amount of household labour.

Adolescent↗
PubMed2001

Inter-generational longitudinal study of social class and depression: a test of social causation and social selection models.

BACKGROUND: Generations of epidemiologists have documented an association between low socio-economic status (SES) and depression (variously defined), but debate continues as to which is the causative factor. AIMS: To test the extent to which social causation (low SES causing depression) and social selection (depression causing low SES) processes are in evidence in an inter-generational longitudinal study. METHOD: Participants (n = 756) were interviewed up to four times over 17 years using the Schedule for Affective Disorders and Schizophrenia (SADS). RESULTS: Low parental education was associated with increased risk for offspring depression, even after controlling for parental depression, offspring gender and offspring age. Neither parental nor offspring depression predicted later levels of offspring occupation, education or income. CONCLUSION: There is evidence for an effect of parental SES on offspring depression (social causation) but not for an effect of either parental or offspring depression on offspring SES (social selection).

Adolescent↗
PubMed1989

Class inequality in health. A methodological study of two measures of social class in relation to sickness insurance diagnoses.

Measures of social class, if related to different class concepts, should differ in external consistency. External consistency depends on the character of the dependent variable. Two measures of social class are here used for independent variables, the socio-economic classification, the official index of Sweden, and a structural class concept. For dependent variables, ICD diagnose chapters, directly and in a simple grouping, are used on a material from health insurance authorities. Class inequality is measured both as to size and direction, by Gini-index and rank-order correlation, respectively. Separate analyses are made for the whole material, men and women, and doctor certified absence days. Results show clear differences between the class measures for diagnoses more closely associated to work conditions, while the measures coincide in other cases.

Absenteeism↗
PubMed1999

Social class and census-based deprivation scores: which is the best predictor of stillbirth rates?

This study investigates whether social class or a census-based deprivation score is a better predictor of stillbirth rates using data for 1993-5 for residents of South Thames (West) Region. Social class is routinely coded for 10% of live births and 100% of stillbirths. A Townsend deprivation score was assigned to each stillbirth and each live birth with a social class code, according to their electoral ward of residence. In unifactorial analyses of stillbirth rate the relationship was stronger with social class (P = 0.008) than with Townsend score (P = 0.11). Both relationships were strengthened by including those births recorded as social class 'other' ['other' vs. social class I odds ratio (OR) = 2.27, P < 0.001; lower vs. upper septile deprivation score OR = 1.45, P = 0.07)]. When social class and Townsend score were analysed together, the ORs for social class remained similar to before, but the Townsend ORs were reduced and non-significant overall. We conclude that social class, which is based on data on each individual, is a better predictor of stillbirth than Townsend score, which is based on data from the area of residence. We recommend further investigation of the stillbirth risk in the subgroups that make up the 'other' social class.

Analysis of Variance↗
PubMed1987

Role of social class in caries occurrence in primary teeth.

The independent effect of social class on (A) the risk of having any caries (deft greater than or equal to 1) and on (B) the risk of having a few caries defects (deft greater than or equal to 3) in primary teeth was studied. The data, which were representative for all Finnish children of this age group, were collected by questionnaires from health centres and homes for 1637 children aged 2.5 to 7.5 years. The response rate was 83%. According to logistic regression analyses, children in the upper social class were clearly at lower risk of having caries than were children in the middle social class, independent of the child's age or sex, reported frequency of toothbrushing, consumption of sugar or use of fluoride tablets. In contrast, children in the lower social class had a higher risk of caries, which was independent of the reported dental health behaviour of the children. The results indicate that the differences among social classes in caries occurrence could not be eliminated by changes in dental health habits. Basic and applied research is needed to identify the relevant factors in socioeconomic status related to caries occurrence so that the differences in dental health between preschool children in different social classes can be reduced.

Child↗
PubMed1996

Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991.

OBJECTIVE: To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. DESIGN: Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. SETTING: England and Wales. SUBJECTS: Children aged 0-15 years. MAIN OUTCOME MEASURES: Death rates from injury and poisoning. RESULTS: Death rates from injury and poisoning have fallen for children in all social classes. The decline for children in social classes IV and V (21% and 2% respectively), however, is smaller than that for children in social classes I and II (32% and 37%). As a result of the differential decline in injury death rates, socioeconomic mortality differentials have increased. In the four years 1979-80 and 1982-83 the injury death rate for children in social class V was 3.5 times that of children in social class I. For the four years 1989-92 the injury death rate for children in social class V was 5.0 times that of children in social class I. Poisson regression modelling showed that the trend in the decline in death rates across the social classes was unlikely to have arisen by chance alone. CONCLUSIONS: Socioeconomic inequalities in child injury death rates have increased. If these gradients persist, the Health of the Nation's target is likely to be met for children in the non-manual social classes but not for those in the manual social classes.

Adolescent↗
PubMed1998

Education and occupational social class: which is the more important indicator of mortality risk?

STUDY OBJECTIVES: In the UK, studies of socioeconomic differentials in mortality have generally relied upon occupational social class as the index of socioeconomic position, while in the US, measures based upon education have been widely used. These two measures have different characteristics; for example, social class can change throughout adult life, while education is unlikely to alter after early adulthood. Therefore different interpretations can be given to the mortality differentials that are seen. The objective of this analysis is to demonstrate the profile of mortality differentials, and the factors underlying these differentials, which are associated with the two socioeconomic measures. DESIGN: Prospective observational study. SETTING: 27 work places in the west of Scotland. PARTICIPANTS: 5749 men aged 35-64 who completed questionnaires and were examined between 1970 and 1973. FINDINGS: At baseline, similar gradients between socioeconomic position and blood pressure, height, lung function, and smoking behaviour were seen, regardless of whether the education or social class measure was used. Manual social class and early termination of full time education were associated with higher blood pressure, shorter height, poorer lung function, and a higher prevalence of smoking. Within education strata, the graded association between smoking and social class remains strong, whereas within social class groups the relation between education and smoking is attenuated. Over 21 years of follow up, 1639 of the men died. Mortality from all causes and from three broad cause of death groups (cardiovascular disease, malignant disease, and other causes) showed similar associations with social class and education. For all cause of death groups, men in manual social classes and men who terminated full time education at an early age had higher death rates. Cardiovascular disease was the cause of death group most strongly associated with education, while the non-cardiovascular non-cancer category was the cause of death group most strongly associated with adulthood social class. The graded association between social class and all cause mortality remains strong and significant within education strata, whereas within social class strata the relation between education and mortality is less clear. CONCLUSIONS: As a single indicator of socioeconomic position occupational social class in adulthood is a better discriminator of socioeconomic differentials in mortality and smoking behaviour than is education. This argues against interpretations that see cultural--rather than material--resources as being the key determinants of socioeconomic differentials in health. The stronger association of education with death from cardiovascular causes than with other causes of death may reflect the function of education as an index of socioeconomic circumstances in early life, which appear to have a particular influence on the risk of cardiovascular disease.

Adult↗