Subjective social status: its determinants and association with health in the Swedish working population (the SLOSH study)

Background: This study aims to confirm associations between subjective social status (SSS) and health in the Swedish working population, to investigate if SSS is related to health over and above conventional measures of socio-economic status and to identify factors related to perception of SSS. Methods: The study includes 2358 men and 2665 women in the age group of 19-68 years who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). SSS was measured using the MacArthur scale, a 10-rung ladder on which individuals indicate where they think they stand in the social hierarchy. Health, health behaviors and social situation were also measured in 2006, while more objective measures of socio-economic position were derived from registry data and interviews in 2003. Results: Perception of SSS was cross-sectionally related to age-adjusted prevalence of suboptimal perceived general health, sleep disturbances, musculoskeletal symptoms, depressive symptoms and emotional exhaustion. Relative Indices of Inequalities (RII) showed significant relationships between SSS and health, which were attenuated by adjustment for general life satisfaction. Adjustment for occupational grade, education and income further attenuated the relationship. The main predictors of SSS in 2006 were occupational grade, personal income and education in 2003; household financial situation, general life satisfaction and job control in 2006. When ranking their SSS, women put more weight on household financial situation and men on their personal income. Conclusion: SSS is associated with prevalence of several health complaints in the Swedish working population over and above conventional SES, indicating that SSS is a valid measure of social inequality in health.