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PubMed2001

Effect of social class at birth on risk and presentation of schizophrenia: case-control study.

OBJECTIVES: To examine if low parental social class increases children's risk of subsequently developing schizophrenia or modifies the presentation. DESIGN: Case-control study with historical controls. SETTING: Geographically defined region in south Dublin. PARTICIPANTS: 352 patients with first presentation of schizophrenia matched with the next registered same sex birth from the same birth registration district. MAIN OUTCOME MEASURES: Social class at birth. Age at presentation to psychiatric services, admission to hospital, and diagnosis of schizophrenia. RESULTS: Risk of schizophrenia was not increased in people from lower social classes. There was a slight excess risk among people in highest social classes (odds ratio 0.59, 95% confidence interval 0.40 to 0.85). However, the mean age at presentation was 24.8 years for patients whose parents were in the highest social class compared with 33.1 years for those in the lowest social class at birth. CONCLUSIONS: Although social class of origin does not seem to be an important risk factor for schizophrenia, it partially determines the age at which patients receive treatment. The relation between low social class at birth and poor outcome may be at least partially mediated through treatment delay.

Adult↗
PubMed2004

Adjusting for case mix and social class in examining variation in home visits between practices.

OBJECTIVES: The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone. METHODS: The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC). RESULTS: The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%). CONCLUSIONS: Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in home visits between practices compared with adjusting for age and sex alone. There is far more variation between patients within practices; however, it is not straightforward to examine the factors influencing this variation. In addition to morbidity and social class, there could also be other unmeasured factors such as varying patient demand for home visits, disability or differences in GP home visiting practice style that could influence the large within-practice variability observed in this study.

Adolescent↗
PubMed2002

[The use of medical services and the utilization rate in screening programs in relation to social class: results of a representative survey in Bavaria].

OBJECTIVES: This article aims to analyse utilisation of medical services and screening programmes in relation to social class. METHODS: 2051 adults in Bavaria were interviewed using computer-assisted telephone interview (CATI) in 1999/2000. Social class was established from the income-adjusted Winkler social category index. Data were standardised by age and sex. If social class differences were found, separate analyses for education and income effects were conducted. RESULTS: Higher education was found to be associated with visits to specialist and vaccinations. The purchase of over-the-counter medication was related to higher education and family income. Frequency of HIV-tests was higher in higher social classes but not related to higher education or better financial situation. Utilisation rates for screening programmes for various types of cancer were similar in all social classes. CONCLUSIONS: The results show that social class differences in health behaviour in Bavaria prevail. Positive health behaviour is often associated with higher education. Compared to earlier findings social class effects on the utilisation of cancer screening appears less pronounced. Preventive measures seem to have reached all social classes to a similar degree.

Adolescent↗
PubMed1992

Diminishing or increasing contrasts? Social class variation in Finnish food consumption patterns, 1979-1990.

The study examines whether social-class-based food consumption patterns changed in Finland during 1979-1990. The data were compiled by the National Public Health Institute in connection with a programme entitled 'Monitoring Health Behaviour among the Finnish Adult Population'. A questionnaire was sent annually to a random sample of Finns (N = 3400-5100, response rate 68-86%). This study was restricted to respondents 25-54 years old. Social class was defined by level of education (low, middle, high). Trends and variations in consumption patterns were studied by cross-tabulations and by fitting logistic regression models. The results show that the proportions of users of butter, high-fat milk and coffee sugar decreased during the study eriod whereas that of regular users of vegetables increased. Since the mid-1980s the shift towards 'healthier' food choices has accelerated among men, yet women are consistently more health-oriented. Social class appears to be a significant determinant of food consumption patterns. Men and women of lower social class follow trends set by upper social classes with a time lag of about ten years. Along with an overall shift towards observance of dietary recommendations, social class differences in Finnish food consumption patterns have diminished, without, however, disappearing altogether.

Adult↗
PubMed1989

Changes in diet and coronary heart disease mortality among social classes in Great Britain.

Coronary heart disease (CHD) mortality has declined in Britain since the early 1970s and followed a reduction in dietary fat intake in the population. We attempted to determine whether there have been changes in dietary fat intakes by social classes and to see whether they correspond to social class changes in CHD mortality, where the greatest reduction has been in the upper social class groups. Dietary fat intake was specially obtained by social class on a household basis from the National Food Survey (NFS) for 1974 and 1981. The decline in saturated fat intake and increase in polyunsaturated fat is shown to have occurred in each social class group, although it was not possible to examine the data separately for men and women. In contrast, the decline in the proportion of current smokers between 1974 and 1980 (from the General Household Survey) was greatest in the higher social classes. Rates of CHD mortality showed the greatest decline among men in social classes I & II over the period 1969/73 to 1979/83. However, despite some problems in the interpretation of the data collected by the NFS, this study shows that recent social class trends in dietary fat intakes are unlikely to account for the differential changes in CHD mortality. Changes in the prevalence of smoking among social classes are more consistent with the change in CHD mortality.

Adult↗
PubMed2001

Class inequalities in women's health: combined impact of childhood and adult social class--a study of 630 US women.

To assess contributions of childhood and adult social class to class gradients in women's health, the authors used gender-neutral household measures of class position in a retrospective cohort study of 630 women enrolled in Examination II of the Kaiser Permanente Women Twins Study (1989-1990, Oakland, CA). The age-adjusted odds of reporting fair or poor health was 2.3 times higher (95% confidence interval (CI)=1.2-4.1), using adult class measures, among women categorized as working class vs non-working class/professional. When stratified by childhood social class, however, the elevated risk of fair/poor health among adult working class compared to non-working class/professional women was evident only among those with a non-working class/professional childhood. Similarly, a working class tendency (based on adult class position) towards elevated levels of low density lipoprotein (LDL) cholesterol (odds ratio (OR)=1.5, 95% CI=0.9-2.7) and post-load glucose (OR=1.8, 95% CI=1.0-3.3) was apparent only among women who were non-working class in childhood. These results indicate that both childhood and adult class position influence class gradients in women's health in the United States.

Adolescent↗
PubMed2001

Links between social class and common mental disorders in Northeast Brazil.

BACKGROUND: Social class is an important aspect of all societies. Social class differences in the prevalence of common mental disorder are likely to vary according to time, culture and stage of economic development. The present study aimed to investigate the intermediaries between social class and common mental disorder in a deprived area of Northeast Brazil. The Self Reporting Questionnaire (SRQ) was used to estimate the prevalence of common mental disorder. METHOD: A cross-sectional survey was conducted of 683 adults, aged 15 years and over, living in a random sample of private households in area II of Olinda, Recife Metropolitan Region, Pernambuco, Brazil. RESULTS: Poor education (odds ratio, OR 2.5, 95% CI 1.2-5.2; <5 years vs > or =11 years education) and low income (OR 2.4, 95% CI 1.0-5.6; < or =1/4 minimum wage vs >1 minimum wage) were independently associated with the prevalence of common mental disorder. Univariate associations with occupation, housing conditions and possession of household appliances could be understood in part by their association with poor education. CONCLUSIONS: Brazil has the second most unequal distribution of income in the world. Disparity in educational attainment could be one of the most important factors perpetuating social inequalities in psychiatric disorder in the country.

Adolescent↗
PubMed1989

Indicators of social class--relationship between prestige of occupation and suburb of residence.

The difficulty of measuring social class is well known. Two indicators of social class, prestige of occupation and prestige of suburb of residence, are considered here. Australian prestige scales which measure these indicators are discussed. Comparisons between the original scales and the recently updated versions indicate that in the Australian community there is general community agreement on the prestige of occupations and of suburbs which has changed little over two decades. However, there is only a weak association between the prestige of the occupation in which a person is employed and the prestige of the suburb in which that person resides. This raises queries concerning the validity of using prestige of suburb as an indicator of social class, and highlights the fact that when conducting research one indicator of social class cannot simply be substituted for another. The implications for investigation of health-related issues are discussed.

Australia↗
PubMed2004

The sources of political orientations in post-industrial society: social class and education revisited.

This paper studies the impact of social class and education on political orientation. We distinguish the 'old' middle class from a new class of social/cultural specialists. However, the difference in their political orientation may especially be related to the level and field of education; the new middle class is more highly educated and often in fields of study that extensively address social competencies, characteristics independently affecting political outcomes. Analyses on Dutch data showed that education is more important in the prediction of 'cultural' liberal issues than social class. Economically-oriented issues are more strongly affected by social class. This means that interests of the new middle class are served by liberal standpoints relating to a strong government and income redistribution policies, but not relating to cultural issues.

Attitude↗
PubMed1990

The effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque, gingivitis and pocketing in adolescents: a longitudinal cohort study.

Reported toothbrushing frequency and the effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque and periodontal disease in a group of 720 adolescents examined at age 11-12 years and again at 15-16 years is presented. At 11-12 years, the mean toothbrushing frequency was 11.5 times per week. By age 15-16 years, it had risen to 13.3 times per week. Children from social class I were less likely to brush once per day or less and more likely to brush twice daily than those from social class V. At both examinations, consistently low negative correlations were seen between reported toothbrushing frequency and the mean scores for buccal and lingual plaque, buccal, mesial and total bleeding. Few significant differences were seen between left- and right-handed toothbrushers at age 11-12 years. These were almost entirely due to differences between the boys. By age 15-16 years, no significant differences existed between the two groups. At both examinations, the boys had higher plaque, bleeding and pocketing scores than did the girls. At 15-16 years of age, all social classes exhibited lower mean total pocketing scores than at age 11-12 years. At 11-12 years of age, the social class differences were mainly contributed by the girls, while at re-examination plaque and bleeding scores for both sexes showed an overall trend to increase from social class I through to social class V. At 11-12 years of age, the boys showed a trend for pocketing to increase from social class I through to social class V. This was absent at 15-16 years of age. The girls showed no such trend at 11-12, but it had emerged by age 15-16. The results again demonstrate the influence of social class and sex rather than toothbrushing frequency and handedness on oral hygiene and gingival health. However, in view of the high number of statistical tests employed, some caution must be exercised in the interpretation of differences significant at the 5 per cent level.

Adolescent↗
PubMed2000

Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994).

BACKGROUND: The objective of this study was to describe the evolution of social class inequalities in Barcelona (Spain) residents in perceived health status, health-related behaviors, and utilization of health services between 1983 and 1994. METHODS: The information was obtained from the Health Interview Surveys conducted in 1983, 1986, 1992, and 1994 in Barcelona. In this study we included noninstitutionalized people ages >14 years. Social class was obtained from the Spanish adaptation of the British Registrar General classification. We studied health status, health-related behaviors, and health services utilization variables. Age-adjusted percentages and the relative index of inequality were obtained. RESULTS: Of the health status variables, having been confined to bed and acute restriction of activity in the 2 weeks prior to the interview showed an increase in inequalities by social class in 1994. The pattern of chronic conditions by social class in men did not change between 1983 and 1994. Women had a higher prevalence of chronic conditions and the inequalities among social classes had increased. In men there were no social class inequalities in smoking in 1983. In 1992 and 1994 smoking was more prevalent in men of social classes IV and V. In women, smoking was more prevalent in social classes I and II in 1983 than in social classes IV and V, something that had changed by 1994. Lack of usual physical activity in men was always more prevalent in social classes I and II, and this difference increased since more people of advantaged classes moved into inactivity. Health services utilization showed no inequalities in the years studied. CONCLUSION: The changing pattern according to social class of smoking and physical activity practice needs to be taken into account by policy-makers and public health workers.

Adolescent↗
PubMed2004

Life-course experiences and mortality by adult social class among young men.

Circumstances over the life-course may contribute to adult social class differences in mortality. However, it is only rarely that the life-course approach has been applied to mortality studies among young adults. The aim of this study is to determine to what extent social class differences in mortality among young Finnish men are explained by living conditions in the parental home and life paths related to transitions in youth. The data for males born in 1956-60 based on the 1990 census records are linked with death records (3184 deaths) by cause of death for 1991-98, and with information on life-course circumstances from the 1970, 1975, 1980, and 1985 censuses. Controlling for living conditions in the parental home-social class, family type, number of siblings, language and region of residence-reduced the high excess mortality of the lower non-manual (RR 1.51, 95% CI: 1.28-1.79), skilled manual (RR 2.94, 2.54-3.40), and unskilled manual class (RR 4.08, 3.51-4.73) by 10% in all-cause mortality. The equivalent reduction for cardiovascular disease was 28% and for alcohol-related causes 16%. The effect of parental home on mortality differences was mainly mediated through its effect on youth paths (pathway model). Educational, marital, and employment paths had a substantial effect-independent of parental home-on social class differences from various causes of death. When all these variables were controlled for adult social class differences in cause specific mortality were reduced by 75-86%. Most of this reduction in mortality differences can be attributed to educational path. However, marital and employment paths had their independent effects, particularly on the excess mortality of unskilled manual workers with disproportionately common exposure to long-term unemployment and living without a partner. In summary, social class differences in total mortality among men in their middle adulthood were only partly determined by parental home but they were mainly attributable to educational, marital, and employment paths in youth.

Adult↗
PubMed1979

The sex differential in ischaemic heart disease: trends by social class 1931 to 1971.

The comparison of trends in ischaemic heart disease (IHD) mortality in different social classes is confounded by historical changes in diagnostic techniques and statistical classification, and possibly by different standards of diagnostic accuracy in the different social classes. The problems can be circumvented by taking advantage of the fact that in middle age (45 to 64) the IHD death rate is much higher in men than in women. This large sex differential is not present in any of the other causes of death with which IHD might easily be confused and it is therefore relatively unaffected by diagnostic errors and variation in classification. The changes that have occurred in the sex differential in Social Classes I and V in England and Wales between 1931 and 1971 confirm anecdotal clinical reports that the male vulnerability to IHD appeared first in Social Class I (professionsl). By 1971 Social Class V (unskilled) had caught up, and the men in these two social classes now experience an almost identical excess in cardiovascular death rate compared with their wives.

Coronary Disease↗
PubMed1983

Mortality and social class in New Zealand II: male mortality by major disease groupings.

Social class differences in male mortality in New Zealand were investigated for each major disease grouping. The patterns found were similar to those for England and Wales with the lower social classes having mortality rates significantly higher than those of the upper social classes for each major cause of death. The strongest social class mortality gradients were found for deaths from accidents, poisonings and violence; diseases of the respiratory system; endocrine, nutritional and metabolic diseases; diseases of the genito-urinary system; and diseases of the digestive system. The gradients for coronary heart disease and neoplasms were weaker, but in the same direction as those found for other disease groupings.

Accidents↗
PubMed1986

A preliminary note on fertility differentials by social class in Suriname.

This paper examines the fertility differentials by social class in Suriname in the 1960s and 1970s, and analyses the sudden stagnation in the decline in fertility that occurred between 1962 and 1974. Substantial differences in fertility by social class existed in the 1960s and 1970s in Suriname, with the number of liveborn children to mothers at each age during the childbearing period being higher for lower class than for middle class mothers. Both social classes contributed to the drop in overall fertility which occurred between 1962-74 although the middle class displayed the largest reduction in fertility. The stabilization of the fertility trend since 1974 is limited to the middle class which seems to have realized its ideal family size.

Age Factors↗
PubMed1998

Social class and coronary artery disease in a urban population of North India in the Indian Lifestyle and Heart Study.

OBJECTIVE: To determine the association of social class with prevalence of coronary risk factors and coronary artery disease (CAD). DESIGN AND SETTING: Total community cross sectional survey of 20 randomly selected streets in the city of Moradabad. SUBJECTS AND METHODS: 1806 urban (904 men and 902 women) randomly selected subjects aged 25-64 years. The survey methods were physician and dietitian administered questionnaire, physical examination and electrocardiography. All subjects were divided into social classes 1-5 based on attributes of education, occupation, per capita income, housing condition and consumer durables and other family assets. RESULTS: Social classes 1, 2 and 3 were mainly high and middle socioeconomic groups and 3 and 4 low income groups. The prevalence of CAD and coronary risk factors hypercholesterolemia, hypertension, diabetes mellitus and sedentary lifestyle were significantly higher among social classes 1, 2 and 3 in both sexes compared to lower social classes. Mean serum cholesterol, triglycerides, low density lipoprotein cholesterol and blood pressure were significantly associated with higher and middle social classes. Smoking was significantly associated with lower social classes. Multivariate logistic regression analysis after adjustment of age revealed that social class was positively associated with CAD (odds ratio: men 0.84, women 0.86), hypercholesterolemia (men 0.87, women 0.85), hypertension (men 0.91, women 0.89), diabetes mellitus (men 0.71, women 0.68) and sedentary lifestyle (men 0.68, women 0.66). Smoking was significantly associated with CAD in men. CONCLUSION: Social class 1, 2 and 3 in an urban population of India have a higher prevalence of CAD and coronary risk factors hypercholesterolemia, hypertension, diabetes mellitus and sedentary lifestyle in both sexes.

Adult↗
PubMed2006

Suicide risk in relation to social class: a national register-based study of adult suicides in Korea, 1999-2001.

BACKGROUND: Few controlled studies have examined social class as a risk factor for suicide in Korea. AIM: The objective of the present study was to investigate the effects of social class on suicide risk in Korea. METHODS: A case-control design was constructed from cause-of-death statistics for the period 1999 to 2001, in Korea, as published by the Korean National Statistical Office. The cases were defined as people aged between 20 and 64 who died by suicide, while the controls were defined as those who died of natural causes in the same age groups. RESULTS AND CONCLUSIONS: The proportions and odds ratios for suicide were higher in young people than in elderly people, and higher for divorced subjects than for cohabitants. They were also higher for residents of rural areas, as opposed to residents of Seoul and other metropolitan areas, and for people in social classes III and IV, than they were for those in social class I. To control the variables that influence risk of suicide, such as age, marital status and area of residence, we used multiple logistic regression. Compared with class I, risk of suicide was higher in social classes III and IV, in both sexes. The principal conclusion of this study is that, regardless of sex, lower social class constitutes a high risk for suicide in Korea, even after controlling for variables such as age, marital status and area of residence. We conclude that a well-controlled and balanced social welfare system could reduce suicide risk, especially among people in lower social class.

Adolescent↗
PubMed1982

Social class risk factors among children with Hodgkin's disease.

We compared the social class characteristics of 66 families with children diagnosed with Hodgkin's disease (HD) from 1959 through 1977 in a defined population with that of 182 "control families" identified by a random process from the population base. The 14 youngest cases (less than 10 years at diagnosis) were from somewhat lower social-class backgrounds than their 37 controls as evidenced by the distribution of median income, single-unit housing, and poverty level of their census tract of residence, as well as by the occupational class of head-of-household. In contrast, the social class characteristics of the 52 older children with HD (10-14 years) were quite similar to that of their 145 controls. This apparent shift from lower to average social class between younger and older children with HD Hodgkin's disease may reflect a shift in their age of exposure to common infections. If true, these findings are consistent with the hypothesis that HD may develop as a rare consequence of a common infection. However, these findings are based on small numbers of cases and on indirect measures of social class.

Adolescent↗