Research Findings: Social class: Social patterning of health Summary papers
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 hence are less likely to report health problems.
We tested this in data from the two older cohorts of the Twenty-07 Study. People were asked the commonly used standard question about long-standing illness from the UK General Household Survey - “Do you have a long-standing illness, disability or infirmity? By long-standing I mean anything that has troubled you over a period of time or that is likely to affect you over a period of time?” Participants were then given additional prompts to identify additional health problems.
We found similar differences in reported health between different social groups regardless of which type of questioning was used, before and after additional prompting. Our findings therefore do not support the idea that more disadvantaged social groups 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.
Macintyre, S., G. Der, et al. (2005). "Are there socio-economic differences in responses to a commonly used self report measure of chronic illness?" International Journal of Epidemiology 34: 461-466.
Relationship between income and health by age and gender
Death rates across different age groups have been shown to be lower among those with higher household income. This study looked at the strength and form of the association between income and health over time in males and females in all three age cohorts from the second-wave of the Twenty-07 Study in 1990-91.
We found that health measures such as height, weight, waist-hip ratio, body mass index, pulse rate, and long-standing illness had linear associations with household income, with people having increasingly poorer health as income falls. The number of recent symptoms of poor health, and self-assessed health reported had curvilinear associations with household income, with poorer health among those with high and low incomes. However, we found blood pressure to be unrelated to household income.
We found stronger evidence of interactions between income and sex for heart disease risk factors relating to body size, such as weight, waist-hip ratio, body mass index, and pulse rate. Men’s health did not seem to improve as much as women’s health with higher income, which might be explained by steeper socioeconomic gradients in heart disease risk factors for women. 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. This may be because the effects of socioeconomic circumstances on health are less marked in adolescence than in adulthood. We suggest that 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.
Der, G., S. Macintyre, et al. (1999). "The relationship of household income to a range of health measures in three age cohorts from the West of Scotland." European Journal of Public Health 9: 271-277.
Patterns of class inequality in health through the lifespan
Data confirming the existence of social inequalities in health have continued to accumulate since the Black Report in the mid-80s highlighted class inequalities across a broad range of causes of death, with an increasing focus on indicators of ill-health and current health status. Despite mounting evidence of inequalities, finding an explanation of the underlying mechanisms that generate and maintain such inequalities has been more elusive.
This paper sought to contribute to the evidence of variation in class inequalities in a range of health measures and across the lifespan using data collected from all three age cohorts of the Twenty-07 Study. Our earlier research commented on class gradients in the youth-adulthood transition in the Twenty-07 Study. Here, we extend the analysis to late working life. Class differences do appear to be largely absent in youth as was previously reported (with height being the notable exception) whereas class differences do exist in most of the adult measures but still with some exceptions.
While orderly relationships between social class and health were seen for the majority of the measures considered, i.e. more disadvantaged groups experienced more ill health; the detailed patterns show considerable diversity. For some aspects of health, such as height, common class gradients were observed for both sexes at each life stage. For others, such as mental health and presence of chronic illness, gradients were evident in later life but not in youth. Others still showed sex but not age differences in class patterning in measures of body shape, or no clear patterns in measures of blood pressures and number of consultations with a GP.
Our findings focus on the apparent consistency of health inequalities in early and late midlife, despite the marked increase in the burden of poor health which manifests between these life stages for almost all indicators of health (except for mental health).
Ford, G., R. Ecob, et al. (1994). "Patterns of class inequality in health through the lifespan: class gradients at 15, 35 and 55 years in the West of Scotland." Social Science and Medicine 39: 1037-1050.
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