title: [Relevance of 'subjective social status' for health risks and health status - results from the KORA-F4-study].
abstract: OBJECTIVE
  In public health research, social status is usually assessed by objective indicators such as educational level and income. Recent studies have shown the importance of including 'subjective social status (SSS)'. The aim of this study is to analyse the influence of SSS on health for the first time in Germany, and to find out if there is an effect over and above the objective indicators of social status.
  
  
  METHODS
  The KORA F4 study took place in 2006-2008 in the region of Augsburg, Southern Germany, with a study population of 3 080 men and women aged 32-81 years. SSS was assessed by a single question with 6 possible responses. For the analyses, 3 SSS categories were differentiated: low, middle and high. The following dependent variables were included: self-rated health (SRH), hypertension (uncontrolled), diabetes, metabolic syndrome, hay fever, no participation in medical cancer prevention, obesity (assessed by body mass index and waist-hip-ratio), smoking, physical inactivity. Logistic regression models were used to estimate the influence of SSS (e. g. adjusted for educational level and income).
  
  
  RESULTS
  About 25% of the participants group themselves into the lowest SSS-category. Without adjustment for educational level and income, SSS is negatively associated with SRH, hypertension, diabetes, metabolic syndrome, obesity, no participation in medical cancer prevention, smoking and physical inactivity; as expected the association with hay fever is positive. After adjustment for educational level and income, not all of these associations remain significant. Some of the adjusted odds ratios (OR) for SSS differ considerably when stratified by gender, for example concerning the variable 'physical inactivity': The comparison of 'SSS low' vs. 'SSS high' shows for men OR 2.35 (95% confidence interval (CI) 1.57-3.50) and for women OR 3.58 (95% CI 2.34-5.47).
  
  
  CONCLUSIONS
  The results from this study strongly suggest that SSS is an important indicator of social status (to date largely disregarded in public health research). Thus, SSS should be applied in addition to other indicators of social status such as educational level and income. The associations with SSS depend on the health indicator studied. Also, sometimes there are large differences when stratified by gender. Further research is needed to fully understand the determinants of SSS and its impact on health.
authors.affiliation: Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Neuherberg.
authors.forename: R
authors.initials: R
authors.lastname: Hegar
authors.forename: A
authors.initials: A
authors.lastname: Döring
authors.forename: A
authors.initials: A
authors.lastname: Mielck
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012923:Social Class; D055815:Young Adult