Relationship of race, sex, social class, and social mobility to depression in normal adults.
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Adult↗
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Social class and psychiatric diagnosis: differential findings in a lower-class sample.
Social class and the American Psychiatric Association Diagnostic and Statistical Manual II Diagnosis were examined for all patients contracting the Department of Psychiatry over a year at a large county hospital. This sample was primarily lower class -50 per cent Class V and 33 per cent in Class IV. All diagnoses showed average class between IV and V. Organic brain syndrome, both psychiatric and non-psychotic, and mental retardation had lower average social class than other diagnoses. A small sample of the diagnosis behaviour disorder of childhood and adolescence was also lower than other diagnoses. Class V patients with mental malfunction may present differently than patients from other social classes. The absence of differences on neurosis and functional psychosis may have been due to the predominance of lower class patients, diagnosticians more familiar with lower class patients, or the allowable choice of diagnoses.
Adolescent↗
[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↗
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↗
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↗
Gender, social class and illness among young people.
Gender and social class differences in illness among young people have been a neglected area in research on social inequities in health. It has been assumed that the illness differentials among adults persist throughout their lives. Only recently have social class health differentials among young people become a topic for research. The aim of this study is, first, to examine gender and social class differences in self-reported illness among young Finns; secondly, to determine whether the relationship between social class and limiting long-standing illness is similar among young men and women. In addition to the two main aims, we also examined whether several background variables have any impact on the relationship between class and illness or, directly, on illness. The data were derived from a nationwide Finnish 'Level of Living Survey', which was carried out by the Central Statistical Office of Finland in 1986. This interview material represents the noninstitutional Finnish population aged 15 years old or older. The number of respondents were 12,057, and the response rate was 87%. In the present study we only examined those who were 15-24-year-olds (N = 2238); i.e. 1101 men and 1137 women; the response rates were 91% and 92% respectively. Young women reported a limiting long-standing illness more often than young men. The prevalence of limiting long-standing illness increased with age. Cross-tabulation analyses showed virtually no relationship between social class and limiting long-standing illness. This held true irrespective of the various measures of social class that were used. Controlling the impact of several background variables in the logistic regression analyses did not alter this general result.
Adolescent↗
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↗
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↗
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↗
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↗
[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↗
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↗
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↗
Diminishing or increasing contrasts? Social class variation in Finnish food consumption patterns, 1979-1990.
The study examines whether social-class-based food consumption patterns changed in Finland during 1979-1990. The data were compiled by the National Public Health Institute in connection with a programme entitled 'Monitoring Health Behaviour among the Finnish Adult Population'. A questionnaire was sent annually to a random sample of Finns (N = 3400-5100, response rate 68-86%). This study was restricted to respondents 25-54 years old. Social class was defined by level of education (low, middle, high). Trends and variations in consumption patterns were studied by cross-tabulations and by fitting logistic regression models. The results show that the proportions of users of butter, high-fat milk and coffee sugar decreased during the study eriod whereas that of regular users of vegetables increased. Since the mid-1980s the shift towards 'healthier' food choices has accelerated among men, yet women are consistently more health-oriented. Social class appears to be a significant determinant of food consumption patterns. Men and women of lower social class follow trends set by upper social classes with a time lag of about ten years. Along with an overall shift towards observance of dietary recommendations, social class differences in Finnish food consumption patterns have diminished, without, however, disappearing altogether.
Adult↗
The effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque, gingivitis and pocketing in adolescents: a longitudinal cohort study.
Reported toothbrushing frequency and the effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque and periodontal disease in a group of 720 adolescents examined at age 11-12 years and again at 15-16 years is presented. At 11-12 years, the mean toothbrushing frequency was 11.5 times per week. By age 15-16 years, it had risen to 13.3 times per week. Children from social class I were less likely to brush once per day or less and more likely to brush twice daily than those from social class V. At both examinations, consistently low negative correlations were seen between reported toothbrushing frequency and the mean scores for buccal and lingual plaque, buccal, mesial and total bleeding. Few significant differences were seen between left- and right-handed toothbrushers at age 11-12 years. These were almost entirely due to differences between the boys. By age 15-16 years, no significant differences existed between the two groups. At both examinations, the boys had higher plaque, bleeding and pocketing scores than did the girls. At 15-16 years of age, all social classes exhibited lower mean total pocketing scores than at age 11-12 years. At 11-12 years of age, the social class differences were mainly contributed by the girls, while at re-examination plaque and bleeding scores for both sexes showed an overall trend to increase from social class I through to social class V. At 11-12 years of age, the boys showed a trend for pocketing to increase from social class I through to social class V. This was absent at 15-16 years of age. The girls showed no such trend at 11-12, but it had emerged by age 15-16. The results again demonstrate the influence of social class and sex rather than toothbrushing frequency and handedness on oral hygiene and gingival health. However, in view of the high number of statistical tests employed, some caution must be exercised in the interpretation of differences significant at the 5 per cent level.
Adolescent↗
The sex differential in ischaemic heart disease: trends by social class 1931 to 1971.
The comparison of trends in ischaemic heart disease (IHD) mortality in different social classes is confounded by historical changes in diagnostic techniques and statistical classification, and possibly by different standards of diagnostic accuracy in the different social classes. The problems can be circumvented by taking advantage of the fact that in middle age (45 to 64) the IHD death rate is much higher in men than in women. This large sex differential is not present in any of the other causes of death with which IHD might easily be confused and it is therefore relatively unaffected by diagnostic errors and variation in classification. The changes that have occurred in the sex differential in Social Classes I and V in England and Wales between 1931 and 1971 confirm anecdotal clinical reports that the male vulnerability to IHD appeared first in Social Class I (professionsl). By 1971 Social Class V (unskilled) had caught up, and the men in these two social classes now experience an almost identical excess in cardiovascular death rate compared with their wives.
Coronary Disease↗
Social class inequalities in the decline of coronary heart disease among New Zealand men, 1975-1977 to 1985-1987.
Coronary heart disease (CHD) is regarded as a disease of developed 'western' societies. Within developed societies, however, CHD is typically a disease of the less affluent socioeconomic classes. This has not always been the case. Forty years ago. CHD was reported to be more common among the upper social classes. In New Zealand, as in other developed countries, this original trend across social classes was reversed during the past 40 years. In 1975-1977, a gradient across social class was observed for both CHD and cerebrovascular disease mortality, with the lowest social classes experiencing the highest mortality. This study has now been repeated for the period 1985-1987. Employed males aged 15-64 years were categorized by the Elley-Irving scale into six social classes. The overall age-standardized mortality rate from CHD declined over the ten-year period, from 163.0 to 121.7 per 100,000 person-years. Over the same period, however, the social class gradient for coronary mortality actually increased. The overall age-standardized mortality rate from cerebrovascular disease also declined over the ten-year period, from 25.9 to 17.7 per 100,000 person-years. A social class gradient for cerebrovascular mortality was present in both periods. In contrast to coronary mortality, however, the social class gradient diminished slightly over the ten-year period.
Adolescent↗
Mother's social class and perinatal problems in a low-problem area.
This study reports the variation in perinatal problems related to social class in one area in Finland. Data on length of gestation, birthweight, one-minute Apgar score, and need for special care in relation to social class were obtained from a large clinical trial (n = 2912) on iron prophylaxis during pregnancy. Social class was determined from the woman's own occupation and education. Occupation was obtained from the women themselves and classified as upper white collar, lower white collar I, lower white collar II, and workers; entrepreneurs, students and women with no information were excluded. Education was obtained by record linkage to the national education register, and all women were classified by the years normally required to attain a certain level: greater than or equal to 13, 12, 10-11, and less than or equal to 9 years of education. Adjusted for age and parity, a week U-shaped curve was found for gestation length and birthweight, best results being found for the women in the second highest social class. The lower the social class, the more infants with poor Apgar scores. As potential intervening variables we studied marital status, pre-pregnancy weight, smoking, and haematocrit in the 28th week of pregnancy. Their inclusion in multivariate analyses influenced only slightly the differences in perinatal problems between the groups. Our results suggest that in Finland there are still differences in perinatal problems between social classes, but that the relationship is not always linear.
Abortion, Spontaneous↗