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.

The mediating role of subjective social status in the association between objective socioeconomic status and mental health status: evidence from Iranian national data.

Introduction: Low socioeconomic status (SES) is identified as a pivotal risk factor for mental health. Objective socioeconomic status (OSS) is measured by tangible resources, whereas subjective social status (SSS) reflects an individual's perception of their OSS. A paucity of literature exists that elucidates the specific psychosocial mechanisms or pathways linking OSS with mental illness via SSS. This research aimed to explore the mediating role of SSS in the OSS-mental health association, utilizing data from the Iranian Mental Health Survey (IranMHS). Methods: This study is a secondary analysis of data from IranMHS, a national survey conducted in 2011 through face-to-face interviews with 7,886 Iranian adults aged 15-64. As part of the original survey, the General Health Questionnaire-28 (GHQ-28) was randomly administered to half of these participants. We focused our analysis on data from 3,759 participants who completed all items of the GHQ-28. OSS was evaluated using education, occupation, wealth, and a combined OSS index, while SSS was measured using the MacArthur Scale. We examined how SSS mediates the associations between OSS factors and GHQ scores, including its four dimensions-somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression- while adjusting for demographic variables and conducting gender-stratified analyses. Results: Among the 3759 respondents, 2157 (57.4%) were women, 2110 (56.1%) lived in urban areas, with an average age of 33.1 years (SD=12.1). SSS mediated the associations between wealth and the overall GHQ score (mediation percentage: 92.3%), education (75.4%), OSS index (66.7%), and occupation (34.0%) on the GHQ score. The most significant mediation effects were observed for wealth on the somatic symptoms, social dysfunction, and depression dimensions, with SSS accounting for more than 80% of these associations. Conclusion: The findings indicate a significant mediating role of SSS in the relationship between OSS and mental health. Enhancing our comprehension of the social determinants that moderate the relationship between objective and subjective socioeconomic status may contribute to a more nuanced understanding of the impact of SES on mental health outcomes.

Subjective social status and nocturnal blood pressure dipping.

OBJECTIVE: Low social status has been linked to cardiovascular disease. Subjective social status (SSS), which represents one's perceived position in a social hierarchy, has been suggested to predict health outcomes beyond objective measures of socioeconomic status. The present study examined if lower SSS is related to reduced nocturnal blood pressure (BP) dipping, a risk factor for cardiovascular disease. METHODS: In this cross-sectional study, a community sample of 53 healthy adults underwent 24-h ambulatory BP monitoring. All participants provided information on SSS and objective measures of socioeconomic status (i.e., education, occupation, and income). SSS was measured in comparison to others in the country (national SSS) as well as in comparison to one's social environment (local SSS) using the German versions of the MacArthur Scales. RESULTS: Analyses found that participants with low local SSS exhibited attenuated nocturnal diastolic blood pressure dipping (ß = 0.29, 95% CI [0.01, 0.57], p = .043) and mean arterial pressure dipping (ß = 0.29, 95% CI [0.01, 0.57], p = .041). These associations remained significant after adjusting for objective socioeconomic status. No significant associations between national SSS and cardiovascular measures were observed. CONCLUSION: In conclusion, one's perceived social position in the social environment (i.e., local SSS) is associated with nocturnal BP dipping. Therefore, local SSS may be an important psychosocial factor linking social inequality and cardiovascular health.

Explaining socioeconomic disparities in health behaviours: A review of biopsychological pathways involving stress and inflammation.

The purpose of this article was to explore how individuals' position in a socioeconomic hierarchy is related to health behaviours that are related to socioeconomic disparities in health. We identified research which shows that: (a) low socioeconomic status (SES) is associated with living in harsh environments, (b) harsh environments are related to increased levels of stress and inflammation, (c) stress and inflammation impact neural systems involved in self-control by sensitising the impulsive system and desensitising the reflective system, (d) the effects are inflated valuations of small immediate rewards and deflated valuations of larger delayed rewards, (e) these effects are observed as increased delay discounting, and (f) delay discounting is positively associated with practicing more unhealthy behaviours. The results are discussed within an adaptive evolutionary framework which lays out how the stress response system, and its interaction with the immune system and brain systems for decision-making and behaviours, provides the biopsychological mechanisms and regulatory shifts that make widespread conditional adaptability possible. Consequences for policy work, interventions, and future research are discussed.

Socioeconomic Status and Psychological Well-Being: Revisiting the Role of Subjective Socioeconomic Status.

Socioeconomic status (SES) is a complex and multidimensional construct, encompassing both independent objective characteristics (e.g., income or education) and subjective people's ratings of their placement in the socioeconomic spectrum. Within the growing literature on subjective SES belongingness and psychological well-being, subjective indices of SES have tended to center on the use of pictorial rank-related social ladders where individuals place themselves relative to others by simultaneously considering their income, educational level, and occupation. This approach, albeit consistent with the idea of these social ladders as summative or cognitive SES markers, might potentially constrain individuals' conceptions of their SES. This research (N = 368; M age = 39.67, SD = 13.40) is intended to expand prior investigations on SES and psychological well-being by revisiting the role of subjective SES. In particular, it (a) proposes an innovative adaptation of the traditional MacArthur Scale of subjective SES to income, education, and occupation, thus resulting in three separate social ladders; and (b) tests the empirical contribution of such three social ladders to psychological well-being. Overall, our findings showed that the novel education and occupation ladders (excluding the income ladder) are predictive of a significant part of the variance levels of psychological well-being that is not due to canonical objective metrics of SES (i.e., income, education, and occupation), or to the conventional MacArthur Scale of subjective SES. Although preliminary, these results underscore the need to further reconsider (subjective) SES-related conceptualization and measurement strategies to gather a more comprehensive understanding of the SES-psychological well-being link.

The Effects of Objective and Subjective Socioeconomic Status on Subjective Well-Being among Rural-to-Urban Migrants in China: The Moderating Role of Subjective Social Mobility.

Although previous investigations have agreed that Chinese rural-to-urban migrants' socioeconomic status (SES) increases with their migration, the association between SES and subjective well-being is uncertain. To address this research gap, the present study proposed that the association between objective SES and subjective well-being is mediated by subjective SES. This model was tested with a sample of 432 Chinese rural-to-urban migrants. The results indicate a significant association between objective SES and subjective well-being and a partial mediating effect of subjective SES. Furthermore, subjective social mobility, which is one's expectation about the possibility to move upward in the social hierarchy, was found to moderate both the direct path from objective SES to subjective well-being and the indirect path from subjective SES to subjective well-being. These findings suggest that Chinese rural-to-urban migrants gained in subjective well-being not only because of direct financial achievement but also because of their perceptions and beliefs about their relative social status.

Socioeconomic Status and Cardiovascular Risk Control in Adults With Diabetes.

OBJECTIVE: To examine the association between subjective social status (SSS) and objective social status (OSS) and cardiovascular disease (CVD) risk factors in adults with type 2 diabetes. METHODS: Adult study participants (N = 358) were recruited from 2 primary care settings. The CVD risk factors included hemoglobin A1c (HbA1c), systolic blood pressure and diastolic blood pressure (DBP) and low-density lipoprotein cholesterol (LDL-C). The OSS was assessed by income, education and employment. The SSS was measured using the validated MacArthur Scales of Subjective Social Status to demarcate self-reported perceptions of having the most money, education and respected job using a ladder scale (1 = rung 1, 10 = rung 10). Multiple linear regression was used to examine associations between CVD risk factors and SSC and OSS controlling for age, sex, race or ethnicity, marital status, employment status, income, study site, comorbidity, education and insurance status. RESULTS: Fully adjusted models showed that rung 2 (P = 0.029), rung 3 (P = 0.032), rung 8 (P = 0.049) and rung 9 (P = 0.032) of the SSS to be significantly associated with poorer DBP. Annual income ≥ $75,000 was significantly associated with lower LDL-C (P = 0.021). Employment was associated with lower HbA1c (P = 0.036), but higher LDL-C (P = 0.002). CONCLUSIONS: The SSS and OSSS levels are differentially associated with HbA1c, DBP and LDL-C. Findings provide new information about patients' perspectives of the relationship between social status and diabetes-related outcomes.