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PubMed1992

Social class differences in infant mortality in Sweden: comparison with England and Wales.

OBJECTIVES: To investigate social class differences in infant mortality in Sweden in the mid-1980s and to compare their magnitude with that of those found in England and Wales. DESIGN: Analysis of risk of infant death by social class in aggregated routine data for the mid-1980s, which included the linkage of Swedish births to the 1985 census. SETTING: Sweden and England and Wales. SUBJECTS: All live births in Sweden (1985-6) and England and Wales (1983-5) and corresponding infant deaths were analysed. The Swedish data were coded to the British registrar general's social class schema. MAIN OUTCOME MEASURES: Risk of death in the neonatal and postneonatal period. RESULTS: Taking the non-manual classes as the reference group, in the neonatal period in Sweden the manual social classes had a relative risk for mortality of 1.20 (95% confidence interval 1.02 to 1.43) and those not classified into a social class a relative risk of 1.08 (0.88 to 1.33). In the postneonatal period the equivalent relative risks were 1.38 (1.08 to 1.77) for manual classes and 2.14 (1.65 to 2.79) for the residual; these are similar to those for England and Wales (1.43 (1.36 to 1.51) for manual classes, 2.62 (2.45 to 2.81) for the residual). CONCLUSIONS: The existence of an equitable health care system and a strong social welfare policy in Sweden has not eliminated inequalities in post-neonatal mortality. Furthermore, the very low risk of infant death in the Swedish non-manual group (4.8/1000 live births) represents a target towards which public health interventions should aim. If this rate prevailed in England and Wales, 63% of postneonatal deaths would be avoided.

England↗
PubMed1975

Relationships of children's grade in school, sex, and social class to teachers' ratings on the behavior problem checklist.

The present study investigated the relationships of children's grade in school, sex, and social class to teachers' ratings on the Behavior Problem Checklist (BPCL). The sample consisted of 1,999 white children from kindergarten through fifth grade who were in regular classes. Three conclusions may be drawn from the study. The first is that grade and the interactions of grade with sex and social class are determinants of scores on the BPCL, but that no particular trends are characteristic of the relationships between these and the dependent variables. The second is that sex and social class are also determinants of scores on the BPCL, with boys and children from the lower social classes having more problems and girls and children from the higher social classes having fewer problems. The third is that the differences between schools and between teachers are responsible for more of the variance on the BPCL than grade, sex, and social class.

Age Factors↗
PubMed1997

Influences of gender and social class on adolescents' perceptions of health.

OBJECTIVE: To explore how gender and social class affect perceptions of health status among 16-year-old adolescents. DESIGN: Cross-sectional survey. SETTING: University psychology laboratory. PARTICIPANS: Fifty upper-middle-class and 48 working-class adolescents stratified by gender. MAIN OUTCOME MEASURES: The general health perceptions (GHP) scale of the Medical Outcomes Survey 36-Item Short Form Health Survey (SF-36). The other self-reported health status domains and 3 measures of different aspects of psychological well-being were included as covariates in analysis of variance models. RESULTS: Upper-middle-class females reported the lowest and upper-middle-class males the highest GHP (76.7 vs 88.4, P=.003). A multivariate regression model (adjusted R2=0.08) revealed significant gender (P=.03) differences in GHP, but not a social class effect, and an interaction effect between gender and class (P=.01). With addition of psychological well-being covariates (P<.001), gender remained significant (P=.04) and a significant portion of the interaction effect (P=.13) was explained. When the self-reported physical health status scales (P<.001) were added to the model (adjusted R2=0.51), gender remained significant (P=.03) and the interaction effect was partially explained (P=.07). CONCLUSIONS: Gender is a crucial factor in understanding the complex relationships between sociostructural inequalities and health differentials. These data suggest that psychological well-being and self-reported physical health status mediate the effects of gender and the gender and social class interaction in explaining variation in GHP. Contrary to the social class gradient hypothesis, upper-middle-class females reported the lowest GHP. These results suggest that the paradigms applicable to early childhood and adulthood may not be appropriate to understand the complex dynamics of adolescence.

Adolescent↗
PubMed1993

Social class and mood disorders: clinical features.

We examined clinical features in 877 in- and outpatients affected by depression who were enrolled in psychopharmacological trials, subdivided according to Hollingshead's method into five social classes. The results showed that social class correlated significantly with the subtypes of mood disorders, with bipolar disorder being more frequent amongst the upper than the lower social classes. Furthermore, as already reported in other countries, social class appeared to influence the psychopathological pattern of depressive symptoms: somatization and anxiety were more frequent amongst the lower social classes, while psychic and cognitive symptoms were more common amongst the upper classes.

Adult↗
PubMed2005

Accuracy of adults' recall of childhood social class: findings from the Aberdeen children of the 1950s study.

BACKGROUND: Although adult reported childhood socioeconomic position has been related to health outcomes in many studies, little is known about the validity of such distantly recalled information. This study evaluated the validity of adults' reports of childhood paternal social class. METHODS: Data are drawn from the Aberdeen children of the 1950s study, a cohort of 12 150 people born in Aberdeen (Scotland) who took part in a school based survey in 1962. In this survey, two indices of early life socioeconomic position were collected: occupational social class at birth (abstracted from maternity records) and occupational social class in childhood (reported during the 1962 survey by the study participants). Between 2000 and 2003, a questionnaire was mailed to traced middle aged cohort members in which inquiries were made about their fathers' occupation when they were aged 12 years. The level of agreement between these reports and prospectively collected data on occupational social class was assessed. RESULTS: In total, 7183 (63.7%) persons responded to the mid-life questionnaire. Agreement was moderate between social class of father recalled in adulthood and that measured in early life (kappa statistics were 0.47 for social class measured at birth, and 0.56 for social class reported by the child). The relation of occupational social class to birth weight and childhood intelligence was in the expected directions, although weaker for adults' reports in comparison with prospectively gathered data. CONCLUSIONS: In studies of adult disease aetiology, associations between childhood social class based on adult recall of parental occupation and health outcomes are likely to underestimate real effects.

Birth Weight↗
PubMed2000

Mortality differences by parental social class from childhood to adulthood.

STUDY OBJECTIVE: To examine mortality differences by parental social class and cause of death from age 5 to age 34. DESIGN: Register-based follow up study based on census records for 1985 and 1990 linked with death records for the period 1987-95. SETTING AND SUBJECTS: The study covers all males and females in non-manual and manual classes in Finland aged 5-34 years in 1987-95 (8135 deaths). Parental social class is defined on the basis of the occupation of the head of household at the time the child was 0-14 years. MAIN OUTCOME MEASURES: All cause mortality, mortality from diseases, mortality from accidents and violence, and alcohol related mortality during the period 1987-95. MAIN RESULTS: At ages 5-14 there is no systematic gradient in mortality by parental social class. Both absolute and relative differences increase with age. The relative rate of male all cause mortality among manual class descendants at ages 25-29 compared with that of upper non-manual class descendants is 1.60 (95% CI 1.37, 1.86). At ages 30-34 the relative rate among males is 1.95 (95 % CI 1.58, 2.42) and among females 1.47 (95% CI 1. 03, 2.10). Among males alcohol related causes of death account for 70% of the excess mortality of sons of manual class parents compared with sons of upper non-manual class parents at ages 25-34. At ages 25-34, both among females and males, the contribution of diseases to the mortality difference increases. CONCLUSIONS: Parental social class has an impact on mortality after childhood mainly through health related behaviours and lifestyles up to age 34.

Adolescent↗
PubMed2000

The excess incidence of squamous cell esophageal cancer among us black men. Role of social class and other risk factors.

PURPOSE: To investigate the relationship between social class factors and squamous cell esophageal cancer and the extent to which alcohol, tobacco, diet, and social class contribute to the five-fold higher incidence among black than white men in the United States.METHODS: Interviews were conducted with 347 incident cases of squamous cell esophageal cancer (119 white males and 228 black males) and 1354 population-based controls (743 white males and 611 black males) from Atlanta, Detroit, and New Jersey. Risks were estimated using unconditional logistic regression controlling for potential confounders.RESULTS: Elevated risks of squamous cell esophageal cancer were associated with indicators of low social class, especially low annual income. The adjusted odds ratios (ORs) for subjects with incomes < $10,000 versus incomes of $25,000 or more were 4.3 (95% CI = 2.1-8.7) for whites and 8.0 (95% CI = 4.3-15.0) for blacks. The combination of all four major risk factors: annual income less than $25,000, moderate/heavy use of alcohol, use of tobacco for six months or longer, and consumption of less than 2.5 servings of raw fruits and vegetables per day accounted for almost all of the squamous cell esophageal cancers in whites (98%) and blacks (99%), and for 99% of the excess incidence among black men.CONCLUSIONS: Lifestyle modifications, especially a lower intake of alcoholic beverages, would markedly decrease the incidence of this cancer in both races and narrow the racial disparity in risk. Further studies into the determinants of social class may help identify a new set of exposures for this tumor that are amendable to intervention.

Journal Article↗
PubMed1993

[Social class and cardiovascular risk factors in Italian-speaking Switzerland: results of the first Swiss population study MONIKA Project 1985-1986].

The relationship of social class and prevalence of risk factors for cardiovascular diseases was investigated within the Swiss MONICA-project, a cross sectional study of the Swiss-Italian population started in 1985/1986. A representative sample of 984 men and 1014 women ages 35 to 64 was selected, the response rate was 78%. Social class was measured by two indicators, occupational status and education. A significant trend was found in age standardized analysis with higher mean blood pressure and body mass index in lower social classes (p < 0.001). When other confounders for cardiovascular diseases were considered in a multiple regression model, the predictive power of social class was moderate. A significant inverse relationship of cardiovascular risk factors and social class was only found for body mass index (both sexes) and exercise in women which was directly related to higher social class and education. No relationship was found for lipids (cholesterol, HDL-cholesterol), blood pressure and smoking in both sexes. Risk factors for cardiovascular diseases beside obesity do not seem to cluster in lower social classes within the Swiss-Italian population.

Adult↗
PubMed1998

Inequalities in mortality by social class measured at 3 stages of the lifecourse.

OBJECTIVES: This study examined how social class, measured at 3 staged of life, contributes to mortality risk. METHODS: A cohort of employed Scottish men (n = 5567) provided their fathers' occupation and their own first and current occupations, from which social class in childhood, at labor-market entry, and at screening (1970 to 1973) was determined. Relative rates of mortality and relative indices of inequality were calculated from 21 years of follow-up. RESULTS: Mortality risk was similar at each stage of life, with men in the higher social classes having the lowest risk. Social class at screening produced the greatest relative indices of inequality. CONCLUSIONS: The widening of inequalities in mortality in adulthood suggests the importance of the accumulation of poor socioeconomic circumstances throughout life.

Adult↗
PubMed1987

Lifestyles and social class: implications for primary care.

Data from the Oxford healthy life survey were used to explore social class variations in beliefs about the determinants of health, willingness to contemplate behaviour change and experience of lifestyle advice in primary care.While the association between lifestyle factors and health was well-recognized by all social groups, those in social classes 1 and 2 were more likely than others to stress the importance of smoking, diet and exercise, while those in social classes 4 and 5 were more likely than middle class people to emphasize the effect of socioeconomic influences on health such as unemployment, income, pollution and housing. Members of all social classes attributed considerable importance to psychosocial influences on health. In all social classes a substantial proportion of overweight people expressed a desire to reduce their weight, smokers to modify their smoking habits and sedentary people to increase the amount of exercise they took. However, there was less interest in dietary change or reduction of alcohol consumption. One third of the smokers and of those who were overweight had received advice from health professionals about behaviour modification, but less than 10% of those in the other risk groups reported receiving advice. There was a high demand for advice on health; 44% of all respondents said they would be interested in receiving advice on a healthier lifestyle.

Attitude to Health↗
PubMed1991

Social class and cardiovascular risk factors in Danish men.

During the last 25 years, a series of epidemiological studies in North-Western Europe and U.S.A. have demonstrated a negative association between social class and the incidence of cardiovascular disease (CVD), that is, an increasing incidence the lower the social class. In studies where possible explanations of this negative gradient have been analyzed, it was concluded that the traditional individual risk factors, such as elevated blood pressure, high serum cholesterol, and smoking, could explain about one half of the differences demonstrated. In a prospective study of a cohort of 504 men from the County of Copenhagen, the participants were examined when 40 and 51 years old. At both examinations the social class of the participants was recorded in addition to a number of cardiovascular risk factors. The latter included both the traditional risk factors and some not previously analyzed in relation to social class. At the 51-year examination we found statistically significant negative associations between social class and the following risk factors: plasma fibrinogen (p less than 0.001), short height (p less than 0.001), smoking (p less than 0.05), physical inactivity in leisure time (p less than 0.01), shift work (p less than 0.05), job strain (p less than 0.05), living alone (p less than 0.01), and having a poor social network (p less than 0.05). Two factors showed a significant opposite association with social class: Type A behaviour (p less than 0.001) and physical inactivity at work (p less than 0.001). In the last 10-15 years, a tendency has been demonstrated in many countries towards a strengthened association between social class and cardiovascular risk factors. This tendency was not found in our cohort. It has been discussed whether some of the social inequalities observed could be due to selection, so that people with a favourable cardiovascular risk profile socially were upward mobile. We found no support for such a selection hypothesis in our study.

Adult↗
PubMed1995

Geographical and social class effects on asthma mortality in England and Wales.

To determine whether asthma mortality is influenced by geographical or social factors, a retrospective analysis of deaths from asthma in England and Wales between 1979-1987 was performed. Death rates in the 15 Regional Health Authority areas of England and Wales were stratified by sex, age group (0-4, 5-34, 35-64, and > 64 years), and occupational social class. Detailed analysis was restricted to subjects aged 5-64 years because adequate social class data was only available over this age range. Death rates were higher in manual occupational groups (social class IIIb-V) than in non-manual occupations (social class I-IIIa), but on further analysis this effect was confined to males aged 35-64 years. In younger subjects (5-34 years), mortality was higher in the south of the country, and this difference was significant in males (P < 0.05). In older subjects (35-64 years), mortality in both sexes was significantly higher in the north of the country. This study demonstrates that mortality is not evenly distributed between social classes or regions of the country.

Adolescent↗
PubMed1989

Social class and risk factors for coronary heart disease in the Federal Republic of Germany. Results of the baseline survey of the German Cardiovascular Prevention Study (GCP).

The relationship between social class and seven important risk factors for coronary heart disease has been evaluated utilising data from the German Cardiovascular Prevention Study baseline survey. Of German residents aged 25 to 69 years, 16,430 were randomly selected from both the six intervention regions and the Federal Republic of Germany to undergo the screening procedures between 1984 and 1986. Among males the prevalence of cigarette smoking and lack of physical activity was associated with social class. For females, overweight and physical activity demonstrated a strong social gradient. No relationship existed between social class and hypercholesterolaemia. The prevalence of Type A behaviour was significantly higher for the upper social classes. The number of CHD risk factors per study subject increased with decreasing social class. Predicted cardiovascular mortality was clearly higher for the lower social class among males in general and for females younger than 60 years. These findings point to the need for risk factor intervention strategies focusing more on the lower social classes in order to achieve more adequate prevention of coronary heart disease.

Adult↗
PubMed1995

Social class and preventive health behaviour: a British example.

STUDY OBJECTIVE: To test the relationship between social class and preventive health behaviour in a British national sample and identify which set of more specific socioeconomic factors best "explained" any observed relationship(s). DESIGN: Secondary analysis from a national cross sectional survey of the health attitudes and health behaviour of men and women aged 18 years and over living in private households in England, Scotland, and Wales. A selection of addresses was made randomly from the electoral register using a three stage design, and then one individual in each household was sampled. A total of 12,254 addresses yielded interviews with 9003 individuals, a response rate of 73.5%. Compared with the census population, the single and divorced/separated are slightly under-represented but otherwise sources of bias are small. PARTICIPANTS: The subset selected was 1671 women and 1026 men aged between 20-45 years with at least one child under 17 living at home. MAIN RESULTS: Social class was strongly associated with the health practices index (HPI, used as a measure of health behaviour) both for women and men (p < 0.001). The set of factors identified for both sexes as having an impact on this relationship were education, tenure, residential overcrowding index, and salience of lifestyle. In addition, their partner's employment status and household income were relevant for women only. These groups of factors did not totally explain the observed relationship but the proportion of variance in HPI attributable to social class was considerably reduced. CONCLUSIONS: Descriptions of the association between social class and health behaviour(s) are of little use to those wishing to mount more effective interventions in health promotion. Multivariable analysis can indicate which specific factors account for much of the social class effect on health behaviour and thereby assist better understanding and targeting of resources.

Adult↗
PubMedDate not supplied

Health and well-being among elderly persons in Israel: the role of social class and immigration status.

OBJECTIVES: The purpose of the study was to compare three groups of Israeli elderly that differ in social class and immigration status on measures of health and psycho-social well-being, and assess the factors which explain their self-rated health (SRH). DESIGN: Based on a random sample of Israeli Jewish elderly (70 +), data were collected from 1138 persons during 1994 by structured home interviews. RESULTS: Social class differences among Israeli veterans were mainly found with regard to psycho-social characteristics. They were less conspicuous in health measures. New immigrants, who had a higher level of education than the veterans, but ranked lower on economic status, reported lower levels of health and psycho-social well-being than the veterans. Self-rated health among the immigrants was mainly explained by objective measures of health, and economic status, while in the higher social class of veterans it was also explained by education and psycho-social variables such as self-esteem and social support. CONCLUSIONS: These findings indicate that in contradiction to the convergence hypothesis, social class and immigration status affect health and well-being also in old age. It is suggested that the immigration crisis and factors related to the standard of living and health services in the countries of origin, as well as the lower social and economic status of the immigrants in Israel, outweigh their relative advantage in age and education in influencing their health and well-being. The differences found among the three groups in the factors that explain self-rated health have implications for the use of economic status as a relevant indicator of social class when considering health status among the elderly, and for the interpretation of SRH, as a global measure of health, in different socio-cultural groups.

Aged↗
PubMedDate not supplied

[Social class differences in bladder cancer in Catalonia].

OBJECTIVE: To assess the presence of socio-economic differences in bladder cancer in a heavily industrialised area of Catalonia, Spain and to evaluate risk factors associated with the presence of these differences. METHODS: 218 cases and 344 population controls resident in the area of Vallès Occidental, Barcelona, were identified prospectively and interviewed during 1993-1995. Socio-economic level was evaluated through attained education and social class on the basis of the last and longest held occupation. Logistic regression was used to derive adjusted odds ratios and 95% confidence intervals. RESULTS: There was no association between education and bladder cancer risk. Social class, evaluated on the basis of longest held job, was weakly related with bladder cancer, with the highest risk occurring in the highest social classes. This pattern was more pronounced when the analysis was done using the last occupation. Occupational exposures modified minimally these results. Among controls, the overall prevalence of smoking did not differ between social class but the prevalence of heavy-smokers (> 48.76 packs-year) was highest among subjects in social class V (35.5%) and lowest in social class I (10%). Adjusting for smoking enlarged social class differences. CONCLUSION: Similarly to the pattern in other European countries, no pronounced differences by social class were observed for bladder cancer in this area of Catalonia. The evaluation of social class patterns was crucially affected by the type of socioeconomic information examined. Measures of life-time experience should be preferred rather than socio-economic level at the time of the disease. Smoking seems to be one of the main mediators for the occurrence of bladder cancer differentials but other, yet unidentified risk factors, must be associated with bladder cancer risk, especially among the highest social classes.

Aged↗
PubMed1999

Shift work, social class, and ischaemic heart disease in middle aged and elderly men; a 22 year follow up in the Copenhagen Male Study.

OBJECTIVES: Shift work has been associated with an increased risk of ischaemic heart disease (IHD). Most published studies have had potential problems with confounding by social class. This study explores shift work as a risk factor for IHD after controlling for social class. METHODS: The Copenhagen male study is a prospective cohort study established in 1970-1 comprising 5249 men aged 40-59. Information obtained included working time, social class, and risk factors for IHD. A second baseline was obtained in 1985-6. The cohort was followed up for 22 years through hospital discharge registers for IHD, and cause of death was recovered from death certificates. RESULTS: One fifth of the cohort was shift working at entry with a significantly larger proportion of shift workers in lower social classes. Risk of IHD and all cause mortality over 22 years, adjusted for age only, for age and social class, and finally for age, social class, smoking, fitness, height, weight, and sleep disturbances, did not differ between shift and day workers. The relative risk of IHD, adjusted for age and social class was 1.0 (95% confidence interval (95% CI) 0.9-1.2). Men being shift workers in both 1971 and 1985 had the same risk as ex-shift workers in an 8 years follow up from the 1985-6 baseline. CONCLUSIONS: The present study questions shift work as an independent risk factor for IHD. The results of the study emphasise the importance of controlling adequately for the interplay of shift work and social class.

Adult↗
PubMed1978

[Social class and mental disorders (an empirical study in Zurich canton)].

The correlation of social class and diagnosis, therapy, mode of admission, frequency of hospitalization was tested in a population of 2103 inpatients of the two governmental and of two private mental hospitals of the Canton Zurich. The results fit to the correlations expected from the literature. The therapeutic procedures as far as reported in the case histories are mainly determined by the hospital type, not so clearly by the subject's social class. High educational status and psychotherapy are correlated. The correlation between social class and therapy is resulting of the class specific admission to one of the two hospital types. There was no sign that within one hospital patients of lower social class were placed at a disadvantage in regard to therapeutic procedures.

Educational Status↗