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PubMed2002

Food label use modifies association of income with dietary quality.

We analyzed the 1994-1996 Continuing Survey of Food Intake by Individuals and the Diet and Health Knowledge Survey (DHKS) to examine whether the relationship between income and dietary quality is modified by food label (FL) use among 20- to 60-y old DHKS respondents who were either household meal preparers, meal planners or food shoppers (n = 2952). Multivariate logistic regression results indicated that the influence of income on dietary quality is mediated by FL use. Those who were wealthier and used FL were significantly less likely to have a lower Healthy Eating Index (HEI) compared with the reference group formed by those in the lower income category who did not use FL [OR = 0.42; 95% confidence interval (CI): 0.31, 0.56]. By contrast, those who were wealthier but did not use FL were as likely as the reference group to have a low HEI (OR = 1.08; 95% CI: 0.74, 1.54). Those who were poorer but used FL were significantly less likely to have a low HEI compared with the reference group (OR = 0.62; 95% CI: 0.48, 0.80). Thus, FL use is associated with improved dietary quality among all income groups with a greater benefit of use among higher income individuals. Income is not associated with improved dietary quality in the absence of FL use.

Adult↗

PubMed2003

Income inequality and infant mortality in New York City.

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6-29.6/1,000 live births; range in income inequality: 12.7-27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P <.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions.

Censuses↗

PubMed2004

The impact of low family income on self-reported health outcomes in patients with rheumatoid arthritis within a publicly funded health-care environment.

OBJECTIVE: Self-rated health (SRH) is an independent, strong predictor of morbidity and mortality. Socio-economic status (SES) is strongly associated with SRH. This study investigated the relationship between SES and SRH outcomes in a sample of patients with rheumatoid arthritis (RA) in Canada. METHODS: Both generic preference-based [Health Utilities Index Mark 3 (HUI3) and Short Form 6D (SF-6D)] and non-preference-based [disease-specific (Rheumatoid Arthritis Quality of Life, RAQoL) and a functional status (Health Assessment Questionnaire, HAQ)] SRH questionnaires were administered to 313 RA patients. Both proximate (education and annual household income) and contextual (neighbourhood income, education and unemployment) measures of SES were captured. Ordinary least squares (OLS) regression was used to adjust for RA severity while assessing the relationship between SRH and SES measures. Two-stage least-squares (TSLS) regression was used to determine if there was an inter-relationship between SES and SRH measures. RESULTS: The sample was well distributed across RA severity and SES measures. Contextual and proximate measures of SES were poorly correlated. Lower levels of proximate SES measures (but not contextual) were associated with poorer SRH outcomes. The OLS regressions showed significant associations between the HUI3 and the SF-6D overall scores and the HAQ for self-reported income. The RAQoL did not differ significantly across SES. TSLS regression confirmed the finding that self-reported income was similarly associated with the SRH measures. CONCLUSIONS: Even in a country with universal access to health-care, the impact of a chronic disease such as RA on SRH is associated with self-reported income. The finding that preference-based measures vary with income independently of RA severity could bias economic evaluation.

Adult↗

PubMedDate not supplied

Milk volume on day 4 and income predictive of lactation adequacy at 6 weeks of mothers of nonnursing preterm infants.

Lactating mothers of preterm infants who are pump-dependent are at high risk for difficulty maintaining an adequate milk supply. This article reports the naturally occurring volume of milk removed from the breast by mechanical expression over time for 81 mothers of nonnursing preterm infants from 4 tertiary care centers in the Midwest. Baseline variables (infant gestation in weeks; intended length in weeks to breastfeed; number of hours post-delivery to first breast stimulation; infant weight in grams; timing of decision to provide mother's milk; income; maternal education, kangaroo care during week 1; previous breastfeeding experience; white, non-Hispanic) and day 4 variables (milk volume, frequency of pumping) were explored for predicting milk adequacy at week 6. Using the significant predictive variables of milk levels at day 4 and income, the logistic regression accurately classified 85% of the 40 mothers with inadequate milk production (<500 mL/d) and 85.5% of the 41 mothers with adequate milk production (> or = 500 mL/d). While controlling for income, the 27 mothers with lowest milk production at 4 days were 9.5 times more likely to have an inadequate milk supply at 6 weeks than the 54 mothers with higher milk production. While controlling for day 4 milk production, lower annual income mothers (< dollar 50,000) were 5 times more at risk of inadequate milk production than those with high income (> or = dollar 50,000) at week 6. This study emphasizes the importance of the amount of milk volume expressed in the early postpartum period during lactogenesis. In addition, neonatal nurses need to be cognizant that income levels may make a difference in milk production.

Adult↗

PubMed1980

Income and illness.

Little research has been directed toward an examination of the health needs of low-income Americans in relation to major governmental medical care programs designed originally to narrow the health gap between "poor" and "nonpoor." Analysis of unpublished data from the 1977 Health Interview Survey of the National Center for Health Statistics shows that about 75 per cent of the gap in restricted activity days and bed disability days--two common measures of the impact of ill-health--between "poor" and "nonpoor" populations is attributable to greater prevalence and severity of activity-limiting chronic conditions among low-income people. Although both income groups report similar types of chronic conditions resulting in activity limitation, the prevalence of all major chronic conditions is greater in the low-income population. Approximately 25 per cent of the low-income population bears the burden of these conditions; the majority of the "poor" report disability day levels similar to the "nonpoor." The substantial impact of chronic conditions should be an important consideration in meeting the health needs of the low-income population. Current government programs, such as Medicare and medicaid, however, are designed primarily to pay for acute care received in hospitals and in physicians' offices.

Activities of Daily Living↗

PubMed2006

The influence of physician race and gender on obstetrician-gynecologists' annual incomes.

OBJECTIVE: A study using 1998 data concluded that incomes of male and female obstetrician-gynecologists were essentially equivalent, after considering only differences in productivity. We examined the association between gender, race, and obstetrician-gynecologists' incomes, after correcting for productivity and other important practice and provider characteristics. METHODS: Survey responses obtained from 1992 to 2001 from 962 actively practicing obstetrician-gynecologists and linear regression modeling were used to estimate the influence of race and gender on physicians' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. RESULTS: Compared with white male and black female obstetrician-gynecologists, black men reported seeing 5% more patient visits and working 18% more hours, while white women reported seeing 18% fewer visits and working 10% fewer annual hours. Women were more likely to be nonowner employees than men. White female obstetrician-gynecologists were less likely than the other groups to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, black men's mean reported annual income was 210,859 dollars, or 78,905 dollars (27%) lower than that for white men (95% confidence interval [CI] 120,082 dollars to 37,729 dollars lower; P < .001); white women's was 242,721 dollars, or 47,043 dollars (16%) lower (95% CI 70,127 dollars to 23,958 dollars lower; P < .001); and black women's was 246,355 dollars, or 43,409 dollars (15%) lower (95% CI 92,296 dollars to 5,478 dollars higher, P = .08). CONCLUSION: During the 1990s, both black race and female gender were associated with substantially lower annual incomes among obstetrician-gynecologists. These findings warrant further exploration to ensure that income differences among physicians are not unjustly driven by race or gender.

Adult↗

PubMed2004

Is income inequality a determinant of population health? Part 1. A systematic review.

This article reviews 98 aggregate and multilevel studies examining the associations between income inequality and health. Overall, there seems to be little support for the idea that income inequality is a major, generalizable determinant of population health differences within or between rich countries. Income inequality may, however, directly influence some health outcomes, such as homicide in some contexts. The strongest evidence for direct health effects is among states in the United States, but even that is somewhat mixed. Despite little support for a direct effect of income inequality on health per se, reducing income inequality by raising the incomes of the most disadvantaged will improve their health, help reduce health inequalities, and generally improve population health.

Aged↗

PubMed2006

Race and gender differences in general internists' annual incomes.

BACKGROUND: Specialty, work effort, and female gender have been shown to be associated with physicians' annual incomes; however, racial differences in physician incomes have not been examined. OBJECTIVE: To determine the influence of race and gender on General Internists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. DESIGN: Retrospective survey-weighted analysis of survey data. PARTICIPANTS: One thousand seven hundred and forty-eight actively practicing General Internists who responded to the American Medical Association's annual survey of physicians between 1992 and 2001. MEASUREMENTS: Work effort, provider and practice characteristics, and adjusted annual incomes for white male, black male, white female, and black female General Internists. RESULTS: Compared with white males, white females completed 22% fewer patient visits and worked 12.5% fewer hours, while black males and females reported completing 17% and 2.8% more visits and worked 15% and 5.5% more annual hours, respectively. After adjustment for work effort, provider characteristics, and practice characteristics, black males' mean annual income was 188,831 dollars or 7,193 dollars (4%) lower than that for white males (95% CI: -31,054 dollars, 16,669 dollars; P=.6); white females' was 159,415 dollars or 36,609 dollars (19%) lower (95% CI: -25,585 dollars, -47,633 dollars; P<.001); and black females' was 139,572 dollars or 56,452 dollars (29%) lower (95% CI: -93,383 dollars, -19,520 dollars; P=.003). CONCLUSIONS: During the 1990s, both black race and female gender were associated with lower annual incomes among General Internists. Differences for females were substantial. These findings warrant further exploration.

Black People↗

PubMed2005

Low income and education levels may cause medication overuse and chronicity in migraine patients.

BACKGROUND: Frequent analgesic drug intake, especially in migraine patients, may induce the risk of medication overuse headache (MOH). The various conditions that may affect the development and the features of MOH have not been determined yet. AIM: To compare MOH patients with migraine as pre-existing headache and episodic migraine patients according to socioeconomic and educational variables. METHODS: Forty-six MOH patients with migraine as pre-existing headache and 61 migraine patients were included into study. The headache characteristics, socioeconomic and educational variables of MOH and migraine groups and subgroups divided according to the education (low/high education subgroups), and income (low/high income subgroups) levels were evaluated. RESULTS: We found that mean duration of education was shorter in MOH patients than migraine patients. There was a negative correlation between duration of education and duration of MOH. The mean duration of MOH was longer and rate of low-income level was higher in patients with low-education level. The duration of education was lower in MOH patients with low income. The frequency of migraine attacks and low-income rate was also higher in low-educated migraine patients. The duration of education was shorter in migraine patients with low income. CONCLUSION: We report that migraineurs with low socioeconomic status may have risk of developing MOH. A better identification of patients at risk of drug-associated headache may contribute to improved health in a group of patients with MOH.

Adult↗

PubMed2001

Effect of gender on ownership and income in veterinary practice.

OBJECTIVE: To estimate the effect of gender on ownership and income in veterinary practice in Australia. METHODS: Questionnaire completed by private veterinary practitioners, and analysed using the SAS System for Windows 7.0. RESULTS: More than three-quarters (78%) of male but 36% of female private practitioners were partial or sole owners of practices. The median annual income for all male practitioners working more than 40 hours/week was $70K, but that for females was $43K. These disparities existed in both city and country practices, and in the case of income it increased with increasing time in the workforce. Male practice owners also reported higher incomes than female owners. CONCLUSIONS: Female veterinary practitioners are less likely to own practices, and more likely to earn low incomes than males. These differentials do not appear to be due to location, hours worked or years since graduation or, in the case of income, to whether they are owners or employees. The evidence points to a lower interest by women than men in the business aspects of veterinary practice.

Female↗

PubMed1999

Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition.

OBJECTIVES: To examine the relationship between the magnitude, and the relative importance of unintentional child injury mortality with socioeconomic development, and to conceptualise the dynamic changes in injury mortality within the framework of epidemiological transition. DESIGN: Ecological cross sectional study using data on 51 countries. MAIN OUTCOME MEASURES: The relationship between total mortality rates, unintentional injury mortality rates, and percentage in children 1-14 years of age with gross national product (GNP) per capita. RESULTS: Unintentional injury mortality rates in children were negatively correlated with GNP per capita. However, by categorising the data, we found some areas of non-correlation: in children 5-14 years in low income versus lower middle income countries, and in all age and gender groups in lower high income versus higher high income countries. A high percentage of total deaths due to injuries was clearest in the lower middle income countries in all age and gender groups. CONCLUSIONS: The changes in child injury mortality in relation to socioeconomic development could be conceptualised as three stages: a stage of high magnitude; a stage of high priority; and a stage of improvement. Most middle income countries are in the high priority stage where both injury mortality rates and injury percentage of total deaths are high.

Adolescent↗

PubMed2006

Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice.

STUDY OBJECTIVE: Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics measure the same underlying phenomena. This paper questions this practice. The study looked for any independent effects of education, income, and occupational class on four health outcomes: diabetes prevalence, myocardial infarction incidence and mortality, and finally all cause mortality in populations from Sweden and Germany. DESIGN: Sweden: follow up of myocardial infarction mortality and all cause mortality in the entire population, based on census linkage to the Cause of Death Registry. Germany: follow up of myocardial infarction morbidity and all cause mortality in statutory health insurance data, plus analysis of prevalence data on diabetes. Multiple regression analyses were performed to calculate the effects of education, income, and occupational class before and after mutual adjustments. SETTING AND PARTICIPANTS: Sweden (all residents aged 25-64) and Germany (Mettman district, Nordrhein-Westfalen, all insured persons aged 25-64). MAIN RESULTS: Correlations between education, income, and occupational class were low to moderate. Which of these yielded the strongest effects on health depended on type of health outcome in question. For diabetes, education was the strongest predictor and for all cause mortality it was income. Myocardial infarction morbidity and mortality showed a more mixed picture. In mutually adjusted analyses each social dimension had an independent effect on each health outcome in both countries. CONCLUSIONS: Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension. Although correlated, they measure different phenomena and tap into different causal mechanisms.

Adult↗

PubMed2006

Mortality after acute myocardial infarction according to income and education.

OBJECTIVE: To study how income and educational level influence mortality after acute myocardial infarction (AMI). DESIGN AND SETTING: Prospective analysis using individual level linkage of registries in Denmark. PARTICIPANTS: All patients 30-74 years old hospitalised for the first time with AMI in Denmark in 1995-2002. MAIN OUTCOME MEASURES: Relative risk (RR) of 30 day mortality and long term mortality (31 days until 31 December 2003) associated with income (adjusted for education) or educational level (adjusted for income) and further adjusted for sex, age, civil status, and comorbidity. RESULTS: The study identified 21 391 patients 30-64 years old and 16 169 patients 65-74 years old. The 30 day mortality was 7.0% among patients 30-64 years old and 15.9% among those 65-74 years old. Among patients surviving the first 30 days, the long term mortality was 9.9% and 28.3%, respectively. The adjusted RR of 30 day mortality and long term mortality among younger patients with low compared with high income was 1.54 (95% confidence interval 1.36 to 1.79) and 1.65 (1.45 to 1.85), respectively. The RR of 30 day and long term mortality among younger patients with low compared with high education was 1.24 (1.03 to 1.50) and 1.33 (1.11 to 1.59), respectively. The RR of 30 day and long term mortality among older patients with low compared with high income was 1.27 (1.15 to 1.41) and 1.38 (1.27 to 1.50), respectively. Older high and low education patients did not differ in mortality. CONCLUSION: This study shows that both educational level and income substantially and independently affect mortality after AMI, indicating that each indicator has specific effects on mortality and that these indicators are not interchangeable.

Acute Disease↗

PubMed2000

Income, occupational position, qualification and health inequalities--competing risks? (comparing indicators of social status).

STUDY OBJECTIVE: The debate on health inequalities has shifted from the consequences of occupational position, as expressed in the Registrar General's classification, to consequences of material living conditions. This change in interest occurred without comparative analyses of different sources of health inequalities. Thus this study investigated the relative contribution of "material resources" (income), "qualification" and "occupational position" for explaining social differentials in mortality. DESIGN AND SETTING: Analyses were performed with records from a statutory health insurance in West Germany. The analyses were performed with data of 84,814 employed men and women between 25 and 65 years of age who were insured between 1987 and 1995 for at least 150 days. RESULTS: The three indicators were statistically associated, but not strong enough to warrant the conclusion that they share the same empirical content. The relative risk (hazard rate) for income by controlling for occupational position and gender for the highest as compared with the lowest category was 1.99 (95% CI 1.66, 2.39). The corresponding relative risk for income by controlling for qualification and gender was 2.03 (95% CI 1.68, 2.46). In both multivariate analyses, the effects of occupational position and qualification were no longer interpretable because of large confidence intervals. In sum, income related relative mortality risks were the comparably highest, while qualification and occupational position were no longer substantial. CONCLUSIONS: The results emphasise the present discussion on the consequences of material living conditions. Income on the one hand and qualification and occupational position on the other are largely independent. Mortality related effects of income override those of the other socioeconomic status indicators. However, seen in a time perspective, qualification may still have a placement function at least for the first occupational position.

Adult↗

PubMed2002

Inequality, residential segregation by income, and mortality in US cities.

STUDY OBJECTIVE: This study was designed to discover whether the relation between income inequality and population death rates within the United States was mediated by the degree of residential segregation between rich and poor. DESIGN: Using data for 276 metropolitan areas in the USA, residential segregation was defined as the extent to which people with different levels of income live in the same or different census tracts. Two segregation measures were used: the ratio of income inequality between household within tracts to the inequality in average income between tracts, and the Jargowsky Neighbourhood Sorting Index. MAIN RESULTS: Results suggest that segregation within urban areas is associated with an additional mortality burden. However, the association between income inequality and mortality in these metropolitan statistical areas was found to be independent of the degree of economic segregation between their constituent neighbourhoods. CONCLUSIONS: Most of the association between income inequality and mortality is not mediated by the effects of greater residential segregation.

Adolescent↗

PubMed2003

Does an increase of low income families affect child health inequalities? A Swedish case study.

STUDY OBJECTIVE: Reduction of health inequalities is a primary public health target in many countries. A change of proportion of low income families might affect child health inequalities. Yet, the importance of family incomes in high income welfare states is not well established. The aim of this study was to investigate the effect of increased percentage of low income families on child health inequalities during an economic recession in Sweden, 1991-1996. DESIGN: Health inequalities for six health indicators were assessed during the period 1991-1996 and during adjacent periods. Relative inequality indices were estimated according to Pamuk and Mackenback. Appraisal of a child's socioeconomic situation was based on social data for the child's residency area. SETTING: The total population of children and adolescents 0-<19 years old living in Stockholm County, Sweden, was studied. Each one year cohort comprised 20 470-25 420 people. MAIN OUTCOME MEASURES: Mortality; rate of low birth weight; days of hospital care for infections, asthma/allergic disorders, and unintentional injuries; and rate of abortions. MAIN RESULTS: Mortality decreased annually by 6.9%. The average relative inequality index for mortality before the recession was 1.40 and was lower during the recession, 1.14. The remaining five health indicators, and the relative inequality index for these indicators, did not differ significantly between the recession years (1991-1996) and adjacent periods. CONCLUSIONS: Relative health inequalities did not change, or decreased, during the recession years. The findings indicate that the connection was weak between child health inequalities and family incomes, within the frame of time and the range of income changes that occurred during the study period.

Adolescent↗

PubMed2002

Tobacco spending and children in low income households.

OBJECTIVE: To examine the role of tobacco use in creating financial hardship for New Zealand (NZ) low income households with children. DATA: The 1996 NZ census (smoking prevalence by household types), Statistics NZ (household spending surveys 1988-98), and NZ Customs (tobacco released from bond 1988-98). MAIN OUTCOME MEASURES: Proportion of children in households with smokers and < or = 15,000 NZ dollars gross income per adult. Proportion of spending on tobacco of second lowest equivalised household disposable income decile and of solo parent households. RESULTS: In < or = 15,000 NZ dollars gross income per adult households with both children and smokers, there were over 90,000 children, or 11% of the total population aged less than 15 years. Enabling second lowest income decile households with smokers to be smoker-free would on average allow an estimated 14% of the non-housing budgets of those households to be reallocated. CONCLUSIONS: The children in low income households with smokers need to be protected from the financial hardship caused by tobacco use. This protection could take the form of more comprehensive government support for such households and stronger tobacco control programmes. A reliance on tobacco price policy alone to deter smokers is likely to have mixed outcomes-for example, increased hardship among some of these households. The challenge for tobacco control is to move from a sole focus on "doing good" towards incorporating the principle of "doing no harm".

Adolescent↗

PubMed2005

The relation of education and income to cognitive function among professional women.

We investigated the relation of educational attainment and annual household income to cognitive function and cognitive decline in community-dwelling women aged 66 years or older. Subjects were 6,314 health professionals participating in the Women's Health Study, among whom information on education and income was self-reported. From 1998 to 2000, we administered five cognitive tests, measuring general cognition, episodic memory and verbal fluency, using a validated telephone interview. Second cognitive assessments were conducted approximately 2 years later; information was complete for 5,573 women at the time of analysis, with 94% follow-up. We used linear and logistic regression to calculate multivariate-adjusted mean differences as well as odds of cognitive impairment (defined as worst 10% of test distribution) and of substantial decline in performance (worst 10% of distribution), across various levels of education and income. After adjusting for numerous potential confounding factors, we found strong trends of increasing mean cognitive performance with increasing level of education (p trend<0.0005 on all cognitive measures). Odds of cognitive impairment also consistently decreased with increasing education. For income, we found significant trends of increasing mean cognitive performance with increasing income on the summary score and on episodic memory (p trends<0.0001). Results were generally similar for cognitive decline over 2 years, although slightly weaker. Thus, in these well-educated, professional women, educational attainment and income both predicted cognitive function and decline.

Aged↗