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      Are self-reported health inequalities widening by income? An analysis of British pseudo birth cohorts born, 1920–1970

      Journal of Epidemiology and Community Health
      BMJ

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          Abstract

          Introduction

          The health of the British population has been shown to be worsening by self-reported health and improving by self-reported limiting illness for those born before and after 1945. Little is known about the inequality in health difference across British birth cohorts by income.

          Methods

          Repeated cross-sections from the British General Household Survey, 1979–2011, are used to create pseudo birth cohorts born, 1920–1970, and their gender stratified, age-adjusted limiting illness and self-rated health (SRH) are estimated by household income tertiles. Absolute and relative differences between the poorest and richest income groups are reported.

          Results

          Absolute inequalities in limiting illness between the richest and poorest households have doubled in women and increased by one and a half times in men for those born in 1920–1922 compared with those born in 1968–1970. Relative inequalities in limiting illness increased by a half in women and doubled in men. Absolute inequalities in SRH between the richest and poorest households increased by almost half in women and more than half in men and relative inequalities increased by 18% in women and 14% in men for those born in 1920–1922 compared with those born in 1968–1970.

          Conclusion

          Inequalities in self-reported health at the same age by household income have widened for successively later-born British cohorts.

          Related collections

          Most cited references16

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          Is Open Access

          Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data

          Objective To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. Design Mendelian randomisation meta-analysis of 56 epidemiological studies. Participants 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers. Main outcome measures Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption. Results Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (−0.88 (−1.19 to −0.56) mm Hg), interleukin-6 levels (−5.2% (−7.8 to −2.4%)), waist circumference (−0.3 (−0.6 to −0.1) cm), and body mass index (−0.17 (−0.24 to −0.10) kg/m2). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)). Conclusions Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.
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            Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010.

            Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010.
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              Relation between socioeconomic status, employment, and health during economic change, 1973-93.

              To investigate the association between the national unemployment rate and class differences in the relation between health and employment during the period 1973-93. Data from general household surveys, 1973-93. Comparison of rates of employment, unemployment, and economic inactivity among those with and without limiting longstanding illness in different socioeconomic groups and how these varied over 20 years. All men aged 20-59 years in each survey between 1973 and 1993. Change over time in class specific rates of employment, unemployment, and economic inactivity in those with and without limiting longstanding illness. Men in socioeconomic groups 1 and 2 with no longstanding illness experienced little decrease in their chances of being in paid employment as the general unemployment rate rose. Those most affected were men in manual groups with limiting longstanding illness. The likelihood of paid employment was affected far less by such illness in non-manual than in manual groups. In group 1 about 85% of men with such illness were in paid employment in 1979 and 75% by 1993; in group 4 the equivalent proportions were 70% and 40%. In men in manual groups with limiting longstanding illness there was no sign of employment rates rising again as the economy recovered. Socioeconomic status makes a large difference to the impact of illness on the ability to remain in paid employment, and this impact increases as unemployment rises. Men with chronic illness in manual occupations were not drawn back into the labour force during the economic recovery of the late 1980s.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Journal of Epidemiology and Community Health
                J Epidemiol Community Health
                BMJ
                0143-005X
                1470-2738
                February 10 2020
                March 2020
                March 2020
                January 20 2020
                : 74
                : 3
                : 255-259
                Article
                10.1136/jech-2019-213186
                31959722
                51a5aa69-c32a-4d21-93eb-ba7d544cbe08
                © 2020
                History

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