Educational inequalities in self-rated health across US states and European countries

The effect of college degree attainment on neurodegenerative symptoms in genetically at-risk women

Using longitudinal data, the present study examined the association between college degree attainment and the manifestation of neurodegenerative symptoms among women (n = 93) at elevated genetic risk. The neurodegenerative symptoms investigated in this study are due to FXTAS (Fragile X-associated Tremor/Ataxia Syndrome), a condition with onset after age 50. Those at risk for FXTAS have a mutation of a single gene found on the X chromosome. FXTAS is characterized by intention tremor, gait ataxia, executive function deficits, memory issues, and neuropathy. College degree attainment has been shown to provide neuroprotective effects in the general population, delaying the development of neurodegenerative conditions such as Alzheimer's disease. For this reason, college degree attainment is a potentially salient resource for those at risk of FXTAS. The results of the present research indicated significantly more severe FXTAS symptoms in women who did not attain a college degree as compared with those who were college graduates, although the two groups were similar in age, genetic risk, household income, health behaviors, and general health problems. Furthermore, symptoms in those who did not attain a college degree worsened over the 9-year study period at a significantly faster rate than the college graduates. The association between college degree attainment and FXTAS symptoms was significantly mediated by depression, which was lower among the graduates than those who did not attain a college degree. Thus, the present research is an example of how a sociodemographic factor can mitigate neurodegenerative conditions in genetically at-risk adults.

Trends in educational disparities in preventive behaviours, risk perception, perceived effectiveness and trust in the first year of the COVID-19 pandemic in Germany

BACKGROUND

Educational disparities in health and health behaviours have always been relevant in public health research and are particularly challenging in the context of the COVID-19 pandemic. First studies suggest that factors important for the containment of the COVID-19 pandemic, such as prevention behaviour, risk perception, perceived effectiveness of containment measures, and trust in authorities handling the pandemic, vary by educational status. This study builds on recent debate by examining trends in absolute and relative educational disparities in these factors in the first year of the COVID-19 pandemic in Germany.

METHODS

Data stem from four waves of the GESIS Panel surveyed between March and October 2020 in Germany (15,902 observations from 4,690 individuals). Trends in absolute and relative disparities were examined for preventive behaviour, risk perception, perceived effectiveness of COVID-19 containment measures, and trust in individuals and institutions handling the COVID-19 pandemic by educational status using sex, age, residence, nationality, children under 16 living in household, family status, household size, the Big Five Inventory, and income class as control factors. Descriptive statistics as well as unadjusted and adjusted linear regression models and random effects models were performed.

RESULTS

We observed an initially rising and then falling trend in preventive behaviour with consistent and significant absolute and relative disparities with a lower preventive behaviour among low educated individuals. Indication of a U-shaped trend with consistent significantly lower values among lower educated individuals was found for risk perception, whereas perceived effectiveness and trust decreased significantly over time but did not significantly vary by educational status.

CONCLUSIONS

Results indicate persistent educational disparities in preventive behaviour and risk perception and a general decline in perceived effectiveness and trust in the first year of the COVID-19 pandemic in Germany. To address this overall downward trend and existing disparities, comprehensive and strategic management is needed to communicate the risks of the pandemic and the benefits of COVID-19 containment measures. Both must be adapted to the different needs of educational groups in particular in order to overcome gaps in preventive behaviour and risk perception by educational status.

Factors Associated with Cardiovascular Disease Risk among Employees at a Portuguese Higher Education Institution

This study aimed to estimate the prevalence of risk factors for cardiovascular disease (CVD) and to assess the CVD risk (CVDRisk) in a sample of workers at a specific workplace: a higher education institution in Portugal. Data were collected using a questionnaire (e.cuidHaMUs.QueST®) with 345 HEI workers from June 2017-June 2018 with a high response rate (93.3%). Two constructs of risks for CVD were considered: (i) metabolic risk and hypertension (CVDRisk1); and (ii) modifiable behavioural risk (CVDRisk2). Logistic regression analyses were used to establish a relationship between risk indexes/constructs (CVDRisk1 and CVDRisk2) and groups of selected variables. The most prevalent CVD risk factor was hypercholesterolaemia (43.2%). Sixty-eight percent of participants were in the construct CVDRisk1 while almost half of the respondents were in CVDRisk2 (45.2%). The consumption of soft drinks twice a week or more contributed to a significantly increased risk of CVD in CVDRisk1. Lack of regular exercise and lack of daily fruit consumption significantly increased the risk of CVD in CVDRisk2. The challenge to decision makers and the occupational medical community is to incorporate this information into the daily practices of health surveillance with an urgent need for health promotional education campaigns in the workplace.

Subjective socio-economic status predicts self-rated health irrespective of objective family socio-economic background

Aim: Subjective appraisals of socio-economic status (SES) are robustly associated with health outcomes, even when controlling for objective SES. Is this because objective SES is not accounted for in a sufficiently exhaustive way? Methods: I pool eight waves of nationally representative survey data from Germany (German General Social Survey, 2004-18, N=13,557) to assess the association between two separate subjective appraisals of SES (a 10-point scale and subjectively chosen social class membership) and poor self-rated health using logit and linear probability models. I account for an exhaustive range of objective SES variables, including respondents' household incomes and social status, as well as occupational status, social class and education of respondents and of their partners, fathers and mothers. Results: The association between subjective SES and poor self-rated health remains stable, even when accounting for a wide range of objective SES markers. This is true for both subjective SES measured on a 10-point scale and as a subjective class identification. Conclusions: Even when controlling for a large number of objective SES markers, subjective SES and self-rated health are linked, suggesting that subjective assessments of SES are meaningful measures of SES which form a distinct pathway to health.

Health inequalities in Eastern Europe. Does the role of the welfare regime differ from Western Europe?

When we study the impact of social policy on health inequalities, we find that most research is based on Western European countries. This study expands the geographical focus by including post-communist countries from Eastern Europe, Russia, and the Caucasus. The 2008/2009 round of the European Values Study (EVS) provides a unique opportunity for this analysis since it covers 23 post-communist countries and 20 Western European countries. The study uses multilevel cross-sectional analyses to examine the moderating role of welfare regimes on socioeconomic health inequalities. Many reviews claim that the results for welfare systems and health inequalities are inconsistent. However, since the studies selected for the reviews are mainly focused on Western Europe-only a few include Central Eastern European countries-we still need to find out how welfare regimes in post-communist countries moderate the link between socioeconomic status and health. A cluster analysis based on 13 social and economic indicators generates 4 welfare clusters within the post-communist countries which are used for further analyses. Regarding the achievements of the communist countries in compulsory secondary education, the expectation is that the educational health inequalities differ between Eastern and Western Europe. The multilevel analyses confirm that social gradients in health related to education and income exist in both Western and Eastern Europe. However, while income-related health inequalities are similar, educational health inequalities are most pronounced in the welfare cluster of the EU Member States of Central and Eastern Europe.

Association of Social Media Use With Social Well-Being, Positive Mental Health, and Self-Rated Health: Disentangling Routine Use From Emotional Connection to Use

Most studies addressing social media use as a normal social behavior with positive or negative effects on health-related outcomes have conceptualized and measured social media use and its effects in terms of dose-effect relations. These studies focus on measuring frequency and duration of use, and have seldom considered users' emotional connections to social media use and the effects associated with such connections. By using a scale with two dimensions capturing users' integration of social media use into their social routines and their emotional connection to the sites' use, the present study has brought preliminary evidence that may help map where social media use, as a normal social behavior, may be considered beneficial or harmful. Data from a nationally representative sample (n = 1,027) of American adults showed that while routine use is associated with positive health outcomes, emotional connection to social media use is associated with negative health outcomes. These associations have been consistent across three health-related outcomes: social well-being, positive mental health, and self-rated health. The data also showed that the strength of the positive and negative associations of routine use and emotional connection with the health outcomes varies across socioeconomic and racial/ethnic population subgroups. Our findings suggest that the link between social media use and health may not only be captured by and explained in terms of conventional dose-effect approaches but may also require a more sophisticated conceptualization and measurement of the social media use behavior.

Psychological Well-Being as an Independent Predictor of Exercise Capacity in Cardiac Rehabilitation Patients With Obesity

Objective: Exercise capacity (EC) is a well-established predictor of cardiovascular health. It is notoriously influenced by several factors, but the independent effect of psychological well-being (PWB) on EC has not yet been explored. The present study aims to investigate (1) whether PWB is an independent predictor of EC over and above selected demographic, behavioral, and biomedical parameters in a sample of CR patients with obesity and (2) whether PWB is a stronger predictor of EC than the other variables.

Methods: Data from 1968 patients were collected at the time of their inclusion in a cardiac rehabilitation (CR) program and retrospectively analyzed in a cross-sectional study. Since cardiorespiratory parameters defined in normal weight populations differ from those of their obese counterparts, an ad hoc validated formula taking body mass index (BMI) into consideration was used to predict EC.

Results: A multiple regression analysis revealed left ventricular eject fraction (LVEF) to be the strongest predictor of EC, followed by PWB, type 2 diabetes (DM), smoking status, atrial fibrillation (AF), and education. Bayesian evaluation of informative hypotheses corroborated LVEF as the best predictor of EC, and confirmed the superiority of PWB over and above DM and smoking status in influencing EC.

Conclusion: These findings strengthen the link between psychological and physical health, suggesting a better PWB is associated with greater EC. Prompt screening of a patient’s mood and readiness to perform an active lifestyle would therefore enhance the long-term health benefits of CR.

Intergenerational social mobility and allostatic load in Great Britain

BACKGROUND

Intergenerational social mobility is hypothesised to be a stressful process that has a negative effect on health. By examining the relationship between own socioeconomic position, parental socioeconomic position and allostatic load (AL) in a representative sample of the British population, we test this hypothesis.

METHODS

Our study uses cross-sectional data from 9851 adult participants of waves 2 and 3 of Understanding Society. The relationship between parental occupational class at age 14 years, respondents' social class at the time of the interview and AL is explored by means of diagonal reference models, which allow us to disentangle the effects of parental social class, own social class and the mobility process. The AL score comprises the following biomarkers: (1) total cholesterol, (2) high-density lipoprotein cholesterol, (3) triglycerides, (4) glycated haemoglobin, (5) C-reactive protein, (6) fibrinogen, (7) systolic blood pressure, (8) diastolic blood pressure, (9) resting heart rate, (10) body mass index and (11) waist circumference.

RESULTS

AL is particularly high among the stable working class and low among the stable upper class. On average, current class and origin class exert about equal weight on current AL. However, social mobility-regardless of whether upwards or downwards-is not detrimental for AL. Furthermore, we find evidence that class of origin may be less important among those outside the labour market for reasons other than retirement.

CONCLUSION

Both own social class and parental social class influence AL to a similar extent. However, we find no evidence that mobility trajectories exert any effects, good or bad, on AL.

Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions

BACKGROUND

Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States.

OBJECTIVE

To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease.

METHODS

A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence.

RESULTS

A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59).

CONCLUSIONS

Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.

Social inequalities in health and mental health in France. The results of a 2010 population-based survey in Paris Metropolitan Area

The present study aimed to assess socioeconomic inequalities in general and mental health, depression and substance use disorders (daily tobacco use, hazardous alcohol use). Data from the 2010 SIRS (French acronym for Health, Inequalities, and Social Ruptures) study, which is deemed to be representative of the French-speaking adult population living in the Paris Metropolitan Area, were analysed. Different socioeconomic position indicators were selected: education, income and perceived financial status. Absolute measures (the slope index of inequality (SII)) and relative measures (the odds ratio (OR) and relative index of inequality (RII)) of health inequalities were used. The OR, RII and SII were adjusted for age, household type and migration characteristics and all analyses were performed separately for men and women. The study included 3,006 adults. The results showed significant relative and absolute socioeconomic inequalities in general, mental health and depression for all socioeconomic position indicators considered (education, income, and perceived financial status). The absolute inequalities were greater for women than for men. Strongest inequalities were observed by perceived financial status for men and women. Education seemed to play a stronger role in inequalities for women, whereas, for men, income seemed to play a stronger role. Only few socioeconomic inequalities were found in daily tobacco use, while a reversed gradient was observed for hazardous alcohol use. We hope that these results will be regularly re-evaluated and compared across time in order to monitor socioeconomic inequalities in health.

Increasing educational inequalities in self-rated health in Brazil, 1998-2013

The objectives of this study are to analyze the associations between educational levels and poor self-rated health (SRH) among adults in Brazil and to assess trends in the prevalence of poor self-rated health across educational groups between 1998 and 2013. Individual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We estimate prevalence rates of poor SRH by education. Using multivariable regressions, we assess the associations between educational levels and poor self-rated health. We use these regressions to predict the estimated ratios between the prevalence rates of those in low vs. high education in order to assess if relative changes in poor SRH have narrowed over time. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education. Results indicate a clear educational gradient in poor SRH. Prevalence ratios show that Brazilian adults with no education have levels of poor SRH that are 7 to 9 times higher than those with some college or more. The difference between those with lowest and highest education increased from 1998 to 2013. Compared to those with no education, there were increases in the prevalence of poor SRH among those with primary and secondary incomplete as well as among those with secondary complete in 2008 and 2013. In conclusion, there is a positive association between poor SRH and low education. Brazil has many social and geographic inequalities in health. Even though educational levels are increasing, there is no improvement in the general subjective health of Brazilians. Health inequalities by race and region highlight the need to improve the health of socially disadvantaged groups in Brazil. Addressing chronic conditions and mental health is needed to improve self-perceptions of health in Brazil as well.