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PubMed2005

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↗
PubMed1997

Alcoholism in social classes and occupations in Sweden.

BACKGROUND: A number of studies have shown variations in the occurrence of alcoholism between different socioeconomic groups and occupations, but it has not been clear to what extent this is related to the average alcohol consumption in the same socioeconomic groups or occupations. METHODS: The relationship between socioeconomic group and occupation and hospital discharge 1981-1983 due to 'diagnoses related to alcoholism' (AD) (alcohol psychosis, alcoholism, and alcohol intoxication) and liver cirrhosis was studied in a cohort of 375,035 men and 140,139 women in 13 counties in Sweden who had reported the same occupation in the censuses of 1960 and 1970. Data on alcohol consumption in different socioeconomic groups and occupations were collected from a conscription investigation and from the Swedish twin registry with data from 1969/70 and 1973 respectively. RESULTS: Intermediate or higher non-manual employees had lower risk of AD as well as of liver cirrhosis compared to manual workers for both sexes. Among males several, mostly blue-collar, occupations had increased relative risks of AD. A high level of association was found between the relative risks of AD and liver cirrhosis in socioeconomic groups, and the relative risk of AD in occupations, and the average alcohol consumption in the same socioeconomic groups/occupations among males. Such an association was not evident among women. CONCLUSION: The study shows, contrary to previous Swedish evidence, that there is a strong relationship between the incidence of alcoholism in socioeconomic groups and occupations and the average alcohol consumption in these groups among men.

Alcohol Drinking↗
PubMed2003

Birthweight and perinatal mortality: paradoxes, social class, and sibling dependencies.

BACKGROUND: Birthweight distributions among second-born infants depend on the birthweights of older siblings, with implications for weight-specific perinatal mortality. We wanted to study whether these relations were explained by socioeconomic levels, and to study time trends in a situation with decreasing perinatal mortality rates. METHODS: Births in the Norwegian Medical Birth Registry from 1967 to 1998 were linked to their mothers through their national identification numbers. The study population was 546 688 mothers with at least two singletons weighing >/==" BORDER="0">500 g at birth. Weight-specific perinatal mortality for second-born siblings in families with first-born siblings in either the highest or the lowest birthweight quartile was analysed. Maternal education and cohabitation status were used as measures of socioeconomic level. RESULTS: For all 500-g categories below 3500 g, mortality rates were significantly higher among second-born infants with an older sibling in the highest rather than the lowest weight quartile. This pattern was the same across three educational levels. The exclusion of preterm births did not change the effect pattern. A comparison of perinatal mortality among second siblings in terms of relative birthweight (z-scores) showed a reversal of the relative risks, although these were only significantly different from unity for the smallest infants. Conclusion The crossover in weight-specific perinatal mortality for second siblings by weight of first sibling is largely independent of socioeconomic level, and is not weakened by the decreasing perinatal mortality rates in the population over time. Family data should be taken into consideration when evaluating the risk of adverse pregnancy outcome relating to weight.

Birth Order↗
PubMed1975

Social class and preschool language skill: III. Semantic mastery of position information.

The four-year-old children of Head Start (two-year-classes of 90 for 1970-71 and 67 for 1971-72) performed on a test of perceptual identification of a sample of six positions approximately as well as did four-year-olds of parents with predominantly college backgrounds. On the other hand, only 22% and 16% of those of Head Start as compared with 70% and 67% of those of the nursery school placed blocks in all six positions that they heard the examiner name, and only 12% and 9% of the former as compared with 45.5% and 44.9% of the latter gave appropriate names for all the six positions designated by the examiner. Sex differences and differences between black and white children of Head Start were negligible and not significant. Somewhat more children of both Head Start and the nursery school showed semantic mastery based on both heard and spoken identification for positions based on body-object relations (in, on, and under) than for those based on object-object relations (in fromt of, between, and in back of). The fact that the children of Head Start perform so much less well than those of the nursery school on the test semantic mastery for position information is highly dissonant with the contention that children of poverty are without either cognitive or linguistic deficit, but quite consonant with the contention that they suffer a deficit that may well and probably does result from the rearing conditions in their homes during the preschool years.

Black or African American↗
PubMed2002

Is obesity replacing or adding to undernutrition? Evidence from different social classes in Brazil.

OBJECTIVE: To describe time trends in under- and overnutrition in different regional and income strata of the child and adult population of Brazil. DESIGN: Nation-wide surveys conducted in 1975, 1989 and 1996/7 in probabilistic samples of 1-4-year-old children and adults 20 years and over. Time trends refer to stunting, wasting and overweight prevalences among children and age-adjusted underweight and obesity prevalences among adults (95% confidence intervals included). SUBJECTS: Individuals examined by each survey in each age group ranged from 1796 young children in 1996 to 78031 adults in 1975. SETTING: North-eastern and south-eastern regions of Brazil. RESULTS: Undernutrition indicators declined intensively and continuously among children and adults in all region and income strata. Obesity remained low and relatively stable among children, but increased intensively and continuously in all regions and income strata among adult males. Obesity also increased intensively and continuously among adult women from the less economically developed region of Brazil (the north-eastern region) and among lower-income women from the more developed region (the south-eastern region). Higher-income women from the more developed region had a significant increase in obesity from 1975 to 1989, followed by a significant decline from 1989 to 1997. CONCLUSIONS: Undernutrition in young children is being controlled in Brazil without evidence of increasing obesity. However, obesity is rapidly replacing undernutrition in most gender, region and income strata of the adult population. Adult obesity is already more frequent than adult undernutrition in the more economically developed region, among all higher-income groups, and also among lower-income women living in the more developed region. These lower-income women are significantly more exposed than their higher-income counterparts to both undernutrition and obesity.

Adult↗
PubMed1975

Social class and preschool language skill: II. semantic mastery of color information.

The four-year-old children of Head Start (two-year-classes of 90 for 1969-71 and 72 for 1971-72) performed on a test of perceptual identification approximately as well as four-year-old nursery-school children of parents predominantly of college background. On the other hand, only 28.9% and 19.4% of the children of Head Start, as compared with 87.9% and 90.2% of the children of the nursery-school pointed correctly to all six of the blocks when the examiner named the colors. Also, only 25.6% and 23.6% of those of Head Start, as compared with 81.8% and 76.5% of those of the nursery school, named the colors of all six blocks as they were designated by the examiners. Sex differences and race differences, except in the case of brown, among the children of Head Start were negligible and not significant. Somewhat more children showed semantic mastery for the warn colors, orange and red, than for the cool colors, blue and green. The finding of a deficiency in semantic mastery for such an elementary abstraction as color is highly dissonant with the contention of many students of sociological linguistics that children of poverty, and especially black children of poverty, are without cognitive or linguistic deficit, and that they fail in school only because they use a dialect differing from standard English. The finding is quite consonant with the contention that children of poverty do have a cognitive and linguistic deficit which may, and probably does, derive from the rearing conditions in their homes during the preschool years.

Black or African American↗
PubMed2005

Variation in quality of men's health care by race/ethnicity and social class.

BACKGROUND: Until recently, minority and poor men have been characterized as "an invisible population," overlooked by public and private efforts to improve the health status of women, children, and the elderly. OBJECTIVE: This study compares the health care experiences of racial and ethnic minority men with that of white men, and low socioeconomic status with those of higher status. MEASURES/SUBJECTS: Quality-of-care measures in multiple clinical domains are evaluated. The authors use data from several databases, including the National Health Interview Survey, Medical Expenditure Panel Survey, and Health Care Cost and Utilization Project State Inpatient Database. The relative difference between each racial/ethnic and socioeconomic group and a fixed reference group is used to assess differences in use of services. Statistical significance is assessed using z tests. RESULTS: Hispanic men were much less likely to receive colorectal cancer screening (relative risk [RR] range, 0.61-0.69), cardiovascular risk factor screening and management (RR, 0.84-0.88), and vaccinations (RR, 0.47-0.94). Black and Asian men were significantly less likely to have received selected preventive services (adult immunization and colorectal cancer screening). The differences in end-stage renal disease care that black and white men received were statistically significant (RR, 0.39-0.97), with black men consistently receiving worse care. For some measures of management of end-stage renal disease, Asian men received care that was similar to or better than that received by non-Hispanic whites. CONCLUSION: Minority men are at a markedly elevated risk for the receipt of poor health care quality. However, generalizations about "minority" men are likely to be misleading and incomplete. There is a considerable variation in the magnitude, direction, and significance of these risks.

Adolescent↗
PubMedDate not supplied

[Social class, mode of admission, severity of illness and hospital mortality: an analysis with "All patient refined DRG" of discharges from the Molinette hospital in Turin].

Data available from the standard hospital discharge database (SDO) allow us to explore differences in health conditions according to different indicators of socioeconomic status (SES). We analysed all the patients aged 30-59, discharged from the S. Giovanni Battista (Molinette) hospital (the main general hospital in Turin, Italy) during three years (1996-1998) (n = 49949). Three health indicators were used as outcomes: a) emergency admission; b) severity of illness (according to the "All Patient Refined DRGs" subclasses); c) hospital mortality. Patients were compared for each outcome according to two different SES indicators: a) level of education; b) employment status. Logistic regression models (both conditional and unconditional) were used to adjust for several potential confounders. Patients with lower education (up to 5 years of schooling), compared to those with 13 or more years of schooling, showed a higher probability of being admitted through the emergency ward (29.1% vs 23.3%), with an odds ratio (OR) = 1.56-95% confidence interval (95% CI) = 1.45-1.68; of being classified in higher severity subclasses of illness (23.3% vs 17.7%, OR = 1.14; 95% CI = 1.07-1.22) and of dying in hospital (2.3% vs 1.6%). However, after adjustment for other prognostic factors (as severity of illness and specific expected mortality), this association disappeared (OR = 1.05, 95% CI = 0.84-1.32). Similar, but somewhat stronger, associations were observed when comparing the unemployed versus the employed. The corresponding figures (ORs; 95% CI) were 1.57 (1.42-1.74) for emergency admission; 1.31 (1.18-1.45) for severity of illness and 1.55 (1.10-2.16) for hospital mortality. In conclusion, this study showed that SES differentials in health are clearly measurable through routine hospital information systems, and documented that patients of low SES, particularly unemployed, experienced a delayed access to hospital, were admitted in poorer general health conditions and had a more unfavourable prognosis.

Catchment Area, Health↗
PubMed1997

Estimating potential savings in cancer deaths by eliminating regional and social class variation in cancer survival in the Nordic countries.

STUDY OBJECTIVES: To examine equity in the health care system with regard to cancer patient care by estimating the level of systematic regional variation in cancer survival in the Nordic countries. Specifically, those cancer sites which exhibit high levels of systematic regional variation in survival and hence inequity were identified. Estimating the reduction in cancer deaths which could be achieved by eliminating this variation so that everyone receives effective care will provide a readily interpretable measure of the amount of systematic regional variation. A comprehensive analysis of regional variation in survival has not previously been conducted so appropriate statistical methodology must be developed. SETTING AND PARTICIPANTS: All those aged 0-90 years who had been diagnosed with at least one of 12 common malignant neoplasms between 1977 and 1992 in Denmark, Finland, Norway, and Sweden. DESIGN: A separate analysis was conducted for each country. Regression models for the relative survival ratio were used to estimate the relative risk of excess mortality attributable to cancer in each region after correcting for age and sex. An estimate of the amount of systematic regional variation in survival was obtained by subtracting the estimated expected random variation from the observed regional variation. An estimate was then made of the potential reduction in the number of cancer deaths for 2008-12 if regional variation in survival were eliminated so that everyone received the same level of effective care. MAIN RESULTS: Between 2008 and 2012, an estimated 2.5% of deaths from cancers in the 12 sites studied could be prevented by eliminating regional variation in survival. The percentage of potentially avoidable deaths did not depend on country or sex but it did depend on cancer site. There was no relationship between the level of regional variation in a given country and the level of survival. The cancer sites for which the greatest percentage savings could be achieved were melanoma (11%) and cervix uteri (6%). The sites for which the highest number of deaths could be prevented were prostate, colon, melanoma, and breast. CONCLUSIONS: This methodology showed a small amount of systematic regional variation in cancer survival in the Nordic countries. The cancer sites with high levels of regional variation identified are potential targets for cancer control programmes.

Adolescent↗
PubMedDate not supplied

[Atopy-suggesting symptoms in the first 2 years of life. Effect of gestational age, nutrition and social class].

In a prospective study on 318 non-selected infants signs of atopy as well as interrelations with feeding regimens and family history of atopic disease were investigated at the age of 1 1/2 year. The study population was recruited from preterm and term babies hospitalized 1985 in the University Children's Hospital Freiburg, Germany. The most common symptom was eczema. In addition, clinical symptoms of atopy in first degree relatives were a significant risk factor. Because the highest incidence of atopic symptoms occurred in preterm born children with allergic background in their families, we therefore consider this population at highest risk to develop atopic disease. On the other hand there was no significant influence of breast feeding, cow's milk formula and the time of intake of allergenic food on the clinical manifestation of atopy in any group. Although eczema occurred predominantly in infants with higher social level the respiratory tract symptoms were reported more frequently in children from working class families. We therefore regard the social status as an important confounding variable in the studies of risk factors for the development of allergy.

Eczema↗
PubMed2000

Are social-class differences in stature partly genetic? A hypothesis revisited.

Twenty-three different, socially homogenous groups of 19-year-old males were selected from a total sample of 57,000 Polish conscripts examined in 1986 and in 1995. Each group consisted of age-mates equated for six criteria of social background: 1) maternal and 2) paternal education, 3) maternal and 4) paternal occupational status, 5) number of children in the family, and 6) degree of urbanization of the subject's locality of residence. Within every one of the 23 groups, subjects who at the age of 19 years were secondary-school or college students, were taller than socially similar peers, who by that age had never moved beyond the level of basic vocational school. Thus, a significant association exists between an individual's potential for upward social mobility and tallness. Such associations must be taken into account when considering the origin and nature of the commonly observed taller stature of the upper over the lower social strata in present-day industrial societies. Am. J. Hum. Biol. 12:97-101, 2000. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗
PubMed2006

[Abortion among young women--the importance of family environment factors and social class].

BACKGROUND: The aim of the study was to investigate possible associations between social background, other aspects of childhood environment and induced abortion among young women. MATERIAL AND METHODS: Norwegian girls (N = 2,198), comprising a representative sample, were followed up through three data collections from they were in their teens in 1992 till they were young adult women (20 - 27 years) seven years later. A questionnaire was used to collect the data and the analyses were conducted by Cox regression. The response rate for the first data collection was 97%. The cumulative response rate over all three data collections was 69 %. RESULTS: In young adulthood we uncovered a steady reduction of induced abortion rates with increasing educational level. Women who had grown up in Northern Norway had higher rates than other women. There was a lower risk for induced abortion when parents were well educated and had fairly good jobs. Further, there were associations to parental divorce, weak parental monitoring and parental alcohol abuse. INTERPRETATION: A host of socioeconomic factors are associated with abortion risk. We need more thorough knowledge about these factors. We can, however, conclude that preventive efforts in this area should be targeted towards groups with risk factors.

Abortion, Legal↗
PubMed2005

Birth and social class: Northern Thai women's lived experiences of caesarean and vaginal birth.

This paper, based on in-depth interviews with Thai women in Northern Thailand, contributes to a sociological understanding of women's childbirth discourses. The findings indicate that the lived experiences of birth differ between individual women. It clearly shows that social resources such as financial resources and education play a salient role in shaping the embodied experience of birth among women in Northern Thailand. Because of their 'everyday lifestyle', middle class women have more control over the experience of childbirth than that of the rural poor women. Middle class women are able to choose where to give birth, have access to private care and actively seek medical technology as a way to have control over their birth. Their material resources enable their choices. These choices seem to be denied to the rural poor women. But not all rural poor women are passive victims of their material resources. No matter how limited the resources women have, they use them. Hence, there are some poor women who actively seek birthing care that enables them to have more control. But regardless of their social positions (urban middle class or rural poor), obstetric interventions are commonly experienced, and most women perceive caesarean birth in a positive light. Several discourses are employed to explain these findings including women's interpretations of their lived world including risk and the medicalisation of childbirth in Thailand. Taking a feminist standpoint, I argue that differences between women need to be taken into account in providing care to women in childbirth so that sensitive and appropriate birthing care can be achieved.

Adult↗