Subjective Socioeconomic Status and Self-Rated Health in the English Longitudinal Study of Aging: A Fixed-Effects Analysis

Background. The association between subjective socio-economic status (SES) and self-rated health is well-established in the literature, yet the majority of studies rely on cross-sectional analyses that only account for few objective markers of socio-economic status. Particularly wealth, which is increasingly thought of as an important dimension of accumulated advantage, is only rarely examined as a confounder.Methods. Using eight waves of panel data from the English Longitudinal Study of Aging (ELSA, 2002-19), we investigate the association between subjective SES and self-rated health. We use random effects models that account for theoretically important time-constant (such as education and social class) and time-varying confounders (such as income and wealth) as well as fixed-effects models, that in addition control for all time-constant confounders, whether observed or unobserved.Results. The fully adjusted fixed-effects model reveals a statistically significant association between subjective SES and self-rated health. Yet, a one-point increase on the subjective SES ladder goes along with a two per cent of a standard deviation increase in self-rated health, only around a quarter of the size of the random-effects estimate. The role of wealth for the subjective SES-self-rated health association is negligible in the fixed-effects specifications.Conclusion. A substantial part, though not all, of the observed association between subjective SES and self-rated health is due to unobserved confounding rather than a causal effect. Reducing health inequalities based on objective SES is likely more effective than based on subjective SES.