Documents 64 results

"Background There are substantial socioeconomic inequalities in both life expectancy and healthcare use in England. In this study, we describe how these two sets of inequalities interact by estimating the social gradient in hospital costs across the life course.Methods Hospital episode statistics, population and index of multiple deprivation data were combined at lower-layer super output area level to estimate inpatient hospital costs for 2011/2012 by age, sex and deprivation quintile. Survival curves were estimated for each of the deprivation groups and used to estimate expected annual costs and cumulative lifetime costs.Results A steep social gradient was observed in overall inpatient hospital admissions, with rates ranging from 31?298/100?000 population in the most affluent fifth of areas to 43?385 in the most deprived fifth. This gradient was steeper for emergency than for elective admissions. The total cost associated with this inequality in 2011/2012 was

"Der Versorgungs-Report 2012 setzt sich schwerpunktmäßig mit der Gesundheit im Alter auseinander. Er beleuchtet das Thema aus verschiedenen Perspektiven unter der Leitfrage, welche Schritte bei der Weiterentwicklung einer bedarfsgerechten medizinisch-pflegerischen und präventiven Versorgung gegangen werden sollten. Die Autoren analysieren Versorgungsrealitäten und zeigen auf, wie Reformansätze zu stabilisieren und zu stärken sind. Die medizinischen und ökonomischen Auswirkungen der demografischen Entwicklung werden ebenso diskutiert wie die damit verbundenen Herausforderungen für die Versorgungsstrukturen. Letzteres geschieht sowohl auf der Systemebene als auch anhand konkreter Projekte."

"BACKGROUND: There is raised risk of mortality following unemployment, and reviews have consistently found worse psychological health among the unemployed. Inflammation is increasingly implicated as a mediating factor relating stress to physical disease and is strongly linked to depression. Inflammation may, therefore, be implicated in processes associated with excess mortality and morbidity during unemployment. This study examined associations of unemployment with inflammatory markers among working-age men and women from England and Scotland.METHODS: Cross-sectional analyses using data from the Health Survey for England and the Scottish Health Survey collected between 1998 and 2010. Systemic inflammation was indexed by serum concentrations of C reactive protein (CRP) and fibrinogen, and compared between participants currently employed/self-employed, currently unemployed and other groups.RESULTS: CRP, fibrinogen and odds of CRP >3?mg/L were all significantly raised for the unemployed, as compared to the employed participants (eg, OR for CRP >3?mg/L=1.43, CI 1.15 to 1.78 N=23?025), following adjustment for age, gender, occupational social class, housing tenure, smoking, alcohol consumption, body mass index, long-term illness and depressive/anxiety symptoms. Strengths of associations varied considerably by both age and country/region, with effects mainly driven by participants aged ?48 and participants from Scotland, which had comparatively high unemployment during this time.CONCLUSIONS: Current unemployment is associated with elevated inflammatory markers using data from two large-scale, nationally representative UK studies. Effect modification by age suggests inflammation may be particularly involved in processes leading to ill-health among the older unemployed. Country/regional effects may suggest the relationship of unemployment with inflammation is strongly influenced by contextual factors, and/or reflect life course accumulation processes."

"BackgroundMortality and morbidity rates are often highest during the winter period, particularly in countries with milder climates. A growing body of research has identified potential socioeconomic, housing and behavioural mediators of cold weather-related adverse health and social outcomes, but an inclusive systematic review of this literature has yet to be performed. Methods A systematic review, with narrative synthesis, of observational research published in English between 2001 and 2011, which quantified associations between socioeconomic, housing or behavioural factors and cold weather-related adverse health or social outcomes. Results Thirty-three studies met the inclusion criteria. Average study quality was not high. Most studies failed to control for all relevant confounding factors, or to conduct research over a long enough period to ascertain causality. Low income, housing conditions and composite fuel poverty measures were most consistently associated with cold weather-related adverse health or social outcomes. Conclusions This review identified socioeconomic, housing and behavioural factors associated with a range of cold weather-related adverse health or social outcomes. Only tentative conclusions can be drawn due to the limitations of existing research. More robust studies are needed to address the methodological issues identified and uncover causal associations. A review of qualitative and intervention studies would help to inform policies to reduce the adverse health and social impacts of cold weather."

"Lives in Peril demonstrates how and why seafarers are a vulnerable group of workers. It argues they are made so by the organisation and structure of their employment; the prioritisation of profit over safety by the actors that engage and control their labour; the limits of enforcement of the regulatory framework that is in place to protect them; and by their weakness as collective actors in relation to capital. The consequences of this vulnerability are seen in data on their occupationally-related morbidity and mortality - evidence that probably only represents a partial picture of the actual extent of the physical, mental and emotional harm resulting from work at sea. This volume's central argument is that this situation is likely to remain broadly unchanged as long as global maritime governance and regulation remains in thrall to the neo-liberal economic and political arguments that drive globalisation, and fails to enforce regulatory standards more robustly."

"Background Although long-term trends in local labour market conditions are likely to influence health, few studies have assessed whether this is so. This paper examines whether (1) trends in local employment rates have relevance for mortality and morbidity outcomes in England and (2) trends are stronger predictors of these outcomes than employment rates measured at one point in time. Methods Using latent class growth models, local areas were classified into eight groups following distinct trends in employment rates between 1981 and 2008. Areas were also categorised in ‘octile' groups by rank of employment rates in 2001. These area groupings were linked to a sample of 207?959 individuals from the Office of National Statistics Longitudinal Study. Associations between area groupings and risk of all-cause mortality and of reporting a limiting long-term illness at the end of the period were measured using logistic regression. Models were adjusted for individuals' socio-demographic characteristics measured in 1981 and for their residential mobility between 1981 and 2001. Results Compared to areas with continuously high employment rates over the period, risk of mortality and morbidity was higher in areas with persistently low or declining employment rates. Findings suggest that long-term trends in local employment rates are useful as predictors of mortality and morbidity differences. These are not so clearly distinguished by only considering employment rates at one point in time. Conclusion Poor health outcomes are associated with long-term economic disadvantage in some areas of England, reflected in employment rates, underlining the importance of efforts to improve health in areas with especially ‘deep-seated' deprivation."

"Background Mortality and morbidity have been shown to follow a ‘social gradient' in Canada and many other countries around the world. Comparatively little, however, is known about whether ageing amplifies, diminishes or sustains socio-economic inequalities in health. Methods Growth curve analysis of seven cycles of the Canadian National Population Health Survey (n=13?682) for adults aged 20 and older at baseline (1994/95). The outcome of interest is the Health Utilities Index Mark 3, a measure of health-related quality of life (HRQL). Models include the deceased so as not to present overly optimistic HRQL values. Socio-economic position is measured separately by household-size-adjusted income and highest level of education attained. Results HRQL is consistently highest for the most affluent and the most highly educated men and women, and is lower, in turn, for middle and lower income and education groups. HRQL declines with age for both men and women. The rate of the decline in HRQL, however, was related neither to income nor to education for men, suggesting stability in the social gradient in HRQL over time for men. There was a sharper decline in HRQL for upper-middle and highest-income groups for women than for the poorest women. Conclusion HRQL is graded by both income and education in Canadian men and women. The grading of HRQL by social position appears to be ‘set' in early adulthood and is stable through mid- and later life."

"Recent research on gender and health challenges the prevailing notion of women's generalized health disadvantage by revealing a more variable pattern of gender differences in health. As such differences come to be comprehended as more complex than previously thought, there is a need to reassess the pathways linking gender and health. Although women reported more chronic stress and life events, their greater exposure accounted for only some of the gender disparity in health, and only for distress. Differential vulnerability to stressors played no role in explaining gender differences in health. These findings raise questions about a gendered, generalized health response to the vicissitudes of life and suggest the need for further theoretical and empirical exploration of "gendered" experiences and their pathways to health."