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Socioeconomic status and health: The role of subjective social status
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Studies have suggested that subjective social status (SSS) is an important predictor of health. This study examined the link between SSS and health in old age and investigated whether SSS mediated the associations between objective indicators of socioeconomic status and health. It used cross-sectional data from the second wave (2004-2005) of the English Longitudinal Study of Ageing, which were collected through personal interviews and nurse visits. The study population consisted of 3368 men and 4065 women aged 52 years or older. The outcome measures included: self-rated health, long-standing illness, depression, hypertension, diabetes, central obesity, high-density lipoprotein cholesterol, triglycerides, fibrinogen, and C-reactive protein. The main independent variable was SSS measured using a scale representing a 10-rung ladder. Wealth, education, and occupational class were employed as covariates along with age and marital status and also, in additional analyses, as the main independent variables. Gender-specific logistic and linear regression analyses were performed. In age-adjusted analyses SSS was related positively to almost all health outcomes. Many of these relationships remained significant after adjustment for covariates. In men, SSS was significantly (p<or=0.05) related to self-rated health, depression, and long-standing illness after adjustment for all covariates, while its association with fibrinogen became non-significant. In women, after adjusting for all covariates, SSS was significantly associated with self-rated health, depression, long-standing illness, diabetes, and high-density lipoprotein cholesterol, but its associations with central obesity and C-reactive protein became non-significant. Further analysis suggested that SSS mediated fully or partially the associations between education, occupational class and self-reported and clinical health measures. On the contrary, SSS did not mediate wealth's associations with the outcome measures, except those with self-reported health measures. Our results suggest that SSS is an important correlate of health in old age, possibly because of its ability to epitomize life-time achievement and socioeconomic status.
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“According to social status research, when individuals are afforded positive status within their cultural institutions, institutions protect against stress and support health (Demakakos et al., 2008; Hatzenbuehler et al., 2013; Sapolsky, 2004). But when institutions relegate individuals into lower statuses, institutions generate stress and derail health (Adler, 2009; Sapolsky, 2004).”
From Cultural trauma as a fundamental cause of health disparities (2022) · cites this paper as Demakakos et al., 2008
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Subjective social status and health
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“Corroborating earlier findings [3,9,10,14,29,30,46], SSS remained significantly related to SRH after adjusting for OSS and also after entering depression into the”
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“This suggests that SSS may act as a psychosocial mechanism for SES variables to impact depressive symptoms (e.g., Demakakos et al., 2008), and there may also be further psychological factors mediating the relationship between SSS and depressive symptoms (e.g., John et al., 2012).”
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“The relationship between subjective socioeconomic status and health in Indonesia is thus similar to that found in the much wealthier populations that dominate research on the subject (Operario et al., 2004; Demakakos et al., 2008) and persists in the presence of controls for the most oft-mentioned omitted measures.”
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Health-Related Behaviors in Older Adults
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“DISCUSSION Objective and subjective measures of SES have been used in health research.(32) In this analysis, we used both objective measures (education, household income and personal income) and subjective indicator (financial strain) of SES.”
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Park, J., Kitayama, S., Markus, H. R., Coe, C. L., Miyamoto, Y., Karasawa, M., Curhan, K. B., Love, G. D., Kawakami, N., Boylan, J. M., et al. (2013) · Emotion · doi:10.1037/a0034273 · Cited by 164
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“According to social status research, when individuals are afforded positive status within their cultural institutions, institutions protect against stress and support health (Demakakos et al., 2008; Hatzenbuehler et al., 2013; Sapolsky, 2004).”
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“In the previous research, however, economic well-being has been found to be associated to household income and other objective indicators of SES [3, 35], and subjective indicators have also been found to be related to health [36].”
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Associations of high sensitivity C-reactive protein levels in schizophrenia and comparison groups
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Subjective and Objective Hierarchies and Their Relations to Psychological Well-Being
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“Because of interrelationships among the socioeconomic variables in affecting health it is important to consider various SES indictors concurrently (Demakakos et al., 2008).”
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“We accounted for SES in a more satisfactory way by adjusting not only for education but also for total net household wealth, which has been found to be related to diabetes more strongly than other indicators of SES in our sample (17).”
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“While lower SSS individuals are more likely to experience depression than people higher in SSS (Adler et al., 2000, 2008; Demakakos et al., 2008), these results suggest that the relationship between SSS and stress-induced inflammation cannot be fully explained by depressive symptoms.”
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“Finally, our findings also indicate the importance of SSS and thus the psychosocial dimension of SEP [20, 49] for incident diabetes in older adults, especially older men.”
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“Much work has looked at wealth and CVD risk factors in the elderly (Adams, Hurd, McFadden, Merrill, & Ribeiro, 2003; Avendano et al., 2009; Demakakos et al., 2008; Fonda et al., 2004; Kington & Smith, 1997; Rooks et al., 2002; Schoenbaum & Waidmann, 1997), but fewer studies have examined the effect of wealth on health…”
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“Subjective standing is a stronger and more consistent predictor of health than are objective measures of socioeconomic status (Adler et al. 2000; Demakakos et al. 2008; Sakurai et al. 2010).”
BackgroundSubjective Social Status and Functional Decline in Older Adults
Chen, B., Covinsky, K. E., Cenzer, I. S., Adler, N. E., & Williams, B. A. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1963-7 · Cited by 83
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“Studies exploring the association between health and subjective social status (SSS) have started to accumulate, but most of these focus on adult populations (Adler et al. 2000, Macleod et al. 2005, Singh-Manoux et al. 2005, Franzini and Fernandez-Esquer 2006, Demakakos et al. 2008).”
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“One such process is subjective SES, one’s perceived position in the social hierarchy [17].”
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“…the health outcome of interest, but researchers have examined other health outcomes such as mortality (Kopp et al., 2004), long-standing illness (Demakakos et al., 2008), composite indicators of physical health (Singh-Manoux, Marmot, & Adler, 2005), physical functioning status (Hu et al.,…”
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“[23] Demakakos P, Nazroo J, Breeze E, et al.”
BackgroundSocioeconomic status and depressive symptoms and suicidality: The role of subjective social status
Madigan, A., & Daly, M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.01.078 · Cited by 78
Cardel, M. I., Johnson, S. L., Courtney, J. B., Dhurandhar, E. J., Keita, A. D., Tomczik, A., Pavela, G., Huo, T., Janicke, D. M., Muller, K., et al. (2016) · Physiology & Behavior · doi:10.1016/j.physbeh.2016.04.024 · Cited by 75
The effect of compulsory schooling on health—evidence from biomarkers
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“Higher CRP levels have also been shown to be associated with subjective social status (Demakakos et al. 2008).”
Pain and mortality: mechanisms for a relationship
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Esteban-Gonzalo, S., Esteban-Gonzalo, L., Cabanas-Sánchez, V., Miret, M., & Veiga, Ó. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082732 · Cited by 73
“Linear regression has been implemented in various fields of study, particularly in research into health and social sciences [51,52].”
Frisher, M., Mendonça, M., Shelton, N. J., Pikhart, H., de Oliveira, C. M., & Holdsworth, C. (2015) · BMC Public Health · doi:10.1186/s12889-015-1993-x · Cited by 72
“A previous study reported similar findings, when the reference category was non-drinkers [27].”
BackgroundResultOld Friends, immunoregulation, and stress resilience
Langgartner, D., Lowry, C. A., & Reber, S. O. (2018) · Pflügers Archiv - European Journal of Physiology · doi:10.1007/s00424-018-2228-7 · Cited by 76
Socioeconomic influences on brain function: implications for health
Muscatell, K. A. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13862 · Cited by 77
Kuo, R. N.-C., & Lai, M. (2013) · International Journal for Equity in Health · doi:10.1186/1475-9276-12-69 · Cited by 69
“In this manner, multiple socioeconomic measures could be included simultaneously in multivariable models without (or with only marginal) problems of collinearity [40,41].”
BackgroundTrace element status in patients with type 2 diabetes in Norway: The HUNT3 Survey
Simić, A., Hansen, A. F., Åsvold, B. O., Romundstad, P., Midthjell, K., Syversen, T. L. M., & Flaten, T. P. (2017) · Journal of Trace Elements in Medicine and Biology · doi:10.1016/j.jtemb.2017.03.001 · Cited by 71
Predictors of self-reported health among the elderly in Ghana: a cross sectional study
Fonta, C. L., Nonvignon, J., Aikins, M., Nwosu, E. O., & Aryeetey, G. C. (2017) · BMC Geriatrics · doi:10.1186/s12877-017-0560-y · Cited by 71
“It is known from literature that people in the high income groups can easily afford healthcare and as such, take care of their healthcare needs better and live longer [62].”
BackgroundKang, E., Hyun, M. K., Choi, S. M., Kim, J., Kim, G.-M., & Woo, J. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414540752 · Cited by 69
“Recent studies have repeatedly shown that while perceived SES was influenced by objective SES, perceived SES independently predicted physical or mental health (Demakakos et al., 2008; Goodman et al., 2007).”
BackgroundGender differences in depression, but not in anxiety in people with epilepsy
Gaus, V., Kiep, H., Holtkamp, M., Burkert, S., & Kendel, F. (2015) · Seizure · doi:10.1016/j.seizure.2015.07.012 · Cited by 69
“in the general population [12].”
Gong, F., Xu, J., & Takeuchi, D. T. (2011) · Journal of Behavioral Medicine · doi:10.1007/s10865-011-9367-z · Cited by 74
“The relationship between subjective SES and health has also been reported in international contexts such as the United Kingdom, Hungry, and Taiwan (Collins & Goldman, 2008; Demakakos et al., 2008; Hu et al., 2005; Piko & Fitzpatrick, 2001; Piko & Fitzpatrick, 2006; SinghManoux et al., 2003, 2005).”
BackgroundAn Odd Ladder to Climb: Socioeconomic Differences Across Levels of Subjective Social Status
Andersson, M. A. (2017) · Social Indicators Research · doi:10.1007/s11205-017-1559-7 · Cited by 67
“…subjective social status outcomes and assignment processes work differently across population or cultural groups defined by gender or race, nationality, geography, or ethnicity (e.g., Adler et al. 2008; Andersson 2015; Demakakos et al. 2008; Franzini and Fernandez-Esquer 2006; Präg et al. 2016).”
BackgroundParticipatory health research with migrants: Opportunities, challenges, and way forwards
Roura, M., Dias, S., LeMaster, J. W., & MacFarlane, A. E. (2021) · Health Expectations · doi:10.1111/hex.13201 · Cited by 66
“These indicators also miss less tangible dimensions of subjective social status [72] (e.g., participation, prestige, integration in social networks) that predict health outcomes independently of traditional indicators of socio-economic status [73].”
BackgroundMoor, I., Richter, M., Ravens‐Sieberer, U., Ottová-Jordan, V., Elgar, F. J., & Pförtner, T. (2015) · European Journal of Public Health · doi:10.1093/eurpub/ckv028 · Cited by 65
Hoggard, L. S., & Hill, L. K. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1228648 · Cited by 65
Subjective well-being in the new China: religion, social capital, and social status.
Chen, Y.-S., & Williams, M. (2016) · British Journal of Sociology · doi:10.1111/1468-4446.12232 · Cited by 51
Personal relative deprivation increases self-selected portion sizes and food intake
Sim, A. Y., Lim, E. X., Forde, C. G., & Cheon, B. K. (2017) · Appetite · doi:10.1016/j.appet.2017.11.100 · Cited by 65
Poverty and transitions in health in later life
Adena, M., & Myck, M. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.06.045 · Cited by 63
“…to the relationship between socio-economic inequalities and health (e.g. Hahn et al., 1995; Mackenbach et al., 1997; Singh-Manoux et al., 2003; Demakakos et al., 2008), the link between material circumstances and broader life-quality outcomes in older age is still relatively poorly understood.”
BackgroundRayment‐Jones, H., Dalrymple, K. V., Harris, J. M., Harden, A., Parslow, E., Georgi, T., & Sandall, J. (2021) · PLoS ONE · doi:10.1371/journal.pone.0250947 · Cited by 71
Gender (in)equality among employees in elder care: implications for health
Elwér, S., Aléx, L., & Hammarström, A. (2012) · International Journal for Equity in Health · doi:10.1186/1475-9276-11-1 · Cited by 62
“The low status of caring work can also in itself be negative for the health of the caregivers because the perception of one’s own position in a social hierarchy is important for self-perceived health [36].”
BackgroundClarke, P. J., & Smith, J. (2011) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbr054 · Cited by 64
Savings, home ownership, and depression in low-income US adults
Ettman, C. K., Cohen, G. H., Vivier, P. M., & Galea, S. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01973-y · Cited by 61
Nemoto, K., Oka, H., Fukuda, H., & Yamakawa, Y. (2017) · PLoS ONE · doi:10.1371/journal.pone.0187137 · Cited by 59
A longitudinal analysis of loneliness, social isolation and falls amongst older people in England
Bu, F., Abell, J. G., Zaninotto, P., & Fancourt, D. E. (2020) · Scientific Reports · doi:10.1038/s41598-020-77104-z · Cited by 66
Cavigelli, S. A., & Chaudhry, H. S. (2012) · Hormones and Behavior · doi:10.1016/j.yhbeh.2012.07.006 · Cited by 60
“Thirteen of 14 studies surveyed confirmed an inverse relationship between SES and CRP (Demakakos et al., 2008; Friedman and Herd, 2010; Gimeno et al., 2007, 2008; Gruenewald et al., 2009; Hagger-Johnson et al., 2012; Maksimović et al., 2008; McDade et al., 2011; Nazmi and Victora, 2007; Petersen et al., 2008; Saijo et…”
BackgroundHair cortisol and cognitive performance in healthy older people
Pulopulos, M. M., Hidalgo, V., Almela, M., Puig‐Pérez, S., Villada, C., & Salvador, A. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.03.002 · Cited by 58
“, 2006) and health (Adler et al., 2000; Singh-Manoux et al., 2005; Demakakos et al., 2008).”
MethodPain and Mortality in Older Adults: The Influence of Pain Phenotype
Smith, D. L., Wilkie, R., Croft, P. R., & McBeth, J. (2017) · Arthritis Care & Research · doi:10.1002/acr.23268 · Cited by 60
“This measure of wealth has been found to be the strongest socioeconomic predictor of health in the ELSA sample (23).”
BackgroundGeorge, P. P., Heng, B. H., Molina, J. D. C., Wong, L. Y., Lin, N. W., & Cheah, J. T. (2012) · International Journal for Equity in Health · doi:10.1186/1475-9276-11-44 · Cited by 57
“However, current information on people’s healthcare preference, health seeking behavior, functional assessment and perception about their health status are either not available or not up to date [5,6].”
BackgroundInfluentialPförtner, T., Günther, S., Levin, K. A., Torsheim, T., & Richter, M. (2014) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2014-204529 · Cited by 57
Assessment of chronic pain and access to pain therapy: a cross-sectional population-based study
Giorno, R. D., Frumento, P., Varrassi, G., Paladini, A., & Coaccioli, S. (2017) · Journal of Pain Research · doi:10.2147/jpr.s136292 · Cited by 57
“, rural areas.(8) These studies, however, are mostly focused on musculoskeletal pain.”
Cole, J., Logan, T., & Walker, R. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.06.018 · Cited by 56
“For example, Demakakos et al. (2008) found that subjective social standing was more strongly associated with self-reported measures of health than with clinical measures.”
Background
Metadata
- Authors
- Demakakos, P., Nazroo, J., Breeze, E., & Marmot, M.
- Affiliations
- University College London (GB)
- University of Manchester (GB)
- Corresponding author
- Demakakos, Panayotes
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 67
- Issue
- 2
- Pages
- 330-340
- ISSN
- 0277-9536 (ISSN-L)
- PMC
- PMC2547480
- OpenAlex
- W2032784487
- Cited by
- 719
- References
- 46
- Citations by year
- 2026: 31 · 2025: 52 · 2024: 54 · 2023: 53 · 2022: 55 · 2021: 51 · 2020: 36 · 2019: 41 · 2018: 50 · 2017: 45 · 2016: 40 · 2015: 32 · 2014: 41 · 2013: 30 · 2012: 32
- FWCI
- 26.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- British Heart Foundation (RG/07/008/23674)
- Economic and Social Research Council (RES-000-23-0590)
- National Institute on Aging (2R01AG7644-01A1, R01AG013196, R01AG017644)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- subjective social status, socioeconomic status, elderly health, self-rated health, depression, chronic disease, mediation, occupational class, wealth, gender differences, fibrinogen, C-reactive protein, English Longitudinal Study of Ageing
- MeSH terms
- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, United Kingdom, Health Status Indicators, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Social Class
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