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Self-rated life expectancy and lifetime socio-economic position: cross-sectional analysis of the British household panel survey.

BACKGROUND: The association between mortality risk and socio-economic position (SEP) across the lifecourse is established. This study investigates whether people's own ratings of their life expectancy are also associated with lifetime SEP. Health behaviour messages, which often emphasize the long-term benefits of behavioural change, may be received differently depending on people's perceptions of their life chances. METHODS: Cross-sectional analysis of 4780 adults aged 25-64 interviewed in the British Household Panel Survey in 2001. RESULTS: Just under a quarter of respondents did not think it likely they would live to 75 or older. People in lower SEPs were more likely to be pessimistic about their life expectancy. This applied across a number of socio-economic measures (father's social class, educational achievement, own social class, and household income). Eight socio-economic lifecourse pathways were compared. In comparison to those following the most advantaged pathway, those experiencing sustained socio-economic disadvantage were most likely to be pessimistic about their longevity, but those experiencing sustained upward mobility did not differ. Comparisons with measures of self-rated general health and limiting illness suggest that self-rated life expectancy is at least partially independent of current health status. CONCLUSIONS: This study shows that people's own perceptions of their life expectancy are associated with lifetime SEP. Self-rated life expectancy, in part, appears to reflect something over and above current health status and smoking behaviour. Given its ease of collection, it would be informative to include self-rated life expectancy in future studies.

Adult↗

Trends of sinusitis in Ibadan, Nigeria.

Sinusitis occurs frequently, complications are infrequent since the introduction of antibiotics and mortality has also decreased significantly for same reason. A retrospective study of 90 patients with sinusitis seen over a 10 year period between 1988 and 1997 in the E. N. T. Department, University College Hospital, Ibadan was done to highlight the general direction and tendency of sinusitis in our environment. There were 50 (56%) males and 40 (44%) females. The average age was 33 years and 70% were under the age 40 years, showed that sinusitis affects mostly children and young adults. 38% in social class V while 10% social Class I. Chronic sinusitis was 93%, acute sinusitis 7% (both types unisinusitis 56%, pansinusitis 29%, multisinusitis 16%). All the cases of unisinusitis were maxillary sinusitis. 85 (94%) had surgical treatment (antrostomy 64%, Fronto ethmoi-dectomy 15%, Caldwell-Luc's 13%, antral lavage 13%). 80 (94%) patients are alive and well after 2 years of follow up, 5 (6%) lost to follow up. Complications arising from sinusitis was seen affecting the orbit in 41%--the largest, followed by sinus wall 32%, no ear complications seen. Thirteen (14%) of the sinusitis cases associated with allergy only, 24 (27%) with polyps only, 6 (1%) with both allergy and polyps. It stresses the interwoveness of these entities (allergy, Polyps, sinusitis)--one predisposes to the other. Thus with these trends of sinusitis being highlighted, it is hoped that this would enhance our knowledge of the pathology, diagnosis and treatment of sinusitis.

Acute Disease↗

Blood lipid associations in 18 year-old men.

The association of cigarette smoking, physical activity at work, and social class with total cholesterol and with high and low density lipoprotein cholesterol were examined in a random sample of 238 males, of 18 years of age, of Rosario, Argentina. The mean (mg/dl) total serum cholesterol of the whole sample was 174.7, the high density lipoprotein cholesterol 52.8, and the low density lipoprotein cholesterol 121.5. Black tobacco consumers, evenly distributed by social class, had higher levels of total and low density lipoprotein cholesterol. Total cholesterol was higher in the high social class, differently from what smokers' distribution by social class, would lead one to expect. While a highly negative association was found between social class and physical activity at work, there were no significant differences in lipoprotein levels between manual and non-manual workers. It is possible that the nutritional differences by social class still prevail over the smoking habit in their influence on the lipoprotein levels in these subjects.

Adolescent↗

Socio-economic and ethnic factors in stillbirth and neonatal mortality in the NE Thames Regional Health Authority (NETRHA) 1983.

All stillbirths and neonatal deaths occurring in the North East Thames region were studied in 1983. This report describes the socio-economic and ethnic differences in that cohort. The stillbirth and neonatal mortality rates of babies born to fathers of social class V (16.8 per 1000 total births) was almost double that of social class I fathers (8.6 per 1000 total births). The most marked social class gradient was seen in the macerated stillbirth groups. Of particular concern was the extremely high stillbirth and neonatal mortality rate for women born in the Indian subcontinent. This was most evident in Pakistani women who had a stillbirth plus neonatal mortality rate of 17.3 per 1000 total births, almost twice that of the women born in the UK (9.0 per 1000 total births). Again, as with social class, macerated stillbirths appeared to contribute disproportionately to the excess mortality. Mortality rates were aggregated into four birthweight specific groups. Asian women had higher mortality rates in the higher birthweight groups, whereas in the lower birthweight group their babies did slightly better. This study indicated that the special needs for working class and ethnic minority mothers within NE Thames were not being met, and the Regional Health Authority was strongly recommended to review services to these groups.

Adult↗

Different social network and social support characteristics, nervous problems and insomnia: theoretical and methodological aspects on some results from the population study 'men born in 1914', Malmö, Sweden.

A representative sample of 68-year-old men in the Swedish city of Malmö, were interviewed in detail regarding their social network, social support and social influence as a part of an extensive examination of their health status. Emphasis in this paper is put on the definition and operationalization of different social network, social support and social influence characteristics included in a tentative model. The reliability and validity of the different social network, social support and social influence indices are analyzed and discussed. The relation between the different indices and marital status and social class are analyzed implying that men living alone and men in the lowest social class have the most insufficient social network, social support and social influence. The indices were then used in an analysis of nervous problems and insomnia. Social anchorage, social participation and contact frequency, all subconcepts of social network, had independent associations with mental health in this cross-sectional study. The addition of the social network, social support and social influence indices to social class and marital status gives a more differentiated and thereby a more valid picture of the association between the psychosocial environment and this type of mental health problems.

Aged↗

Are increases in cigarette taxation regressive?

Using the latest published data from Tobacco Advisory Council surveys, this paper re-evaluates the question of whether or not increases in cigarette taxation are regressive in the United Kingdom. The extended data set shows no evidence of increasing price-elasticity by social class as found in a major previous study. To the contrary, there appears to be no clear pattern in the price responsiveness of smoking behaviour across different social classes. Increases in cigarette taxation, while reducing smoking levels in all groups, fall most heavily on men and women in the lowest social class. Men and women in social class five can expect to pay eight and eleven times more of a tax increase respectively, than their social class one counterparts. Taken as a proportion of relative incomes, the regressive nature of increases in cigarette taxation is even more pronounced.

Adult↗

[Not Available].

Using the data basis of the Mannheim Cohort Study the present paper investigates the correlation between socio-economic Status and psychogenic impairment due to predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative adult Community sample. The period of observation amounted up to 11,1 years. Subjects investigated within our follow-up study for this interval (n=301) were drawn from an representative adult Community population sample (N=600). Within the three step class model members of the lower class were at all investigation time points significantly stronger impaired compared to the members of the middleand upper class. Investigating the clinical impairment related to the intragenerative class mobility those subjects, which could achieve a social rise between two points of investigation were even prior, to the first investigation time point, less affected compared to the ones remaining in their social class. Vice versa subjects in the process of an social decline presented a stronger psychogenic impairment prior to their decline compared to those, which remained stable in their social class. These dynamic correlations offer evidence for the effect of the socalled "drift-hypothesis", which postulates, that persons due to their disease decline in their social Status respectively after improving rise to a higher social class.

Epidemiology↗

Explaining the social gradient in smoking in pregnancy: early life course accumulation and cross-sectional clustering of social risk exposures in the 1958 British national cohort.

Smoking in pregnancy is a major determinant of low birthweight and a range of adverse infant health outcomes. There is a well-established social gradient in smoking in pregnancy in the US and northern Europe. Social gradients in health-related behaviours may result from longitudinal accumulation and cross-sectional clustering of social risk exposures. There is, however, no published confirmation of this explanation in empirical data with smoking in pregnancy as the outcome. This study aimed to test the effects of longitudinal accumulation and cross-sectional clustering of social risk exposures on smoking in pregnancy using data on the first pregnancies of 3163 female members of the 1958 British national cohort. Social class at birth and aged 11 years was used to create three dichotomous variables representing cumulative social class (both manual, one manual and one non-manual, both non-manual) early in the lifecourse. Cross-sectional clustering of social risk was represented by four dichotomous variables created from combinations of maternal age (<20 vs. 20+), own social class (manual vs. non-manual) and educational attainment (low vs. other). Cumulative social class in early childhood was associated with smoking in pregnancy in bivariate analysis but not after adjustment for cross-sectional clustering of social risk exposures. However, women who had been in the manual social groups at birth and 11 years were at increased risk of cross-sectional clustering of social risk exposures around pregnancy suggesting a pathway from early lifecourse risk exposure to social risk factors associated with a high risk of smoking in pregnancy. These findings suggest that the social gradient in smoking in pregnancy results from longitudinal accumulation and cross-sectional clustering of social risk exposures. Interventions aimed at reducing social inequalities in smoking in pregnancy need to account for cumulative and cross-sectionally clustered effects of social risk exposures.

Adolescent↗

The disadvantage of being advantaged?--on a social gradient in excess mortality among alcohol abusers.

Do alcohol abusers from upper social classes have a more elevated excess mortality than alcohol abusers from lower social classes? This question was empirically assessed by analyses on data from a 40-year prospective study of more than 40,000 Norwegian conscripts on whom data on social class (i.e. educational level), alcohol abuse (admission to treatment) and cause specific mortality before the age of 60 years were available. The results demonstrated a social gradient in excess mortality: relative risk of premature death was 2.7 among those with the lowest educational level (primary school only) increasing to 6.2 among those with the highest educational level at conscription (grammar school). Among the alcohol abusers the risk of premature death, was slightly, but not significantly higher among those highly educated as compared to those with less education. Thus, alcohol abuse was not only found to elevate the individual's risk of premature death, but it also appeared to outweigh the advantages of those more socially privileged with respect to health and mortality. The question as to whether social class differences in selection to treatment could account for the observed social gradient in excess mortality is focused in the discussion.

Adult↗

Childhood IQ and social factors on smoking behaviour, lung function and smoking-related outcomes in adulthood: linking the Scottish Mental Survey 1932 and the Midspan studies.

OBJECTIVE: To investigate the associations of childhood IQ and adult social factors, and smoking behaviour, lung function (forced expiratory volume in one second; FEV(1)), and smoking-related outcomes in adulthood. DESIGN: Retrospective cohort study. METHOD: Participants were from the Midspan prospective studies conducted on Scottish adults in the 1970s. The sample consisted of 938 Midspan participants born in 1921 who were successfully matched with their cognitive ability test results on the Scottish Mental Survey 1932. RESULTS: Structural equation modelling showed that age 11 IQ was not directly associated with smoking consumption, but that IQ and adult social class had indirect effects on smoking consumption via deprivation category. The influence of IQ on FEV(1) was partly indirect via social class. Gender influenced smoking consumption and also IQ and social class. There was a 21% higher risk of having a smoking-related hospital admission, cancer, or death during 25 years of follow-up for each standard deviation disadvantage in IQ. Adjustment for adult social class, deprivation category, and smoking reduced the association to 10%. CONCLUSION: Childhood IQ was associated with social factors which influenced lung function in adulthood, but was not associated directly with smoking consumption. In future studies, it is important to consider other pathways which may account for variance in the link between childhood IQ and health in later life.

Adult↗

Growth of children from 0-5 years: with special reference to mother's smoking in pregnancy.

A cohort of 1163 pregnant women in two small towns in South Wales, UK, was identified and followed until the children born to them were five years of age. Growth in these children is described and a number of determinants identified. Social-class differences were very small at birth but differences in height became clear by the age of two years and in head circumference before this. In height the differences were largely accounted for by greater growth in social class I, but there was a gradient in head circumference throughout all the social classes. The social class effects gradually increased as the children became older. Parity of the mothers had a small effect on size at birth but age of the mother had no effect once parity was allowed for. Data on illnesses in the children were collected but no effect on growth could be detected. By far the most important determinant of growth which could be controlled is maternal smoking. About 40% of the women smoked, about 17% heavily (15 or more cigarettes per day) and the prevalence of smoking altered little during pregnancy. There was a graded effect of smoking on growth up to a 9% deficit in birth-weight, a 2% deficit in length at birth and a 1.5% deficit in head circumference in the babies born to the mothers who smoked most heavily (25 or more cigarettes per day) compared with non-smokers. There effects decreased with age but there were still residual effects at age five years.

Adult↗

Association of adult socioeconomic position with hypertension in older people.

OBJECTIVE: To determine the role of obesity, adult behavioural risk factors, and markers of specific childhood exposures in the association between adult socioeconomic position and hypertension in a cohort of people aged 60 years and older. DESIGN: Cross sectional study. SETTING: Spain. PARTICIPANTS: 4009 subjects representative of the Spanish non-institutionalised population aged 60 years and older. MAIN OUTCOME MEASURE: Prevalence of hyperteMarinhonsion according to education and social class, and proportion of excess difference in hypertension prevalence in lower socioeconomic groups explained by different risk factors for hypertension. RESULTS: The highest prevalence of hypertension was seen in subjects with less education and in those belonging to a low social class. In men, the hypertension risk factors analysed did not explain the difference in prevalence by education, but they explained almost half of the difference by social class. In women, these risk factors explained the differences in hypertension prevalence by education and a substantial part of the differences by social class. Central and general obesity, and physical inactivity were the risk factors that were the most important in this association in women. CONCLUSIONS: In women, socioeconomic position has no direct effect on hypertension in the case of education and only a small effect in the case of social class. In contrast, most of the effect of education and half of the effect of social class on hypertension in men is direct or, at least, is not explained by the risk factors analysed. The mechanisms that can explain the association between socioeconomic position and hypertension in older men remain to be established.

Aged↗

[Social differences in the prenatal and postnatal mortality: Switzerland 1979-1985].

The influence of social factors on birthweight and fetal and infant mortality was investigated in the Swiss birth cohort from 1979-85 (N = 519,933). The proportion of newborns with low-birthweight (less than 2500 g) was higher in lower social classes. Stillbirth-rate, neonatal and postneonatal mortality were higher in lower social classes, too. When controlling for birthweight, the increase in mortality in the lower social classes became somewhat less striking. Marked social differences in perinatal mortality were found in the newborns with normal weight, whereas almost no difference could be detected in the low-birthweight-group.

Birth Weight↗

Socioeconomic differences in childhood hospital inpatient service utilisation and costs: prospective cohort study.

STUDY OBJECTIVE: To examine the association between socioeconomic position at the time of birth and the use and cost of hospital inpatient services during the first 10 years of life. DESIGN: Analysis of a database of linked birth registrations, hospital records, and death certificates. Associations between the social class of the head of household and hospital inpatient service utilisation and costs during the first 10 years of life were analysed using multilevel multiple regression modelling. PARTICIPANTS AND SETTING: All 117 212 children born to women who both lived and delivered in hospital in Oxfordshire or West Berkshire, southern England, during the period 1 January 1979 to 31 December 1988. MAIN RESULTS: The study showed that children born into social classes II, III-NM, III-M, IV, and V were more likely to be admitted to hospital, spend longer in hospital overall, and generate greater hospital costs than children born into social class I. The adjusted effect regarding hospital inpatient admissions, days, and costs was 1.27 (95% CI: 1.26, 1.27), 1.20 (1.19, 1.21), and 1.50 (1.49, 1.53), respectively, for children born into social class V when compared with children born into social class I. The impact of social class on hospital inpatient admissions, days, and costs was most acutely felt during years 3-10 of life as compared with the first two years of life. CONCLUSIONS: Health service decision makers need to be alert to the adverse sequelae that might result from socioeconomic disadvantage when planning health services for children. Particular attention should be paid to targeting deprived populations with prevention interventions that are known to be effective.

Child↗

Child to adult socioeconomic conditions and obesity in a national cohort.

OBJECTIVE: Critical stages in childhood are suspected for adult obesity. We sought to identify (i) whether risk of adult obesity is influenced by childhood socioeconomic conditions in addition to those in adulthood; and (ii) whether conditions in childhood act independently or through their association with education or parental obesity. DESIGN: Longitudinal, 1958 British birth cohort. SUBJECTS: A total of 11 405 men and women followed to age 33 y. MEASUREMENTS: Social class at birth and ages 7, 11, 16, 23 and 33 y. Obesity (BMI> or =30) at age 33 y. RESULTS: Social class was related to obesity, cross-sectionally at ages 16 (women), 23 and 33 y, but not at younger ages. In analysis of adult obesity (age 33 y) and social class at five life stages, class at age 7 y significantly predicted obesity for women (adjusted odds ratio (OR)=1.31, that is, the odds increased by 31% for each decrease in social class). For men, class at birth and age 23 y predicted adult obesity (adjusted OR=1.19 and 1.16, respectively). Education was also associated with adult obesity, increasing the odds by 30% (men) and 35% (women) for each decrease in qualification level. Adjustment for education level and parental BMI did not abolish the effect on adult obesity of class at age 7 y among women, nor of class at birth among men, while class at age 23 y reduced to borderline significance. CONCLUSIONS: Cross-sectional associations for social class and obesity can be misleading and obscure effects of childhood socioeconomic conditions. Influences around birth to age 7 y have a long-lasting impact on the risk of adult obesity.

Adolescent↗

Narrowing social inequalities in health? analysis of trends in mortality among babies of lone mothers (abridged version 2)

Objectives: To examine trends in mortality among babies registered solely by their mother (lone mothers) and to compare these with trends in infant mortality for couple registrations overall and couple registrations subdivided by social class of father. Design: Analysis of trends in infant death rates from 1975 to 1996 for the three groups. The data source was the national linked infant mortality file, containing all records of infant death in England and Wales linked to the respective birth records. Setting: England and Wales. Participants: All live births (n=14.3 million) from 1975 to 1996; all deaths of infants from birth to 12 months of age over the same period (n=135 800). Main outcome measures: Death rates in the perinatal, neonatal, and postneonatal periods and for infancy overall. Results: For the babies of lone mothers infant mortality has fallen to less than a third of the 1975 level, with a clear reduction in the gap between the mortality in these babies compared with all couple registrations: the excess mortality in solely registered births was 79% in 1975 reducing to 33% in 1996. Most of the narrowing of the sole-couple differential was associated with the neonatal period, for which there is now no appreciable gap. For couple registrations analysed by social class of father, infant death rates have more than halved in each social class from 1975 to 1996. The reductions in mortality were greater in the late 1970s and early 1990s. Infant death rates in classes IV-V remained between 50% and 65% higher than in classes I-II. Differentials between social classes were largest in the postneonatal period and smallest in the perinatal and neonatal periods. The gap in perinatal and neonatal mortality between the babies of lone mothers and couple parents in social classes IV-V has disappeared. Conclusions: The differential in infant mortality between social classes still exists, whereas the differential between sole and couple registrations has decreased, showing positive progress in the reduction of inequalities. As the reduction in the differential was confined to the neonatal period these improvements may be more a reflection of healthcare factors than of factors associated with lone mothers' social and economic circumstances.

Journal Article↗

Time trends in socio-economic differences in incidence rates of cancers of the breast and female genital organs (Finland, 1971-1995).

The magnitude of socio-economic differences in health varies between societies, and over time within societies. Even in the Nordic countries, where socio-economic differences are not as striking as elsewhere, such differences have been observed. We have studied social class variation among 45- to 69-year-old Finns during 1971-1995 in the incidence of cancers of the breast, ovary, corpus and cervix uteri, vulva and vagina, by means of a computerised record linkage of the Finnish Cancer Registry and the 1970 Population Census, which included social class data. Cancers of cervix uteri (both invasive and in situ) and vagina were associated with low social class. Cancers of the breast (both in men and women) were most common in high social classes throughout the whole observation period 1971-1995, whereas for cancer of the corpus uteri, the positive social class association disappeared in the early 1980s. For cancer of the vulva and ovary, no clear differences by social class were observed. We believe that socio-economic differences usually point to life styles or life conditions (e.g., reproductive patterns, viral infections, diet, physical activity, prevalence of overweight and obesity, smoking and alcohol consumption or combinations of these factors) that may be risk factors for the specific cancers studied.

Aged↗

Marital status: association with social and economic circumstances, psychological state and outcomes of pregnancy.

We examined the association of marital status with economic, social and psychological factors and with the outcomes of pregnancy (defined as onset of labour, type of delivery, live and still births and birthweight). The study population was 1431 white women consecutively booking for antenatal care. Birth registrations were inspected. Of 278 women who were unmarried during pregnancy, 61 per cent were cohabiting, 26 per cent were living with adults other than the father and 13 per cent were living alone. Compared with the married women, unmarried women overall were, on average, younger, less educated, of lower social class, in poorer economic circumstances, more dependent on state support and less satisfied with their living arrangements. Irrespective of age and social class, they were less likely to have planned the pregnancy, more likely to smoke and drink, to book later for antenatal care and to miss more appointments. In general, unmarried women were more likely to have some indication of depression and to experience more serious life events during the pregnancy. Controlling for age and social class, the categories 'married', 'cohabiting' and 'on their own' showed significant trends from best to worst. Those living with adults other than the father showed intermediate results. There were no significant effects of marital status, controlled for age and social class, and associated social, economic and psychological circumstances on outcomes of pregnancy. Forty-one per cent of births to women on their own, 35 per cent to women living with other adults and 11 per cent to women cohabiting during pregnancy were registered by only one parent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗