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At least 19 recordsLinked to original sources
PubMed1977

Health status, socioeconomic status and utilization of outpatient services for members of a prepaid group practice.

When evaluating the effectiveness of medical care programs, one concern is whether receipt of care is based upon health care needs or upon socioeconomic status. This study describes the relation between health status and socioeconomic status and attempts to determine which has the greater effect on ambulatory care utilization. The study setting was an operating HMO serving a cross-sectional membership of nearly 200,000 persons. Outpatient utilization data were derived from the medical records of a five per cent sample of health plan members for 1969 and 1970. Social, economic, situational, and attitudinal data were provided by 2,603 respondents in a household interview survey. Since a population's perceived health status may reflect health need, information from the survey provided measures of health status that ranged from specific symptoms and complaints to a general measure of perceived health status. Although the findings varied somewhat according to which variables were considered, they generally showed health status to correlate more highly than socioeconomic factors with the utilization of services in this medical care system. An exception was the use of preventive services, which was not significantly related to health status measures but rather, for women, to education and, to a lesser extent, income.

Absenteeism↗
PubMed1996

Migration status, socioeconomic status, and mortality rates in Mexican Americans and non-Hispanic whites: the San Antonio Heart Study.

It has been claimed that Mexican Americans have a favorable mortality experience despite their low socioeconomic status (SES). The present study compared all-cause mortality of non-Hispanic whites with that of United States-born and foreign-born (i.e., born in Mexico) Mexican Americans. Subjects were 3735 residents of San Antonio, TX, who were followed-up for 7-8 years. The sex-age adjusted death rates per 1000 person-years were higher for United States-born Mexican Americans (5.7) than for non-Hispanic whites (3.8) or for foreign-born Mexican Americans (3.6). Foreign-born Mexican Americans had the lowest socioeconomic status (SES), and non-Hispanic whites had the highest SES. After adjustment for SES, the mortality ratio for United States-born Mexican Americans compared with foreign-born Mexican Americans was 1.9 (95% confidence interval, 1.0-3.5), while the ratio for United States-born Mexican Americans compared with non-Hispanic whites was 1.0 (95% confidence interval, 0.7-1.6). Stratified analysis revealed that those in the lowest SES tertiles had threefold greater risk of death than those in the highest tertiles among both United States-born Mexican Americans and non-Hispanic whites (test for trend, P < 0.001). These data suggest that lower SES is strongly associated with increased mortality. After adjustment for SES, mortality rates were similar for United States-born Mexican Americans and non-Hispanic whites. Foreign-born Mexican Americans had the lowest mortality rates of the three groups.

Adult↗
PubMedDate not supplied

Relationships of religion, health status, and socioeconomic status to the quality of life of individuals who are HIV positive.

The present study tested three hypotheses about the quality of life of individuals who are HIV positive. It was hypothesized that quality of life among HIV-positive individuals would be directly related to their (1) health status, (2) religious affiliation, and (3) religious faith. A correlational design was used with a nonrandom sample of 40 subjects (32 males and 8 females) who were HIV positive. Bivariate analyses were conducted to obtain intercorrelational among several independent variables, including two measures of religion (religious affiliation and a composite measure of religious faith), number of symptoms, level of physical functioning, and various demographic measures, including socioeconomic status. Stepwise regression confirmed all three hypotheses, revealing that four independent variables made significant, positive contributions to subjects' scores on the Quality of Life Index (QLI). These were socioeconomic status, religious affiliation (affiliation vs. no affiliation), religious faith, and a combined measure of health status based upon the participants' number of symptoms and Karnofsky Performance Status. The other independent variables (age, ethnicity, and gender) did not make significant contributions to the regression model, accounting for only 2.3% of the variance in the QLI.

Adaptation, Psychological↗
PubMed2005

Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration.

In developed countries, persons of low socioeconomic status (SES) are generally less likely to consume diets consistent with dietary guidelines. Little is known about the mechanisms that underlie SES differences in eating behaviours. Since women are often responsible for dietary choices within households, this qualitative study investigated factors that may contribute to socioeconomic inequalities in dietary behaviour among women. Semi-structured interviews were conducted with 19 high-, 19 mid- and 18 low- SES women, recruited from Melbourne, Australia, using an area-level indicator of SES. An ecological framework, in which individual, social and environmental level influences on diet were considered, was used to guide the development of interview questions and interpretation of the data. Thematic analysis was undertaken to identify the main themes emerging from the data. Several key influences varied by SES. These included food-related values such as health consciousness, and a lack of time due to family commitments (more salient among higher SES women), as well as perceived high cost of healthy eating and lack of time due to work commitments (more important for low SES women). Reported availability of and access to good quality healthy foods did not differ strikingly across SES groups. Public health strategies aimed at reducing SES inequalities in diet might focus on promoting healthy diets that are low cost, as well as promoting time-efficient food preparation strategies for all women.

Adult↗
PubMed2003

Educational level, socioeconomic status and aphasia research: a comment on Connor et al. (2001)--effect of socioeconomic status on aphasia severity and recovery.

Is there a relation between socioeconomic factors and aphasia severity and recovery? describe correlations between the educational level and socioeconomic status of aphasic subjects with aphasia severity and subsequent recovery. As stated in the introduction by, studies of the influence of educational level and literacy (or illiteracy) on aphasia severity have yielded conflicting results, while no significant link between socioeconomic status and aphasia severity and recovery has been established. In this brief note, we will comment on their findings and conclusions, beginning first with a brief review of literacy and aphasia research, and complexities encountered in these fields of investigation. This serves as a general background to our specific comments on, which will be focusing on methodological issues and the importance of taking normative values in consideration when subjects with different socio-cultural or socio-economic backgrounds are assessed.

Aphasia↗
PubMed2006

Socioeconomic status and health in childhood: a comment on Chen, Martin and Matthews, "Socioeconomic status and health: do gradients differ within childhood and adolescence?" (62:9, 2006, 2161-2170).

Understanding whether the gradient in children's health becomes steeper with age is an important first step in uncovering the mechanisms that connect economic and health status, and in recommending sensible interventions to protect children's health. To that end, this paper examines why two sets of authors, Chen et al. [Socioeconomic status and health: Do gradients differ within childhood and adolescence? Social Science & Medicine, 62, 2161-2170.] and Case et al. [Economic status and health in childhood: The origins of the gradient. American Economic Review, 92, 1308-1334.], using data from the same source, reach markedly different conclusions about income-health gradients in childhood. We find that differences can be explained primarily by the inclusion (exclusion) of a small number of young adults who live independently.

Adolescent↗
PubMedDate not supplied

Impact of race on breast cancer in lower socioeconomic status women.

Lower socioeconomic status and lack of access to care are often implicated as plausible causes for African American women to present with later stage breast cancer than Caucasian women. Our objective is to determine if racial differences are present in newly diagnosed breast cancer in women of equivalent socioeconomic status. A retrospective review of prospectively gathered data from women with newly diagnosed breast cancer was performed. All women presented to the indigent (uninsured and below the poverty line) breast clinic for evaluation and treatment of their breast pathology. Data pertaining to epidemiologic factors, diagnosis, pathology, and treatment were collected. The data were analyzed by chi-squared and tailed t-tests. Between March 2002 and May 2004, 52 women (African American=36, Caucasian=16) were diagnosed with breast cancer at our clinic. The median age for both groups at presentation was 56.6 years. The staging assessment based on the pathologic size of the tumor was also equivalent between African American and Caucasian women at 2.29 cm and 2.21 cm, respectively. Metastatic lymph node involvement occurred in 14 women (African American=7, Caucasian=7), with 19.4% African American and 43.8% Caucasian being node positive (p=0.068). In fact, there were no statistically significant differences between the races for menarche, menopause, body mass index (BMI), duration of symptoms before presentation, type of diagnostic biopsy or surgery chosen, histology, receptor status, utilization of chemotherapy and radiation, and length of follow-up. The only statistical differences found were in the age of the first live birth (African American=19, Caucasian=22; p=0.028), the use of ultrasound in initial evaluation of a breast mass (less use in African American; p=0.012), and utilization of sentinel lymph node biopsy (Caucasian=75%, African American=42%; p=0.026). Breast cancer in African American women traditionally presents at a more advanced stage and with poor prognostic features. However, when matched for lower socioeconomic status, racial disparities essentially disappear.

Black People↗
PubMed2002

Inflammatory cytokines, socioeconomic status, and acute stress responsivity.

Socioeconomic status is a major determinant of coronary heart disease (CHD). Proinflammatory cytokines are implicated in the etiology of CHD, and are also sensitive to emotional stress. We hypothesised that concentration of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 receptor antagonist (IL-1Ra) would be inversely related to socioeconomic status, and that cytokine responses to stress would be associated with SES. One hundred and twenty-five middle-aged men and 105 women from the Whitehall II epidemiological cohort were tested, and socioeconomic status was indexed by grade of employment, with participants divided into high, intermediate, and low status groups. Plasma concentrations at rest of TNF-alpha, IL-1Ra, and IL-6 (women only) were associated with socioeconomic status, with lower levels in the high status group, but the effect was non-linear. There was no relationship between socioeconomic status and cytokine responses to stress, but sex differences were observed, with men showing greater TNF-alpha, and women greater IL-6 and IL-1Ra increases. The role of inflammatory cytokines in mediating psychosocial influences on CHD is discussed.

Acute Disease↗
PubMed2005

Low socioeconomic status of the opposite sex is a risk factor for middle aged mortality.

OBJECTIVES: To examine the relations between subjective social status, and objective socioeconomic status (as measured by income and education) in relation to male/female middle aged mortality rates across 150 sub-regions in Hungary. DESIGN: Cross sectional, ecological analyses. SETTING: 150 sub-regions of Hungary. PARTICIPANTS AND METHODS: 12,643 people were interviewed in the Hungaro-study 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were subjective social status, personal income, and education. MAIN OUTCOME MEASURE: For ecological analyses, sex specific mortality rates were calculated for the middle aged population (45-64 years) in the 150 sub-regions of Hungary. RESULTS: In ecological analyses, education and subjective social status of women were more significantly associated with middle aged male mortality, than were male education, male subjective social status, and income. Among the socioeconomic factors female education was the most important protective factor of male mid-aged mortality. Subjective social status of the opposite sex was significantly associated with mid-aged mortality, more among men than among women. CONCLUSION: Pronounced sex interactions were found in the relations of education, subjective social status, and middle aged mortality rates. Men seem to be more vulnerable to the socioeconomic status of women than women to the effects of socioeconomic status of men. Subjective social status of women was an important predictor of mortality among middle aged men as was female education. The results suggest that improved socioeconomic status of women is protective for male health as well as for female health.

Cross-Sectional Studies↗
PubMed2004

Smoking from adolescence to adulthood: the effects of parental and own socioeconomic status.

BACKGROUND: The aim of the study was to examine the effects of parental socioeconomic status, own socioeconomic status and social mobility upon the development of smoking from adolescence to adulthood. METHODS: Subjects were the participants of the North Karelia Youth Project study from six schools in Eastern Finland. At the baseline in 1978 they were 13 year-olds (n=903) and in the last of the six surveys in 1993 they were 28-year-olds. The parents were studied in 1978 and 1980. The association between smoking and socioeconomic status was measured by education, occupation and income in adolescence and adulthood, and social mobility was measured by the difference between parental and own education. RESULTS: In general, parental socioeconomic status was not significantly associated with the subjects' smoking in adolescence or adulthood. Own socioeconomic status measured at the age of 21 and 28 was strongly related to smoking. Those who were most educated in adulthood had smoked the least already from the age of 13. Social mobility was not significantly associated with smoking. CONCLUSION: The study stresses the importance of own socioeconomic status in relation to smoking, but parental socioeconomic status or social mobility does not have direct effects on smoking. Socioeconomic differences in smoking should be understood as an important determinant for health inequalities.

Adolescent↗
PubMedDate not supplied

Prostate-specific antigen levels in African-Americans correlate with insurance status as an indicator of socioeconomic status.

PURPOSE: African-Americans have a higher age-adjusted incidence and a higher disease-specific mortality than whites. Two potential causes are differences in biology or socioeconomic status, the latter leading to differences in access, delivery, or utilization of health care. In this study, we compare serum prostate-specific antigen (PSA) levels for comparable stage and grade-disease, as well as individual insurance status. PSA is a demonstrated indicator of the size and virulence of tumor and is correlated with prognosis. Insurance status has been linked with income and education and is an indicator of access to medical care. PATIENTS AND METHODS: All patients were referred to the University of Chicago Center for Radiation Therapy (UCCRT) with stages A-C (T1-4) prostate cancer. They were seen in four different facilities, designated A through D, and were evaluated and staged by the faculty of UCCRT using the same criteria. Hospitals A and B are large teaching hospitals located within the city of Chicago; C and D are suburban and urban community hospitals, respectively. A total of 341 patients seen between May 1987 to November 1992 are included in this study. RESULTS: In univariate analysis, PSA levels were significantly associated with stage, grade, and race. Higher mean PSA levels were seen with increasing clinical stage and grade. African-Americans had higher mean values than whites. Private insurance and managed care patients had lower values than Medicare-only patients. Within each race, the above results were reproduced, except for insurance status, which was significant only in African-Americans. In multivariate analysis, stage, grade, and insurance status were significant in African-Americans, whereas only stage and grade were significant in whites. Within comparable insurance status, stage, and grade, no racial differences were found, except among Medicare-only patients, with African-Americans who had stage B or grade 2 disease having higher mean PSA levels than whites. Racial differences were seen at hospital B, but not at hospital A. No racial comparisons could be made at hospitals C or D due to an insufficient number of African-American patients. At hospital A, whites and African-Americans had comparable private plus HMO insurance distributions (81.1% and 86.9%, respectively); at hospital B, the distribution was quite different--only 4.4% of whites had Medicare-only insurance while 31.8% African-Americans had no supplementary insurance. For all patients in the multivariate analysis, racial difference was seen only among Medicare-only patients. CONCLUSIONS: Our results suggest that socioeconomic differences are responsible for the racial differences noted in prostate cancer. Our findings of higher PSA levels in African-American Medicare-only patients may result from the many African-Americans disproportionately uninsured throughout their lives compared with whites and thus using services at later stages of disease. A second possible explanation is cultural or ethnic differences in care-seeking behavior, with poorer African-Americans less likely to pursue care for disease until it has progressed. Our findings can explain the dichotomy of poorer overall outcome among African-Americans with prostate cancer, but comparable stage-adjusted outcome with comparable treatments between African-Americans and whites.

Aged↗
PubMed2000

Child's stress hormone levels correlate with mother's socioeconomic status and depressive state.

BACKGROUND: Individuals with lower socioeconomic status report greater exposure to stressful life events and a greater impact of these events on their lives than individuals with higher socioeconomic status, and this relationship between socioeconomic status and health begins at the earliest stages of life. To extend on these results, we performed a psychoneuroendocrine study of 217 children and 139 mothers. METHODS: Salivary cortisol levels and cognitive function were assessed in children, and a semistructured phone interview measuring symptoms of stress and depression was conducted with their mothers. RESULTS: Children with low socioeconomic status present significantly higher salivary cortisol levels than children with high socioeconomic status, and this socioeconomic status effect emerges as early as age 6. We also report that a child's cortisol level is significantly correlated with his or her mother's extent of depressive symptomatology. CONCLUSIONS: These results offer a neurobiological determinant to the well-known association between socioeconomic status and health that begins early in life.

Age Factors↗
PubMed1991

Physical activity behaviors in lower and higher socioeconomic status populations.

Few data on physical activity habits among populations of low socioeconomic status have been published. The authors studied physical activity habits--leisure-time physical activity, job-related physical activity, household physical activity, and walking--among 172 lower socioeconomic status women and 84 lower socioeconomic status men and compared their habits with those of 208 higher socioeconomic status women and 95 higher socioeconomic status men. All subjects resided in the greater Pittsburgh, Pennsylvania, area. Data collection occurred throughout 1986. Lower socioeconomic status women, the least active group, averaged 1,536 +/- 1,701 minutes/week (+/- standard deviation) of total physical activity, whereas higher socioeconomic status women, the most active group, averaged 2,079 +/- 1,807 minutes/week (p less than 0.0001). Higher socioeconomic status men averaged 1,952 +/- 1,799 minutes/week, and lower socioeconomic status men averaged 1,948 +/- 1,916 minutes/week. Higher socioeconomic status women spent significantly more time each week in leisure-time physical activity, job-related physical activity, and household physical activity than did lower socioeconomic status women. Lower socioeconomic status men spent significantly more time each week walking and doing household chores, whereas higher socioeconomic status men tended to be more active in leisure-time physical activity. These data suggest important quantitative and qualitative differences in physical activity among population subgroups. In view of the important role of physical activity in promoting physical and mental health, reasons for the differences among groups of varying socioeconomic status must be examined and elucidated.

Adult↗
PubMed1994

Age, socioeconomic status, and mortality at the aggregate level.

STUDY OBJECTIVE: Indicators of socioeconomic status are associated with age. This study aimed to analyse the influence of the age distribution on the ranking of small areas by socioeconomic status and on the association between their socioeconomic status and standardised mortality. DESIGN: The ranking of small areas by socioeconomic status indicators (educational level, income, and unemployment) was compared with crude values and after correction for their age structure. The age and gender standardised mortality ratios (SMRs) of these areas for the age group 1-64 years was then rank correlated with both crude and age standardised measures of socioeconomic status. SETTING: This study used data for all (n = 22) boroughs of Amsterdam for the period 1986-91. MAIN RESULTS: Correction of indicators of socioeconomic status for the age structure of the population hardly affects the ranking of Amsterdam boroughs by socioeconomic status. All rank correlations between crude and age standardised socioeconomic status measures are above 0.95. Rank correlations between SMR and these socioeconomic status measures also hardly change after correction for the age structure of boroughs except for education. Mean income per earner is the socioeconomic status indicator most strongly associated with the SMR. CONCLUSIONS: This study shows that the age structure of Amsterdam boroughs has almost no influence on their ranking by socioeconomic status and a limited influence on the association between their socioeconomic status and SMR, except for educational level. The latter indicator has the strongest association with age. This result and theoretical considerations indicate that a correction for the age structure of the population will be more important if small areas differ little with regard to socioeconomic status, if they vary considerably in age structure, or if a given indicator of socioeconomic status shows a strong cohort effect or age association.

Adolescent↗
PubMed2006

Heritability for adolescent antisocial behavior differs with socioeconomic status: gene-environment interaction.

BACKGROUND: Socioeconomic status is often assumed to be of importance for the development of antisocial behavior, yet it explains only a fraction of the variance. One explanation for this paradox could be that socioeconomic status moderates the influence of genetic and environmental effects on antisocial behavior. METHOD: TCHAD is a Swedish longitudinal population-based twin study that contains 1,480 twin pairs born 1985-1986. The present study included 1,133 twin pairs, aged 16-17 years. Antisocial behavior was measured through self-report. Family socioeconomic status was assessed by parental-reported education and occupational status. Neighborhood socioeconomic conditions were assessed using five aggregated level variables: ethnic diversity, basic educational level, unemployment level, buying power, and crime-rate. We used structural equation modeling to test whether socioeconomic status interacted with latent genetic and environmental effects for antisocial behavior. RESULTS: Genetic influences on antisocial behavior were more important in adolescents in socioeconomically more advantaged environments, whereas the shared environment was higher in adolescents in socioeconomically less advantaged environments. Heritability for antisocial behavior was higher in girls than in boys, irrespective of socioeconomic background. CONCLUSIONS: Our results suggest that different intervention policies should be considered in different socioeconomic areas. In socioeconomically advantaged areas, it might be more fruitful to focus on individually based preventions and treatments. In socioeconomically disadvantaged areas, intervention and prevention policies might be more effective on a community level, to account for shared environmental risk factors.

Adolescent↗
PubMed2005

Chronic kidney disease and life course socioeconomic status: a review.

Socioeconomic status (SES) may modify the effect of well-established risk factors on the development of kidney disease. Yet, recently, a paradigm shift has occurred with an emphasis on the direct effect of SES on the development of disease. This article covers the role SES may play in initiating and promoting chronic kidney disease (CKD) in the United States, with an emphasis on life-course SES. The literature on SES and kidney disease is discussed. Life-course and social epidemiology approaches are described. Salient risk factors and markers that are associated with both SES and kidney disease early in life include diet, birth weight, and infant mortality. Risk factors associated with individual SES later in life include diabetes mellitus, hypertension, diet, smoking, alcohol, drug use, occupational and environmental exposures, infection, and access to health care. An argument is made for incorporating area-level SES measures. Future research should incorporate both individual and area-level SES and be placed in the context of the life course.

Health Status↗