Sebastian Günther

The use of parental occupation in adolescent health surveys. An application of ISCO-based measures of occupational status

Background Recent research has emphasised that the challenge in researching socioeconomic differences in adolescent health cross-nationally lies in providing valid and comparable measures of socioeconomic position (SEP) across regions. This study aims to examine measures of occupational status derived from the International Standard Classification of Occupations (ISCO), alongside commonly used affluence measures in association with adolescent self-rated health (SRH). Methods Data were from the 2005/2006 ‘Health Behaviour in School-aged Children study’ (HBSC); 27u2005649 individuals aged 11, 13 and 15u2005years from Germany, Macedonia, Norway, Turkey, Wales and Scotland. Three occupational scales were compared: the International Socioeconomic Index of Occupational Status (ISEI), the Standard International Occupational Prestige Scale (SIOPS) and the Erikson–Goldthorpe–Portocarero class categories (EGP). Correlation analyses compared these occupational scales with the family affluence scale (FAS) and a family well-off measure, while logistic regression assessed the association between occupational scales and poor SRH. Multiple imputation techniques investigated possible bias arising from parental occupation missingness. Results Moderate correlations existed between occupational scales and FAS and family well-off. Socioeconomic inequalities in poor SRH were found for ISEI, SIOPS and EGP in all regions, independent of FAS and family well-off. Models of imputed data sets did not alter the results. The relationship between SEP and SRH was therefore not biased by high levels of missing values for ISCO. Conclusions ISCO-based indicators of occupational status in cross-national self-administered adolescent health surveys were found to be robust measures of SEP in adolescence. These measure different aspects of SEP independent of FAS and family well-off.

Herausforderungen in der Analyse von Versorgungsungleichheiten in der Kinderrehabilitation

BACKGROUNDnSocial inequalities on access and utilization of inpatient rehabilitation among adolescents have rarely been studied.nnnMETHODSnParents of children with chronic health conditions (age of 7-17) were interviewed about access and utilization of inpatient rehabilitation. Parents were recruited through pediatricians as well as rehabilitation centers in Central Germany.nnnRESULTSnDespite of numerous recruitment measures the participation by pediatricians was low. Also expanding the sample did not remedial. Furthermore, fewer adolescents with need of rehabilitation were achieved than expected. The analysis is subject to these restrictions, nevertheless, they still allow explorative statements about access and utilization of pediatric rehabilitation.nnnCONCLUSIONnDespite major challenges in recruitment, pediatricians should be considered into analysis of inequalities in rehabilitation because of their gatekeeper function.

Educational inequalities in subjective health in Germany from 1994 to 2014: a trend analysis using the German Socio-Economic Panel study (GSOEP)

Introduction As trend studies have shown, health inequalities by income and occupation have widened or remained stable. However, research on time trends in educational inequalities in health in Germany is scarce. The aim of this study is to analyse how educational inequalities in health evolved over a period of 21 years in the middle-aged population in Germany, and whether the trends differ by gender. Methods Data were obtained from the German Socio-Economic Panel covering the period from 1994 to 2014. In total, n=16u2009339 participants (106u2009221 person years) aged 30–49 years were included in the study sample. Educational level was measured based on the ‘Comparative Analysis of Social Mobility in Industrial Nations’ (CASMIN) classification. Health outcomes were self-rated health (SRH) as well as (mental and physical) health-related quality of life (HRQOL, SF-12v2). Absolute Index of Inequality (Slope Index of Inequality (SII)) and Relative Index of Inequality (RII) were calculated using linear and logarithmic regression analyses with robust SEs. Results Significant educational inequalities in SRH and physical HRQOL were found for almost every survey year from 1994 to 2014. Relative inequalities in SRH ranged from 1.50 to 2.10 in men and 1.25 to 1.87 in women (RII). Regarding physical HRQOL, the lowest educational group yielded 4.5 to 6.6 points (men) and 3.3 to 6.1 points (women) lower scores (SII). Although educational level increased over time, absolute and relative health inequalities remained largely stable over the last 21 years. For mental HRQOL, only few educational inequalities were found. Discussion This study found persistent educational inequalities in SRH and physical HRQOL among adults in Germany from 1994 to 2014. Our findings highlight the need to intensify efforts in social and health policies to tackle these persistent inequalities.

Intergenerationale Mobilität und gesundheitliche Ungleichheiten in Ost- und Westdeutschland

BACKGROUNDnSocial mobility processes, i.u2009e. the movement of axa0person from one social position to another, are central mechanisms for explaining health inequalities. Social differences in health status or behaviour may also change with changes in social status. This article examines the importance of intergenerational mobility, i.u2009e. the rise and fall of social status in relation to parental social position, for subjective health in East and West Germany and whether this relationship has changed over 20xa0years.nnnMATERIAL AND METHODSnThe data basis is the socio-economic panel from 1992-2012. Employees aged between 25xa0and 59xa0were taken into account. Different mobility paths were determined by comparing their current occupational positions with those of their parents. For these, prevalence and logistic regression of subjective health were calculated.nnnRESULTSnThose in low occupational positions rated their health more often as being worse in all periods. Upwardly mobile individuals had axa0lower risk of poorer health (OR 0.72) compared to those who remained in their original position. Persons affected by downward mobility had axa0similarly worse self-rated health (OR 1.55 or OR 1.86). Significant differences in gender or region of origin (East-West Germany) could not be determined. Education and income contribute to explaining the relationship.nnnCONCLUSIONnThe results suggest that social advancement has axa0positive effect on health, whereas social decline is negative - regardless of gender, region of origin or time. It is therefore important to reinforce political efforts aimed at increasing the mobility opportunities of all social groups in axa0positive sense and thus reducing social inequalities.ZusammenfassungHintergrundSoziale Mobilitätsprozesse, d.u2009h. die Bewegung einer Person aus einer sozialen Position in eine andere, stellen einen zentralen Mechanismus zur Erklärung gesundheitlicher Ungleichheiten dar. Sozial bedingte Unterschiede im Gesundheitszustand oder im Gesundheitsverhalten können sich mit dem Wechsel der eigenen Position ebenfalls ändern. Der Beitrag untersucht, welche Bedeutung intergenerationale Mobilität, also ein Auf- bzw. Abstieg gegenüber der elterlichen Position, in Ost- und Westdeutschland für die subjektive Gesundheit hat und ob sich dieser Zusammenhang innerhalb von 20xa0Jahren verändert hat.Material und MethodenDatenbasis ist das Sozio-oekonomische Panel der Jahre 1992–2012. Berücksichtigt wurden Erwerbstätige zwischen 25xa0und 59xa0Jahren. Anhand des Vergleichs ihrer aktuellen Stellungen mit denen ihrer Eltern wurden Mobilitätspfade bestimmt. Für diese wurden Prävalenzen und logistische Regressionen der subjektiven Gesundheit berechnet.ErgebnisseJene in niedrigen beruflichen Stellungen bewerteten ihre Gesundheit zu allen Zeitperioden häufiger schlechter. Aufwärtsmobile Personen hatten im Vergleich zu jenen, die in ihrer Herkunftsstellung verblieben, ein geringeres Risiko einer schlechteren Gesundheit (OR 0,72). Personen, die abstiegen, schätzten ihre Gesundheit schlechter ein (OR 1,55 bzw. OR 1,86). Signifikante Unterschiede nach Geschlecht oder Herkunftsregion konnten nicht festgestellt werden. Bildung und Einkommen tragen zur Erklärung des Zusammenhangs bei.SchlussfolgerungDie Ergebnisse deuten an, dass sich ein sozialer Aufstieg positiv auf die Gesundheit auswirkt, ein sozialer Abstieg dagegen eher negativ – unabhängig von Geschlecht, Herkunftsregion oder Zeitverlauf. Es ist daher wichtig, die Mobilitätschancen aller gesellschaftlichen Gruppen zu erhöhen und damit soziale Ungleichheiten zu reduzieren.AbstractBackgroundSocial mobility processes, i.u2009e. the movement of axa0person from one social position to another, are central mechanisms for explaining health inequalities. Social differences in health status or behaviour may also change with changes in social status. This article examines the importance of intergenerational mobility, i.u2009e. the rise and fall of social status in relation to parental social position, for subjective health in East and West Germany and whether this relationship has changed over 20xa0years.Material and methodsThe data basis is the socio-economic panel from 1992–2012. Employees aged between 25xa0and 59xa0were taken into account. Different mobility paths were determined by comparing their current occupational positions with those of their parents. For these, prevalence and logistic regression of subjective health were calculated.ResultsThose in low occupational positions rated their health more often as being worse in all periods. Upwardly mobile individuals had axa0lower risk of poorer health (OR 0.72) compared to those who remained in their original position. Persons affected by downward mobility had axa0similarly worse self-rated health (OR 1.55 or OR 1.86). Significant differences in gender or region of origin (East-West Germany) could not be determined. Education and income contribute to explaining the relationship.ConclusionThe results suggest that social advancement has axa0positive effect on health, whereas social decline is negative – regardless of gender, region of origin or time. It is therefore important to reinforce political efforts aimed at increasing the mobility opportunities of all social groups in axa0positive sense and thus reducing social inequalities.Cohort studies are a longitudinal observational study type. They are firmly established within epidemiology to assess the course of diseases and risk factors. Yet, standards to describe and evaluate quality characteristics of cohort studies need further development. Within the TMF (aEuroTechnologie- und Methodenplattform fur die vernetzte medizinische Forschung e. V.) project Quality management standards in cohort studies, a catalogue of requirements was compiled and evaluated, focusing on the preparation and conduct of epidemiologic cohort studies. The catalogue of requirements was established based on a consensus process between representatives of seven German epidemiologic cohort studies. For this purpose, a set of expert meetings (telephone, face-to-face, web-based) was conducted and the importance of each element of the catalogue was assessed as well as its implementation. A catalogue of requirements with 138 requirements was consented. It is structured into ten sections: 1. Study documentation;2. Selection of instruments;3. Study implementation, 4. Organizational structure;5. Qualification and certification;6. Participant recruitment;7. Preparation, conduct and follow-up processing of examinations;8. Study logistics and maintenance, 9. Data capture and data management;10. Reporting and monitoring. In total, 41 elements were categorized as being essential, 91 as important, and 6 as less important. The catalogue of requirements provides a guideline to improve the preparation and operation of cohort studies. The evaluation of the importance and degree of implementation of requirements depended on the study design. With adaptations, the catalogue might be transferable to other study types.

Intergenerationale Mobilität und gesundheitliche Ungleichheiten in Ost- und WestdeutschlandIntergenerational mobility and health inequalities in East and West Germany

BACKGROUNDnSocial mobility processes, i.u2009e. the movement of axa0person from one social position to another, are central mechanisms for explaining health inequalities. Social differences in health status or behaviour may also change with changes in social status. This article examines the importance of intergenerational mobility, i.u2009e. the rise and fall of social status in relation to parental social position, for subjective health in East and West Germany and whether this relationship has changed over 20xa0years.nnnMATERIAL AND METHODSnThe data basis is the socio-economic panel from 1992-2012. Employees aged between 25xa0and 59xa0were taken into account. Different mobility paths were determined by comparing their current occupational positions with those of their parents. For these, prevalence and logistic regression of subjective health were calculated.nnnRESULTSnThose in low occupational positions rated their health more often as being worse in all periods. Upwardly mobile individuals had axa0lower risk of poorer health (OR 0.72) compared to those who remained in their original position. Persons affected by downward mobility had axa0similarly worse self-rated health (OR 1.55 or OR 1.86). Significant differences in gender or region of origin (East-West Germany) could not be determined. Education and income contribute to explaining the relationship.nnnCONCLUSIONnThe results suggest that social advancement has axa0positive effect on health, whereas social decline is negative - regardless of gender, region of origin or time. It is therefore important to reinforce political efforts aimed at increasing the mobility opportunities of all social groups in axa0positive sense and thus reducing social inequalities.ZusammenfassungHintergrundSoziale Mobilitätsprozesse, d.u2009h. die Bewegung einer Person aus einer sozialen Position in eine andere, stellen einen zentralen Mechanismus zur Erklärung gesundheitlicher Ungleichheiten dar. Sozial bedingte Unterschiede im Gesundheitszustand oder im Gesundheitsverhalten können sich mit dem Wechsel der eigenen Position ebenfalls ändern. Der Beitrag untersucht, welche Bedeutung intergenerationale Mobilität, also ein Auf- bzw. Abstieg gegenüber der elterlichen Position, in Ost- und Westdeutschland für die subjektive Gesundheit hat und ob sich dieser Zusammenhang innerhalb von 20xa0Jahren verändert hat.Material und MethodenDatenbasis ist das Sozio-oekonomische Panel der Jahre 1992–2012. Berücksichtigt wurden Erwerbstätige zwischen 25xa0und 59xa0Jahren. Anhand des Vergleichs ihrer aktuellen Stellungen mit denen ihrer Eltern wurden Mobilitätspfade bestimmt. Für diese wurden Prävalenzen und logistische Regressionen der subjektiven Gesundheit berechnet.ErgebnisseJene in niedrigen beruflichen Stellungen bewerteten ihre Gesundheit zu allen Zeitperioden häufiger schlechter. Aufwärtsmobile Personen hatten im Vergleich zu jenen, die in ihrer Herkunftsstellung verblieben, ein geringeres Risiko einer schlechteren Gesundheit (OR 0,72). Personen, die abstiegen, schätzten ihre Gesundheit schlechter ein (OR 1,55 bzw. OR 1,86). Signifikante Unterschiede nach Geschlecht oder Herkunftsregion konnten nicht festgestellt werden. Bildung und Einkommen tragen zur Erklärung des Zusammenhangs bei.SchlussfolgerungDie Ergebnisse deuten an, dass sich ein sozialer Aufstieg positiv auf die Gesundheit auswirkt, ein sozialer Abstieg dagegen eher negativ – unabhängig von Geschlecht, Herkunftsregion oder Zeitverlauf. Es ist daher wichtig, die Mobilitätschancen aller gesellschaftlichen Gruppen zu erhöhen und damit soziale Ungleichheiten zu reduzieren.AbstractBackgroundSocial mobility processes, i.u2009e. the movement of axa0person from one social position to another, are central mechanisms for explaining health inequalities. Social differences in health status or behaviour may also change with changes in social status. This article examines the importance of intergenerational mobility, i.u2009e. the rise and fall of social status in relation to parental social position, for subjective health in East and West Germany and whether this relationship has changed over 20xa0years.Material and methodsThe data basis is the socio-economic panel from 1992–2012. Employees aged between 25xa0and 59xa0were taken into account. Different mobility paths were determined by comparing their current occupational positions with those of their parents. For these, prevalence and logistic regression of subjective health were calculated.ResultsThose in low occupational positions rated their health more often as being worse in all periods. Upwardly mobile individuals had axa0lower risk of poorer health (OR 0.72) compared to those who remained in their original position. Persons affected by downward mobility had axa0similarly worse self-rated health (OR 1.55 or OR 1.86). Significant differences in gender or region of origin (East-West Germany) could not be determined. Education and income contribute to explaining the relationship.ConclusionThe results suggest that social advancement has axa0positive effect on health, whereas social decline is negative – regardless of gender, region of origin or time. It is therefore important to reinforce political efforts aimed at increasing the mobility opportunities of all social groups in axa0positive sense and thus reducing social inequalities.Cohort studies are a longitudinal observational study type. They are firmly established within epidemiology to assess the course of diseases and risk factors. Yet, standards to describe and evaluate quality characteristics of cohort studies need further development. Within the TMF (aEuroTechnologie- und Methodenplattform fur die vernetzte medizinische Forschung e. V.) project Quality management standards in cohort studies, a catalogue of requirements was compiled and evaluated, focusing on the preparation and conduct of epidemiologic cohort studies. The catalogue of requirements was established based on a consensus process between representatives of seven German epidemiologic cohort studies. For this purpose, a set of expert meetings (telephone, face-to-face, web-based) was conducted and the importance of each element of the catalogue was assessed as well as its implementation. A catalogue of requirements with 138 requirements was consented. It is structured into ten sections: 1. Study documentation;2. Selection of instruments;3. Study implementation, 4. Organizational structure;5. Qualification and certification;6. Participant recruitment;7. Preparation, conduct and follow-up processing of examinations;8. Study logistics and maintenance, 9. Data capture and data management;10. Reporting and monitoring. In total, 41 elements were categorized as being essential, 91 as important, and 6 as less important. The catalogue of requirements provides a guideline to improve the preparation and operation of cohort studies. The evaluation of the importance and degree of implementation of requirements depended on the study design. With adaptations, the catalogue might be transferable to other study types.