Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men
Section snippets
Social position and health
For much of the 20th Century, and especially over the past 25 years, epidemiological research has focused on the relation between social position and health (Davey Smith, 1997). In one sense, this relation appears straightforward. Poorer health is associated with social disadvantage. In the UK at least, this has been true for most overall health indicators since the 19th century (Chadwick, 1965; Stevenson, 1923; Logan, 1954; Black, Morris, Smith, & Townsend, 1980; Davey Smith, Gunnell, &
Study population
The current investigation is based on a cohort of 5232 men aged 35–64 years (mean age 48) recruited from 27 workplaces in Scotland between 1970 and 1973. The workplaces were chosen to provide a sample of the occupational spectrum of the male working population. They included engineering, manufacturing and petrochemical plants; a publishing house, civil service departments; administrative and professional divisions from British Rail; legal and dental offices; architectural institutes and banks (
Results
In general, disadvantageous social position was associated with an unfavourable profile of disease risk factors whatever the measure of social position used (Table 1). The exceptions to this rule were plasma cholesterol, perceived stress, and job satisfaction where advantageous social position was associated with an adverse risk profile. Nine hundred and six men described themselves as “managers”, 459 as “foremen” and 3867 as “employees”. Foremen reported higher stress than employees and only
Health and social position
Social disadvantage was associated with poorer health (as indexed by all cause mortality) in this population, whatever the measure of social position used. Having a father in a manual occupation was the strongest predictor of poorer health. Other strong predictors were height and car access. Workplace status, current occupation, educational status and area of residence were all strongly associated with health in age-adjusted analyses. Adjustment for health behaviours and physiological risk
Acknowledgements
The work of Victor Hawthorne, Charles Gillis, David Hole and Pauline MacKinnon has provided us with the data required for this analysis. A grant within phase two of the Economic and Social Research Council’s, Health Variations research programme allowed linkage to hospital admission data. JM is supported by a Career Scientist fellowship from the Department of Health. All views expressed are those of the authors and not necessarily of the Department of Health.
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