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Coustaury C, Jeannot E, Moreau A, Nietge C, Maharani A, Richards L, Präg P. Subjective socioeconomic status and self-rated health in the English Longitudinal Study of Aging: A fixed-effects analysis. Soc Sci Med 2023; 336:116235. [PMID: 37757700 DOI: 10.1016/j.socscimed.2023.116235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/02/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
Higher subjective socio-economic status (SES) goes along with better self-rated health: This finding is well-established in the literature, yet the majority of studies it is based on only rely on cross-sectional analyses and only account for few potential confounders of the association. Particularly wealth, which is increasingly thought of as an important dimension of accumulated advantage, is only rarely examined as a confounder. Using eight waves of panel data from the English Longitudinal Study of Aging (ELSA, 2002-19), we investigate the association between subjective SES and self-rated health. We use random effects models that account for theoretically important time-constant (such as education and social class) and time-varying confounders (such as income and wealth) as well as fixed-effects models, that in addition control for all time-constant confounders, whether observed or unobserved. The fully adjusted fixed-effects model reveals a statistically significant association between subjective SES and self-rated health. Yet, a one-point increase on the subjective SES ladder goes along with a two per cent of a standard deviation increase in self-rated health, only around a quarter of the size of the random-effects estimate. The role of wealth for the subjective SES-self-rated health association is negligible in the fixed-effects specifications. Smoking, drinking, and physical activity do not appear to mediate the association. A substantial part, though not all, of the observed association between subjective SES and self-rated health is due to unobserved confounding rather than a causal effect. Reducing health inequalities based on objective SES is likely more effective than based on subjective SES.
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Affiliation(s)
- Camille Coustaury
- École Nationale de la Statistique et de l'Administration Économique (ENSAE), Institut Polytechnique de Paris, 5 avenue Le Chatelier, 91764, Palaiseau, France.
| | - Elias Jeannot
- École Nationale de la Statistique et de l'Administration Économique (ENSAE), Institut Polytechnique de Paris, 5 avenue Le Chatelier, 91764, Palaiseau, France.
| | - Adele Moreau
- École Nationale de la Statistique et de l'Administration Économique (ENSAE), Institut Polytechnique de Paris, 5 avenue Le Chatelier, 91764, Palaiseau, France.
| | - Clotilde Nietge
- École Nationale de la Statistique et de l'Administration Économique (ENSAE), Institut Polytechnique de Paris, 5 avenue Le Chatelier, 91764, Palaiseau, France.
| | - Asri Maharani
- University of Manchester, 176 Oxford Road, Manchester, M13 9PY, United Kingdom.
| | - Lindsay Richards
- University of Oxford, 42-3 Park End Street, Oxford, OX1 1JD, United Kingdom.
| | - Patrick Präg
- Center for Research in Economics and Statistics (CREST), École Nationale de la Statistique et de l'Administration Économique (ENSAE), Institut Polytechnique de Paris, 5 avenue Le Chatelier, 91764, Palaiseau, France.
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Hamil-Luker J, O’Rand AM. Black/white differences in the relationship between debt and risk of heart attack across cohorts. SSM Popul Health 2023; 22:101373. [PMID: 36915601 PMCID: PMC10005910 DOI: 10.1016/j.ssmph.2023.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Background Numerous studies show that increasing levels of education, income, assets, and occupational status are linked to greater improvements in White adults' health than Black adults'. Research has yet to determine, however, whether there are racial differences in the relationship between health and debt and whether this relationship varies across cohorts. Methods Using data from the 1992-2018 Health and Retirement Study, we use survival analyses to examine the link between debt and heart attack risk among the Prewar Cohort, born 1931-1941, and Baby Boomers, born 1948-1959. Results Higher unsecured debt is associated with increased heart attack risk for Black adults, especially among Baby Boomers and during economic recessions. Higher mortgage debt is associated with lower risk of heart attack for White but not Black Baby Boomers. The relationship between debt and heart attack risk remains after controlling for health behaviors, depressive symptoms, and other economic resources that are concentrated among respondents with high levels of debt. Conclusion Debt is predictive of heart attack risk, but the direction and strength of the relationship varies by type of debt, debtors' racial identity, and economic context.
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Self-rated Health and Objective Health Status Among Rural-to-Urban Migrants in China: A Healthy Housing Perspective. POPULATION RESEARCH AND POLICY REVIEW 2023. [DOI: 10.1007/s11113-023-09752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Carmona-Derqui D, Torres-Tellez J, Montero-Soler A. Effects of Housing Deprivation on Health: Empirical Evidence from Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2405. [PMID: 36767772 PMCID: PMC9916325 DOI: 10.3390/ijerph20032405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Severe housing deprivation rates in Spain have tripled in just four years, affecting 3.4% of the population in 2020, with a higher incidence among the low-income population (9.2%). Despite the social aspect of the problem, minimal research has been carried out in Spain on the effects that the various forms of housing deprivation have on health. This study analyzes the impact of housing deprivation on health outcomes, with the objective of achieving results that facilitate the creation of improved public policies. Microdata are used from the Living Conditions Survey carried out by the National Institute of Statistics for the period 2009-2019, and several multilevel logistic regression models are presented to control for possible regional differences. The results show that the elements with the greatest effect on objective health are noise, leaks and harmful temperatures in housing. In addition, environmental factors, such as pollution, neighborhood crime and the number of units in a given apartment building, can be added to the list. As a result, we conclude that there are certain structural and environmental elements in housing and the environment in which is located that have a more intense impact on objective health and on the subjective perception of a person's state of health.
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Affiliation(s)
| | - Jonathan Torres-Tellez
- Facultad de Economía, Universidad de Málaga, 29071 Málaga, Spain
- Facultad de Derecho, Pablo de Olavide University, 41013 Seville, Spain
| | - Alberto Montero-Soler
- Department of Public Finance, Economic Policy and Political Economy, Universidad de Málaga, 29071 Málaga, Spain
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Clair A, Baker E. Cold homes and mental health harm: Evidence from the UK Household Longitudinal Study. Soc Sci Med 2022; 314:115461. [PMID: 36327633 DOI: 10.1016/j.socscimed.2022.115461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/25/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
Cold homes are associated with a range of serious health conditions as well as excess winter mortality. Despite a comparatively mild climate cold homes are a significant problem in the UK, with a recent estimate finding that over one-quarter of low-income households had been unable to adequately heat their home in winter 2022. The magnitude of cold housing in a country that benefits from a mild climate indicates indifference towards, or acceptance of, a significant minority of people living in inadequate conditions on the part of policy makers. Cold homes are therefore a source of social harm. Recent changes to the household energy price cap, the rising cost of living, the ongoing effects of the benefit cap, and below inflation uprating to social security benefits is likely to greatly exacerbate this issue. In this research we use data from the UK Household Longitudinal Study to explore whether living in a cold home causes mental health harm. We control for mental distress and housing temperature on entry to the survey in order to account for the potentially bi-directional relationship. Multilevel discrete-time event history models show that the transition into living in a home that is not suitably warm is associated with nearly double the odds of experiencing severe mental distress for those who had no mental distress at the beginning of the survey; and over three times the odds of severe mental distress for those previously on the borderline of severe mental distress. These results show the significant costs of failing to ensure that people are able to live in homes in which they are able to live comfortably by even the most basic standards. These costs will be felt not just individually, but also more broadly in terms of increased health spending and reduced working.
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Affiliation(s)
- Amy Clair
- Australian Centre for Housing Research, University of Adelaide, Australia.
| | - Emma Baker
- Australian Centre for Housing Research, University of Adelaide, Australia.
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6
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Dotsikas K, Osborn D, Walters K, Dykxhoorn J. Trajectories of housing affordability and mental health problems: a population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:769-778. [PMID: 35767014 PMCID: PMC10097755 DOI: 10.1007/s00127-022-02314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE With housing costs increasing faster than incomes and a limited supply of social housing options, many households face unaffordable housing. Housing affordability problems may negatively impact mental health; however, longitudinal evidence is limited. This study investigates the association between trajectories of housing affordability problems and mental health. METHODS We used data from 30,025 households from Understanding Society, a longitudinal household survey from the UK. Participants spending 30% or more of household income on housing were categorised as facing housing affordability problems. We estimated group-based trajectories of housing affordability problems from 9 waves of data (2009-2019). We used linear regression to calculate the association between the trajectories and mental health problems, as measured by General Health Questionnaire (GHQ) score in Wave 10 (2018-2020). RESULTS We found six distinct trajectories of housing affordability problems. Those in the 'stable low' group had a consistently low probability of affordability problems, whilst those in 'high falling' group had a sustained high probability in the earlier waves of the study, subsequently decreasing over time. The adjusted analysis showed that trajectory group membership over the first nine waves of data predicted GHQ score in 2018-2020 (Wave 10). Compared to the 'stable low' group, those in the 'high falling' group had a GHQ score that was 1.06 (95% CI 0.53-1.58) points higher. CONCLUSION This study provides evidence that sustained exposure to housing affordability problems is associated with long-term worse mental health, even in the absence of more recent problems.
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Affiliation(s)
- Kate Dotsikas
- Division of Psychiatry, University College London, London, W1T 7NF, UK.
| | - David Osborn
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jennifer Dykxhoorn
- Division of Psychiatry, University College London, London, W1T 7NF, UK
- Department of Primary Care and Population Health, University College London, London, UK
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Vásquez-Vera C, Carrere J, Borrell C, Vásquez-Vera H. Neglected housing insecurity and its relationship with renters health: the case of Barcelona, Spain. GACETA SANITARIA 2021; 36:207-213. [PMID: 34742601 DOI: 10.1016/j.gaceta.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze by gender the relationship of forced displacements due to neglected housing insecurity with the physical and mental health of renters in Barcelona in 2019, distinguishing between economic (EHI) and legal (LHI) housing insecurity. METHOD We conducted a cross-sectional study based on the Survey of the Living Conditions of Renters in the Barcelona Metropolitan Area 2019 (1021 women; 584 men). Self-reported health and mental well-being were the dependents variables; the main explanatory variable was neglected housing insecurity. We used adjusted robust Poisson regression models to compare health outcomes among people affected by neglected housing insecurity and those who were not affected. RESULTS We observed that the probability of worse health outcomes are greater in those affected by EHI, followed by those affected by LHI, both compared to those who have not been affected by housing insecurity. This association are mainly observed in mental health of renters affected by EHI, even after adjusting for socioeconomic and other housing variables (in women PR: 1,17, CI95%: 1,03-1,33; in men PR: 1,21, CI95%: 1,01-1,43). CONCLUSIONS Neglected housing insecurity is associated with worse mental health. Enhancing the visibility of neglected housing insecurity and raising awareness of its effects on health is urgently needed to tackle this massive but hidden problem.
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Affiliation(s)
- Constanza Vásquez-Vera
- Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Juli Carrere
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Hugo Vásquez-Vera
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Pulido J, Hoyos J, Martínez-Ruiz V, Sordo L, Fernández-Navarro P, Barrio G, Regidor E. Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position. Health Place 2021; 71:102666. [PMID: 34507036 DOI: 10.1016/j.healthplace.2021.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/24/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.
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Affiliation(s)
- J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain
| | - J Hoyos
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain.
| | - V Martínez-Ruiz
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Avda. de La Investigación 11. 18016, Granada, Spain
| | - L Sordo
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain
| | - P Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Calle Sinesio Delgado, 4. 28029, Madrid, Spain
| | - G Barrio
- CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; National School of Public Health. Carlos III Institute of Health, Calle Sinesio Delgado, 4. 28029, Madrid, Spain
| | - E Regidor
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid. Plaza Ramón y Cajal, S/n., 28040, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP). Monforte de Lemos, 3-5. 28029, Madrid, Spain; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Calle Del Profesor Martín Lagos. 28040, Madrid, Spain
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Gil-Salmeron A, Smith L, Yang L, Rieder A, Grabovac I. Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:856-866. [PMID: 33586224 DOI: 10.1111/hsc.13313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/09/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.
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Affiliation(s)
- Alejandro Gil-Salmeron
- Polibenestar Research Institute, University of Valencia, Valencia, Spain
- International Foundation for Integrated Care, Oxford, UK
| | - Lee Smith
- The Cambridge Center for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anita Rieder
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Nagy-Borsy E, Vági Z, Skerlecz P, Szeitl B, Kiss I, Rákosy Z. Health status and health behaviour of the Hungarian homeless people. ACTA ACUST UNITED AC 2021; 79:15. [PMID: 33531045 PMCID: PMC7852122 DOI: 10.1186/s13690-021-00534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Homelessness has risen recently in Europe, but there is lack of comprehensive health data on this population. Our aim was to characterize the health of the Hungarian homeless population. METHODS We performed a health survey with 453 homeless individuals. The results were compared to the age and sex standardized data of the general Hungarian population and its lowest income quintile from the European Health Interview Survey 2014. The differences by the ETHOS classification within the homeless population were also studied. RESULTS Significantly fewer homeless people reported good health status than in the general population or in its lowest income quintile (p< 0.001). Of the participants 70% had at least one chronic disease, only 41% of them visited a GP and 35% took medication in the previous 12 months. While 59% of the lowest income quintile and 50% of the general population had at least one chronic disease, almost all of them visited a physician and took medication. The highest prevalence of morbidity (80%) and multimorbidity (46%) was reported in the houseless group. The majority of the homeless people were current smokers, the prevalence was much higher than in the two reference populations (p< 0.001). The prevalence of heavy drinkers was the highest among the roofless participants (40%). CONCLUSIONS Homeless people have much poorer health and they utilize health services less than the most disadvantaged quintile of the general population. There is a clear social gradient within the homeless population, as well, which calls for integrated approaches for specific interventions to improve their health.
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Affiliation(s)
- Emese Nagy-Borsy
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Zsolt Vági
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Petra Skerlecz
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | | | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Zsuzsa Rákosy
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary.
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Dackehag M, Ellegård LM, Gerdtham UG, Nilsson T. Debt and mental health: new insights about the relationship and the importance of the measure of mental health. Eur J Public Health 2020; 29:488-493. [PMID: 30715315 PMCID: PMC6533593 DOI: 10.1093/eurpub/ckz002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Empirical research suggests that household debt and payment difficulties are detrimental to mental health. Despite well-known measurement problems that may contaminate analyses using subjective self-reported health measures, our knowledge is very limited concerning the effect of payment difficulties on 'objective' measures of mental health. Moreover, few studies use longitudinal data to examine the relationship. This study combines rich survey data and longitudinal data from administrative registers on a representative sample of the Swedish population to examine the relationship between payment difficulties and subjective and objective measures of mental health. METHODS We use data from a large survey of Swedish inhabitants (The Swedish Living Conditions Surveys) combined with data from administrative registers. We investigate both directions of the relationship between mental ill health and payment difficulties, controlling for previous mental health status and previous experiences of payment difficulties. We compare the association between payment difficulties and a self-reported measure of anxiety with the associations between payment difficulties and objective measures of mental ill health from a register of psychopharmaceutical drug consumption. RESULTS Payment difficulties associate with subjectively reported mental ill health, but less to psychopharmaca use. For objective measures, we find stronger evidence of a link running from mental ill health to later payment difficulties. CONCLUSIONS Self-reported and objective measures of mental problems may convey different messages regarding the impact of payment difficulties on mental health. Policy measures depend on whether the primary target group is individuals with severe mental problems or individuals with mild anxiety.
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Affiliation(s)
| | | | - Ulf-G Gerdtham
- Department of Economics, Lund University, Lund, Sweden.,Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden
| | - Therese Nilsson
- Department of Economics, Lund University, Lund, Sweden.,Research Institute of Industrial Economics (IFN), Stockholm, Sweden
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12
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Bayesian analysis of Turkish Income and Living Conditions data, using clustered longitudinal ordinal modelling with Bridge distributed random effects. STAT MODEL 2020. [DOI: 10.1177/1471082x20920122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article is motivated by the panel surveys, called Statistics on Income and Living Conditions (SILC), conducted annually on (randomly selected) country representative households to monitor EU 2020 aims on poverty reduction. We particularly consider the surveys conducted in Turkey within the scope of integration to the EU. Our main interests are on health aspects of economic and living conditions. The outcome is self-reported health that is clustered longitudinal ordinal, since repeated measures of it are nested within individuals and individuals are nested within families. Economic and living conditions have been measured through a number of individual- and family-level explanatory variables. The questions of interest are on the marginal relationships between the outcome and covariates that we address using a polytomous logistic regression with Bridge distributed random effects. This choice of distribution allows us to directly obtain marginal inferences in the presence of random effects. Widely used Normal distribution is also considered as the random effects distribution. Samples from the joint posterior densities of parameters and random effects are drawn using Markov Chain Monte Carlo. Interesting findings from the public health point of view are that differences were found between the subgroups of employment status, income level and panel year in terms of odds of reporting better health.
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Ribeiro AI, Barros H. Affordable, Social, and Substandard Housing and Mortality: The EPIPorto Cohort Study, 1999-2019. Am J Public Health 2020; 110:1060-1067. [PMID: 32437286 DOI: 10.2105/ajph.2020.305661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the association between residence in different housing typologies and all-cause and cause-specific mortality, and to compare with the 25 × 25 risk factors defined by the World Health Organization.Methods. We used data from EPIPorto cohort (Porto, Portugal; n = 2485). We georeferenced and matched participants to a housing type-conventional, affordable, social, or substandard housing (locally called ilhas). We used Poisson regression models to estimate mortality rates and associations.Results. Age- and sex-adjusted mortality rates (per 100 000 person-years) were 713 (95% confidence interval [CI] = 584, 863) for individuals residing in conventional housing, and 1019 (95% CI = 637, 1551), 1200 (95% CI = 916, 1551), and 1239 (95% CI = 839, 1772) for individuals residing in affordable housing, social housing, and ilhas, respectively. After further adjustment, the associations between mortality and residence in social housing (rate ratio [RR] = 1.59; 95% CI = 1.22, 2.06) and in ilhas (RR = 1.64; 95% CI = 1.12, 2.33) remained. The association between disadvantaged housing and mortality was stronger than that observed for well-established risk factors such as hypertension, sedentariness, heavy drinking, manual occupation, or obesity.Conclusions. Disadvantaged housing is a major risk factor for mortality that should be accounted for by health policies and surveillance systems.
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Affiliation(s)
- Ana Isabel Ribeiro
- The authors are with EPIUnit-Instituto de Saúde Pública and Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- The authors are with EPIUnit-Instituto de Saúde Pública and Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Thompson K, Ophem JV, Wagemakers A. Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges. ECONOMICS AND HUMAN BIOLOGY 2019; 35:162-184. [PMID: 31376735 DOI: 10.1016/j.ehb.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - Johan van Ophem
- Chair Group Urban Economics, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Chair Group Health and Society, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
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Mazeikaite G, O'Donoghue C, Sologon DM. The Great Recession, financial strain and self-assessed health in Ireland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:579-596. [PMID: 30564918 PMCID: PMC6517350 DOI: 10.1007/s10198-018-1019-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/04/2018] [Indexed: 06/09/2023]
Abstract
In this paper, we study the effects of the 2008 economic crisis on general health in one of the most severely affected EU economies-Ireland. We examine the relationship between compositional changes in demographic and socio-economic factors, such as education, income, and financial strain, and changes in the prevalence of poor self-assessed health over a 5-year period (2008-2013). We apply a generalised Oaxaca-Blinder decomposition approach for non-linear regression models proposed by Fairlie (1999, 2005). Results show that the increased financial strain explained the largest part of the increase in poor health in the Irish population and different sub-groups. Changes in the economic activity status and population structure also had a significant positive effect. The expansion of education had a significant negative effect, preventing further increases in poor health. Wealthier and better educated individuals experienced larger relative increases in poor health, which led to reduced socio-economic health inequalities.
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Affiliation(s)
- Gintare Mazeikaite
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-Sur-Alzette, Luxembourg.
- Maastricht University/UNU-MERIT, Maastricht, Netherlands.
| | | | - Denisa M Sologon
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-Sur-Alzette, Luxembourg
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Clair A, Hughes A. Housing and health: new evidence using biomarker data. J Epidemiol Community Health 2019; 73:256-262. [PMID: 30642891 PMCID: PMC6580751 DOI: 10.1136/jech-2018-211431] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/26/2018] [Accepted: 11/25/2018] [Indexed: 11/24/2022]
Abstract
Background The link between housing and health is well established and long-standing, however much of the evidence relies on self-reported health measures. While these are useful, the availability of biomarker data allows us to add to this evidence using objective indicators of health. Methods In this paper, we use C-reactive protein (CRP), a biomarker associated with infection and stress, alongside information relating to housing details, demographic characteristics and health behaviours taken from the UK Household Longitudinal Study. Hierarchical linear regression models estimate CRP for individual housing characteristics, and all available housing characteristics, controlling for confounders. Results Results indicate that housing tenure, type, cost burden and desire to stay in current home are associated with CRP. Private renters have significantly higher (worse) CRP than owners with a mortgage. In terms of housing type, respondents living in detached homes had lower CRP than those in semidetached or terraced houses, or those living in flats. Housing cost burden is associated with lower CRP, although further analysis indicates that this is the case only for low-income renters. Desire to stay in current home is significantly associated with higher CRP. Conclusions A number of housing characteristics were associated with CRP. These results further support an important role for housing in health.
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Affiliation(s)
- Amy Clair
- ESRC Research Centre on Micro-Social Change, Institute for Social and Economic Research, University of Essex, Colchester, UK
| | - Amanda Hughes
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Janssen F, Kibele E, Reus Pons M, Vandenheede H, de Valk HAG. [Healthy life expectancy of older migrants and non-migrants in three European countries over time]. Tijdschr Gerontol Geriatr 2018; 49:232-243. [PMID: 30456699 DOI: 10.1007/s12439-018-0267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
We analysed differences in healthy life expectancy at age 50 (HLE50) between migrants and non-migrants in Belgium, the Netherlands, and England and Wales, and their trends over time between 2001 and 2011 in the latter two countries. Population, mortality and health data were derived from registers, census or surveys. HLE50 was calculated for non-migrants, western and non-western migrants by sex. We applied decomposition techniques to determine whether differences in HLE50 between origin groups and changes in HLE50 over time were attributable to either differences in mortality or health. The results show that in all three countries and among both sexes, older migrants, in particular those from non-western origin, could expect to live fewer years in good health than older non-migrants, mainly because of differences in self-rated health. Differences in HLE50 between migrants and non-migrants diminished over time in the Netherlands, but they increased in England and Wales. Improvements in HLE50 over time were mainly attributable to mortality decline. Interventions aimed at reducing the health and mortality inequalities between older migrants and non-migrants should focus on prevention, and target especially non-western migrants.
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Affiliation(s)
- Fanny Janssen
- Population Research Centre, Faculteit Ruimtelijke Wetenschappen, Rijksuniversiteit Groningen, Groningen, Nederland.,Interdisciplinair Demografisch Instituut/KNAW/Rijksuniversiteit Groningen, Den Haag, Nederland
| | - Eva Kibele
- Statistisches Landesamt Bremen, Bremen, Duitsland
| | - Matias Reus Pons
- Population Research Centre, Faculteit Ruimtelijke Wetenschappen, Rijksuniversiteit Groningen, Groningen, Nederland
| | | | - Helga A G de Valk
- Interdisciplinair Demografisch Instituut/KNAW/Rijksuniversiteit Groningen, Den Haag, Nederland.
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Reus-Pons M, Kibele EUB, Janssen F. Differences in healthy life expectancy between older migrants and non-migrants in three European countries over time. Int J Public Health 2017; 62:531-540. [PMID: 28239745 PMCID: PMC5429905 DOI: 10.1007/s00038-017-0949-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES We analysed differences in healthy life expectancy at age 50 (HLE50) between migrants and non-migrants in Belgium , the Netherlands, and England and Wales, and their trends over time between 2001 and 2011 in the latter two countries. METHODS Population, mortality and health data were derived from registers, census or surveys. HLE50 and the share of remaining healthy life years were calculated for non-migrants, western and non-western migrants by sex. We applied decomposition techniques to answer whether differences in HLE50 between origin groups and changes in HLE50 over time were attributable to either differences in mortality or health. RESULTS In all three countries, older (non-western) migrants could expect to live less years in good health than older non-migrants. Differences in HLE50 between migrants and non-migrants diminished over time in the Netherlands, but they increased in England and Wales. General health, rather than mortality, mainly explained (trends in) inequalities in healthy life expectancy between migrants and non-migrants. CONCLUSIONS Interventions aimed at reducing the health and mortality inequalities between older migrants and non-migrants should focus on prevention, and target especially non-western migrants.
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Affiliation(s)
- Matias Reus-Pons
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Eva U B Kibele
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Fanny Janssen
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute (NIDI), The Hague, The Netherlands
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