Bedeutung des subjektiven sozialen Status für die gesundheitliche Lage von Männern und Frauen in Deutschland

Abstract

In health research and epidemiology, socioeconomic status (SES) is traditionally determined using objective indicators such as education, occupation, and income. Since the early 2000s, studies have additionally examined the health implications of subjective social status (SSS). Whereas objective SES indicators are used to classify people as belonging to a specific socioeconomic group, SSS describes how people self-evaluate their position in the social hierarchy and with which status group they feel affiliated. Most studies using this approach are from the USA. In Germany, research on the association between SSS and health is very scarce. This dissertation is the first study using German national data to examine the health implications of SSS among men and women living in Germany. The statistical analyses are based on cross-sectional data derived from the German General Social Survey (ALLBUS) and from the Robert Koch Institute's German Health Update (GEDA) study. Associations between SSS and several health indicators were explored using correlation and regression analysis, while adjustments were made for objective SES indicators and potential confounders. The construct validity of a German version of the MacArthur scale, which has been established internationally as a standard instrument to measure SSS, was examined using correlation and factor analysis. Low SSS was associated with physical and mental health problems in men and women. Many of the associations persisted after adjusting for objective SES indicators and potential confounders, partly with differences between men and women. Mediation analyses revealed a significant indirect relationship between objective SES and depressive symptoms through SSS. With regard to the construct validity of the German MacArthur Scale, the scale showed stronger correlations with measures of similar constructs than with measures of dissimilar constructs. Factor analysis did not show considerable loadings of the scale on external factors of mental well-being and depressiveness. This dissertation presents the first national results for Germany on the association between SSS and health. The results indicate that low SSS may have adverse health implications in men and women beyond the impact of objective SES, which is consistent with previous studies from other countries. Moreover, perceptions of social disadvantage may partly explain the link between objective SES and health. Hence, the concept of SSS offers innovative potential for describing and explaining health inequalities. Stronger theoretical grounding and longitudinal data are needed to further establish the concept of SSS in health research and epidemiology.