Educational differences in mobility: the contribution of physical workload, obesity, smoking and chronic conditions.
BACKGROUND
In earlier studies, determinants of socioeconomic gradient in mobility have not been measured comprehensively.


OBJECTIVE
To assess the contribution of chronic morbidity, obesity, smoking and physical workload to inequalities in mobility.


METHODS
This was a cross-sectional study on 2572 persons (76% of a nationally representative sample of the Finnish population aged > or = 55 years). Mobility limitations were measured by self-reports and performance rates.


RESULTS
According to a wide array of self-reported and test-based indicators, persons with a lower level of education showed more mobility limitations than those with a higher level. The age-adjusted ORs for limitations in stair climbing were threefold in the lowest-educational category compared with the highest one (OR 3.3 in men and 2.9 in women for self-reported limitations, and 3.5 in men and 2.2 in women for test-based limitations). When obesity, smoking, work-related physical loading and clinically diagnosed chronic diseases were simultaneously accounted for, the educational differences in stair-climbing limitations vanished or were greatly diminished. In women, obesity contributed most to the differences, followed by a history of physically strenuous work, knee and hip osteoarthritis and cardiovascular diseases. In men, diabetes, work-related physical loading, musculoskeletal diseases, obesity and smoking contributed substantially to the inequalities.


CONCLUSIONS
Great educational inequalities exist in various measures of mobility. Common chronic diseases, obesity, smoking and workload appeared to be the main pathways from low education to mobility limitations. General health promotion using methods that also yield good results in the lowest-educational groups is thus a good strategy to reduce the disparities in mobility.
Sainio
Päivi
P
National Public Health Institute, Department of Health and Functional Capacity, Mannerheimintie 166, 00300 Helsinki, Finland. paivi.sainio@ktl.fi
Martelin
Tuija
T
Koskinen
Seppo
S
Heliövaara
Markku
M
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000523:psychology; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D004522:Educational Status; D019317:Evidence-Based Medicine; D005260:Female; D005387:Finland; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology* / Q000523:psychology; D009765:Obesity / Q000150:complications* / Q000523:psychology; D010003:Osteoarthritis / Q000150:complications / Q000523:psychology; D012907:Smoking / Q000009:adverse effects*; D012923:Social Class; D016526:Workload