Health disparities across the lifespan: Meaning, methods, and mechanisms

Abstract

Over the past two decades, exponential growth of empirical research has fueled markedly increased concern about health disparities. In this paper, we show the progression of research on socioeconomic status (SES) and health through several eras. The first era reflected an implicit threshold model of the association of poverty and health. The second era produced evidence for a graded association between SES and health where each improvement in education, income, occupation, or wealth is associated with better health outcomes. Moving from description of the association to exploration of pathways, the third era focused on mechanisms linking SES and health, whereas the fourth era expanded on mechanisms to consider multilevel influences, and a fifth era added a focus on interactions among factors, not just their main effects or contributions as mediators. Questions from earlier eras remain active areas of research, while later eras add depth and complexity.

Regional socioeconomic disparities in outcomes for workers with low back pain in the United States

“…The state‐level variables previously associated with health outcomes were: (i) annual state poverty rate for each year 2002‐2008, measured as percentage of state population with income below 100% poverty; (ii) household income inequality (Gini coefficient), a ratio ranging between 0 (complete income equality) and 1 (complete income inequality)37, 38; (iii) unemployment rate39, 40; and (iv) the rate of disabled workers receiving Social Security Disability Insurance (SSDI). We included state WC policies on wage replacement and medical benefits (2002‐2008, see Table 1) known to impact medical cost and LOD 25.…”

Life course socioeconomic status and DNA methylation in genes related to stress reactivity and inflammation: The multi-ethnic study of atherosclerosis

“…Low SES is associated with increased exposure to stressful life events and chronic strains, as well as decreased access to material and psychosocial resources that can buffer the negative impact of stress on health. 53 For example, children in low SES families are more likely than their higher SES counterparts to be exposed to chronic and acute stressors, such as harsh, inconsistent parenting, family conflict, housing instability, and neighborhood violence, 54 while low SES adults are more likely to be exposed to financial stress, relationship difficulties, divorce, and violent victimization. 55 Low socioeconomic status may also induce stress in children and adults via social subordination.…”

“…35 In addition to stress exposure, SES may be linked to DNAm through other pathways, such as negative affect, household or occupational exposure to carcinogens and pathogens, and diet and physical activity. 53 More work is needed to disentangle the social, environmental, psychological, and behavioral mechanisms underlying associations between SES and DNA methylation.…”

Variation in supermarket exposure to energy-dense snack foods by socio-economic position

“…Behavioural justice suggests that 'no group should bear a disproportionate share of health problems resulting from inadequate resources for engaging in healthy behaviours' (14) . Although this definition focuses on the resources required for healthy behaviours, the same principles apply with regard to limiting environments that stimulate unhealthy behaviours.…”