Socioeconomic inequalities in health in the working population: the contribution of working conditions

BACKGROUND: The aim was to study the impact of different categories of working conditions on the association between occupational class and self-reported health in the working population. METHODS: Data were collected through a postal survey conducted in 1991 among inhabitants of 18 municipalities in the southeastern Netherlands. Data concerned 4521 working men and 2411 working women and included current occupational class (seven classes), working conditions (physical working conditions, job control, job demands, social support at work), perceived general health (very good or good versus less than good) and demographic confounders. Data were analysed with logistic regression techniques. RESULTS: For both men and women we observed a higher odds ratio for a less than good perceived general health in the lower occupational classes (adjusted for confounders). The odds of a less than good perceived general health was larger among people reporting more hazardous physical working conditions, lower job control, lower social support at work and among those in the highest category of job demands. Results were similar for men and women. Men and women in the lower occupational classes reported more hazardous physical working conditions and lower job control as compared to those in higher occupational classes. High job demands were more often reported in the higher occupational classes, while social support at work was not clearly related to occupational class. When physical working conditions and job control were added simultaneously to a model with occupational class and confounders, the odds ratios for occupational classes were reduced substantially. For men, the per cent change in the odds ratios for the occupational classes ranged between 35% and 83%, and for women between 35% and 46%. CONCLUSIONS: A substantial part of the association between occupational class and a less than good perceived general health in the working population could be attributed to a differential distribution of hazardous physical working conditions and a low job control across occupational classes. This suggests that interventions aimed at improving these working conditions might result in a reduction of socioeconomic inequalities in health in the working population.     

Observations on mortality in selected working populations

Mortality among employees of selected enterprises in which excellent health care programmes are carried on, was observed to evaluate employees' health levels and to establish objectives for future health care programmes. Also, these data were compared with those for all Japanese and for Japanese employees belonging to the corresponding occupational groups. Seventy-three enterprises which continuously participated in the mortality survey implemented by the Japan Research Organization of Industrial Health Care for the period between 1976 and 1980, were subjected to this study. The observed employees amounted to 3,502,580 person-years. Sex and age distributions of the employees were available for 47 enterprises and the observed employees totalled 2,598,672 person-years. The main results are as follows: Mortality rate (per 100,000) is stable between 140 and 150 throughout the observed period and the average value is 145.0. The average mortality rate for males, aged 40 to 54, is 272.6. Malignant neoplasms were the main cause of death and account for 37-38%. In second place and below are heart diseases, cerebrovascular diseases, accidents, suicide and liver cirrhosis. Malignant neoplasms, especially of the stomach, lung and pancreas, show a trend to increase, and cerebrovascular diseases and liver cirrhosis show a trend to decrease. Among heart diseases, ischemic heart disease accounts for about 40% and shows no marked fluctuation. Among cerebrovascular diseases, the relative frequency of subarachnoid hemorrhage is increasing. Comparing the mortality rates for males aged 40 to 54 by industry, "Iron, steel & nonferrous metal manufacturing" and "Electricity and gas supply" show significantly higher values, and "Finance & insurance" and "Communications" show significantly lower values than the total. The distribution of main causes of death for males, aged 40 to 54, was compared by major occupational groups using Proportional Mortality Ratio (PMR). A significantly high frequency of malignant neoplasms (especially of the stomach) is observed for "Professional & technical workers, managers and officials" and that of suicide for "Craftmen, production process workers and labourers" and that of cerebrovascular diseases (especially cerebral hemorrhage) for "Protective service workers." Standardized Mortality Ratio (SMR) for males, aged 20 to 54, from all causes of death, calculated on the basis of all Japanese males in 1978 is 0.57. SMR for this population from malignant neoplasms is 0.89.(ABSTRACT TRUNCATED AT 400 WORDS)     

Socioeconomic inequalities in mortality among elderly people in 11 European populations

STUDY OBJECTIVE: To describe mortality inequalities related to education and housing tenure in 11 European populations and to describe the age pattern of relative and absolute socioeconomic inequalities in mortality in the elderly European population. DESIGN AND METHODS: Data from mortality registries linked with population census data of 11 countries and regions of Europe were acquired for the beginning of the 1990s. Indicators of socioeconomic status were educational level and housing tenure. The study determined mortality rate ratios, relative indices of inequality (RII), and mortality rate differences. The age range was 30 to 90+ years. Analyses were performed on the pooled European data, including all populations, and on the data of populations separately. Data were included from Finland, Norway, Denmark, England and Wales, Belgium, France, Austria, Switzerland, Barcelona, Madrid, and Turin. MAIN RESULTS: In Europe (populations pooled) relative inequalities in mortality decreased with increasing age, but persisted. Absolute educational mortality differences increased until the ages 90+. In some of the populations, relative inequalities among older women were as large as those among middle aged women. The decline of relative educational inequalities was largest in Norway (men and women) and Austria (men). Relative educational inequalities did not decrease, or hardly decreased with age in England and Wales (men), Belgium, Switzerland, Austria, and Turin (women). CONCLUSIONS: Socioeconomic inequalities in mortality among older men and women were found to persist in each country, sometimes of similar magnitude as those among the middle aged. Mortality inequalities among older populations are an important public health problem in Europe.     

Injuries in working populations: black-white differences.

BACKGROUND. Although "accidents and adverse effects" mortality is higher among Blacks than Whites, annual injury rates reported in the National Health Interview Survey (NHIS) are lower among Blacks. We evaluated the influence of sociodemographic risk factors on injury rates among working adults. METHODS. NHIS data from 1983 through 1987 for currently working adults were used. Methods were developed to estimate standard errors using data from different sample frames and sample sizes. RESULTS. Working Blacks had fewer reported injuries requiring medical attention or restriction of usual activities than working Whites (22.0 vs 27.0 per 100 persons per year). The difference was pronounced among younger adults in both sexes and among both poor and nonpoor. However, age, sex, and income could not completely explain racial differentials. "At-work" injury rates (36% of all injury episodes) were similar for Blacks and Whites (9.2 vs 9.9 per 100 persons per year), except low-income Blacks and Blacks in service or blue-collar occupations had nonsignificantly smaller at-work injury rates. CONCLUSION. Possible reporting biases could not be completely eliminated. However, available evidence does not rule out a true difference in injury rates by race, highlighting the complexity of understanding the etiology of injuries and, hence, developing public health programs to prevent injuries.     

Socioeconomic status and obesity in adult populations of developing countries: a review

A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. 2. The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases. 3. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US$ 2500, the mid-point value for lower-middle-income economies. The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all. A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004.     

Socioeconomic inequalities in self-rated health: role of work-to-family conflict in married Korean working women

Little evidence exists on the role of work-to-family conflict (WFC) in explaining socioeconomic inequality in self-rated health (SRH). We examined the association between socioeconomic status (SES) and SRH and tested the mediating effect of WFC in the association between SES and SRH among married Korean working women. A cross-sectional study was conducted using data from the 2014 Korean Longitudinal Survey of Women and Family. Participants were 3,226 women. Three SES indicators were used: income as measured by income-to-needs ratio; education categorized into college vs. noncollege education levels; and occupation classified by white vs. pink/blue-collar occupations. Lower levels of all the SES indicators were significantly associated with poor SRH and higher levels of WFC. The higher levels of WFC were also significantly associated with poor SRH. In the relation between SES and SRH, WFC showed a partial mediating effect for income (z = ?4.13, p < .001) and full mediating effects for education (z = ?3.79, p < .001) and occupation (z = ?4.59, p < .001). WFC played a mediating role in explaining socioeconomic health inequality among married Korean working women. Workplace strategies focused on alleviating the WFC levels of socioeconomically disadvantaged married women may be crucial for improving their health status.     

Socioeconomic variation in the impact of obesity on health-related quality of life

There is evidence that obesity has a negative impact on health-related quality of life (HRQL). However, little attention has been paid to variations in this impact between population groups. This study investigates the relationship between HRQL and obesity, and whether or not this relationship varies by socioeconomic status (SES). Data were taken from four rounds of the Health Survey for England (2003-2006; n = 33,716) for persons aged 16 and above. Banded total annual household income is regressed against a comprehensive set of SES indicators using interval regression. We use the equivalised predicted values from this model, categorised into quartiles, as our measure of SES. We regress EQ-5D scores against interactions between body mass index and SES categories. Obesity is negatively correlated with HRQL. The negative impact of obesity is greater in people from lower SES groups. Overweight and obese people in lower SES groups have lower HRQL than those of normal weight in the same SES group, and have lower HRQL than those in higher SES groups of the same weight. This trend is also observed after controlling for individual and household characteristics, although the statistical significance and magnitude of effects is diminished.     

Socioeconomic factors that impact patient no-shows in the ambulatory urology clinic

Journal of Public Health - This study seeks to identify patient socioeconomic factors that may be associated with no-shows to our academic urology clinics. This was a retrospective analysis of...     

Respiratory health impact of working in sawmills in eastern Canada

Air contamination in sawmills can cause respiratory health problems. The authors measured respirable dust, bacteria, endotoxins, and molds collected from 17 sawmills in eastern Canada. A total of 1,205 sawmill workers answered a respiratory-health questionnaire, and they all participated in lung-function measurements, skin-prick tests, and venous blood sampling for specific immunoglobulins against molds found in the sawmills. Workers had normal lung functions, and most respiratory symptoms could be explained by smoking histories. Workers in pine sawmills had a greater prevalence of positive skin-prick test to pine than did workers in sawmills where other woods were used. High levels of specific antibodies were seen in some workers. The presence of a positive skin-prick test and/or specific antibodies had no impact on lung function(s). These Quebec sawmill workers did not experience significant respiratory illnesses; however, some of these workers may be at a higher risk of developing asthma and hypersensitivity pneumonitis than nonworkers.     

Indirect estimation of maximal oxygen uptake for study of working populations

A total of 345 shipyard workers (aged 23 to 47) volunteered to perform progressive exercise on a cycle ergometer (15 W/min increments) up to the symptom limited maximum. The results were used to obtain maximal oxygen uptake (nO2 max), the oxygen uptake at a respiratory exchange ratio of unity (nO2 at R1.0), and cardiac frequency at an oxygen uptake of 45 mmol/min (fC45). In this group 156 men (45% of initial population) attained nO2 max as defined, 108 (31%) withdrew or did not exercise maximally, and 49 (14%) had transient electrocardiographic abnormalities. For the 156 men extrapolation of the relation of cardiac frequency on oxygen uptake to the predicted maximal cardiac frequency resulted in overestimation of nO2 max by 9.6%. nO2 Max per kg body mass was negatively correlated with body mass. nO2 Max (mean value 130.6 mmol/min) was described in terms of age, fat free mass, smoking (yes or no), and level of habitual activity (rated 1 to 4): the standard error of the estimate (SEE) was 17.3 mmol/min (R2 0.42); the equation was suitable for reference values. For estimating the nO2 max of individual men an empirical relation based on nO2 at R1.0, fC45, fat free mass, and % body fat had an SEE of 12.1 mmol/min (R2 0.67). Seventy six per cent of men (88% of those who exercised) attained nO2 at R1.0 (oxygen uptake approximately 73% of maximum). Thus the nO2 max could be estimated in a higher proportion of men than could achieve nO2 max. The estimate is appropriate for assessing exercise capacity in relation to employment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Socioeconomic status, working conditions and self-rated health in Switzerland: explaining the gradient in men and women

Objectives:  Epidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. Methods:  A representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme. Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. Results:  Data show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. Conclusion:  The study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studies. Submitted: 24 August 2007; revised: 06 May 2008, 11 August 2008; accepted: 19 October 2008     

Indirect estimation of maximal oxygen uptake for study of working populations.

A total of 345 shipyard workers (aged 23 to 47) volunteered to perform progressive exercise on a cycle ergometer (15 W/min increments) up to the symptom limited maximum. The results were used to obtain maximal oxygen uptake (nO2 max), the oxygen uptake at a respiratory exchange ratio of unity (nO2 at R1.0), and cardiac frequency at an oxygen uptake of 45 mmol/min (fC45). In this group 156 men (45% of initial population) attained nO2 max as defined, 108 (31%) withdrew or did not exercise maximally, and 49 (14%) had transient electrocardiographic abnormalities. For the 156 men extrapolation of the relation of cardiac frequency on oxygen uptake to the predicted maximal cardiac frequency resulted in overestimation of nO2 max by 9.6%. nO2 Max per kg body mass was negatively correlated with body mass. nO2 Max (mean value 130.6 mmol/min) was described in terms of age, fat free mass, smoking (yes or no), and level of habitual activity (rated 1 to 4): the standard error of the estimate (SEE) was 17.3 mmol/min (R2 0.42); the equation was suitable for reference values. For estimating the nO2 max of individual men an empirical relation based on nO2 at R1.0, fC45, fat free mass, and % body fat had an SEE of 12.1 mmol/min (R2 0.67). Seventy six per cent of men (88% of those who exercised) attained nO2 at R1.0 (oxygen uptake approximately 73% of maximum). Thus the nO2 max could be estimated in a higher proportion of men than could achieve nO2 max. The estimate is appropriate for assessing exercise capacity in relation to employment.(ABSTRACT TRUNCATED AT 250 WORDS)     

The impact of sexually transmitted diseases on minority populations

Sexually transmitted diseases (STD) are more prevalent among some minority populations in the United States than they are among the white majority. Primary and secondary syphilis occurs 45 times as often among non-Hispanic blacks as among non-Hispanic whites and 13 times as often among Hispanics as among non-Hispanic whites, according to morbidity reports received in 1988 by the Centers for Disease Control. Gonorrhea is reported more commonly among some minorities, with 1988 rates per 100,000 population being 54 for whites, 1,801 for blacks, and 201 for Hispanics. The reasons for the higher incidence of STD among some minorities are unknown. Data on racial differences in behavior and disease susceptibility are meager and do not account for the observed differences. Poverty, which is more common among some minorities than among the white majority, is closely associated with the prevalence of STD and may be a link between membership in a minority population and an increased risk.     

Prevalence and correlates of ventricular premature beats detected by ambulatory electrocardiography in working populations

The associations of ventricular premature beats detected on a one-hour ambulatory electrocardiogram with demographic, behavioral, physiologic, and anthropometric variables were examined in 2,331 factory workers aged 20-69 years. Ventricular premature beats were more prevalent with increasing age and with abnormal resting electrocardiograms. From the age of 40, they were more common among males than among females. An association with ethnicity was observed, ventricular premature beats being most common among Israelis of European origin. In univariate analysis, resting heart rate was inversely associated with the presence of ventricular premature beats for females only. Ambulatory heart rate was positively associated with ventricular premature beats only among males. No associations with smoking habits or relative weight were found. Among males and females with normal electrocardiograms, systolic and diastolic blood pressures were significant correlates of ventricular premature beats in univariate analysis and after controlling for age, resting and ambulatory heart rates, and ethnic origin.