Socioeconomic Status and Health Disparity in the United States

Abstract

Low socioeconomic status (SES) has been associated with high rates of many chronic diseases. This study was a cluster analysis of data from 9,830 adults in the 1994-96 Continuing Survey of Food Intakes by the Individuals (1994-96 CSFII) in order to characterize more fully the biologic and social factors that might be associated with chronic diseases. The study employed cluster analysis to define three SES groups (low, middle, and high) based on income, education, age, gender, and race. A significant increase was found in self-reported diabetes, hypertension, heart disease, obesity, and stroke across these groups, being highest in the lowest SES group. Results revealed that health disparity in the U.S. may be substantial, with some population groups bearing a disproportionate burden of chronic diseases.     

Causal connections between socio-economic status and health: reciprocal effects and mediating mechanisms

Using structural equation modeling techniques on data from a nationally representative longitudinal survey, we first explored the reciprocal relationships between socio-economic status (SES) and health status. We then estimated the degree to which health-related lifestyles/behaviors and psychosocial distress are mediating mechanisms of these relationships. As predicted, SES positively affects health, and health positively affects SES. Although the causal path from SES to health is stronger than the reverse, these findings confirmed the hypothesis that both social causation and health selection contribute to social inequalities in health. In terms of the mediating mechanisms through which SES and health affect each other, more than a third of the overall SES-health relationship was accounted for by health-related lifestyles/behaviors and psychosocial distress. A notable part of the effect of SES on health is due to differences in psychological distress, with the effects of health-related lifestyles/behaviors being much smaller. On the other hand, in terms of the effects of health on SES, differences in weight and sleeping behavior are more important than psychological distress.     

The resources that matter: fundamental social causes of health disparities and the challenge of intelligence

A robust and very persistent association between indicators of socioeconomic status (SES) and the onset of life-threatening disease is a prominent concern of medical sociology. The persistence of the association over time and its generality across very different places suggests that no fixed set of intervening risk and protective factors can account for the connection. Instead, fundamental-cause theory views SES-related resources of knowledge, money, power prestige, and beneficial social connections as flexible resources that allow people to avoid risks and adopt protective strategies no matter what the risk and protective factors are in a given place or time. Recently, however, intelligence has been proposed as an alternative flexible resource that could fully account for the association between SES and health and thereby find its place as the epidemiologists' "elusive fundamental cause" (Gottfredson 2004). We examine the direct effects of intelligence test scores and adult SES in two data sets containing measures of intelligence, SES, and health. In analyses of prospective data from both the Wisconsin Longitudinal Study and the Health and Retirement Survey, we find little evidence of a direct effect of intelligence on health once adult education and income are held constant. In contrast, the significant effects of education and income on health change very little when intelligence is controlled. Although data limitations do not allow a definitive resolution of the issue, this evidence is inconsistent with the claim that intelligence is the elusive fundamental cause of health disparities, and instead supports the idea that the flexible resources people actively use to gain a health advantage are the SES-related resources of knowledge, money, power, prestige, and beneficial social connections.     

Racial/Ethnic Disparities in Health: The Role of Lifestyle,Education, Income,and Wealth

Abstract

This article addresses the persistent relationship between race/ethnicity, SES, health-related lifestyle behaviors, and self-reported health using data from the 1995 National Health Interview Survey and its topical supplements. Through a series of models, we found that both SES (education, income, home ownership, and house and business monetary value) and health-related lifestyle behaviors (physical activity, nutrition awareness, and smoking) contribute to racial/ethnic disparities in self-reported health. Further, the impact of education on smoking behavior and self-reported health differs by race/ethnicity, with non-Hispanic whites receiving greater health benefits from education than African Americans and Hispanics. Although SES and lifestyle behaviors are indirect paths through which race/ethnicity affects health, the relationship between SES and health also is shaped by racial/ethnic status.     

Socioeconomic Status,Psychosocial Factors and Health in Urban Guyana

Abstract

This study seeks to understand the relationship between socioeconomic status (SES) and self-reported indicators of physical and mental health in an urban Third World context. The data come from a probability sample of 654 adult residents of Georgetown, Guyana. There is a significant inverse association between formal education and morbidity for four of the six measures of health status. In this research the extent to which self-concept, health behaviors, stress and social ties are linked to health status and SES, and can explain SES differences in health status is explored. Psychosocial factors, especially the self-concept measures (self-esteem and mastery) play a moderate role in accounting for educational differences in health status.     

Linear trend or graded association: an international study of objective and subjective socioeconomic inequalities in self-rated health

Abstract

Despite the well-documented socioeconomic inequalities in health, it is less known about how objective and subjective socioeconomic statuses (SES) are related to self-rated health (SRH) in an international context. Using data from the 2007 International Social Survey Program (ISSP) that included 33 countries across six continents (N?=?40,049), we found that for objective SES, either education or income, or both were related to SRH as general linear trends (i.e., higher SES was associated with better SRH as a general trend) rather than graded associations (i.e., adjacent levels of SES were associated with SRH in a dose–response relationship). After controlling for subjective SES, the magnitude of the associations between objective SES and SRH reduced, whereas the associations between subjective SES and SRH remained strong in nearly all countries. Findings suggested that more rigorous analyses are needed to clearly describe the SES-health associations, and future international research should expand to include subjective measures of SES.     

Health outcomes of elementary school students in New Brunswick. The education perspective

With data from the New Brunswick School Climate Study (N = 6,883 students from 147 schools), this study examined individual differences in and school effects on health outcomes of students. Results of hierarchical linear modeling showed that females reported experiencing more physical health problems, eating less healthy food, and doing fewer exercises than males. Students of high socioeconomic status (SES) reported eating more healthy food and doing more exercises than students of low SES. Native students reported experiencing more physical health problems and eating less healthy food than nonnative students. Students of single parents reported eating more healthy food and exercising more than students of both parents. Schools showed effects on health outcomes over and above the effects of students. Students in schools with high SES and positive disciplinary climate reported fewer physical and mental health problems. Students in large schools reported less healthy food intake and fewer physical exercises.     

Adolescents’ Subjective Social Status Predicts Day‐to‐Day Mental Health and Future Substance Use

Adolescents’ subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross‐sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low‐SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18‐month follow‐up. Results showed that with each perceived step “up” the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.     

Cross-Cultural Perspectives on Illness and Wellness: Implications for Depression1

The purpose of this research is to determine the relationships among race, socioeconomic status (SES) and depressive symptomatology. Contrary to the findings of over 20 years ofpsychiatric epidemiology, two research teams have recently reported that Blacks, primarily those oflow SES, are significantly more depressed than Whites occupying the same status. Using the same epidemiologic field survey data as one of these research groups (Whites = 1,648; Blacks = 450), the issues of race, SES, and depression are reopened for examination. Depressive symptomatology was measured by the Florida Health Study Depression Scale. The findings indicated that, in general, Blacks had significantly higher levels of depressive symptomatology than Whites. However, these differences were eliminated once SES, a composite of occupational status, education, and household income, was statistically controlled. Race, in other words, was not found to be an independent predictor of depression. The author concludes that poverty is hazardous to one's psychological well-being and that race, by itself, is merely a proxy for socioeconomic status. In addition, methodological issues associated with the conceptualization and opera~ tionalization of socioeconomic status and mental health constructs such as depression are explored.     

“It's Hardly Fair to Bring a Child Into the World With the Way Things Look…”: Anomie,Mistrust, and the Impact of Race,SES, and Gender

This article examines the impact of race, socioeconomic status (SES ), and gender on subjective outlook using anomie and general mistrust as indicators. Specifically, this study addresses the following questions: (1) How do African Americans and whites compare with respect to anomie and mistrust? (2) Do racial differences in anomie and mistrust vary by SES ? (3) Do African American women have higher levels of anomie and mistrust than whites and African American men? and (4) Are African Americans becoming more or less trusting and anomic over time? Using data from the General Social Survey (GSS) (1972–2014), the analysis reveals significant racial differences in social outlook as measured by anomie and mistrust. African Americans indicate higher levels of both anomie and mistrust than whites even after controls for SES and the other variables. The racial gap in anomie and mistrust increases with increases in SES . Being African American and female is associated with higher levels of anomie but not mistrust. African American mistrust decreases relative to whites over time. More affluent African Americans’ anomie levels slightly increase relative to similar whites over time. Explanations using the “rage of a privileged class” and “intersectionality” ideas are evaluated.     

Cross-cultural perspectives on illness and wellness: Implications for depression

The purpose of this research is to determine the relationships among race, socioeconomic status (SES) and depressive symptomatology. Contrary to the findings of over 20 years of psychiatric epidemiology, two research teams have recently reported that Blacks, primarily those of low SES, are significantly more depressed than Whites occupying the same status. Using the same epidemiologic field survey data as one of these research groups (Whites=1,648; Blacks=450), the issues of race, SES, and depression are reopened for examination. Depressive symptomatology was measured by the Florida Health Study Depression Scale. The findings indicated that, in general, Blacks had significantly higher levels of depressive symptomatology than Whites. However, these differences were eliminated once SES, a composite of occupational status, education, and household income, was statistically controlled. Race, in other words, was not found to be an independent predictor of depression. The author concludes that poverty is hazardous to one's psychological well-being and that race, by itself, is merely a proxy for socioeconomic status. In addition, methodological issues associated with the conceptualization and operationalization of socioeconomic status and mental health constructs such as depression are explored.Paper presented at the Conference on Multicultural Perspectives on Mental Illness, May 1994, St. John's University.     

Effects of urbanism,race, and class on happiness and physical health

The joint effects of urbanism, race, and socioeconomic status on self reported health and happiness are studied. Relationships of “neighborhood fear” and unemployment with health and happiness are also studied within different urban/rural race‐class categories. It is hypothesized that 1) lower socioeconomic status (SES) blacks residing in central cities will report the poorest health and lowest happiness and 2) “neighborhood fear” and unemployment will be most strongly related to health and happiness among central city lower SES blacks. The sample is pooled data from the 1972–1983 National Opinion Research Center (NORC) General Social Surveys. Findings indicate that urbanism has a modest negative relationship to happiness, but low SES urban blacks are not uniquely low in happiness. Contrary to the central city hypothesis, neighborhood fear is most strongly related to health among suburban blacks with less than high school or high school graduation attainment. A relative deprivation explanation is advanced. Unemployment negatively relates to the happiness of blacks and whites in a variety of urban‐SES‐race categories.     

Histories of poverty and self-rated health trajectories

This paper investigates the dynamic relationship between poverty histories and self-rated health trajectories. We are interested in patterns of change in individuals' health over time and the ways in which such patterns are structured by continuity and change in poverty experiences. Data, collected for adults aged 25 and older in 1984 (N = 7,258), are from the 1968-1996 annual waves of Panel Study of Income Dynamics (PSID). Individual growth curves allow us to investigate health trajectories as continuous processes, as well as individual and group heterogeneity in these trajectories. We find that, on average, health deteriorates slowly over time, but there is significant variation in health in 1984 and the rate at which health declines. Histories of poverty partly accounted for the sources of individual differences in self-rated health in 1984, but they were not related to health change over time. Although increasing incomes were better for self-rated health than falling incomes, current economic circumstances did not erase the health effects of earlier poverty experiences.     

Work Trajectories of Female and Male Immigrants in Spain

This article aims to examine in depth the work trajectories of individuals over time, in order to provide a wider perspective of the employment history of immigrants compared to native people, by gender and for more than one decade (2005–2017) in Spain. We use microdata (cohort and multivariate analysis) from the Labour Force Survey and carry out a comparison for three groups: the Spanish born in Spain, the Spanish born abroad, and the non-Spanish born abroad. The results confirm that the non-Spanish born-abroad group is characterized by the existence of segmented assimilation. All foreigners suffered a loss in their work trajectories, since their employment rate in 2017 has as yet neither reached the level of the last years of the previous economic expansion nor the level of the previous cohorts at the same age.     

Family Structure and Child Mortality in Sub‐Saharan Africa: Cross‐National Effects of Polygyny

This study applies multilevel logistic regression to Demographic and Health Survey data from 22 sub‐Saharan African countries to examine whether the relationship between child mortality and family structure, with a specific emphasis on polygyny, varies cross‐nationally and over time. Hypotheses were developed on the basis of competing theories on the relationship between child health and family structure. Although children of mothers in polygynous marriages are more likely to die than those of mothers in monogamous unions, the relationship is constant across time. Familial factors including education, socioeconomic status (SES), and urban residence accounted for most of the observed cross‐national variation associated with polygyny. Consequently, improving maternal education and household SES would greatly benefit child health in sub‐Saharan Africa.     

How Migrant Status Affects Health Beyond Socioeconomic Status: Evidence from Austria

The debate on health inequalities usually focuses on the interplay between socioeconomic status (SES) and health, where it is widely accepted that the former influences the latter. However, little is known on whether the influence of SES on health is sufficient to explain the observed lower health statuses among various migrant groups in European countries. This paper presents a model that integrates the influences of SES and migrant status on health and tests its implications empirically for Austria. Several ordered logit regressions are performed, whose results show that particular migrant groups are disadvantaged with respect to health. In addition, the overall influence of migrant status on health is considerably stronger for women than for men, while health status of men is influenced by interactions between migrant status and occupational status.     

Race, socioeconomic status, and psychological distress: an examination of differential vulnerability

Using data from a 1985 epidemiological survey of 2,115 adults in Florida, this research has two goals: it tests the proposition that race and SES jointly influence mental health, and it examines the contribution of undesirable life events and economic problems to psychological distress across SES groups. Using multiple indicators of SES and mental health, we found that the evidence for a model of joint influence of race and SES on mental health varied with the measures being used. The most general conclusion is that SES interacts with race to increase psychological symptoms of distress. Partitioning the sample into three SES categories (low, middle, high), we examined the contribution of stressors to the greater distress among lower-SES blacks compared to other blacks and lower-SES whites. Lower-SES blacks are more vulnerable than lower-SES whites to the impact of undesirable events, but they are less vulnerable than lower-SES whites to the impact of economic problems. Lower-SES blacks are more vulnerable than middle-SES blacks to the impact of both discrete events and economic problems. Limitations of the study indicate a need for future longitudinal studies with measures of coping resources and support networks to further our understanding of the race, social class and psychological distress relationship.     

Converging health inequalities in later life--an artifact of mortality selection

An emergent issue in the health inequalities debate is how socioeconomic status (SES) and physical health relate over the life course. Many studies indicate that the SES-health relationship diminishes in later life. The present research tests the hypothesis that this convergence in health inequalities is an artifact of mortality selection, which biases downwards the "true" association between SES and health in later life. By including respondents who had subsequently died or were loss-to-followup into the analysis, I assess the sensitivity of the age-specific association between education and health to sample selection processes. I study U.S. adults followed for approximately ten years using the NHANES I Epidemiologic Followup Study. Results based on the surviving sample are robust to the inclusion of people selected out of the sample due to mortality or attrition. Sample selection biases do not appear to explain the convergence in health inequalities in late life.