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Background In rich countries, smokers, active or passive, often belong to disadvantaged groups. Less is known of tobacco patterns in the developing world. Hence, we seek out to investigate mental and physical health consequences of smoke exposure as well as tobacco-related inequality in transitional middle-income Thailand. Methods We studied a nationwide cohort of 87,151 middle-aged and older adults that we have been following for eight years (2005–2013) for emerging chronic diseases. Logistic regression was used to identify attributes associated with passive smoke exposure. Longitudinal associations between smoke exposure and wellbeing (SF-8) or psychological distress (Kessler 6) were investigated with multiple linear regression or multivariate logistic regression analysis. Results A high proportion of cohort members, especially females, were passive smokers at home and at public transport stations; males were more exposed at workplace and recreational places. We observed a social gradient with more passive smoking in poorer people. We also observed a dose response relationship linking graded smoke exposures (current, former, passive, non-exposed) to less wellbeing and more psychological distress (p-trend

Background: The burden of chronic disease continues to rise as populations age. There is relatively little published on the socioeconomic distribution of this burden in older people. This study quantifies absolute and relative income-related inequalities in prevalence of chronic diseases, severe physical functioning limitation and high psychological distress in mid-age and older people in Australia. Methods: Cross-sectional study of 208,450 participants in the 45 and Up Study, a population-based cohort of men and women aged 45–106 years from New South Wales, Australia. Chronic conditions included self-reported heart disease, diabetes, Parkinson’s disease, cancer and osteoarthritis; physical functioning limitation (severe/not) was measured using Medical Outcomes Study measures and psychological distress (high/not) using the Kessler Psychological Distress Scale. For each outcome, prevalence was estimated in relation to annual household income (6 categories). Prevalence differences (PDs) and ratios (PRs) were generated, comparing the lowest income category (

Background Few studies have examined the link between self-reported health (SRH) and subsequent mortality in developing countries, and very few considered mortality effects of changes in SRH. We examined the relationship between SRH and subsequent all cause or cause-specific mortality in Thailand. We also noted if mortality varied after people changed their SRH. Methods We used longitudinal data including SRH from a nationwide Thai Cohort Study (baseline 2005 - follow-up 2009) and linked to official death records (2005–2012). Cox regression examined the association between SRH in 2005 and subsequent all-cause mortality or cause-specific mortality, with results given as confounder-adjusted hazard ratios (HR). We further assessed association between changes in SRH during 2005–2009 and mortality from 2009 to 2012. Results Poor SRH at baseline independently relates strongly with subsequent cardiovascular disease (CVD) mortality (HR = 2.8, CI: 1.3-5.9) and “other” causes of death (HR = 1.9, CI: 1.1-3.3) but moderately with cancer mortality (HR = 1.4, CI: 0.7-3.0). SRH did not exhibit a relationship with injury mortality (HR = 1.0, CI: 0.5-2.1). Worsening SRH from 2005 to 2009 associated with increased mortality in 2009–2012 for females but not for males. Conclusions In Thailand, SRH is a good predictor of population mortality due to internal causes (e.g. CVD). SRH is holistic, simple to measure and low cost; when repeated it measures dynamic health status. In many developing countries chronic diseases are emerging and morbidity information is limited. SRH could help monitor such transitions in burdens and trends of population health.

Background Caregivers constitute an important informal workforce, often undervalued, facing challenges to maintain their caring role, health and wellbeing. Little is known about caregivers in middle-income countries like Thailand. This study investigates the physical and mental health of Thai adult caregivers. Methods This report derives from distance-learning students working and residing throughout Thailand and recruited for a health-risk transition study in 2005 (N=87,134) from Sukhothai Thammathirat Open University. The cohort follow-up questionnaire in 2009 (N = 60,569) includes questions on caregiver status which were not available in 2005; accordingly, this study is confined to analysis of the 2009 data. We report cross-sectional associations between caregiver status and health. Results Among the study participants in 2009, 27.5% reported being part-time caregivers and 6.6% reported being full-time caregivers. Compared to male non-caregivers, being a part-time or full-time male caregiver was associated with lower back pain (covariate-Adjusted Odds Ratios, AOR 1.36 and 1.67), with poor psychological health (AOR 1.16 and 1.68), but not with poor self-assessed health. Compared to female non-caregivers, being a part- or full-time female caregiver was associated with lower back pain (AOR 1.47 and 1.84), psychological distress (AOR 1.32 and 1.52), and poor self-assessed health (AOR 1.21 and 1.34). Conclusions Adult caregivers in Thailand experienced a consistent adverse physical and mental health burden. A dose–response effect was evident, with odds ratios higher for full-time caregivers than for part-time, and non-caregivers. Our findings should raise awareness of caregivers, their unmet needs, and support required in Thailand and other similar middle-income countries.