1551
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Emerson E, Hatton C. Chapter 4 Socioeconomic Position, Poverty, and Family Research. FAMILIES 2009. [DOI: 10.1016/s0074-7750(09)37004-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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1552
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Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE. Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 2009; 9:322-9. [PMID: 19560993 PMCID: PMC2746875 DOI: 10.1016/j.acap.2009.04.005] [Citation(s) in RCA: 272] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/30/2009] [Accepted: 04/08/2009] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the extent to which the 2007 definitions for severe obesity (body mass index [BMI] > or = 99th percentile for age and gender) and morbid obesity (BMI > or = 40kg/m(2)) affects different groups of American children and adolescents and has increased over time. METHODS Analysis of nationally representative data from the National Health and Nutrition Examination Survey (NHANES) II, III, and 1999-2004; 12 384 US children and adolescents ages 2 to 19 years were included in the analysis. Outcome measures were the proportion of subjects with severe and morbid obesity, with age, gender, race, and poverty-income ratio (PIR) as key variables. RESULTS In 1999-2004, 3.8% of children 2 to 19 years old had a BMI in the > or = 99th percentile, with higher prevalence among boys than girls (4.6% vs 2.9%; P < .001). Prevalence was highest among blacks, 5.7% and Mexican Americans, 5.2%, compared with whites, 3.1% (P < .001). The prevalence differed by the PIR category as well (4.3% for those with PIR < or = 3 vs 2.5% for those with PIR>3; P=.002). BMI > or = 40kg/m(2) was found in 1.3% of adolescents ages 12 to 19 years, with similar associations with race and poverty. The overall prevalence of BMI > or = 99th percentile has increased by more than 300% since NHANES II (1976), and over 70% since NHANES III (1994) in children 2 to 19 years of age. CONCLUSIONS Rates of severe childhood obesity have tripled in the last 25 years, with significant differences by race, gender, and poverty. This places demands on health care and community services, especially because the highest rates are among children who are frequently underserved by the health care system.
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Affiliation(s)
- Joseph A. Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephen R. Cook
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Peggy Auinger
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jonathan D. Klein
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sarah E. Barlow
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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1553
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Kelsall HL, Baglietto L, Muller D, Haydon AM, English DR, Giles GG. The effect of socioeconomic status on survival from colorectal cancer in the Melbourne Collaborative Cohort Study. Soc Sci Med 2009; 68:290-7. [DOI: 10.1016/j.socscimed.2008.09.070] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Indexed: 11/28/2022]
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1554
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Kim SR, Kim OK, Yun KE, Khang YH, Cho HJ. Socioeconomic Factors Associated with Initiating and Quitting Cigarette Smoking Among Korean Men. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.6.415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- So-Ra Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ok-Kil Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Eun Yun
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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1555
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Pau A, Khan SS, Babar MG, Croucher R. Dental pain and care-seeking in 11-14-yr-old adolescents in a low-income country. Eur J Oral Sci 2008; 116:451-7. [PMID: 18821988 DOI: 10.1111/j.1600-0722.2008.00563.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this article was to document the 1-month dental pain prevalence in 11-14-yr-old subjects attending Grade Six of middle schools in Peshawar, Pakistan, and to explore the effect of dental pain and the impact on daily living on dental care-seeking. A self-completed questionnaire survey of all 13 middle schools in University Town, Peshawar, Pakistan, was carried out in April 2007. Questionnaire items on dental pain were adapted from the dental pain screening questionnaire (DePaQ) and items on the impact on daily living were adapted from the child-oral impact on daily performance (OIDP-Child) questionnaire. Regression analysis was carried out to determine the relative usefulness of predictors for care-seeking. The prevalence of dental pain was estimated to be 30.4%, and care-seeking in those reporting pain was estimated to be 64%. Care-seeking was associated with 'pain felt in one tooth', 'painful tooth felt loose', 'difficulties sleeping', and 'difficulties playing', which accounted for 35% of the explained variance. The findings substantiate dental pain as an important dental public health concern in Pakistan and support the hypothesis that assessment of dental pain characteristics can add to the accuracy of dental need estimation.
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Affiliation(s)
- Allan Pau
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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1556
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Watt HC, Carson C, Lawlor DA, Patel R, Ebrahim S. Influence of life course socioeconomic position on older women's health behaviors: findings from the British Women's Heart and Health Study. Am J Public Health 2008; 99:320-7. [PMID: 19059863 DOI: 10.2105/ajph.2007.129288] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between health behaviors and socioeconomic status (SES) in childhood and adult life. METHODS Self-reported diet, smoking, and physical activity were determined among 3523 women aged 60 to 79 years recruited from general practices in 23 British towns from 1999 through 2001. RESULTS The most affluent women reported eating more fruit, vegetables, chicken, and fish and less red or processed meat than did less affluent women. Affluent women were less likely to smoke and more likely to exercise. Life course SES did not influence the types of fat, bread, and milk consumed. Adult SES predicted consumption of all foods considered and predicted smoking and physical activity habits independently of childhood SES. Childhood SES predicted fruit and vegetable consumption independently of adult SES and, to a lesser extent, predicted physical activity. Downward social mobility over the life course was associated with poorer diets and reduced physical activity. CONCLUSIONS Among older women, healthful eating and physical activity were associated with both current and childhood SES. Interventions designed to improve social inequalities in health behaviors should be applied during both childhood and adult life.
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Affiliation(s)
- Hilary C Watt
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England
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1557
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The contribution of occupational factors to social inequalities in health: Findings from the national French SUMER survey. Soc Sci Med 2008; 67:1870-81. [DOI: 10.1016/j.socscimed.2008.09.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Indexed: 11/19/2022]
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1558
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Bovet P, Chiolero A, Shamlaye C, Paccaud F. Prevalence of overweight in the Seychelles: 15 year trends and association with socio-economic status. Obes Rev 2008; 9:511-7. [PMID: 18673305 DOI: 10.1111/j.1467-789x.2008.00513.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We assessed the 15-year trends in the distribution of body mass index (BMI) and the prevalence of overweight in the Seychelles (Indian Ocean, African Region) and the relationship with socio-economic status (SES). Three population-based examination surveys were conducted in 1989, 1994 and 2004. Occupation was categorized as 'labourer', 'intermediate' or 'professional'. Education was also assessed in 1994 and 2004. Between 1989 and 2004, mean BMI increased markedly in all sex and age categories (overall: 0.16 kg m(-2) per calendar year, which corresponds to 0.46 kg per calendar year). The prevalence of overweight (including obesity, BMI >or= 25 kg m(-2)) increased from 29% to 52% in men and from 50% to 67% in women. The prevalence of obesity (BMI >or= 30 kg m(-2)) increased from 4% to 15% in men and from 23% to 34% in women. Overweight was associated inversely with occupation in women and directly in men in all surveys. In multivariate analysis, overweight was associated similarly (direction and magnitude) to occupation and education. In conclusion, the increasing prevalence of overweight and obesity over time in all age, sex and SES categories suggests large-scale changes in societal obesogenic factors. The sex-specific association of SES with overweight suggests that prevention measures should be tailored accordingly.
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Affiliation(s)
- P Bovet
- Ministry of Health and Social Development, Victoria, Republic of Seychelles.
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1559
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Bolte G, Fromme H. Socioeconomic determinants of children's environmental tobacco smoke exposure and family's home smoking policy. Eur J Public Health 2008; 19:52-8. [PMID: 19033356 DOI: 10.1093/eurpub/ckn114] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gabriele Bolte
- Department of Environmental Health, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.
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1560
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Siahpush M, Spittal M, Singh GK. Happiness and life satisfaction prospectively predict self-rated health, physical health, and the presence of limiting, long-term health conditions. Am J Health Promot 2008; 23:18-26. [PMID: 18785370 DOI: 10.4278/ajhp.061023137] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the effect of happiness and life satisfaction on health. DESIGN Longitudinal data from waves 1 and 3, conducted in 2001 and 2004, respectively, of the Household Income and Labour Dynamics in Australia survey. SETTING Australia. SUBJECTS A total of 9981 respondents aged 18 years and older. MEASURES Outcomes were self-reported health; the absence of long-term, limiting health conditions; and physical health. Happiness was assessed with the following question: "During the past 4 weeks, have you been a happy person"? Life satisfaction was determined with the following question: "All things considered, how satisfied are you with your life"? ANALYSIS We used multiple regression analysis to estimate odds ratios (ORs), beta coefficients (beta), and 95% confidence intervals (CIs) for the associations between baseline happiness or life satisfaction and health at wave 3. RESULTS Baseline happiness and life satisfaction both were positively associated at wave 3 with excellent, very good, or good health (OR = 1.50, CI = 1.33-1.70, p < .0001; and OR = 1.62, CI = 1.27-2.08, p < .0001, respectively); with the absence of long-term, limiting health conditions (OR = 1.53, CI = 1.35-1.75, p < .0001; and OR = 1.51, CI = 1.25-1.82, p < .0001, respectively); and with higher physical health levels (beta = .99, CI = .60-1.39, p < .0001; and beta = .99, CI = .20-1.78, p < .0145, respectively). CONCLUSION This study showed that happier people and those who were more satisfied with their lives at baseline reported better health (self-rated health; absence of limiting, long-term conditions; and physical health) at the 2-year follow-up when adjusted for baseline health and other relevant covariates.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health Sciences, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA.
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1561
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Réponse au commentaire de M. Grignon et F. Jusot. Rev Epidemiol Sante Publique 2008; 56:356-7. [DOI: 10.1016/j.respe.2008.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 08/29/2008] [Indexed: 11/19/2022] Open
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1562
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Lifecourse Social Conditions and Racial and Ethnic Patterns of Cognitive Aging. Neuropsychol Rev 2008; 18:223-54. [DOI: 10.1007/s11065-008-9064-z] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 11/26/2022]
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1563
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Dalton SO, Steding-Jessen M, Gislum M, Frederiksen K, Engholm G, Schüz J. Social inequality and incidence of and survival from cancer in a population-based study in Denmark, 1994-2003: Background, aims, material and methods. Eur J Cancer 2008; 44:1938-49. [PMID: 18684615 DOI: 10.1016/j.ejca.2008.06.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 06/06/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this register-based study was to identify variations in cancer incidence and survival after cancer in Denmark on the basis of a range of socioeconomic, demographic and health-related indicators. The indicators were level of education, disposable income, affiliation to the work market, social class, housing tenure, size of dwelling, cohabitation status, type of district, ethnicity, Charlson comorbidity index, depression and schizophrenia measured at the individual level on an annual basis. The study population comprised all Danish residents born between 1925 and 1973 and aged >or=30 years, who were followed up for cancer incidence in 1994-2003 and for survival in 1994-2006. The study was based on 3.22 million persons, yielding almost 26 million person-years and 147,973 cancers. In this paper, we provide a detailed description of the indicators and the statistical methods, and we discuss the strengths and limitations of our approach.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark.
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1564
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Dalton SO, Schüz J, Engholm G, Johansen C, Kjaer SK, Steding-Jessen M, Storm HH, Olsen JH. Social inequality in incidence of and survival from cancer in a population-based study in Denmark, 1994-2003: Summary of findings. Eur J Cancer 2008; 44:2074-85. [PMID: 18674895 DOI: 10.1016/j.ejca.2008.06.018] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 06/10/2008] [Accepted: 06/16/2008] [Indexed: 11/25/2022]
Abstract
The purpose of this nationwide, population register-based study was to describe variations in cancer incidence and survival by social position in a social welfare state, Denmark, on the basis of a range of socioeconomic, demographic and health-related indicators. Our study population comprised all 3.22 million Danish residents born in 1925-1973 and aged >or=30 years, who were followed up for cancer incidence in 1994-2003 and for survival in 1994-2006, yielding 147,973 cancers. The incidence increased with lower education and income, especially for tobacco- and other lifestyle-related cancers, although for cancers of the breast and prostate and malignant melanoma the association was inverse. Conversely there was a general increase in incidence among early retirement pensioners, persons living in rented housing and those living in the smallest dwellings. Also incidence rates were generally higher in persons living alone compared to those living with a partner and in the capital area compared to the rural areas. Social inequality in the prognosis of most cancers was observed, despite the equal access to health care in Denmark, with poorer relative survival related to fewer advantages, regardless of how they were measured, often most pronounced in the first year after diagnosis. Also living alone and having somatic or psychiatric comorbidity negatively impacted the relative survival after most cancers. Our study shows that inequalities in cancer incidence and survival must be addressed in all aspects of public health, with interventions both to reduce incidence and to prolong survival.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark.
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1565
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1566
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Adult education and child mortality in India: the influence of caste, household wealth, and urbanization. Epidemiology 2008; 19:294-301. [PMID: 18300716 DOI: 10.1097/ede.0b013e3181632c75] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although socioeconomic position is generally found to be related to health, the associations can be different for different measures of socioeconomic position. We examined the association between adult education and child mortality, and the influence of other socioeconomic markers (caste, household wealth, and urbanization) on this association. METHODS Data were drawn from the 1998-1999 Indian National Family Health Survey, conducted in 26 states and comprising 66,367 children age 5 years or under. Adult education, for the head of household and spouse, was categorized into 0, 1-8, and 9 or more years of schooling. We used logistic regression to estimate associations between education and child mortality in analysis adjusted for other socioeconomic markers. Effect modification by caste, household wealth, and urbanization was assessed by fitting an interaction term with education. RESULTS Compared with those who had no education, 9 or more years of education for the head of household and for the spouse were associated with lower child mortality (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.48-0.62 and OR = 0.44; 95% CI = 0.36-0.54, respectively) in analyses adjusted for age, sex, and state of residence. Further adjustments for caste and urbanization attenuated these associations slightly; when adjustments were made for household wealth the associations were attenuated more substantially. Nevertheless, in fully adjusted models, 9 or more years of education for the head of household (OR = 0.81; 95% CI = 0.70-0.93) and the spouse (OR = 0.75; 95% CI = 0.60-0.94) remained associated with lower child mortality. There was no effect modification of this association by caste, household wealth, and urbanization. CONCLUSION Adult education has a protective association with child mortality in India. Caste, household wealth, and urbanization do not modify or completely attenuate this association.
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1567
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Scazufca M, Menezes PR, Araya R, Di Rienzo VD, Almeida OP, Gunnell D, Lawlor DA. Risk factors across the life course and dementia in a Brazilian population: results from the Sao Paulo Ageing & Health Study (SPAH). Int J Epidemiol 2008; 37:879-90. [DOI: 10.1093/ije/dyn125] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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1568
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Morgen CS, Bjørk C, Andersen PK, Mortensen LH, Nybo Andersen AM. Socioeconomic position and the risk of preterm birth--a study within the Danish National Birth Cohort. Int J Epidemiol 2008; 37:1109-20. [PMID: 18577529 DOI: 10.1093/ije/dyn112] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low socioeconomic position is generally associated with increased risk of preterm birth, but it remains unclear whether the inequality depends on the socioeconomic measure used, if the associations differ according to the degree of prematurity, and how individual level risk factors mediate the association. METHODS The hazard ratios (HR) of preterm birth associated with five different measures of socioeconomic position and three degrees of preterm birth were analysed in a dataset of 75 890 singleton pregnancies (1996-2002) from the Danish National Birth Cohort. This, and the mediating role of selected individual level risk factors (smoking, alcohol consumption, binge drinking, pre-pregnancy body mass index, gestational weight gain) were estimated, using Cox regression analyses. RESULTS Mothers with <10 years of education had an elevated risk of preterm birth compared with mothers with >12 years of education and the association interacted with parity, while income and occupation affected the risk to a lesser degree. The adjusted HR for less educated nulliparous and parous women were 1.22 (95% CI 1.04-1.42) and 1.56 (95% CI 1.31-1.87), respectively, compared with women with >12 years of education. For parous women with <10 years of education inclusion of smoking in the model decreased the HR of preterm birth to 1.43 (95% CI 1.19-1.72). CONCLUSIONS Maternal educational level was the strongest predictor of preterm birth among five socioeconomic measures and the gradient did not differ significantly according to the degree of preterm birth. For parous women smoking explained some of the educational gradient but in general the selected risk factors only reduced the relative educational gradient in preterm birth marginally.
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1569
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Bastos JL, Gigante DP, Peres KG. Toothache prevalence and associated factors: a population based study in southern Brazil. Oral Dis 2008; 14:320-6. [PMID: 18449961 DOI: 10.1111/j.1601-0825.2007.01379.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to estimate toothache prevalence and associated factors among adult residents in Pelotas, a southern Brazilian city. METHODS A cross-sectional population-based study was carried out in individuals aged > or = 20 years (n = 3353). A multi-stage sampling scheme was adopted, and data collection was performed at participants' homes through standardized pre-tested questionnaires. Toothache in the past 6 months was regarded as the outcome. Socioeconomic and demographic data as well as health-related behavioural data were collected. All analyses were undertaken with a Poisson regression model, following a hierarchical conceptual model. RESULTS The response rate was 93.5% and toothache prevalence was 17.7% (95% CI 16.0-19.3). Multivariable analyses revealed that toothache was more likely to be reported by those with low educational attainment and low family income. Younger subjects, women and black people were also more likely to report toothache. Current smokers and problem drinkers were at increased risk of experiencing toothache in the past 6 months. CONCLUSIONS The toothache prevalence reported in the present study is not negligible and should initiate the formulation of preventive policies and support the planning of local oral health services.
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Affiliation(s)
- J L Bastos
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
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1570
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Deboosere P, Gadeyne S, Van Oyen H. The 1991–2004 Evolution in Life Expectancy by Educational Level in Belgium Based on Linked Census and Population Register Data. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2008. [DOI: 10.1007/s10680-008-9167-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lifecourse socioeconomic predictors of midlife drinking patterns, problems and abstention: findings from the 1958 British Birth Cohort Study. Drug Alcohol Depend 2008; 95:269-78. [PMID: 18339490 DOI: 10.1016/j.drugalcdep.2008.01.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 01/22/2008] [Accepted: 01/23/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research suggests that outcomes associated with drinking may differ depending upon patterns of consumption, drinking related symptoms and social problems. This paper investigated socioeconomic predictors (measuring multiple indices, period and consistency of disadvantage) of midlife drinking patterns. METHODS Socioeconomic information from the 1958 British Birth Cohort Study (n=9146) included: manual socioeconomic position and owner/buyer residential tenure (7, 11, 16, 33 and 42 y), and educational attainment (33 y). At 45 y, the overlap between drinking patterns was explored using the Alcohol Use Disorders Identification Test. Patterns included: 'Moderate-binge' (binge drinkers with low-problem scores, consuming within UK sensible drinking weekly guidelines); Low-Problem Heavy (LPH) drinkers (regardless of binge); 'Problem' (and heavy or binge) and 'Non-/occasional' (< or =monthly) drinkers. These categories were compared to 'Low-risk' drinkers. RESULTS Socioeconomic disadvantage was consistently associated with moderate-binge, non-/occasional and problem but not LPH drinking. The highest risk was associated with multiple and persistent disadvantage across childhood and adulthood; this risk was partially accounted for education. Non-/occasional and moderate-binge drinking was predicted by disadvantage during childhood alone. The socioeconomic disadvantage of non-/occasional drinkers was not explained by past problem or heavy drinking. CONCLUSIONS Socioeconomic disadvantage across the lifecourse was consistently linked to specific drinking patterns. Furthermore, associations linking socioeconomic disadvantage with drinking patterns will typically be underestimated if multiple and persistent disadvantage is not investigated. The role of persistent socioeconomic disadvantage in the poor health of non-drinkers and moderate-binge drinkers needs investigation. The findings support current initiatives targeting the reduction of social and individual costs associated with specific drinking patterns.
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1573
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Hadden WC, Rockswold PD. Increasing differential mortality by educational attainment in adults in the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2008; 38:47-61. [PMID: 18341122 DOI: 10.2190/hs.38.1.c] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Economic inequality has increased substantially in the United States since the early 1970s. Inequality in mortality increased from 1960 to 1986. To assess the trend in inequality in mortality the authors calculate age-adjusted mortality rates by educational attainment for 2000 and compare them with rates from 1960 and 1986, using relative and absolute indexes of inequality. Rates are calculated for non-Hispanic white and black adults aged 25 to 64 years, using mortality data from U.S. Vital Statistics and population estimates from the Census Public Use Microdata Sample. The trend toward increasing inequality in mortality between 1960 and 1986 accelerated from 1986 to 2000. Improvements in mortality went disproportionately to those with the most education. Mortality rates for whites with low education, which declined from 1960 to 1986, actually rose from 1986 to 2000. The relative change was greatest for those with only a high school education. This change, however, is largely explained by shifts in the distribution of education, which left those with a high school education in a lower position. The increase in inequality was particularly strong in whites and stronger in men than in women. For black men there was a small decline in absolute inequality between 1986 and 2000.
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Felícitas Domínguez-Berjón M, Borrell C, Cano-Serral G, Esnaola S, Nolasco A, Isabel Pasarín M, Ramis R, Saurina C, Escolar-Pujolar A. Construcción de un índice de privación a partir de datos censales en grandes ciudades españolas (Proyecto MEDEA). GACETA SANITARIA 2008; 22:179-87. [DOI: 10.1157/13123961] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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1575
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Naess O, Strand BH, Smith GD. Childhood and adulthood socioeconomic position across 20 causes of death: a prospective cohort study of 800,000 Norwegian men and women. J Epidemiol Community Health 2008; 61:1004-9. [PMID: 17933960 DOI: 10.1136/jech.2006.052811] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the impact of childhood and adulthood socioeconomic position (SEP) across 20 causes of death in a large population-wide sample of Norwegian men and women. METHODS Census data on parental occupational class from 1960 and data from the tax register on household income in 1990 were linked to the death register for 1990-2001, and 20 causes of death were studied. Relative indices of inequalities were computed. Norwegians in the age group 0-20 years in 1960 and still alive in 1990 were followed for deaths in 1990 to 2001. This follow up involved 795,324 individuals (78%) and 20,887 deaths. MAIN RESULTS In men most support for an effect of childhood socioeconomic position was found for stomach cancer, lung cancer, coronary heart disease, "other violent death", and all causes of death. In women similar effects were found for lung cancer, cervical cancer, coronary heart disease, chronic obstructive pulmonary disease, and all causes of death. CONCLUSIONS The effect of childhood socioeconomic position relative to adulthood varies by cause of death. Although there are some exceptions, the patterns in men and women are generally similar.
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Affiliation(s)
- Oyvind Naess
- Institute of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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1576
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Maternal educational level and risk of gestational hypertension: the Generation R Study. J Hum Hypertens 2008; 22:483-92. [PMID: 18418401 DOI: 10.1038/jhh.2008.22] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrollment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrollment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrollment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrollment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.
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1577
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Cooper R, Lucke J, Lawlor DA, Mishra G, Chang JH, Ebrahim S, Kuh D, Dobson A. Socioeconomic position and hysterectomy: a cross-cohort comparison of women in Australia and Great Britain. J Epidemiol Community Health 2008; 62:1057-63. [PMID: 18413433 PMCID: PMC2582341 DOI: 10.1136/jech.2007.071001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the associations between indicators of socioeconomic position (SEP) and hysterectomy in two Australian and two British cohorts. STUDY POPULATION Women participating in the Australian Longitudinal Study on Women's Health (ALSWH), born 1921-1926 and 1946-1951, and two cohorts of British women, the British Women's Heart and Health Study and the MRC National Survey of Health and Development, born at similar times (1920 to 1939 and 1946, respectively) and surveyed at similar ages to the ALSWH cohorts. METHODS Relative indices of inequality were derived for own and head of household occupational class, educational level attained and age at leaving school. Logistic regression was used to test the associations between these indicators of SEP and self-reported hysterectomy and/or oophorectomy. RESULTS Inverse associations between indicators of SEP and hysterectomy were found in both the Australian and British cohorts of women born in 1946 or later. There was also evidence of an inverse association between education and hysterectomy in the older Australian cohort. However, the associations in this older cohort were weaker than those found in the mid-aged Australian cohort. In the older British cohort, born in the 1920s and 1930s, little evidence of association between SEP in adulthood and hysterectomy was found. CONCLUSIONS These results suggest that inverse associations between indicators of SEP and hysterectomy are stronger in younger than in older cohorts in both Australia and Great Britain. They provide further evidence of the dynamic nature of the association between indicators of SEP and hysterectomy.
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Affiliation(s)
- R Cooper
- MRC National Survey of Health and Development, Department of Epidemiology and PublicHealth, University College London, London, UK.
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1578
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The Effects of Education, Social Class and Income on Non-alcohol- and Alcohol-Associated Suicide Mortality: A Register-based Study of Finnish Men Aged 25–64. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2008. [DOI: 10.1007/s10680-007-9147-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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1579
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Sánchez E, Regidor E, de la Fuente L, Luquero FJ, de Mateo S. [Role of antiretroviral therapy in the reduction of the association between low educational level and AIDS-related mortality]. Med Clin (Barc) 2008; 130:133-5. [PMID: 18279630 DOI: 10.1157/13115769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE AIDS-related mortality has been classically associated with lowest socioeconomic groups. In Spain, the highly active antiretroviral therapy (HAART) is delivered without cost; therefore this treatment it should have reduced the great social inequalities in AIDS-mortality seen before the HAART era. This study aims to assess the absolute and relative socioeconomic differences in AIDS-mortality in the Region of Madrid after the introduction of HAART. PATIENTS AND METHOD Two twenty-months cohorts were created, in 1996 and 2001, which correspond to an early and late HAART-era respectively. Absolute and relative differences in the AIDS-mortality rates were calculated for both periods using generalized linear models. RESULTS Absolute differences between the lowest and highest education level AIDS-related deaths decreased around 70% in the 2001 cohort. Those with lowest education level achieved the highest reduction rate, hence relative differences descended as well. CONCLUSIONS HAART has had an essential role in decreasing social inequalities in AIDS-mortality.
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Affiliation(s)
- Elisabeth Sánchez
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España.
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1580
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Frederiksen BL, Osler M, Harling H, Jørgensen T. Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study. Br J Cancer 2008; 98:668-73. [PMID: 18231103 PMCID: PMC2243153 DOI: 10.1038/sj.bjc.6604215] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We investigated stage at diagnosis in relation to socioeconomic status (SES) among 15 274 patients with colorectal adenocarcinoma diagnosed in 1996–2004 nationwide in Denmark. The effect of SES on the risk of being diagnosed with distant metastasis was analysed using logistic regression models. A reduction in the risk of being diagnosed with distant metastasis was seen in elderly rectal cancer patients with high income, living in owner–occupied housing and living with a partner. Among younger rectal cancer patients, a reduced risk was seen in those having long education. No social gradient was found among colon cancer patients. The social gradient found in rectal cancer patients was significantly different from the lack of association found among colon cancer patients. There are socioeconomic inequalities in the risk of being diagnosed with distant metastasis of a rectal, but not a colonic, cancer. The different risk profile of these two cancers may reflect differences in symptomatology.
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Affiliation(s)
- B L Frederiksen
- Research Centre for Prevention and Health, Glostrup University Hospital, 2600 Glostrup, Denmark.
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1581
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Adam M, Rebholz CE, Egger M, Zwahlen M, Kuehni CE. Childhood leukaemia and socioeconomic status: what is the evidence? RADIATION PROTECTION DOSIMETRY 2008; 132:246-54. [PMID: 18927134 DOI: 10.1093/rpd/ncn261] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The objectives of this systematic review are to summarise the current literature on socioeconomic status (SES) and the risk of childhood leukaemia, to highlight methodological problems and formulate recommendations for future research. Starting from the systematic review of Poole et al. (Socioeconomic status and childhood leukaemia: a review. Int. J. Epidemiol. 2006;35(2):370-384.), an electronic literature search was performed covering August 2002-April 2008. It showed that (1) the results are heterogeneous, with no clear evidence to support a relation between SES and childhood leukaemia; (2) a number of factors, most importantly selection bias, might explain inconsistencies between studies; (3) there is some support for an association between SES at birth (rather than later in childhood) and childhood leukaemia and (4) if there are any associations, these are weak, limited to the most extreme SES groups (the 10-20% most or least deprived). This makes it unlikely that they would act as strong confounders in research addressing associations between other exposures and childhood leukaemia. Future research should minimise case and control selection bias, distinguish between different SES measures and leukaemia subtypes and consider timing of exposures and cancer outcomes.
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Affiliation(s)
- Martin Adam
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern CH-3012, Switzerland
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1582
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Socioeconomic inequalities in unintended pregnancy and abortion decision. J Urban Health 2008; 85:125-35. [PMID: 18038210 PMCID: PMC2430141 DOI: 10.1007/s11524-007-9233-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 10/11/2007] [Indexed: 01/27/2023]
Abstract
Pregnancy planning allows women to better control their life trajectory and contributes to the future child's health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education incomplete had more unintended pregnancies (OR=7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy.
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1583
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Ribet C, Melchior M, Lang T, Zins M, Goldberg M, Leclerc A. [Characterisation and measurement of social position in epidemiologic studies]. Rev Epidemiol Sante Publique 2007; 55:285-95. [PMID: 17597326 DOI: 10.1016/j.respe.2007.04.001] [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] [Received: 03/14/2006] [Accepted: 04/05/2007] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The terms "socioeconomic status", "socioeconomic position", "social classes" ... are widely used in epidemiology. They refer to various aspects of social position which is associated with many aspects of health. The position of individuals in the social hierarchy is multidimensional, i.e. defined by various socioeconomic factors. They can be individual (for example educational level, employment status, and occupation), household related (for example household income) or neighbourhood related (for example unemployment rate in the district of residence). These various factors can be associated with health at different periods during the life course, via a number of mechanisms, and they can possibly interact with one another. No socioeconomic indicator is better than the others or adequate in all study contexts. AIM AND METHODS This paper presents a description of various socioeconomic indicators, and describes what they measure, and the advantages and limits of each of them. CONCLUSION No indicator can be recommended in particular. Within the limit of available variables, the most relevant measurement depends on many elements, such as the study population and the aspect of health being investigated.
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Affiliation(s)
- C Ribet
- Unité mixte 687, Inserm-Cmants, Saint-Maurice, France.
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1584
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Tjønneland A, Olsen A, Boll K, Stripp C, Christensen J, Engholm G, Overvad K. Study design, exposure variables, and socioeconomic determinants of participation in Diet, Cancer and Health: a population-based prospective cohort study of 57,053 men and women in Denmark. Scand J Public Health 2007; 35:432-41. [PMID: 17786808 DOI: 10.1080/14034940601047986] [Citation(s) in RCA: 509] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Diet is considered an important aspect of lifestyle related to cancer development. To contribute further knowledge within this field a Danish prospective cohort study "Diet, Cancer and Health" has been initiated. The aims of this paper are to give a description of the study design, measurement procedures, and differences between participants and non-participants with special reference to socioeconomic characteristics. METHODS A total of 160,725 individuals 50-64 years of age living in Copenhagen or Aarhus were invited to participate. Information concerning diet and other lifestyle factors was obtained from 57,053 participants using questionnaires and interviews. Anthropometric measurements were taken and biological material collected. In addition, detailed (selected) socioeconomic information on all invited persons including 103,671 non-participants was obtained from statistical registers in Statistics Denmark. RESULTS Differences were seen between participants and non-participants on a number of socioeconomic factors. The highest participation in relation to education was found among participants with higher education, with a significant tendency to be highest in the second highest level of higher education (3-4 years). Married people were more likely to participate than persons living alone or cohabiting. CONCLUSION Results from the prospective cohort study "Diet, Cancer and Health" support the general assumption that lower socioeconomic groups are underrepresented in epidemiological studies.
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Affiliation(s)
- Anne Tjønneland
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
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1585
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Virtanen M, Vahtera J, Pentti J, Honkonen T, Elovainio M, Kivimäki M. Job strain and psychologic distress influence on sickness absence among Finnish employees. Am J Prev Med 2007; 33:182-7. [PMID: 17826576 DOI: 10.1016/j.amepre.2007.05.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 04/30/2007] [Accepted: 05/08/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Work stress is a recognized risk factor for mental health disorders, but it is not known whether work stress is associated with the morbidity among individuals with psychologic distress. Another shortcoming in earlier research is related to common method bias-the use of individual perceptions of both work stress and psychologic distress. This prospective study was assessed using the General Health Questionnaire (GHQ-12), which identified psychologic distress as a predictor of sickness absence and the effect of work-unit measures of job strain on sickness absence among cases. METHODS Survey data were collected on work stress, indicated by high job strain, for a cohort of public sector employees (6,663 women, 1,323 men), aged 18 to 62 at baseline in 2000-2002, identified as GHQ-12 cases. Coworker assessments of job strain were used to control for bias due to response style. A 2-year follow-up included recorded long-term (>7 days) medically certified sickness absence. Adjustments were made for age, socioeconomic position, baseline chronic physical disease, smoking, and heavy alcohol consumption. RESULTS Cases with psychologic distress had 1.3 to 1.4 times higher incidence of long-term sickness absence than non cases. Among cases, high job strain predicted sickness absence (hazard ratio 1.17 in women, 1.41 in men). The significant effect of job strain on sickness absence was found among workers in high socioeconomic positions (hazard ratio 1.54 for women, 1.58 for men) but not among employees in low socioeconomic positions (hazard ratio 1.06 for women, 1.31 for men). CONCLUSIONS Psychologic distress has an independent effect on medically certified sickness absence. The identification of employees with high job strain and the improvement of their working conditions should be considered as an important target in the prevention of adverse consequences of psychologic distress.
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Affiliation(s)
- Marianna Virtanen
- Finnish Institute of Occupational Health, Topeliuksenkatu, Helsinki, Finland.
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1586
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Ribet C, Melchior M, Lang T, Zins M, Goldberg M, Leclerc A. Characterization and measurement of social position in epidemiologic studies. Rev Epidemiol Sante Publique 2007. [DOI: 10.1016/j.respe.2007.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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1587
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Popham F, Mitchell R. Relation of employment status to socioeconomic position and physical activity types. Prev Med 2007; 45:182-8. [PMID: 17662379 DOI: 10.1016/j.ypmed.2007.06.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 06/11/2007] [Accepted: 06/11/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate further associations between socioeconomic position and overall physical activity levels and specific types of physical activity. To investigate the role of employment status and health in these associations. METHODS Cross-sectional analysis of self-reported physical activity of 2346 men and 2941 women aged 25 to 64 interviewed for the 2003 Scottish Health Survey. Poisson regression was used to generate prevalence ratios in multivariate analysis. RESULTS Accumulated socioeconomic disadvantage was associated with doing little or no overall physical activity (19 and 16% of most advantaged men and women vs. 44 and 40% for most disadvantaged, age adjusted prevalence ratio: 2.02, 95% CI 1.60,2.56 and 2.21, 95% CI 1.81,2.71 for men and women). The association was attenuated by accounting for employment status and health (prevalence ratio 1.15, 95% CI 0.90,1.47 and 1.50, 95% CI 1.22,1.84 for men and women). Despite occupational activity being associated with lower socioeconomic position, the most disadvantaged did not have the highest rates because they were most likely to be out of employment. CONCLUSION Comparing only those achieving the recommended level of physical activity to all others may obscure clear socioeconomic differences in physical activity. Policies to increase physical activity participation for the most disadvantaged are needed.
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Affiliation(s)
- Frank Popham
- Research Unit in Health, Behaviour and Change, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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1588
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Menvielle G, Chastang JF, Luce D, Leclerc A. [Changing social disparities and mortality in France (1968-1996): cause of death analysis by educational level]. Rev Epidemiol Sante Publique 2007; 55:97-105. [PMID: 17434278 DOI: 10.1016/j.respe.2006.10.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 10/24/2006] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little information is available on temporal trend in socioeconomic inequalities in cause of death mortality in France. The aim of this paper was to study educational differences in mortality in France by cause of death and their temporal trend. METHODS We used a representative sample of 1% of the French population and compared four periods (1968-1974, 1975-1981, 1982-1988, 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in mortality were studied among men and women aged 30-64 at the beginning of each period. Analyses were conducted for all deaths and for the following causes of death: all cancers, lung cancer (among men), upper aerodigestive tract cancers (among men), breast cancer (among women), colorectal cancer, other cancers, cardiovascular diseases, ischaemic heart diseases, cerebrovascular diseases, other cardiovascular diseases, external causes, other causes of death. Socioeconomic inequalities were quantified with relative risks and relative indices of inequality. The relative indices of inequality measures socioeconomic inequalities across the population and can be interpreted as the ratio of mortality rates of those with the lowest to those with the highest socioeconomic status. RESULTS Analyses showed an increase in educational differences in all cause mortality among men (the relative indices of inequality increased from 1.96 to 2.77 from the first to the last period) and among women (the relative indices of inequality increased from 1.87 to 2.53). Socioeconomic inequalities increased for all cause of death studied among women, and for cancer and cardiovascular diseases among men. The contribution of cancer mortality to difference in overall mortality between the lowest and the highest levels of education increased strongly over the whole study period, especially among women. CONCLUSION This study shows that large socioeconomic inequalities in mortality are observed in France, and that they increase over time among men and women.
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Affiliation(s)
- G Menvielle
- Inserm U687, HNSM, 14, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
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1589
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Lostao L, Regidor E, Geyer S, Aïach P. Patient cost sharing and physician visits by socioeconomic position: findings in three Western European countries. J Epidemiol Community Health 2007; 61:416-20. [PMID: 17435208 PMCID: PMC2465680 DOI: 10.1136/jech.2006.047126] [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] [Indexed: 11/04/2022]
Abstract
The association between educational level and the probability of physician visits in three Western European countries, one of which has a system of patient cost sharing was evaluated. Cross-sectional surveys were performed in France, Germany and Spain around 1990 and around 2000. People representative of the French, German and Spanish populations, aged 25-74 years were studied. The probability of physician visits decreased in the second period with respect to the first in France and Germany, but it increased in Spain. In the two periods studied, subjects with low educational level had a lower probability of physician visits than those with high educational level in France, in contrast with the general trend in Germany and Spain. In both periods, France had patient cost sharing whereas Germany and Spain did not. The existence of patient cost sharing in the healthcare systems of Western European countries raises doubts about the possibility of making use of health services independent of individual socioeconomic position.
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Affiliation(s)
- Lourdes Lostao
- Department of Sociology, Universidad Pública de Navarra, Campus de Arrosadía, 31006 Pamplona-Navarra, Spain.
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1590
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Fukuda Y, Nakao H, Imai H. Different income information as an indicator for health inequality among Japanese adults. J Epidemiol 2007; 17:93-9. [PMID: 17545696 PMCID: PMC7058454 DOI: 10.2188/jea.17.93] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are several alternative indicators of income information, which is a fundamental measure of individual socioeconomic position. In this study, we compared the degrees of associations of four types of income information with health variables among Japanese adults. METHODS Using a nationally representative sample of 29,446 men and 32,917 women aged 20 years and over, the associations between four income indicators and health variables were examined using the odds ratio in logistic regression analysis and the concentration index by sex and age group (20-59 years and 60+ years). Income indicators consisted of total household income, equivalent household income, total household expenditure, and equivalent household expenditure. Current smoking and self-rated health statuses were used as health variables. RESULTS A low income was associated with a high prevalence of smoking and fair/poor self-rated health, with some differences among sex and age groups and income indicators, but less difference among methods of statistical analyses. Total and equivalent incomes were similarly and more markedly associated with smoking and self-rated health statuses, whereas equivalent expenditure showed the smallest degree of health difference. For the population aged 60+ years, the degree of health differences in smoking was similar between income and expenditure. CONCLUSIONS Although the degree of income-related health differences is dependent on health outcome and both sex and age group, this study suggests that either crude or equivalent household income is a useful indicator for health inequality among Japanese adults.
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Affiliation(s)
- Yoshiharu Fukuda
- Department of Epidemiology, National Institute of Public Health, Wako, Saitama, Japan.
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1591
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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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1592
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Whitehead M. A typology of actions to tackle social inequalities in health. J Epidemiol Community Health 2007; 61:473-8. [PMID: 17496254 PMCID: PMC2465710 DOI: 10.1136/jech.2005.037242] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2005] [Indexed: 11/04/2022]
Affiliation(s)
- Margaret Whitehead
- Division of Public Health, University of Liverpool, Liverpool L69 3GB, UK.
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1593
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Preti A, Pinna C, Nocco S, Pilia S, Mulliri E, Micheli V, Casta MC, Petretto DR, Masala C. Rural/urban differences in the distribution of eating disorder symptoms among adolescents from community samples. Aust N Z J Psychiatry 2007; 41:525-35. [PMID: 17508323 DOI: 10.1080/00048670701332292] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Rural/urban differences in the prevalence of mental disorders have often been reported in the last 30 years, among others in the distribution of eating disorder symptoms and suicide rates. The role of sex, age and socioeconomic status in the differences by place of residence has often been neglected in past studies. METHOD Two independent community samples of students (mean age=17.4 years, SD=1.4), taken from among those attending high school in an urban district (Cagliari; n=817) and in a rural one (Carbonia; n=507) of south Sardinia, Italy, were invited to fill in the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Test (BAT) and the revised Hopkins Symptom checklist (SCL-90-R). RESULTS Female students scored higher than male students on all inventories. In male participants, the scores on the EAT were higher in the urban than in the rural sample. Conversely, in both male and female students the rural sample reported higher scores on the BITE symptoms subscale. When the comparison was confined to the fraction of those who scored higher than the suggested cut-off on the EAT and the BITE, students in the urban sample outnumbered those in the rural sample. No other differences were found. Socioeconomic status and age did not influence the differences in the reporting of eating disorder symptoms by place of residence. CONCLUSIONS Although caution is required when reading the findings drawn from self-report instruments, it is evident that the factors influencing the distribution of eating disorder symptoms and their psychological correlates by place of residence are far more complex than currently thought.
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Affiliation(s)
- Antonio Preti
- Department of Psychology, University of Cagliari, Cagliari, Italy.
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1594
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Evans S, Keenan TR, Shipton EA. Psychosocial adjustment and physical health of children living with maternal chronic pain. J Paediatr Child Health 2007; 43:262-70. [PMID: 17444828 DOI: 10.1111/j.1440-1754.2007.01057.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM There is limited research examining the functioning of children living with parental chronic pain and illness. The aim of this study was to examine the psychosocial adjustment and physical health of children living with a mother experiencing chronic pain. METHODS One-hundred and three children aged 6-12 years served as participants, with approximately equal numbers of children in maternal chronic pain (n=55) and control groups (n=48). Children completed self-reports about their internalising behaviour, health and attachment security. Mothers, fathers and teachers completed questionnaires relating to children's internalising and externalising behaviour, social behaviour and physical health. RESULTS Reports from children, mothers and fathers indicated significantly more internalising, externalising, insecure attachment and social and health problems for children in the maternal chronic pain group compared with control children. Teachers reported decreased social skills and increased pain complaints for children in the maternal chronic pain group. Boys in the maternal chronic pain group appear to be affected more than girls. Boys reported more anxiety and insecure attachment, while mothers reported greater social problems and increased illness behaviour for boys. Characteristics of the mother's pain condition, such as, severity, length and frequency were generally unrelated to child functioning. CONCLUSIONS The study demonstrates the importance of maternal and family variables to child outcomes. The results are discussed in terms of maternal chronic pain comprising a considerable, yet rarely studied, influence in the lives of young children.
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Affiliation(s)
- Subhadra Evans
- Department of Health and Social Care, University of Canterbury, New Zealand.
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1595
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Menvielle G, Chastang J, Luce D, Leclerc A. Temporal trends in socioeconomic inequality in mortality in France between 1968 and 1996. Study of educational differences by cause of death. Rev Epidemiol Sante Publique 2007. [DOI: 10.1016/j.respe.2006.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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1596
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Adamson J. Commentary: Disability and education--the Madonna factor? Int J Epidemiol 2007; 36:365-7. [PMID: 17470487 DOI: 10.1093/ije/dym028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joy Adamson
- Department of Health Sciences, University of York, Heslington, York, UK.
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1597
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Fukuda Y, Nakamura K, Takano T, Nakao H, Imai H. Socioeconomic status and cancer screening in Japanese males: Large inequlaity in middle-aged and urban residents. Environ Health Prev Med 2007; 12:90-6. [PMID: 21431825 PMCID: PMC2723645 DOI: 10.1007/bf02898155] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 01/30/2007] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Cancer screening has become common in Japan. However, little is known about the socioeconomic factors affecting cancer screening participation. This study was performed to examine the association between socioeconomic status and cancer screening participation in Japanese males. METHODS Using the data of 23,394 males sampled from across Japan, the associations between self-reported participation in screenings for three types of cancer (i.e., stomach, lung and colon) and socioeconomic variables, including marital status, types of residential area (metropolitan/nonmetropolitan), household income, and employment status, were examined using multilevel logistic regression by age group (40 to 64 and ≥65 years). RESULTS The cancer screening participation rates were 34.5% (stomach), 21.3% (lung), and 24.8% (colon) for the total population studied. Being married, living in a nonmetropolitan area, having a higher income and being employed in a large-scale company showed independent associations with a higher rate of cancer screening participation for all three types of cancer. Income-related differences in cancer screening were more pronounced in the middle-aged population than in the elderly population, and in metropolitan areas than in nonmetropolitan areas. CONCLUSIONS There are notable socioeconomic differences in cancer screening participation in Japan. To promote cancer screening, socioeconomic factors should be considered, particularly for middle-aged and urban residents.
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Affiliation(s)
- Yoshiharu Fukuda
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan,
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1598
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Choi YJ, Jeong BG, Cho SI, Jung-Choi K, Jang SN, Kang M, Khang YH. A Review on Socioeconomic Position Indicators in Health Inequality Research. J Prev Med Public Health 2007; 40:475-86. [DOI: 10.3961/jpmph.2007.40.6.475] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yong-Jun Choi
- Department of Social and Preventive Medicine, College of Medicine, Health Services Research Center, Hallym University, Korea
| | - Baek-Geun Jeong
- Department of Preventive Medicine, Institute of Health Science, Gyeongsang National University, Korea
| | - Sung-Il Cho
- School of Public Health, Seoul National University, Korea
| | - Kyunghee Jung-Choi
- Division of Occupational and Environmental Medicine, KyungHee University Medical Center, Korea
| | - Soong-Nang Jang
- Institute of Health and Environment, Seoul National University, Korea
| | - Minah Kang
- Department of Public Administration, College of Social Sciences, Ewha Womans University, Korea
| | - Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Korea
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1599
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Lallukka T, Laaksonen M, Rahkonen O, Roos E, Lahelma E. Multiple socio-economic circumstances and healthy food habits. Eur J Clin Nutr 2006; 61:701-10. [PMID: 17180154 DOI: 10.1038/sj.ejcn.1602583] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine associations between seven indicators of socio-economic circumstances and healthy food habits, while taking into account assumed temporal order between these socio-economic indicators. DESIGN AND SETTING Data were derived from cross-sectional postal questionnaires in 2000-2002. Socio-economic circumstances were assessed by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Healthy food habits were measured by an index consisting of consumption of fresh vegetables, fruit or berries, rye bread, fish and choosing vegetable fats on bread and oil in cooking. Sequential logistic regression models were used, adjusting for age and marital status. PARTICIPANTS Employees of the City of Helsinki, Finland (n=8960, aged 40-60 years). RESULTS Healthy food habits were reported by 28% of women and by 17% of men. Own education, occupational class, household income, home ownership and current economic difficulties were associated with healthy food habits. These associations were attenuated but mainly remained after mutual adjustments for the socio-economic indicators. Among women, a pathway was found suggesting that part of the effects of education on food habits were mediated through occupational class. CONCLUSIONS Employees in higher and lower socio-economic positions differ in their food habits, and those in lower positions and economically disadvantaged are less likely to report healthy food habits. Health promotion programmes and food policies should encourage healthier food choices among those in lower socio-economic positions and among those with economic difficulties in particular.
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Affiliation(s)
- T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.
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1600
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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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