Manual Social Class Research Articles

Migraciones internas en España durante el siglo xx: un nuevo eje para el estudio de las desigualdades sociales en salud

ObjectiveCatalonia and the Basque Country received substantial immigration quotas from the rest of Spain during the twentieth century. This study aimed to analyze inequalities in health by birthplace (the population born in the same region or other autonomous regions) in these two geographical areas. MethodsWe conducted a cross-sectional study in the non-institutionalized population aged 50 to 79 years, with data from the health surveys of Catalonia 2006 (n=5,483) and the Basque Country 2007 (n=3,424). We used log-binomial models to estimate the prevalence ratios (PR) of poor self-rated health by birthplace, stratified by sex and social class, and successively adjusted for age, social class and educational attainment. ResultsImmigrants from other autonomous regions had poorer self-rated health than the native-born population, both in the Basque Country (age-adjusted PR in men 1.30, 95% CI 1.11-1.54; women 1.42, 95% CI 1.25-1.62,) and in Catalonia (PR in men 1.41, 95% CI 1.26-1.62; PR in women 1.25, 95% CI 1.16-1.35). PRs were reduced but remained significant after adjustment for social class and educational attainment and stratification by manual or non-manual social class. ConclusionsIn both communities there are health inequalities that are detrimental to the immigrant population from the rest of Spain, which constitutes approximately half of the population in the studied age cohorts. Future studies should explore the persistence of these inequalities in other health indicators and their reproduction in second generations, and identify entry points for preventive policies.

P2-103 Is the socioeconomic patterning of type II diabetes mediated by sleeping problems? Evidence from the west of Scotland

IntroductionSleep deprivation produces physiological changes similar to those that occur in the development of diabetes. Sleeping patterns may therefore act as a mediator between socioeconomic status and diabetes.MethodsData are from...

Longitudinal associations of socioeconomic position in childhood and adulthood with decline in lung function over 20 years: results from a population-based cohort of British men

BackgroundAssociations of socioeconomic position with lung function are reported mostly from cross-sectional studies. The aim of this study was to investigate the associations between socioeconomic position both in adulthood and...

Determinantes sociales de sobrepeso y obesidad en España 2006

Obesity in the Spanish adult population has almost doubled from 1987 to 2003. The aim is to update the prevalence of overweight and obesity, and reassess its main social determinants using the National Health Household Survey (ENS) from 2006. Cross sectional study based on the ENS-2006. Sample of 29,478 adults who answered questions on self-reported weight and height. We calculated the body mass index (WHO classification) for the dependent variable. Sociodemographic independent variables used were age, sex, marriage status, educational level, social class (manual, non-manual), and monthly income. A descriptive study was conducted as well as different logistic regression models. In 2006, the prevalence of overweight is higher in men (43.9%) than women (28.9%). Sex differences were not observed in the prevalence of obesity (15.0%). The multinomial logistic regression analysis shows significant associations between obesity and marriage status: married OR=1.69 (1.51-1.89), widower OR=1.77 (1.45-2.16); population without education: OR=2.77 (2.34-3.28) and income below 600 €: OR=1.50 (1.18-1.91). There was a statistically significant interaction (p<0.001) between sex and social class. Women from manual social class have 49% more chances to be overweight and 96% greater risk of obesity compared to non-manual social class women. In addition, men of manual social class have less risk of overweight (18%) and obesity (12%) than non-manual social class men. Gender and socioeconomic status are key social determinants for obesity in Spain and, consequently, this needs to be addressed when developing preventive activities.

Social Class Differences in Secular Trends in Established Coronary Risk Factors over 20 Years: A Cohort Study of British Men from 1978–80 to 1998–2000

BackgroundCoronary heart disease (CHD) mortality in the UK since the late 1970s has declined more markedly among higher socioeconomic groups. However, little is known about changes in coronary risk factors in different socioeconomic groups. This study examined whether changes in established coronary risk factors in Britain over 20 years between 1978–80 and 1998–2000 differed between socioeconomic groups.Methods and FindingsA socioeconomically representative cohort of 7735 British men aged 40–59 years was followed-up from 1978–80 to 1998–2000; data on blood pressure (BP), cholesterol, body mass index (BMI) and cigarette smoking were collected at both points in 4252 survivors. Social class was based on longest-held occupation in middle-age. Compared with men in non-manual occupations, men in manual occupations experienced a greater increase in BMI (mean difference = 0.33 kg/m2; 95%CI 0.14–0.53; p for interaction = 0.001), a smaller decline in non-HDL cholesterol (difference in mean change = 0.18 mmol/l; 95%CI 0.11–0.25, p for interaction≤0.0001) and a smaller increase in HDL cholesterol (difference in mean change = 0.04 mmol/l; 95%CI 0.02–0.06, p for interaction≤0.0001). However, mean systolic BP declined more in manual than non-manual groups (difference in mean change = 3.6; 95%CI 2.1–5.1, p for interaction≤0.0001). The odds of being a current smoker in 1978–80 and 1998–2000 did not differ between non-manual and manual social classes (p for interaction = 0.51).ConclusionSeveral key risk factors for CHD and type 2 diabetes showed less favourable changes in men in manual occupations. Continuing priority is needed to improve adverse cardiovascular risk profiles in socially disadvantaged groups in the UK.

Factors associated with age of onset and type of menopause in a cohort of UK women

We sought to describe the pattern of age at menopause and factors associated with type of menopause. This was a prospective cohort study of 5113 postmenopausal health survey respondents in the Royal College of General Practitioners' Oral Contraception Study. Logistic regression was used to evaluate associations between sociodemographics, lifestyle, and medical history and menopause type. Median age at natural menopause (n = 3650) was 49.0 years (interquartile range, 45.0-51.0), and at surgical menopause (n = 1463) was 42.4 years (38.0-46.4). Early natural menopause was associated with smoking, ever-use of oral contraception, sterilization, and history of endometriosis (all increased odds ratios) and ever-use of hormone replacement therapy (decreased). Surgical menopause was associated with manual social class, sterilization, and having a history of endometriosis, menorrhagia, or painful menstruation (all increased), and ever-use of hormone replacement therapy (decreased). Age at natural menopause was younger in this cohort than in other studies. More associations were found for surgical menopause than early natural menopause.

Migration-related health inequalities: Showing the complex interactions between gender, social class and place of origin

In this paper, we briefly review theories and findings on migration and health from the health equity perspective, and then analyse migration-related health inequalities taking into account gender, social class and migration characteristics in the adult population aged 25-64 living in Catalonia, Spain. On the basis of the characterisation of migration types derived from the review, we distinguished between immigrants from other regions of Spain and those from other countries, and within each group, those from richer or poorer areas; foreign immigrants from low-income countries were also distinguished according to duration of residence. Further stratification by sex and social class was applied. Groups were compared in relation to self-assessed health in two cross-sectional population-based surveys, and in relation to indicators of socio-economic conditions (individual income, an index of material and financial assets, and an index of employment precariousness) in one survey. Social class and gender inequalities were evident in both health and socio-economic conditions, and within both the native and immigrant subgroups. Migration-related health inequalities affected both internal and international immigrants, but were mainly limited to those from poor areas, were generally consistent with their socio-economic deprivation, and apparently more pronounced in manual social classes and especially for women. Foreign immigrants from poor countries had the poorest socio-economic situation but relatively better health (especially men with shorter length of residence). Our findings on immigrants from Spain highlight the transitory nature of the 'healthy immigrant effect', and that action on inequality in socio-economic determinants affecting migrant groups should not be deferred.

Linking Young People’s Knowledge of Public Health Guidelines to Physical Activity Levels in England

Using the 2007 Health Survey for England, we examine whether knowledge of guidelines is linked to physical activity levels for 1,954 children aged 11-15, and the correlates of adhering to the guidelines. For girls, knowing the guidelines was associated with meeting them, but was weak among boys, for whom only white ethnicity was associated with meeting the guidelines. For girls, being younger, white, and from a manual social class background was associated with meeting the guidelines. Findings support the call for physical activity-promoting policy and programs aimed at specific groups of children who are prone to lower levels of activity.

Historical note: early years of the 1946 British birth cohort study

The article by Michael Wadsworth in the previous issue of this journal (Wadsworth 2010) prompted thoughts about the importance to life course studies of social history. Wadsworth demonstrated this relevance in his pioneering volume The Imprint of Time (Wadsworth 1991). The present text adds a little further information about the social history of the parents of the 1946 cohort and the 1946 cohort’s early years. The social history of a birth cohort’s parents is a relevant, if somewhat neglected topic, because it shapes the ideas and values which surround the cohort during its early years of dependency. At the time the 1946 cohort was born, over 70 per cent of the male population was employed in manual occupations, with them and their families assigned to one of the manual social classes. The present historical note mentions some possibly relevant features of their experience. The recruits to the 1946 British birth cohort study mostly were conceived during July 1945, the month in which Attlee’s post-war Labour Government was elected, and gestated by mothers who had endured nearly six full years of war. The experience of women during the 1939-1945 war shaped the mental and physical health which the mothers brought to conception and gestation, while the ideas with which they raised their young children were coloured also by their socialisation in the pre-war world and the reality of post-war austerity. Each of these phases presents a complex picture of benefits and hardships, with a woman’s likelihood of experiencing one rather than the other being linked to their social class. Working class mothers were most likely to have suffered hardship at one or more points: pre-war; wartime; post-war austerity. The older mothers of the 1946 cohort had fathers and brothers killed in World War I or crippled by gas or amputation; and often carried rickets from the failure to add vitamin D to the wartime whale oil margarine or heart valve defects from childhood rheumatic fever. All knew of neighbours and kin invalided or dead by respiratory tuberculosis. The ubiquitous out-door toilet ensured that bedrooms smelt of urine from the chamber pot under the bed; and insect infestation in the fabric of poor terraced housing encouraged their inhabitants to sleep in the street during the summer months. High unemployment due to the mass closure of heavy industry in the north and west of Britain was, in time, counter-balanced by new light industry in the midlands and south-east. Routes out of the working class were offered by the merchant marine, police, nursing and teaching, where women had to resign on marriage. Suburban homes, bought on mortgage, were strip-built along Metroland, allowing more space in the centre of cities. The cinema, cigarettes and lipstick brought a new glamour to life. Cycling and motor-bikes allowed escape from locality; truck driving along the developing national road network was an adventure of navigation and machine repair; and crystal wireless brought the international into everyday life. The cruelties of the Poor Law (means testing; break-up of families on entry to Work House; the able-bodied forced to tramp every day to the next Work House) ensured a terror of relying on welfare (Spring Rice 1939; Greenwood 1939; Stevenson

Inequalities in disability-free life expectancy by social class and area type: England, 2001–03

Disability-free life expectancy (DFLE) is an important indicator which combines longevity with functional health status. This article examines inequalities in DFLE by socio-economic position in England, and between Local Authorities (LAs) in the deprived 'Spearhead group' and other LAs. Census and vital event data available from the ONS Longitudinal Study were used to calculate estimates of DFLE based on limiting long-term illness or disability status for each Registrar General's Social Class (RGSC) in 2001-03, in England as a whole and within the 'Spearhead group' and non-Spearhead LAs. A predominantly linear relationship was present with DFLE increasing with rising social class. The differences observed in DFLE at birth and at age 65 between people assigned to the professional and unskilled manual social classes were statistically significant and substantial, demonstrating a clear social inequality in the amount of life, the functional health status during those years lived, their absolute number, and thus the relative proportion of life spent free from a limiting long-term illness or disability.Among professional men, no statistically significant differences in DFLE at birth were found between the 'Spearhead group' and the non-Spearhead LAs. However, men assigned to the other social classes in the 'Spearhead group' were disadvantaged in terms of lower DFLE than their counterparts in the non-Spearhead LAs. Manual women living in non-spearhead LAs had comparable DFLE to women assigned to the managerial and technical and skilled non-manual social classes living in the 'Spearhead group'.The magnitude of inequality in DFLE at birth between professionals and the unskilled manual class in the proportion of life spent free of a limiting long-term illness or disability also varied between the 'Spearhead group' and non-Spearhead LAs: among men, a difference of 7.7 per cent was present in non-Spearhead LAs, compared with 13.1 per cent in the 'Spearhead group'; among women, the equivalent differences were 5.2 per cent and 9.4 per cent. These results confirm that the assumptions made with regard to sex differences in DFLE need to be set in the context of socio-economic position, and assumptions made regarding sex and social differences need to set in the context of geography. The scale of the inequalities shown is important for policy responses and understanding of differences in service needs.

Inequalities in healthy life expectancy by social class and area type: England, 2001–03

Healthy life expectancy (HLE) is an important indicator which combines longevity with health status. This article examines inequalities in HLE by socio-economic position in England, and between Local Authorities (LAs) in the deprived 'Spearhead group' and other LAs. Census and vital event data available from the ONS Longitudinal Study were used to calculate estimates of HLE based on general health status for each Registrar General's Social Class (RGSC) in 2001-03, in England as a whole and within the 'Spearhead group' and non-Spearhead LAs. A predominantly linear relationship was present with HLE increasing with rising social class. The differences observed in HLE at birth and at age 65 between people assigned to the professional and unskilled manual social classes were statistically significant and substantial, demonstrating a clear social inequality in the amount of life, the quality of those years lived, the absolute number of healthy life years, and thus the relative proportion of life spent in 'Good' or 'Fairly Good' health.HLEs at birth were statistically significantly higher for women than for men in the non-Spearhead LAs for all social classes; however, in the 'Spearhead group' of areas higher HLEs in women were only present among the skilled non-manual, skilled manual and partly skilled social classes. This suggests that an interaction effect between sex and area in the level of HLE may be operating.The magnitude of inequality in HLE between professionals and the unskilled manual class in the proportion of life spent in 'Good' or 'Fairly Good' health also varied between the 'Spearhead group' and non-Spearhead LAs: among men, a difference of 6.6 per cent was present in non-Spearhead LAs, compared with 10.6 per cent in the 'Spearhead group'; among women, the equivalent differences were 5.3 per cent and 7.6 per cent. The within-class HLEs for men and women were lower in the 'Spearhead group' compared with the non-Spearhead LAs, and statistically significantly lower among the intervening social classes for men; among women they are significant for all social classes other than the professional class. The scale of inequalities shown is important for policy responses and understanding of differences in service needs.

Time trends in childhood and adolescent obesity in England from 1995 to 2007 and projections of prevalence to 2015

BackgroundThe aim was to examine the 1995–2007 childhood and adolescent obesity trends and project prevalence to 2015 by age group and social class.MethodsParticipants were children aged 2–10 and adolescents aged...

Changes in environmental tobacco smoke (ETS) exposure over a 20‐year period: cross‐sectional and longitudinal analyses

AimsTo examine long-term changes in environmental tobacco smoke (ETS) exposure in British men between 1978 and 2000, using serum cotinine.DesignProspective cohort: British Regional Heart Study.SettingGeneral practices in 24 towns in England, Wales and Scotland.ParticipantsNon-smoking men: 2125 studied at baseline [questionnaire (Q1): 1978–80, aged 40–59 years], 3046 studied 20 years later (Q20: 1998–2000, aged 60–79 years) and 1208 studied at both times. Non-smokers were men reporting no current smoking with cotinine < 15 ng/ml at Q1 and/or Q20.MeasurementsSerum cotinine to assess ETS exposure.FindingsIn cross-sectional analysis, geometric mean cotinine level declined from 1.36 ng/ml [95% confidence interval (CI): 1.31, 1.42] at Q1 to 0.19 ng/ml (95% CI: 0.18, 0.19) at Q20. The prevalence of cotinine levels ≤ 0.7 ng/ml [associated with low coronary heart disease (CHD) risk] rose from 27.1% at Q1 to 83.3% at Q20. Manual social class and northern region of residence were associated with higher mean cotinine levels both at Q1 and Q20; older age was associated with lower cotinine level at Q20 only. Among 1208 persistent non-smokers, cotinine fell by 1.47 ng/ml (95% CI: 1.37, 1.57), 86% decline. Absolute falls in cotinine were greater in manual occupational groups, in the Midlands and Scotland compared to southern England, although percentage decline was very similar across groups.ConclusionsA marked decline in ETS exposure occurred in Britain between 1978 and 2000, which is likely to have reduced ETS-related disease risks appreciably before the introduction of legislation banning smoking in public places.

Perinatal risk factors and coeliac disease in children and young adults: a record linkage study

Little is known about perinatal risk factors and coeliac disease. To investigate the relationship between perinatal risk factors and subsequent coeliac disease among offspring. Record linked abstracts of birth registrations, maternity, in-patient and day case records in a defined population of southern England. Using univariate analysis, coeliac disease in the child was associated with maternal coeliac disease (odds ratio = 20.6; 95% CI = 5.04-84.0; based on two cases in both mother and child) and with social class, year of birth, maternal smoking and parity. Multivariate analysis confirmed an increased risk of coeliac disease of 3.79 (95% CI = 1.85-7.79) for classes IV and V compared with I and II, an increased risk of 1.92 (1.06-3.49) for births during 1975-1979 compared with 1970-1974 and an increased risk of 1.80 (1.05-3.09) for 'subsequent' compared with 'first' births. Smoking during pregnancy was no longer associated with coeliac disease. Because numbers were small, maternal coeliac disease was excluded from the multivariate analysis. This study shows increased risks of coeliac disease for manual social classes, births during the late 1970s and 'subsequent' births. Overall, perinatal risk factors seem to have a limited role in the aetiology of coeliac disease in children and young adults.

Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012

Background:This study aims to project the prevalence of adult obesity to 2012 by age groups and social class, by extrapolating the prevalence trends from 1993 to 2004. Repeated cross-sectional surveys...

Contribution of Midparental BMI and Other Determinants of Obesity in Adult Offspring

The aim of this study was to evaluate midparental BMI among intergenerational factors associated with obesity in adult offspring. The data was from an unusual two-generational observational design of 1,477 married couples from Renfrew and Paisley in Scotland who were aged 45-64 years when screened in 1972-1976, and 1,040 sons and 1,298 daughters aged 30-59 years when screened in 1996. BMI was categorized as normal (< 25 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (> or = 30 kg/m(2)) in offspring and parents. Midparental BMI was defined as the mean of the mother's and father's BMI. Low physical activity, nonsmoking status, higher cholesterol level, and manual social class were all associated with increased BMI in offspring. The effect of reported dietary intake was less clear. Offspring of obese parents (defined by midparental BMI) were over four times more likely to be obese than offspring of normal weight parents. Midparental BMI had a strong effect on offspring BMI, independent of social class, smoking habit, physical activity, and reported dietary intake. Adding midparental BMI to the regression model more than doubled the explained variation of offspring BMI from 7.7 to 17%. Every 1 kg/m(2) increment in midparental BMI was associated with a BMI greater by 0.51 kg/m(2) in offspring. We conclude that midparental BMI is a useful simple tool to predict offspring BMI. Whether it represents genetic or environmental family effects, it is easily ascertained by the individual and could be used in health promotion and clinical settings to target individuals who are at increased risk of becoming obese.

Are social inequalities in mortality in Britain narrowing? Time trends from 1978 to 2005 in a population-based study of older men

Objective:To examine whether social inequalities in all-cause and coronary heart disease (CHD) mortality in Britain have reduced between 1978 and 2005.Design:A prospective study of a socioeconomically representative population.Setting:24 British towns.Participants:7735...

Predictors of Poor Outcome in Patients With Neck Pain Treated by Physical Therapy

This study evaluated predictors of poor outcome in patients with neck pain treated by physical therapy, and sought to compare the findings of empirical data with physical therapy practitioners' subjective perceptions about predictors of outcome. This study was a secondary analysis of data from a randomized controlled trial assessing physical therapy treatments for neck pain (n=346). A baseline questionnaire provided data on a number of potential risk factors of poor outcome at follow-up. Follow-up was conducted at 6 weeks and 6 months by postal questionnaire with outcome defined separately by perceived (global) change and minimal clinically important differences in the Northwick Park Neck Pain Questionnaire (MCID-NPQ). Therapists' perceptions of predictors for treatment outcome were captured using a separate questionnaire, and the ratings compared with ranks derived from the 6-month trial data. Baseline characteristics accounted for a much greater proportion of explained variance for global change compared with MCID-NPQ at 6 months. Independent biopsychosocial characteristics included manual social class, catastrophizing, anxiety and depression, low treatment expectations, severity of baseline neck pain/disability, presence of comorbid back pain, and older age. Physical therapist ranks correlated highly with those derived from the trial data. Significant predictors of outcome were identified, particularly at 6 months, including psychosocial, functional, and demographic indicators. Our findings suggest that physical therapists are collectively aware of the relative importance of physical and psychosocial factors in predicting clinical outcome. However, a significant amount of variability in outcomes in our prognostic models remained largely unexplained, indicating that we need to explore further underlying factors to inform clinical decision-making.

Are childhood socio-economic circumstances related to coronary heart disease risk? Findings from a population-based study of older men

The independent influence of childhood social circumstances on health in later life remains uncertain. We examined the extent to which childhood socio-economic circumstances are related to the risk of coronary heart disease (CHD) in older British men, taking account of adult social class and behavioural risk factors. A socio-economically representative sample of 5552 British men (52-74 years) with retrospective assessment of childhood socio-economic circumstances (father's occupation and childhood household amenities) who were followed up for CHD (fatal and non-fatal) for 12 years. Men whose childhood social class was manual had an increased hazard ratio (HR) 1.34 (95% CI 1.11-1.63)-this effect was diminished when adjusted for adult social class and adult behavioural risk factors (cigarette smoking, alcohol, physical activity and body weight) (HR 1.19; 95% CI 0.97-1.46). Men whose family did not own a car in their childhood were at increased CHD risk even after adjustments for adult social class and behaviours (HR 1.35, 95% CI 1.04-1.75). Men with combined exposure to both childhood and adult manual social class had the highest risk of CHD (HR 1.51; 95% CI 1.19-1.91); this was substantially reduced by adjustment for adult behavioural risk factors (adjusted HR 1.28; 95% CI 0.99-1.65). Less affluent socio-economic conditions in childhood may have a modest persisting influence on risk of CHD in later life.

Prevalence of cardiovascular risk factors among ethnic groups: Results from the Health Surveys for England

Objective To identify independent risk factors associated with cardiovascular disease (CVD) and diabetes for each minority ethnic group and the general population in England and explore the independent association of ethnicity and CVD and diabetes. Participants Nationally representative samples of 2362 Black Caribbean, 2467 Indian, 2204 Pakistanis, 1985 Bangladeshis, 1385 Chinese, 2398 Irish, and 30,744 adults from the general population living in private households. Results CVD was relatively more common among: Indian and Chinese men with high waist–hip ratio; Indian, Bangladeshi and Irish with diabetes; Black Caribbean, Indian and Pakistani with hypertension; Bangladeshi and Pakistani ex-smokers and Indian ex-smokers and current-smokers; Pakistani that were moderate-drinkers and Indian heavy drinkers; Black Carribean Indian, Pakistani and Irish physically inactive; Pakistani in manual social class; and Bangladeshi in low income. Black Caribbean, Bangladeshi and Chinese participants and Indian and Pakistani women had significantly lower odds ratios of having CVD, compared with the general population. The odds of having diabetes were significantly higher for Black Caribbean, Indian, Pakistani and Bangladeshi, Chinese (men only) than participants from the general population. Conclusions CVD prevention through control of risk factors, especially diabetes and hypertension, should not only address the general population, but also target people from these groups.