Cleon Tsimbos

Socio-demographic and health-related factors affecting depression of the Greek population in later life: an analysis using SHARE data

Depression in later life is one of the most prevalent conditions forecasted to rise to the second most burdensome health condition worldwide by 2020. Using data from the 2004 Study of Health Ageing and Retirement in Europe (SHARE: release 1) on 857 Greek males and 1,032 females aged 50 or higher this study explores, firstly, associations of socio-demographic and health related indicators with depressive symptoms (EURO-D) and, secondly, attempts to identify patterns and structures among them. To achieve the first objective, the 12-item summated EURO-D scale is used in binary form with a cut-off point clinically validated by the EURODEP. Use of logistic regression pinpoints strong associations with gender, years of education, co-morbidity, disability, cognitive function and past depression. Women, less educated persons, those with poor physical health, declining cognitive function and a history of depression are significantly more at risk of scoring higher than three at the EURO-D scale. The role of age is not as clear. To achieve the second objective, multiple correspondence analysis is used in the first instance and factor analysis for binary data subsequently; two components are identified within EURO-D and continuous factor scores are produced. These factors are called “affective suffering” and “motivation”. Linear regression models reveal that the first component is responsible for the gender while the second for the age differentials in EURO-D; additionally we find that, apart from physical health indicators which are strongly related to both factors, other associations differ. Further exploration of this differentiation seems of interest, particularly as there is an indication that “motivation” may be an affectively neutral condition.

An assessment of socio-economic inequalities in health among elderly in Greece, Italy and Spain

ObjectiveThis study explores socio-economic inequalities in health among Mediterranean people aged 50 or higher.MethodsThe data used in the analysis come from the Survey of Health, Ageing and Retirement in Europe, wave 1, release 2; the sample includes 2,671 Greek, 2,502 Italian and 2,343 Spanish persons. Seven health indicators are examined using age-sex standardized prevalence rates and logistic regression models. Concentration indices are also computed for self-rated health (SRH).ResultsSocio-economic position of individuals declines with age. Persons of lower socio-economic position experience worse health in all instances. Independently of education and gender, Greek persons display the lowest prevalence rates for SRH and physical and depressive symptoms, Spanish exhibit the highest rates for chronic conditions, and Italians perform better regarding functional limitations. Within-country analysis shows that the magnitude of socio-economic inequalities in SRH is greatest in Greece, followed by Spain and lastly by Italy.ConclusionsThe analysis reconfirms the advantage of high over low socio-economic position for all countries and health indicators and proves education as an important correlate compared to wealth and income among the elderly.

Demographic and socioeconomic determinants of low birth weight and preterm births among natives and immigrants in Greece: an analysis using nationwide vital registration micro-data.

The present study makes use of nationwide individual-level vital registration data on the single live births occurring in Greece in 2006 to explore associations of socio-demographic factors with adverse pregnancy outcomes, using multinomial logistic regression models. The findings indicate that important risk factors associated with low birth weight preterm and intra-uterine growth retarded births (IUGR) include female sex, primiparity, age of mother over 35, illegitimacy and prior history of stillbirths, infant and child deaths. These constitute risk factors for normal weight preterm births as well, though associations with sex and primiparity in this case point to the opposite direction. Residing in large metropolitan areas is related to a greater risk of an IUGR birth. Among Greek women, educational attainment has a protective effect while housewife status is linked to higher chances of an IUGR birth. For immigrant mothers however, the opposite holds. The study also shows that normal weight preterm births form a distinct group.

Socio-economic inequalities in physical functioning: a comparative study of English and Greek elderly men

ABSTRACT The associations between socio-economic position (SEP) and physical functioning have frequently been investigated but little is known about which measures of SEP are the best to use for older people. This study examined how different SEP indicators related to the physical functioning of men aged 50 or more years in England and Greece. The data derived from Wave 1 of the English Longitudinal Study of Ageing (ELSA) and from the Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported physical functioning limitations and mobility difficulties were combined and categorised into ‘no disability’, ‘mild disability’ and ‘severe disability’. The SEP indicators studied were: wealth, educational level and occupational class. The findings indicate that respondents with less wealth, fewer educational qualifications and lower occupational class were more likely to experience mild or severe physical disability than those of high SEP. When all three measures of SEP were adjusted for each other, in both samples wealth maintained a strong association with mild and severe disability, while education was associated with severe disability but only among English men. Occupational class was not strongly associated with physical disability in either case. Hence, among English and Greek older men, wealth was a more important predictor of physical functioning difficulties than either occupational class or education.

Modelling the effects of maternal socio-demographic characteristics on the preterm and term birth weight distributions in Greece using quantile regression.

The present study aims at modelling the effects of maternal socio-demographic characteristics on the birth weight distribution in Greece. The analysis is based on nationwide vital registration micro-data; 103,266 single live births recorded in 2006 are considered. Quantile regression models, allowing for the effects of covariates to vary across the conditional distribution of the dependent variable, birth weight, are applied to preterm and term births separately. The statistical analysis shows that the effects of most factors differentiate across the birth weight distributions. Ordinary Least Squares (OLS) coefficients, on the other hand, systematically underestimate effects at the lower tail and overestimate effects among heavier babies. Hence, quantile regression has a strong advantage over the OLS method. The findings also indicate that birth weight distributions of term and preterm infants are distinct and should be analysed separately. For both distributions female sex, primiparity, age of mother over 35 and prior history of stillbirths and child deaths are related to lower birth weight while higher educational attainment has a protective effect. Among term births, illegitimacy, living in big metropolitan areas and immigrant status of the mother are also significant predictors. For preterm births the impact of age of mother, parity and, in particular, prior stillbirths or deceased children is very pronounced.

Differentials in sex ratio at birth among natives and immigrants in greece: An analysis employing nationwide micro-data

This study uses micro-level information on the live births registered in Greece for 2006 to assess differentials in the propensity to have a male offspring between natives and immigrants. The sex ratio at birth for the whole population is 106.3 but it is considerably higher among immigrants (110.9) than among natives (105.4). Relatively high sex ratios at birth are observed for several migrant groups; differentials between natives, on the one hand, and Albanians (109.5) and Asians (129.0), on the other, are significant. The high sex ratio at birth for Albanians seems typical of that population. For Asians, the result is consistent with international findings though it may also be partly related to the small number of observations.

Disability trends among older adults in ten European countries over 2004–2013, using various indicators and Survey of Health, Ageing and Retirement in Europe (SHARE) data

ABSTRACT In the context of the prospective increase in the numbers of older adults in Europe and of conflicting findings regarding recent disability trends, the present study uses cross-sectional data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), covering the period 2004–2013, and aims at the assessment of trends in disability by sex and broad age group (50–64 and 65 and over) for the ten countries participating in all waves, based on four different measures: limitations in activities of daily living (ADLs), limitations in instrumental ADLs, mobility difficulties and the Global Activity Limitation Indicator. The analysis uses logistic regression models adjusted for age and, subsequently, also for chronic conditions. The findings indicate improvements both in mild/moderate activity restrictions and in functional limitations for several countries, especially among men and women aged 65 and over. Regarding severe disability (ADLs) there is mostly a lack of any significant trend and only a few declines. In several instances, the observed trends are linked to changes in chronic conditions; significant improvements net of chronic conditions are found mainly in Sweden but also in the Netherlands, Austria, Germany, Italy and France. Overall, the estimated trends often differentiate by country, age group and sex while they depend upon the specificities of the measures used in the analysis.

Life expectancy in Greece 1991–2007: regional variations and spatial clustering

Abstract Please click here to download the map associated with this article. In the absence of regional estimates of life-longevity for Greece, we have constructed abridged life tables by sex for the 51 prefectures of the country for 1991, 2001 and 2007, using the Reference to a Standard Table technique. The paper focuses on regional variations and spatial patterns of life expectancy at birth. This is the first time that such demographic information is presented for Greece. Conventional mapping depicts the improvements in mortality achieved for males and females during 1991–2007 as well as the advantage of the islands and of the southern regions of the country over northern Greece. Maps based on local indicators of spatial association (LISA) reveal a cluster of prefectures with low e0 values, covering mainly regions of northern Greece (Macedonia and Thrace) and three clusters with high values, including mainly prefectures of the Peloponnese, the islands of Dodecanese and Crete. Patterns are fairly similar for males and females. The analysis also shows that since 2001 sex differences in life expectancy have been narrowing, indicating that Greece follows the patterns observed in other European and developed countries with a time lag of about two decades.

Regional mortality differentials in Greece by selected causes of death: 2006–2008

Deaths due to neoplasms and diseases of the circulatory and the respiratory system represent 80% of all deaths in Greece. In the context of dearth of statistical analysis of spatial patterns of cause-specific mortality in Greece, this paper aims at studying the distribution and structure of appropriate mortality measures for the above mentioned causes of death at prefecture level. To achieve this, official statistics on deaths (2006–2008) and population (2007) are employed and Standardized Mortality Ratios (SMRs) by gender and cause of death are estimated using as ‘standard’ mortality schedule the national age-sex and cause-specific death rates. Estimation of Morans I statistic revealed the existence of significant positive spatial autocorrelation for neoplasms and circulatory diseases. Empirical Bayes procedures were employed to adjust SMR values which, although show less dispersion, were close to the original estimates. The thematic maps depict regions with relatively high (SMRs > 100) or low (SMRs < 100) mortality and their significance levels, indicating that spatial patterns exhibit many similarities between sexes for each cause of death. SMRs for neoplasms and circulatory diseases show a roughly similar tendency; lower mortality compared to the countrys average in southern and western Greece and the islands, and higher mortality in northern Greece, especially in the Region of East Macedonia and Thrace. Patterns due to respiratory diseases, on the other hand, differ somewhat but the corresponding relative risks are not as significant. Thorough observation and analysis of the conditions prevailing in northern Greece is needed to identify factors exacerbating ill health.

Mortality by Cause of Death Among Immigrants and Natives in a South European Country: The Case of Greece, 2011

The aim of the paper is to examine for the first time in Greece mortality by cause of death among immigrants. The analysis makes use of vital registration statistics for 2010–2012 and census data for 2011; standardised mortality ratios are estimated for four distinct groups: natives, migrants from EU-27 (excluding Greece), other Europeans (mainly Albanians) and those from all other countries (mainly Asia/Africa). All immigrants seem to experience favourable mortality from neoplasms but higher mortality from external causes in comparison to Greeks. The results regarding cardiovascular diseases are mixed. Persons originating in Asian/African regions exhibit higher mortality from infectious diseases and TB. The findings highlight the specificities of immigrant mortality which stem from pre-existing conditions in the country of origin as well as from the adverse socio-economic environment in the country of destination. As immigrants experience some excessive ‘avoidable’ mortality implementation of appropriate measures should be a social policy priority.