Self-reported health and socio-economic inequalities in England, 1996–2009: Repeated national cross-sectional study

Hendramoorthy Maheswaran,Stavros Petrou,Emil Kupek

doi:10.1016/j.socscimed.2015.05.026

Abstract

Tackling social inequalities in health has been a priority for recent UK governments. We used repeated national cross-sectional data for 155,311 participants (aged ≥16 years) in the Health Survey of England to examine trends in socio-economic inequalities in self-reported health over a recent period of sustained policy focus by successive UK governments aimed at tackling social inequalities in health. Socio-economic related inequalities in self-reported health were estimated using the Registrar General's occupational classification (1996–2009), and for sensitivity analyses, the National Statistics Socio-Economic Classification (NS-SEC; 2001–2011). Multi-level regression was used to evaluate time trends in General Health Questionnaire (GHQ-12) scores and bad or very bad self-assessed health (SAH), as well as EQ-5D utility scores.The study found that the probability of reporting GHQ-12 scores ≥4 and ≥ 1 was higher in those from lower social classes, and decreased for all social classes between 1997 and 2009. For SAH, the probability of reporting bad or very bad health remained relatively constant for social class I (professional) [0.028 (95%CI: 0.026, 0.029) in 1996 compared to 0.028 (95%CI: 0.024, 0.032) in 2009], but increased in lower social classes, with the greatest increase observed amongst those in social class V (unskilled manual) [0.089 (95%CI: 0.085, 0.093) in 1996 compared to 0.155 (95%CI: 0.141, 0.168) in 2009]. EQ-5D utility scores were lower for those in lower social classes, but remained comparable across survey years. In sensitivity analyses using the NS-SEC, health outcomes improved from 2001 to 2011, with no evidence of widening socio-economic inequalities. Our findings suggest that socio-economic inequalities have persisted, with evidence of widening for some adverse self-reported health outcomes.

Highlights

A plethora of research highlights that those of lower socioeconomic position are at increased risk of adverse health outcomes, including cardiovascular disease (Mackenbach et al, 2003), cancers (Coleman et al, 2004; Forrest et al, 2013; Parikh et al, 2003), mental health problems (Jokela et al, 2013), and unhealthy lifestyle behavioural factors (Devaux and Sassi, 2013; Rumble and Pevalin, 2013)
As the purpose of the study was to investigate the trends in selfreported health status across socio-economic groups, we controlled for a range of individual-level covariates shown to have an independent association with the outcomes of interest (Maheswaran et al, 2013)
Similar distributions of sociodemographic characteristics were observed for the 155,311 participants included in the primary analyses (1996e2009), and the 115,622 participants included in the National Statistics Socio-Economic Classification (NS-SEC) focused sensitivity analyses during years 2001e2011

Summary

Introduction

A plethora of research highlights that those of lower socioeconomic position are at increased risk of adverse health outcomes, including cardiovascular disease (Mackenbach et al, 2003), cancers (Coleman et al, 2004; Forrest et al, 2013; Parikh et al, 2003), mental health problems (Jokela et al, 2013), and unhealthy lifestyle behavioural factors (Devaux and Sassi, 2013; Rumble and Pevalin, 2013) This is likely to require increased expenditure the by health services and result in reduced productivity (Marmot et al, 2010; WHO, 2008). It was not until the late 1990's, after the publication of the Acheson Report (Acheson, 1998), that tackling social inequalities in health became a priority for health policy in the UK

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