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PubMed1998

Mortality variations in England and Wales between types of place: an analysis of the ONS longitudinal study. Office of National Statistics.

This study investigates the extent to which individuals, in England and Wales, in different types of place experience differential mortality once account is taken of personal (individual and household) social circumstances. Data comes from the Longitudinal Study of England and Wales of the Office of National Statistics, the respondents being a one percent national random sample of people aged between 25 and 74 at the 1971 census, followed until the end of 1985. For males and females separately, differences in mortality are found for the 36 types of Craig-Webber classification in models which include, at the individual level, a number of demographic and socio-economic variables (women being classified by their own occupation). In general, for both males and females, the same types of place have elevated or lowered mortality. For males a (cross-level) interaction exists between the proportion in the area in professional social classes and individual social class, the effects of individual social class being larger in areas containing a higher proportion of those in professional occupations. For females mortality is negatively related to the proportion of car-ownership in the area.

Adult↗
PubMed2004

Social inequalities and disability in older men: prospective findings from the British regional heart study.

The independent association of socio-economic position with self-reported disability was assessed. The effect of home and car ownership as additional indices of socio-economic position within occupational social classes was explored. Data from a prospective study of a cohort of 7735 men aged 40-59 years at recruitment and representative of the occupational social class distribution of middle-aged men in Great Britain were used. Men were selected from one general practice in each of 24 towns in England, Wales and Scotland in 1978-1980. The present study concerns 5773 (88.4% of those able to take part) men aged 52-73 years at follow up in 1992 who completed the disability section of a postal questionnaire. A quarter (1453) of men reported disability. Socio-economic position measured as both occupational class (social class I vs. V: age-adjusted OR 5.0, 95% CI 3.4-7.5) and ownership of home and car (both vs. neither: age-adjusted OR 2.8, 95% CI 2.3-3.4) showed a graded relationship with likelihood of reporting disability in 1992. Within all social class groups, those owning both home and car had a lower risk of disability than those who owned neither, even after adjustment for a wide range of risk factors. Men from manual occupations were more likely than those in non-manual occupations to report disability on developing chronic diseases. The relationship between socio-economic position and severe, but not milder, disability appeared to be independent of disease status. Socio-economic position is a strong predictor of disability in later life independent of a wide range of lifestyle factors and presence of diagnosed disease. The likelihood of reporting disability between and within social class groups is influenced by material wealth.

Activities of Daily Living↗
PubMed2003

Socioeconomic health inequalities among a nationally representative sample of Danish adolescents: the role of different types of social relations.

STUDY OBJECTIVE: To investigate the role of different types of social relations in adolescent health inequalities. DESIGN: Cross sectional study. Measures included family social class, indices of social relations to parents, friends, teachers, and school. SETTING: Random sample of 55 schools in Denmark. PARTICIPANTS: Nationally representative sample of 5205 students from grades 5, 7, and 9. MAIN OUTCOME MEASURES: Self reported physical and psychological symptoms. RESULTS: Adolescents from families of lower socioeconomic position reported more physical and psychological symptoms. This ranged from 40% increased odds for multiple physical symptoms among less advantaged girls, to 90% increased odds of multiple psychological symptoms for less advantaged boys. Relationships with friends or teachers showed small social class differences, while strong and consistent social class differences were found in the ways adolescents reported their own and their parents relations to school. For example, girls from families of lower socioeconomic position were more than four times as likely to report their parents unwilling to attend school meetings (odds ratio=4.54, 95% confidence intervals: 2.68 to 7.69). Poorer relations with parents, peers, teachers, and school were all associated with worse health. Patterns of parent-child relations with the school were the greatest contributors to socioeconomic differences in physical and psychological symptoms. CONCLUSIONS: The school is one of the first important social institutions directly experienced by children and socioeconomic differences in how adolescents and their parents relate to the school may be part of the cascade of early life influences that can lead to later social and health disadvantage.

Adolescent↗
PubMed2003

Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953.

OBJECTIVE: To examine the relation between socioeconomic position in early life and mortality in young adulthood, taking birth weight and childhood cognitive function into account. DESIGN: A longitudinal study with record linkage to the Civil Registration System and Cause of Death Registry. The data were analysed using Cox regression. SETTING: The metropolitan area of Copenhagen, Denmark. SUBJECTS: 7493 male singletons born in 1953, who completed a questionnaire with various cognitive measures, in school at age 12 years, and for whom birth certificates with data on birth and parental characteristics had been traced manually in 1965. This population was followed up from April 1968 to January 2002 for information on mortality. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular diseases, and violent deaths. RESULTS: Men whose fathers were working class or of unknown social class at time of birth had higher mortality rates compared with those whose fathers were high/middle class: hazard ratio 1.39 (95% CI 1.15 to 1.67) and 2.04 (95% CI 1.48 to 2.83) respectively. Birth weight and childhood cognitive function were both related to father's social class and inversely associated with all cause mortality. The association between father's social class and mortality attenuated (HR(working class)1.30 (1.08 to 1.56); HR(unknown class)1.81 (1.30 to 2.52)) after control for birth weight and cognitive function. Mortality from cardiovascular diseases and violent deaths was also significantly higher among men with fathers from the lower social classes. CONCLUSION: The inverse association between father's social class at time of birth and early adult mortality remains, however somewhat attenuated, after adjustment for birth weight and cognitive function.

Adolescent↗
PubMed1992

[Voting behavior of the elderly: motivation and background].

On the occasion of the Dutch election for the Second Chamber of Parliament held on September 6, 1989 the Central Bureau of Statistics conducted a National Voters Survey (NKO). Voting behaviour and information about the backgrounds of this behaviour were collected among 1506 voters. A formerly developed explanatory model of party choice of the electorate also appears to apply to the 382 elderly voters (55 years and older) in the sample. The results show that party choice of elderly is mainly determined by the characteristics income, social class, religion, social values (social criticism) and opinions about politicians. The elderly differ from the younger voters (18-54 years old) on several points. For the elderly, the characteristics sex, education and social class play a more important role, whereas certain values (family values and postmaterialism) are more relevant for the 18-54 year-old group. In addition it turned out that as far as the explanation of party choice is concerned, the elderly are not a homogeneous group. Voters aged 75-plus in particular can be distinguished from the 55-64 and 65-74 year-old groups.

Age Factors↗
PubMed2003

Associations of measures of lung function with insulin resistance and Type 2 diabetes: findings from the British Women's Heart and Health Study.

AIMS/HYPOTHESIS: The aim of this study was to assess the associations of lung function with insulin resistance and Type 2 diabetes. METHODS: We did a cross-sectional study of 3911 women who were 60 to 79 years old from 23 British towns, assessing the association of measures of lung function with insulin resistance (based on fasting insulin and glucose concentrations) and Type 2 diabetes (World Health Organisation diagnostic criteria). RESULTS: Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were inversely associated with insulin resistance and prevalence of Type 2 diabetes. In age-adjusted analyses, the homeostasis model assessment (HOMA) score (insulin resistance) decreased by 5% (95% CI: 2-7%) for a one standard deviation increase in log FEV1 and by 8% (95% CI: 6-10%) for a one standard deviation increase in log FVC. With additional adjustment for height, smoking, BMI, waist-to-hip ratio, physical activity, white cell count, adult social class, childhood social class and respiratory medication, these associations attenuated to 3% (95% CI: 1 to 5%) and 5% (95% CI: 3 to 8%). The fully adjusted odds ratio for diabetes prevalence was 0.85 (95% CI: 0.74-0.98) for a one standard deviation increase in log FEV1 and 0.80 (95% CI: 0.70-0.92) for a one standard deviation increase in log FVC. Forced expiratory flow in the central period of FVC was not associated with insulin resistance or diabetes. CONCLUSIONS/INTERPRETATION: Lung function measures which predominantly reflect lung volume are inversely associated with insulin resistance and Type 2 diabetes. These associations could reflect childhood exposures which affect lung growth and also programme insulin resistance.

Aged↗
PubMed1989

Obesity, adipose tissue distribution and health in men--the study of men born in 1913.

Recent studies suggest that cardiovascular disease is associated with abdominal distribution of adipose tissue rather than obesity in terms of total body fat. A number of other variables, known to be associated with obesity, were therefore examined in a cohort of randomly selected middle-aged men in relation to abdominal distribution of adipose tissue, measured as the ratio of the circumferences of the waist and hips (WHR), as well as to degree of obesity, measured as body mass index (BMI). These variables included anthropometric variables, cardiovascular risk factors as well as socioeconomic factors and physical health. Increased WHR, independent of BMI, was negatively associated with height, and hip circumference. Positive associations were found with blood pressure, cholesterol, triglycerides, fibrinogen and smoking. In addition positive associations were found with low social class and social group, illness in terms of sick leave, frequent use of health facilities such as X-rays, as well as diseases such as peptic ulcer. In sharp contrast to this, BMI, independent of WHR, was not associated with physical health variables or social class. Generalized obesity seemed to be associated with good health in the variables measured. There were positive associations to various anthropometric variables, including lean body mass. High BMI was also associated with elevated blood pressure and triglycerides. Several of the indicators of poor health traditionally associated with obesity thus do not seem to be characteristic for obesity in middle-aged men selected at random from the population but rather for an abdominal fat distribution, independent of obesity.

Abdomen↗
PubMed1996

Birthweight, body-mass index in middle age, and incident coronary heart disease.

BACKGROUND: Several studies have shown a relation between fetal development, as shown by birthweight, and later coronary heart disease. This study investigated whether this relation is predominantly the consequence of early life exposures, or can best be explained in terms of an interaction between influences in early life and in adulthood. METHODS: This prospective study in Caerphilly, South Wales, included 1258 men, aged 45-59 at initial screening, who were able to provide birthweight data. These men are from an initial cohort of 2512 men, from whom information has been obtained in a series of examinations since 1979 on health-related behaviours, incidence of coronary heart disease, and risk factors. The main outcome measure was fatal and non-fatal coronary heart disease during 10 years of follow-up. FINDINGS: Higher birthweight was related to lower risk of coronary heart disease during the follow-up period: coronary heart disease occurred in 46 (11.6%) men in the lowest birthweight tertile, 44 (12.0%) of those in the middle tertile, and 38 (9.1%) of those in the highest tertile (p = 0.03). Stratification of the cohort by body-mass index (BMI) revealed a significant interaction such that the inverse association between birthweight and risk of coronary heart disease was restricted to men in the top tertile of BMI (interaction test p = 0.048 adjusted for age, and p = 0.012 fully adjusted). Within the top BMI tertile, coronary heart disease occurred in 19 (16.4%) of men in the lowest birthweight tertile, 13 (12.6%) of those in the middle tertile, and 13 (7.5%) of those in the highest tertile (p = 0.0005). These associations were not changed substantially by adjustment for age, father's social class, own social class, marital status, fibrinogen and cholesterol concentrations, systolic blood pressure, and smoking history. INTERPRETATION: The association between birthweight and risk of coronary heart disease cannot be explained by associations with childhood or adulthood socioeconomic status. Nor do conventional risk factors for coronary heart disease in adulthood account for the association. However, there is an important interaction between birthweight and BMI such that the increased risk of coronary heart disease associated with low birthweight is restricted to people who have high BMI in adulthood. Risk of coronary heart disease seems to be defined by the combined effect of early-life and later-life exposures.

Birth Weight↗
PubMed1999

An investigation of social and class differences in very-low birth weight outcomes: a continuing public health concern.

The objective of this study was to examine the relationship of nonmedical factors, including socioeconomic status, social class, education, race, and social support, to low birth weight. In a case-control study of all resident very-low-birth-weight births between December 1, 1989, and March 31, 1991, mothers completed an extensive survey related to their experience of pregnancy, including prenatal and postnatal care. Cases were defined as very-low-birth-weight (VLBW) infants and were matched to moderately-low-birth-weight and normal-birth-weight infants in race, age, and maternal residence. The hypothesis that social and class factors are more predictive of low birth weight than medical factors alone for women without chronic health problems was supported. Although the degree of the association varies depending on birth weight outcome, race even though addressed through matching--continued to play an important role in birth outcomes. A comparison of logistic model performance with and without the inclusion of social factors indicated the importance these variables play in prediction of birth outcomes. This is one of the few studies undertaken that explicitly investigates impact of patient factors on medical care.

Adult↗
PubMed1984

The effect of social factors on referrals for orthodontic advice and treatment.

All patients with information related to social class who were referred to the Orthodontic Department of Glasgow Dental Hospital over a 5-year period were investigated in this study. This referred population is different from the general population with proportionally fewer of the lower social classes. Social class did not affect the distance travelled to receive advice or treatment. However, proportionally more patients from social Classes I and V received complicated therapy.

Dental Clinics↗
PubMed2002

Socio-economic differences in incidence rates of cancers of the male genital organs in Finland, 1971-95.

We studied social class variation in the incidence of cancers of the prostate, testis, penis and scrotum among 1.1 million Finnish men (45-69 years of age) during 1971-95. The incidence of prostate cancer (6,972 cases) was increasing during the study period; the highest at all the times occurred in Social Class I (highest social class), 40-50% higher than in Social Class IV (lowest). The social class gradient was strongest in localized disease but there was some variation in incidence of non-localized prostate cancer. A total of 174 testicular cancer cases were diagnosed during the study period. In the early 1970s, the incidence of testicular cancer in Social Class I was 5-fold compared to Social Classes III and IV. Thereafter, the incidence rate decreased in Social Class I, but increased in the lower classes. The positive social class gradient was similar for seminomas and non-seminomas. For penile cancer (n = 128), the incidence decreased over time and social class variation was small. Only 6 cases of scrotum cancer were observed. In testicular cancer the strong positive social class association in the early 1970s is disappearing along with converging incidence trend slopes in different social classes. The difference diminished to less than 2-fold in the 1990s. Reasons for this observation remain open.

Finland↗
PubMed2004

The social epidemiology of coping with infertility.

BACKGROUND: To analyse the cross-sectional association between coping responses with infertility and occupational social class. Infertility is evenly distributed across social classes in Denmark, and there is free access to high-quality assisted reproduction technology. METHODS: Data were based on a questionnaire in a consecutive sample of 1169 women and 1081 Danish men who were about to begin assisted reproduction treatment. The coping measure was developed from an adaptation of Lazarus and Folkman's Ways of Coping Questionnaire and based on results from interviews with infertile people. The measure was developed in four categories: active-avoidance coping; active-confronting coping; passive-avoidance coping; meaning-based coping. These subscales were later confirmed by factor analysis. Occupational social class was measured in a standardized way. RESULTS: Contrary to expectations, the logistic regression analyses showed that women from lower social classes V + VI and men from social classes III + IV used significantly more active-confronting coping. Women from lower social classes V + VI used significantly more meaning-based coping. Both men and women from social classes III - VI used significantly more passive-avoidance coping and significantly less active-avoidance coping. CONCLUSION: Due to the significant social differences in coping with infertility, the study suggested that elements of coping may be learned from one's social network and reference group.

Adaptation, Psychological↗
PubMed1997

Lifetime socioeconomic position and mortality: prospective observational study.

OBJECTIVES: To assess the influence of socioeconomic position over a lifetime on risk factors for cardiovascular disease, on morbidity, and on mortality from various causes. DESIGN: Prospective observational study with 21 years of follow up. Social class was determined as manual or non-manual at three stages of participants' lives: from the social class of their father's job, the social class of their first job, and the social class of their job at the time of screening. A cumulative social class indicator was constructed, ranging from non-manual social class at all three stages of life to manual social class at all three stages. SETTING: 27 workplaces in the west of Scotland. PARTICIPANTS: 5766 men aged 35-64 at the time of examination. MAIN OUTCOME MEASURES: Prevalence and level of risk factors for cardiovascular disease; morbidity; and mortality from broad causes of death. RESULTS: From non-manual social class locations at all three life stages to manual at all stages there were strong positive trends for blood pressure, body mass index, current cigarette smoking, angina, and bronchitis. Inverse trends were seen for height, cholesterol concentration, lung function, and being an ex-smoker. 1580 men died during follow up. Age adjusted relative death rates in comparison with the men of non-manual social class locations at all three stages of life were 1.29 (95% confidence interval 1.08 to 1.56) in men of two non-manual and one manual social class; 1.45 (1.21 to 1.73) in men of two manual and one non-manual social class; and 1.71 (1.46 to 2.01) in men of manual social class at all three stages. Mortality from cardiovascular disease showed a similar graded association with cumulative social class. Mortality from cancer was mainly raised among men of manual social class at all three stages. Adjustment for a wide range of risk factors caused little attenuation in the association of cumulative social class with mortality from all causes and from cardiovascular disease; greater attenuation was seen in the association with mortality from non-cardiovascular, non-cancer disease. Fathers having a manual [corrected] occupation was strongly associated with mortality from cardiovascular disease: relative rate 1.41 (1.15 to 1.72). Participants' social class at the time of screening was more strongly associated than the other social class indicators with mortality from cancer and from non-cardiovascular, non-cancer causes. CONCLUSIONS: Socioeconomic factors acting over the lifetime affect health and risk of premature death. The relative importance of influences at different stages varies for the cause of death. Studies with data on socioeconomic circumstances at only one stage of life are inadequate for fully elucidating the contribution of socioeconomic factors to health and mortality risk.

Adult↗
PubMed2006

Linkage of survey data with district-level lung cancer registrations: a method of bias reduction in ecological studies.

OBJECTIVE: To investigate a stratified ecological method for reducing ecological bias in studies that use aggregate data, by incorporating information on individual-level risk factors into the analysis. DESIGN: Cross-sectional study investigating associations between socioeconomic risk factors and lung cancer in the north of England, using 1991 UK Census Small Area Statistics and Sample of Anonymised Records with lung cancer registrations from three regional cancer registries for 1993-6. SETTING AND PATIENTS: 92 local authority districts in the north of England containing over three million people aged 45-74 years. RESULTS: Generally, groups considered more socioeconomically disadvantaged had an increased risk of lung cancer across districts. In the standard ecological analysis, effects for non-car ownership, social class III manual, social class IV/V and socioeconomic inactivity were insignificant, suggesting ecological bias. In the stratified ecological analysis these effects became significant (rate ratio (RR) 2.23, 95% confidence interval (CI) 1.79 to 2.78, p<0.001; RR 1.35, 95% CI 1.04 to 1.74, p = 0.022; RR 2.36, 95% CI 1.86 to 2.99, p<0.001; and RR 0.72, 95% CI 0.53 to 0.98, p = 0.039, respectively), and spuriously large positive effects for the social class III non-manual (RR 20.29) and unemployment groups (RR 147.53) reduced to a more reasonable level (RR 1.92, 95% CI 1.46 to 2.52, p<0.001; and RR 2.36, 95% CI 1.22 to 4.55, p = 0.011, respectively). CONCLUSIONS: Stratified ecological analysis incorporating information on individual-level covariates reduced the bias seen in a standard ecological analysis. The method is straightforward to apply and allows the linkage of health data with data from any large-scale complex survey where district of residence is known.

Adult↗
PubMed1996

Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study.

OBJECTIVE: To evaluate the prognostic significance of microalbuminuria and overt diabetic nephropathy and other putative risk factors for cardiovascular and all cause mortality in insulin dependent diabetes. DESIGN: Ten year observational follow up study. SETTING: Outpatient diabetic clinic in a tertiary referral centre. SUBJECTS: All 939 adults with insulin dependent diabetes (duration of diabetes five years or more) attending the clinic in 1984; 593 had normal urinary albumin excretion (< or = 30 mg/24 h), 181 persistent microalbuminuria (31-299 mg/24 h), and 165 overt nephropathy (> or = 300 mg/24 h). MAIN OUTCOME MEASURE: All cause and cardiovascular mortality. RESULTS: Fifteen per cent of patients (90/593) with normoalbuminuria, 25% (45/181) with microalbuminuria, and 44% (72/165) with overt nephropathy at baseline died during follow up. Cox multiple regression analysis identified the following significant predictors of all cause mortality: male sex (relative risk 2.03; 95% confidence interval 1.37 to 3.02), age (1.07; 1.06 to 1.08), height (0.96; 0.94 to 0.98), smoking (1.51; 1.09 to 2.08), social class V versus social class IV (1.70; 1.25 to 2.31), log10 urinary albumin excretion (1.45; 1.18 to 1.77), hypertension (1.63; 1.18 to 2.25), log10 serum creatinine concentration (8.96; 3.34 to 24.08), and haemoglobin A1c concentration (1.11; 1.03 to 1.20). Age, smoking, microalbuminuria, overt nephropathy, and hypertension were significant predictors of cardiovascular mortality. Mortality in patients with microalbuminuria was only slightly increased compared with that in patients with normoalbuminuria. Median survival time after the onset of overt diabetic nephropathy was 13.9 years (95% confidence interval 11.8 to 17.2 years). CONCLUSIONS: Abnormally increased urinary albumin excretion and other potentially modifiable risk factors such as hypertension, smoking, poor glycaemic control, and social class predict increased mortality in insulin dependent diabetes. Microalbuminuria by itself confers only a small increase in mortality. The prognosis of patients with overt diabetic nephropathy has improved, probably owing to effective antihypertensive treatment.

Adult↗
PubMed1991

Differential social support and life change as contributors to the social class-distress relationship in older adults.

Four hypotheses previously put forth to explain the strong association between social class and mental health in the general population were examined in 1,326 older adults (55 years and older). Respondents were interviewed 3 times at 6-month intervals. Lower class was associated with more past life changes (occurring before Wave 1) and more subsequent life events (occurring between Waves 1 and 3); these changes were predictive of distress, supporting the differential exposure hypothesis. Lower class was associated with weaker social support (embeddedness), which was related to distress, supporting the resource deterrent hypothesis. There was little evidence that people of the lower classes were more vulnerable to stress or that their status was due to their weaker social support; thus, the differential vulnerability and applied buffering hypotheses were not consistently supported. Social support does appear to be a versatile resource for older adults. A significant portion of the class-distress relationship was not accounted for by life change, social support, or the interaction between these factors.

Adaptation, Psychological↗
PubMed1986

Occupational mortality from gastric and duodenal ulcer.

The pronounced geographical and temporal variations in gastric and duodenal ulcer suggest that important environmental factors must play a part in their aetiology. To determine the nature of possible factors, the Registrar General's decennial supplement and the vital statistics special reports of the United States Department of Health, Education, and Welfare on occupational mortality were analysed for occupation-specific mortality from peptic ulcer. The data disclose a high mortality from both types of ulcer among manual workers and a low mortality among sedentary occupations. This general pattern runs parallel to a low mortality from gastric and duodenal ulcer among the high social classes and a high mortality in the low social classes. Married women displayed a gradient of gastric ulcer mortality increasing from social class 1 to social class 5 but gave no evidence of social class correlation with respect to duodenal ulcer. The significant correlation between mortality from gastric and duodenal ulcer among different occupations could suggest that both types of ulcer hold some of the precipitating environmental risks in common. In duodenal ulcer the varying extent of energy expenditure among different occupations may be responsible for the different risk of contracting duodenal ulcer and dying from it. The association between energy expenditure and peptic ulcer mortality seems to be less important for gastric ulcer where additional factors associated with social class may also be operating.

Duodenal Ulcer↗