(HEA1a) Sociology of Medicine, Health, and Illness I: Social Inequalities in Health

This session focuses on the theoretical, methodological, and empirical issues pertaining to the sociology of health and health care. Papers explore health inequities, individuals’ experiences of illness and/or interactions with health care services, intersections between work and health, health care professions, and organization of the health care system. Tags: Equality and Inequality, Health and Care, Policy

Organizers: Elena Neiterman, University of Waterloo, Michael Halpin, Dalhousie University; Chair: Marit Solbjør, Norwegian University of Science and Technology

Presentations

Anders Holm, Western University

Some evidence on the effectiveness of universal health care Medicare, socio-economic status, and self-reported health in Canada

Canada’s Medicare system is a universal health care system (UHC) with the explicit goal to improve overall health and reduce differences in health related to socio-economic status (SES). Using a natural experiment research design, we explore the extent to which these objectives have been achieved. Linear probability models are fitted to data from two waves of the General Social Survey of Canada. Accounting for general changes over time, we assess the relationship between years of exposure to Medicare and the self-reported health of Canadians born between 1922 and 1972. Medicare has had a positive, though modest, impact on self-reported health. It has not decreased socio-economic differences in health, however. In fact, exposure to Medicare is associated with a widening difference in self-reported health between those with a university degree and those without one. We argue that this growing difference reflects social and cultural capital factors.

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Non-presenting authors: Robert Andersen, Western University; Kamma Andersen, Western University; Anders hjort-trolle, Rockwool foundation

Jalal Uddin, Dalhousie University

Impact of childhood adversity on cardiovascular disease among middle-aged and older Canadians: Differential protective role of social support across sex and nativity statuses

It is now well established that childhood toxic stress is associated with morbidity and mortality decades later. Research has also demonstrated differential exposure to and impact of adverse childhood experiences (ACE) for different population groups. Although research to date has clearly outlined the causal effects of ACE on adult health outcomes, fewer studies have explicitly examined how resilience resources in adult life may guard against childhood stressors that impact cardiovascular disease risk. This study examines the associations of ACEs with cardiovascular disease among middle-aged and older Canadians. Further, we examine how social support availability buffers against childhood stressors in shaping the risk of cardiovascular disease (CVD) and test whether the buffering process differs by sex and nativity status. Guided by the sociological framework of the stress process, we hypothesize that protective resources, such as social support, buffer ACE’s harmful impacts on CVD risk, and social stratification factors, such as sex and nativity, may modify the buffering process. This is a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA). The CLSA is a nationally representative prospective longitudinal study that collects psychosocial, clinical, and biomarker data from a cohort of approximately 50,000 individuals aged 45 or above. The current analysis is based on an analytic sample of 32,688 participants aged 45-89 from the baseline (2011-2015). The outcome is a binary measure of any CVD event self-reported in the baseline tracking and comprehensive cohorts of the CLSA. The exposure is the number of ACEs experienced in childhood. The ACE module consists of retrospectively reported 14 items on household dysfunctions, economic hardship, and physical and emotional abuse. Perceived social support is measured using the 19-item Medical Outcomes Study (MOS) questionnaire. The analysis uses logistic regression to estimate ACEs’ associations with CVD in sequentially adjusted models controlling for sociodemographic (e.g., age, sex, marital status, nativity, education, income, and home ownership), CVD risk factors (e.g., smoking, alcohol drinking, physical exercise, and BMI), and perceived social support. The analysis examined whether ACEs’ effect on CVD risk differs by social support, sex, and nativity status by employing statistical interactions. Overall, 13% of participants reported any CVD. The prevalence of CVD was higher among males (14.5%) versus females (10.7%) and slightly higher among those born in Canada (12.6%) versus foreign-born participants (11.9%). We found a consistent association of ACE categories with any CVD outcome. Across models with sequential adjustment of covariates, participants with a higher number of ACEs were more likely to have any CVD. The magnitude of the association of 3 or more ACEs with any CVD was higher in males (Odds ratio: 1.43, CI: 1.08-1.89) than in females (Odds ratio: 1.24, CI: 0.94-1.63) and among participants born in Canada (Odds ratio: 1.33, CI: 1.08-1.66) than those were foreign-born (Odds ratio: 1.29, CI: 0.80-2.08). Further, we observed significant effect modification by perceived social support, broadly suggesting buffering of the harmful associations of ACEs with CVD outcome at higher social support scores. The buffering processes of social support further differ by sex and nativity categories, suggesting a stronger protective role of social support for females and foreign-born participants. This study finds differential associations of ACE with CVD outcomes among population subgroups in a nationally representative sample of middle-aged and older Canadians. Social support strongly buffers the impact of ACE on CVD risk and may differ for males and females and by nativity status. Our findings have policy implications for investing in social interventions that help develop nurturing, resilient, and protective communities in Canada.

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Non-presenting authors: Emran Hasan, School of Health Administration, Dalhousie University; Mario Ulises Pérez-Zepeda, Dalhousie University; Melissa Andrew, Dalhousie University; Susan Kirkland, Dalhousie University

Jiaxin Gu, University of British Columbia; Qiang Fu, University of British Columbia

Estimating Four Decades of Adolescent Binge Drinking in the US: A Modified Poisson Approach

Despite the decades-long fight against underage drinking on federal and state levels, adolescent binge drinking remains a serious public health and safety concern in the United States. Youth that indulge in alcoholism are more likely to exhibit low academic achievement, long-term physical and emotional impairments, potential cognitive deficits, increasing risks of suicide ideation and attempts, risky behaviors, and other substance abuse during adolescence and early adulthood. Underage drinking also has collateral damages, such as alcohol-related traffic crashes and fatalities of passengers and pedestrians. As by far the most popular psychoactive substance across all ages in the United States, alcohol has been widely consumed by adolescents despite the country’s minimum legal drinking age of 21 years old. Existing institutional efforts to combat with underage drinking include the implementation of the Minimum Legal Drinking Age (MLDA) law in the 1980s and the more recent Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking in 2007. These legislative and administrative efforts, together with intervention and prevention programs, may have strengthened public awareness of adolescent binge drinking and curbed alcohol use among American adolescents. For example, 28.4% of individuals aged 18 reported having at least one alcoholic beverage in the past 30 days in 2022, compared to 72.1% in 1978. Also, their prevalence of daily alcohol use in the past 30 days dropped from 5.7% in 1978 to 1.5% in 2022. Yet, key methodological and conceptual issues remain when analyzing adolescent binge drinking. Given the sensitive nature of substance use and recall bias, existing surveys such as the MTF study, the Youth Risk Behavior Surveillance System, the National Longitudinal Study of Adolescent to Adult Health, and Canadian Health Survey on Children and Youth often use grouped and right-censored counts (GRC) to measure frequencies of adolescent risky behaviors. Due to the lack of statistical tools for analyzing GRC counts, researchers previously treated those counts as categories so that they can be analyzed using multinomial or ordered logistic regression, which resulted in a serious loss of information contained in GRC counts. Meanwhile, adolescent drinking behaviors are often unevenly distributed across socio-demographic groups. It is therefore conceptually important to distinguish between those who are at risk of binge drinking and those who are not, and also distinguish between the overall incidence and incidence of those at risk of binge drinking. By compiling 47 waves of national representative data from the Monitoring the Future (MTF) study, we analyzed two types of adolescent problematic drinking behaviors, past-two-week excessive drinking and past-month drunkenness, using the modified Poisson (mixture) approach to grouped and right-censored counts (GRC). Our results show that the overall decrease in incidence rates was attributable to substantial reductions in the risks of excessive drinking (45.99% in 1980 and 10.47% in 2021) and drunkenness (34.92% in 1998 and 13.14% in 2021). However, at-risk adolescents only showed mild reductions in incidence rates in the last four decades. Being female, Black, attending schools in the South or West, having better academic performance, and growing up in intact families significantly protected adolescents against binge drinking. Adolescent binge drinking followed a very gendered pattern, where male adolescents constantly experienced higher risks and drank more heavily than their female peers once at risk. Gender disparities narrowed with time in overall incidence and risks for both binge drinking behaviors and converged for excessive drinking in the more recent years (specifically later stages of the COVID-19 pandemic). We, therefore, suggested that the modified Poisson approach is a necessary and useful tool to separate incidence, risk, and at-risk incidence in epidemiological studies with GRC counts. The alarming high incidence rates of at-risk adolescents, especially those male binge drinkers, warrant further investigation.

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Non-presenting authors: Minheng Chen, University of British Columbia; Xin Guo, The University of Queensland