After unification: gender and subjective health status in East and West Germany

Sport Participation and Subjective Outcomes of Health in Middle-Aged Men: A Scoping Review

Although sport participation is intrinsically motivating and improves the physical health of middle-aged men, its influence on subjective health measures, such as health-related quality of life, self-rated health, or well-being is unclear. The purpose of this scoping review was to describe the existing literature that has assessed male sport participants and their subjective health. MEDLINE, Embase, Emcare, PsycInfo, SPORTDiscus, Cochrane Library, and Web of Science were searched, and reference lists of included studies were pearled. Included were original peer-reviewed studies reporting a marker of subjective health in males, 35 to 54 years (average), who participated in sport. The search identified 21 eligible articles, 18 quantitative, 2 mixed-methods, and 1 qualitative, from 13 different countries. Eighteen studies were cross-sectional. A broad range of outcomes were assessed, with the most common being quality of life/health-related quality of life (n = 6) and self-rated health (n = 6). Most studies assessing quality of life, health-related quality of life, or self-rated health demonstrated a positive association with sport participation, while sport participation was not related to measures of life satisfaction, flourishing, happiness or global well-being; however, limited studies examined these latter outcomes. Sport participation appears to be related to better select subjective health outcomes in middle-aged men. However, most available data are cross-sectional and thus causation cannot be determined. Randomized intervention trials are required to determine whether sport participation improves the subjective health of middle-aged men.

Open Science Framework registration:https://osf.io/zypds

Socio-political context as determinant of childhood maltreatment: a population-based study among women and men in East and West Germany

Aim

Being subjected to childhood maltreatment has devastating long-term adverse effects and is a major risk factor for mental health problems in adult life. There is empirical support that socio-political factors can be risk factors for childhood maltreatment. Here we examine whether socio-political context predicts self-rated childhood maltreatment in a sample of the German population.

Methods

Data were drawn from surveys of representative samples of the East and West German population, including participants born 1980 or earlier (5836 participants; 3146 women). Childhood maltreatment was assessed using the Childhood Trauma Screener, the German short screening version of the childhood trauma questionnaire. To examine whether socio-political context is a predictor of childhood maltreatment in women and men, we conducted logistic regression analyses.

Results

We found that in women, socio-political context (West Germany) significantly predicted childhood maltreatment (odds ratio [95% confidence interval] 1.7 [1.2–2.5], 1.6 [1.1–2.3], 2.5 [1.6–4.1] and 1.8 [1.3–2.5] for emotional neglect, and emotional, physical and sexual violence, respectively). In men, the socio-political context (West Germany) was a predictor of physical and sexual violence (odds ratio [95% confidence interval] 1.8 [1.2–2.7] and 2.5 [1.4–4.5]), respectively. Concerning emotional neglect and violence, socio-political context was not a significant predictor in men. The examination of differential item functioning revealed that our results could not be attributed to differential response behaviour between East and West Germans caused by item bias.

Conclusions

The results suggest that socio-political context is an important determinant to consider when examining childhood maltreatment. Future research should continue to focus on risk and protective factors at the societal level, such as legal frameworks addressing gender equality and child protection laws, to create further evidence for population-wide prevention strategies ensuring safe, nurturing and thriving environments for children and families.

The interplay of gender, social context, and long-term unemployment effects on subjective health trajectories

Background

While a strong negative impact of unemployment on health has been established, the present research examined the lesser studied interplay of gender, social context and job loss on health trajectories.

Methods

Data from the German Socio-Economic Panel was used, which provided a representative sample of 6838 participants. Using latent growth modelling the effects of gender, social context (East vs. West Germans), unemployment (none, short-term or long-term), and their interactions were examined on health (single item measures of self-rated health and life satisfaction respectively).

Results

Social context in general significantly predicted the trajectories of self-rated health and life satisfaction. Most notably, data analysis revealed that West German women reported significantly lower baseline values of self-rated health following unemployment and did not recover to the levels of their East German counterparts. Only long-term, not short-term unemployment was related to lower baseline values of self-rated health, whereas, in relation to baseline values of life satisfaction, both types of unemployment had a similar negative effect.

Conclusions

In an economic crisis, individuals who already carry a higher burden, and not only those most directly affected economically, may show the greatest health effects.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10324-8.

Trends in gender differences in health at working ages among West and East Germans

Before 1990, Germany was divided for more than 40 years. While divided, significant mortality disparities between the populations of East and West Germany emerged. In the years following reunification, East German mortality improved considerably, eventually converging with West German levels. In this study, we explore changes in the gender differences in health at ages 20–59 across the eastern and western regions of Germany using data from the German Socio-Economic Panel (SOEP) for the 1990–2013 period. We apply random-effects linear regressions to the SOEP data to identify trends in health, measured as self-assessed health satisfaction, after German reunification.

The findings indicate that women were substantially less satisfied with their health than men in both West and East Germany, but that the gender gap was larger in East Germany than in West Germany. Furthermore, the results show that respondents’ satisfaction with their health decreased over time, and that the decline was steeper among men – and particularly among East German men – than among women. Thus, the initial male advantage in health in East and West Germany in the years immediately after reunification diminished over time, and even reversed to become a female advantage in East Germany. One interpretation of this finding is that stress-inducing post-reunification changes in the political and social landscape of East Germany had lasting damaging consequences for men’s health.

Ongoing risky health behaviors and high levels of economic insecurity due to unemployment could have had long-lasting effects on the health of the working-aged population. A partial explanation for our finding that health declined more sharply among East German men than among their female counterparts could be that women have better compensatory mechanisms than men for dealing with psychosocial stress.

Gender-dependent associations between socioeconomic status and tooth loss in working age people in the Study of Health in Pomerania (SHIP), Germany

OBJECTIVES

Individual impact and the effect magnitude of socioeconomic key indicators (income, education and occupation) and of gender on oral health are ambiguous. In primary analyses of cross-sectional data among participants of the Study of Health in Pomerania (north-east Germany), women with low school education and low income were at highest risk for missing teeth, whereas being single was a risk indicator for missing teeth in men. Using the 5-year follow-up of this study, we aimed at verifying these findings and at investigating the gender-dependent impact of key socioeconomic indicators on tooth loss.

METHODS

The longitudinal data originate from 1971 subjects (1062 women) aged 25-59 enrolled from 1997 to 2001 and again from 2002 to 2006. The effects of marital status, household income, school education and occupational prestige for tooth loss were examined by gender using negative binomial regression analyses.

RESULTS

Low education and low income were moderately [relative risks (RR) between 1.6 and 2.0] associated with tooth loss among both women and men, whereas occupational prestige was not. After multiple imputations of missing data, less-educated women with lower income exhibited the highest risk of tooth loss [RR=3.1; 95% confidence interval (CI)=1.7-5.5 for <10 years of school education and the lowest income tertile] and tooth loss was more likely in single men (RR=1.5; 95% CI=1.0-2.2) than in single women (RR=0.9; 95% CI=0.6-1.3).

CONCLUSIONS

The primary cross-sectional results were partly confirmed. Socioeconomic factors help to explain differences in tooth loss, although the causal pathways are speculative. To improve dental health, the policies should target not only the individual, e.g. oral health promotion, but also an entire population by better education and higher wage employment.

Regional variation and time trends in mortality from ischaemic heart disease: East and West Germany 10 years after reunification

STUDY OBJECTIVE

Within Europe, a pronounced geographical gradient of mortality from ischaemic heart disease has been observed with the highest burden in the north east and the lowest in the south west. The study objective was to compare mortality from ischaemic heart disease between former East and West Germany since reunification.

DESIGN

Analyses of age standardised mortality rates from ischaemic heart disease (ICD-9 410-414, ICD-10 I20-I25) between 1990-1991 and 2000.

SETTING

Former East and West Germany.

MAIN RESULTS

After a peak in the early 1990s, mortality from ischaemic heart disease has substantially declined in both parts of Germany (from 222 to 169 per 100 000 in the East and from 150 to 116 per 100 000 in the West). The regional difference, however, remained rather constant: the rate ratio between the pooled mortality in the East compared with the West was 1.51 (95% CI 1.46 to 1.56) in 1991 and 1.45 (95% CI 1.39 to 1.50) in 2000. These rate ratios were higher in women (1.63 in 1991 and 1.52 in 2000) compared with men (1.45 and 1.44, respectively).

CONCLUSIONS

Within Germany, there has been a pronounced east-west gradient of mortality from ischaemic heart disease since reunification. Further insight into possible underlying reasons may lead to improved preventive strategies.

Changing health inequalities in east and west Germany since unification

The unification of Germany in 1990 brought about substantial social and economic changes in its eastern part, with new uncertainties and, despite increasing overall income, rising inequality. This paper explores the potential impact on health of these changes during the 1990s, looking specifically at income-related health inequalities in east and west Germany and its modulation by psychosocial factors. We used data from the German Socio-Economic Panel (GSOEP) for the years 1992 and 1997, including individuals aged 25+. We investigated changes in self-perceived health in the two parts of Germany and its socio-economic and psychosocial determinants. Analyses estimated odds ratios of less than good health using logistic regression. In 1992, 47% of east Germans rated their health worse than good compared with 54% in the west. By 1997, the east-west gap in self-rated health had disappeared, with the prevalence of poor health increasing to 56% in both parts. Income and education were important determinants of health in east and west, with, in the age-sex-adjusted model, those having available less than 60% of median equivalent income being at increased risk of poor health in 1992 (OR(east) 2.39, 1.45-3.94; OR(west) 2.04, 1.65-2.52). Addition of education reduced the strength of this relationship only slightly. In the west, income-related health inequalities widened between 1992 and 1997 yet the initially stronger gradient declined in the east, despite an overall increase in income inequality (OR(east) 1.63, 1.04-2.56; OR(west) 2.65, 2.19-3.21). The impact of education remained stable. Psychosocial variables were important determinants, mediating the effects of income, with leisure-cultural social involvement exerting the strongest effect in both east and west.The results show that, unlike in the west, the overall increase in income inequality in east Germany between 1992 and 1997 was not accompanied by a simultaneous increase in income-related health inequalities. This suggests that mechanisms involved in the association of socio-economic factors and health possibly behave differently in east and west.

Smoking and perceived health in Hong Kong Chinese

This population-based cross-sectional study examined the associations between smoking and perceived health in Hong Kong. 6117 healthy Chinese (3053 men, 3064 women), aged 25-74 years, were randomly selected for telephone interviews in Hong Kong in 1994-96. Adjusted odds ratios (ORs) of having poor or very poor perceived health (against good or very good) were calculated. In men, the ORs (and 95 percent confidence intervals) for current smokers in young (25-39) and middle age (40-59) were close to unity, but that of 1.97 (1.01, 3.85) in old age (60-74) was significantly raised. The adjusted ORs for male quitters were 1.98 (0.43, 9.14), 1.70 (0.75, 3.81) and 2.59 (1.23, 3.33) for young, middle and old age, respectively. Compared with current smokers, the adjusted ORs for quitters was 2.30 (1.07, 4.92) for those who had quit for less than 5 years, 2.02 (0.80, 5.11) for 5-9 years and 1.14 (0.47, 2.75) for 10 years or more. Among former smokers, each year of quitting was associated with 7 percent reduction in reporting poor or very poor perceived health with OR of 0.93 (0.85, 1.01). In women, the ORs were 1.95 (1.15, 3.28) for current and 1.54 (0.60, 3.94) for former smokers. In both genders combined, the overall ORs were 1.41 (1.04, 1.92) for current and 1.94 (1.27, 2.97) for former smokers. In conclusion, former smokers apparently had the worst perceived health but long-term quitting was beneficial. Overall, current smokers had worse perceived health than never smokers, but in men the excess risk was mainly observed in old age. The perceived health of smokers may have implications for the approaches used in smoking cessation.

Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall

STUDY OBJECTIVE

To compare the health status and factors influencing the health of populations that had previously lived under different political systems.

DESIGN

Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted.

SETTING

East and West Berlin shortly after reunification 1991.

PARTICIPANTS

Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%).

RESULTS

Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Or(age adjusted)= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin.

CONCLUSIONS

For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.