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Education, job position, income or multidimensional indices? Associations between different socioeconomic status indicators and chronic low back pain in a German sample: a longitudinal field study.

ABSTRACT: OBJECTIVE:To investigate associations between socioeconomic status (SES) indicators (education, job position, income, multidimensional index) and the genesis of chronic low back pain (CLBP). DESIGN:Longitudinal field study (baseline and 6-month follow-up). SETTING:Four medical clinics across Germany. PARTICIPANTS:352 people were included according to the following criteria: (1) between 18 and 65 years of age, (2) intermittent pain and (3) an understanding of the study and the ability to answer a questionnaire without help. Exclusion criteria were: (1) pregnancy, (2) inability to stand upright, (3) inability to give sick leave information, (4) signs of serious spinal pathology, (5) acute pain in the past 7 days or (6) an incomplete SES indicators questionnaire. OUTCOME MEASURES:Subjective intensity and disability of CLBP. RESULTS:Analysis showed that job position was the best single predictor of CLBP intensity, followed by a multidimensional index. Education and income had no significant association with intensity. Subjective disability was best predicted by job position, succeeded by the multidimensional index and education, while income again had no significant association. CONCLUSION:The results showed that SES indicators have different strong associations with the genesis of CLBP and should therefore not be used interchangeably. Job position was found to be the single most important indicator. These results could be helpful in the planning of back pain care programmes, but in general, more research on the relationship between SES and health outcomes is needed.

SUBMITTER: Fliesser M

PROVIDER: S-EPMC5931294 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Education, job position, income or multidimensional indices? Associations between different socioeconomic status indicators and chronic low back pain in a German sample: a longitudinal field study.

Fliesser Michael M De Witt Huberts Jessie J Wippert Pia-Maria PM

BMJ open 20180428 4

<h4>Objective</h4>To investigate associations between socioeconomic status (SES) indicators (education, job position, income, multidimensional index) and the genesis of chronic low back pain (CLBP).<h4>Design</h4>Longitudinal field study (baseline and 6-month follow-up).<h4>Setting</h4>Four medical clinics across Germany.<h4>Participants</h4>352 people were included according to the following criteria: (1) between 18 and 65 years of age, (2) intermittent pain and (3) an understanding of the stud ...[more]

PMID: 29705759

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Project description:Importance:Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear. Objective:To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale. Data Sources:A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed. Study Selection:Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis. Data Extraction And Synthesis:Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias. Main Outcomes and Measures:Levels of job burnout, job satisfaction, and job motivation as indicators of job morale. Results:Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation. Conclusions and Relevance:The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.

Project description:BACKGROUND: We investigated the associations between education and leisure-time, occupational, sedentary and total physical-activity levels based on data from the German National Health Interview and Examination Survey 1998 (GNHIES98). The roles of income level, occupational status and other mediating variables for these associations were also examined. METHODS: The total study sample of the GNHIES98 comprised 7,124 participants between the ages of 18 and 79. Complete information was available for 6,800 persons on leisure-time, sedentary and total physical-activity outcomes and for 3,809 persons in regular employment on occupational activity outcomes. The associations between educational level and physical activity (occupational, sedentary, leisure-time and total physical activity) were analysed separately for men and women using multivariate logistic regression analysis. Odds ratios (OR) of educational level on physical-activity outcomes were calculated and adjusted for age, region, occupation, income and other mediating variables. RESULTS: After adjusting for age and region, a higher education level was associated with more leisure-time activity - with an OR of 1.6 (95% CI, 1.3-2.0) for men with secondary education and 2.1 (1.7-2.7) for men with tertiary education compared to men with primary education. The corresponding ORs for women were 1.3 (1.1-1.6) and 1.7 (1.2-2.4), respectively. Higher education was associated with a lower level of vigorous work activity: an OR of 6.9 (4.6-10.3) for men with secondary education and 18.6 (12.0-27.3) for men with primary education compared to men with tertiary education. The corresponding ORs for women were 2.8 (2.0-4.0) and 5.8 (4.0-8.5), respectively. Higher education was also associated with a lower level of total activity: an OR of 2.9 (2.2-3.8) for men with secondary education and 4.3 (3.3-5.6) for men with tertiary education compared to men with primary education. The corresponding ORs for women were 1.6 (1.2-2.0) and 1.6 (1.2-2.1), respectively. CONCLUSIONS: In Germany adults with a lower level of education are more physically active, both at work and overall, compared to adults with a higher education level, although they are less physically active in their leisure time. Higher work-related activity levels among adults with lower education may explain why they are less active in their leisure time.

Project description:BackgroundAlcohol consumption contributes to excess morbidity and mortality in part through the development of alcohol-related medical conditions (AMCs, including alcoholic cardiomyopathy, hepatitis, cirrhosis, etc.). The current study aimed to clarify the extent to which risk for these outcomes differs as a function of socioeconomic position (SEP), as discrepancies could lead to exacerbated health disparities.Methods and findingsWe used longitudinal Swedish national registries to estimate the individual and joint associations between 2 SEP indicators, educational attainment and income level, and risk of AMC based on International Classification of Diseases codes, while controlling for other sociodemographic covariates and psychiatric illness. We conducted Cox proportional hazards models in sex-stratified analyses (N = 1,162,679 females and N = 1,196,659 males), beginning observation at age 40 with follow-up through December 2018, death, or emigration. By the end of follow-up, 4,253 (0.37%) females and 11,183 (0.93%) males had received an AMC registration, corresponding to overall AMC incidence rates among females and males of 2.01 and 5.20, respectively. In sex-stratified models adjusted for birth year, marital status, region of origin, internalizing and externalizing disorder registrations, and alcohol use disorder (AUD) registration, lower educational attainment was associated with higher risk of AMC in both females (hazard ratios [HRs] = 1.40 to 2.46 for low- and mid-level educational attainment across 0 to 15 years of observation) and males (HRs = 1.13 to 1.48). Likewise, risk of AMC was increased for those with lower income levels (females: HRs = 1.10 to 5.86; males: HRs = 1.07 to 6.41). In secondary analyses, we further adjusted for aggregate familial risk of AUD by including family genetic risk scores for AUD (FGRSAUD), estimated using medical, pharmacy, and criminal registries in extended families, as covariates. While FGRSAUD were associated with risk of AMC in adjusted models (HR = 1.17 for females and HR = 1.21 for males), estimates for education and income level remained largely unchanged. Furthermore, FGRSAUD interacted with income level, but not education level, such that those at higher familial liability to AUD were more susceptible to the adverse effect of low income. Limitations of these analyses include the possibility of false negatives for psychiatric illness registrations, changes in income after age 40 that were not accounted for due to modeling restrictions, restriction to residents of a high-income country, and the inability to account for individual-level alcohol consumption using registry data.ConclusionsUsing comprehensive national registry data, these analyses demonstrate that individuals with lower levels of education and/or income are at higher risk of developing AMC. These associations persist even when accounting for a range of sociodemographic, psychiatric, and familial risk factors. Differences in risk could contribute to further health disparities, potentially warranting increased screening and prevention efforts in clinical and public health settings.

Project description:Background/objectivesThe supine sagittal abdominal diameter (SAD) and standing waist circumference (WC) describe abdominal size. The SAD/height ratio (SADHtR) or WC/height ratio (WHtR) may better identify cardiometabolic disorders than BMI (weight/height2), but population-based distributions of SADHtR and WHtR are not widely available. Abdominal adiposity may differ by sociodemographic characteristics.Subjects/methodsAnthropometry, including SAD by sliding-beam caliper, was performed on 9894 non-pregnant adults ?20 years in the US National Health and Nutrition Examination Surveys of 2011-2014. Applying survey design factors and sampling weights, we estimated nationally representative SADHtR and WHtR distributions by sex, age, educational attainment, and four ancestral groups.ResultsThe median (10th percentile, 90th percentile) for men's SADHtR was 0.130 (0.103, 0.165) and WHtR 0.569 (0.467, 0.690). For women, median SADHtR was 0.132 (0.102, 0.175) and WHtR 0.586 (0.473, 0.738). Medians for SADHtR and WHtR increased steadily through age 79. The median BMI, however, reached maximum values at ages 40-49 (men) or 60-69 (women) and then declined. Low educational attainment, adjusted for age and ancestry, was associated with elevated SADHtR more strongly than elevated BMI. While non-Hispanic Asians had substantially lower BMI compared to all other ancestral groups (adjusted for sex, age and education), their relative reductions in SADHtR and WHtR, were less marked.ConclusionsThese cross-sectional data are consistent with monotonically increasing abdominal adipose tissue through the years of adulthood but decreasing mass in non-abdominal regions beyond middle age. They suggest also that visceral adipose tissue, estimated by SADHtR, expands differentially in association with low socioeconomic position. Insofar as Asians have lower BMIs than other populations, employing abdominal indicators may attenuate the adiposity differences reported between ancestral groups. Documenting the distribution and sociodemographic features of SADHtR and WHtR supports the clinical and epidemiologic adoption of these adiposity indicators.

Project description:The developmental health of young children is highly influenced by the socioeconomic conditions in which they are raised. How to accurately measure these conditions is a point of debate in the current literature on child development, health, and social determinants. We have evaluated four existing indices of socioeconomic status (SES) to determine the most relevant for the analysis of early childhood development (ECD) in Canada. Following a literature review of published SES indices which used 2006 Canadian Census data, four indices were chosen based on their relevance to ECD and the number of citations in subsequent articles. These were: the Canadian Deprivation Index, the Socioeconomic Factor Index, the Canadian Marginalization Index and an index created by the Early Childhood Mapping Project in Alberta, Canada. The indices were replicated using SES data for 2038 customized geographic neighbourhoods encompassing 99.9% of the Canadian population, and the relationship of the indices to ECD was investigated by linking to aggregated data from the Early Development Instrument (EDI), a teacher-completed questionnaire used to assess kindergarten children's physical, social, emotional, and cognitive development, and communication skills. The derived SES indices were compared based on four criteria: the input variables used, the index structure, the interpretability of the index and the variance they explained (R2) in the different EDI outcome measures. In terms of variance explained, material components of the SES indices (e.g., income, education) consistently showed the strongest association with children's language and cognitive development. The patterns of association for the non-material SES components and the other developmental domains of the EDI were more complex. We discuss the findings in regard to current developments in the field, and the need for refining empirical and theoretical approaches to examine associations between different facets of SES contextual factors and different aspects of ECD outcomes.

Project description:BackgroundThe relation between socioeconomic position (SEP) and obesity measured by body mass index (BMI), a measure of weight for height, has been extensively reviewed in children, showing consistent associations between disadvantaged SEP and higher BMI in high-income countries (HICs) and lower BMI in middle-income countries (MICs). Fat mass (FM), a more accurate measure of adiposity, and fat-free mass (FFM) are not captured by BMI, but have been shown to track from childhood to adulthood, and be important for cardiovascular health and functional outcomes in later life. It is not clear whether body composition is associated with SEP. We systematically reviewed the association between SEP and body composition in childhood.MethodsA systematic review was carried out following PRISMA guidelines. The protocol was pre-registered with PROSPERO (CRD42019119937). Original studies in the English language, which examined the association between SEP and body composition in childhood, were included. An electronic search of three databases was conducted. Two independent reviewers carried out screening, data extraction and quality assessment. Due to heterogeneity in results, a narrative synthesis was conducted. Heterogeneity in findings according to SEP, sex, body composition measure and country income level was investigated.Results50 papers were included, the majority from HICs. No papers were from low-income countries. Disadvantage in childhood was associated with greater FM and lower FFM in HICs, but with lower FM and lower FFM in MICs. When measures of FFM indexed to height were used there was no evidence of associations with SEP. In HICs, more studies reported associations between disadvantaged SEP and higher FM among girls comparative to boys.ConclusionsInequalities in FM are evident in HICs and, in the opposite direction, in MICs and follow similar trends to inequalities for BMI. Inequalities in height are likely important in understanding inequalities in FFM.

Dataset Information

Education, job position, income or multidimensional indices? Associations between different socioeconomic status indicators and chronic low back pain in a German sample: a longitudinal field study.

Publications

Education, job position, income or multidimensional indices? Associations between different socioeconomic status indicators and chronic low back pain in a German sample: a longitudinal field study.

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