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Raftopoulou A, Gil Trasfi J. Income-related inequality in obesity and its determinants in Spain: What happens beyond the obesity threshold? INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:135-153. [PMID: 37537420 PMCID: PMC10960917 DOI: 10.1007/s10754-023-09360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/24/2023] [Indexed: 08/05/2023]
Abstract
This paper computes and decomposes income-related inequalities in three metrics of obesity, namely, status, depth and severity, for Spain, a European country characterized by a universal health care system with very high and rising obesity prevalence rates. Furthermore, this paper investigates the main determinants of the reduction in obesity inequalities observed over time among the female Spanish population. To compute these inequality indexes, we use cross-sectional and individual-level data gathered from the Spanish National Health Survey. We document income-related inequalities in obesity, that are more pronounced in depth and severity and are to the detriment of poor women in Spain. University education is the most important determinant for all three inequality indexes. We further report that inequalities in obesity tend to decline over time for women, which is explained mainly by a substantial decrease in the degree of inequality in secondary education and a large decrease in the income elasticity of obesity.
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Affiliation(s)
- Athina Raftopoulou
- Department of Economics, University of Patras, 265 04, Rio Patras, University Campus, Greece.
| | - Joan Gil Trasfi
- Department of Economics and BEAT, Universitat de Barcelona, Barcelona, Spain
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Kim MK, Bhattacharya J, Bhattacharya J. Is income inequality linked to infectious disease prevalence? A hypothesis-generating study using tuberculosis. Soc Sci Med 2024; 345:116639. [PMID: 38364719 DOI: 10.1016/j.socscimed.2024.116639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
We study the association between infectious disease incidence and income inequality. We hypothesize that random social mixing in an income-unequal society brings into contact a) susceptible and infected poor and b) the infected-poor and the susceptible-rich, raising infectious disease incidence. We analyzed publicly available, country-level panel data for a large cross-section of countries between 1995 and 2013 to examine whether countries with elevated levels of income inequality have higher rates of pulmonary Tuberculosis (TB) incidence per capita. A "negative control" using anemia and diabetes (both non-communicable diseases and hence impervious to the hypothesized mechanism) is also applied. We find that high levels of income inequality are positively associated with tuberculosis incidence. All else equal, countries with income-Gini coefficients 10% apart show a statistically significant 4% difference in tuberculosis incidence. Income inequality had a null effect on the negative controls. Our cross-country regression results suggest that income inequality may create conditions where TB spreads more easily, and policy action to reduce income inequities could directly contribute to a reduced TB burden.
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SHIMONOVICH MICHAL, CAMPBELL MHAIRI, THOMSON RACHELM, BROADBENT PHILIP, WELLS VALERIE, KOPASKER DANIEL, McCARTNEY GERRY, THOMSON HILARY, PEARCE ANNA, KATIKIREDDI SVITTAL. Causal Assessment of Income Inequality on Self-Rated Health and All-Cause Mortality: A Systematic Review and Meta-Analysis. Milbank Q 2024; 102:141-182. [PMID: 38294094 PMCID: PMC10938942 DOI: 10.1111/1468-0009.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 02/01/2024] Open
Abstract
Policy Points Income is thought to impact a broad range of health outcomes. However, whether income inequality (how unequal the distribution of income is in a population) has an additional impact on health is extensively debated. Studies that use multilevel data, which have recently increased in popularity, are necessary to separate the contextual effects of income inequality on health from the effects of individual income on health. Our systematic review found only small associations between income inequality and poor self-rated health and all-cause mortality. The available evidence does not suggest causality, although it remains methodologically flawed and limited, with very few studies using natural experimental approaches or examining income inequality at the national level. CONTEXT Whether income inequality has a direct effect on health or is only associated because of the effect of individual income has long been debated. We aimed to understand the association between income inequality and self-rated health (SRH) and all-cause mortality (mortality) and assess if these relationships are likely to be causal. METHODS We searched Medline, ISI Web of Science, Embase, and EconLit (PROSPERO: CRD42021252791) for studies considering income inequality and SRH or mortality using multilevel data and adjusting for individual-level socioeconomic position. We calculated pooled odds ratios (ORs) for poor SRH and relative risk ratios (RRs) for mortality from random-effects meta-analyses. We critically appraised included studies using the Risk of Bias in Nonrandomized Studies - of Interventions tool. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework and causality using Bradford Hill (BH) viewpoints. FINDINGS The primary meta-analyses included 2,916,576 participants in 38 cross-sectional studies assessing SRH and 10,727,470 participants in 14 cohort studies of mortality. Per 0.05-unit increase in the Gini coefficient, a measure of income inequality, the ORs and RRs (95% confidence intervals) for SRH and mortality were 1.06 (1.03-1.08) and 1.02 (1.00-1.04), respectively. A total of 63.2% of SRH and 50.0% of mortality studies were at serious risk of bias (RoB), resulting in very low and low certainty ratings, respectively. For SRH and mortality, we did not identify relevant evidence to assess the specificity or, for SRH only, the experiment BH viewpoints; evidence for strength of association and dose-response gradient was inconclusive because of the high RoB; we found evidence in support of temporality and plausibility. CONCLUSIONS Increased income inequality is only marginally associated with SRH and mortality, but the current evidence base is too methodologically limited to support a causal relationship. To address the gaps we identified, future research should focus on income inequality measured at the national level and addressing confounding with natural experiment approaches.
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Affiliation(s)
- MICHAL SHIMONOVICH
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - MHAIRI CAMPBELL
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - RACHEL M. THOMSON
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - PHILIP BROADBENT
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - VALERIE WELLS
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - DANIEL KOPASKER
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - GERRY McCARTNEY
- School of Social and Political SciencesUniversity of Glasgow
| | - HILARY THOMSON
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - ANNA PEARCE
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - S. VITTAL KATIKIREDDI
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
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Jørgensen RE, Hovde Lyngstad T. Does local income and wealth inequality affect mortality? A register-based fixed effects study of 58 million person-years. Scand J Public Health 2024; 52:58-63. [PMID: 36271601 PMCID: PMC10845829 DOI: 10.1177/14034948221126264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
Abstract
Aim: The Income Inequality Hypothesis asserts that income inequality causes negative health burdens within wealthy nations. We aimed to test the hypothesis in Norway, examining the relationship between both income and wealth inequality, net of individual economic resources, and individual all-cause mortality. To this day, little is known about the association between wealth inequality and mortality. In Norway, wealth is far more unequally distributed than income and can be a more prevalent indicator of long-term financial security. Methods: We estimated discrete-time event history models from Norwegian register data, covering all Norwegian-born men and women aged 25-84 years during the period 1993-2013. We include fixed effects at the municipal level, adjusting for time-invariant characteristics in the local area. Our data contain approximately 58.5 million person-year observations after sample restrictions. Results: Overall, increased income and wealth inequality (measured using Gini coefficients of individuals' pensionable income and net worth) is not associated with higher mortality risk in Norway. With a one percentage point increase in income inequality, odds ratio (OR) for mortality was estimated at 0.998 (95% confidence interval (CI) 0.996-1.001) for men and 1.002 (95% CI 0.999-1.006) for women. Corresponding OR from increased wealth inequality was 0.998 (95% CI 0.997-1.000) for men and 0.999 (95% CI 0.998-1.001) for women. Conclusions: Our results raise further doubts about the existence of a contextual effect of economic inequality on health, at least in a Nordic setting. Extensive health policies, relatively generous benefits and high levels of trust could potentially function as a buffer against negative health consequences of increased economic inequality in Norway.
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Affiliation(s)
- Ruth E. Jørgensen
- Department of Sociology and Human Geography, University of Oslo, Norway
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Benny C, Siddiqi A, Pabayo R. Income inequality and 'hospitalisations of despair' in Canada: a study on longitudinal, population-based data. J Epidemiol Community Health 2023; 78:33-39. [PMID: 37739771 DOI: 10.1136/jech-2023-220900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Rates of drug overdoses, alcohol-related liver disease and suicide attempts represent a major public health burden in Canada. While the existing literature does highlight some evidence of association between income inequality and mental health and deaths of despair, no existing research has investigated more intermediate events. As such, the objective of the current study is to investigate the association between income inequality and hospitalisations of despair over time. METHODS Data from the 2006 Canadian Census, the 2007/2008 Canadian Community Health Survey and the 2007-2018 Discharge Abstract Database were linked. Data were analysed using Cox proportional hazards modelling accounting for robust standard errors at the area level to investigate associations between income inequality at baseline and hazards for hospitalisations of despair, hospitalisations attributable to drug overdose, alcohol-related liver disease and suicide attempts, and all-cause hospitalisations, while controlling for sociodemographics characteristics (including income) and relevant area-level variables. RESULTS The results highlighted statistically significant associations between income inequality and hazard of hospitalisations of despair (HR 1.38, 95% CI 1.06 to 1.80), hospitalisations related to drug overdose (HR 1.51, 95% CI 1.07 to 2.13) and all-cause hospitalisations (HR 1.17, 95% CI 1.05 to 1.30). The association between income inequality and hospitalisations related to alcohol-related liver disease and suicide attempts/self-harm were not statistically significant. CONCLUSION Overall, the results showed evidence of associations between income inequality and hospitalisations of despair, drug overdose-related hospitalisations and all-cause hospitalisations. These findings are applicable to upstream policy discussion regarding reducing income inequality and identify potential points of intervention for prevention of drug overdose, alcohol-related liver disease and suicide attempts/self-harm.
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Affiliation(s)
- Claire Benny
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Alam MF, Wildman J, Abdul Rahim H. Income inequality and its association with COVID-19 cases and deaths: a cross-country analysis in the Eastern Mediterranean region. BMJ Glob Health 2023; 8:e012271. [PMID: 37918870 PMCID: PMC10626889 DOI: 10.1136/bmjgh-2023-012271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION There is limited evidence on the associations between economic and social disparities in the Eastern Mediterranean region (EMR) with COVID-19 infections and deaths. This study aims to investigate the relationship between income inequalities using Gini coefficients and COVID-19 cases and deaths per million population in the EMR countries. METHODS Country-level data on monthly COVID-19 cases and deaths between March 2020 and October 2021, along with data on selected confounders, were collected from publicly available databases. Mixed-effect negative binomial and inverse hyperbolic sine transformation regressions were estimated to examine the association. RESULTS The study showed that, in the EMR, a unit increase in Gini coefficient is associated with approximately 7.2% and 3.9% increase in COVID-19 cases and deaths per million population, respectively. The magnitude and direction of the association between income inequality and COVID-19 cases and deaths per-million population still remain the same after excluding four warzone countries from the analysis. CONCLUSION This increase in COVID-19 cases and deaths is underpinned by the fact that a large number of the population in the region is living in conditions of poverty, with inadequate housing, comorbidities and limited or virtually no access to essential healthcare services. Healthcare policy-makers across countries in the region need to implement effective interventions in areas of income inequality, where it may be linked to increasing the risk of COVID-19 cases and deaths.
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Affiliation(s)
- Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - John Wildman
- Department of Economics, Newcastle University, Newcastle upon Tyne, UK
| | - Hanan Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Le DD, Quashie NT, Brandt M, Ibuka Y. Wealth inequalities in physical and cognitive impairments across Japan and Europe: the role of health expenditure and infrastructure. Int J Equity Health 2023; 22:123. [PMID: 37386627 PMCID: PMC10308628 DOI: 10.1186/s12939-023-01906-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/04/2023] [Indexed: 07/01/2023] Open
Abstract
Although prior research has provided insights into the association between country-level factors and health inequalities, key research gaps remain. First, most previous studies examine subjective rather than objective health measures. Second, the wealth dimension in health inequalities is understudied. Third, a handful of studies explicitly focus on older adults. To bridge these research gaps, this study measures wealth-related inequalities in physical and cognitive impairments and examines the extent to which welfare states moderate wealth inequalities in physical and cognitive impairments among older people across Japan and Europe. We utilized harmonized data on non-institutionalized individuals aged 50-75 from the Japanese Study of Aging and Retirement (JSTAR) and the Survey of Health, Ageing and Retirement in Europe (SHARE) (N = 31,969 for physical impairments and 31,348 for cognitive impairments). Our multilevel linear regression analyses examined whether national public health spending and healthcare access resources explained cross-country differences in wealth inequalities in physical and cognitive impairments. We applied a concentration index to quantify the degree of wealth inequalities in impairments. The findings indicate that inequalities in both impairment outcomes favored wealthier individuals in all countries, but the magnitude of inequality varied by country. Furthermore, a higher share of public health spending, lower out-of-pocket expenditure, and higher investment in healthcare resources were associated with lower wealth inequalities, especially for physical impairments. Our findings suggest that different health interventions and policies may be needed to mitigate specific impairment inequalities.
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Affiliation(s)
- Dung D Le
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato-Ku, Tokyo, 108-8345, Japan
| | - Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, RI, 02881, USA
| | - Martina Brandt
- Faculty of Social Sciences, TU Dortmund, Emil Figge Str. 50, 44227, Dortmund, Germany
| | - Yoko Ibuka
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato-Ku, Tokyo, 108-8345, Japan.
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Shih YCT, Bradley C, Yabroff KR. Ecological and individualistic fallacies in health disparities research. J Natl Cancer Inst 2023; 115:488-491. [PMID: 36912704 PMCID: PMC10165478 DOI: 10.1093/jnci/djad047] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Affiliation(s)
- Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cathy Bradley
- University of Colorado Comprehensive Cancer Center and Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Berkowitz SA, Palakshappa D. Gaps in the welfare state: A role-based model of poverty risk in the U.S. PLoS One 2023; 18:e0284251. [PMID: 37053136 PMCID: PMC10101477 DOI: 10.1371/journal.pone.0284251] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Research clearly demonstrates that income matters greatly to health. However, income distribution and its relationship to poverty risk is often misunderstood. METHODS We provide a structural account of income distribution and poverty risk in the U.S., rooted in the 'roles' that individuals inhabit with relation to the 'factor payment system' (market distribution of income to individuals through wages and asset ownership). Principal roles are child, older adult, and, among working-age adults, disabled individual, student, unemployed individual, caregiver, or paid laborer. Moreover, the roles of other members of an individual's household also influence an individual's income level. This account implies that 1) roles other than paid laborer will be associated with greater poverty risk, 2) household composition will be associated with poverty risk, and 3) income support policies for those not able to engage in paid labor are critical for avoiding poverty. We test hypotheses implied by this account using 2019 and 2022 U.S. Census Current Population Survey data. The exposure variables in our analyses relate to roles and household composition. The outcomes relate to income and poverty risk. RESULTS In 2019, 40.1 million individuals (12.7% of the population) experienced poverty under the U.S. Census' Supplemental Poverty Measure. All roles other than paid laborer were associated with greater poverty risk (p < .001 for all comparisons). Household composition, particularly more children and disabled working-age adults, and fewer paid laborers, was also associated with greater poverty risk (p < .001 for all comparisons). Five key policy areas-child benefits, older-age pensions, disability and sickness insurance, unemployment insurance, and out-of-pocket healthcare spending-represented gaps in the welfare state strongly associated with poverty risk. CONCLUSIONS The role one inhabits and household composition are associated with poverty risk. This understanding of income distribution and poverty risk may be useful for social policy.
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Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
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Munir M, Zakaria ZA, Nisar H, Ahmed Z, Korma SA, Esatbeyoglu T. Global human obesity and global social index: Relationship and clustering. Front Nutr 2023; 10:1150403. [PMID: 37063335 PMCID: PMC10092351 DOI: 10.3389/fnut.2023.1150403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionObesity, a complex, multifactorial disease, is considered a global disease burden widely affecting the quality of life across different populations. Factors involved in obesity involve genetics, behavior and socioeconomic and environmental origins, each contributing to the risk of debilitating morbidity and mortality. However, the trends across the world vary due to various globalization parameters.MethodsThis article tends to identify the global social indicators, compiled into a global index, and develop a correlation between the global social index created by using the human development index, social and political globalization, the global happiness index, and the quality of infrastructure, institutions, and individuals using the internet factors and its effect on global obesity.Results and DiscussionOur results identified a positive correlation between medium human development levels with obesity compared to low and very high human development levels. Economic stability due to rapid industrialization has increased the buying capacity and changed the global food system, which seems to be the major driver of the rise of global obesity.ConclusionThe results decipher that global social indicators and overall social index have positively affected global obesity, which will help policymakers and governmental organizations monitor the obesity patterns across their regions by a significant contribution from globally influenced social factors.
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Affiliation(s)
- Mubbasher Munir
- Faculty of Informatics and Computing, University of Sultan Zainal Abidin, Terengganu, Malaysia
- Department of Economics and Statistics, University of Management and Technology, Lahore, Pakistan
- *Correspondence: Mubbasher Munir,
| | - Zahrahtul Amani Zakaria
- Faculty of Informatics and Computing, University of Sultan Zainal Abidin, Terengganu, Malaysia
| | - Haseeb Nisar
- Department of Life Sciences, University of Management and Technology, Lahore, Pakistan
| | - Zahoor Ahmed
- Department of Human Nutrition and Dietetics, School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
| | - Sameh A. Korma
- Department of Food Science, Faculty of Agriculture, Zagazig University, Zagazig, Egypt
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China
| | - Tuba Esatbeyoglu
- Department of Food Development and Food Quality, Institute of Food Science and Human Nutrition, Gottfried Wilhelm Leibniz University Hannover, Hannover, Germany
- Tuba Esatbeyoglu,
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de Siqueira Filha NT, Li J, Phillips-Howard PA, Quayyum Z, Kibuchi E, Mithu MIH, Vidyasagaran A, Sai V, Manzoor F, Karuga R, Awal A, Chumo I, Rao V, Mberu B, Smith J, Saidu S, Tolhurst R, Mazumdar S, Rosu L, Garimella S, Elsey H. The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries. Int J Equity Health 2022; 21:191. [PMID: 36585704 PMCID: PMC9805259 DOI: 10.1186/s12939-022-01804-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs. METHODS This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs. RESULTS We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality. CONCLUSIONS Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.
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Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | | | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social &, University of Glasgow, Public Health Sciences Unit, Glasgow, UK
| | | | | | - Varun Sai
- The George Institute for Global Health, New Delhi, India
| | - Farzana Manzoor
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Abdul Awal
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Centres, Mumbai, India
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - John Smith
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Samuel Saidu
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK
| | - Sumit Mazumdar
- University of York, Centre for Health Economics, York, UK
| | - Laura Rosu
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
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Liu H, Hu T. Impact of socioeconomic status and health risk on fall inequality among older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4961-e4974. [PMID: 35833421 DOI: 10.1111/hsc.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 05/17/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Socio-economic status (SES) is one of the important indicators reflecting individual social participation and resource allocation, and it plays an important role in individual health shock. Health shock indicates the body being in a non-healthy state, such as illness, injury and death. This study used data from the China Health and Retirement Longitudinal Study conducted in 2013, 2015 and 2018 and utilised the panel logit model, causal step-by-step analysis and path analysis to empirically test the impact of SES on fall inequality among the elderly and the mediating effect of health shock. The results demonstrated obvious group inequality in the fall risk among older adults, the core of which was the impact of SES on health, causing health inequality and affecting fall inequality. The activities of daily living and pain rate of the high-income group were 61.16% and 28.69%, respectively, that of the low-income group. The evaluation of good sight and hearing were 3.6833 and 3.8572 times, respectively, that of the low-income group. The non-depressive status was 38.4638 times of the low-income group. The path effect confirmed the mediating role of health shock. Therefore, this study concluded that SES had an important impact on the risk of falls among the elderly, and this impact was mainly from health shock. This study proposed that to reduce the incidence of falls among the elderly, differences in health shock risks among the elderly with different SES must be actively monitored and accurate and effective policy interventions should be implemented from the level of group heterogeneity.
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Affiliation(s)
- Huan Liu
- School of Society, Soochow University, Su Zhou, China
| | - Tiantian Hu
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
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Svalestuen S. Is the mediating effect of psychosocial stress on the income–health relationship moderated by income inequality? SSM Popul Health 2022; 20:101302. [DOI: 10.1016/j.ssmph.2022.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
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Dierx JAJ, Kasper HDP. The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group. Front Public Health 2022; 10:849013. [PMID: 36324452 PMCID: PMC9618935 DOI: 10.3389/fpubh.2022.849013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.
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Affiliation(s)
- John A. J. Dierx
- Department of Caring Society, Research Group Living in Motion, Avans University of Applied Science, Breda, Netherlands,*Correspondence: John A. J. Dierx
| | - Hans D. P. Kasper
- Department of Marketing and Market Research, Maastricht University School of Business and Economics, Maastricht University, Maastricht, Netherlands
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Law TH, Ng CP, Poi AWH. The sources of the Kuznets relationship between the COVID-19 mortality rate and economic performance. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 81:103233. [PMID: 36093278 PMCID: PMC9444851 DOI: 10.1016/j.ijdrr.2022.103233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
This paper discusses the findings of an empirical analysis of the Kuznets, or reverse U-shaped relationship, between the COVID-19 mortality rate and economic performance. In the early stages of economic development, the COVID-19 mortality rate is anticipated to rise with rising economic activity and urbanization. Eventually, the mortality rate decreases at higher economic development levels as people and the government are more capable of investing in disease abatement measures. The quality of political institutions, wealth distribution, urbanization, vaccination rate, and improvements in healthcare systems are hypothesized to affect the COVID-19 mortality rate. Examining this relationship can be effective in understanding the change in the COVID-19 mortality rate at different economic performance stages and in identifying appropriate preventive measures. This study employed the negative binomial regression to model a cross-sectional dataset of 137 countries. Results indicated that the relationship between the per-head gross domestic product (GDP) level and the COVID-19 mortality rate appeared to follow a pattern like the Kuznets curve, implying that changes in institutional quality, healthcare advancements, wealth distribution, urbanization, vaccination rate, and the percentage of the elderly population were significant in explaining the relationship. Improvement of the healthcare system has a notable effect on lowering the COVID-19 mortality rate under more effective government conditions. Additionally, the results suggested that a higher per-head GDP is required to reverse the rising trend of the mortality rate under higher income inequality. Based on these results, preventive measures, and policies to reduce COVID-19 mortalities were recommended in the conclusion section.
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Affiliation(s)
- Teik Hua Law
- Road Safety Research Center, Faculty of Engineering, Universiti Putra Malaysia, 43400 Selangor, Malaysia
| | - Choy Peng Ng
- Civil Engineering Department, Faculty of Engineering, Universiti Pertahanan Nasional Malaysia, 57000 Kuala Lumpur, Malaysia
| | - Alvin Wai Hoong Poi
- Road Safety Engineering and Environment Research Center, Malaysian Institute of Road Safety Research, 43000 Kajang, Selangor, Malaysia
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Xiang G, Liu J, Zhong S, Deng M. Comprehensive metrological and content analysis of the income inequality research in health field: A bibliometric analysis. Front Public Health 2022; 10:901112. [PMID: 36187638 PMCID: PMC9515572 DOI: 10.3389/fpubh.2022.901112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
The association between income inequality in a society and the poor health status of its people has attracted the attention of researchers from multiple disciplines. Based on the ISI Web of Science database, bibliometric methods were used to analyze 546 articles related to income inequality research in health field published between 1997 and 2021. We found that the USA contributed most articles, the Harvard Univ was the most influential institution, Social Science & Medicine was the most influential journal, and Kawachi I was the most influential author; the main hotspots included the income inequality, income, health inequality, mortality, socioeconomic factors, concentration index, social capital, self-rated health, income distribution, infant mortality, and population health in 1997-2021; the cardiovascular disease risk factor, social capital income inequality, individual mortality risk, income-related inequalities, understanding income inequalities, income inequality household income, and state income inequality had been the hot research topics in 1997-2003; the self-assessed health, achieving equity, income-related inequalities, oral health, mental health, European panel, occupational class, and cardiovascular diseases had been the hot research topics in 2004-2011; the adolescent emotional problem, South Africa, avoidable mortality, rising inequalities, results from world health survey, working-age adult, spatial aggregation change, prospective study, and mental health-empirical evidence had been the hot research topics in 2012-2021; there were 11 articles with strong transformation potential during 2012-2021. The research results of this paper are helpful to the scientific understanding of the current status of income inequality research in health field.
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Affiliation(s)
- Guocheng Xiang
- School of Business, Hunan University of Science and Technology, Xiangtan, China,College of Economics and Trade, Hunan University of Technology and Business, Changsha, China
| | - Jingjing Liu
- School of Business, Hunan University of Science and Technology, Xiangtan, China
| | - Shihu Zhong
- Department of Applied Economics, Shanghai National Accounting Institute, Shanghai, China,*Correspondence: Shihu Zhong
| | - Mingjun Deng
- Research Center of Big Data and Intelligent Decision, Hunan University of Science and Technology, Xiangtan, China
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Relative deprivation, depression and quality of life among adults in Shandong Province, China: A conditional process analysis based on social support. J Affect Disord 2022; 312:136-143. [PMID: 35750092 DOI: 10.1016/j.jad.2022.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 05/26/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Relative deprivation has been confirmed as one of the pathways underlying the link between income inequality and health. However, the mechanism between relative deprivation and health was still unclear. This study aimed to test the mediating role of depression and the moderating role of social support in the association between relative deprivation and quality of life. METHODS Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. In total, 8496 adults were included to complete the measures of relative deprivation, depressive symptoms, perceived social support, and quality of life. RESULTS Relative deprivation was negatively associated with quality of life, and depressive symptoms could mediate this association. Furthermore, the direct effect of relative deprivation on quality of life and the indirect effect of depressive symptoms in this relationship were moderated by perceived social support. Both these two effects were stronger for individuals with a low level of perceived social support. LIMITATIONS Data are cross-sectional, and causal conclusions cannot be drawn. All measures were based on participant self-report. CONCLUSIONS Personal relative deprivation has negative effects on quality of life. Social support moderated the direct effect of relative deprivation and the mediating effect of depressive symptoms on quality of life. For individuals with a high level of relative deprivation, particularly those with a low level of social support, interventions tailoring psychological services and community-based activities could be designed to reduce relative deprivation and promote social support for disadvantaged individuals.
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Zimmer Z, Fraser K, Grol-Prokopczyk H, Zajacova A. A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors. Pain 2022; 163:1740-1750. [PMID: 35027516 PMCID: PMC9198107 DOI: 10.1097/j.pain.0000000000002557] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is wide variation in population-level pain prevalence estimates in studies of survey data around the world. The role of country-level social, economic, and political contextual factors in explaining this variation has not been adequately examined. We estimated the prevalence of unspecified pain in adults aged 25+ years across 52 countries using data from the World Health Survey 2002 to 2004. Combining data sources and estimating multilevel regressions, we compared country-level pain prevalence and explored which country-level contextual factors explain cross-country variations in prevalence, accounting for individual-level demographic factors. The overall weighted age- and sex-standardized prevalence of pain across countries was estimated to be 27.5%, with significant variation across countries (ranging from 9.9% to 50.3%). Women, older persons, and rural residents were significantly more likely to report pain. Five country-level variables had robust and significant associations with pain prevalence: the Gini Index, population density, the Gender Inequality Index, life expectancy, and global region. The model including Gender Inequality Index explained the most cross-country variance. However, even when accounting for country-level variables, some variation in pain prevalence remains, suggesting a complex interaction between personal, local, economic, and political impacts, as well as inherent differences in language, interpretations of health, and other difficult to assess cultural idiosyncrasies. The results give new insight into the high prevalence of pain around the world and its demonstrated association with macrofactors, particularly income and gender inequalities, providing justification for regarding pain as a global health priority.
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Affiliation(s)
- Zachary Zimmer
- Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Kathryn Fraser
- Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | | | - Anna Zajacova
- Department of Sociology, University of Western Ontario, London, ON, CA
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Zare H, Meyerson NS, Nwankwo CA, Thorpe RJ. How Income and Income Inequality Drive Depressive Symptoms in U.S. Adults, Does Sex Matter: 2005-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6227. [PMID: 35627767 PMCID: PMC9140340 DOI: 10.3390/ijerph19106227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Depression is one of the leading causes of disability in the United States. Depression prevalence varies by income and sex, but more evidence is needed on the role income inequality may play in these associations. OBJECTIVE To examine the association between the Poverty to Income Ratio (PIR)-as a proxy for income-and depressive symptoms in adults ages 20 years and older, and to test how depression was concentrated among PIR. DESIGN Using the 2005-2016 National Health and Nutrition Examination Survey (NHANES), we employed Negative Binomial Regression (NBRG) in a sample of 24,166 adults. We used a 9-item PHQ (Public Health Questionnaire, PHQ-9) to measure the presence of depressive symptoms as an outcome variable. Additionally, we plotted a concentration curve to explain how depression is distributed among PIR. RESULTS In comparison with high-income, the low-income population in the study suffered more from greater than or equal to ten on the PHQ-9 by 4.5 and 3.5 times, respectively. The results of NBRG have shown that people with low-PIR (IRR: 1.30, 95% CI: 1.23-1.37) and medium-PIR (IRR: 1.55, 95% CI: 1.46-1.65) have experienced a higher relative risk ratio of having depressive symptoms. Women have a higher IRR (IRR: 1.29, 95% CI: 1.24-1.34) than men. We observed that depression was concentrated among low-PIR men and women, with a higher concentration among women. CONCLUSION AND RELEVANCE Addressing depression should target low-income populations and populations with higher income inequality.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD 20774, USA
| | - Nicholas S. Meyerson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
| | - Chineze Adania Nwankwo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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20
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Góngora-Salazar P, Casabianca MS, Rodríguez-Lesmes P. Income inequality and self-rated health status in Colombia. Int J Equity Health 2022; 21:69. [PMID: 35578287 PMCID: PMC9108691 DOI: 10.1186/s12939-022-01659-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background The negative association between income inequality and health has been known in the literature as the Income Inequality Hypothesis (IIH). Despite the multiple studies examining the validity of this hypothesis, evidence is still inconclusive, and the debate remains unsolved. In addition, relatively few studies have focused their attention on developing or emerging economies, where levels of inequality tend to be the highest in the world. This work examines the statistical association between income inequality and self-rated health status in Colombia, a highly unequal Latin American country. Methods To explore whether this association is present in the general population or whether it is only confined to the bottom of the income distribution, we use data from the 2011–2019 National Quality of Life Survey. Multiple probit estimations are considered for testing the robustness of the IIH. Results Evidence favouring the IIH was found, even after controlling for individual income levels, average regional income, and socioeconomic characteristics. The link between income inequality and the probability of reporting poor health seems to be present across all income quintiles. However, the magnitude of such association is considerably smaller when using inequality measures with relatively greater sensitivity to income differences among the rich. Conclusions The association between regional income inequality and individual's self-rated health status in Colombia is not only confined to low-income individuals but extends across all socioeconomic strata. This association is robust to the income inequality measure implemented, the income-unit of analysis, and changes in the sample. It is suggested that reducing income disparities can potentially contribute to improving individual's health. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01659-8.
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Affiliation(s)
- Pamela Góngora-Salazar
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK. .,Alianza EFI, Universidad del Rosario, Calle 12 C No 4 -69, Bogotá, 111711, Colombia. .,School of Economics, Universidad del Rosario, Calle 12 C No. 4 - 69, 111711, Bogotá, Colombia.
| | - María Sofía Casabianca
- School of Economics, Universidad del Rosario, Calle 12 C No. 4 - 69, 111711, Bogotá, Colombia
| | - Paul Rodríguez-Lesmes
- School of Economics, Universidad del Rosario, Calle 12 C No. 4 - 69, 111711, Bogotá, Colombia
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Tao W, Zhao D, Yue H, Horton I, Tian X, Xu Z, Sun HJ. The Influence of Growth Mindset on the Mental Health and Life Events of College Students. Front Psychol 2022; 13:821206. [PMID: 35496212 PMCID: PMC9046553 DOI: 10.3389/fpsyg.2022.821206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Growth mindset refers to our core belief that our talents can be developed through practice, which may influence our thoughts and behaviors. Growth mindset has been studied in a variety of fields, including education, sports, and management. However, few studies have explored whether differences in individuals' growth mindsets influence college students' self-reported mental health. Using the Growth Mindset Scale, Adolescent Self-rating Life Events Checklist, and SCL-90 Scale, data was collected from 2,505 freshmen in a University in China. Findings revealed that the students within the growth mindset group scored significantly lower on "mental health issues" and "stress due to life events" than the students in the fixed mindset group. Our findings suggest that individuals with a growth mindset are less prone to mental health problems than individuals with a fixed mindset.
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Affiliation(s)
- Weidong Tao
- Department of Psychology, School of Teacher Education, Huzhou University, Huzhou, China
| | - Dongchi Zhao
- Department of Psychology, School of Teacher Education, Huzhou University, Huzhou, China
| | - Huilan Yue
- Department of Psychology, School of Teacher Education, Huzhou University, Huzhou, China
| | - Isabel Horton
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Xiuju Tian
- Department of Psychology, School of Teacher Education, Huzhou University, Huzhou, China
| | - Zhen Xu
- Department of Psychology, School of Teacher Education, Huzhou University, Huzhou, China
| | - Hong-Jin Sun
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
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Helsloot I, Hanekamp JC. Building Blocks Towards a Proportionate Chemicals Policy With a Focus on the Netherlands. Dose Response 2022; 20:15593258221086475. [PMID: 35498373 PMCID: PMC9039294 DOI: 10.1177/15593258221086475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/20/2022] [Indexed: 12/05/2022]
Abstract
In this contribution, we propose that ‘sound’ government policy should be characterised
by a proportionate, integral vision with due consideration to tradeoffs between social
costs and benefits. This principle also applies to government policy regarding the
protection of workers from exposure to chemicals. It should be taken into account that
having a job is a huge health benefit. Less educated people are statistically likely to
enjoy ten additional healthy years, if employed. Although there is no
debate about the risks of exposure to high doses of chemicals, there is most certainly
debate on the magnitude, nature and possible cumulative effects of low-dose exposure to
chemicals. These are established by model-based assumptions. The current advisory
structure in which the Health Council of the Netherlands restricts its focus to the
immediate health benefits for workers on the basis of risk avoidance models, and the
Social and Economic Council of the Netherlands which focuses primarily on policy costs for
trade and industry, is hardly a sound basis for well-considered decision making. The
challenge for the scientific experts is to provide political administrators with an
insightful social cost-benefit analysis, including all the concomitant
uncertainties.
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Affiliation(s)
- Ira Helsloot
- Politics of Safety and Security at the Faculty of Management Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Jaap C. Hanekamp
- Department of Science, University College Roosevelt, Middelburg, the Netherlands
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Mitchell JH, Runkle JD, Andersen LM, Shay E, Sugg MM. Inequalities in Life Expectancy Across North Carolina: A Spatial Analysis of the Social Determinants of Health and the Index of Concentration at Extremes. FAMILY & COMMUNITY HEALTH 2022; 45:77-90. [PMID: 35125487 DOI: 10.1097/fch.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Health inequalities are characterized by spatial patterns of social, economic, and political factors. Life expectancy (LE) is a commonly used indicator of overall population health and health inequalities that allows for comparison across different spatial and temporal regions. The objective of this study was to examine geographic inequalities in LE across North Carolina census tracts by comparing the performance of 2 popular geospatial health indices: Social Determinants of Health (SDoH) and the Index of Concentration at Extremes (ICE). A principal components analysis (PCA) was used to address multicollinearity among variables and aggregate data into components to examine SDoH, while the ICE was constructed using the simple subtraction of geospatial variables. Spatial regression models were employed to compare both indices in relation to LE to evaluate their predictability for population health. For individual SDoH and ICE components, poverty and income had the strongest positive correlation with LE. However, the common spatial techniques of adding PCA components together for a final SDoH aggregate measure resulted in a poor relationship with LE. Results indicated that both metrics can be used to determine spatial patterns of inequities in LE and that the ICE metric has similar success to the more computationally complex SDoH metric. Public health practitioners may find the ICE metric's high predictability matched with lower data requirements to be more feasible to implement in population health monitoring.
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Affiliation(s)
- Jessica H Mitchell
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina (Mss Mitchell and Andersen and Drs Shay and Sugg); and North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina (Dr Runkle)
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Shimonovich M, Pearce A, Thomson H, McCartney G, Katikireddi SV. Assessing the causal relationship between income inequality and mortality and self-rated health: protocol for systematic review and meta-analysis. Syst Rev 2022; 11:20. [PMID: 35115055 PMCID: PMC8815171 DOI: 10.1186/s13643-022-01892-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Income inequality has been linked to health and mortality. While there has been extensive research exploring the relationship, the evidence for whether the relationship is causal remains disputed. We describe the methods for a systematic review that will transparently assess whether a causal relationship exists between income inequality and mortality and self-rated health. METHODS We will identify relevant studies using search terms relating to income inequality, mortality, and self-rated health (SRH). Four databases will be searched: MEDLINE, ISI Web of Science, EMBASE, and the National Bureau of Economic Research. The inclusion criteria have been developed to identify the study designs best suited to assess causality: multilevel studies that have conditioned upon individual income (or a comparable measure, such as socioeconomic position) and natural experiment studies. Risk of bias assessment of included studies will be conducted using ROBINS-I. Where possible, we will convert all measures of income inequality into Gini coefficients and standardize the effect estimate of income inequality on mortality/SRH. We will conduct random-effects meta-analysis to estimate pooled effect estimates when possible. We will assess causality using modified Bradford Hill viewpoints and assess certainty using GRADE. DISCUSSION This systematic review protocol lays out the complexity of the relationship between income inequality and individual health, as well as our approach for assessing causality. Understanding whether income inequality impacts the health of individuals within a population has major policy implications. By setting out our methods and approach as transparently as we can, we hope this systematic review can provide clarity to an important topic for public policy and public health, as well as acting as an exemplar for other "causal reviews".
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Affiliation(s)
- Michal Shimonovich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom.
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Hilary Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Gerry McCartney
- College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
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Poor worker’s long working hours paradox: evidence from the Korea National Health and Nutrition Examination Survey, 2013-2018. Ann Occup Environ Med 2022; 34:e2. [PMID: 35425616 PMCID: PMC8980752 DOI: 10.35371/aoem.2022.34.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Because income and working hours are closely related, the health impact of working hours can vary according to economic status. This study aimed to investigate the relationship between working hours and the risk of poor self-rated health according to household income level. Methods We used the data from the Korea National Health and Nutrition Examination Survey VI and VII. The information on working hours and self-rated health was obtained from the questionnaire. After stratifying by household income level, the risk of poor self-rated health for long working hour group (≥ 52 hours a week), compared to the 35–51 working hour group as a reference, were calculated using multiple logistic regression. Results Long working hours increased the risk of poor self-rated health in the group with the highest income, but not in the group with the lowest income. On the other hand, the overall weighted prevalence of poor self-rated health was higher in the low-income group. Conclusions The relationship between long working hours and the risk of poor self-rated health varied by household income level. This phenomenon, in which the health effects of long working hours appear to diminish in low-income households can be referred to as the ‘poor worker’s long working hours paradox’. Our findings suggest that the recent working hour restriction policy implemented by the Korean government should be promoted, together with a basic wage preservation to improve workers’ general health and well-being.
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Income inequalities, social support and depressive symptoms among older adults in Europe: a multilevel cross-sectional study. Eur J Ageing 2021; 19:663-675. [PMID: 36052202 PMCID: PMC9424474 DOI: 10.1007/s10433-021-00670-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 01/30/2023] Open
Abstract
This study analysed the association between income inequality and depression from a multilevel perspective among older adults in Europe, including an examination of the role of social support. The data came from Eurostat’s European Health Interview Survey (EHIS). Selected participants were aged 65 years or above (n = 68,417) and located in 24 European countries. The outcome variable (depression) was measured using the eight-item Patient Health Questionnaire (PHQ-8). The resulting dataset included individual-level (level-1) and aggregate-level (level 2) exposure variables. Level-1 included income quintiles and social support as exposure variables and sex, age, living alone, limitation in activities of daily living and general activity limitation as control variables. Level 2 included the Gini coefficient, healthcare expenditure and dependency ratio. A multilevel linear regression analysis was performed with maximum likelihood (ML) estimation. All the income quintiles from 1 to 4 showed higher average scores for depression than quintile 5 (the highest). Higher social support scores were associated with lower scores for depression. An interaction was found between income quintile and social support, with higher levels of social support associated with lower scores for depression in quintiles 1 and 2. Higher Gini coefficient scores were associated with higher scores for depression. A significative random slope for social support was also found, meaning that the relationship between social support and depression differed across countries. No significant interaction was found between the Gini coefficient and social support. The study findings suggest that more unequal societies provide a less favourable context for the mental health of older adults. There are also significant country-dependent differences in terms of the relationship between support and mental health among older adults.
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Davies JB. Economic Inequality and COVID-19 Deaths and Cases in the First Wave: A Cross-Country Analysis. CANADIAN PUBLIC POLICY. ANALYSE DE POLITIQUES 2021; 47:537-553. [PMID: 36039094 PMCID: PMC9395158 DOI: 10.3138/cpp.2021-033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The cross-country relationship of coronavirus disease 2019 (COVID-19) case and death rates with previously measured income inequality and poverty in the pandemic's first wave is studied, controlling for other underlying factors, in a worldwide sample of countries. If the estimated associations are interpreted as causal, the Gini coefficient for income has a significant positive effect on both cases and deaths per capita in regressions using the full sample and for cases but not for deaths when Organisation for Economic Co-operation and Development (OECD) and non-OECD sub-samples are treated separately. The Gini coefficient for wealth has a significant positive effect on cases, but not on deaths, in both sub-samples and in the full sample. Poverty generally has weak positive effects in the full and non-OECD samples, but a relative poverty measure has a strong positive effect on cases in the OECD sample. Analysis of the gap between COVID-19 first-wave cases and deaths per capita in Canada and the higher rates in the United States indicates that 37 percent of the cases gap and 28 percent of the deaths gap could be attributed to the higher-income Gini in the United States according to the full-sample regressions.
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Affiliation(s)
- James B Davies
- Department of Economics, University of Western Ontario, London, Ontario, Canada
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28
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Alao R, Nur H, Fivian E, Shankar B, Kadiyala S, Harris-Fry H. Economic inequality in malnutrition: a global systematic review and meta-analysis. BMJ Glob Health 2021; 6:e006906. [PMID: 34887302 PMCID: PMC8663078 DOI: 10.1136/bmjgh-2021-006906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition. METHODS We conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15-49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses. RESULTS From 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX -0.15 (95% CI -0.19 to -0.11)) and wasting (-0.03 (95% CI -0.05 to -0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI -0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (-0.02 (95% CI -0.08 to 0.05)) or North America (-0.04 (95% CI -0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)). CONCLUSIONS There is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed. PROSPERO REGISTRATION NUMBER CRD42020201572.
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Affiliation(s)
- Rotimi Alao
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hayaan Nur
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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29
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McGuire F, Kreif N, Smith PC. The effect of distance on maternal institutional delivery choice: Evidence from Malawi. HEALTH ECONOMICS 2021; 30:2144-2167. [PMID: 34096127 DOI: 10.1002/hec.4368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
In many low- and middle-income countries, geographical accessibility continues to be a barrier to health care utilization. In this paper, we aim to better understand the full relationship between distance to providers and utilization of maternal delivery services. We address three methodological challenges: non-linear effects between distance and utilization; unobserved heterogeneity through non-random distance "assignment"; and heterogeneous effects of distance. Linking Malawi Demographic Health Survey household data to Service Provision Assessment facility data, we consider distance as a continuous treatment variable, estimating a Dose-Response Function based on generalized propensity scores, allowing exploration of non-linearities in the effect of an increment in distance at different distance exposures. Using an instrumental variables approach, we examine the potential for unobserved differences between women residing at different distances to health facilities. Our results suggest distance significantly reduces the probability of having a facility delivery, with evidence of non-linearities in the effect. The negative relationship is shown to be particularly strong for women with poor health knowledge and lower socio-economic status, with important implications for equity. We also find evidence of potential unobserved confounding, suggesting that methods that ignore such confounding may underestimate the effect of distance on the utilization of health services.
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Affiliation(s)
- Finn McGuire
- Centre for Health Economics, University of York, York, UK
- Department of Economics, University of York, York, UK
| | - Noemi Kreif
- Centre for Health Economics, University of York, York, UK
| | - Peter C Smith
- Centre for Health Economics, University of York, York, UK
- Imperial College Business School, Imperial College, London, UK
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30
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Shi J, Tarkiainen L, Martikainen P, van Raalte A. The impact of income definitions on mortality inequalities. SSM Popul Health 2021; 15:100915. [PMID: 34527804 PMCID: PMC8433258 DOI: 10.1016/j.ssmph.2021.100915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Income is a strong predictor of adult mortality. Measuring income is not as simple as it may sound. It can be conceptualized at the individual or the household level, with the former better reflecting an individual's earning ability, and the latter better capturing living standards. Furthermore, respondents are often grouped into income categories based on their positions in the income distribution, and this operationalization can be done on the basis of age-specific or total population income distributions. In this study, we look at how four combinations of different conceptualizations (individual vs. household) and operationalizations (age-specific vs. total population) of income can affect mortality inequality estimates. Using Finnish registry data, we constructed period life tables for ages 25+ from 1996 to 2017 by gender and for four income definitions. The results indicated that the slope index of inequality for life expectancy varied by 1.1-5.7 years between income definitions, with larger differences observed for women than for men. The overall age patterns of relative index of inequality for mortality rates yielded by the four definitions were similar, but the levels differed. The period trends across income definitions were consistent for men, but not for women. We conclude that researchers should pay particular attention to the choice of the income definitions when analyzing the association between income and mortality, and when comparing the magnitude of inequality across studies and over time.
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Affiliation(s)
- Jiaxin Shi
- Max Planck Institute for Demographic Research, Rostock, Germany
- Leverhulme Centre for Demographic Science, Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - Lasse Tarkiainen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Unit, University of Helsinki, Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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31
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Qin W, Xu L, Wu S, Shao H. Income, Relative Deprivation and the Self-Rated Health of Older People in Urban and Rural China. Front Public Health 2021; 9:658649. [PMID: 34295864 PMCID: PMC8291363 DOI: 10.3389/fpubh.2021.658649] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Substantial evidence indicated that absolute income is directly associated with health. Few studies have, however, examined if relative income may be equally associated with health. This study aimed to investigate the association between absolute income/relative deprivation (RD) and self-rated health (SRH). We also investigated whether the urban-rural difference was existing in these associations. Methods: Using cross-sectional data of 7,070 participants in the Shandong Family Health Service Survey of older people, this study applied binary logistic model and semi-parametric model to estimate the effect of absolute income and relative deprivation on SRH of older people. The Kakwani Index was used as a measure of relative deprivation at the individual level. Results: Absolute income has a significant positive effect on the SRH among both urban and rural older people. When considered RD as a variable, both absolute income and RD have negative significant effects on SRH among all older people. In addition, the negative effect of RD on rural elderly is more pronounced than that of urban older populations. Semi-parametric regression results show that there was a complex non-linear relationship between income and SRH. Psychological distress substantially attenuated the association between relative deprivation and SRH. Conclusions: Relative deprivation is negatively associated with self-rated health in both urban and rural older people after controlling the absolute income. RD may partly explain the association between income inequality and worse health status. Compared with the urban elderly, the effect of income-based relative deprivation on SRH was more pronounced among the rural elderly, and more care should be given to the lower income and rural older populations.
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Affiliation(s)
- Wenzhe Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Health Commission (NHC) Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Health Commission (NHC) Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Shoucai Wu
- Department of Geriatrics, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, China
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
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32
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Xu Y, Yilmazer T. Childhood socioeconomic status, adulthood obesity and health: The role of parental permanent and transitory income. Soc Sci Med 2021; 283:114178. [PMID: 34225035 DOI: 10.1016/j.socscimed.2021.114178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022]
Abstract
Children from low SES backgrounds experience long-term economic deprivation in addition to excessive income volatility during childhood. Little is known about whether parental income influences adulthood weight and health through either prolonged or transitory hardship. Using the intergenerational feature of the Panel Study of Income Dynamics (PSID), we link parents' income records from a 47-year panel (1968-2015 waves) to health outcomes of 3976 adult children (1999-2015 waves) in the United States. We calculate parental permanent income to measure prolonged disadvantages, as well as transitory income peaks and valleys at various early-life stages to measure transitory advantages and disadvantages, respectively. Our findings show that parental permanent income is negatively associated with obesity and adverse health outcomes in multiple adulthood stages. We also detect negative associations between transitory income peaks in adolescence and adverse weight and health outcomes. Our findings provide strong empirical support for the influence of prolonged material hardship on adverse weight and health outcomes and no support for the influence of transitory material hardship. Our findings also show that policies that improve parental permanent income and provide higher transitory income are essential to generate healthier adults.
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Affiliation(s)
- Yilan Xu
- Department of Agricultural and Consumer Economics, University of Illinois at Urbana-Champaign, 309 Mumford Hall, 1301 W. Gregory Drive, Urbana, IL, 61801, USA.
| | - Tansel Yilmazer
- Department of Human Sciences, Ohio State University, 1787 Neil Avenue, 115C Campbell Hall, Columbus, OH, 43210, USA.
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33
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Jaeggi AV, Blackwell AD, von Rueden C, Trumble BC, Stieglitz J, Garcia AR, Kraft TS, Beheim BA, Hooper PL, Kaplan H, Gurven M. Do wealth and inequality associate with health in a small-scale subsistence society? eLife 2021; 10:59437. [PMID: 33988506 PMCID: PMC8225390 DOI: 10.7554/elife.59437] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
In high-income countries, one’s relative socio-economic position and economic inequality may affect health and well-being, arguably via psychosocial stress. We tested this in a small-scale subsistence society, the Tsimane, by associating relative household wealth (n = 871) and community-level wealth inequality (n = 40, Gini = 0.15–0.53) with a range of psychological variables, stressors, and health outcomes (depressive symptoms [n = 670], social conflicts [n = 401], non-social problems [n = 398], social support [n = 399], cortisol [n = 811], body mass index [n = 9,926], blood pressure [n = 3,195], self-rated health [n = 2523], morbidities [n = 1542]) controlling for community-average wealth, age, sex, household size, community size, and distance to markets. Wealthier people largely had better outcomes while inequality associated with more respiratory disease, a leading cause of mortality. Greater inequality and lower wealth were associated with higher blood pressure. Psychosocial factors did not mediate wealth-health associations. Thus, relative socio-economic position and inequality may affect health across diverse societies, though this is likely exacerbated in high-income countries. Poverty is bad for health. People living in poverty are more likely to struggle to afford nutritious food, lack access to health care, or be overworked or stressed. This may make them susceptible to chronic diseases, contribute to faster aging, and shorten their lifespans. In high-income countries, there is growing evidence to suggest that a person’s ‘rank’ in society also impacts their health. For example, individuals who have a lower position in the social hierarchy report worse health outcomes, regardless of their incomes. But it is unclear why living in an unequal society or having a lower social status contributes to poorer health. One possibility is that inequalities in society are creating a stressful environment that leads to worse physical and mental outcomes. It is thought that this stress largely comes from how humans evolved to prioritize reaching a higher social status over having a long and healthy life. If this is the case, this would mean that the link between social status and health would also be present in non-industrialized communities where social hierarchies tend to be less pronounced. To test this, Jaeggi, Blackwell et al. studied the Indigenous Tsimane population in Bolivia who live in small communities and forage and farm their own food. The income and relative wealth of 870 households from 40 Tsimane communities were compared against various outcomes, including symptoms associated with depression, stress hormone levels, blood pressure, self-rated health and several diseases. Jaeggi, Blackwell et al. found poverty and inequality did not negatively impact all of the health outcomes measured as has been previously reported for industrialized societies. However, blood pressure was higher among people with lower incomes or those who lived in more unequal communities. But because the Tsimane people generally have low blood pressure, the differences were too small to have much effect on their health. People who lived in more unequal communities were also three times more likely to have respiratory infections, but the reason for this was unclear. This shows that social determinants such as a person’s wealth or inequality can affect health, even in communities with less rigid social hierarchies. In industrial societies the effect may be worse in part because they are compounded by lifestyle factors, such as diets rich in fat and sugar, and physical inactivity which can also increase blood pressure. This information may help policy makers reduce health disparities by addressing some of the social determinants of health and the lifestyle factors that cause them.
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Affiliation(s)
- Adrian V Jaeggi
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.,Department of Anthropology, Emory University, Atlanta, United States
| | - Aaron D Blackwell
- Department of Anthropology, Washington State University, Pulman, United States
| | | | - Benjamin C Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, United States.,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, United States
| | | | - Angela R Garcia
- Department of Anthropology, Emory University, Atlanta, United States.,School of Human Evolution and Social Change, Arizona State University, Tempe, United States.,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, United States
| | - Thomas S Kraft
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, United States
| | - Bret A Beheim
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Paul L Hooper
- Economic Science Institute, Chapman University, Irvine, United States.,Department of Anthropology, University of New Mexico, Albuquerque, United States
| | - Hillard Kaplan
- Economic Science Institute, Chapman University, Irvine, United States
| | - Michael Gurven
- Department of Anthropology, University of California, Santa Barbara, Santa Barbara, United States
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34
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Shah MI, Ullah I, Xingjian X, Haipeng H, Rehman A, Zeeshan M, Alam Afridi FE. Modeling Trade Openness and Life Expectancy in China. Risk Manag Healthc Policy 2021; 14:1689-1701. [PMID: 33935523 PMCID: PMC8079350 DOI: 10.2147/rmhp.s298381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study investigates life expectancy and trade openness in China for the period 1960–2018. Methods We purposed a theoretical model that is tested for China by applying regime-switching regression. Results Our findings suggest that trade openness increases life expectancy in China; trade affects life expectancy from two aspects; firstly, trade expansion and industrialization lead to high economic activities and resulted in raise the income of the people in society leading to improve life expectancy. Secondly, industrial expansion increases the CO2 emissions which leads to imposes a negative implication on human health and thus reduces life expectancy. Conclusion Thus, the net effect of trade liberalization depends on the value of income effect and volume of CO2 emissions. Therefore, the government needs to support the trade policies which causes a low level of CO2 emissions, the government may provide incentives to exports and industrialists to adopted green energy in the production process. Besides, the government may impose some regulations such as carbon tax to mitigate the CO2 emissions in society.
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Affiliation(s)
- Muhammad Imran Shah
- School of Mathematics and Statistics, Wuhan University, Wuhan, People's Republic of China
| | - Irfan Ullah
- Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People's Republic of China
| | - Xiao Xingjian
- Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People's Republic of China
| | - Huang Haipeng
- Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People's Republic of China
| | - Alam Rehman
- Faculty of Management Sciences, National University of Modern Languages Islamabad, Islamabad, Pakistan
| | - Muhammad Zeeshan
- College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province, 125105, People's Republic of China
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35
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Yang S, Chen X, Wang L, Wu T, Fei T, Xiao Q, Zhang G, Ning Y, Jia P. Walkability indices and childhood obesity: A review of epidemiologic evidence. Obes Rev 2021; 22 Suppl 1:e13096. [PMID: 33185012 PMCID: PMC7988583 DOI: 10.1111/obr.13096] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
The lack of an active neighbourhood living environment can impact community health to a great extent. One such impact manifests in walkability, a measure of urban design in connecting places and facilitating physical activity. Although a low level of walkability is generally considered to be a risk factor for childhood obesity, this association has not been established in obesity research. To further examine this association, we conducted a literature search on PubMed, Web of Science and Scopus for articles published until 31 December 2018. The included literature examined the association between measures of walkability (e.g., walkability score and walkability index) and weight-related behaviours and/or outcomes among children aged under 18 years. A total of 13 studies conducted in seven countries were identified, including 12 cross-sectional studies and one longitudinal study. The sample size ranged from 98 to 37 460, with a mean of 4971 ± 10 618, and the age of samples ranged from 2 to 18. Eight studies reported that a higher level of walkability was associated with active lifestyles and healthy weight status, which was not supported by five studies. In addition to reviewing the state-of-the-art of applications of walkability indices in childhood obesity studies, this study also provides guidance on when and how to use walkability indices in future obesity-related research.
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Affiliation(s)
- Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Xiang Chen
- Department of Geography, University of Connecticut, Storrs, Connecticut, USA
| | - Lei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tong Wu
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Teng Fei
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,School of Resources and Environmental Science, Wuhan University, Wuhan, China
| | - Qian Xiao
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gang Zhang
- Sichuan Provincial Hospital for Women and Children (Affiliated Women and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Yi Ning
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Peking University Health Science Center Meinian Public Health Research Institute, Beijing, China.,Meinian Institute of Health, Beijing, China
| | - Peng Jia
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
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36
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Does inequality have a silver lining? Municipal income inequality and obesity in Mexico. Soc Sci Med 2021; 272:113710. [PMID: 33516086 DOI: 10.1016/j.socscimed.2021.113710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
Income inequality and obesity are both widespread socioeconomic issues, particularly salient in middle-income countries. This article seeks to detect the relationship between local income inequality and excess weight in Mexico, using robust municipal income inequality measures generated through small area estimation method and instrumental variable multilevel estimations. Our results emphasize a negative impact of municipal income inequality on individual bodyweight, especially for women. We also explore the potential channels through which income inequality may decrease bodyweight. Three-stage least squares estimations highlight that the social capital pathway, the public policy pathway and the psychological pathway help to explain the negative effect of inequality on excess weight. Our results are fairly robust to alternative inequality measures and nutritional indicators.
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37
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Reames TG, Daley DM, Pierce JC. Exploring the Nexus of Energy Burden, Social Capital, and Environmental Quality in Shaping Health in US Counties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E620. [PMID: 33450890 PMCID: PMC7828329 DOI: 10.3390/ijerph18020620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/04/2022]
Abstract
The United States spends more on health care than any other OECD country, yet the nation's health is declining. Recent research has identified multiple sources for this decline, including one's position in social and economic structures, environmental quality, and individual and collective social capital. This paper assesses the primary hypotheses that the health effects of household energy burden, social capital and environmental quality on aggregated community health levels remain while controlling for other determinants. The analysis moves beyond prior research by integrating multiple secondary data sources to assess those effects across US counties. Three indicators of public health are analyzed (premature mortality, self-reported health, and life expectancy). The county-level energy burden is measured by the percent of household income spent on housing energy bills for low- and moderate-income households. In addition to energy burden, social capital, environmental quality and other determinants are included in the analysis. The results produced by multivariate regression models support the primary hypotheses, even while a number of control variables also have a significant effect on health. The paper concludes that public health is associated with a complex nexus of factors, including environmental quality and social capital, and that energy burden needs to be among the considerations.
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Affiliation(s)
- Tony G. Reames
- School for Environment & Sustainability, University of Michigan, 440 Church St., Ann Arbor, MI 48109, USA
| | - Dorothy M. Daley
- School of Public Affairs & Administration and Environmental Studies Program, University of Kansas, Lawrence, KS 66045, USA;
| | - John C. Pierce
- School of Public Affairs & Administration, University of Kansas, Lawrence, KS 66045, USA;
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38
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Rose CM, Gupta S, Buszkiewicz J, Ko LK, Mou J, Cook A, Moudon AV, Aggarwal A, Drewnowski A. Small increments in diet cost can improve compliance with the Dietary Guidelines for Americans. Soc Sci Med 2020; 266:113359. [PMID: 32949981 DOI: 10.1016/j.socscimed.2020.113359] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
Adherence to the Dietary Guidelines for Americans (DGA) may involve higher diet costs. This study assessed the relation between two measures of food spending and diet quality among adult participants (N = 768) in the Seattle Obesity Study (SOS III). All participants completed socio-demographic and food expenditure surveys and the Fred Hutch food frequency questionnaire. Dietary intakes were joined with local supermarket prices to estimate individual-level diet costs. Healthy Eating Index (HEI- 2015) scores measured compliance with DGA. Multiple linear regressions using Generalized Estimating Equations with robust standard errors showed that lower food spending was associated with younger age, Hispanic ethnicity, and lower socioeconomic status. Even though higher HEI-2015 scores were associated with higher diet costs per 2000 kcal, much individual variability was observed. A positive curvilinear relationship was observed in adjusted models. At lower cost diets, a $100/month increase in cost (from $150 to $250) was associated with a 20.6% increase in HEI-2015. For higher levels of diet cost (from $350 to $450) there were diminishing returns (2.8% increase in HEI- 2015). These findings indicate that increases in food spending at the lower end of the range have the most potential to improve diet quality.
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Affiliation(s)
- Chelsea M Rose
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - Shilpi Gupta
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - James Buszkiewicz
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - Linda K Ko
- Division of Public Health Sciences Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA; Department of Health Services, University of Washington, Seattle, WA, 98105, USA.
| | - Jin Mou
- MultiCare Institute for Research & Innovation, Tacoma, WA, USA.
| | - Andrea Cook
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Dept of Biostatistics, University of Washington, Seattle, WA, USA.
| | | | - Anju Aggarwal
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
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Ng N, Lundevaller E, Malmberg G, Edvinsson S. Income inequality and old-age mortality in Sweden: do regional development and lagged effect matter? Health Place 2020; 64:102384. [PMID: 32838898 DOI: 10.1016/j.healthplace.2020.102384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/20/2022]
Abstract
We designed a retrospective cohort study for exploring the impact of municipality-level income inequality, based on the Gini 1986, 2004 indices, on all-cause old-age mortality among the older Swedish population during 2005-2009. We controlled for the confounding effects of individual and regional correlates and the lag effects of inequality by using multilevel logistic regression. The effects of income inequality were not consistent across age cohorts and, among the youngest cohorts, were negligible. This study reiterates that individual-level economics rather than the immediate or lagged effects of income inequality matter more for old-age mortality, even after controlling for individual and regional factors.
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Affiliation(s)
- Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Sweden; Global and Public Health, School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Demographic and Ageing Research, Umeå University, Sweden.
| | | | - Gunnar Malmberg
- Centre for Demographic and Ageing Research, Umeå University, Sweden; Department of Geography, Umeå University, Sweden.
| | - Sören Edvinsson
- Centre for Demographic and Ageing Research, Umeå University, Sweden.
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40
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Abstract
COVID-19 has catalyzed the adoption of virtual medical care in Canada. Virtual care can improve access to healthcare services, particularly for those in remote locations or with health conditions that make seeing a doctor in person difficult or unsafe. However, virtual walk-in clinic models that do not connect patients with their own doctors can lead to fragmented, lower quality care. Although virtual walk-in clinics can be helpful for those who temporarily lack access to a family doctor, they should not be relied on as a long-term substitute to an established relationship with a primary care provider. Virtual care also raises significant privacy issues that policy-makers must address prior to implementing these models. Patients should be cautious of the artificial intelligence recommendations generated by some virtual care applications, which have been linked to quality of care concerns.
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Affiliation(s)
- Lorian Hardcastle
- Faculty of Law and Cumming School of Medicine, 2129University of Calgary, Calgary, Alberta, Canada
| | - Ubaka Ogbogu
- Faculty of Law and Faculty of Pharmacy & Pharmaceutical Sciences, 3158University of Alberta, Edmonton, Alberta, Canada
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41
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[Health inequalities: new theoretical perspectives]. Salud Colect 2020; 16:e2751. [PMID: 32574463 DOI: 10.18294/sc.2020.2751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
This article, I intend to articulate the theoretical problem of economic and social inequalities with the issue of the social determination of health. Initially, I provide a summary of Rawls' and Sen's theories of justice and equity as an illustration of the dominant perspective in Northern epistemologies. Second, I discuss applications of this theoretical framework in the literature on social inequalities and the social determination of health-illness-care. Thirdly, I present a semantic matrix proposed for the difference-distinction-inequality-inequity-iniquity series to help reduce the existing terminological confusion. Next, I introduce a synthetic theoretical model about the poverty-inequality dyad, referring to the concepts of social resources, health practices, health services, and health situation/conditions. Finally, oriented by an epistemological perspective from the global South, and taking the current Brazilian situation as a case study, I discuss political implications of the complex contemporary conjuncture, pertinent to the hypothesis that a process of transformation of economic inequalities into new forms of social inequities and health iniquities is currently underway.
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Thompson K, Wagemakers A, van Ophem J. Assessing health outcomes in the aftermath of the great recession: a comparison of Spain and the Netherlands. Int J Equity Health 2020; 19:84. [PMID: 32503561 PMCID: PMC7275523 DOI: 10.1186/s12939-020-01203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Background Across time and space, financial security has been shown to impact health outcomes, with the acute loss of financial security being particularly detrimental. We compare financial security’s association with health in Spain and the Netherlands. These countries respectively exemplify low and high levels of financial security, general trends that have been exacerbated by the Great Recession of the 2010s. Methods We exploit the Spanish (n = 1001) and Dutch (n = 1010) editions of the European Social Survey 7, conducted in 2014, and condense relevant financial security- and health-related survey questions into latent variables using factor analyses. Using the component loadings as quasi-weightings, we generate one financial security variable and three health variables (mental, physical and social). Then, we run ordinary least squares regressions interacting financial security and nationality, for each of the three health outcomes. Results In unadjusted models, we find that financial security (p < 0.01) is positively associated with the three health outcomes, while being Spanish relative to being Dutch (p < 0.01) is associated with worse health outcomes. However, the results of the interaction term show that being Spanish relative to being Dutch weakens the relationship between physical health and social health, although not mental health. Conclusions We find evidence that financial security’s influence on health outcomes may vary in different contexts. This may be an important aspect of determining the Great Recession’s influence on health outcomes. Our study is a first step in understanding how the relationships between financial security and health may differ in countries with different experiences of the Great Recession.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemarie Wagemakers
- Health and Society Group, Wageningen University & Research, Wageningen, the Netherlands.
| | - Johan van Ophem
- Urban Economics Group, Wageningen University & Research, Wageningen, the Netherlands
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43
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Timming AR, French MT. The effect of genetic vs nongenetic parental care on adult children's income and wealth in later life: An evolutionary analysis. Am J Hum Biol 2020; 33:e23431. [PMID: 32445518 DOI: 10.1002/ajhb.23431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Using Wave IV of the National Longitudinal Study of Adolescent to Adult Health data set, this preregistered study set out to investigate the effect of parental care arrangements (eg, genetically related parents, adoptive, step/ foster, genetic nonparental relative, and no parental figure) on adult children's income and wealth in later life. METHODS Consistent with the preregistration plan, multivariate analyses of covariance were first used to examine, separately, the effects of paternal and maternal care arrangements on children's income and wealth in later life. Further post hoc exploratory analyses were carried out to evaluate the robustness of the findings. RESULTS The results indicate that individual earnings in later life are unrelated to paternal care arrangements, thus questioning a key tenet of kin selection theory. However, children raised by biological fathers and adoptive fathers still enjoy significant economic advantages over nongenetic father figures and homes without fathers in relation to household income and wealth. CONCLUSIONS Prevailing theories suggest that children raised by relatives, nongenetically related parents, and no father or mother suffer from a lack of parental investment that should manifest itself in reduced earnings and assets in adulthood. These theories are only partially correct, with evidence pointing to no deleterious effect of variable parental arrangements on individual earnings.
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Affiliation(s)
- Andrew R Timming
- Human Resource Management, University of Western Australia Business School, Crawley, Western Australia, Australia
| | - Michael T French
- Health Management and Policy, Miami Herbert Business School, University of Miami, Coral Gables, Florida, USA
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Luo W, Xie Y. Economic growth, income inequality and life expectancy in China. Soc Sci Med 2020; 256:113046. [PMID: 32446156 DOI: 10.1016/j.socscimed.2020.113046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/18/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
China had made dramatic health gains before its economic reform that began in 1978 produced rapid economic growth in the ensuing years. Since the economic reform, China's income inequality has substantially increased, and health gains have stagnated. This article investigates the extent to which China's health stagnation may be attributable to the rise in income inequality in China. By simulating the improvement in life expectancy that could have resulted if, ceteris paribus, income inequality had stayed constant at the lowest level after the founding of the People's Republic of China in 1949, we find that the sharply increasing income inequality in China has contributed to life loss in China's population, about 0.6 years for men and 0.4 years for women. These findings suggest that redistribution of income from rich to poor may be one of the most important policy levers for improving population health in China.
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Affiliation(s)
- Weixiang Luo
- Institute of Population Research, Fudan University, Shanghai, China.
| | - Yu Xie
- Department of Sociology, Princeton University, Princeton, NJ, USA; Center for Social Research, Peking University, Beijing, China.
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Cai J, Laporte A, Zhang L, Zhao Y, Tang D, Fan H, Deng L, Coyte PC. Impacts of Absolute and Relative Income on Self-Rated Health in Urban and Rural China. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 52:129-140. [PMID: 32363997 DOI: 10.1177/0020731420922689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to assess the impacts of absolute and relative income on self-rated health (SRH) of residents in rural and urban China. Data were derived from the China Health and Nutrition Survey. Three distinct measures of relative income were considered (Gini coefficient, Yitzhaki index, and Deaton index) and computed for 3 geographic units (nation, province, and community). Nonlinear dynamic models for panel data were employed to test the absolute and relative income hypotheses. Absolute income was significantly associated with SRH among urban and rural populations. Relative income, as measured by the Gini coefficient, the Yitzhaki index, and the Deaton index, had statistically significant and negative impacts on SRH among the rural population, regardless of the reference group. For the urban population, the Gini coefficient was associated with SRH regardless of the reference group. In contrast, only the Yitzhaki index and the Deaton index at the provincial level were associated with SRH among the urban population. Our findings may provide a reference for policymakers to implement health policies designed to improve population health.
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Affiliation(s)
- Jiaoli Cai
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Canadian Centre for Health Economics, Toronto, Ontario, Canada
| | - Li Zhang
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Yulin Zhao
- School of Economics, Wuhan University of Technology, Wuhan, China
| | - Di Tang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.,School of Public Administration, East China Normal University, Shanghai, China
| | - Hongli Fan
- School of Insurance, Shandong University of Finance and Economics, Jinan, China
| | - Liqian Deng
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Canadian Centre for Health Economics, Toronto, Ontario, Canada
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46
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Thompson K, Ophem JV, Wagemakers A. Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges. ECONOMICS AND HUMAN BIOLOGY 2019; 35:162-184. [PMID: 31376735 DOI: 10.1016/j.ehb.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - Johan van Ophem
- Chair Group Urban Economics, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Chair Group Health and Society, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
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47
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Elgar FJ, Gariepy G, Dirks M. Early-Life Exposure to Income Inequality and Adolescent Bullying-Reply. JAMA Pediatr 2019; 173:1212-1213. [PMID: 31609442 DOI: 10.1001/jamapediatrics.2019.3974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Frank J Elgar
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
| | - Genevieve Gariepy
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Melanie Dirks
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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A "Swiss paradox" in the United States? Level of spatial aggregation changes the association between income inequality and morbidity for older Americans. Int J Health Geogr 2019; 18:28. [PMID: 31775750 PMCID: PMC6880635 DOI: 10.1186/s12942-019-0192-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/19/2019] [Indexed: 12/29/2022] Open
Abstract
Although a preponderance of research indicates that increased income inequality negatively impacts population health, several international studies found that a greater income inequality was associated with better population health when measured on a fine geographic level of aggregation. This finding is known as a “Swiss paradox”. To date, no studies have examined variability in the associations between income inequality and health outcomes by spatial aggregation level in the US. Therefore, this study examined associations between income inequality (Gini index, GI) and population health by geographic level using a large, nationally representative dataset of older adults. We geographically linked respondents’ county data from the 2012 Behavioral Risk Factor Surveillance System to 2012 American Community Survey data. Using generalized linear models, we estimated the association between GI decile on the state and county levels and five population health outcomes (diabetes, obesity, smoking, sedentary lifestyle and self-rated health), accounting for confounders and complex sampling. Although state-level GI was not significantly associated with obesity rates (b = − 0.245, 95% CI − 0.497, 0.008), there was a significant, negative association between county-level GI and obesity rates (b = − 0.416, 95% CI − 0.629, − 0.202). State-level GI also associated with an increased diabetes rate (b = 0.304, 95% CI 0.063, 0.546), but the association was not significant for county-level GI and diabetes rate (b = − 0.101, 95% CI − 0.305, 0.104). Associations between both county-level GI and state-level GI and current smoking status were also not significant. These findings show the associations between income inequality and health vary by spatial aggregation level and challenge the preponderance of evidence suggesting that income inequality is consistently associated with worse health. Further research is needed to understand the nuances behind these observed associations to design informed policies and programs designed to reduce socioeconomic health inequities among older adults.
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Pan C, Fan Q, Yang J, Deng D. Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4018. [PMID: 31635191 PMCID: PMC6843958 DOI: 10.3390/ijerph16204018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/12/2019] [Accepted: 10/19/2019] [Indexed: 11/16/2022]
Abstract
Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index (WI) and Erreygers index (EI). Following this, it compares health inequalities among the elderly in different age groups, and finally, uses the Shapley and recentered influence function-index-ordinary least squares (RIF-I-OLS) model to decompose the effect of four factors on health inequality among the elderly in rural China. The QWB score distribution shows that the health of the elderly in rural China improved with social economic development and medical reform from 2002 to 2014. However, at the same time, we were surprised to find that the health level of the 65-74 years old group has been declining steadily since 2008. This phenomenon implies that the incidence of chronic diseases is moving towards the younger elderly. The WI and EI show that there is indeed pro-rich health inequality among the rural elderly, the health inequality of the younger age groups is more serious than that of the older age groups, and the former incidence of health inequality is higher. Health inequality in the age group of 65-74 years old is higher than that in other groups, and the trend of change fluctuated downward from 2002 to 2014. Health inequality in the age group of 75-84 years old is lower than that in the group of 65-74 years old, but higher than that in the other age groups. The results of Shapley decomposition show that demographic characteristics, socioeconomic status (SES), health care access, and quality of later life contributed 0.0054, 0.0130, 0.0442, and 0.0218 to the health inequality index of the elderly, which accounted for 6.40%, 15.39%, 52.41%, and 25.80% of health inequality index. From the results of RIF-I-OLS decomposition, this paper has analyzed detailed factors' marginal effects on health inequality from four dimensions, which indicates that the health inequality among the elderly in rural China was mainly caused by the disparity of income, medical expenses, and living arrangement.
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Affiliation(s)
- Changjian Pan
- Economics and Management School, Wuhan University, Wuhan 430072, China.
| | - Qiuyan Fan
- Centre for Social Security Studies, Wuhan University, Wuhan 430072, China.
| | - Jing Yang
- Centre for Social Security Studies, Wuhan University, Wuhan 430072, China.
| | - Dasong Deng
- Centre for Social Security Studies, Wuhan University, Wuhan 430072, China.
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50
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Pham A. Modeling the Effect of Income Segregation on Communicable Disease Transmission. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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