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Cited by 2,048Health disparities and outcomesPublic Health and Social InequalitiesCardiovascular Health and Risk Factors

Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.

Winkleby, M A, Jatulis, D E, Frank, E, Fortmann, S P·1992·American Journal of Public Health
DOI 10.2105/ajph.82.6.816
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Abstract

BACKGROUND. Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. METHODS. Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). RESULTS. The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P less than .05). CONCLUSION. If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health.

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  • There is strong evidence of a dose response between years of education and many health-related risk and protective behaviors among US adults.

    “There is also strong evidence of a dose response between years of education and many health-related risk and protective behaviors among US adults.”

    From Education improves public health and promotes health equity (2015) · cites this paper as [29]

  • Among US adults, the prevalence of several risk behaviors is generally higher among those with fewer than nine years of formal education, begins to decline among those with nine to 12 years, and continues to decline with additional years of education.

    “the prevalence of several risk behaviors is generally higher among those with fewer than nine years of formal education, begins to decline among those who have nine to 12 years of formal education, and continues to decline with additional years of education”

    From Education improves public health and promotes health equity (2015) · cites this paper as [29]

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Authors
Winkleby, M. A., Jatulis, D. E., Frank, E., & Fortmann, S. P.
Affiliations
Stanford Medicine (US)
ORCID
Venue
American Journal of Public Health
Publisher
American Public Health Association
Published
1992-06
Volume
82
Issue
6
Pages
816-820
ISSN
  • 0090-0036 (ISSN-L)
  • 1541-0048
DOI
10.2105/ajph.82.6.816
OpenAlex
W2165030669
Cited by
2,048
References
34
Citations by year
2026: 35 · 2025: 58 · 2024: 58 · 2023: 70 · 2022: 89 · 2021: 116 · 2020: 103 · 2019: 117 · 2018: 109 · 2017: 100 · 2016: 90 · 2015: 100 · 2014: 89 · 2013: 77 · 2012: 64
FWCI
30.39
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Public Health (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hl021906-19)
  • National Heart, Lung, and Blood Institute (1-RO1-HL-21906)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
socioeconomic status, cardiovascular risk factors, educational attainment, income, occupational status, cigarette smoking, blood pressure, cholesterol, health disparities
MeSH terms
Adult, Blood Pressure, California, Cardiovascular Diseases, Cholesterol, Cross-Sectional Studies, Educational Status, Female, Health Status Indicators, Humans, Income, Cholesterol, HDL, Male, Middle Aged, Occupations, Predictive Value of Tests, Regression Analysis, Smoking, Socioeconomic Factors, Prevalence

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