low-SES Individuals Research Articles

Birth-cohort trends in older-age functional disability and their relationship with socio-economic status: Evidence from a pooling of repeated cross-sectional population-based studies for the UK

We examine birth-cohort trends behind recent changes in the prevalence of functional disability in the older population living in private households in the United Kingdom (UK). By using three different socio-economic indicators available in the nationally representative cross-sectional data on older individuals interviewed between 2002 and 2012 in the Family Resource Survey (FRS) (96,733 respondents), we investigate the extent to which the overall trends have been more favourable among more advantaged than disadvantaged socioeconomic groups.Compared to the cohort of people born in 1924, successive cohorts of older men have lower odds of having at least one functional difficulty (FD), whereas no significant trend was found for women. Among people with at least one FD, however, the number of disabilities increases for each successive cohort of older women (incidence rate ratio 1.027, 95% confidence interval 1.023 to 1.031, P < 0.001) and men (incidence rate ratio 1.028, 95% confidence interval 1.024 to 1.033, P < 0.001). By allowing interactions between birth cohort and SES indicators, a significant increasing cohort trend in the number of reported FDs was found among older men and women at lower SES, whereas an almost stable pattern was observed at high SES. Our results suggest that the overall slightly increasing birth-cohort trend in functional difficulties observed among current cohorts of older people in the UK hides underlying increases among low SES individuals and a relative small reduction among high SES individuals. Further studies are needed to understand the causes of such trends and to propose appropriate interventions. However, if the SES differentials in trends in FDs observed in the past continue, this could have important implications for the future costs of the public system of care and support for people with care needs.

Fetal Malnutrition and Academic Success: Evidence from Muslim Immigrants in Denmark

This paper examines the impact of potential fetal malnutrition on the academic proficiency of Muslim students in Denmark. We account for the endogeneity of fetal malnutrition by using the exposure to the month of Ramadan during time in utero as a natural experiment, under the assumption that some Muslim women might have fasted during Ramadan when they were pregnant. In some of our specifications, we use a sample of students from predominantly non-Muslim countries as an additional control group to address potential seasonality in cognitive outcomes in a difference-indifferences framework. Our outcome measures are the standardized test scores from the national exams on the subjects of Danish, English, Math, and Science administered by the Danish Ministry of Education. Our results indicate that fetal exposure to Ramadan has a negative impact on the achievement scores of Muslim students, especially females. Our analysis further reveals that most of these effects are concentrated on the children with low socioeconomic status (SES) background. These results indicate that fetal insults such as exposure to malnutrition may not only hamper the cognitive development of children subject to such conditions, but it may also complicate the efforts of policy-makers in improving the human capital, health, and labor market outcomes of low-SES individuals. Our findings highlight the importance of interventions designed to help economically disadvantaged women during pregnancy.

Air Pollution, Health, and Environmental Justice Implications of Shifting Transportation Fuels in the United States

Background: Vehicles are a major contributor to air pollution health effects. Exposures in the U.S. are generally higher for low-socioeconomic status (SES) than for high-SES individuals. Air quality-related environmental justice outcomes are dependent both on intra-urban population demographic and exposure patterns and on the long range transport of pollutants. It is not practical to simulate both of these effects using conventional air quality modeling techniques. Aims: To understand health and environmental justice impacts of transportation interventions. Methods: We develop and apply a spatially and temporally explicit life cycle inventory to estimate emission changes per technology. We additionally develop a novel chemical transport model (CTM) for air pollution which can capture both intra-urban concentration gradients and long-range pollutant transport. We estimate air pollution health impacts from changes in fine particulate matter (PM2.5) concentrations for white, nonwhite, high-income, and low-income individuals from the use of conventional gasoline vehicles versus alternatives: gasoline-electric hybrid cars, diesel cars, compressed natural gas (CNG) cars, cars fueled by ethanol from corn grain or corn stover, or electric vehicles powered by electricity from various sources. Results: Electric vehicles powered by electricity generated from natural gas or from wind, wave, or solar power decrease overall exposures and also shift health burdens away from low-SES individuals (i.e., decrease environmental injustice). Vehicles powered by corn ethanol or by coal electricity cause the greatest decreases in environmental injustice, but they also cause the greatest increases in overall health damages. On average, about 40% of health impacts are caused by primarily emitted PM2.5; 60% are from PM2.5 formed from by secondary chemical reactions. Conclusion: Switching to alternative technologies for transportation can decrease both health risk and environmental injustice.

The growing socioeconomic disparity in dietary quality: mind the gap.

Disparity in dietary quality is a public health concern in the United States. Excess caloric intake induces obesity and diabetes mellitus, which in turn cause cardiovascular diseases. Similarly,poorerdietaryqualityhasbeenshowntoaffecthealth outcomes, whether directly or via intermediate chronic conditions such as hypertension and dyslipidemia. The link between lower socioeconomicstatus (SES)andunhealthfuldiet ismultifactorial.People of lower SES tend to have less access to healthful food; “food deserts”denote areaswhere residentsmayhavedifficulty getting nutritious food, mostly in poorer communities.1 Higher prices keep poorer people from buying more healthful food. Lower-SES individuals alsomayhave limitedknowledgeabout the effect of an unhealthful diet on their health. Federal and state governments have attempted to address the issueofdietarydisparitymostly through theSupplemental NutritionAssistance Program (SNAP, formerly known as theFoodStampProgram).2More than47million SNAPparticipants receivebenefits averaging$133perpersonpermonth (nearly $80 billion per year in total). Currently, there is neither any incentive tobuyhealthful foodnor restrictionof benefits for unhealthful food; households can use SNAP benefits tobuy“junk food”suchas softdrinks, candy, andpotatochips. This issue has provoked multiple debates in Congress and elsewhere.3-5 Several studies have investigated the effect of SNAPparticipationondietaryquality,but the resultshavebeen inconclusive. For example, the recently published study from theUSDepartmentofAgriculture (USDA)comparingSNAPparticipantsandnonparticipantsofequivalentSESusingdata from the National Health and Nutrition Examination Survey (NHANES) showed that SNAP participants had slightly lower overall Healthy Eating Index scores but also that SNAP participants consumed less saturated fat and sodium.6 Whereas these studies provided important information about individual-level associations of SNAP,wealsohaveneededbird’seye national-level evaluation ofwhether these governmental efforts have affected the nationwide temporal trend in dietary quality. In this context, the new study byWang et al7 successfully illustrates the trend from 1999 to 2010 in discrepancy of dietary quality by SES in the United States, using the Alternate Healthy Eating Index 2010 (AHEI-2010) to measure dietary quality by SES category, definedon thebasis of education and income level. Scoreson theAHEI-2010 improved for thepopulation as awhole, but the gap in scores (excluding the trans fat component, which was not measured in NHANES) between higher-SES and lower-SES groups widened during the observed period. The growing chasm indietary quality by SES confronts us with thepossibility that the governmental efforts tomind this gap have been insufficient. It is disappointing that the improvement seen in those of higher SES was not seen in the lower-SES group. How could we close the dietary quality gap? First, we could restrict benefits to more healthful foods, as has been done by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which restricts purchasable foods with the benefit. There have been proposals to adopt a pilot state-specific restriction on soft drinks. For example, New York state asked the federal government to waive SNAP rules to permit a pilot project excluding SNAP benefits for sugar-sweetened beverages in New York, New York, but the USDA denied this request for the reasons that “the scale and scope of the proposed demonstration is too large and complex”3 and that unresolved operational challenges could greatly affect the food retailers accepting SNAP benefits.3,4 Instead, the USDA conducted a large randomized controlled study, the Healthy Incentives Pilot (HIP), which provided financial incentives for more healthful foods (30 cents for every SNAP dollar spent on fruits or vegetables).8 Interim findings from the study suggest that HIP changed Related article page 1587 Trends in Dietary Quality Among US Adults Original Investigation Research

Social disadvantage and network turnover.

Research shows that socially disadvantaged groups--especially African Americans and people of low socioeconomic status (SES)--experience more unstable social environments. I argue that this causes higher rates of turnover within their personal social networks. This is a particularly important issue among disadvantaged older adults, who may benefit from stable networks. This article, therefore, examines whether social disadvantage is related to various aspects of personal network change. Social network change was assessed using longitudinal egocentric network data from the National Social Life, Health, and Aging Project, a study of older adults conducted between 2005 and 2011. Data collection in Wave 2 included a technique for comparing respondents' confidant network rosters between waves. Rates of network losses, deaths, and additions were modeled using multivariate Poisson regression. African Americans and low-SES individuals lost more confidants--especially due to death--than did whites and college-educated respondents. African Americans also added more confidants than whites. However, neither African Americans nor low-SES individuals were able to match confidant losses with new additions to the extent that others did, resulting in higher levels of confidant network shrinkage. These trends are partly, but not entirely, explained by disadvantaged individuals' poorer health and their greater risk of widowhood or marital dissolution. Additional work is needed to shed light on the role played by race- and class-based segregation on group differences in social network turnover. Social gerontologists should examine the role these differences play in explaining the link between social disadvantage and important outcomes in later life, such as health decline.

Educating low-SES and LEP survivors about breast cancer research: pilot test of the Health Research Engagement Intervention.

The Health Research Engagement Intervention (HREI) aims to reduce information and access disparities for breast cancer research opportunities among low-socioeconomic status (SES) and limited English proficient (LEP) breast cancer survivors by providing neutral, non-trial-specific information about health research via a trusted patient navigator. Qualitative methods in the context of a community-based participatory research design were used to iteratively design the HREI in collaboration with community-based care navigators from a trusted community organization, Shanti Project, and to locate appropriate research studies in collaboration with a web-based trial-matching service, BreastCancerTrials.org (BCT). Navigators were first trained in clinical trials and health research and then to deliver the HREI, providing feedback that was incorporated into both the HREI design and BCT's interface. Our intervention pilot with low SES and LEP survivors (n = 12) demonstrated interest in learning about "health research." All 12 participants opted to obtain more information when offered the opportunity. Post-intervention questionnaires showed that three of 11 (27%) participants independently pursued additional information about research opportunities either online or by phone in the week following the intervention. Post-intervention navigator questionnaires indicated that navigators could confidently and efficiently deliver the intervention. LEP patients who pursued information independently faced language barriers. The HREI is a promising and potentially scalable intervention to increase access to neutral information about breast cancer research opportunities for low-SES and LEP individuals. However, in order for it to be effective, systems barriers to participation such as language accessibility at sources of health research information must be addressed.

Socioeconomic Inequalities in Risk of Hospitalization for Community-Acquired Bacteremia: A Danish Population-Based Case-Control Study

In a Danish population-based case-control study, we examined the association between socioeconomic status (SES) and risk of community-acquired bacteremia, as well as the contribution of chronic diseases and substance abuse to differences in bacteremia risk. Analyses were based on 4,117 patients aged 30-65 years who were hospitalized with first-time community-acquired bacteremia during 2000-2008 and 41,170 population controls matched by sex, age, and region of residence. Individual-level information on SES (education and income), chronic diseases, and substance abuse was retrieved from public and medical registries. Conditional logistic regression was used to compute odds ratios for bacteremia. Persons of low SES had a substantially higher risk of bacteremia than those of high SES (for short duration of education vs. long duration, odds ratio = 2.30 (95% confidence interval: 2.10, 2.52); for low income vs. high income, odds ratio = 2.77 (95% confidence interval: 2.54, 3.02)). A higher prevalence of chronic diseases and substance abuse in low-SES individuals versus high-SES individuals explained 43%-48% of the socioeconomic differences in bacteremia risk. In a country with a universal welfare system, differences in the burden of chronic diseases and substance abuse seem to have major importance in explaining inequalities in bacteremia risk.

Consistent associations between measures of psychological stress and CMV antibody levels in a large occupational sample

Cytomegalovirus (CMV) is a herpes virus that has been implicated in biological aging and impaired health. Evidence, largely accrued from small-scale studies involving select populations, suggests that stress may promote non-clinical reactivation of this virus. However, absent is evidence from larger studies, which allow better statistical adjustment for confounding and mediating factors, in more representative samples. The present study involved a large occupational cohort (N=887, mean age=44, 88% male). Questionnaires assessed psychological (i.e., depression, anxiety, vital exhaustion, SF-12 mental health), demographic, socioeconomic (SES), and lifestyle variables. Plasma samples were analyzed for both the presence and level of CMV-specific IgG antibodies (CMV-IgG), used as markers for infection status and viral reactivation, respectively. Also assessed were potential biological mediators of stress-induced reactivation, such as inflammation (C-reactive protein) and HPA function (awakening and diurnal cortisol). Predictors of CMV infection and CMV-IgG among the infected individuals were analyzed using logistic and linear regression analyses, respectively. Confirming prior reports, lower SES (education and job status) was positively associated with infection status. Among those infected (N=329), higher CMV-IgG were associated with increased anxiety (β=.14, p<.05), depression (β=.11, p=.06), vital exhaustion (β=.14, p<.05), and decreased SF-12 mental health (β=-.14, p<.05), adjusting for a range of potential confounders. Exploratory analyses showed that these associations were generally stronger in low SES individuals. We found no evidence that elevated inflammation or HPA-function mediated any of the associations. In the largest study to date, we established associations between CMV-IgG levels and multiple indicators of psychological stress. These results demonstrate the robustness of prior findings, and extend these to a general working population. We propose that stress-induced CMV replication warrants further research as a psychobiological mechanism linking stress, aging and health.

Food reinforcement partially mediates the effect of socioeconomic status on body mass index

Low socioeconomic status (low SES), as defined by income or educational attainment, has been associated with obesity in industrialized nations. Low SES persons have limited resources and may experience food insecurity that increases food reinforcement. Food reinforcement has been positively related to energy intake and weight status, and increased food reinforcement may explain the higher prevalence of obesity among low SES individuals who have restricted access to low-energy-dense foods and non-food reinforcers. We measured annual household income, highest education level completed and food reinforcement in 166 adults of varying body mass index (BMI, kg/m2). Multivariate linear regression analyses controlling for age, sex, minority status, session hunger and the reinforcing value of non-food alternatives showed that household income was related to food reinforcement (p = 0.048) and BMI (p = 0.019), and that food reinforcement was related to BMI (p = 0.0017). Path analyses revealed a significant indirect effect of household income on BMI through food reinforcement, suggesting that the relationship between lower household income and greater BMI was mediated in part by increased food reinforcement. A similar pattern of results was observed when education level was used as the proxy for SES. These findings support the hypothesis that deprivation and restricted food choice associated with low SES enhance food reinforcement, increasing the risk for obesity.

Socioeconomic Status and Health: Mediating and Moderating Factors

Health disparities (differences in health by socioeconomic groups) are a pressing issue in our society. This article provides an overview of a multilevel approach that seeks to understand the mechanisms underlying health disparities by considering factors at the individual, family, and neighborhood levels. In addition, we describe an approach to connecting these factors to various levels of biological processes (systemic inflammation, cellular processes, and genomic pathways) that drive disease pathophysiology. In the second half of the article, we address the question of why some low-socioeconomic-status (low-SES) individuals manage to maintain good physical health. We identify naturally occurring psychosocial factors that help buffer these individuals from adverse physiological responses and pathogenic processes leading to chronic disease. What is protective for low-SES individuals is not the same as what is protective for high-SES individuals, and this needs to be taken into account in interventions aimed at reducing health disparities.

Social Patterning in Body Mass Index (BMI) Among Contemporary Immigrant Groups: The Emergence of a Gradient

Although adult body mass index (BMI) displays considerable social patterning worldwide, the direction and strength of the relationship between BMI and socioeconomic status (SES) varies cross nationally. We examine social gradients in BMI for contemporary U.S. immigrants and evaluate whether their SES-BMI gradient patterns are shaped by underlying gradients in immigrant origin countries and whether they are further patterned by time in the United States. Data come from the New Immigrant Survey, the only nationally representative survey of contemporary immigrants. Results indicate that the inverse SES-BMI gradients observed among this population are strongest among women originating in highly developed countries. After arrival in the United States, however, inverse gradient patterns are driven largely by higher weights among low-SES individuals, particularly those from less-developed countries. We conclude that although certain immigrants appear to be uniquely protected from weight gain, poorer individuals from less-developed countries are doubly disadvantaged; this raises concerns about worsening inequalities in both diet and behavior between the rich and poor upon arrival to the United States.

P.4.a.002 Retrospective and prospective systematic evaluation of the mental effect of ICD implantation

Social class is a robust predictor of health, with risk for disease and mortality increasing towards the lower end of the socioeconomic (SES) spectrum. While certain psychological characteristics, such as high sense of control, can protect low-SES individuals from adverse health outcomes, very few studies have investigated the biological mechanisms underlying these relationships. In this study, we tested whether sense of control mitigated the associations between SES and cortisol activity, and SES and physical health in daily life (i.e., number and severity of physical symptoms). Next, we tested whether individual differences in cortisol secretion would act as a mechanism by which SES and perceived control influenced physical health. In a large national sample from the Midlife in the United States (MIDUS) survey, we found that SES interacted with perceived control in predicting morning cortisol levels, cortisol slopes, number of physical symptoms, and severity of physical symptoms. Specifically, SES disparities in these health outcomes were more pronounced among individuals reporting low levels of perceived control than among individuals endorsing high levels of perceived control. Further, we found that a flatter cortisol slope mediated the link between lower SES and greater number and severity of physical symptoms for those individuals who reported lower levels of perceived control, but not for individuals reporting higher levels of perceived control. These findings suggest that perception of greater control may act as a buffer against the effect of low SES on health-related physiological processes.

Protective Factors for Health Among Low-Socioeconomic-Status Individuals

Low socioeconomic status (SES) is associated with a wide array of poor health outcomes. Nonetheless, some low-SES individuals maintain good physical health despite facing recurrent, severe adversities in life. This article describes a “shift-and-persist” model that explains why that is. The model states that in the midst of adversity, some low-SES children find role models who teach them to trust others, to better regulate their emotions, and to focus on their futures. Over a lifetime, these low-SES individuals may develop an approach to life that prioritizes shifting (accepting stress for what it is and adapting oneself to it) in combination with persisting (enduring life challenges by holding on to meaning and optimism). This combination of shifting and persisting strategies mitigates physiological responses to the barrage of stressors confronted by low-SES individuals and forestalls pathogenic sequelae that lead to chronic disease. Identifying health-relevant protective qualities that naturally occur in some low-SES individuals represents one important approach for improving the health of those who confront a lifetime of disadvantages.

“Shift-and-Persist” Strategies

Some individuals, despite facing recurrent, severe adversities in life such as low socioeconomic status (SES), are nonetheless able to maintain good physical health. This article explores why these individuals deviate from the expected association of low SES and poor health and outlines a “shift-and-persist” model to explain the psychobiological mechanisms involved. This model proposes that, in the midst of adversity, some children find role models who teach them to trust others, better regulate their emotions, and focus on their futures. Over a lifetime, these low-SES children develop an approach to life that prioritizes shifting oneself (accepting stress for what it is and adapting the self through reappraisals) in combination with persisting (enduring life with strength by holding on to meaning and optimism). This combination of shift-and-persist strategies mitigates sympathetic-nervous-system and hypothalamic–pituitary–adrenocortical responses to the barrage of stressors that low-SES individuals confront. This tendency vectors individuals off the trajectory to chronic disease by forestalling pathogenic sequelae of stress reactivity, like insulin resistance, high blood pressure, and systemic inflammation. We outline evidence for the model and argue that efforts to identify resilience-promoting processes are important in this economic climate, given limited resources for improving the financial circumstances of disadvantaged individuals.

Examining the pathways linking lower socioeconomic status and advanced melanoma

Low socioeconomic status (SES) is associated with more advanced melanoma at diagnosis and decreased survival. Exploring the pathways linking lower SES and thicker melanoma will help guide public and professional strategies to reduce deaths. The authors surveyed 566 newly diagnosed patients at Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System, and University of Michigan. SES was assessed by education level (high school/general education degree or less [HS], associate/technical school degree, or ≥college graduate). All data was obtained by self-report among patients within three months of their diagnosis. HS-educated individuals were significantly more likely than college graduates to believe that melanoma was not very serious (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.79-4.71) and were less likely to know the asymmetry, borders (irregular), color (variegated), and diameter (>6 mm) (ABCD) melanoma rule or the difference between melanoma and ordinary skin growths (OR, 0.34 [95% CI, 0.23-0.52] and 0.26 [95% CI, 0.16-0.41] respectively). Physicians were less likely to have ever told HS-educated versus college-educated individuals they were at risk for skin cancer (OR, 0.46; 95% CI, 0.31-0.71) or instructed them on how to examine their skin for signs of melanoma (OR, 0.40; 95% CI, 0.25-0.63). HS-educated individuals were less likely to have received a physician skin examination within the year before diagnosis (OR, 0.54; 95% CI, 0.37-0.80). Decreased melanoma risk perception and knowledge among low-SES individuals and decreased physician communication regarding skin examinations of these individuals may be key components of the consistently observed socioeconomic gradient in mortality. The current findings suggest the need to raise melanoma awareness among lower-SES patients and to increase physician awareness of socioeconomic disparities in clinical communication and care.

Who Converts to Vote-By-Mail? Evidence From a Field Experiment

Over the past decade, permanent absentee voting, or “Vote-by-Mail” (VBM), has become increasingly popular. More than half the U.S. states offer their citizens the option to vote by mail. Yet until now, we have known relatively little about which voters are most likely to use this option when it is available, and what (if anything) can be done to convert voters effectively to permanent VBM status. In this paper, we address both these issues. We conduct a field experiment with all registered voters in California’s San Joaquin County as our subjects, where a randomly chosen treatment group receives postcards – a low-cost conversion option – offering them the chance to easily obtain permanent VBM status. We supplement this experiment with a survey of a subset of these voters, allowing identification of what types of voters are most likely to convert to VBM. Though the low-cost postcard treatment did significantly increase conversion to permanent VBM status, this effect shows up at disproportionately high rates among groups that already vote at higher rates.

Disparities by Ethnicity and Socioeconomic Status in the Use of Weight Loss Treatments

Prior research suggests that ethnic minorities and individuals of low socioeconomic status (SES) may be more likely to attempt weight loss using unproven methods. Data were from a national, random-digit-dial telephone survey of weight loss practices. Seven modalities of weight loss were examined. Multivariable analysis controlled for clinical and sociodemographic variables (including race/ethnicity, SES, and body mass index), as well as self-perception of weight and weight loss attitudes. In multivariable analysis, African Americans (OR, 1.71; 95% CI, 1.05-2.78; p =.03) and Latinos (OR, 1.69; 95% CI, 1.11-2.60; p = .016) were more likely than Caucasians to report use of over-the-counter (OTC) weight loss supplements. African Americans (OR, 0.39; 95% CI, 0.21-0.71; p = .002) and Latinos (OR, 0.56; CI, 0.33-0.97; p = .038) also were less likely than Caucasians to report use of commercial weight loss programs. Higher-SES individuals were more likely than low-SES persons to report self-directed attempts at weight loss (OR, 1.39; CI, 1.00-1.93; p = .05) and commercial programs (OR, 2.12; CI, 1.51-2.97; p < .001) and less likely to report use of OTC supplements (OR, 0.64; CI, 0.47-0.88]; p = .006). African Americans were more likely than Caucasians to report use of medically supervised programs (OR, 1.74; CI, 1.06-2.86; p = .028). With the exception of medically supervised programs, ethnic minorities and low-SES individuals are generally more likely to report use of unproven methods for weight loss and less likely to report use of potentially beneficial treatments. These findings should be explored in more detail. Use of proven treatments for weight management should be encouraged.

Being Poor and Coping With Stress: Health Behaviors and the Risk of Death

Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n = 40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.

Perceptions of Body Weight Among Older Adults: Analyses of the Intersection of Gender, Race, and Socioeconomic Status

We examine the effects of gender, race, and socioeconomic status (SES) on perceptions of body weight among older adults and the role of status-based differences in BMI in these processes. Data are derived from face-to-face interviews with 1,164 adults aged 65 years and older in the District of Columbia and two counties in Maryland in 2000-2001. With "perceived appropriate weight" as the comparison group, multinomial logistic regression analyses indicate that white adults, women, and high-SES individuals are more likely than black adults, men, and low-SES individuals to describe themselves as overweight or obese. However, these disparities are observed only after statistically adjusting for race, gender, and SES disparities in BMI. Moreover, the positive effect of SES on the likelihood of reporting overweight or obese perceptions is strongest among black women. Among low SES individuals, white women are more likely than men and black women to describe themselves as obese (relative to the "perceived appropriate weight" category). Our observations underscore the importance of taking SES contingencies into account when exploring race-gender differences in perceived body weight. This study further contributes to the literature by documenting the important suppression patterns associated with race, gender, and SES differences in BMI.

Socioeconomic inequalities in depression: a meta-analysis.

Low socioeconomic status (SES) is generally associated with high psychiatric morbidity, more disability, and poorer access to health care. Among psychiatric disorders, depression exhibits a more controversial association with SES. The authors carried out a meta-analysis to evaluate the magnitude, shape, and modifiers of such an association. The search found 51 prevalence studies, five incidence studies, and four persistence studies meeting the criteria. A random effects model was applied to the odds ratio of the lowest SES group compared with the highest, and meta-regression was used to assess the dose-response relation and the influence of covariates. Results indicated that low-SES individuals had higher odds of being depressed (odds ratio = 1.81, p < 0.001), but the odds of a new episode (odds ratio = 1.24, p = 0.004) were lower than the odds of persisting depression (odds ratio = 2.06, p < 0.001). A dose-response relation was observed for education and income. Socioeconomic inequality in depression is heterogeneous and varies according to the way psychiatric disorder is measured, to the definition and measurement of SES, and to contextual features such as region and time. Nonetheless, the authors found compelling evidence for socioeconomic inequality in depression. Strategies for tackling inequality in depression are needed, especially in relation to the course of the disorder.