Components Of Socioeconomic Status Research Articles

Perception of the Impact of Type 1 Diabetes on Low-Income Families

The purpose of this study was to explore the psychosocial impact of type 1 diabetes (T1DM) on low-income families of various racial/ethnic backgrounds. A qualitative study using qualitative descriptive methods was conducted with a total of 21 patient-parent dyads from African American, Hispanic, and white heritage, respectively. An interview guide was developed to explore each family's attitudes and beliefs related to diabetes. Although all subjects were in excellent metabolic control (mean A1C levels were between 7.3% and 7.6%), there were a number of identifiable differences in the perception of the impact of T1DM among the 3 groups. Themes in the data demonstrated differences in the following areas: (1) view of diabetes and its effects on the family; (2) ability to successfully treat diabetes; (3) ability to cope with diabetes; and (4) experiences with the health care system. Most notable themes include a disparity across racial/ethnic groups in the preoccupation with the disease after diagnosis, cultural and financial factors identified, and differences in treatment modalities and reasons for their use. Diabetes education and care need to carefully address such differences. Although these differences are likely multifactorial, with components of socioeconomic status, family structure, and family experiences involved, it is evident that ethnicity itself is an important factor that can affect the ability of families to manage and cope with diabetes.

Association of socioeconomic profiles with cardiovascular risk factors in Iran: the Isfahan Healthy Heart Program

To determine the relationship between socioeconomic status (SES) and cardiovascular disease (CVD) risk factors. A representative sample of adult populations living in three cities in Iran was studied. The demographic and subjective data were collected by questionnaires prepared and validated for this study; physical examination and laboratory tests were conducted under standard protocols. Three components of SES including education, occupation, and income were determined. The univariate ANOVA was used for statistical analysis. The population studied (99.3% response rate) comprised 12,514 subjects (51% females, mean age 38.4 ± 14.3 years). While higher education was a protective factor against smoking in men OR = 0.8 (95% CI = 0.7-0.8), it increased the risk of smoking in women OR = 1.2 (95% CI = 1.02-1.5). The other risk factors increased with education especially in men. Higher income level increased the OR of CVD risk factors. Occupation had an inverse association with the aforementioned risk factors. The employed individuals had higher serum lipid level and body mass index than unemployed individual. In line with previous studies, we found an association between SES and CVD risk factors. Education level was the strongest associated factor.

Socio-economic status and oesophageal cancer: results from a population-based case–control study in a high-risk area

Cancer registries in the 1970s showed that parts of Golestan Province in Iran had the highest rate of oesophageal squamous cell carcinoma (OSCC) in the world. More recent studies have shown that while rates are still high, they are approximately half of what they were before, which might be attributable to improved socio-economic status (SES) and living conditions in this area. We examined a wide range of SES indicators to investigate the association between different SES components and risk of OSCC in the region. Data were obtained from a population-based case-control study conducted between 2003 and 2007 with 300 histologically proven OSCC cases and 571 matched neighbourhood controls. We used conditional logistic regression to compare cases and controls for individual SES indicators, for a composite wealth score constructed using multiple correspondence analysis, and for factors obtained from factors analysis. We found that various dimensions of SES, such as education, wealth and being married were all inversely related to OSCC. The strongest inverse association was found with education. Compared with no education, the adjusted odds ratios (95% confidence intervals) for primary education and high school or beyond were 0.52 (0.27-0.98) and 0.20 (0.06-0.65), respectively. The strong association of SES with OSCC after adjustment for known risk factors implies the presence of yet unidentified risk factors that are correlated with our SES measures; identification of these factors could be the target of future studies. Our results also emphasize the importance of using multiple SES measures in epidemiological studies.

Who can afford to look to the future ? The relationship between socio-economic status and proactive coping

The aim of this article was to examine, whether middle-aged and older adults spontaneously engage in proactive coping to prevent future problems associated with ageing and whether differences in proactive coping were associated with socio-economic status (SES). As part of the cross-sectional Second Dutch National Survey of General Practice (DNSGP-2, 2001), a representative sample of 3189 adults aged 50-70 years filled in a questionnaire measuring proactive coping. In addition, data were collected regarding the three main components of SES, namely educational level, income and occupational status, as well as participants' health status. We found that higher SES, especially with respect to income and education, was positively associated with proactive coping. This relationship was not moderated, but was partially mediated by physical health problems. People with higher income and higher educational level used more proactive coping strategies in their daily life to offset potential problems associated with ageing. Physical health status partially explained the SES-differences in proactive coping. It seems that people with lower SES undertake less future-oriented activities as a result of the fact that present health problems require attention and drain resources.

Socioeconomic predictors of weight loss after laparoscopic Roux-Y gastric bypass

Successful weight loss after laparoscopic Roux-Y gastric bypass (LRYGB) hinges on many elements including neurohormonal, anatomical, and postoperative behavioral changes. To date, the effects of socioeconomic factors have been inadequately studied. We examine several components of socioeconomic status and its relationship to weight loss after LRYGB. Between August 2002 and July 2006, 405 LRYGB were performed by a single surgeon. Patient demographics were entered into a longitudinal, prospective database. At 1-year follow-up, 309 patients were available for analysis. Regional median household income (RMAHI) and primary insurance carrier were used as surrogates for preoperative socioeconomic status. Analysis of covariance (ANCOVA) test was used for statistical analysis. According to RMAHI, we divided the patients into three groups: US $20,001-40,000 (group A, n = 67), US $40,001-60,000 (group B, n = 153), and more than US $60,000 (group C, n = 89). Initial body mass index (BMI) was 52.76 +/- 1.01, 51.28 +/- 0.67, and 48.87 +/- 0.94 kg/m2, respectively. Additionally, patients were divided according to private insurance or state-based insurance. A total of 274 patients had private insurance, with an initial mean BMI of 50.6 kg/m2, and 35 patients had state-based insurance, with an initial BMI of 53.0 kg/m2. After 1 year, weight loss in groups A, B and C was 110.6 +/- 4.3, 110.0 +/- 2.5, and 103.9 +/- 3.6 lb with BMI decrease of 17.7 +/- 0.6, 17.7 +/- 0.4, and 16.9 +/- 0.6 kg/m2, respectively. Weight loss in the private insurance group was 49.2 +/- 0.9 kg compared with 50.2 +/- 2.3 kg in the state-based group with BMI decrease of 17.4 +/- 0.3 and 18.4 +/- 0.8 kg/m2, respectively. There were no statistical significances in the effect of socioeconomic status, median household income, and insurance carrier on postoperative weight loss. With appropriate patient selection, the socioeconomic status of patients undergoing LRYGB does not affect postoperative weight loss.

Use of proxy measures in estimating socioeconomic inequalities in malaria prevalence

To present and compare socioeconomic status (SES) rankings of households using consumption and an asset-based index as two alternative measures of SES; and to compare and evaluate the performance of these two measures in multivariate analyses of the socioeconomic gradient in malaria prevalence. Data for the study come from a survey of 557 households in 25 study villages in Tanzania in 2004. Household SES was determined using consumption and an asset-based index calculated using Principal Components Analysis on a set of household variables. In multivariate analyses of malaria prevalence, we also used two other measures of disease prevalence: parasitaemia and self-report of malaria or fever in the 2 weeks before interview. Household rankings based on the two measures of SES differ substantially. In multivariate analyses, there was a statistically significant negative association between both measures of SES and parasitaemia but not between either measure of SES and self-reported malaria. Age of individual, use of a mosquito net, and wall construction were negatively and significantly associated with parasitaemia, whilst roof construction was positively associated with parasitaemia. Only age remained significant when malaria self-report was used as the measure of disease prevalence. An asset index is an effective alternative to consumption in measuring the socioeconomic gradient in malaria parasitaemia, but self-report may be an unreliable measure of malaria prevalence for this purpose.

Socioeconomic status (SES) as a determinant of adherence to treatment in HIV infected patients: a systematic review of the literature

ObjectivesIt has been shown that socioeconomic status (SES) is associated with adherence to treatment of patients with several chronic diseases. However, there is a controversy regarding the impact of SES on adherence among patients with the human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). Thus, we sought to perform a systematic review of the evidence regarding the association of SES with adherence to treatment of patients with HIV/AIDS.MethodsWe searched the PubMed database to identify studies concerning SES and HIV/AIDS and collected data regarding the association between various determinants of SES (income, education, occupation) and adherence.FindingsWe initially identified 116 potentially relevant articles and reviewed in detail 17 original studies, which contained data that were helpful in evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. No original research study has specifically focused on the possible association between SES and adherence to treatment of patients with HIV/AIDS. Among the reviewed studies that examined the impact of income and education on adherence to antiretroviral treatment, only half and less than a third, respectively, found a statistically significant association between these main determinants of SES and adherence of patients infected with HIV/AIDS.ConclusionOur systematic review of the available evidence does not provide conclusive support for existence of a clear association between SES and adherence among patients infected with HIV/AIDS. There seemed to be a positive trend among components of SES (income, education, occupation) and adherence to antiretroviral treatment in many of the reviewed studies, however most of the studies did not establish a statistically significant association between determinants of SES and adherence.

Socio-economic status, permanent income, and fertility: A latent-variable approach

This paper examines how permanent income and other components of socio-economic status (SES) are related to fertility in less developed countries. Because permanent income cannot be measured directly, we employ a latent-variable method. We compare our results with those of the more common proxy-variable method and investigate the consequences of not accounting for measurement error. Using data from Ghana and Peru, we find that permanent income has a large, negative influence on fertility and that research must take the latent nature of permanent income into account to uncover its influence. Controlling for measurement error in the proxies for permanent income can also lead to substantial changes in the estimated effects of control variables. Finally, we examine which of the common proxies for permanent income most closely capture the concept. The results have implications beyond this specific dependent variable, providing evidence on the sensitivity of microanalyses to the treatment of long-term economic status.

The Growing Importance of Socioeconomic Aspects in Cardiovascular Disease

Objective: Disparities in mortality between socioeconomic groups have widened during the last decades in Europe, and socioeconomic inequalities in health have been marked as one of the most important issues to be tackled by public health policy. Previous studies have shown an inverse relationship between socioeconomic status (SES) defined by education, income, occupation, social status and neighbourhood environment, and the occurrence of cardiovascular risk factors and disease (CVD). In Italy, poor evidence exists about the relative burden of every single component of SES leading to a higher prevalence of CVD. The aim of this study was to investigate the relationship between SES and CVD in a cohort of patients admitted to our institution over a period of 9 months. Methods: We retrospectively studied 656 patients admitted to our institution over a period of 9 months, performing a correlation between individual SES and the prevalence of CVD. Admissions included day-hospital and ordinary regimens. Occupation was defined by different categories: employed, unemployed, student, housewife, retired/unable, whereas educational level was classified as no qualification, primary school certificate, secondary school certificate, school-leaving certificate, degree or other academic qualifications. A high educational level was defined as school-leaving certificate, degree or other academic certificate, while primary school certificate or no qualification corresponded to a low educational level. Concerning the causes of disease related to admission, we considered all registered diagnoses according to the WHO classification of disease (ICD-9). Results: Educational level and heart disease appeared to be inversely related, showing that people with hypertensive disease and coronary artery disease (CAD) belonged mainly to the low educational group (r = −0.13, p = 0.001). Gender did not alter such findings significantly: the higher the educational level, the lower the prevalence of hypertensive disease and CAD in women (r = −0.17, p = 0.001) and men (r = −0.18, p = 0.001). Occupational status seemed to mainly influence the prevalence of CAD (r = −0.24; p < 0.001). In addition, an association between educational level and the choice of admission regimen has been observed (r = −0.27; p < 0.001). In the examined population, a more frequent rate of the day-hospital regimen was recorded among high-level qualification subjects compared with ordinary admissions (7.1% vs 6.6%, p < 0.001). Conclusions: In this retrospective analysis from an Italian registry, we observed a decrease in the prevalence of CVD with increasing educational status. However, the mechanism underlying this relationship remains uncertain and needs to be addressed in further studies.

Area-level socio-economic status and health status among adults with asthma and rhinitis

Socio-economic status (SES) may affect health status in airway disease at the individual and area level. In a cohort of adults with asthma, rhinitis or both conditions, questionnaire-derived individual-level SES and principal components analysis (PCA) of census data for area-level SES factors were used. Regression analysis was utilised to study the associations among individual- and area-level SES for the following four health status measures: severity of asthma scores and the Short Form-12 Physical Component Scale (SF-12 PCS) (n = 404); asthma-specific quality of life (QoL) scores (n = 340); and forced expiratory volume in one second (FEV1) per cent predicted (n = 218). PCA yielded a two-factor solution for area-level SES. Factor 1 (lower area-level SES) was significantly associated with poorer SF-12 PCS and worse asthma QoL. These associations remained significant after adding individual-level SES. Factor 1 was also significantly associated with severity of asthma scores, but not after addition of the individual-level SES. Factor 2 (suburban area-level SES) was associated with lower FEV1 per cent predicted in combined area-level and individual SES models. In conclusion, area-level socio-economic status is linked to some, but not all, of the studied health status measures after taking into account individual-level socio-economic status.

Ehnicity and Health Disparities Among the Elderly in Taiwan

Two measures of health, an index of functional and disability status and global selfrated health, and their transitions over a seven-year period were compared across two ethnic groups of elders in Taiwan: Mainlanders and Taiwanese. This ethnic division is considered a salient dimension of social stratification, shaping the two groups of elders'pathways through life. The results showed that Taiwanese elders experience a disproportionate burden on the two measures of health in part because of their lower socioeconomic status (SES). Also, Taiwanese elders are more likely to develop adverse health transitions than their Mainlander counterparts, and variations in perceptions of chronic illnesses may exist across ethnicity. The results suggest that both ethnicity and SES play important roles in linking social status to health status among this cohort of elders. Ethnicity and SES affect health collectively, and different components of SES may not confer the same health benefits across ethnic groups.

Variation in the Associations of Education, Occupation, Income, and Assets with Functional Limitations in Older Mexican Americans

The primary aim was to examine the particular components of socioeconomic status that may be associated with functional limitation among older Mexican American men and women. Using baseline data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, the education, past occupation, household income, and assets of those with and without limitations in activities of daily living (ADL), instrumental activities of daily living (IADL), and those scoring 9 versus < 9 on the performance oriented mobility assessment (POMA) were compared. Not completing at least 12 years of education was associated with a two-fold higher likelihood of having an IADL limitation, but not significantly associated with other indicators of functional limitation. Men who had been skilled manual, farm workers, or laborers were 1.82 to 2.59 times as likely as those who had been white-collar workers to have a POMA score below 9. Homemakers had significantly higher odds of all three measures of functional/mobility impairment than women white-collar workers. Different dimensions of socioeconomic status may be associated with separate aspects of functional limitation in distinct ways, which vary by sex.

Education and the Changing Shape of the Income Gradient in Health

Research on the social determinants of health has increasingly sought to understand the relative importance of different features of socioeconomic status. Much of the ensuing debate has wavered between education and income, with recent research leaning increasingly toward income. This research has not, however, consistently explored interactions between different features of socioeconomic status and, in trying to understand the independent effects of different components of socioeconomic status, may have missed important features of socioeconomic position. With an eye toward examining how features of socioeconomic status combine and coalesce, this paper examines variation in the income-health association by level of education. Theories derived both from medical sociology and health economics suggest synergistic interactions between income and education, but they are unclear as to the direction and magnitude of these interactions. Results from two large and nationally representative data sets (the 1996-1997 Community Tracking Study and the 1972-2000 General Social Survey) indicate that the positive relationship between income and health varies substantially in both its strength and shape by level of education. Education improves health, and its effects are larger at lower levels of income. Moreover, education reduces the strength and curvature of the income-health relationship. Consequently, those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less well educated. The linear "gradient" relationship between income and health is, thus, more characteristic of groups with higher levels of education. Additional analyses indicate that these interactions existed in the United States in each of the last three decades. The results are discussed in light of theory regarding the perpetuation of health disparities, as well as current debates regarding the apparent incompatibility of distributive versus aggregative goals in health policy.

Letting the “Gini” out of the bottle: Social causation and the obesity epidemic

Letting the “Gini” out of the bottle: Social causation and the obesity epidemic

Which aspects of socioeconomic status are related to obesity among men and women?

This study aimed to investigate the relationships between body weight and fat distribution, and four empirically derived domains of socioeconomic status: employment, housing, migration status and family unit. A population-based study was used. A total of 8667 randomly-selected adults (4167 men; 4500 women) who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objective height, weight and body fat distribution, and a range of sociodemographic indicators. Results demonstrated associations for women, after controlling for age, between the employment domain, and body mass index and waist-to-hip ratio. Low status employed women were 1.4 times as likely to be overweight as high status employed women. There were less consistent relationships observed among these factors for men. Relationships between family unit and indicators of body weight and body fat distribution were observed for both men and women, with those who were married, particularly men (OR = 1.6, 95% CI 1.4-2.0), at higher risk of overweight. The migration and housing socioeconomic status domains were not consistently associated with body mass index or waist-to-hip ratio. These findings indicate that different components of socioeconomic status may be important in predicting obesity, and thus should be examined separately. Future research would benefit from investigating the underlying mechanisms governing the relationships between socioeconomic status domains further, particularly those related to employment and family unit and obesity.

The California Wellness Foundation's grant making in work and health.

The California Wellness Foundation's grant making in work and health.

Essay: Rediscovering The Social Determinants Of Health

Essay: Rediscovering The Social Determinants Of Health

Early cognitive development and parental education

Relations between cognitive development in infancy and early childhood, and parental education were examined. Previous research has found little association between measures of the parenting environment, including parental education and socio-economic status (SES), and cognitive development in infants and children under 2 years of age. However, the earlier studies may not have reliably measured individual differences in cognitive abilities, thus, there is uncertainty as to what age elements in the parental environment affect cognitive development. Seventy-six infants were tested on a range of cognitive tasks at 3-month intervals between the ages of 9 and 18 months. Information on parental education (a component of SES) was collected. Seventy-one of the children returned at 27 months and completed the Bayley Scales of Infant Development, Mental Scale, which was used as an outcome measure for the earlier tasks. The findings present a clear indication that cognitive development in early childhood is affected by the parenting environment, at least from as early as 12 months. Copyright © 1999 John Wiley & Sons, Ltd.

La mortalite differentielle par cancer suivant le milieu social: Le cas de la region metropolitaine de Montreal, 1971

Cancer mortality rates vary from area to area. Part of this variation is due to socio-economic characteristics of the area and part to other factors including the availability of health services. Three social indicators associated with cancer mortality are used to estimate variations between low and high census sectors within the metropolitan region of Montreal. The components of socio-economic status which have been used are revenue (median family income), education (college and university level) and occupation (higher status profession). For each of the three zones of the metropolitan area: the city of Montreal, the island of Montreal not included the city of Montreal, the north and south shores of the metropolitan area twenty five census sectors have been chosen which having higher or lower positions for each of the socio-economic components. For each group standardized death rates were evaluated for each type of cancer and the Poisson test was applied to judge whether the differences between the projected rate and the observed rate were significant. The results indicate a strong indirect relation between the standardized mortality rates and the socio-economic status in the central city. In the case of lung cancer, the spatial distribution showed district gradients of occurrence between the central-city and the suburbs.

Language and Political Behavior: A Methodology for Utilizing the Linguistic Component of Socioeconomic Status

This paper attempts to show the relevance of sociolinguistic methodology for social and political research. In particular, it reveals that, at least for the data analyzed, a sociolinguistic measure of socioeconomic status (SES) is a more powerful predictor of political behavior than are the traditional measures of SES (e.g., income and education). The paper explicates in detail the three stages necessary for carrying out this kind of research, examining data collected in Costa Rica. The findings strongly encourage the incorporation of sociolinguistic measures into survey research.