Is Low Socioeconomic Status a Major Risk Factor for Poor Health?

Government health policies should stop excluding socioeconomic status as a risk factor for diseases, according to a study published in The Lancet.

Socioeconomic status is one of the strongest predictors of illness and early death worldwide, according to the authors. Despite this, it is often overlooked in health policies.

The investigators sought to compare the impact of low socioeconomic status against 6 main health risk factors: diabetes, high blood pressure, high alcohol intake, physical inactivity, and smoking.

These major risk factors are defined by the World Health Organization (WHO) in its Global Action Plan for the Prevention and Control of Non-communicable Diseases. The plan’s goal is to reduce non-communicable diseases by 25% by 2025. However, it omits socioeconomic status as a risk factor for these diseases, according to the authors.

The investigators used data from 48 studies comprised of more than 1.7 million people. They used an individual’s job title to estimate their socioeconomic status, and examined whether they died early.

Compared with the participants’ wealthier counterparts, the results of the study showed that individuals with a low socioeconomic status were almost 1.5 times more likely to die before the age of 85 years. Among individuals with low socioeconomic status, 55,600 died before the age of 85 years, compared with 25,452 individuals with a high socioeconomic status.

The investigators estimated that approximately 41% of men and 27% of women had low socioeconomic status, which was associated with a reduced life expectancy of 2.1 years. The greatest reduction observed were for diabetes and smoking (3.9 years and 4.8 years, respectively).

High blood pressure, high alcohol consumption, and obesity were associated with smaller reductions in life expectancy compared with low socioeconomic status.

“Education, income, and work are known to affect health, but few studies have examined how important these socioeconomic factors actually are,” said senior author Mika Kivimaki. “Our study aims to compare the effect of socioeconomic status with the major risk factors targeted in global health strategies.”

The findings indicated that socioeconomic factors should be included with conventional risk factors as part of key risks for illness, according to the authors.

“Socioeconomic status is important because it is a summary measure of lifetime exposures to hazardous circumstances and behaviors that goes beyond the risk factors for non-communicable diseases that policies usually address,” said senior author Paolo Vineis.

Limitations to the study were that only an individual’s occupational position was used as an indication of socioeconomic status, and that it is difficult to separate the effects of socioeconomic status from other risk factors.

“Given the huge impact of socioeconomic status on health, it’s vital that governments accept it as a major risk factor and stop excluding it from health policy,” said lead author Dr Silvia Stringhini. “Reducing poverty, improving education, and creating safe home, school, and work environments are central to overcoming the impact of socioeconomic deprivation. BY doing this, socioeconomic status could be targeted and improved, leading to better wealth and health for many.”