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BEDREHELSE-Bedre helse og livskvalitet

Tracing causes of inequalities in health and well-being: Analysis of rich longitudinal data

Alternativ tittel: Sporing av årsaker til ulikheter i helse og velvære: Analyser basert på Tromsø-undersøkelsene

Tildelt: kr 10,7 mill.

Målet med prosjektet er å utvide kunnskapen om hvordan livsvilkår i barndommen sammen med sosioøkonomiske forhold og helseatferd påvirker folks helse og velvære i voksen alder. Data fra Tromsø-undersøkelsene gjør det mulig å spore årsaker til slike ulikheter, basert på et bredt spekter av observert helseinformasjon sammen med deltakernes egenrapporterte verdsetting av sin helserelaterte livskvalitet og velvære. Et gjennomgående funn er at vanskelige økonomiske forhold i familien under oppveksten er assosiert med dårligere helse og livskvalitet i voksen alder, også etter at vi justerer for forskjeller i utdanning og inntekt. Våre analyser viser også en tydelig gradient langs hver av tre sosioøkonomiske indikatorer (utdanning, yrke, inntekt). Disse sammenhengene gjelder både for helserelatert livskvalitet og tilfredshet med livet. Vi viser også at foreldres helse har varige konsekvenser for avkommets helse: helseulikheter kan i større grad kan forklares av levestandard i barndommen og foreldres sykelighet, enn av eget utdanningsnivå. Vi undersøker også i hvilken grad helseulikheter forklares av systematiske forskjeller i helseatferd. Videre viser vi at individer med høy motstandsdyktighet (resiliens) går tidligere tilbake i jobb etter å ha opplevd alvorlig sykdom. Basert på survey-data av representative befolkningsutvalg i Norge og Australia søker vi å forklare hvordan folk vurderer sin egen sosiale status avhengig av sin utdanning, yrke, inntekt, samt deres barndomsforhold. Mens inntekt er relativ viktig i Australia, er yrke og utdanning relativt sett viktigere i Norge. For øvrig viser resultatene at gode levekår i barndommen og en mor med høy utdanning øker folks oppfatning av sin status, også etter at vi har tatt hensyn til deres utdanning, yrke og inntekt.

Two PhD-candidates have completed and defended their thesis, and one candidate has submitted her thesis. So far, nine articles are published in relevant international peer-reviewed journals. In addition to the main data from The Tromsø Study, some papers have applied data from Norwegian and Danish registries. Furthermore, small-scale online surveys have been carried out in Norway, Australia, Canada, UK, and US that have addressed specific topics related to: i) explaining subjective socioeconomic status, and; ii) the inclusion of psycho-social domains in health outcome measures. We show the existence of a social health gradient in Norway, along each of the three most widely applied indicators of socioeconomic position; education, occupation and income, for each of three measures of health and wellbeing. We show that the education health gradient is wider when health is measured by quality-adjusted life expectancy, than life expectancy alone. A consistent finding in several papers is that difficult childhood financial circumstances have lasting effects on adult health and wellbeing, as well as labour market participation, even after adjusting for relevant variables such as education, occupation and income. We combine educational attainment and household income into a composite measure of socioeconomic position. We find that childhood financial circumstances matter for subjective social status in adulthood, even after adjusting for education, occupation and income. We find that resilient individuals are more likely to return to work after experiencing a health shock, and that labour market participation after a health shock varies with the severity of the health shock and is consistently higher among individuals with tertiary education. We find that parental wealth and health explain more of observed health variations than education. We find that parental education have lasting effects on adult health behaviours, and that partner’s education is significantly associated with health and health behaviours. Preliminary analyses suggest that health inequalities are more strongly associated with individual variations in their level of healthy behaviours than their level of education.

How patients experience adverse health events, and how they can partake through own efforts to improve their health, is of central importance for healthcare planners worldwide. Based on panel data that include a broad range of diagnostic information together with quantitative measures of patient reported health related quality of life (HRQoL) and subjective well-being (SWB) expressed along internationally validated instruments, the Tromsø Study offers a unique opportunity to answer vital research questions. Objective and subjective measures of health including descriptions of sudden health events allow us to study how health shocks may lead to changes in key health determinants such as, individuals' health related behaviours and job market participation. By linking data on health and well-being with information on early life events, health related behaviour, socio-economic characteristics, and social support, we will explore how individuals' early life circumstances and life course impact on their ability to 'bounce back' and cope with adverse health events. There is evidence on the direction of associations between the key health determinants (socio-economic factors, life style, and social network), and current health and wellbeing, yet the strengths and relative importance of the associations require more knowledge. Our access to an existing extensive panel data set including both survey data and registry data, as well as information on childhood circumstances, provides a unique opportunity to investigate causal pathways. This project will generate new evidence to be published in high ranking international journals. This project will strengthen collaborative research across strong international research environments. It will also foster stronger ties to stakeholders (patients and social workers) through dissemination of results in workshops. Through these workshops we hope to generate new ideas for interventions targeting both young adults and the elderly.

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BEDREHELSE-Bedre helse og livskvalitet