Lifetime socioeconomic position and mortality: prospective observational study

Abstract

Objective: To investigate the effect of socioeconomic group (with reference to age and sex) on the rate of, course of, and survival after coronary events. Design: Community coronary event register from 1985 to 1991. Setting: City of Glasgow north of the River Clyde, population 196 000. Subjects: 3991 men and 1551 women aged 25-64 years on the Glasgow MONICA coronary event register with definite or fatal possible or unclassifiable events according to the criteria of the World Health Organisation's MONICA project (monitoring trends and determinants in cardiovascular disease). Main outcome measures: Rate of coronary events; proportion of subjects reaching hospital alive; case fatality in admitted patients and in community overall. Results: Event rates increased with age for both sexes and were greater in men than women at all ages. The rate increased 1.7-fold in men and 2.4-fold in women from the least (Q1) to the most (Q4) deprived socioeconomic quarter. The socioeconomic gradient decreased with age and was steeper for women than men. The proportion treated in hospital (66%) decreased with age, was greater in women than men, and decreased in both sexes with increasing deprivation (age standardised odds ratio 0.82 for Q4 v Q1) Case fatality in hospital (20%) increased with age, was greater for women than men when age was standardised, and showed no strong socioeconomic pattern. Overall case fatality in the community (50%) increased with age, was similar between the sexes, and increased from Q1 to Q4 (age standardised odds ratio 1.12 in men, 1.18 in women). Conclusions: Socioeconomic group affects not only death rates from myocardial infarction but also event rates and chance of admission. This should be taken into account when different groups of patients are compared. Because social deprivation is associated with so many more deaths outside hospital, primary and secondary prevention are more likely than acute hospital care to reduce the socioeconomic variation in mortality.

Subjective Social Status and Functional Decline in Older Adults

“…Evidence suggests that the cumulative life experience influences health trajectories in a way that no static timepoint can capture. [26][27][28][29] Despite this evidence, it has been difficult to find a way to better account for the collective effect of lifetime SES. Indeed, evidence has shown that the effects of socioeconomic disparities on health may have the most impact earlier in life, perhaps due to mortality selection.…”

Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

“…Unhealthy diet, lack of exercise and drug use, particularly tobacco use, has only become strongly associated with social disadvantage relatively recently (Tate, 1999). This may explain why, in some studies, consideration of established physiological and behavioural risk factors seems to account for only a relatively small proportion of relative inequality in health between social groups (Davey Smith, Hart, Blane, Gillis & Hawthorne, 1997) (Marmot, Bosma, Hemingway, Brunner & Stansfeld, 1997). Similarly, access to health technology appears to be socially patterned and as technology becomes more effective this patterning is likely to contribute to health inequalities (Watt, 2002).…”

“…Whether participants regularly drove a car was measured based on a single question on this. An area-based measure of deprivation was derived from the postcode of participant's normal place of residence according to the system of Carstairs and Morris (Carstairs & Morris, 1991) (Davey Smith, Hart, Blane, Gillis & Hawthorne, 1997). Scores were categorised as deprived (scores 6-7), middle (scores 4-5) and affluent (scores 1-3).…”

The Scottish Mental Survey 1932 linked to the Midspan studies: a prospective investigation of childhood intelligence and future health

“…The first team is responsible for the Midspan prospective cohort studies conducted in the west of Scotland on adult men and women in the 1970s. These studies have generated novel findings on the use of social, lifestyle and health factors to predict mortality [4][5][6][7][8] , hospital admissions 9; 10 , and specific disease outcomes such as cardiorespiratory illness 11 , stroke 12 and cancer 13 . The participants have been followed up for mortality and cancer since inception, and have recently been linked with the Scottish Morbidity Records (SMR) system, enabling data on physical and mental illness to be investigated.…”