Concept of health and disease: social gradient in health: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Concept of health and disease: social gradient in health

Sample item

A long-running study of civil servants finds that mortality rises in steps from the highest to the lowest employment grade, even though all have stable jobs and access to health care. This finding best demonstrates:

ABerkson's biasBEcological fallacyCA social gradient in healthDThe healthy worker effect

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. A social gradient in health

A social gradient means that health worsens progressively down the social hierarchy, not only among the very poor. Stable employment and access to care in this group suggest that status, control and psychosocial factors contribute. It is a central idea in the social determinants of health.

Option by option

A. Berkson's bias
Berkson's bias arises from using hospitalised patients as study subjects.
B. Ecological fallacy
Ecological fallacy arises when group-level data are wrongly applied to individuals, but this study uses individual data.
C. A social gradient in health (correct)
Correct. A stepwise rise in mortality down the employment grades is a social gradient.
D. The healthy worker effect
The healthy worker effect makes employed people look healthier than the general population and does not describe differences within a workforce.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this PSM question

What is the answer to this PSM question?

The best answer is C, A social gradient in health. A social gradient means that health worsens progressively down the social hierarchy, not only among the very poor.

Why is "Berkson's bias" not the answer?

Berkson's bias arises from using hospitalised patients as study subjects.

Why is "Ecological fallacy" not the answer?

Ecological fallacy arises when group-level data are wrongly applied to individuals, but this study uses individual data.

Why is "The healthy worker effect" not the answer?

The healthy worker effect makes employed people look healthier than the general population and does not describe differences within a workforce.

What concept does this question test?

It tests Concept of health and disease: social gradient in health in PSM. Stable employment and access to care in this group suggest that status, control and psychosocial factors contribute. It is a central idea in the social determinants of health.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Concept of health and disease: social gradient in health?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.