EVIDENCE ON INEQUALITY IN HEALTH FROM A NATIONAL SURVEY

doi:10.1016/S0140-6736(87)93062-5

The Lancet

Volume 330, Issue 8549, 4 July 1987, Pages 30-33

https://doi.org/10.1016/S0140-6736(87)93062-5 Get rights and content

Abstract

The debate about social inequality in health in Britain has so far been based principally on mortality rates. A survey of morbidity and fitness in a large representative sample of adults living in private households in England, Wales, and Scotland reveals striking differences between social classes in self-defined health status, the reported incidence of illness, the prevalence of chronic disease, and measured physiological fitness. The disadvantage in health status does not simply relate to a minority in the poorest social circumstances but appears to be related in a very regular way-to the social class structure.

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Cited by (136)

The effects of using participatory working time scheduling software on working hour characteristics and wellbeing: A quasi-experimental study of irregular shift work
2020, International Journal of Nursing Studies
Citation Excerpt :
The response options were on a five-point Likert-type scale from never to very often, and they were dichotomized: ‘never’ to ‘sometimes’ as not having work-life conflict, and ‘often’ and ‘very often’ as having work-life conflict. Perceived health was measured using a five-point Likert-type scale from good to poor (Blaxter 1987). When dichotomized, poor perceived health included the alternatives ‘poor’ and ‘rather poor’, and good perceived health the three alternatives ‘intermediate’, ‘rather good’ and ‘good’.
Studies in the health care sector indicate that good work time control is associated with better perceived wellbeing but also with non-ergonomic work schedules, such as compressed work schedules. Participatory working time scheduling is a collaborative approach to scheduling shift work. Currently, there is a lack of information on whether working hour characteristics and employees’ wellbeing in irregular shift work change after implementing participatory working time scheduling.
To investigate the effects of using digital participatory working time scheduling software on working hour characteristics and well-being among Finnish hospital employees.
We compared changes in objective working hour characteristics and wellbeing between 2015 and 2017 among employees (n = 677, mainly nurses and practical nurses) when using participatory working time scheduling software (participatory scheduling, n = 283) and traditional shift scheduling (traditional scheduling, n = 394). The statistical analyses were conducted using the repeated measures general linear model and the generalized logit model for binomial and multinomial variables adjusted for age, sex, education, shift work experience, control over scheduling of shifts at baseline (where applicable) and hospital district.
The proportion of long work shifts (≥ 12 h) increased to a greater extent (F = 4.642, p = 0.032) with the participatory scheduling than with the traditional scheduling. In comparison to traditional scheduling, the perceived control over scheduling of shifts increased (OR 3.24, 95% CI 1.73-6.06) and excessive sleepiness in connection with evening shifts decreased (OR 0.40, 95% CI 0.16-0.99) significantly with participatory scheduling. None of the other wellbeing variables showed statistically significant changes in the adjusted models.
The proportion of long work shifts and perceived control over scheduling of shifts increased more among employees using participatory working time scheduling than among those using traditional scheduling. Otherwise, using participatory working time scheduling software had little effect on both objectively measured working hour characteristics and perceived wellbeing in comparison to traditional scheduling. The results merit confirmation in a larger sample with a longer follow-up.
Tweetable abstract
Participatory working time scheduling combines individual flexibility and staffing requirements in shift work.
Associations Between Socioeconomic Status and Major Complications in Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complication (EDC) Study
2011, Annals of Epidemiology
Citation Excerpt :
Socioeconomic status (SES) is inversely associated with many chronic diseases in the general population, with disadvantaged individuals faring worse than others (1–3), and this health inequality is becoming more pronounced over time (4).
To understand the effect of socioeconomic status (SES) on the risk of complications in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes complications in a prospective, observational T1D cohort study.
Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24−32) in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected to maximize income, education, and occupation potential and to minimize the effect of advanced diabetes complications on SES.
The incidences over 1 to 20 years’ follow-up of end-stage renal disease and coronary artery disease were two to three times greater for T1D individuals without, compared with those with a college degree (p < .05 for both), whereas the incidence of autonomic neuropathy was significantly greater for low-income and/or nonprofessional participants (p < .05 for both). HbA_1c was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted end-stage renal disease (hazard ratio [HR], 2.9; 95% confidence interval [95% CI], 1.1−7.7) and coronary artery disease (HR, 2.5, 95% CI, 1.3−4.9), whereas lower income predicted autonomic neuropathy (HR, 1.7; 95% CI, 1.0−2.9) and lower-extremity arterial disease (HR, 3.7; 95% CI, 1.1−11.9).
These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, greater complications from diabetes.
Access to spine care for the poor and near poor
2009, Spine Journal
Citation Excerpt :
That said, the current paper is intended to be descriptive and not prescriptive, depicting the current situation without “taking sides.” As noted in the Introduction, there are valid reasons why access to care for poor/near poor patients may be more difficult—fewer spinal surgeons serving poorer locales [3–5], a tendency for poorer patients to present with increased severity of disease and multiple comorbidities [6–14]. The “validity” of insurance status alone (as demonstrated in this paper) as a reason for referral, however, is clearly more controversial.
Access to care for poor/near poor patients is a concerning and growing problem within the American system of medical care.
The objective of this study was to examine the relationship between health insurance status and access to spine care among patients below 65 years of age eventually receiving treatment at our tertiary academic medical center.
Descriptive study based on chart review and telephone interviews.
Two groups of 64 patients each with surgical pathology of limited complexity and limited comorbidities, one with Medicaid insurance and one with private, commercial insurance.
Reasons for referral, travel distance, travel time, frequency of visits, and proximity of fellowship-trained spinal surgeons.
Two groups, each with 64 consecutive spine surgical patients, were studied and compared. Group One had “Medicaid” coverage and Group Two was privately insured. All patients (both groups) were treated surgically for similar pathology of limited complexity and had limited comorbdities. They were assessed to determine the difficulties they encountered in receiving care before referral to our medical center including factors such as referral by a local provider based on insurance status alone and travel time/distance/frequency to eventually receive care at our center. The availability of local care for these patients (fellowship-trained spine surgeons in their local area) was also assessed.
The great majority (78%) of poor/near poor patients with Medicaid coverage from counties at some distance from (and local to) our center were referred/deferred on the basis of insurance status alone given surgical problems which could have comfortably been addressed by orthopedic surgeons, neurosurgeons, or fellowship-trained spine surgeons local to the patient. This difficulty in access to care results in a significant burden (measured in time/travel/costs) for these patients.
The poor/near poor with Medicaid insurance have less access to local spine care than those with private, commercial health insurance. The implications (from both surgeon and patient perspectives) of this dilemma are discussed.
Perceived social position and health in older adults in Taiwan
2008, Social Science and Medicine
We examined whether perceived social position predicted mental and physical health outcomes (depressive symptoms, cognitive impairment, mobility restrictions, and self-assessed health) in a prospective study based on a nationally representative sample of older persons in Taiwan. Cross-sectional and longitudinal models were used to demonstrate the relationship between perceived social position and health, as reported by participants in the Social Environment and Biomarkers of Aging Study in Taiwan (SEBAS). Lower perceived social position predicted declining health beyond what was accounted for by objective indicators of socioeconomic position. As predicted, the effect was substantially reduced for all health outcomes in the presence of controls for baseline health. After including these controls, perceived social position was significantly related only to depressive symptoms. The findings suggest that the strength of the association between perceived social position and health may have been overstated in cross-sectional studies.
Economic implications of obesity
2007, Surgical Management of Obesity
Socioeconomic Status Influences the Relationship between Fear-Avoidance Beliefs Work and Disability
2011, Pain Medicine
Citation Excerpt :
In addition to this psychological model, the prevalence of chronic pain has been reported to vary with socio–economic levels [6]. In general, differences in socioeconomic status (SES) are associated with differences in lifestyle and health conditions, where low socioeconomic status is related with an adverse health outcome [7,8]. Therefore, researchers studying biopsychosocial models should consider the mechanisms by which SES influences psychosocial pathways and health outcomes [9].
Biopsychosocial models are currently accepted for study of low back pain (LBP), but there is little evidence investigating socioeconomic status (SES) influence on disability, pain intensity, and physical impairment. The present study examined SES (income and education) and fear–avoidance model (fear–avoidance beliefs and pain catastrophizing) for their influence on disability, pain intensity and physical impairment.
Cohort study, where patients (n = 108) were referred to physical therapy for treatment of acute or sub–acute LBP and completed standard questionnaires.
SES had no statistically significant associations with disability, pain intensity, or physical impairment. Moderation analysis indicated that the interaction between fear–avoidance beliefs about work and SES accounted for significant amount of variance in disability scores (Beta = −0.24, t = −2.71, P = 0.008). The interaction indicated that people in the low SES group experienced a higher association of fear avoidance beliefs and disability at baseline, 4 weeks, and 6 months. Other moderation results between psychological factors and SES were not observed for pain intensity and physical impairment.
This study adds to the growing literature examining biopsychosocial models by considering SES. Our results suggest SES had a minimal influence on pain intensity and physical impairment, but did interact with fear–avoidance beliefs to influence disability.

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Health and Social ClassEVIDENCE ON INEQUALITY IN HEALTH FROM A NATIONAL SURVEY

Abstract

Lancet

Lancet

Inequalities in health: Report of a research working group

Health and Social Class
EVIDENCE ON INEQUALITY IN HEALTH FROM A NATIONAL SURVEY