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Kravdal Ø. A broader perspective on education and mortality: are we influenced by other people's education? Soc Sci Med 2007; 66:620-36. [PMID: 18023954 DOI: 10.1016/j.socscimed.2007.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Indexed: 10/22/2022]
Abstract
The objective of this study was to find out whether the educational achievements of family members and people in the municipality have an impact on a person's mortality, net of the well-known strong influence of his or her own education. Using register data, discrete-time hazard models for all-cause mortality in 1980-2003 were estimated for all Norwegian men and women born between 1950 and 1973 (i.e. age 30-53). There were 23,692 deaths during the 19.1 million person-years of follow-up. The education of a former or current spouse had the clearest beneficial effect, although own education was more important. Mortality was also negatively associated with the education of the oldest sibling and to a lesser extent with that of the sibling-in-law and father-in-law. The average education in the municipality was not generally related to mortality, but a beneficial effect was seen among men with college education. In contrast to this, parents' education affected mortality adversely, especially among women. The data did not allow causal pathways to be identified, but possible mechanisms were discussed. For example, it was argued that others' education may affect mortality favourably through transmission of knowledge, imitation of behaviour, economic support, and the quality of health services. In some societies, childhood health might also be an issue. On the other hand, having better-educated family members or living in a community with many better-educated people, who typically also have higher incomes, may trigger psychosocial stress. However, one should be careful to interpret the observed relationships as reflecting purely causal effects. Various unobserved factors may influence the person's choice of spouse and place of residence as well as mortality, and having parents with higher (lower) education may signal that the person has had special problems (resources) during childhood or adolescence, which also may have implications for later health.
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Affiliation(s)
- Øystein Kravdal
- Department of Economics, University of Oslo, Blindern, 0317 Oslo, Norway.
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52
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Individual social characteristics, municipal environment, and the prevalence of weight problems in early childhood: a multilevel analysis. Rev Epidemiol Sante Publique 2007. [DOI: 10.1016/j.respe.2007.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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53
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Dragano N, Bobak M, Wege N, Peasey A, Verde PE, Kubinova R, Weyers S, Moebus S, Möhlenkamp S, Stang A, Erbel R, Jöckel KH, Siegrist J, Pikhart H. Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health 2007; 7:255. [PMID: 17888149 PMCID: PMC2099437 DOI: 10.1186/1471-2458-7-255] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 09/21/2007] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Inequalities in the distribution of behaviour related risk factors are one possible explanation for this trend. In our study, we examined the association between cardiovascular risk factors and neighbourhood characteristics. To assess the consistency of associations the design is cross-national with data from nine industrial towns from the Czech Republic and Germany. Methods We combined datasets from two population based studies, one in Germany ('Heinz Nixdorf Recall (HNR) Study'), and one in the Czech Republic ('Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) Study'). Participation rates were 56% in the HNR and 55% in the HAPIEE study. The subsample for this particular analysis consists of 11,554 men and women from nine German and Czech towns. Census based information on social characteristics of 326 neighbourhoods were collected from local administrative authorities. We used unemployment rate and overcrowding as area-level markers of socioeconomic status (SES). The cardiovascular risk factors obesity, hypertension, smoking and physical inactivity were used as response variables. Regression models were complemented by individual-level social status (education) and relevant covariates. Results Smoking, obesity and low physical activity were more common in deprived neighbourhoods in Germany, even when personal characteristics including individual education were controlled for. For hypertension associations were weak. In the Czech Republic associations were observed for smoking and physical inactivity, but not for obesity and hypertension when individual-level covariates were adjusted for. The strongest association was found for smoking in both countries: in the fully adjusted model the odds ratio for 'high unemployment rate' was 1.30 [95% CI 1.02–1.66] in the Czech Republic and 1.60 [95% CI 1.29–1.98] in Germany. Conclusion In this comparative study, the effects of neighbourhood deprivation varied by country and risk factor; the strongest and most consistent effects were found for smoking. Results indicate that area level SES is associated with health related lifestyles, which might be a possible pathway linking social status and cardiovascular disease. Individual-level education had a considerable influence on the association between neighbourhood characteristics and risk factors.
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Affiliation(s)
- Nico Dragano
- Department of Medical Sociology, Heinrich-Heine-University Düsseldorf, Germany
| | - Martin Bobak
- International Institute for Health and Society, Department of Epidemiology and Public Health, University College London, UK
| | - Natalia Wege
- Department of Medical Sociology, Heinrich-Heine-University Düsseldorf, Germany
| | - Anne Peasey
- International Institute for Health and Society, Department of Epidemiology and Public Health, University College London, UK
| | - Pablo E Verde
- Department of Medical Sociology, Heinrich-Heine-University Düsseldorf, Germany
| | - Ruzena Kubinova
- Centre for Environmental Health, National Institute of Public Health, Prague, Czech Republic
| | - Simone Weyers
- Department of Medical Sociology, Heinrich-Heine-University Düsseldorf, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Germany
| | - Stefan Möhlenkamp
- Clinic of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany
| | - Andreas Stang
- Institute of Medical Epidemiology, Biometry and Informatics, University Hospital of Halle, Germany
| | - Raimund Erbel
- Clinic of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Germany
| | - Johannes Siegrist
- Department of Medical Sociology, Heinrich-Heine-University Düsseldorf, Germany
| | - Hynek Pikhart
- International Institute for Health and Society, Department of Epidemiology and Public Health, University College London, UK
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Piro FN, Næss Ø, Claussen B. Area deprivation and its association with health in a cross-sectional study: are the results biased by recent migration? Int J Equity Health 2007; 6:10. [PMID: 17883855 PMCID: PMC2072941 DOI: 10.1186/1475-9276-6-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 09/20/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between area deprivation and health has mostly been examined in cross-sectional studies or prospective studies with short follow-up. These studies have rarely taken migration into account. This is a possible source of misclassification of exposure, i.e. an unknown number of study participants are attributed an exposure of area deprivation that they may have experienced too short for it to have any influence. The aim of this article was to examine to what extent associations between area deprivation and health outcomes were biased by recent migration. METHODS Based on data from the Oslo Health Study, a cross-sectional study conducted in 2000 in Oslo, Norway, we used six health outcomes (self rated health, mental health, coronary heart disease, chronic obstructive pulmonary disease, smoking and exercise) and considered migration nine years prior to the study conduct. Migration into Oslo, between the areas of Oslo, and the changes in area deprivation during the period were taken into account. Associations were investigated by multilevel logistic regression analyses. RESULTS After adjustment for individual socio-demographic variables we found significant associations between area deprivation and all health outcomes. Accounting for migration into Oslo and between areas of Oslo did not change these associations much. However, the people who migrated into Oslo were younger and had lower prevalences of unfavourable health outcomes than those who were already living in Oslo. But since they were evenly distributed across the area deprivation quintiles, they had little influence on the associations between area deprivation and health. Evidence of selective migration within Oslo was weak, as both moving up and down in the deprivation hierarchy was associated with significantly worse health than not moving. CONCLUSION We have documented significant associations between area deprivation and health outcomes in Oslo after adjustment for socio-demographic variables in a cross-sectional study. These associations were weakly biased by recent migration. From our results it still appears that migration prior to study conduct may be relevant to investigate even within a relatively short period of time, whereas changes in area deprivation during such a period is of limited interest.
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Affiliation(s)
- Fredrik Niclas Piro
- Institute of General Practice and Community Medicine, University of Oslo, Norway
| | - Øyvind Næss
- Institute of General Practice and Community Medicine, University of Oslo, Norway
| | - Bjørgulf Claussen
- Institute of General Practice and Community Medicine, University of Oslo, Norway
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Verger P, Saliba B, Guagliardo V, Bouhnik AD, Eichenbaum-Voline S. [Individual social characteristics, municipal environment and the prevalence of weight problems in early childhood: a multilevel analysis]. Rev Epidemiol Sante Publique 2007; 55:347-56. [PMID: 17881174 DOI: 10.1016/j.respe.2007.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Accepted: 06/01/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have examined the prevalence of weight problems before the age of 5 years although this period is critical in the development of obesity. An inverse association between socio-economic status and weight problems is well documented in adult women but not for young children. Similarly several studies of adults and adolescents or older children show that the prevalence of weight problems is associated with the level of deprivation of the neighbourhood environment and the degree of urbanization, independent of social individual factors, even though this has not been examined for young children. METHODS We evaluated prevalence rates of weight problems in children aged 3.5-4.5 years in southeastern France and their association with both individual social factors and municipal environment characteristics. Random stratified cluster sampling allowed us to select 112 nursery schools. Physicians from the early childhood protective services conducted a mandatory medical examination and collected data with a new questionnaire (EVALMATER), developed to standardise these examinations. Overweight and obesity were defined by international references after calculation of each child's BMI (kg/m(2)). We constructed a social disadvantage index to assess characteristics of the municipalities where the nursery schools were located and used multilevel analysis to study the associations of municipal characteristics (the disadvantage index and a urban/rural classification of the municipalities) with weight problems independently of individual socio-economic variables. RESULTS The study included 2495/2959 (84.3%) children, with a mean age of 3.9+/-0.3 years. The prevalence of overweight was 8.2% (CI95%=7.1-9.3) and that of obesity 2.1% (CI95%=1.5-2.7). Prevalence of obesity was significantly higher in girls, only children, those who had not attended day-care before nursery school, whose mother was not employed, or whose father was not a white-collar-worker. Independently of these variables, it was also significantly higher among children who lived in urban areas or deprived municipalities. None of these factors were found associated with overweight alone. CONCLUSION Actions of prevention in France should target parents of young children.
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Affiliation(s)
- P Verger
- Observatoire régional de la santé, Provence-Alpes-Côte d'Azur (ORS PACA), Marseille, France.
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56
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Kravdal Ø. A fixed-effects multilevel analysis of how community family structure affects individual mortality in Norway. Demography 2007; 44:519-37. [PMID: 17913009 DOI: 10.1353/dem.2007.0029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
By using register data for the entire Norwegian population aged 50–89 in the period 1980–1999, during which there were about 720,000 deaths, I estimate how the proportions of persons who were divorced or never married in the municipality affected all-cause mortality, net of individual marital status. The data include individual histories of changes in marital status and places of residence, providing a rare opportunity to enter municipality fixed effects into the model, thereby capturing the time-invariant unobserved factors at that level. The positive health externality of marriage that is suggested in the literature is supported by some of the estimates for women. Other estimates—especially those for men—point in the opposite direction. One possible interpretation of these findings is that social cohesion is perhaps not as beneficial for people’s health as often claimed, at least not for both sexes. Alternatively, the results may reflect that marriage perhaps undermines rather than strengthens social cohesion, or that other mechanisms are involved—for example, those that are related to people’s perceptions of their health relative to the health of others. Estimates from models without such municipality fixed effects are markedly different, but these also shed doubt on the notion that a high proportion of unmarried persons generally increases individual mortality.
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Affiliation(s)
- Øystein Kravdal
- Department of Economics, University of Oslo, P.O. Box 1095 Blindern, N-0317 Oslo, Norway.
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57
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Chaix B, Rosvall M, Merlo J. Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort. J Epidemiol Community Health 2007; 61:349-55. [PMID: 17372297 PMCID: PMC2652944 DOI: 10.1136/jech.2006.047597] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In a public health perspective, it is of interest to assess the magnitude of geographical variations in ischaemic heart disease (IHD) mortality and quantify the strength of contextual effects on IHD. OBJECTIVE To investigate whether area effects vary according to the individual and contextual characteristics of the population, socioeconomic contextual influences were assessed in different age groups and within territories of differing population densities. DESIGN Multilevel survival analysis of a 28-year longitudinal database. PARTICIPANTS 341 048 residents of the Scania region in Sweden, reaching age 50-79 years in 1996, followed up over 7 years. RESULTS After adjustment for several individual socioeconomic indicators over the adult age, Cox multilevel models indicated geographical variations in IHD mortality and socioeconomic contextual effects on the mortality risk. However, the magnitude of geographical variations and strength of contextual effects were modified by the age of individuals and the population density of their residential area: socioeconomic contextual effects were much stronger among non-elderly than among elderly adults, and much larger within urban territories than within rural ones. As a consequence, among non-elderly residents of urban territories, the socioeconomic contextual effect was almost as large as the effect of individual 20-year cumulated income. CONCLUSIONS Non-elderly residents of deprived urban neighbourhoods constitute a major target for both contextual epidemiology of coronary disease and public health interventions aimed at reducing the detrimental effects of the social environment on IHD.
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Affiliation(s)
- Basile Chaix
- UMR-S 707 Inserm-Université Pierre et Marie Curie-Parise Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012 Paris 6, France.
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Bowling A, Stafford M. How do objective and subjective assessments of neighbourhood influence social and physical functioning in older age? Findings from a British survey of ageing. Soc Sci Med 2007; 64:2533-49. [PMID: 17433509 DOI: 10.1016/j.socscimed.2007.03.009] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Indexed: 10/23/2022]
Abstract
The objective was to investigate associations between type of area, individuals' perceptions of their neighbourhoods, and indicators of social and physical functioning. Social functioning was measured using numbers of social activities and frequency of social contacts in the past month. Physical functioning was measured with Townsend's Activities of Daily Living scale. The study was a British cross-sectional population survey of people aged 65 plus living at home. Multilevel analyses indicated that respondents who lived in affluent areas were less likely to have low levels of social activity independently of individual demographic and socio-economic characteristics. Individuals' perceptions of the area as neighbourly and having good facilities were also independently associated with lower likelihood of low social activities. Affluence of the area and perceived neighbourhood were associated with physical functioning, although these associations disappeared once adjustment was made for individuals' characteristics. Both objective and more subjective measures of the neighbourhood independently contributed to our understanding of the determinants of social and physical functioning in older age. The unique value of this paper is its inclusion of the influence of perceived neighbourhood on the social and physical functioning of an older population, which are key components of active ageing.
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Affiliation(s)
- Ann Bowling
- University College London, London, London, UK.
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59
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Chaix B, Rosvall M, Merlo J. Neighborhood socioeconomic deprivation and residential instability: effects on incidence of ischemic heart disease and survival after myocardial infarction. Epidemiology 2006; 18:104-11. [PMID: 17130687 DOI: 10.1097/01.ede.0000249573.22856.9a] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous literature has shown that neighborhood socioeconomic position influences the risk of ischemic heart disease, but little is known about the mechanisms linking the residential context to ischemic heart disease incidence and mortality. We examined whether neighborhood socioeconomic position and neighborhood residential stability (as a determinant of social interaction patterns) have an influence on ischemic heart disease risk. Moreover, we investigated whether dissimilar contextual influences operate at different stages of the disease process, ie, on incidence, 1-day case-fatality, and long-term survival after acute myocardial infarction (MI). METHODS Using a large 27-year longitudinal cohort (baseline: 1 January 1996) defined in the Scania region, Sweden, we estimated multilevel survival models adjusted for individual sociodemographic factors and previous diseases of the persons. RESULTS After adjustment, multilevel survival models indicated that the incidence of ischemic heart disease increased with neighborhood socioeconomic deprivation but was only weakly associated with neighborhood residential instability (for high vs low residential instability, hazard ratio = 1.2; 95% credible interval = 1.0-1.4). Conversely, beyond effects of individual and contextual socioeconomic circumstances and distance to the hospital, we saw a markedly higher 1-day case-fatality (4.9; 1.8-15) and shorter survival time after MI among individuals still alive 28 days after MI (4.3; 1.2-17) in neighborhoods with a high versus low residential instability. CONCLUSIONS Effects of residential instability on post-MI survival may be mediated by the lower availability of social support in residentially unstable neighborhoods, suggesting a new class of intermediate processes that should be taken into account when investigating contextual influences on ischemic heart disease. Moreover, dissimilar contextual effects may operate at various stages of the disease process (ie, on incidence, case-fatality, and survival after MI).
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Affiliation(s)
- Basile Chaix
- Community Medicine and Public Health, the Department of Clinical Sciences, Malmö University Hospital, Lund University, Malmö, Sweden.
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Merlo J, Chaix B. Neighbourhood effects and the real world beyond randomized community trials: a reply to Michael J Oakes. Int J Epidemiol 2006; 35:1361-3. [PMID: 17008359 DOI: 10.1093/ije/dyl211] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oakes JM. Commentary: advancing neighbourhood-effects research--selection, inferential support, and structural confounding. Int J Epidemiol 2006; 35:643-7. [PMID: 16556642 DOI: 10.1093/ije/dyl054] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Michael Oakes
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
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