Perceived social rank and physiology: A meta-analysis of experimental manipulations.

Abstract

Objective: Socioeconomic disparities in cardiovascular health are well established, but the role that stress and related physiological changes play in such disparities is still unclear. There is tentative evidence for a correlation between lower socioeconomic position and poorer cardiovascular response to stress, but observational designs do not allow for conclusions regarding causality. The current study presents results from a systematic review and meta-analysis on experimental manipulations of social rank and changes in cardiovascular reactivity and cortisol.

Method: A meta-analysis was conducted (N = 2,005), including 25 studies (20 cardiovascular and five cortisol) and 71 effects (66 cardiovascular and five cortisol).

Results: Primary analyses showed a nonsignificant effect of social rank manipulations on physiological outcomes (g = -0.04, p = .54, SE = 0.07, 95% confidence interval [CI] [-0.18, 0.09]). However, moderator analyses revealed that for studies that manipulated social rank based on socioeconomic factors (e.g., personal income, parental income/education), lower rank was significantly associated with heightened cardiovascular reactivity (g = -0.24, p = .006, SE = 0.09, 95% CI [-0.41, -0.07]). No significant effect was found for studies that used performance-based social rank manipulations (i.e., cognitive tasks such as word tracing and number counting).

Conclusion: Results support the potentially causal influence of lower socioeconomic position on poorer cardiovascular health through elevated cardiovascular stress reactivity. We discuss the relevance of these findings to the role of psychophysiology for socioeconomic disparities in cardiovascular health. (PsycInfo Database Record (c) 2025 APA, all rights reserved).