Socioeconomic Status Gradient Research Articles

Is the association between long-term care and subjective well-being socio-economically stratified? Evidence from Europe

ABSTRACT Informal and formal care receipt can affect the overall subjective well-being of care recipients. While much attention has been devoted to the mechanisms by which care use relates to subsequent well-being, no previous research has examined socio-economic stratification in this association. This question is important given that the proportion of disabled older adults relying exclusively on informal caregivers is expected to rise, especially among lower socio-economic status (SES) groups. This study examines SES gradients in the associations of informal and formal care use with subjective well-being, and across four care contexts (Northern, Western, Southern and Eastern Europe) using data on functionally impaired Europeans aged 50 + from the Survey of Health, Ageing & Retirement in Europe (n = 6,012). We investigate how wealth and education moderate the associations between take-up of informal and formal care and changes in subjective well-being (i.e. quality of life and depressive symptoms). We also investigate whether this relationship differs by care context. We find little evidence of SES differences in the association between the onset of care and subjective well-being regardless of the care context. We interpret our findings in light of previous theory and derive implications for future research on the relationship between care receipt and well-being.

Trends in mental health problems among Swedish adolescents: Do school-related factors play a role?

The aim of this study is to investigate the extent to which school-related factors, such as school liking, participation in decision-making, school-related parental support, teachers' support, and school physical environment, explain trends in mental health problems. The problems considered are psychosomatic symptoms (PSS), depressive symptoms (DS), suicidal ideations (SI), and suicide attempts (SA) among Swedish adolescents of varying socioeconomic status (SES) from 2004 to 2020. We analyzed data collected through repeated cross-sectional surveys from 19,873 15-year-old students at schools in a county in Sweden. Boys and girls each constituted 50% of the participants. We fitted linear and logistic regression models to investigate associations between the school-related factors and trends in mental health problems. Increased school-related parental support and school liking were cross-sectionally associated with decreased PSS, DS and SI, with school liking also associated with decreased SA. Conducive school physical environment was also found to be cross-sectionally associated with lower PSS and DS scores. Over time, mental health problems have shown a general increase among adolescents in the low SES group and a decrease among those in the high SES group. While school-related factors explained the improvement in mental health in the high SES group, we found such association only between parental support trends in PSS and DS, along with participation and trends in SA over time among adolescents in the low SES group. The results show that school-related factors play significant roles in influencing adolescent mental health. The influence, however, varied across SES gradients over time. This suggests that working against inequities in school-related factors would help address inequities in mental health.

Changes in family investment in children’s out-of-school education in China, 2010–2018

Despite the growing perception of and concern about the rising cost burden of out-of-school education on families in China, few studies to date have comprehensively examined how family investment in out-of-school education has changed over time. Capitalizing on longitudinal data from the China Family Panel Studies (CFPS) for 2010–2018, this study analyzes the trend in family investment in children’s out-of-school education (measured by children’s rates of participation and families’ absolute and relative monetary expenditure) during that period. We also examine how this trend differs by family socioeconomic status (SES) and by children’s level of schooling (preschool, primary school, junior high school). Our results show a large and growing number of families invest in out-of-school education in their children’s preschool years, with a significant SES gradient. Furthermore, family investment in out-of-school education has increased significantly between 2010 and 2018, with SES disparities in investment persisting and even widening during the same period. These findings carry important implications for understanding educational inequality in contemporary China as well as for policy making to promote educational equality.

The double burden of malnutrition among young Chinese children: a hierarchical structure of socioeconomic inequality indicators

Extant studies have deployed variable-centered methods to examine predictors of children’s nutritional status, and few focus on the double burden of malnutrition among young Chinese children. This paper adopts a person-centered approach and leverages data from large samples of Chinese families (the China Health and Nutrition Survey, CHNS 2004–2015, and China Family Panel Studies, CFPS 2010–2018) to examine trends in the prevalence of stunting, overweight, and stuntingoverweight in early childhood. We developed a hierarchical structure of socioeconomic indicators, including region (Eastern-Central-Western), urbanicity (urban-rural), and family socioeconomic status gradient (four quartiles). We assessed relative risks for malnutrition for 24 subgroups of children from varying socioeconomic strata. Results indicate that the prevalence of stunting decreased consistently while the prevalence of being overweight increased first, followed by a decreasing trend. Moreover, a small group of stuntedoverweight children (4.7%) was identified. Data from the CHNS indicated that children from affluent families in the Central region were prone to being overweight. Data from the CFPS indicate that underprivileged groups (children from poor rural families living in Western China) were at higher risk for both undernutrition and overnutrition than their more advantaged peers. The findings suggest that children in poor, rural areas in Western China should be targeted for malnutrition alleviation.

Are there social inequalities in caesarean section rates in Europe?

Abstract Background Lower socioeconomic status (SES) is strongly associated with adverse perinatal health outcome, such as preterm birth and stillbirth. We investigated whether the caesarean section (CS) rate, which may reflect a greater prevalence of maternal health complications, was also higher in disadvantaged populations. Methods The study uses aggregate routine birth data from European countries collected with the Euro-Peristat federated analysis protocol. We analysed CS rates (total births by CS/total births) by SES from 2015 to 2020. Mothers’ education level (primary/lower secondary; upper secondary; postsecondary) was the preferred SES indicator; if unavailable, parents’ occupation or area-based deprivation scores were used and harmonised into three groups (low, medium, high). Results 17 countries provided data on maternal education, 5 on area-based deprivation, 1 on parents’ occupation. CS rates ranged from 16.7% (Lithuania) to 48.5% (Cyprus) in the low SES group and from 16.8% (the Netherlands) to 55.2% (Cyprus) in the high SES group. Patterns across SES groups were diverse, with greater use of CS in higher SES groups (Croatia: 19.6%, 24.1%, 26.7% and Ireland: 30.3%, 33.4%, 35.5% for low, medium and high SES respectively), whereas elsewhere, more disadvantaged SES groups had higher CS rates: Italy: 37.1%, 35.2%, 33.7%, Denmark: 22.0%, 21.9%; 19.8% and Luxembourg: 34.5%, 33.2%, 29.9%. In some countries, rates were similar across groups (France: 21.3%, 20.7%, 21.3% and the Netherlands: 17.2%, 17.0%, 16.8%). Risk ratios of CS in low versus high SES groups ranged from 0.74 (95% CI R0.70-0.77) in Croatia to 1.15 (95% CI 1.12-1.19) in Luxembourg. Conclusions Our results do not show that CS was consistently associated with social disadvantage. Instead, we found surprising variations in the SES gradient between countries, raising questions about CS practices and their interaction with maternal characteristics in European countries.

Socio-economic distribution of modifiable risk factors for cardiovascular diseases: An analysis of the national longitudinal ageing study in India

The association of socioeconomic status (SES) with modifiable risk factors for cardiovascular diseases (CVDs) is unclear in developing nations. We studied SES variations in major risk factors and their percentage distribution for adults aged 45 years or above in India. Using individual records of 59,672 individuals aged 45 years or above from the Longitudinal Ageing Study in India Wave 1 (cross-sectional study design), 2017–18, we chart age-and-sex-adjusted prevalence of clinical risk factors such as measured high blood pressure, hypertension, overweight, obesity, central adiposity and self-reported high blood glucose; and lifestyle risk factors such as excessive use of alcohol, current use of smoking and smokeless tobacco and physical inactivity across SES variables of education, quintiles of mean per capita expenditure and social caste. Multivariable analysis was used to explore the SES gradient of risk factors. The sample used in the study is predominantly rural (69.9%), illiterate (50.7%), has more females (54.2%), and belongs to other backward classes (45.6%). Prevalence of high blood pressure, overweight, obesity, central adiposity, high blood glucose, and physical inactivity increased; and excessive alcohol consumption and current use of smoking/smokeless tobacco decreased with income, education, and social caste. However, no significant income gradient was noted for lifestyle risk factors except the use of smokeless tobacco. The income gradient was largest for central adiposity (waist-circumference) with a difference of 23.4 percentage points as it increased from 38.7% among the poorest to 62.1% among the richest. The major burden of CVDs risk factors among older adults aged 45+ years falls among high SES.

The Association Between Socioeconomic Status and Use of Time in Australian Children and Adolescents

PurposeThere are well-known socioeconomic status (SES) gradients in children and adolescents' health which may be associated with time use. Our aim was to evaluate the association between Australian children's 24-hour time use and SES using four separate surveys from 2005 to 2021. MethodsTime use was assessed in 4526 8-19-year-olds from the 2005 Health of Young Victorians, 2007 National Children's Nutrition and Physical Activity, 2015 Child Health CheckPoint, and 2019-21 Life on Holidays study. Each survey used the same reliable, valid, 24-hour recall instrument. SES was quantified using tertiles of household income, education, and postcode-level measures. Compositional data analysis was used to compare 24-hour time use between SES categories, adjusting for age, sex, and puberty. ResultsTime-use compositions differed significantly by SES in each survey. Relative to the lowest SES, children from the highest SES accumulated on average 31 min/day more School-related time, 6 min/day more Passive Transport and 6 min/day more Self-care. Conversely, they accumulated 30 min/day less Screen Time (which included computer time), 11 min/day less sleep, and spent 7 min/day less in Domestic/Social activities. There were only small differences in Quiet Time and Physical Activity. DiscussionSES-related differences in time use were robust across ages 8-19, a 16-year timespan, diverse Australian geographical regions, and using different SES metrics. The exchange of about 30 min/day between School-related activities and Screen Time amounts to >180 hours extra exposure to School-related activities annually in the highest SES category relative to the lowest, equivalent to >6 weeks of school time per year.

The path increasingly travelled: Vocational entry qualifications, socioeconomic status and university outcomes

AbstractMany countries have introduced flexibility in their admissions equivalents for tertiary education, allowing students to apply with vocational rather than academic qualifications at upper secondary level. However, entrants with vocational qualifications are generally less likely to succeed at university. Students from disadvantaged backgrounds are also, on average, less likely to succeed: they are more likely to drop out, or graduate with a lower class degree, even when they have the same prior attainment scores and take the same university course. Rich individual‐level data in England drawn from administrative records allow us to link outcomes at university with social background and attainment and qualification routes at school, going back to lower secondary level, before academic and vocational pathways diverge. We can thus use the English example to explore whether the relative lack of success of students from low socioeconomic status (SES) backgrounds is in part because they are more likely to enter university with non‐traditional qualifications that offer less effective preparation for study. Our results reveal a significant penalty associated with entering university with these vocational qualifications. Controlling for qualification type reduces the SES gradient in dropping out of university by 42%, and graduation with a lower class degree by 28%, although significant SES gradients in success still remain. There is a tension between allowing students from lower SES backgrounds to use vocational routes to enter university and these persistent gaps in university outcomes. Countries using both vocational and academic routes as pathways to university should be aware of this potential conflict.

The inverse relationship between income and the prevalence of dementia in high-income nations

Dementia continues to be a serious problem worldwide. A negative relationship between the prevalence of dementia and the level of socioeconomic status (SES), such as income can be observed in most countries. The aim of the study in this paper is to explore the possible pathways that contribute to this negative relationship. This article analyses and presents three possible causes of health inequalities between SES gradients in dementia and possible solutions to them, through a large collection of articles. Differences in health literacy, housing levels and social support caused by SES such as different incomes lead to social inequalities in health through behavioral/cultural pathway material pathway and psychosocial pathway respectively.

Waiting times in healthcare: equal treatment for equal need?

BackgroundIn many universal health systems, waiting times act as a non-monetary rationing mechanism, one that should be based on clinical need rather than the ability to pay. However, there is growing evidence that among patients with similar levels of need, waiting times often differ according to socioeconomic status. The mechanisms underlying inequality in access remain unclear.MethodsUsing data for Spain, we study whether waiting times for primary and specialist care depend on patients’ socioeconomic status (SES). Additionally, we make use of the continuous nature of our data to explore whether the SES-related differences in waiting times found for specialist consultations vary among different points of the waiting time distribution.ResultsOur results reveal the presence of a SES gradient in waiting times for specialist services explained on the basis of education, employment status and income. In addition, for primary care, we found evidence of a slightly more moderate SES gradient mostly based on employment status. Furthermore, although quantile regression estimates indicated the presence of a SES gradient within the distribution of waiting times for specialist visits, the SES differences attenuated in the context of longer waiting times in the public sector but did not disappear.ConclusionOur findings suggest the principle of equal treatment for equal need, assumed to be inherent to national health systems such as the Spanish system, is not applied in practice. Determining the mechanism(s) underlying this selective barrier to healthcare is of crucial importance for policymakers, especially in the current COVID-19 health and economic crises, which could exacerbate these inequalities as increasing numbers of treatments are having to be postponed.

The Diabetes Health Plan and Healthcare Utilization Among Beneficiaries with Low Incomes

BackgroundThe socioeconomic status (SES) gradient in hospital and emergency room utilization among adults with type 2 diabetes (T2DM) is partially driven by cost-related non-adherence.ObjectiveTo test the impact of the Diabetes Health Plan (DHP), a diabetes-specific health plan incorporating value-based insurance design principles on healthcare utilization among low-income adults with T2DM.DesignTo examine the impact of the DHP on healthcare utilization, we employed a difference-in-differences (DID) study design with a propensity-matched comparison group. We modeled count and dichotomous outcomes using Poisson and logit models, respectively.ParticipantsCohort of adults (18–64) with T2DM, with an annual household income <$ 30,000, and who were continuously enrolled in an employer-sponsored UnitedHealthcare plan for at least 2 years between 2009 and 2014.InterventionsThe DHP reduces or eliminates out-of-pocket costs for disease management visits, diabetes-related medicines, and diabetes self-monitoring supplies. The DHP also provides access to diabetes-specific telephone case management as well as other online resources.Main MeasuresNumber of disease management visits (N = 1732), any emergency room utilization (N = 1758), and any hospitalization (N = 1733), within the year.Key ResultsDID models predicting disease management visits suggested that DHP-exposed beneficiaries had 1.7 fewer in-person disease management visits per year (− 1.70 [95% CI: − 2.19, − 1.20], p < 0.001), on average, than comparison beneficiaries. Models for emergency room (0.00 [95% CI: − 0.06, 0.06], p = 0.966) and hospital utilization (− 0.03 [95% CI: − 0.08, − 0.01], p = 0.164) did not demonstrate statistically significant changes associated with DHP exposure.ConclusionsWhile no relationship between DHP exposure and high-cost utilization was observed in the short term, fewer in-person disease management visits were observed. Future studies are needed to determine the clinical implications of these findings.

Is early formal childcare an equalizer? How attending childcare and education centres affects children’s cognitive and socio-emotional skills in Germany

Abstract This study examines the role of formal childcare under the age of three in tackling the early social inequality in children’s cognitive and socio-emotional competencies in Germany, by drawing on the new-born sample of the National Educational Panel Study. To this end, we study first whether the access to formal early childhood education and care (ECEC) differs by parents’ socio-economic status (SES), by means of logistic regressions. Second, we analyse the main effect of attending ECEC institutions. Third, we ask whether the effect of attending ECEC on children’s competencies differs by SES. We perform OLS regression with inverse probability weighting to address confounding bias possibly arising from selection into care arrangements. Moreover, we developed a counterfactual analysis to compare the observed SES gradient in children’s competencies with two alternative extreme scenarios, one characterized by the absence of ECEC, and the other by universalistic access to ECEC. Our findings show that ECEC attendance is socially stratified and suggest an equalizing impact of ECEC institutions. We conclude that ECEC can play a compensatory function on social stratification, by making the expansion of formal early childcare expenditures a fruitful investment for more equal opportunities.

A Tale of Two Offices: The Socioeconomic Environment’s Effect on Job Performance While Working From Home

In response to the global COVID-19 pandemic, many businesses closed their offices and asked their employees to work from home. The transition to remote work has yielded performance gains for many companies; so much so that many firms are planning to continue to use remote work after the pandemic subsides. Nevertheless, such benefits may not be distributed equally throughout the workforce. Drawing on the sociocognitive theory of socioeconomic status (SES), we predict that one’s home working environment features salient signals of their social status that affect their performance. Based on a sample of 304 remote workers from within the United States collected during the COVID-19 shutdown, we find that individuals whose home offices connote higher levels of SES report a greater sense of control over their environment, which ultimately is associated with higher levels of perceived job performance. Furthermore, we find that the more time an individual spends in their home office, the stronger the relationship between their environment-based SES and their personal sense of control. Taken as a whole, our findings suggest that because home working environments are arrayed along an SES gradient, they present another mechanism by which pre-existing inequalities may be made salient as a result of the COVID-19 pandemic.

Does Social and Economic Disadvantage Predict Lower Engagement with Parenting Interventions? An Integrative Analysis Using Individual Participant Data

There is a social gradient to the determinants of health; low socioeconomic status (SES) has been linked to reduced educational attainment and employment prospects, which in turn affect physical and mental wellbeing. One goal of preventive interventions, such as parenting programs, is to reduce these health inequalities by supporting families with difficulties that are often patterned by SES. Despite these intentions, a recent individual participant data (IPD) meta-analysis of the Incredible Years (IY) parenting program found no evidence for differential benefit by socioeconomic disadvantage (Gardner et al. in Public Health Resesearch 5, 1–144, 2017). However, it did not examine whether this was influenced by engagement in the intervention. Using intervention arm data from this pooled dataset (13 trials; N = 1078), we examined whether there was an SES gradient to intervention attendance (an indicator of engagement). We ran mixed-effects Poisson regression models to estimate incidence rate ratios (IRRs) for program attendance for each of five (binary) markers of SES: low income; unemployment; low education status; teen parent; and lone parent status. The multilevel structure of the data allowed for comparison of within-trial and between-trial effects, including tests for contextual effects. We found evidence that low SES was associated with reduced attendance at parenting programs—an 8–19% reduction depending on the SES marker. However, there was no evidence that this association is impacted by differences in SES composition between trials or by the attendance levels of higher-SES families. The findings underscore the importance of developing and prioritizing strategies that enable engagement in parenting interventions and encourage program attendance by low-SES families.

The gendered playing field: Family socioeconomic status and national gender inequality in adolescents’ out-of-school physical activity

Research has shown that both gender and family socioeconomic status (SES) are important determinants of adolescents' physical activity (PA). This study expands our current knowledge by exploring the moderating role of family SES on gender differences in adolescents' out-of-school PA. We also examine whether this moderating effect varies across countries with different levels of gender inequality. Based on existing empirical studies and theoretical framework, it is hypothesized that 1) gender differences in out-of-school PA would be smaller among adolescents from higher SES families due to them being more likely to share egalitarian gender norms, and 2) this SES gradient in gender differences in adolescents' out-of-school PA would be more salient in countries with lower levels of gender inequality. A total of 316,657 15-year-old adolescents in 50 countries from the 2015 Programme for International Student Assessment (PISA) survey were analyzed. Our multilevel negative binomial regression models show that the gender gap in out-of-school PA is mitigated among families with higher SES, but this moderating role of family SES is less noticeable in countries with higher levels of national gender inequality. Our findings suggest the importance of egalitarian gender culture at both individual and macro-level in understanding gender disparities in adolescents’ PA.

The role of socioeconomic status gradients for the child's developmental health

ABSTRACT Gradients across socioeconomic status occur for many children's health and improvement in high-income countries. The objective is to explore infant growth and child development in four developed countries around the socioeconomic landscape. In this paper, Structural Equation Modeling (SEM) enhances the socioeconomic status gradients for the child's developmental health. The proposed model develops the socioeconomic status is related to a huge list of health issues, including low birth weight, cardiovascular diseases, hypertension, arthritis, diabetes, and cancer, regardless of whether it is determined by income, education, or profession. This is a global phenomenon, seen in countries with low, medium, and high incomes. The size of disparities found in scores and percentiles across neighborhoods is comparable to the results of more developed growth forecasters such as sex. These results have significant consequences for the nature of tailored, efficient, and timely programs to support early childhood success.

Immigration Shocks and Marriage Market Sorting

Recent work shows a puzzle in the early twentieth century United States: as intergenerational mobility decreased, assortative mating increased. We argue that these two facts are causally related by using a shock to intergenerational mobility caused by falling immigration with the Quota Acts of 1921 and 1924, which essentially closed the borders to European immigration. We find that lower immigration caused lower intergenerational mobility, causing assortative mating to increase. We also look at the choice of nativity of spouse, finding that socioeconomic status gradients increase for every outcome as immigration decreases.

Gender gaps in cognitive and noncognitive skills among adolescents in India

Gender gaps in skills exist around the world but differ remarkably among countries. This paper uses a unique data set with more than 20,000 adolescents in rural India to explore gender gaps in cognitive and noncognitive skills. We find that boys have considerable advantages over girls on several indicators of cognitive and noncognitive skills that remains robust to a wide range of controls and specification choices. We also examine the correlates of cognitive and noncognitive outcomes, paying close attention to socioeconomic status (SES) and pro-female gender attitudes. We find a steep positive gradient in SES as well as for pro-female gender attitudes, with stronger associations between the SES gradient and skills. Further, high socioeconomic status and more pro-female gender attitudes are both strongly correlated with reducing the gender gap in cognitive and noncognitive outcomes.

The socioeconomic gradient in child health and noncognitive skills: Evidence from the Czech Republic

We investigate the presence of a socioeconomic status (SES) gradient in children’s health and noncognitive skill development, and its evolution with child age using cohort data from the Czech Republic. We show that family SES are positively associated with better child health. These effects start to emerge at age 3 and are persistent for all subsequent ages. We find a modest strengthening of the gradient as the children grow older. Similarly, at the lowest distribution of average family income, children lag in their noncognitive skills. We find evidence that children enter school with substantial differences in noncognitive skill endowments based on family SES. This correlation persists when controlling for poor health at birth, the roles of specific and chronic health problems, housing conditions, and partner characteristics. Maternal health status explains some of the association between family income and child noncognitive skills. We account for the endogeniety of SES and non-linearities in measures.

Socioeconomic Status, Institutional Power, and Body Mass Index among Chinese Adults.

Despite the vast literature on the socioeconomic status (SES) gradient of obesity among adult people, no study has investigated the relationship between institutional power and body mass index. Using national survey data from the “China Labor-force Dynamics Survey 2016” (CLDS 2016), multistage cluster-stratified probability proportional to size (PPS) sampling was employed to select cases from 29 provinces, cities, and autonomous regions in China. This study adopts an institutional approach to explore the influences of SES and institutional power on the state of being overweight or severely overweight (obese) among Chinese adults. It is shown that SES has a non-linear influence on being overweight or obese, higher education has a negative effect on being overweight or obese, income has an inverted U-shaped effect on being overweight or obese, and having a managerial or administrative job has a positive effect on being overweight but less so on obesity. These findings reveal that disparities in health outcome and risks are due to inequality in SES. The work unit is a stronger predictor of adults being overweight or obese than occupation. Working in the public sector has a positive effect on being overweight relative to working in the private sector, and only state institutions and government departments have a positive association with obesity. Our results indicate that institutional structure still has effects on individuals’ life chances in the era of China’s market transition.