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PubMed1996

Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States.

OBJECTIVE: To determine the effect of income inequality as measured by the Robin Hood index and the Gini coefficient on all cause and cause specific mortality in the United States. DESIGN: Cross sectional ecological study. SETTING: Households in the United States. MAIN OUTCOME MEASURES: Disease specific mortality, income, household size, poverty, and smoking rates for each state. RESULTS: The Robin Hood index was positively correlated with total mortality adjusted for age (r = 0.54; P < 0.05). This association remained after adjustment for poverty (P < 0.007), where each percentage increase in the index was associated with' an increase in the total mortality of 21.68 deaths per 100,000. Effects of the index were also found for infant mortality (P = 0.013); coronary heart disease (P = 0.004); malignant neoplasms (P = 0.023); and homicide (P < 0.001). Strong associations were also found between the index and causes of death amenable to medical intervention. The Gini coefficient showed very little correlation with any of the causes of death. CONCLUSION: Variations between states in the inequality of income were associated with increased mortality from several causes. The size of the gap between the wealthy and less well off--as distinct from the absolute standard of living enjoyed by the poor--seems to matter in its own right. The findings suggest that policies that deal with the growing inequities in income distribution may have an important impact on the health of the population.

Adult↗
PubMed2002

Education, income inequality, and mortality: a multiple regression analysis.

OBJECTIVE: To test whether the relation between income inequality and mortality found in US states is because of different levels of formal education. DESIGN: Cross sectional, multiple regression analysis. SETTING: All US states and the District of Columbia (n=51). DATA SOURCES: US census statistics and vital statistics for the years 1989 and 1990. MAIN OUTCOME MEASURE: Multiple regression analysis with age adjusted mortality from all causes as the dependent variable and 3 independent variables-the Gini coefficient, per capita income, and percentage of people aged >/=18 years without a high school diploma. RESULTS: The income inequality effect disappeared when percentage of people without a high school diploma was added to the regression models. The fit of the regression significantly improved when education was added to the model. CONCLUSIONS: Lack of high school education accounts for the income inequality effect and is a powerful predictor of mortality variation among US states.

Adult↗
PubMed2004

The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities.

OBJECTIVE: To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities. DESIGN: Cross sectional ecological study. OUTCOME MEASURES: All cause death rates and death rates attributable to preventable or immediate causes for people under age 75. PREDICTOR MEASURES: Income inequality, city spending, and social factors. SETTING: All central cities in the US with population equal to or greater than 100 000. RESULTS: Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads. CONCLUSIONS: Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time.

Adolescent↗
PubMed2003

Education and income: which is more important for mental health?

STUDY OBJECTIVE: To assess which indicators of socioeconomic status are associated with an increased prevalence of common mental disorders. DESIGN: Cross sectional household survey. SETTING: Santiago, Chile. PARTICIPANTS: Random sample of adults aged 16-65 residing in private households. MAIN RESULTS: Less education (odds ratio 2.44, 95% confidence intervals 1.50 to 3.97), a recent income decrease (odds ratio 2.14, 1.70 to 2.70), and poor housing (odds ratio 1.53, 1.05 to 2.23), were the only socioeconomic status variables that remained significantly associated with an increased prevalence of common mental disorders after adjustments. The prevalence of common mental disorders was also higher among people with manual unskilled occupations, overcrowded housing, and lower per capita income but these associations disappeared after adjustment for other explanatory and confounding variables. CONCLUSIONS: There is a strong, inverse, and independent association between education and common mental disorders. However, income was not associated with the prevalence of common mental disorders, after adjusting for other socioeconomic variables. Similar results have been found in other Latin American studies but British studies tend to find the opposite, that income but not education is associated with common mental disorders. Understanding the impact of socioeconomic factors on mental health requires research in poor as well as rich countries.

Adolescent↗
PubMed2003

Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States.

BACKGROUND: Social capital has been related to a number of important public health variables such as child welfare, mortality, and health status. However, the relation of social capital to infectious diseases has received relatively little attention. The relation of social capital to health measures is often posited to be related to the key societal variables of poverty and income inequality. Therefore, any exploration of the correlation between social capital and infectious diseases should also include examination of the association with poverty and income inequality. OBJECTIVE: This study examined the state level association between social capital, poverty, income inequality, and four infectious diseases that have important public health implications given their long term sequelae: gonorrhoea, syphilis, chlamydia, and AIDS. METHOD: A state level, correlational analysis (including bivariate linear correlational analysis, and multivariate linear stepwise regression analysis) was carried out. 1999 state level rates of gonorrhoea, syphilis, chlamydia, and AIDS were the main outcome measures. RESULTS: In bivariate analyses, poverty was significantly correlated with chlamydia; income inequality was significantly correlated with chlamydia and AIDS case rates; and social capital was significantly correlated with all outcome measures. In stepwise multiple regression analyses, social capital was always the strongest predictor variable. CONCLUSIONS: These results suggest that social capital is highly predictive of at least some infectious diseases. The results indicate the need for further research into this relation, and suggest the potential need for structural interventions designed to increase social capital in communities.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Income, housing, and fire injuries: a census tract analysis.

OBJECTIVES: This study investigates the social and demographic correlates of nonfatal structural fire injury rates for the civilian population for Philadelphia census tracts during 1993-2001. METHODS: The author analyzed 1,563 fire injuries by census tract using the 1990 census (STF 3) and unpublished data from the Office of the Fire Marshal of the Philadelphia Fire Department. Injury rates were calculated per 1,000 residents of a given census tract. Multiple regression was used to determine significant variables in predicting fire injuries in a given census tract over a nine-year period and interaction effects between two of these variables-age of housing and income. RESULTS: Multiple regression analysis indicates that older housing (prior to 1940), low income, the prevalence of vacant houses, and the ability to speak English have significant independent effects on fire injury rates in Philadelphia. In addition, the results show a significant interaction between older housing and low income. CONCLUSIONS: Given the finding of very high rates of fire injuries in census tracts that are both low income and have older housing, fire prevention units can take preventative measures. Fire protection devices, especially smoke alarms, should be distributed in the neighborhoods most at risk. Multiple occupancy dwellings should have sprinkler systems and fire extinguishers. Laws concerning the maintenance of older rental housing need to be strictly enforced. Vacant houses should be effectively boarded up or renovated for residential use. Fire prevention material should be distributed in a number of languages to meet local needs.

Burns↗
PubMed1988

Income under female versus male control: hypotheses from a theory of gender stratification and data from the Third World.

This article presents a summary of Blumberg's general theory of gender stratification, which emphasizes relative male/female control of economic resources as a main (although not sole) predictor of a broad array of gender stratification consequences. It also reviews evidence from numerous Third World countries that men and women spend income under their control differently--with women holding back less for themselves and spending more on child nutrition and family basic human needs. Thus the data indicate that when women lose control of income, what is affected is not only their relative marital/familial power (and self-esteem) but also family well-being. Moreover, evidence is presented that planned Third World development projects that rely on female labor but do not provide women with a return to that labor also are likely to suffer: women will attempt to reallocate their efforts to tasks yielding income under their own control. In Africa, where women raise most locally marketed/consumed food and usually have specific familial obligations that require them to have independently controlled income, the bypassing of women farmers and undercutting their returns may be an important--albeit unheralded--factor in the region's food crisis. In sum, the Third World data support both the theory of gender stratification and the relative resources approach to marital power, and point the way to broadening the US marital/family power debate to include male/female spending patterns.

Africa↗
PubMed1988

Income redistribution effect of the Swedish sickness allowance insurance in a comparison of two concepts of social class.

Social insurances effect income distributions between social strata. Here, insurance returns in relation to income are studied on the Swedish sickness allowance insurance, which is intended to redistribute from higher to lower social strata. Two measures of social class are used, the socio-economic classification, the official index of Sweden, and a structural class concept, which in earlier results discriminates better for material factors such as income and work conditions. The material consists of all sickness cases of 1983 for 3,161 persons, sampled from insurance registers and cross-classified with registers at taxation authorities. Data on insurance returns, incomes, and occupation are used. Results clearly confirm the intended redistribution effect, but considerably clearer with the structural class concept. The effect is even stronger than intended for some strata, where the system seems to lack in implementation. The consequences for choice of class measure are finally discussed.

Adolescent↗
PubMed1998

Discrimination and pension income among aging women.

Using data from the National Longitudinal Survey of Labor Market Experience, Mature Women's Cohort, this study examined the extent to which discrimination influenced pension receipt and levels of pension income among women aged 55-69 in 1992. It found that discrimination affected the level of pension income beyond that of demographic and human capital variables, when controlling for wage-related income, only among moderate-to-affluent near-elderly women. No relation was found between discrimination and receipt of pension income.

Aged↗
PubMed2004

Healthy aging at older ages: are income and education important?

Being higher on the socio-economic scale is correlated with being in better health, but is there is a causal relationship? Using 3 years of longitudinal data for individuals aged 50 and older from the Canadian Survey of Labour and Income Dynamics, we study the health transitions for those who were in good health in the first year, focusing especially on income and education. The initial good health restriction removes from the sample those whose incomes may have been affected by a previous history of poor health, thus avoiding a well-known problem of econometric endogeneity. We then ask, for those in good health, whether later transitions in health status are related to socio-economic status. We find that they are-that changes in health status over the subsequent 2 years are related, in particular, to income and education.

Aged↗
PubMed1996

Income, health status, and insurance coverage of small group employees in a voluntary purchasing arrangement.

The ongoing health care reform discussion has highlighted the problems of insuring small group employees. Several state and private initiatives have attempted to address some of these problems through the formation of voluntary small group purchasing arrangements. This article uses data from one such initiative, Health Care Group of Arizona (HCGA), to describe the income, health status, and prior insurance of small group employees who enrolled in prepaid health plans through HCGA. It also compares employee enrollees to nonenrollees along these dimensions. The findings suggest that HCGA enrollees had relatively low incomes and that about three-quarters were without health insurance prior to enrollment. Higher income employee enrollees were more likely to report health conditions at enrollment even after controlling for other factors including age. Enrollees were less likely than nonenrollees to have prior health insurance but were more likely to be drawn from lower income groups and to report recent health conditions.

Adolescent↗
PubMed1998

Differences in net incomes of male and female owner general practitioners.

The authors analyzed the mean net income of a cohort of male and female dentists with similar demographics and practice characteristics. The authors found that the average net income of these male dentists is higher than it is for their female counterparts. This difference is statistically significant and monetarily tangible, amounting to an annual net income balance of about $26,000 (22 percent) in favor of male dentists. If such a difference in net income persists, it could affect the profession as well as the distribution of dental school enrollments.

Adult↗
PubMed1998

Net income, gross billings and practice expenses of independent dentists.

One way to measure the vitality of a profession is to look at the trend in its practitioners' real incomes. During the 10-year period 1986 through 1995, the average real net income of all independent dentists rose 30.7 percent, or 2.7 percent annually, after being adjusted for inflation using 1995 U.S. dollars. The national per capita personal income (base = 1995) increased 10.1 percent during this same period, or about 1.0 percent annually [corrected]. Using real per capita income as a benchmark, the authors found that the purchasing power of dentists as a group has increased more rapidly than the purchasing power of the overall U.S. population.

Fees, Dental↗
PubMed2006

Inequalities in access to medical care by income in developed countries.

BACKGROUND: Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000. METHODS: Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use. RESULTS: We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. INTERPRETATION: Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.

Adolescent↗
PubMed2003

[Household insecticides: pattern of use according to per capita income].

OBJECTIVE: Although insecticides are widely used in many countries, few studies of their use in households have been conducted. This study was carried out to describe the household use of insecticides according to per capita income. METHODS: From October 1999 to January 2000, questionnaires on the use of household insecticides were applied to 2,039 households in the urban area of Pelotas, Brazil. Data was collected on income, use of insecticides in the 12 months prior to the interview, product type and chemical group of the insecticides found in the households and, mechanical protection used for insect control. Chi-square test for trends was used to assess relationships, prevalence rates and confidence intervals. RESULTS: Household insecticides were used in 89% of the households visited at least in one occasion in the 12 months prior to the interview. In 79% one or more units of insecticides were found in the household at the time of the interview. The most common types were aerosols and tablet refills for electric devices of the pyrethroid chemical group. Mechanical protection against insects was not widely used. CONCLUSIONS: Higher income households most frequently had insecticides in the form of pyrethroid aerosols while organophosphate sprays were more frequently found in lower income households.

Aerosols↗
PubMed1976

Dental visits by income and race in ten urban and two rural areas.

Household surveys in 12 low income areas found large differences in dental visit rates after control for income and race. The dental visit rate for Red Hook (NYC) exceeded the national rate whereas in seven of the areas the rate was below national averages by 40 per cent or more. The ranges in dental visit rate for low income Blacks was from two-thirds the national rate (in two areas of the South) to two to three times greater than the comparable national rate (in three areas of the Northeast). Lesser but nevertheless large variations among area dental visit rates existed for other race and income groups.

Adolescent↗
PubMed1997

Social capital, income inequality, and mortality.

OBJECTIVES: Recent studies have demonstrated that income inequality is related to mortality rates. It was hypothesized, in this study, that income inequality is related to reduction in social cohesion and that disinvestment in social capital is in turn associated with increased mortality. METHODS: In this cross-sectional ecologic study based on data from 39 states, social capital was measured by weighted responses to two items from the General Social Survey: per capita density of membership in voluntary groups in each state and level of social trust, as gauged by the proportion of residents in each state who believed that people could be trusted. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state. RESULTS: Income inequality was strongly correlated with both per capita group membership (r = -.46) and lack of social trust (r = .76). In turn, both social trust and group membership were associated with total mortality, as well as rates of death from coronary heart disease, malignant neoplasms, and infant mortality. CONCLUSIONS: These data support the notion that income inequality leads to increased mortality via disinvestment in social capital.

Coronary Disease↗
PubMed2000

The effects of race/ethnicity and income on early childhood asthma prevalence and health care use.

OBJECTIVES: Asthma is the most common chronic illness among US children and is most prevalent in low-income and minority groups. We used multivariate models to disentangle the effects of race/ethnicity, income, and other individual-level risk factors on asthma in a population-based sample of children aged 3 years. METHODS: Data are from the 1988 National Maternal and Infant Health Survey and 1991 Longitudinal Follow-Up. Odds ratios of asthma prevalence, hospitalization, and emergency room use were estimated, with control for socioeconomic characteristics, health behaviors, and insurance. RESULTS: Asthma prevalence, hospitalization, and emergency room use declined with increasing income for non-Black but not Black children. CONCLUSIONS: Lifetime income and sociodemographic characteristics do not explain the excess risks of asthma and emergency health care use for asthma among young Black children.

Asthma↗