Changes between pre-crisis and crisis period in socioeconomic inequalities in health and stimulant use in Netherlands.

BACKGROUND: International research suggests an impact of economic crises on population health, with different effects among different socioeconomic groups. Since the end of 2008 the Netherlands experienced a period of economic crisis. Our study explores how inequalities in perceived general and mental health, and alcohol and tobacco use changed after the recession started. METHODS: We used data from the Dutch Health Interview Surveys: 2006-2008 (pre-crisis period) and 2009-2013 (crisis period). Respondents aged 25-64 were divided into socioeconomic groups based on labour status, income level and income change. Inequalities in health and stimulant use among these socioeconomic groups were described by period and changes between the pre-crisis and crisis period were investigated using logistic regression models. RESULTS: Most inequalities did not change, with some exceptions. For perceived general health, inequalities between employed persons and persons not in the labour force were larger in the crisis period (unfavourable trends for those not in the labour force). For smoking, inequalities between unemployed and employed persons were larger in the crisis period (decreasing smoking rates only for those employed), as did inequalities between persons with low and high income levels (decreasing smoking rates for those with higher income levels). Excessive drinking decreased among employed persons and persons with a decrease in income, while it remained stable among persons not in the labour force and among persons with an increase in income. CONCLUSION: The widening of some socioeconomic inequalities in health and stimulant use might suggest an enhanced vulnerability of lower socioeconomic groups to the post-2008 crisis.

Hospital admissions and school dropout: a retrospective cohort study of the 'selection hypothesis'.

BACKGROUND: School dropout is an important predictor of poor health and of high relevance for public health (in accord with the 'causation hypothesis'). Rather than examining how dropout affects health, we set out to examine how poor health might affect school dropout (in accord with the 'selection hypothesis'). Hospital admissions are potentially indicative of more serious disease and might be expected to result in learning backlogs. METHODS: Longitudinal data of the Dutch Secondary Education Pupil Cohort 1993 (VOCL'93) and the National Medical Registration (LMR) were combined. The study population consisted of 16,239 pupils who were followed from first grade at secondary school until they left fulltime education. Pupils were monitored regarding both their educational careers and their hospital admissions. Nine percent had a hospital admission and 10% became a school dropout. RESULTS: Hospital admissions were only predictive of later school dropout for pupils starting in the highest type of secondary education (pre-university education) [OR 1.54 (95% CI 1.05-2.26)], not for pupils with lower educational levels. Pre-university pupils who had been hospitalized for more than 9 days [OR 2.34 (95% CI 1.08-5.09)] or who were hospitalized more than three times [OR 4.20 (95% CI 1.75-10.04)] had particularly heightened odds of school dropout. CONCLUSION: Our findings further support the 'selection hypothesis' and confirm the relevance of dropout for public health. Public health workers and educational professionals should probably aim at intensified monitoring of children who have been hospitalized and simultaneously aim at improving accessibility to (higher quality) education in the hospital.

Is personality a driving force for socioeconomic differences in young adults' health care use? A prospective cohort study.

OBJECTIVES: To relate personality characteristics at the age of 12 to socioeconomic differences in health care use in young adulthood. And thereby examining the extent to which socioeconomic differences in the use of health care in young adulthood are based on differences in personality characteristics, independent of the (parental) socioeconomic background. METHODS: Personality of more than 13,000 Dutch 12-year old participants was related to their health and socioeconomic position after a follow-up of 13 years (when the participants had become young adults). RESULTS: In young adulthood, low socioeconomic status was related to high health care use (e.g. low education -hospital admission: OR = 2.21; low income -GP costs: OR = 1.25). Odds ratios (for the socioeconomic health differences) did not decrease when controlled for personality. CONCLUSIONS: In this Dutch sample of younger people, personality appeared not to be a driving force for socioeconomic differences in health care use. Findings thus do not support the personality-related, indirect selection perspective on the explanation of socioeconomic differences in health.

Harmful drinking after job loss: a stronger association during the post-2008 economic crisis?

OBJECTIVES: This study investigated, among the Dutch working population, whether job loss during the post-2008 economic crisis is associated with harmful drinking and whether this association is stronger than before the crisis. METHODS: Repeated cross-sectional data from the Dutch Health Interview Survey 2004-2013 were used to define episodic drinking (≥6 glasses on 1 day ≥1/week) and chronic drinking (≥14 glasses/week for women and ≥21 for men). These data were linked to longitudinal data from tax registries, to measure the experience and duration of job loss during a 5-year working history. RESULTS: Before the crisis, job loss experience and duration were not associated with harmful drinking. During the crisis, job loss for more than 6 months was associated with episodic drinking [OR 1.40 (95% CI 1.01; 1.94)], while current job loss was associated with chronic drinking [OR 1.43 (95% CI 1.03; 1.98)]. These associations were most clear in men and different between the pre-crisis and crisis period (p interaction = 0.023 and 0.035, respectively). CONCLUSIONS: The results suggest that economic crises strengthen the potential impact of job loss on harmful drinking, predominately among men.

Impact of the post-2008 economic crisis on harmful drinking in the Dutch working-age population.

BACKGROUND: Studies on the impact of economic crises on alcohol consumption have yielded ambiguous results. Therefore, we studied changes in trends in harmful drinking among Dutch working-age men and women after the post-2008 economic crisis started. We also assessed whether these trend changes differed across age and socioeconomic groups. METHODS: We used repeated cross-sectional data from the Dutch Health Interview Survey conducted by Statistics Netherlands. Representative samples were independently drawn each month (January, 2004-December, 2013). Our working-age study population consisted of 20,140 men and 22,394 women aged 25-64. For men and women, episodic drinking was defined as drinking ≥6 glasses on one day at least once a week. Chronic drinking was defined as consuming ≥14 glasses/week for women and ≥21 for men. Segmented logistic regression was used to model trend changes separately in men and women. RESULTS: A downward trend in episodic and chronic drinking before the crisis slowed down after the crisis started. For episodic drinking, we observed a ceasing-of-decline among men aged 35-44/45-54/55-64, compared to a start-of-decline among those aged 25-34 (p-interaction=0.042/0.020/0.047). For chronic drinking, we observed a ceasing-of-decline among women (p=0.023) but not among men in general (p=0.238). Among men, a ceasing-of-decline did occur in those with a high income, but a start-of-decline was found among those with a low income (p-interaction=0.049). CONCLUSION: In some subgroups of the Dutch working-age population, the downward trend in episodic and chronic drinking ceased after the crisis started. This suggests that the crisis had an upward effect on harmful drinking, but only in specific populations.

Educational Inequalities in Exit from Paid Employment among Dutch Workers: The Influence of Health, Lifestyle and Work.

BACKGROUND: Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment. METHODS: 14,708 Dutch employees participated in a ten-year follow-up study during 1999-2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach. RESULTS: Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors. CONCLUSIONS: There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.

The effect of ill health and socioeconomic status on labor force exit and re-employment: a prospective study with ten years follow-up in the Netherlands.

OBJECTIVES: The aim of this study was to investigate the effect of ill health and socioeconomic status on labor force exit due to unemployment, early retirement, disability pension, or becoming economically inactive. A secondary objective was to investigate the effect of ill health and socioeconomic status on return to work. METHODS: A representative sample of the Dutch working population (N=15 152) was selected for a prospective study with ten years follow-up (93 917 person-years). Perceived health and individual and household characteristics were measured at baseline with the Permanent Quality of Life Survey (POLS) during 1999-2002. Statistics Netherlands ascertained employment status monthly from January 1999 to December 2008. Cox proportional hazards analyses were used to determine the factors that predicted labor force exit and return to work. RESULTS: Ill health increased the likelihood of labor force exit into unemployment [hazard ratio (HR) 1.89], disability pension (HR 6.39), and early retirement (HR 1.20), but was not a determinant of becoming economically inactive (HR 1.07). Workers with low socioeconomic status were, even after adjusting for ill health, more likely to leave the labor force due to unemployment, disability pension, and economic inactivity. Workers with ill health at baseline were less likely to return to work after unemployment (HR 0.75) or disability pension (HR 0.62). Socioeconomic status did not influence re-employment. CONCLUSIONS: Ill health is an important determinant for entering and maintaining paid employment. Workers with lower education were at increased risk for health-based selection out of paid employment. Policies to improve labor force participation, especially among low socioeconomic level workers, should protect workers with health problems against exclusion from the labor force.

[Home care in deprived districts: what is the role of material wealth?]. / Thuiszorg in aandachtswijken: wat is de rol van materiële welvaart?

OBJECTIVE: To examine if there is a higher uptake of home care among residents of deprived districts and to determine if this can be attributed to the lower levels of income and wealth of these residents. DESIGN: Retrospective, descriptive study. METHOD: The study focused on residents aged 50 and above. We obtained data on uptake of home care in 2007 from national care registries, which were combined with fiscal registry data on income and wealth. Postcode data were used to distinguish between 40 'deprived' districts and all other Dutch districts. RESULTS: In the deprived districts more residents received home care than in other districts. This difference was greatest among residents aged 50 to 69 years. After correction for age, sex and country of origin, the difference was substantial (odds ratio (OR): 1.31). After correction for differences in income this difference was halved (OR: 1.17).The difference was further strongly reduced after correction for wealth (OR: 1.06). In deprived districts there was a higher uptake of domestic care (OR: 1.12) but the inverse was true for personal care (OR: 0.95). The latter was most marked in residents aged 80 and above (OR: 0.88). CONCLUSION: The higher uptake of home care among residents of deprived districts can be attributed to low levels of income and wealth. In the Netherlands, changes in home care arrangements at national and local level should take into account people with financial problems and the districts in which they live.