Inequalities in mental health in the working population of Spain: a National Health Survey-based study

ObjectiveIn the working population, poor mental health is a significant problem whose prevalence rates and associated factors could differ by gender, especially in a period of socioeconomic changes. The aims of this study were: a) to determine the prevalence of poor mental health in the working population of Spain in 2011; b) to identify the association of this prevalence with socioeconomic and work-related variables for men and women separately; c) to determine if the patterns differ by gender.MethodsA cross-sectional study was conducted with data from the National Health Survey of Spain (2011). Of the 21,007 participants in the survey, we selected 7396 whose employment status was described as “working” The General Health Questionnaire (GHQ-12) was used as a screening tool to detect poor mental health. Prevalences were calculated and bivariate and multivariate logistic regression models were fitted to verify the association between variables.ResultsThe prevalence of poor mental health was higher among women (19.9%) than men (13.9%), the overall prevalence being 16.8%. The variables associated with a higher prevalence were type of contract and work-related variables in men, and age and socioeconomic variables in women.ConclusionsThis study shows that, in the working population of Spain, the prevalence of poor mental health and its related factors differ by gender. Poor mental health is mainly related to socioeconomic variables in women but is mostly associated with work-related variables in men.     

Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain

ObjectiveTo describe social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain.MethodWe used data from 20,406 individuals aged 18 or older from the 2017 Spanish National Health Survey. We measured socioeconomic position using occupational social class and used data on self-reported cardiovascular risk factors: high cholesterol, diabetes, hypertension, obesity, and smoking. We estimated the relative risk of inequality using Poisson regression models. Analyses were stratified by men and women and by region (autonomous communities).ResultsOverall, the relative risk of inequality was 1.02, 1.13, 1.06, 1.17 and 1.09 for high cholesterol, diabetes, hypertension, obesity, and current smoking, respectively. Ocuupational social class inequities in diabetes, hypertension, and obesity was stronger for women. Results showed a large regional heterogeneity in these inequities; some regions (e.g. Asturias and Balearic Islands) presented wider social inequities in cardiovascular risk factors than others (e.g. Galicia, Navarra or Murcia).ConclusionIn Spain, we found marked social inequities in the prevalence of cardiovascular risk factors, with wide regional and women/men heterogeneity in these inequities. Education, social, economic and health policies at the regional level could reduce health inequities in cardiovascular risk factors and, thus, prevent cardiovascular disease.     

Estado de salud de personas inmigrantes en Cataluña desde una perspectiva de género: Proyecto PELFI

ObjectiveThe objective of the study is to assess the health status of immigrant men and women from non-EU countries living in the Metropolitan Area of Barcelona (Catalonia, Spain) and to identify the social determinants of health from a gender perspective.MethodCross-sectional analysis from a cohort of immigrant families recruited in Badalona and Santa Coloma de Gramenet, in Spain (PELFI cohort). In 2015–2016, 167 immigrants answered the baseline epidemiological questionnaire and the 5-level EuroQol instrument (EQ-5D) which measures health status. To identify health determinants, Tobit models were constructed to the EQ-5D index.ResultsWomen rated poorer self-perceived health (p = 0.005). To be diagnosed with and illness was only associated with poor self-perceived health among men (p < 0.05). Length of residence, domestic work, and especially double workload deteriorated women's health. After adjusting models by demographics and social determinants, permanent administrative status (?0.136; p = 0.015) and social support (0.182; p = 0.02) were associated with health status in both sexes. To have a job was associated with better health only in men.ConclusionsNon-EU immigrants living in the Metropolitan Area of Barcelona are a socially vulnerable group of population and present inequalities in health by sex. Social support and occupation are key factors of their health status. Interventions to reduce immigrant vulnerabilities and inequalities in health should promote their social inclusion and cohesion from a gender perspective.     

Salud autorreferida: influencia de la pobreza y la desigualdad del área de residencia

ObjectiveTo evaluate the influence of income inequality and poverty in the towns of Bogotá, Colombia, on poor self-rated health among their residents.MethodsThe study was based on a multipurpose survey applied in Bogotá-Colombia. A hierarchical data structure (individuals = level1, locations = level 2) was used to define a logit-type multilevel logistic model. The dependent variable was self-perceived poor health, and local variables were income inequality and poverty. All analyses were controlled for socio-demographic variables and stratified by sex.ResultsThe prevalence of self-reported fair or poor health in the study population was 23.2%. Women showed a greater risk of ill health, as well as men and women with a low educational level, older persons, those without work in the last week and persons affiliated to the subsidized health system. The highest levels of poverty in the city increased the risk of poor health. Cross-level interactions showed that young women and men with a low education level were the most affected by income inequality in the locality.ConclusionsIn Bogotá, there are geographical differences in the perception of health. Higher rates of poverty and income inequality were associated with an increased risk of self-perceived poor health. Notable findings were the large health inequalities at the individual and local levels.     

Community action for health in socioeconomically deprived neighbourhoods in Barcelona: Evaluating its effects on health and social class health inequalities

BackgroundThe aim of this study was to analyse trends in several health-related indicators in socioeconomically deprived neighbourhoods in Barcelona with strong community action for health (CA), and compare them to neighbourhoods without such community action. A secondary goal was to analyse trends in socioeconomic inequalities in health in both types of neighbourhood.MethodsWe performed a quasi-experimental pre-post study using data from the Barcelona Health Surveys of 2001 and 2011. Our dependent variables were self-perceived health, mental health, previous drug use, and smoking cessation. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% Confidence Intervals (95% CI).ResultsThe percentage of men who had ever used drugs decreased over time in neighbourhoods with strong CA (PR = 0.48; 95% CI:0.25–0.92, from 2001 to 2011), but not in neighbourhoods without CA (PR = 1.02; 95% CI:0.74–1.40). However, the prevalence of poor mental health among men increased more in neighbourhoods with strong CA than in neighbourhoods without CA (p-value = 0.025). Among women, social class inequalities in poor mental health and smoking cessation decreased over time in neighbourhoods with strong CA but not in neighbourhoods without CA.ConclusionsOur study shows promising results regarding the effect of community action on health, particularly in terms of inequalities. Our results highlight the importance of allocating resources to implement and continuously evaluate CA initiatives.     

Impacto del confinamiento por la COVID-19 en la salud autopercibida en Chile según género

ObjectiveTo analyse the social factors associated with self-perceived health during the COVID-19 lockdown in the Chilean resident population according to gender perspective.MethodCross-sectional study conducted during the COVID-19 lockdown between May 17 and August 17, 2020 with an online survey. Self-perceived health was analysed in the population aged 18 years or older in relation to social variables. Multivariate logistic regression models were constructed to assess the association between independent variables with self-perceived health, through adjusted odds ratio (aOR). Analyses were stratified by sex (M: men; W: women).Results5981 persons were analysed (women: 63.9%). 29.6% of women and 19.2% of men reported poor self-perceived health. In women it worsens with increasing age. Worse self-perceived health was mainly associated with lack of social support (ORa M: 2.05; ORa W: 2.34), concern about living together at home (ORa M: 1.66; ORa W: 1.38), perceived inadequate housing conditions (ORa M: 1.89; ORa W: 2.63), and disagreement with government measures (ORa M: 2.80; ORa W: 1.82). In women, it was also associated with informal work or being inactive in the labour market (ORa: 2.11). In men worse self-perceived health was associated with being self-employed (ORa: 1.65; confidence interval [CI]: 1.11–2.45) and has secondary education (ORa: 2.81; CI: 1.32–5.98).ConclusionsThe social impact of lockdown in self-perceived health is related to gender, age, care work, and socioeconomic conditions, as well as, by disagreement with the measures implemented to manage the pandemic.     

Factors related to inhibition of lactation by pharmacological means at birth in a Spanish referral hospital (2011-2017)

ObjectiveTo describe the maternal, neonatal and pregnancy characteristics related to inhibition of lactation (IL) with cabergoline.MethodWe assessed 20,965 occasions of breastfeeding initiation, according to data collected from obstetric records at the Hospital Clinic of Barcelona (Spain) between January 2011 and December 2017.ResultsIL decreased over the study period from 8.78% to 6.18% (odds ratio [OR]: 0.93 per year; 95% confidence interval [95%CI]: 0.90-0.95). Women with a lower educational level (OR: 2.5; 95%CI: 2.0-3.0), mothers living in more depressed areas (OR: 1.08 per 10 extra points over 100; 95%CI: 1.04-1.12), smokers (OR: 2.2; 95%CI: 1.9-2.6), and those with more children (OR: 1.2 for each sibling; 95%CI: 1.1-1.3), preterm birth (OR: 1.8; 95%CI: 1.4-2.3), multiple births (OR: 1.6; 95%CI: 1.2-2.1) and a higher risk pregnancy (OR: 1.3 per risk point; 95%CI: 1.2-1.4) showed a higher prevalence of IL. Compared to women born in Spain, IL was less likely in all other women with the exception of Chinese women (OR: 7.0; 95%CI: 5.7-8.6). These disparities remained during the study period.ConclusionsFactors related to lower socioeconomic status and poor health were more likely to be associated with IL. The overall use of cabergoline decreased during the study period while inequalities persisted. Taking these inequalities into account is the first step to addressing them.     

Social and material determinants of health in participants in an active labor market program in Barcelona

Background

Unemployment affects the physical and mental health of affected individuals, which can be explained by its direct effect on worsening finances due to the lack of income as well as by its negative psychosocial effects. “Employment in the Neighborhoods” return to work program was implemented in Barcelona specifically in the neighborhoods characterized with a greater economic deprivation and by high unemployment to improve personal and occupational abilities and skills of the participants to reintegrate them into the workforce. The aim of this study is to determine the association between the lack of economic resources and psychosocial factors with respect to mental health and self-rated health in unemployed persons participating in the program “Employment in the Neighborhoods”.

Methods

Cross-sectional study. Data collected from a self-administered questionnaire. Generalized linear models were constructed, adjusted by age and social class, to estimate prevalence ratios and analyze any possible association between economic resources, psychosocial factors and poor self-rated health and mental health.

Results

Nine hundred forty-eight persons of 2763 participants in the “Employment in the Neighborhoods” program completed the questionnaire. 46.9% were women. 72.5% of women and 61.9% of men were at risk of poor mental health and 25.5% of women and 21.1% of men reported poor self-rated health. Low self-esteem [women: PR 1.88 95%CI (1.24–2.84); men: PR 2.51 95%CI (1.57–4.02)] and medium social support [2.01 (1.30–3.09)], in men, and low social support [1.74 (1.13–2.68)] in women are associated with worsening of self-rated health. In men, low self-esteem [1.40 (1.19–1.64)] and delay in paying bills [1.38 (1.17–1.64)] were associated with the risk of poor mental health; in women were associated low self-esteem [1.27 (1.11–1.44)] and received a non-contributory allowance [1.37 (1.09–1.74)].

Conclusions

Economic resources, self-esteem and social support are necessary for good general and mental health among unemployed persons. The high prevalence of poor mental health among persons participating in the active labor market program “Employment in the Neighborhoods” could be due to a substantial deficit in these factors.

     

La precariedad laboral medida de forma multidimensional: distribución social y asociación con la salud en Cataluña

ObjectiveTo show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale.MethodA cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender.ResultsThe prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health.ConclusionsPrecarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities.     

¿Cómo afectan las distintas dimensiones de la precariedad laboral a la salud mental?

ObjectiveTo analyse the relationship between precarious employment, measured by dimensions and as a multidimensional index, on the mental health of salaried men and women in the Basque Country (Spain).MethodA subsample (n = 3345) of the 2018 Basque Autonomous Community Health Survey was used to calculate the standardised prevalence of poor mental health according to the degree of precarious employment, measured as a composite scale and by each of its dimensions, and to perform robust Poisson regression models to analyse the association between precarious employment, also composite and by dimensions, and the mental health of the salaried population.ResultsPrecarious employment is significantly associated with poor mental health among men (prevalence ratio [PR]: 3.51; 95% confidence interval [95%CI]: 2.05–6.01) and women (PR: 3.42; 95%CI: 2.35–4.97). Additionally, some of its constituent dimensions, such as wage level among both sexes (PR: 2.58, 95%CI: 1.65–4.03, and PR: 2.29, 95%CI: 1.58–3.32) or vulnerability among women (PR: 2.55; 95%CI: 1.80–3.61), also appear to be significantly and independently related to poorer mental health status.ConclusionsIt is necessary to approach precarious employment from a multidimensional perspective, and to know the relative importance of each of its dimensions, both for research into its effects on health and for policy interventions directed at combating this phenomenon.     

Self-reported health and associated factors among the immigrant populations in Norway

Aim

The immigrant population continues to increase in Norway, and Somali immigrants and their descendants are presently the largest non-Western group. We have limited knowledge about the health status in this population. The aim of this study was to assess self-perceived health status among Somalis in Norway.

Method

We used data from a study assessing risk factors for lifestyle diseases among Somali immigrants in Oslo, which was conducted between December 2015 and October 2016, among men and women aged 20–73 who were living in the Sagene borough in Oslo.

Results

The study population included 221 participants (112 females and 110 males). Overall, 78% of the participants (70% of females and 86% males) rated their health status as good or very good. Women had poorer self-reported health (p?=?0.003) than men. Being unemployed and having diabetes, stress, and sleeping problems were associated with poor self-reported health, but time lived in Norway, education level, Norwegian language proficiency, and high BMI were not significantly associated. Around 2/3 of the participants reported being physically inactive, while around half reported walking or moving more than 30 min per day. Self-reported chronic diseases such as diabetes and hypertension were 5% and 9% respectively.

Conclusion

This study has shown the different patterns of self-reported health status among Somali immigrants in Norway, as associated with gender, age, psychosocial conditions, and employment status. Further research is needed to explain why Somali women in Norway have poorer self-reported health than men. The findings from this study should provide direction to healthcare providers for improving health among immigrants, for example through implementing a community-driven and culturally appropriate lifestyle intervention program.

     

Inmigración y salud: desigualdades entre la población autóctona e inmigrante en el País Vasco

Objective

To analyze health inequalities between native and immigrant populations in the Basque Country (Spain) and the role of several mediating determinants in explaining these differences.

Methods

A cross-sectional study was performed in the population aged 18 to 64 years in the Basque Country. We used data from the Basque Health Survey 2007 (n = 4,270) and the Basque Health Survey for Immigrants 2009 (n = 745). We calculated differences in health inequalities in poor perceived health between the native population and immigrant populations from distinct regions (China, Latin America, the Maghreb and Senegal). To measure the association between poor perceived health and place of origin, and to adjust this association by several mediating variables, odds ratios (OR) were calculated through logistic regression models.

Results

Immigrants had poorer perceived health than natives in the Basque Country, regardless of age. These differences could be explained by the lower educational level, worse employment status, lower social support, and perceived discrimination among immigrants, both in men and women. After adjustment was performed for all the variables, health status was better among men from China (OR: 0.18; 95% confidence interval [CI95%]: 0.04-0.91) and Maghreb (OR: 0.26; 95% CI: 0.08-0.91) and among Latin American women (OR: 0.36; 95% CI: 0.14-0.92) than in the native population.

Conclusions

These results show the need to continue to monitor social and health inequalities between the native and immigrant populations, as well as to support the policies that improve the socioeconomic conditions of immigrants.     

健康贫困与卫生公平

目的 通过实证研究的方式,了解我国城乡二元结构下健康与贫困的关联程度,分析健康贫困风险的关键影响因素,为摆脱健康贫困问题找到路径。 方法 以2012年CFPS成人数据库中35 719个访问对象作为样本,以国家贫困线作为判断低收入的标准,以自评健康状况作为健康标准,用logistic回归分析法了解健康贫困风险的社会因素和疾病因素。 结果 在调查的≥16岁成年人口中,自评不健康的人群占18 % ,存在健康贫困风险的人群占13 % ;不健康与低收入之间存在明显相关关系（P < 0.01）,在城乡二元结构下,农村地区不健康与低收入的关联程度更高;性别、年龄和受教育程度均是导致健康贫困风险的关键社会因素(P < 0.01);导致疾病产生的贫困因素,并不在于贫困本身,而在于与贫困有关的低下的教育水平和有待改善的居住环境(P < 0.01);恶性肿瘤、血液疾病和生殖系统疾病因病致贫的效应更为显著(P < 0.01)。 结论 中国健康贫困问题是脱贫的关键,健康贫困与教育贫困和环境贫困之间存在密切的关联。由于城乡社会人口结构的差异,健康贫困问题表现出不同的程度和特点,在精准扶贫的背景下,需要根据社会特征和疾病特征采取有针对性的扶贫策略。     

Socioeconomic Inequalities in Unintended Pregnancy and Abortion Decision

Pregnancy planning allows women to better control their life trajectory and contributes to the future child’s health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education uncompleted had more unintended pregnancies (OR = 7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy. Font-Ribera, Pérez, Salvador, and Borrell are with the Health Information Service, Agency of Public Health of Barcelona, Barcelona, Spain; Pérez and Borrell are with the University Pompeu Fabra, Barcelona, Spain; Pérez and Borrell are with the CIBER in Epìdemiology and Public Health (CIBERESP), Barcelona, Spain; Pérez is with the Agency of Public Health of Barcelona, Barcelona, Spain.     

Soledad no deseada,salud y desigualdades sociales a lo largo del ciclo vital

ObjectiveTo analyse the prevalence of unwanted loneliness in our context and its association with health from a life cycle and social inequalities perspective.MethodCross-sectional study based on data from the Health Survey of the Basque Country (n = 7.228; response rate 79%). The prevalence of unwanted loneliness, its association with perceived health and mental health, and social inequalities according to social class were analysed. To analyse the association, age-adjusted prevalence ratios (PR) calculated from robust Poisson models were calculated.ResultsThe feeling of unwanted loneliness affects 23.3% of men and 29.7% of women, being higher in older people and young adults, and in the most disadvantaged social classes. Feeling alone is associated with worse health, both general (PRa men 2.11, 95% confidence interval [95%CI] 1.77-2.51; PRa women 2.10, 95%CI 1.83-2.41) and mental (PRa men 3.95, 95%CI 3.15-4.95; RPa women 3.50, 95%CI 2.99-4.12). Social inequalities in loneliness, as well as the association between it and poor health, was greater among young adults.ConclusionsThe results of the study have important implications for intervention in the reduction and prevention of unwanted loneliness, underlining the importance of the life cycle and social inequalities.