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PubMed2007

Income-related inequality in mental health in Britain: the concentration index approach.

BACKGROUND: Reduction of health inequalities is a major policy goal in the UK. While there is general recognition of the disadvantaged position of people with mental health problems, the extent of inequality, particularly the association with socio-economic characteristics, has not been widely studied. We aimed to measure income-related inequality in the distribution of psychiatric disorders and to compare with inequality in other health domains. METHOD: The concentration index (CI) approach was used to examine income-related inequality in mental health using data from the Psychiatric Morbidity Survey 2000 for Britain. RESULTS: There is marked inequality unfavourable to lower income groups with respect to mental health disorders. The extent of inequality increases with the severity of problems, with the greatest inequality observed for psychosis. Income-related inequality for psychiatric disorders is higher than for general health in the UK. Standardized CIs suggest that these inequalities are not due to the demographic composition of the income quintiles. CONCLUSIONS: Income-related inequalities exist in mental health in Britain. As much of the observed inequality is probably due to factors associated with income and not due to the demographic composition of the income quintiles, it may be that these inequalities are potentially 'avoidable'.

Adolescent↗

PubMed2002

Do young adults demand more dental services as their income increases?

Several studies from the USA have shown that there is a positive and strong relationship between income and demand for dental care. All these studies have been performed on populations where treatment needs were high. Today, young adults represent one group of the population where treatment needs are low. But young adults will not necessarily demand or utilize more dental services as their income increases. As we do not know the extent to which demand will increase when income increases among young adults, future needs for dental manpower could be less than predicted from previous studies. The aim of the present study was to examine the relationship between income and demand/utilization for dental services among young adults in Norway. The analyses were performed on two large sets of survey data, collected in 1985 and 1995, which were representative of the Norwegian population aged 20 years and above. The main finding was that the increase in demand with an increase in income was less for young adults than for older adults. In particular, there was a marked fall in the income elasticities among young adults from 1985 to 1995. The fall in the income elasticity corresponds to a marked decrease in the prevalence of dental diseases among young adults during that period. Our results imply that future policies for dental manpower should take into account the lower income elasticity for young adults compared to for older adults, and that future needs for dental personnel should be planned accordingly.

Adult↗

PubMed1996

Temporal discounting in choice between delayed rewards: the role of age and income.

This study examined the effects of age and income temporal discounting (i.e. the decrease in the subjective value of a reward as the delay to its receipt increases). The value of delayed hypothetical monetary rewards was discounted at similar rates by adults of different ages but similar income levels, but at different rates by adults of similar age but different income levels. Specifically, lower income older adults showed a greater degree of temporal discounting than did either upper income older adults or upper income younger adults, but there were no age differences in discounting between the upper income groups. Comparison of these findings with those of a previous study (Green, Fry, & Myerson, 1994) suggests that impulsivity in decision making declines rapidly in young adulthood, reaching stable levels in the 30s. Further, age and income appear to interact in determining the impulsivity of decision making by adults.

Adult↗

PubMed2006

The TCN/AACN 2005 "salary survey": professional practices, beliefs, and incomes of U.S. neuropsychologists.

Doctoral-level members of Division 40 (Clinical Neuropsychology) of the American Psychological Association and other neuropsychologists were invited to participate in a web-based survey in early 2005. Response rate was estimated to be between 28.5 and 31.3%. The range of years postdoctorate was 1-51. Demonstrating the substantial proportional change in gender taking place in the field, 7 of 10 postdoctoral residents were women. Whereas the median age of APA members has been over 50 since the early 1990s, the current median age of clinical neuropsychologists is 47 and has essentially remained unchanged since 1994, indicating substantial entrance of young psychologists into the field. Use of testing assistants remains commonplace. The "flexible battery" approach has increased in popularity and predominates, whereas endorsement of the "standardized battery" approach continues to decline. More than 90% of respondents are engaged in full-time or full-time plus part-time employment. Incomes from 2004 vary considerably by years of clinical practice, work setting, amount of forensic practice, and region of country. Job satisfaction has little relationship to income and is comparable across most variables (e.g., work setting, professional identity, amount of forensic activity), whereas income satisfaction has a stronger relationship to actual income, at least at the higher income levels. Job satisfaction of neuropsychologists in general is higher than reported for other U.S. jobs. Fewer than one in five respondents is considering changing job position and very few individuals are considering leaving neuropsychology or psychology for a different field. More than 8 of 10 respondents experienced an income increase in the last five years, whereas fewer than 1 in 10 experienced a decrease. While higher than reported by other types of psychologists, neuropsychology incomes have lagged behind inflation when compared to 1992 data. Numerous breakdowns related to income and professional activities are provided.

Academies and Institutes↗

PubMed1997

The interrelationship between income, health and employment status.

BACKGROUND: The aim of the study was to test the hypothesis that the relatively strong association between income and health compared to that between education/occupation and health, can partly be interpreted in terms of an association between employment status and health. METHODS: Health indicators used were the prevalence of one or more chronic conditions, and perceived general health. Data were generated from a postal survey, part of the baseline data collection of a Dutch prospective cohort study on socioeconomic inequalities in health. RESULTS: After controlling for differences in other socioeconomic indicators, the association between income and health was found to be stronger than that between occupation or education and health. Most of the difference in strength was found to be due to employment status, especially among men. Controlling for employment status, and controlling for the distribution of those with a long-term work disability in particular, reduced the risks of lower income groups, whereas the risks of lower educational and occupational groups hardly changed. CONCLUSIONS: These results suggest that the relatively strong association between income and health can for a large part be interpreted in terms of an interrelationship between employment status, income and health. More specifically, it is largely due to the concentration of the long-term disabled in lower income groups. This indicates the importance of the selection mechanism, as these groups are excluded from paid employment because of their health status, leading to a lowering of income. However, income was still found to be related to perceived general health after controlling for employment status especially among women. This suggests that an explanation in terms of an effect of material factors on health may also be important.

Adult↗

PubMed2005

Low-income Canadian Aboriginal and non-Aboriginal parent-child interactions.

BACKGROUND: Limited research is available on the performance of North American Aboriginal(1) people on the Nursing Child Assessment Teaching Scales (NCATS) and available research examines parent-child interactions within Aboriginal samples drawn from the USA. Most published normative data on low-income people's performance on the NCATS are also limited to samples drawn from the USA. The purpose of this research study was to use the NCATS measure to: (1) begin to develop a knowledge base that describes the parent-child interactions observed in Canadian low-income samples; and (2) explore the relationship between parent-infant interactions and ethnicity (Aboriginal or Non-Aboriginal) within a low-income Canadian sample. METHODS: Secondary analysis was completed on data collected as part of a larger study designed to examine the impact of low-income situations on pre-school children's health and development in Edmonton, Alberta, Canada. The NCATS measure of parent-child interaction was administered to all children (1-36 months old) and their parents in the low-income non-probability sample. The sample derived for secondary analysis consists of 12 Aboriginal parent-child pairs (11 mothers and 1 father) and 48 Non-Aboriginal parent-child pairs (47 mothers and 1 father). RESULTS: The data analysis suggests that although low-income Aboriginal parents may be less verbal with their children in interactions, the overall interaction quality is not different from that of other low-income parents. However, both groups' parent-child interaction scores were less than the published 10th percentile cut-off score, indicating 'worrisome scores' and less than optimal interactions. CONCLUSION: While the findings that compare the Aboriginal and Non-Aboriginal samples are limited by the small sample size, the fact that these findings agree with those from heterogeneous Aboriginal samples drawn from the USA are encouraging. Finally, the findings provide needed information about parent-child interactions in Canadian low-income urban samples including data from Aboriginal parents and children.

Alberta↗

PubMed2005

Relatively poor, absolutely ill? A study of regional income inequality in Russia and its possible health consequences.

STUDY OBJECTIVE: To investigate whether the income distribution in a Russian region has a "contextual" effect on individuals' self rated health, and whether the regional income distributions are related to regional health differences. METHODS: The Russia longitudinal monitoring survey (RLMS) is a survey (n = 7696) that is representative of the Russian population. With multilevel regressions both individual as well as contextual effects on self rated health were estimated. MAIN RESULTS: The effect of income inequality is not negative on men's self rated health as long as the level of inequality is not very great. When inequality levels are high, however, there is a tendency for men's health to be negatively affected. Regional health differences among men are in part explained by regional income differences. On the other hand, women do not seem to be affected in the same way, and individual characteristics like age and educational level seem to be more important. CONCLUSIONS: It seems that a rise in income inequality has no negative effect on men's self rated health as long as the level of inequality is not very great. On the other hand, when inequality levels are higher a rise tends to affect men's health negatively. A curvilinear relation between self rated health and income distribution is an interesting hypothesis. It could help to explain the confusing results that arise when you look at countries with a high degree of income inequality (USA) and those with lower income inequality (for example, Japan and New Zealand).

Attitude to Health↗

PubMed2003

Effects of income and wealth on GHQ depression and poor self rated health in white collar women and men in the Whitehall II study.

STUDY OBJECTIVE: To determine whether measures of income and wealth are associated with poor self rated health and GHQ depression. DESIGN: Whitehall II study of London based civil servants re-interviewed between 1997-1999; 7162 participants. MAIN RESULTS: A twofold age adjusted difference in morbidity was observed between the top and bottom of the personal income hierarchy for both sexes. For household income and particularly for wealth these associations are stronger. After adjusting for health at baseline the associations between personal income and both health outcomes are reduced by about 40%-60%. For household income the attenuation is somewhat smaller and for wealth is about 30%. Adjusting for other sociodemographic factors leads to further attenuation of the effects. CONCLUSIONS: The associations between income, particularly personal income, and morbidity can be largely accounted for by pre-existing health and other measures of social position. The strong independent association between household wealth-a measure of income earned over decades and across generations-and morbidity are likely to be related to a set of early and current material and psychosocial benefits.

Adult↗

PubMed2005

Household income histories and child mental health trajectories.

Although it is widely accepted that low household income is associated with worse child mental health, less is known about whether income histories, often differentiated into stable and dynamic components, also matter. Using longitudinal data from the Child Supplement of the National Longitudinal Study of Youth, comprising the repeated measures of children ages 4 to 14 from 1986 to 1998 inclusive, I estimate generalized linear mixed models to evaluate the influence of household income histories on child depression and antisocial behavior over time. Results indicate that, at initial interview, low household income is associated with higher levels of depression and antisocial behavior; subsequent improvements in household income reduce child mental health problems. Further, the effect of initial household income on the rate of change in child depression attenuates as children grow older, whereas for antisocial behavior the effect of initial household income becomes stronger over time. These findings highlight the importance of understanding the ways in which children are influenced by their families' income histories.

Adolescent↗

PubMedDate not supplied

Rethinking race/ethnicity, income, and childhood asthma: racial/ethnic disparities concentrated among the very poor.

OBJECTIVE: Past studies of the prevalence of childhood asthma have yielded conflicting findings as to whether racial/ethnic disparities remain after other factors, such as income, are taken into account. The objective of this study was to examine the association of race/ethnicity and family income with the prevalence of childhood asthma and to assess whether racial/ethnic disparities vary by income strata. METHODS: Cross-sectional data on 14,244 children aged <18 years old in the 1997 National Health Interview Survey were examined. The authors used logistic regression to analyze the independent and joint effects of race/ethnicity and income-to-federal poverty level (FPL) ratio, adjusting for demographic covariates. The main outcome measure was parental report of the child having ever been diagnosed with asthma. RESULTS: Bivariate analyses, based on weighted percentages, revealed that asthma was more prevalent among non-Hispanic black children (13.6%) than among non-Hispanic white children (11.2%; p<0.01), but the prevalence of asthma did not differ significantly between Hispanic children (10.1%) and non-Hispanic white children (11.2%; p=0.13). Overall, non-Hispanic black children were at higher risk for asthma than non-Hispanic white children (adjusted odds ratio [OR]=1.20; 95% confidence interval [CI] 1.03, 1.40), after adjustment for sociodemographic variables, including the ratio of annual family income to the FPL. Asthma prevalence did not differ between Hispanic children and non-Hispanic white children in adjusted analyses (adjusted OR=0.85; 95% CI 0.71, 1.02). Analyses stratified by income revealed that only among children from families with incomes less than half the FPL did non-Hispanic black children have a higher risk of asthma than non-Hispanic white children (adjusted OR=1.99; 95% CI 1.09, 3.64). No black vs. white differences existed at other income levels. Subsequent analyses of these very poor children that took into account additional potentially explanatory variables did not attenuate the higher asthma risk for very poor non-Hispanic black children relative to very poor non-Hispanic white children. CONCLUSIONS: Non-Hispanic black children were at substantially higher risk of asthma than non-Hispanic white children only among the very poor. The concentration of racial/ethnic differences only among the very poor suggests that patterns of social and environmental exposures must overshadow any hypothetical genetic risk.

Adolescent↗

PubMed2004

Economic diversity in medical education: the relationship between students' family income and academic performance, career choice, and student debt.

Providing access to higher education across all income groups is a national priority. This analysis assessed the performance, career choice, and educational indebtedness of medical college students whose educational pursuits were assisted by the provision of financial support. The study looked at designated outcomes (academic performance, specialty choice, accumulated debt) in relation to the independent variable, family (parental) income, of 1,464 students who graduated from Jefferson Medical College between 1992 and 2002. Students were classified into groups of high, moderate, and low income based on their parental income. During the basic science years, the high-income group performed better; however, in the clinical years, performance measures were similar. Those in the high-income group tended to pursue surgery, while those in the low-income group preferred family medicine. The mean of accumulated educational debt was significantly higher for the low-income group. The study provides support for maintaining economic diversity in medical education.

Career Choice↗

PubMed2003

The impact of minority group status on the projected retirement income of divorced women in the baby boom cohort.

Using projections from the Social Security Administration's Modeling Income in the Near Term (MINT1), we examine the characteristics and retirement income of white non-Hispanic, black non-Hispanic, and Hispanic divorced women in the baby boom cohort. Although we find significant differences in retirement income for divorced women of different racial and ethnic groups, the characteristics associated with higher or lower retirement income are very similar. That is, being college educated, owning a home, and having pension and asset income, for example, correspond to increased retirement income for all racial and ethnic groups. However, because black and Hispanic women are less likely than white women to be college educated, to own their home, and to have pension and asset income, their retirement income tends to be lower than that of white women. We conclude the paper by briefly discussing policy options to address the retirement needs of divorced women.

Black People↗

PubMed1984

An overview of substance use among New York State's upper income householders.

A 1981 survey of substance use among household residents in New York State found rates of use consistently higher among the upper income group ($50,000 and over) than among groups with lower incomes. In addition, measures of the seriousness of the problem also revealed higher rates among the upper income group than the other income groups. In terms of preferences for treatment, the upper income group substance user clearly opts for the private professional. The findings generally suggest that there are few qualitative differences in patterns of substance-taking among the income groups, and it might be hypothesized that the availability of disposable income in the upper income group and some situational factors may facilitate that group's substance-using behavior.

Data Collection↗

PubMed1993

Physician incomes under an all-payer fee schedule.

This DataWatch estimates physicians' net incomes under various scenarios for universal adoption of the Medicare fee schedule. American Medical Association (AMA) data on physicians' gross incomes by payer are adjusted for differences in fees across Medicare, Medicaid, and private payers. Net income (gross income net of practice costs) is shown under several alternatives. Average net incomes would range from roughly $100,000 to $200,000, depending on specialty and the particular assumptions used. General practitioners' incomes would typically rise, and income differences across specialties would be narrowed significantly. The Medicare fee schedule, as intended, would increase incomes of primary care physicians relative to specialists.

Costs and Cost Analysis↗

PubMed1999

Low birth weight: race and maternal nativity--impact of community income.

BACKGROUND: The purpose of this article is to determine the effect of community income as a co-factor in the association of low birth weight, race, and maternal nativity in New York City. METHODS: New York City birth records, 1988 through 1994, provided data on maternal and infant characteristics. There were 274 121 white and 279 826 black mothers included in this study. Black mothers were classified as US-born (South and Northeast) and foreign-born (the Caribbean, South America, and Africa). Based on the 1990 US census income data, census tracts of the city were aggregated by tertile of per capita income as low-, middle-, and high-income communities. Incidence of low birth weight was estimated by race, maternal nativity in the city as a whole, and each income community. RESULTS: Overall, black women had a substantially higher risk of low birth weight infants (<2500 g) than did whites (13.1% vs 4.8%). Foreign-born black mothers had a birth weight advantage over US-born black mothers (10.0% vs 16.7%). After controlling for socioeconomic and medical characteristics, the risks of low birth weight for blacks compared with whites were 0.95 (95% confidence interval: 0. 87-1.03) and 0.86 (0.69-1.02) for Caribbean- and African-born black mothers, respectively. Moreover, in low-income communities, compared with white mothers, the risks for Caribbean- and African-born black mothers were 0.88 (0.79-0.97) and 0.77 (0.61-0.96), respectively. By contrast, US and South American-born black mothers had a consistently higher risk of low birth weight infants, regardless of community income level. CONCLUSION: Low birth weight was significantly less frequent among whites than among blacks. However, this overall finding masked substantial variation among blacks, determined by maternal nativity and the income level of the community in which they lived. In fact, Caribbean- and African-born black mothers had birth outcomes generally similar to and, in poor communities, even more favorable than those for whites.

Africa↗

PubMed1999

The prevalence of low income among childbearing women in California: implications for the private and public sectors.

OBJECTIVES: This study examined the income distribution of childbearing women in California and sought to identify income groups at increased risk of untimely prenatal care. METHODS: A 1994/95 cross-sectional statewide survey of 10,132 postpartum women was used. RESULTS: Sixty-five percent of all childbearing women had low income (0%-200% of the federal poverty level), and 46% were poor (0%-100% of the federal poverty level). Thirty-five percent of women with private prenatal coverage had low income. Most low-income women with Medi-Cal (California's Medicaid) or private coverage received their prenatal care at private-sector sites. Compared with women with incomes over 400% of the poverty level, both poor and near-poor women were at significantly elevated risk of untimely care after adjustment for insurance, education, age, parity, marital status, and ethnicity (adjusted odds ratios = 5.32 and 3.09, respectively). CONCLUSIONS: This study's results indicate that low-income women are the mainstream maternity population, not a "special needs" subgroup; even among privately insured childbearing women, a substantial proportion have low income. Efforts to increase timely prenatal care initiation cannot focus solely on women with Medicaid, the uninsured, women in absolute poverty, or those who receive care at public-sector sites.

Adolescent↗

PubMedDate not supplied

The relationship between primary care, income inequality, and mortality in US States, 1980-1995.

OBJECTIVES: This study tests the robustness of the relationships between primary care, income inequality, and population health by (1) assessing the relationship during 4 time periods-1980, 1985, 1990 and 1995; (2) examining the independent effect of components of the primary care physician supply; (3) using 2 different measures of income inequality (Robin Hood index and Gini coefficient); and (4) testing the robustness of the association by using 5-year time-lagged independent variables. DATA SOURCES/STUDY SETTING: Data are derived from the Compressed Mortality Files, the US Department of Commerce and the Census Bureau, the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the American Medical Association Physician Master File. The unit of analysis was the 50 US states over a 15-year period. STUDY DESIGN: Ecological, cross-sectional design for 4 selected years (1980, 1985, 1990, 1995), and incorporating 5-year time-lagged independent variables. The main outcome measure is age-standardized, all-cause mortality per 100,000 population in all 50 US states in all 4 time periods. DATA COLLECTION/EXTRACTION METHODS: The study used secondary data from publicly available data sets. The CDC WONDER/PC software was used to obtain mortality data and directly standardize them for age to the 1980 US population. Data used to calculate the income inequality measure came from the US census population and housing summary tapes for the years 1980 to 1995. Counts of the number of households that fell into each income interval along with the total aggregate income and the median household income were obtained for each state. The Gini coefficient for each state was calculated using software developed for this purpose. RESULTS: In weighted multivariate regressions, both contemporaneous and time-lagged income inequality measures (Gini coefficient, Robin Hood Index) were significantly associated with all-cause mortality (P <.05 for both measures for all time periods). Contemporaneous and time-lagged primary care physician-to-population ratios were significantly associated with lower all-cause mortality (P <.05 for all 4 time periods), whereas specialty care measures were associated with higher mortality (P <.05 for all time periods, except 1990, where P <.1). Among primary care subspecialties, only family medicine was consistently associated with lower mortality (P <.01 for all time periods). CONCLUSIONS: Enhancing primary care, particularly family medicine, even in states with high levels of income inequality, could lead to lower all-cause mortality in those states.

Cross-Sectional Studies↗

PubMed1995

Multiple-trait prediction of transmitting abilities for herd life and estimation of economic weights using relative net income adjusted for opportunity cost.

Genetic and phenotypic (co)variances among linear type traits, final score, first lactation milk and fat yield, and 84-mo totals for longevity, relative net income, and relative net income adjusted for opportunity cost of postponed replacement were estimated with a multiple-trait sire model. Data were from 433,116 cows in herds participating in the classification program for conformation traits of the Holstein Association of America. Yield information from all cows in classified herds indicated that classified cows are not a random sample. Heritability of net income adjusted for opportunity cost was higher, .17, than unadjusted net income, .12, but the genetic correlation between the estimates of net income was high, .97. Adjusted net income also had high genetic correlations with first lactation milk yield, .80; fat yield, .60; and dairy form, .48. Heritability of longevity (months in milk to 84 mo) was .06. Adjustment of net income for opportunity cost lowered the genetic correlation with longevity from .84 to .70. Evaluation of lifetime merit using traits measured during first lactation with economic weights developed using adjusted net income was more accurate than indirect prediction of longevity; the approximate reliability of a first-crop AI sire for lifetime merit was .65 compared with .42 for longevity.

Animals↗