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PubMed1995

Higher rates of SIDS persist in low income groups.

OBJECTIVE: To examine how changes in the rates of sudden infant death syndrome (SIDS) have varied in different income groups during a 25 year period. METHODOLOGY: Census data were obtained for five census periods (1971, 1976, 1981, 1986 and 1991) on the number of SIDS cases and inevitable deaths. Census area units (CAU) were ranked according to the average income earned by adults over the age of 15 years for each census year. The CAU were then divided into three equal income groups: low, middle and high. RESULTS: The rates of SIDS differed significantly between the three income groups for the 1991 census period with the low income SIDS rate being 4.6/1000 births compared to 1.2/1000 live births for the higher income groups (Chi-squared = 18.3, P < 0.0001). There was no association between rates of inevitable deaths and income groups. CONCLUSION: Currently, low income groups have three times the rate of SIDS compared to those in higher income groups. The reason for this is probably because the disadvantaged groups carry an overall higher burden of risk factors for SIDS. This must be kept in mind as further SIDS educational programmes are developed and implemented.

Adult↗

PubMed1995

Demographics of cardiac arrest: association with residence in a low-income area.

OBJECTIVE: To report cardiac arrest demographics and assess whether arrest rate is associated with differences in intracity regional population densities, incomes, or race distributions. METHODS: One-year retrospective review of out-of-hospital cardiac arrests in a city with a two-tier emergency medical service (EMS) system. Associations of population density, median income, and race data with age- and gender-adjusted cardiac arrest rates for seven city regions and groupings of high- and low-income census tracts were made. RESULTS: Median income, but not race or population density, was associated with sex- and age-adjusted intracity regional cardiac arrest rates (p = 0.034). This association of cardiac arrest rate with income status was magnified when the 20 lowest and the 20 highest income census tracts were compared. Cardiac arrest victims in these two income groups did not differ in regard to rate of witnessed arrest, bystander-administered CPR, or previous cardiac disease. Rates of survival to hospital discharge were not significantly different between the two groups. CONCLUSION: The association of lower income with cardiac arrest suggests that cardiac health promotion and EMS intervention measures, including CPR instruction, should be targeted to lower-income neighborhoods. These findings may help explain previous studies suggesting a racial or population density association with cardiac arrest rates.

Cardiopulmonary Resuscitation↗

PubMed1998

Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis.

OBJECTIVE: To determine the effect of inequalities in income within a state on self rated health status while controlling for individual characteristics such as socioeconomic status. DESIGN: Cross sectional multilevel study. Data were collected on income distribution in each of the 50 states in the United States. The Gini coefficient was used to measure statewide inequalities in income. Random probability samples of individuals in each state were collected by the 1993 and 1994 behavioural risk factor surveillance system, a random digit telephone survey. The survey collects information on an individual's income, education, self rated health and other health risk factors. SETTING: All 50 states. SUBJECTS: Civilian, non-institutionalised (that is, non-incarcerated and non-hospitalised) US residents aged 18 years or older. MAIN OUTCOME MEASURE: Self rated health status. RESULTS: When personal characteristics and household income were controlled for, individuals living in states with the greatest inequalities in income were 30% more likely to report their health as fair or poor than individuals living in states with the smallest inequalities in income. CONCLUSIONS: Inequality in the distribution of income was associated with an adverse impact on health independent of the effect of household income.

Adolescent↗

PubMed2002

Influence of family income on hospital visits for asthma among Canadian school children.

BACKGROUND: A study was undertaken to investigate the mechanisms by which socioeconomic status may influence asthma morbidity in Canada. METHODS: A total of 2968 schoolchildren aged 5-19 years with reported asthma were divided into three family income ranges. Hospital visits and risk factors for asthma, ascertained by questionnaire, were compared between the three groups. RESULTS: The mean (SE) annual period prevalence of a hospital visit was 25.0 (3.1)% among schoolchildren with household incomes of less than $20 000 Canadian compared with 16.0 (1.3)% among those with incomes of more than $60 000 (p<0.05). Students with asthma from lower income households were more likely to be younger and exposed to environmental tobacco smoke and cats, and their parents were more likely to have a lower educational attainment and be unmarried (p<0.05). Across all income groups, younger age, lower parental education, having unmarried parents, and regular exposure to environmental tobacco smoke were each associated with an increase in risk of a hospital visit (p<0.05). No increased risk was detected due to sex, having pets, and not taking dust control measures. Although not statistically significant at p<0.05, there may have been an interactive effect between income and susceptibility to environmental tobacco smoke. In the lower income group those children who were regularly exposed to second hand smoke had a 79% higher risk of a hospital visit compared with a 45% higher risk in the higher income group. In a logistic regression model the association between income and hospital visit was no longer significant after adjusting for differences in reported exposure to passive smoking. CONCLUSION: Socially disadvantaged Canadian schoolchildren have increased asthma morbidity. Exposure to cigarette smoke appears to be one important explanation for this observation.

Adolescent↗

PubMed2001

Income inequality and the prevalence of common mental disorders in Britain.

BACKGROUND: It has been hypothesised that the association between greater income inequality and increased mortality is mediated by poor psychosocial health. AIMS: To test the hypothesis that individuals in regions of Britain with the highest income inequality have a higher prevalence of the common mental disorders, after adjusting for individual income. METHOD: Cross-sectional survey of 8191 adults aged 16-75 in private households in England, Wales and Scotland. The prevalence of common mental disorders was assessed using the General Health Questionnaire. RESULTS: The association between income inequality and prevalence of the common mental disorders varied with individual income level. Among persons with the highest incomes, common mental disorders were more frequent in regions with greater income inequality (as indicated by high Gini coefficient) (adjusted OR 1.31,95% C1 1.05-1.65; P: = 0.02). The opposite was true for those with the lowest incomes. CONCLUSIONS: Income inequality was associated with worse mental health among the most affluent individuals.

Adolescent↗

PubMed1991

Income, race, and surgery in Maryland.

BACKGROUND: We describe common surgical and medical hospital admission rates for Maryland residents, exploring systematic effects of race and income. METHODS: The data comprise Maryland hospital discharges and population estimates for 1985 to 1987. Patient income is the race-specific median family income of residence zip code. Logistic regression is used to measure incidence by race, income, and residence for surgical and medical reasons for admission. RESULTS: Population rates for discretionary orthopedic, vascular, and laryngologic surgery tend to increase with community income levels. Coronary and carotid artery surgery rates are two to three times higher among Whites. The more discretionary the procedure, the lower is the relative incidence among Blacks. By contrast, admission rates for most medical reasons decline with increasing income levels and are elevated among Blacks. The affluent receive coronary artery procedures whereas the poor are hospitalized for coronary artery disease. CONCLUSIONS: Blacks and the poor appear to have higher illness burdens requiring hospital care. Discretionary surgeries have a White predominance and increase with income; medical admissions have a Black predominance and decline with income. Race and community income level are important factors in differential hospital utilization rates.

Adult↗

PubMed2001

Impact of diabetes on employment and income in Manitoba, Canada.

OBJECTIVE: To compare employment and income of working-age (18-64 years) people with and without diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective population-based cohort study based in Manitoba, Canada, consisting of 25,554 individuals without diabetes and 608 with diabetes, of whom 242 had a complication of the disease. Adjusted odds ratios (ORs) of employment and income variables were determined. RESULTS: Diabetic individuals with complications were twice as likely not to be in the labor force (OR 2.07 [95% CI 1.49-2.87]) than nondiabetic individuals. This difference was not evident for diabetic individuals without complications (OR 1.20 [0.93-1.56]). Diabetic individuals without complications had incomes similar to those of nondiabetic individuals. The total income of diabetic individuals with complications was 72% of the income of nondiabetic individuals. When the analysis was limited to only those in the labor force, diabetic workers with complications still had only 85% the employment income of nondiabetic people. Diabetic individuals with complications received 58% more social support income. In a separate analysis of aboriginal individuals, complicated diabetes was not associated with an increased likelihood of not working or a decrease in employment income. CONCLUSIONS: In general, complications of diabetes and the absence of the disease affect the ability to earn income in Manitoba, Canada. This effect was not identified in the aboriginal population of the province.

Adult↗

PubMed1998

Optimization of sire selection based on maximization of guaranteed income and risk associated with sire merit.

A method based on discounted income and risk assessment was developed to aid in the selection of dairy sires. The discounted profit generated from milk production of daughters was proposed as the suitable composite selection criterion to combine estimates of predicted transmitting ability (PTA) for yields of milk, fat, and protein and estimates of sire evaluations for dystocia or expected progeny difference. Steps are described to derive discounted profit (defined as expected income) for a sire with known PTA and evaluation for dystocia. The derivation of profit considered costs for semen, dystocia, heifer raising, production and maintenance of the daughter, and income from milk. Variance of income from a sire depended on the reliability of his PTA and evaluation for dystocia. Total variance from a selected set of sires was defined as the risk. A quadratic programming procedure was developed to identify the best set of sires from a given pool of sires that met a desired expected income goal with minimum risk. Combinations of sires with minimum risk for all possible levels of expected income were defined by the expected income variance frontier. The set of sires at the maximum lower boundary for 95% confidence of the expected income variance frontier was defined as the optimum set of sires to be selected; the optimum set maximized the 95% guaranteed expected income. The quadratic programming procedure provided the optimum percentage of cows to be mated to each sire in the selected set.

Animals↗

PubMed2000

Area income as a predictor of preventable hospitalizations in the Harris County Hospital District, Houston.

This study assesses whether geographical area income based on census data is a good predictor of preventable (or ambulatory care-sensitive) hospitalizations in a large public hospital system in Texas, and how area income correlates with the socioeconomic status reported by patients. Documenting a correspondence between area and individual-level income, as well as meaningful variation in rates of avoidable hospitalizations across subgroups and areas with varying concentrations of low-income persons, points to the validity and utility of this approach for monitoring how well public hospital systems in Texas address the needs of those they most directly serve. Area income may not fully reflect the disproportionately lower socioeconomic status of patients seen in the public hospital system. Nonetheless, living in lower-income zip codes was associated with higher preventable hospitalization rates for the predominantly low-income population served by the public hospital system. A tenfold difference found in the adjusted rates of hospitalizations for preventable conditions compared with control (or marker) conditions among persons living in low-income areas signals the likelihood of substantial unmet needs in this population. Small-area analysis and related comparisons of rates of preventable hospitalizations in high- and low-income areas provide useful indicators for monitoring and assessing the performance of public hospital systems in Texas.

Ambulatory Care↗

PubMed2005

Household income and earnings losses among 6,396 persons with rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) causes disability and reduced productivity. There are no large quantitative studies of earnings and productivity losses in patients with clinical RA, and no studies of household income losses. We describe methods for obtaining earnings and household income losses that are applicable to working as well as nonworking RA patients, and we perform such studies using these methods. METHODS: We estimated cross-sectional expected annual earnings and household income losses in 6,649 persons with RA from Current Populations Survey (CPS) and O*NET (Occupational Information Network) data, and we estimated expected household income and earnings losses based on demographic characteristics after adjustment to Medical Outcomes Study Short-Form 36 (SF-36) population norms (internal method). Workplace productivity was measured by the Work Limitations Questionnaire (WLQ). RESULTS: 27.9% of patients aged < or = 65 years considered themselves disabled after 14.6 years of RA, and 8.8% received disability benefits. Annual earnings losses ranged between USD 2,319 and USD 3,407 by the CPS and internal method (preferred), with losses of 9.3% and 10.9%. A 0.25 difference in Health Assessment Questionnaire (HAQ) score was associated with a $1,095 difference in annual earnings. Productivity losses were 6% based on work limitations identified by the WLQ. Household income loss (percentage loss) including transfer payments was USD 6,287 (11.8%) for all patients, USD 4,247 (6.9%) for employed patients, and USD 7,374 (14.8%) for nonworking patients. Among nonworking nondisabled patients aged < or = 65 years, income loss was 14.1%. CONCLUSION: As measured by annual household income loss, the overall impact of RA is USD 6,287 (11.8%). Earnings and household income are dependent on functional status, education, age, ethnicity, and marital status. Income loss is predicted by the HAQ, HAQ-II, Modified HAQ, and SF-36.

Aged↗

PubMed2005

Quality of life after successful epilepsy surgery: evaluation by occupational achievement and income acquisition.

OBJECTIVES: A comprehensive epilepsy surgery program has been developed at Chulalongkorn University Hospital, Thailand to reach an international standard level, rendering patients good surgical outcomes comparable to developed countries. After successful operation, seizure free patients have become independent, self earning or employed. However, quality of life (QOL) in terms of occupational achievement and income acquisition after epilepsy surgery has never been studied. These indicators reflect the ultimate QOL in the aspects of actual independency, intact brain functions, mental health and psycho-social interactions. The authors therefore conduct the study on improvement of QOL after successful epilepsy surgery using these parameters. MATERIAL AND METHOD: One hundred and eleven intractable epilepsy who have become seizure free to worthwhile improved (Engel class I to III) after standard presurgical evaluation and epilepsy surgery from January 2002 to December 2004 were evaluated. The patients were followed up for 3 years. The occupational status and incomes were categorized according to the ranking of the patients' functioning levels. The pre and post surgery work abilities, employment and incomes were interviewed and compared. Mc Nemar test and paired t-test were used for statistical analyses. RESULTS: The average age of the 111 adults (54 males and 57 females) was 33.7 +/- 9.2 years. Eighty two percent of the patients had temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and underwent standard anterior temporal lobectomy. The rest had tumors, cortical dysplasia or scar and received lesionectomy or cortical resection assisted by intra-operative or intra-cranial EEG. The overall seizure free rate is 83.8%. The occupational status of the subjects was shown to improve significantly after surgery from unemployed to higher categories of professional achievement (p < 0.001). The number of unemployed and no income individuals decreased from 66 to 25 cases (62.1% reduction rate) after surgery (p < 0. 001). Reciprocally, the number of persons who achieved professional jobs with regular incomes or salaries increase from 30 to 53 cases (43.4% increasing rate) (p < 0.001). The patients who have not acquired any income increment showed improvement in working ability after epilepsy surgery. The average annual incomes per capita shows the increasing rate of 45.08%, from 55,657.85 Baht (approximately U.S. dollars 1390) to 80,748.15 Baht (approximately U.S. dollars 2018), with strong statistical significance (p < 0.001). The improvement is best seen in seizure free than in non-seizure free subjects. CONCLUSION: The present study, to the authors 'knowledge, is the first to use work abilities, professional achievement and income acquisition to assess the ultimate QOL after epilepsy surgery. Most subjects have been shown to significantly improve their postoperative lives in terms of occupational accomplishment and income increment, especially in seizure free individuals. The need for expansion of epilepsy surgery is emphasized.

Achievement↗

PubMedDate not supplied

[Income as a condition of self care in the aged].

The current type of distribution of tasks between the generations leads to a system of income maintenance programs for the aged, which is based on their own past (largely statutory) provision for their old age income via public institutions. On the whole, the aged are to a very limited degree in the labor force. Most of them receive public transfer payments. On the average, the diverse income maintenance systems dependent on own past performance provide a fairly substantial income level when compared with wages and salaries. The transfer level is largely dependent on the type of old age security institution, on the extent of past labor force participation or contribution and past income; consequently it is quite diverse. Sex largely correlates with income differentials. While some groups end up with retirement incomes higher than their last wage income, others are definitely needy. Especially women constitute a substantial part of the poor. Besides low income, the danger of becoming a nursing case makes the aged dependent on other persons' or institutions' aid. The forthcoming reform of the public pension system shows little hope of eliminating the pockets of poverty among the aged by assuring a redistribution also among the aged.

Aged↗

PubMedDate not supplied

Income and racial patterns of dietary vitamin C intake among black and white girls.

The authors examined the influence of income and race on mean dietary vitamin C intake and the risk of dietary vitamin C intake at levels below the recommended dietary allowance (RDA). They performed a cross-sectional analysis of 2,032 black and white 9- and 10-year-old females, from a wide range of income groups, who participated in the National Heart, Lung, and Blood Institute Growth and Health Study. Mean intake of vitamin C, exclusive of vitamin supplements and determined by 3-day diet records, exceeded the RDA of 45 milligrams per day for that age group in all racial and income categories. The investigators found that annual household income was directly associated with mean dietary vitamin C intake (P < 0.0001) and that blacks had higher mean dietary vitamin C intakes than whites (P < 0.01). Among both blacks and whites, household income and risk of below-RDA vitamin C intake were inversely correlated, but this trend was statistically significant for blacks only (P < 0.05). Except for the lowest level income group (less than $10,000 per year), black girls from households with incomes less than $30,000 per year were at increased risk for below-RDA vitamin C intake (relative risk = 1.93 in the $10,000-$19,999 per year group and 1.63 in the $20,000-29,999 per year group, P < 0.05), compared with black girls in the highest income category. One-quarter of white girls overall and more than 30 percent of white girls in the lowest two income groups had below-RDA vitamin C intakes. If the findings are generalizable,they underscore the importance of public health programs to address the adequacy of dietary vitamin C intake among preadolescent black and white females.

Black or African American↗

PubMed2001

Children in food-insufficient, low-income families: prevalence, health, and nutrition status.

OBJECTIVE: To examine characteristics of US children living in food-insufficient households and to compare food and nutrient intakes, physical inactivity, and overweight and underweight status of children in food-insufficient households with those in food-sufficient households. DESIGN: Cross-sectional, nationally representative sample of children and households from the Continuing Survey of Food Intakes by Individuals, from 1994 to 1996. PARTICIPANTS: A group of 3790 households, including 5669 children (ages 0-17 years). MAIN OUTCOME MEASURE(S): Estimates of food insufficiency for children were based on the reported adequacy of their households, described as "often don't have enough to eat" or "sometimes don't have enough to eat." Nutrient consumption was based on two 24-hour dietary recalls from in-person interviews. RESULTS: Three percent of all households with children, and 7.5% of low-income families with children experienced food insufficiency. Several demographic and characteristic differences were observed between the food-sufficient and food-insufficient low-income groups. Children of low-income families, either food-sufficient or food-insufficient, had similar macronutrient and micronutrient intake, reported exercise, television watching, and percentage of overweight and underweight. When compared with the higher-income food-sufficient households, children in the low-income food-insufficient households consumed fewer calories (P =.05) and total carbohydrates (P =.004), but had a higher cholesterol intake (P =.02). The low-income food-insufficient group included more overweight children (P =.04), consumed less fruits (P =.04), and spent more time watching television (P =.02). CONCLUSIONS: While not different from low-income families who do not report food insufficiency, low-income families with food insufficiency had children who differed from high-income families in several nutrition and anthropometric measures. Clinicians should be aware of the possible effects of poverty and lack of access to food on child health and nutrition status. The long-term effects of these are not yet known.

Adolescent↗

PubMed1995

Concurrent self-administration of ethanol and an alternative nondrug reinforcer in monkeys: effects of income (session length) on demand for drug.

Eight rhesus monkeys (Macaca mulata) were trained to self-administer orally delivered ethanol (8%) and saccharin (0.03 or 0.3% wt/vol) or water under concurrent fixed-ratio (FR) schedules. The FR requirement for saccharin was fixed at 32, while the FR for ethanol was varied (4, 8, 16, 32, 64 and 128) in a non-systematic order to assess demand for drug. Demand was defined as consumption plotted as a function of price (FR). Income was defined as the duration of access to available resources. Income was varied by allowing access to the concurrently available liquids 20, 60 or 180 min per day. Order of testing was counter-balanced across monkeys. Saccharin deliveries were much higher than ethanol deliveries under the 180-min income condition; however, they were lower than ethanol deliveries when income was reduced to 20 min and the ethanol FR was 4, 8 or 16. Thus, when the price of drug was relatively low, consumption of drug exceeded that of the nondrug reinforcer, and that relationship was reversed as income decreased. Saccharin deliveries sustained a proportionally greater reduction due to decreased income compared to ethanol deliveries. As income decreased from 180 to 20 min, saccharin deliveries were reduced by an average of 79.1% (across ethanol FR conditions) while ethanol deliveries were reduced by an average of 41.2 and 40.8% when concurrent saccharin or water were available, respectively; thus, drug self-administration was more resistant to income changes than saccharin. The demand for ethanol was shifted downward in a parallel fashion as income decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

PubMed2003

The income elasticity of health care spending. A comparison of parametric and nonparametric approaches.

Parametric and nonparametric estimation techniques are compared in estimating the relationship between income and health expenditures with implications for the reliability of past estimates of health expenditure income elasticity. Relative to a more flexible nonparametric approach, a parametric approach can generate over or underestimates in health expenditure. Three time series cross-section data sets are used: (a) United States state level data from 1980-1997, (b) Canadian province level data from 1965-2000, and (c) national level data for 16 OECD countries from 1960-1997. Relative to ordinary least squares, locally weighted scatterplot smoothing allows for variability in the income elasticity of health spending as income varies. Generally, results of the latter suggest that income elasticities are higher at low-income levels and lower at higher income levels. As well, these results confirm that income elasticity does vary by level of analysis with international income elasticities being generally larger than national or regional studies.

Journal Article↗

PubMed2004

Geographical inequalities of mortality by income in two developed island countries: a cross-national comparison of Britain and Japan.

In this paper we examine the ecological relations between household income distribution and age-grouped mortality in Britain and Japan. Comparable datasets were prepared in terms of age intervals of mortality, household income intervals and geographical units for years around 1990. Then we conducted a series of regression analyses to associate absolute and relative income indices with age and sex-specific standardized mortality ratios (SMRs). The results are as follows: (1) In Britain mortality is lower where inequalities in income are lower, while in Japan there is no obvious relationship. It is, however, apparent that-just as in the case of the USA and Canada-Britain and Japan appear to merge and appear part of a greater pattern when considered as a series of city regions. Thus an overall global relationship between income inequality and mortality may exist. To assess such global relationship, further studies using cross-national regional datasets covering a wide rage of rich nations are desirable. (2) Income-mortality relations are consistent among different age-sex groups in Britain, but there are substantial differences in the relationships as revealed between different demographic groups in Japan. In particular, while absolute income levels are correlated negatively with mortality of working-age men in both countries, mortality of elderly people in Japan is higher where absolute income is higher. This indicates the different historical contexts to the health divides these two different geographical contexts, but further consideration of a more historically nuanced understanding of income-mortality relations is required.

Adult↗

PubMed2003

Associations among social support, income, and symptoms of depression in an educated sample: the UNC Alumni Heart Study.

It has been suggested that the inverse association between social support and depression may be stronger in persons with lower income. This study tested the support x income hypothesis in a sample of 2,472 individuals enrolled in the UNC Alumni Heart Study. The income was examined as a moderator of the relation between support and self-reported ratings of symptoms of depression. The appraisal subscale of the Interpersonal Support Evaluation Scale, household income level, and their interaction were modeled as predictors of depression ratings. The support x income interaction term was significantly associated with symptoms of depression, F (2, 2471)=4.71, p=.007. Social support was more strongly associated inversely with depression ratings in persons with lower income as compared to those with higher income. The present results extend previous work regarding the moderating effect of income to a sample of relatively high education and income level.

Adult↗