Study of environmental, social, and paternal factors in preterm delivery using sibs and half sibs. A population-based study in Denmark.
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OBJECTIVE: The aim of this study was to evaluate the influence on preterm delivery of changes in putative genetic and environmental risk factors between two consecutive births. Low social status is a suspected risk indicator of preterm delivery, but the impact of social mobility has not been studied before. PARTICIPANTS: The study uses national cohorts in which women act as their own controls. Subjects were identified by means of registries: 10,455 women who gave birth to a preterm child and had a subsequent live birth between 1980 and 1992 and 9849 women who gave birth to a child after 37 completed weeks of gestation and had a subsequent live born child in the same time period formed the cohorts. METHODS: The risk of having a premature infant in the subsequent pregnancy was analysed in each cohort as a function of changes in male partner, residency, occupation, and social status between the two pregnancies. RESULTS: There was a strong tendency to repeat a preterm delivery (18% v 6% in the general population). Social decline was associated with a moderate increase in the recurrence risk (OR: 1.22; 95% CI: 1.02, 1.47). In the reference cohort the risk of preterm delivery associated with changing from a rural to an urban municipality was 2.03 (95% CI: 1.14, 3.64). CONCLUSIONS: Social decline and moving to an urban municipality may be associated with preterm delivery. (+info)
Social mobility and health related behaviours in young people.
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STUDY OBJECTIVE: To assess the influences related to social mobility, particularly health related behaviours, as one potential explanation for the social class variation in health among adults. DESIGN: The study is based on questionnaire data from the Adolescent Health and Lifestyle Surveys of 1985, 1987, and 1989. SETTING: The whole of Finland. PARTICIPANTS: A representative sample of 8355 adolescents. The response rate was 79%. MEASUREMENT AND MAIN RESULTS: The relation between social mobility and health related behaviours among 16 and 18 year old young people was studied. The measure of social mobility was based on a combination of the social class of origin and achieved social position measured by the present educational status, educational attainment, and labour market position. Three mobility groups were constructed: the downwardly mobile, the upwardly mobile and the stable. Health related behaviours in an upwardly or downwardly mobile group were compared with a stable group from the same social class of origin by calculating relative risks (RR). RRs were assessed by calculating age and sex adjusted rate ratios approximating a Mantel-Haenszel estimate. In logistic regression analyses the independent effects of the social class of origin and the achieved social position were investigated. Most of the nine behaviours studied (smoking, alcohol use, heavy intoxication, coffee drinking, tooth brushing, consumption of sweets, lack of physical exercise, choice of bread spread, and consumption of milk) were related to the direction of mobility so that health compromising behaviours were more frequent among downwardly mobile and less frequent among upwardly mobile young people than their stable peers. Achieved social position proved to determine health related behaviours more strongly than class of origin, thus emphasising the way education facilitates both health values and behaviours as well as the future social position. CONCLUSIONS: The close relation between social mobility and health related behaviours is concluded to be a part of an explanation of social class differences in health observed among adults. (+info)
When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood.
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STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88. PARTICIPANTS: 4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances. MAIN RESULTS: Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent. CONCLUSIONS: Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood. (+info)
Socioeconomic and demographic predictors of mortality and institutional residence among middle aged and older people: results from the Longitudinal Study.
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STUDY OBJECTIVES: To identify socioeconomic and demographic predictors of long term mortality and institutional residence in old age, taking into account changes in socioeconomic and demographic circumstances between the 1971 and 1981 censuses. DESIGN: Multivariate logistic regression modelling of outcomes for 10 year age cohorts of each gender. The outcomes were death by 31 December 1992; being in an institution in 1991. SETTING: Members of the Longitudinal Study (a 1% sample of the British Census): 43,092 men and 50,839 women aged 55-74 in 1971. MAIN RESULTS: Being in rented accommodation and in a household without access to a car carried 35-45% higher mortality rate over 21 years and similar excess risk of being in an institution in 1991. Marital status and living arrangements were weaker predictors of death but being single was a major predictor of moving to an institution for men. Losing household access to a car was a strong factor for mortality for men and for institutionalisation for men aged 55-64 in 1971. The effects were weaker for women. Moving into rented accommodation was a predictor of both outcomes for women and of death for the younger cohort of men. People who started to live alone in the inter-census period were at reduced risk of dying. CONCLUSIONS: These results demonstrate persistence of inequalities in health related outcomes throughout old age, both in those with unfavourable circumstances in mid-life and in those who, in later life, have lost earlier advantages. (+info)
Influence of socioeconomic circumstances in early and later life on stroke risk among men in a Scottish cohort study.
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BACKGROUND AND PURPOSE: The purpose of the study was to investigate stroke risk by socioeconomic measures. METHODS: The analysis was based on a large cohort study of 5765 working men, from 27 workplaces in Scotland, who were screened between 1970 and 1973. Stroke was defined as having a hospital admission with a main diagnosis of stroke or dying of stroke in the 25-year follow-up period. RESULTS: There were 416 men who had a stroke. Men with manual occupations when screened, on first entering the workforce, men with manual occupations, and men whose fathers had manual occupations had significantly higher rates of stroke than men in the nonmanual categories. Men who left full-time education at age 16 years or under also had significantly higher rates of stroke. Men living in more deprived areas had higher rates of stroke, but the rates were not statistically significant. The most marked difference was in relation to father's social class, and although adjusting for risk factors for stroke attenuated the relative rates, men whose fathers were in manual social classes had higher relative rates of stroke than men whose fathers were in nonmanual classes (adjusted relative rate for father's social class III manual was 1.37 [95% CI 1.03 to 1.81] and for father's social class IV or V was 1.46 [1.09 to 1.96]). Men who were upwardly mobile (father's social class manual, own social class nonmanual) had a rate of stroke similar to that of stable manual men. CONCLUSIONS: Poorer socioeconomic circumstance was associated with greater stroke risk, with adverse early-life circumstances of particular importance. (+info)
Health-related mobility, health inequalities and gradient constraint. Discussion and results from a Norwegian study.
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BACKGROUND: Recent studies have argued that health-related mobility does not widen social class health differentials, but rather moderates them. This is termed gradient constraint. This paper examines gradient constraint from a theoretical and empirical angle. METHODS: How health-related mobility influences social class health differentials is discussed using hypothetical models. In a Norwegian survey with data on intergenerational mobility (N = 1,853 males aged 30-69 years), mean health and height values for different subsections of the sample were analysed. RESULTS: When initial social class health differences are large and mobility widespread, health-related mobility may lead to smaller differentials, but the result depends on how closely mobility varies with health. This empirical study found non-significant increases in height and health differentials from class of origin to class of destination. The interpretation has to consider effects of both social mobility and social causation. Health is measured in the post-mobility situation and the effects of social mobility and social causation are difficult to separate from each other for most of the health indicators analysed. However, this limitation does not apply to height which is not influenced by social causation during adulthood. In these data mobility did not reduce the height differential. CONCLUSION: Health-related mobility can either lead to smaller or larger social class health differentials. The specific effects of social mobility cannot be determined without knowing how social causation has interfered. The intergenerational mobility process analysed in this paper does not show gradient constraint as regards the height differential between the worker and higher occupational categories. (+info)
Are inequalities in height underestimated by adult social position? Effects of changing social structure and height selection in a cohort study.
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OBJECTIVES: To investigate whether changing social structure and social mobility related to height generate (inflate) inequalities in height. DESIGN: Longitudinal 1958 British birth cohort study. SETTING: England, Scotland, and Wales. PARTICIPANTS: 10 176 people born 3-9 March 1958 for whom data were available at age 33 years. MAIN OUTCOME MEASURES: Adult height and social class at age 33 years; class of origin (father's occupation when participant was 7 years old). RESULTS: Adult height showed a social gradient with class at age 7 years and age 33 years. The difference in mean height between extreme groups was greater for class of origin than for adult class, reducing from 2.21 cm to 1.62 cm for men and from 2.18 cm to 1.74 cm for women. This narrowing inequality was due mainly to a decrease in mean height in classes I and II. This was because of the pattern of height related social mobility in which, for example, men moving into classes I and II were taller (mean 177.2 cm) than men remaining in class III manual (mean 176.1 cm) yet shorter than men with class I and II origins (mean 178.3 cm) and the relatively large number of individuals moving into classes I and II. Changes in the structure of society, seen here with the general trend of upward social mobility, have acted to diminish inequalities in adult height. CONCLUSIONS: The combination of changing social structure and height related mobility constrains, rather than inflates, inequalities in height and may lead to an underestimation of the role of childhood socioeconomic factors in the development of inequalities in adult disease. (+info)
Impact of upward social mobility on population mortality: analysis with routine data.
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OBJECTIVE: To examine the contribution of changes in the distribution of social class to the mortality of the whole population between 1970-2 and 1991-3. DESIGN: Examination of routine data at two time points: 1970-2 and 1991-3. DATA SOURCE: Data provided by the Office for National Statistics. MAIN OUTCOME MEASURES: Difference for the total population in the number of deaths between 1971 and 1991. Proportion of difference accounted for by change in population size, change in risk of death within each social class, or change in distribution of population across social classes. RESULTS: Reductions in mortality between 1970-2 and 1991-3 among men in England and Wales were partially (16% of all deaths) attributable to increases in the proportion of men in higher social classes, representing 3943 fewer deaths per year or one less death for every 3056 men in 1991-3 compared with 1970-2. CONCLUSION: Some of the observed reduction in mortality seen between 1970-2 and 1991-3 can be accounted for by improved overall socioeconomic status of the population. (+info)