Socio-ecological perspective of older age life expectancy: income, gender inequality, and financial crisis in Europe

The Effect of Structural Gender Inequality Revealed in Small for Gestational Age

Background

This study proposes that being small for gestational age (SGA) is not only an important indicator for neonatal health but also could be a consequence of gender inequality. Low birth weight (LBW) has been widely used as a measurement for adverse birth outcomes, whereas much less attention has been given to the use of small for gestational age (SGA). Despite the importance and worldwide acknowledgement of promoting gender equality and women's empowerment to improve maternal and infant health, previous studies on SGA have focused on nutritional status, social and medical infrastructures, and socioeconomic status. The impact of structural violence against women on SGA has not been explored sufficiently. Therefore, the aim of this study was to examine the effect of gender inequality on SGA, using the Gender Inequality Index (GII).

Methods

A total of 106 low- and middle-income countries (LMICs) from the most recent three global datasets-Institute of Health Metrics and Evaluation (IHME), the UN Development Programme (UNDP), and World Bank-were assessed.

Results

Findings from generalized linear model analysis suggest that significant links exist between years of potential life lost (YLL) from SGA and gender inequality, maternal health status, and country level of income.

Conclusions

Our findings advance the understanding of the role of gender inequality on SGA and reiterate the importance of considering structural violence in maternal and infant health research. These associations can support the message of designing public health and socioeconomic development as well as creating campaigns to promote gender equality in efforts to advance maternal and infant health and to prevent adverse birth outcomes across the globe.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40609-022-00245-8.

Social Determinants of Remaining Life Expectancy at Age 60: A District-Level Analysis in Germany

Remaining life expectancy at age 60 (in short: RLE) is an important indicator of the health status of a population's elders. Until now, RLE has not been thoroughly investigated at the district level in Germany. In this study we analyzed, based on recent publicly available data (2015-2017), and for men and women separately, how large the RLE differences were in Germany across the 401 districts. Furthermore, we examined a wide range of potential social determinants in terms of their bivariate and multivariate (i.e., partial) impact on men's and women's RLE. Men's district-level RLE ranged between 19.89 and 24.32 years, women's district-level RLE between 23.67 and 27.16 years. The best single predictor both for men's and women's RLE at district level was 'proportion of employees with academic degree' with standardized partial regression coefficients of 0.42 (men) and 0.51 (women). Second and third in rank were classic economic predictors, such as 'household income' (men), 'proportion of elder with financial elder support' (women), and 'unemployment' (men and women). Indicators expressing the availability of medical services and staffing levels of nursing homes and services had at best a marginal partial impact. This study contributes to the growing body of evidence that a population's educational level is a decisive determinant of population health resp. life expectancy in contemporary industrialized societies.

Recent quantitative research on determinants of health in high income countries: A scoping review

Background

Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature.

Methods

We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013—July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis.

Results

Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health.

Conclusions

We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants’ influence.

Housing Preferences of Seniors and Pre-Senior Citizens in Poland—A Case Study

This article identifies and compares the housing preferences of seniors and pre-senior citizens in Poland. In addition, the attitude of residents of large cities in the Wielkopolskie Voivodeship towards senior citizens’ housing was determined. Surveys were conducted in the two largest cities of this region. The influence of the potential behaviors of this group of society on the development of housing was also examined. Results showed that differentiation of housing preferences was visible primarily when choosing the type of development and size of the dwelling. Seniors preferred smaller units in multi-family housing construction. Pre-senior citizens, on the other hand, were more likely to think about living in a single-family house. The location of a new dwelling was also important. Seniors, more often than people aged 50–59, chose a location in the city center. Pre-senior citizens, in contrast, more often decided to live in a rural area or outside the city center. Moreover, the attitude of seniors towards senior citizens’ housing is undecided, which may indicate that many people may change their housing preferences in the future and decide to move.

Association of body mass index and gross national income with caries experience in children in 117 countries

Objective: To evaluate the association of body mass index (BMI) and gross national income (GNI) per capita with dental caries experience in children at population levels.Methods: This ecological study used global data of decay, missing, and filled teeth (DMFT), BMI, and GNI. DMFT data of 12 years old children from 117 countries were obtained from the World Health Organization. BMI data of children and adolescents from the same 117 countries were retrieved from the NCD Risk Factor Collaboration and GNI per capita from the World Bank. ANOVA test, Pearson's correlation coefficient (r), and multivariable linear regression were performed.Results: Globally mean BMI ranged from 16.1 to 22.2 in children. Low-income countries had the lowest BMI (17.41 ± 0.57) and high-income countries had the highest BMI (20.14 ± 0.87) (p < .001). The highest mean DMFT was observed in upper-middle-income countries (2.48 ± 1.16) and the lowest in low-income countries (1.22 ± 0.83) (p = .001). There was no significant correlation between BMI and dental caries (DMFT) (r = .063; p = .498). However, there were significant correlations between GNI per capita and BMI (r = 0.366; p < .001) and GNI per capita and DMFT (r= -0.252; p = .007). In multivariable linear regression, GNI per capita was negatively associated with caries experience in children (B= -1.83; p < .001).Conclusion: The study found that BMI was associated with income levels of the countries. GNI per capita significantly and negatively correlated with DMFT in children. Further investigation into the association between BMI and dental caries is warranted.

Ecological study of the association between mental illness with human development, income inequalities and unemployment across OECD countries

OBJECTIVES

Recent studies have demonstrated worsened mental health in relatively highly developed countries impacted by social inequalities and unemployment. Here, we investigate (1) whether mental health issues are differently or similarly affected by these social factors and (2) whether their effects on mental health are related or unrelated to each other.

SETTING

Analysis at the country level among Organization for Economic Cooperation and Development (OECD) countries (n=36). Data on social indicators were collected from OECD and the United Nations Development Programme databases. Data on the prevalence of mental issues were obtained from the Institute for Health Metrics and Evaluation's Global Burden of Disease study 2017.

PARTICIPANTS

No involvement of participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using linear regression models, we investigated the relative contribution played by human development (as measured by the Human Development Index (HDI)), social inequalities (Gini index) and unemployment (unemployment rate) on the prevalence of 10 mental health issues. We then measured the relationship between the socioeconomic factors' effects on mental issues using 2×2 Pearson's correlation test and principal component analysis.

RESULTS

First, the overall effect of each socioeconomic factor on a combination of mental health disorders was large (r range: 0.51 to 0.76; p<0.002). However, the influence of social factors on mental health was relative to each mental issue (r range: -0.34 to 0.74). Second, the socioeconomic factors' effects on mental health showed strong interdependence (r_HDI-Gini=0.93, r_HDI-unemploy=0.81, r_{unemploy-Gini}=0.84; p<0.001. Principal component analysis demonstrated that the first principal component of the three variables (r_HDI, r_Gini, r_unemploy) explained 91.5% of the variance.

CONCLUSION

These results implore a reanalysis of the socioeconomic determinants of mental health where (1) the heterogeneity of mental health issues would be taken into account and (2) each socioeconomic indicator's effect would be analysed and interpreted in conjunction with the others.

Catastrophic health expenditure and health-related quality of life among older adults in China

Older adults have more health-care needs and higher financial burdens but fewer income resources compared to other age groups in China. Meanwhile, substantial inequalities exist between rural and urban older adults in terms of welfare benefits level, access to health care, quality of care and financial resources to pay for health-care services. Using 2011–2013 panel data from the China Health and Retirement Longitudinal Study and a difference-in-differences methodology, this study examined the association between the incidence of catastrophic health expenditure (CHE) and health-related quality of life among older adults in China. To distinguish the dynamic of CHE and generate rigorous estimates, we categorised the older adults into four groups: CHE entry group, non-CHE group, CHE exit group and CHE persistent group. Overall, we found that entry into CHE was associated with poorer physical and mental health for both rural and urban older adults, but this association was more consistent and robust for physical than for mental health. Exiting CHE was found to have a weak and sporadic positive association with physical and mental health across rural and urban areas. The results suggest that financial resources and social services are needed in China to support older adults who experience CHE persistently or periodically to help improve their health outcomes.

Age-related changes in retrobulbar circulation: a literature review

Introduction

The advances in research methods used in ophthalmology allow for an increasingly accurate examination of the eyes, as well as the morphology and function of the vessels. Colour Doppler imaging is still the first-line method for the analysis of parameters of retrobulbar circulation. Therefore, the aim of this work was to present the current state of knowledge about anatomical and functional age-related changes in retrobulbar arteries.

Methods

A literature search was performed mainly based on the PubMed database.

Results

The anatomy of retrobulbar arteries, histological background of age-related vascular changes, age-related changes in retrobulbar blood flow in the ophthalmic artery, central retinal artery, short posterior ciliary arteries, and the reference values for the age-dependent retrobulbar circulation parameters measured by colour Doppler imaging are discussed in this review.

Conclusion

The age of the subject should always be taken into account when interpreting the parameters of retrobulbar blood flow measured by colour Doppler imaging.

Access to Employment, Volunteer Activities, and Community Events and Perceptions of Age-Friendliness: The Role of Social Connectedness

The aim of this study was to investigate the direct and indirect effects of access to employment, volunteer opportunities, and community events on older adults' perception of age-friendliness and feelings of connectedness. Data were from an age-friendly community survey conducted in a Midwestern city in the United States. We analyzed the responses of 264 older adult residents (50 years and older) using path analysis. Results showed that access to community events, job resources, and connectedness were predictors of older adults' perceptions of age-friendliness of their community, and that connectedness mediated the relationship between access to community events and perceived age-friendliness. The findings help to refine the concept of an age-friendly community from older adults' perspectives and emphasize the importance of fostering interactions through community events to enhance older adults' feelings of connectedness.

Why are hospitalisations too long? A simple checklist for identifying the main social barriers to hospital discharge from a nephrology ward

The present increase in life span has been accompanied by an even higher increase in the burden of comorbidity. The challenges to healthcare systems are enormous and performance measures have been introduced to make the provision of healthcare more cost-efficient. Performance of hospitalisation is basically defined by the relationship between hospital stay, use of hospital resources, and main diagnosis/diagnoses and complication(s), adjusted for case mix. These factors, combined in different indexes, are compared with the performance of similar hospitals in the same and other countries. The reasons why an approach like this is being employed are clear.Cutting costs cannot be the only criteria, in particular in elderly, high-comorbidity patients: in this population, although social issues are important determinants of hospital stay, they are rarely taken into account or quantified in evaluations. Quantifying the impact of the "social barriers" to care can serve as a marker of the overall quality of treatment a network provides, and point to specific out-of-hospital needs, necessary to improve in-hospital performance. We therefore propose a simple, empiric medico-social checklist that can be used in nephrology wards to assess the presence of social barriers to hospital discharge and quantify their weight.Using the checklist should allow: identifying patients with social frailty that could complicate hospitalisation and/or discharge; evaluating the social needs of patient and entourage at the beginning of hospitalisation, adopting timely procedures, within the partnership with out-of-hospital teams; facilitating prioritization of interventions by social workers.The following ten items were empirically identified: reason for hospitalisation; hospitalisation in relation to the caregiver's problems; recurrent unplanned hospitalisations or early re-hospitalisation; social/family isolation; presence of a dependent relative in the patient's household; lack of housing or unsuitable housing/accommodation; loss of autonomy; lack of economic resources; lack of a safe environment; evidence of physical or psychological abuse.The simple tool here described needs validation; the present proposal is aimed at raising attention on the importance of non-medical issues in medical organisation in our specialty, and is open to discussion, to allow its refinement.

Effects on inequality in life expectancy from a social ecology perspective

Background

Inequality in life expectancy (ILE) is defined as inequality in the distribution of expected span of life-based on data from survival tables estimated using the Atkinson inequality index. ILE can be influenced by socio-ecological indicators including the Gini coefficient, secondary education, output per worker, and old age pension. This study examined the effects on ILE from a social ecology perspective.

Methods

This analysis is based on ILE data from 108 countries obtained from the United Nations Development Programme. Data on socio-ecological indicators were obtained from the United Nations database. The associations between socio-ecological indicators and ILE were assessed using correlation coefficients and multiple regression models.

Results

Significant correlations were evident between ILE and the following indicators from a socio-ecological perspective: Gini coefficient (GC: r = 0.335, p = 0.001) as an indicator of income inequality, female population with at least some secondary education (FSE: r = − 0.757, p = 0.001), male population with at least some secondary education (MSE: r = − 0.741, p = 0.001), output per worker as a measure of labor productivity (OPW: r = − 0.714, p = 0.001), and number of old age pension recipients (OPR: r = − 0.641, p = 0.001). In multivariate regression, the ILE predictors were higher GC and lower levels of FSE, MSE, OPW, and OPR (R² = 0.648, p < 0.001).

Conclusions

Socio-ecological factors have an important effect on ILE. Policies that address ILE should consider targeted socio-ecological factors, such as the Gini coefficient of income inequality, that give a personal perspective of economic deprivation, attainment of at least a secondary education by both females and males that gives a social environment perspective, output per worker that indicates labor productivity, and the number of old age pension recipients that indicates social security from a public policy perspective.