Subjective Social Status and Cardiometabolic Risk Markers by Intersectionality of Race/Ethnicity and Sex Among U.S. Young Adults

• Published in: Annals of behavioral medicine 2022-05, Vol.56 (5), p.442-460
• Main Authors: McClain, Amanda C, Gallo, Linda C, Mattei, Josiemer
• Format: Article
• Language: English
• Subjects: Adolescent; Body Mass Index; Cardiovascular Diseases; Ethnicity; Female; Humans; Intersectional Framework; Longitudinal Studies; Male; Regular; Risk Factors; Social Status; Young Adult
• ISSN: 0883-6612; 1532-4796
• DOI: 10.1093/abm/kaab025

Abstract Background Subjective social status (SSS) has shown inverse relationships with cardiometabolic risk, but intersectionalities of race/ethnicity and sex may indicate more nuanced relationships. Purpose To investigate associations of SSS with cardiometabolic risk markers by race/ethnicity and sex. Methods Data were from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (n = 4,847; 24–32 years), which collected biological cardiometabolic risk markers. A 10-step ladder captured SSS; respondents indicated on which step they perceived they stood in relation to other people in the U.S. higher values indicated higher SSS (range: 1–10). We tested the relationship between SSS and individual markers using generalized least square means linear regression models, testing three-way interactions between SSS, race/ethnicity, and sex (p < .10) before stratification. Results SSS–race/ethnicity–sex interactions were significantly associated with waist circumference (p ≤ .0001), body mass index (BMI; p ≤ .0001), systolic blood pressure (SBP; p ≤ .0001), diastolic blood pressure (DBP; p = .0004), and high-density lipoprotein cholesterol (HDL-C; p = .07). SSS was associated with waist circumference (β [SE]: −1.2 (0.4), p < .05) and BMI (−0.6 [0.2], p < .01) for non-Hispanic White females, compared with males; with HDL-C among non-Hispanic White (0.2 [0.1]; p < .05) and Hispanic (0.3 (0.1); p < .05) females, compared with males; with SBP for non-Hispanic Asian (1.7 [0.8]; p < .05) and Multiracial (1.8 [0.8]; p < .05), versus White, females; and with DBP for non-Hispanic Black (0.8 [0.3]; p < .01), versus White, males. Conclusions SSS was differentially related to cardiometabolic risk markers by race/ethnicity and sex, suggesting intersectional aspects. Clinical and research applications of SSS should consider race/ethnicity- and sex-specific pathways influencing cardiometabolic risk. Young White women with higher levels of subjective social status had smaller waist circumference and lower systolic blood pressure, but higher subjective social status was not as protective for young White men, Asian women, or Multiracial women.