Social class and chronic illness.

Abstract

This paper traces a three-stage history of theorization on the causal relationship between social class and chronic illness, focusing in particular on the contributions of Kadushin and Mechanic. Five areas of agreement between Kadushin and Mechanic are presented as a basis for further analysis: (1) the importance of data from the National Health Survey; (2) the necessity for controlling for age as an important variable; (3) the more severe measures of chronic diseases, as shown by criteria of activity limitation or work loss, are clearly class related, with the greatest magnitude of change between the lowest income category and the next highest category; (4) there are no data from other studies that can be counted as opposing the above evidence; (5) there is agreement that it is more likely that persons will accurately report more severe episodes of chronic illness than less severe episodes. Two central research questions are then addressed: What is the true shape of the relationship between socioeconomic status and chronic disease? What are the most reasonable of the possible causes of this relationship? Analysis of new material from the National Health Survey is presented in answer to these questions. The utility of these data for this purpose is defended. Certain relationships are noted: For whites and non-whites, with age adjusted or not adjusted, there is a strong relationship between income and measures of chronic disease. With a threefold division of the income category, the magnitude of the differences between income levels is large. These relationships hold over a wide range of specific chronic diseases. The conclusion is drawn that Kadushin's hypothesis of overreaction to illness by the lower classes is of little significance. More study is needed of the downwardly mobile effects of chronic illness. The effects of poor health and low socioeconomic status are presumed to be circular.