Objective and subjective socioeconomic status and health symptoms in patients following hematopoietic stem cell transplantation

Objective Recent research indicates that subjective socioeconomic status (SES) - the perception of one's own SES compared with other people - is an important predictor of cancer-related health outcomes. Subjective SES may function as a psychosocial mechanism by which objective SES affects health, well-being, and, more broadly, quality of life among cancer survivors. This study tested whether the association between objective SES and indicators of quality of life was mediated by subjective SES in a sample of cancer survivors who had undergone hematopoietic stem cell transplantation. Methods Hematopoietic stem cell transplantation survivors (N = 268) completed measures of objective and subjective SES, along with four measures related to quality of life (depressive symptoms, health-related quality of life, symptoms of generalized distress, and posttraumatic stress disorder symptoms). Results Higher objective SES was associated with greater quality of life across all four measures. Subjective SES mediated the relationship between objective SES and depressive symptoms (total indirect effect b = -0.09, 95% confidence interval [CI] [-0.15, -0.05]), generalized distress (total indirect effect b = -0.08, 95% CI [-0.13, -0.04]), health-related quality of life (total indirect effect b = 0.10, 95% CI [0.06, 0.17]), and posttraumatic stress disorder (total indirect effect b = -0.08, 95% CI [-0.14, -0.04]). Conclusions Findings extend work on subjective SES to cancer and suggest that SES gradients in patient outcomes after cancer may reflect not only material resources but also psychosocial factors related to rank within social hierarchies. Further research may provide insights useful for reducing disparities in this population.