Inequalities in women's health: looking at mortality differentials using an alternative approach

Data obtained from follow up of the 1971 census sample in the Office of Population Censuses and Surveys longitudinal study of England and Wales were used to look at women''s mortality differentials at ages 15-59. Women were grouped by combining information on marital state, own occupation, husband''s occupation (if married), economic activity, and indicators of household wealth (housing tenure and access to a car). Large groups were found with considerable differences in mortality. High mortality was associated with working in manual occupations and living in rented housing with no car in the household. In contrast, low mortality was associated with non-manual occupations and living in owner occupied housing with a car. Among married housewives and single women these extreme groups contributed 44% of expected deaths, the disadvantaged group experiencing death rates two and a half times that of the advantaged group. Smaller differences were found among married women with an occupational class.These findings are further evidence of the “health divide” in England and Wales and show that accurately to reflect the relation between a woman''s life circumstances and mortality it is necessary to utilise other measures than those based solely on occupation.     

Night Work and Mortality: Prospective Study Among Finnish Employees Over the Time Span 1984 to 2008

There is considerable evidence showing that night work is associated with increased morbidity, but only a few studies have focused on its relation to mortality. This study investigates the relationship between the type of working-time arrangement (weekly night work/daytime work) and total and cause-specific mortality among men and women. The data consist of a representative working conditions survey of Finnish employees conducted in 1984 (2286 men/2216 women), which has been combined with register-based follow-up data from Statistics Finland covering the years 1985–2008. In the 1984 survey, the employees were asked if they worked during the night (23:00–06:00?h) and if so, how often. In this study, the authors compare employees who worked at night (121 men/89 women) to daytime employees who did not do night work (1325 men/1560 women). The relative risk of death was examined by Cox proportional hazards analyses adjusted for background (age, level of education, family situation, and county), health (longstanding illness, pain symptoms, smoking status, and psychological symptoms), and work-related factors (weekly working hours, physical and psychological demands, demands of learning at work, and perceived job insecurity). Female employees working at night had a 2.25-fold higher risk of mortality than female dayworkers (95% confidence interval [CI] 1.20–4.20) after adjustment for background and health- and work-related factors. In addition to total mortality, night work was also associated with tumor mortality. Female night workers had a 2.82-fold higher risk of tumor mortality than female dayworkers (95% CI 1.20–6.65) in the adjusted model. Among men, no such significant association was observed. The present study indicated that female night workers had a higher risk of both total and tumor mortality compared to female daytime employees. Additional research on the potential factors and mechanisms behind the association between night work and mortality is required. (Author correspondence: jouko.natti@uta.fi)     

Night work and mortality: prospective study among Finnish employees over the time span 1984 to 2008

There is considerable evidence showing that night work is associated with increased morbidity, but only a few studies have focused on its relation to mortality. This study investigates the relationship between the type of working-time arrangement (weekly night work/daytime work) and total and cause-specific mortality among men and women. The data consist of a representative working conditions survey of Finnish employees conducted in 1984 (2286 men/2216 women), which has been combined with register-based follow-up data from Statistics Finland covering the years 1985-2008. In the 1984 survey, the employees were asked if they worked during the night (23:00-06:00 h) and if so, how often. In this study, the authors compare employees who worked at night (121 men/89 women) to daytime employees who did not do night work (1325 men/1560 women). The relative risk of death was examined by Cox proportional hazards analyses adjusted for background (age, level of education, family situation, and county), health (longstanding illness, pain symptoms, smoking status, and psychological symptoms), and work-related factors (weekly working hours, physical and psychological demands, demands of learning at work, and perceived job insecurity). Female employees working at night had a 2.25-fold higher risk of mortality than female dayworkers (95% confidence interval [CI] 1.20-4.20) after adjustment for background and health- and work-related factors. In addition to total mortality, night work was also associated with tumor mortality. Female night workers had a 2.82-fold higher risk of tumor mortality than female dayworkers (95% CI 1.20-6.65) in the adjusted model. Among men, no such significant association was observed. The present study indicated that female night workers had a higher risk of both total and tumor mortality compared to female daytime employees. Additional research on the potential factors and mechanisms behind the association between night work and mortality is required.     

Demographic and health status risk factors in childbearing among Indian women. Evidence from hospital data for the later stages of fertility decline

Indirect estimates of maternal mortality in India indicate that fertility decline has reduced maternal deaths by reducing the frequency of pregnancy and childbirth. The earlier stages of fertility decline are also likely to have lowered maternal mortality by reducing the risk of pregnancy and childbirth as the proportion of births among risky multiparous, older women declines. However, further fertility decline may well be associated with some increase in risk. Risk will also remain high if the health status of Indian girls and women remains poor. This study uses a sample of maternal deaths and deliveries among patients who survived which occurred in Civil Hospital, Ahmedabad, Gujarat during 1982-1993 to investigate these issues further. The women in the sample have relatively low fertility and represent a fairly late stage of fertility decline. They also have persistently poor health status. Logit regression analysis reveals that although fertility decline is associated with some increase in risk, poor health status is the more important maternal mortality risk factor. Without attention to female health, even childbearing among expectant mothers with low fertility continues to be hazardous.     

Health inequalities: new concerns about the children of single mothers.

OBJECTIVES--To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities. DESIGN--Reanalysis of data published in the childhood supplement of the registrar general''s decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census. RESULTS--Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614,000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100,000 a year, 42% worse than in social class V (48.4/100,000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15. CONCLUSION--Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation''s health should acknowledge the importance of material and social deprivation more explicitly.     

Socioeconomic variation in admission for diseases of female genital system and breast in a national cohort aged 15-43.

OBJECTIVE--To investigate socioeconomic variation among young women in the risk of hospital admission for diseases (including neoplasms) of the female genital system and breast and for the common surgical procedures of dilatation and curettage and hysterectomy. DESIGN--Large nationally representative cohort study with individual records of confirmed admissions to NHS and private hospitals since birth and data on occupational and educational experience. SETTING--England, Scotland, and Wales. PATIENTS--General population sample of 1628 women, 1549 of whom had a complete admissions record for the ages of 15-43 years. MAIN OUTCOME MEASURES--The percentage of women admitted for neoplasms or other diseases of the female genital system and breast or who had dilatation and curettage or hysterectomy between the ages of 15 and 43 years. RESULTS--By the age of 43, 35% of women had been admitted, 17% had undergone dilatation and curettage at least once, and 10% had had a hysterectomy. There were significant inverse educational gradients, the risk of admission increasing more than twofold between the most and least educated women. The differential risk was most striking for disorders of menstruation, in which only 1% of those with the highest educational qualifications and 19% of those with minimal qualifications had been admitted to hospital. There was a significant educational gradient in the hysterectomy rate (from 1% to 15%) and a twofold difference in the risk of dilatation and curettage. There were also significant gradients in risk of admission and of hysterectomy according to partner''s social class. CONCLUSIONS--Socioeconomic variations in the risk of dilatation and curettage and of hysterectomy were large. Lessening the socioeconomic gradient in risks of admissions and surgery for diseases of the female genital system and breast, particularly for menstrual disorders, could have important resource implications.     

Perinatal mortality in eastern Uganda: a community based prospective cohort study

Background

To achieve a child mortality reduction according to millennium development goal 4, it is necessary to considerably reduce neonatal mortality. We report stillbirth and early neonatal mortality risks as well as determinants of perinatal mortality in Eastern Uganda.

Methods

A community-based prospective cohort study was conducted between 2006 and 2008. A total of 835 pregnant women were followed up for pregnancy outcome and survival of their children until 7 days after delivery. Mother''s residence, age, parity, bed net use and whether delivery took place at home were included in multivariable regression analyses to identify risk factors for perinatal death.

Results

The stillbirth risk was 19 per 1,000 pregnancies and the early neonatal death risk 22 per 1,000 live births. Overall, the perinatal mortality risk was 41 [95%CI: 27, 54] per 1,000 pregnancies. Of the deaths, 47% followed complicated deliveries and 24% preterm births. Perinatal mortality was 63/1,000 pregnancies among teenage mothers, 76/1,000 pregnancies among nulliparous women and 61/1,000 pregnancies among women delivering at home who, after controlling for potential confounders, had a 3.7 (95%CI: 1.8, 7.4) times higher perinatal mortality than women who gave birth in a health facility. This association was considerably stronger among nulliparous women [RR 8.0 (95%CI: 2.9, 21.6)] than among women with a previous live birth [RR 1.8 (95%CI: 0.7, 4.5)]. All perinatal deaths occurred among women who did not sleep under a mosquito net. Women living in urban slums had a higher risk of losing their babies than those in rural areas [RR: 2.7 (95%CI: 1.4, 5.3)].

Conclusion

Our findings strengthen arguments for ensuring that pregnant women have access to and use adequate delivery facilities and bed nets.     

Individual and occupational risk factors for knee osteoarthritis: results of a case-control study in Germany

Introduction

A number of occupational risk factors are discussed in relation to the development and progress of knee joint diseases (for example, working in a kneeling or squatting posture, lifting and carrying heavy weights). Besides the occupational factors, a number of individual risk factors are important. The distinction between work-related and other factors is crucial in assessing the risk and in deriving preventive measures in occupational health.

Methods

In a case-control study, patients with and without symptomatic knee osteoarthritis (OA) were questioned by means of a standardised questionnaire complemented by a semi-standardised interview. Controls were matched and assigned to the cases by gender and age. Conditional logistic regression was used in analysing data.

Results

In total, 739 cases and 571 controls were included in the study. In women and men, several individual and occupational predictors for knee OA could be described: obesity (odds ratio (OR) up to 17.65 in women and up to 12.56 in men); kneeling/squatting (women, OR 2.52 (>8,934 hours/life); men, 2.16 (574 to 12,244 hours/life), 2.47 (>12,244 hours/life)); genetic predisposition (women, OR 2.17; men, OR 2.37); and sports with a risk of unapparent trauma (women, OR 2.47 (≥1,440 hours/life); men, 2.58 (≥3,232 hours/life)). In women, malalignment of the knee (OR 11.54), pain in the knee already in childhood (OR 2.08), and the daily lifting and carrying of loads (≥1,088 tons/life, OR 2.13) were related to an increased OR; sitting and smoking led to a reduced OR.

Conclusions

The results support a dose-response relationship between kneeling/squatting and symptomatic knee OA in men and, for the first time, in women. The results concerning general and occupational predictors for knee OA reflect the findings from the literature quite well. Yet occupational risks such as jumping or climbing stairs/ladders, as discussed in the literature, did not correlate with symptomatic knee OA in the present study. With regards to occupational health, prevention measures should focus on the reduction of kneeling activities and the lifting and carrying of loads as well as general risk factors, most notably the reduction of obesity. More intervention studies of the effectiveness of tools and working methods for reducing knee straining activities are needed.     

Endometrial carcinoma in high‐risk populations: is it time to consider a screening policy?

Endometrial carcinoma (EC) is the leading female genital tract malignancy in industrialized countries. It will become an important public health problem in the coming years in the USA and Europe, where its incidence is increasing, and next‐generation interventions should include periodical screening in high‐risk women. In this review, we discuss the importance to gynaecologists of detecting women at high risk and offering an adequate screening programme. Screening for EC is particularly challenging and there is currently no proven programme for the surveillance of women estimated to be at an increased risk of developing this form of cancer. The data in the literature, including this and previous issues of Cytopathology, and personal experience suggest that endometrial liquid‐based cytology (LBC) might play an essential role in a screening policy for EC. LBC may enable practitioners to reduce age‐adjusted mortality for women at high risk for EC.     

“They See Us As Machines:” The Experience of Recent Immigrant Women in the Low Wage Informal Labor Sector

This study explores the organization of work and occupational health risk as elicited from recently immigrated women (n = 8) who have been in the US for less than three years and employed in informal work sectors such as cleaning and factory work in the greater Boston area in Massachusetts. Additional interviews (n = 8) with Community Key Informants with knowledge of this sector and representatives of temporary employment agencies in the area provides further context to the interviews conducted with recent immigrant women. These results were also compared with our immigrant occupational health survey, a large project that spawned this study. Responses from the study participants suggest health outcomes consistent with being a day-laborer scholarship, new immigrant women are especially at higher risk within these low wage informal work sectors. A difference in health experiences based on ethnicity and occupation was also observed. Low skilled temporary jobs are fashioned around meeting the job performance expectations of the employer; the worker’s needs are hardly addressed, resulting in low work standards, little worker protection and poor health outcomes. The rising prevalence of non-standard employment or informal labor sector requires that policies or labor market legislation be revised to meet the needs presented by these marginalized workers.     

Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal U.S. women

Objective: To assess the relationship among recreational physical activity (PA), non‐occupational sedentary behavior, and 7‐year weight gain among postmenopausal U.S. women 40 to 69 years old. Research Methods and Procedures: In 1992 and 1999, 18,583 healthy female participants from the Cancer Prevention Study II Nutrition Cohort completed questionnaires on anthropometric characteristics and lifestyle factors. The associations between recreational PA [in metabolic equivalent (MET) hours per week] and non‐occupational sedentary behavior (in hours per day) at baseline and risk for 7‐year weight gain (5 to 9 or ≥10 vs. ±4 pounds) were assessed using multivariate logistic regression analysis. Results: Neither PA nor sedentary behavior was associated with a 5‐ to 9‐pound weight gain. Among women who were not overweight at baseline (BMI <25.0), the odds of ≥10‐pound weight gain were 12% lower (odds ratio, 0.88; 95% confidence interval, 0.77 to 0.99) for those in the highest category of recreational PA (≥18 MET h/wk) compared with >0 to <4 MET h/wk; odds were 47% higher (odds ratio, 1.47; 95% confidence interval, 1.21 to 1.79) for non‐overweight women who reported ≥6 h/d of non‐occupational sedentary behavior compared with <3 h/d. Neither PA nor sedentary behavior were associated with risk of ≥10‐pound weight gain weight among women who were overweight at baseline (BMI ≥25.0). Discussion: Both recreational PA and non‐occupational sedentary behavior independently predicted risk of ≥10‐pound weight gain among postmenopausal women who were not overweight at baseline. Public health messages to prevent weight gain among normal‐weight postmenopausal women may need to focus on decreasing time spent in sedentary behaviors and increasing the amount of time spent on PA.     

Social class,non-employment,and chronic illness: continuing the inequalities in health debate.

The 1981-2 General Household Survey showed steep class gradients in limiting longstanding illness for men and women aged 20-59 that were very similar to the class gradients in mortality in the 1979-83 decennial supplement. The class gradient for women classified by their husband''s occupation was stronger than that when they were classified by their own occupation. Men and women who lacked paid employment reported poorer health than the employed and were concentrated in the lower social classes. Inequalities in ill health due to class were partly caused by the higher proportion in the lower social classes who were without work. Class differences in ill health still existed, however, among the currently employed, with unskilled men reporting particularly poor health and women manual workers reporting poorer health than women in non-manual jobs. Class differences were greater for the occupationless than for the currently employed. Thus class remains an important indicator of health inequalities despite the current high level of unemployment.     

Shift work and mortality

Despite results linking shift work with ill health, only a few studies have addressed its relation with mortality. The purpose of the present study was to examine the hypothesis that shift work is a predictor of mortality. The study involved a sample of 22,411 individuals of the Swedish population. Data were obtained through annual phone interviews done between 1979 and 2000. Cox regression analysis was used to assess the association between shift work/day work as the independent variable and death/survival during the subsequent years as the dependent variable. Separate analyses were carried out for female and male white- and blue-collar workers, respectively. The results were adjusted for age, stress, physical work load, disease at the outset of the study, and smoking. Mortality was significantly increased for female white-collar workers, with a Hazard Ratio of 2.61 and a 95% confidence interval of 1.26-5.41. No other significant effects were found. It is concluded that blue-collar shift work is not related to mortality, but that risk of death is increased for women white-collar shift workers compared to women white-collar day workers.     

Chlamydia in canine or feline coronary arteriosclerotic lesions

Background

This study examined the associations of job control, organizational justice and bullying at the workplace with emotional exhaustion. This was done by adjusting firstly for age and occupational class, secondly physical work factors, thirdly mutually adjusting for the three psychosocial factors and fourthly adjusting for all studied variables simultaneously. Data were derived from the Helsinki Health Study baseline surveys conducted in 2001 and 2002, including 40-60-year-old employees of the City of Helsinki (n = 5819, response rate 66%). Exhaustion was measured with a six-item subscale from Maslach Burnout Inventory (MBI). Psychosocial factors included Karasek's job control, organizational justice and bullying at the workplace. Logistic regression analysis was used.

Results

Among women 23% and among men 20% reported symptoms of emotional exhaustion. Among women all psychosocial factors were associated with exhaustion when adjusted for age and occupational class as confounders. When physical work factors were additionally adjusted for, the associations slightly attenuated but remained. When psychosocial work factors were simultaneously adjusted for each other, their associations with exhaustion attenuated but remained. Among men all psychosocial factors were associated with exhaustion when adjusted for confounders only. When adjusted for physical work factors the associations slightly attenuated. When psychosocial factors were simultaneously adjusted for each other, associations of organizational justice and bullying with exhaustion attenuated but remained whereas job control lost its association.

Conclusions

Identifying risk factors for emotional exhaustion is vital for preventing subsequent processes leading to burnout. Psychosocial factors are likely to contribute to exhaustion among female as well as male employees. Thus management and occupational health care should devote more attention to the psychosocial work environment in order to be able to prevent exhaustion and burnout at the workplaces.     

Salivary Immunoglobulin A Secretion Rate Is Negatively Associated with Cancer Mortality: The West of Scotland Twenty-07 Study

Immunoglobulins are essential for combating infectious disease although very high levels can indicate underlying pathology. The present study examined associations between secretory immunoglobulin A (sIgA) in saliva and mortality rates in the general population. Participants were 639 adults from the eldest cohort of the West of Scotland Twenty-07 Study aged 63 years at the time of saliva sampling in 1995. From unstimulated 2-minute saliva samples, saliva volume and S-IgA concentration were measured, and S-IgA secretion rate determined as their product. Mortality data were tracked for 19 years. Cox proportional hazard models were applied to compute hazard ratios (HR) for all-cause mortality from sIgA secretion rate. Associations were adjusted for gender, assay batch, household occupational group, smoking, medication usage, and self-reported health. There was a negative association between log sIgA secretion rate and all-cause mortality, HR = 0.81, 95%CI = 0.73–0.91, p < .001. Further analysis of specific causes of mortality revealed that the all-cause association was due to an underlying association with cancer mortality and in particular with cancers other than lung cancer. The HR for non-lung cancer was 0.68 (95%CI = 0.54 to 0.85) implying a 32% reduction in mortality risk per standard deviation rise in log sIgA secretion rate. Effects were stronger for men than women. For deaths from respiratory diseases, sIgA secretion had a non-linear relationship with mortality risk whereby only the very lowest levels of secretion were associated with elevated risk. SIgA concentration revealed a similar but weaker pattern of association. In the present study, higher secretion rates of sIgA were associated with a decreased risk of death from cancer, specifically non-lung cancer, as well as from respiratory disease. Thus, it appears that sIgA plays a protective role among older adults, and could serve as a marker of mortality risk, specifically cancer mortality.     

Roma women in Athenian firms: do they face wage bias?

In the current study, we analyse the effect of having a Roma background on women's wages. By utilizing data from sixteen multiethnic municipalities in which Roma live, we estimate that 66.2 per cent of the wage differential between Roma and non-Roma female workers cannot be explained by differences in observed characteristics. Prejudices against Roma women are discussed and appear to explain the wage gap found here. The occupational segregation of the Roma in low-paid jobs and employers' statistical motivations are also found to influence wages earned by Roma. This study concludes that there is a need for better implementation of existing laws, rules and regulations, which would counter the discrimination against minority women in the labour market. In addition, a better means of assessing workers' skills might contribute to the reduction of wage discrimination, and greater educational achievement would significantly boost the economic status of Roma women.     

Why Londoners have low death rates from ischaemic heart disease and stroke.

OBJECTIVE--To explain the low death rates from cardiovascular disease in London. SETTING--London and the other counties of England and Wales. SUBJECTS--Women living in London during 1901-10 and people in London dying during 1968-78. RESULTS--At the beginning of the twentieth century young women aged 15-34 in London had remarkably low death rates, largely because of low rates for tuberculosis and other infectious diseases and low mortality during childbirth. Their low death rates contrasted with the high rates in girls under 15 years. CONCLUSIONS--Large numbers of young women had migrated into London from agricultural counties in southern England and went into domestic service, where the diet was usually very good. Recent findings suggest that a mother''s nutrition and health has a major effect on the risk of cardiovascular disease in the next generation. The low cardiovascular mortality in London is consistent with this, and contrasts with the high mortality from other common diseases.     

The health of a nation predicts their mate preferences: cross-cultural variation in women's preferences for masculinized male faces

Recent formulations of sexual selection theory emphasize how mate choice can be affected by environmental factors, such as predation risk and resource quality. Women vary greatly in the extent to which they prefer male masculinity and this variation is hypothesized to reflect differences in how women resolve the trade-off between the costs (e.g. low investment) and benefits (e.g. healthy offspring) associated with choosing a masculine partner. A strong prediction of this trade-off theory is that women''s masculinity preferences will be stronger in cultures where poor health is particularly harmful to survival. We investigated the relationship between women''s preferences for male facial masculinity and a health index derived from World Health Organization statistics for mortality rates, life expectancies and the impact of communicable disease. Across 30 countries, masculinity preference increased as health decreased. This relationship was independent of cross-cultural differences in wealth or women''s mating strategies. These findings show non-arbitrary cross-cultural differences in facial attractiveness judgements and demonstrate the use of trade-off theory for investigating cross-cultural variation in women''s mate preferences.     

未婚人工流产女性生殖健康知识知晓现状调查及其影响因素分析

摘要 目的：探究未婚人工流产女性生殖健康知识知晓现状,并分析其影响因素。方法：随机选取2018年3月~2021年5月期间在同济大学附属第一妇婴保健院计划生育科终止妊娠的未婚女性486例作为研究对象。其中,拒绝调查者21例,实际调查465例,应答率95.68%（465/486）,数据清理后有效问卷459份,有效率为98.71%（459/465）。调查未婚人工流产女性生殖健康知识知晓现状,未婚人工流产女性生殖健康知识知晓情况的危险因素采用单因素及多因素Logistic回归分析。结果：研究对象中,女性生殖健康知识知晓总分最低分17分,最高分为92分,平均（65.74±10.82）分;得分大于80分者179例,优良率为39.00%（179/459）。得分在80分及其以下的女性280例。未婚人工流产女性生殖健康知识知晓情况与年龄、女方文化程度、父母婚姻状况、流产次数、工作性质、居住地、恋爱经历、男方文化程度有关（P<0.05）。而与家庭月收入、更换工作次数无关（P>0.05）。年龄、男方文化程度工作性质、居住地、女方文化程度、流产次数、父母婚姻状况是未婚人工流产女性生殖健康知识知晓情况的影响因素（P<0.05）。结论：未婚人工流产女性生殖健康知识知晓水平一般,受到年龄、女方文化程度、父母婚姻状况等多种因素影响,应针对其影响因素特点加强生殖健康知识的宣教,以降低人工流产的风险。