Socioeconomic gradients in health
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Socioeconomic gradients in health
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[post_date] => 2024-12-27 12:36:21
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[post_content] => Practice Passage (Question 1-5)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
Social scientists have examined the associations between social class and health. In general, wealthy people are found to live longer on average than middle-class people, and middle-class people live longer than poor people, but not longer than rich people. One researcher referred to this gradient as the “status syndrome”. This concept can be illustrated using an example of a short ride on the Washington DC subway. From the southeast of downtown DC to Montgomery County, Maryland, for each mile traveled, life expectancy rises by about 1.5 years. At this rate, a twenty-year gap would exist between poor Blacks at one end of the journey and rich Whites at the other.
The US Panel Study of Income Dynamics (Study 1) used a sample of 8,500 men and women who were followed for a twenty-year period, 1972-1991, or until they died. The study examined the risk of dying (in the twenty-year period) to average household income. Table 1 shows the risk of death in each group relative to the best-off group (those with incomes of 70k or more were arbitrarily at a risk of dying of 1, and all other groups were compared with them). Two genders were combined, and the differences between income groups such as differences in age, sex, race, family size, and time period are taken into account. For example, in the 20-30k income group, 2.21 means that they have a 2.21 relative risk of dying indicating that they were 121% more likely to die in the twenty-year period compared to the richest group.
Table 1: Relative risk of death in the US Panel Study of Income Dynamics
This relationship between income and health has shown to be true even in countries where everyone has access to health care, and when comparing those who have similar rates of smoking, obesity, and alcohol use. Now, let’s say that hypothetically, a second group of researchers used the same data and adjusted for an additional variable related to a person’s socioeconomic status--educational attainment. Hypothetical Study 2 attempts to see whether the effect of income on mortality would change when controlling for a person’s education level. The results are shown in Table 2.
Table 2: Hypothetical effect of income on mortality after adjusting for educational attainment in addition to age, sex, race, family size, and time period.
Sources: Adapted from M. Marmot, “The Status Syndrome: How Social Standing Affects Our Health and Longevity.” Copyright 2004. Owl Books.
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[question] => According to Table 1, which of the following is true?
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[description] => Reason for the Correct Answer:
The baseline group is the rich group (>70k), with the risk of dying as 1, and every other income group is compared to the baseline group.
Men and women in the 50-70k group had a risk of death of 1.34 relative to the baseline group (richest).
Men and women in the 50-70k group had a relative risk of death of 1.34, which means that they were 34% more likely to die compared to the baseline rich group.
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[each_answer] => A. Based on the information offered in Table 1, we cannot conclude that there is a social gradient in risk of death.
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[each_answer] => B. Men and women in the 50-70k income group had a relative risk of dying of 1.34, indicating that they were 34% more likely to die in the twenty-year period compared to the richest group.
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[each_answer] => C. Men and women in the 30-50k income group had a relative risk of death of 1.59, indicating that they were 159% more likely to die compared to the richest group.
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[each_answer] => D. Men and women in the <15k income group had a risk of death 3.89 times that of the 15-20k group in the twenty-year period.
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[quiz_unique_key] => 3873426850
[question] => According to Table 2, which of the following is true?
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[answer] => 1
[description] => Reason for the Correct Answer:
The table still presents the association between income level and risk of death, but controlling for educational level among samples.
Compared to the Risk of Death column that did NOT adjust for education, the risk of death in the adjusted education column is lower for each income category.
After adjusting for education, the effect of income on death risk was lessened.
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[each_answer] => A. When adjusting for educational level, the effect of income on mortality was reduced.
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[each_answer] => B. Higher-income groups are more likely to include people with higher education.
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[each_answer] => C. When adjusting for educational level, the social gradient was no longer observable.
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[each_answer] => D. The highest education group has the lowest risk of death.
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[quiz_unique_key] => 83407773
[question] => If a researcher wants to directly examine the effects of education level on mortality risk, how would this change the design of the original study?
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[answer] => 2
[description] => Reason for the Correct Answer:
When examining the effect of education on risk of death (mortality), mortality would be the dependent variable.
The variable that explains variations in the outcome variable (mortality) is called the independent variable.
Education level would be the independent variable since it would explain differences in death risk. A new independent variable would be added.
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[each_answer] => A. The variables would not change.
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[each_answer] => B. A new independent variable would be added.
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[each_answer] => C. A new dependent variable would be added.
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[each_answer] => D. A new intervening variable would be added.
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[quiz_unique_key] => 2261298308
[question] => Socioeconomic gradients in health can be best explained by which of the following basic concepts?
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[answer] => 2
[description] => Reason for the Correct Answer:
Socioeconomic gradients have to do with the distribution of inequalities in the social system.
Social gradients in health refer to how inequalities in population health are related to inequalities in social status (such as income or education).
Socioeconomic gradients in health are an aspect of social stratification (how people are categorized into rankings of socioeconomic tiers).
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[each_answer] => A. Social exclusion
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[each_answer] => B. Social stratification
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[each_answer] => C. Social bias
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[each_answer] => D. Racial prejudice
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[quiz_unique_key] => 574431310
[question] => Which of the following is true about the concept “status syndrome”?
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[answer] => 1
[description] => Reason for the Correct Answer:
Socioeconomic differences in health are not confined to poor health for those at the bottom and good health for everyone else.
There is a social gradient in health even in individuals who are not of the lowest social status.
Status syndrome refers to this gradient, the higher the social status, the better the health and it affects all social strata.
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[each_answer] => A. Status syndrome refers to the social gradient in health in individuals across different social standings.
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[each_answer] => B. Status syndrome is about the inequality of the top and bottom income brackets of society.
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[each_answer] => C. Status syndrome affects the health of the affluent more than the poor.
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[each_answer] => D. Heart disease that only affects the poor is an example of status syndrome.
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