Lower subjective social status was associated with increased odds of coronary artery disease (OR 1.82; 95% CI 1.10-2.99), hypertension, diabetes, and dyslipidaemia compared to higher status.
Meta-Analysis
Does lower subjective social status increase the odds of cardiovascular disease and risk factors in adults?
Lower subjective social status is associated with increased odds of cardiovascular disease and risk factors, though the effect is attenuated when adjusting for objective socioeconomic status.
Odds Ratio: 1.82 (95% CI 1.1–2.99)
OBJECTIVE: To determine the association between subjective social status (SSS), or the individual's perception of his or her position in the social hierarchy, and the odds of coronary artery disease (CAD), hypertension, diabetes, obesity and dyslipidaemia. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, SocINDEX, Web of Science and reference lists of all included studies up to October 2014, with a verification search in July 2015. Inclusion criteria were original studies in adults that reported odds, risk or hazard ratios of at least one outcome of interest (CAD, hypertension, diabetes, obesity or dyslipidaemia), comparing 'lower' versus 'higher' SSS groups, where SSS is measured on a self-anchoring ladder. ORs were pooled using a random-effects model. RESULTS: 10 studies were included in the systematic review; 9 of these were included in the meta-analysis. In analyses unadjusted for objective socioeconomic status (SES) measures such as income, education or occupation, the pooled OR comparing the bottom versus the top of the SSS ladder was 1.82 (95% CI 1.10 to 2.99) for CAD, 1.88 (95% CI 1.27 to 2.79) for hypertension, 1.90 (95% CI 1.25 to 2.87) for diabetes, 3.68 (95% CI 2.03 to 6.64) for dyslipidaemia and 1.57 (95% CI 0.95 to 2.59) for obesity. These associations were attenuated when adjusting for objective SES measures, with the only statistically significant association remaining for dyslipidaemia (OR 2.10, 95% CI 1.09 to 4.06), though all ORs remained greater than 1. CONCLUSIONS: Lower SSS is associated with significantly increased odds of CAD, hypertension, diabetes and dyslipidaemia, with a trend towards increased odds of obesity. These trends are consistently present, though the effects attenuated when adjusting for SES, suggesting that perception of one's own status on a social hierarchy has health effects above and beyond one's actual income, occupation and education.
Tang et al. (2016) conducted a meta-analysis in Cardiovascular disease and risk factors. Lower subjective social status vs. Higher subjective social status was evaluated on Coronary artery disease (unadjusted for objective SES) (OR 1.82, 95% CI 1.10-2.99). Lower subjective social status was associated with increased odds of coronary artery disease (OR 1.82; 95% CI 1.10-2.99), hypertension, diabetes, and dyslipidaemia compared to higher status.