Parental income gradients in adult health: a national cohort study

Production losses from morbidity and mortality by disease, age and sex in Norway

AIM

The inclusion of production losses in health care priority setting is extensively debated. However, few studies allow for a comparison of these losses across relevant clinical and demographic categories. Our objective was to provide comprehensive estimates of Norwegian production losses from morbidity and mortality by age, sex and disease category.

METHODS

National registries, tax records, labour force surveys, household and population statistics and data from the Global Burden of Disease were combined to estimate production losses for 12 disease categories, 38 age and sex groups and four causes of production loss. The production losses were estimated via lost wages in accordance with a human capital approach for 2019.

RESULTS

The main causes of production losses in 2019 were mental and substance use disorders, totalling NOK121.6bn (32.7% of total production losses). This was followed by musculoskeletal disorders, neurological disorders, injuries, and neoplasms, which accounted for 25.2%, 7.4%, 7.4% and 6.5% of total production losses, respectively. Production losses due to sick leave, disability insurance and work assessment allowance were higher for females than for males, whereas production losses due to premature mortality were higher for males. The latter was related to neoplasms, cardiovascular disease and injuries. Across age categories, non-fatal conditions with a high prevalence among working populations caused the largest production losses.

CONCLUSIONS

The inclusion of production losses in health care priority debates in Norway could result in an emphasis on chronic diseases that occur among younger populations at the expense of fatal diseases among older age groups.

Social inequality in the association between life transitions into adulthood and depressed mood: a 27-year longitudinal study

Background

Few studies have considered the life-course development of depressive symptoms in relation to life transitions in early-adulthood and whether these might affect depressive trajectories differently depending on specific indicators of parental socioeconomic status (SES). In the present work, we explore these questions using the adolescent pathway model as a guiding framework to test socially differential exposure, tracking and vulnerability of the effects of life transitions on depressed mood across different socioeconomic backgrounds.

Methods

Latent growth modeling was used to estimate the associations between indicators of parental SES (parental education and household income) and depressed mood from age 13 to 40 with life transitions (leaving the parental home, leaving the educational system, beginning cohabitation, attaining employment) as pathways between the two. Our analyses were based on a 27-year longitudinal dataset (n = 1242) of a Norwegian cohort with 10 time points in total. To make socioeconomic comparisons, three groups (low, mid, and high) were made for parental education and income respectively.

Results

Depressed mood decreased from age 13 to 40. The low and high parental education groups showed a stable difference in depressed mood during early adolescence, which decreased in young adulthood and then increased slightly in mid-adulthood. The low household income group showed higher depressed mood across young adulthood compared to the medium and higher household income groups. For life transitions, leaving the parental home and beginning cohabitation was associated with an added downturn of the trajectory of depressed mood when adjusting for other transitions. However, adolescents with high parental education showed a relatively stronger decrease in depressed mood when leaving the parental home. Similarly, adolescents with a high household income showed a relatively stronger decrease in depressed mood when leaving the educational system.

Conclusions

Depressed mood decreased over time and developed differently depending on parental education and household income. Life transitions were generally associated with reductions in depressed mood across time, but lower SES youths were not found to be more socially vulnerable these effects.

Genetic and clinical factors underlying a self-reported family history of heart disease

AIMS

To estimate how much information conveyed by self-reported family history of heart disease (FHHD) is already explained by clinical and genetic risk factors.

METHODS AND RESULTS

Cross-sectional analysis of UK Biobank participants without pre-existing coronary artery disease using a multivariable model with self-reported FHHD as the outcome. Clinical (diabetes, hypertension, smoking, apolipoprotein B-to-apolipoprotein AI ratio, waist-to-hip ratio, high sensitivity C-reactive protein, lipoprotein(a), triglycerides) and genetic risk factors (polygenic risk score for coronary artery disease [PRSCAD], heterozygous familial hypercholesterolemia [HeFH]) were exposures. Models were adjusted for age, sex, and cholesterol-lowering medication use. Multiple logistic regression models were fitted to associate FHHD with risk factors, with continuous variables treated as quintiles. Population attributable risks (PAR) were subsequently calculated from the resultant odds ratios. Among 166 714 individuals, 72 052 (43.2%) participants reported an FHHD. In a multivariable model, genetic risk factors PRSCAD (OR 1.30, CI 1.27-1.33) and HeFH (OR 1.31, 1.11-1.54) were most strongly associated with FHHD. Clinical risk factors followed: hypertension (OR 1.18, CI 1.15-1.21), lipoprotein(a) (OR 1.17, CI 1.14-1.20), apolipoprotein B-to-apolipoprotein AI ratio (OR 1.13, 95% CI 1.10-1.16), and triglycerides (OR 1.07, CI 1.04-1.10). For the PAR analyses: 21.9% (CI 18.19-25.63) of the risk of reporting an FHHD is attributed to clinical factors, 22.2% (CI% 20.44-23.88) is attributed to genetic factors, and 36.0% (CI 33.31-38.68) is attributed to genetic and clinical factors combined.

CONCLUSIONS

A combined model of clinical and genetic risk factors explains only 36% of the likelihood of FHHD, implying additional value in the family history.

Bosnian Paternal War Orphans: Mental Health in Postwar Time

ABSTRACT

More research on the medium- and long-term effects of childhood exposure to war, including orphanhood, is needed. We compared 50 orphans 1 who lost their father during the war in Bosnia and Herzegovina (1992-1995) and 50 age- and sex-matched adolescents from two-parent families during 2011-2012 in terms of sociodemographic characteristics, behavioral/emotional problems, depression, resilience, maternal mental health, and perceived social support. The two groups differed on sociodemographic factors, that is, number of children, family composition, income, school grades, and refugeehood. Paternal war orphans did not differ in terms of adolescent mental health and resilience from their nonorphaned peers, controlling for sociodemographic variables. The mothers of orphans had comparably more posttraumatic psychopathology. As for perceived resources for social support, orphans identified those comparably more often among distant relatives and in the community, that is, religious officials and mental health professionals, and less often among siblings, paternal grandparents, paternal and maternal uncles/aunts, school friends and teachers. Our findings suggest that contextual factors may play an important role in orphans' postwar mental health.

Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study

This study aimed to describe the health status of children and how social deprivation affects their use of healthcare services and mortality. Children living in mainland France were selected from the national health data system (SNDS) on their date of birth or birthday in 2018 (< 18 years) and followed for one year. Information included data on healthcare reimbursements, long-term chronic diseases (LTDs) eligible for 100% reimbursement, geographic deprivation index (FDep) by quintile (Q5 most disadvantaged), and individual complementary universal insurance (CMUc) status, granted to households with an annual income below the French poverty level. The number of children who had at least one annual visit or hospital admission was compared using the ratio of geographic deprivation (rQ5/Q1) and CMUc (rCMUc/Not) after gender and age-standardization. Over 13 million children were included; 17.5% had CMUc, with an increase across quintiles (rQ5/Q1 = 3.5) and 4.0% a LTD (rQ5/Q1 = 1.44). The 10 most frequent LTDs (6 psychiatric) were more common as the deprivation increased. Visits to general practitioners (GPs) were similar (≈84%) for each FDep quintile and the density of GPs similar. The density decreased with increasing deprivation for specialists and visits: paediatricians (rQ5/Q1 = 0.46) and psychiatrists (rQ5/Q1 = 0.26). Dentist visits also decreased (rQ5/Q1 = 0.86) and deprived children were more often hospitalised for dental caries (rQ5/Q1 = 2.17, 2.1% vs 0.7%). Emergency department (ED) visits increased with deprivation (rCMUc/Not = 1.35, 30% vs 22%) but 50% of CMUc children lived in a municipality with an ED vs. 25% without. Approximately 9% of children were admitted for a short stay and 4.5% for a stay > 1 night (rQ5/Q1 = 1.44). Psychiatric hospitalization was more frequent for children with CMUc (rCMUc/Not = 3.5, 0.7% vs 0.2%). Higher mortality was observed for deprived children < 18 years (rQ5/Q1 = 1.59). Our results show a lower use of pediatricians, other specialists, and dentists among deprived children that may be due, in part, to an insufficient supply of care in their area of residence. These results have been used to recommend optimization and specifically adapted individual or area-wide policies on the use of healthcare services, their density, and activities.

The association between persistent low parental income during preschool age and mental disorder in adolescence and early adulthood: a Norwegian register-based study of migrants and non-migrants

BACKGROUND

Low socioeconomic status during childhood is associated with increased risk of mental disorders later in life. Yet, there is limited research on whether this association varies by migrant background, despite an overrepresentation of migrants among the economically disadvantaged.

METHODS

Using national register data on a study population of 577,072 individuals, we investigated the association between persistent low parental income during preschool, measured at age 3-5 years and mental disorder during adolescence and early adulthood, measured between ages 16-25. Outpatient mental healthcare (OPMH) service use was a proxy for mental disorder and was measured between 2006 and 2015. We applied discrete-time logistic regression analyses with interaction terms to study differences in the relationship between persistent low parental income and OPMH service use by migrant background and gender.

RESULTS

Persistent low parental income during preschool age was associated with increased odds of OPMH service use in adolescence and early adulthood (aOR = 1.99, 95% CI 1.90-2.08), even after adjusting for gender, migrant background, parental education and persistent lower income at later ages (aOR = 1.33, 95% CI 1.27-1.40). Statistically significant interactions between migrant background and persistent low parental income were recalculated and presented as marginal yearly probabilities. These results showed that the association was in the opposite direction for migrants; those in the higher income group had higher probability of OPMH service use, although the differences were non-significant for some groups. The relationship did not vary by gender.

CONCLUSIONS

Social inequalities in mental health, as measured by OPMH service use, may have an onset already in childhood. Interventions to reduce inequalities should therefore start early in the life course. Since the association differed for migrants, future research should aim to investigate the mechanisms behind these disparities.