There is a persistent relationship between socioeconomic status and physical health outcomes found in the literature; however the variables mediating this relationship are many, and ways that they interact with each other are complex. The goal of understanding this relationship is to decrease the disparity in health by socioeconomic status.
This study tested a biopsychosocial model proposed by David Williams (1990) to explain the relationship between socioeconomic status and physical health outcomes. The model included the following latent factors: demographics, socioeconomic status, biomedical risk, medical care, psychosocial variables, and health outcomes. The model was tested through a secondary data analysis.
The 1937 women who participated entered one of six Portland area clinics over a three year period for prenatal care. Data was collected over three time points; two interviewsdone during the pregnancy and birth outcome data, taken from medical records. There were 1134 women with complete data for the purpose of this analysis.
Confirmatory factor analysis was used to verify that the measurement tools fit the measurement model for the latent factors. After dropping four of the 28 measures, the fit was adequate and covariance structure modelling was used to test the structural model proposed by Williams. The fit of the model was adequate, however, only 3.8% of the variance in the outcomes measures was explained by the model, and three of the five paths leading to outcomes were insignificant.
An alternative model with psychosocial variables broken into the two factors of psychosocial resources and behaviors was also tested with similar results. The variance explained in outcomes was 4.3% and the only factors with paths significantly related to outcomes were demographics and biomedical risk.
It is of note in both models that SES was a very powerful predictor of the medical care variable, predicting over 50% of its variance. The psychosocial variable also had 20.7% and 18.8% of its variance explained by the preceding factors in Williams\u27 model and the alternative model respectively.
Since the model did fit the data, it is believed improvements in utility of the model could be seen if a study was designed specifically for testing this model
