Is Loneliness an Undervalued Pathway between Socio-Economic Disadvantage and Health?

Loneliness is a growing public health issue. It is more common in disadvantaged groups and has been associated with a range of poor health outcomes. Loneliness may also form an independent pathway between socio-economic disadvantage and poor health. Therefore, the aim of this study was to explore the contribution of loneliness to socio-economic health inequalities. These contributions were studied in a Dutch national sample (n = 445,748 adults (≥19 y.o.)) in Poisson and logistic regression models, controlling for age, gender, marital status, migration background, BMI, alcohol consumption, smoking, and physical activity. Loneliness explained 21% of socioeconomic health inequalities between the lowest and highest socio-economic groups in self-reported chronic disease prevalence, 27% in poorer self-rated health, and 51% in psychological distress. Subgroup analyses revealed that for young adults, loneliness had a larger contribution to socioeconomic gaps in self-rated health (37%) than in 80+-year-olds (16%). Our findings suggest that loneliness may be a social determinant of health, contributing to the socioeconomic health gap independently of well-documented factors such as lifestyles and demographics, in particular for young adults. Public health policies targeting socioeconomic health inequalities could benefit from integrating loneliness into their policies, especially for young adults.

1240Socioeconomic Inequalities in Adolescent Metabolic Syndrome and Depression: no mediation by parental depression and parenting

Background We assessed to what extent parental depression and parenting style mediate the relationships between different measures of parental socioeconomic status (SES) and both depression and metabolic syndrome (MetS) in adolescents, and whether these mechanisms differ by sex. Methods Data were from the prospective multigenerational Dutch Lifelines Cohort Study. Our sample consisted of 1,217 adolescents with an average follow-up of 33.3 (SD = 7.33) months and a median baseline age of 13 (IQR:13-14) years. We used structural equation models to assess the direct and indirect effects of SES on baseline and changes at follow-up in both depression and MetS, and to assess moderation by sex. Results Parental education had a small direct effect on adolescent cMetS. For each additional year of education, cMetS scores were 0.098 (95%CI: 0.020; 0.184) units lower at baseline and decreased 0.079 (95%CI: 0.004; 0.158) units at follow-up. No indirect effects via parenting style or parental depression were found, and there was no moderation by sex. Additionally, parenting style was consistently associated with baseline cMetS and depression, and improvements in parenting style were consistently associated with decreasing depression scores. Conclusions The results indicate that improving parenting style may improve health for all adolescents. However, in this study parental depression and parenting style did not account for adolescent socioeconomic health inequalities. This may be partly due to good access to social services within the Netherlands. Key messages Improvements in parenting style may improve adolescent health. Additionally, pathways to counteract socioeconomic differences require further elucidation.

Socioeconomic Health Inequalities in Adolescent Metabolic Syndrome and Depression: No Mediation by Parental Depression and Parenting Style

We assessed to what extent parental depression and parenting style mediate the relationships between different measures of parental socioeconomic status (SES) and both depression and metabolic syndrome (MetS) in adolescents, and whether sex moderates these mechanisms. Data were from the prospective multigenerational Dutch Lifelines Cohort Study. Our sample consisted of 1217 adolescents with an average follow-up of 33.3 (SD = 7.33) months and a median baseline age of 13 (IQR:13–14) years. We used structural equation models to assess the direct and indirect effects of SES on baseline and changes at follow-up in both depression and MetS, and to assess moderation by sex. For each additional year of education, continuous MetS scores were 0.098 (95%CI: 0.020; 0.184) units lower at baseline and decreased 0.079 (95%CI: 0.004; 0.158) units at follow-up. No other direct or indirect effects of SES were found, and there was no moderation by sex. Additionally, warmer parenting style was generally associated with more favorable outcome scores. Therefore, improving parenting style may improve health for all adolescents. However, in this study parental depression and parenting style did not account for adolescent socioeconomic health inequalities. This may be partly due to good access to social services within the Netherlands.

Socioeconomic Health Inequalities in Europe

This chapter discusses the role of law and human rights in socioeconomic health inequalities in Europe. Given that socioeconomic health inequalities are largely unnecessary and avoidable, it is widely claimed that they lead to health inequities (i.e., avoidable inequalities in health). Addressing health inequities is considered to be an ‘ethical imperative’ and a ‘matter of social justice’. Human rights standards provide a moral and legal framework for assessing matters of social justice, including socioeconomic health inequalities. This chapter analyses how the main European organizations (EU and Council of Europe) address health inequalities. Specific attention is paid to the role of human rights law as a tool that may give support and priority to improving health and reducing inequities. By way of explaining how social determinants are addressed at the domestic level, the chapter discusses (the approaches to) socioeconomic health inequalities in the United Kingdom and the Netherlands. The chapter establishes that while not as dramatic as in the United States, socioeconomic health inequalities are a reality in Europe, and that inequalities have widened both between and within European countries. It concludes that reducing health inequalities should be a key priority in European and domestic health policy, and that human rights law plays an important role in informing what needs to be done.

Trends in Socioeconomic Health Inequalities in Kazakhstan

According to the relative income hypothesis, the health status of a population is determined by its horizontal social and financial conditions, both mutually interrelated factors. As a former republic of the Soviet Union, Kazakhstan is a particularly interesting case in which to explore the impact of health-related inequalities due to economic, sociodemographic, and institutional changes experienced as the country transitioned to independent status. The goal of this article is to examine the degree to which commonly-used socioeconomic determinants (education, income, living conditions, marital status, occupation) are associated with health inequalities in Kazakhstan. We found significant differences in the health status characteristics among the population. Poor health was found to be significantly associated with living conditions and income level. This article will assist policy makers in developing and improving existing social and health policies to address the apparent lack of health-related equity in Kazakhstan.

Widespread and widely widening? Examining absolute socioeconomic health inequalities in northern Sweden across twelve health indicators

Background Socioeconomic inequalities in health is a widely studied topic. However, epidemiological research tends to focus on one or a few outcomes conditioned on one indicator, overlooking the fact that health inequalities can vary depending on the outcome studied and the indicator used. To bridge this gap, this study aims to provide a comprehensive picture of the patterns of socioeconomic health inequalities in Northern Sweden over time, across a range of health outcomes, using an ‘outcome-wide’ epidemiological approach. Method Cross-sectional data from three waves of the ‘Health on Equal Terms’ survey, distributed in 2006, 2010 and 2014 were used. Firstly, socioeconomic inequalities by income and education for twelve outcomes (self-rated health, self-rated dental health, overweight, hypertension, diabetes, long-term illness, stress, depression, psychological distress, smoking, risky alcohol consumption, and physical inactivity) were examined by calculating the Slope Index of Inequality. Secondly, time trends for each outcome and socioeconomic indicator were estimated. Results Income inequalities increased for psychological distress and physical inactivity in men as well as for self-rated health, overweight, hypertension, long-term illness, and smoking among women. Educational inequalities increased for hypertension, long-term illness, and stress (the latter favouring lower education) in women. The only instance of decreasing income inequalities was seen for long-term illness in men, while education inequalities decreased for long-term illness in men and poor self-rated health, poor self-rated dental health, and smoking in women. Conclusion Patterns of absolute socioeconomic inequalities in health vary by health and socioeconomic indicator, as well as between men and women. Overall, trends appear more stagnant in men while they fluctuate in women. Income inequalities seem to be generally greater than educational inequalities when looking across several different health indicators, a message that can only be derived from this type of outcome-wide study. These disparate findings suggest that generalised and universal statements about the development of health inequalities can be too simplistic and potentially misleading. Nonetheless, despite inequalities being complex, they do exist and tend to increase. Thus, an outcome-wide approach is a valuable method which should be utilised to generate evidence for prioritisations of policy decisions.