The sociodemographic and health characteristics of the study population are shown in . African-Americans comprised 70.6%, Whites 9.8%, and Hispanics 16.5% of the 1,322 women for whom the three surveys were available. The age range for this cohort was 13–43 years, with a mean age of 23.9 years. Almost 40% (39.3%) of the women did not graduate from high school, while 17.7% received at least some post high school education. Almost 65% (64.8%) of the women reported a total income of less than $1200 per month. More than 90% (93.6%) of the women reported receiving public assistance. More than 5% (5.2%) indicated that they had experienced a utility shutoff and over 2% (2.6%) reported being homeless at some point since their last childbirth. The distribution of the Subjective Social Status scale indicated that the vast majority of respondents perceived themselves to be average, despite median incomes ($800/month) well below that for the U.S. as a whole. Specifically, more than 7 out of ten (71.9%) placed themselves close to the middle (rung scores from 4 to 7) of the subjective status ladder.
Descriptive characteristics of the study population
The relationships between subjective social status, income, and education with each of the health outcome variables are provided in . In general the associations between SSS and health are strong and persistent. Relatively poor overall physical and emotional health during pregnancy, the presence of major health problems, perceived stress and depressive symptomatology are all significantly and inversely related to SSS. For example, compared to women who rated themselves high on the SSS scale, those who rated themselves in the lowest category were more than twice as likely to report their overall physical health during pregnancy (24.6 vs. 11.4%), and their emotional health in the postpartum period (31.4 vs. 14.1%) to be relatively poor. Consistent with these overall self-reported items, women in the lowest compared to highest SSS group were more likely to have indicated one or more major health problems (45.6 vs. 30.8%), far more likely to be in the high stress category (50.4 vs. 20.9%) and to have depressive symptomatology (32.9 vs. 15.4%).
Relationship between heath outcomes and subjective social status (SSS), income, and education (GAMMA = γ)
Income and education were inversely related to some of the health outcomes, although not as strongly or as consistently as was the case for SSS. Physical health during pregnancy was unrelated to either income or education, while overall physical health was related to education but not to income. Overall emotional health in the postpartum period was related to both income and education, but overall emotional health during pregnancy was related only to income. As was the case for SSS, perceived stress and depressive symptomatology were related to both income and education, although the relationships were somewhat stronger for SSS.
The results from the logistic regression analyses are presented in and . Models A, B and C show the unadjusted odds ratios for SSS, Income and Education, respectively. Model D presents the odds ratios adjusted for income and education; and in Model E the odds ratios are adjusted for all additional measures of social status. Presenting the results in this manner allows us to compare the relative strength and robustness of the relationship between SSS and high stress () and self-rated poor physical health (), when all other measures of SES are taken into account. As we can see in , the relationship between SSS and high stress is strong and persistent even after accounting for objective SES measures. Women in the low SSS category were far more likely than women in the highest category to have high stress levels, even after controlling for income and education (OR 3.66; 95% CI 2.25, 5.95). Even after adjusting for all other SES measures those in the low SSS category were still far more likely than those in the highest category to have high stress levels (OR 3.24; 95% CI 1.98, 5.30). Note that after adjusting for SSS, education is unrelated to high stress and income is only weakly related. Women in the lowest income group were somewhat more likely to have high stress levels compared to women with the most income after adjusting for SSS (OR 1.87; 95% CI 1.31, 2.68), but the effect size is considerably smaller than that for SSS.
Logistic regression results: relationships between SSS, income, education, selected measures of impoverishment and high stress levelsa
Logistic regression results: relationships between SSS, income, education, selected measures of impoverishment, and mother’s overall physical healtha
The relationship between SSS and self-rated physical health was also persistent even after accounting for objective SES measures (). Specifically, women in the low SSS category were far more likely than women in the highest category to rate their overall postpartum physical health as poor, even after controlling education and income (OR 2.15; 95% CI 1.16, 3.99). After adjusting for all other SES measures those in the low SSS category were still far more likely than those in the highest category to have relatively poor postpartum physical health (OR 2.04; 95% CI 1.09, 3.82). Note that after adjusting for SSS, income and education were unrelated to poor physical health.
A summary of results for additional health outcomes is reported in . Adjusted odds ratios and 95% confidence intervals associated with low and medium compared to high SSS are presented, in each case after adjusting for income, education and all three other objective SES measures. The results show that for every other outcome, women in the low SSS category were significantly more likely to have worse health outcomes, even after adjusting for SES measures. Women in the low SSS category, for example, were 1.95 times more likely than women in the high SSS category to have depressive symptomatology (OR 1.95; 95% CI 1.1.12, 3.38) (), as well as two times more likely to report being in relatively poor physical health in pregnancy (OR 2.53; 95% CI 1.34, 4.80) ().
The relationship of subjective social status on health outcomes. a. Adjusted odds ratios: summary of effects of SSS on measures of emotional health; b. Adjusted odds ratios: effects of SSS on measures of physical health