Gender Patterns of Socioeconomic Differences in Premature Mortality: Follow-up of the Hungarian Epidemiological Panel
- First Online:
- 130 Downloads
Gender differences in premature mortality rates and in the size of socioeconomic inequalities in mortality vary across countries.
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.
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.
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.
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.
KeywordsHungary Premature mortality Gender differences Socioeconomic status Work Depression
- 3.Marmot MG, Wilkinson R. Social determinants of health. Oxford: Oxford University Press; 1999.Google Scholar
- 4.Wilkinson RG. Health, civic society in Eastern Europe before 1989. In: Hertzman C, editor. Environmental and non-environmental determinants of the East-West life expectancy gap. Amsterdam: Kluwer; 1996.Google Scholar
- 5.Marmot M, Wilkinson R. The Social Pattern of Health and disease. In: Blane D, Brunner E, Wilkinson R, editors. Health and Social Organization. Evanston, IL: Routledge; 1996. p. 42–70.Google Scholar
- 18.Pongrácz M, Murinkó L. Household work distribution. In: Changes of Roles. Report about the Situation of Men and Women. Budapest: TÁRKI ZRT; 2009. p. 95–116.Google Scholar
- 19.Lynch J, Kaplan G. Socioeconomic position. In: Berkman L, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000. p. 13–35.Google Scholar
- 21.Marmot M. Status syndrome. London: Times Books; 2004.Google Scholar
- 22.Jonassaint CR, et al. Low Life Course Socioeconomic Status (SES) is Associated with Negative NEO PI-R Personality Patterns. Int J Behav Med. 2009; (in press).Google Scholar
- 26.Kopp MS, Skrabski Á, Lőke J. The Hungarian state of Mind in a Transforming society. In: Spéder Z, editor. Hungary in Flux, Society, Politics and Transformation. Hamburg: Verlag Dr. Reinhold Kramer; 1999. p. 117–34.Google Scholar
- 34.Demographic Yearbook. Budapest: Central Statistical Office; 2006.Google Scholar
- 39.Rózsa S, Szádóczky E, Füredi J. Psychometric properties of the Hungarian version of the shortened Beck Depression Inventory. Psychiatr Hung. 2001;16:384–402.Google Scholar
- 40.Schwarzer R. Measurement of perceived self-efficacy. Psychometric scales for cross-cultural research. Berlin: Freie Universität; 1993.Google Scholar
- 46.Rothman KJ, Greenland S, Lash TL. Modern epidemiology. Philadelphia: Wolters Kluwer/Lippincott Williams&Wilkins; 2008. p. 71–83.Google Scholar
- 48.Demographic Yearbook. United Nations; 2002.Google Scholar
- 49.Human Development Report 2007/2008 Available from: www.undp.org.
- 51.Black D et al. Inequalities in health: the black report. Health divide. London: Penguin; 1992.Google Scholar
- 53.Cockerham WC. Health and social change in Russia and Eastern Europe. New York: Routledge; 1999. p. 123–41.Google Scholar
- 54.Andorka R. The Week Links in Social Integration- System Transformation in Hungary. In: Spéder Z, editor. Hungary in Flux, Society, Politics and Transformation. Hamburg: Kramer; 1999. p. 19–33.Google Scholar
- 55.Eurobarometer: Health in the European Union. European Commission; 2006.Google Scholar
- 57.Hofstede G. Culture’s consequences, comparing values, behaviors, institutions, and organizations across nations. Thousand Oaks: Sage; 2001.Google Scholar
- 67.Laszlo KD. Psychosocial Factors and Prognosis in Coronary Heart Disease. In: Department of Public Health Sciences. Stockholm: Karolinska Institutet; 2009.Google Scholar