Socioeconomic Status and Health: What We Know and What We Don't
NANCY E. ADLER,
JOAN M. OSTROVE,
Corresponding Author
NANCY E. ADLER
Health Psychology Program, Center for Health and Community, University of California, SF, San Francisco, California 94143-0844, USA
Address for correspondence: Nancy E. Adler, Health Psychology Program, Center for Health and Community, University of California San Francisco, 3333 California Street, Suite 465, California 94143-0844, USA. 415-476-7759 (voice); 415-476-7744 (fax). e-mail: [email protected]Search for more papers by this authorJOAN M. OSTROVE
Department of Psychology, Macalester College, St. Paul, Minnesota 55105, USA
Search for more papers by this authorNANCY E. ADLER,
JOAN M. OSTROVE,
Corresponding Author
NANCY E. ADLER
Health Psychology Program, Center for Health and Community, University of California, SF, San Francisco, California 94143-0844, USA
Address for correspondence: Nancy E. Adler, Health Psychology Program, Center for Health and Community, University of California San Francisco, 3333 California Street, Suite 465, California 94143-0844, USA. 415-476-7759 (voice); 415-476-7744 (fax). e-mail: [email protected]Search for more papers by this authorJOAN M. OSTROVE
Department of Psychology, Macalester College, St. Paul, Minnesota 55105, USA
Search for more papers by this authorFirst published: 06 February 2006
Citations: 1,012
Abstract
Abstract: In the past 15 years, we have seen a marked increase in research on socioeconomic status (SES) and health. Research in the first part of this era examined the nature of the relationship of SES and health, revealing a graded association; SES is important to health not only for those in poverty, but at all levels of SES. On average, the more advantaged individuals are, the better their health. In this paper we examine the data regarding the SES-health gradient, addressing causal direction, generalizability across populations and diseases, and associations with health for different indicators of SES. In the most recent era, researchers are increasingly exploring the mechanisms by which SES exerts an influence on health. There are multiple pathways by which SES determines health; a comprehensive analysis must include macroeconomic contexts and social factors as well as more immediate social environments, individual psychological and behavioral factors, and biological predispositions and processes.
REFERENCES
- 1 Adler, N.E., T. Boyce, M.A. Chesney, S. Cohen, S. Folkman, R.L. Kahn & S.L. Syme. 1993. Socioeconomic status and health: the challenge of the gradient. Am. Psychol. 49: 15–24.
- 2 Adler, N.E. & E. Epel. 1999. Relationship of subjective and objective social status with psychological and physical health in healthy white women. Under review.
- 3 Adler, N.E. B. Singer & M. Coriell. 1999. SES and health: for who the gradient holds. In preparation.
- 4 Bunker, C.H., F.A.M. Ukoli, M.U. Nwankwo et al. 1992. Factors associated with hypertension in Nigerian civil servants. Prevent. Med. 21: 710–722.
- 5 Bunker, J.P., D.S. Gomby & B.H. Kehrer, Eds. 1989. Pathways to health: the role of social factors. The Henry J. Kaiser Family Foundation, Menlo Park, CA.
- 6 Cantwell, M.F., M.T. McKenna, E. McCray & I.M. Onorato. 1998. Tuburculosis and race/ethnicity in the United States: impact of socioeconomic status. Am. J. Respir. Crit. Care Med. 157: 1016–1020.
- 7 Carnon, A.G. et al. 1994. Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer. Br. Med. J. 309: 1054–1057.
- 8 Cunningham, L.S. & J.L. Kelsey. 1984. Epidemiology of musculoskeletal impairments and associated disability. J. Pub. Health 74: 574–579.
- 9 Dayal, H.H., R.N. Power & C. Chiu. 1982. Race and socio-economic status in survival from breast cancer. J. Chronic Dis. 35: 675–683.
- 10 Devessa, S.S. & E.L. Diamond. 1980. Association of breast cancer and cervical cancer incidences with income and education among whites and lacks. J. Nat. Cancer Inst. 65(3): 515–528.
- 11 Diez-Roux, A.V. et al. 1997. Neighborhood environments and coronary heart disease: a multilevel analysis. Am. J. Epidemiol. 146: 48–63.
- 12 Feinstein, J.S. 1993. The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 71: 279–322.
- 13 Fox, A.J., P.O. Goldblatt & D.R. Jones. 1985. Social class mortality differentials: artefact, selection, or life circumstance. J. Epidemiol. Commun. Health 39: 1–8.
- 14 Haan, M., G.A. Kaplan & T. Camacho. 1987. Poverty and health: prospective evidence from the Alameda County Study. Am. J. Epidemiol. 125: 989–998.
- 15 Haan, M.N., G.A. Kaplan & S.L. Syme. 1989. Socioeconomic status and health: old observations and new thoughts. In Pathways to Health: The Role of Social Factors. J.P. Bunker, D.S. Gomby & B.H. Kehrer, Eds.: 76-117. The Henry J. Kaiser Family Foundation, Menlo Park.
- 16 Hakama, M., T. Hakulinen, E. Pukkala, E. Saxen & L. Teppo. 1982. Risk indicators of breast cancer and cervical cancer on ecologic and individual levels. Am. J. Epidemiol. 116(6): 990–1000.
- 17 Helmers, K., D. Posluszny & D.S. Krantz. 1994. Associations of hostility and coronary artery disease: a review of studies. In Anger, Hostility, and the Heart. A. Siegman & T. Smith, Eds. Erlbaum, Hillsdale.
- 18 Kaplan, G.A. & J.E. Keil. 1993. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 88: 1973–1998.
- 19 Kaplan, G.A., E.R. Pamuk, J.W. Lynch, R.D. Cohen & J.L. Balfour. 1996. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. Br. Med. J. 312: 999–1003.
- 20 Kaufman, J.S., R.S. Cooper & D.L. McGee. 1997. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology 8: 621–628.
- 21 Kennedy, B.P., I. Kawachi & D. Prothrow-Stith. 1996. Income distribution and mortality: cross-sectional ecological study of the Robin Hood index in the United States. Br. Med. J. 312: 1004–1007.
- 22 Kogevinas, M. & M. Porta. 1997. Socioeconomic differences in cancer survival: a review of the evidence. IARC Sci. Pub. 138: 177–206.
- 23 Krieger, N. & S. Sidney. 1996. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am. J. Pub. Health 86: 1370–1378.
- 24 Kunst, A.E., C.W.N. Looman & J.P. Mackenbach. 1990. Socioeconomic mortality differences in the Netherlands in 1950-1984: A regional study of cause specific mortality. Soc. Sci. Med., 31: 141–152.
- 25 Macintyre, S., S. MacIver & A. Sooman. 1993. Area, class and health: should we be focusing on places or people? J. Soc. Pol. 22: 213–234.
- 26 Mackenbach, J.P., A.E. Kunst, A.E. Cavelaars, F. Groenhof, J.J. Geurts & EU Working Group on Socioeconomic Inequalities in Health. 1997. Socioeconomic inequalities in morbidity and mortality in Western Europe. Lancet 349: 1655–1659.
- 27 Mackillop, W.J., J. Zhang-Salomons, P.A. Groome, L. Paszat & E. Holowaty. 1997. Socioeconomic status and cancer survival in Ontario. J. Clin. Oncol. 15: 1680–1689.
- 28 Marmot, M.G., M.J. Shipley & G. Rose. 1984. Inequalities in death: specific explanations of a general pattern?. Lancet 1: 1003–1006.
- 29 Matthews, K.A., S.F. Kelsey, E.N. Meilahn, L.H. Kuller & R.R. Wing. 1989. Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am. J. Epidemiol. 129: 1132–1144.
- 30 Marmot, M. 1992. Coronary heart disease: rise and fall of a modern epidemic. In Coronary Heart Disease Epidemiology. M. Marmot & P. Elliott, Eds.: 3-19. Oxford University Press, New York.
- 31 McEwen, B.S. 1998. Protective and damaging effects of stress mediators. N. Engl. J. Med. 338: 171–179.
- 32 O'Campo, P., X. Xue, M.C. Wang & M. Caughy. 1997. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am. J. Pub. Health 87: 1113–1118.
- 33 Ostrove, J.M. & N.E. Adler. 1998. The relationship of socioeconomic status, labor force participation, and health among men and women. J. Health Psychol. 3: 451–463.
- 34 Ostrove, J.M., N.E. Adler, M. Kuppermann & A.E. Washington. Resources and rankings: alternative assessments of socioeconomic status and their relationship to health in an ethnically diverse sample of women. Under review.
- 35 Pamuk, E., D. Makuc, K. Heck, C. Reuben & K. Lochner. 1998. Socioeconomic Status and Health Chartbook. Health, United States, 1998. National Center for Health Statistics, Hyattsville, MD.
- 36 Wadsworth, M.E.J. 1986. Serious illness in childhood and its association with later-life achievement. In Class and Health. Research and Longitudinal Data. R.G. Wilkinson, Ed.: 50-74. Tavistock Publications, New York.
- 37 Williams, D.R. & C. Collins. 1995. U.S. socioeconomic and racial differentials in health: patterns and explanations. Annu. Rev. Sociol. 21: 349–386.
- 38 Wilkinson, R.G. 1992. Income distribution and life expectancy. Br. Med. J. 304: 165–168.
- 39 Winkleby, M.A., D.E. Jatulis, E. Frank & S.P. Fortmann. 1992. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am. J. Pub. Health 82: 816–820.
- 40 Winkleby, M.A., C. Cubbin, D.K. Ahn & H.C. Kraemer. 1999. Pathways by which SES and ethnicity influence cardiovascular disease risk factors. Ann. N.Y. Acad. Sci. 896: this volume.
- 41 Hertzman, C. 1999. The biological embedding of early experience and its effects on health in adulthood. Ann. N.Y. Acad Sci. 896: this volume.
- 42 Williams, D.R. 1999. Race, socioeconomic status, and health: the added effects of racism and discrimination. Ann. N.Y. Acad. Sci. 896: this volume.
- 43 Kaplan, J.R.& S.B. Manuck. 1999. Status, stress, and atherosclerosis: the role of environment and individual behavior. Ann. N.Y. Acad. Sci. 896: this volume.
- 44 McEwen, B.S.& T. Seeman. 1999. Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. Ann. N.Y. Acad. Sci. 896: this volume.
- 45 Anderson, N.B. 1999. Solving the puzzle of SES and health: the need for interdisciplinary, multilevel research. Ann. N.Y. Acad. Sci. 896: this volume.
- 46 Lee, P.R. 1999. Socioeconomic status and health: policy implications in research, public health, and medical care. Ann. N.Y. Acad. Sci. 896: this volume.
- 47 Tarlov, A.R. 1999. Public policy frameworks for improving population health. Ann. N.Y. Acad. Sci. 896: this volume.
- 48 Cohen, S. 1999. Social status and susceptibility to respiratory infections. Ann. N.Y. Acad. Sci. 896: this volume.
