Widespread and widely widening? Examining absolute socioeconomic health inequalities in northern Sweden across twelve health indicators

Abstract Background Socioeconomic inequalities in health is a widely studied topic. However, epidemiological research tends to focus on one or a few outcomes conditioned on one indicator, overlooking the fact that health inequalities can vary depending on the outcome studied and the indicator used. To bridge this gap, this study aims to provide a comprehensive picture of the patterns of socioeconomic health inequalities in Northern Sweden over time, across a range of health outcomes, using an ‘outcome-wide’ epidemiological approach. Method Cross-sectional data from three waves of the ‘Health on Equal Terms’ survey, distributed in 2006, 2010 and 2014 were used. Firstly, socioeconomic inequalities by income and education for twelve outcomes (self-rated health, self-rated dental health, overweight, hypertension, diabetes, long-term illness, stress, depression, psychological distress, smoking, risky alcohol consumption, and physical inactivity) were examined by calculating the Slope Index of Inequality. Secondly, time trends for each outcome and socioeconomic indicator were estimated. Results Income inequalities increased for psychological distress and physical inactivity in men as well as for self-rated health, overweight, hypertension, long-term illness, and smoking among women. Educational inequalities increased for hypertension, long-term illness, and stress (the latter favouring lower education) in women. The only instance of decreasing income inequalities was seen for long-term illness in men, while education inequalities decreased for long-term illness in men and poor self-rated health, poor self-rated dental health, and smoking in women. Conclusion Patterns of absolute socioeconomic inequalities in health vary by health and socioeconomic indicator, as well as between men and women. Overall, trends appear more stagnant in men while they fluctuate in women. Income inequalities seem to be generally greater than educational inequalities when looking across several different health indicators, a message that can only be derived from this type of outcome-wide study. These disparate findings suggest that generalised and universal statements about the development of health inequalities can be too simplistic and potentially misleading. Nonetheless, despite inequalities being complex, they do exist and tend to increase. Thus, an outcome-wide approach is a valuable method which should be utilised to generate evidence for prioritisations of policy decisions.

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Is Loneliness an Undervalued Pathway between Socio-Economic Disadvantage and Health?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910177 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10177

Author(s):

Rachelle Meisters ◽

Polina Putrik ◽

Daan Westra ◽

Hans Bosma ◽

Dirk Ruwaard ◽

...

Keyword(s):

Public Health ◽

Young Adults ◽

Health Inequalities ◽

National Sample ◽

Social Determinant ◽

Poor Health ◽

Public Health Issue ◽

Economic Disadvantage ◽

Self Rated Health ◽

Socioeconomic Health Inequalities

Loneliness is a growing public health issue. It is more common in disadvantaged groups and has been associated with a range of poor health outcomes. Loneliness may also form an independent pathway between socio-economic disadvantage and poor health. Therefore, the aim of this study was to explore the contribution of loneliness to socio-economic health inequalities. These contributions were studied in a Dutch national sample (n = 445,748 adults (≥19 y.o.)) in Poisson and logistic regression models, controlling for age, gender, marital status, migration background, BMI, alcohol consumption, smoking, and physical activity. Loneliness explained 21% of socioeconomic health inequalities between the lowest and highest socio-economic groups in self-reported chronic disease prevalence, 27% in poorer self-rated health, and 51% in psychological distress. Subgroup analyses revealed that for young adults, loneliness had a larger contribution to socioeconomic gaps in self-rated health (37%) than in 80+-year-olds (16%). Our findings suggest that loneliness may be a social determinant of health, contributing to the socioeconomic health gap independently of well-documented factors such as lifestyles and demographics, in particular for young adults. Public health policies targeting socioeconomic health inequalities could benefit from integrating loneliness into their policies, especially for young adults.

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Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211794 ◽

2019 ◽

Vol 73 (10) ◽

pp. 963-970 ◽

Cited By ~ 4

Author(s):

Irene Moor ◽

Mirte A G Kuipers ◽

Vincent Lorant ◽

Timo-Kolja Pförtner ◽

Jaana M Kinnunen ◽

...

Keyword(s):

Socioeconomic Status ◽

Academic Performance ◽

Adolescent Health ◽

Health Inequalities ◽

Parental Education ◽

Socioeconomic Inequalities ◽

Family Affluence ◽

Self Rated Health ◽

Pocket Money ◽

Family Ses

BackgroundAlthough there is evidence for socioeconomic inequalities in health and health behaviour in adolescents, different indicators of socioeconomic status (SES) have rarely been compared within one data sample. We examined associations of five SES indicators with self-rated health (SRH) and smoking (ie, a leading cause of health inequalities) in Europe.MethodsData of adolescents aged 14–17 years old were obtained from the 2013 SILNE survey (smoking inequalities: learning from natural experiments), carried out in 50 schools in 6 European cities (N=10 900). Capturing subjective perceptions of relative SES and objective measures of education and wealth, we measured adolescents’ own SES (academic performance, pocket money), parental SES (parental educational level) and family SES (Family Affluence Scale, subjective social status (SSS)). Logistic regression models with SRH and smoking as dependent variables included all SES indicators, age and gender.ResultsCorrelations between SES indicators were weak to moderate. Low academic performance (OR=1.96, 95% CI 1.53 to 2.51) and low SSS (OR=2.75, 95% CI 2.12 to 3.55) were the strongest indicators of poor SRH after adjusting for other SES-indicators. Results for SSS were consistent across countries, while associations with academic performance varied. Low academic performance (OR=5.71, 95% CI 4.63 to 7.06) and more pocket money (OR=0.21, 95% CI 0.18 to 0.26) were most strongly associated with smoking in all countries.ConclusionsSocioeconomic inequalities in adolescent health were largest according to SES indicators more closely related to the adolescent’s education as well as the adolescent’s perception of relative family SES, rather than objective indicators of parental education and material family affluence. For future studies on adolescent health inequalities, consideration of adolescent-related SES indicators was recommended.

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Investigating equalisation of health inequalities during adolescence in four low-income and middle-income countries: an analysis of the Young Lives cohort study

BMJ Open ◽

10.1136/bmjopen-2018-022114 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022114 ◽

Cited By ~ 1

Author(s):

Joseph L Ward ◽

Russell M Viner

Keyword(s):

Health Inequalities ◽

Low Income ◽

Health Indicators ◽

Wealth Index ◽

Middle Income ◽

Socioeconomic Gradients ◽

Middle Income Countries ◽

Multiple Health ◽

Young Lives

ObjectiveTo investigate if socioeconomic gradients in health reduce during adolescence (the equalisation hypothesis) in four low-income and middle-income countries (LMIC).SettingAnalysis of the Young Lives Study cohorts in Ethiopia, Peru, Vietnam and India.ParticipantsA total of 3395 participants (across the four cohorts) aged 6–10 years at enrolment and followed up for 11 years.Outcomes measuredChange in income-related health inequalities from mid-childhood to late adolescence. Socioeconomic status was determined by wealth index quartile. The health indicators included were self-reported health, injuries in the previous 4 years, presence of long-term health problems, low mood, alcohol use, overweight/obesity, thinness and stunting. The relative risk of each adverse health outcome between highest and lowest wealth index quartile were compared across four waves of the study within each country.ResultsWe found steep socioeconomic gradients across multiple health indicators in all four countries. Socioeconomic gradients remained similar across all waves of the study, with no significant decrease during adolescence.ConclusionWe found no consistent evidence of equalisation for income-related health inequalities in youth in these LMIC. Socioeconomic gradients for health in these cohorts appear to persist and be equally damaging across the early life course and during adolescence.

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Educational Inequalities in Self-Rated Health across US States and European Countries

10.31219/osf.io/sk5tf ◽

2017 ◽

Author(s):

Patrick Präg ◽

SV Subramanian

Keyword(s):

Health Inequalities ◽

Binary Logistic Regression ◽

European Countries ◽

Behavioral Risk ◽

Educational Inequalities ◽

Us States ◽

Federal States ◽

Self Rated Health ◽

The Us ◽

Vast Variation

The US show a distinct health disadvantage when compared to other high-income nations. A potential lever to reduce this disadvantage is to improve the health situation of lower socioeconomic groups. Our objective is to explore how the considerable within-US variation in health inequalities compares to the health inequalities across other Western countries. Representative survey data from 45 European countries and the US federal states were obtained from the fourth wave of the European Values Study (EVS, 2008) and the 2008 wave of the Behavioral Risk Factor Surveillance System (BRFSS). Using binary logistic regression, we analyze different forms of educational inequalities in self-rated health (SRH), adjusted for age and sex. The extent of educational inequalities in SRH varies considerably over European countries and US states; with US states in general showing greater inequality, however differences between US states and European countries are less clear than commonly assumed. The US have considerable differences in educational inequalities in SRH across geographic locations. To understand the reasons for the US health disadvantage, comparative research has to take into account the vast variation in health inequalities within the US.

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Educational Inequalities in Self-Rated Health across US States and European Countries

10.31235/osf.io/vm2zp ◽

2019 ◽

Author(s):

Patrick Präg ◽

SV Subramanian

Keyword(s):

Health Inequalities ◽

Binary Logistic Regression ◽

European Countries ◽

Behavioral Risk ◽

Educational Inequalities ◽

Us States ◽

Federal States ◽

Self Rated Health ◽

The Us ◽

Vast Variation

The US shows a distinct health disadvantage when compared to other high-income nations. A potential lever to reduce this disadvantage is to improve the health situation of lower socioeconomic groups. Our objective is to explore how the considerable within-US variation in health inequalities compares to the health inequalities across other Western countries. Methods: Representative survey data from 44 European countries and the US federal states were obtained from the fourth wave of the European Values Study (EVS) and the 2008 wave of the Behavioral Risk Factor Surveillance System. Using binary logistic regression, we analyze different forms of educational inequalities in self-rated health (SRH), adjusted for age and sex. Results: The extent of educational inequalities in SRH varies considerably over European countries and US states; with US states in general showing greater inequality, however, differences between US states and European countries are less clear than commonly assumed. Conclusions: The US has considerable differences in educational inequalities in SRH across geographic locations. To understand the reasons for the US health disadvantage, comparative research has to take into account the vast variation in health inequalities within the US.

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Trends in socioeconomic inequalities in self-rated health in Germany: a time-trend analysis of repeated cross-sectional health surveys between 2003 and 2012

BMJ Open ◽

10.1136/bmjopen-2019-030216 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030216

Author(s):

Benjamin Wachtler ◽

Jens Hoebel ◽

Thomas Lampert

Keyword(s):

Adult Population ◽

Socioeconomic Inequalities ◽

Cross Sectional ◽

Absolute Income ◽

Self Rated Health ◽

Private Households ◽

Income Inequalities ◽

Absolute And Relative Inequalities ◽

Linear Probability ◽

German Adult

ObjectivesThis study assessed the extent of educational and income inequalities in self-rated health (SRH) in the German adult population between 2003 and 2012 and how these inequalities changed over time.DesignRepeated cross-sectional health interview surveys conducted in 2003, 2009, 2010 and 2012.Setting and participantsThe study population was the German adult population aged 25–69, living in private households in Germany. In total 54 197 randomly selected participants (2003: 6890; 2009: 16 418; 2010: 17 145; 2012: 13 744) were included.Main outcome measuresSRH was assessed with one single question. Five answer categories were dichotomised into good (‘very good’ and ‘good’) versus poor (‘moderate’, ‘poor’, ‘very poor’) SRH. To estimate the extent of the correlation between absolute and relative inequalities in SRH on the one hand, and income and education on the other; slope indices of inequality (SII) and relative indices of inequality (RII) were estimated using linear probability and log-binomial regression models.ResultsThere were considerable and persisting educational and income inequalities in SRH in every survey year. Absolute educational inequalities were largely stable (2003: SII=0.25, 95% CI 0.21 to 0.30; 2012: 0.29, 95% CI 0.25 to 0.33; p trend=0.359). Similarly, absolute income inequalities were stable (2003: SII=0.22, 95% CI 0.17 to 0.27; 2012: SII=0.26, 95% CI 0.22 to 0.30; p trend=0.168). RII by education (2003: 2.53, 95% CI 2.11 to 3.03; 2012: 2.72, 95% CI 2.36 to 3.13; p trend=0.531) and income (2003: 2.09. 95% CI 1.75 to 2.49; 2012: 2.53, 95% CI 2.19 to 2.92; p trend=0.051) were equally stable over the same period.ConclusionsWe found considerable and persisting absolute and relative socioeconomic inequalities in SRH in the German adult population between 2003 and 2012, with those in lower socioeconomic position reporting poorer SRH. These findings should be a concern for both public health professionals and political decision makers.

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SOCIOECONOMIC INEQUALITIES IN SELF-REPORTED HEALTH AND PHYSICAL FUNCTIONING IN ARGENTINA: FINDINGS FROM THE NATIONAL SURVEY ON QUALITY OF LIFE OF OLDER ADULTS 2012 (ENCaViAM)

Journal of Biosocial Science ◽

10.1017/s0021932016000651 ◽

2016 ◽

Vol 49 (5) ◽

pp. 597-610 ◽

Cited By ~ 2

Author(s):

Santiago Rodríguez López ◽

Sonia E. Colantonio ◽

Dora E. Celton

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Physical Functioning ◽

Daily Living ◽

Relative Size ◽

Health Indicators ◽

Socioeconomic Inequalities ◽

Income Inequalities ◽

Reported Health

SummaryThis study aimed to evaluate educational and income inequalities in self-reported health (SRH), and physical functioning (limitations in Activities of Daily Living (ADL)/Instrumental Activities of Daily Living (IADL)), among 60-year-old and older adults in Argentina. Using cross-sectional data from the Argentinian National Survey on Quality of Life of Older Adults 2012 (Encuesta Nacional sobre Calidad de Vida de Adultos Mayores, ENCaViAM), gender-specific socioeconomic inequalities in SRH and ADL and IADL limitations were studied in relation to educational level and householdper capitaincome. The Relative Index of Inequality (RII) – an index of the relative size of socioeconomic inequalities in health – was used. Socioeconomic inequalities in the studied health indicators were found – except for limitations in ADL among women – favouring socially advantaged groups. The results remained largely significant after full adjustment, suggesting that educational and income inequalities, mainly in SRH and IADL, were robust and somehow independent of age, marital status, physical activity, the use of several medications, depression and the occurrence of falls. The findings add to the existing knowledge on the relative size of the socioeconomic inequalities in subjective health indicators among Argentinian older adults, which are to the detriment of lower socioeconomic groups. The results could be used to inform planning interventions aimed at decreasing socioeconomic inequalities in health, to the benefit of socially disadvantaged adults.

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Monitoring inequalities in self-rated health over 36 years among Finnish women and men

European Journal of Public Health ◽

10.1093/eurpub/ckz187.084 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

E Lahelma ◽

O Pietiläinen ◽

O Pentala-Nikulainen ◽

S Helakorpi ◽

O Rahkonen

Keyword(s):

Health Inequalities ◽

Global Financial Crisis ◽

Economic Recession ◽

Continuous Variable ◽

Educational Inequalities ◽

Men And Women ◽

Relative Index ◽

Women Health ◽

Self Rated Health ◽

Index Of Inequality

Abstract Background Health inequalities across countries and populations are well established, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among adult Finns, considering individual covariates and macro-economic fluctuations. Methods Data were derived from representative annual surveys in 1979-2014 among men and women and covered ages 25-64. Nine periods were used (n = 8870-14235). Our health outcome was less-than-good self-rated health and our socioeconomic indicator was completed years of education as a continuous variable. Nine time-variant sociodemographic and health-related covariates were included. Educational inequalities in self-rated health were examined by relative index of inequality (RII) and slope index of inequality (SII). Results Linear trends suggested stable overall development in both relative and absolute health equalities during 36 years. Period specific analyses showed that among men relative and absolute inequalities narrowed immediately after economic recession in Finland in 1993-94, and among women, inequalities narrowed during global financial crisis in 2008-09. Adjusting for covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the period specific patterning of health inequalities. Conclusions Educational inequalities in self-rated health persisted during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance calls for powerful measures to tackle health inequalities, such as preventing unhealthy behaviours, obesity and unemployment in particular among the lower educated. Key messages Health inequalities have persisted in Finland over 36 years, with unhealthy behaviors and unemployment affecting their magnitude. Health inequalities narrowed during economic recessions, but widened soon back to pre-recession level.

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The interplay of gender, social context, and long-term unemployment effects on subjective health trajectories

BMC Public Health ◽

10.1186/s12889-021-10324-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Laura Altweck ◽

Stefanie Hahm ◽

Holger Muehlan ◽

Tobias Gfesser ◽

Christine Ulke ◽

...

Keyword(s):

Life Satisfaction ◽

Social Context ◽

Negative Impact ◽

Subjective Health ◽

Short Term ◽

Self Rated Health ◽

Health Trajectories ◽

Lower Baseline ◽

Baseline Values

Abstract Background While a strong negative impact of unemployment on health has been established, the present research examined the lesser studied interplay of gender, social context and job loss on health trajectories. Methods Data from the German Socio-Economic Panel was used, which provided a representative sample of 6838 participants. Using latent growth modelling the effects of gender, social context (East vs. West Germans), unemployment (none, short-term or long-term), and their interactions were examined on health (single item measures of self-rated health and life satisfaction respectively). Results Social context in general significantly predicted the trajectories of self-rated health and life satisfaction. Most notably, data analysis revealed that West German women reported significantly lower baseline values of self-rated health following unemployment and did not recover to the levels of their East German counterparts. Only long-term, not short-term unemployment was related to lower baseline values of self-rated health, whereas, in relation to baseline values of life satisfaction, both types of unemployment had a similar negative effect. Conclusions In an economic crisis, individuals who already carry a higher burden, and not only those most directly affected economically, may show the greatest health effects.

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Healthcare in Cuba: Sustainability Challenges in an Ageing System

Journal of Latin American Studies ◽

10.1017/s0022216x20001236 ◽

2021 ◽

Vol 53 (1) ◽

pp. 133-159

Author(s):

Carmelo Mesa-Lago ◽

Sergio Díaz-Briquets

Keyword(s):

Healthcare System ◽

Health Indicators ◽

Population Ageing ◽

Financial Sustainability ◽

Physical Infrastructure ◽

Sustainability Challenges

AbstractThis article assumes a balanced position between two contrasting views regarding the accessibility, quality, efficiency and financial sustainability of the Cuban healthcare system. It evaluates those issues in the 2006–20 period by identifying strengths and weaknesses based on a comprehensive statistical compilation of health indicators, physical infrastructure trends, availability of physicians and other elements to assess the system's long-term financial sustainability. Finally, it examines the likely consequences of population ageing on healthcare, including potential policies.

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