Previous studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Inequalities in the distribution of behaviour related risk factors are one possible explanation for this trend. In our study, we examined the association between cardiovascular risk factors and neighbourhood characteristics. To assess the consistency of associations the design is cross-national with data from nine industrial towns from the Czech Republic and Germany. We combined datasets from two population based studies, one in Germany ('Heinz Nixdorf Recall (HNR) Study'), and one in the Czech Republic ('Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) Study'). Participation rates were 56% in the HNR and 55% in the HAPIEE study. The subsample for this particular analysis consists of 11,554 men and women from nine German and Czech towns. Census based information on social characteristics of 326 neighbourhoods were collected from local administrative authorities. We used unemployment rate and overcrowding as area-level markers of socioeconomic status (SES). The cardiovascular risk factors obesity, hypertension, smoking and physical inactivity were used as response variables. Regression models were complemented by individual-level social status (education) and relevant covariates. Smoking, obesity and low physical activity were more common in deprived neighbourhoods in Germany, even when personal characteristics including individual education were controlled for. For hypertension associations were weak. In the Czech Republic associations were observed for smoking and physical inactivity, but not for obesity and hypertension when individual-level covariates were adjusted for. The strongest association was found for smoking in both countries: in the fully adjusted model the odds ratio for 'high unemployment rate' was 1.30 [95% CI 1.02–1.66] in the Czech Republic and 1.60 [95% CI 1.29–1.98] in Germany. In this comparative study, the effects of neighbourhood deprivation varied by country and risk factor; the strongest and most consistent effects were found for smoking. Results indicate that area level SES is associated with health related lifestyles, which might be a possible pathway linking social status and cardiovascular disease. Individual-level education had a considerable influence on the association between neighbourhood characteristics and risk factors.

Study objective: To study systematically the separate and combined effects of work stress and socioeconomic position on three measures of health in an unselected working population. Design: Two exposures (high demand/low control (“job strain”); effort–reward imbalance at work) are related to angina pectoris, depression, and poor self-rated health in a cross-sectional study design in which socioeconomic position was measured by occupational position and educational level. Setting: Baseline data of a prospective population-based cohort study in Germany, collected between 2000 and 2003. Participants: 1749 employed or self-employed men and women (36.3% of total sample) aged 45–65 years. Main results: Effort–reward imbalance and job strain were associated with elevated odds ratios of all three health measures, using logistic regression analysis. The prevalence of poorer health was always highest in subgroups defined by high work stress and low socioeconomic position, with respective odds ratios ranging from 2.30 to 2.98 (95% CI 1.38 to 4.52) for self-rated health, 1.70 to 2.24 (95% CI 1.04 to 3.88) for angina and 2.61 to 8.20 (95% CI 1.53 to 14.15) for depression. Conclusion: Although stress at work was related to poorer health in the total study group, the strongest associations were consistently observed in men and women with low educational level or low occupational position. Worksite health promotion should be directed primarily towards these target groups.

Background: Providing a valid and sensitive measure of different domains of cognitive performance in epidemiologic studies of early old-age populations presents a methodological challenge, given the broad range of variability in cognitive functioning in this age group. Objectives: (1) To provide data on the distribution of cognitive performance scores in a representative sample of an early old-age population, and (2) to assess psychometric properties of a short cognitive performance measure developed within the framework of a cohort study. Design: Population-based cohort study. Setting and Participants: As part of the second examination of the Heinz Nixdorf Recall Study, 4,145 participants aged 50–80 years underwent a short cognitive performance assessment composed of 5 subtests with a mean duration of 7.31 min. Additionally, a subsample of 656 participants had a detailed neuropsychological and neurological examination. Methods: Age- and education-specific cognitive performance scores in the total sample were calculated. Based on data from the subsample, concurrent validity was examined by comparing findings with a clinically validated neuropsychological assessment. Results: In the total sample, younger and more highly educated participants had higher scores of cognitive performance. In the subsample, a good accuracy [area under the curve (AUC) = 0.81 (0.74–0.87)] of the short cognitive performance assessment compared with results from a clinically established Alzheimer disease assessment scale and diagnosis of mild cognitive impairment [AUC = 0.82 (0.78–0.82)] was observed. Conclusion: This brief, cognitive performance measure, documenting good psychometric properties, can be useful in future epidemiological investigations exploring different domains and overall cognitive functioning in early old-age populations.

Unemployment and job insecurity have been reported to be associated with a higher risk of depression. The purpose of this study was to evaluate the separate and combined effects of lifetime unemployment experience and job insecurity on the incidence of depression in an unselected working population in Germany. Data from the German Socio-Economic Panel (GSOEP) study were used, as was a final sample of those currently employed, with complete data at baseline (2009) and follow-up (2011) restricted to those free of depression in 2009 (n = 7073). Poisson regression analysis was applied to test the prospective associations between unemployment, job insecurity, and a two-year incident of depression. Results showed that the experience of unemployment and perceived job insecurity were significantly associated with a higher risk of depression during the two-year follow-up (risk ratios 1.64; 95% confidence intervals (1.16, 2.31) and risk ratios 1.48; 95% confidence intervals (1.13, 1.92), respectively). Notably, the strongest risk was observed among participants with insecure jobs and past long-term unemployment (risk ratios 2.15; 95% confidence intervals (1.32; 3.52)). In conclusion, even during employment, the experience of lifetime unemployment led to a higher risk of depression. The combination of previous unemployment experience and anticipated job insecurity increased the risk of developing depression. Results support health promotion with special emphasis on unemployment and precarious working conditions.