Socio-economic determinants of health behaviours across age groups: results of a cross-sectional survey.

BACKGROUND: The aim of this study was to analyse the impact of different socio-economic variables on the lifestyle factors, like lack of physical activity, diet rich in meat, and smoking, across sex and age groups in the general Austrian population to formulate more targeted public health measures. METHODS: The Austrian Health Interview Survey 2006-07 contains data of 15,474 people, representative for the general population. Statistical analyses included linear and logistic regression models. RESULTS: Lack of physical activity was more prevalent in women, while unhealthy nutrition and daily smoking were more prevalent in men. Overall, profession was the strongest predictor for health behaviour in men, while the educational level played the most significant role in women. Subjects in higher age groups had a more healthy nutrition and were less likely to smoke, but had a higher chance for lack of physical activity. DISCUSSION: Socio-economic factors predict lifestyle choices differently in different age groups. For example, in men, the highest percentage of daily smokers was found in the middle age, while the youngest age group was the one that smoked the most in women. Furthermore, the educational level had a reverse effect on women in the oldest age group, where those with tertiary education smoked three times more than those with less education. Our results emphasise the importance of taking a holistic approach towards health, including educational, cultural and age-specific policies to improve the overall health status and health equality of a population.

Social status as a mediator of self-perceived health, quality of life and health-related behaviour in obesity.

OBJECTIVES: Obesity prevalence is increasing worldwide and associated with a high health risk. Unfavourable psychological factors, lower self-ratings of health and worse health-related behaviour can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of our study was to investigate whether normal weight vs. obese subjects with a high vs. low socioeconomic status (SES) differ with regard to self-perceived health, quality of life and health-related behaviour. METHODS: Data of the Austrian Health Interview Survey (ATHIS) 2006/07, precisely of 8015 subjects were analysed stratified by sex and adjusted by age concerning these outcomes. RESULTS: The results have shown that men and women with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, intensity of physical activities, alcohol consumption, and eating behaviour (men: p <0.001; women: p<0.001). A significant interaction between the body mass index (BMI) and SES occurred in men concerning quality of life in the domains physical (p<0.05) and psychological health (p<0.01), in women as to self-perceived health (p<0.01), quality of life in the domains physical health (p<0.01) and environment (p<0.05), as well as physical activities (p<0.01). CONCLUSION: The SES has a strong negative impact on health-related variables, especially in obese subjects, and therefore risk assessment in the primary health-care setting should include socioeconomic factors. Furthermore, a continued strong public health programme is required with an absolute priority placed on obese subjects of low SES.

Descriptive epidemiology of thyroid carcinoma in Carinthia, Austria: 1984-2001. Histopathologic features and tumor classification of 734 cases under elevated general iodination of table salt since 1990: population-based age-stratified analysis on thyroid carcinoma incidence.

INTRODUCTION: The aim of the study was to investigate the current thyroid carcinoma (TC) incidence in Carinthia, a former iodine-deficient, goiter-endemic region in Austria with approximately 550,000 inhabitants from 1984 to 2001. Using age-cohort analysis we analyzed the TC incidence under the impact of two regional risk factors: the contamination of Austrian soils by the radioactive fallout in from Chernobyl 1986 and the increased iodination of table salt in a general program of goiter prophylaxis begun in 1991. To evaluate the characteristics of TC incidence, we compared the results of the periods 1984-1989, 1990-1995, and 1996-2001. RESULTS: A total of 734 TC cases were diagnosed. Papillary, follicular, medullary, oxyphilic, and anaplastic TC accounted for 76%, 18%, 3%, 1%, and 2%, respectively. The female to male ratio was 3:1. The annual incidence rate increased by 8.05% in females and 11.6% in males. TC cases younger than 40 years of age accounted for 22.6%, with a rate increase of 18% per year in young males, the female-to-male ratio decreased from 8.3, 6.1, 2.7 younger than 40 in the compared periods. Along with a further increase in papillary TC incidence and papillary thyroid carcinoma (PTC) follicular thyroid carcinoma (FTC) ratio in the adult population, the ratio tended to decrease in the younger than 40-year-old population. T4 class TC and loco-regional lymph node involvement increased significantly. INTERPRETATION: The observed changes in TC incidence, particularly in the young population, as in adults, could be linked to the abovementioned risk factors involved in the initiation and early growth of TC, and iodine may play a role in stimulating overall thyroid activity.

Associations of income with self-reported ill-health and health resources in a rural community sample of Austria.

OBJECTIVES: Three levels of health indicators (1) self-reported ill-health, (2) internal health resources, and (3) external health resources were analysed in relation to a four-category house-hold income distribution in order to describe possible social gradients. The particular aim of this study was to obtain information on the association of income data with self-reported ill-health. METHODS: This cross-sectional study was based on a health survey. The sample represents around 10% of the rural population of some communities in Styria, randomly selected from the population registry. Interview data was collected from 3781 participants aged 15 years and older, 1559 males and 2222 females. RESULTS: The results show that individuals from lower house-hold income classes are disadvantaged with regard to indicators of ill-health, internal and external health resources. Overall, the link between low income and poor health is highly consistent within our data. CONCLUSIONS: Considering our results we conclude that internal and external health resources are as unequally distributed over income levels as health outcome indicators.

A model and application for estimating completeness of registration.

Completeness of population-based registration systems is recognized to be an important aspect of the quality of information in registries which has to be examined. In this paper a model is presented which was used to estimate completeness of reporting of Down syndrome data notified to the Styrian Malformation registry between 1985-92. The model introduced is based on the two-source capture-recapture method allowing for time-varying parameters. For estimation of the parameters a discrete-time filtering algorithm was developed. For the used data set, an estimate of completeness derived from this model was in good agreement with an independent estimator based on demographic data and maternal age-specific Down syndrome risks whereas the usual two-source capture-recapture method gave a higher estimate.

[Problem orientation in social medicine--participation in social medicine]. / Problemorientierung im Fach Sozialmedizin--Sozialmedizin zum Mitmachen.

Problem-oriented learning is gaining increasing importance in medical education. The current discussion on reforming medical education in the medical schools in Austria reflects this importance. At the medical school in Graz for many years teaching the core module "social medicine" has been problem-oriented. Small groups of students work on selected topics of public health. The topics are related to every day practice and their particular psychosocial ramifications and consequences are illucidated. This subject is required in the last year of medical school. The students are not familiar with problem-based learning and have difficulties in adapting. To be better prepared for the coming changes in the discipline of medicine, the social dimension should be integrated earlier into medical education. The most efficient way of doing so should be clarified in the discussion of the reform in medical education.

[Use of unconventional therapies by cancer patients]. / Nutzung unkonventioneller Heilverfahren bei Krebserkrankungen.

Unconventional therapies are increasingly accepted and used by professionals and lay persons. In this study, we analyzed correlations between sociodemographic variables of cancer patients, their disease and use of unconventional therapies. In an oncological out-patient department we collected the data relevant for the study objectives by means of a questionnaire. The sample comprised of 154 persons. The younger age group, married individuals and those in mid level occupational positions had more experience with unconventional therapies. The strongest predictors for usage were "age", length of illness" and "being able to go to work or to do house work". Doctors should be familiar with these methods in order to support their oncologic patients. As unconventional therapies will be used more often research should be intensified.

[Representative early summer meningoencephalitis vaccination rates of school children in Styria]. / Repräsentative FSME-Impfquoten der Schulkinder in der Steiermark.

Since the introduction of the Austrian TBE (tick-borne encephalitis) vaccination program in 1981 immunization coverage of children has not been investigated sufficiently. We investigated the influence of geographic and sociodemographic factors on the immunization coverage of school children in order to identify subpopulations with low immunization coverage. To this end a representative cross-sectional study was carried out in the county of Styria, Austria. The target population were children in the first, fourth and seventh year of school education. Therefore, the sample consisting of 3,196 children was divided into three age groups. children aged around 7, 10 and 13 years. The information concerning the immunization status of each child was recorded by means of an anonymous questionnaire given to parents by the classroom teachers on advice of the supervisory school authority. This procedure ensured the high overall response rate of 85.0%. The prevalence of at least one TBE vaccination was 91.4% for the 7 year old, 97.3% for the 10 and 97.1% for the 13 year old. The prevalence of basic TBE immunization was 84.0%, 91.7% and 92.3% resp. The lowest vaccination rates were found in families with four or more children and for those children who had mothers of the lowest educational level. Thus, for the future management of immunization programs it is crucial to put special emphasis on the identified population groups with deficient immunization coverage. The overall vaccination rates can be judged as satisfactory in the 13 year old children.

[Different occupational groups of women and selected nutrition-related risk factors for osteoporosis]. / Unterschiedliche Berufsgruppen von Frauen und ausgewählte ernährungsbedingte Risikofaktoren für die Osteoporose.

This paper studies the prevalence of risk factors considered responsible for osteoporosis in women of 4 occupational groups: farmers, blue collar workers, white collar workers/civil servants and housewives. We analyzed nutritional factors associated with osteoporosis in the scientific literature. The total sample comprises of 2185 individuals of which 658 women were taken into the analyses. The data set was based on a health survey conducted in 10 selected rural communities of Styria in Austria between 1995 and 1996. Sociodemographic data, lifestyles, internal and external resources as well as indicators off ill-health were surveyed through standardized personal interviews. The results show that the women of the 4 occupational groups were differently strained regarding nutritional risk factors. Our results suggest that efficient intervention programs to prevent osteoporosis need to specifically focus on the various life contexts of women.

[Epidemiologic and statistical interaction models and consequences for regression analysis]. / Epidemiologische und statistische Interaktionsmodelle und Folgen für die Regressionsanalyse.

Different ways to define interaction between exposition factors in epidemiological studies as well as the choice between additive and multiplicative no interaction leads frequently to confusion during data analysis. In their standard form methods of event data analysis such as Poisson or logistic regression assume a multiplicative parameterization of no interaction. However, evidence from empirical investigations as well as causal models of disease etiology, e.g. the simple independent action model of Finney or the sufficient-component-causes model of Rothman, suggest additive or other kinds of non-multiplicative concepts of no interaction. For additive structured data we illustrate the asymptotic bias ("interaction-bias") of main effect estimates which are based on inappropriate data analysis using multiplicative models and omitting significant or non-significant interaction terms. We show that both the epidemiological study design as well as the underlying causal model are determinants of the interaction structure of the data and should be considered in the model selection process. The definition of interaction should distinguish between risk, rate and odds if risks are not very small. Using generalized linear models with parametrical link functions we are able to analyze non-multiplicative interaction structures.

Educational status and resources for child care as predictors of TBE vaccination coverage in schoolchildren of an endemic area in Austria.

Since the introduction of the Austrian tick-borne encephalitis (TBE) vaccination program in 1981 vaccination coverage of children has not been investigated sufficiently. Numerous socioeconomic and demographic factors have been identified as being associated with low vaccination coverage in childhood for most vaccinations. This study focuses on parental educational status and on resources for child care as determinants of tick-borne encephalitis (TBE) vaccination coverage of schoolchildren in an endemic TBE area of Austria. The target population were children in the first, fourth and seventh year of school education in Styria, Austria. Therefore, the sample consisting of 2470 children was divided into three age groups, children aged 7, 10 and 13 years. We performed a representative cross-sectional study. The information concerning the vaccination status of each child was recorded by means of an anonymous questionnaire given to the parents by the classroom teachers. This procedure ensured a high overall response rate of 79.8%. The prevalence of at least one TBE vaccination was 93.9% for the 7 year old, 97.8% for the 10 and 97.9% for the 13 year old. The lowest vaccination rates were found in families with four or more children (94.0%) and for those children who had unemployed parents (92.9%). The multivariate analysis indicates that TBE vaccination coverage is affected by a large number of children in the family (p = 0.0003), an urban place of residence (p = 0.0001) and by a low level of education of the mother (p = 0.013). The results suggest that, though overall high coverage in schoolchildren, vaccination programmes should be focused on large and socially deprived families.

The impact of sociodemographic, environmental, and behavioral factors, and cerebrovascular risk factors as potential predictors of the mattis dementia rating scale.

BACKGROUND: Age and education have been found to affect the Mattis Dementia Rating Scale (MDRS) score of elderly normals, but there have been no studies assessing the influence of environmental and behavioral factors on this scale. Their role as potential predictors of the MDRS total score was investigated. METHODS: The MDRS was administered to 1,927 normal elderly subjects in the setting of a stroke prevention study. Results were correlated with 16 sociodemographic, environmental, and behavioral factors, and cerebrovascular risk factors. Study statistics resulted from multiple logistic regression analysis. RESULTS: Results indicated that higher age and arterial hypertension were associated with poorer cognitive performance, while better education and moderate general life stress exerted a positive effect on the participants' test results. CONCLUSIONS: Thus, besides the well-established factors of age and educational level, moderate general life stress and hypertension were identified as relevant predictors in determining the MDRS test performance of elderly normals.

Health behaviour and risk behaviour: socioeconomic differences in an Austrian rural county.

The aim of this study is to illustrate the impact of socioeconomic differences on two basic kinds of health-related behaviour defined as health behaviour (HB) and risk behaviour (RB). We analysed data derived from a health survey on health-related behaviour and self-reported morbidity in relation to demographic and socioeconomic factors. The survey consists of a random sample of 27,344 individuals taken from 79 communities from the rural population of Styria (Austria). Using directly standardised indicators both HB and RB revealed clear but inverse associations with education, SES and gender. HB rises and RB falls with years of schooling completed. HB is higher in women (103.5 versus 95.0, p < 0.01) whereas RB is higher in men (128.9 versus 80.1, p < 0.01). Different patterns of association with age were found. We conclude that both HB and RB should be considered as mediating factors between SES and health status.

Characteristics of women currently using hormone replacement therapy in rural areas of Styria, Austria.

There are no clear-cut guidelines on "hormone replacement therapy". Each women should be individually counselled regarding her risks and then given "therapy". We studied a rural population in Styria that uses non-contraceptive hormones. Our analyses were based on data drawn from a cross-sectional health survey between 1995 and 1996. Our study sample comprised 499 women 40 to 65 years old; 97 of the women were using hormones (19.4%). According to the univariate analysis, women currently using hormones had a higher level of psychosomatic complaints, a higher frequency of health check-ups and visits to physicians, and reported a higher use of vitamin supplements than the non-users. The results are significant. Compared with other studies, the direction of the selection effect is inverse. Doctors attribute complaints to the perimenopausal status of the women and prescribe hormones in the hope of alleviating the problems. Medical interventions may interfere with possible alternative ways of coping with the menopause allowing for change in different aspects of a woman's life.

The relationship between body weight and patterns of smoking in women and men.

BACKGROUND: In the scientific literature, studies of the relationship between cigarette smoking and body weight yield conflicting results. Weight-lowering effects in women and men have been associated with smoking, however, no effects on weight have been proven. The purpose of this study was to examine the gender-related association between cigarette smoking and relative weight in a rural population in Styria, Austria. METHODS: A database from a health survey conducted between 1989 and 1993 in 79 selected rural communities of Styria was used for these analyses. The sample consisted of 27,344 participants, 16,185 women and 11,159 men, aged > or = 15 years. We controlled for possible confounding factors such as age, years of education, alcohol consumption, regular physical activity, and chronic diseases. RESULTS: For women and men, in comparison to non- and ex-smokers, smoking is significantly correlated with lower body mass index (BMI). In contrast, heavy smoking and smoking cessation are significantly associated with higher relative weight. CONCLUSIONS: We found significant results confirming an association between cigarette smoking and lower BMI in women and men, whereas heavy smoking as well as smoking cessation were significantly correlated with higher relative weight. Health intervention programmes to quit smoking should take into account the underlying perceived benefits of smoking with regard to weight, especially its gender specificity.

Employment status and its health-related effects in rural Styria, Austria.

BACKGROUND: Unemployment has become a serious social problem in industrialized countries. Job loss produces health-related disorders. Health-related data of the unemployed are scarce and prompted us to survey this group. METHODS: A database of a health survey conducted between 1989 and 1993 in 79 selected rural communities of Styria (Austria) was used to analyze risk factors and employment status. The sample consisted of 8,747 individuals, 345 unemployed and 8,402 employed. RESULTS: Risk behavior is higher among unemployed individuals than among those employed, particularly for males. Unemployed males were significantly less motivated to reduce weight and to change dietary habits than their counterparts, and they had significantly more anxieties, sleeping disorders, and lack of appetite. A similar pattern was found with regard to gastrointestinal and chronic liver and respiratory diseases. In addition, the unemployed utilized medical services more often. CONCLUSIONS: This is the first study on health-related indicators and unemployment status in Austria. Job loss implies health-related disorders. The effectiveness of reducing the morbidity of the population in general is also dependent on intervention programs focusing on the specific needs of this high-risk group, e.g., adapting primary health care to its needs and fostering social support networks.