International comparators and poverty and health in Europe

Summary points: In 1970 male life expectancy at age 15 was 56 in countries that now form the European Union; 55 in the communist countries of central and eastern Europe (excluding the Soviet Union); and 52 in the Soviet Union. In 1997 male life expectancy was 60 in the countries that now form the European Union; 54 in the former communist countries of central and eastern Europe (excluding the former Soviet Union); and 48 in Russia. The relative disadvantage for women was similar, but the absolute differences were smaller. Mortality changes after 1989 in eastern Europe were correlated with changes in gross domestic product and changes in income inequalities. In the 1980s there were inequalities in health within individual countries in eastern Europe; these were wider after 1989. Inequalities in health within individual countries in eastern Europe were more strongly related to education than to measures of economic wellbeing

Household item ownership and self-rated health: material and psychosocial explanations

Background: There has been an ongoing debate whether the effects of socioeconomic factors on health are due to absolute poverty and material factors or to relative deprivation and psychosocial factors. In the present analyses, we examined the importance for health of material factors, which may have a direct effect on health, and of those that may affect health indirectly, through psychosocial mechanisms.Methods: Random national samples of men and women in Hungary (n=973) and Poland (n=1141) were interviewed (response rates 58% and 59%, respectively). The subjects reported their self-rated health, socioeconomic circumstances, including ownership of different household items, and perceived control over life. Household items were categorised as "basic needs", "socially oriented", and "luxury". We examined the association between the ownership of different groups of items and self-rated health. Since the lists of household items were different in Hungary and Poland, we conducted parallel identical analyses of the Hungarian and Polish data.Results: The overall prevalence of poor or very poor health was 13% in Poland and 25% in Hungary. Education, material deprivation and the number of household items were all associated with poor health in bivariate analyses. All three groups of household items were positively related to self-rated health in age-adjusted analyses. The relation of basic needs items to poor health disappeared after controlling for other socioeconomic variables (mainly material deprivation). The relation of socially oriented and luxury items to poor health, however, persisted in multivariate models. The results were similar in both datasets.Conclusions: These data suggest that health is influenced by both material and psychosocial aspects of socioeconomic factors

Alcohol consumption is associated with increased all-cause mortality in Russian men and women: a cohort study based on the mortality of relatives

Objectives: To examine the relationships between frequency of alcohol consumption and of binge drinking and adult mortality in Russian men and women.Methods : Using modified indirect demographic techniques, a convenience cohort was constructed based on survey respondents? information about their close relatives. A random sample general population of the Russian Federation of 7172 respondents (response rate 61%) provided information on 10475 male and 3129 female relatives, including age, vital status and frequency of alcohol consumption and binge drinking. These relatives formed the cohort analysed in this report. The outcome measure was all-cause mortality after the age of 30 years.Findings: There was a strong linear relationship between frequency of drinking and of binge drinking and all-cause mortality in men; after controlling for smoking and calendar period of birth, the relative risk of death in daily drinkers compared to occasional drinkers was 1.52 (95% CI 1.33 ?1.75). Male binge drinkers had higher mortality than drinkers who did not binge, which persisted after adjustment for drinking frequency (adjusted RR 1.09 (1.00-1.19). In women, the increased mortality was confined to a small group of those who binged at least once a month (adjusted relative risk 2.68, 1.54-4.66). Conclusions: The results suggest a positive association between alcohol and mortality in Russia. There was no evidence for the protective effect of drinking seen in western populations. Alcohol appears to have contributed to the high long-term mortality rates in Russian men, but it is unlikely to be a major cause of female mortality. Objectives: To examine the relationships between frequency of alcohol consumption and of binge drinking and adult mortality in Russian men and women.Methods : Using modified indirect demographic techniques, a convenience cohort was constructed based on survey respondents? information about their close relatives. A random sample general population of the Russian Federation of 7172 respondents (response rate 61%) provided information on 10475 male and 3129 female relatives, including age, vital status and frequency of alcohol consumption and binge drinking. These relatives formed the cohort analysed in this report. The outcome measure was all-cause mortality after the age of 30 years.Findings: There was a strong linear relationship between frequency of drinking and of binge drinking and all-cause mortality in men; after controlling for smoking and calendar period of birth, the relative risk of death in daily drinkers compared to occasional drinkers was 1.52 (95% CI 1.33 ?1.75). Male binge drinkers had higher mortality than drinkers who did not binge, which persisted after adjustment for drinking frequency (adjusted RR 1.09 (1.00-1.19). In women, the increased mortality was confined to a small group of those who binged at least once a month (adjusted relative risk 2.68, 1.54-4.66). Conclusions: The results suggest a positive association between alcohol and mortality in Russia. There was no evidence for the protective effect of drinking seen in western populations. Alcohol appears to have contributed to the high long-term mortality rates in Russian men, but it is unlikely to be a major cause of female mortality

Levels and distribution of self-rated health in the Kazakh population: results from the Kazakhstan household health survey 2012

BACKGROUND: The high and fluctuating mortality and rising health inequalities in post-Soviet countries have attracted considerable attention. However, there are very few individual-level data on distribution of health outcomes in Central Asian countries of the former Soviet Union. We analysed socioeconomic predictors of two self-rated health outcomes in a national survey in Kazakhstan. METHODS: We used data from the 2012 Kazakhstan Household Health Survey on 12,560 respondents aged 15+. Self-rated health, self-reported worsening of health, and a range of socio-demographic variables were collected in an interview. The self-rated health outcomes were dichotomized and logistic regression was used to estimate their associations with education, income, ownership of a car, second house and computer, marital status, ethnicity and urban/rural residence. RESULTS: The prevalence of poor/very poor self-rated health was 5.3%, and 11.0% of participants reported worse health compared to 1 year ago. After controlling for age, sex and region, all socio-demographic factors were related to self-rated health. After adjusting for all variables, education and car ownership showed the most consistent effects; the odds ratio of poor health and worsening of health were 0.43 (95% confidence interval 0.32-0.58) and 0.54 (0.44-0.68) for university vs. primary education, respectively, and 0.64 (0.51-0.82) and 0.68 (0.58-0.80) for car ownership, respectively. Unmarried persons, ethnic Russians and urban residents also had increased prevalence of poor health in multivariable models. CONCLUSIONS: Despite the limitations of using subjective health measures, these data suggest strong associations between two measures of self-rated health and a number of socioeconomic characteristics. Future studies and health policy initiatives in Kazakhstan and other Central Asian countries should take social determinants of health into account

Patient-Centered Beliefs Among Patients and Providers in Kazakhstan

BACKGROUND: Health services in Kazakhstan have undergone radical reforms since its independence in 1991, but levels of dissatisfaction among patients remain high. We investigated whether healthcare providers and patients at one hospital in Astana, Kazakhstan, believe the doctor-patient interaction should be doctor-centered vs patient-centered. METHODS: We conducted a cross-sectional study of the responses to various surveys of 200 patients (response rate, 74%) and 201 healthcare providers (response rate, 86%) in a general hospital in Astana, Kazakhstan. The participants completed a questionnaire containing the Patient-Practitioner Orientation Scale (PPOS) and scales assessing life and job satisfaction, job effort-job reward balance, and patient evaluation of communication. Analyses were restricted to those with valid data on the variables age, sex, and PPOS (147 providers and 150 patients). RESULTS: An overwhelming majority of doctors (80%), nurses (87%), and patients (93%) were doctor-oriented. Among patients, higher patient-oriented scores were statistically significantly associated with higher satisfaction with communication with healthcare providers (P=0.038) and with life satisfaction (P=0.009). CONCLUSION: Only a small percentage of doctors, nurses, and patients reported that their interaction should be patient-centered. This congruence between providers and patients does not explain dissatisfaction, but the finding that patient-centered patients were more satisfied suggests an area for improvement

Household availability of dietary fats and cardiovascular disease and mortality: prospective evidence from Russia

Background: The aim of this analysis was to examine the prospective association between household availability of lard, butter, margarine and vegetable oil with all-cause mortality and cardiovascular disease (CVD) incidence in a general population sample in Russia. Methods: Data from the Russian Longitudinal Monitoring Survey were used. 6618 adult individuals with no previous CVD who were recruited for the study in 1994 and followed-up in subsequent years were included in the analysis. Household availability of lard, butter, margarine and vegetable oil were assessed at baseline with questions on whether these food items were purchased by the participants’ family. Self-reported information on heart attack or stroke (CVD) and death reported by another household member were used as outcome. Results: Over the median follow-up of 11 years, 1787 participants died or reported incident CVD. In the multivariable adjusted survival models, household availability of lard was significantly associated with the combined outcome of CVD incidence and/or death (OR in the high vs. no availability categories: 1.31; 95% CI: 1.05–1.62). The associations with butter (1.06; 0.93–1.20), margarine (1.18; 0.94–1.47) and vegetable oil (0.92; 0.80–1.06) were not statistically significant. When self-reported CVD and mortality were examined separately, the association regarding lard was particularly strong for CVD (1.52; 1.11–2.09). Conclusion: Our results suggest that lard, a dietary fat of animal origin traditionally used in Eastern European cooking, is of a particular concern regarding CVD risk. Replacing it with plant-based oils in cooking practices is strongly recommended

Four-year trajectories of episodic memory decline in mid-late life by living arrangements: a cross-national comparison between China and England

BACKGROUND: There is mixed evidence on the association between living arrangements and mid-late life cognition, which may be due to distinct familial arrangements and preferences between populations. To address such heterogeneity, we assessed these associations in China and England. METHODS: Four-year trajectories of episodic memory scores (0–20, word recall test) by living arrangements (living with partner only, living with partner and children/grandchildren, living with no partner but with children/grandchildren, and living alone) were estimated using latent growth curve modelling for men and women aged 50+ from China (n=12 801) and England (n=10 964). RESULTS: After adjusting for baseline socioeconomic, health behaviours and health covariates, worse baseline memory was found in Chinese adults living with no partner but with children/grandchildren and in Chinese women living with partner and children/grandchildren, compared with those living with partner only. Better baseline memory was associated with living alone in English women. A faster memory decline was found in Chinese men living with no partner but with children/grandchildren (−0.122 word/year, 95% CI −0.213 to –0.031), as well as in English women living with children/grandchildren with (−0.114, 95% CI −0.180 to –0.049) or without (−0.118, 95% CI −0.209 to –0.026) a partner, and those living alone (−0.075, 95% CI −0.127 to –0.024). No differences at baseline nor over follow-up were found between English men in different living arrangements. CONCLUSIONS: Overall, our findings did not confirm the protective effects of co-residence with children/grandchildren, nor the detrimental effects of living alone on mid-late life cognition in China and England