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PubMed1999

Cognitive function in the Caerphilly study: associations with age social class, education and mood.

Baseline cognitive function was established for a study of pre-symptomatic cognitive decline in 1870 men from the general population aged 55-69 years as part of the third examination of the Caerphilly Study. Cognitive assessment included the AH4, a four choice serial reaction time task, a modified CAMCOG, MMSE, NART and various memory tests. Distributions and relationships with age, social class, education and mood at time of testing are presented for a younger population than has previously been available. Multiple linear regression showed cognitive function to be independently associated with all four factors. The age effect was equivalent to one half of a standard deviation (SD) in CRT and AH4 scores. Only the NART score was not associated with age, supporting the use of NART score as an estimate of pre-morbid IQ. The largest age adjusted differences between men with low and normal mood were for the AH4 (3 points, t = 5.6, p < 0.0001) and the CAMCOG (2 points, t = 5.8, p < 0.0001). The smallest age adjusted effect of mood was for the CRT (33 ms, t = 2.14, p = 0.32) and the MMSE (0.4 points, t = 2.97, p = 0.003). Age, mood and education adjusted social class effects were very large ranging between around 0.5 SD for the CRT, and 1.0 SD for the AH4 and NART, respectively. For educational status age, mood and social class adjusted differences were also substantial with tests for trend showing the largest differences for the NART (t = 12, p < 0.0001) and modified CAMCOG (t = 10.6, p < 0.0001) with the smallest differences for the CRT (t = 2.73, p = 0.006).

Affect↗
PubMed1991

Nutrient intakes of different social-class groups: results from the Scottish Heart Health Study (SHHS).

Food frequency questionnaire and socio-demographic data were collected from over 10,000 Scottish men and women aged 40-59 years in a cross-sectional study of coronary heart disease (CHD) risk factors. Dietary intake, including the antioxidant vitamins C and E and beta-carotene, was assessed for different socio-economic groups. Trends in nutrient intakes were found with social-class (occupational) groups I-V. The non-manual-manual distinctions were clear even after standardizing for serum cotinine, and alternative classification by housing tenure and level of education did not confound the social-class effect. Total energy intake was significantly higher in the manual (men 10,363 KJ, women 7507 KJ) than in the non-manual (men 9156 KJ, women 7169 KJ) groups, and all nutrient amounts except for vitamin C, vitamin E, beta-carotene and fibre were significantly higher in the manual than the non-manual groups. Alcohol intake was lower in manual women, but higher in manual men compared with their respective non-manual groups. Sex and social-class differences were maintained after adjusting for total energy. Women in general, and manual women in particular, had the highest percentage energy from total fat (40.2) and saturated fat (18.2), while the percentage energy from polyunsaturated fat was lower in men than women, and lowest in manual men (4.4). The polyunsaturated:saturated fat (P:S) ratios were, for non-manual and manual men 0.32 and 0.31, and for non-manual and manual women 0.31 and 0.28. Fibre and antioxidant vitamin intakes, when expressed as nutrient densities, were lower in men than women, and lowest in manual men. Overall, men and women in manual occupations had a poorer-quality diet than did those in non-manual occupations. The coincident low P:S ratios and low antioxidant vitamin intakes in manual groups may contribute to an increased risk of CHD. Thus, the findings are compatible with the view that poor diet may be a contributory factor to the higher mortality rates for CHD which occur in the lower socio-economic groups.

Adult↗
PubMed1985

The fertility transition in nineteenth-century England and Wales: a social class model?

"The changing relationship between fertility and the standard of living is examined in the long term. The model presented provides a means of focusing on the cross-sectional association between fertility, especially marital fertility, and social class during the nineteenth-century fertility transition in England and Wales. An inverse relationship is revealed by all four of the perspectives adopted, but the problems inherent in defining social classes and the significance of fertility behaviour particular to occupations diminish the value of very broad generalizations."

Birth Rate↗
PubMedDate not supplied

Childhood IQ, social class, deprivation, and their relationships with mortality and morbidity risk in later life: prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies.

OBJECTIVE: To investigate how childhood mental ability (IQ) is related to mortality and morbidity risk, when socioeconomic factors are also considered. METHODS: Participants were from the Midspan studies conducted on adults in the 1970s; 938 Midspan participants were successfully matched with the Scottish Mental Survey 1932 in which children born in 1921 and attending Scottish schools on June 1, 1932, took a cognitive ability test. Mortality, hospital admissions, and cancer incidence in the 25 years after the Midspan screening were investigated in relation to childhood IQ, social class, and deprivation. RESULTS: The risk of dying in 25 years was 17% higher for each standard deviation disadvantage in childhood IQ. Adjustment for social class and deprivation category accounted for some, but not all, of this higher risk, reducing it to 12%. Analysis by IQ quartile showed a substantial increased risk of death for the lowest-scoring quarter only. Structural equation modeling indicated that the effect of childhood IQ on mortality was partly indirectly influenced by social factors. Cause-specific mortality or hospital admission showed that lower IQ was associated with higher risks for all cardiovascular disease and coronary heart disease. Cause-specific mortality or cancer incidence risk was higher with decreasing IQ for lung cancer. CONCLUSIONS: Lower childhood IQ was related to higher mortality risk and some specific causes of death or morbidity. Childhood IQ may be considered as a marker for risk of death or illness in later life in similar and complementary ways to social class or deprivation category.

Adult↗
PubMed1986

Social class and survival on the S.S. Titanic.

Passengers' chances of surviving the sinking of the S.S. Titanic were related to their sex and their social class: females were more likely to survive than males, and the chances of survival declined with social class as measured by the class in which the passenger travelled. The probable reasons for these differences in rates of survival are discussed as are the reasons accepted by the Mersey Committee of Inquiry into the sinking.

England↗
PubMed2001

Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971-95.

STUDY OBJECTIVE: To quantify the contribution of different causes of death and age groups for trends in life expectancy for two major social classes. DESIGN AND SETTING: Prospective study of mortality in Finland among all over 35 year old men and women. Baseline social class (manual/non-manual) was from the 1970, 1975, 1980, 1985 and 1990 census records, and follow up was by computerised record linkage to death certificates for 1971-1995. MAIN RESULTS: From the early 1970s to the early 1990s life expectancy at age 35 increased by about five and four years among Finnish men and women respectively, with largest gains among 55-74 year old men and 65-84 year old women. Life expectancy increase was 5.1 years among non-manual and 3.8 years among manual men; corresponding figures for women were 3.6 and 3.0 years. In the 1980s, when differences in life expectancy increased most rapidly, decline in cardiovascular disease mortality was more rapid in the non-manual than the manual class. Furthermore, increasing mortality for alcohol associated causes, "other diseases", and accidents and violence were most prominent in the manual class. CONCLUSIONS: Explanations of increasing social inequalities in mortality that are based on one underlying factor are difficult to reconcile with the variability in the cause specific trends in social inequalities in mortality. The contribution of older ages to social inequalities in mortality should be more widely recognised.

Adult↗
PubMed1997

Too much like school: social class, age, marital status and attendance/non-attendance at antenatal classes.

OBJECTIVE: To investigate patterns of attendance and non-attendance at National Health Service antenatal classes of first-time mothers in the indigenous white population of a large northern city of the UK. DESIGN: Survey using questionnaires, and selected participants were then given an in-depth interview. SETTING: Five maternity wards in two large northern hospitals in the UK. In-depth interviews took place in the respondents' homes. PARTICIPANTS: Fifty newly delivered women were surveyed of whom 18 took part in the follow-up interviews. FINDINGS: There was a clear hierarchy in attendance and non-attendance based on social class, with middle class women being the most regular attenders, closely followed by older, married, working class women. However, overall social class differences were found to be accounted for by the overwhelming non attendance of young, unmarried, working class women. Older, married, working class women were found to have attendance patterns which were close to their middle class counterparts, and what differences there were seemed to be based on material factors. KEY CONCLUSIONS: The majority of women felt that antenatal classes were too technical and did not address emotional and psychological issues. However, young, single unmarried women perceived the classes most negatively. If midwives are to attract such young women, their fears and their need for peer support will have to be recognised.

Adult↗
PubMed1991

Secular trends in social class and sex differences in adult height.

Trends in social class and sex differences in adult mean height in Great Britain since the turn of the century were investigated using data from parents and offspring in the 1946 and 1958 British birth cohort studies (n = 50,000). There has been an increase of 1.09 cm per decade in the mean height of men but only 0.36 cm per decade in the mean height of women. On average men from non-manual origins were 1.97 cm taller than men from manual origins and the figure for women was 1.61 cm. Trends in class differences in height for those born between the beginning of the century and 1958 have been small; fluctuations have occurred over the period but were unsynchronized for men and women.

Adult↗
PubMed1990

Malignant melanoma in England: risks associated with naevi, freckles, social class, hair colour, and sunburn.

In a case-control study in the Midlands of England, 195 subjects with superficial spreading or nodular melanoma were compared to age- and sex-matched controls chosen from all inpatients or outpatients in hospitals serving the defined source population. Significant increases in melanoma risk, after adjustment for other factors, were seen in association with total naevi on the arms (odds ratio (OR), for 15+ naevi compared to none = 3.8), intense freckling as an adult (OR = 6.2), and as a child (OR = 6.0), and higher social class (OR = 2.4). Positive single factor associations were also seen with light or red hair colour, tendency to sunburn easily, and a history of sunburn at ages 8-12, although these were not significant when adjusted for the other factors. No significant effect was seen with naevi greater than 6 mm, or with raised naevi, when adjusted for total number of naevi. Total arm naevi and density of freckling had independent effects, consistent with a multiplicative effect, the OR in those with 10+ naevi and heavy freckling being 20.8. The risk associated with red hair was independent of naevi, but associated with freckling. The strongest association with sunburn history was seen with a history of sunburn in childhood, with sunburn at later times, having smaller effects, or none. These results shows that freckling and social class as well as naevi are strong and independent risk indicators for melanoma. These associations were generally consistent by type of melanoma, sex, age, and extent of regular exposure of the body site affected, although the social class gradient was observed neither for nodular melanoma nor for melanomas occurring on the most exposed body sites.

Adult↗
PubMedDate not supplied

Social class, health and aging: socioeconomic determinants of self-reported morbidity among the noninstitutionalized elderly in Canada.

Despite the vast amount of literature on the relationship between social class and health, little work has been done on postretirement populations. Using the 1991 General Social Survey, a sample of respondents (N = 1,943) aged 65 to 99 were selected for analysis. Three social class variables, income adequacy, education and occupation, were used along with several lifestyle variables and demographic controls to predict six different measures of health status. The findings supported a "condition-specific" approach to the study of class differences in morbidity. Income adequacy was the most consistent class predictor of these health measures in this sample. As well, 'risky' lifestyle variables were used to test the hypothesis that such factors may mediate the relationship between class and health. This hypothesis was not well supported in these data.

Aged↗
PubMed1991

The influence of education and social class on the diagnosis of dementia in a community population.

We have reported previously that poorly educated elderly people and those of low social class were at much increased risk of scoring below the customary cut-point on the Mini-Mental State Examination, a widely-used, brief cognitive screening test. As part of the same study, subjects who scored 23 or less on the MMSE out of a maximum of 30 points, and a sample of those who scored 24 or 25 points, were assessed by psychiatrists using a structured, diagnostic interview. Assuming that persons who scored 26 points or above were cognitively intact (our data suggest that 2% or less were not), neither educational attainment nor social class had any influence on the likelihood that subjects would be diagnosed as demented. Our data suggest that social and psychological factors contribute substantially to cognitive test scores and serve to emphasize the importance of detailed assessment procedures in epidemiological surveys of dementia.

Aged↗
PubMed1977

Social class, birth order, and newborn experience.

Early home experiences of a group of 32 2-week old infants, equally divided according to social class, birth order, and sex, were studied. Naturalistic observations were taken on 2 consecutive days for a total of 6 hours. Compared with later-borns, firstborns received significantly more caretaker interaction on all variables studied. Compared with lower-SES infants, those from higher-SES homes received significantly more direct verbal interaction although the 2 groups did not differ on total periods of other types of caretaking interaction. The findings are consistent with birth order and social class differences reported in home environments of older infants and children.

Birth Order↗
PubMed1986

Social class and changes in health-related habits in Finland in 1973-1983.

The aim of this project was to study social class differences with respect to various health-related habits and especially to note the changes in these habits after a 10-year follow-up period. From this study conclusions can be drawn as to whether health education efforts and increased interest in personal health has been more widely adopted by the more educated groups than the less educated groups, whose morbidity and mortality rates are higher. The sample consisted of 902 white-collar and blue-collar workers. Smoking was found to be more common among blue-collar workers in both years. Smoking rates had declined in all groups except female blue-collar workers. Occasions of drinking were more frequent among white-collar than blue-collar workers. However, heavier forms of drinking were more common in male blue-collar than white-collar groups, while the opposite was true among women. Dietary habits in white-collar groups were closer to the "official" recommendations than in the respective blue-collar groups in both years. White-collar men were physically more active at the time of the first investigation, and even more so ten years later. Among women, social class differences were in the same direction, but less marked. In conclusion, in the early 1970s the health-related habits examined were, in most instances, less favourable among blue-collar than white-collar workers. No consistent pattern of change in these habits was observed in the 10-year follow-up. At the end of the follow-up, many of the "inequalities" still persisted.

Adult↗
PubMed1976

Social class and association membership: an analysis of age-graded and non-age-graded voluntary participation.

This paper examines the relationship between social class and both age-graded and non-age-graded voluntary association membership in a sample of 320 older people. Special attention is focused on one age-graded association with an examination of recruitment, participation, and attrition over a 6-year period. No significant social class differences were found in the tendency to hold at least one association membership, or in the tendency to be extensively involved in voluntary associations. Higher class individuals, however, were more likely to belong to age graded associations. There were no significant class differences between new members and those who failed to join as the result of an aggressive peer recruitment effort by members of one "senior center." Similarly, for those who joined there were no class differences in participation or attrition over a 6-year period.

Aged↗
PubMed1984

The who and why of pain: analysis by social class.

Physicians with an interest in pain have long suggested that the poor complain more and have a higher prevalence of neuroticism than do higher social groups. This assumption was tested by analysing the pain patterns in 500 consecutive patients attending a pain relief clinic. Results implied that scores for presenting pain, anxiety, and depression were similar to all social groups. After treatment scores for residual pain were significantly lower in all social classes, with greatest reduction in classes III, IV, and V. Almost identical results were obtained in a subgroup of patients with cancer but not in a subgroup with sciatica. That patients from the lower social classes have a higher perception of pain and are more neurotic than other group is a myth, probably resulting from poor communication between clinicians and patients of dissimilar socioeconomic class.

Anxiety↗
PubMed2006

Racial/Ethnic and social class differences in preventive care practices among persons with diabetes.

BACKGROUND: Diabetes is the sixth leading cause of death in the United States. Persons with diabetes are at increased risk for serious complications including CVD, stroke, retinopathy, amputation, and nephropathy. Minorities have the highest incidence and prevalence of diabetes and related complications compared to other racial groups. Preventive care practices such as smoking cessation, eye examinations, feet examinations, and yearly checkups can prevent or delay the incidence and progression of diabetes related complications. The purpose of this study was to examine racial/ethnic differences in diabetes preventive care practices by several socio-demographic characteristics including social class. METHODS: Data from the Behavioral Risk Factor Surveillance Survey for 1998-2001 were used for analyses. The study population consisted of persons who indicated having diabetes on the BRFSS, 35 yrs and older, and Non-Hispanic Black, non-Hispanic White, or Hispanic persons. Logistic regression was used in analyses. RESULTS: Contrary to our hypotheses, Blacks and Hispanics engaged in preventive care more frequently than Whites. Whites were less likely to have seen a doctor in the previous year, less likely to have had a foot exam, more likely to smoke, and less likely to have attempted smoking cessation. Persons of lower social class were at greatest risk for not receiving preventive care regardless of race/ethnicity. Persons with no health care coverage were twice as likely to have not visited the doctor in the previous year and twice as likely to have not had an eye exam, 1.5 times more likely to have not had a foot exam or attempted smoking cessation. CONCLUSION: This study showed that persons of lower social class and persons with no health insurance are at greatest risk for not receiving preventive services.

Adult↗
PubMedDate not supplied

[Proposal of an indicator of "social class" based on the occupation].

Socioeconomic level is a variable related with health. In order to obtain an indicator of this variable which is suitable for epidemiological and public health studies, we propose to assign the "social class" on the basis of occupation. Having as a reference the British Classification of Social Class we have used the National Classification of Occupations (CNO) for social classification. Once elaborated, we have used the classification in two population-based studies. More than 96% of individuals studied could be classified. We evaluate the usefulness of this indicator and its limitations. Also, we have indicate the need of validating the proposed classification in the future.

Epidemiologic Methods↗
PubMed1995

The influence of social class on health status: American and British research on health inequalities.

PURPOSE: To summarize recent and past American and British studies on the relationship of social class and health status. DATA SOURCES: A systematic review of the pertinent British and American literature, including references identified from bibliographies of books and recent articles. STUDY SELECTION: Published English-language studies that report original or summary data describing socioeconomic status and mortality/morbidity are emphasized. DATA SYNTHESIS: Social class, whether measured by occupation, income, or education, has a marked effect on mortality and morbidity. Use of British and American standardized mortality ratios (SMRs) shows that the gap between the advantaged upper socioeconomic classes and the disadvantaged lower classes has become wider from 1930 to 1980. Explanations for this inequality in health status by socioeconomic status point to four factors: artefact, social selection, culture/behavior, and material/structural conditions. A synthesis of existing literature suggests that material deprivation and social deprivation are the most important factors contributing to this association, although data from longitudinal studies implicate social hierarchy. CONCLUSION: The reviewed studies point to growing inequalities in health status between those of lower and those of higher socioeconomic status. Clinicians and teachers in internal medicine should incorporate this knowledge in assessing patients and adopt a perspective that takes account of socioeconomic factors in diagnostic and management decisions.

Female↗