Re-examining the social gradient in health: A study of Dutch men, 1850-1984.

Today, a social gradient in health is clearly visible. Individuals with higher socio-economic statuses tend to live longer lives, and are less likely to be disabled or chronically ill. However, there is debate over when the social gradient emerged: is it a constant across contexts, or a particular feature of certain societies? Often, social gradients are not found in historical contexts. This is perhaps because historical studies use mortality as their sole measure of health, which may not fully reflect the health statuses of the living. Using another health indicator may help to identify whether a social gradient in health was present in historical contexts. One alternative measure of health is body height, a barometer of population health. In this study, we accordingly examined socio-economic status's relationship to both adult mortality and body height. A sample of Dutch men (n=3396), born between 1850 and 1900, was used. Socio-economic status was measured with parental occupational class, and height was measured at age 20. Survival analyses (for mortality at age 20 or later) and linear regressions (for height at age 20) were performed. We found no clear gradient in occupational class's relationship to adult mortality. Regarding height, individuals from elite backgrounds were estimated to be 2.82 cm cm taller (95% CI: 1.41-4.24) than those from unskilled working backgrounds. While a gradient in height was present in earlier birth cohorts, it was not visible among men born between 1885 and 1900. These findings indicate that there was a social gradient in health in the late nineteenth and twentieth centuries, although the gradient perhaps changed based on the indicator and time period being examined. This may mean that the social gradient in health is more persistent over time than it appears when only examining the social gradient in mortality.