The association between socioeconomic status and changes in health in Europe

Numerous studies have found disparities in health between socioeconomic groups in modern societies (van Doorslaer, Wagstaff et al., 1997; Huisman, Kunst et al., 2004; Dalstra, Kunst et al., 2005). Many international studies targeted at measuring disparities in morbidity use self-perceived health as outcome, which is a broad, generic measure of health. Although many studies found that self-perceived health is a good predictor of mortality (Idler and Benyamini 1997), differences in reporting and expectations may influence this outcome. A more specific measure of morbidity is self-reported chronic diseases. Several country-specific longitudinal studies have examined socioeconomic disparities in chronic diseases such as heart disease and stroke (Mackenbach, Cavelaars et al., 2000; Avendano, Kunst et al., 2005). However, there are few European overviews of disparities in chronic disease incidence, as existing studies are based on cross-sectional data (Cavelaars, Kunst et al., 1998; Dalstra, Kunst et al., 2005) or mortality as an outcome (Mackenbach, Bos et al., 2003; Huisman, Kunst et al., 2004; Avendano, Kunst et al., 2005). Based on data from two waves of the SHARE study, this paper examines disparities between socioeconomic groups in incident chronic diseases, death, poor self-perceived health and disability. It is generally known that risk factors are not spread evenly over socioeconomic groups (Cavelaars, Kunst et al., 1998). Therefore, we also examined the association between socioeconomic status and incident health outcomes adjusting for modifiable risk factors

Do Americans have higher mortality than Europeans at all levels of the education distribution?: a comparison of the United States and 14 European countries

Among industrialized countries, the United States ranks near the bottom on life expectancy at birth. In 2006, the average American man and woman could expect to live 75 and 80 years, respectively, while the average Western European man and woman could expect to live 77 and 83 years, respectively (World Health Organization, 2009; World Health Organization Regional Office for Europe, 2010). Although the extent to which this is attributable to differences in the health care system is unknown, the United States spends two to three times more than other industrialized countries on medical care (Anderson and Hussey, 2001; Organisation for Economic Co-operation and Development, 2006). This suggests that at least part of the causes of the U.S. disadvantage might lie elsewhere. A plausible hypothesis is that disparities in mortality in the United States are larger than in other high-income countries, particularly in Western Europe. This implies that U.S. excess mortality might be attributable to higher excess mortality in those with low levels of education, while mortality levels for those with secondary or higher education might be comparable in Europe and the United States. Population composition is more diverse in the United States in terms of geography, race, and ethnicity, which may translate into larger health disparities than in Europe. Health care and social policies also differ dramatically between Europe and the United States. Most noticeably, while access to health care is nearly universal in Western Europe, about 41 million Americans remain uninsured (Adams, Dey, and Vickerie, 2007). In addition, compared with European countries, the United States has lower provision of social transfers (e.g., social retirement benefits, unemployment compensation, sick pay) and fewer redistributive policies, resulting in substantially larger income and wealth inequalities (Organisation for Economic Co-operation and Development, 2008; Wolf, 1996). Whether the less generous U.S. policies translate into larger mortality inequalities has not yet been established. The overall excess mortality in the United States compared with Western Europe is well documented (Organisation for Economic Co-operation and Development, 2006; World Health Organization, 2009). However, whether Americans of all education levels have higher mortality than comparable Europeans is yet unknown. Earlier mortality studies have focused only on the strength of education effects, yielding mixed results (Dahl et al., 2006; Kunst and Mackenbach, 1994; Mackenbach et al., 1999). Two recent studies suggest that although older Americans of all education, wealth, and income levels report poorer health than equivalent Europeans, the U.S. health disadvantage is largest among the poor and less educated (Avendano et al., 2009; Banks et al., 2006). Although based on cross-sectional and self-reported data, these findings support the hypothesis that larger health disparities in the United States partly explain the overall U.S. health disadvantage. A competing hypothesis is that Americans of all education levels experience higher mortality than equivalent Europeans. If true, one would expect U.S. residents of all education levels to have higher mortality rates than comparable Europeans. In this study, we examined cross-national differences in mortality by education level in the United States and 14 European countries in the 1990s and compared the magnitude of the disparities in mortality by education among these populations

PKA-induced phosphorylation of ERα at serine 305 and high PAK1 levels is associated with sensitivity to tamoxifen in ER-positive breast cancer

Phosphorylation of estrogen receptor alpha at serine 305 (ER alpha S305-P) by protein kinase A (PKA) or p21-activated kinase 1 (PAK1) has experimentally been associated with tamoxifen sensitivity. Here, we investigated the clinical application of this knowledge to predict tamoxifen resistance in ER-positive breast cancer patients. Using immunohistochemistry, a score including PAK1 and co-expression of PKA and ER alpha S305-P (PKA/ER alpha S305-P) was developed on a training set consisting of 103 patients treated with tamoxifen for metastatic disease, and validated on 231 patients randomized between adjuvant tamoxifen or no treatment. In the training set, PAK1 levels were associated with tumor progression after tamoxifen (HR 1.57, 95% CI 0.99-2.48), as was co-expression of PKA and ER alpha S305-P (HR 2.00, 95% CI 1.14-3.52). In the validation set, a significant tamoxifen benefit was found among the 73% patients negative for PAK1 and PKA/ER alpha S305-P (HR 0.54, 95% CI 0.34-0.87), while others (27%) were likely to have no benefit from tamoxifen (HR 0.88, 95% 0.42-1.82). The test for interaction showed a significant difference in recurrence-free survival between groups defined by PAK1 and PKA/ER alpha S305-P (P = 0.037). Elevated PAK1 and PKA/ER alpha S305-P appeared to influence tamoxifen sensitivity. Both PAK1 and PKA/ER alpha S305-P levels were associated with sensitivity to tamoxifen in breast tumors and the combination of these variables should be considered in predicting tamoxifen benefit

Can Reporting Heterogeneity Explain Differences in Depressive Symptoms Across Europe?

Socioeconomic, Depression, Reporting style, International, Vignettes,