The importance of socioeconomic indicators in determining health and health-related risks in Southern Croatia

Abstract

Uvod: Socioekonomske nejednakosti jedan su od najvažnijih javnozdravstvenih problema u praksi i istraživanju. Njihov utjecaj na zdravlje prepoznat je u cijelom svijetu. Socioekonomski status utječe i na zdravlje i zdravstvene odrednice kao što su životni stil i obrasci ponašanja što uključuje pušenje, izloženost stresu, društvenu osamljenost, tjelesnu aktivnost, obrasce prehrane i preventivna zdravstvena ponašanja. Cilj: Istražiti povezanost socioekonomskog statusa i zdravstvenih pokazatelja u populacijama osamljenog otoka Visa (N=1,025), manje osamljenog otoka Korčule (N=969) i obalnog grada Splita kao drugog najvećeg grada u Hrvatskoj (N=1,012). Materijali i metode: Pomoću povijesti bolesti i anketnih upitnika izvedene su 33 izlazne varijable koje su analizirane koristeći logističku regresiju kroz 6 analitičkih modela (za tri lokacije istraživanja i oba spola zasebno). U populacija otoka Visa je praćena i smrtnost te su ovi podatci analizirani pomoću Cox-ove regresije. Rezultati: Socioekonomske nejednakosti pokazale su se slabo povezanima s zdravljem i zdravstvenim pokazateljima. U matrici od 33 izlazne varijable i 13 pokazatelja socioekonomskog statusa samo je 10 povezanosti bilo značajno na razini značajnosti P<0,001. Nijedna od povezanosti nije se ponovila kroz različite populacije ni kroz oba spola. Nije zabilježena ni povezanost socioekonomskog statusa i smrtnosti na otoku Visu. Zaključak: Očekivano je da homogene otočne populacije imaju veće razine homogenosti i sukladno tomu slabije izražene socioekonomske nejednakosti u zdravlju. Manjak jače povezanosti u gradskoj populaciji Splita vjerojatno je rezultat mehanizama koji su se održali iz bivšeg komunističkog režima i visoke razine zadržane formalne i neformalne društvene potpore.Background: Socioeconomic inequalities have been identified as one of the most interesting targets in public health research and practice. Their impact on health seems to be strongly expressed across the entire human population. The effect of socioeconomic inequalities also extends to more determinants of morbidity, such as lifestyle and behavioural patterns, including smoking, stress, social isolation, physical activity, diet and preventive health behaviours. Objectives: The aim was to investigate the association of socioeconomic status and health outcomes in populations of the remote island of Vis (N=1,025), less remote island of Korcula (N=969) and the coastal city of Split (N=1,012), the second largest city in Croatia. Materials and methods: Medical history and survey information were used to create 33 variables that were analysed using logistic regression in 6 analytic models (for every research location and both genders). The population from the island of Vis was followed up and mortality data was used to calculate hazard ratios using Cox regression. Results: Socioeconomic inequalities were poorly associated with health and disease indices. In the matrix of 33 outcome variables and 13 socioeconomic predictor classes, only 10 associations were significant at the level of P<0.001. None of the associations was replicated across samples or gender. We did not detect the association of any socioeconomic estimate with mortality data for the island of Vis. Conclusions: Homogenous island populations were expected to have greater levels of social homogeneity and consequently less expressed inequalities in health. The lack of stronger association in the urban population of Split is likely the result of the mechanisms that persisted from the former communist regime and high level of retained formal and informal social support