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PubMed1989

[Health, nutrition and the social classes: the empirical link evident in a large urban center, Brazil].

The relationship between social class and nutritional status, although frequently presumed true, has scarcely ever been studied empirically. The health and nutritional status of a sample of children from different social classes in the city of S. Paulo (Brazil) are studied by means of an on operational classification of social class. Through the analysis of the height for age distribution normal growth--and, therefore, favourable health status--as found only among the burgeoisie and the small-burgeoisie, these two classes together constituting about 30% of the total population. Significant divergences from an expected anthropometric standard were found among all the segments of the working-class population. Differences in income and schooling among the classes corroborate the empirical link found between social class and health and nutritional status.

Brazil↗
PubMed1992

Morbidity in early childhood, sex differences, birth order and social class.

STUDY OBJECTIVE: The aim of the study was to investigate the relationship between morbidity in early childhood and gender, birth order, and social class. DESIGN: The study used data collected in the Nijmegen Continuous Morbidity Registration. All presented morbidity and a number of personal data were available. SETTING: The survey population was regional; four general practices in the east of The Netherlands. PARTICIPANTS: The study population included all children born in the four practices from 1971 to 1984. They were followed up till the age of five (1537 children). MEASUREMENTS AND MAIN RESULTS: Morbidity of children in the first five years was allocated to three degrees of seriousness and to 14 diagnosis groups. The morbidity of all children was analysed for boys and girls, first-born, second-born, and later-born children, and low, middle, and high social class. Boys presented more morbidity than girls; in particular, nervous disorders, lower respiratory tract infections, and accidents. First-born children presented more morbidity than later-born children; in particular, non-serious diseases, nervous disorders, and colds. Lower social class children presented more moderately serious and non-serious morbidity, colds, lower respiratory tract infections, and skin diseases. Logistic regression analysis showed that high social class, being the first-born child, and male gender were the most important factors related to presented morbidity in general practice. CONCLUSIONS: High social class, low social class, gender, and being the first-born child were, in this sequence, related to morbidity in early childhood presented to the general practitioner in this study population.

Birth Order↗
PubMed1988

Haemostatic and other risk factors for ischaemic heart disease and social class: evidence from the Caerphilly and Speedwell studies.

There are marked associations between social class and mortality from ischaemic heart disease (IHD). Using data from the Caerphilly and Speedwell Collaborative Heart Disease Studies the relationships between a number of known risk factors for IHD and social class are explored. The overall conclusions are that lipids and obesity are unlikely to play any part in explaining social differences in ischaemic heart disease. Blood pressure, particularly stystolic pressure, could be involved but the two data sets are inconsistent and associations are only shown in Speedwell. There are marked differences in the haemostatic related variables in the various social classes and the pattern of these is similar in Caerphilly and Speedwell. It is possible therefore that the class pattern of IHD is generated, in part at least, by differences in haemostatic mechanisms. These differences in haemostatic function are almost entirely due to the large social class differences in smoking habit. It is possible therefore that the class differences in IHD result from differences in smoking habit.

Blood Pressure↗
PubMed1982

Social class distribution of fathers of children enrolled in the Iowa Autism Program.

The social class distribution of fathers with autistic children attending a locally well-known and state-supported modern autism program was examined and was compared to the social class distributions observed in a nonautistic, mentally retarded population, in children with other psychiatric disorders, and in the general population from which the present autistic sample was drawn. No significant differences were found among the groups. The findings supported the view that if studies are not biased by certain selection factors outside the autistic child's clinical picture and diagnosis, and if services become better known and readily available, then no differences in social class distribution between autistic and nonautistic groups occur. The results suggest that social class is not an important factor in the origin of autistic syndrome.

Autistic Disorder↗
PubMed1990

Cerebral palsy: social class differences in prevalence in relation to birthweight and severity of disability.

STUDY OBJECTIVE: The aim of the study was to examine the possible influence of social class on the prevalence of cerebral palsy. DESIGN: The study was a retrospective population based survey of all cases of cerebral palsy. SETTING: The study involved all cases of cerebral palsy born to residents in the Eastern Health Board area of the Republic of Ireland between 1976 and 1981 inclusive. PATIENTS: There were 289 cases of cerebral palsy during the study period. Thirty one were excluded because they were attributable to postneonatal brain damage, leaving 258 children for analysis. Cases with uncertain diagnosis were excluded. MAIN RESULTS: There was a clear social class gradient in the overall prevalence of cerebral palsy, also evident in the individual syndromes of hemiplegia and diplegia. No such gradient was detected in the other syndromes, either singly or in combination. Among cases of low birthweight (less than or equal to 2500 g), the prevalence was the same across the social class range after allowing for the increased low birthweight rate in the lower social class categories. Among normal birthweight cases there was a strong positive association with decreasing social class. Intrauterine growth retardation seemed to be a factor in cerebral palsy in all social class groups. Prevalence of cerebral palsy severe enough to prevent walking by the fourth birthday, but not of cases ambulant by this age, increased with socioeconomic disadvantage. CONCLUSIONS: The clear social class gradients in hemiplegia and diplegia suggest that environmental factors play an important role in the aetiology of these syndromes, but there was no evidence of a contribution from this type of factor in the remaining types of cerebral palsy.

Birth Weight↗
PubMed2005

What accounts for the relationship between social class and smoking cessation? Results of a path analysis.

Despite the overall decline in cigarette smoking prevalence in the US, social class inequalities in smoking are likely to persist, or even to widen. One possible reason for the increasing gap in smoking prevalence across social class could be our lack of understanding of causal mechanisms: in other words, what accounts for the social gradient in smoking behavior? In this paper, we examine the mechanisms behind social gradients related to smoking cessation by use of path analysis techniques. The data come from a 3-year follow-up telephone survey of a cohort of US adults. The sample for the present analysis was drawn from the 481 respondents who reported being smokers and employed at baseline and who completed the follow-up interview. We examined two social class indicators, educational attainment and household income, in relation to smoking cessation. We tested the potential mediating effects of the following variables: differential use of resources for smoking cessation (e.g., booklet, pamphlet, quit line, nicotine replacement therapy and smoking cessation program), differential environments in terms of smoking at worksite and home, and differences in peer smoking. Our path analyses suggest that smokers from high social class are likely to use effective resources for smoking cessation and have restrictive home environment in terms of smoking, which leads to a relatively higher smoking cessation rate compared to those from low social class. The results of this study suggest that interventions should target resources for smoking cessation and home environments in terms of smoking to reduce socio-economic disparities in smoking cessation.

Adult↗
PubMed1990

Relationship of social class characteristics and risk factors for coronary heart disease in West Germany.

A cross-sectional analysis of the baseline survey of the German Cardiovascular Prevention Study was carried out to analyse the relationship between four different social class characteristics and major risk factors for coronary heart disease. 4,796 randomly selected German residents aged 25-69 years participated in the health survey between 1984 and 1986. The response rate was 66.2%. No significant association with social class variables was observed for prevalence of hypertension, hypercholesterolaemia or low high density lipoproteins. Multiple logistic regression analysis showed that obesity and lack of physical activity were significantly more prevalent in lower social classes for both sexes, while for cigarette smoking this relationship held for males only. The strongest social class gradient was found for lack of physical activity, adjusted odds ratio 4.75, P less than 0.001, comparing lowest social class by composite index to highest. The number of coronary heart disease risk factors per study subject increased strongly with decreasing social class. Education, measured as years of schooling, showed a stronger association with coronary heart disease risk factors than household income, occupational status, or a three-dimensional composite index of social class. These findings indicate the need to focus on lower social class population groups when carrying out community-based coronary heart disease primary prevention programmes, particularly with regard to smoking, obesity, and lack of physical activity.

Adult↗
PubMed1993

Social class differences in mortality from diseases amenable to medical intervention in New Zealand.

Social class differences in mortality from causes of death amenable to medical intervention were examined. All deaths in New Zealand males aged 15-64 years during the periods 1975-1977 and 1985-1987 were identified. Strong social class gradients in mortality from causes of death amenable to medical intervention were observed during both periods. Furthermore, social class inequalities were more pronounced for amenable causes of mortality than for non-amenable causes. However, a marked decline in the age-standardized mortality rate from amenable causes was observed, with the rate falling by 30% over the 10-year study period. This decline was twice as large as the drop in the non-amenable mortality rate. Despite the fall in the death rate from amenable causes, social class inequalities in mortality persisted among New Zealand men, with the lowest socioeconomic group experiencing a death rate from amenable causes of mortality that was 3.5 times higher than men in the highest socioeconomic group.

Adolescent↗
PubMed1989

The effects of social class on the uptake of orthodontic treatment.

The relationship between social class and uptake of orthodontic treatment was investigated in a longitudinal cohort study of 1018 children living in South Glamorgan, Wales. Previous studies have shown that working class people make less use of dental services and receive inferior dental care than middle class people. The present investigation examined the role of one factor which appears likely to contribute to this effect: namely, the uptake of orthodontic treatment by families from different social classes. If a significant association were shown then findings relating to the effectiveness of orthodontic treatment might be confounded by this social class factor.

Adolescent↗
PubMed2001

Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance?

OBJECTIVE: To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage. DESIGN: 1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994. SETTING: Catalonia (Spain). STUDY PARTICIPANTS: The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n = 12,245). MAIN OUTCOME MEASURES: Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class. RESULTS: Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50% for classes I and II to 16% for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes IV and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes). CONCLUSION: The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.

Adolescent↗
PubMed1988

Is the Jarman score better than social class at assessing the need for prevention and primary care?

This paper reports an analysis by small areas of various measures of disease and the use of cervical smear services in the city of Sheffield. The correlation of these with social class and the Jarman underprivileged area score were compared. Wide variations in mortality rates between electoral wards in Sheffield were demonstrated, particularly for deaths from diseases with a large preventable component. Social class correlated more strongly with all-cause mortality (r = 0.69) and preventable mortality (r = 0.91) than did the Jarman score. There was no significant correlation between routine cervical smear rate and either social class or the Jarman score among women under the age of 35 years. Among older women, however, there was a high degree of correlation with fewest smears being taken in the most deprived wards. Social class was more strongly correlated with the invasive cervical cancer rate in electoral wards than was the Jarman score, and was thus a better indicator of the need for cervical screening. However, the Jarman score showed a greater degree of (negative) correlation with the uptake of cervical screening than did social class with disproportionately fewer smears being taken by general practitioners in areas of highest need. Social class may be better than the Jarman score as an indicator of both ill-health and the need for preventive health services in Sheffield. Information is routinely collected decenially on social class and needs little further computation, unlike the Jarman score. Furthermore, much is already known about the relationships between social class and both ill-health and the need for preventive services.

Adolescent↗
PubMed2005

Area deprivation, social class, and quality of life among people aged 75 years and over in Britain.

BACKGROUND: There is a shortage of research studies that assess how selected characteristics of neighbourhood and personal social circumstances contribute towards health-related quality of life (QoL) among older people. METHODS: Analysis of baseline data for 5581 people aged > or =75 years and over from the Trial of Assessment and Management of Older People in the Community. The scores for four dimensions from the UK version of the Sickness Impact Profile and for the Philadelphia Geriatric Morale Scale were analysed in relation to individual social class and the Carstairs score of socioeconomic deprivation for the enumeration district of residence. RESULTS: In age and sex adjusted analyses, the proportion of participants of social class IV/V living in the most deprived areas who were in the quintile with worst QoL scores was more than double that among those from social class I/II living in the least deprived areas. Individual social class and area deprivation score contributed roughly equally to this doubling for home management, self-care and social interaction, whereas social class appeared a stronger determinant for mobility. Adjustment for living circumstances, health symptoms, and health behaviours substantially reduced the excess risk associated with social class and area deprivation. Being in a rural area was associated with lower risk of poor morale. CONCLUSION: Poor socioeconomic characteristics of both the area and the individual are associated with worse functioning (QoL) of older people in the community. This is not fully explained by health status. Policy should consider community-level interventions as well as those directed at individuals.

Aged↗
PubMed1989

Deprivation and mortality: an alternative to social class?

Mortality rates for males aged 20 to 64 in Scotland (1980-1982) display an increasing gradient both by social class (from class 1 to 5) and by the deprivation category of the area (from affluent to deprived) in which the event occurred. Social classes also exhibit gradients in mortality across deprivation categories, the corresponding rates in the most deprived category being around twice those in the most affluent areas. The gradients by deprivation category remain after standardizing for differences in social class composition. Within health boards in Scotland populations show only minor variability in terms of social class, while their composition on the dimension of deprivation is markedly diverse, and the classification of populations by the deprivation category of their area of residence appears to offer a superior basis for the explanation of differences in mortality between health boards than does social class. This evidence of area effects supports a proposal for area socioeconomic characteristics to be adopted as key variables in epidemiological analysis, and for an area classification to be designed and incorporated in the 1991 census output for use on a consistent basis.

Adult↗
PubMed1999

Socioeconomic status and birth weight: comparison of an area-based measure with the Registrar General's social class.

OBJECTIVE: To compare the relation of birth weight with socioeconomic status measured by an area-based measure of material deprivation and by the Registrar General's social class. SETTING: West Midlands Health Region 1991-93. STUDY DESIGN: Retrospective cohort study. METHOD: Birthweight data by enumeration district deciles ranked by Townsend Deprivation Index based on 1991 census data for all live births in the West Midlands Health Region were studied in three consecutive whole year birth cohorts, 1991 to 1993 and by Registrar General's social class in a 10% sample of live births (within marriage and jointly registered, provided by the Office of National Statistics) in the same region for the same period. Estimated proportions of births < 2500 g and < 3500 g "attributable" to social inequalities were compared for both socioeconomic status measures. The proportion of infants in each birthweight group were calculated for both measures. Relative risk (95% confidence intervals) of birth in each birthweight group for lowest versus highest socioeconomic status groups were calculated. RESULTS: The estimated proportions of births < 2500 g "attributable" to social inequalities were 30% using the area-based measure and 27% using the Registrar General's social class. For births < 3500 g, the estimated proportions were 12% for the area-based measure and 7% for social class. There was a positive linear relation between the proportion of babies weighing > or = 3500 g and increasing socio-economic status measured by either method. Gradients in the opposite direction were noted for the proportion of babies born in the other birth weight groups. Relative risk of birth weight < 3500 g was 1.30 (95% CIs 1.28, 1.32) for most versus least deprived decile and 1.17 (95% CIs 1.10, 1.25) for social class V versus I. For birth weight < 2500 g the risks were 1.99 (95% CIs 1.85, 2.18) and 2.04 (95% CIs 1.53, 2.73) respectively and for birth weight < 1500 g, 2.11 (95% CIs 1.73, 2.57) for most versus least deprived decile (numbers too small for analysis in the Office of National Statistics sample). CONCLUSION: A substantial proportion of births < 2500 g and < 1500 g are statistically "attributable" to social inequality. The results demonstrate that, using either socioeconomic measure, the likelihood of being born weighing > or = 3500 g, the most advantageous group, is substantially greater in the socially advantaged. Using the area-based measure, an estimated 12% of births < 3500 g could be ascribed to social inequalities whereas the same figure using social class was 7%. These findings suggest that this proxy measure of socioeconomic status may be a better discriminator in the study of pregnancy outcomes in this population than classification by occupational social class. Another advantage is its almost universal availability in routine records and its universal population coverage.

Birth Weight↗
PubMed1986

Social class and psychiatric outcome.

Although social status has been shown to relate to rates of certain types of psychiatric disorder and to treatment received, little information is available regarding social class and clinical improvement over time. This report presents findings from a prospective follow-up study of a representative sample of first-admission psychiatric patients. A variety of clinical characteristics were analyzed at hospital admission and 2-year follow-up. The social status of the individual patient, the social status of the patient's parents, and the social status associated with the patient's residential area were found to be correlated with improvement over the 2-year follow-up period.

Adolescent↗
PubMed1998

Atopy in children and parental social class.

OBJECTIVES: This analysis was conducted to determine whether atopic disorders were related to social class in a pediatric population of a former socialist country. METHODS: A cross-sectional study of 2471 schoolchildren was carried out in 1992 and 1993 in 3 towns in the former East Germany. Parents completed a standardized questionnaire regarding health events and lifestyle factors. In addition, skin-prick tests were performed and total serum immunoglobulin (IgE) was determined. RESULTS: Lifetime prevalence rates for atopic disease and rates of allergic sensitization were highest in children from social class III (in which parents had more than 10 years of formal education) and lowest in social class I (less than 10 years of parental education), while rates in social class II (10 years of parental education) were constant at an intermediate level. CONCLUSIONS: The data confirmed the assumption that in formerly socialist countries social inequalities existed under the socialist system, which were reflected by a social gradient in health outcomes. The findings support the hypothesis that increased access to modern lifestyle could be one reason for the increasing rates of atopic disorders during the last 3 decades.

Adolescent↗
PubMed1981

Influence of social class on the risk of recurrence of anencephalus and spina bifida.

This study suggests that social class has an effect on the incidence of anencephalus and spina bifida, the malformations being more frequent in the lower socio-economic groups. A family study of 226 patients with a CNS malformation suggests that social class also may be important in determining the recurrence risk of such malformations: there are higher risks in social classes III, IV and V than in social classes I and II.

Anencephaly↗
PubMed2003

Effect of living conditions in the parental home and youth paths on the social class differences in mortality among women.

AIMS: A longitudinal study was undertaken to assess the effects of parental home and youth paths on the adult social class differences in mortality among women. METHODS: The study used population registration data on all Finnish women aged 30-34 in 1990 for whom information on their childhood characteristics and youth paths were available from the 1970, 1975, 1980, 1985, and 1990 censuses. Cause of death follow-up was for the period 1991-98 (1185 deaths). RESULTS: Adjusting for parental social class, family type, and number of siblings attenuated the effects of adult social class on cardiovascular disease mortality by 27%; for all external causes this attenuation was negligible. Educational, marital, and employment paths accounted for a substantial part (30-85%) of the social class differences in mortality for all specific causes of death. CONCLUSIONS: Although living conditions in the parental home were associated with mediating life trajectories in youth their effect on adult social class differences in mortality was moderate. Youth paths have a pervasive influence on mortality risks and social class differences in mortality in middle adulthood.

Adult↗