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Under capital’s thumb: longitudinal associations between relational social class and health
  1. Jerzy Eisenberg-Guyot,
  2. Anjum Hajat
  1. Epidemiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Jerzy Eisenberg-Guyot, Epidemiology, University of Washington, Seattle, WA 98195, USA; jerzy{at}


Background We used a relational social-class measure based on property ownership and managerial authority to analyse the longitudinal relationships between class, self-rated health (SRH) and mental illness. To our knowledge, this is the first study using a relational social-class measure to evaluate these relationships longitudinally.

Methods Using Panel Study of Income Dynamics data from 1984 to 2017, we first assigned respondents aged 25–64 to the not in the labour force (NILF), worker, manager, petit bourgeois (PB) or capitalist classes based on business ownership, managerial authority and employment status. Next, using Cox models, we estimated the confounder-adjusted associations between 2-year-lagged class and incidence of poor/fair SRH and serious mental illness. We also tested whether the associations varied by gender, whether they persisted after more-fully adjusting for traditional socioeconomic-status measures (education and income) and how they changed temporally.

Results We identified large inequities in poor/fair SRH. NILFs had the greatest hazard, followed by workers, PBs, managers and capitalists. We also identified large inequities in serious mental illness; NILFs and workers had the greatest hazard, while capitalists had the lowest. Class inequities in both outcomes lessened but remained considerable after confounder and socioeconomic-status adjustment, and we found some evidence that the class–SRH relationship varied by gender, as being NILF was more harmful among men than women. Additionally, class inequities in the outcomes decreased somewhat over time.

Conclusion We identified substantial class inequities in SRH and mental illness. Our findings demonstrate the importance of using relational social-class measures to deepen understanding of health inequities’ root causes.

  • social class
  • social epidemiology
  • health inequalities
  • social factors in

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  • Correction notice This article has been corrected since it first published online. A sentence that was no longer relevant in the context of the published version of the analysis has been removed.

  • Twitter @JerzyEisenGuyot

  • Contributors JEG conceived and designed this study, acquired and managed the data, conducted the analyses, interpreted the results and wrote the initial draft of the manuscript. AH advised JEG on study conceptualisation and design, data management and results interpretation and he provided critical feedback on subsequent drafts of the manuscript. Both authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

  • Funding JEG’s and AH’s work was partly supported by a grant from the National Institute on Aging of the National Institutes of Health (R01AG060011).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The Panel Study of Income Dynamics is a publicly available data source operated by the University of Michigan. Data can be obtained at: