Oberndorfer, M. , Leyland, A. H. , Pearce, J., Grabovac, I., Hannah, M. K. and Dorner, T. E. (2023) Unequally unequal? Contextual-level status inequality and social cohesion moderating the association between individual-level socioeconomic position and systemic chronic inflammation. Social Science and Medicine, 333, 116185. (doi: 10.1016/j.socscimed.2023.116185) (PMID:37598618)
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Abstract
Background: Status inequality is hypothesised to increase socioeconomic inequalities in health by creating an environment in which social cohesion erodes and social comparisons intensify. Such an environment may cause systemic chronic inflammation. Although these are often-used explanations in social epidemiology, empirical tests remain rare. Methods: We analysed data from the West of Scotland Twenty-07 Study. Our sample consisted of 1977 participants in 499 small residential areas. Systemic chronic inflammation was measured by high-sensitivity C-reactive protein (hs-CRP; <10 mg/L). An area-level measurement of status inequality was created using census data and contextual-level social cohesion was measured applying ecometrics. We estimated linear multilevel models with cross-level interactions between socioeconomic position (SEP), status inequality, and social cohesion adjusted for age and gender. Our main analysis on postcode sector-level was re-estimated on three smaller spatial levels. Results: The difference in hs-CRP between disadvantaged and advantaged SEPs (0.806 mg/L; p = 0.063; [95%CI: −0.044; 1.656]) was highest among participants living in areas where most residents were in advantaged SEPs. In these status distributions, high social cohesion was associated with a shallower socioeconomic gradient in hs-CRP and low social cohesion was associated with a steeper gradient. In areas with an equal mix of SEPs or most residents in disadvantaged SEPs, the estimated difference in hs-CRP between disadvantaged and advantaged SEPs was −0.039 mg/L (p = 0.898; [95%CI: 0.644; 0.566]) and −0.257 mg/L (p = 0.568; [95%CI: 1.139; 0.625]) respectively. In these status distributions, the gradient in hs-CRP appeared steeper when social cohesion was high and potentially reversed when social cohesion was low. Results were broadly consistent when using area-levels smaller than postcode sectors. Conclusions: Inequalities in hs-CRP were greatest among participants living in areas wherein a majority of residents were in advantaged SEPs and social cohesion was low. In other combinations of these contextual characteristics, inequalities in systemic chronic inflammation were not detectable or potentially even reversed.
| Item Type: | Articles |
|---|---|
| Additional Information: | MO was funded by the Marietta-Blau Scholarship (MPC-2021-00178) funded by the Austrian Federal Ministry of Education, Science and Research. The work of AHL, MKH and MO was supported by the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). The West of Scotland Twenty-07 Study is funded by the UK Medical Research Council and the data were originally collected by the MRC Social and Public Health Sciences Unit (MC_A540_53462). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Hannah, Mrs Mary-Kate and Leyland, Professor Alastair and Oberndorfer, Mr Moritz |
| Authors: | Oberndorfer, M., Leyland, A. H., Pearce, J., Grabovac, I., Hannah, M. K., and Dorner, T. E. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care |
| Journal Name: | Social Science and Medicine |
| Publisher: | Elsevier |
| ISSN: | 0277-9536 |
| ISSN (Online): | 1873-5347 |
| Published Online: | 18 July 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in Social Science and Medicine 333:116185 |
| Publisher Policy: | Reproduced under a Creative Commons license |
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