Subjective socioeconomic status and presence of the metabolic syndrome in midlife community volunteers

Objective indices of socioeconomic status (SES) predict diverse sources of morbidity and mortality as well as numerous biological and behavioral risk factors for disease. Here we examine whether subjective measures of SES may be similarly associated with measured risk factors including the metabolic syndrome and its components of elevated blood pressure, high fasting glucose, dyslipidemia, and central adiposity. Observations were based on a community sample of 981 adults (30-54 years of age; 52% female; 84% white, 16% African American). Subjective SES was measured, using the nationally referenced (U.S.) MacArthur Scale of Subjective Social Status, and objective SES was indexed by composite of years of education and family income. Likelihood of meeting the criteria for presence of the metabolic syndrome varied inversely with subjective SES (odds ratio [OR] = 0.75; 95% Confidence Interval [CI] = 0.64-0.88, for a 1-standard deviation increase in subjective SES, adjusted for age, sex, and race), and this association persisted on further adjustment for objective SES (OR = 0.82; 95% CI = 0.68-0.99). Subjective SES was also associated inversely with blood pressure, waist circumference, and serum triglycerides, and positively with HDL cholesterol. Level of physical activity and smoking status were predicted by subjective SES as well, but adjusting for these health behaviors did not appreciably reduce associations of subjective SES with metabolic syndrome and syndrome components. These findings support speculation that perceived social standing is associated with prominent cardiovascular risk factors and may prove a useful adjunct to conventional socioeconomic indicators in epidemiological research.