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PubMed1988

Improving the income support of the chronically mentally ill: a model program to address the needs of the ex-psychiatric patient.

Interest in developing support services for the long-term mentally ill has increased in recent years. One of the most important aspects of support essential to the basic community survival of the chronic patient is income maintenance. Unfortunately, support in this area has been declining for this population. The purpose of this paper is to briefly outline the decline in the overall well-being of patients who rely on social assistance, describe a model income maintenance program established in a provincial psychiatric hospital, and, to evaluate the program's success in alleviating the financial problems of the long-term mentally ill. The income maintenance program described has proven to be a successful method of improving the economic situation of the long-term mentally ill. In its first 30 months of operation, the income status of over 3,000 patients has been systematically reviewed and 77% of those eligible have been converted to higher social assistance rates. The conversion has resulted in a 30 to 40% increase in income for the patients involved. The program has also contributed to improved relations with hospital staff and social assistance offices.

Aftercare↗
PubMed2003

Income inequality and health: a critical review of the literature.

This article critically reviews published literature on the relationship between income inequality and health outcomes. Studies are systematically assessed in terms of design, data quality, measures, health outcomes, and covariates analyzed. At least 33 studies indicate a significant association between income inequality and health outcomes, while at least 12 studies do not find such an association. Inconsistencies include the following: (1) the model of health determinants is different in nearly every study, (2) income inequality measures and data are inconsistent, (3) studies are performed on different combinations of countries and/or states, (4) the time period in which studies are conducted is not consistent, and (5) health outcome measures differ. The relationship between income inequality and health is unclear. Future studies will require a more comprehensive model of health production that includes health system covariates, sufficient sample size, and adjustment for inconsistencies in income inequality data.

Health Services Research↗
PubMed2006

Differences in parenting needs of fathers of children with chronic conditions related to family income.

Children with chronic conditions now survive longer than has been true historically, creating a need to promote optimal growth and development for themselves, their family members and the family as a whole. This article reporting a midwestern United States study compares the concerns and coping strategies of fathers of chronically-ill children with household annual incomes less than $50,000 with fathers of chronically-ill children with household incomes of $50,000 or more. The sample of 48 fathers completed the Hymovich Family Perception Inventory anonymously. The results revealed differences in the parenting concerns of fathers related to family income. The low-income fathers expressed a desire for more knowledge about the children's condition and worries about family finances. Professional anticipatory guidance and dissemination of information holds promise for providing the support needed by fathers of children with chronic conditions, particularly those with lower household incomes.

Adaptation, Psychological↗
PubMed2005

Health insurance, neighborhood income, and emergency department usage by Utah children 1996-1998.

BACKGROUND: It is estimated that approximately half of emergency department (ED) usage in the U.S. and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors. We examined pediatric ED usage in a U.S. state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children. METHODS: Emergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care. RESULTS: Children with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88-2.96). There was no reduction in Medicaid ED usage following the transition to managed care. CONCLUSION: Usage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies.

Adolescent↗
PubMed2005

Increased risk of depression in COPD patients with higher education and income.

This study examined potential modifying effects of income and education on the relationship between chronic obstructive pulmonary disease (COPD) and depression. The analysis was based on 44,963 Canadians aged 35 years or more who participated in the Canadian National Population Health Survey in 1996-1997. Logistic regression analysis was used to examine the association between prevalence of depression and COPD according to sex, income adequacy or educational level. We used a bootstrap procedure to take sampling weights and design effects into account. People with COPD had twice the prevalence of depression compared to those without COPD. The association tended to be stronger in well-educated men [adjusted odds ratio (OR) = 3.02, 95% confidence interval (CI) = 1.04, 8.75] and women (OR = 2.60, 95% CI = 1.55, 4.38) than those less educated (men: OR= 1.19, 95% CI = 0.47, 3.05; women: OR = 1.93, 95% CI = 0.96, 3.87). An increased prevalence of depression associated with COPD was also found in women with higher household income (adjusted odds ratio = 4.57, 95% CI = 2.27, 9.19) than those with lower income. However, this pattern was not found in men. In conclusion, COPD patients with higher education are more likely to be depressed. The modifying effect of income may vary by gender. Possible reasons for these findings are explored.

Adult↗
PubMed2002

Midlife income, occupation, APOE status, and dementia: a population-based study.

OBJECTIVE: To examine the relationship between socioeconomic factors and APOE carrier status on the development of dementia. METHODS: Subjects were derived from random, population-based samples previously studied in surveys carried out in 1972, 1977, 1982, and 1987. After an average follow-up of 21 years, 1449 (73%) subjects aged 65 to 79 years were re-examined in 1998. The diagnosis of dementia among the nonparticipants was derived from patient records of the local hospitals and primary health care clinics. RESULTS: Low income level at old age was related to dementia, but low income level at midlife was not a risk factor for dementia. Dementia was also associated with decreasing income level, from midlife to old age 21 years later, when dementia was diagnosed. A sedentary occupation (office, service, or intellectual work) was associated with a decreased risk for dementia among participants; however, when the nonparticipants were included in the analysis, the associations were no longer significant. Low educational level and the APOE epsilon4 allele independently increased the risk for dementia. CONCLUSIONS: Reduction in income level during follow-up and low income level at old age might be the consequence of a dementing process rather than being associated with risk evolution of dementia.

Aged↗
PubMed1977

Interfacing national health insurance and income maintenance: why health and welfare reform go together.

The current debate on national health insurance has not given sufficient attention to the impact of various proposals upon income maintenance programs. Health and welfare benefits are difficult to coordinate and frequently work at cross purposes. Health care benefits are one of several in-kind forms of income that can affect the economic behavior and well-being of welfare recipients. As an in-kind form of income, subsidized health insurance for low income persons can undermine the objectives of public assistance, particularly the willingness to work, by making some individuals worse off when income rises. Five national health insurance proposals are analyzed to determine how each will interface with cash transfer programs. Most of these proposals perpetuate many of the benefit coordination problems that now exist with the Medicaid program. The article concludes by delineating some of the difficult policy decisions that must be made if health and welfare reforms are to be meaningful.

Aid to Families with Dependent Children↗
PubMed2003

Utilization of general practitioner services in New Zealand and its relationship with income, ethnicity and government subsidy.

The New Zealand primary care system involves user part-charges for general practitioner (GP) care. This study explores the relationship between the use of GP services in New Zealand and government subsidies, income and ethnicity. The study used the 1996/97 New Zealand Health Survey dataset, a nationally representative household survey of health status and health service utilization. Multivariate logistic regression models were used to estimate the likelihood of visiting the GP at least once in 12 months, and the likelihood of frequent visits (at least six visits in 12 months). Adjustment was made for health need (as indicated by global self-reported health status and a number of specific disease and health-related behaviour measures), together with a range of other relevant demographic and socio-economic variables. Following these adjustments, low-income groups and Mäori were found to be significantly less likely to visit the GP at least once in the year, but there were no significant differences across income or ethnic groups in the likelihood of frequent visits. These results suggest that the system of low-income targeted government subsidies reduces, but does not fully compensate for the barrier posed by doctors' fees. Moreover, there appear to be barriers for indigenous groups, in addition to income.

Adolescent↗
PubMed1997

Attitudes about breast cancer and mammography: racial, income, and educational differences.

This study examined the effect of race, income, and education on perceived susceptibility to and control over breast cancer, perceived benefits of and barriers to mammography, and knowledge about breast cancer and mammography use, in addition to determining if predictors for mammography use differed between races. Self-reported mailed survey data were obtained from a convenience sample of 1083 church women (78% Caucasian, 22% African-American) > or = 50 years with no history of breast cancer. ANOVA identified higher susceptibility and lower knowledge scores for African-American women; higher knowledge scores for upper income women of both races; interactions between race and income for benefits and perceived control; and interactions between race and education for barriers. African-American women were more likely to regard fear of radiation as a barrier to mammography (OR = .34; CI = .20, .57) and were more likely to worry about getting breast cancer (OR = .50; CI = .30, .82). Caucasian women were more likely to regard cost as a barrier (OR = 2.36, CI = 1.27, 4.40). For both races, variables predictive of ever having a mammogram were perceived control (White: OR = .69, CI = .54, .88; Black: OR = .50, CI = .38, .92), perceived barriers (White: OR = .88, CI = .83, .95; Black: OR = .75, CI = .64, .88), and knowledge (White: OR = 1.18, CI = 1.04, 1.33; Black: OR = 1.28, CI = 1.02, 1.61). Perceived benefits was predictive only for Caucasians (OR = 1.71, CI = 1.42, 2.06). Racial differences in perceived barriers to mammography and findings about the knowledge differences related to race, income, and education provide direction for health education efforts. The significance of cost factors for Caucasian and low-income women suggest that access barriers remain despite increased use of mammography.

Black or African American↗
PubMed2001

Constructing deservingness: federal welfare reform, supplemental security income, and elderly immigrants.

On August 22, 1996, President Clinton signed the welfare reform law that ended eligibility for all immigrants to federal means tested entitlements. Poor elderly immigrants on Supplemental Security Income were specifically targeted. This article documents how the print media responded to these policy changes. The following are the major research questions: (1) How were older immigrants on Supplemental Security Income portrayed in the print media before and after federal welfare reform? (2) Who was involved in the print media coverage of older immigrants on Supplemental Security Income before and after federal welfare reform? (3) What types of statements were made by those involved in the print media coverage of older immigrants on Supplemental Security Income, before and after federal welfare reform? The approach used was an in-depth content analysis of newspaper articles from major U.S. newspapers. The findings demonstrate that older immigrants were constructed as "undeserving" in news articles prior to the passage of the federal welfare reform bill. However, after the passage of the federal welfare reform bill the coverage of older immigrants on Supplemental Security Income started to change, and older immigrants were portrayed as "deserving." In advancing aging policy for poor, vulnerable elderly, such as elderly immigrants, advocates, health and social service providers can play an influential role in bringing their voices to the print media.

Aged↗
PubMed1986

Adolescents' substance use: impact of ethnicity, income, and availability.

This study examines ethnic differences in reported use of cigarettes, alcohol, cannabis, hard drugs, and non-prescription medications among a sample of adolescents and attempts to explain these differences in terms of income, ease of acquisition, and availability from friends. Data were obtained from 847 students three times over a five-year period. Results indicate consistent and significant differences among ethnic groups substance use at all three points in time. It was hypothesized that ethnic groups have differential access to substances and economic resources to purchase various drugs. To test these hypotheses, availability from friends, perceived ease of acquisition, income from earnings and gifts/allowances, and initial substance use were examined across ethnic groups and then used as covariates of the substance differences. A split-plot repeated measures design with covariates was used to compare changes in substance use across time and between ethnic groups. Earned income made a significant impact on explaining the ethnic differences for cigarette, alcohol, and given income on cannabis consumption. Adding community variables such as availability from friends, ease of acquisition, and initial drug use not only eliminates the effects of income variables on drug use, but in most cases, the ethnic differences among adolescents as well.

Adolescent↗
PubMed2002

Employment and income status of adults with developmental disabilities living in the community.

A comprehensive national portrait of employment and income status of adults with developmental disabilities was estimated through secondary analyses of the 1990 and the 1991 Survey of Income and Program Participation. Results indicate that the majority of adults with developmental disabilities had very limited economic resources, even when earnings from employment and benefits from governmental income support programs were both included. The minority, who worked in a variety of occupations, were earning higher incomes than previous estimates. The overwhelming majority were unemployed. Implications of the low-income profile and potential underutilization of employment services was discussed.

Activities of Daily Living↗
PubMed2002

Income, race, and preventable hospitalizations: a small area analysis in New Jersey.

This research examines the effect of income, race, and cultural factors on preventable hospitalizations, using age and sex-adjusted preventable admissions from 53 contiguous zip codes in New Jersey from 1993 to 1995. Low income was strongly associated with high rates of preventable hospitalization in the study zip codes. Income is likely a proxy for education level, barriers to accessing primary care, and health insurance. A floor effect of income levels was present that may reflect a natural level of preventable hospitalization not affected by income, education, or health insurance status. An independent relationship found between nonwhite race and high preventable hospitalization may be in part the result of delays in seeking care affected by antecedent cultural factors. Removing financial barriers is critical but may be insufficient for reducing preventable hospitalizations if other barriers are not also addressed.

Adolescent↗
PubMed2006

Effect of neighbourhood income and maternal education on birth outcomes: a population-based study.

BACKGROUND: Maternal socioeconomic status (SES) is an important determinant of inequity in maternal and fetal health. We sought to determine the extent to which associations between adverse birth outcomes and SES can be identified using individual-level measures (maternal level of education) and community-level measures (neighbourhood income). METHODS: In Quebec, the birth registration form includes a field for the mother's years of education. Using data from birth registration certificates, we identified all births from 1991 to 2000. Using maternal postal codes that can be linked to census enumeration areas, we determined neighbourhood income levels that reflect SES. RESULTS: Lower levels of both maternal education and neighbourhood income were associated with elevated crude risks of preterm birth, small-for-gestational-age (SGA) birth, stillbirth and neonatal and postneonatal death. The effects of maternal education were stronger than, and independent of, those of neighbourhood income. Compared with women in the highest neighbourhood income quintile, women in the lowest quintile were significantly more likely to have a preterm birth (adjusted odds ratio [OR] 1.14, 95% confidence interval [CI] 1.10-1.17), SGA birth (OR 1.18, 95% CI 1.15-1.21) or stillbirth (OR 1.30, 95% CI 1.13-1.48); compared with mothers who had completed community college or at least some university, mothers who had not completed high school were significantly more likely to have a preterm birth (adjusted OR 1.48, 95% CI 1.44-1.52), SGA birth (OR 1.86, 95% CI 1.82-1.91) or stillbirth (OR 1.54, 95% CI 1.36-1.74). INTERPRETATION: Individual and, to a lesser extent, neighbourhood-level SES measures are independent indicators for subpopulations at risk of adverse birth outcomes. Women with lower education levels and those living in poorer neighbourhoods are more vulnerable to adverse birth outcomes and may benefit from heightened clinical vigilance and counselling.

Educational Status↗
PubMed2002

[Association of children's consumption of processed foods and family income in the city of São Paulo, Brazil].

OBJECTIVE: To describe children's consumption of processed foods and its relationship with per capita family income based on a household survey. METHODS: Food consumption was studied in a statistical sample of 718 children living in the city of São Paulo in the period 1995-1996. A 24-hour dietary recall was used. Data regarding the association of children's consumption of 24 processed foods and per capita family income (arranged in quartiles) was analyzed. RESULTS: Consumption of sugar was higher among children of low income families whereas the consumption of chocolate powder, chocolate, yogurt, infant formula and soft drinks was higher among children of high income families (p< 0.05). CONCLUSIONS: It seems that per capita family income affects the consumption of some processed foods.

Brazil↗
PubMed1997

Very-low-birthweight infants and income incongruity among African American and white parents in Chicago.

OBJECTIVES: Illinois vital records for 1982/1983 and US census income data for 1980 were analyzed to ascertain the relationship of income incongruity, race, and very low birthweight. METHODS: Positive income incongruity was considered present when study infants resided in wealthier neighborhoods than non-Latino Whites at the same level of parental education attainment and marital status. RESULTS: The odds ratios of very low birthweight for African Americans (n = 44,266) and Whites (n = 27,139) who experienced positive income incongruity were 0.7 (95% confidence interval [CI] = 0.5, 0.9) and 0.6 (95% CI = 0.5, 0.9), respectively. CONCLUSIONS: Positive income incongruity is associated with lower race-specific rates of very low birthweight.

Adolescent↗
PubMed2001

The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas.

OBJECTIVES: This study assessed whether income inequality and primary care physician supply have a different effect on mortality among Blacks compared with Whites. METHODS: We conducted a multivariate ecologic analysis of 1990 data from 273 US metropolitan areas. RESULTS: Both income inequality and primary care physician supply were significantly associated with White mortality (P < .01). After the inclusion of the socioeconomic status covariates, the effect of income inequality on Black mortality remained significant (P < .01), but the effect of primary care physician supply was no longer significant (P > .10), particularly in areas with high income inequality. CONCLUSIONS: Improvement in population health requires addressing socioeconomic determinants of health, including income inequality and primary care availability and access.

Black or African American↗
PubMed2003

Income inequality, illiteracy rate, and life expectancy in Brazil.

OBJECTIVES: The link between income disparities and health has been studied mostly in developed nations. This study assesses the relationship between income disparities and life expectancy in Brazil and measures the impact of illiteracy rates on the association. METHODS: The units of analysis (n = 27) are all the Brazilian states and the federal capital. Simple and multiple linear regressions were performed to measure the association between income disparity, measured by the Gini coefficient, gross domestic product (GDP) per capita, and illiteracy rate. Data came from publicly available sources at the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. RESULTS: Income disparities and illiteracy rates were negatively associated with life expectancy in Brazil. GDP per capita was positively associated with life expectancy. The inclusion of illiteracy rates in the regression model removed the effect of income disparities. CONCLUSIONS: Illiteracy rate is strongly associated with life expectancy in Brazil. This finding is in accord with reports from the United States and has implications for health policy and planning for both developed and developing countries.

Aged↗