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PubMed1980

Social class and race differences in family interaction: pathological, normative, or confounding methodological factors?

The interaction patterns of 64 well-adjusted family triads, divided into eight equal groups by race, social class, and sex of adolescent, were assessed across observational and self-report measures of family affect, conflict, and dominance. Any social class or race differences similar to those of prior research could not be described as deficits since all families met extensive criteria to assure favorable psychosocial adjustment. However, in contrast to much extant literature, statistical analyses revealed few social class or race effects. In light of the present strict methodological controls, it is suggested that previous findings of race and social class differences might have resulted from uncontrolled sampling, procedural, or measurement factors.

Adolescent↗
PubMed1991

Helicobacter pylori infection rates in relation to age and social class in a population of Welsh men.

The seroprevalence of IgG antibodies to Helicobacter pylori was determined using a standard enzyme linked immunosorbent assay in a population of 749 randomly selected men, aged 30-75 years, from Caerphilly, South Wales. The overall prevalence of H pylori was 56.9%, increasing sharply in middle age from 29.8% in those aged 30-34 to over 59% in those aged 45 or older (p less than 0.0001). Age standardised seroprevalence rates were lowest in combined social class categories I and II (49.2%), intermediate in categories IIIN and M (57.5%), and highest in categories IV and V (62.2%) (p = 0.01). In those aged 30-34 years, the prevalence rate for those in combined social class categories IV and V was 57.9% - double the rate for social class categories IIIM and N (28.3%) and five times the prevalence rate in those in social class categories I and II (11.1%). These differences in the infection patterns of H pylori by social class are consistent with patterns of peptic ulcer disease and gastric cancer.

Adult↗
PubMed1987

Measures of social class based on education for use in health studies in developing countries.

In this paper we consider the appropriateness of education, compared to occupation and income, as a measure of social class for use in health-related studies in developing societies in transition. Three evaluation criteria were used, namely, the feasibility of constructing the measure, its sensitivity in reflecting relevant social class life conditions, and its ability to produce a family-level measure of social class. We used two data sets from community health surveys in areas of Amman city, Jordan, and in Beirut city, Lebanon, to define a family-based average educational score. We then proceeded, using the Beirut data, to test the score's ability to discriminate social class effects on family health, compared to a more standard representation based on the educational level of the head of the family. It was found that the performance of the average educational score was often better than, but not consistently superior to, the educational level of the head of the family.

Developing Countries↗
PubMed1985

Office encounters in general practice in the Hamilton Health District I: social class patterns among employed males, 15-64.

Recent epidemiological research indicates that a strong inverse relationship exists between social class and mortality for almost every cause of death among employed males in the age group 15-64. On such epidemiological evidence higher levels of health service use among lower socio-economic strata might be expected. Data from a survey of office encounters in general practices in the Hamilton health district reveal social class differences in the expected direction--especially for severe conditions--but the differentials recorded are not substantial. It is suggested that this shortfall in predicted class differentials in office encounters is explained by social class variations in patterns of symptom recognition and help-seeking and in access to care. Such differences mean that lower class men receive less medical attention than their experience of ill-health might warrant.

Adolescent↗
PubMed1995

Helicobacter pylori infection: relation with cardiovascular risk factors, ischaemic heart disease, and social class.

OBJECTIVE: To determine whether Helicobacter pylori infection is associated with the development of ischaemic heart disease and whether such infection can explain the social class inequality in ischaemic heart disease. DESIGN: Cardiovascular risk factor levels, prevalence of ischaemic heart disease (Rose questionnaire angina, and/or a history of myocardial infarction), and serum antibodies to H pylori (enzyme linked immunosorbent assay) were assessed in a cross sectional population based survey. SETTING: Belfast and surrounding districts, Northern Ireland. PARTICIPANTS: 1182 men and 1198 women aged 25-64 years randomly selected from the Central Services Agency's general practitioner lists. MAIN OUTCOME MEASURES: The relation of H pylori infection with cardiovascular risk factors and ischaemic heart disease. The association of social class with ischaemic heart disease. RESULTS: Systolic and diastolic blood pressure, plasma viscosity, and total cholesterol were not associated with H pylori infection. A weak negative association existed between H pylori infection and fibrinogen (mean (SE) difference in fibrinogen between infected and uninfected individuals -0.09 (0.04) g/l, P = 0.02) and between infection in women and high density lipoprotein (HDL) cholesterol (mean (SE) difference in HDL cholesterol between infected and uninfected individuals -0.06 (0.02) mmol/l, P = 0.006). A potentially important association was demonstrated between H pylori infection and ischaemic heart disease but this did not reach statistical significance (odds ratio (95% confidence interval (CI) 1.51 (0.93 to 2.45), P = 0.1). Social class was associated with ischaemic heart disease independently of cardiovascular risk factors and H pylori infection (odds ratio, manual v non-manual (95% CI) 1.82 (1.14 to 2.91), P = 0.01). CONCLUSION: H pylori may be independently associated with the development of ischaemic heart disease but if this is so the mechanism by which this effect is exerted is not through increased concentration of plasma fibrinogen. H pylori infection does not explain the social class inequality in ischaemic heart disease which exists independently of known cardiovascular risk factors.

Adult↗
PubMed1975

Social class and frequency of XYY and XXY.

The karyotype and paternal social class were determined for 10,348 consecutively born males. No significant difference in paternal social class was associated with the occurrence of the XYY or the XXY karyotype. This argues against the suggestion that socioeconomic factors significantly affect the frequency of the nondisjunctional events leading to these chromosome abnormalities.

Age Factors↗
PubMed1998

Social class and obesity in 12-year-old children in Brussels: influence of gender and ethnic origin.

UNLABELLED: From their school health files, the body mass index of 2607 children, 1268 boys and 1339 girls, from the Brussels region of Belgium was analysed. The aim was to study the relationship between obesity and social class, gender and nationality. In Belgian girls, the lower their social class, the higher was the prevalence and severity of obesity. There was no such significant relationship in Belgian boys, nor in immigrant children of either sex, although the overall prevalence of obesity was similar in all groups. These results question certain hypotheses proposed to explain the relationship between social class and obesity. CONCLUSION: From early adolescence on, social inequality influences the prevalence of obesity in Belgian girls, but not in Belgian boys nor in immigrant children. Prevention of obesity should take into account the influence of gender, social class and ethnic origin.

Belgium↗
PubMed2001

The widening social class gap of preventive health behaviours in Spain.

As a way of forecasting future evolution of inequalities in disease burden and mortality, trends in preventive health behaviours by social class were examined. Using the Spanish National Health Survey from 1987 to 1997 the evolution of the Health Practices Index (smoking, alcohol consumption, physical exercise, sleep hours and the Quetelet index) is described for the Spanish non-institutionalised adult population. In the last 10 years the disadvantaged population of Spain (social class groups IV and V) has not opted for healthier behavioural choices. On the contrary the Health Practices Index figures have worsened during the study period. Conversely, the more affluent groups (social class groups I, II and III) have exhibited a net gain in the index. Due to this, an increase in the existing gap in health inequalities in Spain in terms of morbidity and mortality can be forecast for the near future. As time trends of a summary indicator of preventive health behaviours by social class have not been described in other countries, a replication of this study in different cultural, social and economic milieus could produce valuable information.

Adult↗
PubMed1988

[Social class and risk factors for coronary heart disease--results of the Regional DHP(German Cardiovascular Prevention) Health Surveys].

Prior to the start of the intervention activities in the five study regions of the German Cardiovascular Prevention Study (GCP), health surveys of representative samples of the population (25 to 69 years) were carried out between 1984 and 1986. In all, 11,527 persons participated in the study. Important socio-structural differences existed between the five study regions. An ecological analysis relating social class characteristics to the prevalence of CHD-risk factors did not show any significant findings. However, a pooling of the data of the five study regions resulted in the demonstration, for both sexes, of a significant association of social class with cigarette smoking and overweight. Hypertension and hypercholesterolemia were not related to social class. The proportion of persons with three or more CHD-risk factors was clearly higher in lower social classes. 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↗
PubMed1997

Prevalence and determinants of hypertension in the Indian social class and heart survey.

To determine the association of socio-economic status (SES) and prevalence of hypertension and its risk factors in a rural population, a cross sectional survey was conducted in two randomly selected villages in the Moradabad district in North India. There were 1935 residents aged over 25 (984 men and 951 women) who were randomly selected and categorised into social classes 1-4 depending upon SES based on occupation, housing conditions, land holding, total per capita income, ownership of consumer durables and education. The prevalence of hypertension diagnosed by JNC V criteria (>140/90 mm Hg) was significantly higher among social class 1 and 2 and showed positive relation with SES in both sexes. Among social class 1 and 2 subjects, there was a higher prevalence of overweight and obesity and sedentary lifestyle. Logistic regression analysis with adjustment of age showed that SES had a positive relation with hypertension (odds ratio: men 1.09, 95% CI 1.05-1.14; women 1.08, 95% CI 1.05-1.13), body mass index (odds ratio: men 1.12, 1.08-1.18; women 1.11, 1.06-1.16) and sedentary lifestyle (odds ratio: men 1.45, 1.32-1.58; women 1.38, 1.26-1.49). Only weak but significant associations were observed with smoking, alcohol and salt intake. The association of hypertension with social class was reduced after adjustment of body mass index, sedentary lifestyle, smoking and salt intake (odds ratio: men 0.96, 0.81-1.14; women 0.73, 0.54-1.04). There was an increase in the prevalence of hypertension and age-specific blood pressure (BP) with increasing age in both sexes. The overall prevalence of hypertension by WHO criteria (>160/95) was 4.6% and by JNC V criteria 20.8%, and the rates were comparable in both sexes. Social class 1 and 2 subjects in rural North India have a higher prevalence of hypertension and its risk factors of overweight and sedentary lifestyle.

Adult↗
PubMed1998

Effect of social class on tumour size at diagnosis and surgical treatment in Danish women with breast cancer.

This study examines the effect of socio-economic inequalities on the tumour size at diagnosis and the choice of surgical treatment in Danish women with breast cancer. The Danish Breast Cancer Cooperative Group (DBCG) registers all women with breast cancer in Denmark and provides clinical register data on tumour size and surgical treatment for 1594 women <75 yr diagnosed with breast cancer between 1991 and 1996. A questionnaire including questions on social class was sent to the women. The tumour size at diagnosis (an indicator of access to treatment) and the surgical procedure (lumpectomy or mastectomy) for patients who were potential candidates for lumpectomy were the main outcome measures examined. Social class was not associated with tumour size at diagnosis. The tumour size was associated with age and the existence of a mammographic screening program in the county. However, treatment was strongly related to social class. Among women considered candidates for lumpectomy 77% underwent lumpectomy in the highest social class, compared to 50% in the lowest social class. Treatment was associated with age, tumour size and hospital status. It was concluded that the study showed no socio-economic inequalities related to access to health services as measured by tumour size, though significant social differences were found regarding treatment.

Breast Neoplasms↗
PubMed1998

The sense of control as a moderator of social class differences in health and well-being.

The authors examined social class differences in 2 aspects of the sense of control (mastery and perceived constraints) in 3 national probability samples of men and women ages 25-75 years (N1 = 1,014; N2 = 1,195; N3 = 3,485). Participants with lower income had lower perceived mastery and higher perceived constraints, as well as poorer health. Results of hierarchical multiple regression analyses showed that for all income groups, higher perceived mastery and lower perceived constraints were related to better health, greater life satisfaction, and lower depressive symptoms. However, control beliefs played a moderating role; participants in the lowest income group with a high sense of control showed levels of health and well-being comparable with the higher income groups. The results provided some evidence that psychosocial variables such as sense of control may be useful in understanding social class differences in health.

Adaptation, Psychological↗
PubMed2002

Relation between racial discrimination, social class, and health among ethnic minority groups.

OBJECTIVES: This study explored associations between racism, social class, and health among ethnic minority people in England and Wales. METHODS: We conducted a series of regression analyses on cross-sectional data from the Fourth National Survey of Ethnic Minorities to explore the relation between different indicators of racism and health and household occupational class. RESULTS: Marked independent associations existed between reported experience of racism and perceptions of Britain as a "racist society," household social class, age, sex, and various mental and physical health indicators. These associations showed reasonable consistency across the different ethnic groups. CONCLUSIONS: The different ways in which racism may manifest itself (as interpersonal violence, institutional discrimination, or socioeconomic disadvantage) all have independent detrimental effects on health, regardless of the health indicator used.

Asia, Western↗
PubMed1983

Mortality, cause of death and social class in the Belfast urban area, 1970.

Intra-urban variations in standardised mortality ratios are investigated for Belfast using data extracted from death certificates. Although the standardised mortality ratios do not exhibit a high degree of spatial order, it is observed that they appear to reflect variations in social class. The relationship between social class and each of the major causes of death is investigated at two scale levels: an ecological (i.e. aggregate) level, and the individual level. It is found that there is a relationship between mortality and social class for almost every major cause of death, but that the nature of this relationship varies between causes of death. It is argued that these variations may provide useful clues as to the causes of these diseases. The findings also suggest that the results of studies conducted at only an ecological level need to be interpreted with extreme caution.

Age Factors↗
PubMed1986

Social class and black-white differences in breast cancer survival.

In the United States, Blacks have poorer survival rates than Whites for breast cancer. The root of this difference--social or genetic--is unclear. Utilizing the Western Washington Cancer Surveillance System and 1980 Census block group data, we examined social class and race as predictors of breast cancer survival in 1,506 women during their first 11 years following diagnosis (251 Blacks, 1,255 Whites). In a Cox regression model, after adjustment for Black-White differences in age, stage, and histology, Black mortality was 1.35 times that of Whites (95%CI = 1.05-1.72). Following additional adjustment for social class, as measured by a variety of block group characteristics, Black mortality was only 1.10 times that of Whites (95%CI = 0.83-1.46). In both Blacks and Whites, poorer social class was a powerful determinant of shortened survival. These results indicate that the observed breast cancer survival differences between Black and White women today in the US today is substantially due to the poorer social class standing of Blacks.

Black People↗
PubMed1996

[Problems and limits in the utilization of the concept of social class in epidemiologic research: a critical review of the literature]

The application of inductive empirical variables in hegemonic alternatives of Epidemiology in order to treat socioeconomic variations in human groups has displayed certain limitations raising the need for new proposals. The use of social class was thus introduced as an analytical category operated according to place in the productive process for the subjects under study. This choice has already shown potentialities in several studies. This paper was intended to identify some limits and problems occurring when using the social class concept in epidemiological research. Besides the need for an adequate theoretical framework, construction of categories consistent with both their theories and the levels of abstraction employed, and the concern for more carefully analyzing the consumer and working modes for each social class (questions that have been discused elsewhere), this paper approaches several issues, as follows: the treatment of social classes as articulated clusters in the research process, the need to adjust the operational scheme to the particularities of each socioeconomic formation, the simplification resulting from the process of reducing the concept of social class to several linked variables, the need for a relatively large sample, the existence of debate over the definition of the position of class groups not participating in production, and subjects with two or more different positions in production.

Journal Article↗
PubMed1999

[Physical aggression and social class].

OBJECTIVE: Considering the increase of violence and the scarcity of informations about the relation between social class and victimization by physical aggression, a study was conducted to investigate this association. METHODS: A hospital-based case-control study. Cases and controls were recruited at a hospital, first-aid clinic, from 1/10/93 to 19/1/95. The study included 191 cases and 222 controls selected from among patients with non-violent clinical-surgical complaints, frequency-matched to cases by sex and age. Using a standardized questionnaire applied by trained interviewers, information obtained included social class, skin color, marital status, smoking habits, alcohol consumption and illicit drug use. RESULTS: Adjusting for sex and age, the risk of victimization by physical aggression was significantly higher for the subproletariat, Odds Ratio (OR) 4.20, 95% Confidence Interval (95% CI) 1.99-8.84; single (OR = 2.10) or informal union (OR = 2.62) as marital status (reference group = married); smokers of more than 10 cigarettes/day (OR = 2.75); alcohol consumption (OR = 2.08 for < or = 240 grams/week and OR = 24.05 for > 240 grams/week); and illicit drug users (OR = 3.07). After adjusting for all factors studied a significant risk remained for the subproletariat (OR = 3.28, 95% CI 1.42-7.59); single as marital status (OR = 2.05, 95% CI 1.09-3.88); and alcohol consumption (OR = 2.01, 95% IC 1.07-3.77 for < or = 240 and OR = 15.93, 95% CI 5.09-49.8 for > 240 grams/week) CONCLUSION: Social class is an important factor in the phenomenon of victimization by physical aggression, with the subproletariat deserving special attention in the strategies of intervention regarding this problem.

Adult↗
PubMed2003

Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk).

OBJECTIVES: To investigate the independent association between individual and area based measures of socioeconomic status and cigarette smoking habit. DESIGN AND SETTING: Cross sectional, population based study. PARTICIPANTS AND METHODS: 12 579 men and 15 132 women aged 39-79 years living in the general community participating in the EPIC-Norfolk Study in 1993-1997. The association between social class, educational status, Townsend residential deprivation level, and cigarette smoking status was examined. MAIN OUTCOME MEASURES: Cigarette smoking status at baseline survey. RESULTS: Social class, educational level, and residential deprivation level independently related to cigarette smoking habit in both men and women. Multivariate age adjusted odds ratios for current smoking in men were 1.62 (95% CI 1.45 to 1.81) for manual compared with non-manual social class, 1.32 (95% CI 1.17 to 1.48) for those with educational level less than O level compared with those with O level qualifications or higher and 1.84 (95% CI 1.62 to 2.08) for high versus low area deprivation level. For women, the odds ratios for current smoking for manual social class were 1.14 (95% CI 1.03 to 1.27); 1.31 (95% CI 1.18 to 1.46) for low educational level and 1.68 (95% CI 1.49 to 1.90) for high residential deprivation respectively. CONCLUSIONS: Residential deprivation level using the Townsend score, individual social class, and educational level all independently predict smoking habit in both men and women. Efforts to reduce cigarette smoking need to tackle not just individual but also area based factors. Understanding the specific factors in deprived areas that influence smoking habit may help inform preventive efforts.

Adult↗