Social Inequalities of Functioning and Perceived Health in Switzerland–A Representative Cross-Sectional Analysis

Jan D Reinhardt,Johannes Siegrist,Erik Von Elm,Christine Fekete

doi:10.1371/journal.pone.0038782

Abstract

Many people worldwide live with a disability, i.e. limitations in functioning. The prevalence is expected to increase due to demographic change and the growing importance of non-communicable disease and injury. To date, many epidemiological studies have used simple dichotomous measures of disability, even though the WHO's International Classification of Functioning, Disability, and Health (ICF) provides a multi-dimensional framework of functioning. We aimed to examine associations of socio-economic status (SES) and social integration in 3 core domains of functioning (impairment, pain, limitations in activity and participation) and perceived health. We conducted a secondary analysis of representative cross-sectional data of the Swiss Health Survey 2007 including 10,336 female and 8,424 male Swiss residents aged 15 or more. Guided by a theoretical ICF-based model, 4 mixed effects Poisson regressions were fitted in order to explain functioning and perceived health by indicators of SES and social integration. Analyses were stratified by age groups (15–30, 31–54, ≥55 years). In all age groups, SES and social integration were significantly associated with functional and perceived health. Among the functional domains, impairment and pain were closely related, and both were associated with limitations in activity and participation. SES, social integration and functioning were related to perceived health. We found pronounced social inequalities in functioning and perceived health, supporting our theoretical model. Social factors play a significant role in the experience of health, even in a wealthy country such as Switzerland. These findings await confirmation in other, particularly lower resourced settings.

Highlights

Around one billion people worldwide are disabled, i.e. experience moderate to severe functional limitations [1]
The overall picture suggests a social gradient of disability in the Swiss general population with higher social class being associated with less disability. In this cross-sectional study of a representative sample of the Swiss population, we found that measures of socio-economic status (SES) and social integration were strongly associated with several dimensions of disability and perceived health
The negative effects of impairments on pain, of pain on impairments, and of impairment and pain on activity and participation could be compensated by higher income, better education and social integration (Tables 2 and 3)

Summary

Introduction

Around one billion people worldwide are disabled, i.e. experience moderate to severe functional limitations [1]. Several previous epidemiologic studies have shown social gradients of disability [8,9,10,11,12,13,14,15,16] and chronic pain [17] These were, mostly confined to the elderly population [8,9,10,11,12,13]. Based on data from the Swiss Health Survey 1997, a social gradient of disability was shown in persons aged 65 and older, but younger respondents were not examined [18]. A report based on the Swiss Health Survey 2007 showed increasing problems in relation to activities of daily living with older age but did not account for SES [19]

Objectives

Methods

Conclusion