Olaf von dem Knesebeck

Socioeconomic status and health among the aged in the United States and Germany: A comparative cross-sectional study

This study investigates socioeconomic status (SES) differences in health among the aged in Germany and the United States. Intra-elderly age differences in the SES-health gradient are also examined. The study uses data from two national telephone surveys conducted in Germany (N=682) and the United States (N=608) using probability samples of non-institutionalised persons 60 years or older. In addition to the traditional indicators of SES (education, income and occupational status), two alternative indicators (assets and home ownership) are utilised. Self-rated health, depression (CES-D) and functional limitations are introduced as health indicators. Results of multiple logistic regression analyses show that income is the best SES predictor of the three health measures among the aged in Germany, whereas education, occupational prestige, assets, and home ownership are not consistently related to health. Respective analyses of the US data demonstrate weaker and less consistent associations of health measures with SES indicators. Consequently, there is a higher percentage of explained variance in health by SES among the aged in Germany compared to the United States. The data also show that social inequalities in health tend to diminish at older ages in the United States, but such disparities vary only slightly by age in Germany. In conclusion, although SES health differences are observed among the elderly in both countries, they are more pronounced in Germany than in the United States where effects are restricted to younger old age. One interpretation of this finding points to higher selective mortality of middle and early old age groups with a low SES in the United States due to stronger health-related deprivation.

The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study

BackgroundMultimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern.MethodsThe MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses.ResultsMultimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status.ConclusionsOur study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups.Trial registrationISRCTN89818205

Perceived work stress, overcommitment, and self-reported musculoskeletal pain: Across-sectional investigation

The objectiveofthis study was to analyze associations of three indicators of perceived work stress (physical job demand, low control at work, andan imbalance between effort and reward), and of overcommitment, a personal pattern of coping with work demands, with musculoskeletal pain. A standardized questionnaire measuring these conditions in addition to self-reported musculoskeletal pain at different locations was administered to a group of 316 male and female employees of a public transport enterprise. After we adjusted for confounding effects of age, sex, socioeconomic status, shift work, and negative affectivity, we observed elevated prevalence odds ratios in employees who scored high on overcommitment, who were exposed to physical job demand, and, to a lesser extent, who reported psychosocial work stress. Results have implications for a more comprehensive approach to primary and secondary prevention of musculoskeletal pain.

Socio-economic position and quality of life among older people in 10 European countries: results of the SHARE study

This study examines associations between quality of life and multiple indicators of socio-economic position among people aged 50 or more years in 10 European countries, and analyses whether the relative importance of the socio-economic measures vary by age. The data are from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2004. 15,080 cases were analysed. Quality of life was measured by a short version of the CASP-19 questionnaire, which represents quality of life as comprising four conceptual domains of individual needs that are particularly relevant in later life: control (C), autonomy (A), self-realisation (S) and pleasure (P). The short version has 12 items (three for each domain). Five indicators of socio-economic position were used: income, education, home ownership, net worth, and car ownership. A multiple logistic regression showed that quality of life was associated with socio-economic position, but that the associations varied by country. Relatively small socio-economic differences in quality of life were observed for Switzerland, but comparatively large differences in Germany. Education, income, net worth, and car ownership consistently related to quality of life, but the association of home ownership was less consistent. There was no indication that the socio-economic differences in quality of life diminished after retirement (i.e. from 65+ years). Conventional measures of socio-economic position (education and income), as well as alternative indicators (car ownership and household net worth), usefully identified the differential risks of poor quality of life among older people before and after the conventional retirement age.

Social productivity and well-being of older people: baseline results from the SHARE study

Social and productive activities have been associated with more favorable well-being and health outcomes in older populations. There is limited consensus on what aspects account for the observed effect and what pathways may underlie their associations. Using data from the 2004 ‘Survey of Health Aging and Retirement in Europe’ (SHARE), based on some 22,000 participants aged 50 and older from ten European countries, this study explores types and quality of productive activities (voluntary work, care for a person, informal help) and its association with two indicators of well-being (depressive symptoms, quality of life). Quality of social productivity is analyzed in the frame of a sociological model based on the notion of exchange reciprocity. Results of multivariate linear regression analysis, adjusted for important confounders, confirm an association of productive activity with well-being. However, this association varies according to experienced quality of exchange: Experienced reciprocity between efforts spent and rewards received is associated with positive well-being (with the exception of caring), while non-reciprocal exchange (high effort and low reward) is associated with negative well-being in all activities. Findings underline the need to improve quality of exchange in socially productive activities as a means of motivating older people to participate in societal life.

Rationale and content of psychenet: the Hamburg Network for Mental Health

With the public-funded research and development project psychenet: the Hamburg Network for Mental Health (2011–2014), the Federal Ministry of Education and Research contributes to strengthening healthcare regions in Germany by establishing new trans-sectoral cooperations and implement and evaluate selected innovations. More than 60 partners from research, health care, health industry and government in the Free and Hanseatic City of Hamburg are promoting innovative measures to improve the treatment for mental disorders. The main objective is to implement integrated healthcare networks based on evidence for effective treatment methods, deriving from high-quality research throughout five indications such as psychosis, depression, somatoform and functional syndromes, anorexia and bulimia and addiction illnesses in adolescence. Those networks are accompanied by additional measures, for example, for improving information and education, addressing occupational health or strengthening the participation of patients and their families suffering from mental illness.

It's about time: physicians' perceptions of time constraints in primary care medical practice in three national healthcare systems

Background:As physicians are pressured to deliver an increasing number of preventive services, follow guidelines, engage in evidence-based practice, and deliver patient-centered care in managerially driven organizations, they struggle with how much control they have over their time. Methods:A secondary analysis was conducted with data from 3 parallel studies of clinical decision making in Germany, the United Kingdom, and the United States with 128 physicians per country. Physicians reported how much time they were allocated and how much time they needed for high-quality care for new patient appointments, routine consultations, and complete physicals. They also reported how much control they had over their time in the office and spending adequate time with patients. Results:German, British, and American physicians were allocated (on average) 16/11/32 minutes for a new patient appointment, 6/10/18 minutes for a routine visit, and 12/20/36 minutes for a complete physical, but felt that they needed more time. Over half of German and American physicians felt that they always or usually had control over the hours they were required to be in their office or spending sufficient time with their patients while less than half of British physicians felt this way. Conclusion:German physicians had the least time allocated and needed for most types of appointment. American physicians had the most time allocated and needed for each type of appointment. However, British physicians felt they had the least control over time in their office and spending sufficient time with patients.

Reported nonreciprocity of social exchange and depressive symptoms Extending the model of effort-reward imbalance beyond work

OBJECTIVE To study associations of stressful experience in close social relationships with depressive symptoms a measure of nonreciprocal social exchange in marital, parental and less specific civic roles was developed. This measure aims at extending the model of effort-reward imbalance beyond work. METHODS Data from two national surveys in Germany (n=682) and the United States (n=608) were collected, using probability samples of persons 60 years or older. Reported nonreciprocity was measured by a Likert scale. Psychometric properties are described. Depressive symptoms were measured by the CES-D Scale and relevant covariates were assessed. RESULTS Logistic regression analysis indicates that the risk of depressive symptoms was about twice as high in elderly men and women reporting nonreciprocity of social exchange compared to nonstressed subjects. CONCLUSION Findings provide preliminary evidence of usefulness of a measure that extends the notion of nonreciprocal social exchange beyond working life.

Relative Impact of Multimorbid Chronic Conditions on Health-Related Quality of Life – Results from the MultiCare Cohort Study

Background Multimorbidity has a negative impact on health-related quality of life (HRQL). Previous studies included only a limited number of conditions. In this study, we analyse the impact of a large number of conditions on HRQL in multimorbid patients without preselecting particular diseases. We also explore the effects of these conditions on the specific dimensions of HRQL. Materials and Methods This analysis is based on a multicenter, prospective cohort study of 3189 multimorbid primary care patients aged 65 to 85. The impact of 45 conditions on HRQL was analysed. The severity of the conditions was rated. The EQ-5D, consisting of 5 dimensions and a visual-analogue-scale (EQ VAS), was employed. Data were analysed using multiple ordinary least squares and multiple logistic regressions. Multimorbidity measured by a weighted count score was significantly associated with lower overall HRQL (EQ VAS), b = −1.02 (SE: 0.06). Parkinson’s disease had the most pronounced negative effect on overall HRQL (EQ VAS), b = −12.29 (SE: 2.18), followed by rheumatism, depression, and obesity. With regard to the individual EQ-5D dimensions, depression (OR = 1.39 to 3.3) and obesity (OR = 1.44 to 1.95) affected all five dimensions of the EQ-5D negatively except for the dimension anxiety/depression. Obesity had a positive effect on this dimension, OR = 0.78 (SE: 0.07). The dimensions “self-care”, OR = 4.52 (SE: 1.37) and “usual activities”, OR = 3.59 (SE: 1.0), were most strongly affected by Parkinson’s disease. As a limitation our sample may only represent patients with at most moderate disease severity. Conclusions The overall HRQL of multimorbid patients decreases with an increasing count and severity of conditions. Parkinson’s disease, depression and obesity have the strongest impact on HRQL. Further studies should address the impact of disease combinations which require very large sample sizes as well as advanced statistical methods.

Work stress of primary care physicians in the US, UK and German health care systems

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions.