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PubMed1982

Caries in primary dentition and social class in high and low fluoride areas.

Of the two random samples studied, the first represented 6--8 year-old residents of a natural high fluoride area (n = 115) and resident of all other areas of Finland (n = 1219). The second sample was representative for 7--9-year-old children participating in public dental care in one Finnish country. Structured questionnaires were used to collect data on social class; caries diagnoses were made by local dentists in municipal dental clinics. Children in the highest social class had the lowest caries experience in both high and low fluoride areas. Differences between middle and lower social class children were small. Fluoride affected caries in the primary dentition similarly in all social classes; in both samples this was shown statistically by nonsignificant interaction between social class and fluoride. In Finland, differences between social classes in caries in the primary dentition cannot be removed solely by implementing water fluoridation.

Child↗
PubMed1995

Do physical and chemical working conditions explain the association of social class with ischaemic heart disease?

The aim of this study was to examine whether physical and chemical working conditions explain the association of social class with ischaemic heart disease (IHD). We investigated the issue in a cohort of 2974 males aged 53-75 years (mean 63) free from overt cardiovascular disease. Potential confounders included were: alcohol consumption, physical activity, tobacco smoking, serum cotinine, serum lipids, serum selenium, body mass index, blood pressure, hypertension, social class, and retirement status. During the follow-up period (1985-1986 to 31 December 1991), 184 men (6.2%) had a first IHD event; 44 events were fatal. Compared to higher social classes (classes I, II and III), lower classes (classes IV and V) had a significantly increased risk of IHD (P < 0.05); the age-adjusted relative risk (RR) with 95% confidence limits was 1.44 (1.06-1.95), P = 0.02. Mean who had been occupationally long-term exposed (> or = 5 years) to either soldering fumes or organic solvents had a significantly higher risk of IHD than unexposed: RRs were 2.1 and 1.7, respectively. After adjustment for all the above potential confounders and including also these two occupational factors, the RR of low social classes was reduced to a non-significant 1.24 (0.87-1.76), P = 0.24, i.e. by 45%. Adjusting for non-occupational factors only reduced the RR from 1.44 to 1.38 (1.0-1.90), P = 0.05, i.e. by about 14%. Assuming that the association of soldering fumes and organic solvents with risk of IHD was causal, it was estimated that 16% of IHD cases in low social class could be ascribed to these exposures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Social class assignment and mortality in Sweden.

The earlier practice of assigning all members of a family to the same social class as that of the household head, typically the father, has in recent years been replaced by either basing individual class position on one's own occupation or of one of the family members, not necessarily the father. These various practices have been extensively scrutinised for more than 20 years. The validity of the approaches has chiefly been tested by checking how well they account for the variation in some criteria, mostly class identification, political attitudes and voting behaviour. Here it is shown, using census data from Sweden, that mortality-rate differences between social classes covering the period 1991-1997 are greater for both men and women when both spouses are assigned to the same social class on the basis of the dominance approach, where the labour market position of either spouse may determine the social class of the family. It is suggested that the common observation that class differences are smaller among women than among men may, at least to some extent, be the result of establishing a woman's class position on the basis of her own occupation rather than the labour market position of her spouse.

Adult↗
PubMed1997

Exposure to occupational carcinogens and social class differences in cancer occurrence.

It has been estimated that occupational exposures are responsible for about 4% of all human cancers in industrialized countries. These cancers are concentrated among manual workers and in the lower social classes, thus contributing to the social class gradient in cancer incidence and mortality. On the basis of the 1971 cancer mortality data from England and Wales, it was estimated that occupational cancer is responsible for about a third of the total cancer difference between high (I, II and III-NM) and low (III-M, IV and V) social classes, and for about half of the difference for lung and bladder cancer. However, direct evidence on the extent of the contribution of occupational exposure to carcinogens to social class differences is lacking, and several problems, such as the possible interaction between carcinogens and the effect of extraoccupational confounding factors, add further elements of uncertainty.

Carcinogens↗
PubMed1995

Social class differences in mortality of men: recent evidence from the OPCS Longitudinal Study. Office of Population Censuses and Surveys.

Social class differences in male mortality by age and cause of death are presented using the most recently available data (1976-89) from the OPCS Longitudinal Study. Consistent differences in mortality by social class (as defined by occupation) are found through to the late 1980s. On a scale of increasing mortality disadvantage, mortality of men in Social Class I was the lowest and mortality of men in Social Class V was the highest.

Adolescent↗
PubMed2005

Social class and all-cause mortality in an urban population of North India.

BACKGROUND: There is a rapid emergence of cardiovascular disease in India with economic development, leading to an increase in mortality due to these diseases. The exact causes of death in India, however, are not known. SUBJECTS AND METHODS: We studied randomly selected death records from 2222 (1385 men and 837 women) victims, aged 25-64 years, out of 3034 death records during 1999-2001 at the Municipal Corporation, Moradabad. All the families of these victims could be contacted individually to find out the causes of death, by scientists/doctors-administered pre-tested verbal autopsy questionnaires, completed with the help of spouses and local treating doctors practising in the concerned lane. Social classes were assessed by a questionnaire based on attributes of per capita income, occupation, education, housing and ownership of consumer luxury items in the household. RESULTS: Causes of mortality included infectious diseases (41.1%, n = 915) such as tuberculosis, pneumonia, chronic obstructive pulmonary disease, diarrhea/dysentery, hepatitis B, and inflammatory brain infections as the commonest causes of death in the urban population of North India. The second most common causes of death were circulatory diseases (29.1%, n = 646), including heart attacks (10.0%), strokes (7.8%), valvular heart disease (7.2%, n = 160), sudden cardiac death, and inflammatory cardiac disease (each 2.0%, n = 44). Malignant neoplasm (5.8%, n = 131), injury (14.0%, n = 313), including accidents, fire and falls, and poisonings were also quite common causes of death. Miscellaneous causes of death were noted in 9.1% (n = 202) death records, including diabetes mellitus (2.2%, n = 49), suicides (1.8%, n = 41), congenital anomalies (1.0, n = 37), dental caries infections (1.9, n = 42), and burns (1.3%, n = 33). Pregnancy and perinatal causes (0.72%, n = 15) were not commonly recorded in our study. Circulatory diseases as the cause of mortality were statistically significantly more common among higher social classes (1-3) than in lower social classes (4 and 5) whose members died more often due to infections. Heart attacks, strokes, hypertension, diabetes and obesity were statistically significantly more common among higher social classes (1-3) as compared to classes 3 and 4, but tobacco intake showed only minor differences among various classes. CONCLUSIONS: This study indicates that circulatory diseases, injury and malignant diseases have become the major causes of death in India, after infections. Members of social classes 1-3 died more often due to circulatory diseases and members in lower social classes died more often due to infections. Urbanization with rapid changes in diet and lifestyle in various social classes, and possibly aging of the population seem to be responsible for the double burden of diseases, related to under- and over-nutrition, causing death in a developing economy. Monitoring of blood pressure and heart rate around the clock for 7 days, with data analysed chronobiologically can detect abnormal circadian patterns associated with a large increase in cardiovascular disease risk, greater than hypertension itself, allowing the institution of prophylactic treatment. Such prehabilitation may be particularly useful to curb the increasing burden of cardiovascular diseases in both developed and developing countries.

Adult↗
PubMed1989

Effects of social class, sex, and region of residence on age at death from cystic fibrosis.

To determine the time trend in age at death from cystic fibrosis and the independent effects of social class, sex, and region of residence mortality data for England and Wales from 1959 to 1986 were analysed. Median age at death increased from 6 months in 1959 to 17 years in 1986 and was higher in most years from 1970 in male patients (by one to six years) and in social classes with non-manual occupations (by one to 12 years). Independent odds ratios for death above the median age for the year of death (calculated for years from 1974, when regions of residence were coded by regional health authority area) were 1.47 (95% confidence interval 1.16 to 1.87) in male compared with female patients and 2.75 (2.16 to 3.52) in non-manual compared with manual social classes. The independent odds of death at above the median age also varied significantly among regions of residence by a ratio of up to 2.67. Social class, sex, and region of residence are all potential determinants of survival of patients with cystic fibrosis. Social class is particularly likely to confound the effect of management in specialist centres on survival.

Adolescent↗
PubMed1989

Health care consumption and consumer social class: a different look at the patient.

Both the need and potential for market segmentation in the health care industry have grown substantially. Social class, a consumer behavior construct applied widely in other marketing contexts, may be useful as a basis for health care segmentation. Using a random sample of 997 households in the Pacific Northwest, the author investigates health care attitudes and behaviors across social class groups. Social class is found to be related positively and significantly to several aspects of health care, including personal health, interest, expenditures, satisfaction, and switching behavior.

Attitude to Health↗
PubMed1998

The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States.

Despite the consistent and strong association of social class with health status, the extent to which racial/ethnic disparities in cancer screening reflect social class is rarely addressed. We hypothesized that the use of cancer screening is positively correlated with social class for black, white and Hispanic Americans. Data from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements were compared for each racial/ethnic group by income, education, age, and gender. For each racial/ethnic group, individuals with less education or income are less likely to be screened. Although specific subgroups increased their use of screening modalities between 1987 and 1992, older black Americans who were poor or had less education reported less screening than similar older white Americans. Although social class is a powerful explanatory variable for younger Americans, racial disparities in cancer screening persist among older black Americans.

Black or African American↗
PubMed2002

Social class and risk of Hodgkin's disease in young-adult women in 1988-94.

Hodgkin's disease (HD) risk in young adults has been associated with higher childhood social class. Although recent decades have witnessed increases in both young-adult HD incidence rates and the socioeconomic affluence reported to influence risk, social class risk factors have not been reexamined. For 204 cases and 254 controls aged 19-44 years from a population-based case-control study of HD diagnosed in 1988-94 in San Francisco area females, we evaluated social class predictors of HD overall and for subgroups defined by age and by ethnicity. HD was associated weakly with a few childhood social class markers but more strongly with combinations of these variables. Risk was higher for women with family-owned than rented childhood homes; for US-born women with single vs. shared bedrooms at age 11; and for women with 2+ births who were from smaller than larger childhood households. These patterns differed by age, with risk appearing to increase over the young-adult years for some factors and to decrease for others. In whites, risk was additionally associated with having a single childhood bedroom in larger households, and with tall adult height in women from smaller childhood households. In nonwhites, risk was higher for single bedrooms at age 11 in smaller childhood households, taller height and higher maternal education. Most study findings support the hypothesis that HD development in young adults follows protection from early exposure to other children. Variation in risk by age suggests differing etiologies across young adulthood, or the importance of birth cohort-appropriate social-class measures. Negative findings for previously reported risk factors may reflect their insufficient heterogeneity of exposure or their failure to measure cohort-relevant exposures in this population.

Adolescent↗
PubMed2001

Family social class, maternal body mass index, childhood body mass index, and age at menarche as predictors of adult obesity.

BACKGROUND: Obesity is an increasingly prevalent nutritional disorder throughout the world and is a risk factor for many chronic diseases. The prevalence of obesity increases with age. OBJECTIVE: The objective was to evaluate the associations between BMI at 31 y of age and family social class during early childhood, maternal body mass index (BMI) before pregnancy, BMI at birth and at 1 and 14 y of age, and age at menarche. DESIGN: This was a longitudinal study of the northern Finland birth cohort for 1966. Subjects were measured at birth and at 1, 14, and 31 y of age. The analysis was restricted to individuals for whom BMI data were available for all measurement points (n = 2876 males and 3404 females). RESULTS: The mean BMI at birth was highest in offspring from the highest social classes, but BMI was inversely related to social class at 1 y. BMI, the waist-to-hip ratio, and the proportion of obese subjects were inversely related to social class at 31 y. The heavier the mother, the heavier the offspring from birth to 31 y. The paired analyses between maternal BMI and daughter's BMI at 31 y showed no significant difference in BMI after adjustment for the age difference. BMI at 14 y was the most important predictor of BMI at 31 y. Early menarche in females was associated with a higher BMI at 14 and 31 y. CONCLUSIONS: Differences in BMI by social class are formed at least partly during early childhood. Low social class of the child's family, a high maternal BMI before pregnancy, a high BMI during adolescence, and early menarche are predictors of obesity in adulthood.

Adolescent↗
PubMed1988

Social class and changes in weight-for-height between childhood and early adulthood.

The changes in weight-for-height of those from different social class backgrounds have been examined in the 1958 longitudinal study. Social class differences in the prevalence of overweight and obesity were found to be negligible in childhood but marked by early adulthood, with a greater percentage of overweight and obesity in lower social classes. This different was three-fold among obese men and two-fold among obese women when respondents were classified on the basis of their own occupation. However, a longer term effect of early class backgrounds also emerged. Children from manual backgrounds were more likely to become overweight and obese young adults (7 per cent of those with average weight-for-height at age 7) compared with their non-manual contemporaries (3 per cent). Interestingly, they were also more likely to remain overweight or obese through to early adulthood. Methods preventing weight gain in early life, whilst poorly developed at present, need to ensure that approaches are relevant to young people with lower social class backgrounds.

Adolescent↗
PubMed1985

Acute appendicitis not associated with social class among children.

Acute appendicitis has previously been found to be associated with social class. In an attempt to confirm this, 125 patients with histologically verified acute appendicitis were compared with 1802 control children, randomly selected from the schools of the City of Helsinki. Social class determination was based on father's occupation in families with two parents, and on mother's occupation in single provider families. No association with social class was found. The proportion of single provider families was around 25% among both cases and controls. Appendicitis patients are one potential source of control groups in epidemiological studies.

Acute Disease↗
PubMed2004

Are inequalities in height narrowing? Comparing effects of social class on height in two generations.

OBJECTIVE: To determine whether social inequalities in height change across generations. METHODS: The target population was from the 1958 British birth cohort, all born 3rd-9th March 1958, followed to 1991, and the offspring of one third of this population. Main outcomes were height measured at 7, 11, 16, and 33 years (cohort members) and once at 4-18 years (offspring). Multilevel models applied to associations of social class of origin with (a) child-to-adult growth trajectory (cohort members), (b) height (offspring), and (c) generational height increment. RESULTS: Height inequalities were observed among cohort members, with differences >2.0 cm at all ages between classes I and II, and IV and V. By adulthood, the difference in mean height had declined significantly in boys and slightly in girls. A secular trend was seen between the two generations. While male offspring had a similar mean height to their fathers in classes I and II, boys in classes IV and V gained 2.1 cm (p<0.001). Height gains of female offspring were evident in all classes, with a greater gain in classes IV and V (non-significant). The social class effect on height was weaker among offspring, with a difference between classes I and II, and IV and V of less than 1 cm. CONCLUSIONS: Social inequalities in height observed among the cohort weakened substantially in the next generation due to a greater height gain among offspring from manual classes. Inequalities in childhood height have narrowed between the two generations in this study.

Adolescent↗
PubMed1985

Social class mortality differentials: artefact, selection or life circumstances?

Data from 10 years follow up of mortality in the OPCS Longitudinal Study are used to relate deaths of men in 1976-81 to their social class as recorded by the 1971 census. Explanations of social class mortality differentials are critically reviewed in the light of these new data. The similarity between the class differentials observed for men aged 15-64 years in this study and those reported in the 1970-2 Decennial Supplement on Occupational Mortality indicate that the published gradients were not in fact grossly distorted by numerator denominator biases. Distortions to gradients observed in the early years of the longitudinal study and ascribed to selective health related mobility out of employment from the principal social classes to the permanently sick had largely worn off after five years of follow up. Sharp gradients at ages over 75 years, similar to those at younger ages, suggest that, for men aged over 50 years, selective health related mobility between social classes does not contribute to differentials in mortality.

Adolescent↗
PubMed1997

Socioeconomic inequality and psychopathology: are socioeconomic status and social class interchangeable?

Two different ways of conceptualizing and measuring socioeconomic inequality (SEI) are described and contrasted: the commonly used socioeconomic status (SES) measures and a neo-Marxist measure of social class. It is argued that SES and social class stem from two different theoretical orientations towards socioeconomic inequality and that they focus on different aspects of inequality. These differences have implications for the role of SEI in relation to psychopathology. Using data from a large scale epidemiological survey that was conducted in Israel, it is shown that SES and social class measures are empirically distinct and that they explain different parts of the variance of psychopathology. It is concluded that since social class is theoretically as well as empirically distinct from SES, it has potential for contributing to our understanding of psychopathological phenomenon.

Adult↗
PubMed1999

Bias related to the exclusion of the economically inactive in studies on social class differences in mortality.

BACKGROUND: To assess how the exclusion of the economically inactive affects levels and trends in social class differences in mortality among men and women at different durations of follow-up. METHODS: Records of the 1970, 1975, 1980 and 1985 censuses on Finnish men and women aged 35-64 linked with records of all deaths during 1971-1990. RESULTS: Exclusion of the economically inactive population underestimates the class differences in the total population by about 25% among men and 60% among women. The bias does not disappear if the first 5 years of follow-up are excluded and the bias can lead to erroneous conclusions about the trends in social class differences in mortality. CONCLUSIONS: Analyses based on the economically active population may lead to significant underestimation of social class differences in mortality, introduce biases in international comparison and may only partially capture the causal mechanisms underlying these mortality differences. Our results further show that although the bias diminishes during the follow-up, it is by no means eliminated after the first 5 years. The underestimation of social class differences in mortality created by the exclusion of the inactive should be more widely recognized and more accurate data on previous occupations should be collected.

Adult↗
PubMed1988

Height and social class in middle-aged British men.

A study of 7735 middle-aged British men drawn from general practices in twenty-four towns shows that there has been a progressive increase in mean height in the men who were born between 1919 and 1939. This is true for both manual and non-manual classes, but the mean heights of the two groups are significantly different and remain widely separated over this period of time. Manual workers lag twenty years behind non-manual workers in their attained height. Data from other studies indicate that this social class difference in adult height is still present in those born up to 1960. The variation in mean height between the twenty-four towns is less marked than the variation in mean height between the social classes. After social class and age have been taken into account, a "town effect" on height is still present. If height is accepted as an indicator of socio-economic circumstances in childhood, then there is a difference in adult height between social class groups in Great Britain which does not appear to be diminishing.

Body Height↗