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PubMed1982

Distribution of family income: improved estimates.

This article describes the results of research to improve estimates of the distribution of family income. In this research, a microdata file was constructed for 1972 using several data sources. The data obtained from these sources were combined and adjusted to produce more precise estimates. Current Population Survey estimates were then evaluated using these improved estimates. Using the improved estimates increased 1972 mean income for all units by 11 percent. The income share of the top 5 percent of the distribution increased substantially. Property income increased and wage and salary income decreased in relative importance. The mean income of family units headed by persons aged 65 or older increased by about 40 percent, by far the largest rise for any group examined; the increase was far lower for low-income family units in that age group. A simple update of mean incomes to 1979 showed no substantial changes from the 1972 pattern of adjustments.

Adolescent↗
PubMed1992

Access to ambulatory care among noninstitutionalized, activity-limited persons 65 and over.

This study examined the impact of income and insurance type on ambulatory care contact use by persons 65 and over who expressed a limitation in their activity. This large group (39% of noninstitutionalized older persons in 1984) had significantly more health problems and ambulatory care contacts than persons not activity-limited. The only previous study on equity in use of physician services among elderly in poorer than average health found relatively little inequality of use due to income and insurance. This study came to the opposite conclusion. Activity-limited persons without Medicare private supplementary insurance, as well as those with supplementary insurance in the bottom and middle of the income distribution, had 15-32% fewer ambulatory care contacts than activity-limited persons with higher income and private supplementary insurance. Particularly striking were the declines in consumption among middle income persons relative to the reference group, indicating that the issue of equity in consumption of health services among older disabled persons affects a much broader group than only the poor and near-poor.

Activities of Daily Living↗
PubMed1999

Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis.

OBJECTIVE: To examine the changing relation between income inequality and mortality through different stages of economic development in Taiwan. DESIGN: Regression analysis of mortality on income inequality for three index years: 1976, 1985, and 1995. SETTING: 21 counties and cities in Taiwan. MAIN OUTCOME MEASURES: All age mortality and age specific mortality in children under age 5. RESULTS: When median household disposable income was controlled for, the association between income inequality and mortality became stronger in 1995 than in 1976. Especially, the association between income inequality and mortality in children aged under 5, with adjustment for differences in median household disposable income, changed from non-significant in 1976 to highly significant in 1995. In 1995, the level of household income after adjustment for income distribution no longer had a bearing on mortality in children under 5. CONCLUSION: The health of the population is affected more by relative income than by absolute income after a country has changed from a developing to a developed economy.

Adolescent↗
PubMed2003

Income, education, and blood pressure in adults in Jamaica, a middle-income developing country.

BACKGROUND: At present, little is known about how socioeconomic status (SES) is related to blood pressure (BP) and hypertension in developing countries. This cross-sectional study examined associations between SES and BP in 2082 adults from a peri-urban area of Jamaica, a middle-income developing country. METHODS: Hypertension (systolic BP >/=140 mmHg, diastolic BP >/=90 mmHg or current hypertensive medication use) was estimated based on self-reported medication use and the mean of the second and third of three manual BP measurements. Income and education were self-reported. Linear or logistic regressions were used to estimate multivariate associations between BP or hypertension and SES. RESULTS: Hypertension prevalence was 20% in men and 28% in women. In both men and women, the income distributions of BP and hypertension were non-linear, indicating elevated levels in low as well as in high-income groups. In contrast to the negative relationships typical for industrialized countries, multivariate-adjusted BP and hypertension were highest in the wealthiest women. In men with some high school education, income was positively associated with BP, while there were negative associations in men with lesser education. Unlike women, mean BP were highest in poor men with limited education. Low SES men were also least likely to receive diagnosis and treatment. CONCLUSIONS: Socioeconomic status is related to BP and hypertension in Jamaica, although relationships are non-linear. Behavioural and environmental factors that explain elevated BP among both low and high SES adults in developing countries must be identified to develop effective prevention strategies.

Adult↗
PubMed1997

Inequalities in income and long-term disability in Spain: analysis of recent hypotheses using cross sectional study based on individual data.

OBJECTIVE: To compare the relation between inequalities in long-term disability and income in the 17 regions of Spain. DESIGN: Data were taken from the survey on impairments, disabilities, and handicaps that was carried out in Spain in 1986. For each region the inequality in long-term disability associated with income was calculated as the odds ratio associated with reducing monthly household income by 10,000 pesetas (about Ponds 50) (estimate of effect of inequality of income) and the odds ratio for the inequality in long-term disability between those at the bottom and those at the top of the income hierarchy (relative index of inequality). MAIN OUTCOME MEASURE: Prevalence of long-term disability. RESULTS: Five of the eight regions where lowering income had a greater effect on long-term disability were among those with the lowest income per head, while six of the remaining nine regions where the effect was smaller were among those with the highest income per head. Three regions with the highest estimate of relative index of inequality had the highest estimate of effect, and another three regions with the lowest estimate of relative index of inequality had the lowest estimate of effect. In contrast, the relative position of the remaining 11 regions varied from one measure to another. CONCLUSIONS: These results support the theory that additional increments in material wellbeing have a negligible effect on health in countries with high socioeconomic development. However, inequality in income distribution did not determine inequality in health between those at the bottom and those at the top of the income hierarchy in many Spanish regions.

Cost of Illness↗
PubMed1982

Distributions of households by size: differences and trends.

"This article deals with the distributions of households by size, that is, by number of persons, as they are observed in international comparisons, and for fewer countries, over time." The contribution of differentials in household size to inequality in income distribution among persons and households is discussed. Data are for both developed and developing countries.

Demography↗
PubMed2001

Economic growth, income equality, and population health among the Asian Tigers.

The "Tiger" economies of Southeast Asia provide examples of developing nations where economic growth and increasing income equality are compatible and, when occurring together, are associated with superior health trends over time. The degree of income inequality in the Asian Tigers declined during the period of rapid economic growth. Traditionally, economists have viewed economic growth and relative parity in income distribution as incompatible, or trade-offs. This poses a public policy dilemma, since a reasonable propensity to increase a nation's overall economic well-being would mean forsaking measures that increase income parity. The Asian Tigers, however, have shown that this need not be viewed as a trade-off. Economic growth and a simultaneous increase in income equality are possible and, with respect to health outcomes, desirable. The authors propose a variety of mechanisms through which income inequality can enhance economic growth, and discuss policies in education, agricultural land reform, and housing that influence the simultaneous attainment of income equality and economic growth.

Asia, Southeastern↗
PubMed1996

An economic analysis of Chinese fertility behavior.

This paper is the first to present a Chinese general fertility model that simultaneously controls for the endogeneity of infant mortality and per capita income determination at county level. Using the 1982 Chinese population census data, comprising 2305 observational units, this analysis improves on existing studies in several ways. First, since all the underlying variables are measured at the Chinese county level, we treat both the per capita income and infant mortality rates as endogenous, as opposed to exogenous as assumed in most previous studies on Chinese fertility. Our testing results strongly reject the null hypothesis of the exogeneity of both infant mortality and income determination within our model. Secondly, concerning the hypothesis of nonlinear income effect on fertility behavior, we examine both the variable income-elasticity and constant income-elasticity models. Strong evidence is obtained in support of the variable income elasticity model, predicting a U-shaped income effect on Chinese general fertility. This suggests that a more equitable income distribution leads to a reduction in the Chinese fertility rates. Thirdly, employing the two stage least squares procedure, we find a much stronger positive replacement effect on infant mortality when the endogeneity of infant mortality and income are both controlled for simultaneously. Our results indicate that Chinese general fertility may well be shaped by optimizing behavior.

Adolescent↗
PubMed2002

Primary care, self-rated health, and reductions in social disparities in health.

OBJECTIVE: To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health. DATA SOURCES: Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care. STUDY DESIGN: Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States. DATA COLLECTION/EXTRACTION METHODS: Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health. PRINCIPAL FINDINGS: Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.

Adult↗
PubMed1979

Effects of jet noise on mortality rates.

Two areas, containing a total of over 160,000 people, were examined for mortality rates; one area was directly under incoming flights, near Los Angeles International Airport (LAX). The other was removed from the LAX flight patterns so that jet noise was not dominant. The two areas were chosen so that they were as nearly alike as possible in age, racial distribution, income and in other relevant factors with the sole major difference of jet noise in one of them. It was found that there was a substantial increase in mortality rates in the area under the jets where there was large noise radiation. In particular, by a most conservative statistical treatment there was in the jet noise area: a 15% increase in deaths due to strokes (cerebro-vascular disease) which accounted for 39 deaths in the two-year period of the study--presumably attributable to the excessive jet noise. Further, in the noise-radiated area there was a 100% increase in deaths due to cirrhosis of the liver (primarily attributed to alcoholism)--amounting to 24 extra deaths in the two years, due to jet noise. One of the disturbing side results of this study was that in these relatively poor regions it appears that there should be about 50% more deaths than were reported and recorded by Los Angeles County. These losses were perhaps due to a concentration of bad, given addresses in the areas in question; this serious loss casts grave doubt on previous studies of eath rates for minority peoples (e.g. blacks), suggesting that the rates may be considerably higher than those previously reported.

Aircraft↗
PubMed2003

Income inequality and ischaemic heart disease in Danish men and women.

BACKGROUND: It has been hypothesized that areas with an unequal income distribution are less likely to invest in health and more likely to have a social environment that influences the development of ischaemic heart disease (IHD) METHODS: We used pooled data from two cohort studies conducted in Copenhagen to analyse the association between area income inequality and first admission to hospital or death from IHD in women and men while controlling for individual income and other IHD risk factors. A total of 11 685 women and 10 036 men, with initial health examinations between 1964 and 1992, were followed for a median of 13.8 years. Information on median income share at parish and municipality levels was obtained from population registers. RESULTS: During follow-up 1700 men and 1204 women experienced an IHD event. At parish level income share was inversely associated with an increased risk of IHD in men (hazard ratio [HR](most versus least equal quartile) = 0.85 (95% CI: 0.73-0.98). Among women there was no relation between parish income inequality and IHD. Subject's household income was inversely related to IHD, and when this variable was controlled for, the association between income inequality at parish level and IHD in men attenuated slightly. When behavioural and biological risk factors were entered into the Cox model this relation attenuated further. However, some of these risk factors might mediate rather than confound the effect of income inequality. The association between income inequality at municipality level and IHD was insignificant for men, while in women the relation had a curved shape with those living in the least equal areas having the lowest risk. CONCLUSIONS: This study provides no clear evidence for an association between income inequality measured at parish or municipality level and IHD in Danish adults. The associations were weak and varied between different strata and geographical levels.

Adult↗
PubMed1999

The impact of public spending on health: does money matter?

We use cross-national data to examine the impact of both public spending on health and non-health factors (economic, educational, cultural) in determining child (under-5) and infant mortality. There are two striking findings. First, the impact of public spending on health is quite small, with a coefficient that is typically both numerically small and statistically insignificant at conventional levels. Independent variation in public spending explains less than one-seventh of 1% of the observed differences in mortality across countries. The estimates imply that for a developing country at average income levels the actual public spending per child death averted is $50,000-100,000. This stands in marked contrast to the typical range of estimates of the cost effectiveness of medical interventions to avert the largest causes of child mortality in developing countries, which is $10-4000. We outline three possible explanations for this divergence of the actual and apparent potential of public spending. Second, whereas health spending is not a powerful determinant of mortality, 95% of cross-national variation in mortality can be explained by a country's income per capita, inequality of income distribution, extent of female education, level of ethnic fragmentation, and predominant religion.

Child, Preschool↗
PubMed2002

Spatial analysis to identify differentials in dental needs by area-based measures.

OBJECTIVES: To examine the association between tooth decay and dental treatment needs in 5-12-year-old schoolchildren in São Paulo with area-level indicators of social development. METHODS: The present study refers to a representative sample of children from the city of São Paulo, Brazil, comprising 2491 girls and boys attending public and private schools in different areas of the city. The assessment of caries and treatment needs followed the international methodological standards prescribed by the World Health Organization. We used spatial data analysis to describe epidemiological measures distributed by small areas, and to explore hypotheses of ecological association between caries indexes and indicators of social development. RESULTS: Schoolchildren in central districts were less affected by tooth decay and presented fewer dental treatment needs when compared to those in peripheral deprived areas. At the spatial level, average family income, unemployment rate, household overcrowding, and an index of inequality of income distribution were significantly correlated with variables measuring children's caries experience. CONCLUSIONS: The heterogeneous distribution of caries indexes by areas of the city indicates higher levels of dental decay in areas of social deprivation. The delimitation of areas with increased risk of caries and greater dental treatment needs should be helpful to public health services for the formulation of policies and the targeting of resources to address these problems.

Brazil↗
PubMed1995

Mortality and income inequality among economically developed countries.

The absence of a correlation between age-adjusted death rates and the average income levels of economically developed countries has led researchers to conclude that income does not affect the mortality levels of economically developed countries. The mortality experiences of the former Soviet Union and some of the eastern European countries have further brought into question the importance of income's distribution in determining mortality among economically developed countries; prior to its breakup, the income distribution of the Soviet Union was as equal as that of Sweden, yet the life expectancy of the Soviets has been dramatically shorter than that of the Swedes. Using insights from a longitudinal microanalysis of U.S. mortality, this study presents evidence that, even for economically developed countries, the income distribution of a nation is an important determinant of its mortality. The results of this study also suggest that the relatively unequal income distribution of the United States is an important contributing factor to its low life expectancy relative to other high-income countries.

Adult↗
PubMed2000

Does social policy matter? Poverty cycles in OECD countries.

Traditionally, poverty was linked to an individual's family phase. This article examines to what extent poverty cycles are still apparent in OECD countries. By combining data on social policy programs and data on income distribution, the authors compare trends between nations. The main question is, how successful have various sociopolitical solutions been in eliminating poverty? Here the focus is on family policy and pensions. Improvements in social policies have impacts on poverty cycles in all countries. In most countries poverty among the elderly has declined, and the young have replaced the old as the lowest income group. In many countries the poverty cycles have flattened out, and life phase is no longer as important as it used to be. Some differences between nations remain, however. High poverty rates among families continue to be an Anglo-American problem, and improvements in this area have been only marginal. Social policy provisions are important for explaining both cross-national variation in poverty and changes over time. The impact is clearest among pensioners. Family-related poverty is lowest in countries that have combined cash benefits with public child-care services that facilitate parents' participation in the labor market.

Adult↗
PubMed1999

Equal dependence of the high prevalence of health problems on age and family income in rural southern areas.

BACKGROUND: People who have periods of low family income are at risk for increased health problems in the future, even if they present a similar clinical picture before the reduction in family income. The association between low income and health status was studied in residents of an area with relatively low-average family income and with a historically unstable economy. METHODS: We surveyed a stratified, clustered sample of residents of Johnson County, Tennessee, using a structured interview. The responses were analyzed in conjunction with national and regional data (National Health Interview Survey). RESULTS: Residents of the geographic area under study had a markedly higher prevalence of self-reported health problems than either the national average or rural areas in the southeast United States. The higher prevalence was accounted for by the combination of age and family income, which had equal effects on health status, but not by age differences alone. CONCLUSIONS: Family income and economic development are critically important to improving community health. Sensible capitation rates in managed care arrangements can be obtained only if the income distribution of an insured population is considered along with their age, sex, and physical health status.

Adolescent↗
PubMed1991

Characteristics and economic implications of migration.

Factors affecting rural-urban migration in India are explored. "The study, based on the sample of 205 migrant households, conducted in the hill region of Uttar Pradesh, attempts to highlight the characteristics of migration and its effects on the pattern of income distribution among the households....[It is found that] migration...is primarily motivated by...socioeconomic condition of households, development of road transport and communication sources, level of education...and various geographical and physical conditions."

Asia↗