O. Fein, THE INFLUENCE OF SOCIAL-CLASS ON HEALTH-STATUS - AMERICAN AND BRITISHRESEARCH ON HEALTH INEQUALITIES, Journal of general internal medicine, 10(10), 1995, pp. 577-586
PURPOSE: To summarize recent and past American and British studies on
the relationship of social class and health status. DATA SOURCES: A sy
stematic review of the pertinent British and American literature, incl
uding references identified from bibliographies of books and recent ar
ticles. STUDY SELECTION: Published English-language studies that repor
t original or summary data describing socioeconomic status and mortali
ty/morbidity are emphasized. DATA SYNTHESIS: Social class, whether mea
sured by occupation, income, or education, has a marked effect on mort
ality and morbidity. Use of British and American standardized mortalit
y ratios (SMRs) shows that the gap between the advantaged upper socioe
conomic classes and the disadvantaged lower classes has become wider f
rom 1930 to 1980, Explanations for this inequality in health status by
socioeconomic status point to four factors: artefact, social selectio
n, culture/behavior. and material/structural conditions, A synthesis o
f existing literature suggests that material deprivation and social de
privation are the most important factors contributing to this associat
ion, although data from longitudinal studies implicate social hierarch
y. CONCLUSION: The reviewed studies point to growing inequalities in h
ealth status between those of lower and those of higher socioeconomic
status, Clinicians and teachers in internal medicine should incorporat
e this knowledge in assessing patients and adopt a perspective that ta
kes account of socioeconomic factors in diagnostic and management deci
sions.