Low Education Group Research Articles

Disaggregation of official demographic projections in sub-groups by education level: the neglected \u201ccomposition effect\u201d in the future path of life expectancy

We developed an innovative method to break down official population forecasts by educational level. The mortality rates of the high education group and low education group were projected using an iterative procedure, whose starting point was the life tables by education level for Italy, based on the year 2012. We provide a set of different scenarios on the convergence/divergence of the mortality differential between the high and low education groups. In each scenario, the demographic size and the life expectancy of the two sub-groups were projected annually over the period 2018–2065. We compared the life expectancy paths in the whole population and in the sub-groups. We found that in all of our projections, population life expectancy converges to the life expectancy of the high education group. We call this feature of our outcomes the “composition effect”, and we show how highly persistent it is, even in scenarios where the mortality differential between social groups is assumed to decrease over time. In a midway scenario, where the mortality differential is assumed to follow an intermediate path between complete disappearance in year 2065 and stability at the 2012 level, and in all the scenarios with a milder convergence hypothesis, our “composition effect” prevails over the effect of convergence for men and women. For instance, assuming stability in the mortality differential, we estimated a life expectancy increase at age 65 of 2.9 and 2.6 years for men, and 3.2 and 3.1 for women, in the low and high education groups, respectively, over the whole projection period. Over the same period, Italian official projections estimate an increase of 3.7 years in life expectancy at age 65 for the whole population. Our results have relevant implications for retirement and ageing policies, in particular for those European countries that have linked statutory retirement age to variations in population life expectancies. In all the scenarios where the composition effect is not offset by a strong convergence of mortality differentials, we show that the statutory retirement age increases faster than the group-specific life expectancies, and this finding implies that the expected time spent in retirement will shrink for the whole population. This potential future outcome seems to be an unintended consequence of the indexation rule.

Gender differences in health insurance coverage in China

BackgroundChina initiated a reform of the health insurance system in the late 1990s. The new insurance, Urban Employee Basic Medical Insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance.MethodsBased on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.ResultsBased on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group.ConclusionsThis paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women’s greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI’s implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.

Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies

SummaryBackgroundPrevious studies have shown an excess risk of Alzheimer's disease and related dementias among women. Education is thought to have a causal association with dementia onset. We aimed to investigate the role of education in influencing sex differences in cognitive ageing.MethodsWe analysed data from two prospective cohort studies in the UK; the English Longitudinal Study of Ageing (ELSA) and the Whitehall II study, to assess sex differences in cognitive performance and cognitive decline by birth cohort (birth year 1930–38, 1939–45, or 1946–55), before and after adjustment for education, and by high and low education level. Memory was assessed using immediate recall, for which data were available from all waves of the ELSA (2002–14) and Whitehall II (1997–2015) studies. Fluency was assessed using a semantic fluency test based on an animal naming task, with data available from all waves of the Whitehall II study and waves one to five (2002–10) and wave seven (2014) of the ELSA study. Cognitive scores were standardised separately in each study based on the mean and SD of the corresponding test among participants aged 50–59 years with secondary education.Findings15 924 participants were included from the two studies. In pooled analyses, women had better memory scores than men in all birth cohorts, irrespective of adjustment for education (eg, at age 60 years, birth cohort 1930–38, mean difference between sexes [male scores minus female scores] –0·25 SDs [95% CI –0·32 to –0·19] after adjustment for education), and in both education level groups. Memory decline was faster in men than in women (at age 60 years, birth cohort 1946–55, mean difference in 13-year change –0·15 SDs [–0·20 to –0·09]; after adjustment for education –0·14 SDs [–0·20 to –0·08]). Men had better fluency scores than women in earlier birth cohorts and in the low education group (at age 60 years, birth cohort 1930–38, mean difference 0·20 SDs [95% CI 0·05 to 0·36]); but women had better fluency scores than men in later birth cohorts and in the high education group (at age 60 years, birth cohort 1946–55, mean difference –0·17 SDs [–0·24 to –0·10]). No sex differences were observed for fluency decline.InterpretationOur findings suggest that decreasing disparities between sexes in education, due to secular increases in educational opportunities, could attenuate sex differences in dementia risk and cognitive decline in the future.FundingNational Institute on Aging, National Institutes of Health; UK Medical Research Council; British Heart Foundation; and National Institute for Health Research.

Risk factors for chronic liver disease in population of Central India: a case-control study from rural India

BackgroundChronic liver disease (CLD) is one of the leading causes of morbidity and mortality in today’s world. Common risk factors for CLD are alcohol, chronic hepatitis B, chronic hepatitis C, non-alcoholic steatohepatitis (NASH), malnutrition, toxins, and some tropical infections. This case-control study was carried out to determine the risk factors of domestic CLD in a resource-constrained setting in central rural India. A hospital-based matched case-control study was carried out among eligible CLD cases from November 2015 to October 2017. A total of 200 cases and 200 age- and gender-matched community controls were selected using consecutive sampling from tertiary care hospitals from central rural India. Information on socio-demographic, etiological was collected through using a pretested structured questionnaire after obtaining informed written consent. Univariate and multivariate analyses were carried out to find the risk factors associated with CLD.ResultsThe median age of study participant was 58.5 years among the cases. There were 75% male and remaining 25% were female in each case and control group. On multivariate analysis, we found less education, poor socioeconomic status, diabetes mellitus, increased body mass index (BMI), alcohol consumption, and tobacco chewing were significant risk factors for CLD in comparison to controls. However, amount of alcohol, smoking, and occupation were not found to be statistically significant association with CLD.ConclusionsThe findings showed that in patients with CLD when compared to controls, high alcohol intake, diabetes mellitus, tobacco chewing, central obesity, low education, and low-income group are significant risk factors in our rural population. An initiative needs to be taken to reduce alcohol, and tobacco chewing habits at various levels through awareness campaigns, strict control, and legislation to limit further abuse. Control of blood glucose and reduction of obesity may be important in preventing CLD in our rural community.

Racial inequality, racial discrimination and obesity incidence in adults from the ELSA-Brasil cohort

BackgroundThis study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also...

Public awareness of early symptoms of acute myocardial infarction among Saudi population.

Introduction:Globally speaking, cardiovascular disease is the leading cause of mortality, with coronary artery disease (CAD) contributing to half of the cases. A major complication of CAD is myocardial infarction (MI). The clinical outcomes of MI are predominantly time-dependent; therefore, it is paramount that the general public is familiar with the early symptoms of MI.Aim:The main objective is to gauge the local public awareness of the early symptoms of MI, and their knowledge of the best course of action to be taken from the onset of symptoms.Method:A cross-sectional study was conducted using google forms. Participants were randomly selected through multiple social media platforms. The study included Saudi citizens who were 18 years or older, with no current or prior experience in the health care field. The questionnaire assessed the participants' awareness of 14 risk factors for CAD. The variables investigated were participants' knowledge of the symptoms, causes, appropriate course of action to be taken, and the risk factors of CAD.Results:A total of 1689 participants were involved in this study. Sixty percent were females, and 29.2% were in the age group of 18–24 years. Seventy-three percent of the participants knew the definition of heart attack, and 90% knew that chest pain is a symptom of a heart attack. Approximately, 75% of the participants recognized that hypertension, cigarette smoking, and high cholesterol are the risk factors of MI. In terms of knowledge, Al Madinah province obtained the highest score when compared with other regions.Conclusion:This study showed the overall knowledge and awareness of CAD was suboptimal, indicating that awareness initiatives and patient education of CAD need more work in Saudi Arabia, especially in high-risk groups and lower education groups. More studies are needed to identify the efficiency and population access of different approaches for CAD awareness.

THE DIFFERENCES IN SUBJECTIVE QUALITY OF LIFE AMONG THE DIVORCED/SEPARATED IN ABU DHABI

This study attempts to understand various aspects of the quality of life (QoL) of the divorced and the separated in Abu Dhabi. A descriptive analysis approach was adopted to explore the differences in some selected QoL indicators, including health perceptions, depressive feelings, social connection, happiness, and life satisfaction between and among various demographical categories of the divorced and the separated. This research drew data from the second cycle of the Quality-of-Life survey in Abu Dhabi conducted in 2019-2020, in which a total of 3,192 divorced or separated individuals participated. The analysis followed mainly a descriptive approach, presenting the means of each well-being variable by various respondent categories. The analysis of variance (ANOVA) was also used to examine the degree of differences. The results show that the divorced/separated generally exhibit a significantly low level of QoL attributes. Moreover, the divorced/separated show significant differences in those selected QoL indicators when gender, age, nationality, income, residence, and education are factored in. Most of the lowest QoL scores were reported by females, lower-income groups, younger age groups, residents of the Al Ain region, low education groups, and non-Emiratis. Policy implications and future research directions are recommended.

National Trends in the Public's Likelihood of Getting a COVID-19 Vaccine in Bangladesh: Understanding the Strategies to Optimize Vaccination Coverage

Background: Although the COVID-19 vaccine has been proved to be safe and effective, mass vaccination in Bangladeshi people remains a challenge even without a cost. A high percentage of reluctance to vaccine could result in poor control of the disease. We aim to identify the prevalence of vaccine acceptance in Bangladeshi adults and analyze the associated sociodemographic, clinical, and healthcare-related factors on the likelihood of getting a COVID-19 vaccine.Methods: This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on uncertainty and reluctance to be vaccinated for COVID-19.Findings: Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a cost, while 8.5% were reluctant to vaccinate. The prevalence of vaccine acceptance will decline to 46.5% if the government introduces a minimum vaccine fee. Moreover, 612 (16.8%) of the 3643 respondents reported adequate adherence to health safety regulations for COVID-19, and 1294 (35.5%) of the respondents reported high confidence in the country's healthcare system. However, the COVID-19 vaccine refusal was significantly increased in elderly, rural, semi-urban, and slum communities, farmers, day laborers, homemakers, low-educated populations, and those who had low confidence in the country's healthcare system. Moreover, the prevalence of vaccine uncertainty is high in the elderly population, low-educated group, day-laborers, presence of chronic diseases, and people with low confidence in the country's healthcare system.Interpretation: A high prevalence of vaccine refusal and uncertainty is observed in rural people and slum dwellers in Bangladesh. This community of people also has a low literacy level, and we found a decreasing trend of prevalence in vaccine acceptance with decreasing education level. It is expected that an app-based registration system would not be appropriate for low-educated groups, and a feasible alternative strategy such as local spot-registration could be devised. Furthermore, for rural, semi-urban, and slum people, outreach centers for vaccination can be established to ensure the vaccine's nearby availability and limit associated travel costs. In rural areas, community health workers, valued community-leaders, and non-governmental organizations can be utilized to motivate and educate people for vaccination against COVID-19. Further, emphasis should be given to the elderly and diseased people with tailored health messages and assurance from healthcare professionals. The media may play a responsible role with the vaccine education program and eliminate the social stigma about the vaccination. Finally, free vaccination should be continued until the end of the vaccination program. Thus Bangladesh's Covid vaccination program can become a model for other low and middle-income countries.Funding Statement: None. Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: The Institutional Review Board approved the study at North South University, Bangladesh (2020/OR-NSU/IRB/1003).

Socio-Economic Family Background and Adult Children’s Health in Germany: The Role of Intergenerational Transmission of Education

AbstractThis study examines consequences of parental education for adult children’s physical and mental health using panel data from the German Socio-Economic Panel study. Based on random-effects growth curve models (N = 15,144 West German respondents born between 1925 and 1998 aged 18–80), we estimate gender-, age-, and cohort-specific trajectories of physical and mental health components of the SF-12 questionnaire for low and high parental education measured biennially from 2002 to 2018. Findings suggest more persistent effects of parental education on physical than mental health. In particular, both daughters and sons of the lower educated group of parents (with neither parent qualified for university) exhibit markedly poorer physical health over the whole life course and worse mental health in mid-life and later life than those of higher educated parents. Thus, children’s health gradients conditional on parental education tend to widen with increasing age. Once children’s educational attainment is held constant, effects of parental education on children’s health mostly vanish. This suggests that in the strongly stratified West German context with its rather low social mobility, intergenerational transmission of education, which, according to our analyses, has been declining among younger cohorts, contributes to cementing long-term health inequalities across the life course.

Is it still a man’s world? Social media news use and gender inequality in online political engagement

ABSTRACT Social media platforms have created new opportunities for political engagement. This has brought about a rich body of literature on the relationship between the two. However, the impact of social media on redressing or augmenting gender inequality in engagement remains underexplored. This cross-national comparative study investigates the role of social media news use in influencing gender inequality in online political engagement across three Sub-Saharan African nations: Kenya, Nigeria, and South Africa. An analysis of survey data suggests that there exists a gender divide in online political engagement in the three countries. Furthermore, the informational use of social media increases the likelihood of online political engagement. Still, social media news use exacerbates gender-driven engagement inequality. Finally, education reinforces the role of social media in engagement inequality such that the gender divide in online political engagement is found to be most significant among the higher than lower educated groups. Theoretical and policy implications are discussed.

Exclusion and Inequality in Late Working Life–On the Gendered Risks for Old-Age Exclusion in Sweden and Poland

The labour market activity of older workers and their ability and disposition to maintain it depend on institutional conditions, age norms, labour demand and shifting overall economic conditions. The paper discusses exclusion and inequality in later working life from a European comparative perspective and emphasises shifts in late work and retirement patterns as well as later-life outcomes in Sweden and Poland. An emphasis is on changing institutional conditions on the national and branch level. Gendered risks for economic exclusion and later life precarity are stressed. Analyses for the two countries are contrasted with Germany and the UK. The analyses are part of the research program ‘Exclusion and Inequality in Late Working Life: Evidence for Policy Innovation Towards Inclusive Extended Work and Sustainable Working Conditions in Sweden and Europe – EIWO’ (2019-24). Analyses use data from SHARE and EU-SILC and address older workers of age 60 and older in Sweden, Poland, German and the UK. They find increasingly heterogeneous preretirement and transition patterns, new gender gaps and increasing risks of economic exclusion in retirement. Situations differ between countries with the prolongation of late working life in Sweden having a mostly positive effect on gender inequalities with low education and specific migrant groups as an exception. Poland is specific case due to unequally low retirement age for woman (60) and for men (65) with consequently large structural gender differences and increases in the process of increasing labour force participation of older workers and increasingly gendered risks for old-age economic exclusion.

Correlation evaluation of the international prostate symptom score (IPSS), visual prostate symptom score (VPSS), and modified visual prostate symptom score (mVPSS) in Thai males with benign prostatic hyperplasia

Objective: To study the correlation between the modified visual prostate symptom score (mVPSS), the visual prostate symptom score (VPSS) and the international prostate symptom score (IPSS) in Thai males who were diagnosed with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Material and Method: One hundred and ten Thai males who were diagnosed with BPH and LUTS by urologists were enrolled onto the study between 1st March and 31st July 2019. They were divided into 2 different groups by simple random sampling. The first group was requested to complete the A questionnaire which was composed of IPSS and VPSS and the second group was assigned to finish the B questionnaire which consisted of IPSS and mVPSS. Both groups had to complete their personal data, including age, education level, monthly income, and duration of treatment for BPH, and they also were classified as high or low educated groups. The correlations between the scores of mVPSS, VPSS, and IPSS in the high or low educated groups were assessed using Pearson’s correlation coefficient with IBM SPSS statistics 22.0. Results: There were statistically significant correlations between mVPSS, VPSS, and IPSS (P<0.05) in total and individual scores, which consisted of quality of life, voiding symptom score, storage symptom score, frequency score and nocturia score. According to this study, it was found that the mVPSS and VPSS questionnaires took less time to complete and were easier than the IPSS. However, in high-educated patients, there was no statistically significant rate to complete the mVPSS, VPSS and IPSS questionnaire by themselves. In addition, this study showed a strong positive correlation between the IPSS versus mVPSS and VPSS in the high-educated groups (r=0.935 and r=0.898, respectively). In contrast, in the low-educated patient group, there was no statistically significant correlation between the VPSS and IPSS questionnaires in frequency score. However, this study found a positive correlation of frequency score between the mVPSS and IPSS questionnaires in all educated groups. Moreover, most patients felt that the mVPSS and VPSS questionnaires were easier to understand and complete than the IPSS questionnaire. Conclusion: The mVPSS shows a statistically significant correlation to the IPSS standard questionnaire, which means that the IPSS can be replaced by the mVPSS in order to evaluate Thai males with BPH and LUTS, because the mVPSS can be used with all educated groups and the patients are able to understand and complete the questionnaire more quickly. For these reasons, the mVPSS is an excellent choice to replace the VPSS and IPSS, which still have many limitations with varieties of patients.

Abstract 13723: Racial/ethnicity and Education Disparities in Hypertension Among U.s. Adults and the Role of Nutrient Quality -- The International Study on Macro/micronutrients (intermap)

Background: Limited education and/or being Black are inversely associated with hypertension in the US. Whether nutrient quality influences these associations remains unclear. Methods: Diet and blood pressure (BP) were measured in 2,195 US adults ages 40-59 years between 1996-99 in the INTERMAP study. Hypertension was defined by 2017 standards—SBP/DBP ≥130/80 mmHg or on BP medication. OMNIHEART-like nutrient score defined nutrient quality (see Table footnote). Higher-education was defined as 17+years of school. Results: Participants were 50% female, 56.2% non-Hispanic (NH) White, 17.4% NH-Black, 12.7% Japanese, 13.6% Hispanic, 24% higher-education, and 42% hypertensive. With multiple adjustments without nutrient score, we observed racial disparity on hypertension in NH-Black vs. NH-White across education levels, and it was more pronounced in the higher-education group; i.e., in the lower-education group, compared to NH-White, relative risk—RR (95% CI) of hypertension in NH-Black was 1.4(1.2-1.6); but it was 2.0 (1.5-2.6) in the higher-education group. Education disparity was seen in NH-White—(RR was 42% lower in those with higher vs. lower-education. Added nutrient score slightly attenuated observed associations (see Table). Nutrient score was also independently associated with hypertension; i.e., compared to the 5 th quintile, RR (95%CI) of hypertension in the 1 st quintile was 1.3(1.1-1.5). There were no interactions of nutrient score with race/ethnicity/education. BMI levels attenuated race/ethnicity/education-hypertension relations and diminished the nutrient profile-hypertension relation. Conclusion: Education levels modified racial disparity between NH-Black and White but maintained independent effects on hypertension, especially in NH-White. Differences in nutrient quality did not account for race/ethnicity/education disparities on hypertension, rather independent effects were largely explained by BMI levels.

Residential Proximity to Major Roadways and Prevalent Hypertension Among Older Women and Men: Results From the Chinese Longitudinal Healthy Longevity Survey.

Background and Objectives: Prior studies suggested that residential proximity to major roadways was associated with increased risks of cardiovascular diseases in developed countries, for which one explanation is that road proximity could heighten the risks of hypertension. However, the association of residential distance to major roadways with hypertension is still unclear in low- and middle-income countries (LMICs) with levels of air pollution and socioeconomic development distinctively different from developed countries.Methods: We derived data from the eighth wave of the Chinese Longitudinal Healthy Longevity Survey, a nationwide prospective cohort. The present study included 12,881 individuals older than 65 years (mean age, 85.2 ± 11.7 years) with 55.8% of them being female. We ascertained the residential proximity to major roadways based on self-reports and hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. We then used logistic regression to examine the association between residential distance to major roadways and hypertension.Results: The odds ratios (ORs) of hypertension for participants living 50 to 100, 101 to 200, and ≥200 meters from major roads were 1.17 [95% confidence interval (95% CI) = 1.02–1.33], 1.21 (95% CI = 1.05–1.41), and 1.22 (95% CI = 1.10–1.34), respectively, compared to those living within 50 m (Pfor trend < 0.001). Significant effects of modifications from socioeconomic status and accessibility to health care resources were observed (Ps for interaction < 0.05). Compared to living within 50 m from a major roadway, the ORs of hypertension for living ≥50 m were higher in manual/agricultural workers, low-education groups, participants without household ventilation, and participants lacking in health education and health care resources. We observed considerable variations across geographic regions with the association in question attenuating in Eastern China but remaining significant in other regions.Conclusion: Residential proximity to major roadways was associated with lower odds of hypertension among older adults in China. The utility of residential proximity to major roadways as a marker of increased risks of hypertension and cardiovascular diseases may need to be revisited in LMICs.

Awareness of Stroke Warning Symptoms, Risk Factors, and Response to Acute Stroke in Biswanath District, Assam, India

This study was undertaken with the following objectives: (a) to find out the awareness of warning symptoms and risk factors of stroke, (b) response to acute stroke, and (c) factors associated with awareness, risk factors, and response to acute stroke among community-dwelling adults in Biswanath district of Assam. Using a cross-sectional design, a community-based study was done among 340 adults (mean age 38 years, men 55%) selected using multistage cluster sampling. Information on sociodemographic variables, stroke warning symptoms, risk factors, and response to acute stroke was collected using an adapted World Health Organization (WHO) STEPs stroke surveillance tool. Bivariate and logistic regression analysis were done to find out the factors associated with stroke warning symptoms, risk factors, and response to acute stroke. A "P" value < .05 was considered for statistical significance. Awareness of stroke was significantly higher among males (P < .01), better educated (P < .01), government employees (P < .05), high-income group (P < .01), and those who reported receiving information from a professional source (P < .01) compared to their counterparts. Knowledge of at least one stroke risk factor and providing at least one correct response to acute stroke was higher among males, better educated, government employees, higher income groups, and those who received information from professional source compared to their counterparts (P < .05). Awareness of stroke warning symptoms, risk factors, and response to acute stroke needs to be improved focusing on women, low education groups, those working in the nongovernment sector, and low-income groups by health professionals.

Self-reported health and the social body

Since the strong predictive power of self-reported health (SRH) for prospective health and social outcomes has been established, researchers have been in a quest to build a theoretical understanding of this widely used health measure. Current literature based predominantly in a biomedical perspective asserts a linear relationship between physical conditions and perception of health. Discrepancies from this expected relationship are considered an important weakness of SRH. Systematic discrepancies between physical conditions and reporting of SRH have been documented across different socio-economic groups. Evidence identified for educational groups shows that for the same level of health status, lower-educated groups report poorer levels of perceived health. This raised doubts whether it is useful to use SRH to measure social inequalities in health within and between countries. To date, sociologists of health have not engaged in the discussion of reporting heterogeneity in SRH. After reviewing existing evidence, we contend that the discrepancy in SRH reporting across social groups argued to be a weakness of SRH as a health measure is a strength from a sociological perspective. SRH as a social measure of health is a better predictor than objective measures of health precisely because it captures the lived experience of the embodied agent.

Disease progression modeling of Alzheimer\u2019s disease according to education level

To develop a disease progression model of Alzheimer’s disease (AD) that shows cognitive decline from subjective cognitive impairments (SCI) to the end stage of AD dementia (ADD) and to investigate the effect of education level on the whole disease spectrum, we enrolled 565 patients who were followed up more than three times and had a clinical dementia rating sum of boxes (CDR-SB). Three cohorts, SCI (n = 85), amnestic mild cognitive impairment (AMCI, n = 240), and ADD (n = 240), were overlapped in two consecutive cohorts (SCI and AMCI, AMCI and ADD) to construct a model of disease course, and a model with multiple single-cohorts was estimated using a mixed-effect model. To examine the effect of education level on disease progression, the disease progression model was developed with data from lower (≤ 12) and higher (> 12) education groups. Disease progression takes 274.3 months (22.9 years) to advance from 0 to 18 points using the CDR-SB. Based on our predictive equation, it takes 116.5 months to progress from SCI to AMCI and 56.2 months to progress from AMCI to ADD. The rate of CDR-SB progression was different according to education level. The lower-education group showed faster CDR-SB progression from SCI to AMCI compared to the higher-education group, and this trend disappeared from AMCI to ADD. In the present study, we developed a disease progression model of AD spectrum from SCI to the end stage of ADD. Our disease modeling provides us with more understanding of the effect of education on cognitive trajectories.

Educational Inequalities in Hospital Use Among Older Adults in England, 2004-2015.

Policy Points US policymakers considering proposals to expand public health care (such as “Medicare for all”) as a means of reducing inequalities in health care access and use could learn from the experiences of nations where well‐funded universal health care systems are already in place.In England, which has a publicly funded universal health care system, the use of core inpatient services by adults 65 years and older is equal across groups defined by education level, after controlling for health status. However, variation among these groups in the use of outpatient and emergency department care developed between 2010 and 2015, a period of relative financial austerity.Based on England's experience, introducing universal health care in the United States seems likely to reduce, but not entirely eliminate, inequalities in health care use across different population groups. ContextExpanding access to health care is once again high on the US political agenda, as is concern about those who are being “left behind.” But is universal health care that is largely free at the point of use sufficient to eliminate inequalities in health care use? To explore this question, we studied variation in the use of hospital care among education‐level‐defined groups of older adults in England, before and after controlling for differences in health status. In England, the National Health Service (NHS) provides health care free to all, but the growth rate for NHS funding has slowed markedly since 2010 during a widespread austerity program, potentially increasing inequalities in access and use.MethodsNovel linkage of data from six waves (2004‐2015) of the English Longitudinal Study of Ageing (ELSA) with participants’ hospital records (Hospital Episode Statistics [HES]) produced longitudinal data for 7,713 older adults (65 years and older) and 25,864 observations. We divided the sample into three groups by education level: low (no formal qualifications), mid (completed compulsory education), and high (at least some higher education). Four outcomes were examined: annual outpatient appointments, elective inpatient admissions, emergency inpatient admissions, and emergency department (ED) visits. We estimated regressions for the periods 2004‐2005 to 2008‐2009 and 2010‐2011 to 2014‐2015 to examine whether potential education‐related inequalities in hospital use increased after the growth rate for NHS funding slowed in 2010.FindingsFor the study period, our sample of ELSA respondents in the low‐education group made 2.44 annual outpatient visits. In comparison, after controlling for health status, we found that participants in the high‐education group made an additional 0.29 outpatient visits annually (95% confidence interval [CI], 0.11‐0.47). Additional outpatient health care use in the high‐education group was driven by follow‐up and routine appointments. This inequality widened after 2010. Between 2010 and 2015, individuals in the high‐education group made 0.48 (95% CI, 0.21‐0.74) more annual outpatient visits than those in the low‐education (16.9% [7.5% to 26.2%] of annual average 2.82 visits). In contrast, after 2010, the high‐education group made 0.04 (95% CI, −0.075 to 0.001) fewer annual ED visits than the low‐education group, which had a mean of 0.30 annual ED visits. No significant differences by education level were found for elective or emergency inpatient admissions in either period.ConclusionsAfter controlling for demographics and health status, there was no evidence of inequality in elective and emergency inpatient admissions among the education groups in our sample. However, a period of financial budget tightening for the NHS after 2010 was associated with the emergence of education gradients in other forms of hospital care, with respondents in the high‐education group using more outpatient care and less ED care than peers in the low‐education group. These estimates point to rising inequalities in the use of hospital care that, if not reversed, could exacerbate existing health inequalities in England. Although the US and UK settings differ in many ways, our results also suggest that a universal health care system would likely reduce inequality in US health care use.

Gender Equality and Gender Inequalities in Self-Reported Health: A Longitudinal Study of 27 European Countries 2004 to 2016.

Significant gender-based health inequalities have been observed across Europe, with women reporting worse health than men. Still, there has been little examination of how the gender–health gap has changed over time, and how it has been shaped by societal gender equality. We used data from the Statistics on Income and Living Conditions Eurostat database (EU-SILC), involving 2,931,081 participants aged 25–64, for 27 European countries. Logistic regressions were performed to model the association between self-reported bad health and gender, in general and over time. Analyses were stratified by employment, education, and clusters of countries according to levels of Gender Equality Index (GEI). Adjusting for age, year, and country, bad health was 17% more likely among women, but this disadvantage ceased after accounting for education and employment. Gender–health inequalities were larger among countries with higher GEI scores and among low-educated groups. The gender–health gap did not reduce significantly between 2004 and 2016, in general and within subgroups. Although societies are becoming more equal, persistent inequalities in employment and income still lead to sustained health differences between men and women.

Tobacco smoking prevalent in Zambian males: Observations from the Zambia Demographic Health Survey 2013-2014

Background: Tobacco smoking is one of the biggest public health threats causing poverty, several illnesses and death. Previous studies found that the lower the education, the higher the risk of smoking. This study assessed the association between education attainment and smoking among participants of the Zambia Demographic Health Survey 2013-2014.Methodology: This was a population-based crosssectional study. Secondary data was extracted from existing Zambia Demographic Health Survey 2013-2014 data sets, from ten provinces in comparison with different variables to constitute a resultant data set which this study used. All successfully interviewed male and female participants who answered the question, “Do you currently smoke cigarettes?” or “Do you currently smoke or use any other type of tobacco?” were included. The data extraction form was used to extract values of dependent and independent variables and imported into statistical analysis tool Stata version 13. Descriptive statistics of individual characteristics, testing for associations using the Pearson's Chi Square test and logistic regression were performed.Results: Overall there were 14773 men and 16411women with mean age of 15-19. Smoking prevalence was 9.9% overall and 20.4% in men, but 0.5% in women. The incidence of tobacco smoking is steadily increasing with increase in age among both men and women. There was a significant increase in the incidence of smoking between 20-24 and 25-29 particularly in male smokers. Higher socioeconomic status seems to have a protective effect, consequently smoking remains highest among poor individuals and lowest among the rich. Higher education groups had a decreased likelihood to smoke with an odds ratio of 0.5 overall, 0.2 in men and 0.1 in women.Conclusions: We report high and unchanging prevalence of smoking predominantly concentrated in rural adult populations with lower education attainment. This suggests past health promotion efforts that targeted whole population may not have been relevant to the most affected groups. This therefore calls for reshaping health promotion messages to target specific populations and settingswith highest burden. Furthermore, this calls for additional explorative studies in order to examine reasons for smoking in lower educated groups including exploring how what has worked in reducing smoking in higher educated groups could be extrapolated to most affected low educated and rural populations