Articlegreen1997

The effects of occupation-based social position on mortality in a large American cohort.

David I. Gregorio · Stephen J. Walsh · Deborah Paturzo

78 citations0/0 files storedAmerican Journal of Public Health

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Health disparities and outcomes Intergenerational and Educational Inequality Studies Public Health and Social Inequalities

Abstract

OBJECTIVES: Four occupation-based measures were used to derive estimates of social position's effect on all-cause mortality among men and women in a large national cohort. METHODS: The National Longitudinal Mortality Study provided information on principal occupation and 9-year follow-up for 229,851 persons aged 25 through 64 years. Cox's proportional hazards model was used to estimate the age-adjusted risk of death relative to six ordinal categories of social position. The Slope Index of Inequality described average change in death rates across categories. RESULTS: Risk of death was consistently elevated among persons at lower positions in the social hierarchy. Estimates comparing lowest with highest categories varied within a narrow range (1.47-1.92 for men and 1.23-1.55 for women). However, several discrepancies among analyses were noted. The analysis by US census groups revealed nonlinear associations, whereas those using other scales found incremental increases in risk. Effect modification by sex was observed for analyses by two of the four measures. Race/ ethnicity did not modify the underlying association between variables. CONCLUSIONS: Our analysis complements previous findings and supports, with few qualifications, the interchangeability of occupation-based measures of social position in mortality studies. Explanations for why relative risk estimates were modified by sex are offered.

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References

1995Social Conditions As Fundamental Causes of Disease 1995Social Conditions as Fundamental Causes of Disease 1991On the measurement of inequalities in health 1988THE MEASUREMENT OF SOCIAL CLASS IN EPIDEMIOLOGY 1993The Relationship between Socioeconomic Status and Health: A Review of the Literature 1993Racism, Sexism, and Social Class: Implications for Studies of Health, Disease, and Well-being 1973Differential Mortality in the United States: A Study in Socioeconomic Epidemiology 1995US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study.

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2009Social Inequality and Racial Discrimination: Risk Factors for Health Disparities in Children of Color 2009Racial Discrimination: A Continuum of Violence Exposure for Children of Color 2008Occupational social class, educational level, smoking and body mass index, and cause-specific mortality in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort 2002Socioeconomic Disparities In Health: Pathways And Policies Inequality in education, income, and occupation exacerbates the gaps between the health “haves” and “have-nots.”

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