Absolute rather than relative income is a better socioeconomic predictor of chronic obstructive pulmonary disease in Swedish adults

Sten Axelsson Fisk,Juan Merlo

doi:10.1186/s12939-017-0566-2

Sten Axelsson Fisk, Juan Merlo

Open Access

https://doi.org/10.1186/s12939-017-0566-2

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Journal: International journal for equity in health	Publication Date: May 4, 2017
Citations: 8	License type: open-access

Affiliation: Lund University

Abstract

BackgroundWhile psychosocial theory claims that socioeconomic status (SES), acting through social comparisons, has an important influence on susceptibility to disease, materialistic theory says that socioeconomic position (SEP) and related access to material resources matter more. However, the relative role of SEP versus SES in chronic obstructive pulmonary disease (COPD) risk has still not been examined.MethodWe investigated the association between SES/SEP and COPD risk among 667 094 older adults, aged 55 to 60, residing in Sweden between 2006 and 2011. Absolute income in five groups by population quintiles depicted SEP and relative income expressed as quintile groups within each absolute income group represented SES. We performed sex-stratified logistic regression models to estimate odds ratios and the area under the receiver operator curve (AUC) to compare the discriminatory accuracy of SES and SEP in relation to COPD.ResultsEven though both absolute (SEP) and relative income (SES) were associated with COPD risk, only absolute income (SEP) presented a clear gradient, so the poorest had a three-fold higher COPD risk than the richest individuals. While the AUC for a model including only age was 0.54 and 0.55 when including relative income (SES), it increased to 0.65 when accounting for absolute income (SEP). SEP rather than SES demonstrated a consistent association with COPD.ConclusionsOur study supports the materialistic theory. Access to material resources seems more relevant to COPD risk than the consequences of low relative income.

Highlights

While psychosocial theory claims that socioeconomic status (SES), acting through social comparisons, has an important influence on susceptibility to disease, materialistic theory says that socioeconomic position (SEP) and related access to material resources matter more
Access to material resources seems more relevant to chronic obstructive pulmonary disease (COPD) risk than the consequences of low relative income
In both men and women there is a clear gradient for absolute income groups with increasing COPD risk as the absolute income decreases

Summary

Introduction

While psychosocial theory claims that socioeconomic status (SES), acting through social comparisons, has an important influence on susceptibility to disease, materialistic theory says that socioeconomic position (SEP) and related access to material resources matter more. Materialistic theory assumes that an individual’s health depends on their own (and only their own) level of income, rather than that of those around them It is a person’s SEP and Axelsson Fisk and Merlo International Journal for Equity in Health (2017) 16:70 the related access to material resources and power that matters most [9, 16]. Sociological mechanisms in adulthood may promote smoking habits [20], low physical activity, and inappropriate nutrition [21] in people with low SEP These factors alone or in combination with harmful occupational exposures [22], air pollution [23, 24], and reduced access to appropriate health care and medication may increase risk of developing COPD in people with low SEP [2]

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