Socioeconomic Differences In Health Research Articles

Socioeconomic Differences in Health Over the Life Cycle in an Egalitarian Country

A strong relationship between health and socioeconomic status is firmly established. Yet, partly due to the multidimensional and dynamic nature of the variables, the causal mechanisms connecting them are poorly understood. This paper argues that adoption of a life-cycle perspective is essential to uncover these causal pathways. A life-cycle perspective also allows investigation of whether the socioeconomically disadvantaged, on top of a lower health level, experience a sharper deterioration of their health over the life cycle. We show that in the Netherlands, as in the US, the socioeconomic gradient in health widens until late-middle age and narrows thereafter. The analysis and the available evidence suggests that the widening gradient is attributable both to health-related withdrawal from the labor force, resulting in lower incomes, and the cumulative protective effect of education on health outcomes. The less educated suffer a double health penalty in that they begin adult life with a slightly lower health level, which subsequently declines at a faster rate. The observed narrowing of the gradient in old age is partly an artefact stemming from the fact that only the most healthy of the disadvantaged survive into old age. It also reflects that after middle age, withdrawal from the labor force increasingly occurs for non health-related reasons.

Socioeconomic Differences in the Health of Black Union Soldiers during the American Civil War

This article investigates patterns of socioeconomic difference in the wartime morbidity and mortality of black Union soldiers during the American Civil War. Among the factors that contributed to lower probabilities of contracting and dying of disease were lighter skin color, a nonfield occupation, residence on a large plantation, and residence in a rural area prior to enlistment. Patterns of disease-specific mortality and timing of death suggest that the differences in the development of immunity to disease and in nutritional status prior to enlistment were responsible for the observed socioeconomic differences in wartime health. For example, the advantages of light-skinned soldiers over dark-skinned and of enlisted men formerly engaged in nonfield occupations over field hands resulted from differences in nutritional status. The lower wartime mortality of ex-slaves from large plantations can be explained by their better-developed immunity and superior nutritional status. The results of this article suggest that there were substantial disparities in the health of the slave population on the eve of the Civil War.

Is health equity considered in systematic reviews of the cochrane musculoskeletal group?

To determine whether Cochrane Musculoskeletal Group (CMSG) systematic reviews and corresponding primary studies of rheumatoid arthritis interventions report and analyze the data needed to assess the effectiveness of interventions in reducing socioeconomic differences in health and/or improving the health of the poor. We selected all CMSG reviews on rheumatoid arthritis published since issue 1, 2003. Fourteen reviews were identified; 147 of the 156 primary studies included in these reviews were obtained and assessed. We extracted data on whether the dimensions place of residence, race/ethnicity/culture, occupation, gender, religion, education, socioeconomic status, and social capital and networks (PROGRESS) were reported or analyzed, and whether any interventions were aimed at disadvantaged or low- and middle-income country populations. Among the dimensions of PROGRESS reported at baseline in 147 primary studies, gender (89%) was the most commonly reported, followed by education (25%) and race/ethnicity (18%). Less than 50% of the systematic reviews reported dimensions of PROGRESS even when they had been reported in the primary study. Of 147 primary studies, 6 (5%) were aimed specifically at disadvantaged populations; another 6 reported on effectiveness by at least 1 dimension of PROGRESS. Primary studies of interventions for rheumatoid arthritis generally reported few variables necessary to answer questions about health inequalities. Most CMSG systematic reviews failed to assess those variables even when described in the primary studies. The Cochrane Health Equity Field welcomes the opportunity to provide guidance to systematic review authors on incorporating equity considerations into their reviews.

Risk of low Apgar score and socioeconomic position: a study of Swedish male births

AimThe aim of this study was to investigate the association between maternal socioeconomic position and a persistent low Apgar score (a score of < 7 at 1 and 5 min following birth).MethodsThe research is based on a population cohort study of 183 637 males born in Sweden between 1973 and 1976. Data from the Medical Birth Register were linked to Population and Housing Censuses.ResultsThere was evidence that mothers working in non-manual (Odds ratio (OR) 0.83 (0.72–0.97)) and self-employed (OR 0.64 (0.44–0.93)) occupations were less likely to have an infant with a low Apgar score, compared to manual workers. There was evidence that the risk of a low Apgar score decreased as the mother's level of education increased, if the infant was born by instrumental (OR 0.86 (0.74–0.99)) or caesarean section (OR 0.80 (0.68–0.93)) delivery, but not by unassisted vaginal delivery (OR 1.01 (0.92–1.10)).ConclusionThere was a lower risk of poor birth condition in male infants born to more educated and non-manual/self-employed mothers. These differences may contribute to our understanding of socioeconomic differences in infant health and development although the results may not be applicable due to changes over the last 30 years.

Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health?

It has often been debated the extent to which known risk factors explain socio-economic differences in health. While common in mortality studies, few studies of morbidity adjust for baseline health. In this study, we argue that there are sound reasons to do so, and examine whether a set of risk factors explain a larger part of social gradients in men and women's self-rated health (SRH) in Denmark when controlling for previous health. We use interval regression models on longitudinal survey data from 1990 and 1995 separately for Danish male and female workers aged 18-59. Large social gradients are found in SRH for both men and women. The included risk factors (smoking, body mass index, high blood pressure and job satisfaction) reduce the educational gradient in SRH by 40% (based on highest versus no education), the wage gradient by 18% and leaves occupational gradients (based on no employment versus white collar workers) unaltered for men. For women, similar gradients are altered by 6 and 22 and 14% in cross-sectional models. Controlling for baseline health 5 years earlier, the risk factors reduce the education, occupation and wage gradients by 45, -15 and 17% for men and by 5, 25 and 15% for women. The findings suggest that common risk factors do not explain a larger fraction of social health inequalities in dynamic than in static models of self-reported health.

Health locus of control beliefs and socio-economic differences in self-rated health

Background. Social inequalities in health are well documented in the social epidemiology literature. However, less is known about the mechanisms linking individual and area-level socio-economic status to health. In this paper we examine whether health locus of control (HLC) beliefs can help to explain socio-economic differences in self-rated health using the multidimensional HLC scale. Methods. Data for this study come from the Caerphilly Health and Social Needs Survey ( n = 10,892). Multilevel modelling was used to examine the variation in HLC beliefs across different socio-demographic groups and levels of neighbourhood socio-economic status, and to investigate whether HLC beliefs mediate the health effects of individual and neighbourhood socio-economic position. Results. This study found that the HLC scales were significantly associated with individual and neighbourhood socio-economic status, as well as with self-rated health. HLC beliefs appeared to mediate some of the health effects of individual socio-economic status and to a lesser extent the health effects of neighbourhood socio-economic status. Conclusions. Some evidence was found that HLC forms part of the pathway between individual and neighbourhood socio-economic status and health. Future research should further explore the psychological consequences of living in economically deprived conditions, alongside material, social and behavioural processes, and examine how this impacts upon people's health and well-being.

Ethnicity Is an Independent Correlate of Biomarkers of Micronutrient Intake and Status in American Adults1 3

Diet may be among the factors that mediate the acknowledged ethnicity and socioeconomic differentials in health. Biomarkers of nutritional exposure avoid reliance on biased self-reports of diet and allow an objective assessment of dietary differentials associated with ethnicity and socioeconomic position. We used data from the NHANES III (n = 13113) and NHANES 1999–2002 (n = 7246) to examine ethnic, education, and income differentials in serum concentrations of nutrients of putative public health importance (vitamins C, D, and E, folate, carotenoids, selenium, and ferritin) in U.S. adults. Multiple regression methods were used to adjust for covariates and complex survey design to examine these associations. The serum β-cryptoxanthin and lutein + zeaxanthin concentrations, adjusted for education and income, were higher in nonwhites (P < 0.0001) relative to non-Hispanic whites. Non-Hispanic blacks had lower serum vitamins C and D, folate, and selenium concentrations relative to non-Hispanic-whites. The biomarker profile (except vitamin D, and folate and ferritin in women) of Mexican-Americans was comparable or better relative to non-Hispanic-whites. Ethnicity associations with mean biomarker concentrations generally paralleled these associations with the proportion of the population at risk of marginal concentrations. Education was an independent positive predictor of serum concentrations of several carotenoids and vitamin C (P ≤ 0.01). Both education and income were independent inverse predictors of risk of marginal vitamin C concentration in men (P ≤ 0.003). Relative to income, ethnicity and education were stronger independent predictors of several outcomes. Ethnic differences in status of several micronutrients persisted after adjustment for education and income, suggesting the importance of ethnicity-specific nutrition interventions.

Socio-Economic Differences in Health, Nutrition, and Population Within Developing Countries: An Overview

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Socioeconomic differences in health among older adults in Mexico

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES–health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education–obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES–health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US.

Socioeconomic Status, Psychosocial Health and Health Behaviours among Hungarian Adolescents

While socioeconomic differences in health, morbidity, and disability are highest among middle-aged persons, there is a certain level of 'equalization' during adolescence and young adulthood. Despite this equalization, however, there still are differences in psychosocial variables or health-related behaviours, often very subtle and sometimes difficult to measure. Using data (n = 1114) on high school students (aged between 14 and 21 years) from the Southern Plain Region, Hungary, the present study looks at the role of multiple SES indicators (objective and subjective; occupation and education; family structure) in adolescents' psychosocial health (self-perceived health, psychosomatic, and depressive symptomatology) and health behaviour (substance use and sports activity). Based on the results of multivariate logistic regression analyses, findings suggest the following: (i) SES self-assessment proved to be a significant predictor of adolescents' psychosocial health and health behaviours; (ii) family structure (that is, living in a non-intact family) also significantly influenced adolescents' psychosocial health and health behaviours; (iii) parents' employment status and schooling had a limited influence on their children's health outcomes; (iv) in a word, SES gradients in adolescents' psychosocial health and health behaviour were inconsistent and sometimes irregular (that is, inverse). The subjective SES measurement plays an important role (positive association), whereas certain types of parents' inactive status (in terms of labour market, that is, unemployment or retirement) seem to act in a predictable way (negative association). Our results indicate that despite certain level of equalization during adolescence, some important relationships between SES variables and health outcomes may occur.

Examining the ``Matthew Effect'' on the motivation and ability to make lifestyle changes in 217 heart rehabilitation patients

Those who are socioeconomically disadvantaged and people with emotional problems have a poorer prognosis for cardiovascular disease. The authors wanted to examine: (1) what effect household income, emotional status, high-risk smoking status, and severity of heart disease had on the ability of individuals to make dietary and exercise improvements after heart disease and (2) to what extent unfavourable lifestyle outcomes among disadvantaged people were mediated by motivational problems. A two-year follow-up study of the combined cohorts of a randomized controlled trial. Level of exercise and present dietary habits were measured at inclusion and after 6 and 24 months. Different motivational factors and emotional distress were measured during rehabilitation. Autonomous self-regulation was lowest among smokers (b = -0.31, p = 0.02) and female participants (b = 0.39, p = 0.004). Participants with high scores of emotional distress predicted lower motivation for all the measures. We found no association between socioeconomic status (household income) and the ability to perform lifestyle changes. Current smoking status predicted lower ability to obtain lifestyle changes on all measures. Emotional distress was related to lower ability to increase physical activity at 6 months' but not at 24 months' follow-up. The mediating effects of motivational factors were insignificant. The results of this study do not support the suspicion that preventive efforts accentuate the socioeconomic differences in cardiovascular health. Health-promotive efforts after heart disease should safeguard that high-risk groups such as smokers are not discouraged from improving their lifestyle in other areas.

Sozialkapital und Gesundheit in Deutschland

The concept of social capital has been intensively discussed in public health during the last years. But there is only little empirical evidence regarding its association with health in Germany up to now. We have used data of the German Socio-Economic Panel (GSOEP) of 2003 to analyse the health utility of social capital. The results suggest a clear positive association among different forms of social capital (trust, norms of reciprocity, participation, social integration) and subjective health. Men and women who are poorly socially integrated regard their own health relatively often as limited. In contrast to these, men and women who hold any form of social capital rate their own health status to be noticeably better. In the multivariate analysis, socio-economic differences in subjective health could be traced back partly to the stock of social capital. In addition to its health utility, social capital may therefore make a contribution to understand the emergence of social inequalities in health. All in all, our results suggest that the concept of social capital should be considered even more in public health. Due to the present lack of empirical evidence, social capital has to be incorporated into more studies in Germany.

Time trends in socioeconomic differences in incidence rates of cancers of gastro-intestinal tract in Finland.

BackgroundThe magnitude of socioeconomic differences in health varies between societies, and over time within a given society. We studied the association between social class and incidence of cancers of the gastro-intestinal tract over time in a large cohort in Finland.MethodsWe studied social class variation among 45–69 year-old Finns during 1971–95 in incidence of cancers of the gastro-intestinal tract by means of a computerized record linkage of the Finnish Cancer Registry and the 1970 Population Census, which included social class data.ResultsThere were 2.3 million individuals in the cohort under follow-up, with 1622 cases of cancer of the esophagus, 8069 stomach (non-cardia), 1116 cardia, 408 small intestine, 6361 colon, 5274 rectum, 1616 liver, 1756 gallbladder, and 5084 pancreas during 1971–1995. Cancers of the esophagus, stomach, cardia, gallbladder and pancreas were most common among persons belonging to a low social class. Cancers of the small intestine in males only, colon in both genders, and rectum in females were most common in the higher social classes. Incidence of stomach cancer decreased and incidence of colon cancer increased over time in both genders in all social classes, and the large differences between social classes remained unchanged over time. Incidence rates of cardia cancer did not change substantially over time.ConclusionThere is a large variation in incidence of cancer of the gastrointestinal tract by social class in Finland. Although much of the observed social class differences probably could be explained by known etiological factors such as diet, physical exercise, alcohol consumption, smoking and exogenous hormone use, part of the variation is apparently attributable to largely unknown factors.

Social Epidemiology: How Socioeconomic Risk Factors Become Health Realities

Lu N, Samuels ME, Wilson R. Socioeconomic differences in health: How much do health behaviors and health insurance coverage account for? J Health Care Poor Underserved. 2004;15(4):618-630. Isaacs SL, Schroeder SA. Class—the ignored determinant of the nation’s health. N Engl J Med. 2004;351(11):1137-1142.

Impact of health literacy on socioeconomic and racial differences in health in an elderly population

Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence. To examine the extent to which low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations. Retrospective cohort study. PARTICIPANTS (OR PATIENTS OR SUBJECTS): Three thousand two hundred and sixty noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, OH; Houston, TX; South Florida; and Tampa, FL. Dependent variables were physical health SF-12 score, mental health SF-12 score, self-reported health status, receipt of influenza vaccine, and receipt of pneumococcal vaccine. Independent variables included health literacy, educational attainment, race, income, age, sex, chronic health conditions, and smoking status. After adjusting for demographic and health-related variables, individuals without a high school education had worse physical and mental health and worse self-reported health status than those with a high school degree. Accounting for health literacy reduced these differences by 22% to 41%. Black individuals had worse self-reported health status and lower influenza and pneumococcal vaccination rates. Accounting for health literacy reduced the observed difference in self-reported health by 25% but did not affect differences in vaccination rates. We found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden.

BackgroundTo more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to social inequalities in mortality in each age group in the whole population of Scania, Sweden.MethodsData from LOMAS (Longitudinal Multilevel Analysis in Skåne) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position (SEP) and workforce participation in 975,938 men and women aged 0 to 80 years, during 1991–2002.ResultsThe results generally showed increasing absolute mortality differences between those holding manual and non-manual occupations with increasing age, while there were inverted u-shaped associations when using relative inequality measures. Cardiovascular diseases (CVD) contributed to 52% of the male socioeconomic difference in overall mortality, cancer to 18%, external causes to 4% and psychiatric disorders to 3%. The corresponding contributions in women were 55%, 21%, 2% and 3%. Additionally, those outside the workforce (i.e., students, housewives, disability pensioners, and the unemployed) showed a strongly increased risk of future mortality in all age groups compared to those inside the workforce. Even though coronary heart disease (CHD) played a major contributing role to the mortality differences seen, stroke and other types of cardiovascular diseases also made substantial contributions. Furthermore, while the most common types of cancers made substantial contributions to the socioeconomic mortality differences, in some age groups more than half of the differences in cancer mortality could be attributed to rarer cancers.ConclusionCHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health.

Education, cumulative advantage, and health

Education’s positive effect on health gets larger as people age. The large socioeconomic differences in health among older Americans mostly accrue earlier in adulthood on gradients set by educational attainment. Education develops abilities that help individuals gain control of their own lives, encouraging and enabling a healthy life. The health-related consequences of education cumulate on many levels, from the socioeconomic (including work and income) and behavioral (including health behaviors like exercising) to the physiological and intracellular. Some accumulations influence each other. In particular, a low sense of control over one’s own life accelerates physical impairment, which in turn decreases the sense of control. That feedback progressively concentrates good physical functioning and a firm sense of personal control together in the better educated while concentrating physical impairment and a sense of powerlessness together in the less well educated, creating large differences in health in old age.

Explaining social inequalities in health by sleep: the Japanese civil servants study

Individuals of low socioeconomic status (SES) are likely to have poor sleep and poor health. This study aims to evaluate whether and how much of the socioeconomic differences in health are explained by sleep. The subjects were 3684 (2471 males and 1213 females) employees aged 20-65 working in local government in Japan. A questionnaire survey was conducted in January 2003. Analysis of covariance (ANCOVA) was performed to examine the association of employment-grade with sleep, measured by the Pittsburgh Sleep Quality Index (PSQI), and with health, measured by the Physical and Mental Component Summary Scales (PCS and MCS) of the Short Form-36 (SF-36). In men, higher grade employees had better sleep and better health. The age-adjusted difference between the highest and the lowest grade employees was 1.9 points (95% confidence interval = 1.0-3.0) in the PCS and 3.4 points (1.8-4.9) in the MCS. The grade difference in health reduced to 1.5 points (0.5-2.5) in the PCS (21.1% reduction) and 2.0 points (0.6-3.4) in the MCS (41.2% reduction), when the PSQI global score was adjusted for. The grade differences in sleep quality contributed more to the health inequalities than sleep quantity. Among women, no significant grade differences were observed in the PSQI global score. The grade differences in the PCS and MCS were weaker and less consistent than those of men, and the differences hardly changed when the PSQI global score was adjusted for. Sleep quality may mediate the relationship between SES and physical and, in particular, mental health in men.

A comparative appraisal of the relationship of education, income and housing tenure with less than good health among the elderly in Europe

The objective of this study was to determine the strength of various socio-economic indicators for predicting less than good health among elderly people aged 60–79 years. Data were obtained from national health surveys from 10 European countries. Education, income and housing tenure were examined in relation to less than good health using standardised prevalence rates and (multiple) logistic regression analyses. The results illustrated that there are substantial health differences among the elderly according to education and income in each country. Both education and income (with men) showed a strong independent relationship with health status. Health differences according to housing tenure were generally somewhat smaller. However, in Great Britain and the Netherlands housing tenure demonstrated large health differences, even after adjustment for education and income. It is recommended that more refined socio-economic measures are developed and that in the meantime both education and income are used when studying socio-economic health differences among the elderly. In some countries, like Great Britain and the Netherlands, however, housing tenure has an additional value.

Die Bedeutung sozialer Ungleichheit für die Gesundheit im Jugendalter

The aim of the study was to investigate socioeconomic differences in adolescent health in Germany. Findings are based on data from 5650 11- to 15-year-old German pupils participating in the cross-national study "Health Behaviour in School-age Children" in 2002. Extend and occurrence of health inequalities depended largely on the selected health out comes. Moreover, there were marked gender-specific differences in respect of socioeconomic differences in health. For both, boys and girls, results showed a strong effect of socioeconomic status (parental occupation and family affluence) on overweight. Allergies yielded comparable results in respect of socioeconomic differences. On the other hand, social inequalities had an influence on psychological health mainly in girls. This effect was found for the number as well as for the extent of socioeconomic health differences. No health inequalities were found in respect of injuries, life satisfaction and underweight, independent of gender. The influence of social inequalities on adolescents' health was considerably more complex and more stratified than expected. The analysis indicates that the special characteristics of adolescence need to be taken into account in the discussion of social inequalities in health. The fact that young people's health is probably less influenced by social inequality then it is during other parts of the life course points attention to adolescence as an important stage for preventive efforts.