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PubMed1978

Chronic disease in former college students. XVII. Sociocultural mobility as a precursor of coronary heart disease and hypertension.

The relationship between sociocultural mobility and subsequent coronary heart disease (CHD) and hypertension (HT) was studied in a cohort of 13,728 male former Harvard University students examined in 1939-1950. All 13,728 were followed for CHD mortality, while 8852 returned self-administered mail questionnaires in 1962 or 1966 and in 1972 which queried for doctor-diagnosed myocardial infarction (MI), angina pectoris (AP) and HT. For each of 98 cases of fatal CHD, 78 cases of MI and 48 cases of AP, four controls were randomly selected. One control was selected for each of 319 HT cases. Significant negative associations between father's occupational status and risk of combined fatal CHD and MI and between geographic mobility and risk of HT were noted in univariate analysis. These associations persisted with stratification by individual confounding factors and by a multivariate confounder-summarizing score. Intergenerational mobility, as indicated by occupational status of the father, was associated with a 1.5 times increased risk of fatal CHD and MI. Intragenerational geographic mobility was associated with a slightly reduced risk of HT.

Adolescent↗
PubMed2005

Socioeconomic status and diagnosed diabetes incidence.

AIMS: To investigate the association between socioeconomic status (SES) and incidence of diabetes. METHODS: We investigated three measures of SES and incidence of diagnosed diabetes among women and men in the NHANES I Epidemiologic Followup Study, 1971-1992, who were free of diagnosed diabetes in 1980. RESULTS: Among women, diabetes incidence was inversely associated with income (measured as percent of the poverty level), education, and occupational status, adjusting for age and race/ethnicity. The hazard ratio (HR) for women with > 16 years education was 0.26 (95% confidence interval (CI) 0.13-0.54) relative to those with < 9 years of education. Adjustment for potential mediators, including body size variables, diet, physical activity, and alcohol and tobacco use, substantially attenuated the associations with income and education. Among men a trend toward lower diabetes incidence with higher income and higher education was evident (the HR for men with household income > 5 times the poverty level was 0.44 (95% CI 0.19-0.98) relative to those under the poverty line), but there was no inverse association of diabetes incidence with occupational status. CONCLUSIONS: SES, assessed with any of three common measures, is a risk factor for diagnosed diabetes in women. Among men these associations are less consistent.

Adult↗
PubMedDate not supplied

Contribution of early and adult factors to socioeconomic variation in blood pressure: thirty-four-year follow-up study of school children.

OBJECTIVE: To prospectively examine the role of childhood and adulthood factors in the association between socioeconomic status (SES) and adult systolic and diastolic blood pressure (SBP, DBP). METHODS: One hundred and five boys and 101 girls who were 8 years of age at entry into the study were observed for 34 years in the Jyväskylä Longitudinal Study of Personality and Social Development, Finland. Data were gathered on educational attainment and occupational status, as indicators of SES, and potential explanatory factors related to 0, (14), 27, 36, and 42 years of age. SBP and DBP were assessed at 15 and 42 years of age. RESULTS: In a structural equation model adjusted for sex and childhood SBP, educational attainment was inversely associated with adult SBP (structural coefficient -0.17, p<.05). Incorporating the effects of parental SES and adult body mass index into the model attenuated this association so that it was no longer significant. Variation in birth weight, unemployment, smoking, alcohol consumption, and use of antihypertensive medication had marginal or no impact on the education-SBP association. No socioeconomic variation was found for DBP or occupational status. CONCLUSIONS: Prospective evidence suggests a weak association between low educational attainment and development of high SBP. Parental SES and adult BMI were the key explanatory factors for this association.

Adolescent↗
PubMed1983

[Changes in the health status in occupational under-water activities].

For the past 10 years of so, Italian professional divers have had obligatory medical check-ups once a year. These check-ups are based on International standards and are particularly important for divers going to work abroad or in the open sea. The present report is based on clinical data about 100 professional divers aged 20-50. The subjects had worked 1-30 years accumulating a total of 200-5000 shallow dives. 41% had also done deep work using intervention and saturation techniques. No significant incidence of common was encountered. Radiology revealed bone alterations in 52 subjects (to the joints in 17 cases). Hearing problems were encountered in 47 divers, mostly slight and often totally or partially cured during the observation period. 5 subjects were found to be unsuitable for saturation work. The aetiopathogenetic significance of the alterations encountered is discussed in terms of the type and duration of diving practised.

Adult↗
PubMed2006

Social inequalities in antidepressant treatment and mortality: a longitudinal register study.

BACKGROUND: Despite an increased prevalence of depression among people of low socio-economic position, it remains unclear whether their treatment with antidepressants appropriately matches their increased need compared with people from more affluent backgrounds. This study examined socio-economic differences in antidepressant prescriptions and mortality related to depressive disorders. METHOD: A longitudinal register study of 17947 male and 47458 female local government employees with linked information on socio-economic indicators (education and occupational status) and data on antidepressant use and mortality associated with depressive disorder (suicide, alcohol-related deaths) during the years 1994 to 2000. RESULTS: In men, antidepressant treatment was less common among low educational groups than among high educational groups (OR 0.87, 95% CI 0.76-0.99) and a corresponding difference was seen between occupational statuses (OR for manual v. upper non-manual 0.72, 95% CI 0.62-0.84). In women, socio-economic position was not associated with antidepressant use. However, both among the men and women, employees with low socio-economic position had increased risk for mental-health-related mortality, as indicated by suicides, deaths from alcohol-related causes, and all-cause mortality. CONCLUSIONS: These data suggest a mismatch in the treatment of depression relative to apparent clinical need, with the lowest levels of treatment concentrated in the lower socio-economic groups, despite evidence of their increased prevalence of depression and suicide.

Adult↗
PubMed1991

Aspects of written language production over adult life.

Self-descriptions written by adults were analyzed to explore the effects of age, gender, vocabulary, nonverbal intelligence, and educational-occupational status on lexical aspects of language and grammatical complexity. Multivariate analyses indicated that, after controlling for other background variables, age had a significant effect on vocabulary diversity, sentence complexity, subordinating conjunctions, and possibly sentence length. Four variables--word output, word length, long words, and readability--were affected mainly by vocabulary and educational-occupational status. An unexpected and small but significant gender difference in the readability of the descriptions was observed across all age groups.

Adult↗
PubMed1994

Post-acute rehabilitation outcome: relationship to case-management techniques and strategy.

Successful outcome for the traumatically brain-injured (TBI) patient is dependent on both a productive clinical therapy program and an effective case-management strategy by the carrier. This retrospective study focuses on identifying those case-management techniques which contributed to improvement in the disability, living, and occupational status of patients in a post-acute rehabilitation program. Statistical analysis indicated a positive relationship between two case-management factors and improved patient outcome. Additional analysis demonstrated predictive qualities of specific admission data for patient program cost. A review of these case-management techniques and their impact on discharge disability, living, and occupational status will be discussed.

Adult↗
PubMed2002

Socioeconomic factors and the presentation, management, and outcome of patients with differentiated thyroid carcinoma.

To determine whether patients from disadvantaged socioeconomic groups present with more advanced thyroid carcinoma or experience differing management and clinical outcomes, we retrospectively reviewed the charts of 292 patients seen at MD Anderson Cancer Center and Ben Taub General Hospital between 1987 and 1994. At diagnosis, the mean age was 42 +/- 16 years, 78% of patients were female, 76% of patients were low risk (TNM stage I or II), and 22% high risk (stage III or IV). Neighborhood income (+/- standard error of the mean [SEM]) (1990 census data) was lower in the high-risk group compared with the low-risk group (US dollars 26200 +/- 1670 vs. US dollars 30900 +/- 870, p = 0.012). Men were more likely than women to present at an older age (47.5 +/- 16.7 vs. 40.2 +/- 16.0, p = 0.0014) and in the high-risk group (46% vs. 15%, p < 0.0001). No socioeconomic factor (ethnicity, marital status, occupation prestige, neighborhood income, insurance type) influenced initial diagnostic assessment. Similarly, no socioeconomic factor influenced initial disease management or the type of follow-up received over the 12-year period. Married patients had a lower 5-year recurrence rate than those unmarried (18% vs. 32%, p = 0.03); however, this did not affect overall or disease-specific survival. Similarly, ethnicity, marital status, occupation prestige, and insurance type did not influence overall or disease-specific survival. Although 10-year overall survival rates were lower in patients in the lowest income quartile (57% vs. 70% for upper, p = 0.0024) and in men compared with women (39% vs. 76%, p < 0.0001), gender alone influenced 10-year disease-specific survival (80% for men, 89% for women, p = 0.047). In summary, no socioeconomic factor appears to affect initial treatment or follow-up pattern in patients with differentiated thyroid cancer. Income and gender may affect stage at initial disease presentation and may be risk factors affecting eventual clinical outcomes.

Adult↗
PubMed2003

Progression of destructive periodontal diseases in three urban minority populations: role of clinical and demographic factors.

BACKGROUND, AIMS: Differences in prevalence, severity and risk factors for destructive periodontal diseases have been reported for ethnic/racial groups. However, it is not certain whether this disparity is due to ethnicity/race or factors associated with ethnicity/race. Therefore, the present study addressed whether the rates of disease progression and clinical and demographic factors associated with disease progression varied among three ethnic/racial groups. METHODS: The study population consisted of 53 Asian-, 69 African- and 62 Hispanic-Americans. Clinical measurements included probing depth, attachment level, gingival erythema, bleeding upon probing, suppuration and plaque. Disease progression was defined as a > 2 mm loss of attachment 2 months post baseline. The demographic variables examined included occupational status, report of a private dentist, years resident in the United States and smoking history. RESULTS: The rate of attachment loss for the entire population was 0.04 mm or 0.24 mm/year. No significant differences were found among the three ethnic/racial groups. Variables associated with subsequent attachment loss for the entire population were age, male gender, mean whole-mouth plaque, erythema, bleeding upon probing, suppuration, attachment loss and probing depth, and belonging to the "unskilled" occupational group. No differences in risk profiles were found among the 3 ethnic/racial groups. Using stepwise logistic regression analysis, a model was developed to relate the clinical and demographic variables examined with subsequent attachment loss. The model indicated that prior attachment loss, gingival erythema, suppuration, being a current smoker and belonging to the "unskilled" occupational group conferred high risk of > 1 site of attachment loss of > 2 mm. CONCLUSIONS: The results of this study suggest that variables associated with ethnicity/race, such as occupational status, are largely responsible for the observed disparity in destructive periodontal disease progression in these populations.

Adult↗
PubMedDate not supplied

Vacation at moderate and low altitude improves perceived health in individuals with metabolic syndrome.

BACKGROUND: Recent data suggest that vacation may improve cardiovascular health, an effect possibly moderated by altitude. The aim of the present study was to study the effect of a 3-week vacation at moderate and low altitude on perceived health in individuals with increased cardiovascular risk. METHODS: Seventy-two overweight males, both occupationally active and retired (mean age=56.6 +/- 7.2 years), with signs of metabolic syndrome were randomly assigned to identical sojourns at either moderate (1,700 m) or low (300 m) altitude and engaged in four 3- to 4-h heart-rate-controlled hiking tours per week. Perceived health was measured 2 weeks before vacation, at the beginning and end of vacation, and 7 weeks after vacation. RESULTS: Fitness, recreational ability, positive and negative mood and social activities improved during vacation, independent of altitude and occupational status, although the day-to-day improvement in quality of sleep was delayed at moderate altitude. During the follow-up examinations, improvements in all reported aspects of health except for social activities were maintained. In comparison to retired individuals, active individuals showed a greater long-term improvement in social activities. CONCLUSION: Vacation positively affects perceived health independent of altitude or occupational status in generally inactive overweight males.

Adult↗
PubMed2006

Effort/reward imbalance and sedentary lifestyle: an observational study in a large occupational cohort.

OBJECTIVES: To investigate the association between effort/reward imbalance (ERI) at work and sedentary lifestyle. METHODS: Cross sectional data from the ongoing Finnish Public Sector Study related to 30,433 women and 7718 men aged 17-64 were used (n = 35,918 after exclusion of participants with missing values in covariates). From the responses to a questionnaire, an aggregated mean score for ERI in a work unit was assigned to each participant. The outcome was sedentary lifestyle defined as <2.00 metabolic equivalent task (MET) hours/day. Logistic regression with generalised estimating equations was used as an analysis method to include both individual and work unit level predictors in the models. Adjustments were made for age, marital status, occupational status, job contract, smoking, and heavy drinking. RESULTS: Twenty five per cent of women and 27% of men had a sedentary lifestyle. High individual level ERI was associated with a higher likelihood of sedentary lifestyle both among women (odds ratio (OR) = 1.08, 95% CI 1.01 to 1.16) and men (OR = 1.17, 95% CI 1.02 to 1.33). These associations were not explained by relevant confounders and they were also independent of work unit level job strain measured as a ratio of job demands and control. CONCLUSIONS: A mismatch between high occupational effort spent and low reward received in turn seems to be associated with an increased risk of sedentary lifestyle, although this association is relatively weak.

Adolescent↗
PubMed2003

Traumatic brain injury brief outcome interview.

There is much evidence that deficits in physical and psychological functioning persist long after traumatic brain injury occurs. This paper presents a brief outcome interview (BOI) that can be administered in person or over the telephone, with evaluation of change in functioning in three areas: (a). occupational status, (b). mobility/activities of daily living (ADL), and (c). social relationships. Forty-four traumatic brain injury participants were evaluated at an average of 6.2 years postinjury with the present BOI as well as with the Glasgow Outcome Scale and Karnofsky Performance Scale (KPS). The BOI demonstrated strong concurrent validity with both scales, as well as strong test-retest reliability. IQ and memory scores obtained at an average of 4.1 months postinjury suggested that the injury was moderately severe. The average score on the GPS suggested "good recovery" and the average score on the KPS suggested "normal activity with effort, some signs or symptoms." These descriptions matched the BOI for the mobility/ADL dimension, for which all respondents reported some form of independent mobility, and 88.6% of the respondents reported no need for any kind of assistance in daily life functioning. However, significant long-term issues were seen for social and occupational functioning. Fifty-four percent said that they did not socialize as much as before their injury, and half of the participants reported not being involved in a romantic relationship in spite of an average age of 32 years. In terms of occupational status, 40.9% reported not working at all at any kind of job. Compared to before their injury, 47.7% said this was less time, 40.9% said that it was for a lower salary, and 54.5% said that their responsibilities were less. The stability of these social and occupational changes was indicated by high test-test reliabilities for the overall BOI score and the three subscale scores (r's ranged from.97 to 1.0). These stable long-term changes are consistent with some other studies and suggest that the social and occupational needs of this population warrant more attention.

Adult↗
PubMed2003

A prospective study of maternal smoking and spontaneous abortion.

BACKGROUND: Cigarette smoking has been considered a risk factor for spontaneous abortion, but conclusions from many studies may be impaired by methodological problems. Studies are required that use data on smoking habits collected before knowledge about outcome of pregnancy and in which adjustment is made for potential confounders. METHODS: All Danish-speaking pregnant women booking for delivery at the Department of Obstetrics and Gynecology, Aarhus University Hospital, from September 1989 to August 1996 were invited to participate in the study (n=24,608 pregnancies, including 321 spontaneous abortions and 100 induced abortions). Information about smoking habits before pregnancy and during the first trimester was obtained from self-administered questionnaires before the knowledge about pregnancy outcome. Information about spontaneous and induced abortions was obtained from the Danish National Patient Registry. We used Cox regression analyses with delayed entry (left truncation) for analyses, and hazard ratios to express the association between smoking and spontaneous abortion. Multivariate analyses were performed using a model including alcohol and coffee intake during pregnancy, maternal age, marital status, occupation, education, prepregnancy body mass index, and parity. RESULTS: Overall, 104 (1.3%) of those contributing time at risk in the first trimester experienced a spontaneous abortion in the first trimester, and 217 (0.9%) of those contributing time at risk in the second trimester experienced a second-trimester abortion. We found no association between smoking and first- and second-trimester abortions. Adjustment for alcohol, coffee, maternal age, marital status, occupation, education, prepregnancy body mass index and parity did not change the result substantially. CONCLUSION: Our study did not support findings from previous studies of an association between smoking and spontaneous abortion.

Abortion, Spontaneous↗
PubMed1984

Alcohol abuse in a rural community in India. Part I: Epidemiological study.

By systematic sampling of households after two stage proportionate random sampling of villages, a total of 4670 persons above 15 years of age were selected from the rural areas of Ajmer district in Rajasthan, India, to estimate the prevalence rate of alcohol abuse and to study its socio-demographic correlates (Part I) and the pattern and characteristics of use (Part II, submitted). The data on these aspects were collected through pre-tested questionnaires. The results showed that prevalence of alcohol abuse in the sample was 24.7% (36.1% for males and 13.4% for females) and the percentage of dependents was 3%. Relative risk of alcohol abuse in males was 3.64 with respect to females. Alcohol abuse was found to be significantly associated with religion (higher in Hindus with a relative risk of 8.65 in males and 5.21 in females), marital status (higher in married with a relative risk of 2.51 in males), age (higher in age group more than 20 years with a relative risk of 2.50 in males and 1.63 in females), family structure (higher in nuclear or joint families with a relative risk of 2.88 in males), educational status (higher in illiterates with a relative risk of 1.53 in males) and occupational status (higher in those engaged in agriculture with a relative risk of 1.43 in males and 1.80 in females). It was not significantly associated with per-capita income. These results have been compared with those in similar studies in the country and the possible reasons for differences, if any, have been discussed.

Adolescent↗
PubMed1986

Multiple myeloma in Western Australia: a case-control study in relation to occupation, father's occupation, socioeconomic status and country of birth.

A death-certificate-based case-control study was undertaken covering 249 patients with multiple myeloma diagnosed in Western Australia from 1975 to 1984 whose deaths were registered in Western Australia in the same period (73.4% of the total diagnosed) and 996 control decedents who were matched to the cases by age, sex and death registration district. Death from multiple myeloma was associated with both farming [odds ratio (OR) 1.44 with 95% confidence interval (CI) 0.81-2.55] and woodworking (OR 1.70 with 95% CI 0.67-4.31) but not with farming as the father's occupation (OR 0.96 with 95% CI 0.66-1.41). It was also more frequent in migrants to Australia than in native-born Australians (OR 1.31 with 95% CI 0.99-1.74) particularly those born in England (OR 1.57 with 95% CI 1.11-2.42) and Italy (OR 2.02 with 95% CI 1.09-3.74). An apparent excess of multiple myeloma in all rural residents appeared to be due to bias introduced by matching for death registration district, as rural residents dying from multiple myeloma were more likely to die and have their deaths registered in the city than other rural residents. A conditional logistic regression analysis showed the above associations to be substantially independent of one another.

Australia↗
PubMed1999

Suicide and unemployment in Italy, 1982-1994.

OBJECTIVE: To investigate whether either the condition of being unemployed, or changes in unemployment rates are associated with suicide risk. DESIGN: Administrative data for suicide according to occupational status have been analysed considering three employment categories: employed, seeking new job (unemployed), seeking first job (never employed). Comparison of suicide rates by economic position and correlation between suicide and unemployment rates have been made. SUBJECTS AND SETTINGS: 20,457 deaths by suicide registered in Italy among economically active people from 1982 to 1994. MAIN OUTCOME MEASURES: Change over time in suicide rates by economic position; coefficient of aggravation according to occupational status. RESULTS: Suicide rates among the unemployed are clearly and constantly higher than those among the employed: up to three times higher among men, and twice as high among women. Among the unemployed a clear and significant rise in suicide rates in both sexes took place over the study period; suicide rates among the employed showed a less marked increase. The rise in suicide rates was accompanied by a concurrent rise in unemployment rate percentage. Men seem to be affected most by this change in unemployment rate percentage; women are subject to less evident influences and variations. CONCLUSION: Different suicidal behaviour trends among unemployed compared with employed people indicate that unemployment (and above all the prospect of not having access to a working role) acts as a contributing factor for suicide. Unemployment, even if symptomatic of a mental disorder, should therefore always be taken into consideration as a risk factor for suicide: the potentially lethal consequences of its negative influence on both self esteem and the ability to use supportive networks in a efficient way is an element to which great attention should be paid.

Adolescent↗
PubMed1994

When pregnant--why induced abortion?

STUDY OBJECTIVE: To study social differences between women seeking induced abortion (cases) and women completing their pregnancy (controls). DESIGN: Case-control study. STUDY SETTING: Data were collected through a structured personal interview of 404 abortion-seeking women and 404 women giving birth at the Gynaecological and Obstetric wards, University Hospital of Trondheim, Norway during 1983. STATISTICAL METHOD: Logistic regression analyses. RESULTS AND CONCLUSION: The prospect of single parenthood was the strongest determinant in describing the difference between abortion-seeking women and women giving birth. In addition, variables such as parity, age, housing situation, previous abortion history, attitudes towards abortion and occupational status were all found to be significant when describing the differences between the two study groups. After confirmation of a positive pregnancy test only women stating unplanned pregnancy face a real decision about what to do. By restricting the control group to women stating unintended pregnancy, the multivariate analyses showed a reduced estimate of the respective odds ratios of choosing abortion in all important variables, while parameters such as "age" and "occupational status" became insignificant. Women in favour of the liberal abortion legislation decided more often on pregnancy termination than women opposed to the law of abortion on demand. However, among those women opposed to the law who still underwent an induced abortion, the same social and demographic characteristics were significant for the decision regarding termination as for the total study group. The study demonstrates the heterogeneity of the group of women terminating their pregnancy and how complex the decision regarding pregnancy termination might be.

Abortion, Induced↗
PubMed1985

Public attitudes towards mental illness--the effects of behaviour, roles and psychiatric labels.

A questionnaire to assess various elements of public attitudes towards the mentally ill was given to 108 subjects. 5 hypotheses were tested. Public attitudes towards mental illness are more rejecting than accepting. Social rejection increases with increasing severity of disturbance in behaviour. Public attitudes towards the mentally ill are related to social class as measured by occupational status and to age of the respondent. Rejection of the mentally ill is decreased by the availability of a non-deviant alternative label. Attitudes of the general population towards the mentally ill will be influenced by the label of mental illness as well as by behaviour indicative of mental illness. All the hypotheses were confirmed with one exception - negative public attitudes were not found to be related to social class as measured by occupational status. Public attitudes towards the mentally ill are more diverse than previous research would imply. Possible future research directions are discussed.

Adolescent↗