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PubMed2003

Socio-economic inequality in ill-health amongst the elderly. Should one use current or permanent income?

In Belgium, income-related inequality in ill-health among the 65- is present, but reduces significantly as soon as one restricts the analysis to the 65+. The main goal of this paper is to check whether these findings (based on current income) are robust to the income concept used. The analysis is repeated using estimates of permanent income. Measured inequality among the 65+ remains very limited, suggesting that the observed findings are not heavily dependent upon the income concept. Finally, I suggest an explanation for the observed difference in inequality between the 65- and the 65+. I argue that this difference is likely to be correlated with differences across income groups of (1) sample attrition; and (2) mortality.

Adult↗

PubMed2003

Income inequality and mortality: time series evidence from Canada.

In this paper, we apply the standard model used in the income strand of the socio-economic status (SES)-population health literature to explain the relationship between mortality and income to pooled cross-section time-series data for Canada. The use of time-series data increases the available degrees of freedom and allows for the possibility that the effects of inequality take time to translate into poorer health outcomes. In light of recent criticisms of aggregate level studies, we do not attempt to differentiate between the absolute and relative inequality hypotheses, but test for the existence of a relationship between mortality and a measure of income inequality. We find that whether an exogenous trend is incorporated or an auto-regressive distributed lag form is used, the coefficients on mean income and the Gini are not significantly different from zero, which contradicts the findings in other parts of the literature, but which is consistent with earlier cross-section evidence for Canada. The results suggest that models that focus exclusively on income as a measure of the impact of SES on mortality are not complete and that health spending and unemployment may be even more important than income growth and dispersion.

Age Factors↗

PubMed2000

Health behaviours and health: evidence that the relationship is not conditional on income adequacy.

This study used Canadian data to examine whether the relationships between two health behaviours (physical activity and smoking) and two measures of health (self-perceived health status and number of chronic health conditions) are conditional on income adequacy. Studies that have investigated the manner in which socioeconomic circumstances, such as income adequacy, and health behaviours interact to influence health are few in number and characterized by inconsistent findings. In addition, there is a complete absence of published Canadian research that has explored these relationships. I investigated the relationship between health behaviours and health by income adequacy with a secondary analysis of data from the first cycle of the National Population Health Survey (NPHS), conducted by Statistics Canada in 1994-95. The sample consisted of 11.941 NPHS respondents 20-64 years of age who did not have an illness or disability that prevented them from being employed. As a whole, findings from a series of hierarchical multiple regression analyses did not provide adequate evidence to conclude that the effects of physical activity and smoking on self-perceived health status and chronic health conditions are conditional on income adequacy. Instead, findings showed that the health behaviours each had a similar degree of influence on the self-perceived health status and number of chronic health conditions of respondents at all income adequacy levels. Moreover, the magnitude of the relationships between the health behaviours and health measures was very small. By enhancing knowledge about both the nature and magnitude of the relationships among Canadians' income adequacy, health behaviours, and health, this study makes a significant contribution to the small body of research that has explored the possibility that the relationship between health behaviours and health varies by socioeconomic circumstances. I conclude the paper with a discussion of the implications that the findings have for public health policies and programs.

Adult↗

PubMed2002

Social capital and health (plus wealth, income inequality and regional health governance).

This article describes an empirical exploration of relationships among aspects of thirty health districts in Saskatchewan, Canada. These aspects include social capital, income inequality, wealth, governance by regional health authorities and population health, the primary dependent variable. The social capital index incorporated associational and civic participation, average and median household incomes served as proxies for wealth, the degree of skew in the distribution of household incomes assessed income inequality while the model for effective governance by District Health Boards (DHBs) focused on reflection of health needs, policy making and implementation, fiscal responsibility and the integration and co-ordination of services. I found no evidence of a relationship between social capital in health districts and the performance of DHBs. Among the determinants of health, wealth appeared unrelated to age-standardised mortality rates while income inequality was positively and social capital was negatively related to mortality. Income inequality was not as strongly related to age-standardised mortality after controlling for social capital. and vice versa, suggesting the two may be comingled somehow when it comes to population health, although they were not significantly related to one another. Of the predictors of social capital the distribution of age in districts appeared to be the most salient; of the predictors of age-standardised mortality rates the gender composition of a district was most salient.

Adolescent↗

PubMed1999

A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study.

A sample of over 400,000 men and women, ages 25-64, from the National Longitudinal Mortality Study (NLMS), a cohort study representative of the noninstitutionalized US population, was followed for mortality between the years of 1979 and 1989 in order to compare and contrast the functional forms of the relationships of education and income with mortality. Results from the study suggest that functional forms for both variables are nonlinear. Education is described significantly better by a trichotomy (represented by less than a high school diploma, a high school diploma or greater but no college diploma, or a college diploma or greater) than by a simple linear function for both men (p < 0.0001 for lack of fit) and women (p = 0.006 for lack of fit). For describing the association between income and mortality, a two-sloped function, where the decrease in mortality associated with a US$1000 increase in income is much greater at incomes below US$22,500 than at incomes above US$22,500, fits significantly better than a linear function for both men (p < 0.0001 for lack of fit) and women (p = 0.0005 for lack of fit). The different shapes for the two functional forms imply that differences in mortality may primarily be a function of income at the low end of the socioeconomic continuum, but primarily a function of education at the high end.

Adult↗

PubMed2000

Gender comparisons of income expectations in the USA at the beginning of medical school during the past 28 years.

This study was designed to investigate gender differences in the USA, in anticipated professional income. Participants were 5314 medical students (3880 men, 1434 women) who entered Jefferson Medical College between 1970 and 1997. The annual peak professional income estimated at the beginning of medical school was the dependent variable and gender within selected time periods was the independent variable. Results showed significant differences between men and women on their anticipated future incomes in different time periods. Women generally expected 23% less income than men. The effect size estimates of the differences were moderately high. The gender gap in income expectations was more pronounced for those who planned to pursue surgery than their counterparts who planned to practice family medicine or pediatrics. A unique feature of this study is that its outcomes could not be confounded by active factors such as experience, working hours, age and productivity. Findings suggest that social learning may contribute to gender gap in anticipated income.

Economics, Medical↗

PubMed2001

Gender differences in income after substance abuse treatment.

This study asked whether men and women who enrolled in substance use treatment reported similar changes in income from work, public assistance, and crime over time. Income data were analyzed for 261 substance users (77 women, 184 men) who entered day or residential treatment, and completed Addiction Severity Index measures at treatment entry and up to 18 months later. Over time, respondents reported increases in employment income. People whose main source of income at baseline had been crime or public assistance showed significant decreases respectively in income from crime or public assistance. Men made greater gains in work income than women did. Across time, men were more likely to be employed than women were. Findings show the economic value of substance use treatment, but less improvement in employment outcomes for women than men.

Adult↗

PubMed2003

Providing affordable family housing and reducing residential segregation by income. A systematic review.

The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.

Family↗

PubMed2004

Family income and its relation to preschool children's adjustment for families in the NICHD Study of Early Child Care.

The current study examines relations of mean-level estimates, linear changes, and instability in income and family processes to child outcomes and addresses whether income, through its impact on family functioning, matters more for children living in poverty. Temporal changes and instability in family processes, but not income, predicted children's adjustment. Cross-sectional mediational analyses indicated that for families living at the poverty threshold, family processes fully mediated the effect of average income over the study period on social behavior but only partially mediated its effect on cognitive-linguistic development. The strength of these associations diminished as average income exceeded the poverty threshold. That is, income had a greater impact on the family functioning and development of poor children than of nonpoor children.

Child Behavior Disorders↗

PubMed2006

Within-child associations between family income and externalizing and internalizing problems.

Within-child associations between family income and child externalizing and internalizing problems were examined using longitudinal data from the NICHD Study of Early Child Care and Youth Development (2004a, 2004b; N=1,132). Variations in income effects were estimated as a function of whether families were poor, whether mothers were partnered, and the number of hours mothers and their partners were employed. On average, children had fewer externalizing problems during times when their families' incomes were relatively high than during times when their families' incomes were relatively low; the estimated benefits of increased income were greatest for children who were chronically poor. For both externalizing and internalizing problems, income was most strongly associated with problems when chronically poor children's mothers were partnered and employed.

Adult↗

PubMed2004

Higher income is more strongly associated with obesity than with obesity-related metabolic disorders in Jamaican adults.

OBJECTIVE: This study compares how income is related to obesity vs two obesity-related cardiovascular disease (CVD) risk factors-diabetes and hypertension-in adults from Jamaica. DESIGN: A cross-sectional population-based survey was used. In total, 847 men and 1249 women aged 25-74 y were randomly recruited from a periurban area in 1993-1998. MEASUREMENTS: Trained interviewers measured anthropometry and blood pressure, obtained fasting blood and collected self-reported data on income and disease history. RESULTS: Income was strongly and positively associated with obesity in men. In women, obesity levels were high even among the very poor, and the income gradient was more moderate. Although obesity-and particularly central fatness-was strongly associated with diabetes and hypertension prevalence, income was not significantly related to these disorders. CONCLUSIONS: Future research in developing countries should independently explore associations between income and obesity vs obesity-related disorders, and identify factors that explain any disparities.

Adult↗

PubMed2003

The influence of income on the experience of informal caregiving: policy implications.

Examining the need for an eldercare policy is relevant and timely because the population is aging, a focus of care has shifted from institutional to community based, and informal caregivers, primarily women, are increasingly pressured to be responsible for eldercare. The purpose of the study is to examine the differences in the experiences of low-income and those who are not low-income informal caregivers. Three hundred questionnaires were mailed to past and present home care clients and 58 questionnaires were returned (19% response rate). This research revealed that low-income caregivers have increased needs for support and education from those who can afford to pay for their support services. Low-income caregivers experience significantly greater caregiver distress than do caregivers who are not low income. The unique needs of low-income caregivers must be considered in the formation of Canadian eldercare policy as increased health care privatization promotes the growing inequality in health care provision.

Aged↗

PubMed2003

Perceived income inequality and suicide rates in Central/Eastern European countries and Western countries, 1990-1993.

Sociological studies on cross-national male and female suicide rates have found numerous factors related to variation in suicide rates. The present study focuses on how perceived differences in income inequality impact suicide rates in 12 different countries, unlike most prior studies on income inequality and suicide that use measures of actual income inequality. Using G. Jasso's (1999) index on perceived income inequality, the author found that perceived income inequality is related more strongly and more consistently to male suicide rates than female suicide rates. Relative to other variables used in this analysis,perceived income inequality also accounts for most of the difference in the gender gap of male versus female suicide rates.

Europe↗

PubMed2005

Does high income buffer the association between adverse working conditions and ill health?

AIM: A study was undertaken to analyse the possible interaction between work environment and income for the probability of self-rated health being less than good. METHODS: Data from the Swedish Survey of Living Conditions for the years 1998 and 1999 were analysed. Employed 20- to 64-year-olds with a registered wage were included (n=5982). The synergy index (SI) was applied, using odds ratios from logistic regressions for men, women, and all. Low and high levels of physical demands, decision authority, skill discretion and psychological demands were separately combined with low- and high-wage income (median split). Full-time work and four sociodemographic factors were controlled for. RESULTS: Significant synergy was found for women when they were exposed to low income and a low level of skill discretion (SI=1.46 [1.01-2.13]), although this was attenuated by education level (SI=1.47 [0.96-2.25]). In general (both sexes), poor health caused by low income and unfavourable work is additive rather than multiplicatively exaggerating the risk among the jointly exposed. CONCLUSION: Work exposures in the form of high physical load, low levels of decision authority and skill discretion, or a high level of psychological demands were significantly related to poor health also when income was high, suggesting that high income does not seem to buffer the detrimental effects of adverse working conditions. As nearly half of employed women were found to be in circumstances marked by synergy, it seems a relevant public health issue to improve these women's conditions at work, by simultaneously increasing, for example, job variety and wages.

Adult↗

PubMed2003

The association between state income inequality and worse health is not confounded by race.

BACKGROUND: The relationship between income inequality and health across US states has been challenged recently on grounds that this relationship may be confounded by the effect of racial composition, measured as the proportion of the state's population who are black. METHODS: Using multilevel statistical models, we examined the association between state income inequality and poor self-rated health. The analysis was based on the pooled 1995 and 1997 Current Population Surveys, comprising 201 221 adults nested within 50 US states. RESULTS: Controlling for the individual effects of age, sex, race, marital status, education, income, health insurance coverage, and employment status, we found a significant effect of state income inequality on poor self-rated health. For every 0.05-increase in the Gini coefficient, the odds ratio (OR) of reporting poor health increased by 1.39 (95% CI: 1.26, 1.51). Additionally controlling for the proportion of the state population who are black did not explain away the effect of income inequality (OR = 1.30; 95% CI: 1.15, 1.45). While being black at the individual level was associated with poorer self-rated health, no significant relationship was found between poor self-rated health and the proportion of black residents in a state. CONCLUSION: Our finding demonstrates that neither race, at the individual level, nor racial composition, as measured at the state level, explain away the previously reported association between income inequality and poorer health status in the US.

Adult↗

PubMed2003

Education, income, and functional limitation transitions among American adults: contrasting onset and progression.

BACKGROUND: Although a robust association between socioeconomic status and health has been shown in past research, the processes that explain the connection are not well understood. This paper seeks to advance such understanding in two ways, first by attending to the distinction between onset of a functional health problem and its progression, and second by addressing whether and how education and income relate differently to the onset versus progression of functional health problems. METHODS: Data come from the Americans' Changing Lives survey (n = 3617). The baseline was conducted in 1986 and outcome status measured in 1994. Activity limitations are categorized into none, mild, moderate, severe. Onset is defined as having no limitation at origin and a limitation at outcome. Progression is defined as limitation of a particular severity at origin and improving, staying the same, or getting worse with respect to the severity. Multinomial regressions determine transition probabilities related to onset and progression. RESULTS: Those with higher income and education are less likely to experience an onset. Only income associates with progression. Those with the highest income are most likely to improve and least likely to get worse in comparison to those with the lowest income. CONCLUSIONS: Education, being determined early in life and influencing psychosocial mechanisms throughout life, may have a greater impact on prevention of activity and functional disorders. Income's role may be both as a prevention factor and as a mechanism for management of health problems.

Activities of Daily Living↗

PubMed2004

Population health and income inequality: new evidence from Israeli time-series analysis.

BACKGROUND AND OBJECTIVES: The relationship between population health and inequality in income distribution has attracted much attention during the last two decades. The purpose of this paper is to examine that relationship using Israeli time-series data, and considering three types of income: economic, pre-tax, and disposable. METHODS: Israeli time series (1979-2000) on life expectancy of men and women at birth and at ages 5 and 65, as well as infant mortality, were related to Gini coefficients measuring inequality in economic, pre-tax (after transfers) and disposable (after taxes) incomes, controlling for gross domestic product (GDP) per capita. This design allows for the estimation of the effects on population health of changes in income inequalities over time as well as of contemporaneous reduction in inequality due to transfers and taxes. RESULTS: None of the three income inequality measures by itself had an effect over time on population health. However, larger contemporaneous reductions in inequality, mainly through the transfers system, were associated with better population health, in particular with lower infant mortality. CONCLUSIONS: A significant part of the temporal improvement in the health of the Israeli population has been due to the increasing effort to reduce inequality in economic income by increasing transfer payments. The results are generally inconsistent with the argument of adverse psychosocial effects of inequality on health, and are consistent with inequality being related to other harmful public goods affecting health and with Rodgers' argument.

Aged↗

PubMed2001

Independent effects of income and education on the risk of obesity in the Brazilian adult population.

With a view to assess the independent effects of income and education on the risk of obesity we studied cross-sectional randomly selected samples of the adult population (20 y and over) living in 1996/97 in the less (northeastern) and the more (southeastern) developed region of Brazil (1971 and 2588 northeastern and 2289 and 2549 southeastern men and women, respectively). Independent effects of income and education on obesity (BMI > or = 30 kg/m(2)) were assessed through logistic regression analyses that controlled for age, ethnicity, household setting (urban or rural) and either education or income. The risk of obesity in men strongly increased with income in the two regions. The level of education did not influence the risk of male obesity in the less developed region but, in the more developed one, better-educated men had slightly less chance to be obese. In the less developed region obesity in women was strongly associated with both income (direct association) and education (inverse association). In the more developed region only the women's education influenced the risk of obesity, and the association between the two variables was inverse and strong as in the less developed region. Findings from this study reveal a scenario that is far from what has been generally admitted for the social distribution of obesity in the developing countries. They indicate that in transition societies income tends to be a risk factor for obesity, whereas education tends to be protective and that both gender and level of economic development are relevant modifiers of the influence exerted by these variables.

Adult↗