Gender patterns of socioeconomic differences in premature mortality: follow-up of the Hungarian Epidemiological Panel.

BACKGROUND: Gender differences in premature mortality rates and in the size of socioeconomic inequalities in mortality vary across countries. PURPOSE: We aimed to quantify the gender differences in the association between socioeconomic status (SES) and premature all-cause mortality and to analyse whether psychosocial factors might associate between SES and mortality among men and women separately in the middle-aged Hungarian population. METHOD: Men (n = 1130) and women (n = 1529), aged 40-69 years, participants in the Hungarian Epidemiological Panel (2002) were followed up for 3.5 years for total mortality. Cox proportional hazard models were used to evaluate the association between several socioeconomic measures and total death. RESULTS: During the follow-up, 99 men (8.8%) and 53 women (3.5%) died. The age-adjusted hazard ratios and the Rothman's synergy indexes showed that each measure of socioeconomic position was more deleterious in men compared with women. When investigating potential explanatory factors for the SES-mortality association, we found that adjustment for severe depression resulted in the most pronounced reduction in the regression coefficients for the association between most socioeconomic factors and male premature death. There was no indication that depression would mediate between SES and mortality in women. Work stress factors, poor lifestyle and low social support also contributed to the explanation of the link between socioeconomic disadvantage and premature death in men. CONCLUSION: Middle-aged Hungarian men seem to be considerably more vulnerable to the chronic stress of material disadvantage than women. This effect modification by gender might partly be explained by a stronger connection between low SES and depressive symptoms in men.

[Why do Hungarian men die early?]. / Miért halnak meg ido elott a magyar férfiak?

The mortality rate for 40- 69-year-old men was 12.2/thousand males of corresponding age in 1960 and 16.2 in 2005: it increased by 33%, while among 40- 69-year-old women it decreased from 9.6 0/thousand females of corresponding age to 7.8. The aim of the present follow up study was to analyze which psychosocial risk factors might explain the high premature mortality rates among Hungarian men. Participants in the Hungarostudy 2002 study, a nationally representative sample, 1130 men and 1529 women were contacted again in the follow up study in 2006, who in 2002 were between the age of 40-69 years. By 2006, 99 men (8.8%) and 53 women (3.5%) died in this age group. Socio-economic, psychosocial and work-related measures, self-rated health, chronic disorders, depressive symptoms (BDI), WHO well-being, negative affect, self-efficacy, meaning in life and health behavioral factors were included in the analysis. After adjustment according to smoking, alcohol abuse, BMI, education and age, a number of variables were significant predictors of mortality only in men: low education, low subjective social status, low personal and family income, insecurity of work, no control in work, severe depression, no meaning in life, low social support from spouse, low social support from child. Socio-economic and work related risk factors predicted only male premature death. Among women dissatisfaction with personal relations was the most important risk factor. Among men depression seems to mediate between these chronic stress factors and premature death.

Work stress and mental health in a changing society.

BACKGROUND: The aim of this representative study in the Hungarian population was to analyse the association between work-related factors and self-reported mental and physical health after controlling for negative affect and hostility as personality traits. METHODS: The effects of job related factors on Beck Depression Score, WHO well-being score and self-rated health (SRH) were analysed in a representative sample of 3153 male and 2710 female economically active Hungarians. RESULTS: In both genders negative affect was the most important correlate of depression, well-being and SRH, whereas hostility was closely associated only with depression. Job insecurity, low control and low social support at work, weekend work hours, job-related life events and dissatisfaction with work and with boss were independent mental health risk factors, but there were important gender differences. Job related factors seem to be equally important predictors of mental health as social support from family. CONCLUSION: The results of this large national representative study indicate that independent of negative affect and hostility, a cluster of stressful work-related psychosocial conditions accounts for a substantial part of variation in self-reported mental and physical health of the economically active population in Hungary.

Chronic stress and social changes: socioeconomic determination of chronic stress.

In the last decades in the transforming societies of Central and Eastern Europe, premature mortality increased dramatically, especially among men. Increasing disparities in socioeconomic conditions have been accompanied by a widening socioeconomic gradient in mortality among men. Social cohesion and meaning in life may help to counterbalance the widening gap in material circumstances. Not the difficult social situation in itself, but the subjective experience of relative disadvantage, the prolonged negative emotional state, that is, chronic stress seems to be the most important risk factor. The health consequences of a low socioeconomic situation among men might be mostly explained by chronic stress caused by work and close-partner-related factors, and the toxic components of this interaction are depression and hopelessness. In the case of women, the broader personal and family relations are the most important health-related factors. Weekend workload, low social support at work and low control at work accounted for a large part of variation in male premature cardiovascular mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most markedly to variations in premature cardiovascular mortality rates among women. There are two general approaches that scientists and practitioners might take: train individuals and groups to use skills that will enable them to cope better with the stressful conditions that are damaging their health; and lobby governments to adopt policies that will result in decreased chronic stress on the societal level.

Psychosocial determinants of premature cardiovascular mortality differences within Hungary.

OBJECTIVES: The life expectancy gap between Central-Eastern European (CEE) countries, including Hungary, and Western Europe (WE) is mainly attributable to excess cardiovascular (CV) mortality in midlife. This study explores the contribution of socioeconomic, work related, psychosocial, and behavioural variables to explaining variations of middle aged male and female CV mortality across 150 sub-regions in Hungary. DESIGN: Cross sectional, ecological analyses. SETTING: 150 sub-regions of Hungary. PARTICIPANTS AND METHODS: 12 643 people were interviewed in Hungarostudy 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were income, education, control in work, job insecurity, weekend working hours, social support, depression, hostility, anomie, smoking, body mass index, and alcohol misuse. MAIN OUTCOME MEASURES: Gender specific standardised premature (45-64 years) total CV, ischaemic heart disease, and cerebrovascular mortality rates in 150 sub-regions of Hungary. RESULTS: Low education and income were the most important determinants of mid-aged CV mortality differences across sub-regions. High weekend workload, low social support at work, and low control at work account for a large part of variation in male premature CV mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most noticeably to variations in premature CV mortality rates among women. Low social support from friends, depression, anomie, hostility, alcohol misuse and cigarette smoking can also explain a considerable part of variations of premature CV mortality differences. CONCLUSION: Variations in middle aged CV mortality rates in a rapidly changing society in CEE are largely accounted for by distinct unfavourable working and other psychosocial stress conditions.

Low socioeconomic status of the opposite sex is a risk factor for middle aged mortality.

OBJECTIVES: To examine the relations between subjective social status, and objective socioeconomic status (as measured by income and education) in relation to male/female middle aged mortality rates across 150 sub-regions in Hungary. DESIGN: Cross sectional, ecological analyses. SETTING: 150 sub-regions of Hungary. PARTICIPANTS AND METHODS: 12,643 people were interviewed in the Hungaro-study 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were subjective social status, personal income, and education. MAIN OUTCOME MEASURE: For ecological analyses, sex specific mortality rates were calculated for the middle aged population (45-64 years) in the 150 sub-regions of Hungary. RESULTS: In ecological analyses, education and subjective social status of women were more significantly associated with middle aged male mortality, than were male education, male subjective social status, and income. Among the socioeconomic factors female education was the most important protective factor of male mid-aged mortality. Subjective social status of the opposite sex was significantly associated with mid-aged mortality, more among men than among women. CONCLUSION: Pronounced sex interactions were found in the relations of education, subjective social status, and middle aged mortality rates. Men seem to be more vulnerable to the socioeconomic status of women than women to the effects of socioeconomic status of men. Subjective social status of women was an important predictor of mortality among middle aged men as was female education. The results suggest that improved socioeconomic status of women is protective for male health as well as for female health.

Self-rated health, subjective social status, and middle-aged mortality in a changing society.

In this study, the authors examined the relationships between self-rated health and subjective and objective socioeconomic status (as measured by income and education) in relation to middle-aged mortality differences in men and women across 20 counties in Hungary through a cross-sectional, ecological study. The authors interviewed 12,643 people in a Hungarostudy 2002 survey, profiling the Hungarian population according to gender, age, and county. They found that mean self-rated health and self-rated disability at the county level were significantly associated with middle-aged mortality differences among counties, with male mortality more closely associated with self-rated health. The authors also noted that self-rated health and socioeconomic status of the opposite gender were significantly associated with middle-aged mortality, but the strength of the association differed by gender. Finally, male middle-aged mortality was more strongly connected to female subjective and objective social status than female mortality was connected with male social status.

Life meaning: an important correlate of health in the Hungarian population.

One of the 5 coping scales in Rahe's Brief Stress and Coping Inventory, entitled Life Meaning, was examined in relation to demographic characteristics, other coping measures, and health status in a sample of 12,640 Hungarian participants. Participants were selected to represent the country's population according to sex, age, and place of residence. The study also explored the contribution of life meaning to the explanation of variations of middle-aged (45-64 years) male and female mortality rates across 150 subregions in Hungary. On an ecological level life meaning proved to be inversely related to male and female oncological, female cardiovascular, and total premature mortality rates in the 150 subregions of Hungary and on an individual level to participants' reported health status. In the total sample of individuals after controlling for gender, age, and education, life meaning scores showed strong correlations with the World Health Organization well-being scale, with self-rated absence of depression, with self-rated health, and with self-rated absence of disability. Although relatively unrelated to age, gender, and education, life meaning was positively related to self-efficacy, importance of religion, problem-oriented coping, and social support.