Self-rated health and mortality in different occupational classes and income groups in Nord-Trøndelag County, Norway

Is Poor Self-Rated Health Associated with Higher Caries Experience in Adults? The HUNT4 Oral Health Study

INTRODUCTION

The association between lower socioeconomic status and a higher risk of dental caries is well established, but the independent association between general health status and dental caries on a population level is less investigated. The aim of this study was to assess the association between self-rated general health and caries experience in an adult Norwegian population and to assess if the associations were modified by age and sex.

METHODS

Data were collected as part of the Trøndelag Health Study (HUNT4) conducted 2017-2019 and a randomly selected subsample (20%) were invited for the HUNT4 Oral Health Study. This cross-sectional study included 4,880 dentate participants aged 19-94 years (response rate 67%). Participants underwent clinical and radiographic oral examinations and caries experience was measured by numbers of decayed (DT), missing (MT), and filled teeth (FT), DMFT index. The DT component consisted of primary and secondary caries in dentine, cavitated root caries, and remaining roots. Questionnaires were used to assess self-rated general health and socioeconomic position, denoted by education, household income, and employment status. Associations between self-rated health and caries experience (DMFT) and components (DT, MT, and FT) were assessed using negative binomial regression models. Ratios of means (RMs) with 95% confidence intervals (CI) for the associations were estimated, adjusting for socioeconomic position.

RESULTS

Individuals with poor self-rated general health had a 29% higher mean number of MT (RM: 1.29 [95% CI: 1.13-1.46]), a 22% higher mean number of DT (RM: 1.22 [95% CI: 1.07-1.39]), and a 7% higher mean number of DMFT (RM: 1.07 [95% CI: 1.04-1.11]) than individuals reporting very good health. Age-stratified analyses presented a more pronounced association between self-rated health and caries experience for individuals below the age of 55 years than for those 55 years or older. Similarly, the association was more evident in women, with significantly higher mean values for DMFT, MT, and FT among women reporting poor health.

CONCLUSIONS

The present study demonstrated an independent association between poor self-rated health and a higher burden of caries experience, adjusted for education, income, and employment status. The association was stronger in women and individuals below the age of 55 years. These findings add new evidence in understanding caries inequalities through self-rated health.

High social risk and mortality. A prospective study in community-dwelling older adults living in a rural Ecuadorian village

High social risk has been associated with mortality, but information on this relationship in remote rural communities is limited. Using the social determinants of health (SDH) specified in the Gijon's social-familial evaluation scale (SFES), we aimed to assess mortality risk according to levels of social risk in community-dwelling older adults living in rural Ecuador. Following a longitudinal population-based design, this study prospectively followed 457 individuals for an average of 8.2 ± 2.6 years. A total of 115 (25.2 %) individuals died during the study years. The mean Gijon's SFES score was 9.4 ± 2.8 points among survivors versus 12.3 ± 4 points among those who died (p < 0.001). Separate models using individual SDH components as exposures showed that deficits in family situation, social relationships and support networks were significantly associated with mortality, whereas economic status and housing factors were not. A Cox-proportional hazard model, with the Gijon's SFES score stratified in tertiles, showed a more than 5-fold increase in mortality among individuals in the third tertile compared with those in first and second tertiles, after adjusting for relevant covariates (HR: 5.36; 95 % C.I.: 3.09 - 9.32). Study results indicate an important contribution of high social risk to mortality, and may help to identify potential interventional targets that are focused on encouraging social interactions, and that may reduce mortality in older adults living in remote settings.

The value of general health perception in health equity research: A community-based cohort study of long-term mortality risk (Finnmark cohort study 1987-2017)

Background

General health perception as measured by self-rated health (SRH) is an individual's synthesis of personal overall health and has value in its own right. In addition, this subjective perspective has a unique predictive power of subsequent mortality and adds valuable information not captured by objective measures. We studied the relationship between SRH and subsequent mortality to demonstrate how simple self-ratings can enhance our understanding of health inequities.

Methods

Data from a population-based survey conducted in Finnmark 1987/1988 were linked to the Norwegian Cause of Death Registry for information on all deaths by the end of 2017. We used Cox proportional hazard regression modelling to estimate the relative effects of all-cause mortality separately for sex and age (30–49 and 50–62 years) with stepwise adjustment for socio-demographics and various other health status and behavioural measures.

Results

The age-adjusted power of mortality prediction of SRH was strong (most pronounced in the youngest age-group) but markedly attenuated by other factors. Education inequality in mortality was most substantial in the youngest age-group, which might partly be due to a combination of selective mortality and historical changes in health inequality. In comparison, educational inequality in SRH was clearly pronounced regardless of age. Work disability pension appeared as the common key factor affecting the mortality prediction of SRH and educational inequity for both subsequent mortality and SRH.

Conclusion

SRH adds unique information to our understanding of health inequities. The consistency in shared predictors of educational inequity concerning both mortality and SRH underscores the correspondence of these measures. In addition to predicting the fatal effects of social selection mechanisms, SRH adds non-fatal effects and seems less prone to selective mortality. The results are relevant to approaches in health equity research and have important policy implications.

•

Self-rated health yielded robust age adjusted mortality predictions.

•

Self-rated health adds unique information to our understanding of health inequities.

•

Educational inequity in mortality is extensive, but it narrows with age, which can be explained by selective mortality and historical changes.

•

Measures to reduce preventable workforce exclusions can be effective for achieving or maintaining health equity.

Unemployment and mortality in a large Italian cohort

BACKGROUND

Aim of this study was to examine the association between unemployment and mortality, taking into account potential confounders of this association. A secondary objective was to assess whether the association between unemployment and mortality was modified by lack of household economic resources.

METHODS

Prospective cohort composed of a representative sample of Italian subjects 30-55 years who participated in the Italian National Health Survey 1999-2000, followed up for mortality up to 2012 (15 656 men and 11 463 women). Data were analyzed using Cox regression models, stratified by gender and adjusted for health status, behavioral risk factors, socioeconomic position and position in the household. The modifying effect of the lack of economic resources was assessed by testing its interaction with unemployment on mortality.

RESULTS

Among women, unemployment was not associated with mortality, whereas among men, higher mortality was found from all causes (HR = 1.82), which was not modified by lack of economic resources, and from neoplasms (HR = 1.59), cardiovascular diseases (HR = 2.58) and suicides (HR = 5.01).

CONCLUSIONS

Results for men were robust to the adjustment for main potential confounders, suggesting a causal relationship between unemployment and mortality. The lack of effect modification by economic resources supports the relevance of the loss of non-material benefits of work on mortality.

Socio-demographic characteristics, diet and health among food insecure UK adults: cross-sectional analysis of the International Food Policy Study

OBJECTIVE

To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health.

DESIGN

Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models.

SETTING

United Kingdom.

PARTICIPANTS

2551 participants (aged 18-64 years); sub-sample (n 1949) used to investigate association between FI and overweight.

RESULTS

FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75).

CONCLUSIONS

FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.

Assessment of self-rated health 5 years after Roux-en-Y gastric bypass for severe obesity

Background

Patients' perceptions of health change after bariatric surgery are complex. The aim of this study was to explore whether self‐rated health (SRH), a widely used tool in public health research, might be relevant as an outcome measure after Roux‐en‐Y gastric bypass (RYGB) for severe obesity.

Methods

This was a single‐centre retrospective study of a local quality registry. SRH score was registered at baseline and 5 years after RYGB. SRH, one of the 36 items in the quality‐of‐life Short Form 36 (SF‐36®) questionnaire, is the answer to this single question: ‘In general, would you say your health is excellent (1), very good (2), good (3), fair (4) or poor (5)?’ Change in SRH was analysed in relation to change in weight, co‐morbidities and quality of life after 5 years.

Results

Of a total of 359 patients who underwent RYGB between September 2006 and February 2011, 233 (64·9 per cent) reported on SRH before and 5 years after surgery. Of these, 180 (77·3 per cent) were women, and the mean(s.d.) age was 40(9) years. Some 154 patients (66·1 per cent) reported an improvement in SRH, 60 (25·8 per cent) had no change, and SRH decreased in 19 patients (8·2 per cent). SRH in improvers was related to better scores in all SF‐36® domains, whereas SRH in non‐improvers was related to unchanged or worsened scores in all SF‐36® domains except physical function.

Conclusion

Two‐thirds of patients reported improved SRH 5 years after RYGB for severe obesity. In view of its simplicity, SRH may be an easy‐to‐use outcome measure in bariatric surgery.

Timing of complementary feeding and associations with maternal and infant characteristics: A Norwegian cross-sectional study

Norwegian Health authorities recommend solid food to be introduced between child age 4-6 months, depending on both the mother´s and infant's needs. The aim of this paper is to describe timing of complementary feeding in a current sample of Norwegian mother/infant-dyads and explore potential associations between timing of introduction to solid foods and a wide range of maternal and infant characteristics known from previous literature to influence early feeding interactions. The paper is based on data from the Norwegian randomized controlled trial Early Food for Future Health. In 2016, a total of 715 mothers completed a web-based questionnaire at child age 5.5 months. We found that 5% of the infants were introduced to solid food before 4 months of age, while 14% were not introduced to solid food at 5.5 months of age. Introduction of solid food before 4 months of age was associated with the infant not being exclusive breastfed the first month, receiving only formula milk at 3 months, the mother being younger, not married/cohabitant, smoking, less educated and having more economic difficulties. Not being introduced to solid food at 5.5 months was associated with the infant being a girl, being exclusive breastfed the first month, receiving only breastmilk at 3 months, the mother being older, married and having 3 or more children. This study shows that there are still clear socioeconomic differences regarding timing of complementary feeding in Norway. Infants of younger, less educated and smoking mothers are at higher risk of not being fed in compliance with the official infant feeding recommendations. Our findings emphasize the importance of targeting socioeconomically disadvantaged mothers for support on healthy feeding practices focusing on the infant`s needs to prevent early onset of social inequalities in health.

Associations between long commutes and subjective health complaints among railway workers in Norway

Commuting is an important aspect of daily life for many employees, but there is little knowledge of how this affects individual commuters' health and well-being. The authors investigated the relationship between commuting and subjective health complaints, using data from a web-based questionnaire. In a sample of 2126 railway employees, 644 (30.3%) had long commute times. A 29-item inventory was used to measure the number and degree of the subjective health complaints. Those who commuted 60 min or more each way were characterized by significantly higher numbers and degrees of subjective health complaints compared with their peers with short commutes. The mean number of complaints was 7.5 among the former group and 6.4 for the latter group (p = 0.009). In a regression model, in which the authors controlled for age, gender, education, self-rated health, and coping, the employees with long commutes reported more complaints than those with short commutes. Significant associations were found between those with long commutes and the number and degree of incidences of self-reported musculoskeletal pain, pseudo-neurologic complaints, and gastrointestinal problems. Commuters who had had long commutes for more than 10 years reported more gastrointestinal and musculoskeletal complaints than those with long commutes for less than 2 years. Also, commuters with long commutes spent less time with their families and leisure activities compared with those with short commutes. The authors conclude that the association between long commute times and higher levels of subjective health complaints should attract the attention of transport planners, employers, and public health policymaker.

•

Long commuters reported more subjective health symptoms than short commuters.

•

Musculoskeletal, gastrointestinal and pseudo neurological complaints were most frequent.

•

Long commuters spent less time with their families and on leisure activities than short commuters.

Health Effects of Unemployment in Europe During the Great Recession: The Impact of Unemployment Generosity

Social and economic security could be particularly important for health among the unemployed. Nevertheless, knowledge is still lacking as to whether and how different policy contexts affect health when people move into unemployment. This article investigates whether and to what degree the unemployment generosity explains why individual health effects of unemployment vary across Europe. The 2008-2011 longitudinal panel of the European Union statistics on income and living conditions (EU-SILC) and fixed-effects models are used to estimate the individual effects of unemployment on self-rated health (SRH). Social spending on unemployment is used as a proxy for unemployment generosity. The results show that unemployment generosity is associated with reduced negative effects of unemployment on SRH. For every increase in adjusted purchasing power standard spending, the negative effect of unemployment on SRH is reduced by 0.003 (SE = 0.001) and the change in SRH is improved by 0.002 (SE = 0.001) for each year following the transition, after controlling for time-variant confounders at the individual level and unemployment rate at the macro level. The association between spending on unemployment and cross-national differences in individual health changes that occur as people enter unemployment provides a robust indication of the mitigating health effects of unemployment generosity.