Cited by 719Health disparities and outcomesPublic Health and Social InequalitiesAging, Health, and Disability

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Socioeconomic status and health: The role of subjective social status

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Demakakos, Panayotes, Nazroo, James, Breeze, Elizabeth, Marmot, Michael·2008·Social Science & Medicine

DOI 10.1016/j.socscimed.2008.03.038PMC PMC2547480

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Abstract

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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Social status and living with a chronic illness: An exploration of assessment and meaning attributed to work and employment
Vassilev, I., Rogers, A. E., Sanders, C., Cheraghi‐Sohi, S., Blickem, C., Brooks, H. L., Kapadia, D., Reeves, D., Doran, T., & Kennedy, A. P. (2014) · Chronic Illness · doi:10.1177/1742395314521641 · Cited by 34
“The latter suggests that SSS may capture subtle aspects of social hierarchy, lifetime achievement or may be an assessment of current and future prospects.(10,11) The contrasting interpretations of SSS are not necessarily incompatible.”
Background
Chronic Pain and Psychological Distress Among Older Adults: A National Longitudinal Study
Bierman, A., & Lee, Y. (2017) · Research on Aging · doi:10.1177/0164027517704970 · Cited by 36
Agisem in the European Region: Finding from the European Social Survey
Swift, H. J., Abrams, D., Marques, S., Vauclair, C., Bratt, C., & Lima, M. L. (2018) · International perspectives on aging · doi:10.1007/978-3-319-73820-8_27 · Cited by 42
The Role of Mastery and Social Support in the Association Between Life Stressors and Psychological Distress in Older Canadians
Gadalla, T. M. (2010) · Journal of Gerontological Social Work · doi:10.1080/01634372.2010.490691 · Cited by 34
“For example, both objective and subjective measures of socioeconomic status were negatively associated with depressive symptoms ( Demakakos, Nazroo, Breeze, & Marmot, 2008 ; Fryers, Melzer, & Jenkins, 2003 ; Hudson, 2005 ; Jang et al, Borenstein-Graves, Chiriboga, & Mortimer, 2005 ).”
Opposite social gradient for alcohol use and misuse among French adolescents
Legleye, S., Janssen, É., Spilka, S., Nézet, O. L., Chau, N., & Beck, F. (2013) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2012.12.007 · Cited by 34
“…the concept of social hierarchy used in instruments designed for adults is generally well understood (Adler, Epel, Castellazzo, & Ickovics, 2000; Demakakos, Nazroo, Breeze, & Marmot, 2008), this is not the case in the most widely used instrument designed for adolescents (Goodman et al., 2001):…”
Method
Do home-visit programs for mothers with infants reduce parenting stress and increase social capital in Japan?
Fujiwara, T., Natsume, K., Okuyama, M., Sato, T., & Kawachi, I. I. (2012) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2011-200793 · Cited by 34
“Subjective economic status was assessed using a four-point Likert scale as follows: stable, fairly stable, barely managing and struggling, developed on the basis of a previous study.(12)”
Method
Examining individual social status using the MacArthur Scale of Subjective Social Status: Findings from the Born in Bradford study
Moss, R. H., Kelly, B., Bird, P. K., & Pickett, K. E. (2023) · SSM - Population Health · doi:10.1016/j.ssmph.2023.101463 · Cited by 38
Associations Between Parental SES and Children’s Health-Related Quality of Life: The Role of Objective and Subjective Social Status
Kim, K. W., Wallander, J. L., Peskin, M. F., Cuccaro, P. M., Elliott, M. N., & Schuster, M. A. (2017) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsx139 · Cited by 34
“In addition, SSS fully mediated the associations of education and occupation with illness, disability, diabetes, and depression in men and of education with HDL-cholesterol in women (Demakakos et al, 2008).”
Is the whole greater than the sum of the parts? Self-rated health and transdisciplinarity
Picard, M. A., Juster, R., & Sabiston, C. M. (2013) · Health · doi:10.4236/health.2013.512a004 · Cited by 34
“[21,30], are more physically active [31,32], report less depressive symptoms [33], experience more positive and less negative affect [34], report more social support and healthy behaviors [35,36], and have higher actual and perceived socio-economic status [37-40].”
One size does not fit all: Links between shift-and-persist and asthma in youth are moderated by perceived social status and experience of unfair treatment
Lam, P. H., Miller, G. E., Chiang, J. J., Levine, C. S., Lê, V. T., Shalowitz, M. U., Story, R. E., & Chen, E. (2018) · Development and Psychopathology · doi:10.1017/s0954579418000913 · Cited by 35
“…parents using the MacArthur Scale of Subjective Social Status (Adler & Stewart, 2007), a commonly used scale with established validity, including associations with objective socioeconomic status measures and with health outcomes (Adler et al., 2000; Chen & Paterson, 2006; Demakakos et al., 2008).”
Method
Using Latent Class Analysis to Explore Complex Associations Between Socioeconomic Status and Adolescent Health and Well-Being
Lowthian, E., Page, N., Meléndez‐Torres, G. J., Murphy, S., Hewitt, G., & Moore, G. F. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.06.013 · Cited by 35
Health Against the Odds: Experiences of Employees in Elder Care From a Gender Perspective
Elwér, S., Aléx, L., & Hammarström, A. (2010) · Qualitative Health Research · doi:10.1177/1049732310371624 · Cited by 32
Beyond “pains” and “gains”: untangling the health consequences of probation
Phelps, M. S., Osman, I. H., Robertson, C. E., & Shlafer, R. J. (2022) · Health & Justice · doi:10.1186/s40352-022-00193-7 · Cited by 31
Individual Wealth Rank, Community Wealth Inequality, and Self-Reported Adult Poor Health: A Test of Hypotheses with Panel Data (2002-2006) from Native Amazonians, Bolivia
Undurraga, E. A., Nyberg, C. H., Eisenberg, D. T. A., Magvanjav, O., Reyes‐García, V., Huanca, T., Leonard, W. R., McDade, T. W., Tanner, S. N., Vadez, V., et al. (2010) · Medical Anthropology Quarterly · doi:10.1111/j.1548-1387.2010.01121.x · Cited by 31
The interplay of subjective social status and essentialist beliefs about cognitive aging on cortisol reactivity to challenge in older adults
Weiss, D. J., & Weiss, M. (2016) · Psychophysiology · doi:10.1111/psyp.12667 · Cited by 34
Does subjective social status predict depressive symptoms in Chinese elderly? A longitudinal study from Hong Kong
Kwong, E., Kwok, T. T. Y., Sumerlin, T. S., Goggins, W. B., Leung, J. C. S., & Kim, J. H. (2020) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2019-212451 · Cited by 31
Feeling matters: perceived social support moderates the relationship between personal relative deprivation and depressive symptoms
Zhao, S., & Peng, L. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03334-8 · Cited by 36
Socio-Environmental Factors Associated with Self-Rated Oral Health in South Africa: A Multilevel Effects Model
Olutola, B. G., & Ayo-Yusuf, O. A. (2012) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph9103465 · Cited by 31
“It has been suggested that subjective social status, which is an important correlate of health, captures the dimensions of social status that the indicators of objective socio-economic status cannot [41].”
Background
Social identity, perceived urban neighborhood quality, and physical inactivity: A comparison study of China, Taiwan, and South Korea
Chen, D., & Lin, Y.-C. (2016) · Health & Place · doi:10.1016/j.healthplace.2016.06.001 · Cited by 31
Perception is Reality: Effect of Subjective Versus Objective Socio-economic Position on Quality of Life
Netuveli, G., & Bartley, M. (2012) · Sociology · doi:10.1177/0038038512455963 · Cited by 30
“Our findings are similar to the considerable amount of evidence linking subjective social status with health (Adler et al., 2000; Demakakos et al., 2008; Franzini and Fernandez-Esquer, 2006; Hu et al., 2005; Ostrove et al., 2000; Singh-Manoux et al., 2003, 2005).”
BackgroundResult
Differences in the influence of daily behavior on health among older adults in urban and rural areas: evidence from China
Liu, W., Zheng, R., Zhang, Y., & Zhang, W. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1259204 · Cited by 30
“Demakakos et al. indicated that economic conditions are an important factor in ensuring the health of older adults, especially in rural areas, where the high-income older adults are significantly healthier (65, 72).”
Background
POOR AND SICK: ESTIMATING THE RELATIONSHIP BETWEEN HOUSEHOLD INCOME AND HEALTH
Economou, A., & Theodossiou, I. (2011) · Review of Income and Wealth · doi:10.1111/j.1475-4991.2010.00416.x · Cited by 31
“…by employment status, education level and income, appears to be associated with better physical health (Blakely et al., 2002; Buckley et al., 2004; Demakakos et al, 2008; Ecob and Davey Smith, 1999; Grundy and Holt, 2000; Wagstaff et al., 2001), with improved emotional and psychological health…”
Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?
Skoumalová, I., Kolarčík, P., Gecková, A. M., Rosenberger, J., Majerníková, M., Klein, D., van Dijk, J. P., & Reijneveld, S. A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16214295 · Cited by 30
“This instrument has been used in previous studies investigating older patients and patients with various health conditions [37,38].”
Method
Social trust and emotional health in rural older adults in China: the mediating and moderating role of subjective well-being and subjective social status
Chen, H., & Zhu, Z. (2021) · BMC Public Health · doi:10.1186/s12889-021-10617-y · Cited by 30
Subjective social status, self-rated health and tobacco smoking: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Camelo, L. D. V., Giatti, L., & Barreto, S. M. (2013) · Journal of Health Psychology · doi:10.1177/1359105313490772 · Cited by 30
“Most studies that analyze associations between SSS and health indicators have adopted only distal references (Adler et al., 2000, 2008; Demakakos et al., 2008; Operario et al., 2004; Singh-Manoux et al., 2005).”
BackgroundMethodResultInfluential
Sexual Minority Status and Self-Rated Health: The Importance of Socioeconomic Status, Age, and Sex
Thomeer, M. B. (2013) · American Journal of Public Health · doi:10.2105/ajph.2012.301040 · Cited by 30
“SES is inversely related to morbidity and mortality risk.(6,15,16) The relationship between sexual minority status and SES is complicated because sexual minority women have higher incomes than do heterosexual women, but this is not the case among men.”
The effect of subjective and objective social class on health-related quality of life: new paradigm using longitudinal analysis
Choi, Y., Kim, J., & Park, E. (2015) · Health and Quality of Life Outcomes · doi:10.1186/s12955-015-0319-0 · Cited by 30
“The association between subjective social class and health-related quality of life (or self-rated health) has been investigated in a number of countries [14, 15, 17, 21, 22, 35, 36].”
BackgroundResultInfluential
Socioeconomic Inequalities and Severity of Plaque Psoriasis at a First Consultation in Dermatology Centers
Mahé, E., Beauchet, A., Reguiaï, Z., Maccari, F., Ruer‐Mulard, M., CHABY, G., Guyadec, T. L., Estève, É., Goujon-Henry, C., Parier, J., et al. (2017) · Acta Dermato Venereologica · doi:10.2340/00015555-2625 · Cited by 30
Socioeconomic status is not associated with type 2 diabetes incidence in an elderly population in Germany: KORA S4/F4 Cohort Study
Kowall, B., Rathmann, W., Straßburger, K., Meisinger, C., Holle, R., & Mielck, A. (2010) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2009.094086 · Cited by 29
“Moreover, the association between the subjective SES and T2DM has only rarely been investigated in elderly people.(17) This study used data of a population-based cohort of elderly subjects to examine the relationship between objective and subjective SES, respectively, and diabetes incidence.”
BackgroundInfluential
A Cross-Sectional Analysis of the Stigma Surrounding Type 2 Diabetes in Colombia
Pedrero, V., Manzi, J. M., & Palacio, L. M. A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312657 · Cited by 31
“This measure has shown good correlations with objective indicators of social position and health indicators [35].”
Method
Subjective social status predicts long-term smoking abstinence
Reitzel, L. R., Businelle, M. S., Kendzor, D. E., Li, Y., Cao, Y., Castro, Y., Mazas, C. A., Cofta-Woerpel, L., Cinciripini, P. M., & Wetter, D. W. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-135 · Cited by 29
“These results add to a growing body of literature documenting that SSS contributes to the prediction of selfrated health [3,4], health indicators [4-6], and health behaviors [7] over and above the influence of objective SES indicators.”
BackgroundResultInfluential
Gendered Physical and Emotional Health Consequences of Situational Couple Violence for Heterosexual Married and Cohabiting Couples
Sillito, C. L. (2012) · Feminist Criminology · doi:10.1177/1557085111431695 · Cited by 29
“In addition, persons of lower SES report worse health than those with higher SES (Demakakos et al., 2008).”
Background
Showing Off to the New Neighbors? Income, Socioeconomic Status and Consumption Patterns of Internal Migrants
Danzer, A. M., Dietz, B. A., Gatskova, K., & Schmillen, A. D. (2013) · Journal of Comparative Economics · doi:10.1016/j.jce.2013.05.002 · Cited by 29
“perception of socioeconomic status has been shown to shape subjective well-being (Di Tella, Haisken-De New and MacCulloch, 2010; Akay, Bargain and Zimmermann, 2012) and the state of health (Adler et al., 2000; Dalstra et al., 2005; Demakakos et al., 2008).”
Background
Class and Health Inequality in Later Life: Patterns, Mechanisms and Implications for Policy
Nazroo, J. Y. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14121533 · Cited by 32
Nonlinear associations between the ratio of family income to poverty and all-cause mortality among adults in NHANES study
Yi, H., Li, M., Dong, Y., Gan, Z., He, L., Xiao-zhong, L., Yu, T., Xia, Z., Xia, Z., Xue, Y., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-63058-z · Cited by 29

Authors: Demakakos, P., Nazroo, J., Breeze, E., & Marmot, M.
Affiliations: University College London (GB)
University of Manchester (GB)
Corresponding author: Demakakos, Panayotes
ORCID: Demakakos, Panayotes
Nazroo, James
Breeze, Elizabeth
Marmot, Michael
Venue: Social Science & Medicine
Publisher: Elsevier BV
Published: 2008-07
Volume: 67
Issue: 2
Pages: 330-340
ISSN: 0277-9536 (ISSN-L)
DOI: 10.1016/j.socscimed.2008.03.038
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Socioeconomic status and health: The role of subjective social status

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