Related Articles

Background

Use of psychotropic drugs is widespread in Europe, and is markedly more common in France than elsewhere. Young adults often fare less well than adolescents on health indicators (injury, homicide, and substance use). This population-based study assessed disparities in psychotropic drug use among people aged 18–29 from different socio-occupational groups and determined whether they were mediated by educational level, health status, income, health-related behaviours, family support, personality traits, or disability.

Methods

A total of 1,257 people aged 18–29, randomly selected in north-eastern France completed a post-mailed questionnaire covering sex, date of birth, height, weight, educational level, occupation, smoking habit, alcohol abuse, income, health-status, diseases, reported disabilities, self-reported personality traits, family support, and frequent psychotropic medication for tiredness, nervousness/anxiety or insomnia. The data were analyzed using the adjusted odds ratios (ORa) computed with logistic models.

Results

Use of psychotropic drugs was common (33.2%). Compared with upper/intermediate professionals, markedly high odds ratios adjusted for sex were found for manual workers (2.57, 95% CI 1.02–6.44), employees (2.58, 1.11–5.98), farmers/craftsmen/tradesmen (4.97, 1.13–21.8), students (2.40, 1.06–5.40), and housewives (3.82, 1.39–10.5). Adjusting for all the confounders considered reduced the estimates to a pronounced degree for manual workers (adjusted OR 1.49, non-significant) but only slightly for the other socio-occupational groups. The odds ratio for unemployed people did not reach statistical significance. The significant confounders were: sex, not-good health status, musculoskeletal disorders and other diseases, being worried, nervous or sad, and lack of family support (adjusted odds ratios between 1.60 and 2.50).

Conclusion

There were marked disparities among young adults from different socio-occupational groups. Sex, health status, musculoskeletal diseases, family support, and personality traits were related to use of psychotropic drugs. These factors mediated the higher risk strongly among manual workers and slightly among the other groups.

Background

Relatively little knowledge is available to date about health literacy among the general population in Europe. It is important to gain insights into health literacy competences among the general population, as this might contribute to more effective health promotion and help clarify socio-economic disparities in health. This paper is part of the European Health Literacy Survey (HLS-EU). It aims to add to the body of theoretical knowledge about health literacy by measuring perceived difficulties with health information in various domains of health, looking at a number of competences. The definition and measure of health literacy is still topic of debate and hardly any instruments are available that are applicable for the general population. The objectives were to obtain an initial measure of health literacy in a sample of the general population in the Netherlands and to relate this measure to education, income, perceived social status, age, and sex.

Methods

The HLS-EU questionnaire was administered face-to-face in a sample of 925 Dutch adults, during July 2011. Perceived difficulties with the health literacy competences for accessing, understanding, appraising and applying information were measured within the domains of healthcare, disease prevention and health promotion. Multiple linear regression analyses were applied to explore the associations between health literacy competences and education, income, perceived social status, age, and sex.

Results

Perceived difficulties with health information and their association with demographic and socio-economic variables vary according to the competence and health domain addressed. Having a low level of education or a low perceived social status or being male were consistently found to be significantly related to relatively low health literacy scores, mainly for accessing and understanding health information.

Conclusions

Perceived difficulties with health information vary between competences and domains of health. Health literacy competences are associated with indicators of socio-economic position and with the domain in which health information is provided.

Aim

The aim of the study was to evaluate whether socio-economic inequalities in the practice of physical activity existed among children and adolescents, using different indicators of socio-economic status (SES).

Subjects and methods

Data were derived from the Italian National Health Interview Survey carried out in 2004–2005, which examined a large random sample of the Italian population using both an interviewer-administered and a self-compiled questionnaire. This study was based on a sample of 15,216 individuals aged 6–17 years. The practice of physical activity was measured on the basis of questions regarding frequency and intensity of activity during leisure time over the past 12 months. Parents’ educational and occupational level, as well as family’s availability of material resource, were used as indicators of SES. Multivariable logistic regression analyses were performed to estimate the contribution of each SES indicator to the practice of physical activity, adjusting for potential confounding factors. The results of the regression models are expressed as odds ratio (OR) with 95% confidence intervals (95% CI).

Results

About 64% of children and adolescents in the sample declared that they participated in moderate or vigorous physical activity at least once a week. After adjustment for gender, age, parental attitudes towards physical activity and geographical area, the practice of physical activity increased with higher parental educational and occupational level and greater availability of material resources. Children and adolescents whose parents held a middle or high educational title were 80% more likely to practice moderate or vigorous physical activity than subjects whose parents had a lower level of education (OR = 1.80, 95% CI: 1.40–2.33), while subjects with unemployed parents had an odds of practicing moderate or vigorous physical activity 0.43 times that of those children whose parents belonged to the top job occupation category (administrative/professionals). Socio-economic differences were about the same when the practice of vigorous physical activity only was considered instead of that of moderate or vigorous physical activity.

Conclusion

Interventions that promote the practice of physical activity, and especially those aimed at the wider physical and social environment, are strongly needed to contrast socio-economic differences in physical activity among children and adolescents.

Background

Social inequalities in cardiovascular diseases are well documented. Yet, the relation of social status inconsistency (having different ranks in two or more status indicators like education, occupational position or income) and medical conditions of heart or vessels is not clear. Status inconsistency (SI) is assumed to be stressful, and the association of psychosocial distress and health is well known. Therefore, we aimed to analyze the relationship between cardiovascular diseases (CVD) and status inconsistency. Another target was to assess the influence of behaviour related risk factors on this association.

Methods

8960 men and 6070 women, aged 45-65 years, from the EPIC-Heidelberg cohort (European Prospective Investigation into Cancer and Nutrition) were included. Socio-economic status was assessed by education/vocational training and occupational position at recruitment. During a median follow-up of 8.7 years, information on CVD was collected.

Results

Compared to status consistent subjects, men who were in a higher occupational position than could be expected given their educational attainment had a nearly two-fold increased incidence of CVD (Odds Ratio (OR) = 1.8, 95% Confidence Interval (CI) = 1.5; 2.4, adjusted for age). Smoking behaviour and BMI differed significantly between those who had adequate occupational positions and those who did not. Yet, these lifestyle factors, as opposed to age, did not contribute to the observed differences in CVD. No association of cardiovascular diseases and status inconsistency was found for women or in cases where education exceeded occupational position.

Conclusions

Status inconsistent men (occupational position > education) had a higher risk of cardiovascular diseases than status consistent men. However, harmful behaviour did not explain this relationship.

STUDY OBJECTIVE: To examine the contribution of childhood health to the explanation of socioeconomic inequalities in health in early adult life. DESIGN: Retrospective data were used, which were obtained from a postal survey in the baseline of a prospective cohort study (the Longitudinal Study on Socio-Economic Health Differences in the Netherlands). Adult socioeconomic status was indicated by educational level, while health was indicated by perceived general health. Childhood health was measured by self reported periods of severe disease in childhood. Relations were analysed using logistic regression models. The reduction in odds ratios of "less than good" perceived general health for different educational groups after adjustment for childhood health was used to estimate the contribution of childhood health. SETTING: The population of the city of Eindhoven and surroundings in the south east of the Netherlands in 1991. PARTICIPANTS: 2511 respondents, aged 25-34 years, men and women, of Dutch nationality, were included in the analysis. MAIN RESULTS: There was a clear association between childhood health and adult health, as well as an association between childhood health and adult socioeconomic status. Approximately 5% to 10% of the increased risk of the lower socioeconomic groups of having a "less than good" perceived general health can be explained by childhood health. CONCLUSIONS: Childhood health contributes to the explanation of socioeconomic inequalities in early adult health. Although this contribution is not very large, it cannot be ignored and has to be interpreted largely in terms of selection on health.

 

Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.

Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.

Background

Norway provides universal health care coverage to all residents, but socio-economic inequalities in health are among the largest in Europe. Evidence on inequalities in health care utilisation is sparse, and the aim of this population based study was to investigate socio-economic inequalities in the utilisation of health care services in Tromsø, Norway.

Methods

We used questionnaire data from the cross-sectional Tromsø Study, conducted in 2007–8. All together 12,982 persons aged 30–87 years participated with the response rate of 65.7%. This is slightly more than one third of the total population (33.8%) in the mentioned age group in Tromsø municipality. By logistic regression analyses we studied associations between household income, education and self-rated occupational status and the utilisation of general practitioner, somatic and psychiatric specialist outpatient services. The outcome variables were probability and frequency of use during the previous 12 months. Analyses were stratified by gender and adjusted for age, marital status, and self-rated health.

Results

Self-rated health was the dominant predictor of health care utilisation. Women’s probability of visiting a general practitioner did not vary by socio-economic status, but high income was associated with less frequent use (odds ratio [OR] for trend 0.89, 95% confidence interval [CI] 0.81-0.98). In men, high income predicted lower probability and frequency of general practitioner utilisation (OR for trend 0.85, CI 0.76-0.94, and 0.86, 0.78-0.95, respectively). Women’s probability of visiting a somatic specialist increased with higher income (OR for trend 1.11, CI 1.01-1.21) and higher education (OR for trend 1.27, CI 1.16-1.39). We found the same trends for men, though significant only for education (OR for trend 1.14, CI 1.05-1.25). The likelihood of visiting psychiatric specialist services increased with higher education and decreased with higher income in women (OR for trend 1.57, CI 1.24-1.98, and 0.69, 0.56-0.86, respectively), but did not vary significantly by socio-economic variables in men. Higher income predicted more frequent use of psychiatric specialist services in men (OR for trend 2.02, CI 1.12-3.63).

Conclusions

This study revealed important inequalities in the utilisation of health care services in Norway, inequalities which may contribute to sustaining inequalities in health outcomes.

Background

We investigated the associations between education and leisure-time, occupational, sedentary and total physical-activity levels based on data from the German National Health Interview and Examination Survey 1998 (GNHIES98). The roles of income level, occupational status and other mediating variables for these associations were also examined.

Methods

The total study sample of the GNHIES98 comprised 7,124 participants between the ages of 18 and 79. Complete information was available for 6,800 persons on leisure-time, sedentary and total physical-activity outcomes and for 3,809 persons in regular employment on occupational activity outcomes. The associations between educational level and physical activity (occupational, sedentary, leisure-time and total physical activity) were analysed separately for men and women using multivariate logistic regression analysis. Odds ratios (OR) of educational level on physical-activity outcomes were calculated and adjusted for age, region, occupation, income and other mediating variables.

Results

After adjusting for age and region, a higher education level was associated with more leisure-time activity – with an OR of 1.6 (95% CI, 1.3-2.0) for men with secondary education and 2.1 (1.7-2.7) for men with tertiary education compared to men with primary education. The corresponding ORs for women were 1.3 (1.1-1.6) and 1.7 (1.2-2.4), respectively. Higher education was associated with a lower level of vigorous work activity: an OR of 6.9 (4.6-10.3) for men with secondary education and 18.6 (12.0-27.3) for men with primary education compared to men with tertiary education. The corresponding ORs for women were 2.8 (2.0-4.0) and 5.8 (4.0-8.5), respectively. Higher education was also associated with a lower level of total activity: an OR of 2.9 (2.2-3.8) for men with secondary education and 4.3 (3.3-5.6) for men with tertiary education compared to men with primary education. The corresponding ORs for women were 1.6 (1.2-2.0) and 1.6 (1.2-2.1), respectively.

Conclusions

In Germany adults with a lower level of education are more physically active, both at work and overall, compared to adults with a higher education level, although they are less physically active in their leisure time. Higher work-related activity levels among adults with lower education may explain why they are less active in their leisure time.

The aim of this study was to estimate the prevalence of migraine in the general Spanish population and its association with socio-demographic and lifestyle factors, self-reported health status, and co-morbidity with other conditions. We analyzed data obtained from adults aged 16 years or older (n = 29,478) who participated in the 2006 Spanish National Health Survey (SNHS), an ongoing, home-based personal interview which examines a nation-wide representative sample of civilian non-institutionalized population residing in main family dwellings (household) of Spain. We analyzed socio-demographic characteristics (gender, age, marital status, educational level, occupational status, and monetary monthly income); self-perceived health status; lifestyle habits (smoking habit, alcohol consumption, sleep habit, physical exercise, and obesity); and presence of other concomitant diseases. The 1-year prevalence of diagnosed migraine (n = 3,433) was 11.02% (95% CI 10.55–11.51). The prevalence was significantly higher among female (15.94%) than male (5.91%) and showed the highest value in the 31–50 years age group (12.11%). Migraine was more common in those of lower income (AOR 1.19, 95% CI 1.01–1.41) and who sleep <8 h/day (AOR 1.18, 95% CI 1.04–1.33). Furthermore, worse health status (AOR 2.04, 95% CI 1.76–2.36) and depression (AOR 1.82 95% CI 1.58–2.11) were related to migraine. Finally, subjects with migraine were significantly more likely to have comorbid conditions, particularly chronic (more than 6 month of duration) neck pain (AOR 2.31, 95% CI 1.98–2.68) and asthma (AOR 1.62, 95% 1.27–2.05). The current Spanish population-based survey has shown that migraine is more frequent in female, between 31 and 50 years and associated to a lower income, poor sleeping, worse health status, depression and several comorbid conditions, particularly chronic neck pain and asthma.

Background

Social networks and social support are supposed to contribute to the development of unequal health within populations. However, little is known about their socio-economic distribution. In this study, we explore this distribution.

Methods

This study analyses the association of two indicators of socio-economic position, education and income, with different measures of social networks and support. Cross-sectional data have been derived from the baseline examination of an epidemiological cohort study of 4.814 middle aged urban inhabitants in Germany (Heinz Nixdorf Recall Study). Bivariate and multivariate logistic regression analysis were carried out to estimate the risk of having poor social networks and support across socio-economic groups.

Results

Socially disadvantaged persons more often report poor social networks and social support. In multivariate analyses, based on education, odds ratios range from 1.0 (highest education) to 4.9 (lowest education) in a graded way. Findings based on income show similar effects, ranging from 1.0 to 2.5. There is one exception: no association of SEP with close ties living nearby and regularly seen was observed.

Conclusion

Poor social networks and low social support are more frequent among socio-economically disadvantaged people. To some extent, this finding varies according to the indicator chosen to measure these social constructs.

OBJECTIVES

This study investigates the prevalence of rheumatoid arthritis (RA) by gender and socio-economic characteristics. It also explores the differences in the employment status between RA patients and the general population without RA in Korea.

METHODS

We analyzed data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) conducted from 2007 to 2009. Prevalence rates were estimated for female and male patients with RA in terms of age, residence, education, income level, and occupation type. The female respondents aged 45 to 64 were divided into the RA population and the non-RA population in order to compare the employment status between the two groups.

RESULTS

The annual physician-diagnosed RA prevalence rate was 1.45%. The prevalence rate was 2.27% for women and 0.62% for men. Individuals with RA had a significantly lower employment rate than individuals without RA (41.7 vs. 68.1%). The main reason for non-employment among RA patients was health-related problems (47.1%). There was statistically significant difference in employment type among the two groups. The experience rates for sick leave and sick-in-bed due to RA were 1.7 and 3.9%, respectively.

CONCLUSION

Middle- and old-aged women accounted for the majority of the Korean RA population, which had a significant lower employment rate compared to the population without RA for both sexes. RA resulted in considerable productivity loss in Korea.

Background

The estimated life expectancy at birth for Indigenous Australians is 10-11 years less than the general Australian population. The mean family income for Indigenous people is also significantly lower than for non-Indigenous people. In this paper we examine poverty or socioeconomic disadvantage as an explanation for the Indigenous health gap in hospital morbidity in Australia.

Methods

We utilised a cross-sectional and ecological design using the Northern Territory public hospitalisation data from 1 July 2004 to 30 June 2008 and socio-economic indexes for areas (SEIFA) from the 2006 census. Multilevel logistic regression models were used to estimate odds ratios and confidence intervals. Both total and potentially avoidable hospitalisations were investigated.

Results

This study indicated that lifting SEIFA scores for family income and education/occupation by two quintile categories for low socio-economic Indigenous groups was sufficient to overcome the excess hospital utilisation among the Indigenous population compared with the non-Indigenous population. The results support a reframing of the Indigenous health gap as being a consequence of poverty and not simplistically of ethnicity.

Conclusions

Socio-economic disadvantage is a likely explanation for a substantial proportion of the hospital morbidity gap between Indigenous and non-Indigenous populations. Efforts to improve Indigenous health outcomes should recognise poverty as an underlying determinant of the health gap.

Background

Public health research is shifting focus to the role of socioeconomic indicators in the promotion of health. As such an understanding of the roles that socio-economic factors play in improving health and health-seeking behaviour is important for public health policy. This is because the share of resources devoted to different policy options should depend on their relative effectiveness.

Objective

To measure the effect of socio-economic status (age, education, occupation, income, religion and family structure) of mothers on the management of febrile conditions in under-fives children

Method

Two hundred mothers who brought their febrile under-five children to a health facility were interviewed on the treatment they gave to their children before reporting at health facility. Data collected were entered and analyzed using the SPSS software. Binary logistic regression was adopted for the quantitative analysis of the effect of socio-economic variables on the mothers' actions prior to utilizing the health facility.

Results

Results showed that while mothers' age was negatively correlated (-0.13), occupation was positively correlated (0.17) with under-fives mothers' action. Education, religion, income and family structure were however insignificant at 5% level

Conclusion

This poses a lot of challenges to policy makers in the developing nations where women's education and earning capacity is low. There is therefore a need to increase the number of women benefiting from micro credit. This will ensure that more women are engaged in a form of occupation that is profitable and can sustain the economic and health needs of the family.

Background

Few studies have examined the association between weight perception and socioeconomic status (SES) in sub-Saharan Africa, and none made this association based on education, occupation and income simultaneously.

Methods

Based on a population-based survey (n = 1255) in the Seychelles, weight and height were measured and self-perception of one's own body weight, education, occupation, and income were assessed by a questionnaire. Individuals were considered to have appropriate weight perception when their self-perceived weight matched their actual body weight.

Results

The prevalence of overweight and obesity was 35% and 28%, respectively. Multivariate analysis among overweight/obese persons showed that appropriate weight perception was directly associated with actual weight, education, occupation and income, and that it was more frequent among women than among men. In a model using all three SES indicators together, only education (OR = 2.5; 95% CI: 1.3-4.8) and occupation (OR = 2.3; 95% CI: 1.2-4.5) were independently associated with appropriate perception of being overweight. The OR reached 6.9 [95% CI: 3.4-14.1] when comparing the highest vs. lowest categories of SES based on a score including all SES indicators and 6.1 [95% CI: 3.0-12.1] for a score based on education and occupation.

Conclusions

Appropriately perceiving one's weight as too high was associated with different SES indicators, female sex and being actually overweight. These findings suggest means and targets for clinical and population-based interventions for weight control. Further studies should examine whether these differences in weight perception underlie differences in cognitive skills, healthy weight norms, or body size ideals.

Aim

To investigate the association between education level, occupation status (a proxy for socio-economic status), and consanguinity in 2 large data sets from Tunisia and Croatia countries with different attitudes toward consanguinity.

Methods

The sample of 1016 students, attending 5 university institutions in Monastir, Tunisia, were interviewed about the educational level and occupation status of their parents and the degree of parental relatedness. In Croatia, a sample of 1001 examinees from 9 isolated island populations was interviewed about their own educational level, occupation status, and consanguinity.

Results

Prevalence of consanguinity (offspring of second cousins or closer) among 1016 Tunisian students was 20.1%, and 9.3% among 1001 Croatian isolates. In Tunisia, the association between consanguinity and both parental degree of education and parental occupation status was highly significant in women (P<0.001), but not significant in men. In Croatia, no statistically significant associations were noted, although there was a consistent trend of increased prevalence of consanguinity with lower education level or occupation status in both genders, but more pronounced in women.

Conclusion

Association between education level, socio-economic status, and consanguinity needs to be taken into account in inbreeding studies in human populations. The relationship may be specific for each studied population and highly dependent on the cultural context. It is generally more pronounced among women in most settings.

Systematic disparities in rates of HIV incidence by socioeconomic status were assessed among men attending three sexually transmitted disease (STD) clinics in Pune, India, to identify key policy-intervention points to increase health equity. Measures of socioeconomic status included level of education, family income, and occupation. From 1993 to 2000, 2,260 HIV-uninfected men who consented to participate in the study were followed on a quarterly basis. Proportional hazards regression analysis of incident HIV infection identified a statistically significant interaction between level of education and genital ulcer disease. Compared to the lowest-risk men without genital ulcer disease who completed high school, the relative risk (RR) for acquisition of HIV was 7.02 (p<0.001) for illiterate men with genital ulcer disease, 3.62 (p<0.001) for men with some education and genital ulcer disease, and 3.02 (p<0.001) for men who completed high school and had genital ulcer disease. For men with no genital ulcer disease and those with no education RR was 1.09 (p=0.84), and for men with primary/middle school it was 1.70 (p=0.03). The study provides evidence that by enhancing access to treatment and interventions that include counselling, education, and provision of condoms for prevention of STDs, especially genital ulcer disease, among disadvantaged men, the disparity in rates of HIV incidence could be lessened considerably. Nevertheless, given the same level of knowledge on AIDS, the same level of risk behaviour, and the same level of biological co-factors, the most disadvantaged men still have higher rates of HIV incidence.

The study reported here explored the associations of body mass index (BMI), socio-economic status (SES), and beverage consumption in a very low income population. A house-to-house survey was conducted in 2003 of 12,873 Mexican adults. The sample was designed to be representative of the poorest communities in seven of Mexico’s thirty-one states.

Greater educational attainment was significantly associated with higher BMI and a greater prevalence of overweight (25≤BMI<30) and obesity (30≤BMI) in men and women. The combined prevalence of overweight and obesity was over 70% in women over the median age of 35.4 years old with at least some primary education compared with a prevalence of 45% in women below the median age with no education. BMI was positively correlated with five of the six SES variables in both sexes: education, occupation, quality of housing conditions, household assets, and subjective social status. BMI and household income were significantly correlated in women but not in men. In the model including all SES variables, education, occupation, housing conditions and household assets all contributed independently and significantly to BMI, and household income and subjective social status did not.

Increased consumption of alcoholic and carbonated sugar beverages was associated with higher SES and higher BMI in men and women. Thus, in spite of the narrow range of socio-economic variability in this population, the increased consumption of high calorie beverages may explain the positive relationship between SES and BMI.

The positive associations between SES and BMI in this low-income, rural population are likely to be related to the changing patterns of food availability, food composition, consumption patterns and cultural factors. Contextually sensitive population-level interventions are critically needed to address obesity and overweight in poor populations, particularly in older women.

The present study aimed to explore the association between caries risk profiles and different sociodemographic factors . The study sample (n = 104) was randomly selected within an urban population in Flanders, Belgium. Caries risk was assessed by anamnesis, clinical examination, salivary tests, and a questionnaire. Age, gender, and socio-economic status were extracted from social insurance data files. Social indicators were “occupational status,” “being entitled to the increased allowance for health care interventions” and having access to the “Maximum Bill” (MAF), initiatives undertaken to protect deprived families. In the bivariate analysis there were significant differences in risk profiles between occupational groups (P < .001), between entitled and non-entitled individuals to the increased allowance (P = .02), and between access or no-access to the MAF (P < .01). The multiple logistic model showed a significantly higher chance of being in the low risk group for individuals with no-access to the MAF compared to those with access (OR:14.33–95% C.I. 2.14–95.84).

Background: To further increase our understanding of socio-economic health inequalities, we need studies considering multiple socio-economic circumstances and comparing different cultural contexts. This study compared the associations of past and present socio-economic circumstances with physical functioning between employees from Finland and Britain.

Methods: Cross-sectional survey data from the Helsinki Health Study (n = 5866) and the Whitehall II Study (n = 3052) were used. Participants were white-collar public sector employees aged 45–60 years. Physical functioning was measured with the SF-36 physical component summary. The socio-economic indicators were parental and own education, childhood and current economic difficulties, occupational class, income, housing tenure.

Results: Childhood and current economic difficulties were independently associated with physical functioning in both cohorts, although in London women childhood difficulties did not reach statistical significance. Own education was independently associated with physical functioning in Helsinki. Occupational class showed associations with physical functioning in both cohorts. These were mainly attenuated by education and income, but in London women there was a strong independent association. The association of income with physical functioning was attenuated by education (Helsinki) and occupational class (London). Parental education and housing tenure showed no consistent associations.

Conclusions: Past and present economic difficulties were independently associated with physical functioning. The conventional socio-economic indicators showed less consistent associations which were partly mediated through other indicators and modified by the national context. The associations that varied according to the indicators and between the cohorts highlight the importance of considering the multiplicity of socio-economic circumstances and comparing different cultural contexts in further studies.

Background

Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used.

Methods

This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting.

Results

One out of ten (10%) and one out of three (32%) adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only.

Conclusions

Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health.

This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs.

Appropriate measurement of socioeconomic status (SES) in health research can be problematic. Conventional SES measures based on ‘objective’ indicators such as income, education, or occupation may have questionable validity in certain populations. The objective of this investigation was to determine if a relatively new measurement of SES, subjective social status (SSS), was more consistently and strongly associated with multiple health outcomes for low income mothers. Data available from a large scale community-based study examining maternal and infant health for a low income urban population were used to examine relationships between SSS and a wide range of postpartum physical and emotional health outcomes. Crosstabulations and multivariate analyses focused on the breadth and depth of these relationships; in addition, the relative strength of the relationships between SSS and the health outcomes was compared to that of conventional measures of SES, including both income and education. SSS was significantly related to all physical and emotional health outcomes examined. The overall pattern of findings indicated that these relationships were independent of, as well as more consistent and stronger than, those between conventional measures of SES and postpartum health outcomes. SSS represents an important dimension of the relationship between SES and postpartum physical and emotional health. In low income populations the failure to account for this dimension likely underestimates the influence of SES on postpartum health. This has important implications for the interpretation of findings in empirical studies which seek to control for the effects of SES on maternal health outcomes.

Study objective

Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics measure the same underlying phenomena. This paper questions this practice. The study looked for any independent effects of education, income, and occupational class on four health outcomes: diabetes prevalence, myocardial infarction incidence and mortality, and finally all cause mortality in populations from Sweden and Germany.

Design

Sweden: follow up of myocardial infarction mortality and all cause mortality in the entire population, based on census linkage to the Cause of Death Registry. Germany: follow up of myocardial infarction morbidity and all cause mortality in statutory health insurance data, plus analysis of prevalence data on diabetes. Multiple regression analyses were performed to calculate the effects of education, income, and occupational class before and after mutual adjustments.

Setting and participants

Sweden (all residents aged 25–64) and Germany (Mettman district, Nordrhein‐Westfalen, all insured persons aged 25–64).

Main results

Correlations between education, income, and occupational class were low to moderate. Which of these yielded the strongest effects on health depended on type of health outcome in question. For diabetes, education was the strongest predictor and for all cause mortality it was income. Myocardial infarction morbidity and mortality showed a more mixed picture. In mutually adjusted analyses each social dimension had an independent effect on each health outcome in both countries.

Conclusions

Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension. Although correlated, they measure different phenomena and tap into different causal mechanisms.

Background

Immigrant elderly are a rapidly growing group in Dutch society; little is known about their health care use. This study assesses whether ethnic disparities in health care use exist and how they can be explained. Applying an established health care access model as explanatory factors, we tested health and socio-economic status, and in view of our research population we added an acculturation variable, elaborated into several sub-domains.

Methods

Cross-sectional study using data from the "Social Position, Health and Well-being of Elderly Immigrants" survey, conducted in 2003 in the Netherlands. The study population consisted of first generation immigrants aged 55 years and older from the four major immigrant populations in the Netherlands and a native Dutch reference group. The average response rate to the survey was 46% (1503/3284; country of origin: Turkey n = 307, Morocco n = 284, Surinam n = 308, the Netherlands Antilles n = 300, the Netherlands n = 304).

Results

High ethnic disparities exist in health and health care utilisation. Immigrant elderly show a higher use of GP services and lower use of physical therapy and home care. Both self-reported health status (need factor) and language competence (part of acculturation) have high explanatory power for all types of health services utilisation; the additional impact of socio-economic status and education is low.

Conclusion

For all health services, health disparities among all four major immigrant groups in the Netherlands translate into utilisation disparities, aggravated by lack of language competence. The resulting pattern of systematic lower health services utilisation of elderly immigrants is a challenge for health care providers and policy makers.