Anu Molarius

Self-rated health, chronic diseases, and symptoms among middle-aged and elderly men and women

The objective was to study the association between chronic diseases, symptoms, and poor self-rated health among men and women and in different age groups, and to assess the contribution of chronic diseases and symptoms to the burden of poor self-rated health in the general population. Self-rated health and self-reported diseases and symptoms were investigated in a population sample of 6,061 men and women aged 35-79 years in Värmland County in Sweden. Odds ratios (OR) and population attributable risks (PAR) were calculated to quantify the contribution of chronic diseases and symptoms to poor self-rated health. Depression, neurological disease, rheumatoid arthritis, and tiredness/weakness had the largest contributions to poor self-rated health in individuals. Among the elderly (65-79 years), neurological disease and cancer had the largest contribution to self-rated health in men, and renal disease, rheumatoid arthritis, and cancer in women. Among the middle-aged (35-64 years), depression and tiredness/weakness were also important, especially in women. From a population perspective, tiredness/weakness explained the largest part of poor self-rated health due to its high prevalence in the population. Depression and musculoskeletal pains were also more important than other chronic diseases and symptoms at the population level. Even though many chronic diseases (such as neurological disease, rheumatoid arthritis, and cancer) are strongly associated with poor self-rated health in the individual, common symptoms (such as tiredness/weakness and musculoskeletal pains) as well as depression contribute more to the total burden of poor self-rated health in the population. More preventive measures should therefore be directed against these conditions, especially when they are not consequences of other diseases.

Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population-based study in Sweden

BackgroundPoor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990s. There is a need for a better understanding of the area for planning preventive activities and health care.MethodsThe study is based on a postal survey questionnaire sent to a random sample of men and women aged 18–84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models.ResultsAbout 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65–74 years.Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms.Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms.ConclusionOur results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors.

Socio-Economic Factors, Lifestyle, and Headache Disorders - A Population-Based Study in Sweden

Objective.— To study the association between socio‐economic factors, lifestyle habits, and self‐reported recurrent headache/migraine (RH/M) in a general population.

The contribution of lifestyle factors to socioeconomic differences in obesity in men and women - a population-based study in Sweden

Background: The objective was to investigate whether and to what extent the association between socioeconomic status and obesity can be explained by lifestyle factors. Methods: The relationship between socioeconomic status (SES) and obesity, and the role of lifestyle factors such as smoking, physical activity, heavy alcohol use, avoidance of dietary fat and propensity to eat fiber-rich food, was studied in a cross-sectional population-based study consisting of 6394 men and women aged 25–74 years in Värmland County in Sweden. Educational level was used for measuring SES. The contribution of the measured lifestyle factors was assessed using logistic regression models. Results: 12% of men and 14% of women were obese. Subjects with high education were leaner than subjects with low education, except among elderly women (65–74 years). Although many lifestyle factors were related to obesity and SES in this study, only a part (18–29%) of the association between educational level and obesity could be explained by the measured lifestyle factors. Physical inactivity and heavy alcohol use were the main factors contributing to this association, whereas smoking and the measured dietary attitudes towards fat and fiber had little additional effect. Conclusions: The findings of this study are consistent with the view that socioeconomic differences in obesity and its consequences can only partly be reduced by changes in lifestyle. Longitudinal studies, a more detailed investigation of the role of dietary factors and more studies including elderly subjects are, however, recommended to further elucidate the association between SES and obesity.

Socioeconomic differences in self-rated oral health and dental care utilisation after the dental care reform in 2008 in Sweden

BackgroundThe aims of this study were to determine self-rated oral health and dental attendance habits among Swedish adults, with special reference to the role of social inequalities, after the Swedish dental care reform in 2008.MethodsThe study is based on a survey questionnaire, sent to 12,235 residents of a Swedish county, in 2012. The age group was 16–84 years: 5,999 (49%) responded. Using chi-square statistics, differences in prevalence of self-rated oral health and regular dental attendance were analysed with respect to gender, age, educational level, family status, employment status and country of birth. Self-rated poor oral health was analysed by multivarite logistic regression adjusting for the different socio-demographic factors, financial security and having refrained from dental treatment for financial reasons.ResultsThree out of four respondents (75%) reported fairly good or very good oral health. Almost 90% claimed to be regular dental attenders. Those who were financially secure reported better oral health. The differences in oral health between those with a cash margin and those without were large whereas the differences between age groups were rather small. About 8% reported that they had refrained from dental treatment for financial reasons during the last three months. Self-rated poor oral health was most common among the unemployed, those on disability pension or on long-term sick leave, those born outside the Nordic countries and those with no cash margin (odds ratios ranging from 2.4 to 4.4). The most important factor contributing to these differences was having refrained from dental treatment for financial reasons.ConclusionThe results are relevant to strategies intended to reduce social inequalities in oral health, affirming the importance of the provision of equitable access to dental care.

Recurrent headache and migraine as a public health problem--a population-based study in Sweden.

Objective.—To study the prevalence of recurrent headache and/or self‐considered migraine (RH/M) and its association with self‐rated health, other symptoms, and use of health care and medication in the general population.

Population change and mortality in men and women

The association between population change and mortality has been investigated for over a century. In the Supplement to the 35th Annual Report of the Registrar-General (1861–1870) it was evident that rapidly urbanising areas, with increasing populations, experienced relatively adverse mortality trends, while districts with declining populations did rather better.1 In 1930 Lewis-Faning1showed that between 1860 and 1910 more rapid population growth was associated adversely with relative mortality, albeit weakly. These data were taken to suggest that rapid industrialisation and urbanisation had unfavourable health effects during a period when infectious diseases were the most important cause of morbidity and mortality. Conversely Hoffman2 examined the trend in death rates in large US cities between 1871 and 1904 and demonstrated that the cities with the greater population growth had the lower mortality rate. Thus the …

Disease, knowledge and society

The purpose of this book is to provide critical analyses of disease, treatment and care as socially structured practices. The authors are Danish and Norwegian social scientists and sociologists—and occasional historians, psychologists and biologists—who belong to Disease and Society Network. The book consists of papers presented at the seminars of this network. The papers have a wide scope, ranging from highly theoretical …

Social inequalities in self-reported refraining from health care due to financial reasons in Sweden: health care on equal terms?

BackgroundThe main goal of the health care system in Sweden is good health and health care on equal terms for the entire population. This study investigated the existence of social inequalities in refraining from health care due to financial reasons in Sweden.MethodsThe study is based on 38,536 persons who responded to a survey questionnaire sent to a random sample of men and women aged 18-84 years in 2008 (response rate 59%). The proportion of persons who during the past three months due to financial reasons limited or refrained from seeking health care, purchasing medicine or seeking dental care is reported. The groups were defined by gender, age, country of origin, educational level and employment status. The prevalence of longstanding illness was used to describe morbidity in these groups. Differences between groups were tested with chi-squared statistics and multivariate logistic regression models.ResultsIn total, 3% reported that they had limited or refrained from seeking health care, 4% from purchasing medicine and 10% from seeking dental care. To refrain from seeking health care was much more common among the unemployed (12%) and those on disability pension (10%) than among employees (2%). It was also more common among young adults and persons born outside the Nordic countries. Similar differences also apply to purchasing medicine and dental care. The odds for refraining from seeking health care, purchasing medicine or seeking dental care due to financial reasons were 2-3 times higher among persons with longstanding illness than among persons with no longstanding illness.ConclusionsThere are social inequalities in self-reported refraining from health care due to financial reasons in Sweden even though the absolute levels vary between different types of care. Often those in most need refrain from seeking health care which contradicts the national goal of the health care system. The results suggest that the fare systems of health care and dental care should be revised because they contribute to inequalities in health care.

Can financial insecurity and condescending treatment explain the higher prevalence of poor self-rated health in women than in men? A population-based cross-sectional study in Sweden

IntroductionWomen have in general poorer self-rated health than men. Both material and psychosocial conditions have been found to be associated with self-rated health. We investigated whether two such factors, financial insecurity and condescending treatment, could explain the difference in self-rated health between women and men.MethodsThe association between the two factors and self-rated health was investigated in a population-based sample of 35,018 respondents. The data were obtained using a postal survey questionnaire sent to a random sample of men and women aged 18-75 years in 2008. The area covers 55 municipalities in central Sweden and the overall response rate was 59%. Multinomial odds ratios for poor self-rated health were calculated adjusting for age, educational level and longstanding illness and in the final model also for financial insecurity and condescending treatment.ResultsThe prevalence of poor self-rated health was 7.4% among women and 6.0% among men. Women reported more often financial insecurity and condescending treatment than men did. The odds ratio for poor self-rated health in relation to good self-rated health was 1.29 (95% CI: 1.17-1.42) for women compared to men when adjusted for age, educational level and longstanding illness. The association became, however, statistically non-significant when adjusted for financial insecurity and condescending treatment.ConclusionThe present findings suggest that women would have as good self-rated health as men if they had similar financial security as men and were not treated in a condescending manner to a larger extent than men. Longitudinal studies are, however, required to confirm this conclusion.