Theory driven analysis of social class and health outcomes using UK nationally representative longitudinal data

Wami, W. , McCartney, G. , Bartley, M., Buchanan, D., Dundas, R. , Katikireddi, S. V. , Mitchell, R. and Walsh, D. (2020) Theory driven analysis of social class and health outcomes using UK nationally representative longitudinal data. International Journal for Equity in Health, 19, 193. (doi: 10.1186/s12939-020-01302-4) (PMID:33115485) (PMCID:PMC7594287)

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Background Social class is frequently used as a means of ranking the population to expose inequalities in health, but less often as a means of understanding the social processes of causation. We explored how effectively different social class mechanisms could be measured by longitudinal cohort data and whether those measures were able to explain health outcomes. Methods Using a theoretically informed approach, we sought to map variables within the National Child Development Study (NCDS) to five different social class mechanisms: social background and early life circumstances; habitus and distinction; exploitation and domination; location within market relations; and power relations. Associations between the SF-36 physical, emotional and general health outcomes at age 50 years and the social class measures within NCDS were then assessed through separate multiple linear regression models. R2 values were used to quantify the proportion of variance in outcomes explained by the independent variables. Results We were able to map the NCDS variables to the each of the social class mechanisms except ‘Power relations’. However, the success of the mapping varied across mechanisms. Furthermore, although relevant associations between exposures and outcomes were observed, the mapped NCDS variables explained little of the variation in health outcomes: for example, for physical functioning, the R2 values ranged from 0.04 to 0.10 across the four mechanisms we could map. Conclusions This study has demonstrated both the potential and the limitations of available cohort studies in measuring aspects of social class theory. The relatively small amount of variation explained in the outcome variables in this study suggests that these are imperfect measures of the different social class mechanisms. However, the study lays an important foundation for further research to understand the complex interactions, at various life stages, between different aspects of social class and subsequent health outcomes.

Item Type:Articles
Additional Information:Funding: This work was supported by Glasgow Centre for Population Health. RD, SVK and WW were supported by the Medical Research Council [MC_UU_12017/13; MC_UU_12017/15] and the Chief Scientist Office of the Scottish Government [SPHSU13; SPHSU15]. SVK also acknowledges funding from a NRS Senior Clinical fellowship (SCAF/15/02). RM’s contribution was supported by the Neighbourhoods and Communities research programme (MC_UU_12017/10) at the MRC/CSO Social and Public Health Sciences Unit.
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Mitchell, Professor Rich and McCartney, Professor Gerard and Wami, Welcome and Walsh, Dr David and Dundas, Professor Ruth
Authors: Wami, W., McCartney, G., Bartley, M., Buchanan, D., Dundas, R., Katikireddi, S. V., Mitchell, R., and Walsh, D.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
Journal Name:International Journal for Equity in Health
ISSN (Online):1475-9276
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in International Journal for Equity in Health 19:193
Publisher Policy:Reproduced under a Creative Commons Licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU13
727621SPHSU Core Renewal: Neighbourhoods and Communities Research ProgrammeAnne EllawayMedical Research Council (MRC)MC_UU_12017/10IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU10
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU15