Socioeconomic Inequalities in Health in 22 European Countries

Mackenbach, Johan P.; Stirbu, Irina; Roskam, Albert-Jan; Schaap, Maartje M.; Menvielle, Gwenn; Leinsalu, Mall; Kunst, Anton E.

doi:10.1056/nejmsa0707519

Cited by 2,639 publications

(2,076 citation statements)

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“…While higher occupational status is linked typically to a more favourable health profile 17, 32, people from higher occupational status groups have reported higher alcohol consumption than those from lower occupational status groups in cohort studies of public sector employees 17. In the present study, higher occupational status and education were associated with increased odds of belonging to the trajectory of slowly declining risky drinking.…”

Section: Discussionmentioning

confidence: 41%

Trajectories of risky drinking around the time of statutory retirement: a longitudinal latent class analysis

et al. 2017

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Background and AimsLife transitions such as retirement may influence alcohol consumption, but only a few studies have described this using longitudinal data. We identified patterns and predictors of risky drinking around the time of retirement.DesignA cohort study assessing trajectories and predictors of risky drinking among employees entering statutory retirement between 2000 and 2011.Setting and ParticipantsA total of 5805 men and women from the Finnish Public Sector study who responded to questions on alcohol consumption one to three times prior to (w−3, w−2, w−1), and one to three times after (w+1, w+2, w+3) retirement.MeasurementsWe assessed trajectories of risky drinking (> 24 units per week among men, > 16 units among women, or an extreme drinking occasion during past year) from pre‐ to post‐retirement, as well as predictors of each alcohol consumption trajectory.FindingsThree trajectories were identified: sustained healthy drinking (81% of participants), temporary increase in risky drinking around retirement (12%) and slowly declining risky drinking after retirement (7%). The strongest pre‐retirement predictors for belonging to the group of temporary increase in risky drinking were current smoking [odds ratio (OR) = 3.90, 95% confidence interval (CI) = 2.70–5.64], male sex (OR = 2.77, 95% CI = 2.16–3.55), depression (OR = 1.44, 95% CI = 1.05–1.99) and work‐place in the metropolitan area (OR = 1.29, 95% CI = 1.00–1.66). Compared with the slowly declining risky drinking group, the temporary increase in risky drinking group was characterized by lower occupational status and education, and work‐place outside the metropolitan area.ConclusionsIn Finland, approximately 12% of people who reach retirement age experience a temporary increase in alcohol consumption to risky levels, while approximately 7% experience a slow decline in risky levels of alcohol consumption. Male gender, smoking, being depressed and working in a metropolitan area are associated with increased likelihood of increased alcohol consumption.

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Section: Discussionmentioning

confidence: 41%

Trajectories of risky drinking around the time of statutory retirement: a longitudinal latent class analysis

et al. 2017

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“…Socioeconomic differences in disease management and outcomes have been reported in studies conducted in a large variety of settings 16, 17. Mechanisms contributing to social gradients in cancer management and prognosis remain incompletely understood, but have been discussed in relation to characteristics of the disease, the host and the health care system 18.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population‐based study

Tomic

Ventimiglia

Robinson

et al. 2018

Intl Journal of Cancer

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Patients with high socioeconomic status (SES) have better cancer outcomes than patients with low SES. This has also been shown in Sweden, a country with tax‐financed health care aiming to provide care on equal terms to all residents. The association between income and educational level and diagnostics and treatment as outlined in national guidelines and prostate cancer (Pca) and all‐cause mortality was assessed in 74,643 men by use of data in the National Prostate Cancer Register of Sweden and a number of other health care registers and demographic databases. In multivariable logistic regression analysis, men with high income had higher probability of Pca detected in a health‐check‐up, top versus bottom income quartile, odds ratio (OR) 1.60 (95% CI 1.45–1.77) and lower probability of waiting more than 3 months for prostatectomy, OR 0.77 (0.69–0.86). Men with the highest incomes also had higher probability of curative treatment for intermediate and high‐risk cancer, OR 1.77 (1.61–1.95) and lower risk of positive margins, (incomplete resection) at prostatectomy, OR 0.80 (0.71–0.90). Similar, but weaker associations were observed for educational level. At 6 years of follow‐up, Pca mortality was modestly lower for men with high income, which was statistically significant for localized high‐risk and metastatic Pca in men with no comorbidities. All‐cause mortality was less than half in top versus bottom quartile of income (12% vs. 30%, p < 0.001) among men above age 65. Our findings underscore the importance of adherence to guidelines to ensure optimal and equal care for all patients diagnosed with cancer.

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“…People who are socially disadvantaged are at a substantially higher risk of suffering alcohol‐related diseases 3. This may be related to binge drinking that is more prevalent among disadvantaged men 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone

Crombie

Irvine

Falconer

et al. 2017

Drug and Alcohol Review

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Introduction and AimsDisadvantaged men suffer substantial harm from heavy drinking. This feasibility study developed and evaluated the methods for a trial of a brief intervention delivered by text messages to disadvantaged men. It aimed to test the methods for recruitment and retention, to monitor engagement with the intervention and assess the overall acceptability of study methods.Design and MethodsDisadvantaged men aged 25–44 years who had ≥2 episodes of binge drinking (≥8 units in one session) in the preceding month were recruited. Two recruitment strategies were assessed: recruitment from general practice registers and by a community outreach strategy. Theoretically and empirically based text messages were tailored to the target group.ResultsThe study recruited 67 disadvantaged men at high risk of alcohol‐related harm, exceeding the target of 60. Evaluation showed that 95% of text messages were delivered, and the men engaged enthusiastically with the intervention. Retention at follow up was 96%. Outcomes were successfully measured on all men followed up. This provided data for the sample size calculation for the full trial. Post‐study evaluation showed high levels of satisfaction with the study.Discussion and ConclusionsThis study has shown that disadvantaged men can be recruited and follow‐up data obtained in an alcohol intervention study. The study methods were acceptable to the participants. The men recruited were at high risk of alcohol‐related harms. It also clarified ways in which the recruitment strategy, the baseline questionnaire and the intervention could be improved. The full trial is currently underway. [Crombie IK, Irvine L, Falconer DW, Williams B, Ricketts IW, Jones C, Humphris G, Norrie J, Slane P, Rice P. Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone. Drug Alcohol Rev 2017;36:468‐476]

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Socioeconomic Inequalities in Health in 22 European Countries

Abstract: We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care.

Cited by 2,639 publications

References 32 publications

Trajectories of risky drinking around the time of statutory retirement: a longitudinal latent class analysis

Trajectories of risky drinking around the time of statutory retirement: a longitudinal latent class analysis

Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population‐based study

Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone

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