Patterns of Socioeconomic Inequality in Adolescent Health Differ According to the Measure of Socioeconomic Position

Socioeconomic differences in health are ubiquitous across age groups, cultures, and health domains. However, variation in the size and pattern of health inequalities appears to relate to the measure of socioeconomic position (SEP) applied. Little attention has been paid to these differences in adolescents and their implications for health surveillance and policy. We examined health inequalities in 1371 adolescents in seven European countries using four measures of SEP: youth-reported material assets and subjective social status and parent-reported material assets and household income. For each SEP variable, we estimated risk ratios, risk differences, concentration curves, and concentration indices of inequality for fair/poor self-rated health and low life satisfaction. Results showed that inequalities in health and life satisfaction were largest when subjective social status was used as the SEP variable. Moreover, health inequalities defined by subjective social status did not change after differences in assets and income were statistically controlled. Although material assets yielded similar health inequalities as household income, the results suggest that subjective and objective SEP relate differently to adolescent health and are not equivalent indicators of the same construct. In addition, possible bidirectional effects on health and wellbeing may inflate health inequalities defined by subjective social status. These results indicate that SEP differences in adolescent health are relate more closely to psychosocial processes than to material inequality.