title: Association between subjective social status and cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the association between subjective social status (SSS), or the individual's perception of his or her position in the social hierarchy, and the odds of coronary artery disease (CAD), hypertension, diabetes, obesity and dyslipidaemia.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, SocINDEX, Web of Science and reference lists of all included studies up to October 2014, with a verification search in July 2015. Inclusion criteria were original studies in adults that reported odds, risk or hazard ratios of at least one outcome of interest (CAD, hypertension, diabetes, obesity or dyslipidaemia), comparing 'lower' versus 'higher' SSS groups, where SSS is measured on a self-anchoring ladder. ORs were pooled using a random-effects model.
  
  
  RESULTS
  10 studies were included in the systematic review; 9 of these were included in the meta-analysis. In analyses unadjusted for objective socioeconomic status (SES) measures such as income, education or occupation, the pooled OR comparing the bottom versus the top of the SSS ladder was 1.82 (95% CI 1.10 to 2.99) for CAD, 1.88 (95% CI 1.27 to 2.79) for hypertension, 1.90 (95% CI 1.25 to 2.87) for diabetes, 3.68 (95% CI 2.03 to 6.64) for dyslipidaemia and 1.57 (95% CI 0.95 to 2.59) for obesity. These associations were attenuated when adjusting for objective SES measures, with the only statistically significant association remaining for dyslipidaemia (OR 2.10, 95% CI 1.09 to 4.06), though all ORs remained greater than 1.
  
  
  CONCLUSIONS
  Lower SSS is associated with significantly increased odds of CAD, hypertension, diabetes and dyslipidaemia, with a trend towards increased odds of obesity. These trends are consistently present, though the effects attenuated when adjusting for SES, suggesting that perception of one's own status on a social hierarchy has health effects above and beyond one's actual income, occupation and education.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Tang
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ruksana
authors.initials: R
authors.lastname: Rashid
authors.affiliation: Department of Sociology, University of Calgary, Calgary, Alberta, Canada O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Godley
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D011050:Policy Making; D011159:Population Surveillance; D012307:Risk Factors; D012923:Social Class
keywords: CARDIOLOGY; EPIDEMIOLOGY; INTERNAL MEDICINE; PUBLIC HEALTH; SOCIAL MEDICINE