Compared to whom? Subjective social status, self-rated health, and referent group sensitivity in a diverse US sample

Emerging research has revealed that subjective social status (SSS), or how people perceive their position in the social hierarchy, is significantly associated with multiple health outcomes. Yet few studies have examined how this association is affected by the person or group to whom respondents are comparing themselves. While previous studies have used distal referent groups when assessing SSS, scholars have suggested that individuals may prefer to make comparisons to those who share similar characteristics to themselves. Overall, there has been little empirical analysis assessing the health impact of comparing oneself to one referent group over another. Using a diverse, national US sample (n=3644), this study explores whether the relationship between SSS and self-rated health is sensitive to the referent used for social comparison. Data are from respondents who completed the ConsumerStyles and HealthStyles mail surveys and who have assessed their SSS against four referents: others in American society, others of the same race or ethnicity, neighbors, and parents at the same age. Self-rated health was the dependent variable, while we controlled for household income, education, home ownership, race/ethnicity, and other covariates. In logistic regression models, SSS using each of the four referents was significantly associated with self-rated health, but the model using the referent of others in American society had the strongest association with self-rated health and was the most parsimonious. Findings validate previous studies which typically have used a more distal referent such as others in American society in exploring the SSS-health relationship. However, future work should explore whether this referent is salient to diverse population groups when making social comparisons. Researchers may also want to consider using SSS as an additional status measure since it may capture more subtle differences in the status hierarchy than traditional economic measures.