title: Women's relative immunity to the socio-economic health gradient: artifact or real?
abstract: BACKGROUND
  Individual and area socio-economic status (SES) are significant predictors of morbidity and mortality in developed and developing countries. However, the span in health from poorest to richest, that is, the socio-economic gradient, appears steeper for men than women.
  
  
  OBJECTIVE
  Our aim is to understand women's apparent immunity to the health harms of the SES gradient.
  
  
  METHODS
  Findings from a non-systematic search of Medline for population-based, SES gradient studies reporting results for both men and women and with health outcomes of morbidity, mortality or self-rated health (SRH) were reflectively analyzed.
  
  
  RESULTS
  The 36 papers reviewed generally showed women to be relatively immune to the SES gradient for all but cardiovascular health outcomes. However, addressing the interconnected nature of socio-economic circumstances, exploring whether some measures of SES had ambiguous meanings for either women or men, including modifiers of SES such as household circumstances, social capital or area gender equity, or using indicators of area SES that were contextual rather than aggregates of individual, compositional measures increased the SES gradient for women. Outcome measures that combined mental and physical health, accounted for gender differences in SRH and adjusted for sex-specific differences in causes of mortality also explained some of the observed amelioration of the SES gradient among women.
  
  
  CONCLUSIONS
  Socio-economic circumstances have a real and sustained impact on individual health. The SES gradient appears stronger for men than for women for all health outcomes other than heart disease. However, some of the observed variability between men and women may be an artifact of biased methodology. Considering webs of causation rather than individual markers of SES along with other sources of gender bias can explain much of women's blunted socio-economic gradient and deepen understanding of the pathways from SES to morbidity and mortality overall.
authors.affiliation: Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada.|Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden; phillip@queensu.ca.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Phillips
authors.affiliation: Division of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Hamberg
mesh_terms: D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D008603:Mental Health; D012737:Sex Factors; D066270:Social Capital; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D016387:Women's Health
keywords: cardiovascular disease; deprivation index; gender; men; morbidity; mortality; sex factors; social capital; socio-economic status; women