Subjective social status, health literacy, and health-related quality of life in South Florida Hispanics

Background: Individuals’ perception of their position in the social hierarchy (subjective social status, SSS) has incremental usefulness in predicting health status beyond objective measures of SES such as income and education. Health literacy has also been related to SES, SSS, and health status. The purpose of these analyses was to evaluate the contributions of each to health status among Hispanics in South Florida.

Methods: As part of another study, 216 Spanish speaking adults aged 18 to 86 completed evaluations of their health literacy with the Test of Functional Health Literacy in Adults (TOFHLA) and a new measure of health literacy, VIDAS. An index of health status was computed from the scales of the MOS SF-36 (EQ-5D), and an index of SES  comprised education, income, and occupational status. SSS was assessed using a social status “ladder” in which participants were asked to place themselves on one of 10 rungs. Regression models included blocks of variables that first included demographics variables, then successively SES, SSS, and health literacy.

Results: Analyses showed that older age and female gender were associated with poorer health status (ps < 0.05). Higher SES was positively related (p = 0.03). Both SSS and health literacy were significantly related to health status (SSS and VIDAS, p =0.02 and 0.001, respectively; SSS and TOFHLA, p= 0.02 and 0.001).

Discussion: Subjective social status and health literacy each make independent contributions to health status. Future research should include both indicators in understanding health-related quality of life.