Kaplan GA. People and places: contrasting perspectives on the association between social class and health. International Journal of Health Services. 1996;26:507-519.
The author emphasizes the importance of considering the clustering together of many risk factors rather than depending on isolated risk factors to explain disparities in health in different areas. Citing a substantial body of evidence demonstrating a strong association between socioeconomic variables and health outcomes, he notes that most analyses conceptualize socioeconomic status as an individual characteristic. The author criticizes the usual tendency to view socioeconomic characteristics as individual characteristics, arguing that some characteristics of groups related to social class (e.g., equity of income distribution) can be measured only at the group level.
To support his argument, the author uses the Alameda County Study in California. First, he summarizes that study's finding that residence in a poverty area is associated with increased mortality rates as well as a subsequent factor analysis of the census tract characteristics intended to determine which characteristics were associated with increased mortality. He notes that clustering of characteristics predicted mortality, while individual census tract characteristics did not. In addition, the author combined variables collected in the questionnaire into scales, categorizing the variables into demands and resources. He then compared telephone survey data with mortality data and found survey respondents with high demands and low resources to be more than 10 times as likely as were respondents with low demands and high resources to die in census tracts with high mortality.
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