Widening inequalities in the risk factors for cardiovascular disease amongst men in England between 1998 and 2006.

OBJECTIVES: Cardiovascular disease is a major cause of morbidity and mortality for which there are many modifiable risk factors. This study investigated changes in social inequalities of cardiovascular disease risk factors amongst men aged 20-64 years in England between 1998 and 2006. STUDY DESIGN: Repeated cross-sectional study. METHODS: Health Survey for England data from 1998, 2003 and 2006 were used. The following physiological risk factors were considered: body mass index, waist-to-hip ratio, blood pressure and total serum cholesterol level. The behavioural risk factors considered were limited physical exercise, smoking status and level of social support. The National Statistics Socio-economic Classification was used to measure socio-economic position. An index of inequality for each risk factor was calculated, and change in inequality over time was assessed by t-tests. RESULTS: Significant cross-sectional inequality was found for waist-to-hip ratio, systolic blood pressure, smoking, limited physical exercise and social support at one or more time points. Between 1998 and 2006, there was a significant increase in inequality for smoking status [relative index of inequality (RII) 4.06-6.65 (t-test: 2.88, P = 0.003)] and limited physical exercise [RII 1.06-1.74 (t-test: 2.92, P = 0.003)]; these increases in inequality over time were due to improvements for those in higher socio-economic classes. CONCLUSIONS: Policies have not had the desired impact of reducing inequalities. Although the long-term effects of these policies might not yet be apparent, available evidence needs to be used to monitor impact and direct policy change to address the possibility of widening inequalities.

Housing repossessions, evictions and common mental illness in the UK: results from a household panel study.

BACKGROUND: The numbers of housing repossessions and evictions in the UK are increasing. This study investigates whether repossessions and evictions increase the likelihood of common mental illness and examine patterns over time. METHODS: Data come from the core longitudinal panel of the British Household Panel Survey (N = 12,390) of adults living in private households. Multivariate fixed-effects regression models are used with weighted data. Common mental illness is measured by the 12-item General Health Questionnaire. RESULTS: Housing repossession is associated with an increased risk of common mental illness (adjusted odds ratio 1.61, 95% confidence interval 1.10 to 2.36), whereas eviction from rented property shows no increased risk (0.97, 0.76 to 1.20). The pattern over time shows a clear increase in the years before repossession. CONCLUSIONS: Repossession of owned property, although a relatively rare event in the panel, significantly increases the risk of common mental illness immediately after the event. In contrast, eviction from rented property is a more common event but is not associated with an increased risk of common mental illness. This difference in association may be due to losing the security of owned housing and the often transitory nature of the rented housing population.

Socio-economic inequalities in health and service utilization in the London Borough of Newham.

OBJECTIVES: To examine the extent of socio-economic inequalities in health in the London Borough of Newham and to compare them with those in the UK as a whole. STUDY DESIGN: Cross-sectional, individual-level observational study with data on socio-economic and health measures from wave one of the Newham Household Panel Survey (n=1723) and wave 11 of the British Household Panel Survey (n=8444). METHODS: Age-standardized comparison of the social distribution, by household social class, education, housing conditions and neighbourhood problems, of six indicators of health and service utilization. Relative index of inequality is used to compare magnitude of inequality across the samples. RESULTS: Age-standardized prevalence ratios for most health and service use indicators indicated that Newham has poorer health and higher utilization compared with the UK as a whole. Significant health inequalities were associated with socio-economic measures in both Newham and Britain, but few significant differences in the relative effects between the two. CONCLUSIONS: Although Newham has higher prevalence of poor health and high service use, the relative effects of socio-economic inequalities are similar to those in Britain as a whole.

Social determinants of health inequalities in Bosnia and Herzegovina.

OBJECTIVE: To examine the social determinants of inequalities in health in Bosnia and Herzegovina in the post-conflict period, and to test if the relative effects vary across the two entities of the Federation of Bosnia and Herzegovina and the Republika Srpska. STUDY DESIGN: Cross-sectional data come from the first wave of the Bosnia and Herzegovina Household Panel Study conducted in 2001, which collected data from 7482 respondents aged 17 years and older based on over 3000 households. METHODS: Distributions and odds ratios for physical limitations and poor mental well-being were calculated over a number of known social determinants. Multivariate logistic regression and t-tests were used to compare risks across entities within the state of Bosnia and Herzegovina. RESULTS: The prevalence of poor mental well-being and physical limitations was significantly higher in the Republika Srpska. Significant differences in poor mental well-being and physical limitations were observed across most determinants within each entity, but only a few of these relative effects differed between entities. CONCLUSIONS: Efforts to tackle absolute differences in poor health between the entities within Bosnia and Herzegovina should be pursued, along with reducing social inequalities.

Social exclusion in clients with comorbid mental health and substance misuse problems.

BACKGROUND: The concept of comorbid mental health problems and substance misuse has gained prominence in the last two decades, due in part to the closure of large psychiatric hospitals and to the increasing prevalence of drug use in the community. This client group has a dual requirement for both medical and social care needs and is at risk for social exclusion. METHODS: A retrospective matched case-control study to examine aspects of social exclusion between service users who have comorbid diagnoses and those with a single diagnosis. Samples were drawn from the service users of a mental health Trust in the South-East of England, from both Adult Mental Health (n = 400) and Drug and Alcohol services (n = 190). Data were collected from Care Programme Approach assessment forms and medical records. McNemar's chi(2) and odds ratios via a conditional logit regression model are used to test for differences in the social exclusion indicators. RESULTS: There were significant differences in social exclusion between the comorbid and singly diagnosed clients of the Adult Mental Health service, but differences were less pronounced between the comorbid and singly diagnosed clients of the specialist Drug and Alcohol service. CONCLUSIONS: Recent Government policy advocates treating comorbid clients within mainstream mental health services. Health care workers need to recognise the likelihood of high levels of social exclusion among clients with comorbid problems.

Beyond biology: the social context of prenatal behaviour and birth outcomes.

OBJECTIVES: In this study we examine the factors that are associated with adverse birth outcomes using a representative national sample. In our analysis we take into account factors which are related to the mother's behaviour during pregnancy and also consider the socio-economic circumstances of the family. METHODS: A series of logistic regression models are used to determine the increased risks of low birth weight, preterm, and small for gestational age births associated with maternal smoking, alcohol consumption and high blood pressure in relation to socio-economic factors, such as family dysfunction, social support, income adequacy, age, and education. RESULTS: All socio-economic factors showed gradients of maternal smoking during pregnancy while only mother's education and socio-economic status demonstrated gradients of alcohol use and high blood pressure. Maternal smoking, high blood pressure, higher levels of family dysfunction, and lower levels of mother's education were found to significantly increase the risk of an adverse birth outcome. CONCLUSIONS: Interventions designed to mitigate the hazards of adverse birth outcomes should be designed to reflect the gradients of risky prenatal maternal behaviours associated with age, education, income, and family dysfunction.

Social class differences in mortality using the National Statistics Socio-economic Classification--too little, too soon: a reply to Chandola.

Chandola's (2000; Social Science and Medicine, 50(5), 641-649) claims that the UK National Statistics Socio-economic Classification (NS-SEC) is not significantly related to mortality are examined. It is shown that this result is likely to be an artefact of the data and methods he uses. Other findings and interpretations in his paper are also critically discussed. In the process, various theoretical, measurement and analysis issues relating to the use of classifications such as the NS-SEC in health research are reviewed.

Revisiting student self-rated physical health.

There has been little research as to the development of self-rated health among adolescents. In this paper, we present a replication of a model of student self-rated health initially proposed by Vingilis, Wade and Adlaf (1998) using data from 1993 Ontario Student Drug Use Survey (n=840). The data for this replication come from the first wave of the US National Longitudinal Study of Adolescent Health (public release data, n=5673). The original model is tested by a series of nested regression equations and path analysis. The results add support for the original model and are notable given that many items used to build the underlying constructs differ across the two datasets.

Multiple applications of the GHQ-12 in a general population sample: an investigation of long-term retest effects.

BACKGROUND: Previous studies have indicated that the 60-, 30-, 28- and 12-item versions of the General Health Questionnaire (GHQ) are liable to retest effects, especially when administered multiple times with short intervals. The aim of this study was to examine data from a large general population sample for evidence of any retest effects over 7 yearly applications. METHODS: A core panel was drawn from the British Household Panel Survey of those respondents who had completed the GHQ-12 seven times from 1991 to 1997 (n = 4749). The panel results were compared with cross-sectional data from the Health Surveys for England for the same years. The analyses were conducted separately for males and females broken down by age groupings. RESULTS: No evidence of retest effects was found. For males, the panel results did not diverge significantly from the cross-sectional results. For females, the panel results did indicate a divergence from the cross-sectional results, but this was due to the age composition of the panel and differing age trajectories. CONCLUSION: The GHQ-12 is a consistent and reliable instrument when used in general population samples with relatively long intervals between applications.

The clustering of severe behavioural, health and educational deficits in Canadian children: preliminary evidence from the National Longitudinal Survey of Children and Youth.

This study identifies a high-risk subpopulation of children with a markedly antisocial behavioural profile in a national sample of Canadian children. We examine a broad array of environmental and child factors that may be associated with this high-risk group. The data are for 18,135 two to eleven year olds in the National Longitudinal Survey of Children and Youth. A cluster analysis was performed to identify children possessing extreme antisocial behaviour across five dimensions: aggression, hyperactivity, prosocial behaviour, emotional difficulties and misconduct. Clusters were compared across structural, family, school, neighbourhood, and health covariates. Membership in this severe cluster is associated with material disadvantage across the range of environmental factors as well as significant deficits in child health and education.