Assessing Socioeconomic Inequality in Self-Rated Health in Four ex-Yugoslav Countries

There has been a growing academic interest in explaining the well-established association between socioeconomic status and health. Among the various proposed mechanisms and pathways, social capital has been recognised as a potentially important antecedent of socioeconomic inequalities in health. However, these interrelationships remain relatively unexplored within the countries of former Yugoslavia. Therefore, this article aims to fill the gap in the literature by exploring the role of individual-level social capital in the relationship between socioeconomic status and self-rated health in four ex-Yugoslav countries. The present study is based on the data from the ninth round of the European Social Survey (2018). The author analysed the data of participants aged 25 and over from Croatia (N = 1534), Montenegro (N = 1002), Serbia (N = 1720) and Slovenia (N = 1149). In order to test the target associations, sequential multivariate logistic regression analysis was performed. The results show that occupational social class and several social capital indicators are associated with self-rated health, although independently of each other. Across all countries, unskilled and skilled manual workers and long-term unemployed individuals were more likely to report poor health compared to non-manual workers, with the exception of Montenegrin skilled manual workers and the long-term unemployed participants from Slovenia. Moreover, despite some cross-country differences in the relationship between individual levels of social capital and self-rated health, social participation was associated with self-rated health across all countries. These findings highlight the importance of encouraging social participation within these countries, which can lead to health benefits through behavioural and psychosocial mechanisms.

Social Relations and Contact With General Practitioner in a Middle-aged Danish Population: A Prospective Register- and Survey-Based Cohort Study

Background: Findings about the relationship between individuals’ social relations and general practitioner (GP) contact are ambiguous as to whether weak social relations are associated with an increased or decreased consultation pattern. Furthermore, social relations may affect GP contact differently for men compared to women, between socioeconomic groups and according to perceived need. The overall aim of the study is to examine the association between functional aspects of social relations, perceived emotional and instrumental social support, the tendency to consult a GP and the frequency of GP contact. Methods: The study comprised 6911 individuals aged 49–61 at baseline from the Copenhagen Aging and Midlife Biobank (CAMB). We conducted a two-part regression to explore the association between perceived emotional and instrumental social support and GP contact (tendency and frequency), controlling for age, sex, occupational social class, cohabitation status and number of morbidities. Conclusions: Results show no overall effect of the perceived social support aspects of social relations on GP contact. Trial registration: The study has been registered and approved by the Danish Data Protection Agency and the local ethical committee (approval No.H-A-2008-126 and No. 2013-41-1814).

Occupational Social Class and Earnings Inequality in Europe: A Comparative Assessment

While there is renewed interest in earnings differentials between social classes, the contribution of social class to overall earnings inequality across countries and net of compositional effects remains largely uncharted territory. This paper uses data from the European Union Statistics on Income and Living Conditions to assess earnings differentials between social classes (as measured by ESeC) and the role of between-class inequality in overall earnings inequality across 30 European countries. We find that there is substantial variation in earnings differences between social classes across countries. Countries with higher levels of between-class inequality tend to display higher levels of overall earnings inequality, but this relationship is far from perfect. Even with highly aggregated class measures, between-class inequality accounts for a non-negligible share of total earnings inequality (between 15 and 25% in most countries). Controlling for observed between-class differences in composition shows that these account for much of the observed between-class earnings inequality, while in most countries between-class differences in returns to observed compositional variables do not play a major role. In all these respects we find considerable variation across countries, implying that both the size of between-class differences in earnings and the primary mechanisms that produce these class differences vary substantially between European countries.

Gender and socioeconomic disparities in reasons for not smoking cigarettes among Danish adolescents

Objective To examine gender and socioeconomic differences in adolescents’ reasons for not smoking cigarettes using self-reported data from Danish 14-year-olds (N = 1,559) collected in 2018. χ2-tests were used to assess whether the proportion of students who rated 12 statements as important reasons for not smoking cigarettes differed according to gender and family occupational social class (OSC). Results More girls than boys stated that thinking the taste of cigarettes is disgusting, not being allowed to smoke by parents, knowing smoking is dangerous, not being allowed to smoke before the age of 18, not wanting to be addicted to smoking, and that smoking makes you smell bad were important reasons for choosing not to smoke cigarettes. More boys than girls reported exercising a lot and having a partner that does not smoke as important reasons for not smoking cigarettes. More students with a high OSC compared with a low OSC stated exercising a lot and that smoking makes you smell bad were important reasons. In conclusion, reasons for not smoking cigarettes differed substantially across gender and less according to socioeconomic position.

Gender and Socioeconomic Disparities in Reasons for Not Smoking Cigarettes Among Danish Adolescents

Objective: To examine gender and socioeconomic differences in adolescents’ reasons for not smoking cigarettes using self-reported data from Danish 14-year-olds (N = 1,559) collected in 2018. χ2-tests were used to assess whether the proportion of students who rated 12 statements as important reasons for not smoking cigarettes differed according to gender and family occupational social class (OSC).Results: More girls than boys stated that thinking the taste of cigarettes is disgusting, not being allowed to smoke by parents, knowing smoking is dangerous, not being allowed to smoke before the age of 18, not wanting to be addicted to smoking, and that smoking makes you smell bad were important reasons for choosing not to smoke cigarettes. More boys than girls reported exercising a lot and having a partner that does not smoke as important reasons for not smoking cigarettes. More students with a high OSC compared with a low OSC stated exercising a lot and that smoking makes you smell bad were important reasons. In conclusion, reasons for not smoking cigarettes differed substantially across gender and less according to socioeconomic position.

Social inequality in obesity in an Eastern Mediterranean population: a national health survey

Background This study aimed to explore socioeconomic factors associated with obesity in the Republic of Cyprus. Methods We interviewed 3021 Greek-Cypriots aged 25-64 years through a multistage survey. We collected self-reported information on demographics, health behaviours (physical activity, smoking, alcohol consumption and dietary intake), socio-economic characteristics (educational attainment, household income and occupational social class) and anthropometric measurements. Obesity was defined as body mass index ≥30 kg/m2. For the association between obesity and each socio-economic indicator, we conducted sex-specific Poisson's regression with robust variance, adjusting for all demographics and health-related behaviours, reporting adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results The prevalence of obesity was 22% and 17% among men and women, respectively. There was a significant trend of higher obesity prevalence with increasing age as well as with being widowed in both genders and being a refugee in men. Obesity prevalence decreased with increasing educational attainment (postgraduate vs. none/gymnasium: a PRmen=0.45; 95%CI=0.25-0.82; a PRwomen=0.41; 95%CI=0.18-0.95; p-trends<0.005), and household income (>€4000/month vs. ≤€1000/month: a PRmen=0.45; 95%CI=0.26-0.81; a PRwomen=0.45; 95%CI=0.22-0.92; p-trends<0.005). Occupational social class did not show any clear association with obesity. After adjustment for health-behaviours as mediators the association between income and obesity in women was attenuated. Conclusions The current study highlights striking social inequalities in obesity among Cypriot men and women, characterised by a linear decrease in obesity prevalence each step up the socioeconomic hierarchy. We recommend that comprehensive and multifaceted public health interventions are considered to address income and education-related barriers resulting in higher obesity rates among specific population sub-groups. Key messages Among Greek Cypriot adults, obesity affects almost one in five whilst obesity prevalence shows gender-specific social inequalities. When investigating social inequalities in health, the choice of socioeconomic indicators should reflect the context of the population and gender-specific differences.

A medicalized hotel as a public health resource for the containment of Covid-19: more than a place for quarantining

ABSTRACT Background To describe the implementation of a medicalized hotel in the community of Madrid as a public health resource for the containment of coronavirus disease (COVID-19) and to describe the characteristics of population benefitted. Methods A descriptive study of the implementation of the Via Castellana Medicalised Hotel (VCMH) was conducted. The average monthly household income, educational level and occupational social class of the subjects admitted were obtained through a survey conducted during their stay. Results There was no guidance for launching; however the hotel was coordinated by a tertiary referral hospital and attended the preventive medicine regulations and the decrees of legal regimes and authorization of health services in Madrid. Between 19 March and the 9 May 2020, 399 patients were admitted; 59% (235) were migrant; the main reason for referral (58%) was a lack of house conditions for quarantining, including overcrowding, which when compared with the migrant status a positive correlation was found. Some other reasons for referral were homelessness and eviction. Most of the survey participants had low monthly household income, educational level and social class. Conclusions This medicalized hotel provided medical care and offered housing to a subgroup of vulnerable population who could not afford a safe quarantine.

Intake of sugar sweetened soft drinks among adolescents: Trends and social inequality in Denmark 2002-2018

Background: Intake of sugar sweetened soft drinks (SSSD) has decreased among adolescents, but trends in social inequality in SSSD intake are unknown. Aim: Examine trends in social inequality in SSSD intake among adolescents in Denmark during 2002–2018. Methods: Five Health Behaviour in School-aged Children surveys with data on SSSD intake and parents’ occupational social class (OSC) from nationally representative samples of 11, 13 and 15 year olds, n =20,112. Results: The overall prevalence of daily SSSD intake decreased from 10.1% in 2002 to 6.4% in 2018. The prevalence decreased in both high OSC (from 8% to 5%) and middle OSC (from 10% to 6%) but remained around 12% in low OSC. The odds ratio (OR) estimates of low compared with high OSC increased over the years around an overall OR of 2.01 (1.74–2.34). Conclusions: Danish adolescents’ SSSD intake decreased during 2002–2018 and was higher the lower the parents’ OSC. Thus, social inequality increased during 2002–2018.

Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland

ObjectivesTo assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages.DesignProspective population-based register study.SettingFinland.Participants11% random sample of the population aged 70–87 years resident in Finland at the end of year 2000 (n=54 964).Main outcome measureIncidence rates, Kaplan-Meier survival probabilities and Cox regression HRs of dementia mortality in 2001–2016 by midlife education, occupational social class and household income measured at ages 53–57 years.ResultsDuring the 528 387 person-years at risk, 11 395 individuals died from dementia (215.7 per 10 000 person-years). Lower midlife education, occupational social class and household income were associated with higher dementia mortality, and the differences persisted to the oldest old ages. Compared with mortality from all other causes, however, the socioeconomic differences emerged later. Dementia accounted for 28% of the difference between low and high education groups in overall mortality at age 70+ years, and for 21% of the difference between lowest and highest household income quintiles. All indicators of socioeconomic position were independently associated with dementia mortality, low household income being the strongest independent predictor (HR=1.24, 95% CI 1.16 to 1.32), followed by basic education (HR=1.14, 1.06 to 1.23). Manual occupational social class was related to a 6% higher hazard (HR=1.06, 1.01 to 1.11) compared with non-manual social class. Adjustment for midlife economic activity, baseline marital status and chronic health conditions attenuated the excess hazard of low midlife household income, although significant effects remained.ConclusionSeveral indicators of socioeconomic position predict dementia mortality independently and socioeconomic inequalities persist into the oldest old ages. The results demonstrate that dementia is among the most important contributors to socioeconomic inequalities in overall mortality at older ages.