Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme

Dietary Customs and Social Deprivation in an Aging Population From Southern Italy: A Machine Learning Approach

Background

Diet and social determinants influence the state of human health. In older adults, the presence of social, physical and psychological barriers increases the probability of deprivation. This study investigated the relationship between social deprivation and eating habits in non-institutionalized older adults from Southern Italy, and identified foods and dietary habits associated with social deprivation.

Methods

We recruited 1,002 subjects, mean age 74 years, from the large population based Salus in Apulia Study. In this cross-sectional study, eating habits and the level of deprivation were assessed with FFQ and DiPCare-Q, respectively.

Results

Deprived subjects (n = 441) included slightly more females, who were slightly older and with a lower level of education. They consumed less fish (23 vs. 26 g), fruiting vegetables (87 vs. 102 g), nuts (6 vs. 9 g) and less “ready to eat” dishes (29 vs. 33 g). A Random Forest (RF) model was used to identify a dietary pattern associated with social deprivation. This pattern included an increased consumption of low-fat dairy products and white meat, and a decreased consumption of wine, leafy vegetables, seafood/shellfish, processed meat, red meat, dairy products, and eggs.

Conclusion

The present study showed that social factors also define diet and eating habits. Subjects with higher levels of deprivation consume cheaper and more readily available food.

Socio-economic gradients in the presence of musculoskeletal and other chronic diseases: results from a cross-sectional study in the Netherlands

Socio-economic gradients in occurrence of diseases have been reported for many chronic conditions. However, whether the magnitude of socio-economic gradients differs across diseases and the extent to which lifestyle mediates such relationships are not known. Cross-sectional data from The National Monitor on Musculoskeletal System was used. Respondents (> 18 years) completed a questionnaire including gender, education, social status, lifestyle, and physician-diagnosed diseases. Logistic regressions investigated the relationship between education and the major chronic diseases (musculoskeletal diseases (MSKD), diabetes, cardiovascular (CVD), cancer, mental, respiratory, any disease). Next, analyses were repeated in individuals with potential to have paid work (i.e., those < 65 having paid work, being unemployed, or receiving living allowance (minimum income)). The mediating role of smoking and BMI between education and occurrence of diseases was assessed by testing indirect effects. From 8904 individuals (mean age 54 years, 46% male), 4378 (49%) had at least one disease. Gradients in occurrence of disease by education were present for all diseases except cancer and mental disease, with the strongest gradient in diabetes (OR 2.0 [95%CI 1.4;2.8]). Unemployment and especially living on minimum income were associated with increased odds to have MSKD and mental and respiratory disease, after adjusting for education. Smoking and obesity mediated part of the relationship between education and disease, with obesity playing more pronounced role. Association between deprivation and occurrence of all major chronic diseases is of comparable magnitude, with education having most consistent contribution. Our results support the notion of the generic (i.e., non-disease specific) mechanisms underlying socio-economic gradients in health.

Socioeconomic indicators in epidemiologic research: A practical example from the LIFEPATH study

Background

Several social indicators have been used in epidemiological research to describe socioeconomic position (SEP) of people in societies. Among SEP indicators, those more frequently used are education, occupational class and income. Differences in the incidence of several health outcomes have been reported consistently, independently from the indicator employed. Main objectives of the study were to present the socioeconomic classifications of the social indicators which will be employed throughout the LIFEPATH project and to compare social gradients in all-cause mortality observed in the participating adult cohorts using the different SEP indicators.

Methods

Information on the available social indicators (education, own and father’s occupational class, income) from eleven adult cohorts participating in LIFEPATH was collected and harmonized. Mortality by SEP for each indicator was estimated by Poisson regression on each cohort and then evaluated using a meta-analytical approach.

Results

In the meta-analysis, among men mortality was significantly inversely associated with both occupational class and education, but not with father’s occupational class; among women, the increase in mortality in lower social strata was smaller than among men and, except for a slight increase in the lowest education category, no significant differences were found.

Conclusions

Among men, the proposed three-level classifications of occupational class and education were found to predict differences in mortality which is consistent with previous research. Results on women suggest that classifying them through their sole SEP, without considering that of their partners, may imply a misclassification of their social position leading to attenuation of mortality differences.

Health inequalities by socioeconomic status among men in the Nord-Trøndelag Health Study, Norway

Aims: This study describes inequalities and trends in health according to socioeconomic status in the Nord-Trøndelag Health Study (HUNT I and II) and contribute to the ongoing discussion on the magnitude of inequalities in health in the Nordic welfare states. To produce data comparable to recent European studies, occupational data in the HUNT Study were reclassifi ed according to the international Erikson Goldthorpe Portocarero (EGP) social class scheme. Methods: Two cross-sectional health surveys were undertaken with a 10-year interval, HUNT I (1984-86) and HUNT II (1995-97). This was a primary healthcare, total-county population study, participants for this analysis being men aged 25-69 years. Results: A consistent pattern was found of increasing health problems with decreasing socioeconomic status for four health variables: self-perceived health, temporary disability, any long-standing health problem, and chronic conditions. The prevalence ratio between the highest and lowest status groups for ``perceived health less than good'' was 2.0 in the first survey and 2.1 in the second 10 years later. The magnitude of differences for the other health outcomes was at this level or smaller, with no signifi cant overall time trend from the mid-1980s to the mid-1990s. Conclusions: The magnitude of socioeconomic gradients in health in this study seemed somewhat smaller than results from national studies, and on the average compared to studies from other European countries; there was no detectable time trend in health differentials. International comparative studies have suggested considerably larger inequalities in health according to social class in Norway using national data.

Mortality differences between self-employed and paid employees: a 5-year follow-up study of the working population in Sweden

Objectives

Analyse mortality differences between self-employed and paid employees with a focus on industrial sector, educational level and gender using Swedish register data.

Methods

A cohort of the total working population (4 776 135 individuals; 7.2% self-employed; 18–100 years of age at baseline 2003) in Sweden with a 5-year follow-up (2004–2008) for all-cause and cause-specific mortality (57 743 deaths). Self-employed individuals were categorised as sole proprietors or limited liability company (LLC) owners according to their enterprise's legal form. Cox proportional hazards models were applied to compare mortality rates between sole proprietors, LLC owners and paid employees, adjusted for sociodemographic confounders.

Results

Mortality from cardiovascular diseases was 16% lower and from suicide 26% lower among LLC owners than among paid employees, adjusted for confounders. Within the industrial category, all-cause mortality was 13–15% lower among sole proprietors and LLC owners compared with employees in manufacturing and mining (MM) as well as personal and cultural services (PCS), and 11–20% higher in sole proprietors in trade, transport and communication and the welfare industry (W). A significant three-way interaction indicated 17–23% lower all-cause mortality among male LLC owners in MM and female sole proprietors in PCS, and 50% higher mortality in female sole proprietors in W than in employees in the same industries.

Conclusions

Mortality differences between self-employed individuals and paid employees vary by the legal form of self-employment, across industries, and by gender. Differences in work environment exposures and working conditions, varying market competition across industries and gender segregation in the labour market are potential mechanisms underlying these findings.

War Experiences and General Health Among People in Bosnia-Herzegovina and Kosovo

War experiences may have an extensive impact on the health status of the exposed populations. This population-based study aimed to examine the relationship between war experiences and self-reported general health in representative sample surveys from Bosnia-Herzegovina (n = 3,313) and Kosovo (n = 1,000). Data were collected with face-to-face interviews fielded in the winter of 2003-2004. Logistic regression analysis was used to compute unadjusted and adjusted odds ratios (ORs). The adjusted effects of the extensiveness of war experiences on poor health were positive in both countries, but they were statistically significant only for Bosnia-Herzegovina: OR = 1.04, 95% CI [1.00, 1.08] for Bosnia-Herzegovina and OR = 1.03, 95% CI [0.98, 1.09] for Kosovo. The strongest observed effect was found for Kosovo only: The extensiveness of war experiences was relatively strongly related to longstanding health problems, OR = 1.09, 95% CI [1.03, 1.15]. We found that war experiences may contribute to increased poorer health in the exposed populations; however, the effects 4-9 years after the war ended were modest. Hence, war experiences seemed to be more strongly related to war-related distress and posttraumatic stress disorder than to self-reported general health.

A school based study of time trends in food habits and their relation to socio-economic status among Norwegian adolescents, 2001-2009

Background

In recent years, adolescents’ food habits have become a major source of concern, and substantial policy and intervention efforts have been made to influence adolescents to consume more fruit and vegetables and less sweets and soft drink. Particular attention has been devoted to the social gradient in food habits, aiming to reduce dietary inequality. However, few internationally published studies have evaluated trends in teenagers’ food habits, or investigated how dietary inequalities develop.

Methods

We used Norwegian cross-sectional data from the international Health Behaviour in School-Aged Children (HBSC) study, collected via three nationally representative and comparable questionnaire surveys in 2001, 2005 and 2009. Food habits were identified by students’ consumption of fruit, vegetables, sweets and sugar rich soft drink. Socio-economic status (SES) was measured with the Family Affluence Scale (FAS). Multilevel logistic regression was used to analyze the data.

Results

The analyses indicated an overall positive trend in food habits among adolescents in Norway. Students were more likely to consume fruit (OR 1.76, CI 1.61-1.92) and vegetables (OR 1.51, CI 1.37-1.66) daily in 2005 as compared to 2001, and were less likely to consume sweets (OR 0.58, CI 0.51-0.66 resp. OR 0.77, CI 0.67-0.90) and soft drink (OR 0.55, CI 0.49-0.62 resp. OR 0.84, CI 0.73-0.96) daily when comparing, respectively, 2005 with 2001 and 2009 with 2005. Across all survey years, students with higher SES were more likely to eat fruit (OR 1.47, CI 1.32-1.65) and vegetables (OR 1.40, CI 1.24-1.58) daily than did students with lower SES. Our analyses indicated that the socio-economic differences were stable in the period 2002 - 2010, with uniform improvement in fruit and vegetable consumption across all SES levels. No significant associations between SES and intake of sweets and sugar-added soft drink were found.

Conclusion

The study identifies an overall improvement in diet among adolescents over a period characterized by onset of as well as ongoing initiatives targeting young people’s food habits. However, the observed socio-economic gradient in fruit and vegetable consumption remained unchanged.

[Inequalities in physical inactivity according educational level in Spain, 1987 and 2007]

Objetivo

Comparar la magnitud de las desigualdades en la frecuencia de inactividad física en España en 1987 y 2007.

Diseño

Estudio descriptivo, diseño transversal, nivel nacional.

Participantes

Datos de la Encuesta Nacional de Salud de 1987 y 2007, población adulta de 25 a 64 años. Tamaño muestral 30.000 sujetos (1987) y 29.478 (2006/7).

Mediciones principales

Variable principal de resultados, inactividad física en tiempo libre. Factor de exposición, nivel educativo. Análisis de prevalencias y asociación a través de odds ratio (OR). Ajuste por variables socioeconómicas: edad en decenios, estado civil, situación laboral, clase social del cabeza de familia e ingresos del hogar.

Resultados

Descenso de la prevalencia de inactividad física en tiempo libre en 2007 respecto a 1987, tanto en mujeres como hombres. Mayores descensos observados entre los sujetos con estudios universitarios. La magnitud de las desigualdades en salud ha aumentado con el tiempo. Así ocurrió por ejemplo con el grupo de varones de 45 a 64 años, con OR de 2,43 (1,91-3,09) en 1987, a OR de 2,77 (2,17-3,54) en 2007, ajustadas por todas las variables socioeconómicas), en el caso de sujetos con peor nivel de estudios.

Conclusiones

La prevalencia de inactividad física descendió entre 1987 y 2007, y los mayores descensos fueron en sujetos con estudios universitarios. La brecha de las diferencias en prevalencias y OR de inactividad física en tiempo libre, ha aumentado con el tiempo. Parece necesario contribuir, desde estrategias de Educación para la Salud y promoción de la equidad, a la reducción de las desigualdades en conductas de riesgo.

Age, occupational class and sickness absence during pregnancy: a retrospective analysis study of the Norwegian population registry

OBJECTIVE

Western women increasingly delay having children to advance their career, and pregnancy is considered to be riskier among older women. In Norway, this development surprisingly coincides with increased sickness absence among young pregnant women, rather than their older counterparts. This paper tests the hypothesis that young pregnant women have a higher number of sick days because this age group includes a higher proportion of working class women, who are more prone to sickness absence.

DESIGN

A zero-inflated Poisson regression was conducted on the Norwegian population registry.

PARTICIPANTS

All pregnant employees giving birth in 2004-2008 were included in the study. A total number of 216 541 pregnancies were observed among 180 483 women.

OUTCOME MEASURE

Number of sick days.

RESULTS

Although the association between age and number of sick days was U-shaped, pregnant women in their early 20s had a higher number of sick days than those in their mid-40s. This was particularly the case for pregnant women with previous births. In this group, 20-year-olds had 12.6 more sick days than 45-year-olds; this age difference was reduced to 6.3 after control for class. Among women undergoing their first pregnancy, 20-year-olds initially had 1.2 more sick days than 45-year-olds, but control for class altered this age difference. After control for class, 45-year-old first-time pregnant women had 2.9 more sick days than 20-year-olds with corresponding characteristics.

CONCLUSIONS

The negative association between age and sickness absence was partly due to younger age groups including more working class women, who were more prone to sickness absence. Young pregnant women's needs for job adjustments should not be underestimated.

Associations of subjective social status with physical activity and body mass index across four Asian countries

OBJECTIVE

The aims of this study were to (1) assess physical activity and weight status differences and (2) explore the direction and shape of subjective social status (SSS) association with physical activity and weight status within four Asian countries.

METHODS

Cross section data of adult respondents from the nationally representative East Asian Social Survey were used for analyses. Logistic regression stratified by gender was conducted for the first aim, and simple and quadratic logistic regression models were used for the second.

RESULTS

SSS was significantly associated with odds of weekly or daily physical activity across all countries and genders, except for South Korean and Japanese females. Quadratic models provided significantly better fit for Chinese males (LR (d.f. = 1) = 6.51, P value <.05) and females (LR (d.f. = 1) = 7.36, P value <.01), South Korean males (LR (d.f. = 1) = 4.40, P value <.05), and Taiwanese females (LR (d.f. = 1) = 4.87, P value <.05).

CONCLUSIONS

This study provides a comparable cross Asian country measure of moderate-to-vigorous physical activity and new findings that a connection exists between SSS and physical activity. Differences of class distinction help explain the different shaped SSS relationships.

The contribution of occupation to health inequality

Health is distributed unequally by occupation. Workers on a lower rung of the occupational ladder report worse health, have a higher probability of disability and die earlier than workers higher up the occupational hierarchy. Using a theoretical framework that unveils some of the potential mechanisms underlying these disparities, three core insights emerge: (i) there is selection into occupation on the basis of initial wealth, education, and health, (ii) there will be behavioural responses to adverse working conditions, which can have compensating or reinforcing effects on health, and (iii) workplace conditions increase health inequalities if workers with initially low socioeconomic status choose harmful occupations and don't offset detrimental health effects. We provide empirical illustrations of these insights using data for the Netherlands and assess the evidence available in the economics literature.

Differences in health complaints among Taiwanese workers in different occupational categories

OBJECTIVES

The objectives of this study were to determine the prevalence of and differences in certain health complaints, including physical symptoms and psychological distress, among workers in different occupational categories and to explore the associations between occupational category and each complaint.

METHODS

A cross-sectional study was conducted using a self-administered questionnaire. A total of 1,628 workers representing seven occupational categories from ten companies in different industries submitted completed questionnaires. The self-administered questionnaire contained three parts: personal data, physical symptoms and psychological distress. Physical symptoms were measured using nine questions developed by a panel of ten general practitioners; the questions included nine common physical symptoms across main organ systems. Psychological distress was measured using the Chinese Health Questionnaire.

RESULTS

Muscle pain (44.7%) and dizziness (30.1%) were the most common symptoms reported by participants, and 16.6% of participants suffered from psychological distress. Significant differences in physical symptoms and psychological distress were found among workers in different occupational categories (Χ(2)=53.59, p<0.001). Compared with service workers, office workers and managers had higher prevalence rates of physical symptoms; office workers also showed a higher prevalence of psychological distress.

CONCLUSIONS

The study merits attention in terms of prevention of health problems in the workplace by focusing on a set of physical symptoms and psychological distress (not merely morbidity). Occupational category should be taken into consideration when planning workplace health promotion. Our findings highlight the need for health promotion programs that specifically target office workers and managers.

Family affluence and cultural capital as indicators of social inequalities in adolescent's eating behaviours: a population-based survey

BACKGROUND

Dietary inequality, via socio-economic inequality, may involve several mechanisms. Different aspects of adolescents' socio-economic circumstances should therefore be considered in order to make effective interventions to promote healthy eating in the young population. Indicators designed to tap socio-economic status among adolescents in particular will facilitate a better understanding of the concept of socio-economic status and how it influences health behaviour among young people. The purpose of this study was to evaluate if material capital and cultural capital individually and independently contribute to the prediction of eating habits in the Norwegian adolescent population.

METHODS

The analysis is based on survey data from the Health Behaviour in School-Aged Children study. The Family Affluence Scale (number of cars, holidays, PC and bedrooms) and number of books in the household were used as indicators of socio-economic status, respectively measuring material capital and cultural capital. Their influence on adolescent's consumption of fruit, vegetables, sweets, soft drinks, and consumption of breakfast and dinner was evaluated. Pearson's correlation, logistic regression and ridit transformation analysis were used to analyse the data.

RESULTS

Higher family affluence was shown to predict consumption of more fruit (OR 1.52) and vegetables (OR 1.39) and consumption of breakfast (OR 1.61) and dinner (1.35). Cultural capital was significantly associated to consumption of fruit (OR 1.85), vegetables (OR 2.38) sweets (OR .45), sugary soft drinks (OR .26), breakfast (OR 2.13) and dinner (OR 1.54). Cultural capital was the strongest predictor to healthy eating among adolescents in Norway.

CONCLUSIONS

Material capital and cultural capital individually and independently contributed to the prediction of healthy eating patterns among adolescents in Norway. Cultural capital is an understudied dimension of the socio-economic status concept and the influence on health behaviour needs to be explored in future studies. Initiatives to promote healthy eating should focus on education, habits and consciousness of a healthy diet, but also at reducing the high cost of fruit and vegetables. There is further a need for developing appropriate indicators for adolescent socio-economic status.

Women's higher likelihood of disability pension: the role of health, family and work. A 5-7 years follow-up of the Hordaland Health Study

Background

Women’s higher risk of disability pension compared with men is found in countries with high female work participation and universal welfare schemes. The aim of the study was to examine the extent to which self-perceived health, family situation and work factors explain women’s higher risk of disability pension. We also explored how these factors influenced the gender difference across educational strata.

Methods

The population-based Hordaland Health Study (HUSK) was conducted in 1997–99 and included inhabitants born in 1953–57 in Hordaland County, Norway. The current study included 5,959 men and 6,306 women in paid work with valid information on education and self-perceived health. Follow-up data on disability pension, for a period of 5–7 years, was obtained by linking the health survey to a national registry of disability pension. Cox regression analyses were employed.

Results

During the follow-up period 99 (1.7%) men and 230 (3.6%) women were awarded disability pension, giving a twofold risk of disability pension for women compared with men. Except for a moderate impact of self-perceived health, adjustment for family situation and work factors did not influence the gender difference in risk. Repeating the analyses in strata of education, the gender difference in risk of disability pension among the highly educated was fully explained by self-perceived health and work factors. In the lower strata of education there remained a substantial unexplained gender difference in risk.

Conclusions

In a Norwegian cohort of middle-aged men and women, self-perceived health, family situation and work factors could not explain women’s higher likelihood of disability pension. However, analyses stratified by educational level indicate that mechanisms behind the gender gap in disability pension differ by educational levels. Recognizing the heterogeneity within gender may contribute to a deeper understanding of women’s higher risk of disability pension.

The wider determinants of inequalities in health: a decomposition analysis

BACKGROUND

The common starting point of many studies scrutinizing the factors underlying health inequalities is that material, cultural-behavioural, and psycho-social factors affect the distribution of health systematically through income, education, occupation, wealth or similar indicators of socioeconomic structure. However, little is known regarding if and to what extent these factors can assert systematic influence on the distribution of health of a population independent of the effects channelled through income, education, or wealth.

METHODS

Using representative data from the German Socioeconomic Panel, we apply Fields' regression based decomposition techniques to decompose variations in health into its sources. Controlling for income, education, occupation, and wealth, we assess the relative importance of the explanatory factors over and above their effect on the variation in health channelled through the commonly applied measures of socioeconomic status.

RESULTS

The analysis suggests that three main factors persistently contribute to variance in health: the capability score, cultural-behavioural variables and to a lower extent, the materialist approach. Of the three, the capability score illustrates the explanatory power of interaction and compound effects as it captures the individual's socioeconomic, social, and psychological resources in relation to his/her exposure to life challenges.

CONCLUSION

Models that take a reductionist perspective and do not allow for the possibility that health inequalities are generated by factors over and above their effect on the variation in health channelled through one of the socioeconomic measures are underspecified and may fail to capture the determinants of health inequalities.

Disability pension by occupational class--the impact of work-related factors: the Hordaland Health Study Cohort

BACKGROUND

The social gradient in disability pension is well recognized, however mechanisms accounting for the gradient are largely unknown. The aim of this study was to examine the association between occupational class and subsequent disability pension among middle-aged men and women, and to what extent work-related factors accounted for the association.

METHODS

A subsample (N = 7031) of the population-based Hordaland Health Study (HUSK) conducted in 1997-99, provided self-reported information on health and work-related factors, and were grouped in four strata by Erikson, Goldthorpe and Portocareros occupational class scheme. The authors obtained follow-up data on disability pension by linking the health survey to national registries of benefit (FD-trygd). They employed Cox regression analysis and adjusted for gender, health (medical conditions, mental health, self-perceived health, somatic symptoms) and work-related factors (working hours, years in current occupation, physical demands, job demands, job control).

RESULTS

A strong gradient in disability pension by occupational class was found. In the fully adjusted model the risk (hazard ratio) ranged from 1.41 (95% CI 0.84 to 2.33) in the routine non-manual class, 1.87 (95% CI 1.07 to 3.27) in the skilled manual class and 2.12 (95% CI 1.14 to 3.95) in the unskilled manual class, employing the administrator and professional class as reference. In the gender and health-adjusted model work-related factors mediated the impact of occupational class on subsequent disability pension with 5% in the routine non-manual class, 26% in the skilled manual class and 24% in the unskilled manual class. The impact of job control and physical demands was modest, and mainly seen among skilled and unskilled manual workers.

CONCLUSIONS

Workers in the skilled and unskilled manual classes had a substantial unexplained risk of disability pension. Work-related factors only had a moderate impact on the disability risk. Literature indicates an accumulation of hazards in the manual classes. This should be taken into account when interpreting the gradient in disability pension.

International differences in self-reported health measures in 33 major metropolitan areas in Europe

BACKGROUND

The increasing concentration of populations into large conurbations in recent decades has not been matched by international health assessments, which remain largely focused at the country level. We aimed to demonstrate the use of routine survey data to compare the health of large metropolitan centres across Europe and determine the extent to which differences are due to socio-economic factors.

METHODS

Multilevel modelling of health survey data on 126,853 individuals from 33 metropolitan areas in the UK, Republic of Ireland, Sweden, Norway, Finland, Spain, Belgium and Germany compared general health, longstanding illness, acute sickness, psychological distress and obesity with the average for all areas, accounting for education and social class.

RESULTS

We found some areas (Greater Glasgow; Greater Manchester, Cheshire and Merseyside; Northumberland, Tyne and Wear and South Yorkshire) had significantly higher levels of poor health. Other areas (West Flanders and Antwerp) had better than average health. Differences in individual socio-economic circumstances did not explain findings. With a few exceptions, acute sickness levels did not vary.

CONCLUSION

Health tended to be worse in metropolitan areas in the north and west of the UK and the central belt and south east of Germany, and more favourable in Sweden and north west Belgium, even accounting for socio-economic composition of local populations. This study demonstrated that combining national health survey data covering different areas is viable but not without technical difficulties. Future comparisons between European regions should be made using standardized sampling, recruitment and data collection protocols, allowing proper monitoring of health inequalities.

Income-related health inequalities in the Nordic countries: examining the role of education, occupational class, and age

Numerous studies have concluded that people's socioeconomic position is related to mortality and morbidity, but that the strength of this association varies considerably both within and between European regions. This has spurred several researchers to more closely examine educational and occupational gradients in health in the Nordic countries to clarify the causes of cross-national differences. However, comparable studies using income as an indicator of socioeconomic position are still lacking. This study uses recent and highly comparable data to fill this gap. The aim of this study is threefold. First, we ask to what extent there is an income gradient in health in the Nordic countries, and to what extent the association differs between these countries. Second and third, we examine whether differences in the attenuation of the income gradient by education and occupational class, and age-specific differences between countries, may act as explanations for differences in the income gradient between the Nordic countries. The data source are three waves of the European Social Survey (ESS, 2002/2004/2006), which included 17,801 people aged 25 and over from Denmark, Finland, Norway, and Sweden. Two subjective health measures (physical/mental self reported health and limiting longstanding illness) were analysed by means of logistic regression. The results show that, in all countries, people reported significantly better health and were less likely to suffer from longstanding illness as they had a higher income. This association is strongest in Norway and Finland and weakest in Denmark. The income gradient in health, but not country differences in this gradient, is partly explained by education and occupational class. Additionally, the strength of the income gradient in health varies between age groups. The relatively high health inequalities between income groups in Norway and Finland are already visible in the youngest age groups. The results imply that the socioeconomic gradient in health will arguably not be strongly reduced in the near future as a result of cohort replacement, as has been suggested in previous studies. Health policy interventions may be particularly important five to ten years prior to retirement and in early adulthood.

Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe

OBJECTIVES

To analyse the associations between socio-economic status (SES), measured using occupation, and self-reported health, and to examine the contribution of various material, occupational and psychosocial factors to social inequalities in health in Europe.

METHODS

This study was based on data from the European Quality of Life Survey (EQLS) carried out in 2003. The total sample consisted of 6038 and 6383 working men and women in 28 countries in Europe (response rates: 30.3-91.2%). Each set of potential material, occupational and psychosocial mediators included between eight and 11 variables. Statistical analysis was performed using multilevel logistic regression analysis.

RESULTS

Significant social differences were observed for self-reported health, manual workers being more likely to be in poor health (OR=1.89, 95% CI 1.46 to 2.46 for men, OR=2.18, 95% CI 1.71 to 2.77 for women). Strong social gradients were found for almost all potential mediating factors, and almost all displayed significant associations with self-reported health. Social differences in health were substantially reduced after adjustment for material, occupational and psychosocial factors, with material factors playing a major role. The four strongest contributions to reducing these differences were found for material deprivation, social exclusion, financial problems and job reward. Taking all mediators into account led to an explanation of the social differences in health by 78-100% for men and women.

CONCLUSION

The association between SES and poor health may be attributed to differential distributions of several dimensions of material, occupational and psychosocial conditions across occupational groups. Interventions targeting different dimensions might result in a reduction in social inequalities in health.

Taller - Healthier - more equal? The biological standard of living in Switzerland in the second half of the 20th century

This paper analyzes the trends in physical stature and body mass of the Swiss population born between 1955 and 1985, based on data collected in the "Living in Switzerland Survey" (Swiss Household Panel) of 2004. Aside from the time trend, we investigate the impact of educational and marital status as well as spatial effects on height and BMI. The results corroborate previous studies: average height increased during the second half of the 20th century for both women and men, better educated individuals are tallest, divorced men are shorter than married men and urban populations enjoy a height advantage over rural ones. We also compare the level and the trend in height to other postindustrial populations to identify key causes of physical growth and conclude that the quality of the health care systems and equal access to it seem to have a greater impact than other redistributive aspects of the welfare state. The relatively low level of inequality in health led to average height in Switzerland that are similar to those obtained in the Scandinavian social-democratic welfare states. Other measures such as income inequality do not have a high explanatory power for the average stature of the Swiss population.

Selection bias in a population survey with registry linkage: potential effect on socioeconomic gradient in cardiovascular risk

Non-participation in population studies is likely to be a source of bias in many types of epidemiologic studies, including those describing social disparities in health. The objective of this paper is to present a non-attendance analysis evaluating the possible impact of selection bias, when investigating the association between education level and cardiovascular risk factors. Data from the INTERGENE research programme including 3,610 randomly selected individuals aged 25-74 (1,908 women and 1,702 men), in West Sweden were used. Only 42% of the invited population participated. Non-attendance analyses were done by comparing data from official registries (Statistics Sweden) covering the entire invited study population. This analysis revealed that participants were more likely to be women, have university education, high income, be married and of Nordic origin compared to non-participants. Among participants, all health behaviours studied were significantly related to education. Physical activity, alcohol use and breakfast consumption were higher in the more educated group, while there were more smokers in the less educated group. Central obesity, obesity and hypertension were also significantly associated with lower education level. Weaker associations were observed for blood lipids, diabetes, high plasma glucose level and perceived stress. The socio-demographic differences between participants and non-participants indicated by the register analysis imply potential biases in epidemiological research. For instance, the positive association between education level and frequent alcohol consumption, may, in part be explained by participation bias. For other risk factors studied, an underestimation of the importance of low socioeconomic status may be more likely.

Association of socioeconomic status and life-style factors with coping strategies in Isfahan Healthy Heart Program, Iran

AIM

To investigate the association between life-style and socioeconomic factors and coping strategies in a community sample in Iran.

METHOD

As part of a community-based study called Isfahan Healthy Heart Program, we studied 17593 individuals older than 19 living in the central part of Iran. Demographic and socioeconomic factors (age, sex, occupation status, marital status, and educational level) and lifestyle variables (smoking status, leisure time physical activity, and psychological distress), and coping strategy were recorded. Data were analyzed by Pearson correlation and multiple linear regression.

RESULTS

Not smoking (women beta=-11.293, P<0.001; men beta=-3.418, P=0.007), having leisure time physical activity (women beta=0.017, P=0.046; men beta=0.005, P=0.043), and higher educational level (women beta=0.344, P=0.015; men beta=0.406, P=0.008) were predictors of adaptive coping strategies, while smoking (women beta=11.849, P<0.001; men beta=9.336, P<0.001), high stress level (women beta=1.588, P=0.000; men beta=1.358, P<0.001), and lower educational level (women beta=-0.443, P=0.013; men beta=-0.427, P=0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (beta=4.983, P<0.001) and negative predictor of maladaptive (beta=-3.355, P=0.023) coping skills in men.

CONCLUSION

Coping strategies of the population in central Iran were highly influenced by socioeconomic status and life-style factors. Programs aimed at improving healthy life-styles and increasing the socioeconomic status could increase adaptive coping skills and decrease maladaptive ones and consequently lead to a more healthy society.

Socioeconomic inequalities in health in 22 European countries

BACKGROUND

Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe.

METHODS

We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes.

RESULTS

In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern.

CONCLUSIONS

We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care.

Does social class predict diet quality?

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

[Characterisation and measurement of social position in epidemiologic studies]

BACKGROUND

The terms "socioeconomic status", "socioeconomic position", "social classes" ... are widely used in epidemiology. They refer to various aspects of social position which is associated with many aspects of health. The position of individuals in the social hierarchy is multidimensional, i.e. defined by various socioeconomic factors. They can be individual (for example educational level, employment status, and occupation), household related (for example household income) or neighbourhood related (for example unemployment rate in the district of residence). These various factors can be associated with health at different periods during the life course, via a number of mechanisms, and they can possibly interact with one another. No socioeconomic indicator is better than the others or adequate in all study contexts.

AIM AND METHODS

This paper presents a description of various socioeconomic indicators, and describes what they measure, and the advantages and limits of each of them.

CONCLUSION

No indicator can be recommended in particular. Within the limit of available variables, the most relevant measurement depends on many elements, such as the study population and the aspect of health being investigated.

Health disparities by occupation, modified by education: a cross-sectional population study

Background

Socio-economic disparities in health status are frequently reported in research. By comparison with education and income, occupational status has been less extensively studied in relation to health status or the occurrence of specific chronic diseases. The aim of this study was to investigate health disparities in the working population based on occupational position and how they were modified by education.

Methods

Our data were derived from the National Survey of General Practice that comprised 104 practices in the Netherlands. 136,189 working people aged 25–64 participated in the study. Occupational position was assessed by the International Socio-Economic Index of occupational position (ISEI). Health outcomes were self-perceived health status and physician-diagnosed diseases. Odds ratios were estimated using multivariate logistic regression analysis.

Results

The lowest occupational position was observed to be associated with poor health in men (OR = 1.6, 95% CI 1,5 to 1.7) and women (OR = 1.3, 95% CI 1.2 to 1.4). The risk of poor health gradually decreased in relation to higher occupational positions. People with the lowest occupational positions were more likely to suffer from depression, diabetes, ischaemic heart disease, arthritis, muscle pain, neck and back pain and tension headache, in comparison to people with the highest occupational position (OR 1.2 to 1.6). A lower educational level induced an additional risk of poor health and disease. We found that gender modified the effects on poor health when both occupational position and education were combined in the analysis.

Conclusion

A low occupational position was consistently associated working people with poor health and physician-diagnosed morbidity. However a low educational level was not. Occupational position and education had a combined effect on self-perceived health, which supports the recent call to improve the conceptual framework of health disparities.

Social determinants of health: a veil that hides socioeconomic position and its relation with health

The emergence of theoretical models of social determinants of health has added conceptual ambiguity to the understanding of social inequalities in health, as it is often not possible to clearly distinguish between socioeconomic position and these determinants. Whether the existence of social inequalities in health is based on differences in health or on differences in social determinants of health that are systematically associated with socioeconomic position, policymakers should be clearly informed of the importance of socioeconomic position for health. Thus, the following three basic requirements are proposed: to reach a consensus about the dimensions that reflect socioeconomic position; to agree about what are to be considered the social determinants of health and whether or not these determinants are a construct that can be distinguished from socioeconomic position; and finally, to establish which dimensions and measures of socioeconomic position are most appropriate for the evaluation of interventions that aim to reduce these inequalities.

Comparison of the effects of low childhood socioeconomic position and low adulthood socioeconomic position on self rated health in four European studies

BACKGROUND

Socioeconomic inequalities in health are a persistent feature throughout Europe. Researchers and policy makers are increasingly using a lifecourse perspective to explain these inequalities and direct policy. However, there are few, if any, cross national lifecourse comparisons in this area.

METHODS

Associations between socioeconomic position (SEP) in childhood and in adulthood and poor self rated health among men and women at midlife were tested in four European studies from England (n = 3615), France (n = 11 595), Germany (n = 4183), and the Netherlands (n = 3801).

RESULTS

For women, mutually adjusted analyses showed significant associations between poor self rated health and low SEP in both childhood and adulthood in England and the Netherlands, only low childhood SEP in Germany and neither childhood nor adulthood SEP in France. For men, mutually adjusted analyses showed significant associations between poor self rated health and low SEP in both childhood and adulthood in France and the Netherlands, only with adult SEP in England and only with childhood SEP in Germany.

CONCLUSION

In most countries adult SEP showed stronger associations with self rated health than childhood SEP. There are both gender and national differences in the associations between childhood and adulthood SEP. Policies designed to reduce inequalities in health need to incorporate a lifecourse perspective that is sensitive to different national and gender issues. Ultimately, more cross national studies are required to better understand these processes.

Relations of occupational stress to occupational class in Japanese civil servants--analysis by two occupational stress models

The aim of the present study was to identify relations between occupational stress and occupational class in Japanese civil servants, using two occupational stress models-the Effort-Reward Imbalance (ERI) Model and the Job Demand-Control (JDC) Model. The subjects were employees of three local public organizations. We distributed self-administered questionnaires and assessed occupational stress by ERI and JDC. We used seven occupational categories based on the Standard Occupational Classification for Japan. The data of 6,423 male and 1,606 female subjects were analyzed by logistic regression analysis to obtain odds ratios (OR) for relations between occupational stress and occupational class. In JDC, male clerical workers, transport/communication workers and protective service workers showed a significantly higher OR of being in the high occupational stress group, compared to managers. In ERI, male professionals/technicians, transport/communication workers, clerical workers and protective service workers showed a significantly higher prevalence OR, compared to managers, the two models giving different results. In ERI, female production workers/laborers and clerical workers had a significantly lower prevalence OR, compared to managers. The results of this study showed that occupational stress differed by occupational class and the two occupational stress models gave different results for occupational classes with high occupational stress.

Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany

BACKGROUND

Unlike other biopsychosocial risk factors, the role of comorbidity in low back pain is largely unknown.

AIMS

The purpose is (1) to generate prevalence data on back pain in the total adult population and (2) to identify the most common physical comorbidities in subjects with back pain. This paper also (3) analyses the gender-specific and age-specific comorbidity structure.

METHODS

The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence and the associated comorbidities. The net sample comprises a total of 7124 Germans aged 18-79.

RESULTS

One in three Germans (34%) experienced back pain during the seven days prior to being interviewed. The one-year prevalence rate is 59%. All the morbidities investigated by us are more common in subjects with back pain than in individuals without back pain. The most common comorbidities associated with back pain are musculoskeletal disorders like rheumatoid arthritis, osteoarthritis and osteoporosis, followed by cardiovascular and cerebrovascular disease.

CONCLUSIONS

The present study investigating 31 physical diseases is the most extensive analysis to date on the topic of back pain and comorbidity. This is an attempt to cast light on the tangled relationships involved in developing and coping with back pain. In view of the large percentage of unspecific back pain, we believe it is important for physicians treating back pain to extend their history and diagnostic analysis skills to embrace comorbidities related to the back pain.

A Prospective Cohort Study of Employment Status and Mortality from Circulatory Disorders among Japanese Workers

This study prospectively examined the association between employment status (employed or self-employed) and the risk of death from circulatory diseases among Japanese workers. A baseline survey was conducted between 1988 and 1990 among 110,792 inhabitants of 45 areas. Follow-up surveys were conducted annually and causes of death were identified from death certificates. Analysis was restricted to 25,945 individuals (15,434 male and 10,511 female) with ages ranging from 40 to 59 years. These subjects were employed or self-employed at the time of recruitment. The risks of self-employment for death due to circulatory system disease, ischemic heart disease and cerebrovascular disease were estimated using the Cox proportional hazards model. During the 10-year follow-up period (151,817 and 104,870 person-years for males and females, respectively), 720 male and 193 female deaths were recorded. No significant differences were detected between the employed and self-employed workers in the total death risk, or the risk of death from ischemic heart disease. However, self-employed men showed a significantly lower risk of death from cerebrovascular disease compared with employed men (relative risk=0.58; 95% confidence interval=0.35, 0.97). Our findings suggest that employed men are at increased risk of death from cerebrovascular disease compared with self-employed men.

Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany

Given the increasing medical and economic implications of back pain, occupation-specific prevalence data may provide important pointers for preventive programmes targeted at promoting preventive behaviour and improving conditions. The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence by occupational category. The net sample comprises a total of 3,488 earners aged 18-69. One in three earners in the Federal Republic of Germany (34%) experienced back pain during the 7 days prior to being interviewed. The 1-year prevalence rate is 60%. Occupational categories associated with a lower-than-average back pain prevalence are highly qualified professionals, senior management, and production occupations associated with a comparatively low degree of manual labour. In contrast, an above-average prevalence was identified for occupations associated with physically strenuous work involving one-sided postures, moving, carrying and holding heavy weights, and work typically performed in poor conditions or bad weather. Our data demonstrates significant inter-occupational differences in terms of self-reported back pain. The results underline the importance of measures to promote preventive behaviour and improve the working conditions of those in low-skill manual labour occupations.

Chronic diseases in self-employed French workers

OBJECTIVE

The objective of this study was to evaluate occupations associated with a high risk of specific chronic diseases in self-employed workers.

METHODS

For each occupational category and gender, the observed and expected numbers of prevalent cases for each chronic disease leading to exemption from copayments by the French National Health Insurance System in 2001 were compared using the age-specific self-employed population rates as a reference.

RESULTS

Dramatic discrepancies were observed depending on occupational categories, specifically for diabetes mellitus, cardiovascular diseases, mental health disorders, chronic respiratory insufficiency, severe liver disorders, and connective tissue diseases.

CONCLUSIONS

Based on this extremely large dataset, several known associations between occupations and specific diseases were confirmed; other potential associations observed require future investigation.

Occupational social class and mortality in a population of men economically active: The contribution of education and employment situation

This study examines how education and employment situation contribute to the association between a classification of occupational class based on skill assets and mortality from different causes of death. Data were obtained by linking records from the 1996 population census for Spanish men aged 35-64 residing in Madrid with 1996 and 1997 mortality records. The risk of mortality was higher in skilled, semi-skilled and unskilled workers than in higher and lower managerial and professional workers. Adjusting for educational level substantially decreased the magnitude of the gradient. The decrease in the gradient after adjusting for employment situation was much smaller. Except in the case of mortality from respiratory diseases, the mortality gradient disappeared after adjusting for both variables. These results show that education and, to a much lesser degree, employment situation explain part of the social gradient observed in mortality from all causes and from broad causes of death, except from respiratory diseases.

The relations between symptoms, somatic and psychiatric conditions, life satisfaction and perceived health. A primary care based study

BACKGROUND

In spite of the fact that self-rated health is such an important factor, little is known about the aetiological background to poor perceived health and also less is known about the impact of life satisfaction on health in a primary care practice population. The aim of this study was to evaluate the effect of socio-demographic characteristics, lifestyle factors, symptoms, somatic and psychiatric conditions as well as health status measures and life satisfaction on perceived health in a multi-ethnic Swedish health practice population.

METHODS

Four-hundred and seventy adult patients, who visited the Jordbro Health Care Centre District (JHC), Haninge Municipality, participated in this study. A general questionnaire with questions about socio-demographic characteristics, lifestyle, health status and chronic disease were used. In addition to that, the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used. Furthermore, physical examinations were conducted. Unconditional logistic regression in successive models was used, adjusted for socio-demographic variables and other confounders.

RESULTS

Life satisfaction is the strongest predictor of poor perceived health in addition to country of birth, number of symptoms and depression. Being born in Sweden or other Nordic countries were related to lower OR as compared to those born outside Europe. The OR for non-depressed vs. depressed was 0.29 (0.17-0.48) and for non-symptomatic vs. symptomatic (1-3 symptoms) 0.25 (0.46-0.48). The OR and 95% CI for low satisfaction with life was 15.40 (5.28-44.97) in comparison to those who are satisfied with life.

CONCLUSION

Country of birth, depression, number of symptoms and life satisfaction are factors related significantly and independently to perceived health. Life satisfaction is the strongest predictor of perceived poor health.

Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries

BACKGROUND

Few studies have compared socioeconomic inequalities in the prevalence of both fatal and non-fatal diseases. This paper aims to give the first international overview for several common chronic diseases.

METHODS

Micro-level data were pooled from non-standardized national health surveys conducted in eight European countries in the 1990s. Surveys ranged in size from 3700 to 41 200 participants. The prevalence of 17 chronic disease groups were analysed in relation to education. Standardized prevalence rates and age-adjusted odds ratios (ORs) were calculated.

RESULTS

Most diseases showed higher prevalence among the lower education group. Stroke, diseases of the nervous system, diabetes, and arthritis displayed relatively large inequalities (OR > 1.50). No socioeconomic differences were evident for cancer, kidney diseases, and skin diseases. Allergy was more common in the higher education group. Relative socioeconomic differences were often smaller among the 60-79 age group as compared with the 25-59 age group. Cancer was more prevalent among the lower educated in the 25-59 age group, but among the higher educated in the 60-79 age group. For diabetes, hypertension, and heart disease, socioeconomic differences were larger among women as compared with men. Inequalities in heart disease were larger in northern European countries as compared with southern European countries.

CONCLUSION

There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

Trends in socioeconomic inequalities in self-assessed health in 10 European countries

BACKGROUND

Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries.

METHODS

Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs).

RESULTS

Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase.

CONCLUSIONS

The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.

Socio-economic-position overall and cause-specific mortality in an Italian rural population

STUDY OBJECTIVE

To investigate the association between socio-economic position, overall and cause-specific mortality, and risk factors in a sample of men and women in the Italian population.

DESIGN

Cohort study. MATISS Project (Malattie Aterosclerotiche Istituto Superiore di Sanità).

SETTING

Rural area, Province of Latina, Lazio, central Italy.

PARTICIPANTS

Baseline data were obtained for 8512 subjects (3982 men and 4530 women), 20-75 years of age, of whom 713 died during 11 (range 2; 15) years of follow-up. Education and occupation (used as measures of socio-economic position), smoking history, alcohol consumption, health status measures, blood pressure, plasma lipids and ECGs were collected at baseline. Linear and logistic regressions were performed to examine the association between socioeconomic position and risk factors. The hazard ratios (HRs) of all-cause, CVD and cancer mortality, according to educational level and occupational categories were computed using Cox proportional hazard models.

MAIN RESULTS

The lower social groups had a more adverse risk factors profile with the exception of smoking habit in women and HDL cholesterol in men. The risk of death in college educated men was 50% of that found for men with no formal education. The risk of cancer in the least educated was 60% higher than for highly educated men. No clear pattern was observed in women. The HRs were not substantially changed when controlling for potential confounding factors. In both men and women mortality did not vary by occupational class.

CONCLUSIONS

The association observed between education and mortality was stronger than previously reported in Italy. This may reflect changes in risk factors profile; in particular with regard to smoking habit. The effect of changes in risk factor distribution will become apparent in future mortality and morbidity patterns.

The health related quality of life of the employees in the Greek hospitals: assessing how healthy are the health workers

Background

The main aim of the study was to assess the health status and health related quality of life of the personnel of the Hellenic Network of Health Promotion Hospitals. The instrument used was SF-36. An additional aim was to contribute to the validation of the SF-36.

Methods

The study instrument was administered to 347 randomly selected employees from seven hospitals within major Athens area. Completed questionnaire were obtained by 292 employees. The statistical significance of the observed differences was tested with parametric (t-test and ANOVA) and non-parametric tests (Mann-Whitney and Kruskall-Wallis). Also, since the Greek national norms have not been published yet, the mean scores on all eight SF-36 dimensions of this study were compared with the U.S and several European national norms just to assess the extent to what there are significant differences between a Greek healthy population and the general populations of several other countries.

Results

Medical doctors and technical personnel (mostly engineers) reported better health status than nurses and administrative and auxiliary personnel; women reported poorer health status than men on all eight SF-36 dimensions; younger employees reported poorer health status than their older counterpartners. Moreover the mean scores on all SF-36 dimensions reported by the participants on this study were considerably lower than the U.S and many European national norms. Also the study results constitute an indication of the SF-36 construct validity.

Conclusion

The findings of this study show that there are major and intense health inequalities among the employees in Greek hospitals.

Social position and health in old age: the relevance of different indicators of social position

AIMS

An analysis was undertaken to investigate social inequalities in health among old men and women in relation to five indicators of social position.

METHODS

The study is based on a population-based cross-sectional survey among 748 75-year-old men and women, which was performed as clinical examinations and interviews in 1989 in Glostrup, a suburban area west of Copenhagen. Social position was measured by vocational education, occupation, social class, income, and housing tenure. Health was measured by number of chronic diseases, tiredness in relation to mobility, need of help in relation to mobility, oral health (number of teeth), and well-being (the CES-D Scale). The statistical analysis included bivariate contingency tables and logistic regression analyses.

RESULTS

Two material wealth variables (income and tenure) were consistently related to nearly all health measures while the relationships between the other social position variables and health showed no consistent patterns. Multiple logistic regression analyses with tenure and income as independent variables and each of the health variables as dependent variables and control for education and occupation showed different patterns for men and women. In men the odds ratios of housing tenure on four health variables were strong and unaffected by education and occupation while in women the odds ratios of income on three health variables were strong and unaffected by education and occupation.

CONCLUSION

This study demonstrates strong, consistent associations between variables of material wealth indicators and various measures of health among 75-year-old men and women.

The relative prevalence of disease symptoms for ill persons: evidence from Benin

In developing countries, the usual modelling of the correlates of health problems is not a good fit for the health phenomena encountered and the available data. Indeed, three common situations occur: (a) it is often the observed symptoms that are used to determine medical interventions instead of specific disease diagnostics or general health indicators; (b) the ill persons described by the data are often affected by multiple health problems; and (c) the correlates of the full spectrum of all symptoms need to be considered together. In this paper, these issues are dealt with by proposing a statistical approach based on competing scores of symptoms that explain their relative prevalence among the observed ill persons. Using multinomial logit models, the relative prevalence of four symptoms was estimated for four age classes of ill persons in Benin. Socio-demographic characteristics, household equipment and consumption behaviour are shown to influence the relative prevalence of symptoms and therefore could be used to decide what treatment to use. Moreover, living standards and economic activities are important and the pattern of symptoms among poor or agricultural ill persons differs from that of the rich or the non-peasants. The proposed method can be used to assist the definition of target groups and to guide the allocation of scarce resources in poor countries.

Health inequalities by education and age in four Nordic countries, 1986 and 1994

STUDY OBJECTIVE

To compare the age pattern of educational health inequalities in four Nordic countries in the mid-1980s and the mid-1990s.

DESIGN

Cross sectional interview surveys at two points of time.

SETTING

Data on self reported limiting longstanding illness, and perceived health were collected from Denmark, Finland, Norway, and Sweden in 1986/87 and in 1994/95.

PARTICIPANTS

Representative samples of the non-institutionalised population at 15 years or older. Analyses were restricted to respondents aged between 25 and 75 (n= 23 325 men and 24 184 women). Response rates varied from 73% to 87%.

MAIN RESULTS

The age adjusted prevalence of limiting longstanding illness in Finland was 10% higher in men and 6% higher in women than in other Nordic countries in 1986/87 but the gap narrowed by 1994/95. Educational health inequalities were largest in Norway. In 1986/87 the odds ratio (OR) for limiting longstanding illness was 11.25 (95% CI 8.66 to 14.62) among men and 8.23 (95% CI 6.60 to 10.27) among women in the oldest age group (65-74 years old) in Finland when the youngest age group (25-34 years old) was used as the reference category (OR=1.00). The age pattern in Finland was steeper than in Sweden (OR=5.02, 95% CI 3.97 to 6.34 in men and 5.29, 95% CI 4.18 to 6.71 in women) or Norway (OR=6.32, 95% CI 4.06 to 9.84 and 5.45, 95% CI 3.81 to 7.82, respectively). In 1994/95 relative health improved in the oldest age group in Finland (OR=5.80, 95% CI 4.33 to 7.78 in men and 5.94, 95% CI 4.52 to 7.79 in women) and in Norway (OR=4.55, 95% CI 3.01 to 6.88 and 3.96, 95% CI 2.70 to 5.81, respectively) but remained stable in Sweden. The study compared health differences by age in different educational categories and found that in Finland in 1986/87 the health in the oldest age group was poorer for secondary (OR=10.59, 95% CI 5.96 to 18.82) or basic educated (OR=9.76, 95% CI 6.66 to 14.30) men than for men with higher education (OR=5.15, 95% CI 2.59 to 10.22). The difference was not found among women or in other Nordic countries and it diminished among men in Finland in 1994/95. The results of perceived health were broadly similar to the above results of limiting longstanding illness.

CONCLUSION

The results suggest that compared with other Nordic countries the comparatively poorer health in Finland is partly attributable to a cohort effect. This may be associated with the lower standard of living in Finland that lasted until the mid-1950s. The cohort effect is also likely to contribute to educational health inequalities among older Finnish men. The results suggest that not only current social policies but also past economic circumstances are likely to affect the overall health status as well as health inequalities.