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Rehnberg J, Östergren O, Almquist YB, Fritzell J, Fors S. The influence of selective mortality on poverty rates in later life: evidence from a Swedish cohort born in 1926. Scand J Public Health 2024:14034948241266437. [PMID: 39185633 DOI: 10.1177/14034948241266437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
AIMS Mortality influences the composition of the surviving population. Higher mortality among low-income individuals than high-income individuals may result in lower poverty rates in the surviving population. The objective of this study was to describe poverty rates for both survivors and deceased individuals in a cohort born in 1926. METHODS We used Swedish total population data on the 1926 birth cohort (n = 83,382), calculating annual poverty rates from 1991 to 2016. We compared poverty rates for the entire cohort, those who died the next year, and those who survived for 5, 10, or 20+ years, measuring the impact of selective mortality as the differences in poverty rates between the cohort and these subgroups. RESULTS Individuals who died the following year had higher poverty rates than the cohort at ages 65-90. Conversely, individuals who survived 5, 10, or 20+ years had lower poverty rates, with relatively small differences (1.1% to 6.9% lower) for survivors of 5 years or longer, and larger differences (26.4% to 32.8% lower) for those who survived 20+ years. CONCLUSIONS Despite differences in mortality rates by income, selective mortality had only a modest impact on poverty rates. If life expectancy rises for all, and a more diverse population reaches old age, our findings indicate a potential slight increase in poverty rates due to reduced mortality as a selective factor. These findings emphasise the need to consider mortality selection when addressing future poverty rates in older adults.
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Affiliation(s)
- Johan Rehnberg
- Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Olof Östergren
- Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, Sweden
| | - Ylva B Almquist
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, Sweden
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Jabin MSR, Samuriwo R, Chilaka M, Yaroson EV. Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review. JMIR Res Protoc 2024; 13:e56346. [PMID: 38635311 PMCID: PMC11066740 DOI: 10.2196/56346] [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: 01/13/2024] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. OBJECTIVE This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. METHODS The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. RESULTS A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. CONCLUSIONS This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/56346.
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Affiliation(s)
| | - Ray Samuriwo
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Marcus Chilaka
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Emilia Vann Yaroson
- Logistics, Transport, Operations and Analytics, Huddersfield Business School, University of Huddersfield, Huddersfield, United Kingdom
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Yu B, Jia P, Dou Q, Yang S. Toward a prognostic model for all-cause mortality among old people with disability in long-term care in China. Arch Gerontol Geriatr 2024; 119:105324. [PMID: 38266531 DOI: 10.1016/j.archger.2023.105324] [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: 09/16/2023] [Revised: 11/19/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Current prognostic model of all-cause mortality may not be applicable for old people with disability in long-term care due to the absence of injury- and care-related predictors. We aimed to develop a prognostic model specifically tailored to this population, based on comprehensive predictors. METHOD We conducted a prospective study involving 41,004 participants aged ≥60 with disability in long-term care across 16 study sites in Southwest China from 2017 to 2021. Participants' demographics, clinical characteristics, disability status, and injury- and care-related information at baseline were used as candidate predictors. We employed a LASSO Cox regression model to develop the prognostic model using the training set (70 % of participants), and the predictive performance was validated in the validation set (30 % of participants). The prognostic index (PI) scores of the prognostic model were used to quantify mortality risk. RESULTS At the end of the 4-year follow-up, 17,797 deaths (43.4 %) were observed. The prognostic model revealed several powerful and robust predictors of mortality across the total sample and subgroups, including higher age, living with comorbidities, physical and perceptual disability, and living with pressure sores. Non-professional care was an additional predictor in older participants. The risk of death for participants in the highest quartile of PI scores was approximately four-fold higher compared to those in the lowest quartile. CONCLUSIONS We developed and validated a prognostic model that can be practically utilized to identify individuals and populations at risk of death among old people with disability in long-term care.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University- The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Department of Clinical Medical College, Affiliated Hospital of Chengdu University, Chengdu, China; Respiratory Department, Chengdu Seventh People's Hospital, Chengdu, China.
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Solovieva S, de Wind A, Undem K, Dudel C, Mehlum IS, van den Heuvel SG, Robroek SJW, Leinonen T. Socioeconomic differences in working life expectancy: a scoping review. BMC Public Health 2024; 24:735. [PMID: 38454363 PMCID: PMC10921693 DOI: 10.1186/s12889-024-18229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND In the last decade, interest in working life expectancy (WLE) and socioeconomic differences in WLE has grown considerably. However, a comprehensive overview of the socioeconomic differences in WLE is lacking. The aim of this review is to systematically map the research literature to improve the insight on differences in WLE and healthy WLE (HWLE) by education, occupational class and income while using different ways of measuring and estimating WLE and to define future research needs. METHODS A systematic search was carried out in Web of Science, PubMed and EMBASE and complemented by relevant publications derived through screening of reference lists of the identified publications and expert knowledge. Reports on differences in WLE or HWLE by education, occupational class or income, published until November 2022, were included. Information on socioeconomic differences in WLE and HWLE was synthesized in absolute and relative terms. RESULTS A total of 26 reports from 21 studies on educational and occupational class differences in WLE or HWLE were included. No reports on income differences were found. On average, WLE in persons with low education is 30% (men) and 27% (women) shorter than in those with high education. The corresponding numbers for occupational class difference were 21% (men) and 27% (women). Low-educated persons were expected to lose more working years due to unemployment and disability retirement than high-educated persons. CONCLUSIONS The identified socioeconomic inequalities are highly relevant for policy makers and pose serious challenges for equitable pension policies. Many policy interventions aimed at increasing the length of working life follow a one-size-fits-all approach which does not take these inequalities into account. More research is needed on socioeconomic differences in HWLE and potential influences of income on working life duration.
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Affiliation(s)
- Svetlana Solovieva
- Finnish Institute of Occupational Health, P.O. Box 40, Työterveyslaitos, Helsinki, 00032, Finland.
| | - Astrid de Wind
- Amsterdam UMC location University of Amsterdam, Public and Occupational Health, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Societal Participation and Health, Amsterdam, The Netherlands
| | - Karina Undem
- National Institute of Occupational Health, Oslo, Norway
| | - Christian Dudel
- Max Planck Institute for Demographic Research, Rostock, Germany
- Federal Institute for Population Research, Wiesbaden, Germany
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Ingrid S Mehlum
- National Institute of Occupational Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Taina Leinonen
- Finnish Institute of Occupational Health, P.O. Box 40, Työterveyslaitos, Helsinki, 00032, Finland
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Yu Q, Wu J. Impact of income inequalities on subjective perception of older adult health: An analysis of healthy life expectancy in China from 1997 to 2006. Geriatr Gerontol Int 2024; 24:109-115. [PMID: 38086009 DOI: 10.1111/ggi.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
AIM Driven by rapid socioeconomic development over recent decades, there are widening income inequalities and subjective health disparities among older adults in China. This study explored the relationship between income inequalities and self-rated healthy life expectancy (HLE) considering potential sex-specific differences. METHODS From a cohort of 1760 individuals aged ≥60 years from the China Health and Nutrition Survey (1997-2006), we calculated age-specific life expectancy (LE), HLE and the proportion of HLE to LE (HLE/LE) by sex using the IMaCh software, incorporated time-varying income levels of older adults. RESULTS Although longevity has significantly improved, the well-being of Chinese older adults could be further enhanced by assessing HLE, as the results showed that at age 60 years, ~20% of their LE was characterized by unhealthiness. Discriminated by economic status, lower-income individuals experienced worse self-rated health compared with the general population and affluent counterparts. For instance, at age 60 years, the LE, HLE and HLE/LE of low-income men were 19.8 (95% CI 18.4-21.1), 16.2 years (95% CI 15.0-17.5) and 81.8%, respectively, lower than their general (21.7, 95% CI: 20.4-23.0; 18.0, 95% CI 16.8-19.2; and 82.9%) and high-income counterparts (25.1, 95% CI 23.1-27.2; 21.4, 95% CI 19.5-23.3; and 85.3%). Sex disparities were noticeable among low-income individuals in HLE/LE, with low-income women showing the most significant disadvantage. CONCLUSIONS Income inequalities exacerbated subjective health disparities among older adults, particularly among lower-income individuals and women. Our findings carry significant implications for formulating public health and social welfare strategies, especially in nations grappling with an aging population and undergoing parallel socioeconomic development. Geriatr Gerontol Int 2024; 24: 109-115.
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Affiliation(s)
- Qi Yu
- Institute of Population Research, Peking University, Beijing, China
| | - Jilei Wu
- Institute of Population Research, Peking University, Beijing, China
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6
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Watt RG. Oral health inequalities-Developments in research, policy and practice over the last 50 years. Community Dent Oral Epidemiol 2023. [PMID: 37243417 DOI: 10.1111/cdoe.12880] [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: 01/17/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
At times of major geopolitical conflict, macroeconomic crisis and the 'aftershocks' of the COVID-19 syndemic still having a global impact, it is the most vulnerable and disadvantaged in society who undoubtedly suffer the most. During these turbulent and uncertain times, it is essential that sufficient policy attention is given to tackling the persistent and stark health inequalities that exist both between and within countries. This commentary aims to critically reflect on developments in oral health inequalities research, policy and practice over the last 50 years. Despite often challenging political contexts, progress has undoubtedly been made in our understanding of the nature and underlying social, economic and political causes of oral health inequalities. A developing body of global research has highlighted patterns of inequalities in oral health that exist across the lifecourse, but less progress has been made in implementing and evaluating policy interventions to tackle these unfair and unjust inequalities in oral health. At a global level through WHO leadership, oral health is at a 'tipping point' with a unique window of opportunity for policy change and development. Transformative policy and system reforms co-produced with community and other key stakeholders are now urgently needed to tackle oral health inequalities.
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Affiliation(s)
- Richard G Watt
- WHO Collaborating Centre in Oral Health Inequalities and Public Health, Department of Epidemiology and Public Health, UCL, London, UK
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Ojalehto E, Finkel D, Russ TC, Karlsson IK, Ericsson M. Influences of genetically predicted and attained education on geographic mobility and their association with mortality. Soc Sci Med 2023; 324:115882. [PMID: 37030096 DOI: 10.1016/j.socscimed.2023.115882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Both educational attainment and genetic propensity to education (PGSEdu) have been associated with geographic mobility. Socioeconomic conditions are, in turn, associated with individuals' health. Geographic mobility could therefore lead to better health for some since it could provide better opportunities, like education. Our aim was to study how attained education and genetic predisposition for higher education are related to geographic mobility, and how they affect the association between geographic mobility and mortality. METHODS We used data from the Swedish Twin Registry (twins born 1926-1955; n = 14,211) in logistic regression models to test if attained education and PGSEdu predicted geographic mobility. Cox regression models were then performed to test if geographic mobility, attained education, and PGSEdu were associated with mortality. RESULTS The results show that both attained education and PGSEdu predicted geographic mobility, in both independent and joint effect models, with higher education associated with higher mobility. Geographic mobility was associated with lower mortality in the independent effect model, but joint effect models showed that this association was completely explained by attained education. CONCLUSIONS To conclude, both attained education and PGSEdu were associated with geographic mobility. Moreover, attained education explained the relationship between geographic mobility and mortality.
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Affiliation(s)
- Elsa Ojalehto
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Deborah Finkel
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA; Aging Research Network - Jönköping, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK; Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ida K Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Aging Research Network - Jönköping, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Malin Ericsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
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Yu H, Sun S, Ling J, Chen H, Liu G. Influence of health literacy on health outcomes of different social strata-- an empirical study based on the data of China's health literacy investigation. Int J Equity Health 2023; 22:42. [PMID: 36899382 PMCID: PMC9999621 DOI: 10.1186/s12939-023-01858-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Health literacy has always been considered as an important factor to promote people's health, but does it have a significant effect on health across all social strata and especially lower social strata? This study aims to analyze the influences of health literacy on health outcomes of different social strata, and then infer whether improving health literacy can reduce health disparities among different social strata. METHODS Utilizing health literacy monitoring data from a city in Zhejiang Province in 2020, the samples are divided into three social strata according to the socioeconomic status score: low, middle and high social stratum, to compare whether there are significant differences in health outcomes between population with lower and higher health literacy among different social strata. In the strata with significant differences, control the confounding factors to further verify the influence of health literacy on health outcomes. RESULTS In low and middle social strata, there are significant differences between population with lower and higher health literacy, when considering the two types of health outcomes (chronic diseases and self-rated health), but in high social stratum, this difference is not significant. After controlling the relevant variables, the influence of health literacy on the prevalence of chronic diseases is statistically significant only in low social stratum, and the health literacy is negatively correlated with the prevalence of chronic diseases(OR = 0.722, P = 0.022). In addition, there are statistical significances for positive impact of health literacy on self-rated health in both low and middle social strata (OR = 1.285, P = 0.047; OR = 1.401, P = 0.023). CONCLUSION Compared with high social stratum, the influence of health literacy on health outcomes of low social stratum (chronic diseases) or both middle and low social strata (self-rated health) is more significant, and both are to improve the health outcomes. This finding suggests that improving residents' health literacy may be an effective way to alleviate the health disparities among different social strata.
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Affiliation(s)
- Huifang Yu
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Siwen Sun
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jie Ling
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Haixiao Chen
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, Zhejiang, China.
| | - Guilin Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Mortality and life expectancy trends in Spain by pension income level for male pensioners in the general regime retiring at the statutory age, 2005-2018. Int J Equity Health 2022; 21:96. [PMID: 35836221 PMCID: PMC9281150 DOI: 10.1186/s12939-022-01697-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Research has generally found a significant inverse relationship in mortality risk across socioeconomic (SE) groups. This paper focuses on Spain, a country for which there continues to be very little evidence available concerning retirement pensioners. We draw on the Continuous Sample of Working Lives (CSWL) to investigate disparities in SE mortality among retired men aged 65 and above over the longest possible period covered by this data source: 2005–2018. We use the initial pension income (PI) level as our single indicator of the SE status of the retired population. Methods The mortality gradient by income is quantified in two ways: via an indicator referred to as “relative mortality”, and by estimating changes in total life expectancy (LE) by PI level at ages 65 and 75 over time. We show that, should the information provided by the relative mortality ratio not be completely clear, a second indicator needs to be introduced to give a broad picture of the true extent of inequality in mortality. Results The first indicator reveals that, for the period covered and for all age groups, the differences in death rates across PI levels widens over time. At older age groups, these differences across PI levels diminish. The second indicator shows that disparities in LE at ages 65 and 75 between pensioners in the lowest and highest income groups are relatively small, although slightly higher than previously reported for Spain. This gap in LE widens over time, from 1.49 to 2.54 years and from 0.71 to 1.40 years respectively for pensioners aged 65 and 75. These differences are statistically significant. Conclusions Along with other behavioral and structural aspects, a combination of factors such as the design of the pension system, the universality and quality of the health system, and high levels of family support could explain why LE inequalities for retired Spanish men are relatively small. To establish the reasons for this increased inequality in LE, more research needs to be carried out. An analysis of all Spanish social security records instead of just a sample would provide us with more information.
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Rehnberg J, Östergren O, Fors S, Fritzell J. Trends in the shape of the income-mortality association in Sweden between 1995 and 2017: a repeated cross-sectional population register study. BMJ Open 2022; 12:e054507. [PMID: 35354639 PMCID: PMC8968639 DOI: 10.1136/bmjopen-2021-054507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We investigate recent trends in income inequalities in mortality and the shape of the association in Sweden. We consider all-cause, preventable and non-preventable mortality for three age groups (30-64, 65-79 and 80+ years). DESIGN AND SETTING Repeated cross-sectional design using Swedish total population register data. PARTICIPANTS All persons aged 30 years and older living in Sweden 1995-1996, 2005-2006 and 2016-2017 (n=8 084 620). METHODS Rate differences and rate ratios for all-cause, preventable and non-preventable mortality were calculated per income decile and age group. RESULTS From 1995 to 2017, relative inequalities in mortality by income increased in Sweden in the age groups 30-64 years and 65-79 years. Absolute inequalities increased in the age group 65-79 years. Among persons aged 80+ years, inequalities were small. The shape of the income-mortality association was curvilinear in the age group 30-64 years; the gradient was stronger below the fourth percentile. In the age group 65-79 years, the shape shifted from linear in 1995-1996 to a more curvilinear shape in 2016-2017. In the oldest age group (80+ years), varied shapes were observed. Inequalities were more pronounced in preventable mortality compared with non-preventable mortality. Income inequalities in preventable and non-preventable mortality increased at similar rates between 1995 and 2017. CONCLUSIONS The continued increase of relative (ages 30-79 years) and absolute (ages 65-79 years) mortality inequalities in Sweden should be a primary concern for public health policy. The uniform increase of inequalities in preventable and non-preventable mortality suggests that a more complex explanatory model than only social causation is responsible for increased health inequalities.
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Affiliation(s)
- Johan Rehnberg
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | - Olof Östergren
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
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11
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Siegel A, Schug JF, Rieger MA. Social Determinants of Remaining Life Expectancy at Age 60: A District-Level Analysis in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1530. [PMID: 35162553 PMCID: PMC8835464 DOI: 10.3390/ijerph19031530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany
| | - Jonas F Schug
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany
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