Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk?
Breckenkamp J, Mielck A, Razum O (2007)
BMC Public Health 7(1): 132.
Zeitschriftenaufsatz
| Veröffentlicht | Englisch
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Breckenkamp, JürgenUniBi;
Mielck, Andreas;
Razum, OliverUniBi
Einrichtung
Abstract / Bemerkung
Background: Socioeconomic status is a predictor not only of mortality, but also of cardiovascular risk and morbidity. An ongoing debate in the field of social inequalities and health focuses on two questions: 1) Is individual health status associated with individual income as well as with income inequality at the aggregate (e. g. regional) level? 2) If there is such an association, does it operate via a psychosocial pathway (e.g. stress) or via a ´´neo-materialistic´´ pathway (e.g. systematic under-investment in societal infrastructures)? For the first time in Germany, we here investigate the association between cardiovascular health status and income inequality at the area level, controlling for individual socio-economic status. Methods: Individual-level explanatory variables (age, socio-economic status) and outcome data (body mass index, blood pressure, cholesterol level) as well as the regional-level variable (proportion of relative poverty) were taken from the baseline survey of the German Cardiovascular Prevention Study, a cross-sectional, community-based, multi-center intervention study, comprising six socio-economically diverse intervention regions, each with about 1800 participants aged 25–69 years. Multilevel modeling was used to examine the effects of individual and regional level variables. Results: Regional effects are small compared to individual effects for all risk factors analyzed. Most of the total variance is explained at the individual level. Only for diastolic blood pressure in men and for cholesterol in both men and women is a statistically significant effect visible at the regional level. Conclusion: Our analysis does not support the assumption that in Germany cardiovascular risk factors were to a large extent associated with income inequality at regional level.
Erscheinungsjahr
2007
Zeitschriftentitel
BMC Public Health
Band
7
Ausgabe
1
Art.-Nr.
132
ISSN
1471-2458
Page URI
https://pub.uni-bielefeld.de/record/1783717
Zitieren
Breckenkamp J, Mielck A, Razum O. Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health. 2007;7(1): 132.
Breckenkamp, J., Mielck, A., & Razum, O. (2007). Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health, 7(1), 132. https://doi.org/10.1186/1471-2458-7-132
Breckenkamp, Jürgen, Mielck, Andreas, and Razum, Oliver. 2007. “Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk?”. BMC Public Health 7 (1): 132.
Breckenkamp, J., Mielck, A., and Razum, O. (2007). Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health 7:132.
Breckenkamp, J., Mielck, A., & Razum, O., 2007. Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health, 7(1): 132.
J. Breckenkamp, A. Mielck, and O. Razum, “Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk?”, BMC Public Health, vol. 7, 2007, : 132.
Breckenkamp, J., Mielck, A., Razum, O.: Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health. 7, : 132 (2007).
Breckenkamp, Jürgen, Mielck, Andreas, and Razum, Oliver. “Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk?”. BMC Public Health 7.1 (2007): 132.
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19 Zitationen in Europe PMC
Daten bereitgestellt von Europe PubMed Central.
Geographic Variations in Cardiometabolic Risk Factors in Luxembourg.
Alkerwi A, Bahi IE, Stranges S, Beissel J, Delagardelle C, Noppe S, Kandala NB., Int J Environ Res Public Health 14(6), 2017
PMID: 28621751
Alkerwi A, Bahi IE, Stranges S, Beissel J, Delagardelle C, Noppe S, Kandala NB., Int J Environ Res Public Health 14(6), 2017
PMID: 28621751
Expansion or compression of long-term care in Germany between 2001 and 2009? A small-area decomposition study based on administrative health data.
Kreft D, Doblhammer G., Popul Health Metr 14(), 2016
PMID: 27418881
Kreft D, Doblhammer G., Popul Health Metr 14(), 2016
PMID: 27418881
Household income and adolescent blood pressure in a Chinese birth cohort: "Children of 1997".
Kwok MK, Subramanian SV, Leung GM, Schooling CM., Soc Sci Med 144(), 2015
PMID: 26397867
Kwok MK, Subramanian SV, Leung GM, Schooling CM., Soc Sci Med 144(), 2015
PMID: 26397867
Inequalities in mortality by socioeconomic factors and Roma ethnicity in the two biggest cities in Slovakia: a multilevel analysis.
Rosicova K, Reijneveld SA, Madarasova Geckova A, Stewart RE, Rosic M, Groothoff JW, van Dijk JP., Int J Equity Health 14(), 2015
PMID: 26541416
Rosicova K, Reijneveld SA, Madarasova Geckova A, Stewart RE, Rosic M, Groothoff JW, van Dijk JP., Int J Equity Health 14(), 2015
PMID: 26541416
Individual- and area-level effects on mortality risk in Germany, both East and West, among male Germans aged 65+.
Kibele EU., Int J Public Health 59(3), 2014
PMID: 23811967
Kibele EU., Int J Public Health 59(3), 2014
PMID: 23811967
Understanding the gap between need and utilization in outpatient care--the effect of supply-side determinants on regional inequities.
Ozegowski S, Sundmacher L., Health Policy 114(1), 2014
PMID: 24016773
Ozegowski S, Sundmacher L., Health Policy 114(1), 2014
PMID: 24016773
Regional and neighborhood disparities in the odds of type 2 diabetes: results from 5 population-based studies in Germany (DIAB-CORE consortium).
Müller G, Kluttig A, Greiser KH, Moebus S, Slomiany U, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K., Am J Epidemiol 178(2), 2013
PMID: 23648804
Müller G, Kluttig A, Greiser KH, Moebus S, Slomiany U, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K., Am J Epidemiol 178(2), 2013
PMID: 23648804
Gender differences in the association of individual social class and neighbourhood unemployment rate with prevalent type 2 diabetes mellitus: a cross-sectional study from the DIAB-CORE consortium.
Müller G, Hartwig S, Greiser KH, Moebus S, Pundt N, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K, DIAB-CORE Consortium., BMJ Open 3(6), 2013
PMID: 23794596
Müller G, Hartwig S, Greiser KH, Moebus S, Pundt N, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K, DIAB-CORE Consortium., BMJ Open 3(6), 2013
PMID: 23794596
Contextual and individual determinants of health among Aussiedler and native Germans.
Kreft D, Doblhammer G., Health Place 18(5), 2012
PMID: 22784776
Kreft D, Doblhammer G., Health Place 18(5), 2012
PMID: 22784776
Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: the 15 cities young stroke study.
Putaala J, Yesilot N, Waje-Andreassen U, Pitkäniemi J, Vassilopoulou S, Nardi K, Odier C, Hofgart G, Engelter S, Burow A, Mihalka L, Kloss M, Ferrari J, Lemmens R, Coban O, Haapaniemi E, Maaijwee N, Rutten-Jacobs L, Rutten-Jacobs L, Bersano A, Cereda C, Baron P, Borellini L, Valcarenghi C, Thomassen L, Grau AJ, Palm F, Urbanek C, Tuncay R, Durukan-Tolvanen A, van Dijk EJ, de Leeuw FE, Thijs V, Greisenegger S, Vemmos K, Lichy C, Bereczki D, Csiba L, Michel P, Leys D, Spengos K, Naess H, Bahar SZ, Tatlisumak T., Stroke 43(10), 2012
PMID: 22798330
Putaala J, Yesilot N, Waje-Andreassen U, Pitkäniemi J, Vassilopoulou S, Nardi K, Odier C, Hofgart G, Engelter S, Burow A, Mihalka L, Kloss M, Ferrari J, Lemmens R, Coban O, Haapaniemi E, Maaijwee N, Rutten-Jacobs L, Rutten-Jacobs L, Bersano A, Cereda C, Baron P, Borellini L, Valcarenghi C, Thomassen L, Grau AJ, Palm F, Urbanek C, Tuncay R, Durukan-Tolvanen A, van Dijk EJ, de Leeuw FE, Thijs V, Greisenegger S, Vemmos K, Lichy C, Bereczki D, Csiba L, Michel P, Leys D, Spengos K, Naess H, Bahar SZ, Tatlisumak T., Stroke 43(10), 2012
PMID: 22798330
Regional deprivation in Bavaria, Germany: linking a new deprivation score with registry data for lung and colorectal cancer.
Kuznetsov L, Maier W, Hunger M, Meyer M, Mielck A., Int J Public Health 57(5), 2012
PMID: 22314543
Kuznetsov L, Maier W, Hunger M, Meyer M, Mielck A., Int J Public Health 57(5), 2012
PMID: 22314543
Geographic variance of cardiovascular risk factors among community women: the national Sister to Sister campaign.
Jarvie JL, Johnson CE, Wang Y, Aslam F, Athanasopoulos LV, Pollin I, Foody JM., J Womens Health (Larchmt) 20(1), 2011
PMID: 21142977
Jarvie JL, Johnson CE, Wang Y, Aslam F, Athanasopoulos LV, Pollin I, Foody JM., J Womens Health (Larchmt) 20(1), 2011
PMID: 21142977
How relevant are district characteristics in explaining subjective health in Germany? A multilevel analysis.
Diehl K, Schneider S., Soc Sci Med 72(7), 2011
PMID: 21420213
Diehl K, Schneider S., Soc Sci Med 72(7), 2011
PMID: 21420213
A prospective cohort study of neighborhood stress and ischemic heart disease in Japan: a multilevel analysis using the JACC study data.
Fujino Y, Tanabe N, Honjo K, Suzuki S, Shirai K, Iso H, Tamakoshi A, JACC Study Group., BMC Public Health 11(), 2011
PMID: 21619568
Fujino Y, Tanabe N, Honjo K, Suzuki S, Shirai K, Iso H, Tamakoshi A, JACC Study Group., BMC Public Health 11(), 2011
PMID: 21619568
The wider determinants of inequalities in health: a decomposition analysis.
Sundmacher L, Scheller-Kreinsen D, Busse R., Int J Equity Health 10(), 2011
PMID: 21791075
Sundmacher L, Scheller-Kreinsen D, Busse R., Int J Equity Health 10(), 2011
PMID: 21791075
The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study.
Voigtländer S, Berger U, Razum O., BMC Public Health 10(), 2010
PMID: 20615214
Voigtländer S, Berger U, Razum O., BMC Public Health 10(), 2010
PMID: 20615214
Geographical variation in cardiovascular incidence: results from the British Women's Heart and Health Study.
Kim LG, Carson C, Lawlor DA, Ebrahim S., BMC Public Health 10(), 2010
PMID: 21078139
Kim LG, Carson C, Lawlor DA, Ebrahim S., BMC Public Health 10(), 2010
PMID: 21078139
Individual socioeconomic factors conditioning cardiovascular disease risk.
Barceló MA, Saez M, de Tuero GC., Am J Hypertens 22(10), 2009
PMID: 19713944
Barceló MA, Saez M, de Tuero GC., Am J Hypertens 22(10), 2009
PMID: 19713944
Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR).
Erbel R, Delaney JA, Lehmann N, McClelland RL, Möhlenkamp S, Kronmal RA, Schmermund A, Moebus S, Dragano N, Stang A, Jöckel KH, Budoff MJ, Multi-Ethnic Study of Atherosclerosis, Investigator Group of the Heinz Nixdorf Recall Study., Eur Heart J 29(22), 2008
PMID: 18845666
Erbel R, Delaney JA, Lehmann N, McClelland RL, Möhlenkamp S, Kronmal RA, Schmermund A, Moebus S, Dragano N, Stang A, Jöckel KH, Budoff MJ, Multi-Ethnic Study of Atherosclerosis, Investigator Group of the Heinz Nixdorf Recall Study., Eur Heart J 29(22), 2008
PMID: 18845666
38 References
Daten bereitgestellt von Europe PubMed Central.
Inequalities in death--specific explanations of a general pattern?
Marmot MG, Shipley MJ, Rose G., Lancet 1(8384), 1984
PMID: 6143919
Marmot MG, Shipley MJ, Rose G., Lancet 1(8384), 1984
PMID: 6143919
Health inequalities among British civil servants: the Whitehall II study.
Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A., Lancet 337(8754), 1991
PMID: 1674771
Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A., Lancet 337(8754), 1991
PMID: 1674771
Income and health: what is the nature of the relationship?
Ecob R, Smith GD., Soc Sci Med 48(5), 1999
PMID: 10080369
Ecob R, Smith GD., Soc Sci Med 48(5), 1999
PMID: 10080369
Social/economic status and disease.
Marmot MG, Kogevinas M, Elston MA., Annu Rev Public Health 8(), 1987
PMID: 3555518
Marmot MG, Kogevinas M, Elston MA., Annu Rev Public Health 8(), 1987
PMID: 3555518
Socioeconomic factors and cardiovascular disease: a review of the literature.
Kaplan GA, Keil JE., Circulation 88(4 Pt 1), 1993
PMID: 8403348
Kaplan GA, Keil JE., Circulation 88(4 Pt 1), 1993
PMID: 8403348
Income differences in mortality: a register-based follow-up study of three million men and women.
Martikainen P, Makela P, Koskinen S, Valkonen T., Int J Epidemiol 30(6), 2001
PMID: 11821353
Martikainen P, Makela P, Koskinen S, Valkonen T., Int J Epidemiol 30(6), 2001
PMID: 11821353
Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review.
Pollitt RA, Rose KM, Kaufman JS., BMC Public Health 5(), 2005
PMID: 15661071
Pollitt RA, Rose KM, Kaufman JS., BMC Public Health 5(), 2005
PMID: 15661071
Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953.
Osler M, Andersen AM, Due P, Lund R, Damsgaard MT, Holstein BE., J Epidemiol Community Health 57(9), 2003
PMID: 12933773
Osler M, Andersen AM, Due P, Lund R, Damsgaard MT, Holstein BE., J Epidemiol Community Health 57(9), 2003
PMID: 12933773
Socioeconomic determinants of health. Health inequalities: relative or absolute material standards?
Wilkinson RG., BMJ 314(7080), 1997
PMID: 9055723
Wilkinson RG., BMJ 314(7080), 1997
PMID: 9055723
Psychosocial and material pathways in the relation between income and health: a response to Lynch et al.
Marmot M, Wilkinson RG., BMJ 322(7296), 2001
PMID: 11358781
Marmot M, Wilkinson RG., BMJ 322(7296), 2001
PMID: 11358781
Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions.
Lynch JW, Smith GD, Kaplan GA, House JS., BMJ 320(7243), 2000
PMID: 10784551
Lynch JW, Smith GD, Kaplan GA, House JS., BMJ 320(7243), 2000
PMID: 10784551
Income inequality and mortality in metropolitan areas of the United States.
Lynch JW, Kaplan GA, Pamuk ER, Cohen RD, Heck KE, Balfour JL, Yen IH., Am J Public Health 88(7), 1998
PMID: 9663157
Lynch JW, Kaplan GA, Pamuk ER, Cohen RD, Heck KE, Balfour JL, Yen IH., Am J Public Health 88(7), 1998
PMID: 9663157
Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics.
Ross NA, Wolfson MC, Dunn JR, Berthelot JM, Kaplan GA, Lynch JW., BMJ 320(7239), 2000
PMID: 10741994
Ross NA, Wolfson MC, Dunn JR, Berthelot JM, Kaplan GA, Lynch JW., BMJ 320(7239), 2000
PMID: 10741994
Income inequality, individual income, and mortality in Danish adults: analysis of pooled data from two cohort studies.
Osler M, Prescott E, Gronbaek M, Christensen U, Due P, Engholm G., BMJ 324(7328), 2002
PMID: 11777797
Osler M, Prescott E, Gronbaek M, Christensen U, Due P, Engholm G., BMJ 324(7328), 2002
PMID: 11777797
Income inequality and population health: a review and explanation of the evidence.
Wilkinson RG, Pickett KE., Soc Sci Med 62(7), 2005
PMID: 16226363
Wilkinson RG, Pickett KE., Soc Sci Med 62(7), 2005
PMID: 16226363
People, places and coronary heart disease risk factors: a multilevel analysis of the Scottish Heart Health Study archive.
Hart C, Ecob R, Smith GD., Soc Sci Med 45(6), 1997
PMID: 9255922
Hart C, Ecob R, Smith GD., Soc Sci Med 45(6), 1997
PMID: 9255922
A multilevel analysis of income inequality and cardiovascular disease risk factors.
Diez-Roux AV, Link BG, Northridge ME., Soc Sci Med 50(5), 2000
PMID: 10658848
Diez-Roux AV, Link BG, Northridge ME., Soc Sci Med 50(5), 2000
PMID: 10658848
Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study.
Borrell LN, Diez Roux AV, Rose K, Catellier D, Clark BL; Atherosclerosis Risk in Communities Study., Int J Epidemiol 33(2), 2004
PMID: 15082648
Borrell LN, Diez Roux AV, Rose K, Catellier D, Clark BL; Atherosclerosis Risk in Communities Study., Int J Epidemiol 33(2), 2004
PMID: 15082648
Bringing context back into epidemiology: variables and fallacies in multilevel analysis.
Diez-Roux AV., Am J Public Health 88(2), 1998
PMID: 9491010
Diez-Roux AV., Am J Public Health 88(2), 1998
PMID: 9491010
Investigating neighborhood and area effects on health.
Diez Roux AV., Am J Public Health 91(11), 2001
PMID: 11684601
Diez Roux AV., Am J Public Health 91(11), 2001
PMID: 11684601
Understanding Public Health Data
AUTHOR UNKNOWN, 0
AUTHOR UNKNOWN, 0
The German Cardiovascular Prevention Study (GCP): design and methods. GCP Study Group.
AUTHOR UNKNOWN, Eur. Heart J. 9(10), 1988
PMID: 3061818
AUTHOR UNKNOWN, Eur. Heart J. 9(10), 1988
PMID: 3061818
Hoffmeister H, Hütter H, Stolzenberg H, Lopez H, Winkler J., 1992
Is husband's class enough? Class location and class identity in the United States, Sweden, Norway, and Australia
Baxter J., 1994
Baxter J., 1994
Hosmer DW, Lemeshow S., 1989
[Statistical analysis of community-based studies -- presentation and comparison of possible solutions with reference to statistical meta-analytic methods]
Twardella D, Bruckner T, Blettner M., Gesundheitswesen 67(1), 2005
PMID: 15672306
Twardella D, Bruckner T, Blettner M., Gesundheitswesen 67(1), 2005
PMID: 15672306
Mielck A., 2005
Mackenbach J., 2006
AUTHOR UNKNOWN, 2000
Comparison of four composite deprivation indices and two census variables in predicting dental caries in 12-year-old children in Wales.
Morgan MZ, Treasure ET., Community Dent Health 18(2), 2001
PMID: 11461064
Morgan MZ, Treasure ET., Community Dent Health 18(2), 2001
PMID: 11461064
AUTHOR UNKNOWN, 2002
Geographical variation in life expectancy at birth in England and Wales is largely explained by deprivation.
Woods LM, Rachet B, Riga M, Stone N, Shah A, Coleman MP., J Epidemiol Community Health 59(2), 2005
PMID: 15650142
Woods LM, Rachet B, Riga M, Stone N, Shah A, Coleman MP., J Epidemiol Community Health 59(2), 2005
PMID: 15650142
Is income inequality a determinant of population health? Part 1. A systematic review.
Lynch J, Smith GD, Harper S, Hillemeier M, Ross N, Kaplan GA, Wolfson M., Milbank Q 82(1), 2004
PMID: 15016244
Lynch J, Smith GD, Harper S, Hillemeier M, Ross N, Kaplan GA, Wolfson M., Milbank Q 82(1), 2004
PMID: 15016244
Is income inequality a determinant of population health? Part 2. U.S. National and regional trends in income inequality and age- and cause-specific mortality.
Lynch J, Smith GD, Harper S, Hillemeier M., Milbank Q 82(2), 2004
PMID: 15225332
Lynch J, Smith GD, Harper S, Hillemeier M., Milbank Q 82(2), 2004
PMID: 15225332
Wohnquartier und Gesundheit: eine Mehrebenenanalyse
Wolf Ch., 2004
Wolf Ch., 2004
Cohen PN., 0
[The healthy migrant effect: role of selection and late entry bias]
Razum O, Rohrmann S., Gesundheitswesen 64(2), 2002
PMID: 11904847
Razum O, Rohrmann S., Gesundheitswesen 64(2), 2002
PMID: 11904847
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