Socioeconomic Differentials In Health: The Role Of Psychosocial Factors (stratification, Health Behavior, Social Support, Mortality).

Abstract

This study examined the extent to which two psychosocial factors--health practices and social integration--explain the association between socioeconomic status (SES) and health. The data come from the Tecumseh Community Health Study (TCHS)--a prospective epidemiological study of a total community in Michigan. There were three major waves of data collection between 1959 and 1969. Tecumseh is a racially homogeneous industrial community with good medical care, a high standard of living and limited representation of low social status groups. Nonetheless, clear SES gradients in health status exist in the TCHS. Education is the most potent SES predictor of health status and its effects are independent of income and occupation. There was no clear and consistent association between income and health. A strong inverse relationship between SES and health was evident for bronchitis and mortality among males. A secular trend was observed in the association between SES and coronary heart disease (CHD). While CHD was positively related to SES at the beginning of the TCHS, it became inversely associated during the course of the study. Smoking, alcohol use and obesity have adverse effects on health status but light smoking is inversely related to hypertension and moderate alcohol use reduces CHD risk. These health practices were clearly linked to SES but the relationship is complex and sex specific. Moreover, these health behaviors play an increasing role, over the course of the TCHS, in explaining SES differentials in health status. The measures of social integration used were unrelated to SES but predictive of health status. Marriage is inversely related to mortality and the association is stronger for men than for women. Family size is positively associated with bronchitis but inversely related to hypertension. Social integration does not explain any of the SES-health relationship. The study concludes that since psychosocial factors derive from social status, the elimination of unhealthy lifestyles, and the consequent improvement of health status, is dependent on efforts designed not to change attitudes and behavior but to improve the SES conditions of the lower social status groups.