| Literature DB >> 34286060 |
Marie Hella Lindberg1, Gang Chen2, Jan Abel Olsen1,2,3, Birgit Abelsen1.
Abstract
In the literature on social inequalities in health, subjective socioeconomic position (SEP) is increasingly applied as a determinant of health, motivated by the hypothesis that having a high subjective SEP is health-enhancing. However, the relative importance of determinants of subjective SEP is not well understood. Objective SEP indicators, such as education, occupation and income, are assumed to determine individuals' position in the status hierarchy. Furthermore, an extensive literature has shown that past childhood SEP affects adult health. Does it also affect subjective SEP? In this paper, we estimate the relative importance of i) the common objective SEP indicators (education, occupation and income) in explaining subjective SEP, and ii) childhood SEP (childhood financial circumstances and parents' education) in determining subjective SEP, after controlling for objective SEP. Given that the relative importance of these factors is expected to differ across institutional settings, we compare data from two countries: Australia and Norway. We use data from an online survey based on adult samples, with N ≈ 1400 from each country. Ordinary least squares regression is conducted to assess how objective and childhood SEP indicators predict subjective SEP. We use Shapley value decomposition to estimate the relative importance of these factors in explaining subjective SEP. Income was the strongest predictor of subjective SEP in Australia; in Norway, it was occupation. Of the childhood SEP variables, childhood financial circumstances were significantly associated with subjective SEP, even after controlling for objective SEP. This association was the strongest in the Norwegian sample. Only the mother's education had a significant impact on subjective SEP. Our findings highlight the need to understand the specific mechanisms between objective and subjective SEP as determinants of inequalities in health, and to assess the role of institutional factors in influencing these complex relationships.Entities:
Keywords: Australia; Childhood circumstances; Health inequalities; Norway; Socioeconomic position; Subjective social status
Year: 2021 PMID: 34286060 PMCID: PMC8278415 DOI: 10.1016/j.ssmph.2021.100864
Source DB: PubMed Journal: SSM Popul Health ISSN: 2352-8273
Sample characteristics.
| Variables | Australia | Norway | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Female | Male | Total | Female | Male | Total | |||||||
| Mean/% | N | Mean/% | N | Mean/% | N | Mean/% | N | Mean/% | N | Mean/% | N | |
| 45.4 (15.9) | 731 | 47.0 (17.5) | 691 | 46.2 (16.7) | 1422 | 42.1 (15.2) | 566 | 45.1 (17.9) | 833 | 43.9 (16.9) | 1399 | |
| (SD) | ||||||||||||
| 5.6 (1.9) | 731 | 5.9 (2.1) | 691 | 5.8 (2.0) | 1422 | 6.0 (2.1) | 566 | 6.4 (2.0) | 827 | 6.2 (2.1) | 1393 | |
| (SD) | ||||||||||||
| Primary education <10 yrs | 27.5 | 201 | 24.5 | 169 | 26.0 | 370 | 8.5 | 48 | 5.5 | 46 | 6.7 | 94 |
| Upper secondary | 35.2 | 257 | 32.7 | 226 | 34.0 | 483 | 32.9 | 186 | 30.7 | 256 | 31.6 | 442 |
| Undergraduate | 22.6 | 165 | 25.0 | 173 | 23.8 | 338 | 28.1 | 159 | 29.4 | 245 | 28.9 | 404 |
| Postgraduate | 14.8 | 108 | 17.8 | 123 | 16.2 | 231 | 30.6 | 173 | 34.3 | 286 | 32.8 | 459 |
| Not in labour force | 39.1 | 286 | 20.7 | 143 | 30.2 | 429 | 26.2 | 148 | 15.6 | 130 | 19.9 | 278 |
| Other professions | 34.0 | 248 | 41.4 | 286 | 37.6 | 534 | 49.7 | 281 | 52.8 | 440 | 51.5 | 721 |
| Managers & professionals | 27.0 | 197 | 37.9 | 262 | 32.3 | 459 | 24.2 | 137 | 31.6 | 263 | 28.6 | 400 |
| Low | 24.5 | 179 | 20.7 | 143 | 22.6 | 322 | 26.2 | 148 | 15.3 | 127 | 19.7 | 275 |
| Lower middle | 26.1 | 191 | 23.4 | 162 | 24.8 | 353 | 34.3 | 194 | 29.7 | 247 | 31.5 | 441 |
| Middle | 21.3 | 156 | 20.3 | 140 | 20.8 | 296 | 11.7 | 66 | 13.2 | 110 | 12.6 | 176 |
| Upper middle | 19.0 | 139 | 24.6 | 170 | 21.7 | 309 | 18.7 | 106 | 24.6 | 205 | 22.2 | 311 |
| High | 9.0 | 66 | 11.0 | 76 | 10.0 | 142 | 9.2 | 52 | 17.3 | 144 | 14.0 | 196 |
| Difficult | 30.1 | 220 | 22.4 | 155 | 26.4 | 375 | 21.4 | 121 | 16.8 | 140 | 18.7 | 261 |
| Neither good nor bad | 30.9 | 226 | 30.7 | 212 | 30.8 | 438 | 34.8 | 197 | 32.4 | 270 | 33.4 | 467 |
| Good | 27.4 | 200 | 32.1 | 222 | 29.7 | 422 | 27.4 | 155 | 32.5 | 271 | 30.5 | 426 |
| Very good | 11.6 | 85 | 14.8 | 102 | 13.2 | 187 | 16.4 | 93 | 18.3 | 152 | 17.5 | 245 |
| ≤ Upper secondary | 82.5 | 603 | 75.8 | 524 | 79.3 | 1127 | 62.9 | 356 | 60.5 | 504 | 61.5 | 860 |
| Tertiary education | 17.5s | 128 | 24.2 | 167 | 20.8 | 295 | 37.1 | 210 | 39.5 | 329 | 38.5 | 539 |
| ≤ Upper secondary | 78.8 | 576 | 69.5 | 480 | 74.3 | 1056 | 59.4 | 336 | 57.3 | 477 | 58.1 | 813 |
| Tertiary education | 21.2 | 155 | 30.5 | 211 | 25.7 | 366 | 40.6 | 230 | 42.7 | 356 | 41.9 | 586 |
Note: The undergraduate and postgraduate education levels correspond to university education up to four years, and university education of four years or more, respectively. Standard deviations (SD) in parentheses for continuous variables. The household income groups correspond to the following income brackets in Australia (in AUD): Low: <35,000; Lower middle: 35,001–65,000; Middle: 65,001–100,000; Upper middle: 100,001–160,000; High: >160,001; in Norway (per 1000 NOK): Low: <349; Lower middle: 350–699; Middle: 700–849; Upper middle: 850–1199; High: >1200.
Descriptive statistics of original data of variables that were collapsed in the regression analyses.
| Australia | Norway | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary education <10 yrs | 60.5 | 442 | 56.4 | 390 | 58.5 | 832 | 35.0 | 198 | 37.6 | 313 | 36.5 | 511 | |
| Upper secondary | 22.0 | 161 | 19.4 | 134 | 20.8 | 295 | 27.9 | 158 | 22.9 | 191 | 25.0 | 349 | |
| Undergraduate | 9.9 | 72 | 13.9 | 96 | 11.8 | 168 | 15.2 | 86 | 17.4 | 145 | 16.5 | 231 | |
| Postgraduate | 7.7 | 56 | 10.3 | 71 | 8.9 | 127 | 21.9 | 124 | 22.1 | 184 | 22.0 | 308 | |
| Primary education <10 yrs | 56.1 | 410 | 46.9 | 324 | 51.6 | 734 | 31.3 | 177 | 28.9 | 241 | 29.9 | 418 | |
| Upper secondary | 22.7 | 166 | 22.6 | 156 | 22.6 | 322 | 28.1 | 159 | 28.3 | 236 | 28.2 | 395 | |
| Undergraduate | 13.1 | 96 | 17.2 | 119 | 15.1 | 215 | 14.8 | 84 | 18.6 | 157 | 17.2 | 241 | |
| Postgraduate | 8.1 | 59 | 13.3 | 92 | 10.6 | 151 | 25.8 | 146 | 23.9 | 199 | 24.7 | 345 | |
| Not in labour force | 39.1 | 286 | 20.7 | 143 | 30.2 | 429 | 26.1 | 148 | 15.6 | 130 | 19.9 | 278 | |
| Machinery operators, drivers & labourers | 3.4 | 25 | 10.4 | 72 | 6.8 | 97 | 10.9 | 62 | 13.3 | 111 | 12.4 | 173 | |
| Sales & service | 27.0 | 197 | 15.3 | 106 | 21.3 | 303 | 28.6 | 162 | 28.5 | 237 | 28.5 | 399 | |
| Technicians & trade workers | 3.6 | 26 | 15.6 | 108 | 9.4 | 134 | 10.2 | 58 | 11.0 | 92 | 10.7 | 150 | |
| Managers & professionals | 27.0 | 197 | 38.0 | 263 | 32.3 | 460 | 24.2 | 137 | 31.6 | 263 | 28.6 | 400 | |
| <25,000 | 13.8 | 101 | 10.0 | 69 | 12.0 | 170 | <349 | 26.1 | 148 | 15.3 | 127 | 19.6 | 275 |
| 25,001–35,000 | 10.7 | 78 | 10.7 | 74 | 10.7 | 152 | 350–499 | 18.0 | 102 | 14.5 | 121 | 15.9 | 223 |
| 35,001–50,000 | 15.2 | 111 | 12.0 | 83 | 13.6 | 194 | 500–699 | 16.2 | 92 | 15.1 | 126 | 15.6 | 218 |
| 50,001–65,000 | 10.9 | 80 | 11.4 | 79 | 11.2 | 159 | 700–849 | 11.6 | 66 | 13.2 | 110 | 12.6 | 176 |
| 65,001–85,000 | 11.4 | 83 | 10.1 | 70 | 10.8 | 153 | 850–999 | 11.6 | 66 | 14.7 | 122 | 13.4 | 188 |
| 85,001–100,000 | 10.0 | 73 | 10.1 | 70 | 10.1 | 143 | 1000–1199 | 7.1 | 40 | 10.0 | 83 | 8.8 | 123 |
| 100,001–130,000 | 11.8 | 86 | 14.3 | 99 | 13.0 | 185 | 1200–1399 | 5.1 | 29 | 7.4 | 62 | 6.5 | 91 |
| 130,001–160,000 | 7.3 | 53 | 10.3 | 71 | 8.7 | 124 | >1400 | 4.2 | 24 | 9.8 | 82 | 7.6 | 106 |
| 160,001–220,000 | 6.6 | 48 | 7.8 | 54 | 7.2 | 102 | |||||||
| >220,001 | 2.5 | 18 | 3.3 | 23 | 2.9 | 41 | |||||||
Comparisons on subjective SEP scores between Australia and Norway, mean (SD).
| Subjective SEP | |||
|---|---|---|---|
| Australia | Norway | T test | |
| 5.8 (2.0) | 6.2 (2.1) | *** | |
| Women | 5.6 (1.9) | 6.0 (2.1) | *** |
| Men | 5.9 (2.1) | 6.4 (2.0) | *** |
| Primary education <10 yrs | 4.9 (2.0) | 4.8 (2.4) | |
| Upper secondary | 5.6 (2.0) | 5.6 (2.1) | |
| Undergraduate | 6.3 (1.7) | 6.3 (1.7) | |
| Postgraduate | 6.8 (2.1) | 7.0 (1.9) | |
| Low | 4.8 (2.1) | 5.3 (2.6) | *** |
| Lower middle | 5.3 (2.0) | 5.9 (2.0) | *** |
| Middle | 5.9 (1.7) | 6.3 (1.7) | ** |
| Upper middle | 6.6 (1.8) | 6.7 (1.5) | |
| High | 7.0 (1.7) | 7.3 (1.6) | * |
| Not in labour force | 4.9 (2.1) | 4.9 (2.2) | |
| Other professions | 5.7 (1.9) | 6.1 (1.9) | *** |
| Managers & professionals | 6.6 (1.8) | 7.3 (1.7) | *** |
| Difficult | 5.2 (2.0) | 5.6 (2.3) | *** |
| Neither good nor bad | 5.6 (1.9) | 5.9 (1.9) | *** |
| Good | 6.1 (1.8) | 6.3 (1.8) | * |
| Very good | 6.7 (2.5) | 7.3 (2.1) | *** |
| Mother: Lower than tertiary | 5.6 (2.0) | 6.0 (2.0) | *** |
| Mother: Tertiary education | 6.6 (2.1) | 6.6 (2.1) | |
| Father: Lower than tertiary | 5.5 (2.0) | 5.9 (2.0) | *** |
| Father: Tertiary education | 6.4 (2.1) | 6.6 (2.1) | * |
Note: *** p < 0.01, ** p < 0.05, * p < 0.1. p values were calculated based on independent samples t-test, with a 5% significance level. Standard deviations (SD) in parentheses.
Fig. 1aDistribution of respondents across the rungs of the subjective SEP ladder, Australia.
Fig. 1bDistribution of respondents across the rungs of the subjective SEP ladder, Norway.
Ordinary least squares regression results explaining subjective SEP, Australia and Norway.
| A | B | C | ||||
|---|---|---|---|---|---|---|
| Australia | Norway | Australia | Norway | Australia | Norway | |
| Education (ref. upper secondary) | ||||||
| Primary education <10 yrs | −0.51*** (0.14) | −0.86*** (0.24) | −0.45*** (0.14) | −0.66*** (0.24) | −0.45*** (0.13) | −0.63*** (0.24) |
| Undergraduate | 0.43*** (0.13) | 0.58*** (0.13) | 0.28** (0.13) | 0.49*** (0.13) | 0.25* (0.13) | 0.42*** (0.12) |
| Postgraduate | 0.84*** (0.17) | 1.15*** (0.13) | 0.58*** (0.17) | 0.65*** (0.14) | 0.39** (0.17) | 0.44*** (0.13) |
| Lower middle | 0.45*** (0.16) | 0.51*** (0.17) | 0.41*** (0.16) | 0.35** (0.17) | 0.47*** (0.15) | 0.45*** (0.16) |
| Middle | 0.90*** (0.16) | 0.79*** (0.19) | 0.77*** (0.16) | 0.59*** (0.19) | 0.81*** (0.16) | 0.69*** (0.18) |
| Upper middle | 1.53*** (0.16) | 1.16*** (0.17) | 1.35*** (0.17) | 0.92*** (0.18) | 1.33*** (0.17) | 1.04*** (0.17) |
| High | 1.98*** (0.19) | 1.64*** (0.18) | 1.78*** (0.20) | 1.27*** (0.19) | 1.75*** (0.19) | 1.28*** (0.18) |
| Not in labour force | −0.24* (0.13) | −0.74*** (0.16) | −0.21 (0.13) | −0.71*** (0.15) | ||
| Managers & professionals | 0.42*** (0.13) | 0.79*** (0.12) | 0.37*** (0.13) | 0.62*** (0.12) | ||
| Difficult | −0.26** (0.12) | −0.06 (0.15) | ||||
| Good | 0.39*** (0.12) | 0.38*** (0.11) | ||||
| Very good | 0.74*** (0.20) | 1.18*** (0.16) | ||||
| Mother's tertiary education | 0.34** (0.15) | 0.30** (0.12) | ||||
| Father's tertiary education | −0.13 (0.14) | −0.03 (0.12) | ||||
| Age (yrs.) | 0.02*** (0.00) | 0.02*** (0.00) | 0.01*** (0.00) | 0.01*** (0.00) | 0.02*** (0.00) | 0.02*** (0.00) |
| Male | 0.12 (0.10) | 0.03 (0.10) | 0.06 (0.10) | −0.02 (0.10) | 0.01 (0.10) | −0.08 (0.09) |
| Constant | 4.05*** (0.22) | 4.23*** (0.19) | 4.30*** (0.24) | 4.73*** (0.22) | 3.91*** (0.25) | 3.97*** (0.24) |
Note: *** p < 0.01, ** p < 0.05, * p < 0.1. The undergraduate and post-graduate education levels correspond to university education up to four years, and university education of four years or more, respectively. Robust standard errors in parentheses. Sampling weights in both countries included.
Fig. 2Relative importance of determinants of subjective SEP as a proportion of the R2, Australia and Norway, respectively. Each determinant's relative importance is reported as the percentage of the explained variance, R2. Based on Shapley value decomposition of Model C in Table 3, in which a 100% corresponds to the models' R2 (21% and 26% in the Australian and Norwegian samples, respectively). Determinants of subjective SEP: education, income, occupation and childhood SEP (childhood financial circumstances and parents' education), age and sex.
OLS analyses of Model C (Table 3) with age and sex interactions
| Australia | Norway | ||
|---|---|---|---|
| Education (ref. upper secondary) | Education (ref. upper secondary) | ||
| Primary education <10 yrs | −0.47***">*** (0.13) | Primary education <10 yrs | −0.61**">** (0.23) |
| Undergraduate | 0.96*** (0.33) | Undergraduate | 0.42*** (0.13) |
| Postgraduate | 1.32*** (0.46) | Postgraduate | 0.75*** (0.17) |
| Lower middle | −0.80* (0.48) | Lower middle | 0.14 (0.21) |
| Middle | −0.36 (0.46) | Middle | 0.30 (0.27) |
| Upper middle | −0.31 (0.48) | Upper middle | 0.64*** (0.23) |
| High | −0.35 (0.54) | High | 0.97*** (0.24) |
| Not in labour force | −0.27** (0.13) | Not in labour force | −0.69*** (0.16) |
| Managers & professionals | 0.34*** (0.13) | Managers & professionals | 0.58*** (0.12) |
| Difficult | −0.28** (0.12) | Difficult | −0.03 (0.15) |
| Good | 1.43*** (0.32) | Good | 0.36*** (0.11) |
| Very good | 0.78*** (0.20) | Very good | 1.67*** (0.22) |
| Mother's tertiary education | 0.33** (0.15) | Mother's tertiary education | 0.31** (0.12) |
| Father's tertiary education | −0.20 (0.14) | Father's tertiary education | −0.01 (0.12) |
| Age (yrs.) | 0.01* (0.01) | Age (yrs.) | 0.02*** (0.00) |
| Male | −0.15 (0.12) | Male | −0.51* (0.26) |
| Age X Undergraduate education | −0.02** (0.01) | Male X Postgraduate education | −0.55*** (0.19) |
| Age X Postgraduate education | −0.02** (0.01) | Male X Lower middle income | 0.83** (0.31) |
| Age X Lower middle income | 0.02*** (0.01) | Male X Middle income | 1.01*** (0.36) |
| Age X Middle income | 0.02*** (0.01) | Male X Upper middle income | 1.01*** (0.31) |
| Age X Upper middle income | 0.03*** (0.01) | Male X High income | 0.96*** (0.34) |
| Age X High income | 0.03*** (0.01) | Male X Very good CFC | −0.91*** (0.27) |
| Age X Good CFC | −0.02*** (0.01) | ||
| Male X Upper middle income | 0.53** (0.22) | ||
| Constant | 4.39*** (0.41) | Constant | 4.07*** (0.27) |
Note: *** p < 0.01, ** p < 0.05, * p < 0.1. There were no significant interactions with age in the Norwegian sample. The undergraduate and post-graduate education levels correspond to university education up to four years, and university education of four years or more, respectively. CFC: childhood financial conditions. Robust standard errors in parentheses. Sampling weights in both countries included.
Ordinary least squares analyses of Model C (Table 3) stratified by sex
| Australia | Norway | |||
|---|---|---|---|---|
| Female | Male | Female | Male | |
| Education (ref. upper secondary) | ||||
| Primary education <10 yrs | −0.42** (0.18) | −0.49** (0.21) | −0.53 (0.33) | −0.74** (0.32) |
| Undergraduate | 0.38** (0.17) | 0.17 (0.19) | 0.61*** (0.20) | 0.20 (0.16) |
| Postgraduate | 0.20 (0.23) | 0.54** (0.25) | 0.75*** (0.21) | 0.13 (0.17) |
| Lower middle | 0.39** (0.20) | 0.57** (0.25) | 0.06 (0.22) | 1.06*** (0.24) |
| Middle | 0.74*** (0.20) | 0.84*** (0.25) | 0.20 (0.27) | 1.43*** (0.25) |
| Upper middle | 1.03*** (0.22) | 1.60*** (0.26) | 0.52** (0.24) | 1.77*** (0.23) |
| High | 1.50*** (0.27) | 1.93*** (0.29) | 0.84*** (0.25) | 2.06*** (0.26) |
| Not in labour force | −0.05 (0.16) | −0.41* (0.22) | −0.86*** (0.23) | −0.41** (0.20) |
| Managers & professionals | 0.60*** (0.19) | 0.20 (0.17) | 0.71*** (0.18) | 0.51*** (0.16) |
| Difficult | −0.10 (0.16) | −0.46** (0.19) | 0.06 (0.23) | −0.08 (0.18) |
| Good | 0.26 (0.17) | 0.51*** (0.17) | 0.32* (0.17) | 0.39*** (0.15) |
| Very good | 0.89*** (0.26) | 0.63** (0.30) | 1.67*** (0.24) | 0.71*** (0.21) |
| Mother's tertiary education | 0.32 (0.20) | 0.35 (0.21) | 0.39** (0.18) | 0.28 (0.17) |
| Father's tertiary education | 0.04 (0.20) | −0.30 (0.19) | −0.12 (0.18) | 0.09 (0.15) |
| Age (yrs.) | 0.02*** (0.00) | 0.02*** (0.00) | 0.02*** (0.01) | 0.02 (0.00) |
| Constant | 3.67*** (0.32) | 4.13*** (0.39) | 3.98*** (0.38) | 3.66*** (0.29) |
Note: *** p < 0.01, ** p < 0.05, * p < 0.1. The undergraduate and post-graduate education levels correspond to university education up to four years, and university education of four years or more, respectively. Robust standard errors in parentheses. Sampling weights in both countries included.