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de Melo Gomides L, Abreu MNS, Assunção AÁ. Long working hours and self-rated health in the national Brazilian working population: gender and employment status differences, 2019. BMC Public Health 2023; 23:2095. [PMID: 37880646 PMCID: PMC10601203 DOI: 10.1186/s12889-023-16973-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The regulation of working hours is governed by legal standards in formal employment. While the association between long working hours and various health outcomes has been extensively studied, there is limited evidence regarding Brazil. The objective of this study was to investigate the association among working hours, employment status, and self-rated health (SRH), taking into account differences between men and women in a national representative sample of the working population in Brazil. METHODS A cross-sectional study was conducted among a representative sample of 33,713 workers in Brazil to assess self-rated health (SRH). We examined the associations between working hours and employment status, categorizing working hours as standard (40-44 h per week) or long (> 44 h per week), and employment status as formal or informal. Logistic regression models were employed, adjusting for sociodemographic, occupational characteristics, and health behaviors. Probabilities of negative SRH were calculated for men and women in different exposure profiles. Results were stratified by gender, and 95% confidence intervals (CIs) were applied to the findings. RESULTS The prevalence of long working hours was higher among informal workers for both men and women. Adjusted odds ratio (AOR) results revealed that informal employment (AORwomen = 1.53; 95% CI: 1.13-2.07 and AORmen = 1.55; 95% CI: 1.22-1.96) and long working hours (AORwomen = 1.23; 95% CI: 1.06-1.43 and AORmen = 1.14; 95% CI: 1.00-1.30) were independently associated with negative SRH. Significant interactions between long working hours and informal employment were observed. Among individuals with the same exposure profile, women who engaged in long working hours had a higher probability of reporting negative SRH compared to men. CONCLUSIONS The results of this study are in line with the literature, as differences between men and women in the likelihood of negative self-rated health were observed. The adverse health effects underscore the importance of implementing intersectoral actions to inform the revision of regulations concerning weekly working hours and the expansion of informal employment in low- and middle-income countries.
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Affiliation(s)
- Luciana de Melo Gomides
- Graduate Program in Public Health, Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
- Institute of Pure and Applied Sciences. Health and Safety Engineering, University of Itajubá, Itabira, MG, Brazil.
| | - Mery Natali Silva Abreu
- Department of Applied Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ada Ávila Assunção
- Graduate Program in Public Health, Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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McNamara CL, McKee M, Stuckler D. Precarious employment and health in the context of COVID-19: a rapid scoping umbrella review. Eur J Public Health 2021; 31:iv40-iv49. [PMID: 34751369 PMCID: PMC8576296 DOI: 10.1093/eurpub/ckab159] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background There are widespread concerns that workers in precarious employment have suffered the most in the COVID-19 pandemic and merit special attention. The aim of this rapid scoping umbrella review was to examine what evidence exists about how COVID-19 has affected the health of this highly vulnerable group, and what gaps remain to be investigated. Methods Five databases were searched for systematic or scoping reviews from January 2020 to May 2021. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews. Results We identified 6 reviews that reported 30 unique relevant primary studies. The included studies indicate that essential (non-health) workers are at greater risk of COVID-19 infection and case fatality than others in their surrounding community. The occupational risk of exposure to COVID-19 also seems to be greater among more precarious categories of workers, including younger workers and workers in low-income and low-skilled occupations. Further, hazardous working conditions faced by many essential workers appear to have amplified the pandemic, as several occupational sites became ‘super-spreaders’, due to an inability to socially distance at work and high contact rates among workers. Finally, employment and financial insecurity generated by the pandemic appears to be associated with negative mental health outcomes. The quality of the included reviews however, and their primary studies, were generally weak and many gaps remain in the evidence base. Conclusions Our study highlights that COVID-19 is creating new health risks for precarious workers as well as exacerbating the pre-existing health risks of precarious employment.
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Affiliation(s)
- Courtney L McNamara
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics, Department of Social & Political Sciences, Bocconi University, Milano, Italy
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Hierarchical Models for International Comparisons: Smoking, Disability, and Social Inequality in 21 European Countries. Epidemiology 2021; 31:282-289. [PMID: 31868828 DOI: 10.1097/ede.0000000000001154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND International comparisons of social inequalities in health outcomes and behaviors are challenging. Due to the level of disaggregation often required, data can be sparse and methods to make adequately powered comparisons are lacking. We aimed to illustrate the value of a hierarchical Bayesian approach that partially pools country-level estimates, reducing the influence of sampling variation and increasing the stability of estimates. We also illustrate a new way of simultaneously displaying the uncertainty of both relative and absolute inequality estimates. METHODS We used the 2014 European Social Survey to estimate smoking prevalence, absolute, and relative inequalities for men and women with and without disabilities in 21 European countries. We simultaneously display smoking prevalence for people without disabilities (x-axis), absolute (y-axis), and relative inequalities (contour lines), capturing the uncertainty of these estimates by plotting a 2-D normal approximation of the posterior distribution from the full probability (Bayesian) analysis. RESULTS Our study confirms that across Europe smoking prevalence is generally higher for people with disabilities than for those without. Our model shifts more extreme prevalence estimates that are based on fewer observations, toward the European mean. CONCLUSIONS We demonstrate the utility of partial pooling to make adequately powered estimates of inequality, allowing estimates from countries with smaller sample sizes to benefit from the increased precision of the European average. Including uncertainty on our inequality plot provides a useful tool for evaluating both the geographical patterns of variation in, and strength of evidence for, differences in social inequalities in health.
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McNamara CL, Toch-Marquardt M, Albani V, Eikemo TA, Bambra C. The contribution of employment and working conditions to occupational inequalities in non-communicable diseases in Europe. Eur J Public Health 2021; 31:181-185. [PMID: 33207369 PMCID: PMC7851888 DOI: 10.1093/eurpub/ckaa175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Social inequalities in non-communicable diseases (NCDs) are evident across all European regions. Employment and working conditions are important determinants of NCDs, however, few comparative studies have examined how these conditions contribute to health inequalities. This study therefore examines the association of non-standard employment and poor working conditions with occupational inequalities in multiple NCDs and whether there are differences by gender and across European regions. METHODS We used cross-sectional data from 20 European countries for women and men aged 25-75 (n = 19 876), from round 7 of the European Social Survey. Data were analyzed for self-rated health (SRH) and 9 NCDs: heart/circulatory problems, high blood pressure, arm/hand pain, breathing problems, diabetes, severe headaches, cancer, obesity and depression. We used logistic regression models, stratified by gender, and adjusted rate ratios to examine whether occupational inequalities in NCDs were reduced after adjusting for non-standard employment and poor working conditions, across European regions. RESULTS After adjustment, occupational inequalities were significantly reduced across all regions of Europe. Reductions were particularly large among the lowest occupational group and for poor-SRH, depression and obesity. For these conditions, reductions were in the range of 60-99%. CONCLUSIONS Employment and working conditions are important determinants of occupational inequalities in NCDs. Labour market regulations should therefore be considered in the formulation of NCD prevention strategies.
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Affiliation(s)
- Courtney L McNamara
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Dragvoll, Trondheim, Norway
| | - Marlen Toch-Marquardt
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Viviana Albani
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Terje A Eikemo
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Dragvoll, Trondheim, Norway
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Tipayamongkholgul M, Kongtip P, Woskie S. Association between occupations and selected noncommunicable diseases: A matched case-control among Thai informal workers. J Occup Health 2021; 63:e12249. [PMID: 34263504 PMCID: PMC8279900 DOI: 10.1002/1348-9585.12249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We conducted a matched case-control study of informal workers to determine the association between occupational classification and selected types of noncommunicable diseases (NCDs). METHOD We extracted data of patients aged ≥18 years from the Thai National Health Security Office database (NHSO) during 2011-2014. Cases were patients who had a primary diagnosis of: diabetes mellitus (E10-E14), hypertension (I10-I15), ischemic heart disease (I20-I25) or stroke (I60-69), or thyroid gland disorder (E00-E07). Controls were patients who had a primary diagnosis of intestinal or parasitic infections (A00-A09 and B25-B99), and were randomly matched 1:1 with cases of the same age and residential area. The four-digit occupation codes recorded in the NHSO were grouped and recoded based on the submajor groups of International Standard Classification of Occupations (ISCO-08) as follows: agricultural workers, unskilled workers, service, and sales workers. Analysis was performed using multivariable conditional logistic regression. RESULTS Occupation and sex inequalities were present among all the selected NCDs. Higher risk for the four selected NCDs was found among unskilled workers. Stronger risk for cardiovascular disease was present among males, while females had a higher risk for metabolic disorders. CONCLUSIONS There is a need to understand what are the key factors that increase the risk for NCDs among informal sector workers. Health promotion campaigns are needed to raise awareness among economically and social disadvantaged informal workers about the risk for NCDs. This will require collaboration between public health and the workforce, and allocation of government budgets to address the needs of these workers.
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Affiliation(s)
| | - Pornpimol Kongtip
- Department of Occupational Health and SafetyFaculty of Public HealthMahidol UniversityBangkokThailand
| | - Susan Woskie
- Department of Public HealthZuckerberg College of Health SciencesUniversity of Massachusetts LowellBostonMAUSA
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Gkiouleka A, Huijts T. Intersectional migration-related health inequalities in Europe: Exploring the role of migrant generation, occupational status & gender. Soc Sci Med 2020; 267:113218. [PMID: 32732096 DOI: 10.1016/j.socscimed.2020.113218] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022]
Abstract
Integrating intersectionality theory and employing a quantitative design, the current study explores how migration-related health inequalities in Europe interact with migrant generation, occupational status and gender. Multilevel logistic regression analyses are conducted using pooled data from six waves of the European Social Survey (2004-2014), from 27 countries for two subjective health measures (general self-reported health and hampering conditions). The results reveal multiple relationships of health inequality that operate simultaneously and the complexity through which the combination of social privilege and disadvantage can have a particularly negative impact on individual health. The 'healthy migrant effect' seems to apply particularly for first-generation immigrants working as manual employees, and within occupational categories, in certain cases non-migrant women are more susceptible to poor health than migrant men. This evidence highlights how the health impact of migration is subject to additional dimensions of social positioning as well as the importance of an intersectional perspective for the monitoring of health inequalities in Europe.
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Affiliation(s)
- Anna Gkiouleka
- Department of Sociology, University of York, Wentworth College, Heslington, YO10 5DD, York, UK.
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Rydland HT, Solheim EF, Eikemo TA. Educational inequalities in high- vs. low-preventable health conditions: Exploring the fundamental cause theory. Soc Sci Med 2020; 267:113145. [PMID: 32646626 DOI: 10.1016/j.socscimed.2020.113145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/07/2019] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
AIM To explore variations in educational gradients or gaps between high- and low-preventable health conditions. BACKGROUND This is one of the first European studies to test whether the association between socioeconomic status and morbidity is stronger for 10 high- than three low-preventable health conditions, by gender across 20 countries. DATA AND METHODS The 2014 European Social Survey included questions on 11 health conditions experienced over the last 12 months, cancer at any age, and symptoms of depression during the last week. We include respondents from 20 countries (Nmen = 12,073; Nwomen = 13,488) aged 25 to 69. We estimated age-adjusted educational gradients on 13 conditions using logistic or OLS-regression stratified by country and gender, and high- and low-preventable pooled conditions variables on pooled country samples. RESULTS Both among men and women the proportion of educational gaps were larger for the high-preventable than the low-preventable conditions in most countries, supporting the Fundamental Cause Theory (FCT) hypothesis. However, there was large variations in the number of significant associations across countries and between genders. In the pooled conditions and countries analysis, no associations were significant among the low-preventable conditions. For the high-preventable conditions there was a weak significant educational gap among men, and a weak but nevertheless more distinctive and complete sigificant educational gradient among women. CONCLUSION In a first explorative comparative European analysis we found support for the FCT hypothesis. Thus, the FCT can be used on morbidity data classified as low- versus high-preventable. We recommend extending this framework with institutional theories to explain within- and between-country health inequalities.
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Affiliation(s)
- Håvard T Rydland
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Erling F Solheim
- Department of Social Sciences, UiT the Arctic University of Norway, Norway.
| | - Terje A Eikemo
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Beckfield J, Balaj M, McNamara CL, Huijts T, Bambra C, Eikemo TA. The health of European populations: introduction to the special supplement on the 2014 European Social Survey (ESS) rotating module on the social determinants of health. Eur J Public Health 2017; 27:3-7. [PMID: 28355648 DOI: 10.1093/eurpub/ckw250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
This introduction summarizes the main findings of the Supplement 'Social inequalities in health and their determinants' to the European Journal of Public Health. The 16 articles that constitute this supplement use the new ESS (2014) health module data to analyze the distribution of health across European populations. Three main themes run across these articles: documentation of cross-national variation in the magnitude and patterning of health inequalities; assessment of health determinants variation across populations and in their contribution to health inequalities; and the examination of the effects of health outcomes across social groups. Social inequalities in health are investigated from an intersectional stance providing ample evidence of inequalities based on socioeconomic status (occupation, education, income), gender, age, geographical location, migrant status and their interactions. Comparison of results across these articles, which employ a wide range of health outcomes, social determinants and social stratification measures, is facilitated by a shared theoretical and analytical approach developed by the authors in this supplement.
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Affiliation(s)
- Jason Beckfield
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tim Huijts
- Department of Sociology, Wentworth College, University of York, York, UK
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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