Socioeconomic Gradients In Health Research Articles

Objective and subjective socioeconomic gradients exist for sleep in children and adolescents.

Socioeconomic position (SEP) is inversely associated with many health outcomes, yielding a socioeconomic gradient in health. In adults, low SEP is associated with short sleep duration, poorer sleep quality, and difficulty initiating and maintaining sleep. Relatively little is known about this relation in youth. The aim of the present study was to examine whether socioeconomic gradients exist for various sleep indices among a healthy sample of children and adolescents. Participants took part in the larger Healthy Heart Project and included 239 youth (69.6% Caucasian; 45.6% female), aged 8-17 years (M = 12.6, SD = 1.9). Parental income and education were used to measure objective SEP. The Subjective Social Status Scale-Youth Version was used to measure subjective SEP. Sleep duration, sleep quality, daytime sleepiness, and sleep disturbances were assessed through self- and parent-report. In children, objective SEP was related with sleep duration (β = .35, p < .01), although subjective SEP was related with daytime sleepiness (βavg = .33, p < .01) and parent-reported sleep duration (β = .23, p < .05). In adolescents, subjective SEP was related with sleep quality (β = .28, p < .01) and parent-reported sleep duration (β = -.18, p < .05), even after controlling for objective SEP. Socioeconomic gradients were observed for multiple sleep measures in youth. Objective parental SEP was related with sleep complaints (e.g., sleep disturbances), and subjective SEP was related with sleep quality and daytime sleepiness. Findings suggest sleep may be one pathway underlying the socioeconomic gradient in health. Future research should aim to elucidate how distinct sleep constructs may explain how socioeconomic status "gets under the skin" to affect health.

Intermarriage and the Unhealthy Assimilation of Immigrant Descendants

This paper studies the effects of assimilation on the of Hispanics in the US. I exploit a unique dataset of linked birth records and use ethnic intermarriage as a metric of acculturation. Intermarried Hispanics have a significantly higher socio-economic status than endogamously married Hispanics. Despite their higher socio-economic status and the positive socio-economic gradient in health, third-generation children of second- generation intermarried Hispanic women are more likely to have poor at birth, even after I account for second-generation at birth, employ only within-family variations in the extent of assimilation, and consider the endogeneity of intermarriage.These results do not appear to be driven by father's selectivity nor by individual unobservable characteristics associated with intermarriage. The children of intermarried natives do not receive the same health penalty, nor do Hispanics intermarried to other ethnic groups. The intermarriage health penalty largely reflects the higher incidence of risky behaviors (e.g., smoking during pregnancy) among intermarried Hispanic women.

Income and Income Inequality as Social Determinants of Health: Do Social Comparisons Play a Role?

Two of the most prominent phenomena in the study of social determinants of health, the socio-economic gradient in health and the income inequality-health association, have both been suggested to be explainable by the mechanism of status comparisons. This, however, has rarely ever been tested in a direct fashion. In this article, we explicate and test this mechanism by assessing the role of social comparison orientation. Research has shown that individuals vary in their propensity to engage in social comparisons, and those with a higher propensity are also more likely to be affected by the outcomes of such comparisons. In our analysis, we check whether the tendency to compare one's income to that of others can contribute to explaining socio-economic disparities in health. Using individual-level data (N = 18,356) from 23 European countries on self-rated overall health and psychological well-being, we show that a high-income comparison orientation neither moderates the negative effect of income inequality on health nor the health differences by relative income. Our findings cast doubt on the crucial role that researchers such as Wilkinson and Pickett (2010) have attributed to the mechanism of status differentiation as the link between social stratification and health outcomes.

The role of new media in marketing unhealthy food and beverages to children and adolescents

theoretical framework that will enable organisation of current and future universal obesity prevention interventions into their likely impact on the socioeconomic gradient of population weight gain. Methods: We partitioned the framework into two scales; the environment where action is taken (micro and macro environments) and the degree to which an intervention targets individual agency or embedded structures to influence behaviour change (characterised by three predominant policy types: agentic, agento-structural and structural). Results: Agentic interventions, which are heavily reliant on individual agency, are more likely to increase socioeconomic inequalities in population weight. Examples of these types of interventions include social marketing, school nutrition education programs and signage to encourage healthy behaviours. Structural interventions generally describe an equal or greater benefit for lower socioeconomic groups and include food procurement policies, restricting the availability of unhealthy foods in schools and a mandatory increase in school physical education time. Agento-structural interventions are mindful of the environment in which health behaviours take place, but individual agency is nonetheless important. Agento-structural interventions include work place design to encourage incidental exercise and mandatory nutrition labelling. There is a lack of empirical evidence and theoretical clarity regarding the socioeconomic impact of agento-structural interventions, however we hypothesise that those aimed at the macroenvironmental context are more likely to have an equitable impact. Conclusions: Examination of the socioeconomic health impact of obesity prevention interventions is crucial. This is especially true for agentostructural interventions, which show great promise for obesity prevention, but where the greatest uncertainty regarding the socioeconomic health impact remains. Failure to do so runs the risk of widening the socioeconomic gradient in health as we strive to prevent obesity.

Modelling social inequalities in health in contemporary Switzerland

The relationship between income and health has been widely established. However, there are some issues which need to be addressed in order to study accurately the socio-economic gradient in health. Firstly, there is a specific issue linked to the dynamic nature of health. The current health status is closely linked to past health circumstances and is a good predictor of future health status. Hence we should implement models which are able to take into account the dynamic nature of health. Secondly, the study of health can be affected by a more general problem that often plagues sociological models aimed at estimating causal effects, that of non-observed heterogeneity leading to endogeneity. Both genetic factors and psychological predispositions that are important predictors of health may easily be correlated with one’s socio-economic status, thus creating endogeneity. If analyzed with the appropriate methods, panel data help us tackle these issues. In this work we study the effect of income on self-assessed health in Switzerland using 13 waves (from 1999 to 2012) of the Swiss Household Panel. We apply a fixed effects model, a random effect model and a dynamic panel model (more precisely, the Mundlak–Chamberlain model). Whereas in both the fixed and the random effects models income appears to be significantly related to health, in the Mundlak–Chamberlain model this effect disappears. Results show that models based on different assumptions and including a different set of controls give quite different results.

Socioeconomic variation in the burden of chronic conditions and health care provision--analyzing administrative individual level data from the Basque Country, Spain.

BackgroundChronic diseases are posing an increasing challenge to society, with the associated burden falling disproportionally on more deprived individuals and geographical areas. Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities. The objectives of this study were to measure the level of socioeconomic-related inequality in prevalence of chronic diseases and to investigate the extent and direction of inequities in health care provision.MethodsA dataset linking clinical and administrative information of the entire population living in the Basque Country, Spain (over 2 million individuals) was used to measure the prevalence of 52 chronic conditions and to quantify individual health care costs. We used a concentration-index approach to measure the extent and direction of inequality with respect to the deprivation of the area of residence of each individual.ResultsMost chronic diseases were found to be disproportionally concentrated among individuals living in more deprived areas, but the extent of the imbalance varies by type of disease and sex. Most of the variation in health care utilization was explained by morbidity burden. However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes.ConclusionsAnalyses of comprehensive administrative clinical information at the individual level allow the socioeconomic gradient in chronic diseases and health care provision to be measured to a level of detail not possible using other sources. This frequently updated source of information can be exploited to monitor trends and evaluate the impact of policy reforms.

Explaining significant differences in subjective and objective measures of cardiovascular health: evidence for the socioeconomic gradient in a population-based study.

BackgroundTo assess prevalence rates of subjective and objective reports of two cardiovascular disorders (hypertension and hypercholesterolemia) for the same subset of respondents in a large-scale study. To determine whether and the extent to which the socioeconomic health gradient differed in the subjective and objective reports of the two cardiovascular disorders.MethodsData from the first wave (2009/2011) of The Irish Longitudinal Study on Ageing were used (n = 4,179). This is a nationally representative study of community-dwelling adults aged 50+ residing in Ireland. Subjective measures were derived from self-reports of doctor-diagnosed hypertension and high cholesterol. Objective measure of hypertension was defined as: systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or on antihypertensive medication. Objective measure of hypercholesterolemia was defined as: total cholesterol ≥5.2 mmol/L and/or on cholesterol-lowering medication. Objective measures of low-density-lipoprotein cholesterol and high-density-lipoprotein cholesterol were also used. Two measures of socioeconomic gradient were employed: education and wealth. Binary and multinomial logistic and linear regression analyses were used. Analyses were adjusted for an extensive battery of covariates, including demographics and measures of physical/behavioural health and health care utilization.ResultsPrevalence of cardiovascular disorders: prevalence of hypertension and hypercholesterolemia was significantly higher when the cardiovascular disorders were measured objectively as compared to self-reports (64% and 72.1% versus 37% and 41.1%, respectively). Socioeconomic gradient in hypertension: the odds of being objectively hypertensive were significantly lower for individuals with tertiary/higher education (OR, 0.74; 95% CI, 0.60-0.92) and in the highest tertile of the wealth distribution (OR, 0.77; 95% CI, 0.62-0.95). In contrast, the associations between socioeconomic status and self-reported hypertension were not statistically significant. Socioeconomic gradient in hypercholesterolemia: wealthier individuals had higher odds of self-reporting elevated cholesterol (OR, 1.28; 95% CI, 1.03-1.58). Associations between socioeconomic status and objectively measured hypercholesterolemia and low-density-lipoprotein cholesterol were not significant. Higher education and, to a lesser extent, greater wealth were associated with higher levels of high-density-lipoprotein cholesterol.ConclusionsClear discrepancies in prevalence rates and gradients by socioeconomic status were found between subjective and objective reports of both disorders. This emphasizes the importance of objective measures when collecting population data.

The socioeconomic health gradient across the life cycle: What role for selective mortality and institutionalization?

Several studies have documented the now fairly stylized fact that health inequalities by income differ across the age distribution: in cross-sections the health gap between rich and poor tends to widen until about age 50 and then declines at higher ages. It has been suggested that selective mortality and institutionalization could be important factors driving the convergence at higher ages. We use eight waves of a health survey linked to four registries (on mortality, hospitalizations, (municipal) residence status and taxable incomes) to test this hypothesis. We construct life cycle profiles of health for birth year/gender/income groups from the health surveys (based on 128,689 observations) and exploit the registries to obtain precise estimates of individual probabilities of mortality and institutionalization using a seven year observation period for 2,521,122 individuals. We generate selection corrected health profiles using an inverse probability weighting procedure and find that attrition is indeed not random: older, poorer and unhealthier individuals are significantly more likely not to survive the next year and to be admitted to an institution. While these selection effects are very significant, they are not very large. We therefore reject the hypothesis that selective dropout is an important determinant of the differential health trajectories by income over the life course in the Netherlands.

HealthPaths—Using health trajectories to estimate and simulate the relative importance of determinants of health-adjusted life expectancy (HALE): a statistical analysis

BackgroundThere is broad agreement that a summary measure of population health such as health-adjusted life expectancy (HALE) is fundamental. While HALE is strongly correlated with income, multivariate analyses ascribing relative importance to a range of socioeconomic determinants are relatively rare. MethodsThis analysis combines very detailed statistical analysis of Statistics Canada's longitudinal National Population Health Survey (NPHS) with the HealthPaths dynamic microsimulation model. Microsimulation is used to synthesise a realistic base-case representative longitudinal population sample and then a series of carefully constructed counterfactual populations, each cutting a link in the “web of causality” estimated from the NPHS. Comparisons of the distributions of health-adjusted life lengths and summary HALE measures between counterfactuals and the base case are then used to estimate the quantitative importance of the determinants being analysed. Replicate simulations plus underlying replicate regressions further enable sophisticated measures of uncertainty in model results. FindingsThis analysis extends an earlier version that focused on four factors: obesity, smoking, education, and Antonovsky's Sense of Coherence (SoC). In that analysis, surprisingly, SoC had the largest potential impact, while education and smoking each accounted for about half as many years of (cause-deleted) HALE, and obesity accounted for relatively little. This analysis extends these results to encompass a broader range of factors, including household income, leisure and daily physical activity, employment, sense of mastery, family membership, and institutional residence. These additions change the rank order and magnitudes of the factors somewhat, reflecting omitted variable biases. The statistical analysis has had to confront a number of challenges with the main dataset, including inertia in health states, missing data, and errors in variables. InterpretationWidely observed socioeconomic gradients in health, when examined in greater detail, are the culmination of myriad co-evolving dynamic processes, where their interacting and joint effects, alone, are small. It is essential to employ an analytical framework that combines robust estimates of individual multivariate health status dynamics with health determinants dynamics in order to assess realistically the sources of health inequalities. FundingCanadian Foundation for Innovation.

The socioeconomic gradient in health: how important is material deprivation?

In this paper we use the Spanish Living Conditions Survey (2005–2008) to investigate the existence of a socioeconomic gradient in health when alternative measures of socioeconomic status, apart from income, are considered. In particular we construct a material deprivation index that reflects minimum standards of quality of life and that incorporates comparison effects with societal peers and we estimate health equations with probit adapted least squares, fixed effects and instrumental variables. Our results reveal that the relationship between health and income operates through comparison information with respect to societal peers. In contrast, material deprivation in terms of financial difficulties, basic necessities and housing conditions exerts a direct effect on individual health. Mixed evidence is found with respect to gender.

Differences in self-assessed health by socioeconomic group amongst people with and without a history of cancer: an analysis using representative data from Scotland

This paper considers socioeconomic inequalities in self-assessed health amongst people with and without a history of cancer using representative data from Scotland. A cross-sectional analysis using the Scottish Health Survey was done. Cancer survivors were identified using linked Cancer Registry data. Bivariate and multivariate analysis was used to compare and contrast self-assessed health amongst those with a history of cancer to those without. Of the 17,505 survey participants, 432 (2.5%) had a history of cancer. After taking into account potential confounders, those in the lowest socioeconomic group were more likely to report poor health than those in the highest group amongst those with a history of cancer [odds ratio, 2.96; confidence interval (CI), 1.82-4.80] and those with no history of cancer (odds ratio, 2.45; CI, 2.21-2.71). Those in the lowest socioeconomic group with no history of cancer had a greater propensity to report poor health than any of the highest groups that did have a history of cancer (p < 0.01). Differences in propensities to indicate poor health were particularly marked amongst those 4years or more post-cancer diagnosis. Findings underline the scale of socioeconomic gradients in health. That disparities were so wide amongst those most temporally distant from initial diagnosis is particularly a concern given improving survival after a cancer diagnosis. Socioeconomic circumstances have a considerable influence on health and well-being. Practitioners and policy makers should consider socioeconomic circumstances in considering approaches to health and social care of cancer survivors.

Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders

A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called “epidemiological paradox” or “immigrant health paradox”. To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002–2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes – perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like “immigrant health paradox” which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.

Expectancies, Socioeconomic Status, and Self-Rated Health: Use of the Simplified TOMCATS Questionnaire

BackgroundCoping has traditionally been measured with inventories containing many items meant to identify specific coping strategies. An alternative is to develop a shorter inventory that focusses on coping expectancies which may determine the extent to which an individual attempts to cope actively.PurposeThis paper explores the usefulness and validity of a simplified seven-item questionnaire (Theoretically Originated Measure of the Cognitive Activation Theory of Stress, TOMCATS) for response outcome expectancies defined either as positive (“coping”), negative (“hopelessness”), or none (“helplessness”). The definitions are based on the Cognitive Activation Theory of Stress (CATS; Ursin and Eriksen, Psychoneuroendocrinology, 29(5):567–92, 2004). The questionnaire was tested in two different samples. First, the questionnaire was compared with a traditional test of coping and then tested for validity in relation to socioeconomic differences in self-reported health.MethodsThe first study was a comparison of the brief TOMCATS with a short version of the Utrecht Coping List (UCL; Eriksen et al., Scand J Psychol, 38(3):175–82, 1997). Both questionnaires were tested in a population of 1,704 Norwegian municipality workers. The second study was a cross-sectional analysis of TOMCATS, subjective and objective socioeconomic status, and health in a representative sample of the Swedish working population in 2003–2005 (N = 11,441).ResultsIn the first study, the coping item in the TOMCATS questionnaire showed an expected significant positive correlation with the UCL factors of instrumental mastery-oriented coping and negative correlations with passive and depressive scores. There were also the expected correlations for the helplessness and hopelessness scores, but there was no clear distinction between helplessness and hopelessness in the way they correlated with the UCL. In the second study, the coping item in TOMCATS and the three-item helplessness scores showed clear and monotonous gradients over a subjective socioeconomic status (SES) ladder. Positive response outcome expectancy (“coping”) was related to high subjective SES and no expectancy (“helplessness”) to low subjective SES. In a model including age and sex, TOMCATS scores explained more variance (r 2 = 0.16) in self-reported health than both subjective (r 2 = 0.08) and objective SES (r 2 = 0.02).ConclusionThe brief TOMCATS questionnaire showed acceptable and significant correlations with a traditional coping questionnaire and is sensitive enough to register systematic differences in response outcome expectancies across the socioeconomic ladder. The results furthermore confirm that psychological and learning factors contribute to the socioeconomic gradient in health.

Intravitreous bevacizumab adult safety data: the evidence so far

Intravitreous bevacizumab adult safety data: the evidence so far

Socioeconomic Status and Health Over the Life Course and Across Generations: Introduction to a Special Issue and Overview of a Unique Data Resource

Abstract

Community and household socioeconomic factors associated with pesticide-using, small farm household members' health: a multi-level, longitudinal analysis.

BackgroundLongitudinal studies using multi-level models to examine health inequalities in lower and middle income countries (LMICs) are rare. We explored socio-economic gradients in health among small farm members participating in a pesticide-related health and agriculture program in highland Ecuador.MethodsWe profiled 24 communities through key informant interviews, secondary data (percent of population with unsatisfied basic needs), and intervention implementation indicators. Pre (2005) and post (2007) surveys of the primary household and crop managers included common questions (education, age, and the health outcome - digit span scaled 0-10)) and pesticide-related practice questions specific to each. Household assets and pesticide use variables were shared across managers. We constructed multi-level models predicting 2007 digit span for each manager type, with staged introduction of predictor variables.Results376 household managers (79% of 2005 participants) and 380 crop managers (76% of 2005 participants) had complete data for analysis. The most important predictor of 2007 digit span was 2005 digit span: β (Standard Error) of 0.31(0.05) per unit for household and 0.17(0.04) for crop managers. Household asset score was next most important: 0.14(0.06) per unit for household and 0.14(0.05) for crop managers. Community percent with unsatisfied basic needs was associated with reductions in 2007 digit span: -0.04(0.01) per percent for household and -0.03(0.01) for crop managers.ConclusionsThe important roles of life endowments and/or persistent neurotoxicity were exemplified by limited change in the health outcome. Gradients by household assets and community deprivation were indicative of ongoing, structural inequities within this LMIC.

Mechanisms for the social gradient in health: Results from a 14-year follow-up of the Northern Swedish Cohort

Although numerous studies have demonstrated a socio-economic gradient in health, there is still a lack of research about the mechanisms behind this gradient. The aim of this study was to analyse possible mechanisms from adolescence to adulthood to explain the socio-economic gradient in somatic symptoms among men and women in the Northern Swedish Cohort. A prospective cohort study was performed, in which all pupils (n=1083) in the last year of compulsory school were followed for 14 years. The response rate was high, with 96.6% still participating after 14 years. The data were mainly collected through repeated comprehensive self-administered questionnaires. The main dependent variable was a combination of socio-economic position and somatic health at 30 years of age. Multivariate multinomial and bivariate logistic regression analyses were undertaken. After controlling for parental working-class position and health-related selection, the authors identified mechanisms from adolescence to adulthood for the socio-economic gradient in health that were related to social relations (poor relationship with father and unemployed friends among men, violence among women), labour market experiences (unemployment among men and women, physically heavy work among women), economic hardship (among women) and poor health behaviour. These analyses contribute to the development of epidemiological methods for analysing mechanisms for the socio-economic gradient in health.

Accumulating Knowledge on the Social Determinants of Health and Infectious Disease

Accumulating Knowledge on the Social Determinants of Health and Infectious Disease

Explaining recent coronary heart disease mortality trends in England by socioeconomic circumstances, 2000–2007

BackgroundThe continuing fall in coronary heart disease (CHD) mortality is widely celebrated. However, the impact of public policies and treatments on socio-economic gradients in health is poorly quantified. Understanding the...

To what extent can deprivation inequalities in mortality and heart disease incidence amongst the working aged in Scotland be explained by smoking? Relative and absolute approaches

Smoking is important for both population health and inequalities in health. There is a growing recognition that its impact on inequalities can be assessed both by standardising smoking rates across socio-economic groups and by assessing the effect of reducing the prevalence of smoking in all groups, so-called relative and absolute approaches. While national level studies (such as census-linkage studies) give vital information on the socio-economic gradient in health they often lack smoking data. Here, small area smoking estimates are linked to a national level longitudinal study to overcome this problem. Results confirm that in relative and especially absolute terms smoking plays an important role in inequalities.