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PubMed2005

Association between childhood and adulthood socioeconomic position and pregnancy induced hypertension: results from the Aberdeen children of the 1950s cohort study.

BACKGROUND: Pregnancy induced hypertension may indicate a tendency towards endothelial and metabolic abnormalities leading to future cardiovascular disease. Childhood socioeconomic adversity is associated with increased cardiovascular disease risk but the association with pregnancy induced hypertension is unknown. AIM: To examine the association of childhood and adulthood socioeconomic position with pregnancy induced hypertension. DESIGN: Historical cohort study with record linkage to obstetric data. SUBJECTS: 3485 women who were born in Aberdeen between 1950 and 1956 and delivered 7080 viable singleton offspring in the period up until to 1999. MAIN OUTCOME MEASURE: Pregnancy induced hypertension (pre-eclampsia and gestational hypertension) in these women's pregnancies. RESULTS: Neither childhood nor adulthood socioeconomic position were associated with either pre-eclampsia or gestational hypertension. The fully adjusted odds ratio (95% confidence interval) comparing those born in manual social classes to those born in non-manual social classes for pre-eclampsia was 1.10 (0.72 to 1.73) and for gestational hypertension was 1.02 (0.83 to 1.32). Similar results comparing women in manual with non-manual social classes classified at the time of each pregnancy were 1.09 (0.73 to 1.67) for pre-eclampsia and 0.99 (0.81 to 1.30) for gestational hypertension. CONCLUSION: Although imprecise these results suggest that neither childhood nor adulthood socioeconomic adversity is associated with pregnancy induced hypertension.

Adult↗
PubMed1996

Epidemiological study of magnesium status and risk of hypertension in a rural population of north India.

This cross-sectional survey was conducted in two randomly selected villages in Moradabad in North India to demonstrate the association of magnesium status with hypertension in relation to socioeconomic status (SES) in a rural population. There were 1769 subjects (894 males, 875 females) between 25 and 64 years of age, randomly selected and divided into social classes 1-4 depending upon various sociological attributes. The survey methods were a validated questionnaire, blood pressure measurements by mercury manometer, and blood analysis for serum magnesium. Social class 1 and 2 were associated with a greater prevalence of hypertension. The overall prevalence of hypertension diagnosed by JNC-V criteria (> 140/90 mm Hg) was 17.7 per cent (n = 313) and the prevalence was comparable in both sexes and increased with age. Among social class 1 and 2 subjects, there was a higher prevalence of obesity and sedentary lifestyle, a lower intake of dietary magnesium, and a lower serum magnesium compared to social class 3. Logistic regression analysis with adjustment for age showed that SES has a positive relation with hypertension (odds ratio 1.08 men, 1.07 women, P < 0.05), body mass index (odds ratio 1.14 men, 1.13 women, P < 0.01), and sedentary lifestyle (odds ratio 1.38 men, 1.32 women, P < 0.05) in both sexes, and with salt intake in women (odds ratio 1.28, P < 0.05). The odds ratio indicated that a higher intake of magnesium (odds ratio 1.14 men, 1.17 women, P < 0.05) and a higher serum magnesium (odds ratio 1.12 men, 1.15 women, P < 0.05) were associated with a lower risk of hypertension. The findings suggest that social class 1 and 2 subjects in some rural populations of India have a higher prevalence of hypertension and dietary intake of magnesium, and serum magnesium levels were inversely associated with the risk of hypertension.

Adult↗
PubMed2004

Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index.

BACKGROUND: When limited resources are available for orthodontic treatment, it is important that those with the greatest need receive treatment. AIMS: The aims of this study were to determine the orthodontic treatment needs of Nigerian children and young adults attending a University Hospital as outpatients, and to determine if a relationship exists between social class and orthodontic treatment need. METHODS: Of 148 consecutive patients attending a hospital department for orthodontic treatment, 136 were children and young adults (67 males, 69 females) between 6 and 18 years of age. These subjects were assessed with the Dental Aesthetic Index (DAI), and classified into two social classes with the Standard Occupational Classification. RESULTS: Almost 30 per cent of the children and young adults presenting for treatment had "no/little" need of orthodontic treatment, 20 per cent had DAI scores between 26 and 30 indicating that treatment was "elective", 15 per cent had a "desirable" need for treatment, and 35 per cent had a "mandatory" need for treatment. There was a significant association (p < 0.05) between treatment need and social class: more subjects from the lower social classes (semi-skilled and unskilled occupations) needed orthodontic treatment than subjects from the higher social classes (professional, managerial, and skilled occupations). CONCLUSION: The study has shown that not all outpatients presenting/referred for orthodontic treatment "need" treatment. Patients from the semi-skilled and unskilled occupations were more likely to need orthodontic treatment than patients from the professional, managerial and skilled occupations.

Adolescent↗
PubMed2002

Severe tooth loss among UK adults--who goes for oral rehabilitation?

A random probability sample of 2667 United Kingdom (UK) addresses was selected in a multistage sampling process. Participants were interviewed about their oral health status--number of teeth possessed and denture status. In addition information was collected about their socio-demographic characteristics (age, gender, social class and income level) and dental service factors--type of service used and difficulty accessing national health service (NHS) care. The response rate was 70%. Six percent (107) claimed they had less than 20 teeth but did not use a denture. Variations in this practice were apparent in relation to a number of socio-demographic factors: age (P < 0.05), gender (P < 0.01) and social class (P < 0.001) but not service related factors. In regression analysis, social class, gender and age emerged as important predictors of this practice. For example, those from lower social classes were approximately half as likely to use dentures despite experiencing considerable tooth loss (OR=0.53, 95% CI 0.34, 0.83), having controlling for other factors. More than one in 20, in Britain claim they have experienced considerable tooth loss but are without resource to a denture. Socio-demographic factors rather than service related factors are associated with this practice, particularly social class.

Adolescent↗
PubMed2006

Family socioeconomic position at birth and future cardiovascular disease risk: findings from the Aberdeen Children of the 1950s cohort study.

OBJECTIVES: We assessed the association of father's social class, recorded at the time of birth, with coronary heart disease and stroke in a British cohort of 11106 individuals born in the 1950s. METHODS: Survival analysis was used to relate social class at birth to the occurrence of either fatal or nonfatal coronary heart disease or stroke. RESULTS: Rates of coronary heart disease and stroke increased across the social class distribution from highest to lowest, and patterns of association were similar for the 2 outcomes. The gender-adjusted hazard ratio of experiencing either coronary heart disease or stroke comparing the manual and nonmanual social class categories was 1.52 (95% confidence interval [CI]=1.14, 2.02). This ratio fell to 1.41 (95% CI = 1.05, 1.88) after adjustment for indicators of intrauterine and childhood growth. Further adjustment for educational attainment reduced the ratio to 1.28 (95% CI=0.94, 1.75). CONCLUSIONS: We found that social class at birth was associated with risk of fatal and nonfatal cardiovascular disease among individuals born in the 1950s, a period of relative prosperity and after the introduction of the welfare state in Britain. This relation appeared to be mediated in part through educational attainment.

Birth Weight↗
PubMed1991

Labelling of rhinitis and hayfever by doctors.

Factors influencing the labelling of rhinitis by doctors were examined in 7702 adults, aged 16-65 years, registered with a group general practice in south London. Individuals with rhinitis were identified by a postal screening questionnaire. Of the 2969 (39%) subjects who replied, 1309 (44%) reported rhinitis. A sample of 340 individuals with and 126 without rhinitis was studied, each being interviewed and having allergy skinprick tests. The information given at interview was compared with that recorded in the medical notes for 75 patients with rhinitis, selected at random to include 25 with seasonal symptoms only, 25 with perennial symptoms only, and 25 with both seasonal and perennial symptoms, plus 25 control subjects. Hayfever was defined as seasonal symptoms provoked by grass and a positive skin test response to grass pollen. Subjects with seasonal symptoms were nearly twice as likely as those with perennial symptoms to be labelled as having rhinitis by their doctor. More than a quarter of the subjects fulfilling our definition of hayfever had not been diagnosed as having hayfever. Subjects from the upper social classes were more likely than those from the lower social classes to be labelled as having hayfever, though there were no significant differences between social classes in the prevalence of hayfever according to our definition. It is concluded that rhinitis is frequently underdiagnosed and misdiagnosed. Increased detection of hayfever could account for the steep rise in consultation rates seen in recent decades.

Adolescent↗
PubMed2005

Changing socioeconomic inequality in infant mortality in Cumbria.

AIMS: To investigate infant deaths in Cumbria, 1950-93, in relation to individual and community level socioeconomic status. METHODS: Retrospective birth cohort study of all 283,668 live births and 4889 infant deaths in Cumbria, 1950-93. Community deprivation (Townsend score) and individual social class were used to estimate socioeconomic status. Logistic regression was used to investigate risk of infant death (early neonatal, neonatal, and postneonatal) in relation to social class and Townsend deprivation score, adjusting for year of birth, birth order, multiple births, and stratified by time period, 1950-65, 1966-75, 1976-85, 1986-93. RESULTS: The risk of infant death in all categories was higher in the lower social classes and more deprived communities, although inequality in risk of neonatal death declined after 1975 to such an extent that there was no significant difference in neonatal death rates by socioeconomic status in the most recent time period. By contrast, there was no narrowing in socioeconomic inequality in postneonatal death risk over the study period. Community deprivation was associated with a significant increased risk of postneonatal death after adjusting for individual level socioeconomic status. CONCLUSIONS: Postneonatal deaths remain higher in the most deprived communities and in the more disadvantaged social classes. The social, lifestyle, and environmental determinates of adverse health outcomes for children need to be fully understood, and interventions should be designed and targeted at the more socially deprived sectors of our community.

England↗
PubMed2001

Health-related mobility, health inequalities and gradient constraint. Discussion and results from a Norwegian study.

BACKGROUND: Recent studies have argued that health-related mobility does not widen social class health differentials, but rather moderates them. This is termed gradient constraint. This paper examines gradient constraint from a theoretical and empirical angle. METHODS: How health-related mobility influences social class health differentials is discussed using hypothetical models. In a Norwegian survey with data on intergenerational mobility (N = 1,853 males aged 30-69 years), mean health and height values for different subsections of the sample were analysed. RESULTS: When initial social class health differences are large and mobility widespread, health-related mobility may lead to smaller differentials, but the result depends on how closely mobility varies with health. This empirical study found non-significant increases in height and health differentials from class of origin to class of destination. The interpretation has to consider effects of both social mobility and social causation. Health is measured in the post-mobility situation and the effects of social mobility and social causation are difficult to separate from each other for most of the health indicators analysed. However, this limitation does not apply to height which is not influenced by social causation during adulthood. In these data mobility did not reduce the height differential. CONCLUSION: Health-related mobility can either lead to smaller or larger social class health differentials. The specific effects of social mobility cannot be determined without knowing how social causation has interfered. The intergenerational mobility process analysed in this paper does not show gradient constraint as regards the height differential between the worker and higher occupational categories.

Adult↗
PubMed1998

Class, health and justice.

Class inequalities in health are intuitively unjust. Although the link between social class and health status has been fully documented, the precise nature of the injustice has not been made clear. Four alternative views are presented, corresponding to four goals: (1) maximizing the sum total of health; (2) equalizing the health status of higher and lower social classes; (3) maximizing the health status of the lowest social class; and (4) maximizing the health status of the sickest individuals in society. The nature of the injustice is further obscured by several theoretical and empirical questions, like the degree and significance of personal responsibility for illness and the relation of the degree of economic inequality to sum total of health.

Health Care Rationing↗
PubMed1999

Inequalities in oral health: a review of the evidence and recommendations for action.

Reducing inequalities in health has become one of the main health policy issues in the late 1990s. The Labour Government set up an independent inquiry into inequalities in health under Sir Donald Acheson to make recommendations on approaches to reducing health inequalities. This paper reviews the evidence on inequalities in oral health in Britain. Dramatic improvements in dental health in children and young adults have taken place in the past 30 years. The levels of caries in permanent teeth of children is low. Widening inequalities in oral health however exist between social classes, regions of England, and among certain minority ethnic groups in pre-school children. The main social class and minority ethnic differences in dental caries is in pre-school children. Wide district and regional differences also exist in prevalence of caries in young children. The area differences relate very strongly to deprivation. In adults the differences in decay experience is less unequal than in children but there are marked social class inequalities in edentulousness. Dental caries decreased in all social classes in the United Kingdom. The main causes of the inequalities are differences in patterns of consumption of non milk extrinsic sugars and fluoridated toothpaste. Improvements in oral health that have occurred over the last 30 years have been largely a result of fluoride toothpaste and social, economic and environmental factors. Oral health inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy. Treatment services will never successfully tackle the underlying cause of oral diseases.

Adult↗
PubMed1979

Epidemiology of myelomeningocele in Utah.

This study suggests that in the Intermountain area of the United States (Utah, Wyoming, Idaho and Montana) there is an effect of social class on the incidence of myelomeningocele: the higher the social class the less the incidence. This survey also suggests that there is an influence from the social class in which the mother was raised, as well as that into which she marries. Birth order and maternal age were found to have no influence on the incidence of myelomeningocele in this study.

Birth Order↗
PubMed2005

The usefulness of area-based socioeconomic measures to monitor social inequalities in health in Southern Europe.

BACKGROUND: The study objective was to investigate the association between health outcomes and several small-area-based socioeconomic measures and also with individual socioeconomic measures as a check on external validity. METHODS: Cross-sectional design based on the analysis of the Barcelona Health Interview Survey of 1992. A representative stratified sample of the non-institutionalised population resident in Barcelona city (Spain) was obtained. The present study refers to the 4171 respondents aged over 14. We studied perceived health status, presence of chronic conditions and smoking as health outcomes. Area socioeconomic measures (1991 census) were generated at census tract level and individual socioeconomic measures were educational level and social class obtained through the survey. RESULTS: With individual socioeconomic measures we observed that the lower the educational level or social class, the higher the probability of reporting a perceived health status of fair, poor or very poor and of presenting some chronic condition. With regard to smoking, among men this trend was similar [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.2-1.9 in social classes IV-V with respect to social classes I-II], while among women it was reversed (OR = 0.7; 95% CI = 0.5-0.9). With the different area-based socioeconomic indicators differences were also observed in this sense, with the exception of smoking in women for which these indicators do not show any differences by socioeconomic level. CONCLUSIONS: With several census area-based socioeconomic measures similar effects on inequalities in health have been observed. In general, these inequalities were in the same sense as those obtained with individual-based measures. Small-area-based socioeconomic measures from the Spanish census could greatly enhance analysis of social inequalities in health, overcoming the absence of socioeconomic data in public health registries and in medical records.

Adolescent↗
PubMed1994

[Atherogenic food habits of population groups in a metropolitan area of southeastern Brazil].

This present study is one part of the project "Atherosclerotic cardiovascular diseases, lipemic disorders, hypertension, obesity and diabetes mellitus in a population of the metropolitan area of S. Paulo, Brazil" undertaken in Cotia county. An alimentary inquiry based on the alimentary history of the individual was carried out among a subsample of the population (568 individuals). The objectives of the inquiry are the following: a) the identification of the atherogenic potential of the diets of different human groups, stratified according to social class and b) the analysis of consumption differentials of some nutrients, which confer atherogenicity to the diet, as between social classes. The consumption differentials were analyzed as between men and women, by social class and taking the 50th percentile (P50) of the sample as the standard of reference, with regard to the following dietary constituents: energy, total proteins, proteins of animal origin, percentages of protein calories (P%), fatty acids, fats (F%) and carbohydrates (CH%). Also, according to this criterion, some diet profiles were analyzed in the light of the recommendations of the National Cholesterol Education Program (NEP) as regards the calorie supplied by fats (F%), saturated fatty acids (SFA%), carbohydrates (CH%) and cholesterol (> 300 mg/day). The following were the findings obtained: the consumption differentials were more pronounced among the men. The social class which presented the largest percentages above the P50 of the sample, with regard to energy, total proteins, fats and carbohydrates, were the non-specialized workers, i.e. the manual laborers who have a high expenditure of energy, an that of small property owners and shop-keepers who lead a sedentary life. The class of the greatest acquisitive power and highest educational level presented a moderate consumption of these constituents. On the other hand, the consumption of the proteins of animal origin, above the P50, among men and women, maintained a direct relationship with socioeconomic level. The proportion of calories coming from fats (F%) and protein (P%) was directly proportional to the acquisitive power of the class, while that of carbohydrates (CH%) presented an inverse relationship. On the other hand, the consumption of cholesterol in excess of 300 mg/day was found to between 37 and 50% and 20 and 32% for men and women, respectively. The percentage of diets with more than 30% of calories coming from fats (F%) varied from 25 to 40% for men and 45 to 50% for women. The participation of the saturated fatty acids (SFA%) in proportions greater or equal to 10 was relatively low for both sexes: being of 5 to 17% for the men and of less than 10% for the women. The percentages of cases in the relationship saturated to unsaturated fatty acids (SFA/UFA) maintaining values less than 1% was also low for the population in general, being of 7 and 22% for the men and less than 10% for the women. It is concluded that diet probably is an important risk factor in cardiovascular diseases, lipemic disorders, obesity and hypertension, for a large part of the population, mainly for the small property owners and shop-keepers, is viable.

Brazil↗
PubMed1991

Low birthweight, preterm, and small for gestational age babies in Scotland, 1981-1984.

STUDY OBJECTIVE: The aim was to examine the effect of maternal age, gravidity, marital status, previous perinatal deaths, and parental social class on babies born low birthweight, preterm, and small for gestational age. DESIGN: The study used data on discharge summaries from all maternity hospitals in Scotland. SETTING: The study was based on all singleton deliveries in Scotland. PARTICIPANTS: The analysis involved information on 259,462 singleton babies born during the four years 1981-84 in Scotland. MEASUREMENTS AND MAIN RESULTS: Previous perinatal death was found to be the strongest predictor for both preterm and low birthweight. Single mothers were at particularly high risk of having a small for gestational age baby and those who were previously married of having a preterm baby. Women aged less than 20 years old, those over 34 years old, nulligravidae, and those of parity 3 or more were also at increased risk of adverse pregnancy outcome. Mothers and fathers in manual social classes and those who could not be assigned a social class on the basis of their occupation were at increased risk for all three adverse outcomes studied. The babies of parents who were in manual occupations were twice as likely as those of parents in non-manual occupations to be small for gestational age and almost twice as likely to be low birthweight. CONCLUSIONS: Mother's social class is a risk factor for adverse pregnancy outcome independent of maternal age, parity, and adverse reproductive history, and also independent of father's social class. Information on both parents' occupations should be collected in maternity discharge systems.

Female↗
PubMed2005

Social mobility, marital status, and mortality risk in an adult life course perspective: the Malmö Preventive Project.

AIMS: Adverse social factors predict increased mortality. This study aimed to assess the influence of social class and marital status on mortality, adding an adult life course perspective. METHODS: In total, 32,907 males and 20,204 females were evaluated based on census data in Malmö, Sweden. Of these subjects, 22,444 males and 10,902 females also took part in health screening. The main outcomes were all-cause and cause-specific mortality rates in subgroups based on social class and marital status, either measured once or repeatedly in adult life. Results were based on a total of 522,807 years of follow-up in men (5,761 deaths) and 239,815 in women (1,354 deaths). RESULTS: Total and cardiovascular mortality were significantly higher in manual male employees with age-adjusted risk ratios (RR) of 1.7 (95% CI 1.5-1.9) and 1.6 (1.3-2.0) in skilled manual workers, and 2.0 (1.7-2.2) and 1.9 (1.6-2.3) in unskilled manual workers, compared with high-level non-manual employees. The differences remained after adjustment for baseline risk factors and prevalent cardiovascular disease, and were similar for women. Increased mortality risk was also documented for subjects who were divorced or unmarried (adjusted for social class), as well as being downward socially mobile or in a permanent low social class (manual) position. CONCLUSIONS: Social class based on occupation, either measured once or repeatedly in adult life, is associated with marked differences in mortality risk in middle-aged subjects. People who remain married/cohabiting or remarry are at lower risk of early death than people who remain unmarried or divorced.

Adult↗
PubMed1995

Social variation in attitudes to obesity in children.

OBJECTIVE: To evaluate variations in children's attitudes to obesity in relation to age, gender and social class. DESIGN: Evaluation of sex, age and social class differences in judgements of figure drawings varying in body shape. SUBJECTS: 180 children aged from 4-11 from six schools, varying in the social background of their pupils. MEASUREMENTS: Self ratings of body shape, choices of ideal body shape now and in adulthood from a range of line drawings of figures varying in fatness, and behavioural and personality stereotype judgements of illustrations of thin, average and fat children. RESULTS: Few children in this age group were fat and few felt too fat; though a substantial minority felt too thin. Girls selected thinner ideal figures than boys. Children demonstrated strongly negative attitudes to obesity, which were less favourable among those who were older and from the higher social status schools. CONCLUSION: There are significant social variations in attitudes to obesity which might be important in understanding variations in the prevalence of obesity and weight control practices.

Aging↗
PubMed1999

[Screening and management of visual disorders in adolescents: impact on social inequality].

A retrospective cohort study was carried out on a sample of 2625 Belgian's children, examined at 12 and 15 year, to analyze the impact of school visual screening on social inequalities for visual acuity. Although uncorrected visual acuity decreased with increase in social class, visual acuity tested with the child's usual correction increased with social class. This social inequalities became more pronounced 2 years after the school visual screening. The lack of accessibility at some levels of health care cancels the reduction of inequalities expected from the school screening.

Adolescent↗
PubMed2004

The irritable bowel syndrome has origins in the childhood socioeconomic environment.

BACKGROUND: The childhood socioeconomic environment has been linked to adult health status in several studies. However, its role in the pathogenesis of adult irritable bowel syndrome (IBS) remains unknown. We aim to assess the influence of the childhood environment on adult IBS, using data from a New Zealand birth cohort study. METHODS: The Dunedin birth cohort was assembled in 1972-1973 and has been followed prospectively to age 26 (n = 980). IBS was classified according to both Rome and Manning criteria, using self-reported symptom data obtained at age 26 yr. Childhood social class was used as a proxy measure of the quality of the childhood socioeconomic environment and was assigned according to the highest average socioeconomic (SES) level of either parent from interviews across the first 15 yr of life. RESULTS: Childhood social class was significantly associated with IBS according to Manning Criteria (p = 0.05) and Rome II Criteria (p = 0.05). The prevailing trend was identical for both measures of IBS in the sex-adjusted models: this trend can be characterized as a general, and near-linear decrease in the odds of IBS across decreasing levels of social class. Contrasts with the reference group were significant on all comparisons for Manning Criteria IBS (high vs upper middle, p = 0.04; lower middle, p = 0.04; low, p = 0.01), and on comparisons involving the two lower social class groups for Rome II Criteria IBS (high vs lower middle, p = 0.03; low, p = 0.03). The associations were attenuated, but not eliminated by further adjustment for adult social class. CONCLUSIONS: An affluent childhood environment is an independent risk factor for adult IBS.

Adult↗