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.     

Socioeconomic status, psychosocial health and health behaviours among Hungarian adolescents

BACKGROUND: While socioeconomic differences in health, morbidity, and disability are highest among middle-aged persons, there is a certain level of 'equalization' during adolescence and young adulthood. Despite this equalization, however, there still are differences in psychosocial variables or health-related behaviours, often very subtle and sometimes difficult to measure. METHODS: Using data (n = 1114) on high school students (aged between 14 and 21 years) from the Southern Plain Region, Hungary, the present study looks at the role of multiple SES indicators (objective and subjective; occupation and education; family structure) in adolescents' psychosocial health (self-perceived health, psychosomatic, and depressive symptomatology) and health behaviour (substance use and sports activity). RESULTS: Based on the results of multivariate logistic regression analyses, findings suggest the following: (i) SES self-assessment proved to be a significant predictor of adolescents' psychosocial health and health behaviours; (ii) family structure (that is, living in a non-intact family) also significantly influenced adolescents' psychosocial health and health behaviours; (iii) parents' employment status and schooling had a limited influence on their children's health outcomes; (iv) in a word, SES gradients in adolescents' psychosocial health and health behaviour were inconsistent and sometimes irregular (that is, inverse). The subjective SES measurement plays an important role (positive association), whereas certain types of parents' inactive status (in terms of labour market, that is, unemployment or retirement) seem to act in a predictable way (negative association). CONCLUSIONS: Our results indicate that despite certain level of equalization during adolescence, some important relationships between SES variables and health outcomes may occur.     

Socioeconomic position,health, and possible explanations: a tale of two cohorts

OBJECTIVES: We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient. METHODS: This longitudinal study of 2 occupational cohorts-5825 London civil servants and 6818 French office-based employees-used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health. RESULTS: Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health. CONCLUSIONS: Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality.     

Psychological, sociological and health behaviour aspects of a long term activation programme for institutionalized elderly people

The present study deals with psychological, sociological and subjective health aspects of social isolation and understimulation in institutional elderly people. In a controlled study over a 6 month period, A programme was devised in collaboration with residents of a senior citizens apartment building and its staff. The aim of the programme was to increase social activation and to encourage among the elderly an enhanced control over their daily lives. It was agreed that the programme implemented should involve no extra costs, overtime work or external resources. Most psychological and sociological variables were stable over the 6 month period. However, social activity level increased 3-fold in the Experimental group compared with the Control group. The E-group also started to attend activities outside the actual programme, and in general spent more time out of doors. Seasonal variations were found in feelings of depression, visits to the country/summer houses, as well as visits by children and neighbours. There were no changes in psychosomatic or psychological complaints indices. However, feelings of restlessness decreased significantly in the E-group over the 6 month period compared with the C-group. There was also a non significant decrease over time in complaints of heart palpitations in the E-group.     

Socioeconomic position in childhood and cardiovascular risk factors in older Spanish people

OBJECTIVE: To investigate the association between childhood social class and the prevalence of cardiovascular risk factors in the elderly. METHODS: Cross-sectional study of 4009 subjects representative of the Spanish non-institutionalized population aged >or =60 years, for whom information was available on father's occupation. We estimated the prevalence of hypertension, obesity, diabetes mellitus, physical inactivity, smoking, and alcohol intake. RESULTS: Belonging to a working social class in childhood is associated with increased hypertension, having ever smoked, and heavy alcohol intake, independent of adult social class in men. No association was found between social class in childhood and the other cardiovascular risk factors in men. Belonging to a working social class in childhood is associated with increased general obesity, abdominal obesity, diabetes mellitus, and physical inactivity in women, but the size of the association for abdominal obesity and diabetes mellitus decreases and the statistical significance disappears after adjusting for adult social class. The highest smoking prevalence was observed in women who were in social class I in childhood and the lowest in women who were in social class IV. CONCLUSIONS: The results of this study show increased prevalence of some cardiovascular risk factors in men who belong to a working social class in childhood, but they do not support the existing evidence about an association between adverse social circumstances in childhood and increased prevalence of cardiovascular risk factors in later life in women.     

Socioeconomic position,gender, health behaviours and biomarkers of cardiovascular disease and diabetes

Socio-economic gradients in cardiovascular disease (CVD) and diabetes have been found throughout the developed world and there is some evidence to suggest that these gradients may be steeper for women. Research on social gradients in biological risk factors for CVD and diabetes has received less attention and we do not know the extent to which gradients in biomarkers vary for men and women.     

Fall-induced deaths among elderly people

Falls and fall-induced injuries in older people are a major public health problem in modern societies with aging populations. Injury is the fifth leading cause of death in older adults, and most of these fatal injuries are related to falls. We have assessed the nationwide trends in fall-induced deaths of older people in Finland for more than 3 decades (1971-2002), and the results showed that the number of fall-induced deaths among elderly Finns is clearly increasing, especially among men.     

Socioeconomic position,gender, and inequalities in self-rated health between Roma and non-Roma in Serbia

Objective  

Roma experience high levels of discrimination and social exclusion. Our objective was to examine differences in self-rated health (SRH) between Roma and non-Roma in Serbia.     

Socioeconomic status, depression, and health service utilization among adolescent women.

This article examines relationships among socioeconomic status (SES), depression, and health services utilization among 5,735 adolescent women. In cross-sectional analyses, effects of SES on having obtained a routine physical examination and use of psychological/emotional counseling in the past year are examined. Then, longitudinal analyses determine the effects of health service utilization on depression at 1 year follow-up (T2) controlling for baseline depression and SES. SES was associated with medical but not mental health service use. SES and health service use independently predicted T2 depression and an income x baseline depression interaction was noted. The findings and their implications are discussed.     

Selective international migration by social position, health behaviour and personality

BACKGROUND: Immigrants is an important minority in many countries, but little is known how they are self-selected. We analysed differences in psycho-social and health behavioural factors between international migrants and non-migrants prior to migration in a large cohort of Finnish twins. METHODS: A questionnaire was sent to Finnish twins in 1975 (response rate 89%, N = 26555 twin individuals). Follow-up data on migration and mortality were derived from population registries in Finland and Sweden up to 31 March 2002. In 1998, another questionnaire was sent to Finnish twins migrated to Sweden and their co-twins (response rate 71%, N = 1534 twin individuals). The data were analysed using Cox and conditional logistic regression models. RESULTS: Life dissatisfaction, higher alcohol use and smoking at baseline predicted future migration. In men additionally, unemployment, neuroticism and extroversion increased the probability to migrate. Similar associations were found for alcohol use in men and smoking in men and women within twin pairs discordant for migration. Twins also reported retrospectively that prior to migration the migrated twin had been less satisfied with his/her educational institution or job and was generally less satisfied with life, used more alcohol (men) and smoked more (women) than the co-twin stayed in Finland. CONCLUSION: Migrants are self-selected by health behavioural and personality factors, which may compromise their health. The special requirements of migrants should be recognized in health care.     

Alcohol consumption patterns and behaviour among people using the health care system in Lower-Normandy

A national study on the prevalence of excessive alcohol consumption behaviour was undertaken throughout France. The results presented in this paper are those from Lower-Normandy. Two surveys were carried out: one among patients of general practitioners, and another among those in hospitals. The following data were specifically examined: the CAGE test score, the use of alcohol, the level of dependence, the conclusion of the care provider and the patient's profile. The results show that the frequency of excessive alcohol consumption in Lower-Normandy remains slightly higher than the national average. However, a significant reduction, which has been confirmed by the decrease in mortality rates, has been obtained within the last two decades. But nevertheless, the fight must continue and with on-going determination, and this aspect must rely more heavily upon general practitioners.     

Socioeconomic position and health status of people who live near busy roads: the Rome Longitudinal Study (RoLS)

Background  

Subjects living close to high traffic roads (HTR) are more likely to suffer from air-pollution related morbidity and mortality. The issue has large public health consequences but few studies have described the main socio-demographic characteristics of people exposed to traffic.     

Chocolate, well-being and health among elderly men

OBJECTIVE: We hypothesized that chocolate preference would be related to health and psychological well-being in old men. DESIGN, SETTING AND PARTICIPANTS: We have followed up a socio-economically homogenous group of men, born in 1919-1934, since the 1960s. In 2002-2003, a mailed questionnaire was used to assess the health and well-being (including questions related to positive life orientation, visual analogue scales and the Zung depression score) of survivors. In addition, candy preference was inquired. Those men who reported no candy consumption (n=108) were excluded from the analyses. OUTCOME MEASURES: Psychological well-being in old age. RESULTS: The response rate was 69% (1367 of 1991). Of the respondents, 860 and 399 preferred chocolate and other type of candy, respectively. The average age in both candy groups was 76 years. Of the respondents, 99% were home-dwelling, 96% were retired and 87% were presently married, without differences between the candy groups. Men preferring chocolate had lower body mass index and waist circumference, and they also reported more exercise and better subjective health (P=0.008) than other candy consumers. Variables related to psychological well-being were consistently better in those preferring chocolate. The differences were statistically significant in feeling of loneliness (P=0.01), feeling of happiness (P=0.01), having plans for the future (P=0.0002) and the Zung depression score (P=0.02). CONCLUSIONS: In this socioeconomically homogenous male cohort, chocolate preference in old age was associated with better health, optimism and better psychological well-being. SPONSORSHIP: The Academy of Finland, the P?ivikki and Sakari Sohlberg Foundation, the Helsinki University Central Hospital and the Finnish Foundation for Cardiovascular Research.