Background Unfair and avoidable inequalities in health, observed for decades, are pervasive and persistent in the United Kingdom and beyond. Policies that aim to reduce inequalities, or at least improve population health in the last decade have focused disproportionately on individual or behavioural factors, with little positive effect. Studying the health of a socioeconomically homogenous sample of Nurses, with intuitively preferential individual characteristics like high levels of education, can serve as a counterfactual – what would our health, and inequalities by deprivation, look like if we all had similar characteristics?
Methods Individual-level records (n = 478,802) from the nationally representative ONS (England & Wales) and Scottish Longitudinal Studies, linked to an adjusted UK-comparable measure of small-area deprivation have been used to compare self-rated health and inequalities in samples of economically active Nurses and Non-Nurses. Descriptive and correlational statistics have been used to assess the relative homogeneity of Nurses to Non-Nurses as well as wider trends in self-rated health and inequalities based on small-area deprivation. In addition, a logistic regression model was built to estimate the effect of Nurses status on self-rated health whilst adjusting for area deprivation and other potential confounders.
Results Nurses are older, predominantly female and are more socioeconomically homogenous than Non-Nurses measured on individual characteristics such as occupational social class or highest level of education. Nurses are more likely than Non-Nurses to live in the least deprived areas (45% vs. 41%) and report Very Good Self-Rated Health (59% vs. 52%). A social gradient by area deprivation exists for those reporting less than good health in both Nurses (Least deprived – 8%, Most deprived – 10%) and Non-Nurses (Least – 9.9%, Most – 18.4%). However, at each level of deprivation Nurses are less likely to report less than good health than Non-Nurses. A logistic regression model, adjusting for demographic characteristics & area deprivation found that the odds of reporting good or better health for Nurses was 1.33 (SLS - 95% CI 1.19 – 1.49) and 1.41 (ONS LS - 95% CI 1.32 – 1.52) times that of Non-Nurses.
Conclusion Nurses report better self-rated health than Non-Nurses and this persists even after adjustment for socioeconomic and demographic differences. This finding is consistent with analysis showing preferential health behaviours in UK Nurses. However, a social gradient by area deprivation still exists, even for a population with preferential individual socioeconomic characteristics.
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