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Wang J, Zhao Z, Yang J, Ng M, Zhou M. The association between education and premature mortality in the Chinese population: a 10-year cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 47:101085. [PMID: 38751727 PMCID: PMC11091532 DOI: 10.1016/j.lanwpc.2024.101085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/23/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Background Recent studies have shown significant associations between education and premature mortality. However, the relationship differs across countries. We aimed to present the latest evidence on the educational inequalities in premature mortality in the Chinese population. Methods We linked two databases, to establish a population-based, ten-year cohort spanning 2010 to 2020. Cox proportional hazard regression analyses adjusting for age, sex and urbanicity were conducted for all-cause mortality, and competing risk models were fitted for cause-specific mortality. We calculated population attributable fraction (PAF) using the hazard ratios (HRs) obtained by regression analyses. Additionally, we fitted models adjusting for risk factors and investigated the mediating effect of income, smoking, alcohol consumption and diets. Findings Compared with individuals with upper secondary and above education, the HR for premature all-cause mortality for those with less than primary education was 1.93 (95% CI: 1.72-2.19). The HRs were the highest for deaths from respiratory diseases (HR = 3.09, 95% CI 1.82-5.27). The excess risk of premature mortality associated with low education was higher among women and urban population. The association of education remained significant after accounting for risk factors, and income was the main mediator, which accounted for 23.0% of mediation in men and 11.1% in women. Interpretation The study's findings support the increased risk of premature mortality associated with low education, particularly in women and urban populations. The considerable number of deaths attributed to educational inequality underscores the necessity for more effective and targeted public health interventions. Funding Chinese Central Government.
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Affiliation(s)
- Jifei Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenping Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Yang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Marie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Maigeng Zhou
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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2
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Mendoza Y, González RE. Objective and subjective measures of air pollution and self-rated health: the evidence from Chile. Int Arch Occup Environ Health 2024; 97:413-433. [PMID: 38493267 DOI: 10.1007/s00420-024-02056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/06/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The literature exploring individual differences in self-rated health has grown fast in recent years. Self-rated health (SRH) is a good indicator of general health status. This empirical study explores the association between outdoor air pollution and SRH in Chile. This type of analysis is infrequent in Latin America. METHODS We used objective and subjective air pollution measures. The first corresponds to PM2.5, and the latter to the perception of a high level of air pollution. Drawing on data from two independent and repeated nationwide surveys over the period 2006-2017 at the individual level in Chile, we performed repeated cross-sectional analyses for each year of survey application. Ordered Logit (OL) and Logit (L) multivariate models were used to investigate the association between SRH and air pollution measures, considering other socioeconomic and demographic covariates. RESULTS We found that the higher is the level of air pollution, the lower the SRH in Chile, regardless of whether air pollution is physically measured or perceived by respondents. The results were consistent over the years in the sign and significance of regression coefficients using two surveys and two forms of the outcome variable. CONCLUSIONS Our findings add evidence that air pollution is a relevant determinant of SRH. In addition, they show that subjective measures of air pollution can be as reliable as physical measures in the analysis of the association between air pollution and human health.
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Affiliation(s)
- Yenniel Mendoza
- Department of Administration and Economics, Faculty of Law and Business, Universidad de la Frontera, Temuco, Chile.
| | - Ricardo E González
- Department of Forest Sciences and Environment, Faculty of Agricultural Sciences and Environment, Universidad de la Frontera, Temuco, Chile
- Centro Nacional de Excelencia para la Industria de la Madera (CENAMAD), Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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3
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Edlibi Al Hage W, Dascălu CG, Balcoș C, Agop-Forna D, Forna NC. Trends in Access to Oral Health Care among Adults from the N-E Region of Romania. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010074. [PMID: 36676698 PMCID: PMC9863676 DOI: 10.3390/medicina59010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Aims and Objectives: To investigate the trends in access to dental services among adults from the N-E region of Romania and to evaluate the factors that influence access to dental care. Material and Methods: A self-administered questionnaire was used to evaluate the access and utilization of dental care among a sample of adults. We collected data on their demographic characteristics, their type of medical insurance, their monthly income, the type of dental office they visited, their reasons for choosing a certain type of dentist office, and their oral hygiene habits. It was found that their financial status determined by the occupation of the individual, as well as their monthly income, influenced their access to medical services. Data were analyzed using SPSS 20.0. Results: Of a total of 696 participants, 55.6% were female, 83.3% were from urban areas, 42.1% were retired, 62.3% of the subjects utilized dental emergency services, and 67.9% of the subjects self-funded their treatment. The reasons for women not attending dental offices included costs (24.3%) and dental fear (9.8%), while men's reasons were high costs (26.4%) and lack of time (5.9%). Significant differences were recorded between gender and reasons for visiting the dentist (p = 0.018), payment for dental services (p = 0.009), and preferred clinic (p = 0.010). In relation to occupation, there were significant differences for most of the variables evaluated (reasons to visit a dentist, payment for dental services, preferred dental clinic, self-rated oral health, etc.). Conclusions: Gender, occupation, and monthly income levels were found to influence access to dental medicine services of Romanians in the N-E region. Dental services were frequently accessed for emergency reasons. Dental services were found to be paid for by state insurance for those with low monthly incomes and self-funded for those with higher monthly incomes.
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Affiliation(s)
- Walid Edlibi Al Hage
- Department of Implantology, Removable Prostheses and Dental Prostheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Gena Dascălu
- Informatics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Carina Balcoș
- Department Surgery, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (C.B.); (D.A.-F.); Tel.: +004-074-553-3607 (C.B.); +004-073-411-7885 (D.A.-F.)
| | - Doriana Agop-Forna
- Department Surgery, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (C.B.); (D.A.-F.); Tel.: +004-074-553-3607 (C.B.); +004-073-411-7885 (D.A.-F.)
| | - Norina Consuela Forna
- Department of Implantology, Removable Prostheses and Dental Prostheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Sponselee HCS, ter Beek L, Renders CM, Robroek SJW, Steenhuis IHM, Kroeze W. Stakeholders' Perceptions Regarding Adaptation and Implementation of Existing Individual and Environmental Workplace Health Promotion Interventions in Blue-Collar Work Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13545. [PMID: 36294131 PMCID: PMC9603088 DOI: 10.3390/ijerph192013545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Blue-collar workers often have disadvantageous health statuses and might therefore benefit from a combination of individual and environmental workplace health promotion interventions. Exploring stakeholders' perceived facilitators and barriers regarding the combined implementation of these interventions in blue-collar work settings is important for effective implementation. A qualitative study consisting of 20 stakeholder interviews within six types of organisations in The Netherlands was conducted. The potential implementation of the evidence-based individual intervention SMARTsize and the environmental intervention company cafeteria 2.0 was discussed. Data were analysed using thematic analysis with a deductive approach. Five main themes emerged: (1) the availability of resources, (2) professional obligation, (3) expected employee cooperation, (4) the compatibility of the proposed health interventions, and (5) the content of implementation tools and procedures. Generally, stakeholders expressed a sense of professional obligation toward workplace health promotion, mentioning that the current societal focus on health and lifestyle provided the perfect opportunity to implement interventions to promote healthy eating and physical activity. However, they often perceived the high doses of employees' occupational physical activity as a barrier. We recommend co-creating interventions, implementation tools, and processes by involving stakeholders with different professional backgrounds and by adapting communication strategies at diverse organisational levels.
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Affiliation(s)
- Hanne C. S. Sponselee
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Lies ter Beek
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Suzan J. W. Robroek
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3015 GD Rotterdam, The Netherlands
| | - Ingrid H. M. Steenhuis
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
- Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, 6717 JS Ede, The Netherlands
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5
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Zhan Y, Han Y, Fang Y. Socioeconomic Disparities in Disability-Free Life Expectancy and Life Expectancy Among Older Chinese Adults From a 7-Year Prospective Cohort Study. Int J Public Health 2022; 67:1604242. [PMID: 35872709 PMCID: PMC9302194 DOI: 10.3389/ijph.2022.1604242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: We examined the magnitude and determinants of socioeconomic disparities in disability-free life expectancy and life expectancy at age 65 (DFLE65 and LE65) in China. Methods: Data from Chinese Longitudinal Healthy Longevity Survey collected during 2011–2018 (8,184 participants aged ≥65) were used. Socioeconomic status (SES) was measured by economic status (ES), and education, respectively. Multistate Markov models and microsimulations were fitted to estimate DFLE65 and LE65. Results: LE65 between high- and low-ES groups differed by 2.20 years for males and 2.04 years for females. The DFLE65 disparity in ES was 1.51 and 1.29 years for males and females, respectively. Not undergoing physical examinations, inadequate fruit/vegetable intake, and stress contributed to 35.10% and 57.36% of DFLE65 disparity in ES, as well as 26.36% and 42.65% of LE65 disparity for males and females, respectively. These disparities in education and ES were of a similar magnitude, while the above factors contributed little to education disparity. Conclusion: Socioeconomic disparities in DFLE65 and LE65 existed in China. Physical examination, fruit/vegetable intake and stress partly explained these disparities.
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Affiliation(s)
- Yuanyuan Zhan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Center for Aging and Health Research, School of Public Health, Xiamen University, Xiamen, China
| | - Yaofeng Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Center for Aging and Health Research, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Center for Aging and Health Research, School of Public Health, Xiamen University, Xiamen, China
- *Correspondence: Ya Fang,
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Nardi A, Dei Bardi L, Davoli M, Agabiti N, Cesaroni G. Differences in mortality between temporary and permanent workers: results from the Rome Longitudinal Study. BMJ Open 2022; 12:e058594. [PMID: 35641005 PMCID: PMC9157355 DOI: 10.1136/bmjopen-2021-058594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Precarious employment is characterised by instability, lack of protection and economic vulnerability. The objective of this study was to assess the association between temporary contracts and mortality. DESIGN Cohort study. SETTING Rome, Italy. PARTICIPANTS All employees, aged 25-65 years, from the Rome Longitudinal Study, followed from 21 October 2001 to the first date among death, migration from Rome, or 31 December 2015. PRIMARY AND SECONDARY OUTCOME MEASURES We investigated all-cause, cardiovascular and accidental mortality. We considered gender, age, place of birth, education, temporary versus permanent contract and sector of employment. We used Cox models to investigate the association between type of contract and total, cardiovascular and accidental mortality in men and women, overall and by employment sector. RESULTS We analysed 597 834 subjects. The proportion of temporary contracts varied by gender (9.6% in men and 13.3% in women) and by employment sector, ranging from 4.5% (public administration) to 27% (recreational, cultural, sports activities) in men. During the study period, 21 136 subjects died. Men with temporary contracts, compared with those with permanent positions, had greater overall mortality risk (HR=1.16, 95% CI 1.09 to 1.24), cardiovascular mortality (HR=1.29, 95% CI 1.14 to 1.45) and accidental mortality (HR=1.27, 95% CI 1.04 to 1.57). In men, the association varied widely among different economic sectors, with greater risks in the industry, building constructions and social services sectors. In women, there was no evidence of association between temporary contracts and mortality. A statistically significant association between temporary contracts and mortality in women was found in the sector of sales and transports only. CONCLUSIONS Temporary work should be considered a determinant of health, particularly for specific economic sectors.
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Affiliation(s)
| | - Luca Dei Bardi
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Giulia Cesaroni
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
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7
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Hamplová D, Klusáček J, Mráček T. Assessment of self-rated health: The relative importance of physiological, mental, and socioeconomic factors. PLoS One 2022; 17:e0267115. [PMID: 35436307 PMCID: PMC9015117 DOI: 10.1371/journal.pone.0267115] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 04/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The general self-rated health (SRH) question is the most common health measure employed in large population surveys. This study contributes to research on the concurrent validity of SRH using representative data with biomarkers from the Czech Republic, a population not previously used to assess the SRH measure. This work determines the relative contribution of biomedical and social characteristics to an individual's SRH assessment. Studies have already explored the associations between SRH and markers of physical health. However, according to a PubMed systematic literature search, the issue of the relative importance of physiological and psychosocial factors that affect individuals' assessments of their SRH has generally been neglected. METHODOLOGY/PRINCIPAL FINDINGS Using data from a specialized epidemiological survey of the Czech population (N = 1021), this study adopted ordinary least squares regression to analyze the extent to which variance in SRH is explained by biomedical measures, mental health, health behavior, and socioeconomic characteristics. This analysis showed that SRH variance can be largely attributed to biomedical and psychological measures. Socioeconomic characteristics (i.e. marital status, education, economic activity, and household income) contributed to around 5% of the total variance. After controlling for age, sex, location, and socioeconomic status, biomarkers (i.e. C-reactive protein, blood glucose, triglyceride, low-density lipoprotein, and high-density lipoprotein), number of medical conditions, and current medications explained 11% of the total SRH variance. Mental health indicators contributed to an additional 9% of the variance. Body mass index and health behaviors (i.e. smoking and alcohol consumption) explained less than 2% of the variance. CONCLUSIONS/SIGNIFICANCE The results suggested that SRH was a valid measure of physiological and mental health in the Czech sample, and the observed differences were likely to have reflected inequalities in bodily and mental functions between social groups.
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Affiliation(s)
- Dana Hamplová
- Institute of Sociology, The Czech Academy of Sciences, Prague, Czech Republic
| | - Jan Klusáček
- Institute of Sociology, The Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Mráček
- Institute of Physiology, The Czech Academy of Sciences, Prague, Czech Republic
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8
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He L, Zhang Z, Wang J, Wang Y, Li T, Yang T, Liu T, Wu Y, Zhang S, Zhang S, Yang H, Wang K. Effects of Serving as a State Functionary on Self-Rated Health: Empirical Evidence From China. Front Public Health 2022; 10:757036. [PMID: 35433593 PMCID: PMC9012441 DOI: 10.3389/fpubh.2022.757036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/24/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose There is a strong link between occupation and self-rated health. Existing research has revealed the effects of occupation on self-rated health outcomes and the corresponding mechanisms. However, there is a lack of research on the effects of state services on self-rated health in China. Therefore, this study focuses on exploring the effects of serving as a state functionary in China on self-rated health to enrich research in related fields. Method Based on the data of 14,138 individuals collected from the 2016 China Labour-Force Dynamics Survey, the logit model was used to investigate the effects of serving as a state functionary on self-rated health and the difference in the effects across different populations. Results The results show that (1) serving as a state functionary has a significant positive effect on self-rated health; (2) self-rated health of elderly state functionaries is higher than that of younger state functionaries; (3) self-rated health of state functionaries in non-eastern regions is higher than that of state functionaries in eastern regions; and (4) state functionaries with lower education have higher self-rated health than highly-educated state functionaries; (5) Higher self-rated health of state functionaries is achieved primarily through better work time, better work environment and lower relative deprivation. Conclusion Serving as a state functionary in China has a significant positive correlation with self-rated health, with differences across populations of state functionaries. This study expands the current literature on the effects of occupation on self-rated health in the context of China.
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Affiliation(s)
- Li He
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
| | - Zixian Zhang
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
| | - Jiangyin Wang
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
| | - Yuting Wang
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
| | - Tianyang Li
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
| | - Tianyi Yang
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
| | - Tianlan Liu
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
| | - Yuanyang Wu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Shuo Zhang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Siqing Zhang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Hualei Yang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Kun Wang
- School of Philosophy, Zhongnan University of Economics and Law, Wuhan, China
- *Correspondence: Kun Wang
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9
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Jones DP, Wootton RE, Gill D, Carter AR, Gunnell D, Munafò MR, Sallis HM. Mental Health as a Mediator of the Association Between Educational Inequality and Cardiovascular Disease: A Mendelian Randomization Study. J Am Heart Assoc 2021; 10:e019340. [PMID: 34472355 PMCID: PMC8649303 DOI: 10.1161/jaha.120.019340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Education is inversely associated with cardiovascular disease (CVD). Several mediators of this have been established; however, a proportion of the protective effect remains unaccounted for. Mental health is a proposed mediator, but current evidence is mixed and subject to bias from confounding factors and reverse causation. Mendelian randomization is an instrumental variable technique that uses genetic proxies for exposures and mediators to reduce such bias. Methods and Results We performed logistic regression and 2‐step Mendelian randomization analyses using UK Biobank data and genetic summary statistics to investigate whether educational attainment affects risk of mental health disorders. We then performed mediation analyses to explore whether mental health disorders mediate the association between educational attainment and cardiovascular risk. Higher levels of educational attainment were associated with reduced depression, anxiety, and CVD in observational analyses (odds ratio [OR], 0.79 [95% CI, 0.77–0.81], 0.76 [95% CI, 0.73–0.79], and 0.75 [95% CI, 0.74–0.76], respectively), and Mendelian randomization analyses provided evidence of causality (OR, 0.72 [95% CI, 0.67–0.77], 0.50 [95% CI, 0.42–0.59], and 0.62 [95% CI, 0.58–0.66], respectively). Both anxiety and depression were associated with CVD in observational analyses (OR, 1.63 [95% CI, 1.49–1.79] and 1.70 [95% CI, 1.59–1.82], respectively) but only depression showed evidence of causality in the Mendelian randomization analyses (OR, 1.09; 95% CI, 1.03–1.15). An estimated 2% of the total protective effect of education on CVD was mediated by depression. Conclusions Higher levels of educational attainment protect against mental health disorders, and reduced depression accounts for a small proportion of the total protective effect of education on CVD.
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Affiliation(s)
- Daniel P Jones
- Department of Population Health Sciences Bristol Medical School University of Bristol UK.,Division of Population Medicine School of MedicineCardiff University UK
| | - Robyn E Wootton
- Department of Population Health Sciences Bristol Medical School University of Bristol UK.,MRC Integrative Epidemiology Unit University of BristolOakfield House Bristol UK
| | - Dipender Gill
- Department of Epidemiology and Biostatistics Imperial College London London UK.,Clinical Pharmacology and Therapeutics Section Institute of Medical and Biomedical Education and Institute for Infection and Immunity St George'sUniversity of London UK
| | - Alice R Carter
- Department of Population Health Sciences Bristol Medical School University of Bristol UK.,MRC Integrative Epidemiology Unit University of BristolOakfield House Bristol UK
| | - David Gunnell
- Department of Population Health Sciences Bristol Medical School University of Bristol UK.,NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation TrustUniversity of Bristol UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit University of BristolOakfield House Bristol UK.,NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation TrustUniversity of Bristol UK.,School of Psychological Science University of Bristol UK
| | - Hannah M Sallis
- Department of Population Health Sciences Bristol Medical School University of Bristol UK.,MRC Integrative Epidemiology Unit University of BristolOakfield House Bristol UK.,School of Psychological Science University of Bristol UK.,Centre for Academic Mental HealthPopulation Health SciencesBristol Medical SchoolUniversity of Bristol UK
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10
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Nusselder WJ, Rubio Valverde J, Bopp M, Brønnum-Hansen H, Deboosere P, Kalediene R, Kovács K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, Wojtyniak B, Mackenbach JP. Determinants of inequalities in years with disability: an international-comparative study. Eur J Public Health 2021; 31:527-533. [PMID: 33221840 PMCID: PMC8277222 DOI: 10.1093/eurpub/ckaa194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father’s manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption. Methods We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010–14 for most countries. We calculated years with disability between the ages of 35 and 80 by education and gender using the Sullivan method, and determined the hypothetical effect of changing the prevalence of each risk factor to the prevalence observed among high educated (‘upward levelling scenario’), using Population Attributable Fractions. Results Years with disability among low educated were higher than among high educated, with a difference of 4.9 years among men and 5.5 years among women for all countries combined. Most risk factors were more prevalent among low educated. We found the largest contributions to inequalities in years with disability for low income (men: 1.0 year; women: 1.4 year), high body-weight (men: 0.6 year; women: 1.2 year) and father’s manual occupation (men: 0.7 year; women: 0.9 year), but contributions differed by country. The contribution of smoking was relatively small. Conclusions Disadvantages in material circumstances (low income), circumstances during childhood (father’s manual occupation) and high body-weight contribute to inequalities in years with disability.
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Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - José Rubio Valverde
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Henrik Brønnum-Hansen
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ramune Kalediene
- Department of Health Management. Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katalin Kovács
- Aging and health. Demographic Research Institute, Budapest, Hungary
| | - Mall Leinsalu
- Department of Sociology. Stockholm Centre for Health and Social Change, Södertörn University, Stockholm, Sweden.,Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,CCIBER Epidemiología y Salud Pública, Instituto Salud Carlos III, Madrid, Spain
| | - Bodgan Wojtyniak
- Department of Population Health Monitoring and Analysis. National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Mawhorter S, Crimmins EM, Ailshire JA. Housing and Cardiometabolic Risk Among Older Renters and Homeowners. HOUSING STUDIES 2021; 38:1342-1364. [PMID: 37849684 PMCID: PMC10578645 DOI: 10.1080/02673037.2021.1941792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/14/2021] [Accepted: 06/02/2021] [Indexed: 10/19/2023]
Abstract
Scholars consistently find that renters have poorer health outcomes when compared with homeowners. Health disparities between renters and homeowners likely widen over the life course, yet few studies have examined this link among older adults, and the connection is not fully understood. Homeowners' relative socioeconomic advantage may explain their better health; renters also more commonly experience adverse housing conditions and financial challenges, both of which can harm health. In this paper, we analyze the extent to which socioeconomic advantage, housing conditions, and financial strain explain the relationship between homeownership and health among adults over age 50, using Health and Retirement Study 2010/2012 data to assess cardiometabolic risk levels using biomarkers for inflammation, cardiovascular health, and metabolic function. We find that people living with poor housing conditions and financial strain have higher cardiometabolic risk levels, even taking socioeconomic advantage into account. This analysis sheds light on the housing-related health challenges of older adults, especially older renters.
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Affiliation(s)
- Sarah Mawhorter
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Eileen M. Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Jennifer A. Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
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12
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Granström F, Garvin P, Molarius A, Kristenson M. Distinguishing independent and shared effects of material/structural conditions and psychosocial resources on educational inequalities in self-rated health: results from structural equation modelling. Public Health 2021; 196:10-17. [PMID: 34129915 DOI: 10.1016/j.puhe.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/12/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to distinguish independent and shared effects of material/structural factors and psychosocial resources in explaining educational inequalities in self-rated health (SRH) by using structural equation modelling. STUDY DESIGN Cross-sectional survey. METHODS Data were derived from a questionnaire sent to a random sample of the population in five counties in Sweden in 2008. The study population (aged 25-75 years) included 15,099 men and 17,883 women. Exploratory structural equation modelling was used to analyse the pathways from educational level to SRH. RESULTS The pathway including both material/structural factors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. sense of coherence and social participation) explained about 40% of educational differences in SRH for both men and women. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the differences. CONCLUSIONS The major pathway explaining educational inequalities in SRH included both material/structural factors and psychosocial resources. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources across educational groups.
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Affiliation(s)
- F Granström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
| | - P Garvin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
| | - A Molarius
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden; Department of Public Health, Karlstad University, Karlstad, Sweden
| | - M Kristenson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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13
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Schram JL, Oude Groeniger J, Schuring M, Proper KI, van Oostrom SH, Robroek SJ, Burdorf A. Working conditions and health behavior as causes of educational inequalities in self-rated health: an inverse odds weighting approach. Scand J Work Environ Health 2021; 47:127-135. [PMID: 32815549 PMCID: PMC8114570 DOI: 10.5271/sjweh.3918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Using a novel mediation method that presents unbiased results even in the presence of exposure–mediator interactions, this study estimated the extent to which working conditions and health behaviors contribute to educational inequalities in self-rated health in the workforce. Methods: Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 16 countries were selected, aged 50–64 years, in paid employment at baseline and with information on education and self-rated health (N=15 028). Education, health behaviors [including body mass index (BMI)] and working conditions were measured at baseline and self-rated health at baseline and two-year follow-up. Causal mediation analysis with inverse odds weighting was used to estimate the total effect of education on self-rated health, decomposed into a natural direct effect (NDE) and natural indirect effect (NIE). Results: Lower educated workers were more likely to perceive their health as poor than higher educated workers [relative risk (RR) 1.48, 95% confidence interval (CI) 1.37–1.60]. They were also more likely to have unfavorable working conditions and unhealthy behaviors, except for alcohol consumption. When all working conditions were included, the remaining NDE was RR 1.30 (95% CI 1.15–1.44). When BMI and health behaviors were included, the remaining NDE was RR 1.40 (95% CI 1.27–1.54). Working conditions explained 38% and health behaviors and BMI explained 16% of educational inequalities in health. Including all mediators explained 64% of educational inequalities in self-rated health. Conclusions: Working conditions and health behaviors explain over half of the educational inequalities in self-rated health. To reduce health inequalities, improving working conditions seems to be more important than introducing health promotion programs in the workforce.
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Affiliation(s)
- Jolinda Ld Schram
- Department of Public Health, Erasmus Medical Centre, Rotterdam 3000 CA, The Netherlands.
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14
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Pedrós Barnils N, Eurenius E, Gustafsson PE. Self-rated health inequalities in the intersection of gender, social class and regional development in Spain: exploring contributions of material and psychosocial factors. Int J Equity Health 2020; 19:85. [PMID: 32503650 PMCID: PMC7275574 DOI: 10.1186/s12939-020-01202-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Inequalities in health across social class, gender and regional context in Spain are well-known; however, there is a lack of research examining how these dimensions of inequality interact. This study explores self-rated health (SRH) inequalities across intersectional positions of gender, social class and region, and the contribution of material and psychosocial factors to these inequalities. Methods Participants were drawn from the cross-sectional 2015 National Living Conditions Survey of Spanish residents aged 19–88 years (N = 27,215; 77% response rate). Eight intersectional positions were formed by combining dichotomous variables of gender, social class and regional development. Poisson regression was used to estimate intersectional inequalities in SRH as prevalence ratios, and the contributions of material and psychosocial factors. Results Results showed both cumulative and heterogeneous inequalities within and across intersectional positions. Inequalities in the intersection of social class and regional development were best explained by the joint contributions of material and psychosocial factors, while gender inequalities within non-manual social class were better explained by material factors alone. Conclusions The results illustrate the complexity of interacting inequalities in health and their underpinnings in Spain. Local and national policies taking this complexity into account are needed to broadly improve equity in health in Spain.
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Affiliation(s)
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
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Bedoya-Pacheco SJ, Emygdio RF, Nascimento JASD, Bravo JAM, Bozza FA. Intensive care inequity in Rio de Janeiro: the effect of spatial distribution of health services on severe acute respiratory infection. Rev Bras Ter Intensiva 2020; 32:72-80. [PMID: 32401976 PMCID: PMC7206958 DOI: 10.5935/0103-507x.20200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To analyze the distribution of adult intensive care units according to geographic region and health sector in Rio de Janeiro and to investigate severe acute respiratory infection mortality in the public sector and its association with critical care capacity in the public sector. METHODS We evaluated the variation in intensive care availability and severe acute respiratory infection mortality in the public sector across different areas of the city in 2014. We utilized databases from the National Registry of Health Establishments, the Brazilian Institute of Geography and Statistics, the National Mortality Information System and the Hospital Admission Information System. RESULTS There is a wide range of intensive care unit beds per capita (from 4.0 intensive care unit beds per 100,000 people in public hospitals in the West Zone to 133.6 intensive care unit beds per 100,000 people in private hospitals in the Center Zone) in the city of Rio de Janeiro. The private sector accounts for almost 75% of the intensive care unit bed supply. The more developed areas of the city concentrate most of the intensive care unit services. Map-based spatial analysis shows a lack of intensive care unit beds in vast territorial extensions in the less developed regions of the city. There is an inverse correlation (r = -0.829; 95%CI -0.946 to -0.675) between public intensive care unit beds per capita in different health planning areas of the city and severe acute respiratory infection mortality in public hospitals. CONCLUSION Our results show a disproportionate intensive care unit bed provision across the city of Rio de Janeiro and the need for a rational distribution of intensive care.
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Affiliation(s)
- Sandro Javier Bedoya-Pacheco
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Romeu Ferreira Emygdio
- Coordenação de Recursos Naturais e Estudos Ambientais, Instituto Brasileiro de Geografia e Estatística, Rio de Janeiro, RJ, Brasil
| | | | | | - Fernando Augusto Bozza
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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16
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de Breij S, Qvist JY, Holman D, Mäcken J, Seitsamo J, Huisman M, Deeg DJH. Educational inequalities in health after work exit: the role of work characteristics. BMC Public Health 2019; 19:1515. [PMID: 31718592 PMCID: PMC6852931 DOI: 10.1186/s12889-019-7872-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background Educational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health. Methods Data from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities. Results The low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries. Conclusion Educational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.
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Affiliation(s)
- Sascha de Breij
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081, HV, Amsterdam, the Netherlands.
| | - Jeevitha Yogachandiran Qvist
- Centre for Comparative Welfare Studies, Department of Politics and Society, Aalborg University, Fibigerstræde 1 88a, 9220, Aalborg, Denmark
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, S10 2TU, UK
| | - Jana Mäcken
- Institute of Sociology and Social Psychology, University of Cologne, Universitätsstr. 22a, 50937, Cologne, Germany
| | - Jorma Seitsamo
- Department of Work Ability and Working Careers, Finnish Institute of Occupational Health, Topeliuksenkatu 41b, FI-00250, Helsinki, Finland
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081, HV, Amsterdam, the Netherlands.,Department of Sociology, VU University Amsterdam, De Boelelaan, 1081, HV, Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081, HV, Amsterdam, the Netherlands
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Mackenbach JP, Valverde JR, Bopp M, Brønnum-Hansen H, Deboosere P, Kalediene R, Kovács K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, Nusselder WJ. Determinants of inequalities in life expectancy: an international comparative study of eight risk factors. LANCET PUBLIC HEALTH 2019; 4:e529-e537. [DOI: 10.1016/s2468-2667(19)30147-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
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18
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Wachtler B, Hoebel J, Lampert T. Trends in socioeconomic inequalities in self-rated health in Germany: a time-trend analysis of repeated cross-sectional health surveys between 2003 and 2012. BMJ Open 2019; 9:e030216. [PMID: 31562151 PMCID: PMC6773326 DOI: 10.1136/bmjopen-2019-030216] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/16/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study assessed the extent of educational and income inequalities in self-rated health (SRH) in the German adult population between 2003 and 2012 and how these inequalities changed over time. DESIGN Repeated cross-sectional health interview surveys conducted in 2003, 2009, 2010 and 2012. SETTING AND PARTICIPANTS The study population was the German adult population aged 25-69, living in private households in Germany. In total 54 197 randomly selected participants (2003: 6890; 2009: 16 418; 2010: 17 145; 2012: 13 744) were included. MAIN OUTCOME MEASURES SRH was assessed with one single question. Five answer categories were dichotomised into good ('very good' and 'good') versus poor ('moderate', 'poor', 'very poor') SRH. To estimate the extent of the correlation between absolute and relative inequalities in SRH on the one hand, and income and education on the other; slope indices of inequality (SII) and relative indices of inequality (RII) were estimated using linear probability and log-binomial regression models. RESULTS There were considerable and persisting educational and income inequalities in SRH in every survey year. Absolute educational inequalities were largely stable (2003: SII=0.25, 95% CI 0.21 to 0.30; 2012: 0.29, 95% CI 0.25 to 0.33; p trend=0.359). Similarly, absolute income inequalities were stable (2003: SII=0.22, 95% CI 0.17 to 0.27; 2012: SII=0.26, 95% CI 0.22 to 0.30; p trend=0.168). RII by education (2003: 2.53, 95% CI 2.11 to 3.03; 2012: 2.72, 95% CI 2.36 to 3.13; p trend=0.531) and income (2003: 2.09. 95% CI 1.75 to 2.49; 2012: 2.53, 95% CI 2.19 to 2.92; p trend=0.051) were equally stable over the same period. CONCLUSIONS We found considerable and persisting absolute and relative socioeconomic inequalities in SRH in the German adult population between 2003 and 2012, with those in lower socioeconomic position reporting poorer SRH. These findings should be a concern for both public health professionals and political decision makers.
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Affiliation(s)
- Benjamin Wachtler
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Jens Hoebel
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
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Bilal U, Cainzos-Achirica M, Cleries M, Santaeugènia S, Corbella X, Comin-Colet J, Vela E. Socioeconomic status, life expectancy and mortality in a universal healthcare setting: An individual-level analysis of >6 million Catalan residents. Prev Med 2019; 123:91-94. [PMID: 30853378 DOI: 10.1016/j.ypmed.2019.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 01/29/2023]
Abstract
We evaluated the association between individual-level socioeconomic status (SES), life expectancy, and mortality, in adult men and women from the general population living in Catalonia, a universal healthcare coverage setting. We used the Catalan Health Surveillance System database, which includes individual-level information on sociodemographic characteristics and mortality for all residents of Catalonia (Spain). We categorized individuals as high, medium, low or very low SES based on annual personal income and welfare receipt. We used 2016 mortality data to estimate life expectancy at age 18, and the probability of death by age, sex and SES categories. We followed a total of 6,027,424 Catalan residents in 2016. Men and women of very low SES had 12.0 and 9.4 years lower life expectancy compared to men and women of high SES, respectively. Low SES was also strongly associated with mortality in both men and women of any age. In the entire adult population of Catalonia, despite the availability of universal, high quality healthcare coverage, low SES is associated with lower life expectancy and higher mortality. Solutions to these large inequalities may combine tailored health promotion and management interventions, with solutions coming from outside of the health sector.
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Affiliation(s)
- Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Miguel Cainzos-Achirica
- Pla Director de Malalties de l'Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Catalonia, Spain; Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Montse Cleries
- Healthcare Information and Knowledge Unit, Health Department of the Government of Catalonia, Spain
| | - Sebastià Santaeugènia
- Chronicity Prevention and Care Programme, Health Department of the Government of Catalonia, Spain; Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic, Vic, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comin-Colet
- Pla Director de Malalties de l'Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Catalonia, Spain; Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Health Department of the Government of Catalonia, Spain
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Wellappuli N, Ekanayake L. Role of oral health‐related behaviors in education inequalities in chronic periodontitis among Sri Lankan men. ACTA ACUST UNITED AC 2019; 10:e12416. [DOI: 10.1111/jicd.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/05/2018] [Accepted: 02/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nimali Wellappuli
- Office of the Provincial Director of Health ServicesColombo Sri Lanka
| | - Lilani Ekanayake
- Department of Community Dental Health Faculty of Dental Sciences University of Peradeniya Peradeniya Sri Lanka
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Bania EV, Eckhoff C, Kvernmo S. Not engaged in education, employment or training (NEET) in an Arctic sociocultural context: the NAAHS cohort study. BMJ Open 2019; 9:e023705. [PMID: 30904841 PMCID: PMC6475364 DOI: 10.1136/bmjopen-2018-023705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The purpose of the study is to explore the prevalence and predictors of not engaged in education, employment or training (NEET) status in a multicultural young adult population in Northern Norway. DESIGN AND SETTING The longitudinal design link a self-reported survey (2003-2005) with an objective registry linkage follow-up 8-10 years later. PARTICIPANTS Of all 5877 tenth graders (aged 15-16 years) in Northern Norway, 83% of the total age cohort from all 87 municipalities participated in the baseline survey. The follow-up studies consisted of 3987 consent giving adolescents (68%), were 365 (9.2%) reported indigenous Sami ethnicity. OUTCOME MEASURES Youth NEET at the age of 23-25 years. METHODS Explanatory variables were sociodemographic factors (gender, ethnicity, residency, parental education), mental health problems and musculoskeletal pain in adolescence. Outcome variable characterised as NEET-status was defined by no educational engagement, long-term recipient of sickness benefit, medical and non-medical benefit receipt or long-term unemployment. RESULTS NEET-status in young adulthood was significantly higher among females (20.9%) than among males (16.2%). Ethnic differences occurred as being NEET among Sami males was significantly higher than among non-Sami males, 23.0% and 15.2% respectively. Minority Sami females experienced NEET-status to a lower degree (16.6%) than non-Sami females (20.8%). Among females adolescent peer problems (adjusted OR=1.09) and hyperactivity problems (adjusted OR=1.10) were associated with later NEET-status. Peer problems (adjusted OR=1.23), conduct problems (adjusted OR=1.17) and musculoskeletal problems (adjusted OR=1.15) in male adolescents were associated with later NEET-status, whereas emotional problems among males predicted significantly less later NEET- status (adjusted OR=0.88).We found lower parental education to be significantly associated with being NEET-later in young adults (females: adjusted OR=2.11, males: adjusted OR=3.22). CONCLUSIONS To address the disengagement of education and work, particular emphasis must be placed on supporting young people struggling with mental and physical health problems.
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Affiliation(s)
| | - Christian Eckhoff
- Child and Adolescent Psychiatry, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Siv Kvernmo
- Child and Adolescent Psychiatry, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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22
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Siegrist J, Wahrendorf M, Goldberg M, Zins M, Hoven H. Is effort-reward imbalance at work associated with different domains of health functioning? Baseline results from the French CONSTANCES study. Int Arch Occup Environ Health 2018; 92:467-480. [PMID: 30406331 DOI: 10.1007/s00420-018-1374-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/28/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite its importance a comprehensive assessment of health functioning has rarely been included in epidemiological investigations of work-related health outcomes. In this study, we analyzed associations of a health-adverse psychosocial work environment with a comprehensive set of subjective and objective measures of health functioning that cover the three domains of affective, cognitive, and physical functioning. METHODS Baseline data from the French CONSTANCES cohort study were used with a sample of 24,327 employed men and women aged 45-60. Psychosocial work environment was measured by the short version of the effort-reward imbalance (ERI) questionnaire. Measures of health functioning were depressive symptoms, semantic fluency, verbal memory, walking speed, standing balance and lung function. RESULTS First, we replicated main psychometric properties of the ERI questionnaire in the French cohort. Second, ERI scales revealed consistent associations with depressive symptoms, but less consistent links to cognitive and physical function. Among men, we observed an association of stressful work with reduced lung function. CONCLUSIONS This study demonstrated consistent associations of stressful work in terms of effort-reward imbalance with affective functioning in a large sample of male and female employees. Relationships with physical functioning were less consistent and restricted to men, and cognitive functioning was only marginally associated with stressful work. We also established the psychometric properties of the French short version of the ERI questionnaire, thus offering a tool for guiding and harmonizing further research in this field.
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Affiliation(s)
- Johannes Siegrist
- Senior Professorship on Work Stress Research, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Marcel Goldberg
- INSERM UMS 11, Paris, France
- Paris Descartes University, Paris, France
| | - Marie Zins
- INSERM UMS 11, Paris, France
- Paris Descartes University, Paris, France
| | - Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
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van Hedel K, van Lenthe FJ, Oude Groeniger J, Mackenbach JP. What's the difference? A gender perspective on understanding educational inequalities in all-cause and cause-specific mortality. BMC Public Health 2018; 18:1105. [PMID: 30200912 PMCID: PMC6131918 DOI: 10.1186/s12889-018-5940-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Material and behavioural factors play an important role in explaining educational inequalities in mortality, but gender differences in these contributions have received little attention thus far. We examined the contribution of a range of possible mediators to relative educational inequalities in mortality for men and women separately. Methods Baseline data (1991) of men and women aged 25 to 74 years participating in the prospective Dutch GLOBE study were linked to almost 23 years of mortality follow-up from Dutch registry data (6099 men and 6935 women). Cox proportional hazard models were used to calculate hazard ratios with 95% confidence intervals, and to investigate the contribution of material (financial difficulties, housing tenure, health insurance), employment-related (type of employment, occupational class of the breadwinner), behavioural (alcohol consumption, smoking, leisure and sports physical activity, body mass index) and family-related factors (marital status, living arrangement, number of children) to educational inequalities in all-cause and cause-specific mortality, i.e. mortality from cancer, cardiovascular disease, other diseases and external causes. Results Educational gradients in mortality were found for both men and women. All factors together explained 62% of educational inequalities in mortality for lowest educated men, and 71% for lowest educated women. Yet, type of employment contributed substantially more to the explanation of educational inequalities in all-cause mortality for men (29%) than for women (− 7%), whereas the breadwinner’s occupational class contributed more for women (41%) than for men (7%). Material factors and employment-related factors contributed more to inequalities in mortality from cardiovascular disease for men than for women, but they explained more of the inequalities in cancer mortality for women than for men. Conclusions Gender differences in the contribution of employment-related factors to the explanation of educational inequalities in all-cause mortality were found, but not of material, behavioural or family-related factors. A full understanding of educational inequalities in mortality benefits from a gender perspective, particularly when considering employment-related factors. Electronic supplementary material The online version of this article (10.1186/s12889-018-5940-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen van Hedel
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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Factors Associated with the Separate and Concurrent Experiences of Food and Housing Insecurity Among Women Living with HIV in Canada. AIDS Behav 2018; 22:3100-3110. [PMID: 29679243 DOI: 10.1007/s10461-018-2119-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
People living with HIV are disproportionately affected by food and housing insecurity. We assessed factors associated with experiencing food and/or housing insecurity among women living with HIV (WLHIV) in Canada. In our sample of WLHIV (N = 1403) 65% reported an income less than $20,000 per year. Most (78.69%) participants reported food and/or housing insecurity: 27.16% reported experiencing food insecurity alone, 14.26% reported housing insecurity alone, and 37.28% reported experiencing food and housing insecurity concurrently. In adjusted multivariable logistic regression analyses, experiencing concurrent food and housing insecurity was associated with: lower income, Black ethnicity versus White, province of residence, current injection drug use, lower resilience, HIV-related stigma, and racial discrimination. Findings underscore the urgent need for health professionals to assess for food and housing insecurity, to address the root causes of poverty, and for federal policy to allocate resources to ameliorate economic insecurity for WLHIV in Canada.
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Schmitz AL, Pförtner TK. Health inequalities in old age: the relative contribution of material, behavioral and psychosocial factors in a German sample. J Public Health (Oxf) 2018; 40:e235-e243. [PMID: 29294096 DOI: 10.1093/pubmed/fdx180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Indexed: 01/28/2023] Open
Abstract
Background Whereas the association between education and health in later life is well described, investigations about the underlying mechanisms of these health inequalities are scarce. This study examines the relative contribution of material, behavioral and psychosocial factors to health inequalities in older Germans. Methods Data were drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analytic sample included 3246 participants aged 60-85 years. We examined the independent and indirect contribution of material, behavioral and psychosocial factors to the association between education and self-rated health based on logistic regression models. Results Material factors were most important as they were additionally working through behavioral and psychosocial factors whereas the independent contribution of behavioral and psychosocial factors was much lower than suggested in the separate analyses of the three explanatory pathways. Conclusions Policy interventions that focus on the improvement of material living conditions might reduce health inequalities in old age. In studies on the underlying mechanisms of health inequalities, material, behavioral and psychosocial factors should be modeled as inter-related predictors as the separate analysis does not reveal their actual contribution so that the relevance of single explanatory pathways might be overestimated.
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Affiliation(s)
- A L Schmitz
- The Institute for Social Research and Social Policy, Cologne, Germany
| | - T-K Pförtner
- Faculty of Human Sciences and Faculty of Medicine, The Institute of Medical Sociology Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
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Stolz E, Mayerl H, Waxenegger A, Freidl W. Explaining the impact of poverty on old-age frailty in Europe: material, psychosocial and behavioural factors. Eur J Public Health 2018; 27:1003-1009. [PMID: 29020312 DOI: 10.1093/eurpub/ckx079] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Previous research found poverty to be associated with adverse health outcomes among older adults but the factors that translate low economic resources into poor physical health are not well understood. The goal of this analysis was to assess the impact of material, psychosocial, and behavioural factors as well as education in explaining the poverty-health link. Methods In total, 28 360 observations from 11 390 community-dwelling respondents (65+) in the Survey of Health, Ageing and Retirement in Europe (2004-13, 10 countries) were analysed. Multilevel growth curve models were used to assess the impact of combined income and asset poverty risk on old-age frailty (frailty index) and associated pathway variables. Results In total, 61.8% of the variation of poverty risk on frailty level was explained by direct and indirect effects. Results stress the role of material and particularly psychosocial factors such as perceived control and social isolation, whereas the role of health behaviour was negligible. Conclusion We suggest to strengthen social policy and public health efforts in order to fight poverty and its deleterious health effects from early age on as well as to broaden the scope of interventions with regard to psychosocial factors.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Anja Waxenegger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
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Moor I, Günther S, Knöchelmann A, Hoebel J, Pförtner TK, Lampert T, Richter M. Educational inequalities in subjective health in Germany from 1994 to 2014: a trend analysis using the German Socio-Economic Panel study (GSOEP). BMJ Open 2018; 8:e019755. [PMID: 29884694 PMCID: PMC6009455 DOI: 10.1136/bmjopen-2017-019755] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION As trend studies have shown, health inequalities by income and occupation have widened or remained stable. However, research on time trends in educational inequalities in health in Germany is scarce. The aim of this study is to analyse how educational inequalities in health evolved over a period of 21 years in the middle-aged population in Germany, and whether the trends differ by gender. METHODS Data were obtained from the German Socio-Economic Panel covering the period from 1994 to 2014. In total, n=16 339 participants (106 221 person years) aged 30-49 years were included in the study sample. Educational level was measured based on the 'Comparative Analysis of Social Mobility in Industrial Nations' (CASMIN) classification. Health outcomes were self-rated health (SRH) as well as (mental and physical) health-related quality of life (HRQOL, SF-12v2). Absolute Index of Inequality (Slope Index of Inequality (SII)) and Relative Index of Inequality (RII) were calculated using linear and logarithmic regression analyses with robust SEs. RESULTS Significant educational inequalities in SRH and physical HRQOL were found for almost every survey year from 1994 to 2014. Relative inequalities in SRH ranged from 1.50 to 2.10 in men and 1.25 to 1.87 in women (RII). Regarding physical HRQOL, the lowest educational group yielded 4.5 to 6.6 points (men) and 3.3 to 6.1 points (women) lower scores (SII). Although educational level increased over time, absolute and relative health inequalities remained largely stable over the last 21 years. For mental HRQOL, only few educational inequalities were found. DISCUSSION This study found persistent educational inequalities in SRH and physical HRQOL among adults in Germany from 1994 to 2014. Our findings highlight the need to intensify efforts in social and health policies to tackle these persistent inequalities.
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Affiliation(s)
- Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Sebastian Günther
- Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Anja Knöchelmann
- Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Jens Hoebel
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Lampert
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany
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Balaj M, McNamara CL, Eikemo TA, Bambra C. The social determinants of inequalities in self-reported health in Europe: findings from the European social survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:107-114. [PMID: 28355634 DOI: 10.1093/eurpub/ckw217] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Health inequalities persist between and within European countries. Such inequalities are usually explained by health behaviours and according to the conditions in which people work and live. However, little is known about the relative contribution of these factors to health inequalities in European countries. This paper aims to investigate the independent and joint contribution of a comprehensive set of behavioural, occupational and living conditions factors in explaining social inequalities in self-rated health (SRH). Method Data from 21 countries was obtained from the 2014 European Social Survey and examined for respondents aged 25-75. Adjusted rate differences (ARD) and adjusted rate risks (ARR), generated from binary logistic regression models, were used to measure health inequalities in SRH and the contribution of behavioural, occupational and living conditions factors. Result Absolute and relative inequalities in SRH were found in all countries and the magnitude of socio-economic inequalities varied considerably between countries. While factors were found to differentially contribute to the explanation of educational inequalities in different European countries, occupational and living conditions factors emerged as the leading causes of inequalities across most of the countries, contributing both independently and jointly with behavioural factors. Conclusion The observed shared effects of different factors to health inequalities points to the interdependent nature of occupational, behavioural and living conditions factors. Tackling health inequalities should be a concentred effort that goes beyond interventions focused on single factors.
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Affiliation(s)
- 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
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Sonoda C, Fukuda H, Kitamura M, Hayashida H, Kawashita Y, Furugen R, Koyama Z, Saito T. Associations among Obesity, Eating Speed, and Oral Health. Obes Facts 2018; 11:165-175. [PMID: 29669358 PMCID: PMC5981670 DOI: 10.1159/000488533] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/17/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study was conducted to understand how eating speed and oral health condition are associated with obesity in Japanese working men. METHODS We studied a total of 863 men attending an annual medical checkup of the Japanese Maritime Self Defense Force in Sasebo City, Japan. Participants answered a questionnaire about their eating speed, and we examined their anthropometric status in terms of BMI, waist circumference, and oral health condition, especially periodontal disease and number of functional teeth. Multivariate logistic regression analyses adjusting for potential confounding variables were performed. RESULTS The multivariate-adjusted odds ratio for waist circumference greater than 90 cm of the 'very fast' group compared to the 'slow, very slow' group was 5.22 (95% confidence interval 1.81-15.06) after adjusting for potential confounding factors. Individuals were more likely to have waist circumference greater than 90 cm if they had a larger 'number of missing functional teeth' (odds ratio 1.14; 95% confidence interval 1.01-1.28) and severe periodontal disease (odds ratio 2.74; 95% confidence interval, 1.46-5.13). CONCLUSION Eating speed, the number of missing functional teeth, and severe periodontal disease are associated independently with larger waist circumference.
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Affiliation(s)
- Chikanobu Sonoda
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Japan Maritime Self-Defense Force, Tokyo, Japan
| | - Hideki Fukuda
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- *Hideki Fukuda, PhD, Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City,
| | - Masayasu Kitamura
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Hideaki Hayashida
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yumiko Kawashita
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Reiko Furugen
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Zenya Koyama
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Toshiyuki Saito
- Department of Oral Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Kong KA, Khang YH, Cho HJ, Jang SM, Jung-Choi K. Neo-Marxian social class inequalities in self-rated health among the employed in South Korea: the role of material, behavioral, psychosocial, and workplace environmental factors. BMC Public Health 2017; 17:345. [PMID: 28427359 PMCID: PMC5397726 DOI: 10.1186/s12889-017-4269-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the pattern of social inequality in self-rated health among the employed using the Wright's social class location indicator, and to assess the roles of material, behavioral, psychosocial, and workplace environmental factors as mediating factors in explaining the social class inequality in self-rated health in South Korea. METHODS This study used data from the 4th Korea National Health and Nutrition Examination Survey from 2007 to 2009. Study subjects included the employed population of 4392 men and 3309 women aged 19-64 years. Subjects were classified into twelve social class positions based on the Wright's social class map. The health outcome was self-rated health. Material, psychosocial, behavioral, and workplace environmental factors were considered as potential mediators in explaining social class health inequality. We calculated prevalence ratios of poor self-rated health according to social class, adjusted for age and mediating factors using Poisson regression models. RESULTS Nonskilled workers and petty bourgeoisie reported worse self-rated health than other social classes among men. The age-adjusted prevalence of petty bourgeoisie and nonskilled workers were about four-fold greater than that of managers. Expert supervisors in the contradictory class location had a greater prevalence of poor self-rated health than experts in men. In women, the prevalence of poor self-rated health was greater in most social classes than their male counterparts, while the differences among social classes within women were not statistically significant. Workplace environmental factors explained the social class inequality by from 24 to 31% in nonskilled and skilled workers and nonskilled supervisors, respectively, and material factors showed an explanatory ability of about 8% for both nonskilled workers and petty bourgeoisie in men. CONCLUSIONS We showed the inequality in self-rated health according to the Wright's social class in an industrialized Asian country. Policy efforts to improve workplace environments in nonskilled and skilled workers and nonskilled supervisors would have a moderate effect on reducing the magnitude of social class inequality in self-rated health. Furthermore, the means to improve power relations in the workplace should be devised to further reduce the social class inequalities in health.
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Affiliation(s)
- Kyoung Ae Kong
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young-Ho Khang
- Department of Health Policy and Management and Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Mi Jang
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyunghee Jung-Choi
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
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Platts LG, Gerry CJ. Social inequalities in self-rated health in Ukraine in 2007: the role of psychosocial, material and behavioural factors. Eur J Public Health 2017; 27:211-217. [PMID: 28339514 DOI: 10.1093/eurpub/ckw143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Despite Ukraine's large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health. Methods Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors. Results In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55-64% in men and 35-47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27-30% in men and 19-27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68-84% in men and 43-60% in women. Conclusions The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty.
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Affiliation(s)
- Loretta G Platts
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Christopher J Gerry
- International Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, Saint Petersburg, Russian Federation
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Zunzunegui MV, Belanger E, Benmarhnia T, Gobbo M, Otero A, Béland F, Zunzunegui F, Ribera-Casado JM. Financial fraud and health: the case of Spain. GACETA SANITARIA 2017; 31:313-319. [PMID: 28259392 DOI: 10.1016/j.gaceta.2016.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine whether financial fraud is associated with poor health sleeping problems and poor quality of life. METHODS Pilot study (n=188) conducted in 2015-2016 in Madrid and León (Spain) by recruiting subjects affected by two types of fraud (preferred shares and foreign currency mortgages) using venue-based sampling. Information on the monetary value of each case of fraud; the dates when subjects became aware of being swindled, lodged legal claim and received financial compensation were collected. Inter-group comparisons of the prevalence of poor physical and mental health, sleep and quality of life were carried according to type of fraud and the 2011-2012 National Health Survey. RESULTS In this conventional sample, victims of financial fraud had poorer health, more mental health and sleeping problems, and poorer quality of life than comparable populations of a similar age. Those who had received financial compensation for preferred share losses had better health and quality of life than those who had not been compensated and those who had taken out foreign currency mortgages. CONCLUSION The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation.
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Affiliation(s)
- Maria Victoria Zunzunegui
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Université de Montréal, Montreal, Quebec, Canada.
| | - Emmanuelle Belanger
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Université de Montréal, Montreal, Quebec, Canada
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, California, United States
| | | | - Angel Otero
- Departamento de Medicina Preventiva, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - François Béland
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Université de Montréal, Montreal, Quebec, Canada
| | - Fernando Zunzunegui
- Department of Private Law, Facultad de Derecho, Universidad Carlos III, Madrid, Spain
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Duchaine CS, Ndjaboué R, Levesque M, Vézina M, Trudel X, Gilbert-Ouimet M, Dionne CE, Mâsse B, Pearce N, Brisson C. Psychosocial work factors and social inequalities in psychological distress: a population-based study. BMC Public Health 2017; 17:91. [PMID: 28100221 PMCID: PMC5241997 DOI: 10.1186/s12889-017-4014-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mental health problems (MHP) are the leading cause of disability worldwide. The inverse association between socioeconomic position (SEP) and MHP has been well documented. There is prospective evidence that factors from the work environment, including adverse psychosocial work factors, could contribute to the development of MHP including psychological distress. However, the contribution of psychosocial work factors to social inequalities in MHP remains unclear. This study evaluates the contribution of psychosocial work factors from two highly supported models, the Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models to SEP inequalities of psychological distress in men and women from a population-based sample of Quebec workers. METHODS Data were collected during a survey on working conditions, health and safety at work. SEP was evaluated using education, occupation and household income. Psychosocial work factors and psychological distress were assessed using validated instruments. Mean differences (MD) in the score of psychological distress were estimated separately for men and women. RESULTS Low education level and low household income were associated with psychological distress among men (MD, 0.56 (95% CI 0.06; 1.05) and 1.26 (95% CI 0.79; 1.73) respectively). In men, the contribution of psychosocial work factors from the DCS and the ERI models to the association between household income and psychological distress ranged from 9% to 24%. No clear inequalities were observed among women. CONCLUSIONS These results suggest that psychosocial work factors from the DCS and the ERI models contribute to explain a part of social inequalities in psychological distress among men. Psychosocial factors at work are frequent and modifiable. The present study supports the relevance of targeting these factors for the primary prevention of MHP and for health policies aiming to reduce social inequalities in mental health.
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Affiliation(s)
- Caroline S. Duchaine
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8 QC Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6 QC Canada
| | - Ruth Ndjaboué
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8 QC Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6 QC Canada
| | - Manon Levesque
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8 QC Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6 QC Canada
| | - Michel Vézina
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6 QC Canada
| | - Xavier Trudel
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8 QC Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6 QC Canada
| | - Mahée Gilbert-Ouimet
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8 QC Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6 QC Canada
| | - Clermont E. Dionne
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8 QC Canada
- Rehabilitation department, Faculty of Medicine, Laval University, 1050 avenue de la médecine, Quebec city, G1V 0A6 QC Canada
| | - Benoît Mâsse
- Social and preventive medicine department, Public Health School, Montreal University, 7101 avenue du Parc, Montreal, H3N 1X9 QC Canada
- Research Center CHU-Ste-Justine, 3175 Côte Ste-Catherine, Montréal, H3T 1C5 Québec Canada
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, UK
| | - Chantal Brisson
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8 QC Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6 QC Canada
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Moor I, Spallek J, Richter M. Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors. J Epidemiol Community Health 2016; 71:565-575. [PMID: 27682963 DOI: 10.1136/jech-2016-207589] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/05/2016] [Accepted: 09/11/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Material, psychosocial and behavioural factors are important explanatory pathways for socioeconomic inequalities in health. The aim of this systematic review was to summarise the available evidence on empirical studies and to analyse the relative contribution of these factors for explaining inequalities in self-rated health. METHODS The study was performed in compliance with PRISMA guidelines. The literature search was conducted in the electronic databases PubMed and Web of Science (1996-2016) as well as by screening of reference lists of obtained articles. Two reviewers performed the search and critical appraisal of the studies. All studies that focus on explaining socioeconomic inequalities in self-rated health, including at least 2 of the 3 main pathways and analysing the relative contribution of these approaches in separate and joint models, were included. RESULTS Eleven publications were included. Separate analyses showed that material, psychosocial and behavioural factors contribute to the explanation of socioeconomic inequalities in self-rated health. However, the combined analyses revealed that material factors contributed most to differences in self-rated health because of their higher independent (direct) effect and additional shared (indirect) effect (through psychosocial and behavioural factors). These results were largely independent of age, gender and indicator of socioeconomic status. CONCLUSIONS The evidence presented might be used for policymakers to identify and to justify prioritisation in terms of prevention and health promotion. The findings show that multiple factors are important for tackling social inequalities in health. Strategies for reducing these inequalities should focus on material/structural living conditions as they shape conditions of psychosocial resources and health behaviour.
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Affiliation(s)
- Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Logie CH, Jenkinson JIR, Earnshaw V, Tharao W, Loutfy MR. A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada. PLoS One 2016; 11:e0162826. [PMID: 27669510 PMCID: PMC5036880 DOI: 10.1371/journal.pone.0162826] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/29/2016] [Indexed: 01/15/2023] Open
Abstract
African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health). We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39) of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154) = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance health.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Jesse I. R. Jenkinson
- Dalla Lana School of Public Health, Social and Behavioural Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Earnshaw
- Human Development and Family Studies, University of Delaware, Newark, Delaware, United States
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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Associations between social vulnerabilities and dietary patterns in European children: the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study. Br J Nutr 2016; 116:1288-1297. [PMID: 27666744 DOI: 10.1017/s0007114516003330] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Socio-economic inequalities in childhood can determine dietary patterns, and therefore future health. This study aimed to explore associations between social vulnerabilities and dietary patterns assessed at two time points, and to investigate the association between accumulation of vulnerabilities and dietary patterns. A total of 9301 children aged 2-9 years participated at baseline and 2-year follow-up examinations of the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS study. In all, three dietary patterns were identified at baseline and follow-up by applying the K-means clustering algorithm based on a higher frequency of consumption of snacks and fast food (processed), sweet foods and drinks (sweet), and fruits and vegetables (healthy). Vulnerable groups were defined at baseline as follows: children whose parents lacked a social network, children from single-parent families, children of migrant origin and children with unemployed parents. Multinomial mixed models were used to assess the associations between social vulnerabilities and children's dietary patterns at baseline and follow-up. Children whose parents lacked a social network (OR 1·31; 99 % CI 1·01, 1·70) and migrants (OR 1·45; 99 % CI 1·15, 1·83) were more likely to be in the processed cluster at baseline and follow-up. Children whose parents were homemakers (OR 0·74; 99 % CI 0·60, 0·92) were less likely to be in the processed cluster at baseline. A higher number of vulnerabilities was associated with a higher probability of children being in the processed cluster (OR 1·78; 99 % CI 1·21, 2·62). Therefore, special attention should be paid to children of vulnerable groups as they present unhealthier dietary patterns.
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Zarulli V. Unobserved Heterogeneity of Frailty in the Analysis of Socioeconomic Differences in Health and Mortality. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2016; 32:55-72. [PMID: 30976210 DOI: 10.1007/s10680-015-9361-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/13/2015] [Indexed: 12/29/2022]
Abstract
The concepts of unobserved frailty and selection have been extensively analyzed with respect to phenomena like mortality deceleration at old ages and mortality convergence or cross overs between populations (for example American black and white populations, men and women). Despite the long-time observation of converging mortality risks in differential socioeconomic mortality research, the interest in the connection between frailty, selection, and health and mortality inequalities over a life course approach has increased only recently. This overview of the literature summarizes the main concepts of unobserved frailty and socioeconomic differences in mortality and how frailty and selection relate to these differences at old ages. It then reviews the evidence coming from the existing studies. Although the number of studies is still limited, the body of research on unobserved frailty and socioeconomic inequalities in health and mortality in a life course approach is growing. The results, however, are contradictory, and whether selection plays a major role in shaping the observed socioeconomic mortality patterns at old ages is still controversial.
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Affiliation(s)
- Virginia Zarulli
- Max Planck Odense Center on the Biodemography of Aging and Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, 5000 Odense, Denmark
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San Sebastian M, Hammarström A, Gustafsson PE. Socioeconomic inequalities in functional somatic symptoms by social and material conditions at four life course periods in Sweden: a decomposition analysis. BMJ Open 2015; 5:e006581. [PMID: 26319773 PMCID: PMC4554899 DOI: 10.1136/bmjopen-2014-006581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Socioeconomic inequalities in health are deemed a worldwide public health problem, but current research is lacking on key points including determinants of socioeconomic differences in health, and not the least variations of these determinants over the life course. Using a 26-year prospective Swedish community-based cohort, we aim at decomposing socioeconomic inequalities in functional somatic symptoms by social and material life circumstances, at 4 periods of the life course. DESIGN Repeated cross-sectional study. SETTING Participants came from the Northern Swedish Cohort (n=1001), who completed questionnaires about occupational class, social and material living conditions, and symptoms at ages 16, 21, 30 and 42. Socioeconomic inequalities were estimated and decomposed using the Blinder-Oaxaca decomposition analysis. RESULTS Inequalities in symptoms between blue-collar and white-collar socioeconomic groups increased along the life course in the sample. In the decomposition analysis, a high proportion of the gap between socioeconomic groups could be explained by social and material living conditions at ages 16 (84% explained), 30 (45%) and 42 (68%), but not at age 21. Specific social (parental illness at age 16 and violence at ages 30 and 42) and material (parental unemployment at age 16, and own unemployment and financial strain at ages 30 and 42) factors contributed jointly to the health gaps. CONCLUSIONS Socioeconomic inequalities in functional somatic symptoms increased along the life course in this Swedish cohort. A considerable portion of the social gaps in health was explained by concurrent social and material conditions, and the importance of specific adversities was dependent on the life course stage. Our findings suggest that socioeconomic inequalities in functional somatic symptoms may be reduced by addressing both social and material living conditions of disadvantaged families, and also that the life course stage needs to be taken into consideration.
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Affiliation(s)
- Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
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Niedzwiedz CL, Pell JP, Mitchell R. The Relationship Between Financial Distress and Life-Course Socioeconomic Inequalities in Well-Being: Cross-National Analysis of European Welfare States. Am J Public Health 2015; 105:2090-8. [PMID: 26270289 DOI: 10.2105/ajph.2015.302722] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We investigated to what extent current financial distress explains the relationship between life-course socioeconomic position and well-being in Southern, Scandinavian, Postcommunist, and Bismarckian welfare regimes. METHODS We analyzed individuals (n = 18 324) aged 50 to 75 years in the Survey of Health, Ageing, and Retirement in Europe, 2006-2009. Well-being was measured with CASP-12 (which stands for control, autonomy, self-realization, and pleasure) and life satisfaction. We generated a life-course socioeconomic index from 8 variables and calculated multilevel regression models (containing individuals nested within 13 countries), as well as stratified single-level models by welfare regime. RESULTS Life-course socioeconomic advantage was related to higher well-being; the difference in life satisfaction between the most and least advantaged was 2.09 (95% confidence interval = 1.87, 2.31) among women and 1.65 (95% confidence interval = 1.43, 1.87) among men. The weakest associations were found among Scandinavian countries. Financial distress was associated with lower well-being and attenuated the relationship between life-course socioeconomic position and well-being in all regimes (ranging from 34.26% in Postcommunist to 72.22% in Scandinavian countries). CONCLUSIONS We found narrower inequalities in well-being in the Scandinavian regime. Reducing financial distress may help improve well-being and reduce inequalities.
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Affiliation(s)
- Claire L Niedzwiedz
- Claire L. Niedzwiedz is with Centre for Research on Environment, Society, and Health, University of Edinburgh, Edinburgh, Scotland. Jill P. Pell is with Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland. Richard Mitchell is with Centre for Research on Environment, Society, and Health, Institute of Health and Wellbeing, University of Glasgow
| | - Jill P Pell
- Claire L. Niedzwiedz is with Centre for Research on Environment, Society, and Health, University of Edinburgh, Edinburgh, Scotland. Jill P. Pell is with Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland. Richard Mitchell is with Centre for Research on Environment, Society, and Health, Institute of Health and Wellbeing, University of Glasgow
| | - Richard Mitchell
- Claire L. Niedzwiedz is with Centre for Research on Environment, Society, and Health, University of Edinburgh, Edinburgh, Scotland. Jill P. Pell is with Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland. Richard Mitchell is with Centre for Research on Environment, Society, and Health, Institute of Health and Wellbeing, University of Glasgow
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Granström F, Molarius A, Garvin P, Elo S, Feldman I, Kristenson M. Exploring trends in and determinants of educational inequalities in self-rated health. Scand J Public Health 2015; 43:677-86. [PMID: 26138729 DOI: 10.1177/1403494815592271] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 01/02/2023]
Abstract
AIMS Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008. METHODS Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression. RESULTS Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH. CONCLUSIONS Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.
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Affiliation(s)
- Fredrik Granström
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anu Molarius
- Västmanland County Council, Competence Centre for Health, Västerås, Sweden
| | - Peter Garvin
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden
| | - Sirkka Elo
- Örebro County Council, Department of Community Medicine and Public Health, Örebro, Sweden
| | - Inna Feldman
- Uppsala County Council, Department of Development, Uppsala, Sweden Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Margareta Kristenson
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Social, economic, and behavioral variables associated with oral health-related quality of life among Brazilian adults. CIENCIA & SAUDE COLETIVA 2015; 20:1531-40. [DOI: 10.1590/1413-81232015205.13562014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/14/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the association between sociodemographic, socioeconomic, psychosocial, and behavioral variables and oral health as assessed using the 14-question short version of the Oral Health Impact Profile (OHIP-14). A cross-sectional study was performed with 1095 adult residents from 38 census tracts in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. Responses to the OHIP-14 were dichotomized, and bivariate (Chi-square) and multivariate analysis (logistic regression and Wald's test) were performed. In the bivariate analysis, the worse effects were reported by female individuals, the elderly, those with low family income, less schooling, those reporting a lower quality of life and social support, and smokers. In the multivariate analysis the following variables maintained their statistical significance: gender (female), age (50-59 years), family income (low), quality of life (low), social support (low, moderate), and smoking (smokers). Individuals' self-perception of their oral health was related to sociodemographic, socioeconomic, psychosocial, and behavioral variables, thus confirming that emphasis should be placed on social factors when addressing oral health problems.
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Socioeconomic inequalities in mortality and repeated measurement of explanatory risk factors in a 25 years follow-up. PLoS One 2015; 10:e0124690. [PMID: 25853571 PMCID: PMC4390361 DOI: 10.1371/journal.pone.0124690] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 03/17/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Socioeconomic inequalities in mortality can be explained by different groups of risk factors. However, little is known whether repeated measurement of risk factors can provide better explanation of socioeconomic inequalities in health. Our study examines the extent to which relative educational and income inequalities in mortality might be explained by explanatory risk factors (behavioral, psychosocial, biomedical risk factors and employment) measured at two points in time, as compared to one measurement at baseline. METHODS AND FINDINGS From the Norwegian total county population-based HUNT Study (years 1984-86 and 1995-1997, respectively) 61 513 men and women aged 25-80 (82.5% of all enrolled) were followed-up for mortality in 25 years until 2009, employing a discrete time survival analysis. Socioeconomic inequalities in mortality were observed. As compared to their highest socioeconomic counterparts, the lowest educated men had an OR (odds ratio) of 1.41 (95% CI 1.29-1.55) and for the lowest income quartile OR = 1.59 (1.48-1.571), for women OR = 1.35 (1.17-1.55), and OR = 1.40 (1.28-1.52), respectively. Baseline explanatory variables attenuated the association between education and income with mortality by 54% and 54% in men, respectively, and by 69% and 18% in women. After entering time-varying variables, this attainment increased to 63% and 59% in men, respectively, and to 25% (income) in women, with no improvement in regard to education in women. Change in biomedical factors and employment did not amend the explanation. CONCLUSIONS Addition of a second measurement for risk factors provided only a modest improvement in explaining educational and income inequalities in mortality in Norwegian men and women. Accounting for change in behavior provided the largest improvement in explained inequalities in mortality for both men and women, as compared to measurement at baseline. Psychosocial factors explained the largest share of income inequalities in mortality for men, but repeated measurement of these factors contributed only to modest improvement in explanation. Further comparative research on the relative importance of explanatory pathways assessed over time is needed.
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Lunau T, Siegrist J, Dragano N, Wahrendorf M. The association between education and work stress: does the policy context matter? PLoS One 2015; 10:e0121573. [PMID: 25812142 PMCID: PMC4374794 DOI: 10.1371/journal.pone.0121573] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 02/18/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Several studies report socioeconomic differences in work stress, where people in lower socioeconomic positions (SEP) are more likely to experience this burden. In the current study, we analyse associations between education and work stress in a large sample of workers from 16 European countries. In addition we explore whether distinct national labour market policies are related to smaller inequalities in work stress according to educational attainment. METHODS We use data collected in 2010/11 in two comparative studies ('Survey of Health, Ageing and Retirement in Europe' and the 'English Longitudinal Study of Ageing'; N = 13695), with samples of men and women aged 50 to 64 from 16 European countries. We measure highest educational degree according to the international standard classification of education (ISCED) and assess work stress in terms of the demand-control and the effort-reward imbalance model. National labour market policies are measured on the basis of policy indicators which are divided into (1) 'protective' policies offering financial compensation to those excluded from the labour market (e.g. replacement rate), and (2) 'integrative' policies supporting disadvantaged individuals on the labour market (e.g. investments into active labour market policies or possibilities for further qualification in later life). In addition to country-specific analyses, we estimate multilevel models and test for interactions between the indicators of national policies and individual education. RESULTS Main findings demonstrate consistent associations between lower education and higher levels of work stress in all countries. The strength of this association, however, varies across countries and is comparatively small in countries offering pronounced 'integrative' policies, in terms of high investments into measures of an active labor market policy and high participation rates in lifelong learning activities. CONCLUSIONS Our results point to different types of policies that may help to reduce educational differences in work stress, in particular policies supporting those who are disadvantaged on the labour market.
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Affiliation(s)
- Thorsten Lunau
- Centre for Health and Society, Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Johannes Siegrist
- Senior Professorship on Work Stress Research, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Centre for Health and Society, Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Morten Wahrendorf
- Centre for Health and Society, Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
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Soskolne V. Preventive health behaviors and physician visits: relevance to health inequality. Isr J Health Policy Res 2015; 4:9. [PMID: 25793103 PMCID: PMC4365535 DOI: 10.1186/s13584-015-0006-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/19/2015] [Indexed: 12/29/2022] Open
Abstract
Clear definitions and measurement of preventive health behaviors, as well as the relevant demographic and socioeconomic variables, is important to understanding what factors explain inequalities in health and in the use of health care services. This commentary addresses issues related to the measurement of preventive health behaviors and suggests a distinction between personal life style behaviors and preventive screening practices in order to better explain the associations between these practices and visits to general practitioners. The commentary notes that physician visits are a health-related behavior which is shaped by socioeconomic status: visits to general practitioners are more prevalent among the poor, while visits to specialists are more prevalent among the rich. Therefore, in any analysis of the factors contributing to socioeconomic inequalities in health, physician visits and preventive health behaviors ought to be included as two distinct sets of health-related behaviors. Changing these health-related behaviors is only one of the interventions that are better developed by healthcare services, while the majority of multi-level efforts to reduce inequalities should be outside of the health sector.
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Affiliation(s)
- Varda Soskolne
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, 52900 Israel
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Moor I, Rathmann K, Lenzi M, Pförtner TK, Nagelhout GE, de Looze M, Bendtsen P, Willemsen M, Kannas L, Kunst AE, Richter M. Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers. Eur J Public Health 2015; 25:457-63. [PMID: 25713016 DOI: 10.1093/eurpub/cku244] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tobacco-related heath inequalities are a major public health concern, with smoking being more prevalent among lower socioeconomic groups. The aim of this study is to investigate the mechanisms leading to socioeconomic inequalities in smoking among 15-year-old adolescents by examining the mediating role of psychosocial factors in the peer group, family and school environment. METHODS Data were derived from the international WHO-collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, including 52 907 15-year-old students from 35 European and North American countries. Socioeconomic position was measured by the Family Affluence Scale. Multilevel logistic regression models were conducted to examine the contribution of family, school and peer factors in explaining the association between family affluence and weekly smoking. RESULTS Across countries, adolescents from low affluent families had an increased risk of weekly smoking (OR(boys) 1.14, confidence interval (CI) 1.05-1.23; OR(girls) 1.36, CI 1.26-1.46) compared with adolescents from high affluent families. Family and school factors mediated the association between family affluence and smoking to a high extent up to 100% (boys) and 81% (girls) in joint analyses. The most important single factors were family structure, relationships with parents, academic achievement and school satisfaction. Peer factors did not mediate the association between family affluence and adolescent smoking. CONCLUSION The association between socioeconomic status and adolescent weekly smoking can largely be explained by an unequal distribution of family- and school-related factors. Focusing on the parent-adolescent relationship and adolescent school achievement can help to better understand inequalities in adolescent smoking behaviour.
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Affiliation(s)
- Irene Moor
- 1 Institute of Medical Sociology (IMS), Medical Faculty, Martin Luther University Halle-Wittenberg, Germany
| | - Katharina Rathmann
- 1 Institute of Medical Sociology (IMS), Medical Faculty, Martin Luther University Halle-Wittenberg, Germany
| | - Michela Lenzi
- 2 Department of Developmental and Social Psychology, University of Padua, Italy
| | - Timo-Kolja Pförtner
- 1 Institute of Medical Sociology (IMS), Medical Faculty, Martin Luther University Halle-Wittenberg, Germany
| | - Gera E Nagelhout
- 3 Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands 4 Alliance Smokefree Holland, The Hague, The Netherlands
| | - Margreet de Looze
- 5 Department of Interdisciplinary Social Sciences, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands
| | - Pernille Bendtsen
- 6 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marc Willemsen
- 3 Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands 4 Alliance Smokefree Holland, The Hague, The Netherlands
| | - Lasse Kannas
- 7 Department of Health Sciences, University of Jyväskylä, Finland
| | - Anton E Kunst
- 8 Department of Public Health, AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Richter
- 1 Institute of Medical Sociology (IMS), Medical Faculty, Martin Luther University Halle-Wittenberg, Germany
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Multilevel analysis of self-perception in oral health and associated factors in Southern Brazilian adults: a cross-sectional study. CAD SAUDE PUBLICA 2015; 31:49-59. [DOI: 10.1590/0102-311x00037814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/05/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the association between individual and contextual variables related to self-perception in oral health among residents in the municipality of São Leopoldo, Rio Grande do Sul State, Brazil. The cross-sectional design involved 1,100 adults in 38 census tracts. The self-perception was evaluated using the Oral Health Impact Profile (OHIP-14) tool. A logistic multilevel analysis was performed. The multivariate analysis revealed that those who are of the female gender, older, with lower scores of quality of life and less social support, with poor healthy eating habits, smokers and those living in low-income census tracts presented higher odds of reporting worse oral health self-perception (OHIP-1). We concluded that individual and contextual variables are associated with oral health self-perception. This is essential information for planning health services wishing to meet the health needs of the population.
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Janzen B, Karunanayake C, Pahwa P, Dyck R, Rennie D, Lawson J, Pickett W, Bryce R, Hagel L, Zhao G, Dosman J. Exploring diversity in socioeconomic inequalities in health among rural dwelling Canadians. J Rural Health 2014; 31:186-98. [PMID: 25546249 DOI: 10.1111/jrh.12101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the patterning of socioeconomic inequalities in health among rural dwelling women and men in a Canadian province, exploring diversity in associations by measure of socioeconomic position, health outcome, and demographic characteristics. METHODS Baseline data from the Saskatchewan Rural Health Study was used, an ongoing prospective cohort study examining the health of rural people in Saskatchewan, Canada. Of the 11,004 eligible addresses, responses to mailed questionnaires were obtained from 4,624 (42%) households, representing 8,261 women and men. Multiple logistic regression was the primary method of analysis; generalized estimating equations were utilized to account for household clustering. Associations between 5 health outcomes (self-rated health, chronic obstructive lung disease, diabetes, heart attack, high blood pressure) and 4 indicators of socioeconomic position (income, education, financial strain, occupational skill level) were assessed, with age and gender as potential effect modifiers. FINDINGS With the exception of occupational skill level, socioeconomic position (SEP) indicators were strongly and inversely related to most health outcomes, often in a graded manner. Associations between SEP and several health outcomes were weaker for older than younger participants (heart attack, high blood pressure, lung disease) and stronger among women compared to men (high blood pressure, lung disease). CONCLUSIONS The patterning of SEP-health associations observed in this rural Canadian sample suggests the need for health promotion strategies and policy initiatives to be broadly targeted at individuals and families occupying a wide range of socioeconomic circumstances.
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Affiliation(s)
- Bonnie Janzen
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Shaw RJ, Benzeval M, Popham F. To what extent do financial strain and labour force status explain social class inequalities in self-rated health? Analysis of 20 countries in the European Social Survey. PLoS One 2014; 9:e110362. [PMID: 25313462 PMCID: PMC4196960 DOI: 10.1371/journal.pone.0110362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Nordic countries do not have the smallest health inequalities despite egalitarian social policies. A possible explanation for this is that drivers of class differences in health such as financial strain and labour force status remain socially patterned in Nordic countries. METHODS Our analyses used data for working age (25-59) men (n = 48,249) and women (n = 52,654) for 20 countries from five rounds (2002-2010) of the European Social Survey. The outcome was self-rated health in 5 categories. Stratified by gender we used fixed effects linear regression models and marginal standardisation to instigate how countries varied in the degree to which class inequalities were attenuated by financial strain and labour force status. RESULTS AND DISCUSSION Before adjustment, Nordic countries had large inequalities in self-rated health relative to other European countries. For example the regression coefficient for the difference in health between working class and professional men living in Norway was 0.34 (95% CI 0.26 to 0.42), while the comparable figure for Spain was 0.15 (95% CI 0.08 to 0.22). Adjusting for financial strain and labour force status led to attenuation of health inequalities in all countries. However, unlike some countries such as Spain, where after adjustment the regression coefficient for working class men was only 0.02 (95% CI -0.05 to 0.10), health inequalities persisted after adjustment for Nordic countries. For Norway the adjusted coefficient was 0.17 (95% CI 0.10 to 0.25). Results for women and men were similar. However, in comparison to men, class inequalities tended to be stronger for women and more persistent after adjustment. CONCLUSIONS Adjusting for financial security and labour force status attenuates a high proportion of health inequalities in some counties, particularly Southern European countries, but attenuation in Nordic countries was modest and did not improve their relative position.
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Affiliation(s)
- Richard J. Shaw
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom
| | - Frank Popham
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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Abstract
Cross-sectional analyses of adult lifespan variation have found an inverse association between socioeconomic position and lifespan variation, but the trends by social class are unknown. We investigated trends in lifespan variation over four decades (1971-2010) by occupational social class (manual, lower nonmanual, upper nonmanual, other) using Finnish register data. We performed age and cause-of-death decompositions of lifespan variation for each sex (a) by occupational class over time and (b) between occupational classes at a shared level of life expectancy. Although life expectancy increased in all classes, lifespan variation was stable among manual workers and decreased only among nonmanual classes. These differences were caused by early-adult mortality: older-age lifespan variation declined for all the classes, but variation in early-adult mortality increased for all classes except the highest. The manual class's high and stagnant lifespan variation was driven by declines in circulatory diseases that were equally spread over early mortality-compressing and older mortality-expanding ages, as well as by high early-adult mortality from external causes. Results were similar for men and women. The results of this study, which is the first to document trends in lifespan variation by social class, suggest that mortality compression is compatible with increasing life expectancy but currently achieved only by higher occupational classes.
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Moor I, Rathmann K, Stronks K, Levin K, Spallek J, Richter M. Psychosocial and behavioural factors in the explanation of socioeconomic inequalities in adolescent health: a multilevel analysis in 28 European and North American countries. J Epidemiol Community Health 2014; 68:912-21. [DOI: 10.1136/jech-2014-203933] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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