Inequalities In Morbidity Research Articles

Socioeconomic inequalities in morbidity among the elderly; a European overview

There is some evidence on socioeconomic inequality in morbidity among elderly people, but this evidence remains fragmentary. This study aims to give a comprehensive overview of educational and income inequalities in morbidity among the elderly of eleven European countries. Data from the first wave of 1994 of the European Community Household Panel were used. The study population comprised a total of 14,107 men and 17,243 women, divided into three age groups: 60–69, 70–79 and 80+. Three health indicators were used: self-assessed health, cut down in daily activities due to a physical or mental problem, and long-term disability. The results indicate that socioeconomic inequalities in morbidity by education and income exist among the elderly in Europe, in all the countries in this study and all age groups, including the oldest old. Inequalities decline with age among women, but not always among men. Greece, Ireland, Italy and The Netherlands most often show large inequalities among men, and Greece, Ireland and Spain do so among women. To conclude, inequalities in morbidity decrease with age, but a substantive part persists in old age. To improve the health of elderly people it is important that the material, social and cultural resources of the elderly are improved.

Social inequalities in morbidity from diabetes mellitus in public primary care clinics in Trinidad and Tobago

Associations between socio-economic status and non-communicable diseases in middle income countries have received little study. We conducted an interview survey to evaluate the associations of morbidity with social conditions among people attending government primary care health centres with diabetes mellitus in Trinidad. Data collected included morbidity from hyperglycaemia, foot problems, visual problems and cardiovascular disease, as well as social and demographic variables. Of 622 subjects, 35% were aged ≥65 years, 54% were Indo-Trinidadian, 13% had no schooling, only 11% were in full-time employment, and 33% had no piped drinking water supply in the home. Prevalent symptoms included itching, reported by 215 (35%), nocturia in 315 (51%), burning or numbness in the feet in 350 (56%), and difficulty with eyesight in 363 (58%). A morbidity summary score was used as dependent variable in regression analyses. Comparing those with no schooling with those with secondary education, the mean difference in morbidity score was 1.77 (95% CI 1.15–2.39), attenuated to 0.71 (0.06–1.37) after adjusting for age, gender, ethnic group and diabetes duration. The equivalent differences for those with no piped water supply in the house, compared with those with, were 0.53 (0.17–0.88) and 0.57 (0.24–0.89). For the unemployed, compared with those in full-time jobs, at ages 15–59 years the differences were 0.85 (0.14–1.56) and 0.58 (−0.11–1.27). We conclude that morbidity in persons with diabetes is associated with indicators of lower socio-economic status and that this association is partly explained by confounding with older age, female gender, longer duration of diabetes and Indo-Trinidadian ethnic group. A negative association between socio-economic status and morbidity from diabetes contributes to a justification for investment of public health resources in the control of diabetes and other non-communicable diseases.

Workplace demands, economic reward, and progression of carotid atherosclerosis.

Characteristics of the work environment have been associated with cardiovascular morbidity and mortality, but it is unclear whether these factors are associated with preclinical manifestations of disease. We investigated the association between job demands, economic reward, and the 4-year progression of carotid atherosclerosis in a population-based sample of 940 Finnish men. Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to estimate changes in plaque height, maximum and mean intima-media thicknesses across combinations of job demands, and income. Associations were examined in relation to atherosclerotic risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. Men who had jobs with high demands and low economic rewards had significantly greater 4-year progression of plaque height (0.33 mm, P = .008) and maximum intima-media thickness (0.32, P = .03) than men with low-demand, high-income jobs. The magnitude of these differences was not greatly attenuated by risk factor adjustment and did not differ when examined by the level of workplace resources, social support, or employment status. Larger differences were observed in a subsample of men who had more advanced atherosclerosis at baseline. These results show that men with demanding work that produces little economic reward have significantly greater progression of carotid atherosclerosis than more advantaged men. The relationship between job demands and health should be understood in a broad framework of interacting economic conditions, social circumstances, and behaviors that cascade over the life course and may ultimately contribute to socioeconomic inequalities in morbidity and mortality.

Socioeconomic inequalities in morbidity and mortality in western Europe

Previous studies of variation in the magnitude of socioeconomic inequalities in health between countries have methodological drawbacks. We tried to overcome these difficulties in a large study that compared inequalities in morbidity and mortality between different countries in western Europe. Data on four indicators of self-reported morbidity by level of education, occupational class, and/or level of income were obtained for 11 countries, and years ranging from 1985 to 1992. Data on total mortality by level of education and/or occupational class were obtained for nine countries for about 1980 to about 1990. We calculated odds ratios or rate ratios to compare a broad lower with a broad upper socioeconomic group. We also calculated an absolute measure for inequalities in mortality, a risk difference, which takes into account differences between countries in average rates of illhealth. Inequalities in health were found in all countries. Odds ratios for morbidity ranged between about 1.5 and 2.5, and rate ratios for mortality between about 1.3 and 1.7. For men's perceived general health, for instance, inequalities by level of education in Norway were larger than in Switzerland or Spain (odds ratios [95% CI]: 2.57 [2.07-3.18], 1.60 [1.30-1.96], 1.65 [1.44-1.88], respectively). For mortality by occupational class, in men aged 30-44, the rate ratio was highest in Finland (1.76 [1.69-1.83]), although there was no large difference in the size of the inequality in those countries with data. For men aged 45-59, for whom France did have data, this country had the largest inequality (1.71 [1.66-1.77]). In the age-group 45-64, the absolute risk difference ranked Finland second after France (9.8% [9.1-10.4], 11.5% [10.7-12.4]), with Sweden and Norway coming out more favourably than on the basis of rate ratios. In a scatter-plot of average rank scores for morbidity versus mortality. Sweden and Norway had larger relative inequalities in health than most other countries for both measures; France fared badly for mortality but was average for morbidity. Our results challenge conventional views on the between-country pattern of inequalities in health in western European countries.

How large are the differences ‐ really? Self‐reported long‐standing illness among working class and middle class men

AbstractSocial inequalities in health are regularly found in health interview surveys, but it has been doubted whether respondents’ self‐reported morbidity can accurately describe social class differences in health. Two hypotheses are current: members of the working class are commonly more preoccupied with their illnesses, and overreport them, compared with those of the middle class: secondly, the latter are more sensitive to their illnesses, have a better chance of getting them diagnosed, and consequently claim a wider array of illnesses in comparison with the former. This paper analyses answers to questions about long‐standing illness from working class and middle class men, aged 25–64, in Norwegian surveys during the 1980s. Working class respondents experience their illnesses as more serious. An analysis of diagnostic categories of the illnesses of both sets of respondents indicates that this subjective experience is realistic. The hypothesis that a high level of psychological malaise among working class men produces a tendency to somatise psycho‐social stress is not supported. The paper concludes that social inequalities in morbidity as shown by self‐reported long‐standing illness will often underestimate true class differences.

Measuring social inequalities in health in the United States: a historical review, 1900-1950.

For over two centuries, U.S. vital statistics routinely have been stratified by age, sex, and race, but not by social class. The usual explanation is that U.S. government officials have not considered social class relevant to health. During the first third of the 20th century, however, questions of socio-economic inequalities in morbidity and mortality ranked high on the agenda of federal and other public health agencies, and routine reporting of U.S. vital statistics and health survey data by socioeconomic measures was nearly institutionalized. This history has largely been lost. In this article, the authors focus on the period from 1900 to 1950 and examine how public health researchers and agencies conceptualized and analyzed socioeconomic inequalities in health. Highlights include production, for 1930, of the first U.S. national death rates stratified by social class, in work sponsored by the National Tuberculosis Association and Bureau of the Census, and the Public Health Service's 1935-1936 National Health Survey, which reported morbidity data stratified by socioeconomic measures. Efforts like these were cut short by the onset of World War II and their legacy erased by the Cold War. Recovering this rich history can help inform current debates about collecting and evaluating data on social inequalities in health.

Women's Position and Demographic Change

Part 1 Women's position as a cause of demographic change: the impact of women's position on demographic change during the course of development - what do we know?, Karen Oppenhem Mason reproductive behaviour - patriarchal structure and demographic change, urban women's autonomy and natural fertility in the Sahel region of Africa, changing family ties, women's position and low fertility, the status of women and the position of children - competition or complementarity? mortality and morbidity - women's position and child mortality and morbidity in less-developed countries, sex differentials in adult mortality in less-developed countries - the evidence and its explanation, the condition of women and the health and mortality of infants and children, social change and mortality decline - women's advantage achieved or regained?, sex inequalities in morbidity and mortality migration - effects of women's position on their migration, Lin Lean Lim. Part 2 Women's position as an outcome of demographic change: historical features of women's position in society, Solvi Sogner the effects of fertility, family organization, sex structure of the labour market and technology on the position of women, Helen Ware birds in a cage - institutional change and women's position in Bangladesh, Shapan Adnan labour migration and female-headed households, Pauline Makinwa-Adebusoye some critical issues - occupational and conjugal inequalities and insecurity - effects on family organization and size, Christine Oppong.

Health and social inequalities in Turkey

Social and economic policies of governments directly influence the health of the people. These policies, in turn, are determined by the national and foreign controllers of power. Economic and social factors in Turkey during the late 1970s led to a new modelling of the economic system, from a Keynesian to a market-oriented and monetarist model. The state mechanism was also altered to form a centralized. authoritarian regime in order to enforce the requirements of the economy. As a result, the middle class diminished in size, inequalities in income distribution increased, unemployment climbed, the purchasing power of wage earners decreased, government spending for education and health was cut and new oppressive laws were enacted. Health services were already urban-biased and hospital-oriented, but new free-market measures were instituted which promoted private health institutions and attempted to transform state-owned and financed hospitals into self-supporting, independent business enterprises. The only school of public health was closed down; preventive medicine expenditures were lowered while hospital rates and drug prices were increased. All these changes affected the health status of the population. Mortality and morbidity inequalities had already existed between the rich and the poor, men and women, urban and rural settlements, educated and illiterate, West and East, always in favour of the former. However, the new policies exacerbated the inequalities. Infectious diseases including tuberculosis increased, nutrition worsened, occupational diseases and work accidents rose to be the highest in Europe. The power-holding minority is not interested in the health of populations and is committed to pursue its social and economic policies. Ad hoc research, especially cross-sectional mortality studies repeated at regular intervals can provide data on the most vulnerable groups as no other valid information exists. There is little hope of these data being used for intervention unless democratic changes take place.

Inequalities in health and gender

Gender inequalities in health are studied in Denmark, Finland, Norway and Sweden on the basis of survey data on morbidity and symptoms of anxiety, and of mental hospitalization statistics. Women have higher rates of illness than men in countries where, and in periods when, they have to a great extent stayed at home as full-time housewives. Participation in paid economic activity and the resulting economical independence thus seems to be beneficial to women's health on the macro-level of society. On the micro-level of individual families, inequality in morbidity by gender is smaller in families with two economical providers than in families where the wife stays at home. The anxiety rates of employed wives are, however, relatively high compared with those of men and non-employed wives. Only in Sweden is the mental health of employed wives good, perhaps because of supportive social policies favouring women's work outside the home. The strain involved in combining family and work among women thus becomes manifest in the appearance of symptoms of anxiety but not in physical morbidity nor mental hospitalization.