Changes in leisure-time physical activity and physical and mental health functioning: a follow-up study.

Functioning will be an increasingly important issue in Finland over the coming decades as the proportion of the population aged 65 and older is growing significantly. However, the associations between changes in physical activity and subsequent health functioning are poorly understood. The aim of this study was to examine how changes in physical activity relate to concurrent and prospective levels of health functioning. Cohort data from the Helsinki Health Study were used. Phase 1 (n = 8960, response rate 67%, 80% women) was conducted among 40- to 60-year-old employees of the City of Helsinki in 2000-2002, phase 2 in 2007 (n = 7332, response rate 83%), and phase 3 in 2012 (n = 6814, response rate 79%). Linear mixed models were used as the main statistical method. Increasing physical activity was associated with higher concurrent and prospective levels of physical health functioning, whereas decreasing activity was associated with lower levels of physical health functioning. The associations were stronger with physical than with mental health functioning. Promoting physical activity among aging people may help to maintain their level of health functioning.

Country specific associations between social contact and mental health: evidence from civil servant studies across Great Britain, Japan and Finland.

OBJECTIVES: Little is known about which component, such as social contact of social networks is associated with mental health or whether such an association can be observed across countries. This study examined whether the association between frequent social contact and mental health differs by composition (relatives or friends) and whether the associations are similar across three occupational cohorts from Great Britain, Japan, and Finland. STUDY DESIGN: Cross-sectional analysis of data from three prospective cohort studies. METHODS: Participants were civil servants of a prospective cohort study based in London (Men: n = 4519; Women: n = 1756), in the West Coast of Japan (Men: n = 2571; Women: n = 1102), and in Helsinki, Finland (Men: n = 1181; Women: n = 5633); we included the information on study variables which is complete. Mental health function was the study outcome, indicated by the total score from the Mental Health Component on the Short Form Health Survey36. Participants reported frequencies of contacts with their relatives or friends via a questionnaire. Age, marital status, and occupational position were treated as confounders in this study. RESULTS: Findings from multiple regression showed that the associations between social contact and mental health function were different depending on country of origin and gender. Among British or Japanese men, frequent contact with both friends and relatives was positively associated with their mental health function, while only social contact with friends was significantly associated with mental health of Finnish men. In women, the patterns of the associations between social contact and mental health were more distinctive: friends for Great Britain, relatives for Japan, and friends and relatives for Finland. These significant associations were independent of the confounders. CONCLUSIONS: Social contact was related to mental health of working people; however, culture and gender are likely to be tapped into.

Common mental disorders and cause-specific disability retirement.

OBJECTIVES: Common mental disorders are prevalent among employees and may cause work disability. We aimed to examine the association between common mental disorders and disability retirement, with an emphasis on the severity of disorders and diagnostic causes for retirement. METHODS: Our data were derived from the Helsinki Health Study cohort on the staff of the City of Helsinki, Finland. The baseline mail surveys were made in 2000-2002 among employees reaching ages 40, 45, 50, 55 and 60 in each year (n=8960, response rate 67%, 80% women). Disability retirement events from national registers (n=628) were followed up by the end of 2010 and linked to the baseline data. After exclusions, the number of participants was 6525. Common mental disorders were measured by the General Health Questionnaire 12-item version (GHQ-12). Covariates at baseline included sociodemographic, work-related and health-related factors. Hazard ratios (HR) and 95% CIs were calculated using Cox proportional hazards models. RESULTS: Common mental disorders showed a graded association with disability retirement. For disability retirement due to any diagnostic cause, the fully adjusted HR for the GHQ-12 score 7-12 was 2.16, 95% CI 1.63 to 2.85. For disability retirement due to mental disorders the corresponding HR was 7.46, 95% CI 4.46 to 12.49. For disability retirement due to musculoskeletal diseases, the association was weaker and did not survive all adjustments. CONCLUSIONS: Common mental disorders are an important antecedent of disability retirement in general and due to mental disorders in particular. Successful measures against common mental disorders may prevent disability retirement due to mental disorders.

Socioeconomic inequalities in cause-specific mortality after disability retirement due to different diseases.

AIMS: Socioeconomic inequalities in both disability retirement and mortality are large. The aim of this study was to examine socioeconomic differences in cause-specific mortality after disability retirement due to different diseases. METHODS: We used administrative register data from various sources linked together by Statistics Finland and included an 11% sample of the Finnish population between the years 1987 and 2007. The data also include an 80% oversample of the deceased during the follow-up. The study included men and women aged 30-64 years at baseline and those who turned 30 during the follow-up. We used Cox regression analysis to examine socioeconomic differences in mortality after disability retirement. RESULTS: Socioeconomic differences in mortality after disability retirement were smaller than in the population in general. However, manual workers had a higher risk of mortality than upper non-manual employees after disability retirement due to mental disorders and cardiovascular diseases, and among men also diseases of the nervous system. After all-cause disability retirement, manual workers ran a higher risk of cardiovascular and alcohol-related death. However, among men who retired due to mental disorders or cardiovascular diseases, differences in social class were found for all causes of death examined. For women, an opposite socioeconomic gradient in mortality after disability retirement from neoplasms was found. Conclusions: The disability retirement process leads to smaller socioeconomic differences in mortality compared with those generally found in the population. This suggests that the disability retirement system is likely to accurately identify chronic health problems with regard to socioeconomic status.

Conflicts between work and family life and subsequent sleep problems among employees from Finland, Britain, and Japan.

PURPOSE: Research on the association between family-to-work and work-to-family conflicts and sleep problems is sparse and mostly cross-sectional. We examined these associations prospectively in three occupational cohorts. METHODS: Data were derived from the Finnish Helsinki Health Study (n = 3,881), the British Whitehall II Study (n = 3,998), and the Japanese Civil Servants Study (n = 1,834). Sleep problems were assessed using the Jenkins sleep questionnaire in the Finnish and British cohorts and the Pittsburgh Sleep Quality Index in the Japanese cohort. Family-to-work and work-to-family conflicts measured whether family life interfered with work or vice versa. Age, baseline sleep problems, job strain, and self-rated health were adjusted for in logistic regression analyses. RESULTS: Adjusted for age and baseline sleep, strong family-to-work conflicts were associated with subsequent sleep problems among Finnish women (OR, 1.33 (95 % CI, 1.02-1.73)) and Japanese employees of both sexes (OR, 7.61 (95 % CI, 1.01-57.2) for women; OR, 1.97 (95 % CI, 1.06-3.66) for men). Strong work-to-family conflicts were associated with subsequent sleep problems in British, Finnish, and Japanese women (OR, 2.36 (95 % CI, 1.42-3.93), 1.62 (95 % CI, 1.20-2.18), and 5.35 (95 % CI, 1.00-28.55), respectively) adjusted for age and baseline sleep problems. In men, this association was seen only in the British cohort (OR, 2.02 (95 % CI, 1.42-2.88)). Adjustments for job strain and self-rated health produced no significant attenuation of these associations. CONCLUSION: Family-to-work and work-to-family conflicts predicted subsequent sleep problems among the majority of employees in three occupational cohorts.

Sleep problems and major weight gain: a follow-up study.

OBJECTIVE: To examine the associations between sleep problems and major weight gain during a 5- to 7-year follow-up among middle-aged women and men. METHODS: The Helsinki Health Study prospective cohort baseline survey data from 2000 to 2002 (n = 8960, response rate 67%) among 40- to 60-year-old municipal employees and follow-up survey data from 2007 (n = 7332, response rate 83%) were used. Logistic regression analysis was used to examine the association between the four-item Jenkins Sleep Questionnaire and major weight gain of 5 kg or more over a 5- to 7-year follow-up. RESULTS: Half of the participants reported at least occasional sleep problems, whereas 13% of women and 17% of men reported no such problems at baseline. The frequency of sleep problems varied by item. Frequent sleep problems were reported by 20% of women and 17% of men. Major weight gain was reported by 25% of women and 24% of men. Trouble falling asleep (odds ratio (OR) 1.65; 95% confidence interval (CI) 1.22, 2.22), waking up several times per night (OR 1.49; 95% CI 1.22, 1.81) and trouble staying asleep (OR 1.41; 95% CI 1.13, 1.75) were associated with major weight gain during the follow-up in women but not in men. In contrast, waking up tired was unassociated with weight gain. The summary measure of the four items was also associated with weight gain in women. Adjusting for baseline body mass index, physical health, health behaviour, marital status, education, work arrangements and sleep duration had only minor effects on the above associations. Adjusting for common mental disorders at baseline, the associations were attenuated but remained for trouble falling asleep, waking up several times per night and trouble staying asleep. Occasional sleep problems were also associated with weight gain. CONCLUSION: Sleep problems likely contribute to weight gain. To prevent major weight gain and obesity, sleep problems need to be taken into account.

The impact of physical activity on sickness absence.

The aim of this study was to examine whether the volume and intensity of physical activity are associated with subsequent sickness absence spells of different lengths, and how much of these associations can be explained by socioeconomic position, body mass index (BMI) and physical health functioning. Baseline data were collected by questionnaire surveys in 2000-2002 among 40-60-year-old employees of Helsinki City (n=6465, 79% women). Sickness absence data were derived from the employer's registers (mean follow-up time 3.9 years). Associations of physical activity with shorter (< or =14 days) and longer (>14 days) sickness absence spells were examined, using Poisson's regression analysis. The volume of physical activity was weakly and somewhat inconsistently associated with sickness absence. However, men and women who were vigorously active systematically had reduced risk of sickness absence, whereas the same volume of moderately intensive physical activity did not reduce the risk of sickness absence. Adjusting for BMI and in particular physical health functioning attenuated these associations, after which the associations lost statistical significance. The results suggest that vigorous physical activity is associated with sickness absence and may contribute to better work ability.

Work-family conflicts and health behaviors among British, Finnish, and Japanese employees.

BACKGROUND: Work-family conflicts are associated with poor health. However, work-family conflicts and health behaviors have been little studied. PURPOSE: This study examined the associations of conflicts between paid work and family life with unhealthy behaviors among British, Finnish, and Japanese employees. METHOD: Data were derived from postal questionnaire surveys among 40 to 60 years old employees from three cohorts, the British Whitehall II Study (n = 3,397), the Finnish Helsinki Health Study (n = 4,958), and the Japanese Civil Servants Study (n = 2,901). Outcomes were current smoking, heavy drinking, physical inactivity, and unhealthy food habits. Work-family conflicts were measured with eight items. Age, marital status, and occupational class were adjusted for in logistic regression analyses. RESULTS: Work-family conflicts had few and inconsistent associations with unhealthy behaviors in all three cohorts. In the Finnish cohort, strong work-family conflicts were associated with current smoking among men. Women with strong conflicts had more often unhealthy food habits and were more often heavy drinkers than women with weaker conflicts. Likewise, British women with strong work-family conflicts were more often heavy drinkers. CONCLUSION: Although work-family conflicts were fairly prevalent in the examined cohorts, these conflicts had but few associations with the studied key health behaviors.

Health-related behaviours and sickness absence from work.

OBJECTIVES: To compare associations of health-related behaviours with self-certified and medically confirmed sickness absence, and to examine whether these associations can be explained by psychosocial and physical working conditions and occupational social class. METHODS: The study included 5470 female and 1464 male employees of the City of Helsinki surveyed in 2000-2002. These data were linked to sickness absence records until the end of 2005, providing a mean follow-up time of 3.9 years. Poisson regression analysis was used to examine associations of smoking, alcohol use, physical activity, dietary habits and relative weight (body mass index) with self-certified (1-3 days) and medically confirmed (> or =4 days) absence spells. Population attributable fractions (PAFs) were calculated to quantify the sickness absence burden related to the behaviours. RESULTS: Smoking and high relative weight were most strongly associated with sickness absence, while the associations of other studied health-related behaviours were weaker. The associations were stronger for medically confirmed sickness absence spells for which heavy smoking and obesity more than doubled the risk of sickness absence in men and nearly doubled it in women. Adjusting for psychosocial working conditions had little or no effect on the associations. Physical working conditions and social class somewhat attenuated the associations, especially for smoking and relative weight. In self-certified sickness absence the PAF for smoking (16.4 in men, 10.3 in women) was largest, while in medically confirmed absence relative weight had the largest PAF (23.5 in men, 15.0 in women). CONCLUSIONS: Health-related behaviours, smoking and high relative weight in particular, were associated with subsequent sickness absence independently of psychosocial and physical working conditions and social class. Decreasing smoking and relative weight is likely to provide important gains in work ability and reduce sickness absence.

The effect of pain on sickness absence among middle-aged municipal employees.

OBJECTIVES: To study the effects of pain on sickness absence, taking into account physical and psychosocial work load and socio-economic position. METHODS: Data consisted of City of Helsinki personnel register data on sickness absence and a cross-sectional questionnaire survey which was carried out among employees of the City of Helsinki who reached the age of 40, 45, 50, 55 or 60 years during the years 2000-2002 (n = 8960, response rate 67%). Data sets were combined for those who gave permission for such linkage (78%). The main statistical method was negative binomial regression analysis. RESULTS: The burden of pain on sickness absence was dependent on the duration of absence: the longer the duration, the higher the burden. Self-certified absence was equally predicted by acute and chronic pain, but medically certified absence was more clearly predicted by chronic pain. Adjustments for a range of work load factors and socio-economic position showed that pain was a relatively independent determinant of subsequent sickness absence, but in particular physical work load and socio-economic position explained a small proportion of the association. Overall, pain accounted for 13% of self-certified absence among women and 8% among men. Corresponding figures were 23% and 25% for medically certified 4-14-day sickness absence and 37% and 30% for absence of over 2 weeks. CONCLUSIONS: The burden of pain on medically certified sickness absence is considerable. Prevention of pain problems is vital for reducing sickness absence rates.

Explanations for gender differences in sickness absence: evidence from middle-aged municipal employees from Finland.

OBJECTIVES: To examine gender differences in sickness absence spells of various lengths and to explain these differences by health status, working conditions and family-related factors. METHODS: The study included 5470 female and 1464 male employees of the City of Helsinki surveyed at baseline in 2000-2. These survey data were linked to the employer's sickness absence records until the end of 2005, providing a mean follow-up time of 3.9 years. Explanations for gender differences in self-certified (1-3 days) and medically confirmed absence spells of various lengths (4 days or more, more than 2 weeks, and more than 60 days) were examined using Poisson regression. RESULTS: Women had 46% higher risk for self-certified sickness absence than men. In medically confirmed spells there was 34% female excess which gradually weakened with lengthening absence, and no differences were observed in spells longer than 60 days. Adjusting for physical functioning and self-reported diagnosed diseases clearly attenuated gender differences in sickness absence spells shorter than two weeks and fully explained them in longer absence spells. Physical work demands explained female excess in medically confirmed absence spells of all lengths, as did work fatigue in spells longer than two weeks. Psychosocial working conditions and family-related factors did not affect the gender differences. Physical health problems, physical work demands and work fatigue were somewhat more prevalent in women than in men, but their impact on sickness absence was similar in both genders. CONCLUSIONS: The overall gender differences in sickness absence are due to relatively short absence spells being more common among women. In longer sickness absence spells the female excess is mainly explained by heavier burden of ill-health and to a lesser extent by higher physical work demands among women. The authors found no support for greater vulnerability to health- and work-related problems among women as reasons for sickness absence.

Multiple socio-economic circumstances and healthy food habits.

OBJECTIVE: To examine associations between seven indicators of socio-economic circumstances and healthy food habits, while taking into account assumed temporal order between these socio-economic indicators. DESIGN AND SETTING: Data were derived from cross-sectional postal questionnaires in 2000-2002. Socio-economic circumstances were assessed by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Healthy food habits were measured by an index consisting of consumption of fresh vegetables, fruit or berries, rye bread, fish and choosing vegetable fats on bread and oil in cooking. Sequential logistic regression models were used, adjusting for age and marital status. PARTICIPANTS: Employees of the City of Helsinki, Finland (n=8960, aged 40-60 years). RESULTS: Healthy food habits were reported by 28% of women and by 17% of men. Own education, occupational class, household income, home ownership and current economic difficulties were associated with healthy food habits. These associations were attenuated but mainly remained after mutual adjustments for the socio-economic indicators. Among women, a pathway was found suggesting that part of the effects of education on food habits were mediated through occupational class. CONCLUSIONS: Employees in higher and lower socio-economic positions differ in their food habits, and those in lower positions and economically disadvantaged are less likely to report healthy food habits. Health promotion programmes and food policies should encourage healthier food choices among those in lower socio-economic positions and among those with economic difficulties in particular.

Applying an equity lens to tobacco-control policies and their uptake in six Western-European countries.

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

Children's use of general practitioner services in the five Nordic countries.

OBJECTIVE: To compare socioeconomic, sociodemographic, and living area differences in children's use of GP services in five Nordic countries from the 1980s to the 1990s and to analyse trends during the period. DESIGN: Cross sectional population surveys using random samples comprising 3000 children aged 2-17 years were conducted in 1984 and 1996 in five Nordic countries. Time trends in use of GP services were studied in each country by age, sex, parents' highest level of education, and living area. SETTING: Five Nordic countries, Denmark, Finland, Iceland, Norway, and Sweden in 1984 and 1996. PARTICIPANTS: A total sample of 15 000 children aged 2-17 years. Altogether 3000 children were selected at random from the national population registers of the national bureaus of statistics in each country. MAIN OUTCOME: Health services utilisation on the basis of responses to a questionnaire item asking whether the parents had consulted a GP with regard to their children's health during the previous three months. MAIN RESULTS: The prevalence of children's utilisation of GP services varied from 14% in 1984 in Sweden to 28% in 1996 in Iceland. A clear time trend towards increasing utilisation of GP services (p<0.05) was found in all countries except in Denmark. Odds ratios for time trends (1984 = 1.00) varied from 1.22 (1.02 to 1.46) in Sweden to 1.92 (1.62 to 2.30) in Norway. After adjusting for independent variables, a statistically borderline significant declining utilisation trend (OR = 0.85 (0.70 to 1.03)) was found for Denmark. CONCLUSION: Children's use of GP services has increased significantly in four of the five Nordic countries.

Associations of SF-36 mental health functioning and work and family related factors with intentions to retire early among employees.

OBJECTIVE: To examine the associations of mental health functioning (SF-36) and work and family related psychosocial factors with intentions to retire early. METHODS: Cross sectional survey data (n = 5037) from the Helsinki Health Study occupational cohort in 2001 and 2002 were used. Intentions to retire early were inquired with a question: "Have you considered retiring before normal retirement age?" Mental health functioning was measured by the Short Form 36 (SF-36) mental component summary (MCS). Work and family related psychosocial factors included job demands and job control, procedural and relational justice, conflicts between work and family, and social network size. Multinomial regression models were used to analyse the data. RESULTS: Poor mental health functioning, unfavourable psychosocial working conditions, and conflicts between work and family were individually related to intentions to retire early. After adjustments for all work and family related factors the odds ratio for low mental health functioning was halved (from OR = 6.05 to 3.67), but nevertheless the association between poor mental health functioning and strong intentions to retire early remained strong. CONCLUSIONS: These findings highlight not only the importance of low mental health and unfavourable working conditions but also the simultaneous impact of conflicts between work and family to employees' intentions to retire early.

Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries.

BACKGROUND: Few studies have compared socioeconomic inequalities in the prevalence of both fatal and non-fatal diseases. This paper aims to give the first international overview for several common chronic diseases. METHODS: Micro-level data were pooled from non-standardized national health surveys conducted in eight European countries in the 1990s. Surveys ranged in size from 3700 to 41 200 participants. The prevalence of 17 chronic disease groups were analysed in relation to education. Standardized prevalence rates and age-adjusted odds ratios (ORs) were calculated. RESULTS: Most diseases showed higher prevalence among the lower education group. Stroke, diseases of the nervous system, diabetes, and arthritis displayed relatively large inequalities (OR > 1.50). No socioeconomic differences were evident for cancer, kidney diseases, and skin diseases. Allergy was more common in the higher education group. Relative socioeconomic differences were often smaller among the 60-79 age group as compared with the 25-59 age group. Cancer was more prevalent among the lower educated in the 25-59 age group, but among the higher educated in the 60-79 age group. For diabetes, hypertension, and heart disease, socioeconomic differences were larger among women as compared with men. Inequalities in heart disease were larger in northern European countries as compared with southern European countries. CONCLUSION: There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

OBJECTIVE: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. DESIGN: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. SETTING: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. PARTICIPANTS: 451 386 non-institutionalised men and women 25-79 years old. MAIN OUTCOME MEASURES: Smoking status, daily quantity of cigarettes consumed by smokers. RESULTS: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. CONCLUSIONS: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Gender differences in the association of age with physical workload and functioning.

AIMS: To test whether (1) physically demanding work is less frequent for older than younger employees, and whether (2) the association of physically demanding work with decline of physical functioning is stronger for older employees than their younger counterparts. The gender differences in these associations were examined. METHODS: Subjects of the study were 40-60 year old employees of the City of Helsinki. Data (n = 5802) were collected with mail questionnaires in 2000 and 2001. Functioning was measured with the Role Limitations due to Physical Health Problems scale of the SF36 health questionnaire. Logistic regression models were used to analyse the data. RESULTS: There was a linear trend of less physically demanding work in older than in younger age groups. This trend was more marked for men than women. Age and physically demanding work were associated with poor functioning. In women the association of physically demanding work with poor functioning tended to be stronger for older than for younger age groups, while the opposite was observed in men. CONCLUSIONS: Results suggest that physically demanding work causes more ailments in women of high age than men. It is possible that less men than women are still employed in physically demanding occupations at high age, even though direct evidence of exit from physically demanding work cannot be obtained from cross-sectional data. In these data the physically demanding occupations for men and women were largely different. High physical workload among women working in social and health care is likely to contribute to the gender differences.

Examining the continuity of self-rated health.

BACKGROUND: The study examines whether self-rated health forms a continuum from poor through average to good health in terms of two groups of health-related variables. METHODS: The data come from the 1994 Finnish Survey on Living Conditions, a representative sample of Finnish men and women aged 25 years or older (n = 7290). Logistic regression analysis was used with two dependent variables: (1) average versus good/excellent self-rated health and (2) poor versus good/excellent self-rated health. Two groups of independent variables were used: (1) risk factors and (2) ill-health indicators. Separate analyses were made for men and women controlling for sociodemographic background variables. RESULTS: Of the risk factors, BMI and physical exercise were associated both with average and poor self-rated health whereas frequency of drinking was only associated with poor health. All used indicators of ill health were strongly associated with average as well as poor self-rated health. With the exception of BMI, the associations of both risk factors and ill health were stronger with poor than with average health. CONCLUSIONS: The study suggests that self-rated health forms a continuum from poor to good health when risk factors and indicators of ill health are considered, and that there are only minor differences in the continuity of self-rated health between men and women.

The association of body mass index with social and economic disadvantage in women and men.

BACKGROUND: Although an inverse relationship between socioeconomic status and body mass index (BMI) is well documented, broad population studies focusing on the association between BMI and various forms of disadvantage such as unemployment, low income or social isolation are rare. METHODS: A nationwide, representative sample of 25-64-year-old Finnish subjects (n = 6016) was classified according to their BMI into four groups: 'thin' (BMI < 20), 'normal' (BMI 20-24.9), 'overweight' (BMI 25-29.9) and 'obese' (BMI > or = 30). Multivariable analyses using logistic regression were conducted with this BMI-grouping as an independent variable to predict social and economic disadvantage, controlling simultaneously for age, educational attainment, region of residence, and limiting long-standing illness. RESULTS: In women, overweight was associated with current unemployment and obesity with long-term unemployment as well as absence of close friends outside the family circle. Both overweight and obesity were associated with low individual earnings. Obese women were also most likely to have low household disposable and individual incomes; a similar pattern was seen among thin women. A small subgroup of thin men were socially and economically disadvantaged with all our indicators whereas excess body weight was not problematic for men. CONCLUSIONS: Deviant body weight is associated with social and economic disadvantage in a gender-specific and partly curvilinear way. In particular, obese women face multiple social and economic disadvantage.