Predictors of healthy aging in men with high life expectancies.

OBJECTIVE: The purpose of this study was to identify risk factors that consistently predict staying healthy in contrast to developing clinical illness and/or physical and mental impairments. METHODS: More than 8000 men of Japanese ancestry were followed for 28 years with repeat examinations and surveillance for deaths and incident clinical illness. Physical and cognitive functions were measured in 1993. Measures of healthy aging included surviving and remaining free of major chronic illnesses and physical and cognitive impairments. RESULTS: Of 6505 healthy men at baseline, 2524 (39%) died prior to the final exam. Of the 3263 available survivors, 41% remained free of major clinical illnesses, 40% remained free of both physical and cognitive impairment, and 19% remained free of both illness and impairment. The most consistent predictors of healthy aging were low blood pressure, low serum glucose, not smoking cigarettes, and not being obese. CONCLUSIONS: Beyond the biological effects of aging, much of the illness and disability in the elderly is related to risk factors present at midlife.     

Incidence and prognosis of ischaemic heart disease with respect to marital status and social class. A national record linkage study.

Increased mortality from ischaemic heart disease (IHD) has been found in previous studies among divorced, widowed, and unskilled middle-aged Finnish men. In this study all cases of IHD in men aged 40-64 during 1972 were analysed by linking death certificates and hospital records (7499 cases with 3136 deaths). Age-adjusted incidence, mortality, and survival rates of the first and third year were calculated by marital status and social class. The highest mortality rate was found among unskilled workers, the highest incidence among widowers and those in the lower professional classes, and the lowest survival rate among divorcees, single persons, and unskilled workers. The ratio of mortality by marital status (1.77) was in part due to survival (ratio 1.44) and in part due to incidence (ratio 1.32). The ratio of mortality by social class (1.44) seemed to be due more to differences in incidence (ratio 1.36) than to differences in survival (ratio 1.18). The distribution of conventional risk factors of IHD by marital status and social class seems to explain only part of the mortality differences.     

Height and social class in middle-aged British men.

A study of 7735 middle-aged British men drawn from general practices in twenty-four towns shows that there has been a progressive increase in mean height in the men who were born between 1919 and 1939. This is true for both manual and non-manual classes, but the mean heights of the two groups are significantly different and remain widely separated over this period of time. Manual workers lag twenty years behind non-manual workers in their attained height. Data from other studies indicate that this social class difference in adult height is still present in those born up to 1960. The variation in mean height between the twenty-four towns is less marked than the variation in mean height between the social classes. After social class and age have been taken into account, a "town effect" on height is still present. If height is accepted as an indicator of socio-economic circumstances in childhood, then there is a difference in adult height between social class groups in Great Britain which does not appear to be diminishing.     

Survival among women with cancer of the uterine cervix: influence of marital status and social class.

STUDY OBJECTIVE--The aim was to investigate whether the survival of women with cancer of the uterine cervix is associated with their marital status and social class. DESIGN--The study was a survey of survival up to 5 years from diagnosis of women with cancer of the cervix registered in the South Thames Cancer Registry, using Cox regression to adjust for marital status, social class, age, and stage at registration. Because of deficiencies in social class data held by the Registry (social class was assigned in only 51% of cases, as opposed to 93% for marital status), the findings were compared with survival data from the OPCS Longitudinal Study. SETTING--During the period of study (1977-81) the South Thames Cancer Registry covered a female population of about 3.5 million in the south east of England. PATIENTS--Data on 1728 women were analysed. MEASUREMENTS AND AND MAIN RESULTS--Apparent differences in crude survival by marital status and social class were examined. These were found to be accounted for by adjustment for age and stage. The better survival of those whose social class was unknown was found to be an artefact of the way in which cancer registries assign social class, but this did not appear to bias registry based studies of social class survival seriously. CONCLUSIONS--(1) After adjusting for age, factors affecting survival in women with cancer of the cervix, such as stage at presentation or host resistance, appear to be similarly distributed in the different marital status and social class groups; (2) for cervical cancer, the marked social class gradient and unusual marital status distribution found in cross sectional mortality data reflect the incidence of the disease, not differences in survival; (3) explanations for these patterns in incidence and mortality data are to be found in the aetiology of the disease.     

Adverse birth outcomes in relation to maternal marital and cohabitation status in Canada

Purpose

An increasing percentage of children are born to couples who cohabit but are not legally married. Using data from a nationally representative Canadian sample, we estimated associations of maternal marital and cohabitation status with stillbirth, infant mortality, preterm birth (PTB), and small- and large-for-gestational-age (SGA and LGA) birth.

Cardiovascular risks and socioeconomic status: differences between men and women in Finland.

STUDY OBJECTIVE--The study aimed to assess the association of different indicators of socioeconomic status with levels of cardiovascular disease risk factors in men and women aged 25-64 years. DESIGN--This was a cross sectional survey, using a community based random sample. SETTING--The provinces of North Karelia and Kuopio in eastern Finland and the cities of Turku and Loimaa and surrounding communities in southwestern Finland in 1987. PARTICIPANTS--Altogether 2164 men and 2182 women aged 25-64 years took part. MEASUREMENTS AND MAIN RESULTS--Data were collected using self administered questionnaires and the measurement of height, body weight, and blood pressure and blood sampling for lipid determinations were done at the survey site. The risk of cardiovascular disease was determined by calculating a simple risk factor score based on the observed values of HDL and total cholesterol, leisure time, physical activity, blood pressure, medication for hypertension, body mass index, and smoking. Indicators of socioeconomic position used were years of education, family income, marital status, and the person's occupation. Lower levels of education, occupation, and income were all significantly associated with an unfavorable risk factor profile in men and women. Education and occupation showed the strongest associations with the risk factor score in both men and women. The results changed little when adjusting for income and marital status. Family income was more strongly associated with the risk factor score in women than men. When adjusting for occupation and education, income was no longer significantly associated with the risk factor score in men. Marital status was not significantly associated with the risk factor score in either sex. CONCLUSIONS--Using the strength of the association with the cardiovascular risk factor score as the criterion for a good socioeconomic indicator, the present study suggests that education and occupation may be equally good indicators in both men and women. Family income may have some additional importance, especially in women.     

Evaluation of reproductive function among men occupationally exposed to a stilbene derivative: I. hormonal and physical status

This is the first of two reports describing a National Institute for Occupational Safety and Health (NIOSH) Health Hazard Evaluation conducted in response to complaints of impotence and decreased libido among male employees who manufactured 4,4'-diaminostilbene-2,2'disulfonic acid (DAS; CAS 81-11-8), an intermediate in the manufacture of fluorescent whitening agents. DAS is structurally similar to the synthetic estrogen diethylstilbestrol (DES). Levels of six reproductive hormones in 30 male workers who manufactured DAS (current DAS workers) and 20 former DAS workers were compared to levels of 35 workers who manufactured plastics additives. Current and former DAS workers had lower mean total testosterone (TT) levels compared to additives workers (458 and 442, respectively, vs. 556 ng/dL; p = 0.05 and 0.04). Current and former DAS workers were 3.6 (95% CI, 0.5-24.4) and 2.2 (95% CI, 0.3-18.0) times more likely than additives workers to have lowest quartile TT levels (<386 ng/dL) after adjustment for age and body mass index. Duration of employment in DAS production was negatively related to the workers' testosterone levels. These data suggest that occupational DAS exposure may be associated with alterations in male reproductive hormone levels. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

Risk of mortality and coronary heart disease by marital status in middle-aged men in The Netherlands.

Between 1972 and 1974, a cardiovascular screening survey was conducted in a stratified sample of 3365 men aged 45-59 in Rotterdam, the Netherlands. Follow-up data collected in 1982 were used to examine the association between marital status and mortality and coronary heart disease while adjusting for various control variables. Nonmarried men had significantly higher relative risks (RR) (95% confidence interval (CI)) of 1.7 (95% CI: 1.2-2.3) and 2.2 (95% CI: 1.2-4.2) for all-cause mortality and coronary mortality than the married. Never married men showed the most consistent relationships with all-cause and coronary mortality, with RR of 2.3 (95% CI: 1.6-3.4) and 2.9 (95% CI: 1.4-6.2) respectively. The RR for these endpoints among the widowed and divorced were all close to unity, except for the risk of coronary mortality among the widowed, which was 2.9 (95% CI: 0.9-10.2). Not being married also increased the risk for fatal and total reinfarction, with RR of 3.6 (95% CI: 1.4-9.1) and 2.5 (95% CI: 1.1-5.6) respectively. The results suggest that in middle-aged Dutch males, the health consequences of not being married may differ for the never married, divorced, and widowed. Selective mating, differential lifestyles or health habits, and lack of social integration were offered as possible explanations.     

Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants

BACKGROUND: Folate and cobalamin status changes markedly during infancy. OBJECTIVE: We aimed to examine the influence of breastfeeding on folate and cobalamin status in healthy infants. DESIGN: In a longitudinal study, we measured serum folate, cobalamin, holotranscobalamin, holohaptocorrin, methylmalonic acid, and homocysteine at birth and at ages 6, 12, and 24 mo (n = 361, 262, 244, and 224, respectively). Breastfeeding status and nutrient intake were assessed by using questionnaires and 7-d weighed-food records (at 12 mo). RESULTS: All indexes changed significantly from birth to age 24 mo (P < 0.001). Folate was high until age 6 mo and then declined. At age 6 mo, folate was positively correlated with duration of exclusive breastfeeding (rho = 0.29; P < 0.001). Cobalamin status declined after birth in breastfed but increased in nonbreastfed infants. Thus, holotranscobalamin (pmol/L) was lower in breastfed than in nonbreastfed children at age 6 mo [geometric mean: 37 (95% CI: 33, 40) and 74 (64, 86), respectively], at 12 mo [51 (46, 56) and 76 (70, 82), respectively], and at 24 mo [65 (50, 83) and 90 (85, 97), respectively; P < 0.05 for all]. Complementary feeding did not increase (6 mo) or modestly increased (12 mo) cobalamin status in breastfed children. At 12 mo, cobalamin intake (microg/d), excluding breast milk cobalamin, was lower in breastfed than in nonbreastfed infants [geometric mean: 1.4 (1.3, 1.6) and 2.4 (2.1, 2.6), respectively; P < 0.001]. However, after adjustment for total cobalamin intake, cobalamin status (ie, holotranscobalamin) remained significantly lower in breastfed than in nonbreastfed infants [54 (49, 59) and 70 (64, 78), respectively; P < 0.001]. CONCLUSIONS: Low cobalamin status is a characteristic finding in breastfed children. Reference limits according to age and breastfeeding status should be considered in early childhood.     

Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971-95.

STUDY OBJECTIVE: To quantify the contribution of different causes of death and age groups for trends in life expectancy for two major social classes. DESIGN AND SETTING: Prospective study of mortality in Finland among all over 35 year old men and women. Baseline social class (manual/non-manual) was from the 1970, 1975, 1980, 1985 and 1990 census records, and follow up was by computerised record linkage to death certificates for 1971-1995. MAIN RESULTS: From the early 1970s to the early 1990s life expectancy at age 35 increased by about five and four years among Finnish men and women respectively, with largest gains among 55-74 year old men and 65-84 year old women. Life expectancy increase was 5.1 years among non-manual and 3.8 years among manual men; corresponding figures for women were 3.6 and 3.0 years. In the 1980s, when differences in life expectancy increased most rapidly, decline in cardiovascular disease mortality was more rapid in the non-manual than the manual class. Furthermore, increasing mortality for alcohol associated causes, "other diseases", and accidents and violence were most prominent in the manual class. CONCLUSIONS: Explanations of increasing social inequalities in mortality that are based on one underlying factor are difficult to reconcile with the variability in the cause specific trends in social inequalities in mortality. The contribution of older ages to social inequalities in mortality should be more widely recognised.     

Trends in lung cancer mortality in Scotland and their relation to cigarette smoking and social class.

This paper describes the trends in lung cancer rates in Scottish men and women during 1959-85, the relationship between lung cancer and cigarette consumption, and between lung cancer and social class, and the urban-rural gradient of lung cancer. Lung cancer rates in Scottish men have declined in all age groups under the age of 74 for at least the past two decades; the most notable decrease was in men aged 40-44 years, whose rates halved between 1970 and 1980. In women, who began smoking in large numbers only after World War II, lung cancer mortality declined slightly in those between 40-54 years and rose in those over 54 years. Trends in cigarette consumption did not fully explain the decline in lung cancer. Marked urban-rural gradients in the SMRs for lung cancer were evident in all periods, and these strengthened over time. Correlations between lung cancer and social class differed markedly from those found in previous studies, except for those with social classes II and V.     

The roles of social class of origin, achieved social class and intergenerational social mobility in explaining social-class inequalities in alcoholism among young men.

The aim of this study was to investigate the role of intergenerational health-related mobility in explaining social-class inequalities in alcoholism among young men. Data on social class of origin and on risk factors in childhood and adolescence, e.g. risk use of alcohol, were collected for 49,323 men, born 1949-51, at enlistment for compulsory military training in 1969/70. Information on achieved socioeconomic class was obtained from Sweden's 1975 census. Data on alcoholism diagnoses were collected from the national in-patient care register 1976-83. Risk indicators for alcoholism established in adolescence were found to be more common among downwardly mobile individuals, and also among stable manual workers, than among those who ended up as non-manual employees. Downwardly mobile individuals, and also stable manual workers, were also found to have an increased risk of alcoholism diagnosis. The increased relative risk could, to a considerable extent, be attributed to factors from childhood/adolescence. In this longitudinal study, it is shown that intergenerational social mobility associated with health-related factors, albeit not with illness itself, made a major contribution to explaining differences in alcoholism between social classes. Factors established in adolescence were important with regard to differences in alcoholism between social classes among young adults. But such adverse conditions did not seem to be well reflected by social class of origin.     

Cerebral palsy: social class differences in prevalence in relation to birthweight and severity of disability.

STUDY OBJECTIVE--The aim of the study was to examine the possible influence of social class on the prevalence of cerebral palsy. DESIGN--The study was a retrospective population based survey of all cases of cerebral palsy. SETTING--The study involved all cases of cerebral palsy born to residents in the Eastern Health Board area of the Republic of Ireland between 1976 and 1981 inclusive. PATIENTS--There were 289 cases of cerebral palsy during the study period. Thirty one were excluded because they were attributable to postneonatal brain damage, leaving 258 children for analysis. Cases with uncertain diagnosis were excluded. MAIN RESULTS--There was a clear social class gradient in the overall prevalence of cerebral palsy, also evident in the individual syndromes of hemiplegia and diplegia. No such gradient was detected in the other syndromes, either singly or in combination. Among cases of low birthweight (less than or equal to 2500 g), the prevalence was the same across the social class range after allowing for the increased low birthweight rate in the lower social class categories. Among normal birthweight cases there was a strong positive association with decreasing social class. Intrauterine growth retardation seemed to be a factor in cerebral palsy in all social class groups. Prevalence of cerebral palsy severe enough to prevent walking by the fourth birthday, but not of cases ambulant by this age, increased with socioeconomic disadvantage. CONCLUSIONS--The clear social class gradients in hemiplegia and diplegia suggest that environmental factors play an important role in the aetiology of these syndromes, but there was no evidence of a contribution from this type of factor in the remaining types of cerebral palsy.     

Mortality in alcohol-related diseases in Sweden during 1971-80 in relation to occupation, marital status and citizenship in 1970.

A new Swedish population register, created by linking Census data to the Cause of Death Registry and covering over 99% of the population, has been used to study the relationship between occupational category, marital status and citizenship in 1970 and mortality in closely alcohol-related diseases during 1971-1980 for the ages 25-64 years. Age-standardized rate ratios (SRR) have been computed for mortality in alcoholism, alcohol intoxication and alcohol psychosis ("AAA") and in liver cirrhosis. SRR-values for both diagnose categories and both sexes were higher than average among not gainfully employed (SRR = 3.71 among males and SRR = 1.96 among females in 1976-80 for "AAA"), among employees in the service sector, engine-drivers and unskilled workers and increased in liver cirrhosis among artists and authors. Among females there were smaller variations in mortality for occupational groups than among males. The SRR-values showed a tendency to be higher in 1976-80 than in 1971-75, probably due to health-related selection to some extent. The alcohol-related mortality was also increased among divorced, widows (SRR = 1.37 for "AAA" and 2.81 for liver cirrhosis in 1976-80) and widowers and among never married males. SRR was much higher among Finnish citizens in Sweden (SRR for "AAA" = 3.85 among males and 2.35 among females in 1976-80) than among males and females living in Finland (SRR for "AAA" = 1.13 among males and 0.36 among females) and also higher than among immigrants from other countries, summed (SRR for "AAA" = 0.62 among males and 0.64 among females).(ABSTRACT TRUNCATED AT 250 WORDS)     

Association of age and social class with suicide among men in Great Britain.

STUDY OBJECTIVE--The aim was to investigate suicide and "undetermined" deaths by age, economic activity status, and social class in Great Britain among males of working age. DESIGN--The study was a cross sectional analysis of Registrar General's data for England and Wales around 1981, repeated for around 1971, and for Scotland around 1971 and 1981. MEASUREMENTS AND MAIN RESULTS--For England and Wales around 1971, suicide and undetermined death rates showed a progressive increase with age and a markedly higher rate in the lower social classes. A significant interaction effect was identified in the central age groups of the lower occupational categories. This interaction was confirmed in the remaining three data sets, notwithstanding some differences in the profile of age specific mortality. Other findings included a higher standardised mortality ratio for the economically inactive, who also showed an earlier peak in age specific mortality, and a relative concentration of undetermined as compared to suicide deaths in the lower social classes, but not all these further results were fully replicated. CONCLUSIONS--There is a concentration of suicide and undetermined deaths in the middle age groups of the lower social classes. Plausible explanations include both the social drift and the social genesis hypotheses, the latter including the effects of long term unemployment.     

Social support at age 33: the influence of gender, employment status and social class.

This paper investigates the conceptualisation and operationalisation of social support and it's relationship to gender, employment status and social class. Clarification of these relationships is sought in order to better understand associations between social support and health. We used data from the 33-year survey of the 1958 British birth cohort study. Individual items and subscales of practical and emotional support were examined. In general, men had lower support than women and social classes IV and V had lower support than classes I and II. Emotional support, either from personal (for example, from friends or family), or combined with organisational sources of support (such as from a church or a financial institution), showed consistent gender and social class patterns. This suggests that emotional support is a robust concept across socio-demographic groups. Less consistent trends were found for practical support, in that socio-demographic trends depended on how practical support was measured. In particular, it depended on whether both personal and organisational sources of support were examined. Gender differences in social support were large and might therefore be expected to contribute to gender differences in health, whereas social class differences in social support were modest, suggesting a minor explanatory role for this factor in accounting for inequalities in health.     

Occupational social class and mortality in a population of men economically active: The contribution of education and employment situation

This study examines how education and employment situation contribute to the association between a classification of occupational class based on skill assets and mortality from different causes of death. Data were obtained by linking records from the 1996 population census for Spanish men aged 35–64 residing in Madrid with 1996 and 1997 mortality records. The risk of mortality was higher in skilled, semi-skilled and unskilled workers than in higher and lower managerial and professional workers. Adjusting for educational level substantially decreased the magnitude of the gradient. The decrease in the gradient after adjusting for employment situation was much smaller. Except in the case of mortality from respiratory diseases, the mortality gradient disappeared after adjusting for both variables. These results show that education and, to a much lesser degree, employment situation explain part of the social gradient observed in mortality from all causes and from broad causes of death, except from respiratory diseases.