Socio-economic inequality in multiple health complaints among adolescents: international comparative study in 37 countries

Bjørn E Holstein, Candace Currie, Will Boyce, Mogens T Damsgaard, Inese Gobina, Gyöngyi Kökönyei, Jørn Hetland, Margaretha de Looze, Matthias Richter, Pernille Due

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVES: To use comparable data from many countries to examine 1) socio-economic inequality in multiple health complaints among adolescents, 2) whether the countries' absolute wealth and economic inequality was associated with symptom load among adolescents, and 3) whether the countries' absolute wealth and economic inequality explained part of the individual level socio-economic variation in health complaints. METHODS: The Health Behaviour in School-aged Children (HBSC) international study from 2005/06 provided data on 204,534 11-, 13- and 15-year old students from nationally random samples of schools in 37 countries in Europe and North America. The outcome measure was prevalence of at least two daily health complaints, measured by the HBSC Symptom Check List. We included three independent variables at the individual level (sex, age group, family affluence measured by the Family Affluence Scale FAS) and two macro level measures on the country's economic situation: wealth measured by Gross National Product (GNP) and distribution of income measured by the Gini coefficient. RESULTS: There was a significant socio-economic variation in health complaints in 31 of the 37 countries. The overall OR (95 % CI) for 2+ daily health complaints for all countries was 1.31 (1.27-1.36) in the medium versus high FAS group and 2.07 (2.00-2.14) in the low versus high FAS group. This socio-economic gradient in health complaints attenuated somewhat in the multilevel models which included macro level data. There was no association between GNP and health complaints. The OR for high symptom load was 1.35 (1.08-1.69) per 10 % increase in Gini coefficient. The socio-economic gradient in health complaints at the individual level was somewhat attenuated in the multilevel models which included macro level data. CONCLUSIONS: There was a significant association between low FAS and high level of health complaints in 30 of 37 countries. Health complaints increased significantly by increasing income inequality in the country.
Original languageEnglish
JournalInternational Journal of Public Health (Print Edition)
Volume54 Suppl 2
Pages (from-to)260-70
Number of pages10
ISSN1661-8556
DOIs
Publication statusPublished - 1. Sep 2009

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complaint
adolescent
Health
health
economics
macro level
gross national product
Health Behavior
affluence
health behavior
school
income
North America
economic situation
random sample
age group
Age Groups
Outcome Assessment (Health Care)
Group

Keywords

  • Adolescent
  • Child
  • Europe
  • Female
  • Health Status Disparities
  • Humans
  • Internationality
  • Male
  • North America
  • Social Class

Cite this

Holstein, Bjørn E ; Currie, Candace ; Boyce, Will ; Damsgaard, Mogens T ; Gobina, Inese ; Kökönyei, Gyöngyi ; Hetland, Jørn ; de Looze, Margaretha ; Richter, Matthias ; Due, Pernille. / Socio-economic inequality in multiple health complaints among adolescents: international comparative study in 37 countries. In: International Journal of Public Health (Print Edition). 2009 ; Vol. 54 Suppl 2. pp. 260-70.
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title = "Socio-economic inequality in multiple health complaints among adolescents: international comparative study in 37 countries",
abstract = "OBJECTIVES: To use comparable data from many countries to examine 1) socio-economic inequality in multiple health complaints among adolescents, 2) whether the countries' absolute wealth and economic inequality was associated with symptom load among adolescents, and 3) whether the countries' absolute wealth and economic inequality explained part of the individual level socio-economic variation in health complaints. METHODS: The Health Behaviour in School-aged Children (HBSC) international study from 2005/06 provided data on 204,534 11-, 13- and 15-year old students from nationally random samples of schools in 37 countries in Europe and North America. The outcome measure was prevalence of at least two daily health complaints, measured by the HBSC Symptom Check List. We included three independent variables at the individual level (sex, age group, family affluence measured by the Family Affluence Scale FAS) and two macro level measures on the country's economic situation: wealth measured by Gross National Product (GNP) and distribution of income measured by the Gini coefficient. RESULTS: There was a significant socio-economic variation in health complaints in 31 of the 37 countries. The overall OR (95 {\%} CI) for 2+ daily health complaints for all countries was 1.31 (1.27-1.36) in the medium versus high FAS group and 2.07 (2.00-2.14) in the low versus high FAS group. This socio-economic gradient in health complaints attenuated somewhat in the multilevel models which included macro level data. There was no association between GNP and health complaints. The OR for high symptom load was 1.35 (1.08-1.69) per 10 {\%} increase in Gini coefficient. The socio-economic gradient in health complaints at the individual level was somewhat attenuated in the multilevel models which included macro level data. CONCLUSIONS: There was a significant association between low FAS and high level of health complaints in 30 of 37 countries. Health complaints increased significantly by increasing income inequality in the country.",
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Socio-economic inequality in multiple health complaints among adolescents: international comparative study in 37 countries. / Holstein, Bjørn E; Currie, Candace; Boyce, Will; Damsgaard, Mogens T; Gobina, Inese; Kökönyei, Gyöngyi; Hetland, Jørn; de Looze, Margaretha; Richter, Matthias; Due, Pernille.

In: International Journal of Public Health (Print Edition), Vol. 54 Suppl 2, 01.09.2009, p. 260-70.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Socio-economic inequality in multiple health complaints among adolescents: international comparative study in 37 countries

AU - Holstein, Bjørn E

AU - Currie, Candace

AU - Boyce, Will

AU - Damsgaard, Mogens T

AU - Gobina, Inese

AU - Kökönyei, Gyöngyi

AU - Hetland, Jørn

AU - de Looze, Margaretha

AU - Richter, Matthias

AU - Due, Pernille

PY - 2009/9/1

Y1 - 2009/9/1

N2 - OBJECTIVES: To use comparable data from many countries to examine 1) socio-economic inequality in multiple health complaints among adolescents, 2) whether the countries' absolute wealth and economic inequality was associated with symptom load among adolescents, and 3) whether the countries' absolute wealth and economic inequality explained part of the individual level socio-economic variation in health complaints. METHODS: The Health Behaviour in School-aged Children (HBSC) international study from 2005/06 provided data on 204,534 11-, 13- and 15-year old students from nationally random samples of schools in 37 countries in Europe and North America. The outcome measure was prevalence of at least two daily health complaints, measured by the HBSC Symptom Check List. We included three independent variables at the individual level (sex, age group, family affluence measured by the Family Affluence Scale FAS) and two macro level measures on the country's economic situation: wealth measured by Gross National Product (GNP) and distribution of income measured by the Gini coefficient. RESULTS: There was a significant socio-economic variation in health complaints in 31 of the 37 countries. The overall OR (95 % CI) for 2+ daily health complaints for all countries was 1.31 (1.27-1.36) in the medium versus high FAS group and 2.07 (2.00-2.14) in the low versus high FAS group. This socio-economic gradient in health complaints attenuated somewhat in the multilevel models which included macro level data. There was no association between GNP and health complaints. The OR for high symptom load was 1.35 (1.08-1.69) per 10 % increase in Gini coefficient. The socio-economic gradient in health complaints at the individual level was somewhat attenuated in the multilevel models which included macro level data. CONCLUSIONS: There was a significant association between low FAS and high level of health complaints in 30 of 37 countries. Health complaints increased significantly by increasing income inequality in the country.

AB - OBJECTIVES: To use comparable data from many countries to examine 1) socio-economic inequality in multiple health complaints among adolescents, 2) whether the countries' absolute wealth and economic inequality was associated with symptom load among adolescents, and 3) whether the countries' absolute wealth and economic inequality explained part of the individual level socio-economic variation in health complaints. METHODS: The Health Behaviour in School-aged Children (HBSC) international study from 2005/06 provided data on 204,534 11-, 13- and 15-year old students from nationally random samples of schools in 37 countries in Europe and North America. The outcome measure was prevalence of at least two daily health complaints, measured by the HBSC Symptom Check List. We included three independent variables at the individual level (sex, age group, family affluence measured by the Family Affluence Scale FAS) and two macro level measures on the country's economic situation: wealth measured by Gross National Product (GNP) and distribution of income measured by the Gini coefficient. RESULTS: There was a significant socio-economic variation in health complaints in 31 of the 37 countries. The overall OR (95 % CI) for 2+ daily health complaints for all countries was 1.31 (1.27-1.36) in the medium versus high FAS group and 2.07 (2.00-2.14) in the low versus high FAS group. This socio-economic gradient in health complaints attenuated somewhat in the multilevel models which included macro level data. There was no association between GNP and health complaints. The OR for high symptom load was 1.35 (1.08-1.69) per 10 % increase in Gini coefficient. The socio-economic gradient in health complaints at the individual level was somewhat attenuated in the multilevel models which included macro level data. CONCLUSIONS: There was a significant association between low FAS and high level of health complaints in 30 of 37 countries. Health complaints increased significantly by increasing income inequality in the country.

KW - Adolescent

KW - Child

KW - Europe

KW - Female

KW - Health Status Disparities

KW - Humans

KW - Internationality

KW - Male

KW - North America

KW - Social Class

U2 - 10.1007/s00038-009-5418-4

DO - 10.1007/s00038-009-5418-4

M3 - Journal article

C2 - 19639254

VL - 54 Suppl 2

SP - 260

EP - 270

JO - International Journal of Public Health

JF - International Journal of Public Health

SN - 1661-8556

ER -