International Journal of Epidemiology, Vol 26, 532-541, Copyright © 1997 by International Epidemiological Association
SG Wannamethee and AG Shaper
OBJECTIVE: It has been suggested that mortality differences between groups
in society may be greater than are indicated by social class based on
occupation. We have examined the relationship between social class and
mortality using home and car ownership as additional indices of
socioeconomic status within social class. DESIGN: A prospective study of a
cohort of men representative of the social class distribution of
middle-aged men in Great Britain. SETTING: One general practice in each of
24 towns in England, Wales and Scotland. SUBJECTS: Five years after the
initial screening of 7735 men aged 40-59 years, 7262 men (94% of the
original cohort) provided information on housing tenure and car ownership
by completing a postal questionnaire. MAIN OUTCOME MEASURE: Deaths from all
causes, cardiovascular, cancer and other non-cardiovascular causes during
an average follow-up of 9.8 years (range 8.5-11.0 years) after the postal
questionnaire. RESULTS: During the follow-up period there were 946 deaths
from all causes among the 7262 men. The lowest mortality rates for all
causes, cardiovascular, cancer and other non-cardiovascular causes were
seen in non-manual social classes I and II. Manual social classes III and
IV+V showed a significant 40% increase in risk of death compared to social
classes I+II, even after adjustment for a wide range of risk factors
(relative risk [RR] = 1.4, 95% confidence interval [CI]: 1.2-1.7 and RR =
1.4, 95% CI: 1.1-1.7 respectively). Within all social class groups, those
owning both home and car showed lower rates than those who owned neither,
even after adjustment for a wide range of risk factors and employment
status. Compared with social classes I+II owning both home and car, all
those not owning home and/or car, in each social group, showed a
significant approximately twofold increase in risk of death. Adjusted RR
for non-manual I+II = 2.1 (95% CI: 1.5-2.9), non-manual III RR = 2.0 (95%
CI: 1.3-2.9), manual III RR = 1.8 (95% CI: 1.4-2.4) and manual IV+V RR =
1.8 (95% CI: 1.3-2.5). Similar relationships were seen in all major
geographical regions of Great Britain. CONCLUSION: Mortality differences
within society are greater than indicated by social class based on
occupation alone. Irrespective of social class, men with greater material
assets have lower rates of mortality from all causes than men less well
endowed, independent of a wide range of lifestyle and biological factors.
These findings suggest that mortality differences within our society are
closely related to relative wealth.
ARTICLES
Socioeconomic status within social class and mortality: a prospective study in middle-aged British men
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
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