Does intergenerational social mobility affect the general health,oral health,and physical function of older adults in England?

BackgroundSocioeconomic status (SES) affects adult health. Material disadvantage experienced in childhood or adulthood is related to high adult disease levels. However, people transition through different socioeconomic paths over the life course. Changes in SES might counteract the effect of childhood SES on adult health, and research on social mobility takes this possibility into account by adopting a trajectory approach and taking a long-term view of the effect of SES on health. The aim of this research was to examine the effects of intergenerational social mobility on adult general health, oral health, and physical functioning in older adults in England.MethodsThis study is based on secondary analysis of data from the English Longitudinal Study of Ageing, which follows the lives of about 12 000 English adults aged 50 and over. Data from waves three and four of the study, were used to create nine social trajectories based on parental and adult occupational SES, resulting in three upwardly mobile, three downwardly mobile, and three stable groups. Regression models were used to estimate the associations between social trajectories and the following outcomes: self-rated health, self-rated oral health, oral-health-related quality of life, total tooth loss, and grip strength, while controlling for socioeconomic background and health-related behaviours.FindingsIntergenerational social mobility was associated with self-rated health (p<0·05 for six of nine trajectories), total tooth loss (p<0·05 for six of nine trajectories), and grip strength (p<0·05 for five of nine trajectories) in the expected direction. For individuals moving one step between middle and low SES, moving upwardly resulted in better health and function than for individuals moving downwardly; the same finding was observed for individuals moving two steps between high and low SES. However, no associations were observed for oral-health-related quality of life and self-rated oral health. Compared with the stable high SES group, remaining in low SES over time was associated with poorer health for all outcomes (odds ratios for general health 4·27, 95% CI 3·47 to 5·27; oral health 1·52, 1·20 to 1·92; tooth loss 6·78, 5·04 to 9·12; oral-health-related quality of life 1·64, 1·11 to 2·43; and β coefficient for grip strength −4·35, −5·60 to −3·11). Adjustment for adult education partly explained these associations.InterpretationThe results suggest that social mobility is an important determinant of health and function; downward mobility led to worse health and upward mobility led to better adult health. However, for oral health, social mobility is related to lifetime accumulation of oral diseases (total tooth loss) rather than current perception of oral health and quality of life.FundingNone.     

Determinants of self-rated health: could health status explain the association between self-rated health and mortality?

The purpose of this study was to investigate factors related to self-rated health and to mortality among 2490 community-living elderly. Respondents were followed for 7.3 years for all-cause mortality. To compare the relative impact of each variable, we employed logistic regression analysis for self-rated health and Cox hazard analysis for mortality. Cox analysis stratified by gender, follow-up periods, age group, and functional status was also employed. Series of analysis found that factors associated with self-rated health and with mortality were not identical. Psychological factors such as perceived isolation at home or 'ikigai (one aspect of psychological well-being)' were associated with self-rated health only. Age, functional status, and social relations were associated both with self-rated health and mortality after controlling for possible confounders. Illnesses and functional status accounted for 35-40% of variances in the fair/poor self-rated health. Differences by gender and functional status were observed in the factors related to self-rated health. Overall, self-rated health effect on mortality was stronger for people with no functional impairment, for shorter follow-up period, and for young-old age group. Although, illnesses and functional status were major determinants of self-rated health, economical, psychological, and social factors were also related to self-rated health.     

What is the health status of cardiology health care personnel in 2001?

The prevention of cardiovascular diseases belongs to priorities of the Czech public health care. Medical personnel should therefore set the example in the healthy way of life. At the meeting of the Working Group for Arrhythmia and Permanent Cardiostimulation at the Czech Cardiological Society, a questionnaire-based investigation for the evaluation of basic risk factors in workers engaged in cardiology (physicians, nurses, technicians) was performed. Our employees represent a paragon for the population in terms of motion activities and smoking in men. All of them also evaluate their subjective health better than the general population does. However, they consume larger amounts of alcohol and keep correct nutrition habits at a lower standard than the general population practices.     

What influences self-perception of health in the elderly? The role of objective health condition, subjective well-being and sense of coherence

The study examines in what way objective health-related variables interfere with psychic health and personality factors in explaining self-perception of health in the elderly. Two hundred and sixty-one patients aged 60 and older of an internal medicine hospital previously examined between 1994 and 1997 were once more contacted five years later. One hundred and sixty-four patients could not be included in the present investigation because of death, dementia, or severe physical illness. Of the 97 patients eligible for this second investigation, 74 agreed to participate. They were investigated extensively by means of psychometric scales and diagnostic interviews. A positive selection effect could be found for the sample of the present investigation with regard to age and health-related variables. Subjective evaluation of health correlated highly with the self-evaluation scales that recorded subjective well-being (life satisfaction, anxiety, and depression), and with the sense of coherence, but not substantially with objective health-related variables. A backward regression resulted in an adjusted R2 = 0.33 for the three retained variables "subjective physical complaints", "sense of coherence" and "self-evaluated depression" which rendered the same variance clarification of subjective health as did the model including all variables. Since the elderly represent the majority of patients treated in general hospitals and as subjective health and subjective physical complaints influence frequency of medical consultations and health care utilization, this is an important issue for consultation-liaison-psychiatry and health policy.     

Is there equity in the home health care market? Understanding racial patterns in the use of formal home health care

OBJECTIVE: This article explores whether the formal home health care (HHC) market is equitable or manifests unexplained racial disparities in use. METHODS: The database is the 1994 National Long Term Care Survey. We estimate logit regression models with a race dummy variable, race interaction terms, and stratification by race. We apply the Oaxaca decomposition technique to quantify whether the observed racial gap in formal HHC use is explained by racial differences in predisposing, enabling, need, and environmental characteristics. RESULT: We find numerous unique racial patterns in HHC use. Blacks with diabetes and low income have higher probabilities of HHC use than their White counterparts. Black older persons have a 25% higher chance of using HHC than Whites. Our Oaxaca analysis indicates that racial differences in predisposing, enabling, need, and environmental characteristics account for the racial gap in use of HHC. DISCUSSION: We find that the HHC market is equitable, enhancing availability, acceptability, and accessibility of care for older Black persons. Thus, the racial differences that we find are not racial disparities.     

Racial and ethnic disparities in the use of health services: bias,preferences, or poor communication?

African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.