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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Associations of socioeconomic status, parenting style, and grit with health behaviors in children using data from the Panel Study on Korean Children (PSKC)
Yang, H.-M. (2021) · Child Health Nursing Research · doi:10.4094/chnr.2021.27.4.309 · Cited by 12
“The links between low socioeconomic status, children's health behaviors, and poor health are well known among the general population [4].”
Background
The role of social connection in opioid use disorder treatment engagement.
Schweitzer, E. M., Urmanche, A. A., Kong, J., Hafezi, S., Zhao, J., Cooperman, N. A., & Konova, A. B. (2023) · Psychology of Addictive Behaviors · doi:10.1037/adb0000934 · Cited by 12
Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana
Quansah, F., Srem‐Sai, M., Agormedah, E. K., Ankomah, F., Hagan, J. E., & Schack, T. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1325441 · Cited by 12
Correlates and determinants of physical activity among older adults of lower versus higher socio-economic status: a systematic review and meta-analysis
Malkowski, O. S., Harvey, J., Townsend, N. P., Kelson, M. J., Foster, C. E., Western, M. J., AlKhatib, A. H., Bourassa, K. J., Burnett, H., Cajita, M., et al. (2025) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-025-01775-y · Cited by 13
“As a contemporary marker of SES, wealth or income is also considered a more appropriate measure for older adults relative to education and occupational class, which are often determined in early adulthood [20].”
Socioeconomic inequalities in self-rated health: role of work-to-family conflict in married Korean working women
Yang, H.-M., & Choo, J. (2019) · Women & Health · doi:10.1080/03630242.2019.1567648 · Cited by 14
“A link between low socioeconomic status (SES) and poor health status, called “socioeconomic inequality in health,” has been found among the general population (Demakakos et al. 2008).”
Background
What are the digitally enabled psychosocial interventions delivered by trained practitioners being offered to adults with life-shortening illnesses and palliative care needs and their informal and professional caregivers? A scoping review
Wood, M. J. M., Walshe, C., & McCullagh, A. (2023) · Palliative & Supportive Care · doi:10.1017/s1478951523000172 · Cited by 13
“This raises the issue of how those disadvantaged by low socioeconomic status (Demakakos et al. 2008) are at risk of digital exclusion from getting the care they need.”
Subjective social status and functional and mobility impairments among older adults: life satisfaction and depression as mediators and moderators
Pai, M., & Muhammad, T. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04380-5 · Cited by 12
“…physiological stress reactions (e.g., hypervigi-lance, increased respiration and heart rate, elevated blood pressure, sleep disturbances, cortisol secretions, and chronic inflammation) [35, 40, 41], and these amplified physiological responses over time can debilitate physical function and mobility.”
BackgroundResult
Physical Health Effects of Intimate Partner Abuse
Sillito, C. L. (2012) · Journal of Family Issues · doi:10.1177/0192513x12448742 · Cited by 12
Body Mass Index and Subjective Social Status: The Coronary Artery Risk Development in Young Adults Study
Dhurandhar, E. J., Pavela, G., Kaiser, K. A., Dutton, G. R., Fontaine, K. R., Kim, D. J., Shikany, J. M., Allison, D. B., & Lewis, C. E. (2017) · Obesity · doi:10.1002/oby.22047 · Cited by 12
“While previous research suggests that SSS mediates the relationship between SES and health outcomes, including self-rated health and depression (24), no prior research has, to our knowledge, tested whether SSS mediates the association between SES and obesity.”
MethodResult
Spontaneous and repeat spontaneous abortion risk in relation to occupational characteristics among working Korean women: a cross-sectional analysis of nationally representative data from Korea
Lee, W., Jung, S. W., Lim, Y.-M., Lee, K.-J., & Lee, J. (2019) · BMC Public Health · doi:10.1186/s12889-019-7728-7 · Cited by 12
Subjective Social Status Predicts Smoking Abstinence Among Light Smokers
Whembolua, G.-L., Davis, J. T., Reitzel, L. R., Guo, H., Thomas, J., Goldade, K., Okuyemi, K. S., & Ahluwalia, J. S. (2012) · American Journal of Health Behavior · doi:10.5993/ajhb.36.5.6 · Cited by 12
Subjective Social Status Is Associated with Dysregulated Eating Behaviors and Greater Body Mass Index in an Urban Predominantly Black and Low-Income Sample
Stojek, M. M., Wardawy, P., Gillespie, C. F., Stevens, J. S., Powers, A. D., & Michopoulos, V. (2021) · Nutrients · doi:10.3390/nu13113893 · Cited by 11
“Among adults, SSS in the society has not been associated with body mass, neither among older British adults [11] nor in a sample of healthy White women [1].”
Background
Childhood socioeconomic status and social integration in later life: Results of the Japan Gerontological Evaluation Study
Ashida, T., Fujiwara, T., & Kondo, K. (2022) · SSM - Population Health · doi:10.1016/j.ssmph.2022.101090 · Cited by 11
Regulating Patients’ Access to Healthcare Services
Reibling, N., & Wendt, C. (2013) · IGI Global eBooks · doi:10.4018/978-1-4666-3982-9.ch005 · Cited by 11
Subjective Social Status, Area Deprivation, and Gender Differences in Health among Chinese Older People
Chen, X., Woo, J., Yu, R., Chung, G. K.-K., Yao, W., & Yeoh, E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19169857 · Cited by 11
“Additionally, subjective social status has been frequently found to be more strongly related to health indicators than traditional socioeconomic measures [7,8], perhaps because a person’s assessment of their relative standing in society is a more comprehensive measure of SES than conventional measures.”
Background
Socioeconomic Status, Social Support, and Quality of Life Among Black Adults
Murphy, E. R., Wippold, G. M., & Crichlow, Z. R. (2024) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-024-02204-9 · Cited by 11
“Indicators of SES, such as access to healthcare services and environmental risk exposure, are known to impact health and health outcomes [21–24].”
Analysis of demographic variation and childhood correlates of financial well-being across 22 countries
Białowolski, P., Makridis, C. A., Bradshaw, M., Węziak‐Białowolska, D., Gundersen, C., Pertel, N. L., Gibson, C. B., Jang, S. J., Padgett, R. N., Johnson, B. R., et al. (2025) · Nature Human Behaviour · doi:10.1038/s41562-025-02207-4 · Cited by 11
“These subjective indicators may potentially influence or correlate with other key health and well-being outcomes, perhaps even more strongly than objective financial measures 8,9 .”
Exploring the Role of Wealth and Religion on the Ownership of Captive Lemurs in Madagascar Using Qualitative and Quantitative Data
Reuter, K. E., Clarke, T. A., LaFleur, M., Ratsimbazafy, J., Kjeldgaard, F. H., Rodríguez, L. G., Schaeffer, T., & Schaefer, M. S. (2018) · Folia Primatologica · doi:10.1159/000477400 · Cited by 11
“…subjective social status (i.e., an individual’s perception of his/her own position in the social hierarchy) is strongly related to objective measures of wealth, even though one’s subjective social status is also based on non-economic criteria such as prestige [Demakakos et al., 2008].”
Background
The independent and joint contribution of objective and subjective socioeconomic status on oral health indicators
Schuch, H. S., Peres, K. G., Haag, D. G., Boing, A. F., & Peres, M. A. (2021) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12715 · Cited by 11
Sleep as a mediator of the relationship between social class and health in higher education students
McGuffog, R., Rubin, M., Boyes, M. E., Caltabiano, M. L., Collison, J., Lovell, G. P., Muldoon, O. T., & Паолини, С. (2023) · British Journal of Psychology · doi:10.1111/bjop.12645 · Cited by 14
“Given that people from lower social class backgrounds tend to have more depressive symptoms than people from higher social class backgrounds (Demakakos et al., 2008; Rubin et al., 2016), and these may be mediated by poor sleep, non-pharmacological sleep interventions could be useful to help improve…”
Background
„Subjektiver sozialer Status“
Hegar, R., & Mielck, A. (2010) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-010-0261-2 · Cited by 11
Perceived Status and National Belonging: The Case of Russian Speakers in Finland and Estonia
Renvik, T. A., Brylka, A., Konttinen, H. M., Vetik, R., & Jasinskaja‐Lahti, I. (2018) · International Review of Social Psychology · doi:10.5334/irsp.149 · Cited by 13
Social Status Perception and Individual Social Capital: Evidence from the US
Bucciol, A., Cicognani, S., & Zarri, L. (2019) · The B E Journal of Economic Analysis & Policy · doi:10.1515/bejeap-2019-0071 · Cited by 11
Intención de Lactar exclusivamente con Leche Materna: Un Estudio Basado en la Teoría de la Conducta Planeada
Gómez-García, J. A., Rojas-Russell, M. E., Serrano-Alvarado, K., Juárez-Castelán, M. A., Huerta-Ibáñez, A., & Ramírez-Aguilar, M. (2019) · Clínica y Salud · doi:10.5093/clysa2019a20 · Cited by 11
Socioeconomic position and eye health outcomes: identifying inequality in rapid population-based surveys
McCormick, I., Kim, M. J., Hydara, A., Olaniyan, S. I., Jobe, M., Badjie, O., Sanyang, N. M. B., Jarju, G., Njai, M., Sankareh, A., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-069325 · Cited by 10
Early Emotional Experiences and Prosocial Behavior among Chinese Adolescents: The Roles of Psychological Suzhi and Subjective Socioeconomic Status
Liu, X., Cao, G., Zhang, L., Chen, Y., Liu, S., Shi, Y., Liu, Y., Li, Y., & Yin, H. (2023) · Behavioral Sciences · doi:10.3390/bs13040283 · Cited by 11
“This measurement for SSS was similarly used in previously published studies [51,58,59].”
Result
Subjective Social Status as a Predictor of Physical and Mental Health Among Early Midlife Adults in the United States: Appraising the Role of Gender
Graham, C., & Ciciurkaite, G. (2023) · Society and Mental Health · doi:10.1177/21568693231213094 · Cited by 10
“We consider these two health outcomes because each is heavily influenced by psychosocial factors, including perceived position in social hierarchies or SSS (Demakakos et al. 2008; Diaz, Guendel-man, and Kuppermann 2014; Guardino and Schet-ter 2022; Hoebel et al. 2017; Seeman et al. 2014).”
Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana
Seidu, A., Malau‐Aduli, B. S., McBain‐Rigg, K. E., Malau‐Aduli, A. E. O., & Emeto, T. I. (2024) · Reproductive Health · doi:10.1186/s12978-024-01810-4 · Cited by 10
Perceived income inequality, perceived unfairness and subjective social status in Europe
Hajdu, G. (2024) · Socio-Economic Review · doi:10.1093/ser/mwae055 · Cited by 11
A New Research Agenda for Social Inequalities in Mortality: Challenges and Open Questions
Sasson, I. E. (2025) · Population and Development Review · doi:10.1111/padr.12717 · Cited by 10
Area Deprivation Index as a predictor of economic risk and social and neighborhood perceptions among families enrolled in Early Head Start
Hooper, A. L., Hustedt, J. T., Slicker, G., Hallam, R. A., Gaviria-Loaiza, J., Vu, J. A.-T., & Han, M. (2022) · Children and Youth Services Review · doi:10.1016/j.childyouth.2022.106468 · Cited by 10
Trajectories of health-related quality of life by change pattern of objective and subjective social status
Kim, E., & Cho, S. (2022) · SSM - Population Health · doi:10.1016/j.ssmph.2022.101061 · Cited by 10
“I want to live, but …” the desire to live and its physical, psychological, spiritual, and social factors among advanced cancer patients: evidence from the APPROACH study in India
Joad, A. K., Hota, A., Agarwal, P., Patel, K., Patel, K., Puri, J., & Shin, S. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-01041-z · Cited by 10
The relationship between subjective social status, impulsivity and addictive behaviours
Tunney, R. J., & Raybould, J. N. (2023) · Psychiatry Research Communications · doi:10.1016/j.psycom.2023.100130 · Cited by 10
Mental health trajectories among women in Australia as they age
Tran, T. D., Hammarberg, K., Ryan, J. L., Lowthian, J. A., Freak‐Poli, R., Owen, A. J., Kirkman, M., Curtis, A. J., Rowe, H. J., Brown, H. L., et al. (2018) · Aging & Mental Health · doi:10.1080/13607863.2018.1474445 · Cited by 10
The relationship between mental disorders and actual and desired subjective social status
de Vries, Y. A., ten Have, M., de Graaf, R., van Dorsselaer, S., Ruiter, N. M. P. D., & de Jonge, P. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796019000805 · Cited by 10
“SSS has generally been found to be associated with (mental) health outcomes even after controlling for objective SES (Adler and Epel, 2000; Singh-Manoux et al., 2003, 2005; Operario et al., 2004; Hu et al., 2005; Franzini and Fernandez-Esquer, 2006; Adler et al., 2008; Collins and Goldman, 2008; Demakakos et al., 2008…”
Background
Examining the relation between the subjective and objective social status with health reported needs and health-seeking behaviour in Dande, Angola
Rosário, E., Severo, M., Francisco, D., Brito, M., & Costa, D. (2021) · BMC Public Health · doi:10.1186/s12889-021-11003-4 · Cited by 12
“Especially in the last two decades, SSS has been used in a variety of settings and shown to be associated, over and above objective SES markers, with different health outcomes [13, 24], such as self-reported health [21, 25, 26], mental health [22, 26], heart rate and sleep latency [27].”
Method
Perceived Socioeconomic Status: A Strong Predictor of Long-Term Outcomes After Injury
Moheb, M. N. E., Lu, K., Herrera‐Escobar, J. P., Orlas, C. P., Breen, K., Sanchez, S. E., Velmahos, G. C., Kaafarani, H. M. A., Salim, A., & Nehra, D. (2022) · Journal of Surgical Research · doi:10.1016/j.jss.2021.12.046 · Cited by 10
The Latina Birth Weight Paradox: the Role of Subjective Social Status
Fleuriet, K. J., & Sunil, T. (2017) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-017-0419-0 · Cited by 10
Nursing students' perceptions of substance abusers: The effect of social status on stigma
Cloyd, M., Stiles, B. L., & Diekhoff, G. M. (2020) · Nurse Education Today · doi:10.1016/j.nedt.2020.104691 · Cited by 11
Do teachers have the knowledge and skills to facilitate effective parental engagement? Findings from a national survey in England
Jones, C. L., Sideropoulos, V., & Palikara, O. (2025) · Educational Review · doi:10.1080/00131911.2025.2506802 · Cited by 9
“This validated measure has been widely used in psychology and health (e.g. Demakakos et al., 2008; Wolff et al., 2010) and has good test-retest reliability (Operario et al., 2004).”
Health-Related Quality of Life in Patients with Health Conditions in Lebanese Community Setting
Dimassi, H. I., Nasser, S. C., Issa, A., Adrian, S. S., & Hazimeh, B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168817 · Cited by 9
“Previous studies demonstrated similar association between level of income, education, social class, and HRQoL [22,23].”
Background

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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