Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women.
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Abstract
A new measure of subjective socioeconomic status (SES) was examined in relation to
self-rated physical health in pregnant women. Except among African Americans, subjective
SES was significantly related to education, household income, and occupation. Subjective
SES was significantly related to self-rated health among all groups. In multiple regression
analyses, subjective SES was a significant predictor of self-rated health after the
effects of objective indicators were accounted for among White and Chinese American
women; among African American women and Latinas, household income was the only significant
predictor of self-rated health. After accounting for the effects of subjective SES
on health, objective indicators made no additional contribution to explaining health
among White and Chinese American women; household income continued to predict health
after accounting for subjective SES among Latinas and African American women.
The association between perceived health ratings ("excellent," "good," "fair," and "poor") and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California, and a subsequent nine-year follow-up. Risk of death during this period was significantly associated with perceived health rating in 1965. The age-adjusted relative risk for mortality from all causes for those who perceived their health as poor as compared to excellent was 2.33 for men and 5.10 for women. The association between level of perceived health and mortality persisted in multiple logistic analyses with controls for age, sex, 1965 physical health status, health practices, social network participation, income, education, health relative to age peers, anomy, morale, depression, and happiness.
The ability of self-rated health status to predict mortality was tested with data from the National Health and Nutrition Examination Survey (NHANES-I) Epidemiologic Follow-Up Study (NHEFS), conducted from 1971-84. The sample consists of adult NHANES-I respondents ages 25-74 years (N = 6,440) for whom data from a comprehensive physical examination at the initial interview and survival status at follow-up are available. Self-rated health consists of the response to the single item, "Would you say your health in general is excellent, very good, good, fair, or poor?" Proportional hazards analyses indicated that, net of its association with medical diagnoses given in the physical examination, demographic factors, and health related behaviors, self-rated health at Time 1 is associated with mortality over the 12-year follow-up period among middle-aged males, but not among elderly males or females of any age.
We compared associations between five indicators of socioeconomic status (maternal education, paternal education, maternal occupation, paternal occupation, family income) and three reproductive outcomes (low birth weight, small for gestational age, preterm delivery) in a representative sample of US births. We used data from the 1988 National Maternal and Infant Health Survey to estimate odds ratios for relationships between the socioeconomic indicators and birth outcomes, separately by race, after controlling for parity, maternal height, marital status, and maternal age. Nearly all socioeconomic indices were associated with low birth weight among both black and white women. However, there was no consistent pattern between the socioeconomic indices and the other outcomes. Maternal and paternal education levels were the best overall predictors. Magnitudes of association differed between black and white women. To accurately assess the impact of low socioeconomic status on reproductive health, definitions of both status and outcome must be made as explicit as possible.
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