Health disparities: Socioeconomic status

Socioeconomic status is one of the strongest predictors of health. Across many diseases and populations, people with lower socioeconomic status experience worse health outcomes and shorter life expectancy. Recognizing how socioeconomic status contributes to health disparities highlights opportunities to improve health equity through clinical care, community partnerships, and advocacy.

Socioeconomic status refers to an individual’s or group’s standing in society based on access to and control over material and social resources. It has three core components: income, educational attainment, and occupation. Income influences access to resources such as housing, nutritious food, healthcare, and medications. Educational attainment can influence employment opportunities, income, and access to health information. Occupation reflects factors such as job security, working conditions, workplace exposures, and social standing, sometimes called occupational prestige. For many people, occupation also affects access to health insurance. Although these components are closely related, they are not interchangeable. Together, these factors interact to shape health in different and often cumulative ways.

To see how these components influence health, let's compare two patients with the same diagnosis.

Meet Alejandro. He’s 45 years old, has a high school diploma, and works as a warehouse packer. Long shifts and a lack of paid sick leave make it difficult for him to attend healthcare appointments. His household income is near the national poverty line, and he has basic health insurance. He lives in a neighborhood with limited access to affordable, nutritious food.

Miguel is also 45 years old and has a high school diploma, but he works as a marketing manager. He has a flexible schedule, paid sick leave, and comprehensive health insurance. His household income is well above the national median, and he lives in a neighborhood with several grocery stores nearby.

Both patients are diagnosed with type 2 diabetes with a hemoglobin A1c of 10%. Twelve months later, Alejandro’s hemoglobin A1c has increased to 12%, and retinal screening shows early signs of diabetic retinopathy. As for Miguel, his hemoglobin A1c has improved to 6%, and he has no diabetes-related complications.

So, what happened?

Over the past year, Alejandro has struggled to prioritize diabetes diagnosis while supporting his family. He has missed appointments because taking time off work means losing income. High out-of-pocket costs have made it difficult to take his medications consistently. Limited access to affordable, nutritious food and few opportunities for physical activity have made lifestyle changes more challenging.

On the other hand, Miguel has been able to attend follow-up appointments, take his medications as prescribed, and make dietary and lifestyle changes supported by his work schedule, income, and neighborhood resources.

Although Alejandro and Miguel have similar educational attainment, differences in income and occupation have contributed to very different health outcomes. Alejandro's lower income limits access to resources, while his occupation creates time and financial constraints that make managing a chronic disease more difficult.

Alejandro’s and Miguel's experiences reflect a broader pattern. Socioeconomic status influences health at both the individual and population levels. Across nearly every disease category, from diabetes and cardiovascular disease to mental illness and maternal and infant mortality, people with lower socioeconomic status experience worse health outcomes. In the United States, the difference in life expectancy between people with the highest and lowest incomes can exceed a decade. Countries with greater income inequality often have poorer overall health outcomes, even when their total wealth is similar. In other words, health is influenced not only by how much wealth a society has, but also by how that wealth is distributed.

Now, how does socioeconomic status influence health? There are four major pathways.

First, lower socioeconomic status may limit access to nutritious food, safe places to be physically active, and healthy living environments, while facing greater exposure to tobacco and environmental hazards.

Second, socioeconomic status can influence access to healthcare and the quality of care received through factors such as insurance coverage, transportation barriers, health literacy, and implicit bias.

Third, limited financial resources can make it more difficult to afford stable housing, reliable transportation, or prescribed medications.

Finally, chronic psychosocial stress, sometimes described as an increased allostatic load, can contribute to persistent inflammation, elevated cortisol levels, and a higher risk of cardiometabolic disease.

These pathways help explain why socioeconomic status is considered both multifaceted and context dependent.

Although income, educational attainment, and occupation are the three core components of socioeconomic status, they do not always move together. For example, someone may have a high level of educational attainment but a relatively low income early in their career, while another person may have a high income through a skilled trade without completing a college degree.