Wealth as an important (and commonly ignored) dimension of socioeconomic status in epidemiology

Social epidemiological studies have shown for decades that wealth shows associations to various health outcomes in addition to more frequently used and established indicators like income, education and occupational status. Measurements of income alone are not able to assess the economic position and resources of individuals, while they neglect transgenerational and cumulative pathways of shaping socioeconomic status (SES) and their impact on health. Despite this established knowledge, the use of measurements of wealth in epidemiological studies is very rare and heterogeneous.Therefore, a number of open questions still need to be answered: How does wealth relate to other socioeconomic and sociodemographic indicators with associations to health? On which pathways is wealth influencing individuals' health? What role does wealth play as a driver for health disparities across populations? Moreover, how does wealth interact with age, gender and race?To further research on these questions, we use this essay to elaborate on the term wealth and its role in social epidemiological research, review results from observational studies, discuss inconsistent results and conclude why it is important to consider wealth as a dimension of SES. In addition, we present a conceptual idea for integrating wealth in a life course-based concept of SES and show what information an assessment of wealth could provide in addition to other established SES indicators.