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PubMed2004

Geographical inequalities of mortality by income in two developed island countries: a cross-national comparison of Britain and Japan.

In this paper we examine the ecological relations between household income distribution and age-grouped mortality in Britain and Japan. Comparable datasets were prepared in terms of age intervals of mortality, household income intervals and geographical units for years around 1990. Then we conducted a series of regression analyses to associate absolute and relative income indices with age and sex-specific standardized mortality ratios (SMRs). The results are as follows: (1) In Britain mortality is lower where inequalities in income are lower, while in Japan there is no obvious relationship. It is, however, apparent that-just as in the case of the USA and Canada-Britain and Japan appear to merge and appear part of a greater pattern when considered as a series of city regions. Thus an overall global relationship between income inequality and mortality may exist. To assess such global relationship, further studies using cross-national regional datasets covering a wide rage of rich nations are desirable. (2) Income-mortality relations are consistent among different age-sex groups in Britain, but there are substantial differences in the relationships as revealed between different demographic groups in Japan. In particular, while absolute income levels are correlated negatively with mortality of working-age men in both countries, mortality of elderly people in Japan is higher where absolute income is higher. This indicates the different historical contexts to the health divides these two different geographical contexts, but further consideration of a more historically nuanced understanding of income-mortality relations is required.

Adult↗
PubMed2004

Blindness registrations and socioeconomic factors in Canada: an ecologic study.

PURPOSE: To investigate the socioeconomic factors associated with blindness registration in Canada and its regions using an ecologic approach. METHODS: Canadian National Institute for the Blind (CNIB) blindness registration data for 1996 were divided into units of analysis using postal codes and correlated with demographic and socioeconomic information collected by the 1996 Census of Canada. A total of 1250 units were analyzed representing 28,429,519 persons (98.55% of the population of Canada). Six socioeconomic factors were examined using weighted linear multivariate regression analysis: I) Percentage of the population aged 65 years and over; 2) Median household income; 3) Percentage of the population with university education; 4) Percentage of income derived from government transfer payments; 5) Recent immigrants; and 6) Visible minorities (blacks, Chinese, South Asians). Regression models were created for Canada as well as five geographic regions within Canada. RESULTS: For Canada as a whole, blindness registration prevalence was positively correlated with age distribution and percentage of recent immigrants, and negatively correlated with level of government assistance income and percentage ethnic Chinese population. For five regional regression models, the common predictor variables were age distribution, median household income and percentage of the population who are black. None of the regional models produced an identical set of correlations. CONCLUSIONS: Socioeconomic factors associated with blindness registration prevalence varied across different regions. Median household income was the second most common factor after age distribution, suggesting that areas with lower incomes tend to utilize more blind services. Higher blindness registration rates were associated with areas that had a higher percentage of the population who were black. Differences in blindness registration rates may reflect under-utilization of blind services and/or variations in disease and treatment rates in different populations.

Aged↗
PubMed2005

Prevalence of selected risk and protective factors for falls in the home.

BACKGROUND: Falls are the most common cause of both fatal and nonfatal unintentional injury in the home environment. This research describes the prevalence of fall-related risk and protective factors in U.S. homes. METHODS: A random-digit-dial survey was conducted of 1003 households in the continental United States to estimate the prevalence of risk and protective factors for falls in homes. Data were weighted to reflect the national distribution of households. RESULTS: Fall hazards such as stairs with four or more steps (70%), absence of railings on stairs (34%), and use of ladders (60%) are common in many households. Use of grab bars and handrails in the bathroom was low, as was the presence of guards and locks on windows (both 25%). However, households with young children and older adults reported greater use of appropriate antifall devices. Sixty-five percent of households with children aged </=2 years reported using safety gates on stairs. Higher household income and owner-occupied (as opposed to rental) homes had an increased prevalence of fall hazards (more stairs without railings, greater use of ladders). CONCLUSIONS: Considerable opportunity exists for increased use of antifall protective devices and reduction of fall hazards.

Accidental Falls↗
PubMed1996

Health care and income distribution in Finland.

This paper examines the effects of health care on income redistribution in Finland. In contrast to earlier studies in this area, the redistributive effect is analysed with noncash transfers from health care utilisation included in household income. Distributional consequences of changing health care financing towards one system or another are analysed in terms of municipality provided public services and sickness insurance based public services. Our results show that, overall, the public health care system distributed income from the rich to the poor. The poorest one-third of the population financed only about one-third of the public health care services they utilised. The distributional implications were, however, markedly different depending on the definition of income used. Whereas health care financing had only a marginal redistributive effect, the effect was substantially increased as noncash transfers from health care utilisation were taken into account.

Data Collection↗
PubMed1976

The fall in household size and the rise of the primary individual in the United States.

The long-term fall in household size in the United States is discussed within the framework of the aging of the population, continuing as the effects of fertility and mortality decline accumulate. Using distributions of households by size from U.S. census data 1790-1970 and a components of change analysis on primary individuals for 1950-1974, household changes are related to demographic change for the periods 1790-1900, 1900-1950, and 1950-1974. Fertility and mortality declines have unambiguous impact on household size until the increases in primary individuals begin. But these, too, have a theoretically interesting, if indirect relationship to population structure.

Adolescent↗
PubMed1999

The potential use of maternal size in priority setting when combating childhood malnutrition.

OBJECTIVE: To devise a strategy for assessing the nutritional status of a household and specifying the major needs in combating childhood wasting, distinguishing between inadequate food availability, poor parental care and/or the need for improved public health measures. DESIGN: An evaluation of the relationship between children's wasting, stunting, or underweight and mothers' or adult women's body mass indexes (BMIs) in the same household. A household was designated as 'malnourished' on the basis of a single child's weight/height of < -2.0 s.d. or at risk of being malnourished if the Z-score was below--1.5. Adult women's BMI was taken to signify adequate household food availability. Sibling concordance of anthropometric measures was investigated. RESULTS: A wide variety of prevalence of severe (BMI < 16.0), moderate (BMI 16.0-16.9) and marginal (17.0-18.4) malnutrition existed in the various study areas. The worst condition was recorded in India, while 18% of the women in Zimbabwe were classified as obese. Similarly wide variation in the prevalence of child wasting and stunting was observed, with the Indian children again faring worst and those in Zimbabwe the best. The within-household analysis of concordance gave higher concordance for height than for weight between siblings. Mothers' BMI was highly correlated with the BMI of all other adult women in the same household and the BMI of all the women was found to be as useful as that of the mother for relating to children's anthropometry. Households with mothers of normal body weight but wasted children were designated as in need of public health measures and improved parental care rather than of enhanced food security. The distribution of households on this combined basis of maternal BMI and child nutritional status highlighted very diverse situations in the various study areas, with higher proportions of combined maternal and child malnutrition in India and in some areas of Ethiopia, while in Zimbabwe only 1-2% presented this condition. On this basis, the principal problem in India was food security; in Zimbabwe household security was rarely apparent, so public health measures and maternal care were designated as problems. In three Ethiopian communities there was a mixture of needs. CONCLUSIONS: A relatively simple household-based approach is proposed to discriminate the most pressing needs in combating childhood malnutrition, and a policy-making tool is suggested for setting priorities in community action.

Adolescent↗
PubMed2004

Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan.

Most countries of the Former Soviet Union (FSU) have either initiated or are contemplating reform of the health sector. With negative real income growth and falling government revenues, a key concern of many governments is to secure additional finance through non-budgetary sources such as hypothecated payroll taxes, voluntary insurance, and increased private finance through patient cost-sharing. However, before such reforms can be considered, information is needed both on the current levels and distribution of household expenditures on health care, and the extent to which increased charges may affect access to health services, especially amongst the poor. This paper uses the Tajikistan Livings Standard Survey to investigate the level and distribution of out-of-pocket payments for health care in Tajikistan and to examine the extent to which such payments act as barriers to health-care access. The data show that there are significant differences in health-care utilisation rates across socio-economic groups and that these differences are related to ability to pay. Official and informal payments are acting both to deter people from seeking medical assistance and once advice has been sought, from receiving the most appropriate treatment. Despite informal exemptions, out-of-pocket payments for health care are exacting a high toll on household welfare with households being forced to sell assets or go into debt to meet the costs of care. Urgent action is needed to ensure equity in access to health care.

Adolescent↗
PubMed1988

On some probability models and their applications to the distribution of the number of migrants from a household.

This paper discusses some probability models in relation to their application to the distribution of the number of migrants from a household. 2 types of distribution of migrants from a household are described here: 1) male migrants aged 15 and above and 2) total number of migrants including females and children from a household. It is found that the model proposed here fitted the several sets of observed data on the number of migrants satisfactorily well.

Asia↗
PubMed2006

Salt dual-fortified with iodine and micronized ground ferric pyrophosphate affects iron status but not hemoglobin in children in Cote d'Ivoire.

Deficiencies of iron and iodine are common in West Africa, and salt is one of very few food vehicles available for fortification. Salt dual-fortified with iodine and micronized ground ferric pyrophosphate (FePP) was tested for its efficacy in rural, tropical Côte d'Ivoire. First, salt and iron intakes, and iron bioavailability were estimated using 3-d weighed food records in 24 households. Local iodized salt was then fortified with 3 mg Fe/g salt as ground FePP (mean particle size = 2.5 mum), and stability, sensory and acceptability trials were done. The dual fortified salt (DFS) was distributed to households and its efficacy compared with that of iodized salt (IS) in a 6-mo, double-blind trial in 5- to 15-y-old iron-deficient children (n = 123). All children were dewormed at baseline. After 6 mo, serum ferritin (SF) and transferrin receptor (TfR) concentrations as well as body iron stores improved significantly in the DFS group but not in the IS GROUP (P < 0.05). Body iron increased from 4.6 +/- 2.7 to 5.9 +/- 2.7 mg/kg (mean +/- SD) in the DFS group; concentrations before and after treatment in the IS group were 5.5 +/- 2.9 and 5.6 +/- 3.1 mg/kg, respectively. The hemoglobin concentration and the prevalence of anemia did not change in either group. The prevalences of malaria, soil-transmitted helminths, and riboflavin deficiency were 55, 14, and 66%, respectively. In tropical West Africa, low-grade salt fortified with micronized ground FePP increased body iron stores but not hemoglobin in children. Iron utilization may have been impaired by the high prevalence of malaria and concurrent nutrient deficiencies.

Adolescent↗
PubMedDate not supplied

Contraceptive prevalence in the slums of Rio de Janeiro.

A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.

Adolescent↗
PubMedDate not supplied

Evaluation of an advertising method for a university family practice center.

Advertising by physicians has become accepted by the public and is practically mandatory in today's competitive marketplace. This study evaluated the feasibility and effectiveness of a specific method of advertising a university family practice center by using fliers targeted to nearby neighborhoods. The fliers were inexpensive handbills describing the center's location and services, distributed to 23,000 households. Six months after distribution of the fliers, a randomized survey of 100 of these households was conducted to determine the fliers' success at increasing consumers' awareness of the center's location and altering consumers' attitudes and behavior concerning using the center's services. In 27% of the households, someone recalled receiving the flier. Half of these still had the fliers in their possession. Two thirds of those who remembered it thought the flier made them consider using the center, and half had called or visited the center. The results show that this technique was effective.

Advertising↗
PubMed2000

State income inequality, household income, and maternal mental and physical health: cross sectional national survey.

OBJECTIVE: To examine the association of state income inequality and individual household income with the mental and physical health of women with young children. DESIGN: Cross sectional study. Individual level data (outcomes, income, and other sociodemographic covariates) from a 1991 follow up survey of a birth cohort established in 1988. State level income inequality calculated from the income distribution of each state from 1990 US census. SETTING: United States, 1991. PARTICIPANTS: Nationally representative stratified random sample of 8060 women who gave birth in 1988 and were successfully contacted (89%) in 1991. MAIN OUTCOME MEASURES: Depressive symptoms (Center for Epidemiologic Studies depression score >15) and self rated health RESULTS: 19% of women reported depressive symptoms, and 7.5% reported fair or poor health. Compared with women in the highest fifth of distribution of household income, women in the lowest fifth were more likely to report depressive symptoms (33% v 9%, P<0.001) and fair or poor health (15% v 2%, P<0. 001). Compared with low income women in states with low income inequality, low income women in states with high income inequality had a higher risk of depressive symptoms (odds ratio 1.6, 95% confidence interval 1.0 to 2.6) and fair or poor health (1.8, 0.9 to 3.5). CONCLUSIONS: High income inequality confers an increased risk of poor mental and physical health, particularly among the poorest women. Both income inequality and household income are important for health in this population.

Adolescent↗
PubMed1983

A method for disaggregate household forecasts.

A method for making household forecasts is proposed "which yields both the total number of households and the number present in any predetermined subgroup of households. The method presupposes that incomplete information is available on the transitions of persons between various age and household categories over a period of time. The forecasting method is capable of spelling out the consequences for the prognoses of adding different amounts of external information to the computations. Such information may include population forecasts by age and sex, trend-based information like restrictions on the size distribution of households, econometric relations between household formation and incomes, etc." The forecasting method is described in theoretical terms. "This description includes the use of information-theoretic arguments to adjust the forecast to external data. The theoretical development is illustrated by an application of the method to data for the Stockholm region [of Sweden]. In relation to this application an outline is given of the use of the methodology for long-term projections."

Demography↗