Social Epidemiology

Individual-Level SES

The concept of SES is commonly used in the social epidemiologic literature to refer to the material and social resources and prestige that characterize individuals and that can allow individuals to be grouped according to relative socioeconomic position (although it should be noted that the term socioeconomic status is a bit of a misnomer, as it appears to emphasize status over material resources). Individual-level SES is typically measured through querying one's income, education, and occupation in surveys. Significant gradients in all-cause and cause-specific mortality for a number of diseases, including coronary heart disease, according to individual SES were established in the classic Whitehall study of British civil servants more than two [Page 986]decades ago (with higher occupational grades being inversely associated with mortality). Similar relations between individual-level income and mortality have also been found among individuals in other countries, including the United States. Several possible mechanisms have been proposed for the presence of these gradients. These include material pathways (e.g., being able to afford more nutritious foods; having more knowledge about healthy behaviors through higher educational attainment; and having the ability to move into a richer neighborhood, which may provide a more conducive environment for healthy behaviors—as will be discussed further) and psychosocial pathways (e.g., fewer occupational demands relative to the degree of job control—as will also be later described).

Area-Level SES

There are conceptual reasons and empirical evidence to support the notion that the levels of socioeconomic resources and amenities across places in which people live affect the health of individuals, even after taking into account the SES of individuals. For instance, the availability of nutritious foods and green spaces plausibly vary across neighborhoods and, in turn, could influence individuals’ diets and physical activity levels. Other characteristics of higher SES neighborhoods that might be relevant to health include the quality of housing and of health services; the presence or lack of ‘incivilities,’ such as graffiti and litter; and environmental hazards, such as air pollution and noise. Studies typically operationalize arealevel SES by aggregating individual-level SES measures (e.g., by taking the median income of individual survey respondents within a neighborhood). A number of studies have found moderate yet statistically significant associations between neighborhood socioeconomic characteristics and one's risk of dying from cardiovascular disease and from any cause, with 1.1 to 1.8 times higher risks of these outcomes after controlling for one's SES. Other studies have reported significant inverse associations between neighborhood SES with chronic disease risk factors, including smoking, diet, physical activity, and hypertension, and with the incidence of coronary heart disease.

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