Non-manual Classes Research Articles

Do social inequalities in health widen or converge with age? Longitudinal evidence from three cohorts in the West of Scotland

BackgroundExisting studies are divided as to whether social inequalities in health widen or converge as people age. In part this is due to reliance on cross-sectional data, but also among longitudinal studies to differences in the measurement of both socioeconomic status (SES) and health and in the treatment of survival effects. The aim of this paper is to examine social inequalities in health as people age using longitudinal data from the West of Scotland Twenty-07 Study to investigate the effect of selective mortality, the timing of the SES measure and cohort on the inequality patterns.MethodsThe Twenty-07 Study has followed three cohorts, born around 1932, 1952 and 1972, from 1987/8 to 2007/8; 4,510 respondents were interviewed at baseline and, at the most recent follow-up, 2,604 were interviewed and 674 had died. Hierarchical repeated-measures models were estimated for self-assessed health status, with and without mortality, with baseline or time-varying social class, sex and cohort.ResultsSocial inequalities in health emerge around the age of 30 after which they widen until the early 60s and then begin to narrow, converging around the age of 75. This pattern is a result of those in manual classes reporting poor health at younger ages, with the gap narrowing as the health of those in non-manual classes declines at older ages. However, employing a more proximal measure of SES reduces inequalities in middle age so that convergence of inequalities is not apparent in old age. Including death in the health outcome steepens the health trajectories at older ages, especially for manual classes, eliminating the convergence in health inequalities, suggesting that healthy survival effects are important. Cohort effects do not appear to affect the pattern of inequalities in health as people age in this study.ConclusionsThere is a general belief that social inequalities in health appear to narrow at older ages; however, taking account of selective mortality and employing more proximal measures of SES removes this convergence, suggesting inequalities in health continue into old age.

Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006

The aim of this study was to analyse the trends and socio-economic inequalities in the use of health care services in Spain between 1993 and 2006. A study of trends was performed using data from six Spanish National Health Surveys (1993, 1995, 1997, 2001, 2003 and 2006). Sample sizes were 21,061; 6,396; 6,396; 21,066; 21,650 and 29,478, respectively. The following dependent variables were analysed: having visited a general practitioner (GP) or specialist in the previous 2 weeks, having visited a dentist within the previous 3 months and having visited a gynaecologist, having used the emergency services or having been hospitalised in the previous year. The main independent variable was social class, classified as manual or non-manual occupation. For each service, age-standardised proportions of use were calculated by survey year, sex and social class, and indices of relative (RII) and absolute (SII) inequality were computed. Trend tests were applied. An increase in the proportion of use was observed for all services, particularly emergency services. Individuals from manual classes were more likely to visit the GP and emergency services than those from non-manual classes. Conversely, those from non-manual classes were more likely to use specialised services. This trend was most notable for dentist visits. Social inequalities did not change significantly during the study period. Despite the increase in the use of health care services, the relationship between social class and the use of these services has remained stable throughout the study period. Achieving equity in the use of specialised care services is still a challenge for universal health care systems.

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...

P1-306 The influence of childhood developmental plasticity and socioeconomic circumstances on adult health biomarkers: longitudinal evidence from the west of Scotland twenty-07 study

Physical development in early life adapts to environmental circumstances through developmental plasticity. Despite short-term gains, altered developmental trajectories can have long-term health consequences. This study investigates the individual and combined...

Preventive Control of Breast and Cervical Cancer in Immigrant and Native Women in Spain: The Role of Country of Origin and Social Class

The study describes the periodic use of cervical and breast cancer screening by women residing in Spain, according to their country of origin, and analyzes whether the observed associations are modified by social class. A cross-sectional design was used, with the study population consisting of women residing in Spain in 2006, ages 25-65 years (N = 10,093) and 40-69 years (N = 6674) in the cervical and breast cancer screening groups, respectively. The information source was Spain's National Health Survey of 2006. The dependent variables were: undergoing periodic cervical cancer screening (every 5 years or less) and breast cancer screening (every 2 years or less). The independent variables were: country of origin, social class, health care coverage, cohabitation, and age. A descriptive analysis was carried out, and robust Poisson regression models were fitted. Women from low-income countries underwent fewer periodic screening exams for cervical cancer and breast cancer. Independent of country of origin, women from the manual classes underwent fewer screening exams than those from the non-manual classes. In the 50-69 years age group, it was mainly women from the manual classes from low-income countries who underwent fewer periodic mammograms. Having only public health care coverage and not cohabiting with a partner were also associated with lower prevalences of use.

Disability pension by occupational class--the impact of work-related factors: the Hordaland Health Study Cohort.

BackgroundThe social gradient in disability pension is well recognized, however mechanisms accounting for the gradient are largely unknown. The aim of this study was to examine the association between occupational class and subsequent disability pension among middle-aged men and women, and to what extent work-related factors accounted for the association.MethodsA subsample (N = 7031) of the population-based Hordaland Health Study (HUSK) conducted in 1997-99, provided self-reported information on health and work-related factors, and were grouped in four strata by Erikson, Goldthorpe and Portocareros occupational class scheme. The authors obtained follow-up data on disability pension by linking the health survey to national registries of benefit (FD-trygd). They employed Cox regression analysis and adjusted for gender, health (medical conditions, mental health, self-perceived health, somatic symptoms) and work-related factors (working hours, years in current occupation, physical demands, job demands, job control).ResultsA strong gradient in disability pension by occupational class was found. In the fully adjusted model the risk (hazard ratio) ranged from 1.41 (95% CI 0.84 to 2.33) in the routine non-manual class, 1.87 (95% CI 1.07 to 3.27) in the skilled manual class and 2.12 (95% CI 1.14 to 3.95) in the unskilled manual class, employing the administrator and professional class as reference. In the gender and health-adjusted model work-related factors mediated the impact of occupational class on subsequent disability pension with 5% in the routine non-manual class, 26% in the skilled manual class and 24% in the unskilled manual class. The impact of job control and physical demands was modest, and mainly seen among skilled and unskilled manual workers.ConclusionsWorkers in the skilled and unskilled manual classes had a substantial unexplained risk of disability pension. Work-related factors only had a moderate impact on the disability risk. Literature indicates an accumulation of hazards in the manual classes. This should be taken into account when interpreting the gradient in disability pension.

Small socio-economic differences in mortality in Spanish older people

Previous studies found smaller mortality inequalities in Southern Europe than in other European populations. This study used a sample of older Spanish adults to identify possible factors explaining these findings. A cohort of 4008 persons aged ≥ 60 years was selected in 2000-01 and followed prospectively until 2008. At baseline, data were collected on education, occupation and major mortality risk factors: social network, lifestyles, diet, obesity and hypertension. Analyses were conducted with Cox regression, and adjusted for the risk factors at baseline. The hazard ratio (HR) and 95% confidence interval (95% CI) for mortality adjusted for age, marital status, region and place of residence in people with low vs. high educational level was 1.13 (0.86-1.50) in men and 1.23 (0.83-1.80) in women. The HR in the manual vs. non-manual occupational class was 0.92 (0.74-1.15) in men and 1.07 (0.86-1.33) in women. Adjustment for the different risk factors decreased or did not change the HR. After full adjustment for all risk factors the mortality HR in those with low education was 0.99 (0.74-1.32) in men and 1.18 (0.80-1.76) in women, while the mortality HR in the manual occupational class was 0.85 (0.68-1.06) in men and 1.04 (0.83-1.30) in women. From a European perspective, mortality inequalities in Spanish older adults are small. The ubiquitous presence of social networks and the widespread adherence to the Mediterranean diet may be responsible for this finding.

Aspirin taking in a south Wales county

In order to determine the taking of regular aspirin within a representative community sample of adults residing in the south Wales county of Caerphilly, we conducted a survey of a sample 9,551 adults resident in the county aged ≥18 years. Questionnaires were returned by 4,558 individuals aged between 25 and 82 years. Nearly 12% of the respondents reported a previous vascular event. Of these, 68% of the men and 55% of the women stated that they took aspirin regularly. Among those with no previous vascular event, 22% of the men and 13% of the women stated that they took aspirin regularly. For those over 50 years of age, the respective figures were 28% of men and 19% of women. Of those taking aspirin, 47% stated that they took 300 mg tablets. There was a small inverse relationship found between aspirin taking and social class, namely 67% and 56% in the manual and non-manual classes respectively. The prevalence of prophylactic aspirin taking by persons who have had a vascular event should be increased, particularly in women. Knowledge of the benefits and the risks of aspirin prophylaxis could be promoted through the community and there should be ongoing monitoring of aspirin taking.

Changes in occupational class differences in leisure-time physical activity: a follow-up study

BackgroundPhysical activity is known to have health benefits across population groups. However, less is known about changes over time in socioeconomic differences in leisure-time physical activity and the reasons for the changes. We hypothesised that class differences in leisure-time physical activity would widen over time due to declining physical activity among the lower occupational classes. We examined whether occupational class differences in leisure-time physical activity change over time in a cohort of Finnish middle-aged women and men. We also examined whether a set of selected covariates could account for the observed changes.MethodsThe data were derived from the Helsinki Health Study cohort mail surveys; the respondents were 40-60-year-old employees of the City of Helsinki at baseline in 2000-2002 (n = 8960, response rate 67%). Follow-up questionnaires were sent to the baseline respondents in 2007 (n = 7332, response rate 83%). The outcome measure was leisure-time physical activity, including commuting, converted to metabolic equivalent tasks (MET). Socioeconomic position was measured by occupational class (professionals, semi-professionals, routine non-manual employees and manual workers). The covariates included baseline age, marital status, limiting long-lasting illness, common mental disorders, job strain, physical and mental health functioning, smoking, body mass index, and employment status at follow-up. Firstly the analyses focused on changes over time in age adjusted prevalence of leisure-time physical activity. Secondly, logistic regression analysis was used to adjust for covariates of changes in occupational class differences in leisure-time physical activity.ResultsAt baseline there were no occupational class differences in leisure-time physical activity. Over the follow-up leisure-time physical activity increased among those in the higher classes and decreased among manual workers, suggesting the emergence of occupational class differences at follow-up. Women in routine non-manual and manual classes and men in the manual class tended to be more often physically inactive in their leisure-time (<14 MET hours/week) and to be less often active (>30 MET hours/week) than those in the top two classes. Adjustment for the covariates did not substantially affect the observed occupational class differences in leisure-time physical activity at follow-up.ConclusionsOccupational class differences in leisure-time physical activity emerged over the follow-up period among both women and men. Leisure-time physical activity needs to be promoted among ageing employees, especially among manual workers.

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...

Current patterns of diet in community-dwelling older men and women: results from the Hertfordshire Cohort Study

dietary patterns analysis takes account of the combined effects of foods and may be a more meaningful way of assessing dietary exposure than considering individual nutrients. Little is known about the dietary patterns of older adults in the UK. to describe the dietary patterns of a population of community-dwelling older men and women and to examine factors associated with compliance with these patterns. 3,217 men and women aged 59-73 years who were participants in the Hertfordshire Cohort Study. diet was assessed using an administered food frequency questionnaire; dietary patterns were identified using principal component analysis. two dietary patterns were identified. The first was characterised by high consumption of fruit, vegetables, oily fish and wholemeal cereals ('prudent' pattern); the second was characterised by high consumption of vegetables, processed and red meat, fish and puddings ('traditional' pattern). High 'prudent' diet scores were more common in women, in men and women in non-manual classes and in non-smokers (all P < 0.05), whilst high 'traditional' diet scores were more common in men, in men and women who had partners and were associated with higher alcohol consumption (all P < 0.05). we have described large variations in food consumption and nutrient intake amongst older adults that are likely to have implications for future health. The specific socio-demographic correlates of the dietary patterns provide insights into the contexts within which good and poor diets exist, and may help in the identification of opportunities for dietary intervention.

All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities

To examine cardiovascular mortality of African migrants in Portugal in relation to socio-economic status. Data from death registrations, 1998-2002, and the 2001 Census were used to derive standardized death rates by country of birth and occupational class/marital status. Compared with native Portuguese, African migrants had higher mortality for all causes, circulatory disease, coronary heart disease and stroke. There was considerable heterogeneity among Africans with Cape Verdeans having higher mortality than Angolans or Mozambiquans. Class differences in mortality were generally greater for African than for Portuguese men. Although the coronary heart disease mortality rate among Africans in a manual class was twice that of those in a nonmanual class, there was no class difference for Portuguese men. Marital status was associated with 2-3-fold differences in mortality rates in both Africans and Portuguese. A larger proportion of Africans were not married which accounted for some of the excess mortality. Adverse cardiovascular mortality experience of African migrants is associated with socio-environmental factors. Investigating how best to achieve risk reduction in Africans should be a public health priority in Portugal.

Does the association between self-rated health and mortality vary by social class?

Self-rated health (SRH) predicts future mortality. Individuals in different social classes with similar physical health status may have different reference levels and criteria against which they judge their health, therefore the SRH–mortality relationship may vary according to social class. We examine the relationship between SRH and mortality by occupational social class in a prospective study of 22,457 men and women aged 39–79 years, without prevalent disease, living in the general community in Norfolk, United Kingdom, recruited using general practice age–sex registers in 1993–1997 and followed up for an average of 10 years. As expected, SRH was related to subsequent mortality. The age and sex adjusted hazard ratio for mortality for those with poor compared to those with excellent SRH was 4.35 (95% confidence interval 3.38–5.59, P < 0.001). The prevalence of poor or moderate SRH was higher in manual than in non-manual classes. However, SRH was similarly related to mortality in manual and non-manual classes: when non-manual classes are compared with manual classes for each category of SRH, the 95% confidence intervals for the mortality hazard ratios overlap. There was no evidence of an interaction between social class and SRH in either men or women. Thus in this population, SRH appears to predict mortality in a similar manner in non-manual and manual classes.

The contribution of maternal working conditions to socio-economic inequalities in birth outcome

The aims of this study were to examine the association between maternal working conditions and birth outcomes, and to determine the extent to which these contributed to class inequalities in six birth outcomes. We used an existing job exposure matrix developed from survey data collected in 1977 and 1979 to apply occupational-level information on working conditions to the national Swedish Registry, including approximately 280,000 mothers and 360,000 births during the period 1980–1985. Data were analysed using multivariate logistic regressions. Low levels of job control, high levels of physical demands and job hazards were more common in manual compared to non-manual classes. The self-employed had intermediate levels of such exposures. Job exposures, particularly low levels of job control, were generally and significantly associated with higher risks for low birthweight, very low birthweight, small for gestational age, all preterm, very preterm and extremely preterm births, but not with mortality. Compared to middle non-manuals (the reference group), lower non-manual and manual classes had higher risks for all birth outcomes, and these risks were nearly all significant. The highest odds ratios were found for skilled and unskilled manual workers in the manufacturing sector, with ratios between 1.35 and 2.66 (all significant). Job control explained a considerable proportion of inequalities in all birth outcomes. Job hazards contributed particularly to very low birthweight and extremely preterm birth, and physical demands to low birthweight and all preterm births. In conclusion, class differences in maternal working conditions clearly contributed to class differences in low birthweight (explained fraction 14–38%), all preterm births (20–46%), very (14–46%) and extremely (12–100%) preterm births. For very low birthweight and small for gestational age, there was a similar contribution in the manufacturing sector only. For all birth outcomes, class differences could still be detected after working conditions were taken into consideration.

Evolución de las desigualdades según la clase social en el control del embarazo en Barcelona (1994-97 frente a 2000-03)

Objective To describe and compare social inequalities in pregnancy care among pregnant women living in Barcelona (Spain) in 2 periods. Methods Two 4-year periods were compared: 1994-1997 and 2000-2003. The study population consisted of pregnant women living in Barcelona and the control sample was drawn from the Barcelona Birth Defects Registry (n;= 905 in 1994-1997; n = 927 in 2000-2003). Medical records and personal interviews with the mothers were used as information sources. The dependent variables were pregnancy planning, prenatal use of folic acid, smoking, the number of obstetric visits, trimester of the first visit, the number of obstetric ultrasound scans, fifth-month diagnostic ultrasound scan, invasive procedures, and smoking cessation. The independent variables were maternal age and social class. Maternal age-adjusted logistic regression models for each dependent variable according to social class were calculated and the results for both 4-year periods were compared. Results Pregnant women in both manual and non-manual occupational classes showed better results in the second period in 7 out of 10 variables (although the results were not identical in the 2 occupational classes). However, when interclass variations between the 2 periods were compared, differences in 8 out of 10 variables were found: 7 indicators were more favorable in the more privileged classes and only one was more favorable in the less privileged classes. Conclusions Except for one of the variables analyzed (more than 3 ultrasound scans), the less privileged classes showed poorer results than the more privileged classes when the tendencies in indicators were compared between the two periods. The gap between social classes in pregnancy care is increasing over time.

Trends in Life Expectancy by Level of Education and Occupational Social Class in Finland 1981-2000

The study analyses trends in life expectancy by level of education and by occupational social class in Finland from 1981 to 2000 to assess to what extent these trends have been in accordance with the target of reducing socioeconomic differences in life expectancy set in the Government public health programme. The study is based on the census records for the population aged 35 or over, which have been linked to the death records for the years 1981 to 2000. The results show that, contrary to the public health target, the difference in the life expectancy between persons with tertiary and basic education and that between upper non-manual and manual occupational classes increased during the 1990s. Differences in the trends in mortality from alcohol-related causes of death and from other cancers than lung cancer accounted for most the increase in the socioeconomic gap among men. Different from the 1980s changes in cardiovascular mortality did not contribute to the increase in the socioeconomic gap. Among women the increase in the socioeconomic gap was mainly due to the heterogeneous group of other diseases and cancers other than lung and breast cancer

Decline in, and lack of difference between, average birth weights among African and Portuguese babies in Portugal

In preliminary data in Portugal, we found that African babies of migrant mothers were heavier than White Portuguese babies born in Lisbon. We investigate whether this pattern is replicated in the national data, and in addition the trends in birth weight in these groups. Births registered between 1995 and 2002 classified by reported nationality of mothers. 849,595 Portuguese births ('Portuguese' nationality, predominantly of European descent) and 22,463 African births ('Angola', 'Cape Verde', or 'Guinea Bissau, Republic of Guinea or Equatorial Guinea' nationality, predominantly of African origin). Among Portuguese births, there was a decline in births to teenaged mothers and an increase to mothers aged >or=35 years, with >9 years of education or in a non-manual class, but among African births there was an increase in births to teenaged mothers and a decline to mothers from advantaged socioeconomic backgrounds. Using the Wilcox-Russell method, overall mean birth weights of term Portuguese (3,303, SD 424 g) and African (3297, SD 441 g) babies were not different but the percentage of small preterm births was higher among African (4.7%) than among Portuguese (2.9%) births. Between 1995 and 2002, mean birth weight of term Portuguese babies declined by 58 g (3,334-3,276 g) and of African babies by 57 g (3,341-3,284 g). The left shift of the birth weight distributions was independent of maternal age, parity, and social factors among Portuguese babies, but among African babies the decrease appeared to be associated with socioeconomic advantage. There has been a downward trend in birth weights in Portugal among both Portuguese and African term births, but average birth weights of the two groups were similar.

Overweight and obesity trends from 1974 to 2003 in English children: what is the role of socioeconomic factors?

Aims: To examine the childhood overweight and obesity prevalence trends between 1974 and 2003 and to assess whether these trends relate to parental social class and household income. Methods: A...

Women's body dissatisfaction, social class, and social mobility

Several studies indicate that socially advantaged women are more dissatisfied with their bodies than socially disadvantaged women. These findings have been based on women's current social class, and no attention has been paid to the social class of her family of origin or to intergenerational social mobility. In the present research 912 54-year-old women from a prospective birth cohort study provided self-report data on current body esteem (appearance and weight dimensions). Childhood and adult social class (manual versus non-manual) were defined based on father's occupation and own or partner's occupation, respectively. This information and the highest educational qualifications recorded by age 26 were gathered prospectively. Indicators of current and adolescent body mass index (BMI) were computed from height and weight values collected at ages 15 (or 11) and 53–54 years. Multiple regression was used to examine the relationship between midlife body esteem and childhood social class, adult social class, educational qualifications, and social mobility, unadjusted and adjusted for BMI. Women from the non-manual classes as adults were more dissatisfied with their weight than women from the manual classes as adults, for a given BMI. Adjusting for BMI, downwardly mobile women were more satisfied with their appearance than stable non-manual women. Adjusting for BMI, higher educational qualifications were associated with more dissatisfaction with weight and with appearance, and education appears to be more important than occupationally defined social class in explaining body dissatisfaction. A clearer understanding of the relationship between socio-economic position and body dissatisfaction demands that the following distinctions are made: weight versus appearance satisfaction, education versus occupation, and current social class versus intergenerational social mobility.

Some work hard while others play hard

The identification of current patterns of physical activity in any population is important in planning public health initiatives. The aim in this paper is to show the various physical activities that contribute to the achievement of current recommendations for physical activity for adults in the West of Scotland and to determine whether these patterns of activity vary with gender, age cohort and social class. Data were collected from a cross-sectional survey of a randomly selected population stratified for age. The participants were 2153 people involved in the West of Scotland Twenty-07 study. Around one third of the population achieved at least 30 minutes of physical activity on most days of the week. Most of this activity occurred in leisure time although work and home activity made a contribution. Lower levels of activity were reported by women and older adults. More men in the manual classes achieved 30 minutes of activity on most days in comparison with men in non-manual classes and this was achieved through work activity rather than leisure activity. Walking was the most frequently reported leisure activity. Not all physical activity was achieved in leisure time and future studies need to use a measurement tool that allows respondents to report physical activity at home, at work and at leisure. These data suggest that targets for physical activity promotion should include women and older adults and there should be an emphasis on walking, since it is a mode of activity accessible to all ages.