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At least 433 records · Page 24Linked to original sources

PubMed2005

Assessing mental health and its association with income and resource utilization in old-old Chinese in Hong Kong.

OBJECTIVES: The authors assessed mental health status and its association with income and resource utilization in old-old Chinese citizens in Hong Kong. METHODS: Stratified disproportional random sampling in 1991-92 assembled a cohort of 1,696 elderly community-dwelling subjects who were age 70 or above, measuring the age and education adjusted mean level of cognitive functioning and geriatric depression, by income groups and further investigating the association between mental health and income by incorporating deficiencies in activities of daily living (ADL) and the presence of major chronic conditions in the multivariate regressions. The association between mental health and resource utilization, including physician visits and use of medication, was examined by multivariate regression analyses. RESULTS: Better cognitive functioning was associated with higher income across groups. Lower geriatric depression was associated with higher income. Cognitive impairment was associated with the ADL deficiencies, and geriatric depression was associated with a number of major chronic conditions and higher resource utilization, including physician visits and medication use. CONCLUSIONS: Income was significantly associated with cognitive functioning and geriatric depression in elderly persons in Hong Kong. Mental health, ADL deficiency, major chronic conditions, and resource utilization are interrelated. The fact that aging in the population is associated with increasing cognitive impairment and geriatric depression presents new challenges in financing and delivering efficient and equitable health care in the region.

Activities of Daily Living↗

PubMed2006

Randomised trials relevant to mental health conducted in low and middle-income countries: protocol for a survey of studies published in 1991, 1995 and 2000 and assessment of their relevance.

BACKGROUND: A substantial proportion of the psychiatric burden of disease falls on the world's poorest nations. Despite this, relatively little is known about the quality and content of clinical research undertaken in these countries, or the relevance of the interventions evaluated and specifically that of randomised trials. This project aims to survey the content, quality and accessibility of a sample of trials relevant to mental health conducted within low and middle-income countries; to compare these with studies conducted in high-income countries; and to assess their relevance for the needs of low and middle-income countries. METHODS: An extensive search for all trials, or possible trials, published in 1991, 1995 and 2000 with participants in low and middle-income countries has already been conducted. Studies evaluating prevention or treatment of a mental health problem within these three years will be identified and further searches conducted to assess completeness of the initial search. Data on study quality and characteristics will be extracted from each report. Accessibility will be estimated based on whether each citation is available on MEDLINE. Trials relevant to schizophrenia will be compared with a random sample of schizophrenia trials from high-income countries in the same years. Topics covered by the trials will be compared with the estimated burden of disease. CONCLUSION: Trials and systematic reviews of trials are the gold standard of evaluation of care and increasingly provide the basis for recommendations to clinicians, to providers of care and to policy makers. Results from this study will present the first assessment of the scope, quality and accessibility of mental health trials in low and middle-income countries.

Biomedical Research↗

PubMed2006

Income differences in cardiovascular disease: is the contribution from work similar in prevalence versus mortality outcomes?

The objective of this research is to study the contribution of adverse working conditions to the association between income and cardiovascular disease (CVD), and to analyze differences across prevalence and mortality outcomes. Cross-sectional data from the Swedish Surveys of Living Conditions, 1996-1999 (N = 6,405), and longitudinal registry data for the period 1990-95 (10,916 CVD deaths) were used, including employed wage earners, aged 40-64. Working conditions were assessed through self-reports and imputed from a job exposure matrix, respectively. Multiple logistic and Poisson regressions were applied. There were strong associations between income and CVD. Those in the lowest income quartile had 3.6 (prevalence) and 2.1 (mortality) times higher risk of CVD, compared to those in the highest income quartile (with a gradient for the intermediate groups). In the survey, low job control and physical demands contributed 8-10% to the association between income and CVD prevalence. This contribution was 10% for low job control in the mortality follow-up. A small proportion of the association between income and the prevalence of or mortality from CVD is attributable to working conditions.

Adult↗

PubMed1993

Income-related cost sharing in health insurance.

The vast majority of health plans in the United States require patients to meet cost-sharing requirements that are unrelated to income. Because this is highly inequitable, the authors propose a new system in which cost sharing is explicitly linked to income levels. This proposal differs from earlier proposals to relate cost sharing to income, which relied on the federal income tax system. In this plan, employers and insurers (both public and private) would collect the information necessary to relate cost sharing amounts to income. The proposal could be applied to nearly any health system reform proposal currently under discussion. The authors examine the experience of a number of U.S. firms that have already incorporated income-related cost sharing, as possible models to apply to health insurance nationwide.

Cost Sharing↗

PubMed2001

The impact of income on children's and adolescents' preventive dental visits.

INTRODUCTION: Limited information is available on the effect of income level on whether people visit a dentist for preventive care, whereas more has been written regarding the effect of income on "any" dental visits--which may include emergencies. Also, little is known of the effects of "near-poor" income (101 to 200 percent of the U.S. federal poverty level) on dental visits and preventive dental visits. The authors examined the impact of income at the "poor" and "near-poor" poverty levels on preventive dental visits made by children and adolescents. METHODS: The authors used data from the 1996 Medical Expenditure Panel Survey for children and adolescents younger than 19 years of age to estimate the percentage of this group who had had preventive dental visits. They performed a multiple logistic regression analysis to adjust poverty levels by race and ethnicity, age and sex. RESULTS: The distribution of preventive dental visits for those who were poor was similar to that for those who were near-poor, but the percentage distribution of preventive visits for children and adolescents with higher income was significantly different from that for those in the lower income groups. This was true across all the variables considered. CONCLUSIONS: It is important to evaluate and monitor preventive care utilization trends for U.S. children and adolescents in the poor and near-poor categories separately, particularly in states that do not provide similar levels of access under the State Children's Health Insurance Program, or SCHIP. Enrollment of eligible children in Medicaid and SCHIP via oral health promotion outreach efforts, access to care and utilization of dental primary and secondary care services must be increased.

Adolescent↗

PubMedDate not supplied

[Income inequality and health: the case of Rio de Janeiro].

This ecological analysis addresses the association between income inequality and health status in the municipality of Rio de Janeiro. Data were analyzed using geo-processing and multiple regression techniques. The following health indicators were used: infant mortality rate; standardized mortality rate; life expectancy at birth; and homicide rate among 15-29-year-old males. Patterns of income inequality were assessed through income distribution indicators: Gini index, Robin Hood index, and top 10 %/bottom 40% average income ratio. The results indicate significant correlations between income distribution indicators and health indicators, providing additional empirical evidence of the association between health status and income inequality. For the homicide rate, the effect of the indicator "density of slum residents" was also relevant, suggesting that further deterioration in health standards may be due to social disruption of deprived communities and the resultant increase in criminal activity. The geo-epidemiological analysis presented here highlights the association between adverse health outcomes and residential concentration of poverty. Social policies focused on slum residents are needed to reduce the harmful effects of relative deprivation.

Adolescent↗

PubMed1999

Income inequality and homicide rates in Rio de Janeiro, Brazil.

OBJECTIVES: This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. METHODS: We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. RESULTS: For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P < .01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. CONCLUSIONS: The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate.

Adolescent↗

PubMed2001

Food insufficiency, family income, and health in US preschool and school-aged children.

OBJECTIVES: This study investigated associations between family income, food insufficiency, and health among US preschool and school-aged children. METHODS: Data from the third National Health and Nutrition Examination Survey were analyzed. Children were classified as food insufficient if the family respondent reported that the family sometimes or often did not get enough food to eat. Regression analyses were conducted with health measures as the outcome variables. Prevalence rates of health variables were compared by family income category, with control for age and gender. Odds ratios for food insufficiency were calculated with control for family income and other potential confounding factors. RESULTS: Low-income children had a higher prevalence of poor/fair health status and iron deficiency than high-income children. After confounding factors, including poverty status, had been controlled, food-insufficient children were significantly more likely to have poorer health status and to experience more frequent stomachaches and headaches than food-sufficient children; preschool food-insufficient children had more frequent colds. CONCLUSIONS: Food insufficiency and low family income are health concerns for US preschool and school-aged children.

Adolescent↗

PubMed2002

Income inequality and mortality in US counties: does minority racial concentration matter?

UNLABELLED: This study examined (1) the relationship between income inequality and mortality among all counties in the contiguous United States to ascertain whether the relationships found for states and metropolitan areas extend to smaller geographic units and (2) the influence of minority racial concentration on the inequality-mortality linkage. METHODS: This county-level ecologic analysis used data from the Compressed Mortality Files and the US Census. Weighted least squares regression models of age-, sex-, and race-adjusted county mortality rates were estimated to examine the additive and interactive effects of income inequality and minority racial concentration. RESULTS: Higher income inequality at the county level was significantly associated with higher total mortality. Higher minority racial concentration also was significantly related to higher mortality and interacted with income inequality. CONCLUSIONS: The relationship between income inequality and mortality is robust for counties in the United States. Minority concentration interacts with income inequality, resulting in higher mortality in counties with low inequality and a high percentage of Blacks than in counties with high inequality and a high percentage of Blacks.

Black or African American↗

PubMed2000

The widening gap in death rates among income groups in the United States from 1967 to 1986.

Death rates in the United States have fallen since the 1960s, but improvements have not been shared equally by all groups. This study investigates the change in inequality in mortality by income level from 1967 to 1986. Comparable death rates are constructed for 1967 and 1986 using National Mortality Followback Surveys as numerators and National Health Interview Surveys as denominators. Direct age-adjusted death rates are calculated for income levels for the U.S. noninstitutionalized civilian population 35 to 64 years old. A summary measure of inequality in mortality adjusts for differences in the size and definition of income groups in the two years. In both 1967 and 1986, mortality decreased with each rise in income level. Measured in relative terms, this inverse relationship was greater in 1986 then in 1967 for men and women, blacks and whites. Between 1967 and 1986, death rates for those with maximal income declined between two and three times more rapidly than did rates for the middle and low income groups. The greatest increase in relative inequality was seen among white males.

Adult↗

PubMed2003

Income, age and financial satisfaction.

Although the effects of income and age on subjective well-being have been widely studied, research on the effects of income and age on financial satisfaction, a major life domain to which income has direct relevance, remains limited. Analyzing data from the General Social Surveys, this article empirically examined the effects of income and age on financial satisfaction. These findings suggest that the social-psychological mechanisms underlying the age differences in the effects of income on financial satisfaction might not reflect a clear-cut status attainment versus status maintenance framework. The findings also served to caution future financial satisfaction research in the choice of income measures and the age grouping.

Adult↗

PubMed1978

Education and income effects in the use of ambulatory services in the United States: an analysis of the 1970 National Health Interview Survey data.

The roles of education and income as determinants for utilization of ambulatory services in the U.S. are investigated by the application of path analysis to a subsample of the 1970 National Health Interview Survey. The methodology permits the identification of both the direct and indirect effects of each independent variable on utilization within a model that views need as the major determinant of care. Previous findings that income has no direct effect on utilization, while education does, are reaffirmed. Contrary to previous analyses, however, it is shown that income does have a strong indirect effect on utilization via its impact on need arising from chronic conditions, measured as limitation of activity. Individuals in the highest income category have a mean annual visit rate of 4.13, while the rate for those in the lowest is 5.43. Most of the differential, 1.3, is attributable to the lower prevalence of chronic conditions in the highest income bracket. The total effect of education, on the other hand, is only 60% of its direct effect since higher educational attainment is associated with lower levels of chronicity. Disaggregation of direct and indirect effects through the need variables shows that income has a greater effect on utilization than does education.

Ambulatory Care↗

PubMed1999

[Income and smoking behavior in Germany--a secondary analysis of data from the 1995 microcensus].

We investigated to what extent two major parameters of the economic situation, namely the household income and the type of the major source of income, are related to smoking behaviour. Study variables are current cigarette smoking and ex-smoking. Databasis is the Public Use File of the "Microcensus 1995", which is a representative survey for Germany, conducted under the auspices of the German Federal Statistical Bureau. Included in the analysis were 185,822 persons aged 18 years and older. 30.9% of males and 18.2% of females are current smokers. 39% of males and 31.2% of females, who had been smokers at any time, stopped smoking. For persons aged 18 to 64 years, we observed strong income-related differences in the smoking prevalence. The higher the income the lower was the rate of smokers. Higher rates for ex-smokers were observed for persons older than 30 years, who had a high household income. For study subjects with a primary income based on unemployment or social welfare payments, we found for both sexes a remarkably higher smoking prevalence. Due to the fact that the underlying causes for the higher prevalence of smoking in the poorer segments of the population are not very well understood, it is rather difficult to establish a comprehensive prevention strategy for this high-risk population group.

Adolescent↗

PubMed1999

Income inequality and health: pathways and mechanisms.

The relationship between income and health is well established: the higher an individual's income, the better his or her health. However, recent research suggests that health may also be affected by the distribution of income within society. We outline the potential mechanisms underlying the so-called relative income hypothesis, which predicts that an individual's health status is better in societies with a more equal distribution of incomes. The effects of income inequality on health may be mediated by underinvestment in social goods, such as public education and health care; disruption of social cohesion and the erosion of social capital; and the harmful psychosocial effects of invidious social comparisons.

Health Status↗

PubMed1984

Unrelated business income tax: an update.

To meet spiraling costs, tax-exempt hospitals increasingly are operating businesses unrelated to direct patient care. Knowing which activities may be open to challenge by the Internal Revenue Service (IRS) is essential to avoid the unrelated business income (UBI) tax. Three criteria must be met for an activity to be taxable as UBI: It must constitute a trade or business; It must be regularly carried on; and It must be unrelated to the organization's exempt purpose. The Internal Revenue Code and IRS rulings clearly exclude the following areas from UBI taxation: Activities performed by unpaid volunteers (e.g., hospital auxiliaries' fund-raising dinners and bazaars and the operation of thrift stores); Operations conducted for the convenience of the organization's members, students, patients, or employees (e.g., gift shops, cafeterias, coffee shops, parking lots, lounges, vending machines, pharmaceutical sales to inpatients and emergency room outpatients, and research activities for students' benefit; The sale of merchandise that has been received by gift (e.g., flea markets, baked goods sales, book sales, and rummage sales); Investment income such as dividends, interest, annuities, royalties, certain rents, and capital gains from the sale of investment assets; Gifts or contributions made directly to the facility; and Bingo games that are conducted commercially. Areas which may be subject to UBI taxation, or in which there have been controversial or contradictory court rulings, include: Pharmaceutical sales to the public or private physicians' patients; and Laboratory services provided to private physicians for treating their patients. IRS private letter rulings, though not precedential, have excluded from UBI taxation the x-ray income from a hospital's branch facility and rental income from property leased for use as a clinic or medical office building that is substantially related to the hospital's exempt functions. Private letter rulings have subjected to UBI taxation the income for a professional standards review organization's private review activities and debt-financed income from property that is not substantially related to the organization's exempt purpose.

Commerce↗

PubMed1985

Insurance coverage and ambulatory medical care of low-income children: United States, 1980.

In the household survey phase of the National Medical Care Utilization and Expenditure Survey of 1980, a survey was conducted of 17,123 persons who constituted a representative sample of the civilian population in the United States not residing in institutions. Through repeated interviews the survey obtained information on the health conditions of these people, the health care services they received in 1980, the costs of these services, and the sources of payment for services. This report, one of a series of reports on the survey findings, provides a profile of low-income children: Their health insurance coverage, health service use, and expenditures for physician visits. Children under 18 years of age in families below 150 percent of the 1980 Federal poverty level are considered low income. However, children who were ineligible to participate in the survey for part of the year are excluded, such as those who were born, who died, or who were institutionalized in 1980. A physician visit is defined as a face-to-face contact with a physician or a nonphysician working under the supervision of a physician. In addition, visits to nurse practitioners and physician assistants who were reported as "independent providers" are included. Otherwise, visits to independent providers (primarily chiropractors and optometrists), mental health visits, visits by physicians to hospital inpatients, and telephone contacts are excluded. Of the 63.9 million children under 18 years of age in the United States in 1980, about one-fourth (16.8 million) lived in low-income families, according to estimates from the National Medical Care Utilization and Expenditure Survey. Nearly one-half (46 percent) of the 16.8 million low-income children were covered by Medicaid for all or part of 1980: 31 percent were covered by Medicaid only for the full year, 3 percent were covered by Medicaid for part of 1980 and uninsured for the remainder of the year, and 12 percent were covered by both Medicaid and private insurance during the year. An additional 30 percent of the low-income children were privately insured for the full year, while 8 percent had private insurance coverage for part of the year and were uninsured otherwise. Sixteen percent of the children in low-income families, or 2.7 million children, were uninsured for all of 1980. When added to the 3 percent with part year Medicaid coverage and the 8 percent with private coverage part of the year, over one-fourth (28 percent) were uninsured for at least part of 1980.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1999

[Sources of income after being denied disability pension].

Restrictions in eligibility criteria for disability pension were introduced in Norway in 1991. The effect of these restrictions on sources of income is an important question in social policy. 157 first time applicants from two counties who were denied disability pension before (1990) and after (1993) the restrictions were studied three years later. Sources of income were established through searches in registers of wages and social security benefits. NOK 3,000 per month was set as the lowest income allowing economic independence. Of the applicants in 1990, 14% were in the workforce three years later. In the post-restriction 1993 sample, this proportion was 21% (p = 0.29). The proportions receiving disability pension were 25% and 22% respectively. The spouse supported 33% of the 1990 applicants, and 22% in the 1993 sample (p = 0.13). Social welfare was the main source of income for 6% and 10% (p = 0.25). Changes in main sources of income following the restriction were relatively small. The main result of this study is that family support is the most prevalent source of income when disability benefits are denied. This is not in accordance with the Government's policy of promoting gainful employment.

Adult↗

PubMed2000

Income inequality and all-cause mortality in the 100 counties of North Carolina.

BACKGROUND: This study evaluated the relationship between income inequality and all-cause mortality in the 100 counties of North Carolina. METHODS: Mortality data for 1985 to 1994 came from the National Center for Health Statistics and household income data from the 1990 Census. Associations between county-level income inequality and age-adjusted, all-cause mortality rates were evaluated in stratified and regression analyses. RESULTS: Stratified analyses suggest that all-cause mortality was directly related to income inequality in all 100 counties and in non-metropolitan statistical area (MSA) counties. This relationship was statistically significant, controlling for per capita income in regression analyses for all age groups except > or =65 years among all 100 counties and for all ages combined and for ages 35 to 64 among non-MSA counties. CONCLUSIONS: A relationship between income inequality and all-cause mortality previously identified nationally among states and MSAs was also found among all counties and non-MSA counties of North Carolina in 1985 to 1994.

Adolescent↗