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Sun F, Zimmer Z, Zajacova A. Educational Differences in Life Expectancies With and Without Pain. J Gerontol B Psychol Sci Soc Sci 2023; 78:695-704. [PMID: 36242782 PMCID: PMC10066743 DOI: 10.1093/geronb/gbac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study computes years and proportion of life that older adults living in the United States can expect to live pain-free and in different pain states, by age, sex, and level of education. The analysis addresses challenges related to dynamics and mortality selection when studying associations between education and pain in older populations. METHODS Data are from National Health and Aging Trends Study, 2011-2020. The sample contains 10,180 respondents who are age 65 and older. Pain expectancy estimates are computed using the Interpolated Markov Chain software that applies probability transitions to multistate life tables. RESULTS Those with higher educational levels expect not only a longer life but also a higher proportion of life without pain. For example, a 65-year-old female with less than high school education expects 18.1 years in total and 5.8 years, or 32% of life, without pain compared with 23.7 years in total with 10.7 years, or 45% of life without pain if she completed college. The education gradient in pain expectancies is more salient for females than males and narrows at the oldest ages. There is no educational disparity in the percent of life with nonlimiting pain. DISCUSSION Education promotes longer life and more pain-free years, but the specific degree of improvement by education varies across demographic groups. More research is needed to explain associations between education and more and less severe and limiting aspects of pain.
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Affiliation(s)
- Feinuo Sun
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Zachary Zimmer
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Anna Zajacova
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
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2
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Hossin MZ, Heshmati A, Koupil I, Goodman A, Mishra GD. Latent class trajectories of socioeconomic position over four time points and mortality: the Uppsala Birth Cohort Study. Eur J Public Health 2022; 32:522-527. [PMID: 35788842 PMCID: PMC9341739 DOI: 10.1093/eurpub/ckac060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study assessed socioeconomic position (SEP) over four time points and employed a latent class analysis (LCA) to explore the associations between longitudinal SEP trajectories and late-life mortality. METHODS We analyzed a cohort of 11 336 members born at the Uppsala University Hospital, Sweden during 1915-29 and followed up for mortality during 1980-2008. SEP was measured at birth, age 10, mid-adulthood and late adulthood. LCA was used to identify SEP trajectories, which were linked to all-cause and cause-specific mortality through Cox proportional hazard regression models. RESULTS The age and birth cohort adjusted hazard ratio (HR) of all-cause mortality among the upwardly mobile from middle vs. stable low SEP was 28% lower in men [HR: 0.72; 95% confidence interval (95% CI): 0.65, 0.81] and 30% lower in women (HR: 0.70; 95% CI: 0.62, 0.78). The corresponding HR of cardiovascular mortality was 30% lower in men (HR: 0.70; 95% CI: 0.60, 0.82) and 31% lower in women (HR: 0.69; 95% CI: 0.58, 0.83). Upward mobility was also associated with decreased HR of mortality from respiratory diseases and injuries among men and from cancer, respiratory diseases, injuries and mental disorders among women. The upwardly mobile were similar to the stable high group in terms of their HRs of mortality from all-causes and cardiovascular, cancer and mental diseases. CONCLUSIONS Upward mobility appeared to be protective of mortality from a wide range of causes. Interventions aiming to prevent deaths can benefit from creating optimal conditions earlier in the life course, letting disadvantaged children maximize their socioeconomic and health potentials.
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Affiliation(s)
- Muhammad Zakir Hossin
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Amy Heshmati
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Ilona Koupil
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Anna Goodman
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Herston, Australia
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3
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Lv D, Shen S, Chen X. Association Between Dynapenic Abdominal Obesity and Fall Risk in Older Adults. Clin Interv Aging 2022; 17:439-445. [PMID: 35418747 PMCID: PMC9001023 DOI: 10.2147/cia.s347053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background In recent years, dynapenic abdominal obesity has received more and more attention. This article aimed to explore the relationship between dynapenic abdominal obesity and fall risk in older adults. Methods In this cross-sectional study, according to waist circumference (≥90 cm for men and ≥85 cm for women) and handgrip strength (<28 kg for men and <18 kg for women), 551 older adults were divided into four groups: dynapenic abdominal obese (D/AO), dynapenic nonabdominal obese (D/NAO), nondynapenic abdominal obese (ND/AO) and nondynapenic nonabdominal obese (ND/NAO). Fall risk was measured by the Tinetti performance-oriented mobility assessment (POMA). Binary logistic regression was used to explore the relationship between D/AO and fall risk. Results D/AO was related to POMA score (odds ratio [OR]=3.39; 95% confidence interval [CI]: 1.47–7.81; P=0.004) after adjusting the confounding variables. However, D/NAO (OR=1.51; 95% CI:0.69–3.32; P=0.302) and ND/AO (OR=1.48; 95% CI:0.74–2.99; P=0.272) were not associated with POMA score. Conclusion This study suggests that older adults with D/AO have a higher risk of falls. Therefore, it is necessary to strengthen the attention to D/AO and relevant interventions should be implemented.
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Affiliation(s)
- Danmei Lv
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310013, People’s Republic of China
| | - Shanshan Shen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310013, People’s Republic of China
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310013, People’s Republic of China
- Correspondence: Xujiao Chen, Department of Geriatrics, Zhejiang Hospital, Lingyin Road #12, Hangzhou, 310013, People’s Republic of China, Email
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Hwang PW, Gomes CDS, Auais M, Braun KL, Guralnik JM, Pirkle CM. Economic Adversity Transitions From Childhood to Older Adulthood Are Differentially Associated With Later-Life Physical Performance Measures in Men and Women in Middle and High-Income Sites. J Aging Health 2019; 31:509-527. [PMID: 29254426 PMCID: PMC6087498 DOI: 10.1177/0898264317736846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: This study examines the relationship between economic adversity transitions from childhood to older adulthood and older adulthood physical performance among 1,998 community-dwelling older adults from five demographically diverse sites from middle and high-income countries. Method: The principal exposure variable was economic adversity transition. No adversity encompassed not experiencing poverty in both childhood and older adulthood, improved described having only experienced poverty in childhood, worsened captured having experienced poverty in older adulthood, and severe is having experienced poverty in both childhood and older adulthood. The short physical performance battery (SPPB) was used for outcome measures. Analyses of the continuous SPPB score used linear regression, while analysis of a binary outcome (SPPB < 8 vs. ≥8) used Poisson regression models with robust error variance, both adjusting for sex, education, and site location. Result: In sex-stratified models, the SPPB < 8 prevalence rate ratio (PRR) was higher for the severe (PRR: 2.80, 95% confidence interval [CI] = [1.70, 4.61]), worsened (PRR: 2.40, 95% CI = [1.41, 4.09]), and improved (PRR: 1.82, 95% CI = [1.11, 3.01]) groups, compared with those with no adversity in childhood or as adults, but only for females. Discussion: Findings from this study indicate that persistent economic adversity has a negative effect on older adult physical performance, especially among women.
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5
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[Socioeconomic inequalities in health in later life]. Z Gerontol Geriatr 2018; 52:91-99. [PMID: 30569288 DOI: 10.1007/s00391-018-01487-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Socioeconomic differences in health and life expectancy are key issues for public health and health policy. In the course of demographic change, in addition to childhood, adolescence and middle adulthood, old age is increasingly becoming the focus of attention in research on health inequalities, with a special emphasis on the transition from working age to retirement. OBJECTIVE How do health inequalities change in the transition from middle to older age and then to very old age? MATERIAL AND METHODS This article reviews the studies available for Germany, supplemented with new analyses based on the German Health Update study and the German Socioeconomic Panel study. In order to set the findings in the context of international research on health inequalities in old age, selected studies from other countries and international comparative studies are additionally considered. RESULTS Social differences in health and remaining life-expectancy also exist in older age, although to a slightly lesser extent than in middle age. There is evidence that as age progresses, health inequalities narrow in some health domains but there is also isolated evidence that health inequalities may widen with age. CONCLUSION The existence of health inequalities in old age indicates that older people from disadvantaged social groups have a particular need for healthcare and support. This poses special challenges for the medical, nursing and psychosocial care system as well as for the social security systems.
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Ki M, Seong Sohn E, An B, Lim J. Differentiation of direct and indirect socioeconomic effects on suicide attempts in South Korea. Medicine (Baltimore) 2017; 96:e9331. [PMID: 29390510 PMCID: PMC5758212 DOI: 10.1097/md.0000000000009331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the wide recognition of the inverse association between socioeconomic position (SEP) and suicidal behaviors, its underlying process and potential mediators are little known. This study investigated the pathway from SEP to suicide attempts with attention to potential mediators.From the Korean Health and Nutrition Examination Survey 2007-2013, which is a nationwide cross-sectional survey of the health and nutritional status, a total of 34,565 participants (≥30 years) were included in the analysis. To unfold the pathways linking SEP to suicide attempts, the direct and indirect effects of 3 SEP measures (educational attainment, household income, and occupational group) and 3 mediators (physical illness, mental health problems, and problematic drinking) were differentiated using structured equation model (SEM).Most of direct and indirect effects of educational attainment, household income, and occupational group on suicide attempts were significant; Nonemployment status had the largest total (β = 0.291, P < .01) and direct effects (β = 0.212, P < .01), while educational attainment had the largest indirect effect (β = -0.124, P < .01). Educational attainment was mainly mediated by physical illness and problem drinking, whereas household income and occupational group were mainly mediated by anxious or depressed mood and problem drinking. Physical illness played a major role in explaining suicide attempts, compared to mental health problem and problem drinking.Overall, experience of socioeconomic disadvantage increased suicide attempts independently of mental and physical problems. An extension of suicide prevention program is required for comprehensively targeting people with general problems such as physical illness and low SEP, complemented to narrowly targeting high risk group with, such as mental health problem.
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Affiliation(s)
- Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | | | - Byungduck An
- Department of Psychology and Philosophy, PaiChai University
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
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Socioeconomic inequalities in health in the context of multimorbidity: A Korean panel study. PLoS One 2017; 12:e0173770. [PMID: 28296975 PMCID: PMC5351993 DOI: 10.1371/journal.pone.0173770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 02/27/2017] [Indexed: 11/19/2022] Open
Abstract
Socioeconomic inequalities in health are commonly known to decrease at late age. Yet, it remains unclear whether socioeconomic inequalities in health at late age appear in relation to multimorbidity, particularly in Korea where social support remains unsatisfactory for older people. Using three waves of Korea Health Panel, data of 19,942 observations with repeated measure were constructed to ensure a temporal sequence between three socioeconomic measures (i.e., poverty, employment status, and education) and multimorbidity with a t to t+1 year transition. A multilevel multinomial model was applied to quantify the socioeconomic impact across different age, diseases and disease groups, both separately and in combination. There were associations between socioeconomic position (SEP) and multimorbidity, and increasing trends of socioeconomic inequalities not only with greater number of morbidity but also with age. The latter result was only observed with employment status through mid-to-early old age; i.e., between the 40s (odds ratio (OR) = 2.45, 95% confidence interval (CI):1.08–5.57) and 70s (OR = 3.48, 95%CI: 1.24–9.74). The patterns of socioeconomic inequalities in multimorbidity varied for particular pairs of diseases and were stronger in the disease pairs co-occurring with mental and cardiovascular diseases but weaker in the disease pairs co-occurring with cancer. Accumulation of adversity tended to intensify with increase in number of diseases and older age, though this finding was not consistently supported. The labour market should be encouraged to actively participate in actions to promote healthy aging needs to be complemented by the provision of more generous and universal income support to the elderly in Korea.
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8
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Yu XQ, Luo Q, Kahn C, Grogan P, O'Connell DL, Jemal A. Contrasting temporal trends in lung cancer incidence by socioeconomic status among women in New South Wales, Australia, 1985-2009. Lung Cancer 2017. [PMID: 28625648 DOI: 10.1016/j.lungcan.2017.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined long-term trends in lung cancer incidence for women by socioeconomic groups in New South Wales (NSW), Australia. METHODS Data on lung cancer incidence for women were extracted from the NSW Cancer Registry database. We divided the study cohort into five quintiles according to an area-based index of education and occupation (IEO) and calculated annual age-standardised incidence rates by IEO quintile for the period 1985-2009. The age-standardised incidence ratio (SIR) was estimated for IEO quintiles and 5-year period of diagnosis using the highest IEO quintile as the reference. RESULTS Overall, lung cancer incidence for women aged 25-69 years increased gradually from 19.8 per 100,000 in 1985 to 25.7 per 100,000 in 2009. The trends by IEO quintile were somewhat comparable from 1985 through to 1995, but from then on rates remained relatively stable for women residing in the highest quintile while increasing for women residing in the remaining four quintiles. Consequently, the SIR for all four of the lower IEO quintiles increased significantly over the 25-year period. For example, the SIR in the lowest IEO quintile increased from 1.16 (95% CI, 0.99-1.37) during 1985-1989 to 1.70 (95% CI, 1.50-1.93) during 2005-2009. The corresponding estimates for women aged 70 years or older showed no clear pattern of socioeconomic gradient. CONCLUSION The increasing gap in lung cancer incidence between women in the highest socioeconomic group and all others suggests that there is a continued need for the broad implementation of tobacco control interventions, so that smoking prevalence is reduced across all segments of the population and the subsequent benefits are shared more equitably across all demographic groups.
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Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Qingwei Luo
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Clare Kahn
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Paul Grogan
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Cancer Council Australia, Sydney, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
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9
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Khang YH, Kim HR. Socioeconomic Inequality in mortality using 12-year follow-up data from nationally representative surveys in South Korea. Int J Equity Health 2016; 15:51. [PMID: 27001045 PMCID: PMC4802872 DOI: 10.1186/s12939-016-0341-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/15/2016] [Indexed: 11/23/2022] Open
Abstract
Background Investigations into socioeconomic inequalities in mortality have rarely used long-term mortality follow-up data from nationally representative samples in Asian countries. A limited subset of indicators for socioeconomic position was employed in prior studies on socioeconomic inequalities in mortality. We examined socioeconomic inequalities in mortality using follow-up 12-year mortality data from nationally representative samples of South Koreans. Methods A total of 10,137 individuals who took part in the 1998 and 2001 Korea National Health and Nutrition Examination Surveys were linked to mortality data from Statistics Korea. Of those individuals, 1,219 (12.1 %) had died as of December 2012. Cox proportional hazard models were used to estimate the relative risks of mortality according to a wide range of socioeconomic position (SEP) indicators after taking into account primary sampling units, stratification, and sample weights. Results Our analysis showed strong evidence that individuals with disadvantaged SEP indicators had greater all-cause mortality risks than their counterparts. The magnitude of the association varied according to gender, age group, and specific SEP indicators. Cause-specific analyses using equivalized income quintiles showed that the magnitude of mortality inequalities tended to be greater for cardiovascular disease and external causes than for cancer. Conclusion Inequalities in mortality exist in every aspect of SEP indicators, both genders, and age groups, and four broad causes of deaths. The South Korean economic development, previously described as effective in both economic growth and relatively equitable income distribution, should be scrutinized regarding its impact on socioeconomic mortality inequalities. Policy measures to reduce inequalities in mortality should be implemented in South Korea. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0341-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul, 03080, South Korea. .,Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Hye-Ryun Kim
- Korea Institute for Health and Social Affairs, Sejong, South Korea
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10
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van Zon SKR, Bültmann U, Mendes de Leon CF, Reijneveld SA. Absolute and Relative Socioeconomic Health Inequalities across Age Groups. PLoS One 2015; 10:e0145947. [PMID: 26717482 PMCID: PMC4696790 DOI: 10.1371/journal.pone.0145947] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/10/2015] [Indexed: 11/21/2022] Open
Abstract
Background The magnitude of socioeconomic health inequalities differs across age groups. It is less clear whether socioeconomic health inequalities differ across age groups by other factors that are known to affect the relation between socioeconomic position and health, like the indicator of socioeconomic position, the health outcome, gender, and as to whether socioeconomic health inequalities are measured in absolute or in relative terms. The aim is to investigate whether absolute and relative socioeconomic health inequalities differ across age groups by indicator of socioeconomic position, health outcome and gender. Methods The study sample was derived from the baseline measurement of the LifeLines Cohort Study and consisted of 95,432 participants. Socioeconomic position was measured as educational level and household income. Physical and mental health were measured with the RAND-36. Age concerned eleven 5-years age groups. Absolute inequalities were examined by comparing means. Relative inequalities were examined by comparing Gini-coefficients. Analyses were performed for both health outcomes by both educational level and household income. Analyses were performed for all age groups, and stratified by gender. Results Absolute and relative socioeconomic health inequalities differed across age groups by indicator of socioeconomic position, health outcome, and gender. Absolute inequalities were most pronounced for mental health by household income. They were larger in younger than older age groups. Relative inequalities were most pronounced for physical health by educational level. Gini-coefficients were largest in young age groups and smallest in older age groups. Conclusions Absolute and relative socioeconomic health inequalities differed cross-sectionally across age groups by indicator of socioeconomic position, health outcome and gender. Researchers should critically consider the implications of choosing a specific age group, in addition to the indicator of socioeconomic position and health outcome, as findings on socioeconomic health inequalities may differ between them.
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Affiliation(s)
- Sander K. R. van Zon
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9700 AD, Groningen, The Netherlands
- * E-mail:
| | - Ute Bültmann
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9700 AD, Groningen, The Netherlands
| | - Carlos F. Mendes de Leon
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, The United States of America
| | - Sijmen A. Reijneveld
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9700 AD, Groningen, The Netherlands
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Kinge JM, Steingrímsdóttir ÓA, Moe JO, Skirbekk V, Næss Ø, Strand BH. Educational differences in life expectancy over five decades among the oldest old in Norway. Age Ageing 2015; 44:1040-5. [PMID: 26396184 DOI: 10.1093/ageing/afv128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/07/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in life expectancy have been shown among the middle aged and the youngest of the old individuals, but the situation in the oldest old is less clear. The aim of this study was to investigate trends in life expectancy at ages 85, 90 and 95 years by education in Norway in the period 1961-2009. METHODS This was a register-based population study including all residents in Norway aged 85 and over. Individual-level data were provided by the Central Population Register and the National Education Database. For each decade during 1961-2009, death rates by 1-year age groups were calculated separately for each sex and three educational categories. Annual life tables were used to calculate life expectancy at ages 85 (e85), 90 (e90) and 95 (e95). RESULTS Educational differentials in life expectancy at each age were non-significant in the early decades, but became significant over time. For example, for the decade 2000-9, a man aged 90 years with primary education had a life expectancy of 3.4 years, while a man with tertiary education could expect to live for 3.8 years. Similar numbers in women were 4.1 and 4.5 years, respectively. Even among 95-year-old men, statistically significant differences in life expectancy were found by education in the two last decades. CONCLUSION Education matters regarding remaining life expectancy also for the oldest old in Norway. Life expectancy at these ages is low, so a growth of 0.5 years in the life expectancy differential is sizeable.
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Affiliation(s)
- Jonas Minet Kinge
- Norwegian Institute of Public Health (NIPH), Oslo 0170, Norway Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | | | - Joakim Oliu Moe
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Vegard Skirbekk
- Norwegian Institute of Public Health (NIPH), Oslo 0170, Norway Columbia Aging Center, Columbia University, New York, NY, USA
| | - Øyvind Næss
- Norwegian Institute of Public Health (NIPH), Oslo 0170, Norway Department of Community Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Heine Strand
- Norwegian Institute of Public Health (NIPH), Oslo 0170, Norway Department of Community Medicine, University of Oslo, Oslo, Norway
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Hedinger D, Hämmig O, Bopp M. Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study. BMC Geriatr 2015; 15:114. [PMID: 26429705 PMCID: PMC4591584 DOI: 10.1186/s12877-015-0111-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Due to demographic ageing and increasing life expectancy, a growing demand for long-term nursing home care can be expected. Stays in nursing homes appear to be more socially determined than hospital stays. We therefore looked at the impact of socio-demographic and health care variables on the length of the last nursing home stay. Methods Nationwide individual data from nursing homes and hospitals in Switzerland were linked with census and mortality records. Gender-specific negative binomial regression models were used to analyze N = 35,739 individuals with an admission age of at least 65 years and deceased in 2007 or 2008 in a nursing home. Results Preceding death, men spent on average 790 days and women 1250 days in the respective nursing home. Adjusted for preceding hospitalizations, care level, cause of death and multimorbidity, a low educational level, living alone or being tenant as well as a low care level at the admission time increased the risk for longer terminal stays. Conversely, a high educational level, being homeowner, being married as well as a high care level at the admission time decreased the risk for longer stays. Discussion The length of the last nursing home stay before death was not only dependent on health-related factors alone, but also substantially depended on socio-demographic determinants such as educational level, homeownership or marital status. The support of elderly people at the admission time of a presumably following nursing home stay should be improved and better evaluated in order to reduce unnecessary and undesired long terminal nursing home stays. Conclusions Health policy should aim at diminishing the role of situational, non-health-related factors in order to empower people to spend the last years before death according to individual needs and preferences.
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Affiliation(s)
- Damian Hedinger
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Oliver Hämmig
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
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13
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Enroth L, Raitanen J, Hervonen A, Nosraty L, Jylhä M. Is socioeconomic status a predictor of mortality in nonagenarians? The vitality 90+ study. Age Ageing 2015; 44:123-9. [PMID: 25002455 DOI: 10.1093/ageing/afu092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND socioeconomic inequalities in mortality are well-known in middle-aged and younger old adults, but the situation of the oldest old is less clear. The aim of this study was to investigate socioeconomic inequalities for all-cause, cardiovascular and dementia mortality among the people aged 90 or older. METHODS the data source was a mailed survey in the Vitality 90+ study (n = 1,276) in 2010. The whole cohort of people 90 years or over irrespective of health status or dwelling place in a geographical area was invited to participate. The participation rate was 79%. Socioeconomic status was measured by occupation and education, and health status by functioning and comorbidity. All-cause and cause-specific mortality was followed for 3 years. The Cox regression, with hazard ratios (HR) and 95% confidence intervals (CI), was applied. RESULTS the all-cause and dementia mortality differed by occupational class. Upper non-manuals had lower all-cause mortality than lower non-manuals (HR: 1.61; 95% CI: 1.11-2.32), skilled manual workers (HR: 1.56 95% CI: 1.09-2.25), unskilled manual workers (HR: 1.88; 95% CI: 1.20-2.94), housewives (HR: 1.77 95% CI: 1.15-2.71) and those with unknown occupation (HR: 2.33; 95% CI: 1.41-3.85). Inequalities in all-cause mortality were largely explained by the differences in functioning. The situation was similar according to education, but inequalities were not statistically significant. Socioeconomic differences in cardiovascular mortality were not significant. CONCLUSIONS socioeconomic inequalities persist in mortality for 90+-year-olds, but their magnitude varies depending on the cause of death and the indicator of socioeconomic status. Mainly, mortality differences are explained by differences in functional status.
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Affiliation(s)
- Linda Enroth
- School of Health Sciences and Gerontology Research Center, University of Tampere, Tampere 33014, Finland
| | - Jani Raitanen
- School of Health Sciences and Gerontology Research Center, University of Tampere, Tampere 33014, Finland UKK Institute for Health Promotion Research, Tampere, Finland
| | - Antti Hervonen
- School of Health Sciences and Gerontology Research Center, University of Tampere, Tampere 33014, Finland
| | - Lily Nosraty
- School of Health Sciences and Gerontology Research Center, University of Tampere, Tampere 33014, Finland
| | - Marja Jylhä
- School of Health Sciences and Gerontology Research Center, University of Tampere, Tampere 33014, Finland
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Vathesatogkit P, Batty GD, Woodward M. Socioeconomic disadvantage and disease-specific mortality in Asia: systematic review with meta-analysis of population-based cohort studies. J Epidemiol Community Health 2014; 68:375-83. [DOI: 10.1136/jech-2013-203053] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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Silva VDL, Cesse EÂP, Albuquerque MDFPMD. Social determinants of death among the elderly: a systematic literature review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 17 Suppl 2:178-93. [DOI: 10.1590/1809-4503201400060015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 06/12/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: This study aims at working on a systematic review of articles published on social determinants associated with the elderly mortality. METHODS: We searched articles published in Portuguese, English and Spanish language periodicals from January 1st 2007 to December 31st 2009, by means of Lilacs and Pubmed databases. Twenty cohort studies were identified, having most of them been developed in European, North-American and Asian countries. RESULTS: The articles analysed provided determinant social factors significantly associated with the elderly mortality: urban/rural and intercontinental variation, be part of ethnic minorities, financial stress, living conditions, schooling, social participation, gender and race discrimination, smoking, alcoholism, physical activities, instrumental activities of daily living, leisure, marital status, equality and healthy lifestyle. CONCLUSION: Mortality amongst the elderly is influenced by social determinants in many levels of reach, from determinants linked to lifestyle to socioeconomic macro-determinants. The actions on these determinants must be guided by the intersectorial perspective and regarded as a priority in the health sector, seeking to provide extended longevity with good quality of life for the population.
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16
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Pu C, Tang GJ, Huang N, Chou YJ. Predictive power of self-rated health for subsequent mortality risk during old age: analysis of data from a nationally representative survey of elderly adults in Taiwan. J Epidemiol 2011; 21:278-84. [PMID: 21606607 PMCID: PMC3899420 DOI: 10.2188/jea.je20100131] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Previous research has investigated differences in the predictive power of self-rated health (SRH) for mortality based on socioeconomic status (SES). However, these studies mainly assessed adults in the general population and did not focus specifically on elderly adults. In addition, this predictive power has never been evaluated using subjective SES, which is an important measure of SES in elderly adults. Methods This study used data from the Survey of the Health and Living Status of the Middle Aged and the Elderly in Taiwan (SHLS) conducted by the Bureau of Health Promotion, Taiwan. The SHLS is a 15-year longitudinal survey based on a nationally representative sample. It was initiated in 1989 with 4049 respondents aged 60 years or older. Both education and subjective financial satisfaction were used as SES measures in the present study. A Cox regression model was used to estimate the interaction between SRH and SES for 3829 individuals without missing data. Results As compared with those who reported their health as good, those who reported their health as poor and their education as high had a higher hazard ratio (hazard ratio = 1.97, 95% confidence interval = 1.35–2.88) for 6–15-year mortality, after adjusting for depressive symptoms, activities of daily living, and instrumental activities of daily living. This HR was significantly higher than those for adults with middle (1.16, 0.93–1.44) and low (1.27, 1.05–1.54) education, based on the χ2 test (P < 0.05 for both comparisons). A similar pattern was observed when financial satisfaction was used as the SES measure. However, the pattern was attenuated when using 5-year mortality from baseline. Conclusions The use of SRH as a single health measure in elderly adults may yield inconsistent results across different SES groups, especially when used as a predictor of a longer-term mortality. This is true regardless of whether objective or subjective measures of SES are used, where both are important measures of SES in elderly adults.
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Affiliation(s)
- Christy Pu
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Zuluaga MC, Guallar-Castillón P, Conthe P, Rodríguez-Pascual C, Graciani A, León-Muñoz LM, Gutiérrez-Fisac JL, Regidor E, Rodríguez-Artalejo F. Housing conditions and mortality in older patients hospitalized for heart failure. Am Heart J 2011; 161:950-5. [PMID: 21570528 DOI: 10.1016/j.ahj.2011.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/01/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although decent housing is recognized as a prerequisite for good health, very few studies in developed countries have examined the influence of housing characteristics on disease prognosis. This work examined whether housing conditions predict mortality in older adults with heart failure (HF). METHODS This is a cohort study comprising 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals between January 1, 2000, and June 30, 2001. At baseline, patients reported whether their homes lacked an elevator (in an apartment building), hot water, heating, an indoor bathroom, a bathtub or shower, individual bedroom, automatic washing machine, and telephone and whether they frequently felt cold. Analyses included all-cause deaths identified prospectively until January 1, 2005. RESULTS Among study participants, 165 (38.1%) lived in a home without one of the services considered; and 111 (25.6%) lacked ≥2 services. During follow-up, 260 deaths (60%) occurred. After adjustment for the main confounders, mortality was higher in those who lived in homes without an elevator (hazard ratio [HR] 1.39, 95% CI 1.07-1.80) and in those who frequently felt cold (HR 1.39, 95% CI 1.01-1.92). In comparison with living in a home with all the services considered, mortality was higher for persons living in a home lacking 1 service (HR 1.42, 95% CI 1.10-1.93) or ≥2 services (HR 1.94, 95% CI 1.37-2.74). Patients living in homes lacking any of the services more often had poor functional status, higher comorbidity, lower educational level, and less income. CONCLUSION Poor housing conditions are associated with higher mortality in HF. Patients living in these homes are especially vulnerable because they have poorer clinical situation and lower socioeconomic position.
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Marra CA, Lynd LD, Harvard SS, Grubisic M. Agreement between aggregate and individual-level measures of income and education: a comparison across three patient groups. BMC Health Serv Res 2011; 11:69. [PMID: 21453534 PMCID: PMC3078843 DOI: 10.1186/1472-6963-11-69] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 03/31/2011] [Indexed: 11/10/2022] Open
Abstract
Background The association between lower socioeconomic status and poorer health outcomes has been observed using both individual-level and aggregate-level measures of income and education. While both are predictive of health outcomes, previous research indicates poor agreement between individual-level and aggregate-level measures. The purpose of this study was to determine the level of agreement between aggregate-level and individual-level measures of income and education among three distinct patient groups, specifically asthma, diabetes, and rheumatoid patients. Methods Individual-level measures of annual household income and education were derived from three separate surveys conducted among patients with asthma (n = 359), diabetes (n = 281) and rheumatoid arthritis (n = 275). Aggregate-level measures of income and education were derived from the 2001 Canadian census, including both census tract-and dissemination area-level measures. Cross-tabulations of individual-level income by aggregate-level income were used to determine the percentage of income classifications in agreement. The kappa statistic (simple and weighted), Spearman's rank correlations, and intra-class correlation coefficient (ICC) were also calculated. Individual-level and aggregate-level education was compared using Chi-Square tests within patient groups. Point biserial correlation coefficients between individual-level and aggregate-level education were computed. Results Individual-level income was poorly correlated with aggregate-level measures, which provided the worst estimations of income among patients in the lowest income category at the individual-level. Both aggregate-level measures were best at approximating individual-level income in patients with diabetes, in whom aggregate-level estimates were only significantly different from individual-level measures for patients in the lowest income category. Among asthma patients, the proportion of patients classified by aggregate-level measures as having a university degree was significantly lower than that classified by individual-level measures. Among diabetes and rheumatoid arthritis patients, differences between aggregate and individual-level measures of education were not significant. Conclusions Agreement between individual-level and aggregate-level measures of socioeconomic status may depend on the patient group as well as patient income. Research is needed to characterize differences between patient groups and help guide the choice of measures of socioeconomic status.
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Affiliation(s)
- Carlo A Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
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