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The influence of factors identified in adolescence and early adulthood on social class inequities of musculoskeletal disorders at age 30: A prospective population-based cohort study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
2004 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 33, no 6, 1353-1360 p.Article in journal (Refereed) Published
Abstract [en]

Background Social class inequities have been observed for most measures of health. A greater understanding of the relative importance of different explanations is required. In this prospective population-based cohort study we explored the contribution of factors, ascertained at different stages between adolescence and early adulthood, to social class inequities in musculoskeletal disorders (MSD) at age 30.

Methods We used data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 and followed up to age 30. Using logistic regression models, we estimated the unadjusted odds ratios (OR) for MSD for blue-collar versus white-collar workers in men and women separately. We assessed the contribution of different factors identified between adolescence and early adulthood by comparing the unadjusted OR for social class differences with OR adjusted for these explanatory factors.

Results We found significant class differences at age 30 with higher MSD among blue-collar workers (OR = 2.03 in men [95% CI: 1.42, 2.90] and 1.98 in women [95% CI: 1.29, 3.02]). After adjustment for explanatory factors, class differences decreased and were no longer significant, with OR of 1.20 in men (95% CI: 0.76, 1.95) and 1.18 in women (95% CI: 0.69, 2.03). School grades at age 16; being single and alcohol consumption at age 21; having children, restricted financial resources, physical activity, alcohol consumption, smoking, and working conditions at age 30 were important for men; parents' social class, school grade, smoking and physical activity at age 16; being single at age 21; and working conditions at age 30 were important for women.

Conclusion The accumulation of adverse behavioural and social circumstances from adolescence to early adulthood may be an explanation for the class differences in MSD at age 30. Interventions aimed at reducing health inequities need to consider exploratory factors identified at early and later stages in life, also including structural determinants of health.

Place, publisher, year, edition, pages
International Epidemiological Association , 2004. Vol. 33, no 6, 1353-1360 p.
Keyword [en]
Social class, inequity, neck pain, low back pain, adolescence, adulthood, longitudinal, prospective study
URN: urn:nbn:se:umu:diva-6087DOI: 10.1093/ije/dyh237OAI: diva2:145755
Författaren har senare bytt efternamn till Novak. Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2010-11-23Bibliographically approved
In thesis
1. Social inequity in health: Explanation from a life course and gender perspective
Open this publication in new window or tab >>Social inequity in health: Explanation from a life course and gender perspective
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: A boy child born in a Gothenburg suburb has a life expectancy that is nine years shorter than that of another child just 23 km away, and among girls the difference is five years. There is no necessary biological reason to this observed difference. In fact, like life length, most diseases follow a social gradient, even in a country like Sweden where many believe there is no class inequity. This social inequity in health tells us that some of us are not achieving our potential in health or in life length compared to our more fortunate fellow citizens.

Aim: This thesis attempts to explore the patterns of health inequities and the pathways by which health inequities develop from a life course and gender perspective. In particular focuses on the importance of material, behavioural, health related and psychosocial circumstances from adolescence to adulthood in explaining social inequity in musculoskeletal disorders (MSDs), obesity, smoking, and social mobility.

Method: All four papers of this thesis were based on quantitative analyses of data from a 14-year follow-up study. The baseline survey was conducted in 1981 in Luleå, Sweden. The survey included all 16-year-old pupils born in 1965. A total of 1081 pupils (575 boys and 506 girls) were surveyed. They were followed up at ages 18, 21 and 30 years with comprehensive self-administered questionnaires. The response rate was 96.5% throughout the 14-year follow-up. In addition to the questionnaires data, school records, and interviews with nurse and teachers’ were used.

Results: There were no class or gender differences in MSDs and in obesity during adolescence, but significantly more girls than boys were smokers. Class and gender differences had emerged when they reached adulthood with more women reporting to have MSDs but more men being overweight and obese. Women continued to be smokers at a higher rate than men through to adulthood. When an intersection between class and gender was considered, a more complex picture emerged. For example, not all women had higher prevalence of MSDs or smoked more than men, rather men with high socioeconomic position (SEP) had lower prevalences of MSDs and smoking than women with high SEP; and these high SEP women had lower prevalences than men with low SEP. The worst-off group was women with low SEP. The obesity pattern was quite the contrary, where women with high SEP had a lower prevalence of obesity than women with low SEP; and these low SEP women had a lower prevalence than men with high SEP. The worst-off group was men with low SEP. Regarding social mobility, health status (other than height in women) and ethnic background were not associated with mobility either for men or women.

The results indicated that unequal distribution of material, psychosocial, health and health related behavioural factors during adolescence, young adulthood and adulthood accounted for the observed social gradients and social mobility. However, several factors from adolescence appeared to be more important for women while recent factors were more important for men. Important adolescent factors for social inequity and downward mobility were: unfavourable material circumstances defined as low SEP of parent, unemployed family member, and had no own room during upbringing; unfavourable psychosocial circumstances defined as parental divorce, poor contact with parents, being less liked in school, and low school control; and poor health related behaviour defined as smoking and physical inactivity. Among these factors, being less liked in school showed consistent association with all outcome measures of this thesis. Being less liked by the teachers and students was found to be more common among adolescents whose parents had low SEP. Men and women who were less liked in school during their adolescence were more likely as adults to be smokers, obese (only women), and downwardly mobile. The dominant adult life factor that contributed to class inequity in MSDs for men and women was physical heavy working conditions, which attributed to an estimated 46.9% (women) and 49.5% (men) of the increased risk in MSDs of the lower SEP group. High alcohol consumption among men with low SEP was an additional factor that contributed to class inequities in health and social mobility.

Conclusion: Social patterning of health in this cohort was gendered and age specific depending on the outcome measures. Unfavourable school environment in early years had long lasting negative influence on later health, health behavior and SEP. The thesis supports the notion of accumulation of risk that social inequities in health occurs due to accumulation of multiple adverse circumstances among the lower SEP group throughout their life course. Schools should be used as a setting for interventions aimed at reducing socioeconomic inequities in health. The detailed policy implications for reduction of social inequities in health among men and women are discussed.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, Institutionen för Folkhälsa och klinisk medicin, 2010. 83 p.
Umeå University medical dissertations, ISSN 0346-6612
social inequity, pathways, social causation, life course, gender, intersectionality, smoking, musculoskeletal disorders, obesity, social mobility, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Public Health, Global Health, Social Medicine and Epidemiology Public Health, Global Health, Social Medicine and Epidemiology Gender Studies
Research subject
Epidemiology; hälso- och sjukvårdsforskning; Nutrition; Occupational and Environmental Medicine
urn:nbn:se:umu:diva-31849 (URN)978-91-7264-950-7 (ISBN)
Public defence
2010-03-12, Tandläkarehögskolan, vån. 9, Sal D, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Available from: 2010-02-19 Created: 2010-02-18 Last updated: 2010-02-19Bibliographically approved

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