Socio-economic status, cortisol and allostatic load: a review of the literature

Int J Epidemiol. 2009 Oct;38(5):1297-309. doi: 10.1093/ije/dyp277. Epub 2009 Aug 31.


Background: The notion that chronic stress contributes to health inequalities by socio-economic status (SES) through physiological wear and tear has received widespread attention. This article reviews the literature testing associations between SES and cortisol, an important biomarker of stress, as well as the summary index of allostatic load (AL).

Methods: A search of all published literature on the PubMed and ISI Web of Knowledge literature search engines was conducted using broad search terms. The authors reviewed abstracts and selected articles that met the inclusion criteria. A total of 26 published studies were included in the review.

Results: Overall, SES was not consistently related to cortisol. Although several studies found an association between lower SES and higher levels of cortisol, many found no association, with some finding the opposite relationship. Lower SES was more consistently related to a blunted pattern of diurnal cortisol secretion, but whether this corresponded to higher or lower overall cortisol exposure varied by study. Approaches to collecting and analysing cortisol varied widely, likely contributing to inconsistent results. Lower SES was more consistently related to higher levels of AL, but primarily via the cardiovascular and metabolic components of AL rather than the neuroendocrine markers.

Conclusions: Current empirical evidence linking SES to cortisol and AL is weak. Future work should standardize approaches to measuring SES, chronic stress and cortisol to better understand these relationships.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Allostasis*
  • Biomarkers / metabolism
  • Humans
  • Hydrocortisone / metabolism*
  • Poverty / psychology
  • Saliva / chemistry*
  • Social Class*
  • Social Environment
  • Stress, Psychological / metabolism*
  • Stress, Psychological / psychology


  • Biomarkers
  • Hydrocortisone