Individual socio-economic status, community socio-economic status and stroke in New Zealand: a case control study

There is considerable debate about the association between individual socio-economic status, community socio-economic status and health. The current study examines individual data from a case-control study of stroke (n = 3489) conducted in Auckland, New Zealand. The study sought to identify whether individual socio-economic status (as measured by income from lifetime occupation) and community socio-economic status (measured in a number of ways) predicts the onset of stroke both independently and after controlling for individual risk factors (e.g., smoking, obesity and hypertension). Logistic regression results show that individual socio-economic status and all of the community socio-economic status measures predict the onset of stroke before controlling for individual risk factors. However, there is a high correlation between the various measures of community socio-economic status. Stepwise regression results suggest that average household income is the measure of community-level socio-economic status with the greatest predictive power. The results suggest that individual income and average household income are significant predictors of onset of stroke both independently and after controlling for behavioural and medical risk factors. Logistic regression analysis of the pathway suggests that individual income is a significant predictor of smoking and obesity, and that community socio-economic status is a significant predictor of heart disease, heavy drinking, diabetes, smoking and obesity.     

Socioeconomic status and health outcomes in a developing country

Although the relationship between socioeconomic status (SES) and health is well documented for developed countries, less evidence has been presented for developing countries. The aim of this paper is to analyse this relationship at the household level for Fiji, a developing country in the South Pacific, using original household survey data. To allow for the endogeneity of SES status in the household health production function, we utilize a simultaneous equation approach where estimates are achieved by full information maximum likelihood. By restricting our sample to one, relatively small island, and including area and district hospital effects, physical geography effects are unpacked from income effects. We measure SES, as permanent income which is constructed using principal components analysis. An alternative specification considers transitory household income. We find that a 1% increase in wealth (our measure of permanent income) would lead to a 15% decrease in the probability of an incapacitating illness occurring intra-household. Although the presence of a strong relationship indicates that relatively small improvements in SES status can significantly improve health at the household level, it is argued that the design of appropriate policy would also require an understanding of the various mechanisms through which the relationship operates.     

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.     

Setting our sights on justice: Contaminated sites and socio-economic deprivation in New Zealand

Research in the United States has shown that living near to sites that have stored or used hazardous substances (hazardous substances sites) is a risk factor for illness. The poor and ethnic minorities are disproportionately represented in this housing and thus are exposed to greater potential health risks. There are more than 10,000 hazardous waste sites in New Zealand but no previous research has related their location to the degree of socio-economic deprivation of the resident population. The aim of this study was to determine the association between hazardous substances sites and the level of socio-economic deprivation of the surrounding neighbourhoods. Data on hazardous substances sites from the computerized database of the Wellington Regional Council was linked to meshblocks used in the 1991 New Zealand Census. Using multivariate analysis, the distribution of these sites across meshblocks was compared with the socio-economic deprivation of the NZDep91 Index of Deprivation for small areas. A strong positive relationship was found between the number of hazardous substances sites and the deprivation of the meshblock (Chi22 = 64.6, p <0.001). 40% of those living in the most deprived socio-economic meshblocks had hazardous sites in their area, compared to less than 10% of those in the most socio-economically advantaged areas. The authors concluded that the number of sites containing hazardous substances is directly related to the level of deprivation in the surrounding meshblock. This relationship raises serious issues about the additional environmental risks poor people are exposed to in New Zealand and the equity responsibilities of regional councils and the national government.     

The SF-36 in an Australian sample: validating a new,generic health status measure

Abstract: The SF-36 is a self-reported, 36-item, generic measure of health status that has been validated for adult age groups in the United States, the United Kingdom and in some non-English-speaking countries. The Australian Bureau of Statistics used it in the 1995 National Health Survey and it has been used in health status measurement, in monitoring health outcomes and in clinical trials. The validity of the SF-36 was examined in the National Centre for Epidemiology and Population Health Record Linkage Study using a sample of 555 respondents to the National Heart Foundation Risk Factor Prevalence Survey in 1989; they were followed up in 1992. Items chosen for the scale had been used in health status assessment and had stood the test of time. The health concepts measured demonstrated good internal consistency. The eight scales of the SF-36 formed factors as predicted in the general health dimensions of physical and mental health. The component scales of the SF-36 demonstrated good discrimination between people with and without health conditions, including those with medical and those with psychiatric types of conditions. Although the SF-36 was a valid measure of general health status among Australian respondents, further work is needed to establish clinical validity and to produce population norms for Australia. Use of the SF-36 will allow Australian and international comparison of health status from the point of view of the users of health services.     

Television documentary in New Zealand and the construction of doctors by lower socio-economic groups

The medical profession remains central to the provision of health care and the treatment of illness within contemporary society. However, the image of doctors and the relationship of the profession with the public is contested. The public persona of doctors has been subjected to re-negotiation in recent years as a result of factors such as health care reforms, the increased autonomy of other health professionals, the rise of the health consumer, and well-publicised cases of medical misadventure. We argue that television viewing is one influential way through which images of medical doctors are socially negotiated. This paper explores the construction of doctors through an analysis of television health documentary coverage and the accounts of lower SES participants in New Zealand. It demonstrates how televised depictions of doctors are integrated into the lifeworlds of viewers. We show that multiple and often contradictory representations of doctors, within both television health coverage and the accounts of our participants, conflate the traditional characterization of the caring professional with more recently established characterizations such as the medical entrepreneur and the bungling quack. The result is a complex and contextually variable image of doctors that embodies tensions surrounding public anxiety over health care reform. Recourse to this more pluralistic image of doctors provides a way for participants to work through the dilemmas posed by reduced access to medical care and the uncertainties of medical treatment, while still maintaining support for universal access to medical care.     

Socioeconomic status and mortality revisited: an extension of the Brisbane area analysis

Abstract: Using the methodology of an earlier study of socioeconomic mortality gradients, we partitioned Brisbane City into five strata of equal size on the basis of suburb scores derived from aggregate socioeconomic census data. Numbers of deaths by stratum, age, sex and cause were obtained from mortality files. For almost all causes, mortality gradients had not changed between 1976–1979 and 1980–1987. A new category, medically-preventable death under age 65, had lower rates in higher-ranking suburbs. Potential years of life lost (PYLL) per unit of population, age-standardised, were also computed by stratum and cause. External causes of death were the main contributors to PYLL among men, with a strong socioeconomic gradient, while neoplasms were most important among women, with little evidence of a social class effect. It is estimated that, in urban Australia, the annual number of additional deaths under age 65 due to socioeconomic circumstances is over 2000 for males and over 1000 for females. This study provides a baseline against which the programs of health advancement initiated in the mid-1980s may be evaluated, or conversely, the effects of societal changes assessed.     

The Dutch Consumer Quality Index: an example of stakeholder involvement in indicator development

Background

Like in several other Western countries, in the Dutch health care system regulated competition has been introduced. In order to make this work, comparable information is required about the performance of health care providers in terms of effectiveness, safety and patient experiences. Without further coordination, external actors will all try to force health care providers to be transparent. For health care providers this might result in a situation in which they have to deliver data for several sets of indicators, defined by different actors. Therefore, in the Netherlands an effort is made to define national sets of performance indicators and related measuring instruments. In this article, the following questions are addressed, using patient experiences as an example:- When and how are stakeholders involved in the development of indicators and instruments that measure the patients' experiences with health care providers?- Does this involvement lead to indicators and instruments that match stakeholders' information needs?

Discussion

The Dutch experiences show that it is possible to implement national indicator sets and to reach consensus about what needs to be measured. Preliminary evaluations show that for health care providers and health insurers the benefits of standardization outweigh the possible loss of tailor-made information. However, it has also become clear that particular attention should be given to the participation of patient/consumer organisations.

Summary

Stakeholder involvement is complex and time-consuming. However, it is the only way to balance the information needs of all the parties that ask for and benefit from transparency, without frustrating the health care system.

     

Socioeconomic status and health: the role of subjective social status

Studies have suggested that subjective social status (SSS) is an important predictor of health. This study examined the link between SSS and health in old age and investigated whether SSS mediated the associations between objective indicators of socioeconomic status and health. It used cross-sectional data from the second wave (2004-2005) of the English Longitudinal Study of Ageing, which were collected through personal interviews and nurse visits. The study population consisted of 3368 men and 4065 women aged 52 years or older. The outcome measures included: self-rated health, long-standing illness, depression, hypertension, diabetes, central obesity, high-density lipoprotein cholesterol, triglycerides, fibrinogen, and C-reactive protein. The main independent variable was SSS measured using a scale representing a 10-rung ladder. Wealth, education, and occupational class were employed as covariates along with age and marital status and also, in additional analyses, as the main independent variables. Gender-specific logistic and linear regression analyses were performed. In age-adjusted analyses SSS was related positively to almost all health outcomes. Many of these relationships remained significant after adjustment for covariates. In men, SSS was significantly (p相似文献   

Urinary iodine and thyroid status of New Zealand residents

OBJECTIVES: The aim of this project was to assess the clinical significance of our low iodine excretions in terms of thyroid hormone status and thyroid volume in an adult population in a low soil iodine area of the South Island of New Zealand. DESIGN AND SETTING: Two-hundred and thirty-three residents of Otago, New Zealand collected two 24 h urine samples for assessment of iodine status. Thyroid status was determined from serum total T(4), TSH and thyroglobulin, and thyroid volumes. Relationships between urinary iodide excretion and measures of thyroid status were determined and subjects were allocated to one of three groups according to low, medium and high iodide excretion, for comparison of thyroid hormones and thyroid volumes. RESULTS: Significant correlations were found for relationships between measures of urinary iodide excretion and thyroid volume and thyroglobulin. Multiple regression analysis of data for subjects divided into three groups according to 24 h urinary iodide excretion (<60, 60-90; >90 microg iodide/day) or iodide/creatinine ratio (<40; 40-60; >60 microg/g Cr) showed significant differences in thyroid volume (P=0.029; P=0.035, respectively) and thyroglobulin (P=0.019; P=0.005, respectively) among the groups. CONCLUSIONS: The results of this study confirm the low iodide excretions of Otago residents, and indicate that the fall in iodine status is being reflected in clinical measures of thyroid status, including enlarged thyroid glands and elevated thyroglobulin. Our observations suggest the possible re-emergence of mild iodine deficiency and goitres in New Zealand. This situation is likely to worsen should iodine intakes continue to fall and continued monitoring of the situation is imperative.     

The New Zealand Socio-economic Index of Occupational Status: methodological revision and imputation for missing data

OBJECTIVES: To revise and update the New Zealand Socio-economic Index (NZSEI) in the light of methodological issues in its construction, and to develop an imputation method for use where occupational information is not available. METHODS: Data were drawn from the following New Zealand national surveys: 1996 Population Census; 1996/97 and 1997/98 Household Economic Surveys; 1996/97 Household Health Survey. Three sets of statistical analyses were applied: alternating least squares to generate socio-economic scores; cluster and discriminant function analyses to identify cut-points; and regression and logistic regression to develop and test imputation methods. RESULTS: Socio-economic scores for the full-time workforce in 1996 showed a different distribution, but much the same occupational ordering, as in 1991. The introduction of part-time workers and income adjustment multipliers for self-employed workers significantly affected scores for management and agricultural titles. The application of cluster and discriminant function analyses generated six groupings that were relatively distinct occupationally. An imputation method based on an averaging of scores within age/qualification categories was found to achieve acceptable results. CONCLUSIONS: Methodological improvements in the construction of the NZSEI have enhanced its empirical robustness, while a simple imputation technique has widened the potential application of the scale.     

Socioeconomic scoring in an urban area of a developing country.

A group of variables that might define “life-style” was selected and a questionnaire based on these was distributed to the families of 2350 schoolchildren in Accra, Ghana to determine the presence or absence of these variables. Analysis of the replies revealed a set of answers that formed a related group. A scoring system was developed in which rarer attributes were weighted, and the community was thus graded by socioeconomic status on a ten-point scale. Principles for developing questionnaires applicable to other types of community were defined.     

Socioeconomic status and childhood leukaemia: a review

BACKGROUND: A long-held view links higher socioeconomic status (SES) to higher rates of childhood leukaemia. Some recent studies exhibit associations in the opposite direction. METHODS: We reviewed journal literature through August 2002 for associations between childhood leukaemia and socioeconomic measures. We determined the direction of each association and its P-value. We described the results with regard to study design, calendar period, geographic locale, and level of the socioeconomic measures (individual or ecological). For measures with sufficient number of results, we computed summary P-values across studies. RESULTS: Case-control studies conducted in North America since 1980 have involved subject interviews or self-administered questionnaires and have consistently reported inverse (negative) associations of childhood leukaemia with individual-level measures of family income, mother's education, and father's education. In contrast, associations have been consistently positive with father's occupational class in record-based case-control studies and with average occupational class in ecological studies. CONCLUSIONS: Connections of SES measures to childhood leukaemia are likely to vary with place and time. Validation studies are needed to estimate SES-related selection and participation in case-control studies. Because different socioeconomic measures (such as income and education) and individual-level and ecological-level measures may represent different risk factors, we advise researchers to report these measures separately rather than in summary indices of social class.     

Measuring ethnicity in New Zealand: developing tools for health outcomes analysis

Objective. This study examines the development of new tools for analysing links between ethnicity and health outcomes. In a New Zealand context, it focuses on (1) how ethnicity is increasingly articulated as a social construct, (2) how individuals belonging to more than one ethnic group have been recorded and reported in research, and (3) health research and policy implications of the growing proportion of New Zealanders who claim multi-ethnic affiliations.

Design. New Zealand provides a microcosm in which to consider ethnicity, indigeneity, migration and intermarriage, and their interacting effects on society, culture, identity and health outcomes. Against a backdrop of historical debates about the measurement of race, and then ethnicity, the paper explores recent changes in the recording and reporting of ethnicity in the five-yearly Census of Population and Dwellings, and in death registrations. These changes are then considered in relation to the study of ethnic health disparities and the development of policies to overcome them.

Results. In the 2001 Census, of those who responded to the ethnicity question, at a level 1 classification 7.9% gave more than one response. In relation to the indigenous people of New Zealand, of all those who recorded Māori as one or more of their ethnic groups, only 56% recorded Māori only. In the younger age groups, less than half the Māori ethnic group were Māori only. Single ethnic categories disguise considerable within-group diversity in outcomes.

Conclusion. While single ethnic group disparity studies have been useful in the past, we suggest that more sophisticated ways of conceptualising and analysing ethnicity data in relation to health disparities are now required in New Zealand. Based on the New Zealand experience, we also suggest that as international migration continues, and as intermarriage becomes more frequent in most countries, there will be pressure to move from single group race-based measures towards culturally-based complex ethnicity measures.     

Socioeconomic status and age at menarche: an examination of multiple indicators in an ethnically diverse cohort

PurposeEthnic disparities exist in US girls' ages at menarche. Overweight and low socioeconomic status (SES) may contribute to these disparities but past research has been equivocal. We sought to determine which SES indicators were associated uniquely with menarche, for which ethnic groups, and whether associations operated through overweight.MethodsUsing National Longitudinal Study of Youth data, we examined associations between SES indicators and age at menarche. Participants were 4851 girls and their mothers. We used survival analyses to examine whether SES, at various time points, was associated with menarche, whether body mass index mediated associations, and whether race/ethnicity modified associations.ResultsBlack and Hispanic girls experienced menarche earlier than whites. After adjusting for SES, there was a 50% reduction in the effect estimate for “being Hispanic” and 40% reduction for “being black” versus “being white” on menarche. SES indicators were associated uniquely with earlier menarche, including mother's unmarried status and lower family income. Associations varied by race/ethnicity. Body mass index did not mediate associations.ConclusionsRacial differences in menarche may in large part be due to SES differences. Future experimental or quasiexperimental studies should examine whether intervening on SES factors could have benefits for delaying menarche among blacks and Hispanics.