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PubMedDate not supplied

The demand for child curative care in two rural thanas of Bangladesh: effect of income and women's employment.

This paper seeks to investigate the determinants of child health care seeking behaviours in rural Bangladesh. In particular, the effects of income, women's access to income, and the prices of obtaining child health care are examined. Data on the use of child curative care were collected in two rural areas of Bangladesh--Abhoynagar Thana of Jessore District and Mirsarai Thana of Chittagong District--in March 1997. In estimating the use of child curative care, the nested multinomial logit specification was used. The results of the analysis indicate that a woman's involvement in a credit union or income generation affected the likelihood that curative child care was used. Household wealth decreased the likelihood that the child had an illness episode and affected the likelihood that curative child care was sought. Among facility characteristics, travel time was statistically significant and was negatively associated with the use of a provider.

Adult↗
PubMed2003

Inhaled corticosteroids in childhood asthma: Income differences in use.

Asthma hospitalization rates in children increase with decreasing level of household income. This research was undertaken to determine whether use of inhaled corticosteroid drugs, which can prevent asthma hospitalizations, followed a similar socioeconomic gradient in children with asthma. We performed a cross-sectional study of association, using population-based prescription and healthcare data sources. Our subjects were 16,862 Manitoba children, aged 5-15 years, with prescriptions for asthma drugs during January 1995-March 1996. Our measures were adjusted for asthma severity, physician specialty, and proportion of children with an inhaled corticosteroid prescription by neighborhood income. Forty-five percent of children treated for asthma had at least one inhaled corticosteroid prescription during January 1995-March 1996. The proportion of children with inhaled corticosteroid prescriptions decreased with successive decreases in neighborhood income. The socioeconomic gradient in the likelihood of an inhaled corticosteroid prescription was most evident among children with mild-moderate asthma who were not in the care of an asthma specialist. In conclusion, a socioeconomic gradient in the use of inhaled corticosteroids prescriptions can be found among children with universal access to healthcare and drug insurance.

Administration, Inhalation↗
PubMed1982

On the relation between origin income and migration.

"While traditional migration theory suggests that the rate of migration is negatively related to income at the origin, many empirical studies of aggregate migration yield a non-significant or even a positive relation. This paper utilizes a simplified model of migration to demonstrate that one possible reason for such results is the imperfect capital market facing migrants. Higher average income at the origin may imply a higher number of individuals who have the cash resources to finance migration, thus generating a positive relation between regional income and migration. The conclusions suggest the use of non-linear specifications in empirical migration studies."

Demography↗
PubMed2006

Income-related health inequality in Belgium: a longitudinal perspective.

This paper provides new evidence on the degree of income-related inequality in self-assessed health in Belgium. First of all, we combine the time dimension, which has been shown to be very important in the analysis of inequality, and the use of the recently developed interval regression approach to transform a categorical health variable in a continuous one. Second, we measure how the long-run inequality differs from the short-run inequality. Finally, we decompose this health-related income mobility index as well as the long-run concentration index (CI) itself into its contributors. Using data from the panel survey of Belgian households (1994-2002), we find that health is pro-rich distributed and that its inequality is underestimated by 9.45% when neglecting the dynamics of individuals over time. Income, education, job status and age are the most important contributors in the CI and the difference between the short-run and long-run inequality.

Adult↗
PubMed1975

Cervical neoplasia in residents of a low-income housing project: an epidemiologic study.

In 1969, a published report estimated that the incidence of cervical cancer in a low-income housing project in Atlanta, G Georgia, might be of epidemic proportion. In 1971, we surveyed this housing project to determine if the prevalence rate of cervical neoplasia was unusually high during the period January, 1969, through September, 1971. From the survey we determined the number of women at risk for cervical neoplasia, and we determined the number of women who had cervical neoplasia from the Tumor Registry at Grady Memorial Hospital. The over-all cervical dysplasia rate was 63/1,000. The over-all prevalence rate of cervical carcinoma in situ was 11/1,000. These rates were compared with rates in two studies which also dealt with the prevalence of cervical neoplasia in low-income black populations. The rates in all three studies were comparable. We conclude that the high rates do not necessarily signify an epidemic, but we suspect that the prevalence of cervical neoplasia in low-income black women is much higher than previously estimated.

Adolescent↗
PubMed1984

Effects of labelling on income, work and social function among hypertensive employees.

Two hundred and thirty hypertensive Canadian steelworkers were followed for 5 years after screening and referral. Data on income, absenteeism and measures of work and social function were collected on these men and on a matched group of 230 normotensive employees. In the fifth year after screening, hypertensive employees earned an average of Can. $1093 less than normotensive employees despite similar incomes in the year before screening. This adverse effect on income was observed regardless of awareness of hypertension at the time of screening or compliance with treatment. Illness-related absenteeism among hypertensives rose in the year following screening and remained elevated for 4 years after screening. Normotensive and hypertensive employees reported similar levels of physical ability and psychological well-being. These findings need verification in other settings before inclusion in cost-effectiveness analyses of the management of hypertension.

Absenteeism↗
PubMed1985

Relative incomes and rates of return for U.S. physicians.

Since 1967 the supply of physicians in the U.S. has been growing by more than 3 percent per annum. This, coupled with public insurer fee discounts, might have been expected to depress both the relative and absolute incomes of physicians in spite of growing insurance coverage and new technologies. Real incomes of physicians did decline at a 0.2 percent annual rate between 1967 and 1980, but this was apparently due to economy-wide events since the income trends for lawyers, dentists, and college graduates were virtually identical. Internal rates of return to undergraduate medical training remained high--between 14 and 17 percent in 1980. Specialty training became more profitable for internists, general surgeons, and obstetricians/gynecologists (all with 10-15 percent rates of return), while pediatricians continued to suffer a financial loss. While Medicare and Medicaid fee discounts have been criticized as inequitable, the programs are also shown to provide a 'hidden subsidy' to physicians during residency training, materially adding to rates of returns.

Data Collection↗
PubMed2005

Inequality in Japan (1892-1941): physical stature, income, and health.

This paper investigates the relationship between physical stature, per capita income, health, and regional inequality in Japan at the prefecture-level for the period 1892-1941. The analysis shows that inequality in income and access to health services explains differences in average height of the population across the 47 Japanese prefectures during this period and that variation in income contributed to changes in height during the 1930s. Annual regional time series of height indicate that Japan experienced a regional convergence in biological welfare before 1914, and that a divergence occurred during the interwar period; personal inequality followed a similar pattern.

Adolescent↗
PubMed2007

The adverse effects of race, insurance status, and low income on the rate of amputation in patients presenting with lower extremity ischemia.

OBJECTIVES: A consequence of delay in the diagnosis of peripheral vascular disease limb loss. This study was undertaken to determine the correlation of low socioeconomic status and race on the severity of ischemic presentation and the subsequent amputation rate. METHODS: Data from the Nationwide Inpatient Sample (NIS) from 1998 to 2002 on patients from urban hospitals with the diagnosis of lower extremity ischemia were evaluated. The population was divided into two groups: the amputation group (AMP) and lower extremity revascularization group (LER). Comorbidities, age, gender, race, ischemic gangrene at presentation, insurance status (no/noncommercial or commercial), and income status at admission were determined. These variables were compared using multivariate logistic regression analyses of the data for risk adjustment. RESULTS: Of 691,833 patients presenting with lower extremity ischemia, 363,193 underwent revascularization (66.3%) or amputation (33.7%). Univariate analysis correlated a statistically significant (P < .0001) higher rate of amputation and multivariate analysis associated significantly higher odds of amputation with the following variables: nonwhites (1.91, 95% confidence interval [CI], 1.65, 2.20), low-income bracket (1.41, 95% CI, 1.18, 1.60), and Medicare & Medicaid (1.81, 95% CI, 1.66, 1.97). Adjusting for other variables of statistical significance, multivariate regression analysis showed a statistically significant risk for amputation based on the nonteaching status of the institution (odds ratio [OR], 1.17, 95% CI, 1.08, 1.30). CONCLUSIONS: Primary amputation was performed with a higher frequency on patients with lower extremity ischemia who were nonwhite, low income, and without commercial insurance. The observed advanced ischemia among these economically disadvantaged patients suggests a delayed diagnosis of peripheral vascular disease, probably due to lack of access to adequate primary care or vascular surgery providers, or both. Better education of the general population and primary care providers to the symptoms and consequences of PVD may reduce the amputation rate in this group.

Aged↗
PubMed2005

Who pays more for health services in middle-income countries: lessons from Mexico.

An evaluative study with a cross-sectional design was carried out on healthcare cost indicators reported by the 2000 National Health Survey in Mexico, to determine which population group had higher health costs/expenditures in relation to family income. The results suggest that in middle-income countries such as Mexico, families with lower incomes tend to pay more for healthcare services.

Cross-Sectional Studies↗
PubMed2004

Analysis of health-related quality of life (HRQL), its distribution, and its distribution by income in Japan, 1989 and 1998.

Research conducted over the past decade has increasingly focused on health inequality. The goals of improving the health of a population are now often expressed as the increase in the average level of health and the decrease in health inequality as clearly specified in the Healthy People 2010 and the World Health Report 2000. Using a nationally representative sample of the 1989 and 1998 waves of the Japanese Comprehensive Survey of Living Conditions of the People on Health and Welfare (CSLC), this research examines the average health-related quality of life (HRQL), its distribution, and its distribution by income share. This study departs from previous health inequality analyses in the following two ways: (1) construction of a measure of HRQL in the CSLC and its application to health inequality analysis, and (2) inclusion of the dead in health inequality analysis using a cross-sectional survey. This study found that between 1989 and 1998 the average HRQL in Japan slightly reduced (0.005 reduction), its inequality by income slightly reduced (0.002 reduction in the difference between the top 20% and bottom 20% income share groups), and its inequality measured by the Gini coefficient slightly increased (0.002 increase). Women's HRQL was almost always lower than men's, except in earlier ages younger than 10 years old. HRQL was more unequally distributed among women than men and in older ages. This analysis shows that the success in the improvement in the length of life in Japan did not always coincide with the improvement in HRQL and provides a basis for the future population health research.

Activities of Daily Living↗
PubMed2006

State-level variations in income-related inequality in health and health achievement in the US.

The objective of this study was to examine state-level variations in income-related inequality in health and overall health achievement in the US. Data that were representative of the US and each state in 2001 were extracted from the Current Population Survey 2001. Income-related inequality in health and health achievement were measured by Health Concentration and Health Achievement Indices, respectively. Significant variations were found across states in income-related inequality in health and health achievement. In particular, states in the south and east regions, on average, experienced a higher degree of health inequality and lower health achievement. About 80% of the state-level variation in health achievement could be explained by demographics, economic structure and performance, and state and local government spending and burden. In contrast, medical care resource indicators were not found to contribute to health achievement in states. States with better health achievement were more urbanized, had lower proportions of minority groups, females and the elderly, fewer individuals below the poverty line, larger primary industry, and lower unemployment rates. Also, per capita state and local government spending, particularly the proportion spent on public health, was positively associated with better health achievement. Because of the direct implications of health level and distribution in resource allocation and social norms, states with a lower level of health achievement need to prioritize efforts in increasing and reallocating resources to diminish health inequality and to improve population health.

Financing, Government↗
PubMed2001

Quality of life in low-income menopausal women attending primary care clinics.

OBJECTIVE: To examine the quality of life and health status of a population of menopausal age primary care attendees that demographically has not been well represented in previous studies, and to describe the relationships between population characteristics and outcomes. DESIGN: Cross-sectional. SETTING: Community primary care clinics. PATIENT(S): Women 45-60 years of age within 5 years of their last period. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants provided demographic information and completed a series of questionnaires, including the Menopause Quality of Life Instrument (MENQOL) and the Short Form-36 health survey (SF-36). RESULT(S): Women who were employed, had higher levels of education, or higher levels of income reported better overall health and fewer menopausal symptoms. The study population scored significantly lower than the national norms on a summary survey of mental and physical health. There were no significant differences between ethnic groups with respect to either menopausal quality of life or health status. CONCLUSION(S): In a generally low income, poorly educated menopausal population, ethnicity did not significantly affect quality of life. Socioeconomic characteristics (less education and lower income) were associated with increased menopausal symptoms.

Ambulatory Care Facilities↗
PubMed1999

Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh.

BACKGROUND: In the control of reproductive-tract infections, including sexually transmitted infections (STIs), in low-income and middle-income countries, WHO recommends syndromic management for individuals with symptoms. This intervention was initially developed in areas where prevalence of such infections is high. We investigated the clinical effectiveness and cost of this approach among a group of women with a low prevalence of infection. METHODS: During a 5-month period, we investigated all women complaining of abnormal vaginal discharge and seeking care at maternal and child health/family-planning centres in Matlab, Bangladesh, for the presence of laboratory-diagnosed reproductive-tract infections and STIs. Syndromic diagnoses made by trained health-care workers were compared with laboratory diagnosis of infection. We then calculated the costs of treating women by means of the recommended WHO algorithm and an adapted algorithm incorporating use of a speculum and simple diagnostic tests. FINDINGS: The prevalence of endogenous infections among 320 women seen was 30%. Cervical infections (Neisseria gonorrhoeae and Chlamydia trachomatis) were found in only three women. The WHO algorithm had a high sensitivity (100%) but a low specificity (zero for bacterial vaginosis, candida, and Trichomonas vaginalis). The speculum-based algorithm had a low sensitivity (between zero and 59%) but a higher specificity (79-97%). Between 36% and 87% of costs would have been spent on uninfected women. INTERPRETATION: The high rate of overtreatment in the population studied carries both financial and social costs--the latter in potentially exposing women misdiagnosed as having an STI to threats of domestic disruption or even violence. We make recommendations for management programmes in areas of low STI prevalence and low income.

Adolescent↗
PubMed1997

Income-related inequalities in health: some international comparisons.

This paper presents evidence on income-related inequalities in self-assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.

Developed Countries↗
PubMed2001

The relationship between per capita income and diffusion of medical technologies.

It is commonly known that per capita income is correlated with the level of health care spending and that technology is a major factor in explaining the increase in health care spending. This study examines differences in the rate of diffusion of medical technologies in Organization for Economic Cooperation and Development countries between 1975 and 1995. We find that the importance of income in explaining the long-term availability of a technology generally declines over time and becomes insignificant for some technologies. In other words, more affluent countries are earlier adopters of new technologies, but access to technology becomes less dependent on income over time. The evidence also suggests that the effects of reimbursement incentives are greater for purchases of diagnostic technologies than for lifesaving technologies and that reimbursement incentive effects are less significant for older technologies.

Biomedical Technology↗
PubMed1986

A profile of emergency physicians 1984-1985: demographic characteristics, practice patterns, and income.

Emergency physicians (EPs) were profiled using data from a recent national survey of physicians. In addition, we compared EPs to other physicians on demographic and practice characteristics. EPs were younger than physicians in other specialties and were less likely to be foreign medical graduates or board certified. EPs were far more likely to be employed by hospitals and on salary. Their net income averaged $93,000 in 1983, although hospital employees had lower average incomes ($83,000) than did those employed by a corporation or self-employed in a group practice ($101,000). Compared to other specialties, their average income was higher than nonsurgeons, but still far below surgeons. While EPs and other physicians spent about 50 to 51 hours per week in medical activities, EPs saw more patients per hour. EPs saw more uninsured individuals. These results have implications for patient access, "entrepreneurism" in the specialty, and credentialing.

Adult↗
PubMedDate not supplied

[Increase in differences in survival according to income per capita in Spain in the last quarter of the twentieth century].

OBJECTIVE: To estimate probability of survival in Spain from 1975 to 1995 according to income per capita quintiles. METHODS: The 50 provinces in Spain were ordered by income per capita in 1975, 1981, 1985, 1990 and 1995. For each quintile and year we estimated the probability of surviving 75 years from birth and the probability of survival in several age intervals in men and women. Probability was estimated by percentages. Subsequently, we calculated differences in the probability of survival between the highest and the lowest income per capita quintiles. RESULTS: Differences in the probability of surviving from birth to the age of 75 years increased from 1.3 in 1975 to 3.1 in 1995 in women, whereas in men the increase was from 0.1 in 1975 to 3.7 in 1995. CONCLUSIONS: In Spain, as in other developed countries, socioeconomic differences in premature mortality increased in the latter decades of the twentieth century.

Adult↗