Elsevier

Social Science & Medicine

Volume 47, Issue 8, October 1998, Pages 1121-1130
Social Science & Medicine

Social mobility and 21 year mortality in a cohort of Scottish men

https://doi.org/10.1016/S0277-9536(98)00061-6Get rights and content

Abstract

The objective of this prospective cohort study was to determine the contribution of changes in social class within and between generations to mortality risk and to socioeconomic differentials in mortality. In 27 workplaces in the west of Scotland. 5567 men aged 35–64 years when screened, provided information on their father's occupation, their own first occupation and their occupation at screening. Mortality risk, from broad causes of death by intergenerational and intragenerational social mobility groups, was measured after 21 years. For all or some of the 3 routes of mobility (childhood to screening, labour market entry to screening and childhood to labour market entry), increasing values were seen across the 4 groups (stable non manual, upwardly mobile, downwardly mobile and stable manual) for diastolic blood pressure, body mass index, current smoking, early school leaving, angina, bronchitis, severe chest pain, and proportion living in deprived areas. Decreasing values were seen for serum cholesterol, height, FEV1, exercise, never and ex-smokers, wine drinkers and car users. For mobility between childhood and screening and between childhood and labour market entry, mortality risk was highest for the stable manual group and lowest for the stable non manual group for all cause, cardiovascular disease and other causes of death. The upwardly and downwardly mobile groups had intermediate risks. For cancer mortality, the stable manual group had the highest risk with the other groups having lower and similar risks. For mobility between labour market entry and screening, the highest risk was for the downwardly mobile group for all cause and cardiovascular mortality. For cancer mortality, the risk was higher for men in manual social classes at all occasions. Adjustment for risk factors attenuated but could not completely explain the differentials in mortality risk. Overall, major differences in mortality risk were seen between the stable non manual and the stable manual groups, to which social mobility does not contribute. With the exception of the small intragenerationally downwardly mobile group there was little evidence that social mobility itself was associated with mortality outcomes different from those expected on the basis of lifetime socioeconomic experience. This is consistent with the suggestion that the main influence of socioeconomic position on mortality risk is an accumulative one, acting across the lifecourse.

Introduction

The role of inequalities in mortality across the socioeconomic spectrum has been of interest for many years, with the publication, in Britain, of the Black report stimulating fresh attempts to understand the processes lying behind these health differentials (DHSS, 1980). Researchers have considered the extent to which social mobility, either up or down the social class hierarchy, contributes to these inequalities (Stern, 1983; Illsley, 1986; Goldblatt, 1989; West, 1991; Blane et al., 1993; Power et al., 1996; Bartley and Plewis, 1997) and come to different conclusions about the importance of the contribution of health-related social mobility to mortality differentials. On the one side, it has been argued that health-related social mobility can explain socioeconomic differences in health and mortality since the healthier rise up the social spectrum and the less healthy go down (Stern, 1983; Illsley, 1986; West, 1991). Researchers on the other side have suggested that the role played by social mobility is small and socioeconomic gradients are constrained (Goldblatt, 1989; Blane et al., 1993; Power et al., 1996; Bartley and Plewis, 1997). This is because those moving upwards, although healthier than the group which they have left, are less healthy than the group which they join, and similarly the less healthy moving downwards are healthier than their destination group. The issue is of importance because if socioeconomic differentials in health are generated by health-related social mobility rather than by the effects of different social environments, then policies aimed at reducing health inequalities through equalising life chances will not succeed.

We have investigated the mortality experience of a large cohort of working men whose social class was known at three stages of their life. In a previous study of this cohort, we analyzed the cumulative effect on mortality of social class at these three stages (Davey Smith et al., 1997). We allocated men to one of four groups depending on the number of occasions their social class was non manual or manual (all three non manual, two non manual and one manual, one non manual and two manual and all three manual). A clear cumulative effect of socioeconomic circumstances over a lifetime was found, with mortality risk positively related to the number of occasions spent in manual social classes. In another study of this cohort, we analyzed mortality by social class at the three stages separately (Hart et al., 1998). We found that mortality risk was similar at each lifestage with men in social classes I and II having the lowest risk. A widening of inequalities in adulthood suggested the importance of the accumulation of poor socioeconomic circumstances throughout life.

In the current study, we have assessed whether the accumulation of socioeconomic risk could be due to health-related social mobility. We looked at three possible routes of social mobility — intergenerational mobility between childhood social class and later adult social class, intragenerational mobility between early adult and later adult social class, and intergenerational mobility between childhood social class and early adult social class. In addition, unlike other studies of social mobility, this cohort has information on individual behavioural and physiological measures, enabling us to see how they contribute to the mortality experience of socially mobile and socially stable groups.

Section snippets

Methods

This analysis was based on part of a cohort of employed people from 27 workplaces in Glasgow, Clydebank and Grangemouth, Scotland, who were screened between 1970 and 1973. The full sample consisted of 6022 men and 1006 women. Participants completed a questionnaire and attended a physical examination. Women have been excluded from this study due to the small number of deaths which have occurred. Full details have been described elsewhere (Blane et al., 1996; Davey Smith et al., 1997).

The

Father's social class and social class at screening

Taking mobility between father's social class and social class at screening, the largest group of men were the socially stable manual workers and the smallest group were the downwardly mobile, who were manual workers at screening but whose fathers had been non manual workers (Table 1). Statistically significant differences between non manual and manual social classes at screening were seen for all the characteristics except body mass index and ECG ischaemia. Differences between the four groups

Interpretation of mortality results

We have shown that overall, mortality experience was worse for the stable manual group, best for the stable non manual group and in between these two for the upwardly and downwardly mobile groups. This is compatible with results from the cumulative social class approach, analyzed in a previous study of mortality in this cohort where men were allocated to one of four groups depending on the number of occasions their social class was non manual or manual (Davey Smith et al., 1997). It was found

Conclusions

The major differentials in mortality were seen between the stable non manual and the stable manual groups, with mobility making only a minor contribution and constraining socioeconomic differentials in mortality. Apart from the intragenerational mobility findings, the mortality risks seen in this study were consistent with a cumulative lifecourse approach. Future studies should consider the importance of obtaining detailed information on socioeconomic position throughout the lifecourse. The

Acknowledgements

Funding was provided by a grant from the NHS Management Executive, Cardiovascular Disease and Stroke Research and Development Initiative. Victor M. Hawthorne was responsible for the original screening study and we thank him for his continuing interest. Charles Gillis, David Hole and Pauline MacKinnon are also thanked for their support.

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