Johanna Muckenhuber

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.

Social capital affects the health of older people more strongly than that of younger people

ABSTRACT The study examines whether social capital affects health of older people more strongly than it affects health of younger individuals. Following Pierre Bourdieus concept, social capital has been analysed on a cognitive dimension, distinguishing between institutional and informal social capital. The analysis is based on the data of the Austrian Health Interview Survey 2006–07 with a representative sample of 15,575 people. Multivariate linear regression models were calculated. Measures of health and social capital were operationalised by indices based on the quality of life inventory of the World Health Organization, the WHOQOL-Brief questionnaire. The analysis has shown institutional social capital to be significantly more important for health of older people (60 years or older) than for younger people. There is a gender difference in the interaction between informal social capital and age in their association with psychological health. In contrast to the sub-sample of women, the psychological health of older men is more strongly affected by a lack of informal social capital than that of younger men. Institutional social capital is of special importance for the health of older people. Therefore health-promotion activities for older people should include activities to strengthen their social capital.

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.

Income Inequality as a Moderator of the Relationship between Psychological Job Demands and Sickness Absence, in Particular in Men: An International Comparison of 23 Countries

Objectives The aim of this study was to investigate whether more sickness absence is reported in countries with higher income inequality than elsewhere, and whether the level of income inequality moderates the association between psycho-social job demands and sickness absence. Methods Our analysis is based on the Fifth European Working Conditions Survey that compared 23 European countries. We performed multi-level regression analysis. On the macro-level of analysis we included the Gini-Index as measure of inequality. On the micro-level of analysis we followed the Karasek-Theorell model and included three scales for psychological job demands, physical job demands, and decision latitude in the model. The model was stratified by sex. Results We found that, in countries with high income inequality, workers report significantly more sickness absence than workers in countries with low income inequality. In addition we found that the level of income inequality moderates the relationship between psychological job demands and sickness absence. High psychological job demands are significantly more strongly related to more days of sickness absence in countries with low income inequality than in countries with high income inequality. Conclusions As the nature and causal pathways of cross-level interaction effects still cannot be fully explained, we argue that future research should aim to explore such causal pathways. In accordance with WHO recommendations we argue that inequalities should be reduced. In addition we state that, particularly in countries with low levels of income inequality, policies should aim to reduce psychological job demands.

Erratum to: Female and male victims of violence in an urban emergency room—prevalence, sociodemographic characteristics, alcohol intake, and injury patterns

SummaryBackgroundViolence as well as alcohol-attributable injuries is a dominant public health issue worldwide. Victims, being injured, frequently visit emergency rooms (ER).MethodsWe interviewed all the patients seeking help in an urban emergency room reporting being victims of violent behavior over a period of 3 months (from November 2011 to January 2012).ResultsOur results showed that 1 out of 23 patients seeking help in our ER was due to forcible means. A total of 15 % of all victims reported domestic violence (75 % women) and others (90 % men) reported brawl as the reason for seeking help. Overall, 80 % of the victims were younger than 40 years. In case of domestic violence, two-third (only women) reported that they were hurt by their intimate partner. At total of 50 % were treated for head wounds and 35 % had injuries of their extremities. One-third of the patients were alcoholized. The victims of brawls mainly suffer from head injuries (69 %). Half of this patient group was under the influence of alcohol.ConclusionsTo conclude, victims of violence seek for help in emergency rooms daily. Alcohol consumption is the main factor for violent behavior. Public health programs to prevent alcohol related violence and therefore, alcohol-attributable injuries have to be implemented. Addressing the need to enhance the awareness of the health professionals has to be an imperative.ZusammenfassungGrundlagenGewalt und Verletzungen, die dem Einfluss von Alkohol zuzuschreiben sind, sind weltweit ein großes Public Health Problem. Die Opfer werden häufig in den Notaufnahmen einer Unfallchirurgie medizinisch versorgt werden.MethodikWir haben über einen Zeitraum von drei Monaten (November 2011 bis Januar 2012) in einer städtischen Notaufnahme all jene PatientInnen interviewt, die angaben, dass sie Opfer von gewalttätigem Verhalten sind.ErgebnisseUnsere Ergebnisse haben gezeigt, dass eine/-r von 23 PatientInnen aufgrund von äußerer Gewalteinwirkung medizinische Hilfe benötigt. 15 % aller Opfer (75 % Frauen) beanspruchen Hilfe aufgrund von häuslicher Gewalt, die anderen (90 % Männer) hauptsächlich aufgrund von Raufhandel. Insgesamt waren 80 % der Opfer jünger als 40 Jahre. Im Fall von häuslicher Gewalt gaben zwei Drittel (nur Frauen) an, dass sie von ihrem Lebenspartner verletzt wurden. 50 % wurden aufgrund von Kopfverletzungen versorgt, 35 % litten an Verletzungen an den Extremitäten. Ein Drittel der PatientInnen war alkoholisiert. Die meisten Opfer von Raufhandel litten an Kopfverletzungen (69 %) und die Hälfte von ihnen war alkoholisiert.SchlussfolgerungenZusammenfassend werden Opfer von Gewalt täglich in der Notaufnahme medizinisch versorgt. Public Health Programme, die Gewalt und alkoholbedingte Verletzungen verhindern, müssten implementiert werden. Das medizinische Personal für dieses Problem zu sensibilisieren ist dringend erforderlich.

The impact of the HDI on the association of psychosocial work demands with sickness absence and presenteeism

BACKGROUND The purpose of this study was to determine whether psychosocial work demands have a different impact on sickness absence and presenteeism in countries with a high vs. countries with a low Human Development Index (HDI). METHODS This article is based on an analysis of the fifth European Working Conditions Survey. We investigated single items as well as complex constructs and indices. Sickness absence and presenteeism were measured as outcome variables. Following the model of Karasek and Theorell, we measured the HDI at the macro level and psychosocial job demands at the micro level as independent variables. RESULTS The multivariate multilevel analysis reveals a significant association between the HDI and the number of days recorded for sickness absence. In countries with a higher HDI, people report a lower number of days with sickness absence. Higher psychosocial job demands are associated with poorer health. There are significant cross-level interaction effects between psychosocial job demands and the HDI for these associations. Psychosocial job demands are stronger associated with sickness absence and presenteeism in high-HDI than in low-HDI countries. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH We argue that Public Health Actions that are connected to work characteristics need to take into consideration the level of HDI of the countries. In low- and high-HDI countries, different actions could be necessary to reach the needs of the working population.

Social status as a mediator of self-perceived health, quality of life and health-related behaviour in obesity.

OBJECTIVES Obesity prevalence is increasing worldwide and associated with a high health risk. Unfavourable psychological factors, lower self-ratings of health and worse health-related behaviour can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of our study was to investigate whether normal weight vs. obese subjects with a high vs. low socioeconomic status (SES) differ with regard to self-perceived health, quality of life and health-related behaviour. METHODS Data of the Austrian Health Interview Survey (ATHIS) 2006/07, precisely of 8015 subjects were analysed stratified by sex and adjusted by age concerning these outcomes. RESULTS The results have shown that men and women with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, intensity of physical activities, alcohol consumption, and eating behaviour (men: p <0.001; women: p<0.001). A significant interaction between the body mass index (BMI) and SES occurred in men concerning quality of life in the domains physical (p<0.05) and psychological health (p<0.01), in women as to self-perceived health (p<0.01), quality of life in the domains physical health (p<0.01) and environment (p<0.05), as well as physical activities (p<0.01). CONCLUSION The SES has a strong negative impact on health-related variables, especially in obese subjects, and therefore risk assessment in the primary health-care setting should include socioeconomic factors. Furthermore, a continued strong public health programme is required with an absolute priority placed on obese subjects of low SES.