Understanding Socioeconomic Disparities in Stroke: an international perspective

The aim of the thesis was to examine the magnitude and explanation of socioeconomic differences in stroke across different world populations. Data from several sources were used including mortality statistics merged with national census data, population cohort studies and general practice registration data. Results indicate that socioeconomic status is associated with higher stroke mortality in many Western populations. Whereas socioeconomic disparities in stroke mortality are similar across Western Europe, there i

Less comprehensive social policies may contribute to lower life expectancies and worse health in the U.S. compared to other high-income countries

Americans lead shorter and less healthy lives than people in other high-income countries. Is this US health disadvantage specific to some US populations, diseases, or particular age groups? And what explains these variations in the length and quality of life between Americans and other high-income countries? Mauricio Avendano and Ichiro Kawachi review the evidence and find the American health disadvantage begins at birth and extends across the life-course, and it is particularly marked for American women and for regions in the US South and Midwest. They propose explanations that include differences in health care, individual behaviors, socioeconomic inequalities, and the physical and the built environment. However, crucial differences in social policy between the US and other high income countries may also underlie an important part of the US’ health disadvantage

Are economic recessions at the time of leaving school associated with worse health in later life?

Men who leave school or university during a recession experience better health in later life than men graduating during a boom, while women experience worse health if leaving school or university during a recession

Under one roof: The effect of co-residing with adult children on depression in later life.

RATIONALE: The number of older parents living without adult children has increased dramatically over the last decades. However, recent trends exacerbated by the Great Recession have led to an increase in intergenerational co-residing. METHODS: We used three waves of data (2004-2010) from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected around the Great Recession to assess the effects of intergenerational co-residence on mental health in later life (n = 50,043). We used an instrumental variable (IV) approach that exploits changes in employment opportunities of adult children during the Great Recession to examine the impact of co-residing with adult children on depression scores measured using the Euro-D scale of depression. RESULTS: Northern European countries exhibited low levels of both co-residence and depression in older age, while most countries in Eastern and Southern Europe had high levels of both co-residence and depression. In OLS models that controlled for measured characteristics, co-residing with an adult child was not associated with depressive symptoms in older parents (β = -0.0387; 95% CI -0.0892 to 0.0118). By contrast, results from IV models suggest that co-residing with an adult child significantly reduces depressive symptoms by 0.731 points (95% CI -1.261 to -0.200) on the 12-item scale. Results were robust to a series of robustness checks including controls for child characteristics, country-specific time trends, and analyses restricted to homeowners. CONCLUSIONS: Our findings suggest that, in the context of high unemployment rates during the Great Recession in Europe, increased intergenerational exchange between adult children and older parents in the form of co-residence had positive mental health effects on older parents

Who suffers during recessions? Economic downturns, job loss, and cardiovascular disease in older Americans

Job loss in the years before retirement has been found to increase risk of cardiovascular disease (CVD), but some studies suggest that CVD mortality among older workers declines during recessions. We hypothesized that recessionary labor market conditions were associated with reduced CVD risk among persons who did not experience job loss and increased CVD risk among persons who lost their jobs. In our analyses, we used longitudinal, nationally representative data from Americans 50 years of age or older who were enrolled in the Health and Retirement Study and surveyed every 2 years from 1992 to 2010 about their employment status and whether they had experienced a stroke or myocardial infarction. To measure local labor market conditions, Health and Retirement Study data were linked to county unemployment rates. Among workers who experienced job loss, recessionary labor market conditions at the time of job loss were associated with a significantly higher CVD risk (hazard ratio = 2.54, 95% confidence interval: 1.39, 4.65). In contrast, among workers who did not experience job loss, recessionary labor market conditions were associated with a lower CVD risk (hazard ratio = 0.50, 95% confidence interval: 0.31, 0.78). These results suggest that recessions might be protective in the absence of job loss but hazardous in the presence of job loss

The Health Effects of US Unemployment Insurance Policy: Does Income from Unemployment Benefits Prevent Cardiovascular Disease?

Objective: Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Methods: Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50–65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. Results: States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71–0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79–1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Conclusion: Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD

Are some populations resilient to recessions? : Economic fluctuations and mortality during a period of economic decline and recovery in Finland

Peer reviewe