Background: In the context of the Irish economic boom we assessed the health, service utilisation and risk behaviour of homeless people in north Dublin city and compared findings with a 1997 study. Methods: A census of homeless adults in north Dublin city was conducted in 2005 using an adapted interviewer-administered questionnaire from the 1997 study. Results: A total of 363 (70%) of the target population participated. Compared to 1997 the population was younger (81% versus 70% under 45 years, P < 0.01) with a higher proportion of women (39% versus 29%, P < 0.05) and long-term homeless (66% versus 44%, P < 0.001). Drug misuse superseded alcohol as the main addiction with a doubling of the proportion reporting past or current drug use (64% versus 32%, P < 0.001). The prevalence of comparable physical chronic conditions was largely unchanged while depression (51% versus 35%, P < 0.01) and anxiety (42% versus 32%, P < 0.05) had increased. There were high rates of blood-borne infections, such as HIV (6%), hepatitis B (5%) and hepatitis C (36%) in 2005 and dental problems (53%) all of which can be associated with drug use. Access to free healthcare had not increased. Similar proportions reported not having medical cards (40% versus 45% NS). Homeless people continued to have higher usage of secondary care services than the general population. Conclusions: This study shows a changing disease profile among the homeless population consistent with a growing drug using population. It confirms that the homeless population in Dublin in terms of health remain excluded from the benefits of an economic boom despite a government policy aimed at redressing social inclusion.

Background: Large geographical variations in the incidence of disability benefits have been reported, but it is unclear to what extent that is confounded by variations in disability rates and disease pattern in the population and whether local variations in rehabilitation and health insurance practice modify the employment effect of disease. We have studied risk of labour market exclusion following incident hospitalization for ischaemic heart disease (IHD), and whether this risk may be modified by contextual factors on the municipal level. Methods: A cohort design on a 10% random sample of the whole Danish population including individuals aged 43–60 years, (n = 516.454 person-years including 840 cases of IHD). The independent variable was incident hospitalization for IHD and outcome variable was defined as job loss 2 years after the event. Regional-level data included all the 275 Danish municipalities in 1996. Results: There was a strong association between incident IHD and labour market exclusion 2 years later, odds ratio (OR) = 2.8 (95% confidence intervals (CI) 2.4–3.4). Men had less risk of being excluded than women and immigrant status, low-educational attainment and co-morbidity were significantly associated with job loss. Also, regional characteristics did independently effect labour market exclusion. However, the individual relative risk of exclusion following incident IHD was not modified substantially when neither the fixed effects of the regional-level variables nor the random effect of municipality was included in the analyses. Conclusion: Geographical variation in incidence of labour market exclusion following incident disease is not primarily an effect of differential social consequences across municipal variations in labour market and socio-economic conditions.

Background: To estimate the risk of hyperemesis gravidarum (HG) among first generation immigrants to Norway by length of residence. Design: A cross-sectional study. Methods: The sample consisted of first generation immigrants with a prevalence of HG exceeding ethnic Norwegians by 50%, registered in the Medical Birth Registry of Norway (MBRN). The women were born in Turkey, Middle East, North Africa, Other Africa, Iran, Pakistan, India and Sri Lanka and Central and South America, the total sample size is 50 904. MBRN data on HG, age, parity, plurality and sex of the baby were linked to information on country of birth, maternal education and duration of stay obtained from Statistics Norway. Independent associations were studied for each immigrant group and adjusted for potential confounders. To account for dependencies in the sample, a generalized estimating equations (GEE) approach was used. Results: For women from Central and South America, adjusted analysis showed a decrease in the risk of HG by longer residency (P for trend = 0.026). A similar but not significant trend was observed for women born in the Middle East (P for trend = 0.097). Women born in Turkey who had been living in Norway for 6–8 years had a higher risk of HG than newcomers, though no trend was observed (P for trend = 0.127). Women born in Iran and North Africa who lived longer in Norway tended to have a higher risk of developing HG than newcomers (P for trend = 0.083 and 0.118, respectively) Conclusion: Associations between HG and duration of residence in Norway did not show a universal pattern across immigrant groups. Women born in Central and South America had a lower risk of HG with increasing length of residence. Some evidence to the contrary was found for women born in Iran, North Africa and Turkey.

Background: Although lower education has been associated with poorer health, few studies have examined whether lower education affects mortality, incidence, both or neither of cancer and cardiovascular disease. Methods: The authors conducted a population-based prospective cohort study among 39 228 men and women who were aged 40–59 years and lived in four areas in Japan. Information on education and lifestyle variables were obtained by a self-administered questionnaire in 1990. Follow-up until the end of 2002 (for incidence) or 2003 (for mortality) ascertained 2573 and 1251 incident cases of cancer and cardiovascular disease, respectively, and 2430 deaths (1064 from cancer, 548 from cardiovascular disease and 818 from other causes). Results: After adjustment for demographic and lifestyle variables, <10 years of education, as compared with >12 years of education, was associated with significantly higher mortality from all causes [hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.05–1.42] and cardiovascular disease (HR = 1.44, 95% CI: 1.01–2.06), but was not associated with higher incidence of cardiovascular disease (HR = 0.96, 95% CI: 0.78–1.18) or higher mortality or incidence of cancer. Conclusion: The findings suggest that lower education is associated with higher mortality from all causes and cardiovascular disease among the Japanese population that is not totally attributable to lifestyle differences or higher cardiovascular disease incidence.

Background: Previous studies have shown that causes of death differ in their relationship to social class, but we lack a more comprehensive description of this variation. The present study provides a detailed and extensive list of social class differences for a large number of specific causes of death. Methods: All deaths between 1991 and 2003 in Sweden were linked with information on household social class from 1990. Relative death risks and excess mortality in groups of causes according to the European shortlist were estimated separately for men and women in eight classes using Cox Regression. Results: A clear mortality gradient among employees was found for the majority of causes, from low-relative death risks among higher managerial and professional occupations to relatively high risks for the unskilled working class. There is considerable variation in the strength of the association, from causes such as malignant melanoma, breast cancer and transport accidents among women, where no clear class differences were found. At the other extreme, mental and behavioural disorders, endocrine, nutritional and metabolic diseases and diseases of the respiratory system all show steep slopes for both men and women. Circulatory diseases and cancer together account for 15–20% of excess mortality. Conclusions: Exceptions to the general pattern—causes of death in which higher social classes are exposed to greater death risks or in which there is no mortality gradient—are practically non-existent. There is nevertheless significant variation in the strength of the class differences in specific causes.