0
June 23, 1993, Vol 269, No. 24 >
ARTICLE | June 23, 1993

Socioeconomic Inequalities in Health: Title and subTitle BreakNo Easy Solution FREE

Nancy E. Adler, PhD; W. Thomas Boyce, MD; Margaret A. Chesney, PhD; Susan Folkman, PhD; S. Leonard Syme, PhD
[+] Author Affiliations

Reprint requests to Graduate Program in Health Psychology, University of California, 1350 Seventh Ave, CSBS-204, San Francisco, CA 94143-0844 (Dr Adler).


JAMA. 1993;269(24):3140-3145. doi:10.1001/jama.1993.03500240084031
Text Size: A A A
Published online
Article
References

Objective.  —Socioeconomic status (SES) is strongly associated with risk of disease and mortality. Universal health insurance is being debated as one remedy for such health inequalities. This article considers mechanisms through which SES affects health and argues that a broader and more comprehensive approach is needed.

Data Sources.  —Published articles surveyed using MEDLINE and review articles and bibliographies.

Methods and Results.  —Research is reviewed on the association of SES with health outcomes in different countries, including those with universal health coverage. Socioeconomic status relates to health at all levels of the SES hierarchy, and access to care accounts for little of this association. Other mechanisms are suggested and implications for policy and clinical practice are discussed.

Conclusion.  —Health insurance coverage alone is not likely to reduce significantly SES differences in health. Attention should be paid both in policy decisions and in clinical practice to other SES-related factors that may influence patterns of health and disease.(JAMA. 1993;269:3140-3145)

REFERENCES

1 +
Antonovsky A.  Social class, life expectancy and overall mortality. Milbank Q . 1967;;45:31-73.
2 +
Syme SL, Berkman LF.  Social class, susceptibility and sickness. Am J Epidemiol . 1976;;104:1-8.
3 +
Haan MN, Kaplan GA, Syme SL.  Socioeconomic states and health: old observations and new thoughts.  In: Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1989;:76-135.
4 +
Marmot MG, Smith GD, Stansfeld S, et al.  Health inequalities among British civil servants: the Whitehall II study. Lancet . 1991;;337:1387-1393.
5 +
Marmot MG, Shipley MJ, Rose G.  Inequalities in death—specific explanations of a general pattern? Lancet . 1984;;1:1003-1006.
6 +
Friedman E.  The uninsured: from dilemma to crisis. JAMA . 1991;;265:2491-2495.
7 +
Chapin CV.  Deaths among taxpayers and nontaxpayers, income tax, Providence, 1865. Am J Public Health . 1924;;14:647-651.
8 +
Coombs LC.  Economic differentials in causes of death. Med Care . 1941;;1:246-255.
9 +
Haan MN, Kaplan GA, Camacho T.  Poverty and health: prospective evidence from the Alameda County Study. Am J Epidemiol . 1987;;125:989-998.
10 +
Kitagawa EM, Hauser PM. Differential Mortality in the United States: A Study of Socioeconomic Epidemiology . Cambridge, Mass: Harvard University Press; 1973;.
11 +
Patno ME.  Mortality and economic level in an urban area. Public Health Rep . 1960;;75:841-851.
12 +
Berg JW, Ross R, Latourette HB.  Economic status and survival of cancer patients. Cancer . 1977;; 39:467-477.
13 +
Dayal HH, Power RN, Chiu C.  Race and socioeconomic status in survival from breast cancer. J Chronic Disability . 1982;;35:675-683.
14 +
Kraus JF, Borhani NO, Franti CE.  Socioeconomic status, ethnicity, and risk of coronary heart disease. Am J Epidemiol . 1980;;111:407-414.
15 +
Marmot MG, Adelstein AM, Robinson N, Rose GA.  Changing social-class distribution of heart disease. BMJ . 1978;;2:1109-1112.
16 +
Marmot MG, Rose G, Shipley MJ, Hamilton PJS.  Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health . 1987;;32:244-249.
17 +
Steinhorn SC, Myers MH, Hanky BH, Pelham VF.  Factors associated with survival differences between black women and white women with cancer of the uterine corpus. Am J Epidemiol . 1986;; 124:85-93.
18 +
Susser M, Watson W, Hopper K. Sociology in Medicine . 3rd ed. Oxford, England: Oxford University Press; 1985;.
19 +
Caldwell JC. Theory of Fertility Decline . London, England: Academic Press; 1982;.
20 +
Omran AR.  The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q . 1971;;49:509-538.
21 +
Adelstein AM.  Life-style in occupational cancer. J Toxicol Environ Health . 1980;;6:953-962.
22 +
Gould JB, LeRoy S.  Socioeconomic status and low birth weight: a racial comparison. Pediatrics . 1988;;82:896-904.
23 +
Wise PH, Meyers A.  Poverty and child health. Pediatr Clin North Am . 1988;;35:1169-1186.
24 +
House JS, Kessler RC, Herzog AR.  Age, socioeconomic status, and health. Milbank Q . 1990;; 68:383-411.
25 +
Haan MN, Kaplan GA.  The contribution of socioeconomic position to minority health.  In: Heckler M, ed. Report of the Secretary's Task Force on Black and Minority Health: Crosscutting Issues in Minority Health . Washington, DC: US Dept of Health and Human Services; 1985;.
26 +
Kaplan GA, Haan MN. Socioeconomic position and health: prospective evidence from the Alameda County Study. Presented at the 114th annual meeting of the American Public Health Association; Las Vegas, Nev; September 29, 1986.
27 +
Devesa SS, Diamond EL.  Association of breast cancer and cervical cancer incidences with income and education among whites and blacks. J Natl Cancer Inst . 1980;;6:515-528.
28 +
Otten M, Teutsch S, Williamson D, Marks J.  The effect of known risk factors on the excess mortality of black adults in the United States. JAMA . 1990;;263:845-850.
29 +
Kessler RC, Neighbors HW.  A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav . 1986;;27:107-115.
30 +
Harburg E, Erfurt JC, Chape C, Hauenstein LS, Schull WJ, Schork MA.  Socioecological stressor areas and black-white blood pressure. J Chronic Dis . 1973;;26:595-611.
31 +
James AJ, Strogatz DS, Wing SB, Ramsey DL.  Socioeconomic status, John Henryism, and hypertension in blacks and whites. Am J Epidemiol . 1987;;126:664-673.
32 +
Townsend P, Davidson N. Inequalities in Health: The Black Report . Harmondsworth, England: Penguin; 1982;.
33 +
Lundberg O.  Causal explanations for class inequality in health—an empirical analysis. Soc Sci Med . 1991;;32:385-393.
34 +
Vågerö D.  Inequality in health—some theoretical and empirical problems. Soc Sci Med . 1991;;32: 367-371.
35 +
Vågerö D, Lundberg O.  Health inequalities in Britain and Sweden. Lancet . 1989;;2:35-36.
36 +
Bunker JP, Gomby DS.  Preface: socioeconomic states and health: an examination of underlying process.  In: Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1989;:xv-xxiv.
37 +
Tofler GH, Muller JE, Stone PH, et al.  Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Am J Cardiol . 1993;;71:1031-1035.
38 +
US Dept of Health, Education and Welfare. Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention . Washington DC: US Dept of Health, Education and Welfare; 1979;.
39 +
Kim K, Moody P.  More resources, better health? a cross-national perspective. Soc Sci Med . 1992;;34: 837-842.
40 +
Doll R.  Health and the environment in the 1990s. Am J Public Health . 1992;;82:933-941.
41 +
Winkelstein W Jr.  Medical care is not health care. JAMA . 1993;;269:2504.
42 +
Diehr PK, Richardson WC, Shortell SM, LoGerfo JP.  Increased access to medical care. Med Care . 1991;;10:989-999.
43 +
Dalen JE, Santiago J.  Insuring the uninsured is not enough. Arch Intern Med . 1991;;151:860-862.
44 +
Haas JS, Udvarhelyi S, Morris CN, Epstein AM.  The effect of providing health coverage to poor uninsured pregnant women in Massachusetts. JAMA . 1993;;269:87-91.
45 +
Ginzberg E, Ostow M.  Beyond universal health insurance to effective health care. JAMA . 1991;; 265:2559-2562.
46 +
Hayward RA, Shapiro MF, Freeman HE, Corey CR.  Who gets screened for cervical and breast cancer? results from a new national survey. Arch Intern Med . 1988;;148:1177-1181.
47 +
Harlan LC, Bernstein AB, Kessler LG.  Cervical cancer screening: who is not screened and why? Am J Public Health . 1991;;81:885-890.
48 +
Salonen JT.  Socioeconomic status and risk of cancer, cerebral stroke, and death due to coronary heart disease and any disease: a longitudinal study in eastern Finland. J Epidemiol Community Health . 1982;;36:294-297.
49 +
Stamler R, Hardy RJ, Payne GH, et al.  Educational level and five-year all-cause mortality in the hypertension detection and follow-up program. Hypertension . 1987;;9:641-646.
50 +
Paffenbarger RS, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med . 1993;;328:538-545.
51 +
Wilhelmsen L.  Coronary heart disease: epidemiology of smoking and intervention studies of smoking. Am Heart J . 1988;;115:242-249.
52 +
Centers for Disease Control. Smoking, Tobacco and Health: A Fact Book . Rockville, Md: US Dept of Health and Human Services, Public Health Service, Office on Smoking and Health; 1987;.
53 +
Matthews K, Kelsey S, Meilahn E, Kuller L, Wing R.  Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am J Epidemiol . 1989;;129: 1132-1144.
54 +
Winkleby M, Fortmann S, Barrett D.  Social class disparities in risk factors for disease: eight-year prevalence patterns by level of education. Prev Med . 1990;;19:1-12.
55 +
Cauley JA, Donfield SM, LaPorte RF, Warhaftig NE.  Physical activity by SES in two population-based cohorts. Med Sci Sports Exercise . 1991;; 23:343-352.
56 +
Jeffrey RW, French SA, Forster JL, Spry VM.  Socioeconomic status differences in health behaviors related to obesity: the Healthy Worker Project. Int J Obes . 1991;;15:689-696.
57 +
Kahn HS, Williamson DF, Stevens JA.  Race and weight change in US women: the roles of socioeconomic and marital status. Am J Public Health . 1991;;81:319-323.
58 +
SobelJ, Stunkard AJ.  Socioeconomic status and obesity: a review of the literature. Psychol Bull . 1989;;105:260-271.
59 +
Stokols D.  Establishing and maintaining health environments. Am Psychol . 1992;;47:6-22.
60 +
Dutton DB, Levine S.  Overview, methodological critique, and reformulation.  In: Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1989;:29-69.
61 +
Byrne DG, Whyte HM.  Life events and myocardial infarction revisited: the role of measures of individual impact. Psychosom Med . 1980;;42: 1-10.
62 +
Cohen S, Tyrrell DAJ, Smith AP.  Psychological stress in humans and susceptibility to the common cold. N Engl J Med . 1991;;325:606-612.
63 +
Cohen S, Tyrrell DAJ, Smith AP.  Negative life events, perceived stress, negative affect, and susceptibility to the common cold. J Pers Soc Psychol . 1993;;64:131-140.
64 +
McLeod JD, Kessler RC.  Socioeconomic status differences in vulnerability to undesirable life events. J Health Soc Behav . 1990;;31:162-172.
65 +
Cohen S, Wills TA.  Stress, social support and the buffering hypothesis. Psychol Bull . 1985;;98: 310-357.
66 +
House JS, Kessler R, Herzog AR, Mero R, Kinney A, Breslow M.  Social stratification, age, and health.  In: Scheie KW, Blazer D, House JS, eds. Aging, Health Behaviors, and Health Outcomes . Hillsdale, NJ: Lawrence Erlbaum; 1991;.
67 +
Ruberman W, Weinblatt E, Goldberg JD, Chaudhary BS.  Psychosocial influences on mortality after myocardial infarction. N Engl J Med . 1984;; 34:552-559.
68 +
Folkman S, Lazarus RS, Gruen RJ, DeLongis A.  Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol . 1986;;50:571-579.
69 +
Rutter M.  Psychosocial resilience and protective mechanisms. Am J Orthopsychiatry . 1987;;57: 316-330.
70 +
Carney RM, Rich MW, Freedlan KE, et al.  Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom Med . 1988;;50:627-633.
71 +
Booth-Kewley S, Friedman HS.  Psychological predictors of heart disease: a quantitative review. Psychol Bull . 1987;;101:343-362.
72 +
Rodin J, Langer E.  Long-term effects of a control-relevant intervention with the institutionalized aged. J Pers Soc Psychol . 1977;;35:897-902.
73 +
Rodin J.  Aging and health: effects of the sense of control. Science . 1986;;233:1271-1276.
74 +
Wilkinson RG.  Income distribution and mortality: a 'natural' experiment. Sociol Health Illness . 1990;;12:391-412.
75 +
Wilkinson RG.  Income distribution and life expectancy. BMJ . 1992;;304:165-168.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Antonovsky A.  Social class, life expectancy and overall mortality. Milbank Q . 1967;;45:31-73.
2 +
Syme SL, Berkman LF.  Social class, susceptibility and sickness. Am J Epidemiol . 1976;;104:1-8.
3 +
Haan MN, Kaplan GA, Syme SL.  Socioeconomic states and health: old observations and new thoughts.  In: Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1989;:76-135.
4 +
Marmot MG, Smith GD, Stansfeld S, et al.  Health inequalities among British civil servants: the Whitehall II study. Lancet . 1991;;337:1387-1393.
5 +
Marmot MG, Shipley MJ, Rose G.  Inequalities in death—specific explanations of a general pattern? Lancet . 1984;;1:1003-1006.
6 +
Friedman E.  The uninsured: from dilemma to crisis. JAMA . 1991;;265:2491-2495.
7 +
Chapin CV.  Deaths among taxpayers and nontaxpayers, income tax, Providence, 1865. Am J Public Health . 1924;;14:647-651.
8 +
Coombs LC.  Economic differentials in causes of death. Med Care . 1941;;1:246-255.
9 +
Haan MN, Kaplan GA, Camacho T.  Poverty and health: prospective evidence from the Alameda County Study. Am J Epidemiol . 1987;;125:989-998.
10 +
Kitagawa EM, Hauser PM. Differential Mortality in the United States: A Study of Socioeconomic Epidemiology . Cambridge, Mass: Harvard University Press; 1973;.
11 +
Patno ME.  Mortality and economic level in an urban area. Public Health Rep . 1960;;75:841-851.
12 +
Berg JW, Ross R, Latourette HB.  Economic status and survival of cancer patients. Cancer . 1977;; 39:467-477.
13 +
Dayal HH, Power RN, Chiu C.  Race and socioeconomic status in survival from breast cancer. J Chronic Disability . 1982;;35:675-683.
14 +
Kraus JF, Borhani NO, Franti CE.  Socioeconomic status, ethnicity, and risk of coronary heart disease. Am J Epidemiol . 1980;;111:407-414.
15 +
Marmot MG, Adelstein AM, Robinson N, Rose GA.  Changing social-class distribution of heart disease. BMJ . 1978;;2:1109-1112.
16 +
Marmot MG, Rose G, Shipley MJ, Hamilton PJS.  Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health . 1987;;32:244-249.
17 +
Steinhorn SC, Myers MH, Hanky BH, Pelham VF.  Factors associated with survival differences between black women and white women with cancer of the uterine corpus. Am J Epidemiol . 1986;; 124:85-93.
18 +
Susser M, Watson W, Hopper K. Sociology in Medicine . 3rd ed. Oxford, England: Oxford University Press; 1985;.
19 +
Caldwell JC. Theory of Fertility Decline . London, England: Academic Press; 1982;.
20 +
Omran AR.  The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q . 1971;;49:509-538.
21 +
Adelstein AM.  Life-style in occupational cancer. J Toxicol Environ Health . 1980;;6:953-962.
22 +
Gould JB, LeRoy S.  Socioeconomic status and low birth weight: a racial comparison. Pediatrics . 1988;;82:896-904.
23 +
Wise PH, Meyers A.  Poverty and child health. Pediatr Clin North Am . 1988;;35:1169-1186.
24 +
House JS, Kessler RC, Herzog AR.  Age, socioeconomic status, and health. Milbank Q . 1990;; 68:383-411.
25 +
Haan MN, Kaplan GA.  The contribution of socioeconomic position to minority health.  In: Heckler M, ed. Report of the Secretary's Task Force on Black and Minority Health: Crosscutting Issues in Minority Health . Washington, DC: US Dept of Health and Human Services; 1985;.
26 +
Kaplan GA, Haan MN. Socioeconomic position and health: prospective evidence from the Alameda County Study. Presented at the 114th annual meeting of the American Public Health Association; Las Vegas, Nev; September 29, 1986.
27 +
Devesa SS, Diamond EL.  Association of breast cancer and cervical cancer incidences with income and education among whites and blacks. J Natl Cancer Inst . 1980;;6:515-528.
28 +
Otten M, Teutsch S, Williamson D, Marks J.  The effect of known risk factors on the excess mortality of black adults in the United States. JAMA . 1990;;263:845-850.
29 +
Kessler RC, Neighbors HW.  A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav . 1986;;27:107-115.
30 +
Harburg E, Erfurt JC, Chape C, Hauenstein LS, Schull WJ, Schork MA.  Socioecological stressor areas and black-white blood pressure. J Chronic Dis . 1973;;26:595-611.
31 +
James AJ, Strogatz DS, Wing SB, Ramsey DL.  Socioeconomic status, John Henryism, and hypertension in blacks and whites. Am J Epidemiol . 1987;;126:664-673.
32 +
Townsend P, Davidson N. Inequalities in Health: The Black Report . Harmondsworth, England: Penguin; 1982;.
33 +
Lundberg O.  Causal explanations for class inequality in health—an empirical analysis. Soc Sci Med . 1991;;32:385-393.
34 +
Vågerö D.  Inequality in health—some theoretical and empirical problems. Soc Sci Med . 1991;;32: 367-371.
35 +
Vågerö D, Lundberg O.  Health inequalities in Britain and Sweden. Lancet . 1989;;2:35-36.
36 +
Bunker JP, Gomby DS.  Preface: socioeconomic states and health: an examination of underlying process.  In: Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1989;:xv-xxiv.
37 +
Tofler GH, Muller JE, Stone PH, et al.  Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Am J Cardiol . 1993;;71:1031-1035.
38 +
US Dept of Health, Education and Welfare. Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention . Washington DC: US Dept of Health, Education and Welfare; 1979;.
39 +
Kim K, Moody P.  More resources, better health? a cross-national perspective. Soc Sci Med . 1992;;34: 837-842.
40 +
Doll R.  Health and the environment in the 1990s. Am J Public Health . 1992;;82:933-941.
41 +
Winkelstein W Jr.  Medical care is not health care. JAMA . 1993;;269:2504.
42 +
Diehr PK, Richardson WC, Shortell SM, LoGerfo JP.  Increased access to medical care. Med Care . 1991;;10:989-999.
43 +
Dalen JE, Santiago J.  Insuring the uninsured is not enough. Arch Intern Med . 1991;;151:860-862.
44 +
Haas JS, Udvarhelyi S, Morris CN, Epstein AM.  The effect of providing health coverage to poor uninsured pregnant women in Massachusetts. JAMA . 1993;;269:87-91.
45 +
Ginzberg E, Ostow M.  Beyond universal health insurance to effective health care. JAMA . 1991;; 265:2559-2562.
46 +
Hayward RA, Shapiro MF, Freeman HE, Corey CR.  Who gets screened for cervical and breast cancer? results from a new national survey. Arch Intern Med . 1988;;148:1177-1181.
47 +
Harlan LC, Bernstein AB, Kessler LG.  Cervical cancer screening: who is not screened and why? Am J Public Health . 1991;;81:885-890.
48 +
Salonen JT.  Socioeconomic status and risk of cancer, cerebral stroke, and death due to coronary heart disease and any disease: a longitudinal study in eastern Finland. J Epidemiol Community Health . 1982;;36:294-297.
49 +
Stamler R, Hardy RJ, Payne GH, et al.  Educational level and five-year all-cause mortality in the hypertension detection and follow-up program. Hypertension . 1987;;9:641-646.
50 +
Paffenbarger RS, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med . 1993;;328:538-545.
51 +
Wilhelmsen L.  Coronary heart disease: epidemiology of smoking and intervention studies of smoking. Am Heart J . 1988;;115:242-249.
52 +
Centers for Disease Control. Smoking, Tobacco and Health: A Fact Book . Rockville, Md: US Dept of Health and Human Services, Public Health Service, Office on Smoking and Health; 1987;.
53 +
Matthews K, Kelsey S, Meilahn E, Kuller L, Wing R.  Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am J Epidemiol . 1989;;129: 1132-1144.
54 +
Winkleby M, Fortmann S, Barrett D.  Social class disparities in risk factors for disease: eight-year prevalence patterns by level of education. Prev Med . 1990;;19:1-12.
55 +
Cauley JA, Donfield SM, LaPorte RF, Warhaftig NE.  Physical activity by SES in two population-based cohorts. Med Sci Sports Exercise . 1991;; 23:343-352.
56 +
Jeffrey RW, French SA, Forster JL, Spry VM.  Socioeconomic status differences in health behaviors related to obesity: the Healthy Worker Project. Int J Obes . 1991;;15:689-696.
57 +
Kahn HS, Williamson DF, Stevens JA.  Race and weight change in US women: the roles of socioeconomic and marital status. Am J Public Health . 1991;;81:319-323.
58 +
SobelJ, Stunkard AJ.  Socioeconomic status and obesity: a review of the literature. Psychol Bull . 1989;;105:260-271.
59 +
Stokols D.  Establishing and maintaining health environments. Am Psychol . 1992;;47:6-22.
60 +
Dutton DB, Levine S.  Overview, methodological critique, and reformulation.  In: Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1989;:29-69.
61 +
Byrne DG, Whyte HM.  Life events and myocardial infarction revisited: the role of measures of individual impact. Psychosom Med . 1980;;42: 1-10.
62 +
Cohen S, Tyrrell DAJ, Smith AP.  Psychological stress in humans and susceptibility to the common cold. N Engl J Med . 1991;;325:606-612.
63 +
Cohen S, Tyrrell DAJ, Smith AP.  Negative life events, perceived stress, negative affect, and susceptibility to the common cold. J Pers Soc Psychol . 1993;;64:131-140.
64 +
McLeod JD, Kessler RC.  Socioeconomic status differences in vulnerability to undesirable life events. J Health Soc Behav . 1990;;31:162-172.
65 +
Cohen S, Wills TA.  Stress, social support and the buffering hypothesis. Psychol Bull . 1985;;98: 310-357.
66 +
House JS, Kessler R, Herzog AR, Mero R, Kinney A, Breslow M.  Social stratification, age, and health.  In: Scheie KW, Blazer D, House JS, eds. Aging, Health Behaviors, and Health Outcomes . Hillsdale, NJ: Lawrence Erlbaum; 1991;.
67 +
Ruberman W, Weinblatt E, Goldberg JD, Chaudhary BS.  Psychosocial influences on mortality after myocardial infarction. N Engl J Med . 1984;; 34:552-559.
68 +
Folkman S, Lazarus RS, Gruen RJ, DeLongis A.  Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol . 1986;;50:571-579.
69 +
Rutter M.  Psychosocial resilience and protective mechanisms. Am J Orthopsychiatry . 1987;;57: 316-330.
70 +
Carney RM, Rich MW, Freedlan KE, et al.  Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom Med . 1988;;50:627-633.
71 +
Booth-Kewley S, Friedman HS.  Psychological predictors of heart disease: a quantitative review. Psychol Bull . 1987;;101:343-362.
72 +
Rodin J, Langer E.  Long-term effects of a control-relevant intervention with the institutionalized aged. J Pers Soc Psychol . 1977;;35:897-902.
73 +
Rodin J.  Aging and health: effects of the sense of control. Science . 1986;;233:1271-1276.
74 +
Wilkinson RG.  Income distribution and mortality: a 'natural' experiment. Sociol Health Illness . 1990;;12:391-412.
75 +
Wilkinson RG.  Income distribution and life expectancy. BMJ . 1992;;304:165-168.

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