Relationship between subjective social status and measures of health in older Taiwanese persons

OBJECTIVES: To compare the association between subjective ladder ranking and health measures with the association between objective indices and health measures in older Taiwanese men and women. DESIGN: Cross-sectional study. SETTING: A population-representative sample of elderly and nearly elderly men and women in Taiwan. PARTICIPANTS: The study included 991 participants from the Social Environment and Biomarkers of Aging Study in Taiwan. MEASUREMENTS: The information collected included demographic characteristics; subjective ladder score of SES; objective measures of SES, including education, income, and occupation; health behaviors; health-related variables such as self-rated health, basic activity of daily living difficulties, instrumental activity of daily living (IADL) difficulties, and physical activity difficulties; and depression score. RESULTS: Low ladder score was associated with poorer self-rated health and more reported IADL and physical activity difficulties, even after adjustment for objective measures of SES and other covariates. The multiply adjusted odds ratio for a one-quartile difference in ladder score and worse self-rated health was 1.19 (95% confidence interval=1.06-1.33). The associations between subjective ladder ranking and health status were generally stronger in those who had 6 years or less of education than in those who received more education. CONCLUSION: A simple subjective assessment of one's ranking on the social hierarchy was associated with self-rated health and physical functional status in an older ethnic Chinese population. The associations were independent of the effects of traditional objective measures of SES, such as education, income, and occupation.