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PubMed2003

Primary care, income inequality, and stroke mortality in the United States: a longitudinal analysis, 1985-1995.

BACKGROUND AND PURPOSE: The goal of this study was to test whether primary care reduces the impact of income inequality on stroke mortality. METHODS: This study used pooled time-series cross-sectional analysis of 11 years of state-level data (n=549). Analyses controlled for education levels, unemployment, racial/ethnic composition, and percent urban. Contemporaneous and time-lagged covariates were modeled. RESULTS: Primary care was negatively associated with stroke mortality in models including all covariates (P<0.0001). The impact of income inequality on stroke mortality was reduced in the presence of primary care (P<0.0001) but disappeared with the addition of covariates (P>0.05). CONCLUSIONS: In the absence of social policy that addresses sociodemographic determinants of health, primary care promotion may serve as a palliative strategy for combating stroke mortality and reducing the adverse impact of income inequality on health.

Cross-Sectional Studies↗
PubMed1994

Sex differences in psychiatrists' practice patterns and incomes.

OBJECTIVE AND METHOD: Using data from the APA's 1988-1989 Professional Activities Survey, the authors compared male and female psychiatrists on demographic characteristics, training, practice patterns, and income. RESULTS: In keeping with previous studies' findings, female respondents on the average were younger than male respondents and more likely to have taken a residency or fellowship in child or adolescent psychiatry, worked fewer hours per week, allocated their working hours differently among types of activities, saw fewer patients per week, and worked in somewhat different settings. Multiple regression analysis showed that women had significantly lower mean net annual income than men after the effects of those predictors were statistically controlled. CONCLUSIONS: Differences in age, training, hours worked in specific settings, and numbers of patients do not completely account for the gender gap in psychiatrists' annual incomes.

Adolescent Psychiatry↗
PubMedDate not supplied

Influences of income, education, age, and ethnicity on physical abuse before and during pregnancy.

OBJECTIVE: To examine the influence of socioeconomic status, education, ethnicity, and age on the prevalence of intimate partner abuse before and during pregnancy. DESIGN: Retrospective correlational analysis. SETTING: Data were collected at six postpartum maternity settings. PARTICIPANTS: 1,004 women from six ethnic groups. MAIN OUTCOME MEASURE: Prevalence of intimate partner violence. RESULTS: 15.9% of study participants reported physical abuse by their current partner and 5.2% reported abuse during pregnancy. Decreased income, not having a high school education, and ethnicity were significantly related to current abuse and abuse during pregnancy in bivariate analyses. Having less than a high school education emerged as the most significant predictor of both abuse variables in multivariate analyses. African American and Puerto Rican women had the highest incidence of abuse in their current relationship. No significant differences were found in rates of abuse during pregnancy among women from different ethnic groups. CONCLUSIONS: The results of this analysis support the notion that abuse is most prevalent among the most disadvantaged women. However, it is not income per se, but rather the highly related variables of education and ethnicity that have the largest effect. Abuse occurs frequently among all women, warranting universal screening during health care encounters. Further research is needed to evaluate relationships between education, ethnicity, income, and abuse.

Adolescent↗
PubMed2005

Household out-of-pocket medical expenditures and National Health Insurance in Taiwan: income and regional inequality.

BACKGROUND: Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. METHODS: Data used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995. RESULTS: An individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan. CONCLUSION: Although NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved.

Adult↗
PubMed2001

Reexamining the evidence of an ecological association between income inequality and health.

Several recent studies have made the provocative claim that income inequality is an important determinant of population health. The primary evidence for this hypothesis is the repeated finding--across countries and across U.S. states--that there is an association between income inequality and aggregate health outcomes. However, most of these studies examine only a single cross section of data and employ few (or even no) control variables. We examine the relationship between income inequality and aggregate health outcomes across thirty countries over a four-decade span and across forty-eight U.S. states over five decades. In large part, our findings contradict previous claims.

Causality↗
PubMed2001

Access to primary care: the role of race and income.

The study has two objectives: (1) to examine the racial differences in access provided by Municipal Health Services Clinics to the Medicare low-income beneficiaries, i.e., those also eligible for Medicaid (dual eligibles), and compare it with access provided to non-dually eligible patients; (2) to examine the racial and income disparities in access for primary and ancillary care services. The Municipal Health Services Program (MHSP) started in 1979 in five cities with the objective to improve access to primary care services. The study's method for measuring access combines use and need of care in a single index. The study finds that the clinics provided better access to dual eligibles than to non-dual eligibles and to nonwhite than to white dual eligibles. However, this was a result of higher use of ancillary services by the clinic nonwhite patients. This was particularly true in large clinics such as Baltimore, where inadequate targeting of the low-income group and higher ancillary use were more significant problems than racial disparity in access.

Black or African American↗
PubMed1984

Upper-income cocaine abusers.

Seventy upper-income cocaine users who called the 800-COCAINE helpline received an extensive telephone interview to assess the nature, extent, and consequences of their cocaine use. The data revealed a high incidence of dysfunctional cocaine use associated with numerous physical, psychological, and social problems. Comparison with an earlier study of middle-income cocaine users highlights the role of drug access as a contributor to intensified use patterns and drug-related consequences. Issues pertaining to treatment of the upper-income cocaine abuser are discussed.

Administration, Intranasal↗
PubMed2005

For love and money? The impact of family structure on family income.

What do the half-century decline in U.S. marriage and the attendant rise in single parenthood mean for the economic well-being of children, especially children living in single-parent families? Adam Thomas and Isabel Sawhill show how differing living arrangements can be expected to affect families' economic well-being. Married-parent and cohabiting households, for example, can benefit from economies of scale and from having two adult earners. The availability of child support for single-parent families and the marriage penalties in the tax and transfer system reduce but rarely completely offset the economic benefits of marriage. Consistent with these expectations, national data on family income show that across all races and for a variety of income measures, children in lone-parent families (single-parent households with no cohabiter) have less family income and are more likely to be poor than children in married-parent families. Cohabiting families are generally better off economically than lone-parent families, but considerably worse off than married-parent families. Thomas and Sawhill acknowledge the possibility that the link between famlily structure and family resources may not be causal. But new research that simulates niarriages between existing single mothers and unattached men with similar characteristics suggests that family structure does affect family resources and that child poverty rates would drop substantially if these mothers were to marry. It does not necessarily follow, however, that policymakers ought to, or even can, do anything about family structure. Marriage is not an economic cure-all for the complex problem of child poverty. It would be a mistake for policymakers to focus on promoting marriage to the exclusion of encouraging and rewarding work or addressing problems such as early out-of-wedlock childbearing. Still, Thomas and Sawhill conclude that a continuation of recent declines in single parenthood, linked most recently to declines in teen and out-of-wedlock births, offers great promise for improving the economic welfare of U.S. children.

Adult↗
PubMed2005

Effect of acculturation and income on Hispanic women's health.

This research examines how acculturation and income affect health care access, utilization, and prevention knowledge among a population of Hispanic women living along the U.S.-Mexico border in Yuma, Arizona, a rural agricultural county. A cross-sectional survey was conducted among 417 Hispanic women with mean age 61.3 years (s.d.=9.2). Most were long-term residents of Yuma County with some elementary and middle school education. Respondents had low monthly household incomes (average: USD $927.77, s.d.=550.40) and 10% reported current employment. The results show that income may be a more important predictor of actual utilization of health care services while acculturation may play a more prominent role with respect to provider preferences. A better understanding of the complex interplay between the individual and the society she inhabits is required in order to develop a meaningful public health intervention that will affect disease risk.

Acculturation↗
PubMed1998

Race, income, urbanicity, and asthma hospitalization in California: a small area analysis.

STUDY OBJECTIVES: To explicate the interrelationship between asthma hospitalization and race/ethnicity and income. DESIGN: Small area ecologic analysis using census and administrative data. SETTING AND PARTICIPANTS: All asthma hospitalizations in California were identified using the 1993 California Hospital Discharge file. Small area analyses of Los Angeles (LA) were compared with published rates in New York City (NYC). RESULTS: In 1993, the age-adjusted asthma hospitalization rate in California for nonelderly blacks was 42.5/10,000-approximately four times higher than other populations. Black rates remained fourfold higher after stratification by age, income, and urbanicity. Multivariate analyses suggest that the association between black race and asthma hospitalization is independent of income. Regardless of race, children and persons living in poverty were at increased risk for asthma hospitalization. Urbanicity was not a predictor for asthma hospitalization. Overall, asthma hospitalization rates in NYC were 2.8 times higher compared with rates in LA; while rates were similar among blacks (60 vs 40/10,000, respectively), Puerto Rican Hispanics in NYC had dramatically higher rates compared with Mexican Hispanics in LA (63 vs 14/10,000, respectively). CONCLUSIONS: After controlling for socioeconomic status, notable differences in asthma hospitalization by race and ethnicity persist. The reasons for the significantly elevated risk of asthma morbidity among blacks remain unclear.

Adolescent↗
PubMed2005

Income inequality and risk of suicide in New York City neighborhoods: a multilevel case-control study.

Evidence on the relationship between income inequality and suicide is inconsistent. Data from the New York City Office of the Chief Medical Examiner for all fatal injuries was collected to conduct a multilevel case-control study. In multilevel models, suicide decedents (n=374) were more likely than accident controls (n=453) to reside in neighborhoods with greater income inequality even after controlling for individual characteristics; this relation was modified by age with an effect overall and among decedents aged 15-34 but not among decedents 35-64. These data suggest that income inequality may contribute to the risk of suicide in younger adults.

Adolescent↗
PubMed2006

[Associations between schooling, income, and body mass index among public employees at an university in Rio de Janeiro, Brazil: the Pró-Saúde Study].

This study focuses on associations between schooling, income, and body mass index (BMI). The analyses are based on data from 3,963 public university employees in Rio de Janeiro, Brazil, participating in phase 1 of a longitudinal study (the Pró-Saúde Study). ANOVA, Wald test, and generalized linear models were used to analyze differences between subgroups. Obesity prevalence was inversely associated with schooling, especially among women (p < 0.001). In regression analyses, schooling and per capita income were not associated with BMI among men. In women, schooling but not income was significantly and inversely associated with BMI (p < 0.001). Thus, low schooling plays an important role in the social determination of obesity, especially among women.

Adult↗
PubMedDate not supplied

[Private health expenditures and income distribution in Brazil].

BACKGROUND: This paper analyses the share of the family private health expenditures in the Brazilian GDP and in personal income; and the distribution of the family private health expenditures among social groups. METHODS: The research utilized the 1998 Brazilian Home Sample Survey (Pesquisa Nacional por Amostra de Domicilios) with the division of the population into four social groups according to the family income per capita; and the distribution of the family private health expenditures among health insurance, physicians, other health professionals, medical tests, drugs, orthopedic and other medical durables, vision products, dental services, hospital care, nursing home care and other health spending. RESULTS: In 1998, only 7.2% of the population with family income per capita up to 1 minimum wage had health insurance and the health expenditures of this group, that represented 52.5% of the population, was US$ 4.62 per capita. For the people with 9 and more minimum wages per capita the health insurance coverage was 83.2% and the health expenditures was US$ 114.66 per capita. CONCLUSIONS: The implementation of the Brazilian public universal health care system in 1988 denominated "Sistema Unico de Saude" was followed by an expressive expansion of private insurance coverage in the 1990's. Even if all public health expenditures had been exclusively directed to the population without any private insurance, these people's health expenditures would only reach 43% of the health expenditures of those with private insurance.

Brazil↗
PubMed2005

Infant mortality and income in 4 world cities: New York, London, Paris, and Tokyo.

OBJECTIVES: We investigated the association between average income or deprivation and infant mortality rate across neighborhoods of 4 world cities. METHODS: Using a maximum likelihood negative binomial regression model that controls for births, we analyzed data for 1988-1992 and 1993-1997. RESULTS: In Manhattan, for both periods, we found an association (.05% significance level) between income and infant mortality. In Tokyo, for both periods, and in Paris and London for period 1, we found none (5% significance level). For period 2, the association just missed statistical significance for Paris, whereas for London it was significant (5% level). CONCLUSIONS: In stark contrast to Tokyo, Paris, and London, the association of income and infant mortality rate was strongly evident in Manhattan.

Data Collection↗
PubMed2005

Adolescent birth rates, total homicides, and income inequality in rich countries.

Income inequality has been associated with both homicides and births to adolescents in the United States and with homicides internationally. We found that adolescent birth rates and general homicide rates were closely correlated with each other internationally (r= 0.95) and within the United States (r = 0.74) and with inequality internationally and within the United States. These results, coupled with no association with absolute income, suggested that violence and births to adolescents may reflect gender-differentiated responses to low social status and could be reduced by reducing income inequality.

Adolescent↗
PubMed1983

The organization of medical practice and primary care physician income.

This study investigates the effect of the organization of medical practice, e.g., solo, fee-for-service group, or health maintenance organization (HMO) settings, on primary care physicians' net incomes. Using pooled data on 2,372 primary care physicians, multivariate regression analysis is used to adjust physicians' 1979 net incomes for differences in medical specialty, workload, sex, and experience before estimating the effects of the organization of medical practice. Among HMO physicians, only those in staff model HMOs were found to have significantly lower net incomes than their fee-for-service group practice counterparts. Accordingly, there is little evidence to support the popular belief that physicians practicing in HMOs consistently earn less than their fee-for-service counterparts. (Am J Public Health 1983; 73:379-383.)

Humans↗
PubMed1986

The relationship of family income to the incidence, external causes, and outcomes of serious brain injury, San Diego County, California.

Among residents of San Diego County, California the incidence and external causes of serious brain injury were related to the median family income of the census tract of residency. Low income tracts had high incidence rates--a finding not changed by adjustment for age and race/ethnicity. For those injured, the type of emergency transport, time from injury to treatment, and outcome of treatment were not related to the median income of the census tract of residency.

Brain Injuries↗
PubMed1994

The use of mammography vans by low-income women: the accuracy of self-reports.

The objective of this study was to determine the accuracy of self-reports of mammography use by low-income income women. Mammography van records were used to verify self-reports of mammography use in the past year by women aged 50 through 75 years who had visited five community health centers (n = 237). Van records verified mammography use for 99% of these women (82% within the previous year and 98% within the past 2 years). Forty percent of those with van records who reported both the month and year of the mammogram were accurate. Inaccurately reported dates were more frequently after (74%) rather than before (26%) the actual date. These findings indicate that self-reports of mammography use by low-income women are generally reliable.

Aged↗