Fredrik Granström1, Anu Molarius2, Peter Garvin3, Sirkka Elo4, Inna Feldman5, Margareta Kristenson6. 1. Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden fredrik.granstrom@dll.se. 2. Västmanland County Council, Competence Centre for Health, Västerås, Sweden. 3. Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden. 4. Örebro County Council, Department of Community Medicine and Public Health, Örebro, Sweden. 5. Uppsala County Council, Department of Development, Uppsala, Sweden Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. 6. Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Abstract
AIMS: Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008. METHODS: Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression. RESULTS: Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH. CONCLUSIONS: Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.
AIMS: Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008. METHODS: Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression. RESULTS: Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH. CONCLUSIONS: Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.
Authors: Lisbeth M Johansson; Hans Lingfors; Marie Golsäter; Margareta Kristenson; Eleonor I Fransson Journal: Health Qual Life Outcomes Date: 2019-02-08 Impact factor: 3.186
Authors: Thaís Lopes de Oliveira; Rosane Harter Griep; Joanna Nery Guimarães; Luana Giatti; Dóra Chor; Maria de Jesus Mendes da Fonseca Journal: BMC Public Health Date: 2019-06-11 Impact factor: 3.295
Authors: Pieter Coenen; Maaike A Huysmans; Andreas Holtermann; Richard Troiano; Paul Jarle Mork; Steinar Krokstad; Els Clays; Willem van Mechelen; Allard J van der Beek Journal: BMJ Open Date: 2018-10-28 Impact factor: 2.692