Multiple risk exposure as a potential explanatory mechanism for the socioeconomic status–health gradient


Address for correspondence: Gary W. Evans, 3M2061 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY 14853, USA.


The social patterning of disease and mortality provokes a search for explanation. One potential underlying explanation for socioeconomic status (SES) gradients in health is exposure to multiple risk factors. Income and class tend to sort individuals into different settings that are often accompanied by systematic differences in environmental quality. Housing and neighborhood quality, pollutants and toxins, crowding and congestion, and noise exposure all vary with SES. Persons lower in SES also experience more adverse interpersonal relationships with family members, friends, supervisors, and community members. Furthermore, exposure to these multiple risk factors is associated with worse health outcomes. Thus, the convergence of exposure to multiple physical and psychosocial risk factors accompanying disadvantage may account for a portion of SES gradients in health in both childhood and adulthood.