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PubMed2006

Social class and type of schizophrenia.

OBJECTIVE: Current and past research strongly indicates a high prevalence of schizophrenia in the lower class in the USA and other stratified societies. To date, no study has tested for a connection between type of schizophrenia and socioeconomic status (SES). We tested for an interrelationship between schizophrenic subtype, SES and race. METHODS: Positive and negative symptom scales were used to evaluate 436 schizophrenic patients at a state hospital in the USA. All patients were also diagnosed by DSM standards. Social class of origin was assessed by the Occupational Classification Distributions of the U.S. Bureau of the Census. Multivariate analysis was conducted with the likelihood ratio chi-square. RESULTS: We uncovered a distinct propensity for deficit schizophrenia to be elevated among the poor. The finding presents as a pure SES effect since the likelihood of deficit schizophrenia does not vary by race when social class is held constant. CONCLUSION: The finding is potentially an important new insight into the epidemiology of schizophrenia. It offers a better understanding for poor outcome among lower class patients in stratified societies such as the United States. It is also consistent with longitudinal research by European investigators.

Humans↗
PubMed2005

Social inequality and alcohol consumption-abuse in Bahia, Brazil-- interactions of gender, ethnicity and social class.

BACKGROUND: This paper reports findings on Alcohol Consumption-Abuse (ACAb) in Bahia, Brazil, a research setting characterized by racial/ethnic and socioeconomic diversity. METHODS: A household survey was conducted with a sample of 2,302 adults. ACAb was defined as daily intake of more than two units of beverage, with drunkenness, or weekly binge drinking plus episodes of drunkenness, or any use of alcoholic beverages with frequent drunkenness, with failed attempts to stop drinking. RESULTS: The rate of 12-month prevalence was 7%, with an overall male: female ratio of 6:1. A positive association of ACAb prevalence with education and social class was found. Male gender and higher socio-economic status were associated with increased odds of ACAb. No relationship was found between ethnicity and ACAb. Stratified analysis yielded consistent gender effects, throughout all strata of independent variables. A strong interaction of gender (male) and social class (upper class) was found for Mulattos and Morenos (maximum Prevalence rate=9.04). CONCLUSION: Interaction patterns found defy simple generalizations based on class, ethnicity, and gender considered alone.

Adult↗
PubMed1992

Misclassification of dementia by the mini-mental state examination--are education and social class the only factors?

The 1988 Melton Mowbray Study of the Elderly comprised an initial screen with the Mini-Mental State Examination (MMSE) followed by a detailed clinical assessment using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) for all those scoring 21 and under on the MMSE, a one in two sample of those scoring 22 or 23 and a one in ten of the remainder. A total of 1579 subjects completed the initial screen with 438 subjects undergoing the CAMDEX assessment. Analysis of those subjects who were found to be free of dementia at the clinical assessment (n = 155) demonstrated that the very elderly, those from the manual social classes and subjects with visual impairments had an increased chance of being misclassified as demented by the MMSE. Low educational level and various measures of physical disability also showed a tendency to result in misclassification as falsely positive by the MMSE when viewed alone but these effects appeared to be due solely to their association with extreme age and/or manual social class.

Activities of Daily Living↗
PubMed1997

Social class and cancer survival in Turin, Italy.

STUDY OBJECTIVE: This study aimed to investigate social differences in cancer survival in residents of Turin, Italy. DESIGN: Incident cases from the Piedmont cancer registry were linked to municipality files and 1981 census data, and followed up from 1985-92. The census provided data on education and housing tenure, which were used as indicators of social class. The case fatality ratio (CFR) was estimated through a proportional hazard model, with socioeconomic indicators as risk factors. MAIN RESULTS: Educated people of both sexes showed better survival for all malignant neoplasms together and, particularly among men, for tumours which show a better prognosis such as cancer of colon-rectum, larynx, prostate, and bladder. The relative risk of dying, compared with people who had only primary school education, decreased from 0.91 for those with middle school education to 0.67 for those who held a university degree. CONCLUSION: There were major differences in cancer survival showing a poorer outcome for those from the lower social stratum, particularly in sites for which effective treatments are available. Since is unlikely that the observed differences could be totally explained by extraneous factors, such as competing mortality, it is concluded that even in a country where the health system offers universal coverage, non-financial barriers act by creating differences in opportunities for better care.

Educational Status↗
PubMed2000

Mobility limitations in the Swedish population from 1968 to 1992: age, gender and social class differences.

Mobility limitations are closely related to disability in old age. The study of mobility limitations in the population may improve the understanding of the development of disability, as well as gender and class patterns in disability in old age. Representative samples of the Swedish population between the ages of 18 and 75 years were interviewed in 1968, 1974, 1981, and 1991. A further sample of people aged 76+ years was interviewed in 1992. The questionnaire included the ability to walk 100 meters, to walk up and down stairs, and to run 100 meters. Mobility limitations begin to appear around age 40 years, and increase with age. In 1992 nearly none in the oldest age group (85+) could run 100 meters, and less than half could walk 100 meters, or go up and down stairs without difficulty. Between 1968 and 1991, the proportion of people with mobility limitations was reduced by one third, with the most prominent reduction among the oldest age groups. Women were more likely to report mobility limitations compared to men at all waves; however, the gender difference decreased between 1968 and 1991. Blue-collar workers had more mobility limitations than white-collar workers, and this discrepancy did not decrease over time. Mobility limitations often begin early in life, and differences between cohorts, men and women, and social classes can be seen well before the age of 50. The results suggest that gender differences in functional limitations among elderly people may decrease in the future, while social class inequalities are likely to persist.

Adolescent↗
PubMed2003

Birthweight, childhood social class, and change in adult blood pressure in the 1946 British birth cohort.

BACKGROUND: The negative effect of birthweight on systolic blood pressure has been suggested to be initiated in utero and amplified with age. We aimed to investigate this hypothesis. METHODS: A sample of 3634 people from a birth cohort study of men and women born in Britain in 1946 were included in analyses. Cohort members have been contacted regularly since birth, and systolic and diastolic blood pressures were measured at ages 36, 43, and 53 years. Multilevel models, with blood pressure as a repeated outcome, were used to test the amplification hypothesis and to compare results for birthweight with those for childhood social class. FINDINGS: Considering both men and women together, a consistent negative association between birthweight and systolic blood pressure was noted from age 36 to 53 years, but no evidence was recorded of substantial amplification with age. A 1 kg higher birthweight was associated with a slower mean increase in systolic blood pressure by -0.4 mm Hg (95% CI -1.3 to 0.4; p=0.3) per 10-year increase in age. Birthweight was not associated with diastolic blood pressure at any age. People from a manual social class in childhood had higher systolic and diastolic blood pressure than did those from a non-manual class. The effect on systolic blood pressure rose with age, by 1.0 mm Hg (95% CI 0.1 to 2.0; p=0.03) per 10 years, but was largely accounted for by current body-mass index, which was an increasingly strong determinant of blood pressure. INTERPRETATION: These findings suggest that weight control throughout life is key to prevention of raised blood pressure during middle age. Understanding the link between the early childhood socioeconomic environment and adult obesity could make this strategy more effective.

Adolescent↗
PubMed1998

Safer sex and social class: findings from a study of men using the 'gay scene' in the West Midlands region of the United Kingdom.

This article reports on associations between socio-demographic factors and safer sexual behaviour among gay and bisexual men in an English region. A cross-sectional survey using an anonymous self-complete questionnaire collected information on sexual behaviour and socio-demographic characteristics. All men using specified 'gay' venues and groups during the data collection period, were offered inclusion. Of the 858 men returning completed questionnaires, a greater proportion (30.3%) were from manual occupations when compared to previous United Kingdom studies. Of the whole sample, 64.6% reported either consistent condom use (safer sexual behaviour) or no anal sex during the last 12 months. No associations were found between age or ethnicity and consistency of condom use. Social class and employment status, however, were associated: those in manual occupations and those not working were more likely to be inconsistent in their condom use and students were more likely to be consistent. Inconsistent condom use was more likely to occur when having anal sex with 'boyfriends', and data on relationship length suggest that this may be occurring inappropriately in relation to risk of HIV infection. These findings suggest that social class and employment status may be related to safer sex practice.

Adolescent↗
PubMed1999

Racial differences in skilled nursing care and home health use: the mediating effects of family structure and social class.

OBJECTIVES: This study investigates whether utilization of skilled nursing facility (SNF) care and Medicare home health differ by race. It then seeks to understand the extent to which family structure and social class explain any differences observed. METHODS: Linking measures from the 1989 National Long-Term Care Survey with Medicare claims data, we model SNF care and home health use as competing risks using a Cox proportional hazards model. Age at first use is the outcome measure, consistent with the analysis of long-term care use as a life-course transition. RESULTS: Blacks postpone both home health and SNF care until later ages than Whites, and both children and grandchildren play a part in deferring their use until even later ages. When formal assistance is needed, Blacks are more apt than Whites to use home health over SNF care. The race difference in SNF use is even greater than that previously reported for all types of nursing home use combined. Social class has little influence on the risk differential. DISCUSSION: Contrary to expectations, Black elders are not counterbalancing their lower rate of SNF use with a higher rate of home health use. This suggests that there are differences in need, preference, or access that are yet to be identified. Future research should consider the relationship between family structure and informal caregiving, variation in physician referral patterns by race, and the availability of long-term care in traditionally African American communities.

Black or African American↗
PubMed2005

Influence of social class on time trends in BMI distribution in 5-year-old French children from 1989 to 1999.

AIMS: To assess the prevalence of obesity and changes in body mass index (BMI) distribution between 1989 and 1999 in 5-y-old children, and to study the influence of parental socioeconomic status on these parameters. METHODS: Two cohorts of children in the final year of nursery school (in the city of Lille, France) were enrolled in 1989 (705 children: mean age=5.6+/-0.4 y) and 1999 (1258 children: mean age=5.6+/-0.5 y). Weight and height were measured, and data about parental occupation were collected during a school medical examination. International Obesity Task Force cutoff points were used to define overweight and obesity. Parental occupation was classified into four categories. RESULTS: The prevalence of obesity increased from 1.8 to 4.9%, and the prevalence of overweight rose from 9.6 to 16.9%. Mean-difference plots allowed qualitative comparisons of the BMI distribution between the surveys: for children from the highest social classes, there was no change in BMI; for children from intermediate classes, there was a up-shift only in the upper part of the distribution with the heaviest children becoming heavier still; finally, for children from the lowest class, there was an increase in BMI across the entire population. CONCLUSIONS: This study of the changes in BMI distribution gives greater insight into the 'obesity epidemic'. Our results show the influence of an interaction between genetic and environmental factors. The increase in BMI in the upper part of the distribution suggests that this is a population with a high degree of susceptibility, whereas the increase in BMI across the whole population in the lowest social class suggests a strong influence of the environment on this group and thus the necessity of appropriate, preventive measures.

Age Distribution↗
PubMed1984

Tonic heart rate level, social class and antisocial behaviour in adolescents.

On the basis of previous empirical research it was hypothesised that (a) antisocial behaviour in adolescence would be characterised by lower tonic heart rate levels and (b) any such relationship would be particularly borne out in the higher social classes where the 'social push' towards antisociality may be relatively weaker. These predictions were tested by relating tonic heart rate levels in a sample of 15 year old male schoolchildren to self-report and teacher ratings of antisocial behaviour/undersocialization. An 'antisocial' group was found to have significantly lower heart rate levels than a 'prosocial' group. Several analyses on high and low class groups resulted in a significant low heart rate/antisociality relationship in the high classes only. It was speculated that the heart rate/antisociality relationship may be mediated by somatotype, or alternatively that low levels in high class antisocials may reflect a vagal passive adaptation to mildly aversive events.

Adolescent↗
PubMed1997

Height and social class in male adolescents from different ethnic backgrounds in Israel.

The relationship between height and social class, independent of the effect of ethnic background was examined. This is a population-based study of 17-year-old israeli-born Jewish males born between 1966-1969 who underwent routine physical examination prior to army recruitment. Inductees descending from 9 ethnic backgrounds-Germany, Hungary, India, Morocco, Poland, Romania, Russia, Yemen and at least 3rd-generation israeli-born were used for this analysis. Anthropometric data was abstracted from the computerized induction examination; socioeconomic status (SES) was assigned according to the residence of each recruit. Statistical analysis included analysis of variance and chi square test for linear trend. Mean height of the total (reference) group was 173.7 cm, ranging from 172.0 cm in the lowest SES level to 175.1 cm in the highest level. The proportion of individuals above the 85th percentile of height of the reference group, increased linearly from 8.7% (lowest SES) to 18.5% (highest SES) (p < 0.01). The mean height of recruits differed considerably among ethnic groups in each SES level and ranged from 170.8 cm (Yemenites) to 175.4 cm (Russian and Romanian) in the total group. In each ethnic group, height differences between extreme levels of SES were observed ranging from 2.3 cm (Morocco) to 4.3 cm (Russia). We conclude that height among 17-year old israeli-born males is positively associated with SES after controlling for ethnicity.

Adolescent↗
PubMed1983

Language and social class: is verbal deprivation a myth?

A study was made of complex usages of language in the spontaneous conversation of 30 4-year-old girls, their mothers and their teachers, at home and at school. There were significant social class differences in frequency, but almost all the usages appeared in the talk of almost all the mothers and children at least once. The working class girls' language style changed more between home and school than did that of the middle class girls. The teachers' talk contained a higher proportion of these usages than the mothers', but the overall input to the children was less at school. The findings are discussed in relation to Labov's argument that verbal deprivation is a myth.

Adult↗
PubMed2001

Francis Galton on twins, heredity and social class.

In 1875 Francis Galton was the first to study twins as a test of the relative strenght of heredity and environment. This paper examines Galton's work on twins, using his surviving working papers. It shows that his enquiry was larger and more systematic than previously realized. Galton issued several hundred questionnaires to parents of twins, with the aim of establishing how far the similarities and differences between twins were affected by their life experiences. The paper also discusses Galton's study in relation to his understanding of the physiology of twinning and his theory of heredity. The modern concept of monozygotic twins had not yet been established, and the similarity between Galton's work and modern twin studies should not be overstated. While Galton's work was important as a pioneering study, in some respects his conclusions went beyond his evidence. The paper finally examines whether Galton's twin studies influenced his position on the links between social class, heredity and social mobility, and surveys the evidence for his views on these issues.

Genetics↗
PubMed1993

Mortality and social class in Maori and nonMaori New Zealand men: changes between 1975-7 and 1985-7.

AIMS: Social class mortality differences in Maori and nonMaori New Zealand men aged 15-64 years have previously been examined for the period 1975-7. The analysis has now been repeated for the period 1985-7 in order to examine changes over time. METHODS: Numerator data were obtained from national death registrations and denominator data were obtained from the 1976 and 1986 censuses. These were used to calculate age-standardized death rates in Maori and nonMaori. RESULTS: Mortality declined by 28% in Maori and 14% in nonMaori between 1975-7 and 1985-7. The death rate for diseases amenable to medical intervention fell by 54% in Maori and 23% in nonMaori, but the Maori death rate was still 2.8 times the nonMaori death rate, whereas the relative risk for nonamenable causes was only 1.4. CONCLUSIONS: Some progress has been achieved in reducing ethnic differences in mortality in New Zealand men, but substantial differences remain for diseases which are amenable to medical intervention (including chronic rheumatic heart disease, hypertensive heart disease, and tuberculosis). It is likely that these differences reflect poor access to culturally safe and appropriate health care in Maori people.

Adolescent↗
PubMed1990

Social class and health in youth: findings from the west of Scotland twenty-07 study.

The assumption that social class inequalities in health are a persistent feature of the life-course has been questioned in a recent issue of this journal. On the evidence of mortality and chronic illness, the pattern in youth in Britain appears to be characterised by the lack of class differentials, a striking contrast to early adulthood where the familiar picture of health inequalities is observed. The possibility that this finding of relative equality in youth is a consequence of the limited, and potentially inappropriate, health indicators used has now been tested on a cohort of 15-year-olds in the West of Scotland. On a range of indicators, from subjective assessments to objective physical measures, very little evidence of class variation in health is found. The possible transience of the youth pattern is, however, indicated by findings from a cohort of 35-year-olds in the same study, among whom marked class gradients in health are apparent. Possible explanations for the transformation of a pattern of relative class equality in youth into one of inequalities in adulthood are discussed.

Adolescent↗
PubMed1981

Sex-role patterns, paternal rearing attitudes and child development in different social classes.

Sex-role patterns, the father's rearing attitude and the child's intellectual and emotional development in different social classes were studied in a randomly selected sample of 58 Swedish unbroken families of a small child. Working class men and women married younger and the women were more often house-wives. Working class men had more often been reared in an "authoritarian" way and more often reared their children in the same way. Upper middle class men had taken a more active part in the care of the child. Working class children scored lower on the intelligence tests, especially the verbal ones and were more often estimated as socially immature.

Adult↗