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Background: Limited lung function represents a serious health impairment. However, studies investigating social inequalities in limited lung function are rare. Thus, the current study investigates which socioeconomic groups are the most affected by overall limited lung function and severely limited lung function. Methods: Data from the population-based German Aging Survey were used (N = 4472), with participants being 40 + years old. Lung function was assessed by the peak flow test. Education, income, and occupational prestige were used as socioeconomic indicators. Results: We found that overall limited lung function was highly prevalent across the whole sample, with about 33% (Women: 35%; Men: 30%) having overall limited lung function and 8% (Women: 7%; Men: 8%) having severely limited lung function. Socioeconomic differences in limited lung function emerged for all three indicators, education, income, and occupational prestige, in both men and women in single effect analyses. These differences persisted for occupational prestige and income when controlling for all indicators simultaneously. Conclusions: Thus, overall and severely limited lung function are highly prevalent health conditions. Men and women with a low occupational position and those with low income are the most affected. Socioeconomic indicators cannot be used interchangeably when studying health inequalities in lung functioning. Occupational hazards and physical working conditions are likely to constitute major risks of health inequalities in limited lung functioning and should be investigated as such by future studies. [ABSTRACT FROM AUTHOR]

The objective of universal health care systems is to achieve equality in the use of health services at the same level of care need. This study evaluates the relationship of socioeconomic position with the frequency of doctor visits in subjects with and without chronic diseases in Germany and Spain. The dependent variables included number of consultations and if a medical consultation occurred. The socioeconomic factors were income and education. The magnitude of the relationship between socioeconomic position and medical consultation frequency was estimated by calculating the percentage ratio using binomial regression and by calculating the difference in consultations by analysis of the covariance, in the case of number of visits. Statistically significant findings according to education were not observed. The percentage ratio in the medical consultations among those with lower and higher income was 1.03 (95% confidence interval [CI] 1.01-2.88) in Germany and 1.11 (95% CI 1.03-1.20) in Spain among subjects with any of the studied chronic conditions. Also, in Germany the difference in the average number of consultations comparing lower income subjects with higher was 3.98 (95% CI 2.40-5.57) in those with chronic conditions. In both countries, there were no differences in the frequency of doctor visits according to education. However, a pro-inequality trend exists in favor of subjects with lower income. [ABSTRACT FROM AUTHOR]

Aim: We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries. Subjects and methods: We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted. Results: We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic. Conclusions: Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups. [ABSTRACT FROM AUTHOR]

Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data (N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged. [ABSTRACT FROM AUTHOR]

It is examined whether older adults' cognitive ability in terms of delayed recall and verbal fluency is improving over time, whether this occurs over all educational levels and both sexes, and whether these changes are due to increasing proportions of individuals with higher education. Analyses are based on the German samples of the Survey on Health, Ageing and Retirement in Europe (waves 2004 and 2013). Achievement levels increased over time and in all age groups. Improvements over educational levels occurred in parallel, differences between educational levels in the earlier survey were later reproduced at higher levels. Increasing proportions of individuals with higher education did not explain improvements of cognitive ability. No sex differences emerged. Improved cognitive abilities could not be explained by upward shifts of educational levels. Improvements in higher age groups may foster improved health status and prolonged self-determined life in the older population. [ABSTRACT FROM AUTHOR]

Objective: The relationship of socioeconomic position with the use of health services may have changed with the emergence of the economic crisis. This study shows that relationship before and during the economic crisis, in Germany and in Spain. Methods: Data from the 2006 and 2011 Socio-Economic Panel carried out in Germany, and from the 2006 and 2011 National Health Surveys carried out in Spain were used. The health services investigated were physician consultations and hospitalization. The measures of socioeconomic position used were education and household income. The magnitude of the relationship between socioeconomic position and the use of each health services was estimated by calculating the percentage ratio by binary regression. Results: In Germany, in both periods, after adjusting for age, sex, type of health insurance and need for care, subjects belonging to the lower educational categories had a lower frequency of physician consultations, while those belonging to the lower income categories had a higher frequency of hospitalization. In the model comparing the two lower socioeconomic categories to the two higher categories, the percentage ratio for physician consultation by education was 0.97 (95%CI 0.96–0.98) in 2006 and 0.96 (95%CI 0.95–0.97) in 2011, and the percentage ratio for hospitalization by income was 1.14 (95%CI 1.05–1.25) in 2006 and 1.12 (95%CI 1.03–1.21) in 2011. In Spain, no significant socioeconomic differences were observed in either period in the frequency of use of these health services in the fully adjusted model. Conclusion: The results suggest that the economic crisis did not alter accessibility to the health system in either country, given that the socioeconomic pattern in the use of these health services was similar before and during the crisis in both countries. [ABSTRACT FROM AUTHOR]

Background: Most studies on health disparities deal with the occurrence of disease, but little is known about inequalities in the utilization of mental health services. This paper examines social inequalities in the utilization of outpatient psychotherapy within a health care system where there are low financial barriers to health care and a lack of specific health policies to address access to psychotherapeutic services. Methods: Registry data of German statutory health insurance for the year 2013 were used (total population: N = 746,963; 10,711 women and men with psychotherapy). Logistic regression analyses were performed to estimate the effects of three socio-economic (SES) indicators on the utilization of psychotherapy. Results: Utilization of psychotherapy by SES status did not correspond to the social structure of the insured population. Social disparities that disadvantaged less privileged women and men were found; this applied to education, income and occupational position. The most pronounced differences were found for education. In contrast, effects of income were rather small. These findings must be interpreted against the backdrop of the absence of financial barriers to outpatient psychotherapy in Germany. Conclusions: A marked degree of psychotherapy under-utilization was found for lower SES groups. Psychotherapists should pay increased attention to clients with lower socio-economic position. Enhancing mental health literacy, as well as reducing the stigma of mental illness, is crucial for increasing the usage of psychotherapeutic services of those who need it most. Relevant health policy is needed to reduce the barriers to, and consequently increase psychotherapy utilization. [ABSTRACT FROM AUTHOR]

Background Many studies have demonstrated the relevance of socioeconomic status (SES) and physical activity (PA) on health among older people. However, little is known about the existence of interaction effects between PA and SES on self-rated health. Methods The following questions were investigated among people aged 65-84: (i) What is the impact of SES (school education and income) and PA on good self-rated health of the following year? and (ii) Do individuals with higher SES benefit more from PA than those with lower SES? Based on data of the German Socioeconomic Panel (GSOEP), binary logistic regression analyses were used to calculate odds ratios and synergy indices (SAB). Results High education in women and high income in men were positively associated with good self-rated health. Physically active older people with lower SES had a better chance of good health than those with higher SES and without PA. In the presence of PA, the effect of SES on health was attenuated. Conclusions Poor evidence was found for synergistic effects between PA and SES, indicating that the effect of PA on health does not differ across SES groups. In support of the mediation hypothesis, our findings suggest that PA accounted for some of the effects of SES on health. [ABSTRACT FROM AUTHOR]

Occupational stress as a key determinant for explaining health inequalities has been well established while the impact of stress related to family work has rarely been considered. This study investigates whether stress in household and family work may contribute to health inequalities in women. We used a population-based sample of German mothers (n = 3129) to determine the total, direct and indirect effects of education on somatic complaints by means of OLS regression-based mediation models. Inference about indirect effects was determined by 95% bias corrected bootstrap confidence intervals. Education was assessed by a measure combining school education and vocational training. Stress was measured using the adopted effort-reward-imbalance (ERI) questionnaire for household and family work. The von Zerssen list of somatic complaints was used as measure of subjective health. We found a significant total effect of education on somatic complaints (p ≤ 0.001) as well as significant indirect effects through ‘effort’ (p = 0.006) and ‘reward’ in household and family work (p ≤ 0.001). However, the subscales of ERI pointed into different directions: while levels of ‘effort’ increased with women's educational attainment, levels of distress related to low ‘reward’ decreased with higher levels of education. Our findings suggest that the effect of women's education on somatic complaints is mediated through stress related to low reward for household and family work. In particular, lack of ‘societal esteem’ for household and family work contributed to health disadvantages in lower educated mothers. We conclude that research on health inequality would benefit from taking stressful experiences in household and family work greater into account. [ABSTRACT FROM AUTHOR]

Background Healthcare utilization either may be guided by a preventive orientation leading to regular visits to the doctor, or it may be triggered by impaired health. Using data from three German national surveys, we wanted to examine whether the effects of income on the utilization of dental health services increased over time owing to the considerable decrease in insurance coverage over the years and the increase in higher out-of-pocket costs from patients. Methods Data from three national dental health surveys (1989, 1997 and 2005) were used. The data of all respondents aged between 35 and 44 years were available, and the number of caries-free and unrestored healthy teeth was used as outcome. Results Over the years, the proportion of routine attenders increased considerably, and the dental health measure used indicates the improvement. The least educated respondents and those with the lowest income profited less than other groups. In spite of higher copayments, the effects of income on the utilization of dental care did not increase over time. Regarding the results of education, a significant effect was only found in the study from 2005. No clear differences between routine- and problem-oriented attenders emerged with respect to the dental health measure chosen. Conclusions Material conditions and education had effects on utilization behaviour. Contrary to expectation, increasing copayments did not yield higher effects of income on healthcare utilization. [ABSTRACT FROM AUTHOR]

Background The effects of six income types (household post-government income, Organisation for Economic Cooperation and Development-weighted household post-government income, individual net income, corrected monthly household income and household net income from wages) on subjective health were compared in order to examine to what extent their effects are different. Methods Data from the German Socio-Economic Panel 2007 were used. The analyses were based on the subsample of 30-60-year-old women and men (N=11 471), incomes were divided into 10 groups of equal size. In addition education, gender and age are considered. Results The effects of the household incomes were similar by ranging from OR 3.1 to 3.7. For individual income the effect was lower (OR 2.1). This has to be interpreted against the backdrop of a large number of subjects with missing income information. This group consists of not employed, unemployed and retired individuals. Conclusion The five types of household incomes can be considered as interchangeable with respect to their effects on subjective health. In empirical studies household-based measures are appropriate if material resources or the purchasing power of households are depicted. Individual income is a different measure that should be chosen if the individual position in terms of status or material success is to be measured. [ABSTRACT FROM AUTHOR]