Bjørgulf Claussen

Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo Mortality Study

Objective: To study the impact of childhood and adulthood social circumstances on cause specific adult mortality. Design: Census data on housing conditions from 1960 and Personal Register income data for 1990 were linked to 1990–94 death registrations, and relative indices of inequality were computed for housing conditions in 1960 and for household income in 1990. Participants: The 128 723 inhabitants in Oslo aged 31–50 years in 1990. Main results: Adulthood mortality was strongly associated with both childhood and adulthood social circumstances among both men and women. Cardiovascular disease mortality was more strongly associated with childhood than with adulthood social circumstances, while the opposite was found for psychiatric and accidental/violent mortality. Smoking related cancer mortality was related to both adulthood and childhood social circumstances in men, but considerably more strongly to adult social circumstances. Conclusions: Childhood social circumstances have an important influence on cardiovascular disease risk in adulthood. Current increases in child poverty that have been seen in Norway over the past two decades could herald unfavourable future trends in adult health.

Health and re-employment in a two year follow up of long term unemployed.

STUDY OBJECTIVE--The aim was to examine re-employment and changes in health during a two year follow up of a representative sample of long term unemployed. DESIGN--This was a cross sectional study and a two year follow up. Health was measured by psychometric testing, Hopkins symptom checklist, General health questionnaire, and medical examination. Health related selection to continuous unemployment and recovery by re-employment was estimated by logistic regression with covariances deduced from the labour market theories of human capital and segmented labour market. SETTING--Four municipalities in Greenland, southern Norway. SUBJECTS--Participants were a random sample of 17 to 63 year old people registered as unemployed for more than 12 weeks. MAIN RESULTS--In the cross sectional study, the prevalence of depression, anxiety, and somatic illness was from four to 10 times higher than in a control group of employed people. In the follow up study, there was considerable health related selection to re-employment. A psychiatric diagnosis was associated with a 70% reduction in chances of obtaining a job. Normal performance on psychometric testing showed a two to three times increased chance of re-employment. Recovery of health following re-employment was less than expected from previous studies. CONCLUSIONS--Health related selection to long term unemployment seems to explain a substantial part of the excess mental morbidity among unemployed people. An increased proportion of the long term unemployed will be vocationally handicapped as years pass, putting a heavy burden on social services.

Physical activity among elderly people in a city population: the influence of neighbourhood level violence and self perceived safety

Study objective: To study the associations between neighbourhood level violence/fear of violence and physical activity among elderly people, accounting for somatic health. Design: Self reported data from the Oslo health study, a cross sectional study conducted in 2000, were linked with sociodemographic and social security data from Statistics Norway. A multilevel regression analysis was conducted by MlwiN using contextual level variables provided by the Oslo City Council. Setting: Oslo, Norway. Participants: 3499 inhabitants aged 74/5 (53.2% of all invitees). Main results: 20.5% of the elderly were physically active less than one hour a week. Somatic health was clearly associated with physical activity among both men and women. Neighbourhood level violence was associated with physical activity only for men, while fear of violence was only associated with physical activity for women. Differences in somatic health did not explain differences in physical activity between neighbourhoods. These differences were explained by socioeconomic variables, and neighbourhood level violence/fear of violence. Conclusions: In a sample of presumably healthy 75/76 year olds in Oslo, the associations between neighbourhood level violence and physical activity (among men), and fear of violence and physical activity (among women), are of the same sizes as those between somatic health and physical activity. These two dimensions of violence have, in contrast with somatic health, an explanatory function in exploring differences in physical activity between neighbourhoods in Oslo.

Health and re-employment in a five-year follow-up of long-term unemployed

Objectives: To study health and re-employment in a five-year follow-up of a community sample of long-term unemployed people. Methods: A random sample registered for more than 12 weeks at the labour offices in Grenland, Norway, were given medical check-ups in 1988 and 1990, and a postal questionnaire in 1993. Results: Only 37% were employed five years after the first spell of long-term unemployment. Recovery after re-employment was demonstrated, indicating that unemployment causes poor mental health. Health-related selection to continuous unemployment was only found for medical diagnoses. The unemployed who might be selected to continuous unemployment because of poor health at the two-year follow-up seemed to deteriorate most. Conclusion: The high morbidity of mental health problems among unemployed people is mostly explained by the causal hypothesis. This is a challenge to preventive medicine. Sick unemployed people should be given special attention.

Psychosocial factors and distress: a comparison between ethnic Norwegians and ethnic Pakistanis in Oslo, Norway

BackgroundIn the Norwegian context, higher mental distress has been reported for the non-Western immigrants compared to the ethnic Norwegians and Western immigrants. This high level of distress is often related to different socio-economic conditions in this group. No efforts have been made earlier to observe the impact of changed psychosocial conditions on the state of mental distress of these immigrant communities due to the migration process. Therefore, the objective of the study was to investigate the association between psychological distress and psychosocial factors among Pakistani immigrants and ethnic Norwegians in Oslo, and to investigate to what extent differences in mental health could be explained by psychosocial and socioeconomic conditions.MethodData was collected from questionnaires as a part of the Oslo Health Study 2000–2001. 13581 Norwegian born (attendance rate 46%) and 339 ethnic Pakistanis (attendance rate 38%) in the selected age groups participated. A 10-item version of Hopkins Symptom Checklist (HSCL) was used as a measure of psychological distress.ResultsPakistanis reported less education and lower employment rate than Norwegians (p < 0.005). The Pakistani immigrants also reported higher distress, mean HSCL score 1.53(1.48–1.59), compared to the ethnic Norwegians, HSCL score 1.30(1.29–1.30). The groups differed significantly (p < 0.005) with respect to social support and feeling of powerlessness, the Pakistanis reporting less support and more powerlessness. The expected difference in mean distress was reduced from 0.23 (0.19–0.29) to 0.07 (0.01–0.12) and 0.12 (0.07–0.18) when adjusted for socioeconomic and social support variables respectively. Adjusting for all these variables simultaneously, the difference in the distress level between the two groups was eliminatedConclusionPoor social support and economic conditions are important mediators of mental health among immigrants. The public health recommendations/interventions should deal with both the economic conditions and social support system of immigrant communities simultaneously.

Education and disability pension: a stronger association than previously found.

Introduction: Although the Norwegian Welfare Law includes rigorous medical criteria for granting disability pensions, several non-medical factors have been shown to be associated with and possible causal factors of pensioning. Objectives: We analysed the relationship between disability pension and detailed information on educational attainment in different diagnostic groups. Methods: All ethnic Norwegians aged 18—66 years and alive on 31 December 2003 (n = 2,522,430) were included. Age, sex, the receipt of a disability pension on 31 December 2003, and the diagnosis on the medical certificate were taken from a national social security file. The file also included six levels of education: primary school, low-level secondary school, secondary school, low-level university, university, and research level. Results: We found a dramatic increase in the prevalence of persons granted disability pension with decreasing years of education across all levels of education. The disparities were much stronger than those seen for other health-related parameters and were especially strong for those with musculoskeletal diagnoses. The disability pension is more a consequence of health problems than a proxy for health status. The demonstrated relationship between education and disability pension may be partly explained by exclusion from the work force because of health-related work problems. Conclusions: To facilitate a more inclusive working life, attention should be focused on the work place’s capacity to include people with different levels of competence and functioning rather than on the health problems of the employees.

Four indicators of socioeconomic position: relative ranking across causes of death:

Objective: A study was undertaken to examine the relative ability of occupational class, education, household income, and housing conditions to discriminate all cause and cause-specific mortality-risk in Oslo, and to see if this relative ability is consistent across the 12 most common causes of death. Design and setting: Census records of inhabitants in Oslo 1990 aged 45 to 64 were linked to death records 1990—98 (n=88,159). All inhabitants were included except those who lacked census data on the independent variables. The relative index of inequality (RII) for each indicator was calculated. Main results: Education, occupation, and housing conditions had similar RIIs for all-cause mortality in both sexes. Household income had low RIIs, particularly in men. For the 12 most common causes of death some heterogeneity in the relative ranking between the four indicators was observed, with causes of death known to be related to early-life social circumstances (stomach cancer, cardiovascular disease, chronic obstructive pulmonary disease) being particularly strongly related to education, and causes of death which were likely to be determined by adult social circumstances (violence, sudden unexpected death) being particularly strongly related to occupation and housing conditions. Conclusions: Education, occupational class, and housing conditions all seemed to discriminate all-cause mortality to a similar degree. However, the cause-specific analysis revealed a heterogeneous pattern.

Cumulative deprivation and cause specific mortality. A census based study of life course influences over three decades

Objective: To examine whether increasing cumulative deprivation has an incremental effect on total as well as cause specific mortality. Design: Census data on housing conditions as indicators of deprivation from 1960, 1970, and 1980 were linked to 1990–98 death registrations. Relative indices of inequalities were computed for housing conditions to measure the cumulative impact of differences in social conditions. Participants: 97 381 (71.1%) 30–49 year old and 70 701 (80.0%) 50–69 year old inhabitants of Oslo, Norway, in 1990 with census information on housing conditions and recorded length of education. Main results: Mortality risk was increased when all censuses’ housing conditions were summed in both age groups and sex. The cause specific analysis indicated such an effect particularly for coronary heart disease, chronic obstructive lung disease, and smoking related cancers. Violent deaths were essentially associated with housing conditions closer to the time of death in men in both age groups and in young women. Conclusions: To fully account for socially mediated risk of death, a full life course approach should be adopted. The relative importance of each stage seems to vary by cause of death.

Inequalities in health: a comparative study between ethnic Norwegians and Pakistanis in Oslo, Norway

BackgroundThe objective of the study was to observe the inequality in health from the perspective of socio-economic factors in relation to ethnic Pakistanis and ethnic Norwegians in Oslo, Norway.MethodData was collected by using an open and structured questionnaire, as a part of the Oslo Health Study 2000–2001. Accordingly 13581 ethnic Norwegians (45% of the eligible) participated as against 339 ethnic Pakistanis (38% of the eligible).ResultsThe ethnic Pakistanis reported a higher prevalence of poor self-rated health 54.7% as opposed to 22.1% (p < 0.001) in ethnic Norwegians, 14% vs. 2.6% (p < 0.001) in diabetes, and 22.0% vs. 9.9% (p < 0.001) in psychological distress. The socio-economic conditions were inversely related to self- rated health, diabetes and distress for the ethnic Norwegians. However, this was surprisingly not the case for the ethnic Pakistanis. Odd ratios did not interfere with the occurrence of diabetes, even after adjusting all the markers of socio-economic status in the multivariate model, while self-reported health and distress showed moderate reduction in the risk estimation.ConclusionThere is a large diversity of self-rated health, prevalence of diabetes and distress among the ethnic Pakistanis and Norwegians. Socio-economic status may partly explain the observed inequalities in health. Uncontrolled variables like genetics, lifestyle factors and psychosocial factors related to migration such as social support, community participation, discrimination, and integration may have contributed to the observed phenomenon. This may underline the importance of a multidisciplinary approach in future studies.

Risk factors for long-term absence due to psychiatric sickness: a register-based 5-year follow-up from the Oslo health study.

Objective: To identify individual and work-related predictors of long-term (>8 weeks) sickness absence with psychiatric diagnoses (LSP). Methods: Data from the Oslo Health Study (response rate 46%) were linked to public registers. A total of 8333 subjects were followed from 2001 through 2005. Cox regression was used to compute hazard ratios for LSP. Results: At least one LSP was present in 7.8% of women and 3.9% of men. Poor support from superior had an independent and moderate effect. Path and linear regression analyses indicated that the effect of support from superior was mediated through mental distress and not the other way around. Self-reported mental distress had a strong independent effect. Conclusions: Women had a higher risk of LSP than men. Low education and poor support from superior and mental distress were found to be determinants of LSP.