Introduction
One of the most pressing issues in epidemiology as part of the general medical sciences is the identification of the exact causes underlying the spread of disease. The identification of causal mechanisms, combined with the identification of patterns of spread and development of pathophysiological conditions, is critical to the search for effective therapy. Thus, clarifying the drivers of a particular disease allows preventive work and containment of active epidemiological growth. One such factor is socioeconomic status, which is thought to have a powerful influence on promoting or restraining the spread of pathology.
In a general sense, socioeconomic status should be understood as the position of an individual or small group in the social hierarchy, which is characterized by their education, income, and occupation. Consequently, three key aspects affect socioeconomic status. On the one hand, the level of education determines an individual’s intellectual resources, or worldview, and moral values, and outlook on the world. On the other hand, an individual’s income determines the availability of certain economic goods or the advisability of replacing them with budgetary but lower-quality alternatives. Finally, occupation determines an individual’s qualifications and competence, allows him or her to be an expert in specific fields, and provides accompanying opportunities related to the business sphere: health insurance, travel, social security, and a sense of belonging. All of this together defines socioeconomic status as part of an individual’s self-identification in society.
From what has been said, it seems clear that the components of socioeconomic status have a tremendous impact on both the physical and psychological health of the individual. More specifically, it has been repeatedly shown that there is a correlation between low socioeconomic status and poor health (APA, 2010). At the same time, lower socioeconomic status has traditionally been associated with an increased likelihood of developing psychopathological processes, including dementia and other psychiatric disorders (APA, 2010). On the other hand, higher socioeconomic status determines a person’s higher social responsibility, including through easier abandonment of bad habits (Clare et al., 2014). Consequently, it is reasonable to expect that people of higher socioeconomic status tend to have more secure and safe housing, access to quality food, and access to health care. Notably, it is incorrect to generalize better health outcomes for all people of higher socioeconomic status because the presence of pathologies may be mediated not only by an individual’s socioeconomic environment but also by a range of hereditary and incidental causes.
Finally, it is essential to recognize that socioeconomic status is an important predictor of the development of atherosclerosis. First of all, atherosclerosis is commonly referred to as a chronic disease that affects arterial vessels of the elastic and muscular-elastic type throughout the patient’s body. With atherosclerosis, foci of fatty, mainly cholesterol, deposits are formed in the inner lining of arterial vessels, which causes narrowing of the lumen of vessels up to their complete blockage. Subsequently, sclerosis — a proliferation of connective tissue — and deposition of calcium mineral salts start in such vessels, which are additional aggravating factors of atherosclerosis. However, there is no consensus regarding the influence of socioeconomic status on this pathology of the cardiovascular system. Thus, on the one hand, Garshick et al. (2017) noted an ambiguous relationship between the variables: although in their study, men with higher socioeconomic status had a higher propensity to develop atherosclerosis, the overall conclusion was that there was no overall relationship between status and likelihood of disease. A probable reason for this discrepancy is the prioritization of issues related to patients’ more affordable diets, including poor-quality food. On the other hand, Kestilä et al. (2012) quite clearly showed that patients with lower socioeconomic status ultimately have a higher chance of atherosclerosis. Thus, certain factors of socioeconomic status are definitely independent predictors of atherosclerosis, and this study aims to summarize the scientific evidence available on this issue. The purpose of this research paper is to examine and describe in detail the potential association that has been found between socioeconomic status and the risk of atherosclerosis.
The Educational Component of Socioeconomic Status
As noted above, education is one of the three most important predictors of socioeconomic status: hence, it is imperative to discuss this component separately. Education should not only be understood as the number of levels of education received — secondary, higher, or academic — but also the quality of that education. It is very likely that, for instance, the same Ph.D. degree can imply a very different level of knowledge among graduates not only of different universities but also of different countries. It is for this reason that citizens of one country often have to validate their degree against the quotations of another country. In other words, education in socioeconomic status is a characteristic of the intellectual development and general erudition of an individual: it shows the level of competencies and skills mastered, as well as the potential development of critical thinking. The question of measuring the educational component of socioeconomic status does not seem difficult. In fact, it is sufficient to ask the patient about the level of his current education — school, college, university — and the number of years that have been devoted to learning. In addition, the specialization an individual has received may be of interest, although this is very indirectly related to the level of socioeconomic status.
There is no doubt that education is essential in covering the basic and higher-order needs of the individual. The significance and value of receiving an education — especially a university education — can be viewed from several perspectives. First, education is positively correlated with greater employment opportunities, as shown by Yadav et al. (2020). The logic behind this thesis is that a trained individual has competencies not only in his or her own narrowly defined area of interest but also in related areas. Consequently, an individual educated as a nurse administrator can work competently in all related fields. Second, a strong correlation has been found between the quality of education received (not just quantity) and income (Assari, 2018). It follows that academic learning is very likely to have a favorable effect on an individual’s income growth, and thus its importance cannot be denied. Finally, very intriguing data show that educational attainment is associated with an individual’s civic responsibility (Evans et al., 2019). In this sense, it should be noted that an educated individual is more likely to be aware of the need to exist in an equal, secure, and stable society, and therefore his actions as a citizen can be directed toward the realization of these principles.
This is enough to determine the potential relationship between the educational component of socioeconomic status and the risk of atherosclerosis. It is very likely that the lower the level of education a person has, the less he or she is aware of the natural and pathogenic processes occurring in his or her body. At the same time, a low level of education correlates positively with a low level of critical thinking; therefore, it is possible to say that these individuals are less likely to assess their own health and to seek the advice of a reliable health care professional. In addition, the less educated a person is, the lower his or her average income tends to be: as a result, lack of education may be associated with being forced to buy cheaper, lower-quality food instead of healthy food. As a result, a low level of education becomes one of the central predictors of socioeconomic status, which in turn affects the increased risk of developing pathological processes in the cardiovascular system.
The academic community has long studied the association between education as a component of socioeconomic status and atherosclerosis. Numerous studies have found that low educational attainment correlates with a higher likelihood of disease among a sample (Van Rossum et al., 1999; Kestilä et al., 2012; Redondo-Bravo et al., 2019). Based on these confirmations, it is acceptable to say that education is an important predictor of the development of atherosclerosis or, to put it differently, positively correlates with the prevalence of this cardiovascular pathology. This means that individuals with a low level and quality of education are very likely to have a higher propensity to get atherosclerosis. In other words, one important step — which can be initiated by the individual in order to reduce the risk of atherosclerosis — is to obtain a reliable and high-quality education, although this is certainly not an absolute guarantee.
The Occupational Component of Socioeconomic Status
In addition to the educational component, an individual’s profession is also critical to socioeconomic status. The profession should be understood as such a social characteristic of a person, which unambiguously indicates his or her belonging to a particular category of people who are engaged in a similar type of labor activity. By carrying out work activity within the framework of professional activity, an individual receives this material compensation expressed in the form of wages, bonuses, and bonus accruals. However, the occupation has not only economic overtones but also makes it possible to meet the intellectual, emotional, cognitive, and cultural needs of the individual. More specifically, when a person chooses a professional vector of development — be it management, accounting, medicine, or science as examples — he or she is able to realize his earlier academic education skills and feel meaningful to society. In general, it should be recognized that a sense of belonging to a work team, collective, or company as a whole is extremely important to an individual’s social needs, as it tends to increase his or her perceived psychological and economic security. Studies often measure the occupational component of socioeconomic status. For this, it is traditionally sufficient to conduct a qualitative structured or semi-structured interview to determine the professional direction, seniority, and career path of an individual. However, it is fair to admit that occupation as a component of socioeconomic status has severe limitations for research. More specifically, the occupation of respondents always severely limits sample sizes, as it does not take into account such cohorts as children and adolescents, the unemployed, and the elderly. Moreover, although a person’s occupation may be related to his or her income and education, occupational activity alone, in isolation from other factors, cannot be a reliable indicator of an individual’s socioeconomic status.
The desire to realize one’s skills within the framework of professional activity is a very legitimate human desire, especially if one takes into account the significance of employment. As it was with the educational component, it is reasonable to consider the profession as part of the socioeconomic status from different sides. Thus, the significance of the profession consists of the individual’s skill development and general mental and physical skills, as shown by Gyansah & Guantai (2018). More specifically, university education can never accurately convey the practical activities of actual work; therefore, the implementation of work will always involve some on-the-job training. Consequently, through training, qualification, and retraining programs, as well as participation in business MICE trips, the worker is able to raise the level of their own knowledge and skills qualitatively. The second most obvious advantage of the profession is the growth of income and bringing profits into the household, which ultimately leads the country to faster economic growth. This is fully justified by strategies to reduce unemployment among the population in order to raise the level of national GDP (del Amo González et al., 2018). Finally, work performance, as it has been studied, is positively correlated with the personal growth of the worker if the working conditions prove to be constructive (West, 1991). Based on the above, it is pertinent to conclude that occupation has a significant contribution to the quality of life. If an individual performs work activities within his or her own interests, it enhances the quality of life through economic well-being, satisfaction with educational needs, and stimulation of personal growth.
In general, it should be said that the influence of occupation as a component of socioeconomic status on the risk of atherosclerosis is a multifactorial function. In this discussion, occupational characteristics of the work performed should be taken into account, such as wage level, activity directions, working conditions, job satisfaction, and resulting occupational stress. It is assumed that the more favorable, comfortable, and safe for the individual the work activity performed, the lower the probability of developing atherosclerosis. This thesis is justified by the fact that if the level of wages received is comfortable if the working schedule is adequate and if there is no severe load leading to stressful states — in the absence of hereditary predisposition — the individual should not be prone to the development of pathology of the cardiovascular system. On the contrary, if the professional activity does not correspond to the personal interests of the individual, it becomes the cause of dissatisfaction with life and a high level of work stress. The constant pressure of such factors can cause general health depression and the formation of atherosclerosis in particular. Consequently, it is appropriate to generalize that the low level of a professional component in socioeconomic status — insecure work, work stress, low salary — are predictors of disease development.
It is legitimate to expect that the academic community has had time to study this factor in the socioeconomic status system as well. For example, one consequence of Adler & Stewart’s (2010) study was to discover the deleterious effect of stress mediated by low socioeconomic status on a high risk of health impairment. For the disease in question, this can be approximated as confirming the hypothesis of a positive correlation between external stress exposure to workload and the development of an atherosclerotic condition. Consequently, an appropriate strategy to inhibit this effect is to revise the corporate human resource management policy or to change the occupation, if acceptable. Similar findings were found in a qualitative study by Shavers (2007), who assessed inequality problems as a function of socioeconomic status. More specifically, the author found that — although employment typically improves an individual’s quality of life — unsuitable working conditions and low job satisfaction can have detrimental effects on a worker’s health, including causing atherosclerosis. In a general summary, academic research recognizes the usefulness of work performance in increasing quality of life but shows that poor and unsafe working conditions can be predictors not only of low socioeconomic status but also of high risk for atherosclerosis.
The Income Component of Socioeconomic Status
Finally, the sense of financial security of the individual, expressed as income, is of unconditional importance within the framework of the question under discussion. Terminologically, income is defined as the totality of all funds received for carrying out work activities. Consequently, the very fact of receiving income is associated with the performance of work, and therefore it is appropriate to consider income as compensation for the time and resources spent. It is also noteworthy that income itself is not an indicator of pure financial security and awareness of the individual. In this sense, it is necessary to distinguish between income and profit in particular, understanding income as part of income, devoid of expenses. For society, however, the level of income is important because historically, it has been established that an individual’s highest income is associated with his or her increased attractiveness and social significance. From an individual’s point of view, an increased income allows one to expand the horizons of financial possibilities and to receive more material — those for which one should pay in money — if one wants to. Consequently, income cannot be associated with wealth because income does not mean the level of accumulated values. Moreover, unlike the level of education or the vector of labor activity, income is a purely quantitative measure expressed in local currency: dollar, euro, sterling, peso, or other currencies. Accordingly, the ideal strategy for measuring this component of socioeconomic status is to survey respondents to find out their income level. Typically, this can either be an exact number or an interval range. In this sense, it is worth noting that individuals often tend to exaggerate their income for reasons of greater attractiveness or to hide accurate data; therefore, the collection of this component may be accompanied by distortions.
A very striking parallel can be drawn between an individual’s income and his or her quality of life. As an indicator of belonging to a certain socioeconomic class, income has a significant impact on health. More specifically, an individual’s increased income, as shown by Kautonen (2017), allows him or her more financial opportunities. This applies to access to health services, purchasing better food, and living in safer urban areas. If one considers the concept of “quality of life” as a symbiosis of the physical and psychological elements of human health, it is reasonable to state that increased income stimulates both of these components. In other words, the presence of increased income opens up new horizons for the individual and qualitatively improves his or her standard of living.
It is evident that income as the third component of socioeconomic status under consideration also has a significant influence on the development of atherosclerosis. In this context, it should be particularly emphasized that cardiovascular disease is the most frequent cause of death in clinical cases. Consequently, how often an individual seeks medical care to control his or her health may determine the risk of developing atherosclerotic conditions. In furtherance of this theme, it should be shown that the frequency of visits to clinical facilities is directly mediated by an individual’s income level. As a rule, poor and low-income citizens cannot afford to visit a doctor, which means that medicine is complex for them to access. This, however, also works on a national scale, when poor and only developing countries demonstrate low availability of medicine and, as a consequence, high incidence of atherosclerosis. In contrast, those individuals with higher incomes are traditionally more likely to seek quality medical care and have excellent insurance coverage. Consequently, these patients should be somewhat less likely to be found to have embryonic forms of atherosclerosis. As a general result, low income as a component of socioeconomic status may be a predictor of the prevalence of atherosclerosis.
Similar theses are found in the works of the academic community. In fact, since income level seems to be a more intuitively understandable quantitative measure than education and occupation, a large number of authors tend to emphasize this component of socioeconomic status. For example, a study by Eisner et al. (2011) clearly showed that low income is positively correlated with the development of chronic obstructive pulmonary disease. In turn, this pathogenic disease of the respiratory system leads to insufficient vascular tissue activity and, consequently, to the development of atherosclerosis. To put it differently, since patients with the chronic obstructive pulmonary disease have an increased chance of developing atherosclerosis, low income can be considered as a significant predictor of these pathologies. At the same time, Thurston et al. (2014), who studied the probability of developing atherosclerosis in economically disadvantaged women, came to a similar conclusion. In other words, for women with a stable low income, who can be considered a vulnerable social group, the risk of disease caused by cardiovascular lesions, namely atherosclerosis, increases. As a general result, low income has been academically postulated as a significant predictor of the development of atherosclerosis in patients.
Conclusion
In conclusion, it should be reiterated that socioeconomic status is an essential descriptive characteristic that takes into account the qualitative and quantitative features of an individual or small social group, whether family and household. Socioeconomic status is at the same time a complex measure that includes such factors as education, occupation, and income. This research paper has consistently shown what each of these components is individual. In short, education should be understood as the level of education received — school, college, university — and its quality. An occupation is a characteristic that determines the direction of an individual’s labor activity, which brings him or her profit. Finally, income should be considered the totality of material values received, but it should not be equated with wealth.
Based on the articles studied, it is appropriate to draw the general conclusion that a low level of socioeconomic status is a description of an individual living disadvantaged. In particular, a low level of education is traditionally associated with a lack of qualifications and high competence, and it also characterizes a lack of developed critical thinking. At the same time, the low occupational part of the socioeconomic status is expressed in the constant pressure of work stress, low life satisfaction as a consequence of unwanted work, and low wages. Low finances also lead to a decrease in socioeconomic status due to the inability of individuals to make the desired purchases and receive quality services.
A positive correlation was found between low socioeconomic status and the risk of atherosclerosis in all components. Thus, when analyzing the sources, it became apparent that low education predicted the development of atherosclerosis due to the patient’s low medical awareness and lack of critical thinking as such. The low occupation was also a predictor of atherosclerosis, as constant work stress and high stress inhibited the cardiovascular system. Finally, low income meant less availability of quality health care services and incomplete insurance packages, which also increased the risk of atherosclerosis.
There are several intriguing findings among the readings. First, Thurston et al. (2014) showed that economically disadvantaged women are prone to atherosclerosis risks regardless of these ethics. At the same time, older women have been shown to be more prone to atherosclerosis than older men, even despite similar levels of socioeconomic status (Van Rossum et al., 1999). Finally, Redondo-Bravo et al. (2019) showed a surprising and contradictory finding that income level and atherosclerosis risk are unrelated, although other studies have stated otherwise.
In a general summary, it should be emphasized that low socioeconomic status is unequivocally associated with a greater likelihood of having atherosclerosis. Low availability of medicine, intake of low-quality food, lack of academic awareness — and even the fact that such a disease exists — as well as the constant pressure of work stress and low level of economic security of an individual or a household, form a low socioeconomic status. In turn, these become direct causes of the development of the pathogenic condition known as atherosclerosis.
References
Adler, N. E., & Stewart, J. (2010). Preface to The Biology of Disadvantage: Socioeconomic Status and Health. Annals of the New York Academy of Sciences, 1186(1), 1–4.
APA. (2010). Aging & socioeconomic status[PDF document].
APA. (2010).Children, youth, families and socioeconomic status [PDF document].
Assari, S. (2018). Blacks’ diminished return of education attainment on subjective health; mediating effect of income. Brain Sciences, 8(9), 176-184.
Clare, P., Bradford, D., Courtney, R. J., Martire, K., & Mattick, R. P. (2014). The relationship between socioeconomic status and “hardcore” smoking over time – greater accumulation of hardened smokers in low-SES than high-SES smokers. Tobacco Control, 23(e2), e133–e138.
del Amo González, M. P. L., BenĂtez, V., & MartĂn-MartĂn, J. J. (2018). Long-term unemployment, income, poverty, and social public expenditure, and their relationship with self-perceived health in Spain (2007–2011). BMC Public Health, 18(1), 1-14.
Eisner, M. D., Blanc, P. D., Omachi, T. A., Yelin, E. H., Sidney, S., Katz, P. P., Ackerson, L. M., Sanchez, G., Tolstykh, I., & Iribarren, C. (2011). Socioeconomic status, race, and COPD health outcomes. Journal of Epidemiology and Community Health (1979), 65(1), 26–34.
Evans, M., Evans, R., & Vemic, A. (2019). Youth civic engagement and formal education in Canada: Shifting expressions, associated challenges. In A. Peterson, G. Stahl, & H. Soong (Eds.), The Palgrave handbook of citizenship and education (pp. 1-17). Palgrave Macmillan.
Gyansah, S. T., & Guantai, H. K. (2018). Career Development in Organizations: Placing the Organizations and Employees are on the same pedestal to enhance maximum productivity. European Journal of Business and Management, 10(14), 40-45.
Kautonen, T., Kibler, E., & Minniti, M. (2017). Late-career entrepreneurship, income and quality of life. Journal of Business Venturing, 32(3), 318-333.
Kestilä, P., Magnussen, C. G., Viikari, J. S.., Kähönen, M., Hutri-Kähönen, N., Taittonen, L., Jula, A., Loo, B.-M., Pietikäinen, M., Jokinen, E., Lehtimäki, T., Kivimäki, M., Juonala, M., & Raitakari, O. T. (2012). Socioeconomic status, cardiovascular risk factors, and subclinical atherosclerosis in young adults: The cardiovascular risk in young Finns study.Arteriosclerosis, Thrombosis, and Vascular Biology, 32(3), 815–821.
Redondo-Bravo, L., Fernández-Alvira, J. M., GĂłrriz, J., Mendiguren, J. M., Sanz, J., Fernández-Friera, L., GarcĂa-Ruiz, J. M., Fernández-Ortiz, A., Ibáñez, B., Bueno, H., & Fuster, V. (2019). Does Socioeconomic Status Influence the Risk of Subclinical Atherosclerosis? A Mediation Model.Journal of the American College of Cardiology, 74(4), 526–535.
Shavers, V. L. (2007). Measurement of socioeconomic status in health disparities research.Journal of the National Medical Association, 99(9), 1013–1023.
Thurston, R. C., El Khoudary, S. R., Derby, C. A., Barinas-Mitchell, E., Lewis, T. T., McClure, C. K., & Matthews, K. A. (2014). Low Socioeconomic Status Over 12 Years and Subclinical Cardiovascular Disease: The Study of Women’s Health Across the Nation. Stroke (1970), 45(4), 954–960.
Van Rossum, C. T. M., Van De Mheen, H., Witteman, J. C. M., Mackenbach, J. P., & Grobbee, D. E. (1999). Socioeconomic status and aortic atherosclerosis in Dutch elderly people: The Rotterdam Study. American Journal of Epidemiology, 150(2), 142–148.
West, T. W. (1991). Impact of the information technology profession. Cause/Effect, 14(1), 5- 8.
Yadav, A. K., Sahni, B., & Jena, P. K. (2020). Education, employment, economic status and empowerment: Implications for maternal health care services utilization in India. Journal of Public Affairs, 21(2), 1-11.