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.     

Combining job and family demands and being healthy: what are the differences between men and women?

BACKGROUND: The objective of this study is to analyse gender inequalities in the combination of job and family life and their effect on health status and use of health care services. METHODS: The data come from the Navarra Survey of Working Conditions (Spain, 1997) carried out on a sample of 2185 workers. The analysis was restricted to 881 men and 400 women, aged 25-64 years, who were married or cohabiting. Dependent variables were self-perceived health status, psychosomatic symptoms, and medical visits, all of them dichotomized. Independent variables were family demands and number of hours of paid work a week. The analysis was adjusted for age and occupational social class. Multivariate logistic regression models, separated by sex, were fitted in order to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: Family demands were not associated with men's health whereas married women who lived in family units of more than three members had a higher risk of poor self-perceived health status (aOR=4.16; 95% CI: 1.37-12.65) and of psychosomatic symptoms (aOR=2.05; 95% CI: 1.12-3.75). Among women, working more than 40 hours a week was also associated with both health indicators and, additionally, with a higher probability of medical visits. CONCLUSION: In order to fully understand social determinants of workers' health, besides social class, gender inequalities in the distribution of family responsibilities should be considered.     

Social factors and periodontitis in an older population

OBJECTIVES: We assessed the prevalences of periodontitis by education and income levels among US adults with data from the third National Health and Nutrition Examination Survey. METHODS: The study was limited to non-Hispanic Blacks, Mexican Americans, and non-Hispanic Whites 50 years of age or older with a complete periodontal assessment during the dental examination. RESULTS: Blacks with higher education and income levels had a significantly higher prevalence of periodontitis than their White and Mexican-American counterparts. The relationship between income level and periodontitis was modified by race/ethnicity. High-income Blacks exhibited a higher prevalence of periodontitis than did low-income Blacks and high-income Whites. CONCLUSIONS: Our findings call attention to the importance of recognizing socioeconomic status-related health differences across racial/ethnic groups within the social, political, and historical context.     

Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery.

BACKGROUND: The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery. OBJECTIVE: To determine the aggregate and comparative interhospital surgical-site infection (SSI) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group. METHOD: Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected. RESULTS: For 4,474 patients undergoing CABG surgery, the aggregate SSI rate was 7.8 infections per 100 procedures (95% confidence interval [CI95], 7.0-8.5), with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures. Multivariate risk factor analysis demonstrated age (odds ratio [OR], 1.02; CI95, 1.01-1.04; P < .001), obesity (OR, 1.8; CI95, 1.4-2.3; P < .001), and diabetes mellitus (OR, 1.6; CI95, 1.2-2.1; P < .001) as independent predictors of SSI. Three hundred thirty-four organisms were isolated from 296 SSIs. Of the total SSIs, methicillin-resistant Staphylococcus aureus was isolated from 32%, methicillin-sensitive S. aureus from 24%, gram-negative bacilli (eg, Enterobacter and Escherichia coli) from 18%, and miscellaneous organisms from the remainder. CONCLUSION: We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery.