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Holseter, C., Dalen, J. D., Krokstad, S., & Eikemo, T. A. (2015). Self-rated health and mortality in different occupational classes and income groups in Nord-Trondelag County, Norway. Tidsskr Nor Laegeforen, 135(5), 434–438.
Abstract: BACKGROUND: People with a lower socioeconomic position have a higher the prevalence of most self-rated health problems. In this article we ask whether this may be attributed to self-rated health not reflecting actual health, understood as mortality, in different socioeconomic groups. MATERIAL AND METHOD: For the study we used data from the Nord-Trondelag Health Study 1984-86 (HUNT1), in which the county's entire adult population aged 20 years and above were invited to participate. The association between self-rated health and mortality in different occupational classes and income groups was analysed. The analysis corrected for age, chronic disease, functional impairment and lifestyle factors. RESULTS: The association between self-rated health and mortality was of the same order of magnitude for the occupational classes and income groups, but persons without work/income and with poor self-rated health stood out. Compared with persons in the highest socioeconomic class, unemployed men had a hazard ratio for death that was three times higher in the follow-up period. For women with no income, the ratio was twice as high. INTERPRETATION Self-rated health and mortality largely conform to the different socioeconomic strata. This supports the perception that socioeconomic differences in health are a reality and represent a significant challenge nationally. Our results also increase the credibility of findings from other studies that use self-reported health in surveys to measure differences and identify the mechanisms that create them.
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Langhammer, A., Krokstad, S., Romundstad, P., Heggland, J., & Holmen, J. (2012). The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms. BMC Med Res Methodol, 12, 143.
Abstract: ATTENTION: This publication contains an error. In table 2 and table 3 the column labels for genders have been replaced; instead of Women / Men there should be Men /Women
BACKGROUND: Population based studies are important for prevalence, incidence and association studies, but their external validity might be threatened by decreasing participation rates. The 50 807 participants in the third survey of the HUNT Study (HUNT3, 2006-08), represented 54% of the invited, necessitating a nonparticipation study. METHODS: Questionnaire data from HUNT3 were compared with data collected from several sources: a short questionnaire to nonparticipants, anonymous data on specific diagnoses and prescribed medication extracted from randomly selected general practices, registry data from Statistics Norway on socioeconomic factors and mortality, and from the Norwegian Prescription Database on drug consumption. RESULTS: Participation rates for HUNT3 depended on age, sex and type of symptoms and diseases, but only small changes were found in the overall prevalence estimates when including data from 6922 nonparticipants. Among nonparticipants, the prevalences of cardiovascular diseases, diabetes mellitus and psychiatric disorders were higher both in nonparticipant data and data extracted from general practice, compared to that reported by participants, whilst the opposite pattern was found, at least among persons younger than 80 years, for urine incontinence, musculoskeletal pain and headache. Registry data showed that the nonparticipants had lower socioeconomic status and a higher mortality than participants. CONCLUSION: Nonparticipants had lower socioeconomic status, higher mortality and showed higher prevalences of several chronic diseases, whilst opposite patterns were found for common problems like musculoskeletal pain, urine incontinence and headache. The impact on associations should be analyzed for each diagnosis, and data making such analyses possible are provided in the present paper.
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Pape, K., Bjorngaard, J. H., De Ridder, K. A. A., Westin, S., Holmen, T. L., & Krokstad, S. (2013). Medical benefits in young Norwegians and their parents, and the contribution of family health and socioeconomic status. The HUNT Study, Norway. Scand J Public Health, 41(5), 455–462.
Abstract: AIMS: Family and intergenerational perspectives might contribute to a better understanding of why young people in many European countries experience work impairment and end up being dependent on public benefits for life sustenance. The aim of this cohort study was to explore the relationship between the receipt of medical benefits in parents and their young adult offspring and the contributions of family health and family socioeconomic status. METHODS: Baseline information on the health of 7597 adolescents and their parents who participated in the HUNT Study 1995-1997 was linked to national registers to identify long-term receipt of medical benefits for parents (1992-1997) and adolescents as they entered adulthood (1998-2008). We used logistic regression to explore the association between parent and offspring receipt of medical benefits, adjusting for family health and socioeconomic status. RESULTS: Among adolescents, 13% received medical benefits from age 20-29. Adolescents whose parents had received medical benefits (26%) were more likely to receive such benefits themselves from age 20-29 compared with adolescents without benefit-receiving parents (age- and sex-adjusted odds ratio (OR) 2.16, 95 % confidence interval (CI) 1.86-2.49). Adjustment for family health reduced this estimate considerably (to OR 1.66, 95% CI 1.38-1.99), whereas adjustment for family socioeconomic status had less impact. CONCLUSIONS: Adolescents whose parents receive medical benefits enter adult working life with an elevated risk of health-related work exclusion. Family health vulnerability appears to be a key to understanding this association, suggesting that more attention to intergenerational continuities of health could be a way to prevent welfare dependence in future generations.
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Skogen, J. C., Knudsen, A. K., Mykletun, A., Nesvag, S., & Overland, S. (2012). Alcohol consumption, problem drinking, abstention and disability pension award. The Nord-Trondelag Health Study (HUNT). Addiction, 107(1), 98–108.
Abstract: AIMS: To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption ('sick-quitting') could explain some of the increased risk for DP among abstainers. DESIGN: Prospective population-based study. SETTING AND PARTICIPANTS: Data were from two waves of the Nord-Trondelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37,729 (alcohol consumption) and 34,666 (problem drinking) participants. MEASUREMENTS: Alcohol consumption was measured by self-reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health-related behaviour, socio-economic status and social activity. FINDINGS: Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92-1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08-3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48-2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01-2.74) were at higher risk for DP than constant abstainers. CONCLUSIONS: Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by 'sick-quitting'.
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