Inequalities In Self-rated Health Research Articles

Why is there a gap in self-rated health among people with hypertension in Zambia? A decomposition of determinants and rural‒urban differences

BackgroundHypertension affects over one billion people globally and is one of the leading causes of premature death. Low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from more affluent and urban populations towards poorer and rural communities. Our study examined inequalities in self-rated health (SRH) among people with hypertension and whether there is a rural‒urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa.MethodsWe utilized the Zambia Household Health Expenditure and Utilization Survey for data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) survey. We applied the Linear Probability Model to assess the association between self-rated health and independent variables as a preliminary step. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups.ResultsAdvanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (73.6%), district HIV prevalence (30.8%) and household expenditure (4.8%) being the most important determinants that explain the health gap.ConclusionsUrban hypertension patients have better SRH than rural patients in Zambia. Education, district HIV prevalence and household expenditure were the most important determinants of the health gap between rural and urban hypertension patients. Policies aimed at promoting educational interventions, improving access to financial resources and strengthening hypertension health services, especially in rural areas, can significantly improve the health of rural patients, and potentially reduce health inequalities between the two regions.

Income-related inequality in health outcomes among older individuals in China: A measurement and decomposition analysis

Population aging in China presents a significant challenge, with projections indicating that individuals aged 65 and above will exceed 30% of the total population by 2050, thereby increasing health-care and long-term care (LTC) demands. Therefore, this study aimed to examine income-related inequality in self-rated health (SRH) and functional ability among older individuals in China while also examining the contribution of socioeconomic factors to health inequality. Data were drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Well-established tools, such as concentration curves, the Erreygers concentration index (EI), and decomposition analysis, were employed to elucidate income-related inequality in health within the sample. The results revealed that for SRH, both unstandardized and standardized concentration curves were observed below the 45° line, with unstandardized EI at 0.068 and standardized EI at 0.033. For functional ability, both unstandardized and standardized concentration curves were observed above the 45° line, with unstandardized EI at −0.016 and standardized EI at −0.003. These results suggest that, after controlling for demographic factors, the better-off group is more likely to report better SRH and less likely to experience functional limitations compared to the worse-off group. Furthermore, this inequality in health outcomes is predominantly driven by socioeconomic factors rather than demographic factors. For SRH, income emerges as the primary contributor to total inequality. Similarly, for functional ability, income emerges as the key factor driving inequality, disproportionately affecting the less affluent population. Consequently, it is crucial for the government to protect older individuals with lower socioeconomic status to mitigate income-related inequality in health by directly providing cash aids and formal LTC, which could contribute to promoting healthy aging in the context of global aging.

A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes

Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants’ age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children’s educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth.

Socioeconomic inequality in self-rated health and its determinants: an Oaxaca blinder decomposition in Ilam, West of Iran during 2023

AimTo determine inequality and decompose it’s in Self-Rated Health (SRH).MethodThis population-based cross-sectional study was undertaken on the entire population of the city of Ilam, Iran, in 2023. Multi-stage stratified cluster random sampling with proportion-to-size approach was used to select the participants. Oaxaca-Blinder decomposition technique was used to show the amount of inequity in SRH and to decompose of the gap of SRH between the poor and the rich group of participants.Results1370 persons participated in the study. The 59.38% of participants stated good SRH status and just 8.86% of participants had poor SRH status. The results of the Oaxaca-Blinder decomposition revealed a considerable gap (15.87%) in the poor status of SRH between the rich and the poor. A large proportion (89.66%) of this difference was described by explained portion of the model. The results of decomposition showed that economic status was directly responsible for explaining 27.98% of overall inequality gap between rich and poor people. Moreover, hopelessness to future (32.64%), having an underlying disease (18.34%) and difference in the education level (10.71%) were associated with an increase in inequality disfavoring the poor.ConclusionFor people suffering from underlying disease, it is suggested to devise policies to improve access to/and remove healthcare utilization barriers. To address hopelessness to future, it is recommended to carry out further studies to reveal factors which affect it in more details. This can help policy makers to formulate more realistic and evidence-informed policies on order to lessen the current socioeconomic inequity in SRH.

Sociodemographic decomposition of inequality in self-rated health: A cross-sectional study in Hubei, China

Objectives: Health inequality is associated with profound social, health and economic costs. Despite extensive studies about inequality in health outcomes, our understanding of inequality in self-rated health is quite limited. This study aimed to determine the inequality in self-rated health and its associated factors in Hubei populations, China. Methods: A cross-sectional questionnaire survey was conducted on the community residents purposively selected from six municipalities in Hubei province, China. Participants were asked to rate their health on a five-point Likert scale, ranging from 1 to 5. A total of 1336 valid questionnaires were collected. Inequality in self-rated health was assessed using concentration index and further decomposed to measure sociodemographic inequality in the health of residents. Results: Two thirds (66%) of respondents rated their health as “excellent/very good/good”, while 34% rated it as fair or poor. The income-related concentration index was 0.0321 (95% CI, 0.0229 to 0.0413), indicating a concentration of poor self-rated health in the low-income groups. The CI of SRH in urban areas was 0.0239, which was lower than that in rural areas (0.0379). Age (17.5%) made the biggest contribution to the inequality in SRH, which was followed by employment (15.7%), income (8.5%), education (4.5%) and physical exercise (3.0%). Conclusions: There exist socioeconomic inequalities in self-rated health in Hubei, China. Policy priorities should be given to rural area, the older people and those with low economic participation.

Educational inequalities in self-rated health and their mediators in late adulthood: Comparison of China and Japan.

Education has an impact on health, but the magnitude of the impact may vary across countries. This cross-sectional study compared educational inequalities in health and their mediators in late adulthood between China and Japan, which both face rapid population aging. We studied the same age cohort (63-72 years) based on two nationwide population-based surveys in 2018: the China Health and Retirement Longitudinal Study (N = 5,277) and Japan's Longitudinal Survey of Middle-Age and Elderly Persons (N = 20,001). The relative index of inequality (RII) in education was used to measure educational inequality in self-rated health (SRH). We then examined the extent to which income, smoking, leisure-time physical activity, and social participation mediated educational inequalities in SRH. In both countries, a lower educational level was associated with a higher risk of poor SRH; in China, however, the gradient was flatter. In China, the RII of education was 1.69 (95% confidence interval [CI]: 1.20-2.39) for men and 1.47 (95% CI: 1.06-2.05) for women. In Japan, meanwhile, RII was 2.70 (95% CI: 2.21-3.28) for men and 2.60 (95% CI: 2.13-3.18) for women. Our mediation analysis based on logistic regression models with bootstrapping also found that social participation was a key mediator of educational inequalities in health in both countries. In all, the results underscore that one's relative position in educational inequalities is a reliable predictor of subjective health in late adulthood in both China and Japan.

Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet

IntroductionHuman health and wellbeing may depend on economic growth, the implication being that policymakers need to choose between population health and the health of ecosystems. Over two decades of low economic growth, Japan's life expectancy grew. Here we assess the temporal changes of subjective health and health inequality during the long-term low economic growth period. MethodsEight triennial cross-sectional nationally representative surveys in Japan over the period of economic stagnation from 1992 to 2013 were used (n = 625,262). Health is defined positively as wellbeing, and negatively as poor health, based on self-rated health. We used Slope and Relative Indices of Inequality to model inequalities in self-rated health based on household income. Temporal changes in health and health inequalities over time were examined separately for children/adolescents, working-age adults, young-old and old-old. ResultsAt the end of the period of economic stagnation (2013), compared to the beginning (1992), the overall prevalence of wellbeing declined slightly in all age groups. However, poor health was stable or declined in the young-old and old-old, respectively, and increased only in working-age adults (Prevalence ratio: 1.14, 95% CI 1.08, 1.20, <0.001). Over time, inequality in wellbeing and poor self-rated health were observed in adults but less consistently for children, but the inequalities did not widen in any age group between the start and end of the stagnation period. ConclusionsAlthough this study was a case study of one country, Japan, and inference to other countries cannot be made with certainty, the findings provide evidence that low economic growth over two decades did not inevitably translate to unfavourable population health. Japanese health inequalities according to income were stable during the study period. Therefore, this study highlighted the possibility that for high-income countries, low economic growth may be compatible with good population health.

Socioeconomic inequality in health in older adults in Brazil.

This study analyzed socioeconomic inequality in self-rated health for older adults (aged fifty or over) in Brazil. Data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). Socioeconomic inequality in self-rated health was measured using the concentration index, which was decomposed to analyze the contribution of different factors. This study revealed that 11.5% of the older adults interviewed reported their health as poor and very poor. For the complete sample, the estimated concentration index, -0.2434, indicated that there is a concentration of poor and very poor self-rated health among older and poorer adults. Income, education and having a private health insurance plan are the factors that contributed most to the observed inequality. The decomposition showed that there are avoidable inequalities in relation to socioeconomic status for older adults in Brazil. These factors can guide the formulation of social and health policies aimed at reducing health inequalities.

Effect of personality traits on socioeconomic inequalities in health, a population-based study.

This study aimed to estimate the effects of positive personality traits (PTs) in income and self-rated dental and general health (SRDH and SRGH) associations in a large South Australian sample. Cross-sectional analyses were conducted using self-reported data collected from 3578 adults (2015-2016). Multivariable regression models assessed the main effects and interactions of the Ten-Item Personality Inventory (TIPI) and income with SRDH and SRGH. Prevalence ratios (PR) of poor health ratings were estimated using Poisson regression. Among all respondents, high-income individuals with stronger Conscientiousness scores had the lowest prevalence of poor SRGH (0.8%), while those with stronger Extraversion (2.9%) and Agreeableness scores (3.4%) had the lowest prevalence of poor SRDH. Poor SRGH was related to weak Conscientiousness (PR=6.9, 95% CI [2.3-20.8]) and Emotional Stability scores (PR=6.0, 95% CI [2.0-18.3]), while poor SRDH was associated with weak Extraversion (PR=2.3, 95% CI [1.2-4.5]), Agreeableness (PR=1.8, 95% CI [1.0-3.2]) and Conscientiousness scores (PR=2.1, 95% CI [1.1-4.0]). Among low-income people, poor health ratings were less prevalent in those with stronger positive PTs scores versus weaker scores. Among low-income respondents, poor SRGH was lower in individuals with stronger versus weaker Conscientiousness scores (10.9% vs 16.2%), and poor SRDH showed lower prevalence in participants with stronger versus weaker Agreeableness scores (18.1% vs 22.6%). Findings showed the association between PTs and the prevalence of poor SRDH and SRGH. Stronger positive PTs modified the self-rated health inequalities associated with low income in a representative sample of the South Australian population.

Disability-related inequalities in health and well-being are mediated by barriers to participation faced by people with disability. A causal mediation analysis

Large inequalities in health and well-being exist between people with and without disability, in part due to poor socio-economic circumstances, and potentially also related to societal factors including issues associated with accessibility and participation. To better understand the contribution of societal factors, we used a unique longitudinal survey of disability in Great Britain to quantify the extent to which barriers to participation contribute to poorer health and well-being. We used data from 2354 individuals who participated in three waves of the Life Opportunities Survey between 2009 and 2014 and compared five health and well-being outcomes (self-rated health, anxiousness, life satisfaction, life worth, happiness) between adults who acquired an impairment and those who remained disability-free. Causal mediation analysis was conducted to quantify how much of the effect of disability acquisition on each outcome was explained by barriers to participation in employment, economic life, transport, community, leisure and civic activities, social contact, and accessibility. People who recently acquired a disability had poorer health and well-being compared to people with no disability. Barriers to participation explained 15% of inequalities in self-rated health, 28% for anxiousness, 32% for life satisfaction, 37% for life worth, and 70% for happiness. A substantial proportion of the inequalities in health and well-being experienced by people with recently acquired disability were socially produced, driven by barriers to participation in different life domains. Furthermore, there was evidence that barriers to participation mediated the effect of well-being measured to a greater extent than the more clinically aligned measures, self-reported health and anxiousness. These findings highlight modifiable factors amenable to public health interventions that could lead to substantial improvements in health and well-being for people with disability.

Educational inequalities in self-rated health and emotional exhaustion among workers during the COVID-19 pandemic: a longitudinal study

ObjectiveThis study aimed to investigate trends in educational inequalities in poor health and emotional exhaustion during the pandemic among workers, and differences in trends between men and women.MethodsFive waves (2019–2021) from the longitudinal study ‘the Netherlands Working Conditions Survey COVID-19 study’ were used (response rates: 32–38%). Generalized logistic mixed models were used to estimate the changes in absolute and relative educational inequalities in poor health and emotional exhaustion for all workers (n = 12,479) and for men and women, separately.ResultsLow and intermediate educated workers reported more often poor health (OR 2.54; 95% CI 1.71–3.77 and OR 2.09; 95% CI 1.68–2.61, respectively) than high educated workers. Intermediate educated women (OR 0.49; 95% CI 0.37–0.64) reported less emotional exhaustion than high educated women, but no differences were observed among men. The prevalence of poor health first decreased across all educational levels until March 2021, and bounced back in November 2021. A similar pattern was found for emotional exhaustion, but for low and intermediate educated workers only. Relative educational inequalities in poor health reduced among men during the pandemic, and absolute differences decreased among men and women by 2.4–2.6%. Relative educational inequalities in emotional exhaustion widened among men only. Absolute differences in emotional exhaustion first increased among both men and women, but narrowed between the last two waves.DiscussionSocioeconomic inequalities for poor self-rated health remained but narrowed in relative and absolute terms during the pandemic. With regard to emotional exhaustion, socioeconomic inequalities returned to pre-COVID-19 levels at the end of 2021.

Regional differences in health further explained

AbstractLike in most Western countries, regional health inequalities are also present in the Netherlands. Explaining these inequalities is necessary for policymakers to target interventions to reduce them. Regional health inequalities are usually attributed to demographic and socio-economic factors, while lifestyle and psychosocial factors are increasingly shown to impact individuals’ health. Therefore, this study analyses the role of lifestyle, loneliness, and self-mastery in explaining regional inequalities, in addition to demographic factors and SES, for self-rated health, presence of chronic diseases, and psychological distress. Analyses are performed in the linked dataset from the Dutch Public Health Services, Statistics Netherlands, and the National Institute for Public Health and the Environment for the year 2016 (n = 334,721). The results show that lifestyle, loneliness and self-mastery contribute to the regional health inequalities in self-rated health and presence of chronic diseases. For psychological distress, both loneliness and self-mastery contribute to the regional health inequalities. Addressing lifestyle and psychosocial factors can offer policymakers additional pathways to bridge regional health inequalities. In this study, the region of Zuid-Limburg represents the reference region. Use compare regions for health and healthcare costs (Regiovergelijker gezondheid en zorgkosten [1]) in order to select all other Dutch regions as reference region.

Development of gender inequality in self-rated health in the life-phase of raising children in Germany from 1994 to 2018 – A decomposition analysis of socioeconomic, psychosocial and family-related influencing factors

Extensive research has documented gender inequalities in self-rated health (SRH) to the disadvantage of women. However, little research has been done on how this gender gap has changed against the backdrop of social change. Using data from the German Socio-Economic Panel Study (GSOEP), this study addressed this issue and examined time-trends in SRH between 1994 and 2018 in women (n = 117,608) and men (n = 101.404) aged 30–49 years. In addition, we analyzed the role of socioeconomic, psychosocial and family-related factors as possible mediators influencing these trends. We performed logistic regression analyses for analyzing the time-trends and applied the Karlson-Holm-Breen (KHB) method for decomposing the time effect into direct and indirect parts via mediators.Over time, the chance of reporting good as well as poor SRH remained largely stable in both genders while the majority of socioeconomic and psychosocial factors pointed towards improvement. The decomposition analysis revealed a positive effect of most of these mediators on the time trend in SRH. After controlling for the mediators, the health trend became negative, leading to a decline in the proportion of good health over time by 5.4%-point and 4.3%-point in women and men, respectively. The same pattern was observed with respect to poor SRH. For both genders, the decline of economic worries and the rise in school education contributed most to the indirect time effect.Our findings indicate a positive development of key socioeconomic and psychosocial health determinants particularly for women, but no corresponding increase in SRH. Thus, gender inequality in SRH remained largely unchanged. However, our results suggest that SRH would have developed much worse if there had been no improvements in the health determinants considered. Further studies are needed to determine what other factors may have counteracted a positive health trend and stood in the way of narrowing the gender health gap.

Trends and Changes in Socio-Economic Inequality in Self-Rated Health among Migrants and Non-Migrants: Repeated Cross-Sectional Analysis of National Survey Data in Germany, 1995-2017.

Socio-economic inequalities in health may change over time, and monitoring such change is relevant to inform adequate policy responses. We aimed to quantify socio-economic inequalities in health among people with direct, indirect and without migration background in Germany and to assess temporal trends and changes between 1995 and 2017. Using nationally representative survey data from the Socio-Economic Panel (SOEP), we quantified absolute and relative socio-economic inequalities in self-reported general health by calculating the slope (SII) and relative index of inequality (RII) with 95% confidence intervals (CI) among each group and year (1995–2017) in a repeated cross-sectional design. Temporal trends were assessed using a GLM regression over the SII and RII, respectively. The total sample size comprised 492,489 observations, including 108,842 (22.23%) among people with migration background. About 31% of the population with and 15% of the population without migration background had a low socio-economic status. Socio-economic inequalities in health persisted in the group with migration background (1995 to 2017), while inequalities in the non-migrant population increased (SII: = 0.04, p < 0.01) and were on a higher level. The highest socio-economic inequalities in health were found among those with direct migration background ( = −0.23, p< 0.01; = −0.33, p < 0.01). The results show that the magnitude and temporal dynamics of inequalities differ among populations with direct, indirect and without migration background. Monitoring systems can capture and investigate these inequalities if migrant populations are adequately integrated into the respective systems.

Intergenerational reproduction and self-rated health in Canada.

Intergenerational processes in which the socioeconomic status of middle- and upper-class parents is reproduced in their children have been extensively documented by social scientists. We mobilized a unique dataset, the Longitudinal and International Study of Adults (LISA) linked to income data from the Canada Revenue Agency (CRA), to investigate the relevance of intergenerational socioeconomic reproduction for inequalities in self-rated health in a national sample of Canadians aged 25 to 50. We found strong intergenerational elasticities implicating both parental education and parental family income in the acquisition of both personal education and personal family income. Parental education was not significantly associated with self-rated health. Parental family income was significantly associated with self-rated health among women only, partly explained by the socioeconomic status of the women themselves. These results suggest that intergenerational reproduction plays a small role in the generation of high levels of self-rated health among Canadian women but not among Canadian men.

Socioeconomic inequalities in self-rated health in Japan, 32 European countries and the United States: an international comparative study.

Japan is known as a country with low self-rated health despite high life expectancy. We compared socioeconomic inequalities in self-rated health in Japan with those in 32 European countries and the US using nationally representative samples. We analysed individual data from the Comprehensive Survey of Living Conditions (Japan), the European Union Statistics on Income and Living Conditions, and the Behavioral Risk Factor Surveillance System (US) in 2016. We used ordered logistic regression models with four ordinal categories of self-rated health as an outcome, and educational level or occupational class as independent variables, controlling for age. In Japan, about half the population perceived their health as 'fair', which was much higher than in Europe (≈20-40%). The odds ratios of lower self-rated health among less educated men compared with more educated were 1.72 (95% confidence interval (CI) 1.61-1.85) in Japan, and ranged from 1.67 to 4.74 in Europe (pooled; 2.10 (95% CI 2.01-2.20)), and 6.65 (95% CI 6.22-7.12) in the US. The odds ratios of lower self-rated health among less educated women were 1.79 (95% CI 1.65-1.95) in Japan, and ranged from 1.89 to 5.30 in Europe (pooled; 2.43 (95% CI 2.33-2.54)), and 8.82 (95% CI 8.29-9.38) in the US. Socioeconomic inequalities were large when self-rated health was low for European countries, but Japan and the US did not follow the pattern. Japan has similar socioeconomic gradient patterns to European countries for self-rated health, and our findings revealed smaller socioeconomic inequalities in self-rated health in Japan compared with those in western countries.

Racial Inequities in Self-Rated Health Across Brazilian Cities: Does Residential Segregation Play a Role?

Racial health inequities may be partially explained by area-level factors such as residential segregation. In this cross-sectional study, using a large, multiracial, representative sample of Brazilian adults (n = 37,009 individuals in the 27 state capitals; National Health Survey (Pesquisa Nacional de Saúde), 2013), we investigated 1) whether individual-level self-rated health (SRH) (fair or poor vs. good or better) varies by race (self-declared White, Brown, or Black) and 2) whether city-level economic or racial residential segregation (using dissimilarity index values in tertiles: low, medium, and high) interacts with race, increasing racial inequities in SRH. Prevalence of fair or poor SRH was 31.5% (Black, Brown, and White people: 36.4%, 34.0%, and 27.3%, respectively). Marginal standardization based on multilevel logistic regression models, adjusted for age, gender, and education, showed that Black and Brown people had, respectively, 20% and 10% higher prevalence of fair or poor SRH than did White people. Furthermore, residential segregation interacted with race such that the more segregated a city, the greater the racial gap among Black, Brown, and White people in fair or poor SRH for both income and race segregation. Policies to reduce racial inequities may need to address residential segregation and its consequences for health.

Assessing Socioeconomic Inequality in Self-Rated Health in Four ex-Yugoslav Countries

There has been a growing academic interest in explaining the well-established association between socioeconomic status and health. Among the various proposed mechanisms and pathways, social capital has been recognised as a potentially important antecedent of socioeconomic inequalities in health. However, these interrelationships remain relatively unexplored within the countries of former Yugoslavia. Therefore, this article aims to fill the gap in the literature by exploring the role of individual-level social capital in the relationship between socioeconomic status and self-rated health in four ex-Yugoslav countries. The present study is based on the data from the ninth round of the European Social Survey (2018). The author analysed the data of participants aged 25 and over from Croatia (N = 1534), Montenegro (N = 1002), Serbia (N = 1720) and Slovenia (N = 1149). In order to test the target associations, sequential multivariate logistic regression analysis was performed. The results show that occupational social class and several social capital indicators are associated with self-rated health, although independently of each other. Across all countries, unskilled and skilled manual workers and long-term unemployed individuals were more likely to report poor health compared to non-manual workers, with the exception of Montenegrin skilled manual workers and the long-term unemployed participants from Slovenia. Moreover, despite some cross-country differences in the relationship between individual levels of social capital and self-rated health, social participation was associated with self-rated health across all countries. These findings highlight the importance of encouraging social participation within these countries, which can lead to health benefits through behavioural and psychosocial mechanisms.

Mediation Effect of Metal Mixtures in the Association Between Socioeconomic Status and Self-rated Health Among US Adults: A Weighted Quantile Sum Mediation Approach

This study aimed to examine the association between socioeconomic status (SES) and self-rated health (SRH) among US adults and the extent to which blood and urinary metal mixtures explain this association. We used 14 years of repeated cross-sectional data that consists of seven consecutive NHANES cycles from 2003 to 2016 (n = 9497). SRH was measured using a 5-point Likert scale, and SES was measured by family income to poverty ratio (FMPIR), levels of education, and employment status. Blood concentration of lead, mercury, and cadmium, and urinary concentrations of ten heavy metals (arsenic, barium, cadmium, cesium, cobalt, lead, mercury, molybdenum, thallium, tungsten) were used as metal mixtures. The total effect of SES on SRH was examined by linear regression model. The direct effect of SES on blood and urinary metal mixtures was examined by the weighted quantile sum (WQS) regression with repeated holdout validation method, and the average causal mediation effects of blood and urinary metal mixtures were examined by model-based causal mediation technique. Results showed that SES indicators [education β: 0.17; 95% Confidence Interval (CI): 0.15, 0.18; employment β: 0.16; 95% CI: 0.12, 0.21; and FMPIR β: 0.09; 95% CI: 0.08, 0.11] were significantly positively, and the WQS indices of blood and urine metal mixtures (blood β: −0.04; 95% CI: − 0.05, − 0.03, urine β: − 0.07; 95% CI: − 0.13, − 0.004) were significantly inversely associated with SRH in the US adults. The novel finding was the mechanism between SES and SRH that exposure to heavy metals may explain socioeconomic inequalities in SRH in the US general population. Longitudinal studies are needed to corroborate this study results.

Trends in absolute and relative educational inequalities in health during times of labour market restructuring in coastal areas: The HUNT Study, Norway

BackgroundRestructuring labour markets offers natural population-level experiments of great social epidemiological interest. Many coastal areas have endured substantial restructuring of their local labour markets following declines in small-scale fishing and transitions to new employment opportunities. It is unknown how educational inequalities in health have developed in formerly fishery-dependent communities during such restructuring. In this study, we compare trends in social inequalities in health in Norwegian coastal areas with adjacent geographical areas between 1984 and 2019. MethodsWe used cross-sectional population-based data from the Trøndelag Health Study (HUNT), collected four times: HUNT1 (1984–86), HUNT2 (1995–97), HUNT3 (2006–08) and HUNT4 (2017–19). Adults above 30 years of age were included. Using Poisson regression, we calculated absolute and relative educational inequalities in self-rated health, using slope (SII) and relative (RII) indices of inequality. ResultsTrends in absolute and relative inequalities in rural coastal health were generally more favourable than in adjacent geographical areas. We found a statistically significant trend of declining relative educational inequalities in self-rated health in the rural coastal population from HUNT1 to HUNT4. Absolute inequalities overall increased from HUNT1 to HUNT4, although a declining trend followed HUNT2. Nonetheless, the rural coastal population exhibited the highest prevalence of poor self-rated health across the four decades. ConclusionsAlthough absolute educational inequalities in self-rated health widened in all geographical areas, the smallest increase was in rural coastal areas. Relative educational inequalities narrowed in this rural coastal population. Considering the concurrent processes of large-scale investments in the Norwegian public sector and welfare schemes, increased fishing fleet safety, and employment opportunities in aquaculture, our findings do not suggest that potential positive effects on public health of this restructuring have benefitted inhabitants with higher educational attainment more than inhabitants with lower educational attainment in this rural coastal population.