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PubMed2002

Association between overweight or obesity and household income and parental body mass index in Australian youth: analysis of the Australian National Nutrition Survey, 1995.

This study is a secondary data analysis based on the 1995 Australian National Nutrition Survey (NNS). A random subsample of 1581 school children aged 7-15 years old from the NNS was studied. The results show the prevalence of overweight, obesity and combined overweight and obesity was 10.6-20.9%, 3.7-7.2% and 15.6-25.7%, respectively. The odds ratio of overweight or obese boys with highest household income was significantly smaller than those with the lowest household income. The proportion of combined overweight and obesity in children whose parents were overweight or obese was significantly greater compared with those whose parents were not. The trend of increasing prevalence of overweight or obesity among children with increasing parental body mass index (BMI) was significant after adjusting for age except the trend of father's BMI for boys. This study provided baseline data on the recent prevalence of overweight or obesity of Australian school children using new international absolute BMI cut-off points. It indicated that young school girls (7-9 years) were more likely to be overweight or obese compared with boys, the prevalence rates of overweight or obesity in older boys (13-15 year) was significantly greater than in other age groups while in girls it was the opposite. The boys with lowest household income ($0-17 500) were more likely to be overweight or obese compared with those with the highest household income (greater than $67 500). Having parents especially mothers who were overweight or obese may increase the risk of children being overweight or obese.

Adolescent↗
PubMedDate not supplied

Income, educational level and body height.

The relation between adult body height and two socio-economic factors (income and educational level) was studied in a large, ethnically homogenous population. In the period 1980-1983 all persons aged 40-54 years (born 1926-1941) in two Norwegian counties were invited to a cardiovascular screening. Ninety per cent (or 38162 persons) of those invited attended and had their height measured. Information concerning income and education was available at an individual level from the 1980 national census. Strong, positive relations were found between mean body height and the socio-economic factors, relations that probably are due to conditions during growth influencing both height, attained education and income abilities. The difference between highest and lowest educational class was 3.3 cm in men and 3.2 cm in women, and between highest and lowest income group 3.5 cm in men and 4.2 cm in women. These differences could not be explained by the strong cohort effect of increasing height in the successive birth cohorts from 1926 to 1941 which also was evident. It should be emphasized that height only could explain a small fraction of the variance in the socio-economic factors and is thus not a usable indicator of an individual's socio-economic status. However, it might contribute with important information concerning social inequalities in groups or population.

Adult↗
PubMed2006

Outcomes of patients in clinical trials with ST-segment elevation myocardial infarction among countries with different gross national incomes.

AIMS: To evaluate whether there is an association between 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI) included in clinical trials and country gross national income (GNI). METHODS AND RESULTS: A retrospective analysis of the databases of five randomized trials including 50 310 patients with STEMI (COBALT 7169, GIK-2 2931, HERO-2 17,089, ASSENT-2 17,005, and ASSENT-3 6116 patients) from 53 countries was performed. Countries were divided into three groups according to their GNI based on the World Bank data: low (less than 2900 US dollars), medium (between 2900 US dollars and 9000 US dollars), and high GNI (more than 9000 US dollars per capita). Baseline characteristics, in-hospital management variables, and 30-day outcomes were evaluated. A previously defined logistic regression model was used to adjust for differences in baseline characteristics and to predict mortality. The observed mortality was higher than the predicted mortality in the low (12.1 vs. 11.8%) and in the medium income groups (9.4 vs. 7.9%), whereas it was lower in the high income group (4.9 vs. 5.6%). CONCLUSION: An inverse relationship between mortality and GNI was observed in STEMI clinical trials. Most of the variability in mortality can be explained by differences in baseline characteristics; however, after adjustment, lower income countries have higher mortality than the expected.

Female↗
PubMed1996

Incidence of malignant melanoma of the skin in Norway, 1955-1989: associations with solar ultraviolet radiation, income and holidays abroad.

BACKGROUND: Norway has the highest incidence of melanoma in Europe. This study analyses geographical variations in melanoma incidence within Norway and their association with possible aetiological factors. METHODS: Data on melanoma incidence from the Norwegian Cancer Registry were used to calculate standardized incidence ratios (SIR) for the 19 counties in Norway for each 5-year period from 1955 to 1989. Multiple regression analysis was used to examine the associations between these SIR and local UVB levels, holidays abroad and income. Similar methods were also used to analyse changes in SIR between 1955-1969 and 1985-1989. RESULTS: There was a highly significant association between melanoma incidence and UVB in each of the time periods studied. Income showed a significant positive association in the 1960s and early 1970s but not later. Foreign holidays showed a significant positive association in the 1980s, but not earlier. Changes in melanoma SIR between 1955-1969 and 1985-1989 were significantly positively associated with holidays abroad and negatively with income levels. CONCLUSIONS: Melanoma incidence in Norway is closely related to local levels of UVB radiation independently of other factors suggesting that local exposures carry significant risk. Risks would probably increase if ozone depletion led to enhanced UVB flux (estimated as 1.6% rise in incidence for each 1% increase in UVB). By the end of the study period income was no longer a significant factor but holidays abroad had started to have a detectable effect on melanoma incidence.

Environmental Exposure↗
PubMed1998

Geocoding and linking data from population-based surveillance and the US Census to evaluate the impact of median household income on the epidemiology of invasive Streptococcus pneumoniae infections.

The emergence of drug-resistant Streptococcus pneumoniae poses new clinical challenges and may also reflect a change in the epidemiology of S. pneumoniae infections. A variety of studies have shown that drug-resistant S. pneumoniae infections are linked to antimicrobial use. It has been hypothesized that persons of high socioeconomic status are at increased risk for a drug-resistant infection because of greater access to antimicrobial drugs. To assess whether median household income is associated with increased risk of penicillin-nonsusceptible S. pneumoniae infections, the authors geocoded and linked data from population-based surveillance for invasive pneumococcal disease with data from the 1990 US Census. Among invasive pneumococcal isolates from Atlanta, Georgia, in 1994, increasing proportions of penicillin-nonsusceptible isolates were associated with higher median household incomes (chi2 for trend, 15.17; p=0.002). Despite higher rates of invasive pneumococcal disease among blacks and persons who resided within lower median household income areas, white patients in areas with higher median household income had a higher risk of being infected with strains that were not susceptible to penicillin (Wilcoxon rank sum, Z=2.66, p=0.008). These findings demonstrated the utility of geocoding and US Census data in describing the epidemiology of drug-resistant S. pneumoniae and also provided more evidence that socioeconomic factors may influence the development of drug resistance.

Adolescent↗
PubMed1984

Regional differences in physical therapists' incomes.

This investigation examines regional differences in the incomes of full-time employed members of the American Physical Therapy Association. The study was undertaken specifically to test the assumption that the gross earned incomes of therapists in New England were less than their peers in other regions. Data came from the 1982 APTA membership survey, based on a random sample of 20 percent of the APTA membership (response rate = 62.8%). Results indicate that in 1981 a significantly greater proportion (women, p less than or equal to .0001; men, p less than or equal to .01) of APTA members in New England had a lower income compared with peers in six other regions. Significant income differences persist even when controlling for age, experience, primary activity or responsibility, entry-level education, and highest earned academic degree.

Adult↗
PubMed2002

Dynamics of income packaging: a 10-year longitudinal study.

This article examines the methods and dynamics of packaging multiple sources of wage and nonwage income as a means of making ends meet over a 10-year period among a sample of displaced steelworkers who lost jobs as a result of plant closings in the 1980s and then experienced extensive downward mobility. The study tracked changes in the respondents' income and employment over a decade, the dynamics of their use of social services, their pooling of a variety of income sources, and the use of social assistance to supplement low wages. The study found that among this sample income packaging was a universal economic strategy and that use of social services did not affect later employment and earnings.

Adult↗
PubMed1978

Paying for medical care: the burden on the disabled. The relationship between the distribution of income and the distributions of medical services and payments.

The study measures the economic vulnerability of disabled persons whose impaired health interfered with their earning ability. This population segment, about one sixth of the total population, represents the extreme both in terms of sensitivity to health problems and losses in economic power. The major findings are given in a nutshell. 1) Inadequate income did not bar the disabled individuals from contact with the medical care system except in the case of the weakest among the weak, the aging women without husbands. This finding suggests that the restraining effect of income can become strong enough to overcome the concern with ill-health, although the inhibiting effect of economic constraints weakens when the concerns with health problems intensifies. (2) Once contact with the health care system had been extablished, there was no evidence to suggest that lack of means to pay for medical services had restricted the quantity of services rendered to the disabled, although inability to pay might have affected the setting in which care was provided. 3) The needed medical care was obtained at a considerable financial sacrifice. As Table 6 shows, the level of direct out-of-pocket payments imposed a heavy burden on low and moderate income households, and this burden eased gradually as household income-levels increased.

Adolescent↗
PubMed1982

Income and race differences in children's health in the mid-1960s.

This article explores income and race differences in eight measures of the health of children ages 6 through 11 as assessed in the early 1960s. It is shown that both income and race differences in health are much less pronounced than they are in infant mortality and birth weight data. Significant differences are found in the health status of black and white children and of children from high- and low-income families, but these are primarily differences with respect to parent-reported (rather than physician-reported) health criteria and they by no means overwhelmingly favor the white or high-income children. These findings underscore the importance of treating children's health status as multidimensional. In addition, these findings will serve as a bench mark for studies of children's health using data for a more recent period.

Black or African American↗
PubMed2004

Disparities in birth outcomes by neighborhood income: temporal trends in rural and urban areas, british columbia.

BACKGROUND: Knowledge of socioeconomic disparities in health is of interest to both the general public and public health policymakers. It is unclear how disparities in birth outcomes by socioeconomic status have changed over time, particularly in settings with universal health insurance and favorable socioeconomic conditions. METHODS: We identified a cohort of all births (n = 713,950) registered in British Columbia, 1985-2000. We compared rates and relative risks (RRs) of preterm birth, small-for-gestational-age (SGA), stillbirth, and neonatal and postneonatal death across neighborhood-income quintiles from Q1 (richest, the reference) to Q5 (poorest) by 4-year intervals in rural and urban areas. Logistic regression was used to control for maternal and pregnancy characteristics. RESULTS: Maternal characteristics varied widely across neighborhood-income quintiles in both rural and urban areas. There were moderate and persistent disparities in birth outcomes across neighborhood-income quintiles in urban but not rural areas. The relative disparities in urban areas did not diminish over time for all birth outcomes and actually rose for postneonatal mortality. For example, crude RRs (95% confidence intervals) for Q5 versus Q1 in urban areas for SGA were 1.44 (1.37-1.52) in 1985-1988 and 1.41 (1.33-1.49) in 1997-2000; for postneonatal death, the corresponding results were 1.61 (1.17-2.20) and 2.20 (1.24-3.92), respectively. Most of the observed disparities could not be explained by observed maternal and pregnancy characteristics. CONCLUSION: Moderate disparities in birth outcomes by neighborhood income persist in urban areas (although not rural areas) of British Columbia, despite a universal health insurance system and generally favorable socioeconomic conditions.

British Columbia↗
PubMed2003

Mapping the SF-12 to preference-based instruments: convergent validity in a low-income, minority population.

BACKGROUND: The profile-based SF-12 has a low respondent burden and is used widely in clinical settings to monitor health and evaluate programs. Deriving preference scores for the SF-12 health profile would permit its use in cost-effectiveness analyses. Previous mapping studies of SF family instruments to preference-based instruments have not examined convergent validity or performance in low-income, minority populations. OBJECTIVES: To map the SF-12 to the EuroQol (EQ-5D Index) and the Health Utilities Index Mark 3 (HUI3) in a low-income, predominantly minority sample. RESEARCH DESIGN: We used a cross-sectional survey data. SUBJECTS: We studied a convenience sample of 240 low-income, predominantly Latino and black patients attending a community health center in New York. MEASURES: We used separate regressions of the EQ-5D Index and HUI3 onto the physical (PCS-12) and mental (MCS-12) components of the SF-12 scores as measures. RESULTS: For the EQ-5D Index regression, the adjusted variance explained was 58% (bootstrap validation 95% confidence interval [CI], 46-66). For the HUI3 regression, the adjusted variance explained was 51% (bootstrap 95% CI, 39-59). The correlation coefficient between the 2 predicted measures was 0.96. The correlation of the predicted HUI3 with the EQ-5D Index (0.73) and the predicted EQ-5D Index with the HUI3 (0.70) exceeded that between the 2 original preference-based measures themselves (0.69). CONCLUSIONS: These pilot results suggest that the SF-12 could be successfully mapped to both the EQ-5D Index and HUI3, yielding preference-based scores that demonstrate convergent validity in a low-income, minority sample.

Adolescent↗
PubMed2000

More or less equal? Comparing Australian income-related inequality in self-reported health with other industrialised countries.

OBJECTIVE: To measure the distribution of self-reported health by income in order to compare the level of health inequality in Australia with other industrialized countries. METHOD: Using data from the two National Health Surveys undertaken in 1989-90 and 1995, concentration indexes were calculated to quantify the distribution of self-reported health by equivalent income. The concentration index for Australia was compared with those reported for nine industrialized countries in Europe and North America. RESULTS: The estimated income-related concentration indexes were -0.1172 in 1989-90 and -0.1094 in 1995. CONCLUSION: The level of health inequality is not significantly different from the US or the UK, but significantly greater than seven other European nations. IMPLICATIONS: Australia has significant income related health inequalities and the distribution of health appears to be more unequal than in many other industrialized nations. There is a need to further investigate and quantify those features of the anglophone societies that set them apart from some other industrialized nations.

Adolescent↗
PubMed2007

Assessment of health-related quality of life in patients treated with hemodialysis in Serbia: influence of comorbidity, age, and income.

The importance of measuring health-related quality of life (HRQoL) in patients on maintenance hemodialysis (HD) is being increasingly recognized, but few studies, especially from the Balkan region, have addressed this issue. The aims of this study were (i) to evaluate HRQoL in an outpatient university-affiliated dialysis facility in South Serbia; (ii) to determine the effects of age, presence of comorbidity, primary kidney disease, dose of HD, and family income; and (iii) to make comparisons of the HRQoL in Serbian patients on chronic HD with that reported by others previously. The study enrolled 192 patients on HD for more than 3 months. Comorbidity was assessed using the index of coexistent diseases (ICED), including two subindexes: index of disease severity (IDS) and index of physical impairment (IPI). Patient's self-assessment of HRQoL was measured by the 36-item short form health survey questionnaire (SF-36), encompassing eight summary scales and two summary dimensions. Ten of the baseline variables had significant associations with parameters of HRQoL. Fitting these variables in linear regression models resulted in 41.9% variance for physical dimension of HRQoL (physical component summary score [PCS]), and 32.5% for mental dimension of HRQoL (mental component summary score [MCS]). However, statistically significant effect had only IDS, IPI, and age for PCS, and income of patients for MCS. We found that an increase in IDS score for one unit is associated with a decrease of PCS by 13.2%, and SF-36 score (total quality of life) by 15.2%. The increase of IPI score by one unit decreases PCS by 16.1% and SF-36 score by 17.5%. A 5-year increase in age is associated with a decrease of PCS by 3.1%, and SF-36 score by 3.8%. The monthly income increase of 10 euros per family member increases MCS by 5.2% and SF-36 score by 3.0%. HRQoL in patients on HD was found markedly impaired. Comorbid conditions have negative and statistically significant correlation with parameters of HRQoL, and could explain poor HRQoL to a remarkable extent. Older age and poor income substantially reduce HRQoL in HD patients.

Age Factors↗
PubMed2005

Family ties: constructing family time in low-income families.

"Family time" is reflected in the process of building and fortifying family relationships. Whereas such time, free of obligatory work, school, and family maintenance activities, is purchased by many families using discretionary income, we explore how low-income mothers make time for and give meaning to focused engagement and relationship development with their children within time constraints idiosyncratic to being poor and relying on welfare. Longitudinal ethnographic data from 61 low-income African American, European American, and Latina American mothers were analyzed to understand how mothers construct family time during daily activities such as talking, play, and meals. We also identify unique cultural factors that shape family time for low-income families, such as changing temporal orientations, centrality of television time, and emotional burdens due to poverty. Implications for family therapy are also discussed.

Activities of Daily Living↗
PubMed2004

Is higher income and educational status associated with poorer outcome in patients with Hodgkin's disease?

OBJECTIVES: The aim of the study was to determine the impact of socioeconomic status on relapse-free survival (RFS) in patients with Hodgkin's disease. METHODS: A number of factors were analyzed for their impact on relapse-free and overall survival in Hodgkin's disease using Cox regression. These factors included socioeconomic status (as defined by education and income), different treatment modalities and established clinical risk factors [e.g. age at diagnosis, stage of disease, involvement of three or more lymph nodes, presence or absence of a large mediastinal mass, E stages or elevation of erythrocyte sedimentation rate (ESR)]. The study used an initial sample of 126 patients recruited between 1969 and 1995 and a larger sample of 218 patients (recruited until 2002). Clinical data on disease and treatment characteristics were collected from medical records. RESULTS: In a univariate analysis, the following parameters had impact on RFS: treatment modality (combined treatment resulted in an improved RFS compared with patients treated with chemo- or radiotherapy alone), educational status and income. The 5- and 10-yr relapse-free survival rates were found to increase with decreasing educational level and decreasing average income per month. These results were significant in the initial and total samples and were also significant using multivariate analysis (hazard ratio for highest vs. lowest education group: 5.88; 95% confidence interval 1.87-18.52; for highest vs. lowest income group: 4.36; 95% confidence interval 1.35-14.05). CONCLUSION: Hodgkin's disease appears to be a striking exception from the usual positive correlation between high socioeconomic status and favorable treatment outcome in patients suffering from tumor. It is suggested that future studies on tumor genetics and biology and more detailed analysis of further socioeconomic parameters may be useful in clarifying this observation.

Adult↗
PubMed2006

Public attitudes toward incentives for organ donation: a national study of different racial/ethnic and income groups.

Attitudes toward monetary and nonmonetary incentives for living (LD) and deceased donation (DD) among the U.S. general public and different racial/ethnic and income groups have not been systematically studied. We studied attitudes via a telephone questionnaire administered to persons aged 18-75 in the continental United States. Among 845 participants (85% of randomized households), less than one-fifth participants were in favor of incentives for DD (range 7-17%). Most persons were in favor of reimbursement of medical costs (91%), paid leave (84%) and priority on the waiting list (59%) for LD. African Americans and Hispanics were more likely than Whites to be in favor of some incentives for DD. African Americans were more likely than Whites to be in favor of monetary incentives for LD. Whites with incomes less than $20 000 were more likely than Whites with greater incomes to be in favor of reimbursement for deceased donors' funeral expenses or medical expenses. The U.S. public is not generally supportive of incentives for DD, but is supportive of limited incentives for LD. Racial/ethnic minorities are more supportive than Whites of some incentives. Persons with low income may be more accepting of certain monetary incentives.

Adult↗
PubMed1994

The nutrition transition in low-income countries: an emerging crisis.

Scientists have long recognized the importance of the demographics and epidemiologic transitions in higher income countries. Only recently has it become understood that similar sets of broadly based changes are occurring in lower income countries. What has not been recognized is that concurrent changes in nutrition are also occurring, with equally important implications for resource allocation in many low-income countries. Several major changes seem to be emerging, leading to a marked shift in the structure of diet and the distribution of body composition in many regions of the world: a rapid reduction in fertility and aging of the population, rapid urbanization, the epidemiologic transition, and economic changes affecting populations in different and uneven ways. These changes vary significantly over time. In general, we find that problems of under- and overnutrition often coexist, reflecting the trend in which an increasing proportion of people consume the types of diets associated with a number of chronic diseases. This is occurring more rapidly than previously seen in higher income countries, or even in Japan and Korea. Examples from Thailand, China, and Brazil provide evidence of the changes and trends in dietary intake, physical activity, and body composition patterns.

Africa↗
PubMed1995

Income distribution and life expectancy: a critical appraisal.

In a series of papers published during the past decade Richard Wilkinson has advanced the view that income inequality is the key determinant of variations in average life expectancy at birth among developed countries. Yet a careful examination of the two sources of data on income distribution most often used by Wilkinson suggests that if they are analysed more appropriately they do not lend support to his claims. More recent data on income distribution is now available for several countries in the Organisation for Economic Development and Cooperation in the mid-1980s and for Great Britain from 1961 to 1991. The use of these data also casts doubt on the hypothesis that inequalities in the distribution of income are closely associated with variations in average life expectancy at birth among the richest nations of the world.

Australia↗