Éva Rásky

The impact of socio-economic status on pain and the perception of disability due to pain.

Pain is a major burden for society and a great challenge for public health. The aim of this study was to evaluate the association of socio‐economic status (SES) with pain, and assess if there were socio‐economic differences in the impairment due to pain, even when the same level of pain was reported. Data were sourced from the Austrian Health Interview Survey 2006–2007, a population based nation‐wide survey with 15,474 respondents. SES, based on education, income and profession was inversely and gradually associated with the prevalence of severe pain, with the number of indicated painful body sites, the intensity of pain, and with the subjective level of feeling disabled through pain. In a stepwise logistic regression model, adjusted for age, gender, diseases, number of painful body sites and intensity of pain, people with lower SES gradually reported greater disability through pain. Even at the same intensity of pain and the same number of painful body sites, people in the lowest as compared to the highest socio‐economic class were twice to three times more likely to feel disabled through pain. Adjusted odds ratios for the lowest group of SES was 2.80 (95% CI, 1.93–4.06) in terms of education, 1.83 (95% CI, 1.40–2.41) in terms of income and 2.05 (95% CI, 1.32–3.19) in terms of profession. This unexplained socio‐economic gradient contributes to the confirmation of the social component in a bio‐psycho‐social model of pain.

Nutrition and Health – The Association between Eating Behavior and Various Health Parameters: A Matched Sample Study

Population-based studies have consistently shown that our diet has an influence on health. Therefore, the aim of our study was to analyze differences between different dietary habit groups in terms of health-related variables. The sample used for this cross-sectional study was taken from the Austrian Health Interview Survey AT-HIS 2006/07. In a first step, subjects were matched according to their age, sex, and socioeconomic status (SES). After matching, the total number of subjects included in the analysis was 1320 (N = 330 for each form of diet – vegetarian, carnivorous diet rich in fruits and vegetables, carnivorous diet less rich in meat, and carnivorous diet rich in meat). Analyses of variance were conducted controlling for lifestyle factors in the following domains: health (self-assessed health, impairment, number of chronic conditions, vascular risk), health care (medical treatment, vaccinations, preventive check-ups), and quality of life. In addition, differences concerning the presence of 18 chronic conditions were analyzed by means of Chi-square tests. Overall, 76.4% of all subjects were female. 40.0% of the individuals were younger than 30 years, 35.4% between 30 and 49 years, and 24.0% older than 50 years. 30.3% of the subjects had a low SES, 48.8% a middle one, and 20.9% had a high SES. Our results revealed that a vegetarian diet is related to a lower BMI and less frequent alcohol consumption. Moreover, our results showed that a vegetarian diet is associated with poorer health (higher incidences of cancer, allergies, and mental health disorders), a higher need for health care, and poorer quality of life. Therefore, public health programs are needed in order to reduce the health risk due to nutritional factors.

Health behaviour and risk behaviour: Socioeconomic differences in an Austrian rural county

The aim of this study is to illustrate the impact of socioeconomic differences on two basic kinds of health-related behaviour defined as health behaviour (HB) and risk behaviour (RB). We analysed data derived from a health survey on health-related behaviour and self-reported morbidity in relation to demographic and socioeconomic factors. The survey consists of a random sample of 27,344 individuals taken from 79 communities from the rural population of Styria (Austria). Using directly standardised indicators both HB and RB revealed clear but inverse associations with education, SES and gender. HB rises and RB falls with years of schooling completed. HB is higher in women (103.5 versus 95.0, p < 0.01) whereas RB is higher in men (128.9 versus 80.1, p < 0.01). Different patterns of association with age were found. We conclude that both HB and RB should be considered as mediating factors between SES and health status.

Impact of socioeconomic position on frailty trajectories in 10 European countries: evidence from the Survey of Health, Ageing and Retirement in Europe (2004–2013)

Background Whether or not, and how, health inequalities change throughout older age is currently under debate. The goal of this study was to assess the net impact of education, occupational class, income and wealth on frailty trajectories among older adults in Continental Europe. Methods We modelled frailty index trajectories within a repeated cohort design among the community-dwelling population (50+) in 10 countries, using growth curve models based on 54 036 observations from 20 965 respondents in 4 waves (2004–2013) of the Survey of Health, Ageing and Retirement in Europe. Results Gaps in frailty due to education, occupational class and wealth continued throughout old age, while the gap due to income, smaller in comparison, converged. Frailty levels were higher and trajectories steeper in later birth cohorts, and the impact of education increased over time. Frailty levels and growth curves were higher in Southern European countries, and results were consistent across countries regarding the continuous effect of education and occupation and more mixed regarding wealth and income. Conclusions Health inequalities due to education, occupational class and wealth tend to persist throughout old age, whereas the negligible effect of income declines with age, which, substantially, highlights the importance of social conditions on the pace of physiological decline in older Europeans and, methodologically, highlights the need to assess multiple measures of socioeconomic position.

A 35-Year Trend Analysis for Back Pain in Austria: The Role of Obesity

Background The prevalence of back pain is constantly increasing and a public health problem of high priority. In Austria there is a lack of empirical evidence for the development of back pain and its related factors. The present study aims to investigate trends in the prevalence of back pain across different subpopulations (sex, age, obesity). Methods A secondary data analysis based on five nationally representative cross-sectional health surveys (1973–2007) was carried out. Face-to-face interviews were conducted in private homes in Austria. Subjects aged 20 years and older were included in the study sample (n = 178,818). Obesity was defined as BMI≥30 kg/m2 and adjusted for self-report bias. Back pain was measured as the self-reported presence of the disorder. Results The age-standardized prevalence of back pain was 32.9% in 2007; it was higher among women than men (p<0.001), higher in older than younger subjects (p<0.001) and higher in obese than non-obese individuals (p<0.001). During the investigation period the absolute change in the prevalence of back pain was +19.4%. Among all subpopulations the prevalence steadily increased. Obese men showed the highest increase of and the greatest risk for back pain. Conclusion These results help to understand the development of back pain in Austria and can be used to plan controlled promotion programs. Further monitoring is recommended in order to control risk groups and plan target group-specific prevention strategies. In Austria particular emphasis should be on obese individuals. We recommend conducting prospective studies to confirm our results and investigate causal relationships.

Self-perceived health, quality of life, and health-related behavior in obesity: is social status a mediator?

SummaryBackgroundObesity prevalence is increasing worldwide and is associated with a high health risk. Unfavorable psychological factors, lower self-ratings of health, and worse health-related behavior can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of this study is to investigate whether obese subjects with a high SES differ from those with a low SES depending on these outcomes.MethodsData of the Austrian Health Interview Survey (ATHIS) 2006/2007—precisely of 760 obese subjects with a low SES and 851 with a high SES—were analyzed stratified by sex and adjusted by age with regard to differences in self-perceived health, quality of life (regarding physical and psychological health, environment, and social relationships), and health-related behavior (smoking, alcohol consumption, eating behavior, physical exercise).ResultsThe results have shown that obese subjects with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, and intensity of physical activities. Furthermore, differences were found in obese women as to smoking behavior, alcohol consumption, and continuance of physical exercise.ConclusionIt seems that not only obesity but also the socioeconomic status plays a role in health, and the risk assessment of obese individuals in the primary health care setting should include socioeconomic factors. Furthermore, public health programs which focus on obese subjects with a low SES are urgently needed.ZusammenfassungHintergrundDie Prävalenz der Adipositas nimmt weltweit zu und ist mit einem hohen Gesundheitsrisiko verbunden. Personen mit einem niedrigen sozioökonomischen Status (SES) weisen ein schlechteres Gesundheitsverhalten, ungünstige psychologische Faktoren und eine schlechtere subjektive Gesundheit auf. Daher war das Ziel dieser Untersuchung, Unterschiede zwischen adipösen Personen mit einem hohen vs. niedrigen SES zu analysieren.MethodenZur Prüfung der Fragestellung wurden die Daten der österreichischen Gesundheitsbefragung 2006/2007 analysiert. Unterschiede im Hinblick auf die subjektive Gesundheit, die Lebensqualität (in den Bereichen physische und psychische Gesundheit, Umgebungsfaktoren und soziale Beziehungen), sowie das Gesundheitsverhalten (Rauchen, Alkoholkonsum, Ess- und Bewegungsverhalten) von 760 adipösen Personen mit einem niedrigen SES und 851 mit einem hohen SES wurden geschlechtsstratifiziert und alterskorrigiert untersucht.ErgebnisseAdipöse Personen mit einem niedrigen SES unterscheiden sich signifikant von jenen mit einem hohen SES hinsichtlich der subjektiven Gesundheit, der Lebensqualität und der Intensität des Bewegungsverhaltens. Weiters wurden Unterschiede in Abhängigkeit vom SES bei adipösen Frauen in Bezug auf ihr Rauchverhalten, ihren Alkoholkonsum und die Häufigkeit ihres Bewegungsverhaltens, festgestellt.SchlussfolgerungDer sozioökonomische Status hat einen wesentlichen Einfluss auf die Gesundheit und das Gesundheitsverhalten bei Adipositas und diese Tatsache sollte in der primärmedizinischen Versorgung berücksichtigt werden. Weiters sind Gesundheitsprogramme, speziell für adipöse Personen mit niedrigem SES, dringend erforderlich.

The Influence of Socioeconomic Factors on Health Parameters in Overweight and Obese Adults

The prevalence of being overweight and of obesity is increasing worldwide, and is associated with a high risk to health. Therefore, the aim of our study was to investigate whether normal weight, overweight and obese subjects of low, middle or high socioeconomic status (SES) differ with regard to their health behavior, health, quality of life, and the use of medical care. Data from the Austrian Health Interview Survey (ATHIS) 2006/07, comprising 3 groups of 1,077 individuals, each of whom were normal weight, overweight, or obese, respectively, and matched according to their age, sex and SES, were analyzed concerning health outcomes. The results show that subjects with a low SES differ significantly from those of high SES in terms of their health behavior, self-perceived health, levels of impairment, chronic conditions, quality of life, and health care. Additionally, obesity in adults is associated with sub-optimal dietary practices and worse health, poorer quality of life and medical care than normal weight and overweight individuals. A significant interaction between the weight class and SES was found concerning physical exercise, impairment due to health problems and chronic diseases. A low SES has a strong negative impact on health, especially in obese individuals. Therefore a continuous target group-oriented, non-discriminatory public health program is required, prioritizing obese subjects with low SES.

Operationalisation of a demand/resource model of health: an explorative study

1define health as follows: “Health is a transactionally produced condition of a dynamic balance between the individual, his/her autonomous potential of self-organisation as well as of self-restoration and his/her social and economic environment. This balance depends upon the availability and use of health-protective and health-restoring factors in the individual and in the environment that can be defined as internal and external resources” (page 9). These resources are essential in coping with strain. Antonovsky 2

The Role of Personal and Job Resources in the Relationship between Psychosocial Job Demands, Mental Strain, and Health Problems

Recent research highlights the importance of both job resources and personal resources in the job demands-resources model. However, the results of previous studies on how these resources are related to each other and how they operate in relation to the health-impairment process of the job demands-resources model are ambiguous. Thus, the authors tested an alternative model, considering job and personal resources to be domains of the same underlying factor and linking this factor to the health-impairment process. Survey data of two Austrian occupational samples (N1 = 8657 and N2 = 9536) were analyzed using confirmatory factor analysis (CFA) and structural equation modeling (SEM). The results revealed that job and personal resources can be considered as indicators of a single resources factor which was negatively related to psychosocial job demands, mental strain, and health problems. Confirming previous studies, we further found that mental strain mediated the relationship between psychosocial job demands and health problems. Our findings suggest that interventions aimed at maintaining health in the context of work may take action on three levels: (1) the prevention of extensive job demands, (2) the reduction of work-related mental strain, and (3) the strengthening of resources.

Quality of screening with conventional Pap smear in Austria – a longitudinal evaluation

BackgroundIn recent decades, the incidence of cervical cancer and cervical cancer mortality in Austria has declined by varying degrees. The Pap smear is to be considered a causal factor for this decline.MethodsThis longitudinal analysis is based on a data set of Pap smear assessments collected by the Committee for Quality Assurance of the Austrian Society of Cytology. Data from 15 laboratories participating in a voluntary self-monitoring program was analyzed for the time span 2004–2008. The data was analyzed in terms of smear quality and assessment quality.A rank-correlation-test for a monotonic trend analysis in the proportion of the three parameters Pap 0, “satisfactory, but limited/SBL”, and Pap IIID/IV for the timespan 2004 to 2008 was carried out.ResultsFor this study, we analyzed an average number of 730,000 smears per year over a five-year period. Specimens from all but two laboratories, i.e. < 2% of all smears, met the quality criterion for Pap 0 (Bethesda 2001 equivalent: Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality), whilst only four laboratories, i.e. < 10% of all smears, reached the national requirement for smears classified as “satisfactory, but limited/SBL”.When using the Pap IIID/IV ratio (LSIL: HSIL/AIS ratio) of 3:1 to 8:1 as a surrogate quality marker for the interpretation of smears, only five laboratories met this criterion during the survey period.The trend analysis indicated only that an increasing number of samples per year is correlated with an increased proportion of Pap 0 and “satisfactory, but limited/SBL” smears.ConclusionsAlthough participants get regular feedback about their results, no general improvements in smear taking or assessment were observed over the years, so mandatory quality management, including the possibility of sanctions, is suggested in order to reduce adverse health effects for women.