Poor health, employment transitions and gender: evidence from the British Household Panel Survey

Objectives

We examined health selection in the context of transitions across employment statuses (employment, unemployment and inactivity), with attention to gender differences.

Methods

60,536 transitions from 7,901 individuals were pooled from 17 waves of the British Household Panel Survey. Associations between self-rated health and transitions across employment statuses were examined using multilevel multinomial analysis.

Results

Health selective employment transitions between year t-1 and t were observed at entry to as well as exit from employment. Associations for poor health with the transitions were similar for men and women in transitions from employment to both unemployment and to inactivity, but with some differences in other transitions. When leaving employment, transitions from employment to unemployment (OR_adjusted(adjusted odds ratio) = 1.51, 95 % CI = 1.21–1.89 for men and OR_adjusted = 1.60, 95 % CI = 1.25–2.04 for women) and to inactivity (OR_adjusted = 1.58, 95 % CI = 1.21–1.89 for men and OR_adjusted = 1.63, 95 % CI = 1.35–1.96 for women) were affected by health status among both men and women. Similarly, poor health lowered the probability of transitions to employment from unemployment and inactivity; however, the negative impact of poor health was statistically significant only for women.

Conclusions

There is a strong relationship between health and transitions both into and out of employment suggesting an independent role for poor health, and these associations were similar for men and women.     

Is the core-periphery labour market structure related to perceived health? findings of the Northern Swedish Cohort

Background

There is controversy as to whether peripheral employment is related to poor health status or not. This study aims at examining whether 1) the accumulation of time in peripheral labour market positions is associated with psychological distress and poor or average self-rated health; 2) the proposed association is different among women than among men.

Method

Participants in the 1995 and 2007 follow-up surveys of the Northern Swedish Cohort (n = 985) completed self-administered questionnaires about psychological and general health and about employment positions during the follow-up years. Associations between 12 year peripheral labour market positions (no, low, medium and high exposure) and health were examined using logistic regression.

Results

Exposure to peripheral employment was positively related to psychological distress in both women and men (p-values for trend < 0.001). Adjustment for sociodemographics and psychological distress at baseline, as well as for unemployment and being out of the labour market at the follow-up, resulted in attenuation of the odds ratios, particularly in the group with high exposure to peripheral employment, although results remained significant in men in the fully adjusted model. Women and men with high exposure to peripheral employment had high odds of poor or average self-rated health, but the association was rendered non-significant after adjustment for the covariates.

Conclusions

Our findings suggest that exposure to peripheral employment positions has an impact particularly on mental health, partly due to the over-representation of other unfavourable social and employment conditions among those with substantial exposure to peripheral employment.

     

Modifying effects of gender, age and enterprise size on the associations between workplace justice and health

Objective

This study examined the distribution of perceived workplace justice and examined the modifying effects of gender, age and enterprise size on the associations between workplace justice and poor health.

Methods

A total of 9,636 male and 7,406 female employees from a national survey conducted in 2007 in Taiwan were studied. A self-administered questionnaire was used to assess workplace justice (9 items), psychosocial work conditions, self-rated health and burnout status.

Results

A clear gradient was observed across employment grades, with employees of lower grades reporting lower workplace justice. Government employees were found to have higher levels of workplace justice than those in private sectors, and among those in private sectors, female employees in larger enterprises were found to have significantly lower workplace justice. Multivariate regression analyses showed that employees with workplace justice in the lowest tertile had increased scores in work-related burnout (11.0 and 12.8 points in men and women, respectively) and increased risks for poor self-rated health (OR = 2.5, 2.6) as compared to those with workplace justice in the highest tertile. The associations were stronger in younger groups than in older groups, and in female employees of larger enterprises than those of smaller enterprises.

Conclusion

Employees with lower socioeconomic position and female employees in larger enterprises might be more likely to be exposed to work practices that give rise to the sense of injustice. The underlying mechanisms for the observed stronger associations between lower workplace justice and poor health in younger groups and in workers of larger enterprises deserve further investigation.     

Differentiating positive and negative self-rated health: results from a cross-sectional study in Estonia

Objectives

To examine possible differences in the correlates of positive and negative self-rated health (SRH).

Methods

Data for 2,127 men and 2,385 women in the 25–74 age group came from the Estonian Health Interview Survey 2006. Multinomial logistic regression analysis was used to study the association of socio-demographic, physical and psychological health and well-being characteristics with positive (good or very good) and negative (bad or very bad) SRH as compared to fair SRH.

Results

Negative SRH was related to male gender, the presence of chronic illnesses, limitations in daily activities and physical functioning, emotional distress, an external locus of control, and to low satisfaction with life and physical fitness. These indicators (except satisfaction with life) were also related to positive SRH, presenting a mirrored pattern of association. Additionally, positive SRH was related to younger age, an Estonian ethnic identity, and to higher education and income.

Conclusions

Although SRH forms a ill/healthy continuum when physical and psychological health characteristics are considered, the broader spectrum of predictors indicates that positive SRH and negative SRH are two distinct and alternative concepts.     

The impact of being the intermediate caring generation and intergenerational transfers on self-reported health of women in Ireland

Objectives

To investigate the associations with being the “sandwich generation” in older women in Ireland and its impact on self-reported health.

Methods

Analysis of 3,196 women from wave 1 of the Irish Longitudinal Study on Ageing (TILDA) was undertaken. Poisson regression was used to determine whether intergenerational transfers, were associated with self-rated physical health and depression, when controlling for other socio-demographic variables.

Results

Multivariate analysis found that women in the sandwich generation who financially supported their children had better self-rated physical health (poor/fair health relative to excellent; RR 0.84, 95 % CI 0.72–0.97). Conversely, the women who provided other care for their children showed evidence of poorer mental health (case-level depression, RR 1.35, 95 %CI 1.05–1.73). Providing financial support for parents was associated with case-level depression (RR 2.21, 95 %CI 1.26–3.86).

Conclusions

Supporting two generations was associated with both better self-rated health and poorer mental health, depending on the type and direction of the transfers. This generation of women have substantial caring responsibilities. Strategies to address the stresses associated with bi-directional intergenerational transfers are needed.     

Interpersonal discrimination and health-related quality of life among black and white men and women in the United States

Objective

We assessed associations between discrimination and health-related quality of life among black and white men and women in the United States.

Methods

We examined data from the National Health Measurement Study, a nationally representative sample of 3,648 adults aged 35–89 in the non-institutionalized US population. These data include self-reported lifetime and everyday discrimination as well as several health utility indexes (EQ-5D, HUI3, and SF-6D). Multiple regression was used to compute mean health utility scores adjusted for age, income, education, and chronic diseases for each race-by-gender subgroup.

Results

Black men and women reported more discrimination compared to white men and women. Health utility tended to be worse as reported discrimination increased. With a few exceptions, differences between mean health utility scores in the lowest and highest discrimination groups exceeded the 0.03 difference generally considered to be a clinically significant difference.

Conclusions

Persons who experienced discrimination tended to score lower on health utility measures. The study also revealed a complex relationship between experiences of discrimination and race and gender. Because of these differential social and demographic relationships caution is urged when interpreting self-rated health measures in research, clinical, and policy settings.     

Erratum to: Interpersonal discrimination and health-related quality of life among black and white men and women in the United States

Objective

We assessed associations between discrimination and health-related quality of life among black and white men and women in the United States.

Methods

We examined data from the National Health Measurement Study, a nationally representative sample of 3,648 adults aged 35–89 in the non-institutionalized US population. These data include self-reported lifetime and everyday discrimination as well as several health utility indexes (EQ-5D, HUI3, and SF-6D). Multiple regression was used to compute mean health utility scores adjusted for age, income, education, and chronic diseases for each race-by-gender subgroup.

Results

Black men and women reported more discrimination than white men and women. Health utility tended to be worse as reported discrimination increased. With a few exceptions, differences between mean health utility scores in the lowest and highest discrimination groups exceeded the 0.03 difference generally considered to be a clinically significant difference.

Conclusions

Persons who experienced discrimination tended to score lower on health utility measures. The study also revealed a complex relationship between experiences of discrimination and race and gender. Because of these differential social and demographic relationships caution is urged when interpreting self-rated health measures in research, clinical, and policy settings.     

Changes in food group consumption and associations with self-rated diet, health, life satisfaction, and mental and physical functioning over 5 years in very old canadian men: The manitoba follow-up study

Objective

To identify longitudinal food group consumption trends and the relationship to perceived changes in diet, health, and functioning.

Design

A prospective longitudinal study.

Setting

Canada

Participants

Seven hundred and thirty-six community-dwelling Canadian men (mean age: 2000=79.4 yrs; 2005=84.5 yrs) participating in the Manitoba Follow-up Study.

Measurements

Self-reported food consumption, self-rated diet and health, life satisfaction, physical and mental functioning from questionnaires completed in 2000 and 2005.

Results

The majority of participants did not consume from all four food groups daily, based on Canada??s Food Guide recommendations, with only 8% in 2000 and up to 15% in 2005. However, over a five year period, more men improved their consumption in each food group than declined. An association was found between change in the self-rating of the healthiness of their diet and change in consumption of vegetables and fruit, or grain products. Men whose self-rating of the healthiness of their diet remained high or improved between 2000 and 2005, were 2.15 times more likely (95%CI=1.45, 3.17) to also have increased consumption of vegetables and fruit, and 1.71 times more likely (95%CI=1.51, 2.54) to have increased consumption of grain products, relative to men whose self-rating of the healthiness of their diet declined between 2000 and 2005. Men who consumed more food groups daily had better mental and physical component scores.

Conclusion

Dietary improvements are possible in very old men. Greater daily food group consumption is associated with better mental and physical functioning. Given these positive findings, there is still a need to identify older men who require support to improve their dietary habits as nearly half of the participants consumed two or fewer groups daily.     

Determinants of self rated health and mortality in Russia – are they the same?

Background

Research into Russia's health crisis during the 1990s includes studies of both mortality and self-rated health, assuming that the determinants of the two are the same. In this paper, we tested this assumption, using data from a single study on both outcomes and socioeconomic, lifestyle and psychological predictor variables.

Methods

We analysed data from 7 rounds (1994–2001) of the Russia Longitudinal Monitoring Survey, a panel study of a general population sample (11,482 adults aged over 18 living in households of 2 or more people). Self-rated health was measured on a 5 point scale and dichotomised by combining responses "very poor" and "poor" into poor health. Deaths (n = 782) during a mean follow up of 4.1 years were reported by another household member. Associations between several predictor variables and poor or very poor self-rated health and mortality were measured using logistic regression and Cox proportional hazards analysis respectively.

Results

Poor self-rated health was significantly associated with mortality; hazard ratios, compared with very good, good or average health, were 1.69 (1.36-2.10) in men and 1.74 (1.38-2.20) in women. Low education predicted both mortality and poor self-rated health, but income predicted subjective health more strongly. Smoking doubled the risk of death but was unrelated to subjective wellbeing. Frequent drinkers experienced greater mortality than occasional drinkers, despite reporting better health. In contrast, dissatisfaction with life predicted poor self-rated health, but not mortality.

Conclusion

Differences between the predictors of subjective health and mortality, even though these outcomes were strongly associated, suggest that influences on subjective health are not restricted to serious disease. These findings also suggest the presence of risk factors for relatively sudden deaths in apparently well people, although further research is required. Meanwhile, caution is required when using studies of self-rated health in Russia to understand the determinants of mortality.     

On age-specific variations in income-related inequalities in diabetes, hypertension and obesity

Objective

This article examines whether the social health gradients in diabetes, hypertension and obesity for men and women vary significantly across different age groups.

Methods

We use a pooled sample of German survey data from the years 2002 and 2006 with a total of 87,601 observations. We employ a varying Wagstaff index derived from the class of Gini-type concentration indices to estimate age-specific income-related health inequalities.

Results

We find significant health disadvantages among poor women in mid-age, but no significant age-specific income-related health inequalities among men. Some leveling of inequalities in diabetes is observed.

Conclusions

The results suggest that variations in age-specific inequalities are unlikely to be a purely artificial result of health-related selection into retirement or mortality.     

Do social relations explain health inequalities? Evidence from a longitudinal survey in a changing eastern German region

Objectives

This study explores the contribution of social relations to explain inequalities in self-rated health in a changing north-eastern German region. So far, there are only few studies that analysed the mediating effects of social relations in a longitudinal design.

Methods

We used data from the Study of Health in Pomerania (SHIP) consisting of 3,300 randomly selected men and women at baseline (2001), and at the 5-year follow-up (2006). Indicators of social inequality were education, equivalent household income and occupational status. Social relations were estimated by the Social Integration Index (SII) and the perceived instrumental and emotional support. Self-rated general health was assessed at both waves of data collection.

Results

Depending on the indicators used, social relations explain up to 35% of the inequalities in self-rated health. Changes in odds ratios are slightly more pronounced when education and income are used as inequality indicator and when adjusting for the SII.

Conclusions

Overall findings suggest that social relations are an important explanatory factor for health inequalities in a deprived German region.     

Atherosclerosis and physical functioning in older men, a longitudinal study

Objective

Functional decline is a major threat to independency, progressing into functional limitations and eventually leading to disability. Chronic diseases, especially cardiovascular diseases, are important determinants of functional limitations and disability. Vascular damage exits long before it is clinically manifest and can have adverse effects on health, physical and cognitive functioning. The objective was to investigate the association between non-invasive atherosclerosis measures and physical functioning in older men.

Design

Prospective cohort study.

Setting

The study was conducted in the general community.

Participants

195 independently living older men.

Measurements

Atherosclerosis was measured by intima media thickness (CIMT) of the common carotid artery using ultrasonography and assessment for presence of atherosclerotic plaques. Physical functioning was measured by isometric handgrip strength and leg extensor strength using a hand held dynamometer, lower extremity function using the physical performance score and ability to perform activities of daily life using the modified Stanford Health Assessment Questionnaire. Linear regression analysis was performed to estimate the associations between CIMT or plaques and physical functioning.

Results

After adjustment for confounders, higher baseline CIMT was associated with lower isometric handgrip strength at follow up (β^CIMT =?7.21, 95% CI[?13.64;?0.77]). No other associations were found between CIMT and physical functioning. In addition, no associations were found for the presence of plaques and physical functioning either at baseline, or at follow-up.

Conclusion

Atherosclerosis, as measured by higher CIMT, is related to a lower isometric handgrip strength at follow-up, but no further associations with physical functioning were found in this longitudinal study among independently living older men.     

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.

     

Contextual effects of community mobilization and communication capacity as a positive factor for self-rated health status: a multi-level analysis

Objectives

We examined relationships between individual-level community participation, two types of contextual effects―community capacity for mobilization and capacity for health communication—and residents’ self-reported health status in order to explore the role health communication may play in community building for health.

Methods

To estimate multi-level effects of the community participation and the two contextual indicators with self-rated health status, we applied hierarchical generalized linear regression to crosssectional data from the Korean National Health and Nutrition Examination Survey.

Results

After adjusting for individual- and community-level confounders, the likelihood of having high self-rated health status is significantly higher among those who live in a region with higher community capacity for mobilization, higher health communication capacity at the community level, and higher participation in community groups at the individual-level.

Conclusions

Our findings suggest that living in a community characterized by higher levels of communication and mobilization capacity is beneficial to residents’ self-rated health status—increasing the odds of high health status by up to 9 %. Thus, building community capacity in mobilization and health communication may help develop better health promotion campaigns.     

Immigration, work and health in Spain: the influence of legal status and employment contract on reported health indicators

Objective

To analyze the relationship of legal status and employment conditions with health indicators in foreign-born and Spanish-born workers in Spain.

Methods

Cross-sectional study of 1,849 foreign-born and 509 Spanish-born workers (2008–2009, ITSAL Project). Considered employment conditions: permanent, temporary and no contract (foreign-born and Spanish-born); considered legal statuses: documented and undocumented (foreign-born). Joint relationships with self-rated health (SRH) and mental health (MH) were analyzed via logistical regression.

Results

When compared with male permanently contracted Spanish-born workers, worse health is seen in undocumented foreign-born, time in Spain ≤3 years (SRH aOR 2.68, 95% CI 1.09–6.56; MH aOR 2.26, 95% CI 1.15–4.42); in Spanish-born, temporary contracts (SRH aOR 2.40, 95% CI 1.04–5.53); and in foreign-born, temporary contracts, time in Spain >3 years (MH: aOR 1.96, 95% CI 1.13–3.38). In females, highest self-rated health risks are in foreign-born, temporary contracts (aOR 2.36, 95% CI 1.13–4.91) and without contracts, time in Spain >3 years (aOR 4.63, 95% CI 1.95–10.97).

Conclusions

Contract type is a health determinant in both foreign-born and Spanish-born workers. This study offers an uncommon exploration of undocumented migration and raises methodological issues to consider in future research.     

The role of gender in the association of social capital, social support, and economic security with self-rated health among older adults in deprived communities in Beirut

Purpose

To examine gender variations in the association of self-rated health (SRH) with social capital, social support, and economic security among older adults from three deprived communities in the suburbs of metropolitan Beirut.

Methods

A population-based cross-sectional study using the Older Adult Component of the Urban Health Survey. Face-to-face interviews were conducted with 328 older men and 412 older women aged 60 years and above. SRH was assessed by a single question and treated as a dichotomous outcome, and several indicators of social capital, social support, and economic security were examined as independent variables.

Results

Women were significantly more likely to report poor SRH compared to men (37.2 vs. 25.9 %, respectively). Better social capital indicators decreased significantly the odds of poor SRH among both men (OR = 0.76, 95 % CI: 0.65–0.89) and women (OR = 0.71, 95 % CI: 0.62–0.82). Social support was strongly associated with SRH among women (OR = 0.56), but not among men (OR = 0.94). The reverse situation was observed for economic security (OR = 0.57 among men, OR = 0.80 among women).

Conclusions

In these deprived neighborhoods, social and economic factors may have gender-specific effects on the promotion of well-being among older adults, with social support being more salient to women’s SRH and economic security being more salient to men’s SRH. In health studies among older people, SRH captures not only social and physical health but also broader economic well-being.     

Education and physical health trajectories in old age. Evidence from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Objectives

The model of cumulative inequality predicts that health differences between educational levels increase with age. Using a variety of analytical approaches and measures of health, studies have, however, reported increasing as well as decreasing and constant patterns of educational health inequality. The aim of this study is use a standardized research design to compare different dimensions of health inequality trajectories across educational levels.

Methods

We used data from two waves (2004/2005 and 2006/2007) of SHARE. The sample consisted of respondents aged 50–80 (n = 14,818). Using OLS regression models, we analyzed trajectories of health inequality in self-reported measures (ADL, IADL, mobility, chronic diseases, and self-rated health) as well as non-invasive objective measures (grip strength) of physical health.

Results

Inequality between higher and lower educated individuals increased significantly in limitations of physical functioning and grip strength. In chronic diseases and self-rated health, the gap between these two groups remained constant.

Conclusion

Although our results mainly supported the model of cumulative inequality, they also showed that the trajectory of the education-health gradient is not uniform but varies across different dimensions of physical health.     

Does social support mediate or moderate socioeconomic differences in self-rated health among adolescents?

Objective

Social support is assumed to be a protective social determinant of health. The aim of this cross-sectional study was to explore whether social support from the father, mother and friends mediates or moderates the association between socioeconomic position and self-rated health among adolescents.

Methods

The sample consisted of 1,863 secondary school students from the Kosice region in Slovakia (mean age 16.85; 53.3% females, response rate 98.9%). We assessed the mediation and moderation effects of social support from the mother, father and friends on the relation between socioeconomic position and self-rated health, performing binary logistic regression models. Socioeconomic position was measured by parents?? education, the family affluence scale and financial strain.

Results

Social support from the father mediated the association between family affluence and self-rated health among both males and females and the association between financial strain and self-rated health among males only. No moderating effect of social support on socioeconomic differences in self-rated health was found.

Conclusion

Father involvement seems to have the potential to mediate socioeconomic differences in health during adolescence.     

Health-related quality of life among adults with work-related asthma in the United States

Purpose

The objective of this study was to examine health-related quality of life among adults with work-related asthma.

Methods

We analyzed 2006–2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance.

Results

Of ever-employed adults with current asthma, an estimated 9.0 % had work-related asthma, 26.9 % had poor self-rated health, 20.6 % had impaired physical health, 18.2 % had impaired mental health, and 10.2 % had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95 % confidence interval (CI), 1.31–1.60], impaired physical health (PR, 1.60; 95 % CI, 1.42–1.80), impaired mental health (PR, 1.55; 95 % CI, 1.34–1.80), and activity limitation (PR, 2.16; 95 % CI, 1.81–2.56).

Conclusions

Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.     

Are barriers in accessing health services in the Roma population associated with worse health status among Roma?

Objectives

The health of Roma has been found to be poorer than that of the majority population. The aim of this study was to explore the differences between Roma and non-Roma regarding perceived barriers in accessing health services. Furthermore, we aimed to assess the association between self-rated health status and Roma ethnicity and explore to what degree barriers in accessing health services explain this association.

Methods

We used data from the cross-sectional HepaMeta study conducted in 2011 in Slovakia. The final sample comprised 452 Roma (mean age 34.7; 35.2 % men) and 403 (mean age 33.5; 45.9 % men) non-Roma respondents.

Results

Roma ethnicity was found to be significantly associated with poorer self-rated health status. A considerable part of this association can be explained by barriers in accessing health services as perceived by Roma.

Conclusions

Worse health in Roma is partially mediated by worse access to health services, apart from a large educational gap between Roma living in settlements and the majority population. Interventions should focus not only on health literacy among Roma but also on the health care system and health care professionals.