Alexander Miething

A matter of perception: exploring the role of income satisfaction in the income-mortality relationship in German survey data 1995-2010.

Individual- and community-level income has been shown to be linked to social inequalities in health and mortality. On the individual level, social comparisons and relative deprivation resulting from them have been identified as relevant mechanisms involved in the relationship between income and health, but it is mainly income-based measures of relative deprivation that have been considered in previous studies. Using income satisfaction, this study employs a perception-based indicator of relative deprivation. The study, covering the period between 1995 and 2010, utilized the German Socio-Economic Panel. The follow-up included 11,056 men and 11,512 women at employment age 25-64. Discrete-time survival analysis with Cox regression was performed to estimate the effects of relative income position and income satisfaction on all-cause mortality. The univariate analysis revealed an income gradient on mortality and further showed a strong association between income satisfaction and survival. After education and employment status were adjusted for, the effect of discontent with income on mortality was still present in the female sample, whereas in the male sample only the income gradient prevailed. When self-rated health was controlled for, the hazard ratios of income satisfaction attenuated and turned non-significant for both men and women while the effects of income position remained stable. In conclusion, the findings suggest that income satisfaction and income position measure different aspects of income inequality and complement one another. Income satisfaction appeared to be a possible contributing component to the causal pathway between income and mortality.

Income and health in different welfare contexts: A comparison of Sweden, East and West Germany

Background: The aim of the present study is to explore whether the association between income and self-rated health in Sweden is similar to that in Germany. Both countries represent relatively similar economic contexts, but also different welfare traditions and historic experiences. Thus, the study compares Sweden with East Germany and West Germany in order to incorporate the aftereffects of reunification in East Germany. Methods: The association between adjusted disposable household income and self-rated health is investigated by exploring cross-sectional survey data for the year 2000. In a sequence of logistic regression models, the risk for poor self-rated health across income quintiles is analysed, controlling for educational status and occupational position. Data sources are the Swedish Level-of-Living Survey and the German Socio-Economic Panel. Results: A relationship between income and health was observed for Sweden, East Germany and West Germany, before as well as after controlling for education and occupational position. The associations were somewhat stronger for women than for men. Similar magnitudes of income-related poor health were detected across the investigated subsamples, but patterns were distinct in the three regions. The highest estimates were not always found in groups with the lowest income position. Conclusions: Given the variation in the results, we found neither advantages nor disadvantages that can be linked to the effectiveness of the welfare contexts under study. We could also not identify an income threshold for poor health across the investigated countries and settings. Nevertheless, the association between income and health persists, although the patterns vary across regional contexts.

Stability and variability in income position over time: exploring their role in self-rated health in Swedish survey data

BackgroundThe adverse relationship between income and health is well documented, but less is known of how income trajectories, i.e. downward or upward trends in income, determine health. We therefore link longitudinal income information to cross-sectional data on self-rated health and conduct logistic regression models in order to investigate income trends over time and their relationship with health.MethodsThe data, with the exception of income information, are derived from the Swedish Level-of-Living Survey 2000. The information on income was drawn from the income register covering the period 1995 to 2000. We used an age-restricted sample of those 30–64 years of age, and generated a series of models accounting for average income position, lagged income position, income decrease and increase, and annual periods in specific income positions. The analysis was conducted for men and women separately.ResultsApart from the overall association between income and health, we found a similar pattern when including average and lagged income in the model. The analysis of length of time in a specific income position showed substantial sex differences in poor health. Income decrease was more strongly associated with men’s poor health, whereas income increase revealed only weak associations with self-rated health.ConclusionsIt was shown that income changes and the time dimension of income are important for self-rated health. Self-rated health responds to decreases in absolute income and lowered rank position in the income distribution to a greater extent than to income gains over time. Lagged lower income position and its associations with health suggest that socio-economic disadvantages accumulate over time.

The Influence of Social Network Characteristics on Peer Clustering in Smoking: A Two-Wave Panel Study of 19- and 23-Year-Old Swedes

Objectives The present study examines how the composition of social networks and perceived relationship content influence peer clustering in smoking, and how the association changes during the transition from late adolescence to early adulthood. Methods The analysis was based on a Swedish two-wave survey sample comprising ego-centric network data. Respondents were 19 years old in the initial wave, and 23 when the follow-up sample was conducted. 17,227 ego-alter dyads were included in the analyses, which corresponds to an average response rate of 48.7 percent. Random effects logistic regression models were performed to calculate gender-specific average marginal effects of social network characteristics on smoking. Results The association of egos’ and alters’ smoking behavior was confirmed and found to be stronger when correlated in the female sample. For females, the associations decreased between age 19 and 23. Interactions between network characteristics and peer clustering in smoking showed that intense social interactions with smokers increase egos’ smoking probability. The influence of network structures on peer clustering in smoking decreased during the transition from late adolescence to early adulthood. Conclusions The study confirmed peer clustering in smoking and revealed that females’ smoking behavior in particular is determined by social interactions. Female smokers’ propensity to interact with other smokers was found to be associated with the quality of peer relationships, frequent social interactions, and network density. The influence of social networks on peer clustering in smoking decreased during the transition from late adolescence to early adulthood.

Trust and all-cause mortality: a multilevel study of US General Social Survey data (1978–2010)

Background Within public health research, generalised trust has been considered an independent predictor of morbidity and mortality for over two decades. However, there are no population-based studies that have scrutinised both contextual-level and individual-level effects of generalised trust on all-cause mortality. We, therefore, aim to investigate such associations by using pooled nationally representative US General Social Survey (GSS) data linked to the National Death Register (NDI). Methods The combined GSS–NDI data from the USA have 90 contextual units. Our sample consisted of 25 270 respondents from 1972 to 2010, with 6424 recorded deaths by 2014. We used multilevel parametric Weibull survival models reporting HRs and 95% CI (credible intervals for Bayesian analysis). Individual-level and contextual-level generalised trust were the exposures of interest; covariates included age, race, gender, marital status, education and household income. Results We found a robust, significant impact of individual-level and contextual-level trust on mortality (HR=0.92, 95% CI 0.88 to 0.97; and HR=0.96, 95% CI 0.93 to 0.98, respectively). There were no discernible gender differences. Neither did we observe any significant cross-level interactions. Conclusion High levels of individual and contextual generalised trust protect against mortality, even after considering numerous individual and aggregated socioeconomic conditions. Its robustness at both levels hints at the importance of psychosocial mechanisms, as well as a trustworthy environment. Declining trust levels across the USA should be of concern; decision makers should consider direct and indirect effects of policy on trust with the view to halting this decline.

Friendship trust and psychological well-being from late adolescence to early adulthood: A structural equation modelling approach

Aims: This study explored the sex-specific associations between friendship trust and the psychological well-being of young Swedes from late adolescence to early adulthood. Methods: A random sample of native Swedes born in 1990 was surveyed at age 19 years and again at age 23 years regarding their own well-being and their relationships with a maximum of five self-named peers. The response rate was 31.3%, resulting in 782 cases to be analysed. We used sex-stratified structural equation models to explore the associations between trust and well-being. Psychological well-being was constructed as the latent variable in the measurement part. The structural part accounted for the autocorrelation of trust with respect to well-being over time and incorporated the cross-lagged effects between late adolescence and early adulthood. Results: It was found that trust increased while well-being decreased for young men and remained stable for young women from 19 to 23 years of age. The young women reported lower well-being at both time points, whereas no sex difference was found for trust. Based on model fit comparisons, a simple model without forward or reward causation was accepted for young men, whereas reversed causation from well-being to trust was suggested for young women. Subsequent analysis based on these assumptions confirmed the reversed effect for young women. Conclusions: The findings suggest that young people do not benefit from trustful social relations to the same extent as adult populations. Young women who express impaired well-being run a greater risk of being members of networks characterized by low friendship trust over time.