Effects of Education and Income on Incident Type 2 Diabetes and Cardiovascular Diseases: a Dutch Prospective Study

BACKGROUND

Education and income, as two primary socioeconomic indicators, are often used interchangeably in health research. However, there is a lack of clear distinction between these two indicators concerning their associations with health.

OBJECTIVE

This study aimed to investigate the separate and combined effects of education and income in relation to incident type 2 diabetes and cardiovascular diseases in the general population.

DESIGN AND PARTICIPANTS

Participants aged between 30 and 65 years from the prospective Dutch Lifelines cohort study were included. Two sub-cohorts were subsequently created, including 83,759 and 91,083 participants for a type 2 diabetes cohort and a cardiovascular diseases cohort, respectively.

MAIN MEASURES

Education and income level were assessed by self-report questionnaires. The outcomes were incident type 2 diabetes and cardiovascular diseases (defined as the earliest non-fatal cardiovascular event).

KEY RESULTS

A total of 1228 new cases of type 2 diabetes (incidence 1.5%) and 3286 (incidence 3.6%) new cases of cardiovascular diseases were identified, after a median follow-up of 43 and 44 months, respectively. Low education and low income (<1000 euro/month) were both positively associated with a higher risk of incident type 2 diabetes (OR 1.24 [95%CI 1.04-1.48] and OR 1.71 [95%CI 1.30-2.26], respectively); and with a higher risk of incident cardiovascular diseases (OR 1.15 [95%CI 1.04-1.28] and OR 1.24 [95%CI 1.02-1.52], respectively); independent of age, sex, lifestyle factors, BMI, clinical biomarkers, comorbid conditions at baseline, and each other. Results from the combined associations of education and income showed that within each education group, a higher income was associated with better health; and similarly, a higher education was associated with better health within each income group, except for the low-income group.

CONCLUSIONS

Education and income were both independently associated with incident type 2 diabetes and cardiovascular diseases. The combined associations of these two socioeconomic indicators revealed that within each education or income level, substantial health disparities existed across strata of the other socioeconomic indicator. Education and income are two equally important socioeconomic indicators in health, and should be considered simultaneously in health research and policymaking.

Overqualification at work and risk of hospitalization for psychiatric and somatic diseases among immigrants in Sweden - a prospective register-based study

OBJECTIVES

This study aimed to (i) describe the prevalence of overqualification at work among immigrants in Sweden and (ii) analyze any association between overqualification and the risk of hospitalization for somatic and psychiatric disease among refugees and labor immigrants.

METHODS

We performed a prospective register study in a cohort of 120 339 adults who immigrated to Sweden in 1991-2005 and were employed in 2006. Education-occupation status was defined as the combination of an individual's highest level of education and their occupation skill level. Individuals were followed from 2007 to 2016 with regard to hospitalization for a psychiatric, cardiovascular, respiratory or musculoskeletal disease or diabetes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated in a multivariate Cox regression analysis adjusted for age, gender, reason for residence and duration of residence.

RESULTS

The overall prevalence of overqualification among immigrants with an academic education was 39%. Overqualified individuals had an increased risk of hospitalization for any disease (HR 1.33, 95% CI 1.21-1.46) compared to "job-matched with an academic education". However, the risk estimates were lower than that of "job-matched with no academic education" (HR 1.56, 1.46-1.68). The increased risk of hospitalization for a psychiatric disease of overqualified individuals did not differ from that of job-matched with no academic education.

CONCLUSION

Our study showed that being overqualified was associated with poorer health outcomes than job-matched individuals with an academic education. Considering the high prevalence of overqualification in immigrants, this constitutes a concern, for both society and individuals.

Relative Employment, Gender Beliefs, and Intimate Partner Coercion and Violence Against New Mothers Across Marital and Residential Contexts

This research builds on prior studies of intimate partner victimization by examining the impact of women's and men's relative employment, gender traditionalism, and gender distrust on coercive control and physical victimization among married, cohabiting, and noncohabiting couples with infants. It merges feminist approaches that emphasize the gendered meaning of work, power, and violence with prior insights regarding differences in levels of intimate violence across family forms. Specifically, this research recognizes that there is variation across married, cohabiting, and dating contexts in the symbolic meaning of work, the salience of traditionalism, and the tenuous status of relationships that may activate gender distrust in the production of compensatory violence and control. Logistic regression models using baseline and Year 1 Fragile Families and Child Well-Being data (n = 2,337) indicate that the predictors of coercive control differ across couple types, with the relative odds of coercion higher among couples in which only the woman is employed, but only when cohabiting. Consistent with expectations, men's gender traditionalism increases coercive control, but only in the context of marriage. Relative employment and gender beliefs did not predict physical victimization among any couple types, but a moderating effect of men's gender distrust on women's sole employment was identified, such that status inconsistency in employment increases the relative odds of physical victimization only when the male partner is distrustful of women.

"I Want, Therefore I Am" - Anticipated Upward Mobility Reduces Ingroup Concern

Empirical findings suggest that members of socially disadvantaged groups who join a better-valued group through individual achievement tend to express low concern for their disadvantaged ingroup (e.g., denial of collective discrimination, low intent to initiate collective action). In the present research, we investigated whether this tendency occurs solely for individuals who have already engaged in social mobility, or also for individuals who psychologically prepare themselves, that is ‘anticipate’, social mobility. Moreover, we examined the role of group identification in this process. In two studies, we looked at the case of ‘frontier workers’, that is people who cross a national border every day to work in another country where the salaries are higher thereby achieving a better socio-economic status than in their home-country. Study 1 (N = 176) examined attitudes of French nationals (both the socially mobile and the non-mobile) and of Swiss nationals toward the non-mobile group. As expected, results showed that the mobile French had more negative attitudes than their non-mobile counterparts, but less negative attitudes than the Swiss. In Study 2 (N = 216), we examined ingroup concern at different stages of the social mobility process by comparing the attitudes of French people who worked in Switzerland (mobile individuals), with those who envisioned (anticipators), or not (non-anticipators), to work in Switzerland. The findings revealed that anticipators’ motivation to get personally involved in collective action for their French ingroup was lower than the non-anticipators’, but higher than the mobile individuals’. Moreover, we found that the decrease in ingroup concern across the different stages of social mobility was accounted for by a lower identification with the inherited ingroup. These findings corroborate the deleterious impact of social mobility on attitudes toward a low-status ingroup, and show that the decrease in ingroup concern already occurs among individuals who anticipate moving up the hierarchy. The discussion focuses on the role of the discounting of inherited identities in both the anticipation and the achievement of a higher-status identity.

Feminism, status inconsistency, and women's intimate partner victimization in heterosexual relationships

This study used a random community sample of 303 women in romantic relationships to investigate the role of educational and employment status inconsistency and patriarchal family ideology as risk factors for intimate partner violence (IPV) victimization, while considering demographic factors and relationship context variables. Sequential multivariate logistic regression models demonstrated a decrease in the odds of IPV victimization for Hispanic women and women who were older as compared with their counterparts. In addition, increased relationship distress, family-of-origin violence, and employment status inconsistency significantly increased the odds of IPV. Clinical intervention strategies and future research directions are discussed.