Monitoring inequities in self-rated health over the life course in population surveillance systems

Decomposing Socioeconomic Inequality in Health Literacy in Iran: A Concentration Index Approach

BACKGROUND

Health literacy is a major factor for health promotion and well-being. In spite of several researches on health literacy, information on the subject of the status of health literacy in Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors.

METHODS

In this cross-sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset-based approach, and principal component analysis (PCA) was performed to estimate the families' SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software.

RESULTS

The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168-0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor.

CONCLUSIONS

The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.

Intergenerational Educational Pathways and Self-Rated Health in Adolescence and Young Adulthood: Results of the German KiGGS Cohort

Health differences in social mobility are often analysed by income differences or different occupational positions. However, in early adulthood many young people still have very diffuse income situations and are not always fully integrated into the labour market despite many having finished school. This article focusses on the link between intergenerational educational pathways and self-rated health (SRH) among young adults considering their SRH in adolescence. The data source used is the German KiGGS cohort study. The analysis sample comprises 2175 young people at baseline (t0: 2003⁻2006 age 14⁻17) and first follow-up (t1: 2009⁻2012 age 19⁻24). Combining parent's and young people's highest school degree, the data can trace patterns of intergenerational educational pathways (constant high level of education, upward mobility, downward mobility, constant low level of education). Young people's SRH was recorded at t0 and t1. During adolescence and young adulthood, participants were less likely to report poor SRH if they had a constant high intergenerational education or if they were upwardly mobile. The differences were particularly striking among young adults: average marginal effects (AME) for poor SRH showed much higher risk among downwardly mobile compared to peers with an intergenerational constant high education (AME: 0.175 [0.099; 0.251]), while the upwardly mobile had a significantly lower risk for less than good SRH than peers with an intergenerational constant low level of education (AME: -0.058 [-0.113; -0.004]). In the context of great societal demands and personal developmental needs, educational differences in health tend to increase in young adulthood. Public Health should pay more attention to educational and health inequalities in young adulthood.

Socio-Economic Status Inequity in Self Rated Health in Patients with Breast Cancer

AIM:

We investigate the evaluation of socio-economic status (SES) inequality on self-rated health (SRH) at women with breast cancer.

STUDY DESIGN:

Cross-sectional study

METHODS:

The current study conducted on all 270 breast cancer patients that were admitted to one of the hospitals of Arak University Medical Sciences (Arak, Iran from April to July 2018) by census (using non-random sampling (accessible sampling). SES was calculated by asset-based questionnaire and Principle Component Analysis (PCA) was performed to estimate the families’ SES. Concentration Index (C) and Curve (CC) was used to measure SES inequality in SRH. The data were analysed with Stata software.

RESULTS:

The number of persons with good SRH by the level of SES was 165 (61.1%) and with poor SRH was 105 (38.9%). The number of persons with good SRH in comparison to same-aged people by level of SES was 135 (50%) and with poor SRH was 135 (50%). Concentration index of SRH in all level of SES was 0.061 (SE = 0.03). Also, Concentration index for SRH in comparison to same-aged people at different levels of SES was -0.044 (SE = 0.03).

CONCLUSION:

The results of this study showed that there is inequality in SRH in a patient with breast cancer of the richest level of SES.

Effect of social mobility in family financial situation and housing tenure on mental health conditions among South Australian adults: results from a population health surveillance system, 2009 to 2011

BACKGROUND

To assess the association of socioeconomic position (SEP), measured by family financial situation and housing tenure in childhood and adulthood, with mental health conditions in adulthood.

METHODS

Representative cross-sectional population data were collected using a risk factor surveillance system in South Australia, Australia. Each month, a random sample were selected from the Electronic White Pages. Participants aged 25 years and above (n = 10429) were asked about doctor diagnosed anxiety, stress or depression, suicidal ideation, psychological distress, demographic and socioeconomic factors using Computer Assisted Telephone Interviewing (CATI). Social mobility measures were derived from housing status and perceived financial situation during adulthood and at 10 years of age.

RESULTS

The prevalence of psychological distress was 8.1 %, current diagnosed mental health condition was 14.8 % and suicidal ideation was 4.3 %. Upward mobility in family financial situation and housing tenure was experienced by 28.6 % and 19.3 %, of respondents respectively. Downward mobility was experienced by 9.4 % for housing tenure and 11.3 % for family financial situation. In the multivariable analysis, after adjusting for age, sex, childhood family structure and adult education, downward social mobility and stable low SEP (both childhood and adulthood), in terms of both housing tenure and financial situation, were positively associated with all three mental health conditions.

CONCLUSION

People with low SEP in adulthood had poor mental health outcomes regardless of their socioeconomic circumstances in childhood. Policies to improve SEP have the potential to reduce mental health conditions in the population.

Early socioeconomic position and self-rated health among civil servants in Brazil: a cross-sectional analysis from the Pró-Saúde cohort study

OBJECTIVES

Although there is evidence that socioeconomic conditions in adulthood are associated with worse self-rated health, the putative effect of early adverse life circumstances on adult self-rated health is not consistent. Besides, little is known on this subject in the context of middle-income countries. We aimed to investigate the association between indicators of socioeconomic position in early life and self-rated health in adulthood, taking into account the influence of current socioeconomic position.

DESIGN

Cross-sectional.

PARTICIPANTS

3339 civil servants (44.5% male) working at a public university in Rio de Janeiro, Brazil, participants of the Pró-Saúde cohort study.

MEASUREMENTS

Through a lifecourse approach, we evaluated if seven indicators of participants' socioeconomic position earlier in life were associated with worse self-rated health in adulthood. Ordinal logistic regression analysis with a proportional odds model was used.

RESULTS

After adjusting for socioeconomic position in adulthood (education and income), the indicators of early socioeconomic position associated with poor self-rated health were as follows: not eating at home due to lack of money at the age of 12 (OR=1.29 95% CI 1.06 to 1.57) and having lived in a small city or rural area at the age of 12 (OR=1.51 95% CI 1.21 to 1.89).

CONCLUSIONS

Self-rated health was associated with two indicators of remarkable experiences of poverty in early life, even when socioeconomic conditions improved throughout life. Our findings have shown a long-term impact of extreme socioeconomic hardship during childhood and/or adolescence on the development of social inequalities in health. In terms of implications for public health, our work emphasises that health policies, usually focused on adult lifestyle interventions, should be complemented by initiatives aimed at reducing socioeconomic inequalities during the earliest stages of development, such as childhood and adolescence.

Factors of change and cumulative factors in self-rated health trajectories: a systematic review

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.

Do post-migration perceptions of social mobility matter for Latino immigrant health?

Latino immigrants exhibit health declines with increasing duration in the United States, which some attribute to a loss in social status after migration or downward social mobility. Yet, research into the distribution of perceived social mobility and patterned associations to Latino health is sparse, despite extensive research to show that economic and social advancement is a key driver of voluntary migration. We investigated Latino immigrant sub-ethnic group variation in the distribution of perceived social mobility, defined as the difference between respondents' perceived social status of origin had they remained in their country of origin and their current social status in the U.S. We also examined the association between perceived social mobility and past-year major depressive episode (MDE) and self-rated fair/poor physical health, and whether Latino sub-ethnicity moderated these associations. We computed weighted logistic regression analyses using the Latino immigrant subsample (N=1561) of the National Latino and Asian American Study. Puerto Rican migrants were more likely to perceive downward social mobility relative to Mexican and Cuban immigrants who were more likely to perceive upward social mobility. Perceived downward social mobility was associated with increased odds of fair/poor physical health and MDE. Latino sub-ethnicity was a statistically significant moderator, such that perceived downward social mobility was associated with higher odds of MDE only among Puerto Rican and Other Latino immigrants. In contrast, perceived upward social mobility was not associated with self-rated fair/poor physical health. Our findings suggest that perceived downward social mobility might be an independent correlate of health among Latino immigrants, and might help explain Latino sub-ethnic group differences in mental health status. Future studies on Latino immigrant health should use prospective designs to examine the physiological and psychological costs associated with perceived changes in social status with integration into the U.S. mainland.

Effect of survey mode on response patterns: comparison of face-to-face and self-administered modes in health surveys

BACKGROUND

While face-to-face interviews are considered the gold standard of survey modes, self-administered questionnaires are often preferred for cost and convenience. This article examines response patterns in two general population health surveys carried out by face-to-face interview and self-administered questionnaire, respectively.

METHOD

Data derives from a health interview survey in the Region of Southern Denmark (face-to-face interview) and The Danish Health and Morbidity Survey 2010 (self-administered questionnaire). Identical questions were used in both surveys. Data on all individuals were obtained from administrative registers and linked to survey data at individual level. Multiple logistic regression analyses were used to examine the effect of survey mode on response patterns.

RESULTS

The non-response rate was higher in the self-administered survey (37.9%) than in the face-to-face interview survey (23.7%). Marital status, ethnic background and highest completed education were associated with non-response in both modes. Furthermore, sex and age were associated with non-response in the self-administered mode. No significant mode effects were observed for indicators related to use of health services, but significant mode effects were observed for indicators related to self-reported health-related quality of life, health behaviour, social relations and morbidity (long-standing illness).

CONCLUSIONS

The same factors were generally associated with non-response in both modes. Indicators based on factual questions with simple answers categories were overall more comparable according to mode than indicators based on questions that involved more subjective assessments. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection.

Intergenerational learning about keeping health: a qualitative regional Australian study

Understanding the conditions under which families try to influence members' health-related practices can provide information to build concepts adding to models of health promotion. This paper reports on an exploratory qualitative study examining the influences of intergenerational relationships in shaping beliefs, knowledge and practices about health and illness in a regional Australian city. We conducted semi-structured interviews with 27 adults with family members of other generations living in the city, all of whom had experience of asthma. We found that overall people's experience of health and illness, particularly in childhood, was taken for granted and not reflected upon. It was in the face of serious illness or death of a family member that objective knowledge about health and illness was sought and integrated within the family leading, in most cases, to significant lifestyle changes or 'doing things differently'. We drew on Bourdieu's concept of the three forms of theoretical knowledge in analysing our findings. We found the concept of knowledge as 'primary taken-for-granted experience', and the concept of praxeological knowledge as the knowledge created by the dialectical relationships between an individual subject and objectives structures were helpful. To influence individual health practices, we need to acknowledge how the family context confirms the taken-for-granted health practices of an individual and the family circumstances that might lead families to seek objective knowledge and make lifestyle changes to promote health.

Vulnerabilidade social, individual e programática em idosos da comunidade: dados do estudo FIBRA, Campinas, SP, Brasil

Condições socioculturais e econômicas interagem com os processos biológicos ao longo da vida, determinando vulnerabilidade ou resiliência na velhice. O objetivo foi investigar relações entre vulnerabilidade social (gênero, idade e renda); individual (comorbidades, sinais e sintomas, incapacidade funcional, suporte social percebido e saúde percebida) e programática (índices de SUS-dependência e de vulnerabilidade social e acesso aos serviços de saúde) em amostra de indivíduos com 65 anos e mais. Participaram 688 idosos recrutados em domicílio, em 88 setores censitários urbanos sorteados, em Campinas, SP. Os dados (de autorrelato) foram obtidos em sessão única de coleta. Dos entrevistados, 470 eram mulheres, com mais comorbidades e sinais e sintomas, mas mais envolvidas em atividades avançadas de vida diária (AAVD) e atividades instrumentais de vida diária (AIVD) do que os homens. A média de idade foi 72,28 ± 5,41 anos e a de renda familiar 4,72 ± 5,28 salários mínimos. As variáveis que melhor explicaram a variabilidade dos dados foram acesso e uso de serviços de saúde, índices de SUS-dependência e de vulnerabilidade social e renda familiar. Condições sociais e renda familiar covariam com vulnerabilidade individual na velhice.

Paid sick days and health care use: an analysis of the 2007 national health interview survey data

BACKGROUND

In identifying factors of health care use, past research has focused on individual-level characteristics or on the health care system itself. This study investigates whether access to paid sick days, an amenable environmental factor outside the health care system, is associated with primary and emergency care use.

METHODS

A nationally representative sample of 14,302 U.S. working adults extracted from the 2007 National Health Interview Survey data was used. Multiple logistic regressions were performed, controlling for demographic variables, health conditions and status, and access to health care.

RESULTS

Workers with lower socioeconomic status, poorer health status, or without health insurance or regular places for care were more likely to lack paid sick days than higher-status workers. For all U.S. working adults, access to paid sick days benefits was significantly associated with increased use of outpatient care but not with reduced use of ER. For U.S. working adults with health insurance coverage, access to paid sick days benefits was significantly associated with increased use of outpatient care and reduced use of emergency care.

CONCLUSIONS

A public policy mandating paid sick days may help facilitate timely access to primary care, reduce avoidable emergency care use, and reduce health disparities among workers.

The differential association between education and infant mortality by nativity status of Chinese American mothers: a life-course perspective

OBJECTIVES

Integrating evidence from demography and epidemiology, we investigated whether the association between maternal achieved status (education) and infant mortality differed by maternal place of origin (nativity) over the life course of Chinese Americans.

METHODS

We conducted a population-based cohort study of singleton live births to US-resident Chinese American mothers using National Center for Health Statistics 1995 to 2000 linked live birth and infant death cohort files. We categorized mothers by nativity (US born [n = 15 040] or foreign born [n = 150 620]) and education (≥ 16 years, 13-15 years, or ≤ 12 years), forming 6 life-course trajectories. We performed Cox proportional hazards regressions of infant mortality.

RESULTS

We found significant nativity-by-education interaction via stratified analyses and testing interaction terms (P < .03) and substantial differentials in infant mortality across divergent maternal life-course trajectories. Low education was more detrimental for the US born, with the highest risk among US-born mothers with 12 years or less of education (adjusted hazard ratio = 2.39; 95% confidence interval = 1.33, 4.27).

CONCLUSIONS

Maternal nativity and education synergistically affect infant mortality among Chinese Americans, suggesting the importance of searching for potential mechanisms over the maternal life course and targeting identified high-risk groups and potential downward mobility.

Soft drink consumption and mental health problems among adults in Australia

OBJECTIVE

To examine the association between soft drink consumption and mental health problems, including self-reported doctor-diagnosed anxiety, stress-related problem and depression, suicidal ideation and psychological distress, among adults in South Australia.

DESIGN

Data were collected using a risk factor surveillance system. Each month a representative random sample of South Australians was selected from the Electronic White Pages with interviews conducted using computer-assisted telephone interviewing.

SETTING

South Australia.

SUBJECTS

Participants were aged 16 years and above.

RESULTS

Among 4741 participants, 12.5% reported daily soft drink consumption of more than half a litre. High levels of soft drink consumption were positively associated with depression, stress-related problem, suicidal ideation, psychological distress and a current mental health condition, but not anxiety. Overall, 24.0% of those having suicidal ideation reported consuming more than half a litre of soft drink per day. In the multivariate analysis, after adjusting for sociodemographic and lifestyle factors, those who consumed more than half a litre of soft drink per day had approximately 60% greater risk of having depression, stress-related problem, suicidal ideation, psychological distress or a current mental health condition, compared with those not consuming soft drinks. The soft drink to total fluid consumption ratio had similar associations with mental health problems.

CONCLUSIONS

There is a positive association between consumption of soft drinks and mental health problems among adults in South Australia.