Determinants of socioeconomic differences in change in physical and mental functioning

Factors Associated With Health-Related Quality of Life Among Older People Exposed to the Jeju 4·3 Incident

OBJECTIVE

We explored factors associated with health-related quality of life (HRQOL), including socio-demographic and clinical characteristics, in among older people exposed to the Jeju 4·3 incident, and aimed to determine the effects of depression, posttraumatic stress disorder (PTSD) and perceived social support on HRQOL.

METHODS

We obtained data from 110 survivors and 1,011 immediate family members of the victims of the Jeju April 3 incident (mean age, 75.1 years), and evaluated the relationships of HRQOL with sociodemographic and clinical characteristics including posttraumatic and depressive symptoms, and perceived social support.

RESULTS

Poorer physical health, psychological health, social relationships, and environment HRQOL domain scores were strongly associated with older age, being a woman, poor socioeconomic status, and symptoms of depression and PTSD. The regression analyses indicated that, when relevant factors were controlled for, perceived social support moderated the negative association between HRQOL and psychiatric symptoms.

CONCLUSION

Our results suggest the importance of sociodemographic characteristics, in addition to psychiatric symptoms, for understanding HRQOL in older people exposed to the Jeju 4·3 incident. These results have important implications for interventions aiming to improve the HRQOL of the victims of the Jeju 4·3 incident.

Educational inequalities in health after work exit: the role of work characteristics

Background

Educational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health.

Methods

Data from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities.

Results

The low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries.

Conclusion

Educational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.

Life Course Patterns of Concurrent Trajectories of BMI and Affective Symptoms of Rural Mothers: Socioeconomic Antecedents and Disease Outcomes in Later Life

OBJECTIVES

The current study, using prospective data over 25 years (1991-2015), concurrently investigates patterns of body mass index (BMI) and affective symptom trajectories in middle-aged mothers and the socioeconomic antecedents and disease outcomes of these patterns.

METHOD

Growth mixture modeling was used to identify latent classes of conjoint health risk trajectories (BMI, depressive symptoms, and anxiety symptoms) from 1991 to 2001. For each latent class, we identified mean trajectories of each health risk. Then, analyses were conducted identifying how these conjoint health risk classes were associated with respondents' socioeconomic background profiles in 1991 and subsequent chronic health problems in 2015.

RESULTS

Socioeconomic background profiles were significantly associated with initially high-risk trajectories. There was a statistically significant association between membership in certain classes of conjoint trajectories and physical health outcomes in later years. Consistent patterns of association with changes in different health outcomes including onset of diseases were observed when classes of conjoint risk trajectories are examined.

DISCUSSION

The identification of members of various conjoint risk trajectory groups provides a potentially useful prognostic tool for early preventive intervention efforts, treatment, and policy formation. Such interventions should promote and develop resiliency factors, thereby aiding in the redirection of middle-aged women's adverse risk trajectories.

The influence of mastery on mother's health in middle years: Moderating role of stressful life context

Using data from 416 middle-aged mothers gathered over the course of a decade, this study examined the influence of mastery trajectories (the initial level and change), on change in physical health. Mastery is defined as one's ability to control and influence his/her life and environment to reach a desired outcome or goal. Both the initial level and change in mastery from 1991 to 1994 were associated with decreased physical health problems over the middle years (1991-2001). Contextual moderation of this association by stressful life contexts including negative life events and work-family conflict was investigated. Moderation analysis showed that under conditions of low contextual life stressors, the level and increase in mastery significantly contributed to decreases in physical health problems in middle-aged mothers. Alternatively, conditions of high contextual life stressors inhibited the ability of mastery to influence physical health of mothers, suggesting that the positive health impact of mastery on physical health is mitigated by stressful life experiences. Implications for the need to maintain important personal resources, such as mastery, during times of stress are discussed.

The association between different domains of quality of life and symptoms in primary care patients with emotional disorders

Despite the importance of quality of life (QoL) in primary care patients with emotional disorders, the specific influence of the symptoms of these disorders and the sociodemographic characteristics of patients on the various QoL domains has received scant attention. The aim of the present study of primary care patients with emotional disorders was to analyse the associations between four different QoL domains and the most prevalent clinical symptoms (i.e., depression, anxiety and somatization), while controlling for sociodemographic variables. A total of 1241 participants from 28 primary care centres in Spain were assessed with the following instruments: the Patient Health Questionnaire (PHQ)-9 to evaluate depression; the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety; PHQ-15 for somatization; and the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-Bref) to assess four broad QoL domains: physical health, psychological health, social relationships, and environment. The associations between the symptoms and QoL domains were examined using hierarchical regression analyses. Adjusted QoL mean values as a function of the number of overlapping diagnoses were calculated. The contribution of sociodemographic variables to most QoL domains was modest, explaining anywhere from 2% to 11% of the variance. However, adding the clinical variables increased the variance explained by 12% to 40% depending on the specific QoL domain. Depression was the strongest predictor for all domains. The number of overlapping diagnoses adversely affected all QoL domains, with each additional diagnosis reducing the main QoL subscales by 5 to 10 points. In primary care patients with a diagnostic impression of an emotional disorders as identified by their treating GP, clinical symptoms explained more of the variance in QoL than sociodemographic factors such as age, sex, level of education, marital status, work status, and income. Given the strong relationship between depressive symptoms and QoL, treatment of depression may constitute a key therapeutic target to improve QoL in people with emotional disorders in primary care.

The mental health of mothers and fathers during pregnancy and early parenthood after successful oocyte donation treatment: A nested case-control study

INTRODUCTION

The aim of this study was to compare the mental health problems between parents after oocyte donation treatment, after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with own gametes and after naturally conceiving (NC).

MATERIAL AND METHODS

This is a prospective, longitudinal questionnaire study. The study group consisted of 26 oocyte donation mothers and their matched IVF/ICSI (n = 52) and NC (n = 52) controls. Matching was performed according to mother's age, parity, type of pregnancy, and number of returned questionnaires. The parents filled-in the General Health Questionnaire (GHQ-36) at gestational weeks 18-20 (T1), and at 2 months (T2) and 12 months (T3) after the childbirth.

RESULTS

Full response rate (T1-T3) for oocyte donation mothers was 76.9% and for oocyte donation fathers was 73.1%. At T1, no significant differences were found between groups in depression, anxiety, sleeping difficulties, or social dysfunction, but they differed at T2 and T3 in anxiety (T2, P = .02; T3, P = .01), in sleeping difficulties (T2, P = .02; T3, P = .04) and in social dysfunction (T2, P = .01; T3, P = .04). Oocyte donation mothers showed less anxiety than NC mothers (T2, T3), and fewer sleeping difficulties and less social dysfunction than IVF/ICSI (T2, T3) and NC mothers (T2). Mental health problems of oocyte donation fathers did not differ from those of IVF/ICSI and NC control fathers at T1-T3.

CONCLUSIONS

Oocyte donation mothers showed fewer mental health symptoms in early parenthood compared with IVF/ICSI and NC mothers. No differences were found among mothers during pregnancy and among fathers at any time point.

Socioeconomic inequality in recovery from poor physical and mental health in mid-life and early old age: prospective Whitehall II cohort study

Background

Few studies have examined the influence of socioeconomic status on recovery from poor physical and mental health.

Methods

Prospective study with four consecutive periods of follow-up (1991–2011) of 7564 civil servants (2228 women) recruited while working in London. Health was measured by the Short-Form 36 questionnaire physical and mental component scores assessed at beginning and end of each of four rounds. Poor health was defined by a score in the lowest 20% of the age–sex-specific distribution. Recovery was defined as changing from a low score at the beginning to a normal score at the end of the round. The analysis took account of retirement status, health behaviours, body mass index and prevalent chronic disease.

Results

Of 24 001 person-observations in the age range 39–83, a total of 8105 identified poor physical or mental health. Lower grade of employment was strongly associated with slower recovery from poor physical health (OR 0.73 (95% CI 0.59 to 0.91); trend P=0.002) in age, sex and ethnicity-adjusted analyses. The association was halved after further adjustment for health behaviours, adiposity, systolic blood pressure (SBP) and serum cholesterol (OR 0.85 (0.68 to 1.07)). In contrast, slower recovery from poor mental health was associated robustly with low employment grade even after multiple adjustment (OR 0.74 (0.59 to 0.93); trend P=0.02).

Conclusions

Socioeconomic inequalities in recovery from poor physical health were explained to a considerable extent by health behaviours, adiposity, SBP and serum cholesterol. These risk factors explained only part of the gradient in recovery for poor mental health.

Stressful Work Trajectories and Depressive Symptoms in Middle-Aged Couples: Moderating Effect of Marital Warmth

OBJECTIVES

The present study investigated the decade-long actor and partner infleunces between husbands' and wives' trajectories of stressful work conditions (SWCs) and their depressive symptoms while also considering the moderation of these influences by spousal warmth.

METHODS

Participants were 330 middle-aged dual-earner couples from the Iowa Midlife Transitions Project. Husbands and wives reported on own SWCs and reported on parenter's warmth in the years of 1991, 1992, and 1994. Depressive symptoms for husbands and wives were measured by the SCL-90-R in 1994 and 2001. Structural equation models, growth curves, and longitudinal data were used to perform our analyses.

RESULTS

For husbands and wives, trajectories of SWCs over early middle years (1991-1994) contributed to depressive symptoms in 1994. Notably, for husbands and wives, the severity (level) of SWCs in 1991 had a persistent influence on depressive symptoms a decade later (2001). For husbands, under conditions of wives' low warmth, SWCs exerted a relatively strong influence on their depressive symptoms. However, under conditions of high warmth from wives, most of these influences were greatly diminished.

DISCUSSION

Results from the current study indicate that contextual life experiences can have a persistent health influences over the life course.

Occupational class inequalities in disability retirement after hospitalisation

AIMS

This study aimed to investigate whether hospitalisation is associated with increased risk of disability retirement differently across four occupational classes.

METHODS

170,510 employees of the City of Helsinki, Finland were followed from 1990 to 2013 using national registers for hospitalisations and disability retirement. Increases in the risk of disability retirement after hospitalisation for any cause, cardiovascular diseases, musculoskeletal disorders, mental disorders, malignant neoplasms, respiratory diseases and injuries were assessed across four occupational classes: professional, semi-professional, routine non-manual and manual, using competing risks models.

RESULTS

In general, hospitalisation showed a slightly more increased risk of disability retirement in the lower ranking occupational classes. Hospitalisation among women for mental disorders showed a more increased risk in the professional class (hazard ratio 14.73, 95% confidence interval 12.67 to 17.12) compared to the routine manual class (hazard ratio 7.27, 95% confidence interval 6.60 to 8.02). Occupational class differences were similar for men and women. The risk of disability retirement among women increased most in the routine non-manual class after hospitalisation for musculoskeletal disorders and injuries, and most in the professional class after hospitalisation for cardiovascular diseases. The corresponding risks among men increased most in the two lowest ranking classes after hospitalisation for injuries.

CONCLUSIONS

Ill-health as measured by hospitalisation affected disability retirement in four occupational classes differently, and the effects also varied by the diagnostic group of hospitalisation. Interventions that tackle work disability should consider the impact of ill-health on functioning while taking into account working conditions in each occupational class.

Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial

BACKGROUND

Since 1995 uterine artery embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. These randomized controlled trials reported outcomes in terms of health-related quality of life, clinical outcomes, efficacy, and cost-effectiveness after 1, 2, and 5 years of follow-up.

OBJECTIVE

The purpose of this study was to compare clinical outcome and health-related quality of life 10 years after uterine artery embolization or hysterectomy in the treatment of heavy menstrual bleeding caused by uterine fibroids in a randomized controlled trial.

STUDY DESIGN

In all, 28 Dutch hospitals recruited patients with symptomatic uterine fibroids who were eligible for hysterectomy. Patients were 1:1 randomly assigned to uterine artery embolization or hysterectomy. The outcomes assessed at 10 years postintervention were reintervention rates, health-related quality of life, and patient satisfaction, which were obtained through validated questionnaires. Study outcomes were analyzed according to original treatment assignment (intention to treat).

RESULTS

A total of 177 patients were randomized from 2002 through 2004. Eventually 81 uterine artery embolization and 75 hysterectomy patients underwent the allocated treatment shortly after randomization. The remaining patients withdrew from the trial. The 10-year questionnaire was mailed when the last included patient had been treated 10 years earlier. The mean duration of follow-up was 133 months (SD 8.58) accompanied by a mean age of 57 years (SD 4.53). Questionnaires were received from 131 of 156 patients (84%). Ten years after treatment, 5 patients underwent secondary hysterectomy resulting in a total of 28 of 81 (35%) (24/77 [31%] after successful uterine artery embolization). Secondary hysterectomies were performed for persisting symptoms in all cases but 1 (for prolapse). After the initial treatment health-related quality of life improved significantly. After 10 years, generic health-related quality of life remained stable, without differences between both groups. The urogenital distress inventory and the defecation distress inventory showed a decrease in both groups, probably related to increasing age, without significant differences between study arms. Satisfaction in both groups remained comparable. The majority of patients declared being (very) satisfied about the received treatment: 78% of the uterine artery embolization group vs 87% in the hysterectomy group.

CONCLUSION

In about two thirds of uterine artery embolization-treated patients with symptomatic uterine fibroids a hysterectomy can be avoided. Health-related quality of life 10 years after uterine artery embolization or hysterectomy remained comparably stable. Uterine artery embolization is a well-documented and less invasive alternative to hysterectomy for symptomatic uterine fibroids on which eligible patients should be counseled.

Mental health functioning (SF-36) and intentions to retire early among ageing municipal employees: The Helsinki Health Study

Aims: To examine the associations of mental health functioning with intentions to retire early among ageing municipal employees. Methods: Cross-sectional survey data (n=7,765) from the Helsinki Health Study in 2000, 2001, and 2002 were used. Intentions to retire early were sought with a question: ``Have you considered retiring before normal retirement age?'' The dependent variable was divided into three categories: 1=no intentions to retire early; 2=weak intentions; 3=strong intentions. Mental health functioning was measured by the Short Form 36 (SF-36) mental component summary (MCS). Other variables included age, sex, physical health functioning (SF-36), limiting longstanding illness, socioeconomic status, and spouse's employment status. Multinomial regression analysis was used to examine the association of mental health functioning with intentions to retire early. Results: Employees with the poorest mental health functioning were much more likely to report strong intentions to retire early (OR 6.09, 95% CI 4.97—7.47) than those with the best mental health functioning. Adjustments for physical health, socioeconomic status, and spouse's employment status did not substantially affect this association. Conclusions: The findings highlight the importance of mental health for intentions to retire early. Strategies aimed at keeping people at work for longer should emphasize the importance of mental well-being and the prevention of poor mental health. More evidence is needed on why mental problems among ageing baby-boomer employees are giving rise to increasing social consequences, although the overall prevalence of mental problems has not increased.

Adverse social factors predict early ageing in middle-aged men and women: the Ebeltoft Health Study, Denmark

Aims: This study examined whether adverse social factors are associated with an increased rate of biological ageing in middle-aged subjects. Methods: The authors investigated five markers of biological ageing in 690 subjects followed for five years in Ebeltoft, Denmark. Mean age at baseline was 40 years (range 30 - 50 years). These markers included repeated measures of pulse pressure, lung function, hearing, physical work capacity and a cardiovascular risk score. A z-score was calculated based on a factor analysis of the five markers used. The relative biological age was finally calculated in relation to chronological age in subgroups of different social class (occupation, educational level) and marital status, at baseline and after follow-up. Results: Men and women from a higher social class appeared to be biologically younger than corresponding subjects from a lower social class (p<0.001). This difference was still evident after 5 years of follow-up (p<0.01) for men and women of different occupations and for women of different educational levels (p<0.01). Married/cohabiting men were biologically younger than single men and this difference increased during the follow-up period in that the difference between groups at five-year follow-up was significant (p<0.05). Conclusions: Middle-aged men and women from a higher social class showed signs of being biologically younger than their corresponding chronological age, while the opposite was found for men and women of lower social class. This discrepancy was still evident after five years of follow-up, and even tended to increase for single men. Differential ageing may thus be an important biological aspect of differences in health according to social class.

The recent economic recession and self-rated health in Estonia, Lithuania and Finland: a comparative cross-sectional study in 2004-2010

BACKGROUND

The late-2000s financial crisis had a severe impact on the national economies on a global scale. In Europe, the Baltic countries were among those most affected with more than a 20% decrease in per capita gross domestic product in 2008-2009. In this study, we explored the effects of economic recession on self-rated health in Estonia and Lithuania using Finland, a neighbouring Nordic welfare state, as a point of reference.

METHODS

Nationally representative cross-sectional data for Estonia (n=10 966), Lithuania (n=7249) and Finland (n=11 602) for 2004-2010 were analysed for changes in age-standardised prevalence rates of less-than-good self-rated health and changes in health inequalities using logistic regression analysis.

RESULTS

The prevalence of less-than-good self-rated health increased slightly (albeit not statistically significantly) in all countries during 2008-2010. This was in sharp contrast to the statistically significant decline in the prevalence of less-than-good health in 2004-2008 in Estonia and Lithuania. Health disparities were larger in Estonia and Lithuania when compared to Finland, but decreased in 2008-2010 (in men only). In Finland, both the prevalence of less-than-good health and health disparities remained fairly stable throughout the period.

CONCLUSIONS

Despite the rapid economic downturn, the short-term health effects in Estonia and Lithuania did not differ from those in Finland, although the recession years marked the end of the previous positive trend in self-rated health. The reduction in health disparities during the recession indicates that different socioeconomic groups were affected disproportionately; however, the reasons for this require further research.

Educational disparities in the burden of disability: contributions of disease prevalence and disabling impact

OBJECTIVES

We assessed the contributions of the prevalence and disabling impact of specific diseases to educational disparities in the prevalence of disability.

METHODS

We examined a large representative survey of the Dutch population, the Dutch Permanent Survey of Living Conditions (2001-2007; n = 24 883; ages 40-97 years). We attributed the prevalence of disability to chronic diseases by using their empirical associations and assuming independent competing causes of disability. We estimated contributions of prevalence and the disabling impact of diseases to disparities in disability using counterfactuals.

RESULTS

We found that the prevalence of disability in individuals with only an elementary education was 19 to 20 percentage points higher than that in individuals with tertiary education. Sixty-five percent of this difference could be attributed to specific chronic diseases, but more so to their disabling impact (49%-51%) than to their prevalence (20%-29%). Back pain, neck or arm conditions, and peripheral vascular disease contributed most to the disparity in men, and arthritis, back pain, and chronic nonspecific lung disease contributed most to the disparity in women.

CONCLUSIONS

Educational disparities in the burden of disability were primarily caused by high disabling impacts of chronic diseases among low educated groups. Tackling disparities might require more effective treatment or rehabilitation of disability in lower socioeconomic groups.

Social class differences in physical functions in middle-aged men and women

OBJECTIVE

The objective of the present study is to analyze gender differences and social class gradients in physical functions; and to study whether the social class gradients in physical functions in midlife differed between men and women.

METHOD

This study used traditionally used physical performance tests and we added several tests of vigorous physical functioning (trunk muscle strength and power and sagittal flexibility). We measured reaction time, one-legged balance, sagittal flexibility, jump height, chair rise ability, trunk muscle- and handgrip strength in 5,412 participants aged 50 to 60 years (68.5% men).

RESULTS

We found gender differences and social class gradients for all physical performance tests. We did not find an interaction between social class and gender, indicating that the social gradient in physical functions did not differ between men and women.

DISCUSSION

Including measures of vigorous physical functioning may add to the existing knowledge on development of functional limitation and poorer functional health later in life.

Early life stress and physical and psychosocial functioning in late adulthood

Background

Severe stress experienced in early life may have long-term effects on adult physiological and psychological health and well-being. We studied physical and psychosocial functioning in late adulthood in subjects separated temporarily from their parents in childhood during World War II.

Methods

The 1803 participants belong to the Helsinki Birth Cohort Study, born 1934–44. Of them, 267 (14.8%) had been evacuated abroad in childhood during WWII and the remaining subjects served as controls. Physical and psychosocial functioning was assessed with the Short Form 36 scale (SF-36) between 2001 and 2004. A test for trends was based on linear regression. All analyses were adjusted for age at clinical examination, social class in childhood and adulthood, smoking, alcohol intake, physical activity, body mass index, cardiovascular disease and diabetes.

Results

Physical functioning in late adulthood was lower among the separated men compared to non-separated men (b = −0.40, 95% confidence interval [95% CI]: −0.71 to −0.08). Those men separated in school age (>7 years) and who were separated for a duration over 2 years had the highest risk for lower physical functioning (b = −0.89, 95% CI: −1.58 to −0.20) and (b = −0.65, 95% CI: −1.25 to −0.05), respectively). Men separated for a duration over 2 years also had lower psychosocial functioning (b = −0.70, 95% CI: −1.35 to −0.06). These differences in physical and psychosocial functioning were not observed among women.

Conclusion

Early life stress may increase the risk for impaired physical functioning in late adulthood among men. Timing and duration of the separation influenced the physical and psychosocial functioning in late adulthood.

The impact of socioeconomic status on changes in the general and mental health of women over time: evidence from a longitudinal study of Australian women

INTRODUCTION

Generally, men and women of higher socioeconomic status (SES) have better health. Little is known about how socioeconomic factors are associated with changes in health as women progress through mid-life. This study uses data from six survey waves (1996 to 2010) of the Australian Longitudinal Study on Women's Health (ALSWH) to examine associations between SES and changes in the general health and mental health of a cohort of women progressing in years from 45-50 to 59-64.

METHODS

Participants were 12,709 women (born 1946-51) in the ALSWH. Outcome measures were the general health and mental health subscales of the Medical Outcomes Study Short Form 36 Questionnaire (SF-36). The measure of SES was derived from factor analysis of responses to questions in the ALSWH baseline survey (1996) on school leaving age, highest qualifications, and current or last occupation. Multi-level random coefficient models, adjusted for socio-demographic factors and health behaviors, were used to analyze repeated measures of general health and mental health. Survey year accounted for changes in factors across time. In the first set of analyses we investigated associations between the SES index, used as a "continuous" variable, and general health and mental health changes over time. To illuminate the impact of different levels of SES on health, a second analysis was conducted in which SES scores were grouped into three approximately equal sized categories or "tertiles" as reported in an earlier ALSWH study. The least square means of general and mental health scores from the longitudinal models were plotted for the three SES tertiles.

RESULTS

The longitudinal analysis showed that, after adjusting for the effects of time and possible confounders, the general (mental) health of this cohort of mid-aged women declined (increased) over time. Higher SES women reported better health than lower SES women, and SES significantly modified the effects of time on both general and mental health in favor of higher SES women.

CONCLUSIONS

This study contributes to our current understanding of how socioeconomic and demographic factors, health behaviors and time impact on changes in the general and mental health of women progressing in years from 45-50 to 59-64.

Socioeconomic circumstances, health behaviours and functional limitations in older persons in four Central and Eastern European populations

OBJECTIVES

to investigate functional limitations and their association with socioeconomic factors in four Central and Eastern European populations.

METHODS

a cross-sectional study of random population samples in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns participating in the HAPIEE study. Functional limitations (classified into tertiles of the SF-36 physical functioning subscale), socioeconomic circumstances and health behaviours were available for 34,431 subjects aged 45-69 years.

RESULTS

the proportion of subjects in the worst tertile of the functional limitations score (≤80% of the maximum score) ranged from 21% of the men in Kaunas to 48% in Krakow women. In multivariate ordered logistic regression, functional limitations were strongly inversely associated with education and positively with material deprivation and with being economically inactive. Functional limitations were more common in male smokers and less common in alcohol drinkers. Socioeconomic characteristics explained some of the differences in functional limitations between populations. Health behaviours explained some of the differences between social groups in both genders and between populations in women.

CONCLUSION

unexpectedly, functional limitations were not most common in the sample from Russia, the country with the highest mortality rates. All socioeconomic measures were strongly associated with functional limitations and made some contribution towards explaining differences in limitations between populations.

Psychosocial stressors in inter-human relationships and health at each life stage: A review

Currently, psychosocial stressors' impacts on health are increasing. Among these stressors, this review focused on inter-human relationships. Since social supports could be protective against ill health, consequences contributing to psychosocial stressors are discussed here in relation to social supports for each stage of childhood, adulthood and elderly status.For childhood, parental divorce/isolation, and child abuse/neglect appeared to be determinants of healthy development at either the initial or later stages. According to prospective studies, such stressors, especially those occurring until around 3 years of age, were associated with later adverse life quality in adulthood. Therefore, nationwide preventive strategies were developed in each country to monitor protective social programs.For adulthood, job strain was focused on Karasek's job strain model, effort-reward imbalance, employment grade and working hours. These psychosocial stressors were shown to affect not only the physical health but also the mental health of working people. These days, since Karoshi and even suicide related to excessive workloads are taking a toll on workplace organization, stress-coping abilities such as a sense of coherence were introduced from the individual-social interaction aspect.For elderly status, retirement, caring for the elderly, and spouse bereavement were discussed as psychosocial stressors. Some evidence indicates that these stressors could be determiants of health. Finally, social supports have been demonstrated to promote health and protect the elderly against diseases and death.

Social inequality in dynamic balance performance in an early old age Spanish population: the role of health and lifestyle associated factors

This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54-75 years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.

Social inequality in onset of mobility limitations in midlife: a longitudinal study in Denmark

The aim of this longitudinal study was to investigate if social inequality in onset of mobility limitations is present in early midlife, and to examine whether common determinants of disability account for social status differences in onset of mobility limitations in midlife. 3,586 40-and 50-year-old Danish men and women enrolled in The Danish Longitudinal Study on Work, Unemployment and Health constituted the study population. Data were collected by mailed questionnaires in 2000 and 2006. Limitations in running 100 m and in climbing two flights of stairs represented two aspects of mobility limitations. Occupational social class was applied as a measure of socioeconomic position. Among individuals reporting no limitations in 2000 social gradients in onset of mobility limitations emerged in 2006. Having a low social class at age 40 and 50 respectively was associated with higher onset of mobility limitations 6 years later, and this association was overall only partly explained by common determinants of disability: smoking, alcohol consumption, physical activity, body mass index, and chronic diseases. These results indicate that the development of mobility limitations might begin earlier in lower compared to higher social strata, and that social status differences in mobility limitations might emerge already in the forties.

Social economic inequalities and mental health II. Methodological aspects and literature review

Summary

Objective - This study provides a framework for mental health inequalities beginners. It describes the methods used to measure socio economic inequalities and the inter-relations with different aspects of mental health: residence, mental health services organisation and main diagnostic categories. Method - Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch usingand relating the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002 (June). The articles selected were integrated with manual search (publications of the same authors, cross-references, working documents and reports of international andregional organisations). Results - Inequality is not an absolute concept and, mainly, it has been changing during the last years. For example, the integration and re-definition of variables that capture, in simple indices, a complex reality; the accent on social more than on economic aspects; the geo-validity and time-reference of the inequality's indices. Moreover, the inequalities could be the result of individual preferences, in this case, the social selectionand social causation issues will raise the suitability for a public intervention. Conclusions - Up to now, research has been mainly concentrated in describing and measuring health inequalities. For designing effective interventions, policy makers need to ground decisions on health-socioeconomic inequalities explanatory models.

Declaration of Interest

this work was partly funded by the Department of the Public Health Sciences “G. Sanarelli” of the University of Rome “La Sapienza” and the Department of Medicine and Public Health of the University of Verona.

Dynamics of family economic hardship and the progression of health problems of husbands and wives during the middle years: a perspective from rural Mid-West

OBJECTIVE

The objective of this study was to investigate the influence of theoretically important dimensions of stability and change in economic hardship during early middle years on decade-long health problems of husbands and wives.

METHOD

The study used prospective data collected from 360 middle-aged husbands and wives during a 12-year period. The variables included self-reported economic hardship (22 items), mental and physical health, and physical impairment.

RESULTS

The results supported the hypothesis that the dynamics of family economic hardship (in terms of stability and change) during the early middle years contribute to subsequent onset of health problems of middle-aged husbands and wives. These health problems in turn progress as an interrelated process through intrahealth-domain continuities, cross-health domain proliferations, and dyadic associations as they pass through midlife.

DISCUSSION

A better understanding of these processes may aid in the formation and effective implementation of health promotion programs for middle-aged husbands and wives.

Gender, depression and physical impairment: an epidemiologic perspective from Aleppo, Syria

OBJECTIVE

Examine the association of physical impairment with gender, depression, and socio-demographics in the community in Aleppo, Syria.

METHOD

We conducted a cross-sectional, population-based study in Aleppo on adults aged 18-65 (N = 2,038). We used a computerized interviewer-administered structured questionnaire. Physical impairment was measured via an adapted 12-item World Health Organization, Health State Description Individual Questionnaire which includes both physical and emotional items. We used physical impairment items score to classify individuals into low, middle, and high physical impairment category. Self-report of physician-diagnosed depression and chronic diseases active in the past year and their current treatment status were obtained.

RESULTS

Sample mean age (SD) was 35.3 (12.1) years, 55% were female, and 4.5% had depression. Female gender, low socioeconomic status (SES), and depression were associated with high physical impairment. Women had more impairment (OR = 3.35, 95% CI: 2.15-5.21) with little change after controlling for depression and chronic diseases, but significantly decreased after controlling for socio-demographics (OR = 1.51, 95% CI: 0.84-2.73). The association with low (vs. high) SES was prominent (OR = 2.48, 95% CI: 1.32-4.67) after controlling for all variables. Depression's association (OR = 4.85, 95% CI: 1.93-12.15) lost significance after controlling for chronic diseases (OR = 2.81, 95% CI: 0.96-8.25), but further adjustment for socio-demographics had little effect.

CONCLUSION

Women and individuals of low SES appear more vulnerable to physical impairment in the community in Aleppo. Depression's association with physical impairment may be mediated through co-existing chronic diseases. Public health planning regarding physical impairment in Syria should encompass these as putative risk factors.

Social Inequality in Onset of Mobility Disability Among Older Danes: The Mediation Effect of Social Relations

Objective: This article investigates social inequality in onset of mobility disability and in measures of social relations and whether social relations mediated the effect of socioeconomic status on mobility. Method: A total of 2,825 nondisabled older men and women, enrolled in the Danish Intervention Study on Preventive Home Visits, constituted the study population. Data were obtained by mailed questionnaires in 1998-1999 and 2001-2002 and by merging analyses to registers at Statistics Denmark. Results: There was a social gradient in onset of mobility disability, with odds ratio of 1.11 (1.07-1.15) per step down the deciles of financial assets and in cohabitation status, social participation, and network diversity. Social relations did not mediate the effect of financial assets on onset of mobility disability. Discussion: The negative effects of low financial assets and poor social relations on mobility appear to be independent. More longitudinal studies on possible mediators of the social gradient in mobility among older people are needed.

The predictors of self-rated health and the relationship between self-rated health and health service needs are similar across socioeconomic groups in Canada

OBJECTIVE

To examine if there are systematic differences in the predictors of self-rated health (SRH) and to examine the relationship between SRH and health care utilization across socioeconomic groups.

STUDY DESIGN AND SETTING

We used cross-sectional data from the Canadian Community Health Survey linked to the Ontario Health Insurance Plan (N=17,109). We examined relative differences in the factors associated with different levels of SRH across socioeconomic groups (as assessed by education and household income) using probit models separately for men and women. We then examined differences in expected health care costs, as assessed by adjusted clinical group weights using administrative health care records, between socioeconomic groups within the same level of SRH.

RESULTS

We found limited differences across the predictive ability of a broad range of physical, mental, health service/care utilization, and health behavior variables on SRH across socioeconomic groups. In addition, no differences were found in the expected health care utilization costs across socioeconomic groups within the same level of SRH.

CONCLUSIONS

The results of this study suggest that SRH assesses a broad variety of factors, including physical health status, mental health status, health service/care utilization, and health behaviors, relatively equally across socioeconomic groups, measured as either education or income.

Social inequalities in grip strength, physical function, and falls among community dwelling older men and women: findings from the Hertfordshire Cohort Study

Objectives. To explore social inequalities in grip strength, SF-36 physical functioning (PF), and falls among older people. Methods. We analyzed data from 3,225 men and women (age 59-73 years) who participated in the Hertfordshire Cohort Study, United Kingdom. Car availability and home ownership were used as markers of material deprivation. Results. A total of 6.4% of men (17.7% women) had no car and 19.3% of men (23.1% women) did not own their home. Having fewer cars was associated with lower grip and poorer PF among men and women (p < .001), and increased falls among men (p < .001). Not owning one's home was associated with lower grip in men and women (p < .001) and poorer PF in men (p < .001). Lower social class was associated with falls among women only (p = .01). Discussion. There are social inequalities in grip strength, PF, and falls among older people. Interventions should consider the contribution of social inequalities to the problem.

Changes in Health between Ages 54 and 65: The Role of Job Characteristics and Socioeconomic Status

We model the relationships between socioeconomic status (SES), the conditions of paid employment, and changes between ages 54 and 65 in a variety of health outcomes: self-reported overall health, musculoskeletal health, and depression. To what extent is SES associated with changes in these health outcomes net of the conditions of paid employment? At the same time, to what extent are the conditions of paid employment independently associated with these outcomes net of SES? To address these questions we use unique data collected from a single cohort of men and women to model changes in these health outcomes between ages 54 and 65. Although results vary across outcomes, it is clear that there are some circumstances in which associations between SES and changes in health can be (at least partly) attributed to working conditions, and that there are other circumstances in which associations between working conditions and changes in health can be (at least partly) attributed to SES. We conclude that the largely disconnected literatures on health disparities (in the social sciences and public health) and job design (in occupational stress and ergonomics) could and should be fruitfully connected.

Impact of coronary heart disease on health functioning in an aging population: are there differences according to socioeconomic position?

OBJECTIVE

To examine differences in the effect of coronary heart disease (CHD) on health functioning according to socioeconomic position. Research on social inequality in health has tended to concentrate on differences in disease prevalence and mortality rather than on the impact of disease on functioning. As outcomes improve for those with CHD, it is important to know how their health is affected in the long term.

METHODS

The analysis uses questionnaire data from phase 3 (1991-1993) to phase 7 (2003-2005) of the Whitehall II Study of civil servants (n = 8292). Differences between those in higher and lower employment grades in the relationship between CHD and physical and mental health functioning were measured according to the Short Form 36 General Health Survey (SF-36). A growth curve model of change in SF-36 physical and mental health from five repeated-measures over the 12-year period was then estimated.

RESULTS

The differences in SF-36 health between those with and without preexisting CHD depended on employment grade. For those with CHD, physical health was initially poorer in lower grades than in higher ones; this difference persisted throughout. The mental health of respondents with CHD in the lowest grades deteriorated over time whereas for members of the higher grades, the prevailing trend was for improving mental health.

CONCLUSIONS

CHD has a more detrimental effect on physical and mental health functioning among those in more disadvantaged socioeconomic positions.

The role of neighborhood level socioeconomic characteristics in Salmonella infections in Michigan (1997-2007): assessment using geographic information system

Background:

The majority of U.S. disease surveillance systems contain incomplete information regarding socioeconomic status (SES) indicators like household or family income and educational attainment in case reports, which reduces the usefulness of surveillance data for these parameters. We investigated the association between select SES attributes at the neighborhood level and Salmonella infections in the three most populated counties in Michigan using a geographic information system.

Methods:

We obtained data on income, education, and race from the 2000 U.S. Census, and the aggregate number of laboratory-confirmed cases of salmonellosis (1997–2006) at the block group level from the Michigan Department of Community Health. We used ArcGIS to visualize the distribution, and Poisson regression analysis to study associations between potential predictor variables and Salmonella infections.

Results:

Based on data from 3,419 block groups, our final multivariate model revealed that block groups with lower educational attainment were less commonly represented among cases than their counterparts with higher education levels (< high school degree vs. ≥ college degree: rate ratio (RR) = 0.79, 95% confidence interval (CI):0.63, 0.99; ≥ and high school degree, but no college degree vs. ≥ college degree: RR = 0.84, 95% CI: 0.76, 0.92). Levels of education also showed a dose-response relation with the outcome variable, i.e., decreasing years of education was associated with a decrease in Salmonella infections incidence at the block group level.

Conclusion:

Education plays a significant role in health-seeking behavior at the population level. It is conceivable that a reporting bias may exist due to a greater detection of Salmonella infections among high education block groups compared to low education block groups resulting from differential access to healthcare. In addition, individuals of higher education block groups who also have greater discretionary income may eat outside the home frequently and be more likely to own pets considered reservoirs of Salmonella, which increase the likelihood of contracting Salmonella infections compared to their counterparts with lower levels of education. Public health authorities should focus on improving the level of disease detection and reporting among communities with lower income and education and further evaluate the role of higher educational attainment in the predisposition for salmonellosis.

History, principles, and practice of health and human rights

Individuals and populations suffer violations of their rights that affect health and wellbeing. Health professionals have a part to play in reduction and prevention of these violations and ensuring that health-related policies and practices promote rights. This needs efforts in terms of advocacy, application of legal standards, and public-health programming. We discuss the changing views of human rights in the context of the HIV/AIDS epidemic and propose further development of the right to health by increased practice, evidence, and action.

Educational differences in mobility: the contribution of physical workload, obesity, smoking and chronic conditions

BACKGROUND

In earlier studies, determinants of socioeconomic gradient in mobility have not been measured comprehensively.

AIM

To assess the contribution of chronic morbidity, obesity, smoking and physical workload to inequalities in mobility.

METHODS

This was a cross-sectional study on 2572 persons (76% of a nationally representative sample of the Finnish population aged > or = 55 years). Mobility limitations were measured by self-reports and performance rates.

RESULTS

According to a wide array of self-reported and test-based indicators, persons with a lower level of education showed more mobility limitations than those with a higher level. The age-adjusted ORs for limitations in stair climbing were threefold in the lowest-educational category compared with the highest one (OR 3.3 in men and 2.9 in women for self-reported limitations, and 3.5 in men and 2.2 in women for test-based limitations). When obesity, smoking, work-related physical loading and clinically diagnosed chronic diseases were simultaneously accounted for, the educational differences in stair-climbing limitations vanished or were greatly diminished. In women, obesity contributed most to the differences, followed by a history of physically strenuous work, knee and hip osteoarthritis and cardiovascular diseases. In men, diabetes, work-related physical loading, musculoskeletal diseases, obesity and smoking contributed substantially to the inequalities.

CONCLUSIONS

Great educational inequalities exist in various measures of mobility. Common chronic diseases, obesity, smoking and workload appeared to be the main pathways from low education to mobility limitations. General health promotion using methods that also yield good results in the lowest-educational groups is thus a good strategy to reduce the disparities in mobility.

Long-term physical activity patterns and health-related quality of life in U.S. women

BACKGROUND

Despite studies showing that physically active individuals report higher quality-of-life scores, few data exist on the impact of changing physical activity levels on subsequent changes in quality of life.

METHODS

Subjects were 63,152 women in the Nurses' Health Study aged 40 to 67 years in 1986. Women reported their physical activity on questionnaires in 1986, 1988, 1992, 1994, and 1996, and were grouped according to quartile of change in activity from 1986 to 1996. Women also reported seven health-related quality-of-life dimensions in 1996 and 2000 using the Medical Outcomes Study Short-Form 36 Health Status Survey. The main outcome measures were scores for each of these seven dimensions in 1996, as well as changes in each of these dimensions from 1996 to 2000. Data were analyzed in 2006.

RESULTS

In age and baseline activity adjusted analyses, compared to women whose physical activity was relatively stable from 1986 to 1996, women who saw any increase in physical activity levels had higher quality-of-life scores in 1996. Among women with a clear increase in physical activity, the increase in quality-of-life scores ranged from 2.23 (95% confidence intervals [CI]=1.94-2.52) for mental health to 8.23 (95% CI=7.49-8.97) for role limitations due to physical problems. Increasing physical activity also was associated with greater increases in quality-of-life scores from 1996 to 2000 compared to women whose physical activity level was stable. The strongest association was for role limitations due to physical problems, where women with a clear increase in physical activity had a significant improvement (1.81, 95% CI=1.09-2.53) in the outcome.

CONCLUSIONS

Long-term physical activity patterns are an important determinant of health-related quality of life.

Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study

BACKGROUND

Common mental disorders do not always show as consistent socioeconomic gradients as severe mental disorders and physical health. This inconsistency may be due to the multitude of socioeconomic measures used and the populations and national contexts studied. We examine the associations between various socioeconomic circumstances and common mental disorders among middle-aged Finnish and British public sector employees.

METHODS

We used survey data from the Finnish Helsinki Health Study (n = 6028) and the British Whitehall II Study (n = 3116). Common mental disorders were measured by GHQ-12. The socioeconomic indicators were parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure and current economic difficulties. Logistic regression analysis was the main statistical method used.

RESULTS

Childhood and current economic difficulties were strongly associated with common mental disorders among men and women in both the Helsinki and the London cohort. The more conventional indicators of socioeconomic circumstances showed weak or inconsistent associations. Differences between the two cohorts and two genders were small.

CONCLUSIONS

Our findings emphasize the importance of past and present economic circumstances to common mental disorders across different countries and genders. Overall, our results suggest that among employee populations, the socioeconomic patterning of common mental disorders may differ from that of other domains of health.

Do stressors explain the association between income and declines in self-rated health? a longitudinal analysis of the national population health survey

Although there is considerable evidence documenting the relationship between lower socioeconomic status (SES) and poorer health, longitudinal research is needed to study mechanisms that may explain this relationship. This study investigated whether income was associated with decline in self-rated health over a 2-year period and whether stressors mediated part of this social gradient. Participants in the National Population Health Survey (NPHS) who rated their health as excellent, very good, or good in 1994 and 1995 were followed over 2 years. Analyses demonstrated that individuals in the 2 lowest household income quintiles had significantly greater odds of experiencing a decline in health status as compared to the highest quintile. Seven of 8 reported stressors at baseline were each associated with a significantly increased odds of experiencing a decline in self-rated health. Furthermore, these stressors explained 16% and 10% of the relationship between the lowest and 2nd lowest income quintiles and decline in self-rated health, respectively. These results suggest that stressors may be 1 mechanism underlying the social gradient in health.

Socioeconomic differences in incident depression in older adults: the role of psychosocial factors, physical health status, and behavioral factors

OBJECTIVE

The objective of this study was to examine the association between socioeconomic status (SES) and the onset of depression in older adults and to determine the relative contribution of psychosocial factors, physical health status, and behavioral factors in explaining this link.

METHODS

Data were from 2593 men and women, aged 55-85 years, participating in the Longitudinal Aging Study Amsterdam. Two indicators of SES were used: education and income. The onset of depression was measured over 9 years of follow-up.

RESULTS

Adjusted hazard ratios of incident depression were significantly higher in those with low education and low income. Psychosocial factors explained on average 16% of the SES differences in incident depression, physical health status on average 7%, and behavioral factors less than 5%.

CONCLUSION

In older adults, low SES predicted the incidence of depression. Part of this association was explained by psychosocial factors and physical health status.

Explanations of socioeconomic differences in changes in physical function in older adults: results from the Longitudinal Aging Study Amsterdam

Background

This study examines the association between socioeconomic status and changes in physical function in younger- (aged 55–70 years) and older-old (aged 70–85 years) adults and seeks to determine the relative contribution of diseases, behavioral, and psychosocial factors in explaining this association.

Methods

Data were from 2,366 men and women, aged 55–85 years, participating in the Longitudinal Aging Study Amsterdam (LASA). Two indicators of socioeconomic status were used: education and income. Physical function was measured by self-reported physical ability over nine years of follow-up.

Results

In older adults, low socioeconomic status was related to a poorer level of physical function during nine years of follow-up. In subjects who were between 55 and 70 years old, there was an additional significant socioeconomic-differential decline in physical function, while socioeconomic differentials did not further widen in subjects 70 years and older. Behavioral factors, mainly BMI and physical activity, largely explained the socioeconomic differences in physical function in the youngest age group, while psychosocial factors reduced socioeconomic status differences most in the oldest age group.

Conclusion

The findings indicate age-specificity of both the pattern of socioeconomic status differences in function in older persons and the mechanisms underlying these associations.

Multiple measures of socioeconomic circumstances and common mental disorders

While serious mental disorders typically show socioeconomic differences similar to physical illness-that is, that lower positions imply poorer health-differences for common mental disorders have been inconsistent. We aim to clarify the associations and pathways between measures of socioeconomic circumstances and common mental disorders by simultaneously analysing several past and present socioeconomic measures. The data were derived from middle-aged women and men employed by the City of Helsinki. Cross-sectional surveys were conducted in 2000-2002 among employees who, during each year, reached 40, 45, 50, 55 or 60 years of age. The pooled data include 8970 respondents (80% women; response rate 67%). Common mental disorders were measured by GHQ-12 and the SF-36 mental component summary. Seven socioeconomic measures were included: parental education, childhood economic difficulties, own education, occupational class, household income, home ownership, and current economic difficulties. Logistic regression analysis was used to examine associations between the socioeconomic circumstances and common mental disorders. Past and present economic difficulties were strongly associated with common mental disorders, whereas conventional past and present socioeconomic status measures showed weak or slightly reverse associations. Adjusting for age and gradually for each socioeconomic measure did not affect the main findings, which were very similar for women and men, as well as for both measures of common mental disorders. While the associations of conventional socioeconomic status measures with common mental disorders were weak and inconsistent, our results highlight the importance of past and present economic difficulties to these disorders.