The influence of social class on health status: American and British research on health inequalities

Abstract

Purpose: To summarize recent and past American and British studies on the relationship of social class and health status.

Data sources: A systematic review of the pertinent British and American literature, including references identified from bibliographies of books and recent articles.

Study selection: Published English-language studies that report original or summary data describing socioeconomic status and mortality/morbidity are emphasized.

Data synthesis: Social class, whether measured by occupation, income, or education, has a marked effect on mortality and morbidity. Use of British and American standardized mortality ratios (SMRs) shows that the gap between the advantaged upper socioeconomic classes and the disadvantaged lower classes has become wider from 1930 to 1980. Explanations for this inequality in health status by socioeconomic status point to four factors: artefact, social selection, culture/behavior, and material/structural conditions. A synthesis of existing literature suggests that material deprivation and social deprivation are the most important factors contributing to this association, although data from longitudinal studies implicate social hierarchy.

Conclusion: The reviewed studies point to growing inequalities in health status between those of lower and those of higher socioeconomic status. Clinicians and teachers in internal medicine should incorporate this knowledge in assessing patients and adopt a perspective that takes account of socioeconomic factors in diagnostic and management decisions.