Lower subjective social status is associated with increased adiposity and self-reported eating in the absence of hunger due to negative affect among children reporting teasing distress.

OBJECTIVES: Low social standing and teasing are independently associated with increased body mass index (BMI) and overeating in children. However, children with low social status may be vulnerable to teasing. METHODS: We tested the statistical interaction of subjective social status (SSS) and subjective socioeconomic status (SSES) and teasing distress on BMI, fat mass index (FMI), and eating in the absence of hunger (EAH) in children (Mage = 13.09 years, SD = 2.50 years; 27.8% overweight/obese). Multiple linear regressions identified the main effects of self-reported SSS (compared to peers in school), distress due to teasing, and their interaction on BMI (n = 115), FMI (n = 114), and child- (n = 100) and parent-reported (n = 97) EAH. RESULTS: Teasing distress was associated with greater BMI, FMI, and child-reported EAH due to negative affect (a subscale of EAH) and total EAH scores. There were no associations of SSS with these outcomes. However, there was an interaction between SSS and teasing distress for BMI, FMI, and EAH from negative affect such that lower SSS was associated with higher BMI, FMI, and EAH from negative affect in the presence of teasing distress. However, there were no main effects or interactions (with teasing distress) of SSES on the outcomes. CONCLUSIONS: These findings suggest that the relationship between lower SSS and increased adiposity and overeating behaviors may be exacerbated by other threats to social standing, such as teasing. Children exposed to multiple social threats may be more susceptible to eating beyond physiological need and obesity than those who experience a single form of perceived social disadvantage.

Effects of Subjective Social Status and Self-Esteem in the Association Between Childhood Abuse and Adulthood Anxiety.

Background: Subjective social status influences anxiety, but at present, the mechanism is not fully understood. It has been reported that negative childhood experiences, such as abuse, can influence depressive symptoms through subjective social status and personality traits, such as self-esteem. A similar mechanism is presumed to underlie anxiety symptoms in adulthood. Therefore, we hypothesized that subjective social status and self-esteem are intermediate factors in the indirect effects of childhood abuse on state anxiety in adulthood, and analyzed the indirect effects via these factors using a path analysis. Subjects and Methods: Child Abuse and Trauma Scale, Subjective Social Status, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory Form Y questionnaires were administered in a self-report format to 404 adult volunteers from January 2014 to August 2014. In addition, a path analysis was conducted to determine whether subjective social status and self-esteem are associated with the indirect effects of childhood abuse on anxiety symptoms in adulthood. Results: Childhood abuse did not directly affect state anxiety in adulthood, but affected state anxiety via subjective social status and self-esteem. Subjective social status affected state anxiety via self-esteem. This model explained 25.2% of the variation in state anxiety in adult volunteers. Conclusion: The present study demonstrated that childhood abuse affects anxiety in adulthood through subjective social status and self-esteem. Therefore, interventions that enhance subjective social status and self-esteem for adults who experienced childhood abuse may help reduce their anxiety.

The progressive place paradox: Status-based health inequalities are magnified in more economically progressive Swiss localities.

Low socioeconomic status (measured both objectively and subjectively) is systematically associated with worse health. Amid renewed interest in contextual influences on health inequalities, we ask whether variation in the prevailing ideological climate moderates the size of the health gap between low and high status individuals. Based on the minority stress hypothesis, we expect that living in an economically progressive place within Switzerland - places where more residents endorse the need for change to the economic status quo - will reduce the magnitude of the health gap. Multilevel modelling of MOSAiCH 2015-2020 data shows the opposite: low status individuals in progressive places report markedly lower subjective health and life satisfaction than similarly low status individuals in conservative places, such that status-based health inequalities are maximised in progressive places. We interpret this apparent progressive place paradox in terms of collective inefficacy and system frustration, which we argue is the corollary of system justification.

Associations Between Subjective Social Status and Health Behaviors Among College Students.

OBJECTIVE: Examine the associations between subjective social status (SSS), diet, and health outcomes in college students. METHODS: Cross-sectional study of 841 students enrolled at a large Midwestern university. Subjective social status within the US, as well as within the university, was measured using the MacArthur Scale of SSS. Outcomes included dietary intake (assessed using the Dietary Screening Questionnaire), body mass index, sleep, physical activity, alcohol use, and vaping behavior. Generalized linear models adjusting for students' sociodemographic characteristics were used to assess associations between SSS and outcomes of interest. RESULTS: Higher SSS-US was associated with 4%, 3%, and 1% higher intake of fruits, whole grains, and fiber, respectively (P < 0.05). Higher SSS-US and SSS-university rankings were both significantly associated with lower body mass index and better sleep duration (P < 0.05). Higher SSS-university rankings were also associated with more days of physical activity and alcohol consumption (P < 0.05). CONCLUSIONS AND IMPLICATIONS: In this exploratory study, higher SSS, apart from alcohol intake, was associated with more favorable health outcomes. More research is needed to consider additional psychological and biological mediators and dynamic aspects of SSS, examine potential interactions between SSS and racial and ethnic identities, and explore potential mechanisms underlying the observed associations.

Psychosocial factors associated with 7-year change in cognition among middle-aged and older Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) and Sociocultural ancillary studies.

INTRODUCTION: Few studies have examined the associations of psychosocial factors with cognitive change in Hispanics/Latinos. METHODS: Data from the Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (HCHS/SOL INCA) and Sociocultural studies were used (n = 2,155; ages ≥45 years). Psychosocial exposures included intrapersonal (ethnic identity, optimism, purpose in life), interpersonal (family cohesion, familism, social networks, social support), and social factors (ethnic discrimination, loneliness, subjective social status). Survey-linear regression models examined associations between psychosocial exposures and 7-year cognitive change (global cognition [GC], verbal learning, memory, word fluency [WF], and digit symbol substitution [DSS]). RESULTS: Familism predicted decline in GC, verbal learning, and memory; family cohesion predicted DSS decline; and loneliness predicted memory decline. Ethnic identity was protective against decline in GC and memory, optimism and social support were protective against decline in memory, and purpose in life was protective against WF decline. DISCUSSION: Psychosocial factors are differentially related to cognitive changes. Culturally relevant factors should be explored in Hispanic/Latino cognitive aging research. HIGHLIGHTS: Psychosocial factors are differentially related to cognitive changes in Latinos. Role of culturally relevant factors on cognition should be further explored. Familism predicted decline in global cognition, verbal learning, and memory. Ethnic identity predicted increase in global cognition and memory.

Subjective social status and functional and mobility impairments among older adults: life satisfaction and depression as mediators and moderators.

BACKGROUND: While functional and mobility impairments (FMIs) have garnered the attention of health researchers in low and middle-income countries (LMICs), including India, research has yet to explore whether and to what extent the perception of one's social status is associated with FMIs. We fill this gap in the literature by examining (1) the association between subjective social status (SSS) and FMIs among older adults in India and (2) whether this association between SSS and FMIs is mediated and moderated by life satisfaction and depression. METHODS: Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults aged 60 years and above. FMIs were assessed using established scales on impairments in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. SSS was assessed using the Macarthur scale. Life satisfaction was measured using responses to five statements gauging respondent's overall satisfaction with life. Depression was calculated using the shortened version of the Composite International Diagnostic Interview (CIDI-SF). Multivariable regression was employed to examine the association between variables, and the interaction terms and Karlson-Holm-Breen (KHB) method were used separately to test the mediation and moderation effects. RESULTS: 39.11% of the sample had a low SSS, 8.26% were depressed, and 32.07% reported low life satisfaction. A total of 8.74%, 10.91%, and 8.45% of the study population reported at least one impairment in ADL, IADL, and mobility, respectively. Older adults in the higher SSS group were less likely to have ADL impairment (beta: -0.017, CI: -0.030, -0.0032) and mobility impairment (beta: -0.044, CI: -0.076, -0.013). Depression moderated the association between SSS and mobility impairment (p-value: 0.025), and life satisfaction moderated the association between SSS and ADL impairments (p-value: 0.041) and SSS and IADL impairments (p-value: 0.037). Depression mediated 20.28%, 31.88%, and 18.39% of the associations of SSS with ADL, IADL, and mobility impairments, respectively. Similarly, life satisfaction mediated 23.24%, 52.69%, and 27.22% of the associations of SSS with ADL, IADL, and mobility impairments. CONCLUSIONS: That SSS is associated with FMIs among older Indians, even after considering their objective socioeconomic status (SES), suggests that the use of SSS is relevant to the study of health inequalities in India. The finding that life satisfaction and depression mediate and moderate this association is crucial in pinpointing those older Indians at risk of the functional and mobility-related repercussions of lower SSS.

Examining individual social status using the MacArthur Scale of Subjective Social Status: Findings from the Born in Bradford study.

Subjective social status is how a person perceives their social class relative to other people and has frequently been associated with people's health and well-being. A frequently used measure of subjective social status is the MacArthur Scale of Subjective Social Status that depicts social status as a 10 rung ladder, asking individuals to rank themselves on this ladder relative to other people, either in their local neighbourhood or wider society. The Born in Bradford's Better Start birth cohort study aims to understand the lives, relationships, wellbeing, and social and economic circumstances of pregnant women and their children in three inner city areas of Bradford, UK. Pregnant mothers were asked to report their subjective social status, using the MacArthur subjective social status scales, comparing themselves to other people in their local neighbourhood and in England as a whole. This paper explores the characteristics of the women who gave responses, examines associations between the MacArthur subjective social status measures and other subjective and objective measures and looks specifically at the characteristics of women who reported either very low or very high subjective social status. On average, women reported that they had a higher social status compared to others within their local neighbourhood (mean ladder rung = 6) and, although participants were from areas of Bradford with very high levels of deprivation, 23% placed themselves on the top three rungs, 8-10. Respondents reported that they had an average social status when comparing themselves to people in all of England (mean ladder rung = 5) and 13% placed themselves on the top rungs 8-10. These findings raise important questions about the interpretation of the MacArthur scale of subjective social status.

Expanded-multidimensional turnover intentions: scale development and validation.

BACKGROUND: This study aims to provide researchers and practitioners with a more elaborate instrument to measure turnover intentions based on the planned behaviour theory model. The questionnaire assesses 5 distinct aspects of turnover intentions (i.e., subjective social status, organisational culture, personal orientation, expectations, and career growth). METHODS: In this cross-sectional study (comprise of 2 studies in one) a wave survey design was applied to a large diversity of workers drawn from the staff of universities, banks, hospitals, factories, and telecommunication companies. Exploratory factor analysis (EFA) was applied the identify the sub-dimensions and Cronbach's alpha to assess the reliability of the first study. In the second study, for the Confirmatory factor analysis to establishing structural model of the dimensions. RESULTS: We demonstrate the reliability, factor structure, and validity evidence based on internal structure and relationship with other variables of the new measure among two samples (N1 = 622; N2 = 433). Twenty-five items with 5 factors were extracted to represent a broader perspective of turnover intention scale. CONCLUSIONS: In total, the study indicates that the assessment can be used to reliably assess several major indicators of turnover intentions. Therefore, improved employees' evaluations and reduced loss of valuable staff as a result of avoidable measures in considering the interests of workers.

Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators.

BACKGROUND: While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment. METHODS: Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions. RESULTS: The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment. CONCLUSIONS: Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.

Subjective Social Status and Longitudinal Changes in Systemic Inflammation.

BACKGROUND: Subjective social status (SSS) refers to a person's perception of their social rank relative to others and is cross-sectionally linked to systemic inflammation independently of objective socioeconomic status. PURPOSE: We test the extent to which SSS relates to multiyear changes in inflammation, or if associations differ by race or sex. METHODS: Healthy adults (N = 331; 30-51 years) completed a baseline visit and 278 participants returned for a second visit 2.85 years later. At both visits, participants underwent a fasting blood draw and completed community (SSSC) and US (SSSUS) versions of the MacArthur Scale. Multiple linear regression analyses examined change in interleukin-6 (IL-6) and C-reactive protein (CRP) predicted by each type of SSS, adjusting for time between visits, sex, race, age, body mass index, smoking, baseline inflammation, and objective socioeconomic status. Additional analyses further adjusted for hopelessness and depressive symptoms. Interactions examined moderations by sex and race. RESULTS: Lower SSSC was longitudinally associated with greater IL-6 independently of all covariates, including education and income (ß = -0.06), hopelessness (ß = -0.06), and depressive symptoms (ß = -0.06). Lower SSSUS was longitudinally associated with greater IL-6 independently of demographic covariates including education and income (ß = -0.06), but was slightly attenuated after adjusting for hopelessness (ß = -0.06) and depressive symptoms (ß = -0.06). There were no associations for CRP or moderation by race or sex. CONCLUSIONS: Lower SSS may be associated with greater circulating markers of inflammation over time as suggested by increases in IL-6.

Subjective social status (SSS) refers to how people perceive their social rank compared with others and has been linked to meaningful differences in physical health. Increases in inflammation may contribute to associations between lower SSS and poorer physical health. In a sample of healthy adults, we examined whether SSS was associated with prospective, multiyear changes in markers of systemic inflammation and if this differed by sex or race. We found that adults who perceived their social status as lower than peers in their community exhibited an accelerated increase in interleukin-6, a marker of systemic inflammation, over a 3-year period. When participants were asked to compare themselves to people in the broader USA, the pattern was similar but less robust. Results were independent of individual differences in sociodemographic characteristics including family-adjusted income and education. Findings did not differ by sex or race and were not explained by differences in adiposity and symptoms of depression and hopelessness. Effects for C-reactive protein, a second marker of inflammation, were generally nonsignificant. Although preliminary, findings suggest an immune pathway by which perceived social status may relate to chronic diseases of aging.

Associations of relative deprivation with self-rated health and health-related quality of life: mediating role of subjective social status.

OBJECTIVES: Relative deprivation has been linked to various adverse health outcomes. However, the potential mediating factors in the association between relative deprivation and health outcomes remain unclear. This study aimed to (1) examine the association between relative deprivation and self-rated health and health-related quality of life among the working-age population in Taiwan and (2) investigate the mediating effect of subjective social status. STUDY DESIGN: Cross-sectional study using nationally representative data. METHODS: Data were obtained from the 2022 Taiwan Social Change Survey conducted from September 2021 to April 2022. We analyzed 1108 participants aged 25-64 years. Relative deprivation was measured using the Yitzhaki Index based on individual monthly income from all sources. Health-related quality of life was assessed using the 12-item Short Form Health Survey. RESULTS: After adjusting for all covariates and absolute income, least-squares regression models indicated a negative association between the Yitzhaki Index and self-rated health, as well as the physical and mental components of health-related quality of life. Furthermore, subjective social status partially mediates the association between relative income deprivation and poorer self-rated health and health-related quality of life. CONCLUSIONS: The findings support the psychosocial effect of the relative deprivation measure, emphasizing the importance of addressing relative deprivation to improve health-related quality of life among the working-age population.

Exploring the Mechanism of Subjective Social Status on Compulsive Shopping Behavior: A Moderated Mediation Model of Self-compassion and Depression.

The present study aimed to explore the mediating role of depression in the relationship between subjective social status (SSS) and compulsive shopping behavior (CSB) and whether self-compassion (SC) played a moderating role in this model. The study was designed based on the cross-sectional method. The final sample includes 664 Vietnamese adults (Mage = 21.95, SD = 5.681 years). Participants completed an online survey, including questionnaires about SSS, CSB, depression, SC, and basic demographic information. First, the study results showed that SSS did not directly affect CSB (p > .05, 95% CI includes zero). Second, a mediating role of depression and a moderating role of SC in the research model was discovered (p < .001, 95% CI does not contain zero). Results indicated that individuals with a higher SSS experienced lower depression. Moreover, during a depressive episode, having a higher level of SC increases CSB. The study highlighted meaningful recommendations to promote consumers' mental health and healthy shopping behaviors.

Does subjective social status affect pain thresholds? - an experimental examination.

Past research regarding the relationship between different constructs of social status and different aspects of pain has yielded divergent results. So far, there are few experimental studies to investigate the causal relationship between social status and pain. Therefore, the present study aimed to examine the effect of perceived social status on pain thresholds by experimentally manipulating participants' subjective social status (SSS). 51 female undergraduates were randomly assigned to a low- or high-status condition. Participants' perceived social standing was temporarily elevated (high SSS condition) or reduced (low SSS condition). Before and after experimental manipulation participants' pressure pain thresholds were assessed. The manipulation check confirmed that participants in the low-status condition reported significantly lower SSS than participants in the high-status condition. A linear mixed model revealed a significant group x time interaction for pain thresholds: Whereas participants' pain thresholds in the low SSS condition increased post manipulation, pain thresholds of participants in the high SSS condition decreased post manipulation (ß = 0.22; 95% CI, 0.002 to 0.432; p < .05). Findings suggest that SSS may have a causal effect on pain thresholds. This effect could either be due to a change in pain perception or a change in pain expression. Future research is needed to determine the mediating factors.

Does migrant workers' subjective social status affect their mental health? Job satisfaction as a longitudinal mediator.

BACKGROUND: Prior studies on migrant workers have explored the effect of their subjective social status and job satisfaction on their mental health, respectively or combined, as well as how their subjective social status affects their job satisfaction. Nonetheless, few have accounted straightforwardly and holistically for the mechanism of interaction between subjective social status, job satisfaction and mental health amongst migrant workers. AIMS: Taking migrant workers in China as the object of study, we intended to probe the longitudinal links between their subjective social status, job satisfaction and mental health, in particular, their job satisfaction as a longitudinal mediator therein. METHOD: Using the three-wave data from the 2014, 2016 and 2018 China Labour-force Dynamics Survey, we defined migrant workers as labourers aged 15 to 64 with agricultural hukou and engaged in non-agricultural work in urban areas. The final valid sample comprised 2,035 individuals. Latent growth models (LGMs) were applied to test the hypothesised relationships. RESULTS: The LGMs based on bootstrapping showed that amongst migrant workers the subjective social status, job satisfaction and mental health tended overall to grow linearly and that the job satisfaction longitudinally mediated between the subjective social status and mental health. CONCLUSIONS: The findings may enlighten policymaking to elevate migrant workers mentally and inform future studies on theoretical and practical fronts.

Subjective social status and health among older adults in China: the longitudinal mediating role of social trust.

BACKGROUND: From a developmental perspective, this study explored the interplays between subjective social status (SSS), social trust (ST), and health status measured by self-rated health (SRH) among older adults in the context of China. It also tested the longitudinal mediation of ST between SSS and SRH. METHODS: After excluding samples with missing values, we analyzed 4,877 individual responses from those aged 60 years or older, extracted from the China Family Panel Studies (CFPS) data in 2014, 2016, and 2018. We used latent growth modeling to test the hypothesized relationships among their SSS, ST, and SRH. RESULTS: Latent growth modeling based on bootstrapping showed that the SSS, ST, and SRH of older adults all increased linearly and that the mechanism of SSS acted on the SRH as follows: the initial level of SSS indirectly influenced the initial level and the growth rate of the SRH, respectively, through the initial level of ST, and the initial level and growth rate of SSS played an indirect role in the growth rate of the SRH through the growth rate of ST. CONCLUSION: The findings have practical implications for promoting health for older adults and realizing active aging in China. Therefore, we recommend establishing a family-centered and community-supported social support system for those with lower social status among older adults and a friendly community environment with various social, cultural, and recreational activities to improve the ST among older adults, thereby improving their health.

When High Subjective Social Status Becomes a Burden: A Japan-U.S. Comparison of Biological Health Markers.

High subjective social status (SSS) is believed to protect health in the current literature. However, high SSS entails social responsibilities that can be stressful in collectivistic cultural contexts. Here, we tested the hypothesis that those socialized in collectivistic societies (e.g., Japan) recognize their high social status as entailing social duties difficult to ignore even when they are excessive. Using cross-cultural survey data (N = 1,289) and a measure of biological health risk (BHR) by biomarkers of inflammation and cardiovascular malfunction, we found that higher SSS predicted lower BHR for American males. In contrast, higher SSS predicted higher BHR for Japanese males, mediated by the perceived difficulty of disengaging from their current goals. In both cultural groups, females showed no association between SSS and BHR. These findings suggest that social status has differing health implications, depending on the relative salience of privileges and burden-producing responsibilities in different cultural contexts.

Subjective social status, race, and metabolic syndrome in women with breast cancer.

PURPOSE: To evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. METHODS: Multicenter cross-sectional study (10 US hospitals) in women (n = 1206) with primary diagnosis of invasive breast cancer received during Mar/2013-Feb/2020. Participants, self-identified as non-Hispanic White or Black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history, and behavioral risks. SSS was measured with the 10-rung MacArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation. RESULTS: Average age was 58 years. On average, the SSS of Black women, given equivalent level of income and education, was lower than the SSS of White women: 6.6 (6.1-7.0) vs 7.7 (7.54-7.79) among college graduates and 6.8 (6.4-7.2) vs 7.6 (7.5-7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet, and physical activity, increasing SSS was associated with a decrease in MetS-Z score, - 0.10 (- 0.16 to - 0.04) per every 2 rung increase in the MacArthur scale. CONCLUSION: Black women with breast cancer rank their SSS lower than White women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modifiable factors that contribute to racial disparities.

Turning their backs on the 'ladder of success'? Unexpected responses to the MacArthur Scale of Subjective Social Status.

Subjective social status measures a person's perception of their social class relative to other people and has theoretically and empirically been positively associated with health and wellbeing. A widely used measure of this construct is the MacArthur Scale of Subjective Social Status, which asks people to report their social status by placing themselves on a ladder which represents the social hierarchy of their society or community; the scale has been used with many different populations across many countries. In this research note, we describe two cases where we encountered unexpected reactions to the MacArthur Scale that we believe highlight (a) the salience of relative social status for people's wellbeing in contemporary society and (b) the concomitant sensitivities raised by measuring this subjective experience. We discuss the implications of these observations for future research.

What alleviates depression among medical workers in emergency risk events? The function of subjective social status.

Medical workers often face serious family-work conflicts and are prone to depressive symptoms. The present study aimed at investigating associations between family-work conflict and depression in emergencies, and at exploring psychological processes involved in this association. A total of 1347 participants were recruited to complete questionnaires. Results showed that the positive effect of family-work conflict on depression was mediated by the basic psychological needs satisfaction, and subjective social status moderated this relationship as a buffer. For individuals with high levels of subjective social status, the direct and indirect effects of family-work conflict on depression were weaker. This study identified the mediating and moderating mechanisms of family-work conflict and depression. The implications of these findings in both theoretical and practical terms will be discussed.

Subjective socioeconomic status: an alternative to objective socioeconomic status.

BACKGROUND: Subjective "ladder" measurements of socio-economic status (SES) are easy-to-administer tools that ask respondents to rate their own SES, allowing them to evaluate their own material resources and determine where it places them relative to their community. Here, we sought to compare the MacArthur Scale of Subjective Social status to the WAMI, an objective measure of SES that includes data on water and sanitation, asset ownership, education, and income. METHODS: Leveraging a study of 595 tuberculosis patients in Lima, Peru, we compared the MacArthur ladder score to the WAMI score using weighted Kappa scores and Spearman's rank correlation coefficient. We identified outliers that fell outside the 95th percentile and assessed the durability of the inconsistencies between scores by re-testing a subset of participants. We then used Akaike information criterion (AIC) to compare the predictability of logistic regression models evaluating the association between the two SES scoring systems and history of asthma. RESULTS: The correlation coefficient between the MacArthur ladder and WAMI scores was 0.37 and the weighted Kappa was 0.26. The correlation coefficients differed by less than 0.04 and the Kappa ranged from 0.26 to 0.34, indicating fair agreement. When we replaced the initial MacArthur ladder scores with retest scores, the number of individuals with disagreements between the two scores decreased from 21 to 10 and the correlation coefficient and weighted Kappa both increased by at least 0.03. Lastly, we found that when we categorized WAMI and MacArthur ladder scores into three groups, both had a linear trend association with history of asthma with effect sizes and AICs that differed by less than 15% and 2 points, respectively. CONCLUSION: Our findings demonstrated fair agreement between the MacArthur ladder and WAMI scores. The agreement between the two SES measurements increased when they were further categorized into 3-5 categories, the form in which SES is often used in epidemiologic studies. The MacArthur score also performed similarly to WAMI in predicting a socio-economically sensitive health outcome. Researchers should consider subjective SES tools as an alternative method for measuring SES, particularly in large health studies where data collection is a burden.