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Socioeconomic inequalities in adolescent health increase
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Data from a time-series analysis of 34 North American and European countries indicated that from 2002 to 2010, socioeconomic inequality increased within adolescent physical and psychological health.
“Health and health behaviors track strongly from early adolescence to adulthood, and inequalities in health are typically established early in life. Socioeconomic status is a major determinant of these inequalities,” study researcher Frank J. Elgar, PhD, of McGill University in Montreal, and colleagues wrote. “To grow up in impoverished and marginalized socioeconomic conditions shortens the lifespan and contributes to poor mental and physical health. An understanding of trends in health inequalities and their social determinants is crucial so that policy can be developed to redress them.”
Researchers assessed data from the Health Behavior in School-aged Children study, which included cross-sectional surveys conducted across North America and Europe, for 2002, 2006 and 2010. Study participants included 492,788 children aged 11, 13 and 15 years. Children self-reported on socioeconomic status, physical activity, BMI, psychological symptoms (irritability/bad temper, feeling low, feeling nervous, difficulty sleeping) and physical symptoms (headache, stomachache, backache, dizziness). Gross national income per person was determined via two databases.
From 2002 to 2010, average physical activity increased from 3.9 days to 4.08 days per week (P < .0001); as did BMI (P < .0001), physical symptoms (P < .0001) and life satisfaction (P = .0034).
In 2002, weekly physical activity differed by –0.79 days between the most and least affluent groups. This difference increased to –0.83 days in 2010 (P = .0008).
Similarly, differences in average BMI (P < .0001), psychological symptoms (P = .036) and physical symptoms (P = .0018) between the most and least affluent groups increased from 2002 to 2010.
Conversely, differences in life satisfaction between the most and least affluent groups decreased from a difference of –0.98 in 2002 to –0.95 in 2010 (P = .0198).
When adjusting for differences between countries over time, analysis indicated each standard deviation increase in per-person income corresponded to a significant increase in physical activity (P < .0001) and life satisfaction (P < .0001), and a decrease in psychological symptoms (P < .0001).
Per-person income also influenced international differences in physical activity (P < .0001), BMI (P < .0001) and life satisfaction (P < .0001).
“These results … have implications for the social and economic development of nations,” Elgar and colleagues wrote. “Health inequalities in youths shape future inequalities in educational attainment, employment, adult health, and life expectancy, and therefore should be made a focus of health policy and surveillance efforts.”
In an accompanying editorial, researchers from Columbia University echoed this sentiment and suggested that schools have a unique opportunity to assess and improve adolescent health.
“Schools not only provide important opportunities to assess the health of adolescents, as evidenced by the study, but are also important platforms to improve health and prevent [noncommunicable diseases] through health education and services (eg, improvement of diet and exercise, prevention of smoking, and provision of vaccinations),” John S. Santelli, MD, MPH, and colleagues wrote.
“However, the onus to close the gaps in social and health care disparities cannot rest with schools alone, but needs the intersectoral efforts of public health, enlightened political leadership, the economic development sector, empowered communities and youth themselves.” – by Amanda Oldt
Disclosure: The study was funded by the Canadian Institutes of Health Research. The researchers report no relevant financial disclosures.
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