title: Socio-economic inequality in multiple health complaints among adolescents: international comparative study in 37 countries.
abstract: OBJECTIVE
  To use comparable data from many countries to examine 1) socio-economic inequality in multiple health complaints among adolescents, 2) whether the countries' absolute wealth and economic inequality was associated with symptom load among adolescents, and 3) whether the countries' absolute wealth and economic inequality explained part of the individual level socio-economic variation in health complaints.
  
  
  METHODS
  The Health Behaviour in School-aged Children (HBSC) international study from 2005/06 provided data on 204,534 11-, 13- and 15-year old students from nationally random samples of schools in 37 countries in Europe and North America. The outcome measure was prevalence of at least two daily health complaints, measured by the HBSC Symptom Check List. We included three independent variables at the individual level (sex, age group, family affluence measured by the Family Affluence Scale FAS) and two macro level measures on the country's economic situation: wealth measured by Gross National Product (GNP) and distribution of income measured by the Gini coefficient.
  
  
  RESULTS
  There was a significant socio-economic variation in health complaints in 31 of the 37 countries. The overall OR (95 % CI) for 2+ daily health complaints for all countries was 1.31 (1.27-1.36) in the medium versus high FAS group and 2.07 (2.00-2.14) in the low versus high FAS group. This socio-economic gradient in health complaints attenuated somewhat in the multilevel models which included macro level data. There was no association between GNP and health complaints. The OR for high symptom load was 1.35 (1.08-1.69) per 10 % increase in Gini coefficient. The socio-economic gradient in health complaints at the individual level was somewhat attenuated in the multilevel models which included macro level data.
  
  
  CONCLUSIONS
  There was a significant association between low FAS and high level of health complaints in 30 of 37 countries. Health complaints increased significantly by increasing income inequality in the country.
authors.affiliation: Department of Public Health, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark. holstein@socmed.ku.dk
authors.forename: Bjørn E
authors.initials: BE
authors.lastname: Holstein
authors.forename: Candace
authors.initials: C
authors.lastname: Currie
authors.forename: Will
authors.initials: W
authors.lastname: Boyce
authors.forename: Mogens T
authors.initials: MT
authors.lastname: Damsgaard
authors.forename: Inese
authors.initials: I
authors.lastname: Gobina
authors.forename: Gyöngyi
authors.initials: G
authors.lastname: Kökönyei
authors.forename: Jørn
authors.initials: J
authors.lastname: Hetland
authors.forename: Margaretha
authors.initials: M
authors.lastname: de Looze
authors.forename: Matthias
authors.initials: M
authors.lastname: Richter
authors.forename: Pernille
authors.initials: P
authors.lastname: Due
mesh_terms: D000293:Adolescent; D002648:Child; D005060:Europe; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D038622:Internationality; D008297:Male; D009656:North America; D012923:Social Class