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J Epidemiol Community Health. Apr 2004; 58(4): 303–307.
PMCID: PMC1732732

The demographic and social class basis of inequality in self reported morbidity: an exploration using the Health Survey for England

Abstract

Study objectives: To assess the relative contribution of age and social class to variations in the prevalence of a selection of self reported health problems. To examine the implications of observed variations for research on health inequalities.

Design: Secondary analysis of the Health Survey for England (1991–1997) using morbidities that are particularly prone to class effects. A statistical measure of the "relative class effect" is introduced to compare the effects of adjusting for social class and age.

Main results: There is substantial variation in the relative importance of the age and class distributions of different diseases. Age effects often overshadow those of class even for conditions where an apparently strong social gradient exists. Only for self reported mental health among women does the social gradient exceed the age gradient. Within the context of a dominating age gradient, social gradients are relatively high for mental health and general health for both sexes. Variation in the relative strengths of the social gradients between the sexes are observed for angina symptoms.

Conclusions: Given variations in the "relative class effect", analysis recognising the distinct contributions of age, sex, and social class to specific morbidities is advocated as a transparent and robust approach to the assessment of morbidity based inequality.

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Selected References

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  • Eachus J, Williams M, Chan P, Smith GD, Grainge M, Donovan J, Frankel S. Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health. BMJ. 1996 Feb 3;312(7026):287–292. [PMC free article] [PubMed]
  • Saul C, Payne N. How does the prevalence of specific morbidities compare with measures of socio-economic status at small area level? J Public Health Med. 1999 Sep;21(3):340–347. [PubMed]
  • Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ. 1998 Mar 7;316(7133):736–741. [PMC free article] [PubMed]
  • Stansfeld SA, Head J, Marmot MG. Explaining social class differences in depression and well-being. Soc Psychiatry Psychiatr Epidemiol. 1998 Jan;33(1):1–9. [PubMed]
  • Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. [PubMed]
  • Morrison C, Woodward M, Leslie W, Tunstall-Pedoe H. Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register. BMJ. 1997 Feb 22;314(7080):541–546. [PMC free article] [PubMed]
  • Smith GD, Hart C, Watt G, Hole D, Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health. 1998 Jun;52(6):399–405. [PMC free article] [PubMed]
  • Woodward M, Shewry MC, Smith WC, Tunstall-Pedoe H. Social status and coronary heart disease: results from the Scottish Heart Health Study. Prev Med. 1992 Jan;21(1):136–148. [PubMed]
  • Duran-Tauleria E, Rona RJ. Geographical and socioeconomic variation in the prevalence of asthma symptoms in English and Scottish children. Thorax. 1999 Jun;54(6):476–481. [PMC free article] [PubMed]
  • Littlejohns P, Macdonald LD. The relationship between severe asthma and social class. Respir Med. 1993 Feb;87(2):139–143. [PubMed]
  • Strachan DP, Anderson HR, Limb ES, O'Neill A, Wells N. A national survey of asthma prevalence, severity, and treatment in Great Britain. Arch Dis Child. 1994 Mar;70(3):174–178. [PMC free article] [PubMed]
  • Meadows P. Variation of diabetes mellitus prevalence in general practice and its relation to deprivation. Diabet Med. 1995 Aug;12(8):696–700. [PubMed]
  • Ismail AA, Beeching NJ, Gill GV, Bellis MA. Capture-recapture-adjusted prevalence rates of type 2 diabetes are related to social deprivation. QJM. 1999 Dec;92(12):707–710. [PubMed]
  • van Loon AJ, Brug J, Goldbohm RA, van den Brandt PA, Burg J [corrected to Brug J] Differences in cancer incidence and mortality among socio-economic groups. Scand J Soc Med. 1995 Jun;23(2):110–120. [PubMed]
  • Montgomery SM, Morris DL, Thompson NP, Subhani J, Pounder RE, Wakefield AJ. Prevalence of inflammatory bowel disease in British 26 year olds: national longitudinal birth cohort. BMJ. 1998 Apr 4;316(7137):1058–1059. [PMC free article] [PubMed]
  • Butland BK, Strachan DP, Lewis S, Bynner J, Butler N, Britton J. Investigation into the increase in hay fever and eczema at age 16 observed between the 1958 and 1970 British birth cohorts. BMJ. 1997 Sep 20;315(7110):717–721. [PMC free article] [PubMed]
  • Cooper Helen. Investigating socio-economic explanations for gender and ethnic inequalities in health. Soc Sci Med. 2002 Mar;54(5):693–706. [PubMed]
  • Matthews S, Manor O, Power C. Social inequalities in health: are there gender differences? Soc Sci Med. 1999 Jan;48(1):49–60. [PubMed]
  • Arber S. Comparing inequalities in women's and men's health: Britain in the 1990s. Soc Sci Med. 1997 Mar;44(6):773–787. [PubMed]
  • Arber S, Ginn J. Gender and inequalities in health in later life. Soc Sci Med. 1993 Jan;36(1):33–46. [PubMed]
  • West P, Macintyre S, Annandale E, Hunt K. Social class and health in youth: findings from the west of Scotland twenty-07 study. Soc Sci Med. 1990;30(6):665–673. [PubMed]
  • Rahkonen O, Arber S, Lahelma E. Health inequalities in early adulthood: a comparison of young men and women in Britain and Finland. Soc Sci Med. 1995 Jul;41(2):163–171. [PubMed]
  • West P. Health inequalities in the early years: is there equalisation in youth? Soc Sci Med. 1997 Mar;44(6):833–858. [PubMed]
  • Ford G, Ecob R, Hunt K, Macintyre S, West P. Patterns of class inequality in health through the lifespan: class gradients at 15, 35 and 55 years in the west of Scotland. Soc Sci Med. 1994 Oct;39(8):1037–1050. [PubMed]
  • Borooah VK. Occupational class and the probability of long-term limiting illness. Soc Sci Med. 1999 Jul;49(2):253–266. [PubMed]

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