SES and disease

Question 1

What is SES (socioeconomic status)?

Answer 1

1. Education
2. Occupation
3. Income

Question 2

What were the main findings of the studies investigating the link between SES and mortality?

Answer 2

• In a nationally representative US sample –> mid-income had 2 times, and low-income had 3 times the mortality rate of high-income!
• In British Civil Servants –> Top admin had HALF the mortality of the next highest position (high demands, but even higher control)

Question 3

What were the findings of the NHANES (National Health and Nutrition Examination Survey) regarding the link between SES and CHD risk?

Answer 3

• Low education predicted BOTH depression and anxiety, which both predict increased CHD risk.
• Low education continued to predict increased CHD risk, even when depression and anxiety were controlled for (i.e. Low education independently predicts CHD!)

Question 4

How does exposure to low SES conditions (even if you are not of low SES) affect your mortality?

Answer 4

Individuals whose fathers had a manual occupations had significantly higher risk ratios for major illnesses (CHD, stroke, lung cancer)

Compared with those who grew up in high SES families, Johns Hopkins graduates from low SES families had a 2.4 times higher risk of developing CHD before age 50.

Question 5

How do the effects of SES on mortality differ across countries?

Answer 5

Countries like US, UK and China don’t have nationalized healthcare - lower SES patients may experience lower quality/delays in appropriate medical treatment.

France and Spain provide people of all SES with the same secondary prevention treatments –> all patients achieved equally good decreases in CHD risk!

Significance:
- If treatment methods are the same across SES, CHD risk can be lowered across all statuses!

Question 6

What could be accounting for the stronger effect of one’s education on one’s SBP (systolic blood pressure) in France, while in the U.S. it is one’s household income that is more strongly affecting one’s SBP?

Answer 6

In France, individuals receive the same quality of healthcare regardless of their income. Thus, education appears to have a stronger effect on their health outcomes.

On the other hand, income DOES determine the quality of healthcare that people can attain in the US!

Question 7

How does income inequality (% of income owned by the bottom 50% of total state income) affect mortality?

Answer 7

• Lower income inequality associated with lower all-cause mortality
• Higher income inequality associated with many negative outcomes (e.g. worse state averages for birth weights, homicides, violent crimes, expenditures on medical care and police protection, unemployment, food stamp use, lack of medical insurance, lower educational attainment)

Question 8

What did researchers find when they studied the “Social determinants of tuberculosis risk in Europe”?

Answer 8

• Higher GDP = lower TB rates
• Higher income inequality = higher TB rates
• GDP and income inequality are strong predictors of TB incidence, accounting for 50% of country level variation!

Question 9

What can be done at the national/state level?

Answer 9

• Nationalized healthcare (single-payer)
• Free education up to the college level at least
• STEM education (prepare students for technological advances)
• Increase minimum wage