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Visser TS, Brul S, Deng J, Bonsel J, van Es E, Eygendaal D, de Vos RJ. Low socioeconomic status is associated with worse treatment outcomes in patients with Achilles tendinopathy. Br J Sports Med 2024; 58:579-585. [PMID: 38569849 DOI: 10.1136/bjsports-2023-107633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To assess whether there is a difference in symptom severity at baseline and 24 weeks follow-up between conservatively managed patients with Achilles tendinopathy (AT) with low socioeconomic status (SES) compared with those with high SES. METHODS In this prospective cohort study, 200 patients with AT were included and treated according to current guidelines. We linked a neighbourhood SES indicator based on income, employment and education level and divided the patient population into quintiles, with Q1 being the highest SES and Q5 the lowest. Symptom severity at baseline and follow-up was assessed using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score. Treatment adherence was not measured. We used a general linear model and the mean VISA-A scores at baseline and at 6, 12 and 24 weeks follow-up were compared between Q1 (n=45) and Q5 (n=39), while adjusting for age, sex, body mass index (BMI), Ankle Activity Score, symptom duration and baseline VISA-A score. RESULTS Patients had a median age of 51 years and median BMI of 25.4, 40% were female. 74%, 70% and 58% of the participants completed the VISA-A at 6, 12 and 24 weeks, respectively. VISA-A scores at baseline were similar for Q1 and Q5 (43.9 and 41.8, p=0.591). At 24 weeks, there was a mean (95% CI) difference of 11.2 (1.0 to 21.3, p=0.032) points in favour of Q1 on the VISA-A score. CONCLUSION AT patients with low SES may have worse outcomes when treated using the current guidelines. The difference in VISA-A score at 24 weeks is larger than the minimal clinically important difference and might be clinically relevant, but comes with uncertainty due to the large dispersion in the data. Clinicians need to consider the impact of social inequality when developing and implementing treatment plans.
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Affiliation(s)
- Tjerk Sleeswijk Visser
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Sports Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Stefano Brul
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jie Deng
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Joshua Bonsel
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Eline van Es
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
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Jennen JGM, Jansen NWH, van Amelsvoort LGPM, Slangen JJM, Kant IJ. Chronic conditions and self-perceived health among older employees in relation to indicators of labour participation and retirement over time. Work 2021; 71:133-150. [PMID: 34924423 PMCID: PMC8842761 DOI: 10.3233/wor-210436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: A significant proportion of older employees leave the labour market early, amongst others via unemployment or disability benefits, implying that health might affect possibilities to extend working life. OBJECTIVE: This study 1) examined associations between chronic conditions (subtypes) and self-perceived health (SPH), independently, and indicators of labour participation and retirement over six-year follow-up among older employees, and 2) explored the impact of differences between prevalent and incident presence of chronic condition(s) in this relation. METHODS: Older workers (aged > 45 years) included in the Maastricht Cohort Study were studied (n = 1,763). The Health and Work Performance Questionnaire assessed chronic conditions and one item from the Short Form health survey-36 assessed SPH. Cox regression analyses assessed associations between chronic conditions and SPH, independently, and retirement intentions, employment status, decreasing working hours, and changes in work over time. RESULTS: Employees with coexistent physical-mental chronic conditions showed higher risks to lose employment and to receive a disability benefit (HR 1.85, 95% CI 1.23–2.78; HR 8.63, 95% CI 2.47–30.11) over time compared to healthy employees. No statistically significant associations were found between SPH and indicators of labour participation and retirement over time. Having chronic condition(s) was cross-sectionally associated with lower SPH scores and larger proportion of part-timers –compared to healthy employees. CONCLUSIONS: Chronic condition(s) among older employees were substantially associated with indicators of labour participation and retirement over time. The role of SPH was mainly instantaneous. Findings provide valuable input for preventive measures aiming to prevent an early labour market exit of older employees.
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Affiliation(s)
- Jacqueline G M Jennen
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nicole W H Jansen
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ludo G P M van Amelsvoort
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos J M Slangen
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - IJmert Kant
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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3
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Hyldgård VB, Johnsen SP, Søgaard R. Index-Based Inequality in Quality of Care: An Empirical Comparison of Apples and Pears. Clin Epidemiol 2021; 13:791-800. [PMID: 34512032 PMCID: PMC8424685 DOI: 10.2147/clep.s311813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/30/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose Socioeconomic inequalities have been studied for decades using a variety of methods, but limited attention has been paid to the way methodological differences influence research findings. We aimed to compare index-based measures of socioeconomic inequality in quality of care. Patients and Data A national cohort of 110,848 unique stroke patients admitted to publicly funded hospitals in Denmark from 2004–2014 was studied. We used individual-level data from national registers and the Danish Stroke Registry. Quality of care was defined as fulfilment of process performance measures based on clinical guidelines recommendations (range 0–100%). Socioeconomic position was operationalised using information on disposable family income (continuous, DKK) and education (categorical, 7 levels). Methods Income- and education-related inequality in quality of care was assessed using concentration indices and the slope index of inequality. All indices were estimated both in absolute and relative terms. Results Income-related inequality appeared to be generally higher than education-related inequality. Depending on the choice of index, the inequality in quality of care increased by 5% or declined by up to 43% during the study period. Unlike the concentration indices the slope index of inequality was highly sensitive to changes in how the income and educational levels were operationalised. Conclusion Careful reporting and interpretation of inequality studies is warranted in order not to misguide decision makers. Unless the policy objective reflects an explicit focus on one specific type of inequality, the use of different inequality indices can lead to different conclusions.
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Affiliation(s)
- Vibe Bolvig Hyldgård
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Health Economics, DEFACTUM, Central Region Denmark, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Ribeiro AI, Fraga S, Correia-Costa L, McCrory C, Barros H. Socioeconomic disadvantage and health in early childhood: a population-based birth cohort study from Portugal. Pediatr Res 2020; 88:503-511. [PMID: 32005033 DOI: 10.1038/s41390-020-0786-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Measuring early socioeconomic inequalities in health provides evidence to understand the patterns of disease. Thus, our aim was to determine which children's health outcomes are patterned by socioeconomics and to what extent the magnitude/direction of the differences vary by socioeconomic measure and outcome. METHODS Data on early childhood (4 years) health was obtained from Generation XXI birth cohort (n = 8647). A total of 27 health outcomes and 13 socioeconomic indicators at the individual level and neighbourhood level were used to calculate the relative index of inequality (RII). RESULTS Socioeconomic inequalities were evident across 21 of the 27 health outcomes. Education, occupation and income more often captured inequalities, compared with neighbourhood deprivation or employment status. Using highest maternal education as reference category, we observed that seizures (RII = 8.64), obesity (2.94), abdominal obesity (2.66), urinary tract infection (2.26), language/speech problems (2.24), hypertension (2.08) and insulin resistance (1.33) were heavily socially patterned, much more common in disadvantaged children. Contrastingly, eczema (0.26) and rhinitis (0.26) were more common among more advantaged children. CONCLUSIONS Socioeconomic inequalities were evident for almost every health outcome assessed, although with varying magnitude/direction according to the socioeconomic indicator and outcome. Our results reinforce that the social gradient in health manifests early in childhood.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Sílvia Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Liane Correia-Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Division of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Cathal McCrory
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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5
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Stynen D, Jansen NWH, Slangen JJM, de Grip A, Kant IJ. Need for recovery and different types of early labour force exit: a prospective cohort study among older workers. Int Arch Occup Environ Health 2019; 92:683-697. [PMID: 30746558 PMCID: PMC6556172 DOI: 10.1007/s00420-019-01404-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study examines the relationship between need for recovery (NFR) and labour force exit (LFE) among older workers. Different types of LFE (early retirement, work disability and unemployment) are considered, and the role of potential confounding and modifying factors, including the availability of early LFE schemes, is examined. Also, associations between NFR and the intention and ability to prolong one's working life, which are known determinants of LFE, are assessed. METHODS A subsample of older workers from the Maastricht Cohort Study was examined (n = 2312). The relationship between NFR and LFE was investigated by means of Cox regression analyses. Logistic regression analyses were performed to investigate cross-sectional associations between NFR and the intention and ability to prolong working life. RESULTS Elevated NFR was associated with a higher risk of overall LFE during a 4-year follow-up period (HR 1.39, 95% CI 1.09-1.78), and specifically with a higher risk of leaving the labour force through early retirement and work disability. When early retirement schemes were available, strong and significant associations between NFR and LFE were observed (HR 2.79, 95% CI 1.29-6.02), whereas no significant associations were found when such schemes were unavailable. Older workers with a higher NFR also had earlier retirement intentions and lower self-assessed abilities (both physical and mental) to prolong their working life until the mandatory retirement age. CONCLUSIONS Because this study shows that NFR is a precursor of LFE among older workers, monitoring NFR is important for timely interventions aimed at reducing NFR to facilitate extended labour participation.
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Affiliation(s)
- D Stynen
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - N W H Jansen
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - J J M Slangen
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A de Grip
- Research Centre for Education and the Labour Market (ROA), Maastricht University, Maastricht, The Netherlands
| | - I J Kant
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Hogeling L, Vaandrager L, Koelen M. Evaluating the Healthy Futures Nearby Program: Protocol for Unraveling Mechanisms in Health-Related Behavior Change and Improving Perceived Health Among Socially Vulnerable Families in the Netherlands. JMIR Res Protoc 2019; 8:e11305. [PMID: 30938690 PMCID: PMC6465974 DOI: 10.2196/11305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The persistence of health inequalities within high-income societies such as the Netherlands indicates the importance of researching effective ways to reduce those inequalities. Multiple strategies for reducing health inequalities have been identified. Specifically targeting health-related behaviors among lower socioeconomic status groups is one of those strategies. All in all, it seems relatively clear what types of approaches in general lead to health-related behavior change. However, it is still unclear how these approaches, in interaction with context, trigger a specific desired change. In the Netherlands, the private funding organization, Fonds NutsOhra, funded 46 small-scale projects under the umbrella of the Healthy Futures Nearby program. The projects aim to reduce vulnerable families' health deprivation by triggering lifestyle changes. OBJECTIVE This study aimed to outline and justify the protocol for the overall evaluation of the program. The evaluation aimed to find out to what extent and how the small-scale projects and approaches within the program affect (or not) health-related behaviors and improve perceived health. METHODS The approach to the overall evaluation of the 46 projects builds on a combination of 3 frequently used evaluation models; it is theory-based, realist informed, and uses a mixed methodology design. Methods include analysis of quantitative project data, document analysis, focus groups, and interviews. A study design has been drawn up that values and uses the multifaceted development of the projects and the influence this might have on implementation and project outcomes. Also, it respects the complex nature of the projects and is suited to studying health promotion mechanisms in depth. Finally, it optimizes the usage of all-quantitative and qualitative-project evaluation data available. RESULTS This study protocol included the design of at least 4 different studies. The results will hence provide information on (1) building and defining theories of change in health promotion practice, (2) mechanisms at work in promotion of healthy behavior among vulnerable families, (3) what works and what does not in professionals' practices in health promotion among those vulnerable groups, and (4) what works and what does not in health promotion projects with a participatory approach. In addition, data will be collected on the overall effectiveness of the 46 initiatives. Data collection started in 2016. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. CONCLUSIONS This overall evaluation provides a unique opportunity. The diversity of projects allows for a study protocol that answers in greater depth questions of how specific health promotion approaches work while also elucidating their effectiveness in a more traditional way. Using a theory-based complexity-sensitive approach that is mainly realist informed, this study also provides an opportunity to see whether combining assumptions from different evaluation perspectives yields relevant information. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/11305.
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Affiliation(s)
- Lette Hogeling
- Health and Society, Department of Social Sciences, Wageningen University and Research, Wageningen, Netherlands
| | - Lenneke Vaandrager
- Health and Society, Department of Social Sciences, Wageningen University and Research, Wageningen, Netherlands
| | - Maria Koelen
- Health and Society, Department of Social Sciences, Wageningen University and Research, Wageningen, Netherlands
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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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Lampert T, Kroll LE, Kuntz B, Hoebel J. Health inequalities in Germany and in international comparison: trends and developments over time. JOURNAL OF HEALTH MONITORING 2018; 3:1-24. [PMID: 35586261 PMCID: PMC8864567 DOI: 10.17886/rki-gbe-2018-036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Social epidemiological research has consistently demonstrated that people with a low socioeconomic status are particularly at risk of diseases, health complaints and functional limitations, and die at younger ages than those with a higher socioeconomic status. Greater stresses and strains in the workplace, family and living environment are under discussion as possible explanations. Health-related behaviours, psycho-social factors and personal resources, which are important in coping with everyday demands, certainly also play a role. From a public health and health policy perspective, reducing these health inequalities is an important goal. Insights into developments and trends in health inequalities over time can contribute towards highlighting new and emerging problems, and can thus help identify possible target groups and settings for relevant interventions. At the same time, these insights provide a basis upon which the success of policies and programmes that have already been implemented can be analysed and measured. Against this background, this review examines how health inequalities in Germany have developed over the last 20 to 30 years and places its findings within the context of the latest international research in this field.
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Affiliation(s)
- Thomas Lampert
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
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Ribeiro AI, Krainski ET, Carvalho MS, Launoy G, Pornet C, de Pina MDF. Does community deprivation determine longevity after the age of 75? A cross-national analysis. Int J Public Health 2018; 63:469-479. [PMID: 29480326 DOI: 10.1007/s00038-018-1081-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/27/2018] [Accepted: 02/10/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Analyze the association between socioeconomic deprivation and old-age survival in Europe, and investigate whether it varies by country and gender. METHODS Our study incorporated five countries (Portugal, Spain, France, Italy, and England). A 10-year survival rate expressing the proportion of population aged 75-84 years who reached 85-94 years old was calculated at area-level for 2001-11. To estimate associations, we used Bayesian spatial models and a transnational measure of deprivation. Attributable/prevention fractions were calculated. RESULTS Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a dose-response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were even weaker. The elimination of socioeconomic differences between areas would increase survival by 7.1%, and even a small reduction in socioeconomic differences would lead to a 1.6% increase. CONCLUSIONS Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal. .,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal. .,INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Elias Teixeira Krainski
- The Norwegian University for Science and Technology, Trondheim, Norway.,Departamento de Estatística, Universidade Federal do Paraná, Curitiba, Brazil
| | - Marilia Sá Carvalho
- PROCC-Programa de Computação Científica, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Guy Launoy
- U1086 INSERM-University of Caen Normandy (FRANCE), CHU Caen, Caen, France
| | - Carole Pornet
- Public Health Department, Regional Health Agency of Normandy, Caen, France
| | - Maria de Fátima de Pina
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICICT/FIOCRUZ, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde/Fundação Oswaldo Cruz, Rio De Janeiro, Brazil.,CARTO, FEN/UERJ, Departamento de Engenharia Cartográfica, Faculdade de Engenharia da, Universidade do Estado do Rio de Janeiro, Rio De Janeiro, Brazil
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10
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The Impact of Physical Work Demands on Need for Recovery, Employment Status, Retirement Intentions, and Ability to Extend Working Careers: A Longitudinal Study Among Older Workers. J Occup Environ Med 2017; 58:e140-51. [PMID: 27058492 DOI: 10.1097/jom.0000000000000687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Prospectively investigating whether different approaches of physical work demands are associated with need for recovery (NFR), employment status, retirement intentions, and ability to prolong working life among older employees from the industry and health care sector. METHODS A subsample from the Maastricht Cohort Study was studied (n = 1126). Poisson, Cox, and logistic regression analyses were performed to investigate outcomes. RESULTS Perceiving physical work demands as strenuous was associated with higher NFR. Continuous physical strain was associated with being out of employment 4 years later. Employees with the highest amount of physical work demands perceived they were less able to prolong working life, although no significant associations between physical work demands and retirement intentions were found. CONCLUSIONS Overall, physical work demands were associated with adverse outcomes, with divergent insights for the different approaches of physical work demands.
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Lobo LAC, Canuto R, Dias-da-Costa JS, Pattussi MP. Tendência temporal da prevalência de hipertensão arterial sistêmica no Brasil. CAD SAUDE PUBLICA 2017; 33:e00035316. [DOI: 10.1590/0102-311x00035316] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022] Open
Abstract
Analisar as prevalências de hipertensão arterial referida por adultos brasileiros acima de 20 anos, e verificar as variáveis socioeconômicas associadas em três períodos de tempo. Os dados são da Pesquisa Nacional por Amostra de Domicílios (PNAD) realizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE) nos anos de 1998 (196.439 participantes), 2003 (231.921) e 2008 (250.664). O desfecho era hipertensão arterial referida. As exposições principais eram renda em Reais e escolaridade em anos de estudos. A análise dos dados foi feita usando-se regressão de Poisson com variância robusta com controle para amostras complexas. Maiores prevalências de hipertensão arterial foram encontradas em pessoas com menor escolaridade, independentemente dos anos estudados e do sexo. Baixa renda esteve associada a maiores prevalências de hipertensão arterial independentemente dos anos estudados na amostra total e nas mulheres. Dentre os homens, esse efeito não foi verificado nos anos de 1998 e 2003. Já em 2008, homens de alta renda apresentaram maiores prevalências de hipertensão arterial, sugerindo modificação de efeito. Dessa forma, o presente trabalho apontou o aumento das prevalências de hipertensão arterial nos períodos estudados, destacando sua associação negativa com aspectos socioeconômicos.
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Affiliation(s)
| | - Raquel Canuto
- Universidade do Vale do Rio dos Sinos, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
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Sugisawa H, Shimizu Y, Kumagai T, Sugisaki H, Ohira S, Shinoda T. Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort. Int J Nephrol Renovasc Dis 2016; 9:171-82. [PMID: 27471405 PMCID: PMC4948840 DOI: 10.2147/ijnrd.s107031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Study purpose Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients. Methods Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors. Results Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or depressive symptoms. Conclusion The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.
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Affiliation(s)
| | - Yumiko Shimizu
- Faculty of Nursing, The Jikei University School of Medicine, Chofu
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Hu Y, van Lenthe FJ, Borsboom GJ, Looman CWN, Bopp M, Burström B, Dzúrová D, Ekholm O, Klumbiene J, Lahelma E, Leinsalu M, Regidor E, Santana P, de Gelder R, Mackenbach JP. Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010. J Epidemiol Community Health 2016; 70:644-52. [PMID: 26787202 DOI: 10.1136/jech-2015-206780] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010. METHODS Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30-79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities. RESULTS We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities. CONCLUSIONS Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.
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Affiliation(s)
- Yannan Hu
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerard J Borsboom
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Matthias Bopp
- Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dagmar Dzúrová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jurate Klumbiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mall Leinsalu
- Stockholm Centre on Health of Societies in Transition, Södertörn University, Huddinge, Sweden Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Paula Santana
- Departamento de Geografia, Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
| | - Rianne de Gelder
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Gandarillas AM, Domínguez-Berjón MF, Soto MJ. Increase in socioeconomic inequalities in mortality in a Southern European region: a small-area ecological study. J Public Health (Oxf) 2015; 38:e29-38. [PMID: 26265477 DOI: 10.1093/pubmed/fdv101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study sought to describe the total mortality trend by socioeconomic deprivation (SED) in the Madrid Autonomous Region, by sex and age group. METHODS Cross-sectional ecological study by census tract, in two periods: 1994-2000 (P1) with SED of 1996 census and 2001-07 (P2) with SED of 2001 census. We calculated the relative risks (RRs) and their 95% credibility intervals (95% CIs) by SED quintile (Q), taking the quintile of least deprivation as reference. Besag-York-Mollié ecological regression models and the Integrated Nested Laplace Approximation procedure were applied. The absolute differences in age-standardized rates were compared by SED quintile. RESULTS Inequalities decreased in young adults: among men aged 20-39 years, the RR in Q5 versus Q1 ranged from 2.73 (95% CI, 2.51-3.02) in P1 to 1.93 (95% CI, 1.76-2.15) in P2, due to the greater improvement in the most underprivileged groups. In contrast, there was an increase in SED-related mortality in the 40-79 age group. Among men aged 40-59 years, the RR in Q5 versus Q1 rose from 1.88 (95% CI, 1.76-2.02) in P1 to 2.29 (95% CI, 2.17-2.43) in P2; the improvement was greater in the most privileged groups. CONCLUSION In a context of an economic boom, inequalities were observed to increase among adults by a greater improvement in the most privileged groups.
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Affiliation(s)
| | | | - M J Soto
- Madrid Regional Health Authority, Madrid, Spain
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15
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Min JW. Trends in income-related health inequalities in self-assessed health in Korea, 1998-2011. Glob Public Health 2014; 9:1053-66. [PMID: 25096263 DOI: 10.1080/17441692.2014.931448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46-59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46-59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.
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Affiliation(s)
- Jong Won Min
- a School of Social Work , San Diego State University , San Diego , CA , USA
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16
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Asgeirsdóttir TL, Ragnarsdóttir DO. Health-income inequality: the effects of the Icelandic economic collapse. Int J Equity Health 2014; 13:50. [PMID: 25063235 PMCID: PMC4119249 DOI: 10.1186/1475-9276-13-50] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/06/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Health-income inequality has been the focus of many studies. The relationship between economic conditions and health has also been widely studied. However, not much is known about how changes in aggregate economic conditions relate to health-income inequality. Nevertheless, such knowledge would have both scientific and practical value as substantial public expenditures are used to decrease such inequalities and opportunities to do so may differ over the business cycle. For this reason we examine the effect of the Icelandic economic collapse in 2008 on health-income inequality. Methods The data used come from a health and lifestyle survey carried out by the Public Health Institute of Iceland in 2007 and 2009. A stratified random sample of 9,807 individuals 18–79 years old received questionnaires and a total of 42.1% answered in both years. As measures of health-income inequality, health-income concentration indices are calculated and decomposed into individual-level determinants. Self-assessed health is used as the health measure in the analyses, but three different measures of income are used: individual income, household income, and equivalized household income. Results In both years there is evidence of health-income inequality favoring the better off. However, changes are apparent between years. For males health-income inequality increases after the crisis while it remains fairly stable for females or slightly decreases. The decomposition analyses show that income itself and disability constitute the most substantial determinants of inequality. The largest increases in contributions between years for males come from being a student, having low education and being obese, as well as age and income but those changes are sensitive to the income measure used. Conclusions Changes in health and income over the business cycle can differ across socioeconomic strata, resulting in cyclicality of income-related health distributions. As substantial fiscal expenditures go to limiting the relationship between income and health, the business-cycle effect on equality, which has up until now not received much attention, needs to be considered.
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Min JW. Trends in Socioeconomic and Racial/Ethnic Inequalities in Self-Assessed Health, Disability, and Mental Health in California: Findings from CHIS 2001–2011. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0027-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Gommans FG, Jansen NWH, Stynen D, de Grip A, Kant I. Need for recovery across work careers: the impact of work, health and personal characteristics. Int Arch Occup Environ Health 2014; 88:281-95. [PMID: 24989905 DOI: 10.1007/s00420-014-0956-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 06/22/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Employees experiencing a high need for recovery (NFR) are at risk of long-term adverse effects in both their health and labour participation. So far, the determinants of NFR across age categories remain unknown. The aim of this study is to investigate the determinants of the NFR among employees in three age categories (30-44, 45-54 and 55-65 years), for men and women separately. METHODS The study was based on data from the prospective Maastricht Cohort Study. Wave T3 (May 1999) was chosen as article baseline (n = 7,900). The follow-up period of 20 months included five follow-up waves. Cox regression analyses were performed to investigate the determinants, which originated from the work environment, health and lifestyle and personal domain of employees, of NFR across age categories over time. RESULTS Cross-sectional results demonstrated substantial differences in mean scores and proportion of cases of NFR across age categories. Longitudinal analyses demonstrated risk factors in the multifactorial aetiology of NFR that played a role in all age categories, but also showed several age-specific risk factors, e.g. low decision latitude appeared to be a risk factor only in the oldest age category. CONCLUSIONS Although selection effects may have occurred, this study shows that the risk factors for a high NFR were different among the age categories. To prevent and reduce a high NFR among employees, it is important to develop preventive measures that target age-specific risk factors.
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Affiliation(s)
- F G Gommans
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands,
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19
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Educational inequalities in mortality by cause of death: first national data for the Netherlands. Int J Public Health 2014; 59:687-96. [DOI: 10.1007/s00038-014-0576-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022] Open
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Muckenhuber J, Fernandez K, Burkert NT, Großschädl F, Freidl W, Rásky É. Trends in inequalities in health, risk and preventive behaviour among the advanced-age population in Austria: 1983-2007. PLoS One 2014; 9:e97400. [PMID: 24840875 PMCID: PMC4026221 DOI: 10.1371/journal.pone.0097400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/17/2014] [Indexed: 11/30/2022] Open
Abstract
Background Although a number of previous research studies have focused on the long-term analysis of the health and health behaviour of the elderly, there is still a shortage of information in relation to the long-term trends regarding health or risk and preventive behaviour in the elderly population taking into account gender differences and differences in educational level. Methods The database comprised subsamples of the Austrian Micro-Census, including individuals aged 65 years and older, for the years 1983, 1991, 1999, and subsamples of the ATHIS (Austrian Health Interview Survey) 2007. A trend analysis was conducted for four health-related variables with the year of the survey and education as predictors. The analysis was stratified by sex. Results We found a general trend towards better self-rated health, better preventive and less risk behaviour among the elderly, while the body mass index has been increasing over the years. There are indeed gender differences regarding the trend in smoking behaviour. While the prevalence of male smoking has been steadily decreasing, female smoking prevalence has not changed. At all points in time, individuals with higher education had significantly better self-rated health than those with lower education but the association between education and preventive behaviour significantly decreased over the years. Conclusion We agree with previous research in concluding that preventive action and health promotion should aim in particular to support older women and men with lower education.
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Affiliation(s)
- Johanna Muckenhuber
- Department of Social Medicine and Epidemiology, Medical University Graz, Graz, Austria
- * E-mail:
| | - Karina Fernandez
- Department of business education and development, Karl-Franzens-University Graz, Graz, Austria
| | - Nathalie T. Burkert
- Department of Social Medicine and Epidemiology, Medical University Graz, Graz, Austria
| | - Franziska Großschädl
- Department of Social Medicine and Epidemiology, Medical University Graz, Graz, Austria
| | - Wolfgang Freidl
- Department of Social Medicine and Epidemiology, Medical University Graz, Graz, Austria
| | - Éva Rásky
- Department of Social Medicine and Epidemiology, Medical University Graz, Graz, Austria
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Dirven JAM, Tange HJ, Muris JWM, van Haaren KMA, Vink G, van Schayck OCP. Early detection of COPD in general practice: implementation, workload and socioeconomic status. A mixed methods observational study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:338-43. [PMID: 23966213 PMCID: PMC6442826 DOI: 10.4104/pcrj.2013.00071] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is underdiagnosed in general practice. Our aim was to implement a population-based approach for the early detection of COPD and to assess its impact on primary care workload and costs, and the influence of socioeconomic status (SES). Methods: An observational study with mixed methods was performed in 10 Dutch general practices of either low or moderate to high SES. The Respiratory Health Screening Questionnaire was posted during a three-month period to all persons aged 45, 55, and 65 years (one age group per month). The practices calculated the risk, and patients at high risk of COPD were invited for spirometry at the practice. The general practitioner used the spirometric results and a consultation to establish a clinical diagnosis. Qualitative and quantitative data on workload, cost, and barriers were evaluated. Results: Ten practices returned 293 (35.3%) COPD risk tests for the three age groups. Participants from low SES practices responded better than those from moderate to high SES practices (40.8% vs. 30.5%). In practices with low SES 17.9% of the tests indicated high risk compared with 16.1% in practices with moderate to high SES. Nine patients (23%) were newly diagnosed with COPD. The healthcare providers' extra workload averaged 18.5 hours during the three months for one standard practice. The average cost of this survey programme (three age groups in three months) was 荤520 for low SES practices and 荤398 for moderate to high SES practices. All healthcare providers affirmed that the extra workload in this survey model is acceptable and feasible when finances are compensated. Conclusions: Early detection of COPD is feasible in daily life primary care. In moderate to high SES practices the costs of detecting COPD were less than in low SES practices.
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Affiliation(s)
- Joseph A M Dirven
- Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands
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Cullati S, Rousseaux E, Gabadinho A, Courvoisier DS, Burton-Jeangros C. Factors of change and cumulative factors in self-rated health trajectories: a systematic review. ADVANCES IN LIFE COURSE RESEARCH 2014; 19:14-27. [PMID: 24796875 DOI: 10.1016/j.alcr.2013.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 06/03/2023]
Abstract
In Western societies, self-rated health (SRH) inequalities have increased over the past decades. Longitudinal studies suggest that the SRH trajectories of disadvantaged populations are declining at a faster rate than those of advantaged populations, resulting in an accumulation of (dis)advantages over the life course, as postulated by the Cumulative Advantage/Disadvantage (CAD) model. The objectives of this study are to conduct a systematic review of the factors influencing SRH trajectories in the adult population and to assess to what extent the findings support the CAD model. Based on the inclusion criteria, 36 articles, using 15 nationally representative databases, were reviewed. The results show that young age, high socioeconomic position and marital transitions (entering a partnership) are advantageous factors of change in SRH trajectories. However, evidence for cumulative influences supporting the CAD model remains limited: gender, ethnicity, education and employment status are only moderately associated with growing influences over time, and the cumulative influences of income, occupation, age and marital status are weak. In conclusion, this systematic review provides consolidated evidence on the factors influencing SRH trajectories, though the inclusion of only 15 nationally representative databases may limit the generalization of the results.
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Affiliation(s)
- Stéphane Cullati
- Swiss National Center of Competence for Research LIVES - Overcoming Vulnerability: Life Course Perspectives, Institute of Demographic and Life Course Studies, University of Geneva, Switzerland.
| | - Emmanuel Rousseaux
- Swiss National Center of Competence for Research LIVES - Overcoming Vulnerability: Life Course Perspectives, Institute of Demographic and Life Course Studies, University of Geneva, Switzerland; Department of Economics, University of Geneva, Switzerland
| | - Alexis Gabadinho
- Swiss National Center of Competence for Research LIVES - Overcoming Vulnerability: Life Course Perspectives, Institute of Demographic and Life Course Studies, University of Geneva, Switzerland
| | - Delphine S Courvoisier
- Swiss National Center of Competence for Research LIVES - Overcoming Vulnerability: Life Course Perspectives, Institute of Demographic and Life Course Studies, University of Geneva, Switzerland; Department of Psychology, Harvard University, United States
| | - Claudine Burton-Jeangros
- Swiss National Center of Competence for Research LIVES - Overcoming Vulnerability: Life Course Perspectives, Institute of Demographic and Life Course Studies, University of Geneva, Switzerland
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Smit ES, Hoving C, Cox VCM, de Vries H. Influence of recruitment strategy on the reach and effect of a web-based multiple tailored smoking cessation intervention among Dutch adult smokers. HEALTH EDUCATION RESEARCH 2012; 27:191-199. [PMID: 22058288 DOI: 10.1093/her/cyr099] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study investigated the influence of two different recruitment strategies on the reach and effect of a web-based multiple tailored smoking cessation program. From May 2009 until June 2010, Dutch adult smokers were recruited via mass media or general practices. Those who completed the baseline questionnaire were followed up during 6 weeks (two follow-ups). Differences between the two samples were assessed regarding baseline characteristics, retention rates, quit attempts and 24-hour point prevalence abstinence. Smokers recruited via general practices (N = 409) were significantly lower educated, less addicted, more motivated to quit smoking and to maintain non-smoking, more often female and more often suffering from cardiovascular or respiratory diseases than mass media respondents (N = 1154). They showed higher retention rates and were more likely to report a quit attempt (64.3 versus 50.7%) and abstinence (43.3 versus 33.1%). More respondents could be recruited via mass media, while general practices respondents showed higher retention rates and were more successful in quitting smoking, though these effects became non-significant when controlling for experimental condition and baseline differences. The choice for a particular recruitment strategy appeared to determine the number and type of smokers recruited and might consequently influence the intervention's potential public health impact.
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Affiliation(s)
- Eline Suzanne Smit
- Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Boateng L, Nicolaou M, Dijkshoorn H, Stronks K, Agyemang C. An exploration of the enablers and barriers in access to the Dutch healthcare system among Ghanaians in Amsterdam. BMC Health Serv Res 2012; 12:75. [PMID: 22443162 PMCID: PMC3348030 DOI: 10.1186/1472-6963-12-75] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/24/2012] [Indexed: 11/18/2022] Open
Abstract
Background Sub-Saharan African populations are growing in many European countries. Data on the health of these populations are rare. Additionally, many sub-Saharan African migrants are confronted with issues of low socio-economic status, acculturation and language difficulties, which may hamper their access to health care. Despite the identification of some of those barriers, little is known about the enabling factors. Knowledge about the enablers and barriers in access to healthcare experienced is important in addressing their health needs and promoting healthcare access. This study aimed to investigate the enabling factors as well as barriers in access to the Dutch healthcare system among the largest sub-Saharan African migrant group (Ghanaians) living in Amsterdam, the Netherlands. Methods Six focus groups were conducted from November 2009 to February 2010. A semi-structured interview guideline was used. Discussions were conducted in English or Twi (Ghanaian dialect), recorded and transcribed verbatim. Analysis was based on the Andersen model of healthcare utilisation using MAXQDA software. Results Knowledge and perceived quality of the health system, awareness of diseases, family and community support, community initiatives and availability of social support were the main enablers to the healthcare system. Difficulties with the Dutch language and mistrust in health care providers were major barriers in access to healthcare. Conclusions Access to healthcare is facilitated mainly by knowledge of and the perceived efficiency and quality of the Dutch healthcare system. However, poor Dutch language proficiency and mistrust in health care providers appear to be important barriers in accessing healthcare. The enablers and barriers identified by this study provide useful information for promoting healthcare access among this and similar Sub-Saharan African communities.
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Affiliation(s)
- Linda Boateng
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Jablonska B, Soares JJF, Sundin O. Pain among women: Associations with socio-economic and work conditions. Eur J Pain 2012; 10:435-47. [PMID: 16054408 DOI: 10.1016/j.ejpain.2005.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 06/07/2005] [Accepted: 06/13/2005] [Indexed: 10/25/2022]
Abstract
We examined pain prevalence (general/body sites) and its characteristics/consequences among a randomised sample of women from the general population between 18 and 64 years (n=3,616). We also scrutinised associations between pain and various factors (e.g. socio-economic) by means of multivariate logistic/linear regression analyses. The women completed a questionnaire assessing various areas (e.g. pain). The design was cross-sectional and data were collected during 8 consecutive weeks. Sixty-three per cent of women reported pain during the last 3 months, of which 65% during more than 3 months. The multivariate analyses revealed associations between various socio-economic factors (e.g. financial strain) and pain in general/all studied body sites. In addition, psychosocial work conditions (i.e. work strain and social support) were significantly related to pain. Moreover, the multivariate analyses conducted among women with pain indicated relationships between socio-economic/psychosocial work conditions, and pain characteristics (e.g. intensity) and consequences (i.e. disability). A large number of women from the general population suffer from pain, in particularly prolonged pain. Women in a deprived socio-economic situation not only run a higher pain risk, but also experience their pain as more severe/disabling than their more privileged counterparts. Improvements of, for example, the socio-economic status among women living in deprived social and material circumstances, along with improved working environment may be crucial to reduce women's pain problems.
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Affiliation(s)
- Beata Jablonska
- Unit of Mental Health, Stockholm Centre of Public Health, Department of Public Health Sciences, Karolinska Institute, P.O. Box 17533, SE-11891 Stockholm, Sweden
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Raat H, Wijtzes A, Jaddoe VWV, Moll HA, Hofman A, Mackenbach JP. The health impact of social disadvantage in early childhood; the Generation R study. Early Hum Dev 2011; 87:729-33. [PMID: 21975277 DOI: 10.1016/j.earlhumdev.2011.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Inequalities in child health are of major concern to policymakers, public health specialists and clinicians. This review of studies within the context of the Generation R study illustrates that inequalities in population health, at least partly, originate in pregnancy and early childhood. The review shows inequalities with regard to the health of the pregnant mother, with regard to the growth of the fetus, with regard to birth outcomes, and with regard to health indicators in early childhood. These results are shown with regard to both biological/somatic outcomes, as well as with regard to psychosocial outcomes and healthy lifestyles. Both socioeconomic inequalities and ethnic inequalities in health are present. Although some inequalities can be explained by known determinants, research needs to be done to reach a full understanding of the pathways between social disadvantage and ill health in early childhood.
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Affiliation(s)
- Hein Raat
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Kroll LE, Lampert T. Changing health inequalities in Germany from 1994 to 2008 between employed and unemployed adults. Int J Public Health 2011; 56:329-39. [DOI: 10.1007/s00038-011-0233-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 12/07/2010] [Accepted: 12/23/2010] [Indexed: 11/24/2022] Open
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Furnee CA, Groot W, Pfann GA. Health and income: a meta-analysis to explore cross-country, gender and age differences. Eur J Public Health 2010; 21:775-80. [DOI: 10.1093/eurpub/ckq166] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Furnée CA, Pfann GA. Individual vulnerability and the nurturing state: The case of self-reported health and relative income. Soc Sci Med 2010; 71:125-33. [DOI: 10.1016/j.socscimed.2010.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 02/18/2010] [Accepted: 03/10/2010] [Indexed: 11/26/2022]
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Fassaert T, Hesselink AE, Verhoeff AP. Acculturation and use of health care services by Turkish and Moroccan migrants: a cross-sectional population-based study. BMC Public Health 2009; 9:332. [PMID: 19744326 PMCID: PMC2749828 DOI: 10.1186/1471-2458-9-332] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 09/10/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is insufficient empirical evidence which shows if and how there is an interrelation between acculturation and health care utilisation. The present study seeks to establish this evidence within first generation Turkish and Moroccan migrants, two of the largest migrant groups in present-day Western Europe. METHODS Data were derived from the Amsterdam Health Monitor 2004, and were complete for 358 Turkish and 288 Moroccan foreign-born migrants. Use of health services (general practitioner, outpatient specialist and health care for mental health problems) was measured by means of self-report. Acculturation was measured by a structured questionnaire grading (i) ethnic self-identification, (ii) social interaction with ethnic Dutch, (iii) communication in Dutch within one's private social network, (iv) emancipation, and (v) cultural orientation towards the public domain. RESULTS Acculturation was hardly associated with the use of general practitioner care. However, in case of higher adaptation to the host culture there was less uptake of outpatient specialist care among Turkish respondents (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82-0.99) and Moroccan male respondents (OR = 0.81, 95% CI = 0.71-0.93). Conversely, there was a higher uptake of mental health care among Turkish men (OR = 0.81, 95% CI = 0.71-0.93) and women (OR = 0.81, 95% CI = 0.71-0.93). Uptake of mental health care among Moroccan respondents again appeared lower (OR = 0.74, 95% CI = 0.55-0.99). Language ability appeared to play a central role in the uptake of health care. CONCLUSION Some results were in accordance with the popular view that an increased participation in the host society is concomitant to an increased use of health services. However, there was heterogeneity across ethnic and gender groups, and across the domains of acculturation. Language ability appeared to play a central role. Further research needs to explore this heterogeneity into more detail. Also, other cultural and/or contextual aspects that influence the use of health services require further identification.
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Affiliation(s)
- Thijs Fassaert
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
- Department of Social Medicine, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Arlette E Hesselink
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
| | - Arnoud P Verhoeff
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
- Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, the Netherlands
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Fassaert T, de Wit MAS, Verhoeff AP, Tuinebreijer WC, Gorissen WHM, Beekman ATF, Dekker J. Uptake of health services for common mental disorders by first-generation Turkish and Moroccan migrants in the Netherlands. BMC Public Health 2009; 9:307. [PMID: 19698174 PMCID: PMC2737538 DOI: 10.1186/1471-2458-9-307] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 08/23/2009] [Indexed: 11/10/2022] Open
Abstract
Background Migration and ethnic minority status have been associated with higher occurrence of common mental disorders (CMD), while mental health care utilisation by non-Western migrants has been reported to be low compared to the general population in Western host countries. Still, the evidence-base for this is poor. This study evaluates uptake of mental health services for CMD and psychological distress among first-generation non-Western migrants in Amsterdam, the Netherlands. Methods A population-based survey. First generation non-Western migrants and ethnic Dutch respondents (N = 580) participated in structured interviews in their own languages. The interview included the Composite International Diagnostic Interview (CIDI) and the Kessler psychological distress scale (K10). Uptake of services was measured by self-report. Data were analysed using weighting techniques and multivariate logistic regression. Results Of subjects with a CMD during six months preceding the interview, 50.9% reported care for mental problems in that period; 35.0% contacted specialised services. In relation to CMD, ethnic groups were equally likely to access specialised mental health services. In relation to psychological distress, however, Moroccan migrants reported less uptake of primary care services (OR = 0.37; 95% CI = 0.15 to 0.88). Conclusion About half of the ethnic Dutch, Turkish and Moroccan population in Amsterdam with CMD contact mental health services. Since the primary purpose of specialised mental health services is to treat "cases", this study provides strong indications for equal access to specialised care for these ethnic groups. The purpose of primary care services is however to treat psychological distress, so that access appears to be lower among Moroccan migrants.
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Affiliation(s)
- Thijs Fassaert
- Department of Epidemiology Documentation & Health Promotion, Municipal Health Service, Amsterdam, the Netherlands.
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Van Ourti T, van Doorslaer E, Koolman X. The effect of income growth and inequality on health inequality: Theory and empirical evidence from the European Panel. JOURNAL OF HEALTH ECONOMICS 2009; 28:525-539. [PMID: 19185942 DOI: 10.1016/j.jhealeco.2008.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 09/25/2008] [Accepted: 12/17/2008] [Indexed: 05/27/2023]
Abstract
Governments of EU countries have declared that they would like to couple income growth with reductions in social inequalities in income and health. We show that, theoretically, both aims can be reconciled only under very specific conditions concerning the type of growth and the income responsiveness of health. We investigate whether these conditions were met in Europe in the 1990s using panel data from the European Community Household Panel. We demonstrate that (i) in most countries, the income elasticity of health was positive and increases with income, and (ii) that income growth was not pro-rich in most EU countries, resulting in small or negligible reductions in income inequality. The combination of both findings explains the modest increases we observe in income-related health inequality in the majority of countries.
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Affiliation(s)
- Tom Van Ourti
- Erasmus School of Economics, Erasmus University Rotterdam, PB 1738, 3000 DR Rotterdam, The Netherlands.
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Chittleborough CR, Taylor AW, Baum FE, Hiller JE. Monitoring inequities in self-rated health over the life course in population surveillance systems. Am J Public Health 2009; 99:680-9. [PMID: 19197081 PMCID: PMC2661477 DOI: 10.2105/ajph.2008.141713] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the effect of social mobility and to assess the use of socioeconomic indicators in monitoring health inequities over time, we examined the association of self-rated health with socioeconomic position over the life course. METHODS Data came from a cross-sectional telephone survey (n = 2999) that included life-course socioeconomic indicators and from a chronic disease and risk factor surveillance system (n = 26 400). Social mobility variables, each with 4 possible intergenerational trajectories, were constructed from family financial situation and housing tenure during childhood and adulthood. RESULTS Low socioeconomic position during both childhood and adulthood and improved financial situation in adulthood were associated with a reduced prevalence of excellent or very good health. Trends over time indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. CONCLUSIONS Our results support policies aiming to improve family financial situation during childhood and housing tenure across the life course. Inclusion of life-course socioeconomic measures in surveillance systems would enable monitoring of health inequities trends among socially mobile groups.
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Affiliation(s)
- Catherine R Chittleborough
- Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia.
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Jaffe DH, Neumark YD, Eisenbach Z, Manor O. Educational inequalities in mortality among Israeli Jews: Changes over time in a dynamic population. Health Place 2008; 14:287-98. [PMID: 17889590 DOI: 10.1016/j.healthplace.2007.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Revised: 06/06/2007] [Accepted: 07/25/2007] [Indexed: 10/23/2022]
Abstract
Changes in educational inequalities in mortality in a country that underwent a sudden population growth were examined using two census-based longitudinal studies from Israel (I, 1983-1992, n=152,150 and II, 1995-2004, n=209,125). Relative changes in educational inequalities in mortality were assessed using mortality rates and odds ratios and their corresponding 95% confidence intervals. Decreases in mortality rates and widening relative educational inequalities in mortality were seen over time. Among recent immigrants, educational inequalities in mortality existed but to a lesser degree than for residents. The widening gap (2.5-fold) in cardiovascular disease mortality risks observed for low versus high educated middle-aged women, was particularly alarming. The observed decreasing mortality rates, indicative of a healthier society, alongside widening educational inequalities in mortality indicates uneven changes within the population.
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Affiliation(s)
- Dena H Jaffe
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
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Khang YH, Yun SC, Lynch JW. Monitoring trends in socioeconomic health inequalities: it matters how you measure. BMC Public Health 2008; 8:66. [PMID: 18284701 PMCID: PMC2266739 DOI: 10.1186/1471-2458-8-66] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 02/20/2008] [Indexed: 11/25/2022] Open
Abstract
Background Odds ratio (OR), a relative measure for health inequality, has frequently been used in prior studies for presenting inequality trends in health and health behaviors. Since OR is not a good approximation of prevalence ratio (PR) when the outcome prevalence is quite high, an important problem may arise when OR trends are used in data in which the outcome variable (e.g., smoking or ill-health) is of relatively high prevalence and varies significantly over time. This study is to compare time trends of odds ratio (OR) and prevalence ratio (PR) for examining time trends in socioeconomic inequality in smoking. Methods A total of 147,805 subjects (71,793 men and 76,017 women) aged 25–64 from three Social Statistics Surveys of Korea from 1999 to 2006 were analyzed. Socioeconomic position indicators were occupational class and education. Results While there were no significant p values for trend in ORs of occupational class among men, trends for PRs were significant. In women, p values for OR trends were similar to those for PR trends. In males, RII by log-binomial regression showed a significant increasing tendency while RII by logistic regression was stable between years. In females, trends of RIIs by logistic regression and log-binomial regression produced a similar level of p values. Conclusion Different methods of measuring trends in socioeconomic health inequalities may lead to different conclusions about whether relative inequalities are increasing or decreasing. Trends in ORs may overstate or understate trends in relative inequality in health when the outcome is of relatively high prevalence and that prevalence varies significantly with time.
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Affiliation(s)
- Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
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Volkers AC, Westert GP, Schellevis FG. Health disparities by occupation, modified by education: a cross-sectional population study. BMC Public Health 2007; 7:196. [PMID: 17686141 PMCID: PMC1988822 DOI: 10.1186/1471-2458-7-196] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 08/08/2007] [Indexed: 11/10/2022] Open
Abstract
Background Socio-economic disparities in health status are frequently reported in research. By comparison with education and income, occupational status has been less extensively studied in relation to health status or the occurrence of specific chronic diseases. The aim of this study was to investigate health disparities in the working population based on occupational position and how they were modified by education. Methods Our data were derived from the National Survey of General Practice that comprised 104 practices in the Netherlands. 136,189 working people aged 25–64 participated in the study. Occupational position was assessed by the International Socio-Economic Index of occupational position (ISEI). Health outcomes were self-perceived health status and physician-diagnosed diseases. Odds ratios were estimated using multivariate logistic regression analysis. Results The lowest occupational position was observed to be associated with poor health in men (OR = 1.6, 95% CI 1,5 to 1.7) and women (OR = 1.3, 95% CI 1.2 to 1.4). The risk of poor health gradually decreased in relation to higher occupational positions. People with the lowest occupational positions were more likely to suffer from depression, diabetes, ischaemic heart disease, arthritis, muscle pain, neck and back pain and tension headache, in comparison to people with the highest occupational position (OR 1.2 to 1.6). A lower educational level induced an additional risk of poor health and disease. We found that gender modified the effects on poor health when both occupational position and education were combined in the analysis. Conclusion A low occupational position was consistently associated working people with poor health and physician-diagnosed morbidity. However a low educational level was not. Occupational position and education had a combined effect on self-perceived health, which supports the recent call to improve the conceptual framework of health disparities.
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Affiliation(s)
- Anita C Volkers
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Gert P Westert
- RIVM (National Institute of Public Health and the Environment), Bilthoven/Tilburg University (TRANZO), Tilburg, The Netherlands
| | - Francois G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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Soares JJF, Grossi G, Sundin O. Burnout among women: associations with demographic/socio-economic, work, life-style and health factors. Arch Womens Ment Health 2007; 10:61-71. [PMID: 17357826 DOI: 10.1007/s00737-007-0170-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 01/13/2007] [Indexed: 01/18/2023]
Abstract
This study examined the occurrence of low/high burnout among women and the demographic/socio-economic, work, life-style, and health "correlates" of high burnout. The sample consisted of 6.000 randomly selected women from the general population, of which 3.591 participated. The design was cross-sectional. The univariate analyses showed that about 21% of the women had high burnout, and compared to those with low burnout, they were more often younger, divorced, blue-collar workers, lower educated, foreigners, on unemployment/retirement/sick-leave, financially strained, used more medication and cigarettes, reported higher work demands and lower control/social support at work, more somatic problems (e.g. pain) and depression. The regression analysis showed that only age, sick-leave, financial strain, medication, work demands, depression and somatic ailments were independently associated with high burnout. Thus, women with high burnout were apparently faring poorly financially, emotionally and physically. Considering our findings, interventions to alleviate their problems may be necessary. We may have provided new insights into women's burnout experiences, but longitudinal studies are warranted to firmly identify "determinants" of burnout.
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Affiliation(s)
- J J F Soares
- Stockholm Center of Public Health, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden.
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Regidor E. Social determinants of health: a veil that hides socioeconomic position and its relation with health. J Epidemiol Community Health 2007; 60:896-901. [PMID: 16973539 PMCID: PMC2566061 DOI: 10.1136/jech.2005.044859] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The emergence of theoretical models of social determinants of health has added conceptual ambiguity to the understanding of social inequalities in health, as it is often not possible to clearly distinguish between socioeconomic position and these determinants. Whether the existence of social inequalities in health is based on differences in health or on differences in social determinants of health that are systematically associated with socioeconomic position, policymakers should be clearly informed of the importance of socioeconomic position for health. Thus, the following three basic requirements are proposed: to reach a consensus about the dimensions that reflect socioeconomic position; to agree about what are to be considered the social determinants of health and whether or not these determinants are a construct that can be distinguished from socioeconomic position; and finally, to establish which dimensions and measures of socioeconomic position are most appropriate for the evaluation of interventions that aim to reduce these inequalities.
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Affiliation(s)
- Enrique Regidor
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.
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Monden C. Partners in health? Exploring resemblance in health between partners in married and cohabiting couples. SOCIOLOGY OF HEALTH & ILLNESS 2007; 29:391-411. [PMID: 17470218 DOI: 10.1111/j.1467-9566.2007.01003.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Sociological theories on family formation and families and health suggest that married and cohabiting partners will resemble each other in health status, positively or negatively. The family is often seen as a health-enhancing agent for individuals. However, there are large health differences among families. This study aims to answer the question whether it is the case that the healthy live with the healthy and individuals with poor health have partners who are also in poor health. Moreover, it examines whether resemblance in health is a consequence of partner choice--educational homogamy in particular--behaviour or shared circumstances. Younger and older couples are compared to investigate whether health resemblance increases over the lifecourse. Analyses of a nationally representative sample of almost 12,000 Dutch couples show that partners are indeed significantly alike with regard to several health indicators. Respondents whose partner reports poor health are almost three times more likely to report poor health than respondents whose partner is in good health. There is a strong accumulation of health problems within households. Partner selection with regard to education causes part of the partner resemblance in health. Less support is found for the hypotheses that risk behaviour, mutual influence or the effects of shared circumstances cause similarity between partners' health status. Surprisingly, partners in older couples, who have been together for a longer time, do not resemble each other significantly more than partners in younger couples. The implications of these findings for sociological theory and social inequalities in health are discussed.
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Giskes K, Turrell G, van Lenthe FJ, Brug J, Mackenbach JP. A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study. Public Health Nutr 2007; 9:75-83. [PMID: 16480537 DOI: 10.1079/phn2005758] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo examine the influence of individual- and area-level socio-economic characteristics on food choice behaviour and dietary intake.SettingThe city of Eindhoven in the south-east Netherlands.DesignA total of 1339 men and women aged 25–79 years were sampled from 85 areas (mean number of participants per area = 18.4, range 2–49). Information on socio-economic position (SEP) and diet was collected by structured face-to-face interviews (response rate 80.9%). Individual-level SEP was measured by education and household income, and area-level deprivation was measured using a composite index that included residents' education, occupation and employment status. Diet was measured on the basis of (1) a grocery food index that captured compliance with dietary guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and saturated fat. Multilevel analyses were performed to examine the independent effects of individual- and area-level socio-economic characteristics on the dietary outcome variables.ResultsAfter adjusting for individual-level SEP, few trends or significant effects of area deprivation were found for the dietary outcomes. Significant associations were found between individual-level SEP and food choice, breakfast consumption and fruit intake, with participants from disadvantaged backgrounds being less likely to report food behaviours or nutrient intakes consistent with dietary recommendations.ConclusionsThe findings suggest that an individual's socio-economic characteristics play a more important role in shaping diet than the socio-economic characteristics of the area in which they live. In this Dutch study, no independent influence of area-level socio-economic characteristics on diet was detected, which contrasts with findings from the USA, the UK and Finland.
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Affiliation(s)
- Katrina Giskes
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
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Regidor E, Martínez D, Astasio P, Ortega P, Calle ME, Domínguez V. Trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain. GACETA SANITARIA 2006; 20:178-82. [PMID: 16756854 DOI: 10.1016/s0213-9111(06)71484-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain between 1987 and 2001. METHODS We estimated the distribution of educational level and per capita provincial income, and the differences in less-than-good self-perceived health by educational level and per capita provincial income in each period. RESULTS The percentage of the population that had completed secondary or higher education was larger and inequality in per capita provincial income was smaller in 2001 than in 1987. In general, the differences in less-than-good self-perceived health by educational level and provincial income were greater in 2001 than in 1987, in both absolute and relative terms. However, when the effect of residual correlation within provinces was taken into account, the differences by per capita provincial income were smaller in 1987 than in 2001. CONCLUSIONS The redistribution of socioeconomic resources achieves greater social justice, but probably does not lead to reduced health inequalities in all cases.
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Affiliation(s)
- Enrique Regidor
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Strand BH, Kunst A. Childhood socioeconomic status and suicide mortality in early adulthood among Norwegian men and women. A prospective study of Norwegians born between 1955 and 1965 followed for suicide from 1990 to 2001. Soc Sci Med 2006; 63:2825-34. [PMID: 16952414 DOI: 10.1016/j.socscimed.2006.07.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Indexed: 11/28/2022]
Abstract
Even though the causes of suicide may be rooted in childhood, it is unknown how socioeconomic position (SEP) in childhood is related to suicide in adulthood. We describe the association between childhood SEP and suicide mortality in adulthood in Norway using registry data on 613807 Norwegians born in 1955-1965. Data on 1013 suicide deaths between 1990 and 2001 were linked to data on SEP indicators, using Cox regression. Suicide mortality was higher among women with high childhood SEP than among women with low childhood SEP. This association was explained in part by family situation in adulthood, but not by adult SEP. For males, after adjustment for adult SEP, we observed a similar but weaker association between suicide and childhood SEP. We discuss several mechanisms which may explain the direct positive association of childhood SEP with suicide mortality in adulthood, especially among females. These are downward mobility, not meeting high demands set by highly educated parents, psychological distress, mental disorder, gender differences and social networks and norms.
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Affiliation(s)
- B H Strand
- Norwegian Institute of Public Health, Oslo, Norway; Erasmus MC, University Medical Center, Rotterdam.
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Adams J, Holland L, White M. Changes in socioeconomic inequalities in census measures of health in England and Wales, 1991-2001. J Epidemiol Community Health 2006; 60:218-20. [PMID: 16476751 PMCID: PMC2465554 DOI: 10.1136/jech.2005.040998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVES To investigate changes in socioeconomic inequalities in census measures of health in England and Wales between 1991 and 2001. DESIGN Indirect standardisation was used to calculate age standardised rates of limiting long term illness and permanent sickness in men and women in all residential wards in England and Wales in 1991 and 2001. The socioeconomic position of each ward was determined using Townsend deprivation scores. SETTING All residential wards in England and Wales in 1991 and 2001. PARTICIPANTS All people aged 16-65 who provided census information in the 1991 or 2001 censuses. MAIN RESULTS There was strong evidence that Townsend deprivation score quintile could predict both logged standardised permanent sickness rate and logged standardised limiting long term illness rate. There was evidence that socioeconomic inequalities in standardised limiting long term illness rates decreased between 1991 and 2001 in both men and women and that socioeconomic inequalities in standardised permanent sickness rates decreased in women but increased in men between 1991 and 2001. CONCLUSIONS As permanent sickness rates seem to reflect labour market accessibility, this study may have found evidence that socioeconomic inequalities in self reported morbidity decreased but inequalities in labour market participation in men increased between 1991 and 2001.
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Affiliation(s)
- Jean Adams
- Public Health Research Group, School of Population and Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK.
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Helasoja V, Lahelma E, Prättälä R, Klumbiene J, Pudule I, Tekkel M. Trends in the magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland during 1994–2004. Public Health 2006; 120:841-53. [PMID: 16879845 DOI: 10.1016/j.puhe.2006.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 04/09/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland. METHODS The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20-64 years) in Estonia (n=9049), Latvia (n=7685), Lithuania (n=11,634) and Finland (n=18,821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms. RESULTS The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women. CONCLUSIONS The period from 1994 to 2004 of relative stabilization since the worst conditions of the social transition has not been followed by notable changes in self-reported health, and this appears to be the situation across all educational groups in the Baltic countries. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better-educated respondents. The factors contributing towards increasing health inequalities may only be visible in the future.
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Affiliation(s)
- Ville Helasoja
- Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
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Ruiz-Ramos M, Escolar Pujolar A, Sánchez Perea J, Garrucho Rivero G. Evolución de las desigualdades sociales en la mortalidad general de la ciudad de Sevilla (1994-2002). GACETA SANITARIA 2006; 20:303-10. [PMID: 16942718 DOI: 10.1157/13091146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To know trends of social inequalities in general mortality in Seville (Spain) between 1997 and 2002. MATERIAL AND METHOD Socioeconomic level of its the residential census tracts was assigned for each death, taken from the Socio-economic Synthetic Index built up after applying a principal components analysis from 2001 census variables. Using mortality indicators its magnitude and trend was described according socio-economic level. RESULTS General mortality standardized rates by age in the census tracts of lowest socio-economic level were 1.32 and 1.25 times greater than in the highest census tracts in men and 1.19 and 1.08 in women respectively in each periods. The truncated rates ratio and potential years of lost life in men went from 1.66 to 2.28 in men and 1.74 to 2.10 in women, respectively. The four years difference in life expectancy at birth between the census tracts of highest and lower level remained unchanged in men, and fell from 1.90 to 0.82 in women. The population attributable risk (all ages) went from 13.18% to 10.46% in men and 10.02% to 2.58% in women. CONCLUSIONS Social inequalities in mortality for the general population decreased mainly in women. The inequalities increased in the early death and between 35-64 years old in men, basically due to a reduced mortality in higher socio-economic level census tracts.
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Adams J, White M. Is the disease risk associated with good self-reported health constant across the socio-economic spectrum? Public Health 2006; 120:70-5. [PMID: 16198383 DOI: 10.1016/j.puhe.2005.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Revised: 04/07/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Self-reported health is likely to be dependent on two key assessments: that of one's own health and that of the best health that could be expected. As many health outcomes are known to vary according to socio-economic position (SEP), it is possible that assessments of the best health that could be expected will vary with SEP. It is, therefore, possible that the disease risk associated with different levels of self-reported health varies according to SEP. We investigated this using data from the 1998 Health Survey for England. METHODS Disease risk was measured as systolic blood pressure and body mass index (BMI), and SEP was measured as occupational social class. Associations between social class and the markers of disease risk were investigated in those reporting different levels of self-reported health using linear regression in order to control for age. RESULTS There were statistically significant socio-economic variations in systolic blood pressure and BMI (in women only) in those who reported their health as good or very good. No such socio-economic variations in disease risk were seen amongst those reporting their health as less than good. CONCLUSIONS The meaning of self-reported health, in terms of disease risk, may not be comparable across the socio-economic spectrum.
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Affiliation(s)
- J Adams
- Public Health Research Group, School of Population and Health Sciences, University of Newcastle upon Tyne, Level 3, DMB, Newcastle upon Tyne NE2 4HH, UK.
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Regidor E, Ronda E, Pascual C, Martínez D, Calle ME, Domínguez V. Decreasing socioeconomic inequalities and increasing health inequalities in Spain: a case study. Am J Public Health 2006; 96:102-8. [PMID: 16317208 PMCID: PMC1470437 DOI: 10.2105/ajph.2004.053983] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the evolution of income inequalities and health inequalities in Spain from the time of the country's entry into the European Union. METHODS We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984-1986 and 1999-2001. RESULTS Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. CONCLUSIONS Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.
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Affiliation(s)
- Enrique Regidor
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.
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Sacker A, Clarke P, Wiggins RD, Bartley M. Social dynamics of health inequalities: a growth curve analysis of aging and self assessed health in the British household panel survey 1991-2001. J Epidemiol Community Health 2005; 59:495-501. [PMID: 15911646 PMCID: PMC1757050 DOI: 10.1136/jech.2004.026278] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study how social inequalities change as people age, this paper presents a growth curve model of self assessed health, which accommodates changes in occupational class and individual health with age. DESIGN Nationally representative interview based longitudinal survey of adults in Great Britain. SETTING Representative members of private households of Great Britain in 1991. PARTICIPANTS Survey respondents (n = 6705), aged 21-59 years in 1991 and followed up annually until 2001. MAIN OUTCOME MEASURE Self assessed health. RESULTS On average, self assessed health declines slowly from early adulthood to retirement age. No significant class differences in health were observed at age 21. Health inequalities emerged later in life with the gap between mean levels of self assessed health of those in managerial and professional occupations and routine occupations widening approaching retirement. Individual variability in health trajectories increased between ages 40 and 59 years so that this widening of mean differences between occupational classes was not significant. When the analysis is confined to people whose occupational class remained constant over time, a far greater difference in health trajectories between occupational classes was seen. CONCLUSIONS The understanding of social inequalities in health at the population level is enriched by an analysis of individual variation in age related declines by social position.
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Affiliation(s)
- Amanda Sacker
- Department of Epidemiology and Public Health, Royal Free and University College London Medical School, 1-19 Torrington Place, London WC1E 6BT, UK.
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Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, Dalstra JAA, Federico B, Helmert U, Judge K, Lahelma E, Moussa K, Ostergren PO, Platt S, Prattala R, Rasmussen NK, Mackenbach JP. Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health 2005; 59:395-401. [PMID: 15831689 PMCID: PMC1733079 DOI: 10.1136/jech.2004.025684] [Citation(s) in RCA: 381] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. DESIGN Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. SETTING Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. PARTICIPANTS 451 386 non-institutionalised men and women 25-79 years old. MAIN OUTCOME MEASURES Smoking status, daily quantity of cigarettes consumed by smokers. RESULTS Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. CONCLUSIONS Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.
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Affiliation(s)
- K Giskes
- Department of Public Health, Erasmus Medical Centre, 3000DR Rotterdam, Netherlands.
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