Socioeconomic Status in Health Research

Abstract

Problems with measuring socioeconomic status (SES)-frequently included in clinical and public health studies as a control variable and less frequently as the variable(s) of main interest-could affect research findings and conclusions, with implications for practice and policy. We critically examine standard SES measurement approaches, illustrating problems with examples from new analyses and the literature. For example, marked racial/ethnic differences in income at a given educational level and in wealth at a given income level raise questions about the socioeconomic comparability of individuals who are similar on education or income alone. Evidence also shows that conclusions about nonsocioeconomic causes of racial/ethnic differences in health may depend on the measure-eg, income, wealth, education, occupation, neighborhood socioeconomic characteristics, or past socioeconomic experiences-used to "control for SES," suggesting that findings from studies that have measured limited aspects of SES should be reassessed. We recommend an outcome- and social group-specific approach to SES measurement that involves (1) considering plausible explanatory pathways and mechanisms, (2) measuring as much relevant socioeconomic information as possible, (3) specifying the particular socioeconomic factors measured (rather than SES overall), and (4) systematically considering how potentially important unmeasured socioeconomic factors may affect conclusions. Better SES measures are needed in data sources, but improvements could be made by using existing information more thoughtfully and acknowledging its limitations.

Multiple socio-economic circumstances and healthy food habits

“…Multicollinearity for socio-economic circumstances has been tested previously, but it was not found (Laaksonen et al, 2005b). Also other previous studies suggest that correlations between different socio-economic circumstances such as education and income are not strong enough to justify using one indicator as a proxy for another (Braveman et al, 2005). Thus, these indicators are not to be considered interchangeable.…”

“…Furthermore, at least partially divergent etiological processes may lie behind the association of each socio-economic indicator and food behaviour (Macintyre, 1997). As socio-economic position is a multidimensional umbrella concept, it has been suggested that studies should include several socio-economic measures and consider their nature, stage over the life course and interrelationships, as well as explanatory pathways through which they may influence health-related outcomes, including food behaviour (Braveman et al, 2005;Galobardes et al, 2006a, b). Examining simultaneously multiple dimensions of socio-economic circumstances helps elucidate our understanding of the observed inequalities and identify potential risk groups for health promotion programmes.…”

“…These, in turn, contribute to adult material resources, such as income and wealth. It is of note, however, that income in itself does not directly measure wealth, as wealth can substantially vary across groups with similar incomes (Braveman et al, 2005). Education reflects one's knowledge and attitudes that may help follow recommended behaviours, for example, adopting healthy food habits.…”

Gender and socio-economic patterning of self-reported sleep problems in Britain

“…A large corpus of research shows that low SES is strongly related to morbidity, mortality and biological risk factors (Backlund, Sorlie & Johnson, 1999;Banks, Marmot, Oldfield & Smith, 2006;Braveman, Cubbin, Egerter, Chideya, Marchi, Metzler, 2005;Fritzell & Lundberg, 2007;Seeman, Merkin, Crimmins, Koretz, Charette & Karlamangla, 2008;Shishehbor, Litaker, Pothier & Lauer, 2006).…”

Road crash involvement and professional status: A prospective study using the French Gazel cohort

“…At the same time, they accumulate high amount of driving while drowsy (McCartt et al 1996). ERR is often invoked but not quantified to explain the social disparities in road safety, especially among children (Braveman et al 2005;Soori and Bhopal 2002;White et al 2000).…”