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SOC243H1 (60)
Lecture 5

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Department
Sociology
Course
SOC243H1
Professor
William Magee
Semester
Winter

Description
Lecture 5: SOC 243 I. Hierarchical Social Position and Health II. Stress Processes (an introduction) I. Hierarchical Social Position and Health  What is hierarchical social position?  Focuses on socioeconomic status (occupational status mixed with education and income) o Useful summary for some things, but research shows that different socioeconomic statuses have different associations o I.e. education associated stronger with other relations, income other relations  Can rate economic groups  Status  one form: occupational status (people who are high statuses, like doctors, politicians)  Issues related to specification of socioeconomic position, i.e.: o Is education a continuous or ordinal measure  Ordinal measure  ranking  Continuous  a rational scale, can use it so every single year of education has a different effect  Can’t study change in health as a function of change in education  so what is proximal (what social factors are proximal) in driving this; what happened recently o For which ages is income a good measure and for which is wealth a better measure  Because older people retire, and income comes from job  If you study income and health, older people have wealth (they have houses, bank accounts) so may want to study home ownership or measures of wealth than income o Should poverty be specified as distinct issue?  Maybe it’s just having less money in some places (but clearly the poor who are really hit hard, like First Nations population)  A lot of place have a poverty line (they fall above and below the line)  But Canada doesn’t have a poverty line (they have low income cut offs)  If family is spending 20% + on basics, then they meet this low income cut off (it’s more contextual) (also based on kids, and how dependants, etc.)  The issue of causal direction o Causation versus selection, reverse causality (causality may be difficult to infer from correlation) o From inside the health, to the outside (resources, income, education) o Health influences education (i.e. overweight among women) of the income quintiles declined over the 25-year study Nevertheless, the rate differences are more relevant period (Chart 3, Table 4). The inter-quintile rate to the public health impact of the changes observed. difference (quintile 5 minus quintile 1) fell from 9.8 If the rate in the richest quintile had applied to all urban per thousand in 1971 to 2.4 per thousand in 1996. Canada, and the same relative rates had also been experienced by non-metropolitan areas, then there Thus, the disparity between the poorest and the richest quintiles diminished markedly in terms of rate would have been approximately 2000 fewer infant differences, although the decline was much less deaths in 1971, compared to only about 500 fewer in 35 o Health selection  health leads you to select into a certain group 1996. In 1996, infant mortality in Canadaís poorest (class category) neighbourhoods, 6.4 deaths for every 1,000 live births, Chart 3 Infant mortality rates, by neighbourhood income quintile, was considerably lower than the national rate for the United States (7.8). However, the rate in Canadaís urban Canada, 1971 to 1996 richest neighbourhoods was no better than Swedenís Deaths per 1,000 national rate (4.0). 20 Mortality rate ratios at various ages Q1 - Richest Q2 With few exceptions, the higher the percentage of low- Q3 income population in a quintile, the higher the age- 16 Q4 specific mortality rate (data not shown). In many Q5 - Poorest respects, trends in mortality rates by income at most other ages were similar to those for infant mortality: in 12 most income quintiles the mortality rate declined over time, but the inter-quintile rate ratios tended to diminish to a much lesser extent. However, the absolute 8 improvements for the poorer quintiles were generally greater than those for the other quintiles, so the rate differences usually diminished over time. In general, the pattern of inter-quintile mortality rate 4 ratiosó expressed as the mortality rate in the poorest quintile divided by the rate in the richest quintileó was similar over time (Table 5). Disparities were largest in 0 1971 1976 1981 1986 1991 1996 infancy (age less than 1) and during the prime working years (ages 25 to 64). Disparities were smallest for Datasources:CanadianMortalityDataBaseandsupplementaladdressfiles; ages 15 to 24 and 75 or older. There were exceptions special tabulations of census population data for children ages 1 to 14, for whom rates were extremely low and unstable, and for men ages 35 to 3%  Poorest group is steeper (higher infant mortality rates) 44, for whom rate ratios increased markedly from 1986 Table 4 Infantmortalityrateper1000byneighbourhoodincomequintile,urbanCanada,1971to1996(95%confidenceintervalsinparentheses) 1971 1986 1991 1996 Total 15.0 (14.5, 15.6) 7.5 (7.2, 7.9) 5.8 (5.5, 6.1) 5.1 (4.8, 5.4) Quintile 1 (richest) 10.2 ( 9.1, 11.3) 5.8 (5.1, 6.6) 4.5 (4.0, 5.2) 4.0 (3.4, 4.6) Quintile 2 12.4 (11.3, 13.1) 5.7 (5.0, 6.5) 5.1 (4.5, 5.8) 4.7 (4.1, 5.4) Quintile 3 15.2 (14.0, 16.5) 7.7 (6.9, 8.6) 5.0 (4.4, 5.7) 4.9 (4.2, 5.5) Quintile 4 16.6 (15.3, 17.9) 8.0 (7.2, 8.9) 6.7 (6.0, 7.5) 5.0 (4.4, 5.7) Quintile 5 (poorest) 20.0 (18.6, 20.5) 10.5 (9.6, 11.6) 7.5 (6.7, 8.3) 6.4 (5.7, 7.1) Rate difference (Q5 - Q1) 9.8 ( 8.1, 11.6) 4.8 (3.5, 6.0) 2.9 (1.9, 3.9) 2.4 (1.5, 3.3) Rate ratio (Q5/Q1) 1.97 (1.73, 2.23) 1.82 (1.56, 2.13) 1.64 (1.39, 1.94) 1.61 (1.34, 1.93) Excess (Total - Q1) 4.9 1.8 1.2 1.1 Excess % (Total - Q1)/Total 32 23 21 22 Data source: Canadian Mortality Data Base and supplemental address files; special tabulations of census population data Note: Census population aged less than 1 used as denominator. Rate differences and rate ratios calculated with unrounded data. Supplement to Health Reports, volume 13, 2002 6 Statistics Canada, Catalogue 82-003 Neighbourhood income and mortality Chart 11 Causes of death showing progress toward ì Health for Allî : age-standardized mortality rates, by neighbourhood income quintile, urban Canada, 1971 to 1996 C - Injuries except motor vehicle A - Ischemic heart disease, males B - Ischemic heart disease, females traffic accidents and suicide ASMR x 100,000 ASMR x 100,000 ASMR x 100,000 420 170 45 Q1 - Richest 400 Q1 - Richest 160 Q1 - Richest Q2 380 40 Q2 150 Q2 Q3 360 Q3 Q3 Q4 340 140 35 Q4 Q4 Q5 - Poorest 320 Q5 - Poorest 130 Q5 - Poorest 300 30 120 280 260 110 25 240 100 20 220 90 200 15 180 80 160 70 10 140 60 120 5 100 50 80 40 0 1971 1976 1981 1986 1991 1996 1971 1976 1981 1986 1991 1996 1971 1976 1981 1986 1991 1996 D - Cirrhosis of liver, males E - Cirrhosis of liver, females F - Uterine cancer, females ASMR x 100,000 ASMR x 100,000 ASMR x 100,000 Q1 - Richest 30 Q2 12 14 Q1 - Richest 28 Q1 - Richest Q2 Q3 11 Q2 13 26 Q4 12 Q3 Q5 - Poorest 10 Q3 Q4 24 Q4 11 9 Q5 - Poorest 22 Q5 - Poorest 10 20 8 9 18
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