SEARCH · PubMed Health

Results for “SOCIAL CLASS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources

PubMed1997

Socioeconomic status within social class and mortality: a prospective study in middle-aged British men.

OBJECTIVE: It has been suggested that mortality differences between groups in society may be greater than are indicated by social class based on occupation. We have examined the relationship between social class and mortality using home and car ownership as additional indices of socioeconomic status within social class. DESIGN: A prospective study of a cohort of men representative of the social class distribution of middle-aged men in Great Britain. SETTING: One general practice in each of 24 towns in England, Wales and Scotland. SUBJECTS: Five years after the initial screening of 7735 men aged 40-59 years, 7262 men (94% of the original cohort) provided information on housing tenure and car ownership by completing a postal questionnaire. MAIN OUTCOME MEASURE: Deaths from all causes, cardiovascular, cancer and other non-cardiovascular causes during an average follow-up of 9.8 years (range 8.5-11.0 years) after the postal questionnaire. RESULTS: During the follow-up period there were 946 deaths from all causes among the 7262 men. The lowest mortality rates for all causes, cardiovascular, cancer and other non-cardiovascular causes were seen in non-manual social classes I and II. Manual social classes III and IV+V showed a significant 40% increase in risk of death compared to social classes I+II, even after adjustment for a wide range of risk factors (relative risk [RR] = 1.4, 95% confidence interval [CI]: 1.2-1.7 and RR = 1.4, 95% CI: 1.1-1.7 respectively). Within all social class groups, those owning both home and car showed lower rates than those who owned neither, even after adjustment for a wide range of risk factors and employment status. Compared with social classes I+II owning both home and car, all those not owning home and/or car, in each social group, showed a significant approximately twofold increase in risk of death. Adjusted RR for non-manual I+II = 2.1 (95% CI: 1.5-2.9), non-manual III RR = 2.0 (95% CI: 1.3-2.9), manual III RR = 1.8 (95% CI: 1.4-2.4) and manual IV+V RR = 1.8 (95% CI: 1.3-2.5). Similar relationships were seen in all major geographical regions of Great Britain. CONCLUSION: Mortality differences within society are greater than indicated by social class based on occupation alone. Irrespective of social class, men with greater material assets have lower rates of mortality from all causes than men less well endowed, independent of a wide range of lifestyle and biological factors. These findings suggest that mortality differences within our society are closely related to relative wealth.

Cardiovascular Diseases↗

PubMed2004

Social class differences in coronary heart disease in middle-aged British men: implications for prevention.

BACKGROUND: Though social class differences in coronary heart disease (CHD) are well recognized, few studies have assessed the effect of imprecision in social class assessment on the relationship or the overall contribution of social class to attributable CHD risk. METHODS: Prospective observational study of the relationship between occupational social class (assessed at baseline and after 20 years), major CHD (coronary death and non-fatal myocardial infarction) and all-cause mortality rates over 20 years among 5628 middle-aged British men with no previous evidence of CHD. RESULTS: The age-adjusted hazard of major CHD for manual men relative to non-manual men was 1.41 (95% CI: 1.21, 1.64) before correction and 1.50 (95% CI: 1.25, 1.79) after correction for imprecision of social class measurement. The imprecision-corrected estimate was attenuated to 1.28 (95% CI: 1.06, 1.54) after adjustment for the adult coronary risk factors (blood cholesterol, blood pressure, body mass index, cigarette smoking, alcohol, physical activity, and lung function) and to 1.20 (95% CI: 0.99, 1.45) following further adjustment for height. The population attributable risk fraction of major CHD for social class (manual versus non-manual) was 22% after correction for imprecision in social class, which was reduced to 14% after adjustment for the adult coronary risk factors, and 10% after further adjustment for height. Similar results were obtained for all-cause mortality. CONCLUSIONS: Even taking account of measurement imprecision, the contribution of social class to overall CHD risk is modest. Population-wide strategies to reduce major CHD risk factors are likely to have greater potential benefits for CHD prevention than strategies designed specifically to reduce social inequalities in CHD.

Cause of Death↗

PubMed2005

Lifestyle, social class, and obesity-the Copenhagen Male Study.

OBJECTIVE: With the implicit purpose of identifying relevant intervention targets, the aim of the study was to test if lifestyle factors associated with obesity are unevenly distributed across social groups, and whether an uneven distribution of such factors may contribute to the explanation of social differences in obesity. DESIGN: Cross-sectional study of 3290 men aged 53-75 years (mean=63) carried out in 1985-1986 using in addition, data from a previous baseline established in 1970-1971. Information about lifestyle factors was obtained from a questionnaire validated during an interview. Potential risk factors were smoking history, alcohol consumption, leisure time physical activity (LTPA), and from the 1985-1986 study only: consumption of tea and coffee, use of sugar in tea or coffee, and avoidance of fat in foods. The clinical examination included measurements of height and weight. Obesity was defined as a body mass index > or =30 (BMI=kg/m2). Based on information about education and job profile the men were subdivided into five social classes. RESULTS: Overall, 291 men (8.8%) were obese. The lower the social class the higher the proportion of obese men: in social classes I and II, 4.5% (of 953), social class III, 9.1% (of 636), social class IV, 11.1% (of 1353), and social class V, 11.6% (of 346), P<0.001 (trend test). Leisure time physical activity, alcohol consumption, smoking habits, use of sugar in hot beverages, and consumption of coffee and tea, were all significantly associated with obesity, either positively or negatively, and even significantly associated with social class. Based on these lifestyle factors it was possible to discriminate subgroups with highly different prevalences of obesity. Despite this, adjustment for identified obesity covariates in a multiple logistic regression analysis did in no way explain the association of social class with obesity. CONCLUSION: Lifestyle factors in concert strongly associated with obesity are unevenly distributed across social classes, yet incapable of explaining the higher prevalence of obesity in lower social classes.

Aged↗

PubMed1984

Mortality and social class in New Zealand. III: male mortality by ethnic group.

Social class differences in male mortality in New Zealand were investigated separately for Maori, Pacific Island and other New Zealand males aged 15-64. All three groups displayed strong social class mortality gradients but, for each class, the Maori mortality rates were approximately 50% higher than the rates for the "other" category, while the Pacific Islander rates generally occupied an intermediate position. The Maori mortality rates were particularly high for the disease groupings of respiratory diseases, infectious diseases, genito-urinary diseases, endocrine, nutritional and metabolic disorders and diseases of the circulatory system other than coronary heart disease and cerebrovascular disease--even when the data were adjusted for age and social class factors. The Pacific Islander rates were high for the same disease groupings except for endocrine, nutritional and metabolic disorders. Overall, there were substantial social class differences and ethnic differences in mortality and these were largely independent so that only about one-fifth of the Maori mortality excess was attributable to social class factors. Four-fifths of the Maori excess was not attributable to such factors indicating that interventions aimed specifically at lower socio-economic groups will not eliminate the current mortality differences between Maoris and non-Maoris.

Adolescent↗

PubMed1996

Influence of fathers' social class on cardiovascular disease in middle-aged men.

BACKGROUND: The independent effect of early life circumstances on adult cardiovascular risk is still unresolved. We assessed the associations of father's social class with cardiovascular risk factors and with risk of ischaemic heart disease and stroke in adult life. METHODS: We did a longitudinal study of cardiovascular disease in 5934 men aged 40-59 years at enrollment. A cross-sectional measurement survey was done between 1978 and 1980 and a follow-up questionnaire was completed in 1992. The main endpoints were non-fatal myocardial infarction and stroke based on general practitioners' reports obtained between screening and 1992 and on recall of physician-diagnosed ischaemic heart disease in the 1992 questionnaire. FINDINGS: Father's social class was strongly associated with social class in adulthood (fathers' occupation was manual for 41.3% of professionals [I] vs 89.1% for unskilled manual workers [V]) and was significantly related to height (non-manual vs manual 175.4 cm [SE 0.2] vs 172.9 cm [0.1], p < 0.0001) and obesity (213 [14.1%] vs 804 [20.1%], p < 0.0001) irrespective of adult social class; no association was found with blood glucose (log, 1.69 [0.005] vs 1.70 [0.003], p = 0.22) or cholesterol (6.34 [0.03] vs 6.29 mmol/L [0.02], p = 0.16. Men whose fathers' social class was manual had significantly higher rates of non-fatal myocardial infarction (342/4006 vs 92/1510) and self-reported physician-diagnosed ischaemic heart disease (686/4006 vs 192/1510) than men whose fathers' social class was non-manual, even after adjustment for adult social class and other established risk factors (relative odds 1.3 [95% Cl 1.0-1.7], p < 0.05 and 1.3 [1.1-1.6], p < 0.01, respectively). The influence of father's social class on non-fatal myocardial infarction and ischaemic heart disease was only seen in men whose adult social class was non-manual. No association was seen between father's social class and non-fatal stroke. INTERPRETATION: Father's social class is strongly associated with adult social class. The higher risk of non-fatal myocardial infarction and self-reported physician-diagnosed ischaemic heart disease seen in men whose father's social class was manual suggests that socioeconomic status early in life has some persisting influence on ischaemic heart disease risk in adult life.

Adult↗

PubMed1999

The role of familial values in understanding the impact of social class on weight concern.

OBJECTIVE: To examine the role of social class on aspects of weight concern and to assess the possible impact of values on mediating this association. METHOD: Two hundred fifty-seven girls ranging in age from 13 to 16, from either a fee paying inner city independent girls school (higher class school, n = 135) or a state comprehensive, inner city girls school (lower class school, n = 122) completed a questionnaire concerning their profile characteristics (age, social class), aspects of their weight concern, and their own and their perceptions of their significant others' values (achievement, family life, and physical appearance). RESULTS: The results showed consistent effects of class on weight concern, with the higher class subjects reporting higher levels of restrained eating, greater body dissatisfaction, and body distortion than their lower class counterparts. The results also showed an effect of class on values, with the lower class subjects placing more importance on family life from both their own perspective and that of their parents and friends, and rating their friends as valuing achievement and physical appearance more than the higher class subjects. In terms of the best predictors of weight concern, the results showed that higher levels of restrained eating were related to being from a higher class, placing greater importance upon physical appearance, preferring a thinner ideal female body, and placing less importance upon family life; greater body dissatisfaction was related to being from a higher social class, placing greater importance upon physical appearance and a lower importance upon achievement, and greater body distortion was related to being from a higher social class and a high value placed upon physical appearance. CONCLUSION: The results indicate both a direct social class/weight concern link and a relationship which is mediated by values. The results are discussed in terms of developing an improved measure of class values and the relatively stable nature of class boundaries.

Adolescent↗

PubMed1986

Occupation, social class and male cancer mortality in New Zealand, 1974-78.

Occupational and social class differences in cancer mortality among New Zealand males aged 15-64 are examined for the period 1974-78. Age-standardized cancer mortality rates are presented for the Registrar General's social classes as well as for each of six occupational orders and 79 occupational groups. The rates for specific cancer sites are also presented for each social class and for those occupational groups with significantly elevated relative risks. The findings of the social class analyses were generally consistent with those of recent British studies with mortality from cancer of the liver, larynx, lung, buccal cavity and stomach being particularly high in the lower social classes and mortality from multiple myeloma, malignant melanoma and lymphatic leukaemia being particularly high in the upper social classes. The findings of the occupational group analyses were also generally in line with those of recent British studies and those associations which have been found in British studies and were also present in the New Zealand data are discussed. It is concluded that there are a number of associations which warrant further investigation including: large bowel cancer in woodworkers and printers; bladder cancer in hairdressers and beauticians; and malignant lymphoma in farmers.

Adult↗

PubMedDate not supplied

Social class gradients and health in childhood.

OBJECTIVE: To determine if there are social class gradients in health in children aged 6 to 11 years. METHODS: Self and parent reports of health of children in 5 sites across the United States were assessed using the Child Health and Illness Profile-Child Edition. Distribution of scores in 4 domains: satisfaction (with health); comfort; resilience; and risk avoidance were used to create profiles of health. Social class was defined as a composite of parental education and work participation. RESULTS: Social class gradients were found for all but the satisfaction domain and for most subdomains in the parent version; the most notable gradient was in the risk avoidance domain, with better health the higher the social class. Apparent gradients did not reach statistical significance in the child reports. Children from a higher social class were more likely to be in excellent/average health and less likely to be in poor health profiles than were lower class children. CONCLUSIONS: The findings generally mirror those from a prior study of adolescents, using the same conceptual framework for health and the same measure of social class, and are consistent with a cumulative effect for most aspects of health, and with a critical-period effect for risky behaviors.

Child↗

PubMed1988

Blood pressure and social class in a Jamaican community.

A study of social factors and blood pressure was conducted in a Jamaican community among a sample of 199 persons ages 30 to 50. After controlling for obesity, age, and respondent tension (and other covariates), interaction effects of social class x sex for systolic and diastolic blood pressure were found. Blood pressure increased with increasing social class for males and decreased with increasing social class for females.

Adult↗

PubMed1998

Social class differences in health until the age of seven years among the Finnish 1987 birth cohort.

Studies on social class differences in childhood health are controversial partly because of different data collection methods, limited sample sizes and the use of limited numbers of health indicators. The increasing collection of health register data enables the use of such data in social class studies. Our purpose was to investigate social class differences in mortality and morbidity among all children born in Finland in 1987 (N=59,865 liveborns) until the age of seven by using several national health registers, and to study whether perinatal health explains these differences. The follow-up was based on data linkage with six national health registers, with 18 regional registers of mentally disabled children, covering the whole country, and with 38 educational registers of the largest county. Morbidity was measured in terms of a cumulative disease index, the cumulative incidence of asthma, diabetes, epilepsy and intellectual disability, hospitalisations, disease-related welfare benefits and special education. Social class, divided in four groups (I-III, Others) was defined by using the mother's occupation at the time the child was seven years old. Our study showed that register-based data collection is a feasible method for studying social class differences in health. In the unadjusted analysis, social class differences were found for all indicators except mortality after the age of one year and for the cumulative incidence of asthma and diabetes. After adjusting for confounders, the children in the lowest social class had the highest risk for poor health outcome both in the perinatal period and in childhood, and had the most intellectual disabilities, the highest mean of hospitalisation days, and received the most special education. The differences were not explained by perinatal health. The health of the children in the lowest social class was poorer, especially regarding mental indicators.

Chi-Square Distribution↗

PubMed1990

Survival among women with cancer of the uterine cervix: influence of marital status and social class.

STUDY OBJECTIVE: The aim was to investigate whether the survival of women with cancer of the uterine cervix is associated with their marital status and social class. DESIGN: The study was a survey of survival up to 5 years from diagnosis of women with cancer of the cervix registered in the South Thames Cancer Registry, using Cox regression to adjust for marital status, social class, age, and stage at registration. Because of deficiencies in social class data held by the Registry (social class was assigned in only 51% of cases, as opposed to 93% for marital status), the findings were compared with survival data from the OPCS Longitudinal Study. SETTING: During the period of study (1977-81) the South Thames Cancer Registry covered a female population of about 3.5 million in the south east of England. PATIENTS: Data on 1728 women were analysed. MEASUREMENTS AND AND MAIN RESULTS: Apparent differences in crude survival by marital status and social class were examined. These were found to be accounted for by adjustment for age and stage. The better survival of those whose social class was unknown was found to be an artefact of the way in which cancer registries assign social class, but this did not appear to bias registry based studies of social class survival seriously. CONCLUSIONS: (1) After adjusting for age, factors affecting survival in women with cancer of the cervix, such as stage at presentation or host resistance, appear to be similarly distributed in the different marital status and social class groups; (2) for cervical cancer, the marked social class gradient and unusual marital status distribution found in cross sectional mortality data reflect the incidence of the disease, not differences in survival; (3) explanations for these patterns in incidence and mortality data are to be found in the aetiology of the disease.

Adult↗

PubMed1982

Social class and birthweight: a new look.

The effects of social class on birthweight, and its interactions with other maternal factors, were examined in groups of women bearing small-for-dates (SFD), average-for-dates (AFD) and large-for-dates (LFD) babies. The relative risk of a lower social class woman having an SFD baby steadily decreased from 1.75 to 1.20 as adjustment was cumulatively made for smoking, hypertension, maternal age and height. The subsequent addition of weight and weight-for-height made little change. The unadjusted risk of a lower social class woman having a LFD baby was very close to unity (0.99). Adjustment for other maternal factors, in the same order as at the other extreme, showed a steady rise to a significant level (1.45) when height was included; but there was a sharp reversal to a non-significant risk of 1.12 when weight was added. The large contribution of obesity in the lower classes seems to counterbalance those for height, age and smoking in the upper classes in the LFD group. The interactional effects of other maternal factors and social class are not operating to an equal and opposite degree at the two extremes of the birthweight range.

Birth Weight↗

PubMed2002

Social class and mortality in older women.

In middle-aged people, social class is one of the strongest predictors of mortality. However, to date, research prospectively evaluating the relationship between social class and mortality in the older persons has produced conflicting results. This may be due to the lack of clinical covariates in many analyses. The objective of this study was to determine the relationship between social class markers-education, income, husband's work history, and personal work history-and mortality in a cohort of older women, after adjusting for clinical and behavioral factors. The participants were 737 ambulatory, community-living women, age 72 and older, followed from 1989 to 1993. In addition to education attained, present income, husband's work history, and personal work history, proportional hazard models adjusted for age, race, marital status, number of chronic conditions, number of medications used, Activities of Daily Living status, Mini-Mental State Exam score, physical activity, and alcohol use. In multivariable models personal work history was the only social class marker that remained significantly associated with mortality. Compared with managers and professionals, women who never worked outside the home had a 3.5 greater risk of death (95% CI, 1.6-7.5), while women who had worked in partly/unskilled or skilled professions were over two and a half times more likely to die; the adjusted hazard ratios were 2.7 (95% CI, 1.2-6.4) and 2.7 (95% CI, 1.3-5.7), respectively. In this population of older women, personal work history was the only social class marker predictive of mortality.

Aged↗

PubMed1997

Social class and race disparities in premature stroke mortality among men in North Carolina.

The purpose of this work was to examine the association between social class and premature stroke mortality among blacks and whites. For black men and white men in North Carolina, aged 35-54 years, mortality data from vital statistics files and population data from Census Public Use Microdata Sample files were matched according to social class for the years 1984-1993. Four categories of social class were defined based upon a two-dimensional classification scheme of occupations. For each category of social class, race-specific age-adjusted stroke mortality rates were calculated, and race-specific prevalences of income, wealth, education, unemployment, and disability were estimated. Women were excluded because comparable information on social class was not available from the mortality and population data sources. For both black men and white men, the highest rates of premature stroke mortality were observed among the lowest social classes. The rate ratios (RR) between the lowest and highest social class were 2.8 for black men and 2.3 for white men. Within each social class, black men had substantially higher rates of premature stroke mortality than white men (black-to-white RR ranged from 4.0 to 4.9). Among both black men and white men, the highest social class consistently had the most favorable levels of income, wealth, education, and employment. The inverse association between social class and stroke mortality for both black men and white men supports the need for stroke prevention efforts that address the structural inequalities in economic and social conditions.

Adult↗

PubMed2006

Social class inequalities in childhood mortality and morbidity in an English population.

The objective of this study was to examine the association between social class of the head of household at the time of birth and mortality and morbidity during the first 10 years of life in a cohort of all 117 212 children born to women who both lived, and delivered in hospital, in Oxfordshire or West Berkshire during the period 1 January 1979 to 31 December 1988. Logistic regression was used to estimate social class gradients, with odds ratios (OR), for mortality during the early neonatal period, late neonatal period, post-neonatal period, post-infancy period and throughout the first 10 years of life. Logistic regression was also used to estimate social class gradients, with ORs, for hospital admission rates for 16 broad groups of diseases during years 0-3, 4-6, 7-10 and throughout the first 10 years of life. Poisson regression was used to estimate social class gradients, with effect sizes, for overall hospital admission rates during years 0-3, 4-6, 7-10 and throughout the first 10 years of life. The study revealed a significant social class gradient in mortality during the first 10 years of life (adjusted OR for each decrement in social class category 1.08; [95% confidence interval 1.03, 1.14]). The study also revealed a significant adjusted social class gradient in hospital admission rates for 14 of the 16 groups of diseases during the first 10 years of life. For the majority of these, the social class gradients had attenuated somewhat by the later childhood years. However, the social class gradient persisted throughout the first 10 years of life for diseases of the respiratory system (1.07 [1.05, 1.08]), diseases of the digestive system (1.06 [1.04, 1.09]), and injury and poisoning (1.07 [1.06, 1.09]). In addition, a significant adjusted social class gradient was found in overall hospital admission rates for each age group studied. This study suggests that there are significant social class inequalities in a wide range of adverse child health outcomes.

Age Factors↗

PubMed2002

Genetics and social class.

OBJECTIVE: To assess claims that genes are a major determinant of social class. DESIGN: Using genetic epidemiological principles, five claims on the role of genes in determining social class are examined: (1) traits that run in families are usually inherited; (2) complex traits can be explained by alleles at a single gene locus; (3) complex traits are transmitted intact from one generation to the next; (4) natural selection explains social advantage. (5) Heritability estimates provide a valid estimate of the importance of genes in explaining complex human traits or behaviour. RESULTS: (1) Traits that run in families can result from environmental exposures that differ by social class. (2) The protein encoded by any single gene has too narrow a range of biological activity to explain traits as complex as social status. (3) Because alleles at different gene loci are transmitted independently, genetic inheritance cannot explain why offspring display the same complex traits as their parents. (4) The propagation of mutations that might result in a selective advantage takes much longer than the time for which any social class has achieved or maintained dominance. (5) Heritability measures are accurate only when environment is maintained constant. This is impossible in evaluating human traits. CONCLUSIONS: The roots of social class differences do not lie in our genes. Consequently, genetics cannot be used as a justification for maintaining a ruling class, limiting procreation among the poor, or minimising social support programmes.

Environment↗

PubMed2004

Is there a north-south divide in social class inequalities in health in Great Britain? Cross sectional study using data from the 2001 census.

OBJECTIVE: To examine individual social class inequalities in self rated general health within and between the constituent countries of Great Britain and the regions of England. DESIGN: Cross sectional study using data from the 2001 national census. SETTING: Great Britain. PARTICIPANTS: Adults aged between 25 and 64 in Great Britain and enumerated in the 2001 population census (n = 25.6 million). MAIN OUTCOME MEASURES: European age standardised rates of self rated general health, for men and women classified by the government social class scheme. RESULTS: In each of the seven social classes, Wales and the North East and North West regions of England had high rates of poor health. There were large social class inequalities in self rated health, with rates of poor health generally increasing from class 1 (higher professional occupations) to class 7 (routine occupations). The size of the health divide varied between regions: the largest rate ratios for routine versus higher professional classes were for Scotland (2.9 for men; 2.8 for women) and London (2.9 for men; 2.4 for women). Women had higher rates of poor health compared to men in the same social class, except in class 6 (semi-routine occupations). CONCLUSIONS: A northwest-southeast divide in social class inequalities existed in Great Britain at the start of the 21st century, with each of the seven social classes having higher rates of poor health in Wales, the North East and North West regions of England than elsewhere. The widest health gap between social classes, however, was in Scotland and London, adding another dimension to the policy debate on resource allocation and targets to tackle the health divide.

Adult↗

PubMed1991

No evidence for social class inequalities in intervention for coronary heart disease in Otago 1987-9.

OBJECTS: to investigate whether social class differences in access to cardiac surgical interventions (angioplasties and coronary artery bypass grafting) could explain social class inequalities in mortality from coronary heart disease. METHODS: rates of therapeutic interventions to treat coronary heart disease were calculated for male patients aged less than 65 years admitted for the first time to Dunedin Hospital with a principal diagnosis of ischaemic heart disease (ICD codes 410-414) during the three year period from 1 January 1987 to 31 December 1989. Patients were categorised into different socioeconomic groups using the Elley-Irving social class scale. RESULTS: no statistically significant trend across social class was observed in the cumulative incidence of cardiac surgical interventions (angioplasties, coronary artery bypass grafts). Similarly there was no statistically significant trend across social class in the incidence rates of cardiac surgical interventions, even after adjustment for age. CONCLUSIONS: social class inequalities in access to cardiac surgical intervention do not appear to explain the observed inequalities in mortality from coronary heart disease.

Angioplasty, Balloon, Coronary↗