Adjusted Prevalence Difference Research Articles

Worklessness and regional differences in the social gradient in general health: Evidence from the 2001 English census

BackgroundThere has been much focus on separating contextual and compositional influences on social inequalities in health. However, there has been less focus on the important role of place in shaping the distribution of risk factors. Spatial variations in worklessness are one such factor. In this paper, then we examine the extent to which between and within regional differences in the social gradient in self-rated general health are associated with differences in rates of worklessness. MethodsData were obtained for men and women of working age (25–59) who had ever worked from the Sample of Anonymised Records (Individual SAR)—a 3% representative sample of the 2001 English Census (349,699 women and 349,181 men). Generalised linear models were used to calculate region and age adjusted prevalence difference for not good health by education (as an indicator of socio-economic status) and employment status. The slope index of an inequality was also calculated for each region. ResultsFor both men and women, educational inequalities in worklessness and not good health are largest in those regions with the highest overall levels of worklessness. Adjusting for worklessness considerably attenuated the educational health gradient within all English regions (by over 60%) and virtually eliminated between region differences. DiscussionMacroeconomic policies, which influence the demand for labour, may have an important role in creating inequalities in general health of the working age population both within and between regions. Employment policy may therefore be one important approach to tackling spatial and socio-economic health inequalities.

Uterine Leiomyomata Associated with Self-Reported Stress Urinary Incontinence

To investigate the association between the presence and characteristics of uterine leiomyomata (UL) and self-reported stress urinary incontinence (SUI). The study included 836 premenopausal participants (474 African American and 362 Caucasian) in the National Institute of Environmental Health Sciences (NIEHS) Uterine Fibroid Study. UL were characterized at baseline with ultrasound screening, and SUI was assessed at follow-up (after 4 years, on average). Linear risk models were used to estimate adjusted prevalence differences (aPD) and 95% confidence intervals (CI), controlling for age, ethnicity, body mass index (BMI), and number of deliveries. Compared with women without UL, SUI prevalence was higher among women with any UL (aPD = 7.4%, 95% CI 0.4-14.3) and women with UL 2-4 cm (aPD = 9.6%, 95% CI 1.3-17.9). Marginally significant results were found for the presence of UL > or =4 cm and anterior UL > or =2 cm. The observed 7% increase in prevalence of this common condition for women with UL is of clinical importance. Further research is needed before concluding that treatment for larger UL might enhance SUI treatment in some women.

Cigarette smoking among immigrant salvadoreans in washington, dc: Behaviors, attitudes, and beliefs

There has been an influx of immigrants from El Salvador to the Washington, DC (DC) area, but little is known about the health behaviors of this population. This study was conducted to describe the prevalence of cigarette smoking among adult Salvadorean immigrants to the DC area. Bilingual interviewers administered a face-to-face interview to participants recruited from throughout the community. Complete data were available for 1,458 participants; 10.8% of those surveyed were current smokers and 11.7% were former smokers. Men were significantly more likely than women to have ever smoked either in the past (adjusted prevalence difference [PD = 21.0%] or currently (PD = 21.2%). The respondents tended to believe that smoking was a “habit” rather than an addition. Only 16% lived in households where smoking was permitted, and the majority supported smoke-free policies in public places, with men and current smokers being less permissive. The smoking behavior exclusively represented the smoking pattern that the Salvadoreans had adopted before immigration. The data suggest that smoking control strategies aimed at this population should seek to reduce the onset of smoking among men and continue to keep smoking among women rare.

Human Antitetanus Serum

<b>Background:</b> Unemployment and economic inactivity are associated with poor health. There are social gradients in unemployment and economic inactivity so it was hypothesised that they may contribute to the social gradient in self rated health. <b>Methods:</b> Data on employment status, socio-economic position (SEP), and self-rated heath were obtained for people of working age (25-59) who had ever worked from a 3% sample of the 2001 English census. The age adjusted prevalence differences in not good general health for four separate measures of SEP were compared to the prevalence differences obtained after additional adjustment for employment status. <b>Results:</b> Prevalence differences for not good health were reduced by 50% or over when adjusting for employment status (for men ranging from 57% to 81%, for women 50% to 74%). <b>Discussion:</b> The social gradient in employment status contributes greatly to the social gradient in self-reported health. Understanding why this is the case could be important for tackling social inequalities in health.