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Research Findings: Social class

Factors associated with socioeconomic advantage or disadvantage such as social class, car or home ownership, education, employment status, and income, and a person’s own perceptions of these are thought to impact on health.  We explore which aspects are better or worse for health, and how these relationships develop over time.

Research on this theme can be grouped into five areas:


Social patterning of health

Does a commonly used measure of health status bias socioeconomic health inequalities?
It has been suggested that socioeconomic gradients in ill health may be underestimated because disadvantaged groups expect their health to be worse and are therefore less likely to report health problems.  Our findings however do not support the idea that social groups living in disadvantaged circumstances are more stoical and more likely to need detailed prompting in order to find out about their health, or that socioeconomic differences are underestimated by using standard and simple questions.

Relationship between income and health by age and gender
It is well established that those with higher income tend to have better health.  We found steeper socioeconomic gradients in heart disease risk factors for women compared to men.  In terms of symptoms reported and self-assessed health, the youngest cohort did not show as much improvement in health with higher income as did the older two cohorts.  The effects of socioeconomic circumstances on health may be less marked in adolescence than in adulthood.  We suggest there is no single relationship between income and health, but the form of the relationship varies according to which aspect of health is being considered as well as by age and sex. 

Patterns of class inequality in health through the lifespan
For some aspects of health, notably height, social class gradients were seen in both sexes at each of the three stages of life course represented in the Twenty-07 Study cohorts.  For others, such as mental health and presence of chronic illness, gradients were evident in later life but not in adolescence.  Other health measures, such as body shape showed differences in class patterning by sex but not for age, while blood pressure and consultations with a GP showed no clear patterns. 

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Effect of people’s material circumstances on health

Can health inequalities in disability in older adults be explained by perceptions of financial hardship and living standards?
People who reported poorer living standards in earlier decades of life were found to have a higher risk of disability in later life than those who reported an affluent childhood. However, people’s perceptions of financial hardship in early life were not found to be a risk factor for disability in later life.

Is early life car ownership a good indicator of socioeconomic position?
Given the changing pattern of car ownership over time, it is important to be cautious about using it as a marker of socioeconomic circumstance.  Car ownership was likely to have been a stronger indicator of family advantage in childhood among those born in the 1930s compared to 1950s.

Do home ownership and car access predict health because they are markers of income or self esteem?
People living in social housing have poorer health than owner occupiers.  We investigated whether this was because home ownership is just a marker for people’s income, an indicator of self-esteem or for another reason.  We found that home ownership and car access were still related to a range of health measures after controlling for income and self esteem. 

Summary papers...

Biological and psychological processes linking social position and health

Does stress influence the association between birth weight and blood pressure?
Differences in early growth patterns of individuals are likely to predict the changes seen in adult blood pressure, but it is unlikely that these differences are mediated by a reaction to mental stress.

Does the presence of supportive others affect blood pressure and heart rate reactions to mental stress?
We found that the presence of a spouse was associated with a reduction in heart rate and blood pressure reactions to mental stress in an everyday environment, and having a spouse/partner present seemed to be appear especially effective for women.

Living a stressful life may affect your immune system
Living a stressful life may affect your immune system in later life increasing the risk of upper respiratory infection and disease.

Life events and blood reactions to mental stress
The nature and extent of the link between difficult life events experienced and heart’s reactions to acute stress in all age cohorts appeared to depend on how often the events occurred, together with the sex of the individual, the size of their social network, and socioeconomic status.

Disability in early old age
Risk of physical disability in early old age was higher among more disadvantaged people and those who had experienced a lifetime of difficult physical working conditions such as working in very noisy, dusty, hot or cold environments, working with fumes or chemicals, working in bent or uncomfortable positions, having monotonous and repetitive work or work that was too hectic, stressful or physically tiring.

Stress prediction of blood pressure status
Blood pressure reactions to mental stress can predict future blood pressure status and the increase observed in resting blood pressure as people get older.  The strength of prediction appears to be greater for those in more disadvantaged socioeconomic positions and for men, more than women.   

Age, sex and social patterning of immunity
Secretion rates of secretory immunoglobulin-A (sIgA), important in the immune system’s defence reaction, were found to be lower in more disadvantaged social classes, and with increasing age.  Males had significantly higher sIgA secretion rates and salivary flow than females. Smokers had lower secretion rates than non-smokers which partly explained the differences between social classes as manual workers are more likely to smoke than professional groups.

Influence of social class on cardiovascular reactions to mental stress

The prevalence of heart disease is greater in men, in manual social classes, and increases with age.  We found that the influence of social class on heart disease is unlikely to be mediated by cardiovascular reactions to stress.

Why is social support linked to increased mental health?
Social support is now firmly established as one of the key factors contributing to mental health.  A person receiving support may feel their self-esteem is being undermined if, for example, the support is felt unnecessary or inappropriate, therefore a cause for mental stress. 

Although our study findings argue that receiving support is potentially harmful, it does not suggest that social support interventions should be ignored, but rather strategies should focus on methods of delivery and on physical benefits that may indirectly influence positive mental health in the long term. 

Summary papers...

Social patterning of health behaviours over time

The importance of being active at work, home and play for mental health
In general, both men and women who do more active leisure pursuits appear to experience lower levels of depression, than those who are less active. 
Impact of retirement on physical activity
After retirement people do not take enough additional exercise at home or at leisure to compensate for the loss of work-based activity before retirement.

Are adults in the West of Scotland doing enough exercise?
Only a third of respondents achieved the recommended levels of physical activity with women and older adults being the least active.  Walking was the most favoured leisure activity.  More men in manual classes achieved the recommendations mainly through work-based activities than professional groups.

Strenuous housework makes women more depressed
By contrast, women were found to be more depressed with increasing amounts of housework

Is sport for all? 
Patterns of physical activity and exercise change as people get older.  Sporting and team activities are rarely undertaken throughout adult life, especially among women and people from more disadvantaged circumstances. The activities that are most commonly taken up and sustained throughout later adult life are walking, swimming, social dancing, keep fit/aerobics and golf. 

Socioeconomic influences on women’s smoking habits
We found that smoking among women was strongly associated with more disadvantaged socioeconomic status in adolescence and adulthood.  Women who are exposed to the health damaging influences of disadvantage throughout their life course are therefore the most likely to face the added health risks associated with smoking.

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Role of IQ in the relationship between social position and health

Does IQ explain socioeconomic inequalities in health?
It has been suggested that IQ may be part of the link between socioeconomic circumstances and health.  Results from the 1930s cohort of the Twenty-07 Study suggest that IQ does not completely explain socioeconomic differences in health but may contribute to them.

Slower reaction times may link lower IQ with earlier death
IQ and reaction times were measured in the 1st wave (1987) of the Twenty-07 Study among the 1930s cohort.  Following this cohort for 14 years suggest that reduced efficiency of information processing (slower reaction times) might link more limited mental ability (IQ) and earlier death.

Reaction time, age and cognitive ability
There is much interest in age-related changes in the way people process information.  We found that simple and choice reaction times became slower and more variable as a person gets older. Women from age 36 to 63 showed more variability in choice reaction times than men.  Age-related differences in reaction times might account for variations in more complex cognitive functions such as reasoning, memory and spatial abilities.

Reaction times and intelligence differences
The Twenty-07 Study was the first investigation of reaction time and intelligence in a large, normal sample of the population. It provided a benchmark for other studies and suggested larger effect sizes than the majority of previous studies, which have tended to be on young student samples.

Summary papers...