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PURPOSE: Self-assessed poor health status is associated with increased risk of mortality in several cardiovascular conditions, but has not been investigated in patients with endocarditis. We examined health status and mortality in patients with endocarditis.METHODS: This is a re-specified substudy of the randomized POET endocarditis trial, which included 400 patients. Patients completed the single-question self-assessed health status from the Short-Form 36 questionnaire at time of randomization and were categorized as having poor or non-poor (excellent/very good, good, or fair) health status. Self-assessed health status and all-cause mortality were examined by a Cox regression model.RESULTS: Self-assessed health status was completed by 266 (67%) patients with a mean age of 68.0 years (± 11.8), 54 (20%) were females, and 86 (32%) had one or more major concurrent medical conditions besides endocarditis. The self-assessed health status distribution was poor (n = 21, 8%) and non-poor (n = 245, 92%). The median follow-up was 3.3 years and death occurred in 9 (43%) and 48 (20%) patients reporting poor and non-poor health status, respectively, and mortality rates [mortality/100 person-years, 95% confidence interval (CI)] were 18.1 (95% CI 9.4-34.8) and 5.4 (95% CI 4.1-7.2), i.e., the crude hazard ratio for death was 3.4 (95% CI: 1.7-7.0, p CONCLUSION: Self-assessed poor health status compared with non-poor health status as assessed by a single question was associated with a threefold increased long-term mortality in patients with endocarditis. POET ClinicalTrials.gov number, NCT01375257.TRIAL REGISTRY: POET ClinicalTrials.gov number, NCT01375257.

Objectives There are studies on associations between obesity and mortality in nursing home (NH) residents, but the presence of concomitant muscle weakness has not been examined. We considered that self-reported weakness might be a low muscle strength proxy marker. We aimed to examine associations of obesity alone, self-reported muscle weakness alone, and their combination with mortality in NH residents. Methods This is a retrospective longitudinal follow-up study. We noted age, sex, nutritional status, functionality, number of chronic diseases, and regular medication. Obesity was assessed by the body fat-percentage method estimated by bioimpedance analysis. Weakness was identified by self-reported muscle weakness. Survival was evaluated with a univariate log-rank test and multivariate Cox regression analyses. Results We included 214 participants. In a median follow-up time of 46 months, mortality occurred in 37.4%. In multivariate analysis adjusted by age, sex, undernutrition, number of chronic diseases, and regular medication, functional scores; \"non-weak non-obese\" participants or \"weak alone\" participants or \"weak+obese\" participants had higher mortality risk when compared with the \"obesity alone\" participants [hazard ratio (HR) = 2.6, 95% confidence interval (CI) = 1.2-5.5, p = 0.01; HR = 2.6, 95% CI = 1.2-5.9, p = 0.02; HR = 3.0, 95% CI = 1.2-7.7, p = 0.02]. Conclusion This is the first report showing that obesity was associated with lower mortality risk if the weakness was not present in NH residents. However, obesity with concomitant weakness was associated with mortality risk similar to non-weak non-obese or weak alone participants. Our study suggests a simple consideration of weakness that can easily be integrated into everyday practice.

Objective: To identify the relationship between religiosity and self-rated health among older adults in Colombia. Methods: Data are drawn from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional survey conducted in 2015 involving 18,871 community-dwelling adults aged 60 years and older living in urban and rural areas of Colombia. Religiosity was assessed by self-rated religiosity (how religious are you: not at all, somewhat or very). Self-rated health during previous 30 days was assessed as very good, good, fair, poor or very poor, analyzed as an ordinal variable (1-5) using weighted logistic regression, adjusting for confounders. Results: Those who were more religious were older, female, had lower socioeconomic status, and were more likely to be married. Multivariate analyses demonstrated that older adults who were more religious had better self-rated health (OR: 0.92, 95% CI: 0.86-0.99, p= 0.038); however, there was a significant interaction effect between gender and religiosity on self-rated health (p= 0.002), such that the relationship between religiosity and health was stronger in men (OR: 0.86, 95% CI: 0.79-0.94, p= 0.001) but not significant in women. Conclusion: Older adults in Colombia who consider themselves more religious, especially men, are less likely to perceive their physical health as poor compared to those who are less religious. Resumen Objetivo: Identificar la relación entre religiosidad y el auto reporte de salud entre adultos mayores en Colombia. Métodos: Los datos provienen del estudio SABE (Salud, Bienestar y Envejecimiento) Colombia, una encuesta transversal realizada en 2015 en la que participaron 18,871 adultos de 60 años o más que viven en la comunidad y provienen de zonas urbanas y rurales en Colombia. La religiosidad fue autoevaluada (qué tan religiosa eres: nada, algo o muy). La autoevaluación de la salud durante los 30 días previos se evaluó como muy buena, buena, regular, mala o muy mala, analizada como variable ordinal (1-5) usando la regresión logística ponderada, ajustando por factores de confusión. Resultados: La edad avanzada, el sexo femenino, estar casado, y tener bajo nivel socioeconómico se asociaron con ser más religiosos. Los análisis multivariados demostraron que ser más religioso se asociaba con mejor salud autoevaluada (OR= 0.92; IC 95%= 0.86-0.99; p= 0.038). Sin embargo hubo una interacción significativa entre género y religiosidad sobre la salud autoevaluada (p= 0.002), tal que la relación entre religiosidad y salud fue mas fuerte en los hombres (OR= 0.86; IC 95%= 0.79-0.94; p= 0.001), pero no fue significativa en mujeres. Conclusión: Los adultos mayores en Colombia que se consideran a sí mismos más religiosos, especialmente los hombres, tienen menos probabilidades de percibir su salud como pobre en comparación con aquellos que son menos religiosos.

Background The unemployed have lower work ability and poorer health than the employed. This situation deteriorates when unemployment continues. The long-term unemployed often have co-morbidities and face many other challenges. This increases the need for a multidimensional assessment of work ability and functioning in different service settings. In this study, we describe the development and analyse the content validity of the Abilitator, a self-report questionnaire on work ability and functioning for those in a weak labour market position. Methods The Abilitator was developed in 2014–2017. Its construct was assessed by members of academic expert panels (n = 30), practical expert panels of professionals (n = 700) and target group clients (n = 28). The structure and the content of the questionnaire was co-developed in 29 workshops and adjusted twice based on the expert panels’ feedback. The Abilitator was also implemented among target group clients (n = 3360) in different services and projects. During its development the Abilitator was linked to the International Classification of Functioning, Disability and Health (ICF). The content validation process followed the guidelines recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel. Results The construct of the Abilitator combines the multidimensional and biopsychosocial models of work ability and functioning. It also includes aspects of social inclusion and employability. It evaluates social, psychological, cognitive and physical functioning, and the ability to cope with everyday life. The content of these concepts was validated by the academic and practical expert panels. The Abilitator’s 79 ICF codes covered 57% of the Generic, 77% of the Brief Vocational Rehabilitation, and 8% of the Minimal Environmental ICF Core Sets. When compared with the Work Ability Index (WAI) and the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the direct equivalences of the ICF codes were 36 and 44%, respectively. Conclusion The Abilitator sufficiently comprehensively covers the relevant aspects to enable the assessment of the overall work ability and functioning of the population in a weak labour market position.

Background: Physical activity (PA) is a key component in management of type 2 diabetes (T2D). Pain might be a barrier to PA especially among older adults with T2D, but surprisingly few studies have investigated the association between chronic pain and PA. Our aim was to evaluate the prevalence of chronic pain among older adults with T2D and to examine the association between chronic pain and PA while taking important life-contextual factors into account. Methods: Data of this register-based, cross-sectional study were collected in a survey among adults with T2D (n=2866). In the current study, only respondents aged 65?75 years were included (response rate 63%, n=1386). Data were analysed by means of descriptive statistics and multivariate logistic regression analysis. Results: In total, 64% reported chronic pain. In specific groups, e.g. women and those who were obese, the prevalence was even higher. Among respondents experiencing chronic pain, frequent pain among women and severe pain among both genders were independently associated with decreased likelihood of being physically active. Moreover, the likelihood of being physically active decreased with higher age and BMI, whereas it increased with higher autonomous motivation and feelings of energy. Among physically active respondents suffering from chronic pain, neither intensity nor frequency of pain explained engagement in exercise (as compared with incidental PA). Instead, men were more likely to exercise regularly as were those with good perceived health and higher autonomous motivation. Conclusions: The prevalence of chronic pain is high among older adults with T2D. This study shows that among those suffering from chronic pain, severe pain is independently and inversely associated with being physically active, as is frequent pain, but only among women. Moreover, the findings show the importance of autonomous motivation and health variables for both incidental PA and exercise among older adults with T2D experiencing chronic pain.

BackgroundNeighbourhood safety has repeatedly been shown to be associated with the health and well-being of the residents. Criminality is often seen as one of the key factors affecting neighbourhood safety. However, the relationship between crime, fear of crime and feelings of safety remains underexplored.MethodsData on socio-demographic, health and safety perceptions was extracted from the Maastricht municipality survey (the Netherlands) (n = 9656 adults) and merged with data on official neighbourhood crime rates from the Police Registry. Pearson correlation coefficients and multilevel logistic regression models were computed to assess the association between aspects of objective and perceived criminality, individuals’ feelings of safety and health.ResultsThe correlation between the police recorded crime and residents’ perceptions of the neighbourhood crime rates was weak (0.14–0.38), with the exception of violent crime (0.59), which indicates that other factors contribute to the perceptions of safety. In turn, the perception of higher rates of violent crime and more nuisance (on the scale 0–10) but not other types of crime or nuisance was positively associated with feeling unsafe (OR 1.27 [1.22;1.32] and 1.39 [1.33;1.46], respectively). Lower general feelings of safety at both the individual and neighbourhood level were consistently associated with worse self-rated health. Among different indicators of safety, the general feelings of safety had the most pronounced association with health, while subjective or objective measures of crime showed limited to no direct relationship with health.ConclusionsPublic health policies targeting safety as a social determinant of health should consider prioritizing areas of violent crime and nuisance to improve general feelings of safety. Further research is needed to understand which factors aside from criminality are driving residents’ feelings of safety.

Background Our paper assesses the relationship between social integration, in terms of social contact and social trust, and one’s individual health. While a large body of research already engaged with clarifying this relationship, we know little about the role one’s immigration background plays in moderating this relationship. With respect to this, we explicitly focus on how one’s immigrant status moderates the relationship between social integration and self-reported health. Previous literature has demonstrably shown that the less socially integrated individuals are, the less likely they are to report good health. Moreover, we know from social capital literature that immigrants have difficulties being socially connected in their host country. Methods With the help of the new MIGHEAL survey, we test this proposed negative relationship. We also compare the results from the MIGHEAL data with findings from the European Social Survey round 7. Our analyses follow a thorough approach testing immigrant background as potential moderating factors. We implement logistic regression models and path analysis to reveal the complex interactive relationship between social integration, immigrant status and self-reported health. Results/Conclusion Our results suggest that immigrant status does play a moderating role in the relationship between social integration and health. This role, however, is limited to the relationship between social activity and self-reported health, which points to a potential endogenous effect. Locked until 21.5.2019 due to copyright restrictions. This is a pre-copyedited, author-produced version of an article accepted for publication in [European Journal of Public Health] following peer review. The version of record is available online at: https://doi.org/10.1093/eurpub/cky206

In this paper, we study the effects of the 2008 economic crisis on general health in one of the most severely affected EU economies-Ireland. We examine the relationship between compositional changes in demographic and socio-economic factors, such as education, income, and financial strain, and changes in the prevalence of poor self-assessed health over a 5-year period (2008-2013). We apply a generalised Oaxaca-Blinder decomposition approach for non-linear regression models proposed by Fairlie (1999, 2005). Results show that the increased financial strain explained the largest part of the increase in poor health in the Irish population and different sub-groups. Changes in the economic activity status and population structure also had a significant positive effect. The expansion of education had a significant negative effect, preventing further increases in poor health. Wealthier and better educated individuals experienced larger relative increases in poor health, which led to reduced socio-economic health inequalities.

OBJECTIVES: Poor psychosocial working conditions increase the likelihood of various types of morbidity and may substantially limit quality of life and possibilities to remain in paid work. To date, however, no studies to our knowledge have quantified the extent to which poor psychosocial working conditions reduce healthy or chronic disease-free life expectancy, which was the focus of this study.METHODS: Data were derived from four cohorts with repeat data: the Finnish Public Sector Study (Finland), GAZEL (France), the Swedish Longitudinal Occupational Survey of Health (Sweden) and Whitehall II (UK). Healthy (in good self-rated health) life expectancy (HLE) and chronic disease-free (free from cardiovascular disease, cancer, respiratory disease and diabetes) life expectancy (CDFLE) was calculated from age 50 to 75 based on 64 394 individuals with data on job strain (high demands in combination with low control) at baseline and health at baseline and follow-up.RESULTS: Multistate life table models showed that job strain was consistently related to shorter HLE (overall 1.7 years difference). The difference in HLE was more pronounced among men (2.0 years compared with 1.5 years for women) and participants in lower occupational positions (2.5 years among low-grade men compared with 1.7 years among high-grade men). Similar differences in HLE, although smaller, were observed among those in intermediate or high occupational positions. Job strain was additionally associated with shorter CDFLE, although this association was weaker and somewhat inconsistent.CONCLUSIONS: These findings suggest that individuals with job strain have a shorter health expectancy compared with those without job strain.

Objectives: This study compared 15 countries for multiplicative effects of gender by education and by income on self-rated health of individuals with chronic medical conditions. Methods: We analyzed data from the Research on Early Life and Aging Trends and Effects (RELATE) Study. Participants were sampled from 15 countries including Argentina, Barbados, Brazil, Chile, Cuba, Costa Rica, China, India, Ghana, Russia, Puerto Rico, South Africa, Mexico, Uruguay, and the United States. The analytical sample was limited to individuals with at least one chronic medical condition. The main outcome of interest was self-rated health (SRH). Country-specific logistic regressions were used for data analysis. We ran separate models with gender × education and gender × income interactions. Results: In Ghana, Uruguay, and India, gender moderated the effects of socioeconomic status (SES) on SRH. In Ghana and Uruguay, education and in Mexico and India, income had a stronger effect on SRH for women than men. Conclusions: Countries vary in gender differences in vulnerability to SES indicators on SRH of patients with chronic medical conditions. Women are more vulnerable than men to the effect of low SES on SRH in Ghana, Uruguay, Mexico, and India.

Several studies have shown ample cross-national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross-national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross-national variation in the health gap between the lower and higher educated in europe is explained by governmental health expenditure, namely, how much governments contribute to a country’s total healthcare costs, and labour market conditions, that is, unemployment rates and modernisation of the labour market. We used information from the european social survey (ess) 2002–2008 on more than 90,000 individuals in 32 european nations, and estimated hierarchical models with cross-level interactions to test our expectations. Our results show that the relative risk of being in poor health of lower educated individuals is smaller in countries where the government spends much on healthcare and with a highly modernised labour market.

This paper develops a method to model the effect of income on self-reported health at the individual level. The model is estimated using the meta-analytic data of 68 studies from 13 countries, and is used to test two hypotheses. The first hypothesis is that income affects health at the individual level. If this is the case, the incidence of poor health will differ across people from different income groups. The second hypothesis is that income differentials are associated with differential vulnerability to poor health. If so, the influence of income on health outcomes will differ across members of different income groups in different countries.The collected data are best described by a log-linear relationship between income and self-reported health. The empirical results confirm both hypotheses. We have found that (a) income inequality affects health at the individual level; (b) the level of self-reported poor health in the bottom deciles of the income distribution increases with the level of inequality in the country's income distribution; and (c) the relative income hypothesis has a stronger explanatory power for our results than the absolute income hypothesis. These results confirm the idea that for comparisons at the individual level, relative income matters more than absolute income. These findings have important policy implications.

Contains fulltext : 90131.pdf (Publisher’s version ) (Closed access) Objective To assess the value of self-rated health assessments by examining the association between education and self-rated poor health. Methods We used the globally representative population-based sample from the 2002 World Health Survey, composed of 219 713 men and women aged 25 and over in 69 countries, to examine the association between education and self-rated poor health. In a binary regression model with a logit link function, we used self-rated poor health as the binary dependent variable, and age, sex and education as the independent variables. Findings Globally, there was an inverse association between years of schooling and self-rated poor health (odds ratio, OR: 0.929; 95% confidence interval, CI: 0.926–0.933). Compared with the individuals in the highest quintile of years of schooling, those in the lowest quintile were twice as likely to report poor health (OR: 2.292; 95% CI: 2.165–2.426). We found a dose–response relationship between quintiles of years of schooling and the ORs for reporting poor health. This association was consistent among men and women; low-, middle- and high-income countries; and regions. Conclusion Our findings suggest that self-reports of health may be useful for epidemiological investigations within countries, even in low-income settings.

The aim was to describe health literacy among the older population of Kosovo, an Albanian speaking post-war country in the Western Balkans, in the context of self-perceived health status and self-reported chronic morbidity. A cross-sectional study was conducted in Kosovo in 2011 including 1753 individuals aged a parts per thousand yen65 years (886 men, 867 women; mean age 73.4 +/- 6.3 years; response rate: 77%). Participants were asked to assess, on a scale from 1 to 5, their level of difficulty with regard to access, understanding, appraisal and application of health information. Sub-scale scores and an overall health literacy score were calculated for each participant. Information on self-perceived health status, presence and number of chronic diseases and socioeconomic characteristics was also collected. Mean values of the overall health literacy score and all sub-scale scores (access, understanding, appraisal and application) were lower among older people who reported a poorer health status or at least one chronic condition compared with individuals who perceived their health status as good or had no chronic conditions (p

OBJECTIVES: To compare self-reported disability and performance-based limitation and their association in elderly men from three European countries. DESIGN: Cross-sectional data from a cohort study collected around 1990. SETTING: Three cohorts from Finland, the Netherlands, and Italy. PARTICIPANTS: One thousand one hundred sixty-one men aged 70 and older. MEASUREMENTS: Disability and functional limitation were measured in a standardized way in three countries. Self-reported disability was estimated by questionnaire, assessing three domains of activities of daily living: instrumental activities of daily living, mobility, and activities of daily living (score 0-3). Functional limitation was measured by performance tests (score 0-16), with 0 indicated the healthiest score. RESULTS: Self-reported disability and performance-based limitation scores differed between countries. Mean self-reported disability score was worse in Italy (0.72) and the Netherlands (0.70) than in Finland (0.54). Italian men scored worst on the performance-based tests (mean 4.80 vs 4.04 for Finland and 3.74 for the Netherlands). Differences in self-reported disability remained after adjusting for performance scores: Dutch men reported more disabilities (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.23-2.25) than men in Finland (reference group) and Italy (OR = 1.08, 95% CI = 0.77-1.53). Self-reported disability was positively associated with performance-based score (OR = 1.28, 95% CI = 1.21-1.35) and did not differ between countries. CONCLUSION: Cross-cultural variation was noted in self-reported disability adjusted for performance score. These differences may be due to sociocultural and physical environmental factors. Self-reported disability was consistently associated with performance-based limitation in Finland, the Netherlands, and Italy.

Several studies have shown ample cross-national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross-national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross-national variation in the health gap between the lower and higher educated in europe is explained by governmental health expenditure, namely, how much governments contribute to a country’s total healthcare costs, and labour market conditions, that is, unemployment rates and modernisation of the labour market. We used information from the european social survey (ess) 2002–2008 on more than 90,000 individuals in 32 european nations, and estimated hierarchical models with cross-level interactions to test our expectations. Our results show that the relative risk of being in poor health of lower educated individuals is smaller in countries where the government spends much on healthcare and with a highly modernised labour market.

Background: Evidence of an effect of income on self-reported poor health (SRPH) is widely available in the literature. We compare this effect across age, different countries and between men and women using meta-analysis. Studies that report on an effect of income lack a homogenous effect size. To overcome this problem we propose a method to derive a homogenous effect size to enable us to compare the effect of income across groups. Methods: We take a meta-analytical approach to examine the effect of income on SRPH. The data consists of reported and calculated odds ratios as a measure of effect for SRPH outcomes across different income categories. Self-reported health outcomes are dichotomised into 'good' and 'poor'. With least-squares techniques, we estimate the functional parameters that describe the log-linear association between income and SRPH. Subsequently, F-tests are performed to show variations between the groups. Results: The relationship between income and SRPH is log-linear for most countries but not significantly for Sweden and the Netherlands. Our results show significant differences in the effect of income between countries. We find that men require a higher income than women to achieve comparable SRPH outcomes, and that the effect of income depends on age. Conclusions: There is significant income related variation in SRPH between different countries even if the levels of income or the standards of living are comparable. For women income affects SRPH differently than for men. The effect of income on SRPH depends on the age of the individual respondent.

Contains fulltext : 90394.pdf (Publisher’s version ) (Closed access) Numerous studies have concluded that people’s socioeconomic position is related to mortality and morbidity, but that the strength of this association varies considerably both within and between European regions. This has spurred several researchers to more closely examine educational and occupational gradients in health in the Nordic countries to clarify the causes of cross-national differences. However, comparable studies using income as an indicator of socioeconomic position are still lacking. This study uses recent and highly comparable data to fill this gap. The aim of this study is threefold. First, we ask to what extent there is an income gradient in health in the Nordic countries, and to what extent the association differs between these countries. Second and third, we examine whether differences in the attenuation of the income gradient by education and occupational class, and age-specific differences between countries, may act as explanations for differences in the income gradient between the Nordic countries. The data source are three waves of the European Social Survey (ESS, 2002/2004/2006), which included 17,801 people aged 25 and over from Denmark, Finland, Norway, and Sweden. Two subjective health measures (physical/mental self reported health and limiting longstanding illness) were analysed by means of logistic regression. The results show that, in all countries, people reported significantly better health and were less likely to suffer from longstanding illness as they had a higher income. This association is strongest in Norway and Finland and weakest in Denmark. The income gradient in health, but not country differences in this gradient, is partly explained by education and occupational class. Additionally, the strength of the income gradient in health varies between age groups. The relatively high health inequalities between income groups in Norway and Finland are already visible in the youngest age groups. The results imply that the socioeconomic gradient in health will arguably not be strongly reduced in the near future as a result of cohort replacement, as has been suggested in previous studies. Health policy interventions may be particularly important five to ten years prior to retirement and in early adulthood. 9 p.

Background The purpose of this study was to assess potential differences in the predictive ability of self-assessed health for mortality between educational groups, and to find explanations for any of these educational differences.Methods We used data from the longitudinal GLOBE study, with a 13-year mortality follow-up. Analyses were performed for people aged between 25-74 years at baseline (n = 16 722). The associations of self-assessed health with mortality were estimated with Cox regression analyses, and the resulting hazard ratios were used as indicators of the 'predictive ability' of self-assessed health for mortality. Differences between educational levels were estimated by including an interaction term of education with self-assessed health in regression models with mortality as the outcome. The analyses were subsequently adjusted for: life threatening chronic conditions, non-life threatening conditions, stressors and health behaviour, to test the contribution of these factors to the predictive ability of self-assessed health.Results Results indicated that the predictive ability of self-assessed health for mortality was greater in men with tertiary education as compared with the lowest educated men. No differences were observed in women. None of the four health aspects accounted for the educational difference in men.Conclusions Because differences in the predictive ability for mortality were limited to the extreme educational groups in men, educational differences in self-assessed health that are reported in numerous studies should not be expected to seriously overestimate educational differences in 'objective' health status.

FP is funded by the Chief Scientist Office of the Scottish Executive Health Department Background: Scotland's overall health record is comparatively poor for a Western European country, particularly amongst people of working age. A number of previous studies have explored why this might be the case by comparing mortality in Scotland with England and Wales. A study in the 1980s showed that the higher prevalence of deprivation in Scotland accounted for Scotland's excess mortality risk. However, more recent studies suggest that deprivation now explains less of this excess. This has led to the suggestion that there is a yet unidentified "Scottish effect" contributing to Scotland's mortality excess. Recent research has also suggested that there could be an unidentified effect influencing Scotland's higher rate of heart disease. This paper explores whether there is also an unexplained Scottish excess, relative to England, in self reports of poor health. Methods: Data came from the individual Sample of Anonymised Records, a 3% random sample of the 2001 UK census. Using logistic regression models, self reports of health (limiting illness and general health) from the working age populations (aged 25 to 64) of Scotland and England were compared. Account was taken of people's country of birth. Stratified analysis by employment status allowed further exploration of Scotland's excess. Results: People born and living in Scotland reported higher levels of poor general health and limiting illness compared to people born and living in England. Adjustment for socioeconomic position and employment status largely explained the higher rates. In the stratified analysis a Scottish excess was seen only amongst the economically inactive born and living in Scotland. For those in employment, people born and living in Scotland actually had slightly lower odds of reporting poor general health and limiting illness than people born and living in England. Conclusion: This analysis suggests that higher rates of poor self reported health in Scotland can be explained by differences in employment and socioeconomic position and so there is unlikely to be an unidentified "Scottish effect" for self reports of health. Scotland's excess of poor general health and limiting illness amongst the economically inactive is probably attributable to its economic and employment history. Publisher PDF

Background Research and policy related to reducing health inequalities has progressed separately within Ireland and Northern Ireland. This paper describes the first exploration of the socio-economic influences on health on the island of Ireland since 1922. Methods Postal survey. Results The response rate was 52%; 11,870 respondents. Men reported more long-standing illness (LLTI) or poor general health (PGH); depression was more common amongst women. Socio-economic gradients in health were evident in both jurisdictions, with the effects of household income being particularly marked. Overall, morbidity levels were significantly better in Ireland than in Northern Ireland: adjusted odds ratio Of 0.79 (95% Cl 0.71- 0.88) for LLTI; 0.64 (0.57 - 0.72) for PGH; 0.90 (0.82 - 0.99) for depression. Conclusions There is evidence of strong and similar socio-economic gradients in health throughout the island of Ireland. This would suggest joint policy approaches or at least further comparative evaluation of the initiatives in each jurisdiction.

BackgroundWomen and men share similar health challenges yet women report poorer health. The study investigates the social determinants of self-reported health in women and men, and male-female differences in health.MethodsData on 103154 men and 125728 women were analysed from 57 countries in the World Health Survey 2002-2004. Item Response Theory was used to construct a composite measure of health. Associations between health and determinants were assessed using multivariate linear regression. Blinder-Oaxaca decomposition partitioned the inequality in health between women and men into an "explained" component that arises because men and women differ in social and economic characteristics, and an "unexplained" component due to the differential effects of these characteristics. Decomposition was repeated for 18 countries in the World Health Organization (WHO) African region and 19 countries in the WHO European region.ResultsWomen's health was significantly lower than men's. Health was associated with education, household economic status, employment, and marital status after controlling for age. In the pooled analysis decomposition showed that 30% of the inequality was "explained", of which almost 75% came from employment, education, marital status. The differential effects of being in paid employment increased the inequality. When countries in Africa and Europe were compared, the "explained" component (31% and 39% respectively) was largely attributed to the social determinants in the African countries and to women's longevity in the European countries. Being in paid employment had a greater positive effect on the health of males in both regions.ConclusionsWays in which age and the social determinants contribute to the poorer health status of women compared with men varies between groups of countries. This study highlights the need for action to address social structures, institutional discrimination and harmful gender norms and roles that differently influence health with ageing.

This study examines the direct and moderating effects of two types of control that employees have over the work situation – job control and job self-efficacy – on the relationship between job insecurity and employee health. The authors hypothesize that job control and job self-efficacy attenuate the negative effects of job insecurity on both a short-term (i.e. need for recovery) and a long-term health outcome (i.e. impaired general health). These hypotheses were examined using survey data collected from a heterogeneous sample of 1368 Belgian workers. Results of moderated regression analysis showed that job control, but not job self-efficacy, buffered the negative effects of job insecurity on employee health. We conclude that organizations can temper the negative health effects of job insecurity by giving their employees more control over their work.