Marital status and health: Descriptive and explanatory studies

DUring the last 30 years social factors have become increasingly important in the evolution of concepts of disease etiology. In the beginning of this century the germ theory and its monocausal orientation, attributing single diseases to single causes (i.e. infectious agents), dominated medical thinking. However, the germ theory failed to explain why only some of those persons exposed to pathogens actually contracted the disease. In addition, the germ theory was less appropriate for the explanation of degenerative causes of death such as cardiovascular diseases and malignant neoplasms, which have replaced Infectious diseases as the main causes of death in this century. The monocausal concept of disease etiology was followed by a multicausal orientation, which emphasized the presence of several interacting causal factors. Multicausal research Initially focused on biological risk factors, such as high serum cholesterol, high blood pressure and cigarette smoking in the development of coronary heart disease. However, this approach also proved to be only partly successful in pinpointing the causes of disease. For instance, only a relatively small proportion of all persons with high serum cholesterol and high blood pressure who smoke cigarettes, develop coronary heart disease and many persons who lack most of these risk factors do develop coronary heart disease. Thus, other factors must be involved in the etiological process. Groups differentiated by social factors have long been found to exhibit characteristic mortality and morbidity patterns. These health differences between social groups (e.g. dif

Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review

OBJECTIVE: To determine the influence of ethnic differences in diabetes care on inequalities in mortality and prevalence of end-stage complications among diabetic patients. The following questions were examined: 1) Are there ethnic differences among diabetic patients in mortality and end-stage complications and 2) are there ethnic differences among diabetic patients in quality of care? RESEARCH DESIGN AND METHODS: A review of the literature on ethnic differences in the prevalence of complications and mortality among diabetic patients and in the quality of diabetes care was performed by systematically searching articles on Medline published from 1987 through October 2004. RESULTS: A total of 51 studies were included, mainly conducted in the U.S. and the U.K. In general, after adjusting for confounders, diabetic patients from ethnic minorities had higher mortality rates and higher risk of diabetes complications. After additional adjustment for risk factors such as smoking, socioeconomic status, income, years of education, and BMI, in most instances ethnic differences disappear. Nevertheless, blacks and Hispanics in the U.S. and Asians in the U.K. have an increased risk of end-stage renal disease, and blacks and Hispanics in the U.S. have an increased risk of retinopathy. Intermediate outcomes of care were worse in blacks, and they were inclined to be worse in Hispanics. Likewise, ethnic differences in quality of care in the U.S. exist: process of care was worse in blacks. CONCLUSIONS: Given the fact that there are ethnic differences in diabetes care and that ethnic differences in some diabetes complications persist after adjustment for risk factors other than diabetes care, it seems the case that ethnic differences in diabetes care contribute to the more adverse disease outcomes of diabetic patients from some ethnic minority groups. Although no generalizations can be made for all ethnic groups in all regions for all kinds of complications, the results do implicate the importance of quality of care in striving for equal health outcomes among ethnic minoriti

Self-assessed health and mortality: could psychosocial factors explain the association?

BACKGROUND: The single-item question of self-assessed health has consistently been reported to be associated with mortality, even after controlling for a wide range of health measurements and known risk factors for mortality. It has been suggested that this association is due to psychosocial factors which are both related to self-assessed health and to mortality. We tested this hypothesis. METHODS: The study was carried out in a subsample (n = 5667) of the GLOBE-population, a prospective cohort study conducted in the southeastern part of the Netherlands. Data on self-assessed health, sociodemographic variables, various aspects of health status, behavioural risk factors, and a number of psychosocial factors (social support, psychosocial stressors, personality traits, and coping styles) were collected by postal survey and structured interview in 1991, and mortality data were collected between 1991 and 1998. Cox proportional hazards analyses were used to calculate the association between self-assessed health and mortality, before and after controlling for the psychosocial variables. RESULTS: After controlling for sociodemographic variables, various aspects of health status, and behavioural risk factors, self-assessed health is still strongly associated with mortality in our dataset (Relative Risk [RR] of dying for 'poor' versus 'very good' self-assessed health = 3.98; 95% CI: 1.65-9.61). After controlli

The effect of age at immigration and generational status of the mother on infant mortality in ethnic minority populations in The Netherlands

Background: Migrant populations consist of migrants with differences in generational status and length of residence. Several studies suggest that health outcomes differ by generational status and duration of residence. We examined the association of generational status and age at immigration of the mother with infant mortality in migrant populations in The Netherlands. Methods: Data from Statistics Netherlands were obtained from 1995 through 2000 for infants of mothers with Dutch, Turkish and Surinamese ethnicity. Mothers were categorized by generational status (Dutch-born and foreign-born) and by age at immigration (0-16 and >16 years). The associations of generational status and age at immigration of the mother with total and cause-specific infant mortality were examined. Results: The infant mortality rate in Turkish mothers rose with lower age at immigration (from 5.5 to 6.4 per 1000) and was highest for Dutch-born Turkish mothers (6.8 per 1000). Infant death from perinatal and congenital causes increased with lower age at immigration and was highest in the Dutch-born Turkish women. In contrast, in Surinamese mothers infant mortality declined with lower age at immigration (from 8.0 to 6.3 per 1000) and was lowest for Dutch-born Surinamese mothers (5.5 per 1000). Generational status and lower age at immigration of Surinamese women were associated with declining mortality of congenital causes. Conclusions: Total and cause-specific infant mortality seem to differ according to generational status and age at immigration of the mother. The direction of these trends however differs between ethnic populations. This may be related to acculturation and selective migration