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International Journal of Behavioral Medicine

Published in:

01-03-2011

Gender Patterns of Socioeconomic Differences in Premature Mortality: Follow-up of the Hungarian Epidemiological Panel

Authors: Mária S. Kopp, Árpád Skrabski, Krisztina D. László, Imre Janszky

Published in: International Journal of Behavioral Medicine | Issue 1/2011

Abstract

Background

Gender differences in premature mortality rates and in the size of socioeconomic inequalities in mortality vary across countries.

Purpose

We aimed to quantify the gender differences in the association between socioeconomic status (SES) and premature all-cause mortality and to analyse whether psychosocial factors might associate between SES and mortality among men and women separately in the middle-aged Hungarian population.

Method

Men (n = 1130) and women (n = 1529), aged 40–69 years, participants in the Hungarian Epidemiological Panel (2002) were followed up for 3.5 years for total mortality. Cox proportional hazard models were used to evaluate the association between several socioeconomic measures and total death.

Results

During the follow-up, 99 men (8.8%) and 53 women (3.5%) died. The age-adjusted hazard ratios and the Rothman’s synergy indexes showed that each measure of socioeconomic position was more deleterious in men compared with women. When investigating potential explanatory factors for the SES–mortality association, we found that adjustment for severe depression resulted in the most pronounced reduction in the regression coefficients for the association between most socioeconomic factors and male premature death. There was no indication that depression would mediate between SES and mortality in women. Work stress factors, poor lifestyle and low social support also contributed to the explanation of the link between socioeconomic disadvantage and premature death in men.

Conclusion

Middle-aged Hungarian men seem to be considerably more vulnerable to the chronic stress of material disadvantage than women. This effect modification by gender might partly be explained by a stronger connection between low SES and depressive symptoms in men.

Bobak M, Marmot M. East-West mortality divide and its potential explanations: proposed research agenda. Bmj. 1996;312(7028):421–5.PubMed

Hardarson T et al. The relationship between educational level and mortality. The Reykjavik study. J Intern Med. 2001;249(6):495–502.CrossRefPubMed

Marmot MG, Wilkinson R. Social determinants of health. Oxford: Oxford University Press; 1999.

Wilkinson RG. Health, civic society in Eastern Europe before 1989. In: Hertzman C, editor. Environmental and non-environmental determinants of the East-West life expectancy gap. Amsterdam: Kluwer; 1996.

Marmot M, Wilkinson R. The Social Pattern of Health and disease. In: Blane D, Brunner E, Wilkinson R, editors. Health and Social Organization. Evanston, IL: Routledge; 1996. p. 42–70.

Marmot MG, Kogevinas M, Elston MA. Social/economic status and disease. Annu Rev Public Health. 1987;8:111–35.CrossRefPubMed

Marmot MG et al. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337(8754):1387–93.CrossRefPubMed

Smith GD et al. Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men. Am J Public Health. 1996;86(4):486–96.CrossRefPubMed

Dennis BH et al. The association of education with coronary heart disease mortality in the USSR Lipid Research Clinics Study. Int J Epidemiol. 1993;22(3):420–7.CrossRefPubMed

10.

Mackenbach JP et al. Socioeconomic inequalities in mortality among women and among men: an international study. Am J Public Health. 1999;89(12):1800–6.CrossRefPubMed

11.

Mackenbach JP et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468–81.CrossRefPubMed

12.

Blane D, Smith GD, Bartley M. Social class differences in years of potential life lost: size, trends, and principal causes. BMJ. 1990;301(6749):429–32.CrossRefPubMed

13.

Koskinen S, Martelin T. Why are socioeconomic mortality differences smaller among women than among men? Soc Sci Med. 1994;38(10):1385–96.CrossRefPubMed

14.

Mustard CA, Etches J. Gender differences in socioeconomic inequality in mortality. J Epidemiol Community Health. 2003;57(12):974–80.CrossRefPubMed

15.

Martikainen P, Blomgren J, Valkonen T. Change in the total and independent effects of education and occupational social class on mortality: analyses of all Finnish men and women in the period 1971–2000. J Epidemiol Community Health. 2007;61(6):499–505.CrossRefPubMed

16.

McDonough P et al. Gender and the socioeconomic gradient in mortality. J Health Soc Behav. 1999;40(1):17–31.CrossRefPubMed

17.

Berkman L, Epstein AM. Beyond health care–socioeconomic status and health. N Engl J Med. 2008;358(23):2509–10.CrossRefPubMed

18.

Pongrácz M, Murinkó L. Household work distribution. In: Changes of Roles. Report about the Situation of Men and Women. Budapest: TÁRKI ZRT; 2009. p. 95–116.

19.

Lynch J, Kaplan G. Socioeconomic position. In: Berkman L, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000. p. 13–35.

20.

Geyer S et al. Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health. 2006;60(9):804–10.CrossRefPubMed

21.

Marmot M. Status syndrome. London: Times Books; 2004.

22.

Jonassaint CR, et al. Low Life Course Socioeconomic Status (SES) is Associated with Negative NEO PI-R Personality Patterns. Int J Behav Med. 2009; (in press).

23.

Sacker A et al. Comparing health inequality in men and women: prospective study of mortality 1986–96. BMJ. 2000;320(7245):1303–7.CrossRefPubMed

24.

Hemstrom O. Health inequalities by wage income in Sweden: the role of work environment. Soc Sci Med. 2005;61(3):637–47.CrossRefPubMed

25.

Kopp MS et al. Low socioeconomic status of the opposite sex is a risk factor for middle aged mortality. J Epidemiol Community Health. 2005;59(8):675–8.CrossRefPubMed

26.

Kopp MS, Skrabski Á, Lőke J. The Hungarian state of Mind in a Transforming society. In: Spéder Z, editor. Hungary in Flux, Society, Politics and Transformation. Hamburg: Verlag Dr. Reinhold Kramer; 1999. p. 117–34.

27.

Kopp MS, Skrabski A, Szedmak S. Socioeconomic factors, severity of depressive symptomatology, and sickness absence rate in the Hungarian population. J Psychosom Res. 1995;39(8):1019–29.CrossRefPubMed

28.

Kopp MS, Skrabski A, Szedmak S. Psychosocial risk factors, inequality and self-rated morbidity in a changing society. Soc Sci Med. 2000;51(9):1351–61.CrossRefPubMed

29.

Rethelyi JM, Berghammer R, Kopp MS. Comorbidity of pain-associated disability and depressive symptoms in connection with sociodemographic variables: results from a cross-sectional epidemiological survey in Hungary. Pain. 2001;93(2):115–21.CrossRefPubMed

30.

Réthelyi J, Kopp MS. Hierarchy disruption: women and men. Behav Brain Sci. 2004;27(2):17–9.CrossRef

31.

Geyer S, Peter R. Income, occupational position, qualification and health inequalities—competing risks? (comparing indicators of social status). J Epidemiol Community Health. 2000;54(4):299–305.CrossRefPubMed

32.

Martikainen P, Valkonen T, Moustgaard H. The effects of individual taxable income, household taxable income, and household disposable income on mortality in Finland, 1998–2004. Popul Stud (Camb). 2009;63(2):147–62.CrossRef

33.

Skrabski A et al. Life meaning: an important correlate of health in the Hungarian population. Int J Behav Med. 2005;12(2):78–85.CrossRefPubMed

34.

Demographic Yearbook. Budapest: Central Statistical Office; 2006.

35.

Rahe RH et al. The stress and coping inventory: an educational and research instrument. Stress Med. 2000;16:199–208.CrossRef

36.

Kopp M et al. Work stress and mental health in a changing society. Eur J Public Health. 2008;18(3):238–44.CrossRefPubMed

37.

Caldwell RA, Pearson JL, Chin RJ. Stress-moderating effects: social support in the context of gender and locus of control. Pers Soc Psychol Bull. 1987;13(1):5–17.CrossRef

38.

Lasa L et al. The use of the Beck Depression Inventory to screen for depression in the general population: a preliminary analysis. J Affect Disord. 2000;57(1–3):261–5.CrossRefPubMed

39.

Rózsa S, Szádóczky E, Füredi J. Psychometric properties of the Hungarian version of the shortened Beck Depression Inventory. Psychiatr Hung. 2001;16:384–402.

40.

Schwarzer R. Measurement of perceived self-efficacy. Psychometric scales for cross-cultural research. Berlin: Freie Universität; 1993.

41.

Kopp M et al. Psychosocial determinants of premature cardiovascular mortality differences within Hungary. J Epidemiol Community Health. 2006;60(9):782–8.CrossRefPubMed

42.

Piccinelli M et al. Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. Bmj. 1997;314(7078):420–4.PubMed

43.

Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.CrossRefPubMed

44.

Greenland S. Quantifying biases in causal models: classical confounding vs collider-stratification bias. Epidemiology. 2003;14(3):300–6.CrossRefPubMed

45.

Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology. 2009;20(4):488–95.CrossRefPubMed

46.

Rothman KJ, Greenland S, Lash TL. Modern epidemiology. Philadelphia: Wolters Kluwer/Lippincott Williams&Wilkins; 2008. p. 71–83.

47.

Lundberg M et al. A SAS program calculating three measures of interaction with confidence intervals. Epidemiology. 1996;7(6):655–6.PubMed

48.

Demographic Yearbook. United Nations; 2002.

49.

Human Development Report 2007/2008 Available from: www.undp.org.

50.

Kopp MS, Rethelyi J. Where psychology meets physiology: chronic stress and premature mortality–the Central-Eastern European health paradox. Brain Res Bull. 2004;62(5):351–67.CrossRefPubMed

51.

Black D et al. Inequalities in health: the black report. Health divide. London: Penguin; 1992.

52.

Stuckler D, King L, McKee M. Mass privatisation and the post-communist mortality crisis: a cross-national analysis. Lancet. 2009;373(9661):399–407.CrossRefPubMed

53.

Cockerham WC. Health and social change in Russia and Eastern Europe. New York: Routledge; 1999. p. 123–41.

54.

Andorka R. The Week Links in Social Integration- System Transformation in Hungary. In: Spéder Z, editor. Hungary in Flux, Society, Politics and Transformation. Hamburg: Kramer; 1999. p. 19–33.

55.

Eurobarometer: Health in the European Union. European Commission; 2006.

56.

Theorell T, Karasek RA. Current issues relating to psychosocial job strain and cardiovascular disease research. J Occup Health Psychol. 1996;1(1):9–26.CrossRefPubMed

57.

Hofstede G. Culture’s consequences, comparing values, behaviors, institutions, and organizations across nations. Thousand Oaks: Sage; 2001.

58.

Hemstrom O. Alcohol-related deaths contribute to socioeconomic differentials in mortality in Sweden. Eur J Public Health. 2002;12(4):254–62.CrossRefPubMed

59.

Makela P, Valkonen T, Martelin T. Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up study. Bmj. 1997;315(7102):211–6.PubMed

60.

Skrabski A, Kopp M, Kawachi I. Social capital in a changing society: cross sectional associations with middle aged female and male mortality rates. J Epidemiol Community Health. 2003;57(2):114–9.CrossRefPubMed

61.

Skrabski A, Kopp M, Kawachi I. Social capital and collective efficacy in Hungary: cross sectional associations with middle aged female and male mortality rates. J Epidemiol Community Health. 2004;58(4):340–5.CrossRefPubMed

62.

Bosma H, Schrijvers C, Mackenbach JP. Socioeconomic inequalities in mortality and importance of perceived control: cohort study. BMJ. 1999;319(7223):1469–70.PubMed

63.

Lundberg J et al. Adverse health effects of low levels of perceived control in Swedish and Russian community samples. BMC Public Health. 2007;7:314.CrossRefPubMed

64.

De Vogli R, Chandola T, Marmot MG. Negative aspects of close relationships and heart disease. Arch Intern Med. 2007;167(18):1951–7.CrossRefPubMed

65.

Weihs KL, Enright TM, Simmens SJ. Close relationships and emotional processing predict decreased mortality in women with breast cancer: preliminary evidence. Psychosom Med. 2008;70(1):117–24.CrossRefPubMed

66.

Hemstrom Ö. Is marriage dissolution linked to differences in mortality risks for men and women? J Marriage Fam. 1996;58(2):366–78.CrossRef

67.

Laszlo KD. Psychosocial Factors and Prognosis in Coronary Heart Disease. In: Department of Public Health Sciences. Stockholm: Karolinska Institutet; 2009.

68.

Laszlo KD, Janszky I, Ahnve S. Income and recurrent events after a coronary event in women. Eur J Epidemiol. 2008;23(10):669–80.CrossRefPubMed

69.

Brunner E. Stress and the biology of inequality. BMJ. 1997;314(7092):1472–6.PubMed

70.

Kristenson M et al. Psychobiological mechanisms of socioeconomic differences in health. Soc Sci Med. 2004;58(8):1511–22.CrossRefPubMed

71.

Chandola T et al. Health selection in the Whitehall II study, UK. Soc Sci Med. 2003;56(10):2059–72.CrossRefPubMed

72.

Kopp MS. Stress: the invisible hand in Eastern Europe’s death rates (interview). Science. 2000;288:1732–3.CrossRef

Title: Gender Patterns of Socioeconomic Differences in Premature Mortality: Follow-up of the Hungarian Epidemiological Panel
Authors: Mária S. Kopp
Árpád Skrabski
Krisztina D. László
Imre Janszky
Publication date: 01-03-2011
Publisher: Springer US
Published in: International Journal of Behavioral Medicine / Issue 1/2011
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-010-9126-5

At a glance: The STEP trials

Springer Medicine

Gender Patterns of Socioeconomic Differences in Premature Mortality: Follow-up of the Hungarian Epidemiological Panel

Abstract

Background

Purpose

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Purpose

Method

Results

Conclusion

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