158 research outputs found
The development of socioeconomic inequalities in anxiety and depression symptoms over the lifecourse
Get PDFPurpose:
Socioeconomic inequalities in anxiety and depression widen with increasing age. This may be due to differences in the incidence or persistence of symptoms. This paper investigates the widening of inequalities in anxiety and depression over the lifecourse.
Methods:
Data were from the West of Scotland Twenty-07 Study, constituting three cohorts aged approximately 16, 36 and 56 years at baseline and re-visited at 5-yearly intervals for 20 years. Symptoms were measured using the Hospital Anxiety and Depression Scale. Adjusting for age and sex, multilevel models with pairs of interviews (n = 6,878) nested within individuals (n = 3,165) were used for each cohort to estimate associations between current symptoms and education or household social class for both those with and without earlier symptoms, approximating socioeconomic differences in incidence and persistence.
Results:
Inequalities in current symptom levels were present for both those with and without earlier symptoms. In the youngest cohort, those with less education were more likely to experience persistent depression and to progress from anxiety to depression. At older ages there were educational and social class differences in both the persistence and incidence of symptoms, though there was more evidence of differential persistence than incidence in the middle cohort and more evidence of differential incidence than persistence in the oldest cohort.
Conclusions:
Differential persistence and symptom progression indicate that intervening to prevent or treat symptoms earlier in life is likely to reduce socioeconomic inequalities later, but attention also needs to be given to late adulthood where differential incidence emerges more strongly than differential persistence
What is the role of income in creating health inequalities? Evidence from cross-sectional and longitudinal studies
Get PDFInequalities in health have been demonstrated for over 150 years in Britain, and in recent decades have been the focus of increasing policy attention. However in order to tackle inequalities in health there needs to be a clear understanding of their underlying causes. Unfortunately, the existing literature often uses different measures of socioeconomic status (SES) interchangeably; or, pays little attention to how they are measured; is still mainly based on cross-sectional data; and, tends to ‘explain away’ associations by adjusting for numerous confounders. These characteristics are unhelpful in elucidating causal processes and hence identifying mechanisms for reducing inequalities. The set of papers presented here aimed to address these issues by focusing explicitly on the role of income in creating health inequalities in order to develop a better understanding of how policies might potentially use income as a means of reducing the health divide.
The first paper based on the General Household Survey (GHS) examined the cross-sectional association between income and health. In comparison to the ‘gold standard’– net equivalent household income - other income measures tended to underestimate the strength of the association at the lower end of the distribution, as did imposing a linear function on it, when non-linear functions performed better statistically. The association was stronger for long-term measures of health status than for recent measures of health state. We also investigated the relative importance of different measures of SES for health, and found that income had a stronger association with all measures of health than did occupational class and education, but a similar association to measures of consumption based on tenure and car ownership.
In the second paper, I analysed GHS data to explore the health of a particularly disadvantaged group in the UK – lone parents – and the extent to which low income might be the cause of their health disadvantage. Both lone mothers and fathers, compared to couple parents, had higher risk of ill health, across a range of measures, and income and other material resources accounted for one third to a half of this, depending on the health outcome. I also explored other possible explanations, such as health selection, other social support and length of time as a lone parent, although these analyses were limited by the data available and the cross-sectional nature of the study.
The remainder of the papers employed longitudinal data to explore more effectively the relationship between income and health by considering its association over time. The third paper was the first British paper to examine income dynamics and health. Using six years of data from the British Household Panel Survey (BHPS) we found a non-linear association between income and subsequent health, controlling for prior health. Average income, and persistent poverty, across five years were more strongly associated with subsequent overall subjective health and limiting longstanding illness, while current income was more important for recent illness and psychosocial distress (measured by the General Health Questionnaire). Decreases in income were associated with raised health risk, but increases did not lead to reduced health problems. Income volatility (i.e. the size of change irrespective of direction) was also associated with health. Controlling for prior health and measuring income before the health outcome both suggested that the association between income and health may be causal. However, it is important to understand income’s role in broader causal pathways.
Paper Four employed both the BHPS and the 1958 birth cohort (National Child Development Study (NCDS)) to examine the role of income in childhood and adulthood for health. Analyses of the NCDS showed that childhood income influenced adult health only indirectly through ‘health capital’ and income potential (education) at age 23. However, in the BHPS, having controlled for earlier health and education and the key social roles – parenting, marriage and employment - that determine income levels, average adult income over five years was still a significant predictor of subsequent health, although childhood SES measures were not. This paper included a policy analysis to assess the effectiveness of policies to reduce health inequalities and found not only that they would have a modest impact, but also that they could worsen inequalities for some groups in society.
The final paper examined the inter-relationships in adulthood between a key cause of income change, income and health. Using 10 years of BHPS data, we examined the extent to which financial difficulties mediated the association between employment change and health. There were complex relationships depending on gender and prior circumstances. Moving out of employment into unemployment increased psychosocial distress, while moving back from unemployment to work improved it. Men retiring from non-manual jobs experienced an improvement in their mental health, while the health of those retiring from manual jobs declined. Women leaving work for family roles experienced a decline in their mental health, while moving back to work did not significantly improve it. Financial difficulties mediated these associations, attenuating the effects by approximately 30% for men and 16% for women. This paper demonstrated the complexity of many associations between SES and health over time, and the importance of considering them within appropriate pathways.
Overall these papers were among the first to consider the association between income and health over time, and within a lifecourse setting; to investigate issues of income measurement and functional form; and, to compare the relative importance of income with other SES measures. In doing this, I considered how the associations varied by health outcome, by gender and at different life stages, and according to whether or not respondents were from manual or non-manual backgrounds or had pre-existing health conditions. Taken together the papers clearly demonstrate a non-linear relationship between income and health, with the steepest associations at the lower end of the distribution. They show that income is part of the pathway between social roles and health, but that it is not the whole explanation. All of this suggests that low income is an important cause of health inequalities and hence fiscal policies to improve the incomes of the poorest in society are a potential mechanism for reducing the health divide
Evidence on the relationship between income and poor health: is the government doing enough?
Get PDFThe government’s report, Opportunity for All: Tackling Poverty and Social Exclusion (Department of Social Security, 1999), identified poor health as one of the major problems associated with low income. However, much of the available evidence on the relationship between income and health is of little help in forming policies to reduce health inequalities, as it has tended to be based on cross-section surveys and is therefore unable to shed much light on causal effects. Here, we make use of two British longitudinal datasets to examine the longer-term influences of income on health within a life-course perspective. We then use the results of our analysis to provide a brief critical assessment of the likely success of the government’s anti-poverty strategy in reducing health inequalities. A more detailed assessment of government policy in this respect can be found in Benzeval et al. (forthcoming).
Does Perceived Physical Attractiveness in Adolescence Predict Better Socioeconomic Position in Adulthood? Evidence from 20 Years of Follow Up in a Population Cohort Study
Get PDFThere is believed to be a 'beauty premium' in key life outcomes: it is thought that people perceived to be more physically attractive have better educational outcomes, higher-status jobs, higher wages, and are more likely to marry. Evidence for these beliefs, however, is generally based on photographs in hypothetical experiments or studies of very specific population subgroups (such as college students). The extent to which physical attractiveness might have a lasting effect on such outcomes in 'real life' situations across the whole population is less well known. Using longitudinal data from a general population cohort of people in the West of Scotland, this paper investigated the association between physical attractiveness at age 15 and key socioeconomic outcomes approximately 20 years later. People assessed as more physically attractive at age 15 had higher socioeconomic positions at age 36- in terms of their employment status, housing tenure and income - and they were more likely to be married; even after adjusting for parental socioeconomic background, their own intelligence, health and self esteem, education and other adult socioeconomic outcomes. For education the association was significant for women but not for men. Understanding why attractiveness is strongly associated with long-term socioeconomic outcomes, after such extensive confounders have been considered, is important. © 2013 Benzeval et al
Neighbourhood deprivation and biomarkers of health in Britain: the mediating role of the physical environment
Get PDFBackground:
Neighborhood deprivation has been consistently linked to poor individual health outcomes; however, studies exploring the mechanisms involved in this association are scarce. The objective of this study was to investigate whether objective measures of the physical environment mediate the association between neighborhood socioeconomic deprivation and biomarkers of health in Britain.
Methods:
We linked individual-level biomarker data from Understanding Society: The UK Household Longitudinal Survey (2010–2012) to neighborhood-level data from different governmental sources. Our outcome variables were forced expiratory volume in 1 s (FEV1%; n=16,347), systolic blood pressure (SBP; n=16,846), body mass index (BMI; n=19,417), and levels of C-reactive protein (CRP; n=11,825). Our measure of neighborhood socioeconomic deprivation was the Carstairs index, and the neighborhood-level mediators were levels of air pollutants (sulphur dioxide [SO2], particulate matter [PM10], nitrogen dioxide [NO2], and carbon monoxide [CO]), green space, and proximity to waste and industrial facilities. We fitted a multilevel mediation model following a multilevel structural equation framework in MPlus v7.4, adjusting for age, gender, and income.
Results:
Residents of poor neighborhoods and those exposed to higher pollution and less green space had worse health outcomes. However, only SO2 exposure significantly and partially mediated the association between neighborhood socioeconomic deprivation and SBP, BMI, and CRP.
Conclusion:
Reducing air pollution exposure and increasing access to green space may improve population health but may not decrease health inequalities in Britain
Alternative measures to BMI:Exploring income-related inequalities in adiposity in Great Britain
Get PDFSocio-economic inequalities in adiposity are of particular interest themselves but also because they may be associated with inequalities in overall health status. Using cross-sectional representative data from Great Britain (1/2010-3/2012) for 13,138 adults (5652 males and 7486 females) over age 20, we aimed to explore the presence of income-related inequalities in alternative adiposity measures by gender and to identify the underlying factors contributing to these inequalities. For this reason, we employed concentration indexes and regression-based decomposition techniques. To control for non-homogeneity in body composition, we employed a variety of adiposity measures including body fat (absolute and percentage) and central adiposity (waist circumference) in addition to the conventional body mass index (BMI). The body fat measures allowed us to distinguish between the fat- and lean-mass components of BMI. We found that the absence of income-related obesity inequalities for males in the existing literature may be attributed to their focus on BMI-based measures. Pro-rich inequalities were evident for the fat-mass and central adiposity measures for males, while this was not the case for BMI. Irrespective of the adiposity measure applied, pro-rich inequalities were evident for females. The decomposition analysis showed that these inequalities were mainly attributable to subjective financial well-being measures (perceptions of financial strain and material deprivation) and education, with the relative contribution of the former being more evident in females. Our findings have important implications for the measurement of socio-economic inequalities in adiposity and indicate that central adiposity and body composition measures should be included health policy agendas. Psycho-social mechanisms, linked to subjective financial well-being, and education -rather than income itself-are more relevant for tackling inequalities
Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample
Get PDFExaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective
How Understanding Society: The UK Household longitudinal study adapted to the COVID-19 pandemic
Get PDFUnderstanding Society is a household panel survey with continuous fieldwork (monthly sam-ples) using a mixed mode design. Prior to March 2020, around half of all interviews were carried out face-to-face, amounting to around 1,150 interviews per month. This article outlines how the survey rapidly transitioned to a protocol without face-to-face interviews and presents some initial indicators of the impact of the change on field outcomes
Parental gender attitudes and children's mental health:Evidence from the UK household longitudinal study
Get PDFGender role attitudes have been found to be associated with the mental health of adults and adolescents, but little is known about whether parents' gender attitudes are associated with their children's mental health. Using data from Understanding Society, the UK Household Longitudinal Study (UKHLS), a large-population representative sample, we examine the links between parental gender role attitudes and child mental health outcomes as measured by the total and five components of the strengths and difficulties questionnaire (SDQ). We construct structural equation models, separately for mothers and for fathers and for children aged 5 and 8, and adjust for key sociodemographic variables. We find that children aged 5 years exhibit fewer emotional and peer relationship problems and are more prosocial when their mothers have more egalitarian (compared to traditionalist) gender role attitudes. We also find that children are more prosocial at age 8 when their mothers have more egalitarian gender role attitudes. No statistically significant mediation effect is observed via maternal parenting behaviour. Fathers' more egalitarian gender role attitudes were associated with higher hyperactivity at age 5 and more prosocial behaviour at age 8. Further, engaging in less negative parenting behaviour completely mediates the association of fathers' more egalitarian gender attitudes with children's mental health across the majority of the SDQ scales. This suggests that parental gender attitudes may be a possible target for the prevention of mental health difficulties among children; however, future research will be required to examine the extent to which the associations we identified reflect causality
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