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Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States.

STUDY OBJECTIVE: s: This study examines the influence of individual and neighbourhood socioeconomic status (SES) on mortality among black, Mexican-American, and white women and men in the US. The authors had three study objectives. Firstly, they examined mortality rates by both individual level SES (measured by income, education, and occupational/employment status) and neighbourhood level SES (index of neighbourhood income/wealth, educational attainment, occupational status, and employment status). Secondly, they examined whether neighbourhood SES was associated with mortality after controlling for individual SES. Thirdly, they calculated the population attributable risk to estimate the reduction in mortality rates if all women and men lived in the highest SES neighbourhoods. DESIGN: National Health Interview Survey (1987-1994), linked with 1990 census tract (neighbourhood proxy) and mortality data through 1997. SETTING/PARTICIPANTS: Nationally representative sample of 59 935 black, 19 201 Mexican-American, and 344 432 white men and women (six gender and racial/ethnic groups), aged 25-64 at interview. MAIN RESULTS: Mortality rates for all six gender and racial/ethnic groups were two to four times higher for those with the lowest incomes (lowest quartile) who lived in the lowest SES neighbourhoods (lowest tertile) compared with those with the highest incomes who lived in the highest SES neighbourhoods. For the six groups, the age adjusted mortality risk associated with living in the lowest SES neighbourhoods ranged from 1.43 to 1.61. The mortality risk decreased but remained significant (p values <.05) after adjusting for each of the three individual measures of SES, with the exception of Mexican-American women. Furthermore, the mortality risk associated with living in the lowest SES neighbourhoods remained significant after simultaneously adjusting for all three individual measures of SES for white men (p<0.001) and white women (p<0.05). Deaths would hypothetically be reduced by about 20% for each subgroup if everyone had the same death rates as those living in the highest SES neighbourhoods (highest tertile). CONCLUSIONS: Living in a low SES neighbourhood confers additional mortality risk beyond individual SES.

Adult↗

[Illness related to occupational factors encountered in a general practice setting].

BACKGROUND: This study examines the extent of illnesses encountered in a general practice setting that are related to occupational factors and their distribution in relation to specific occupations and diagnostic groups. MATERIAL AND METHODS: From December 2000 until May 2001, all patients between 20 and 67 years of age who came in to our rural community medical centre on the coast of central Norway, were asked to fill in a questionnaire about their reason for seeing a doctor, their occupational status, and whether they saw their current illness as related to occupational factors. If they did, they were also asked about what factors they deemed the most important. RESULTS: Among the 412 occupationally active respondents, 40% of women and 54% of men saw a possible or definite relationship between occupational factors and their current illness. Repetitive work and physically hard work were the two factors most frequently mentioned. INTERPRETATION: Occupational factors as causes of or influencing factors for illness in general practice seem to be more frequent than anticipated. There also seems to be a potential for prevention of illness and disability through better collaboration between general practitioners, occupational health services hospital based departments of occupational medicine.

Adult↗

Gender and race differences in the correlation between body mass and education in the 1971-1975 NHANES I.

STUDY OBJECTIVE: Differences in the correlation between body mass index and education across four gender and race groups were investigated while simultaneously accounting for occupation, income, marital status, and age. DESIGN: The study used analysis of covariance techniques to calculate average body mass and confidence intervals within education categories while simultaneously adjusting for the covariates: age, square of age, family income, marital status, and occupation. SETTING: Data were drawn from the US National Health and Nutrition Examination Survey (NHANES I), 1971-1975. NHANES I is a national probability sample designed to gather information on the non-institutionalised US civilians, ages 1-74 years. SUBJECTS: Samples of 8211 white women, 1673 black women, 6188 white men, and 1023 black men were drawn from the NHANES I, 1971-1975. MAIN RESULTS: Data in the female samples indicate a strictly inverse relation between body mass and years of schooling among white women and an inverted "U" association among black women, achieving a maximum around 8 to 11 years of schooling. In the male samples data indicate inverted "U" relations among both black and white men, reaching maxima between 12 and 15 years of schooling. The sides of the "U" curve are much steeper for black than for white men. CONCLUSIONS: The four gender/race categories display four different body mass index and education associations. These four associations are only slightly altered by simultaneously adjusting for two additional measures of socioeconomic status: occupation and income.

Age Factors↗

Lost productive work time after mild to moderate traumatic brain injury with and without hospitalization.

OBJECTIVE: Lost productivity after mild traumatic brain injury (TBI) is a large component of the economic costs of brain trauma in the United States. This is the first prospective study of employment after mild TBI to include patients not admitted to a hospital. METHODS: Concurrent inception cohorts of 210 working-age adults with mild to moderate TBI and 122 patients who sustained general trauma not involving the brain were recruited at a trauma center and followed up to 6 months later. Outcomes were time from injury until first day worked and problems reported after resuming work. RESULTS: Most patients who worked after their injury remained employed 6 months later in a similar capacity as before the injury. No consistent differences were demonstrated between employment outcomes of patients with mild TBI and those with general trauma. The majority of nonhospitalized patients with mild TBI did not work for at least 1 month and did not begin working until 1 to 3 months after injury. Most patients with moderate TBI remained unemployed at 6 months postinjury. Patients with lower preinjury occupational status tended to have longer work absences. CONCLUSION: Lost productive work time after nonhospitalized TBI may cause significant economic costs because these injuries are frequent. Contrary to the theory that brain injury is more disabling to patients in cognitively demanding occupations, patients with higher job status tended to begin work earlier. A technique is needed to screen patients with mild TBI for risk of employment problems. Rehabilitation after moderate TBI may help to minimize lost productivity.

Adult↗

Sociological and social-psychological correlates of anomia among a random sample of aged.

In this investigation the distribution of responses on an anomia index (Srole's anomia scale) was examined for a national probability sample of the elderly. Step-wise multiple regression procedures were used to determine the relative importance of the independent variables in explaining the variation of anomia. Of the zero-order correlations, the "sociological" variables, e.g., education, work status, occupational prestige, and yearly income, were the strongest correlates of anomia. The social psychological variables, viz., various attitudinal and perceptual phenomena, also exhibited reasonably strong correlations. Those variables labeled "activity/organizational," e.g., various indices of social engagement, revealed the lowest correlations. In step-wise regression analysis six statistically significant explanatory variables were, in descending order: (1) a judgement of one's relative financial standing, (2) city size, (3) race, (4) work status, (5) education, and (6) occupational prestige.

Aged↗

Personal beliefs and alternative childbirth choices: a survey of 552 women who planned to give birth at home.

In Australia, planning to give birth at home was unusual in the middle to late 1980s, a choice made by only about 0.5 percent of women. This study investigated the personal beliefs and circumstances of 552 women who planned to give birth at home. Results showed that these women came from diverse backgrounds and beliefs, although in general they were of higher than average educational and occupational status, and less likely to hold Christian beliefs relative to the Australian community in general. Their lives and experiences reflected both unconventional and more traditional choices, and the view that women who give birth at home characteristically belong to the counterculture could not be justified. The findings of this study suggest that stereotypes of women who give birth at home do not apply to the circumstances of substantial numbers of women.

Adult↗

Myopia, use of eyes, and living habits among men aged 33-37 years.

As a part of a more extensive research project on health and functional capacity among a representative sample of men, the living habits and backgrounds of myopic men between 33 and 37 years of age living in the town of Jyväskylä were studied in comparison with non-myopic men of the same age. The prevalence of a negative spheric equivalent, which was considered as a criterion of myopia, was 25%. It was found that the myopic, on the average, had been more interested in reading from childhood onwards, their educational and occupational status were higher, and their body structure was lighter. As children they had taken less physical exercise, but as adults no difference was found in physical exercise between the myopic and non-myopic.

Adult↗

Sickness absence as a predictor of mortality among male and female employees.

OBJECTIVE: To determine the extent to which sickness absence is predictive of mortality. DESIGN: Prospective cohort study. Data on medically certified long term absences (>3 days), self certified short term absences (1-3 days), and sick days were derived from employers' records and data on mortality from the national mortality register. SETTING: 10 towns in Finland. PARTICIPANTS: 12821 male and 28915 female Finnish municipal employees with a job contract of five consecutive years. The mean follow up was 4.5 years. MAIN RESULTS: After adjustment for age, occupational status, and type of employment contract, the overall mortality rate was 4.3 (95% confidence intervals 2.6 to 7.0) and 3.3 (2.1 to 5.3) times greater in men and women with more than one long term absences per year than in those with no absence. The corresponding hazard ratios for more than 15 annual sick days were 4.7 (2.3 to 9.6) and 3.7 (1.5 to 9.1). Both these measures of sickness absence were also predictive of deaths from cardiovascular disease, cancer, alcohol related causes, and suicide. Associations between short term sickness absences and mortality were weaker and changed to non-significant after adjustment for long term sickness absence. CONCLUSIONS: These findings suggest that measures of sickness absence, such as long term absence spells and sick days, are strong predictors of all cause mortality and mortality due to cardiovascular disease, cancer, alcohol related causes, and suicide.

Adolescent↗

Performance of schizophrenic patients on a motor-free visual perception test.

The Motor-Free Visual Perception Test (MVPT) was administered to 15 chronic schizophrenic patients and 15 normal controls, ages 40 to 60, to see whether, perceptual deficits would be found on non-motor tasks. Groups significantly affected performance on the MVPT, as did occupational status. In the schizophrenic group only, efficiency of intellectual functioning was positively related to how well they performed on the MVPT. Age, educational level, and IQ had no significant impact on functioning on this test in either group. The schizophrenic patients made more errors on the more complex operations of the MVPT, and the only significant group differences in percentage of subjects' own errors was in figure-ground. The MVPT may be useful in screening for visual-perceptual deficits in adult schizophrenic patients.

Adult↗

The coloured elderly in Cape Town--a psychosocial, psychiatric and medical community survey. Part I. Introduction and psychosocial data.

A survey of 150 non-institutionalized Coloured persons over the age of 65 years living in Cape Town was undertaken to examine their psychosocial, psychiatric and medical condition. This article covers procedural and psychosocial aspects; Parts II and III will deal with others. Overall, respondents were poorly educated, with low income and occupational status. Social functioning and life satisfaction were reported to be good in over 80%. Family and social support appeared to be strong. Many respondents were involved in household duties (87%), child care (46%) and activities outside the home (66%). The high degree of satisfaction in the face of economic adversity may be due to family support and role maintenance. Findings are compared with those of previous studies, and the possibility that changes in circumstances are occurring is noted.

Black or African American↗

Occupational outcome in military aviators after psychiatric hospitalization.

OBJECTIVE: To determine if psychiatric hospitalization precluded a return to occupational status in United States Air Force aviators. DESIGN: A 7-yr retrospective review that joined hospitalization and occupational databases using individual identifiers. SUBJECTS: From a population of over 35,000 USAF rated aviation officers present between January 1986 and December 1990, 214 were both psychiatrically hospitalized and on flying status the quarter prior. PRIMARY OUTCOME MEASURE: Return to flying duties during a minimum follow-up period of 2 yr. RESULTS: Within 2 yr from psychiatric admission, 138 (64.5%) aviators returned to flying status; 141 (65.9%) returned over 7 yr. In this patient population, an affective disorder diagnosis predicted poor outcome (chi 2 = 12.86; df = 1; p = 0.0003), independent of length of hospitalization. CONCLUSION: Psychiatric hospitalization did not prevent a return to flying status for a majority of these high functioning aviators. Although an affective disorder diagnosis negatively affected occupational outcome, it is unclear whether institutional policy or poor prognosis was etiologic.

Adjustment Disorders↗

Trends in higher qualifications, 1971 to 1991.

This article has highlighted just some key features derived from a brief analysis of a small part of the statistics available from the tables on qualified manpower from the last three censuses. There is scope for wider analysis using the data on employment status, occupation and industry.

Adolescent↗

Health risk factors and occupation among Iowa workers.

BACKGROUND: Health behaviors represent major risks for premature morbidity and mortality. This study aimed to establish whether health risks varied substantially across occupational groups. METHODS: We focused on the 2223 Iowa Behavioral Risk Factor Surveillance System (BRFSS) subjects who reported, in 1999, that they were currently working. RESULTS: Even after controlling for age and gender, we found significant associations between occupation and health risk factors. We found these associations among the different categories of health risk factors, including insurance/access, health conditions, preventive behaviors, and screening behaviors. CONCLUSIONS: The considerable differences in the prevalence of risk factors for chronic disease and injury across occupational groups in Iowa underscore the need for nationwide ongoing collection of occupational status in the BRFSS. These national data on the distribution of risk factors across occupations will support development of more targeted prevention interventions.

Adolescent↗

Predicting participation in retirement preparation programs.

Using data from the National Longitudinal Survey of Mature Men, the current study estimated the probability of participation in a retirement preparation program. Results are presented from a multivariate logit analysis. The study found (a) that occupational status, marital status, health status, preretirement income, and constraint by mandatory retirement rules are significant predictors of participation, and (b) that positive sample selectivity bias exists.

Aged↗

Socioeconomic factors and cardiovascular disease: a review of the literature.

Despite recent declines in mortality, cardiovascular diseases are the leading cause of death in the United States today. It appears that many of the major risk factors for coronary disease have been identified. Researchers are still learning about different modifiable factors that may influence cardiovascular diseases. Socioeconomic status may provide a new focus. The principal measures of SES have been education, occupation, and income or combinations of these. Education has been the most frequent measure because it does not usually change (as occupation or income might) after young adulthood, information about education can be obtained easily, and it is unlikely that poor health in adulthood influences level of education. However, other measures of SES have merit, and the most informative strategy would incorporate multiple indicators of SES. A variety of psychosocial measures--for example, certain aspects of occupational status--may be important mediators of SES and disease. The hypothesis that high job strain may adversely affect health status has a rational basis and is supported by evidence from a limited number of studies. There is a considerable body of evidence for a relation between socioeconomic factors and all-cause mortality. These findings have been replicated repeatedly for 80 years across measures of socioeconomic level and in geographically diverse populations. During 40 years of study there has been a consistent inverse relation between cardiovascular disease, primarily coronary heart disease, and many of the indicators of SES. Evidence for this relation has been derived from prevalence, prospective, and retrospective cohort studies. Of particular importance to the hypothesis that SES is a risk factor for cardiovascular disease was the finding by several investigators that the patterns of association of SES with coronary disease had changed in men during the past 30 to 40 years and that SES has been associated with the decline of coronary mortality since the mid-1960s. However, the declines in coronary mortality of the last few decades have not affected all segments of society equally. There is some evidence that areas with the poorest socioenvironmental conditions experience later onset in the decline in cardiovascular mortality. A number of studies suggest that poor living conditions in childhood and adolescence contribute to increased risk of arteriosclerosis. Some of these studies have been criticized because of their nature, and others for inadequate control of confounding factors.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Biological age, health, and health-risk indicators among 25-57-year-old men in two parts of Finland.

Biological age, health, and health-risk indicators were examined among 460 systematically chosen men, aged 25-57 years, in two parts of Finland. Morbidity rates and the prevalence of some health-risk indicators were higher and the standard of living lower in North Karelia than in South-West Finland. The index of biological age (IBA) did not show significant differences between the districts and did not correlate with health-risk indicators. People working in physically hard occupations (industrial and mining workers) were found to have more diseases and had higher IBA values than had workers in lighter occupations. The results suggest that both ageing and morbidity are regulated by occupational status and social conditions connected with it.

Adult↗

Does occupational social class predict coronary heart disease after retirement? A 12-year follow-up study in Sweden.

AIMS: To examine whether socioeconomic status and coronary heart disease (CHD) risk factors remain significant predictors of CHD among people aged >or=65 years. Previous studies in this age group are few and inconsistent. METHODS: Follow-up study of a simple random sample of Swedish women and men aged >or=65 years interviewed in a national survey 1988-89 and followed up until 31 December 2000, for CHD incidence rates. Cox regression was used to study the association between socioeconomic status (occupation) and CHD, after adjustment for age, sex, physical activity, smoking, BMI, diabetes, and hypertension. Participants with CHD hospitalization two years before the start of the study and those who rated their general health as poor were excluded. RESULTS: Among manual workers and lower-level employees the risk of CHD was significantly higher than among middle-level employees and professionals (49% and 50%, respectively), after adjustment for age and sex. The association between low socioeconomic status and increased CHD risk disappeared after adjustment for the CHD risk factors, which were more prevalent among those with low socioeconomic status. All the CHD risk factors (with the exception of BMI) were associated with increased CHD incidence rates. CONCLUSIONS: Low socioeconomic status remains a significant predictor of CHD among people aged >or=65 years. Healthcare policies among elderly patients should encourage physical activity and smoking cessation in all socioeconomic groups.

Aged↗

Current status of the occupational health and safety countermeasures in Beijing, China.

This paper describes the current status of occupational health and safety countermeasures in Beijing, China. It includes the network and organization of occupational health, occupational health personnel, the refitting of industrial structures, hazardous agents at workplaces, the classification and incident rates of occupational diseases. The management of occupational health and safety, new challenges and opportunities for occupational health and safety are also discussed. Countermeasures for occupational health and safety have been formulated by the government of Beijing. At present, they are being implemented and enforced by: (1) strengthening the management of occupational hygiene; (2) encouraging and supporting employment units establishing the occupational health quality management system; (3) promoting research on the prevention and treatment of occupational diseases; (4) improving the transparency in occupational health and safety; (5) motivating the government to improve regulation and standards and (6) developing external occupational health and safety aid programs.

China↗