Background: Three different conceptualizations of occupational prestige were contrasted by applying social stratification to four exemplarily selected psychoactive substances. Although these conceptualizations partly measure the same construct, it is hypothesized that the gradient of occupational inequality differs depending on the type of conceptualization. Method: Data were taken from the 2012 German Epidemiological Survey of Substance Abuse. The study sample comprised n ¼ 9084 individuals of the general population aged 18-64 years. Use and heavy use of cigarettes, alcohol, cannabis and analgesics were stratified by (a) employment status (six groups: employed, marginally employed, apprenticeship, unemployed, retired and other), (b) occupational status (five groups: low to high) and (c) occupational social class (two groups: blue-collar and white-collar). Absolute and relative differences between occupational groups were calculated. All analyses were stratified by gender. Results: Risk for smoking was increased amongst unemployed males and blue-collar workers. Retired persons, people with low occupational status and female blue-collar workers had a diminished risk for alcohol consumption; apprentices had an increased risk. Amongst males, low occupational status and blue-collar work was associated with episodic heavy drinking. Unemployment and blue-collar work was related to cannabis use. Risk for heavy analgesics use was increased amongst unemployed women, men with low occupational status and male blue-collar workers, respectively. Conclusions: The results suggest that occupational inequality differs depending on the applied conceptualizations of occupational prestige. Consequently, they should not be used interchangeably. ARTICLE HISTORY

It has been shown that socio-economic status (SES) and health are closely linked to one another. Now we focus on further questions, and one of the most important ones is whether these "health inequalities" increase with time. In Germany, there is little discussion about this question and no review summarising the empirical evidence is available.This review focuses on 4 dimensions: time trends of health inequalities concerning mortality (or, respectively, life expectancy), self-rated health, smoking and obesity. First we included all empirical analyses from Germany, and all analyses from other European countries published between 2008 and 2012. Then, step-wise, 44 studies (including 5 from Germany) were selected by predefined criteria for a detailed -description of empirical results and methods.The number of publications has strong-ly increased in recent years, illustrating the growing interest in time trends of health inequalities. The empirical results of the 44 studies could be summarised in the following way: All in all, 184 empirical results are reported about time trends in health inequalities and 112 of them show increasing inequalities; decreasing inequalities are shown in 13 reports. The studies from Germany point in the same direction (i. e., most results indicate increasing health inequalities). It is also important to stress that there is great -heterogeneity concerning the methodical approaches. Some studies analyse health inequalities by individual socio-economic status (e. g., educational level), others by regional deprivation. Sometimes changes in the extent of health inequalities over time are not calculated explicitly. Some papers do not include absolute and relative measures of inequalities, but just one of them.In Germany, there is a need for more empirical studies looking at time trends of health inequalities; the available datasets should be used more often for this type of analysis. If possible, further studies should include individual SES and regional deprivation, measures of absolute and relative inequality (stratified by sex, with significance tests for time trend), and they should cover as many points in time as possible. Also, it would be important to relate the chang-es in health inequalities to the other changes in the society.

No abstract

The analyses focused on time trends in health inequalities in the 25 to 64-year-old population of Augsburg. The analyses are based on four independent cross-sectional surveys from the MONICA/KORA study covering 15 years: 1984/1985 (n = 4,022), 1989/1990 (n = 3,966), 1994/1995 (n = 3,916) and 1999/2000 (n = 3,492). Socioeconomic status (SES) was assessed by educational level and per capita household income with separate analyses for each of these two variables. Both absolute and relative health inequalities were calculated. The results showed that inequalities in self-rated health did not change very much (with some indications for increasing inequalities). However, concerning smoking the results clearly pointed towards increasing health inequalities (for example concerning relative inequalities among women by educational level: significant increase from survey to survey of about 20 %). The prevalence of obesity was increased in all SES groups but the inequalities did not change very much. These time trends show that the efforts aimed at reducing health inequalities should be intensified.