The role of income inequality as an ecological determinant of mental health: A nation-wide multilevel analysis on an Italian sample

INTRODUCTION

Income inequality, a pivotal determinant of general and mental health, operates through intricate mechanisms at various geographical scales. While established at country or region levels, the impact of lower-level (municipal or neighborhood) inequality remains inconsistent. This study explores the influence of regional- and municipal-level income inequality on individual psychological distress during the COVID-19 pandemic in Italy, employing a multilevel data analysis.

MATERIALS AND METHODS

In a post hoc analysis of data from the first wave of the pandemic (March to April 2020), three hierarchical levels were considered: individual participants, municipalities, and regions. Depressive and anxiety symptoms were measured using the PHQ-9 and GAD-7 scales, while the Gini coefficient gauged income inequality at municipal and regional levels. The analysis incorporated demographic variables as potential confounders.

RESULTS

The study encompassed 21 regions, 3,900 municipalities, and 21,477 subjects. Income inequality at both regional and municipal levels exhibited associations with distress scores, suggesting independent effects. Notably, higher distress scores were identified in southern regions with elevated inequality, despite a more substantial COVID-19 impact in the north.

DISCUSSION

Findings contribute to existing literature by emphasizing the independent impact of lower-level (municipal) and higher-level (regional) income inequality on population psychopathology. The study supports theories suggesting diverse pathways through which inequality at different levels influences health, such as potential associations with healthcare system dysfunction at the regional level and welfare dysfunction at the municipal level. The observed north-south gradient in distress scores highlights the need for psychosocial interventions to alleviate income inequality, especially in historically disadvantaged southern regions. Future research should explore the nuanced interplay between income inequality and various ecological variables to provide a comprehensive understanding of its health impact.

The U-Shaped Curve of Health Inequalities Over the 20th and 21st Centuries

This article examines historical trends in health inequalities over the 20th and 21st centuries. Drawing on studies from the United States, United Kingdom, Sweden, and Western Europe, it concludes that there is evidence of a u-shaped curve in (relative) health inequalities. These trends in health inequalities broadly parallel those identified by economists with regards to the u-shaped curve of income and wealth inequalities across the 20th and 21st centuries. The article argues that-as with income inequalities-health inequalities generally decreased across the twentieth century through to the early 1980s. They then started to increase and accelerated further from 2010, particularly in the United Kingdom and the United States. The article sets out four distinct policy periods that shaped the evolution of trends in health inequalities: the Interbellum Era, 1920-1950; the Trente Glorieuse, 1950-1980; Neoliberalism, 1980-2010; and the Crisis Age, 2010-present. The u-shaped curve of health inequalities over this period suggests that social policies, health care access, and political incorporation have driven changes over time. Taking this long view of changes in health inequalities emphasizes the importance of politics and policy for future health improvement.

Causal Assessment of Income Inequality on Self-Rated Health and All-Cause Mortality: A Systematic Review and Meta-Analysis

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.

Income Inequality, Economic Complexity, and Renewable Energy Impacts in Controlling Consumption-Based Carbon Emissions

Although many studies have been conducted on the role of renewable energy in the environment, literature has ignored the potential role of socioeconomic indicators in renewable energy and pollution nexus. Also, critical questions arose with the critical factors, such as income inequality and economic complexity, have not been answered properly. This study explores the nexus between income inequality, economic complexity, renewable energy consumption, GDP per capita, and pollution and thus aims to reach efficient policy strategies by revealing empirical evidence. The study follows an environmental impact model structure and conducts the panel-corrected standard errors and fixed effect regression. BRICS countries (Brazil, Russia, India, China, and South Africa) are selected to conduct our research. Annual data covering the period 1990-2017 for the sample countries are employed. Consumption-based carbon dioxide emissions as an indicator of environmental pollution are used since income inequality makes more sense in terms of the consumption side of an economy and is more related to consumers rather than the production sector. The obtained results reveal that income inequality has a positive and significant impact on consumption-based carbon dioxide emissions. However, GDP per capita, renewable energy, and economic complexity reduce pollution. It is also observed that the interaction term of inequality and renewable energy decreases emissions. Findings confirm that socioeconomic indicators, such as economic complexity and income inequality with the interaction of renewable energy, are crucial factors in reducing emissions and designing a greener future.

Quantifying income inequality in years of life lost to COVID-19: a prediction model approach using Dutch administrative data

BACKGROUND

Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50+.

METHODS

Extensive administrative data were used to model probability of dying within the year for the entire 50+ population in 2019, considering age, sex, disposable income and health care use (n = 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy.

RESULTS

Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile.

CONCLUSIONS

Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.

Food Environment Quality and Cardiovascular Disease Mortality in the United States: a County-Level Analysis from 2017 to 2019

BACKGROUND

Upstream socioeconomic circumstances including food insecurity and food desert are important drivers of community-level health disparities in cardiovascular mortality let alone traditional risk factors. The study assessed the association between differences in food environment quality and cardiovascular mortality in US adults.

DESIGN

Retrospective analysis of the association between cardiovascular mortality among US adults aged 45 and above and food environment quality, measured as the food environment index (FEI), in 2615 US counties. FEI was measured by equal weights of food insecurity (limited access to a reliable food source) and food desert (limited access to healthy food), ranging from 0 (worst) to 10 (best). Age-adjusted cardiovascular mortality rates per 100,000 adults aged 45 and above in the calendar year 2017-2019. County-level association between CVD mortality rate and FEI was modeled using generalized linear regression. Data were weighted using county population.

RESULT

Median CVD deaths per 100,000 population were 645.4 (IQR 561.5, 747.0) among adults aged 45 years and above across US counties in 2017-2019. About 12.8% (IQR 10.7%, 15.1%) of residents were food insecure and 6.3% (IQR 3.6%, 9.9%) were living in food desert areas. Comparing counties by FEI quartiles, the CVD mortality rate was higher in the least healthy FE counties (704.3 vs 598.6 deaths per 100,000 population) compared to the healthiest FE counties. One unit increase in FEI was associated with - 12.95 CVD deaths/100,000 population. In the subgroup analysis of counties with higher income inequality, the healthiest food environment was associated with 46.4 lower CVD deaths/100,000 population than the least healthy food environment. One unit increase in FEI in counties with higher income inequality was associated with a fivefold decrease in CVD mortality difference in African American counties (- 18.4 deaths/100,000 population) when compared to non-African American counties (- 3.63 deaths/100,000 population).

CONCLUSION

In this retrospective multi-county study in the USA, a higher food environment index was significantly associated with lower cardiovascular mortality.

Towards integrated sustainability for China's rural revitalization: an analysis of income inequality and public health

Introduction

Ensuring healthy lives and promoting well-being are paramount among the priorities outlined in the 17 Sustainable Development Goals (SDGs) established by the United Nations. In China, rural revitalization stands as a pivotal national strategy aimed at fostering prosperity and sustainable development in rural areas. Despite its comprehensive evaluation system, which encompasses industry, ecology, culture, organization, and livelihood, the current index system overlooks the critical dimension of public health in rural areas. The existing body of literature predominantly focuses on the correlation between income and health, leaving a gap in understanding the relationship between income inequality and health from the perspective of villagers. This study addresses this gap by utilizing data from 3,771 villager samples and 302 village samples obtained from the 2019 China Rural Revitalization Survey (CRRS) to explore the correlation between income inequality and public health in China's rural areas.

Methods

We employ the Ordered Logistic Regression (Ologit) model in the baseline regression and heterogeneity analysis. Additionally, a mediating effect analysis, using the Sobel test, examines the role of villagers' health awareness as a mediating variable in the correlation between income inequality and villagers' health.

Results

The empirical findings of this study unveil a statistically significant adverse influence of income inequality on public health in China's rural areas. Furthermore, the research identifies that participation in regular exercise and the attainment of higher education levels serve as effective measures to alleviate the detrimental impact of income inequality on the health of rural residents. Additionally, income inequality is observed to shape villagers' health awareness, thereby influencing their overall health status.

Conclusion

The study's outcomes have significant implications for policymakers and governmental authorities, providing valuable insights into some pathways for enhancing public health in rural China. Ultimately, these insights contribute to the broader objective of achieving integrated sustainability in rural China.

Pandemics, Income Inequality, and Refugees: The Case of COVID-19

Refugees are more vulnerable to COVID-19 due to factors such as low standard of living, accommodation in crowded households, difficulty in receiving health care due to high treatment costs in some countries, and inability to access public health and social services. The increasing income inequalities, anxiety about providing minimum living conditions, and fear of being unemployed compel refugees to continue their jobs, and this affects the number of cases and case-related deaths. The aim of the study is to analyze the impact of refugees and income inequality on COVID-19 cases and deaths in 95 countries for the year 2021 using Poisson regression, Negative Binomial Regression, and Machine Learning methods. According to the estimation results, refugees and income inequalities increase both COVID-19 cases and deaths. On the other hand, the impact of income inequality on COVID-19 cases and deaths is stronger than on refugees.

Determinants of individual income in EU countries: implications for social policy targeting

Introduction

The introduction of the Income Index constructed by authors as well as the identification of demographic, socio-economic and occupation-related factors influencing the income of individuals in EU countries is the main contribution of the paper. The Income Index makes it possible to analyze data of individuals from all EU countries.

Methods

The multiple hierarchical regression of EU-SILC microdata provides the factors that influence individuals' income.

Results

Outcomes show through which factors can be intervened in social policy settings to reduce income inequality. Factors significantly affecting the Income Index are the household composition, occupation sector (typically agriculture and accommodation and services are related to low incomes) and the degree of urbanization (rural areas with the lowest incomes of individuals).

Discussion

Findings confirm ongoing discussions about the specific position of single parent households in the labour market and their need for social support.

Income Is a Stronger Predictor of Subjective Social Class in More Economically Unequal Places

In this research, we examine how the lay conceptualization of subjective social class varies based on economic contexts. We argue that income should be a more central component of subjective social class in areas with higher income inequality. To address the issue of low power in existing research, we combined local-level income inequality indicators with large-scale repeated cross-sectional data, enabling the most reliable test to date on how the relationship between income and subjective social class is moderated by inequality. We used nationally representative datasets from the United States and South Korea (encompassing 25,000+ participants from 1,246 regional-year units). In both cultural contexts, our multilevel models revealed that income is a stronger predictor of subjective social class in regions with higher levels of income inequality. This work advances the theoretical and empirical understanding of how income and income inequality interact to shape the perception of one's position in the social hierarchy.

Economic Inequality Fosters the Belief That Success Is Zero-Sum

Ten studies (N = 3,628; including five pre-registered), using correlational and experimental methods and employing various measures and manipulations, reveal that perceived economic inequality fosters zero-sum beliefs about economic success-the belief that one person's gains are inevitably offset by others' losses. As the gap between the rich and the poor expands, American participants increasingly believed that one can only get richer at others' expense. Moreover, perceptions of economic inequality fostered zero-sum beliefs even when the distribution of resources was not strictly zero-sum and did so beyond the effect of various demographics variables (household income, education, subjective socioeconomic status) and individual differences (political ideology, social dominance orientation, interpersonal trust). Finally, I find that zero-sum beliefs account for the effect of inequality on people's view of the world as unjust. The article concludes with a discussion of the theoretical and practical implications of zero-sum beliefs about economic success.

American Muslims' Attitudes Toward Homosexuality: Exploring the Effects of Gender, Religiosity, and Income Inequality

Literature on Muslims and Islam has not empirically assessed the impact of American Muslims' gender, religiosity, income inequality, and the interaction between the latter two factors, on their attitudes toward homosexuality. Using logistic regression models fitted to data from the 2017 Pew Survey of US Muslims (n = 712), this article assesses these factors' effects on their view that society should either accept or discourage homosexuality. Findings reveal that men, compared with women, and more religious individuals tend to express homonegativity; while those from higher-income households are likely to agree that society should accept same-sex relationships. Also, the religiosity-prejudice association is moderated by income inequality. These findings have important religious and social implications. Firstly, the prevailing approach of essentializing Islamic perspectives on homosexuality as being favorable or prejudicial overlooks that they are socially contingent. Secondly, policies contributing to Muslim minorities' economic well-being can encourage them to embrace liberal religious and social values.

Analysis of COVID-19 Case Demographics and Disease Outcomes in Gary, Indiana

BACKGROUND

The COVID-19 pandemic further exposed the prevalence of existing health disparities in Black communities in the U.S. The current study evaluates COVID-19 data collected in Gary, Indiana, from June 2020 to June 2021. We hypothesized that the number of COVID-19 cases, hospitalizations, and deaths were influenced by race and income.

METHODS

In collaboration with the Gary Health Department (GHD), we analyzed demographic data on COVID-19-positive cases.

RESULTS

Compared to Gary's non-Black population, age- and population-adjusted rates of hospitalizations and deaths in the Black population were 3-fold (p < 0.0001) and 2-fold (p < 0.05) higher, respectively. This is despite a higher infection rate (p < 0.0001) in the non-Black population. The median household income of a zip code was negatively correlated with COVID-19 hospitalizations (R2 = 0.6345, p = 0.03), but did not correlate with infections and deaths.

CONCLUSIONS

The current study demonstrates clear health disparities of income and race in the context of COVID-19-related infections and outcomes in the city of Gary. Indiana University School of Medicine Northwest and GHD officials can collaborate to utilize these data for the reallocation of resources and health education efforts in Gary's highly populated, low-income, and predominantly Black neighborhoods. It should also prompt further investigation into national health resource allocation.

Supermarket top-up of Healthy Start vouchers increases fruit and vegetable purchases in low-income households

Stark, widening health and income inequalities in the United Kingdom underpin the need for increased support for low-income families to access affordable and nutritious foods. Using anonymised supermarket loyalty card transaction records, this study aimed to assess how an additional Healthy Start voucher (HSV) top-up of £2, redeemable only against fruit and vegetables (FVs), was associated with FV purchases among at-risk households. Transaction and redemption records from 150 loyalty card-holding households, living in northern England, who had engaged with the top-up scheme, were analysed to assess the potential overall population impact. Using a pre-post study design, 133 of these households' records from 2021 were compared with equivalent time periods in 2019 and 2020. Records were linked to product, customer and store data, permitting comparisons using Wilcoxon matched-pairs sign-ranked tests and relationships assessed with Spearman's Rho. These analyses demonstrated that 0.9 more portions of FV per day per household were purchased during the scheme compared to the 2019 baseline (p = 0.0017). The percentage of FV weight within total baskets also increased by 1.6 percentage points (p = 0.0242), although the proportional spend on FV did not change. During the scheme period, FV purchased was higher by 0.4 percentage points (p = 0.0012) and 1.6 percentage points (p = 0.0062) according to spend and weight, respectively, in top-up redeeming baskets compared to non-top-up redeeming baskets with at least one FV item and was associated with 5.5 more HSV 'Suggested' FV portions (p < 0.0001). The median weight of FV purchased increased from 41.83 kg in 2019 to 54.14 kg in 2021 (p = 0.0017). However, top-up vouchers were only redeemed on 9.1% of occasions where FV were purchased. In summary, this study provides novel data showing that safeguarding funds exclusively for FV can help to increase access to FV in low-income households. These results yield important insights to inform public policy aimed at levelling up health inequalities.

Distribution of the compression and expansion of morbidity in 194 countries and territories, 1990-2016: The role of income inequality

Studies on detailed types of health changes and the associations between the types and income inequality are inadequate. This study analyses the global distribution of the compression and expansion of morbidity in 194 countries and territories between 1990 and 2016, and investigates the role of income inequality in the distribution. This study shows that all seven types of health changes coexist, despite being distributed unevenly. The relative expansion of morbidity with increased or constant life expectancy (Type 6, 54.48%) is the most popular type, followed by the relative compression of morbidity with increased or constant life expectancy (Type 3, 30.71%). Income distribution within a society matters for health changes. Societies with greater income inequality tend to have Type 6, a worse scenario of health changes. Measures to reduce income inequality or mitigate its adverse effects will contribute to the relative compression of morbidity with increased or constant life expectancy.

Economic Growth, Income Inequality and Food Safety Risk

Food safety risk, as an implicit cost of social and economic development, endangers the health of global residents, including China. To systematically understand the impact of socioeconomic development on food safety risk and to establish a sound modern governance system of food safety in China, this paper uses provincial panel data from 2011 to 2020 to explore the relationship between food safety risk and socio-economic development factors such as economic growth and income inequality by employing a two-way fixed effect model and moderating effect model. The results show that the food safety risk is a Kuznets curve, and the turning point is about RMB 58,104.59 per capita GDP (based on prices in 2011). However, under the moderating effect of income inequality, the turning point of the Kuznets curve of food safety risk will shift to the right, and the curve will be flattened. In other words, income inequality has a negative moderating effect on the "inverted U-shaped" relationship between economic growth and food safety risk. When dealing with food safety problems, the goal of stable and sustained economic growth and common prosperity should be incorporated into policy formulation to enhance the governance effectiveness of food safety risk.

Social disparities in alcohol's harm to others: evidence from 32 European countries

BACKGROUND

Alcohol use can cause harm not only to the person who consumes it but also to others. Prior research has found that these alcohol-attributable harms to others differ across socioeconomic groups, though several findings have been contradictory. The aim of this contribution was to study the role of individual-level and population-level income inequalities in alcohol's harm to others among women and men.

METHODS

Logistic regression analysis of cross-sectional survey data from 2021, covering 39,629 respondents from 32 European countries. Harms from others' drinking were defined as experiences of physical harm, involvement in a serious argument, or involvement in a traffic accident, due to another person's drinking, within the past year. We examined the association of individual-level income and country-specific income inequality (Gini index) with harms from a known person's or a stranger's drinking, adjusting for the respondent's age, daily drinking levels, and at least monthly risky single-occasion drinking.

RESULTS

At the individual level, people with lower incomes had 21% to 47% increased odds of reporting harms from a known person's drinking (women and men) or stranger's drinking (men only) than their same-gender counterparts in the highest income quintile. At the national level, countries with higher income inequality showed increased risks of harms from a known person's drinking among women (OR = 1.09, 95% confidence interval [CI]: 1.05 - 1.14), while among men the risk of harm from strangers' drinking decreased with higher income inequality (OR = 0.86, 95% CI: 0.81 - 0.92). These associations with income inequality were observed among respondents from all but the lowest income groups.

CONCLUSION

Alcohol can cause harm to others, with women and people with low incomes being disproportionally exposed to these harms. Alcohol control policies targeting high consumption levels, especially among men, as well as upstream policies to reduce inequalities, are needed to lower the health burden of alcohol beyond those who consume it.

A Competitiveness-Based Theoretical Framework on the Psychology of Income Inequality

Social scientists have begun to extensively study how living in contexts with high income inequality affects psychological outcomes. Herein we overview a conceptual framework that integrates, organizes, and extends these complex (and sometimes contradictory) findings. First, we describe studies showing that income inequality breeds an ethos of competitiveness. Second, we argue that the inequality-competitiveness relation explains why income inequality (a) promotes status-focused behaviors aimed at lifting oneself up and/or bringing others down, (b) harms social relations when they pose an obstacle to one's economic advancement, (c) exerts opposing effects on well-being via avoidance motivation (focusing on the risk of economic failure) and approach motivation (focusing on the prospect of economic success), and (d) represents a threat to those who perceive they do not have sufficient individual/contextual resources to cope with the demands of competition but a challenge to those with sufficient resources. We also discuss limitations and future directions for research.

Exploring the relationship between mental health and dialect use among Chinese older adults: a moderated mediation estimation

Background

Mental health, conceptualized as psychological status that includes rational cognition, emotional stability, and interpersonal harmony, is highly relevant to the expected health and well-being of all humans. China is facing the dual risk of increased aging and mental health disorders in older adults, while the established studies have rarely focused on the influence of dialect on the mental health of Chinese older adults. The present study aims to capture the relationship between dialect and mental health in Chinese older adults.

Methods

We use cross-sectional data from the nationally representative China Family Panel Studies, which encompasses the dialect use, mental health, and other socioeconomic features of 4,420 respondents. We construct a moderated mediation model that uses dialects and mental health as the independent and dependent variables and income inequality and subjective well-being as the mediator and moderator to reveal the relationship between dialect and mental health in Chinese older adults.

Results

(1) Dialects are shown to have a negative influence on the mental health of older adults in the current study (coefficient = -0.354, 95% CI = [-0.608, -0.097]). (2) Income inequality positively mediates the correlation between dialects and mental health (coefficient = 0.019, 95% CI = [0.010, 0.045]). (3) Subjective well-being negatively moderates the potential mechanism between dialects and mental health (coefficient = -0.126, 95% CI = [-0.284, -0.010]).

Conclusion

The use of dialects is associated with worse mental health outcomes in Chinese older adults, while this negative influence is positively mediated by income inequality and negatively moderated by subjective well-being, simultaneously. This study contributes to the knowledge enrichment of government workers, older adults with mental disorders, medical staff, and other stakeholders.

The socioeconomic context of stigma: examining the relationship between economic conditions and attitudes towards people with mental illness across European countries

Introduction

Efforts to reduce the stigma associated with mental illness have intensified over the past 30 years with a particular focus on improving public attitudes. Difficult economic circumstances can be harmful to intergroup relations, but little is known about whether there is a relationship between socioeconomic conditions and attitudes towards people with mental illnesses.

Methods

Random effects logistic regression modelling was employed to explore the relationship between individual financial circumstances, contextual socioeconomic factors and difficulty speaking to a person with a significant mental illness across European countries.

Results

Lower GDP per capita and higher income inequality at the country level, alongside individual financial difficulties, were each associated with a greater likelihood of reporting difficulty speaking to a person with a significant mental illness.

Discussion

Micro and macro-economic factors are associated with public attitudes towards people with mental illness across Europe. With prolonged economic instability predicted over the coming years in Europe it is important that these findings are taken into consideration when designing mental health and social policies, in order to safeguard the progress that has been made in reducing mental health stigma to date.

How can environmental degradation and income disparities influence national health: an eye bird view on China's provinces

Growing socio-economic disparity is a global issue that could disturb community health. Numerous case studies have examined the health influences of income disparities as well as the patterns that implicate those disparities. Therefore, this study attempts to examine the core determinants of mortality rate, which are environmental degradation, green energy, health expenditures, and technology (ICT) for the 25 provinces of China over the period of 2005-2020. This study uses a series of estimators to investigate the preferred objectives in which CS-ARDL and common correlated effect mean group (CCE-MG). Estimated results show the significant contribution of environmental deterioration and income inequality to the mortality rate. Furthermore, health expenditures, ICT, and green energy significantly reduce the mortality rate. Similarly, the moderate effect of income inequality on health expenditure, green energy, and ICT significantly reduces the mortality rate in selected provinces of China. More interestingly, the current study suggests policy implications to reduce the rising trend of mortality rate.

The gender gap in the ownership of promising land

Using millions of observations compiled from the public administrative data of Taiwan, we find a surprising gender inequity in terms of real estate: Men own more land than women, and the annual rate of return (ROR) of men's land outperform women's by almost 1% per year. The latter finding of gender-based ROR difference is in sharp contrast to prior evidence that women outperform men in security investment, and also suggests a quantity-and-quality double jeopardy in female land ownership which, given the heavy weight of real estate in individual wealth, has important implications for wealth inequality among men and women. Our statistical analyses suggest that such a gender-based difference in land ROR cannot be attributed to individual-level factors such as liquidity preferences, risk attitudes, investment experience, and behavioral biases, as described in the literature. Rather, we hypothesize parental gender bias-a phenomenon that is still prevalent today-to be the key macrolevel factor. To test our hypothesis, we partition our observations into two groups: an experimental group in which parents can exercise gender discretion, and a control group in which parents cannot exercise such discretion. Our empirical evidence shows that the gender difference with respect to land ROR only exists in the experimental group. For many societies with long-lasting patriarchal traditions, our analysis provides a perspective to help explain gender differences in wealth distribution and social mobility.

Using a Structural Intersectionality Approach to Understand Drivers of Health Inequities

Clinical nurses and nurse scientists should consider how societal systems of inequality interact, affect the health of individuals, and exacerbate health inequities, especially for Black women. In this short review, we examine a recent study that introduces an innovative approach to measuring intersectional systems of inequality at the state level and their impact on health referred to as structural intersectionality. Implications for nursing practice and nursing science are discussed.

Contextualizing physical activity in rural adults: Do relationships between income inequality, neighborhood environments, and physical activity exist?

OBJECTIVE

To examine if income inequality, social cohesion, and neighborhood walkability are associated with physical activity among rural adults.

DATA SOURCE

Cross-sectional data came from a telephone survey (August 2020-March 2021) that examined food access, physical activity, and neighborhood environments across rural counties in a southeastern state.

STUDY DESIGN

Multinomial logistic regression models assessed the likelihood of being active versus inactive and insufficiently active versus inactive in this rural population. Coefficients are presented as relative risk ratios (RRRs). Statistical significance was determined using 95% confidence intervals (CIs). All analyses were performed in STATA 16.1.

DATA COLLECTION/EXTRACTION METHODS

Trained university students administered the survey. Students verbally obtained consent, read survey items, and recorded responses into Qualtrics software. Upon survey completion, respondents were mailed a $10 incentive card and printed informed consent form. Eligible participants were ≥18 years old and current residents of included counties.

PRINCIPAL FINDINGS

Respondents in neighborhoods with relatively high social cohesion versus low social cohesion were more likely to be active than inactive (RRR = 2.50, 95% CI: 1.27-4.90, p < 0.01), after accounting for all other variables in the model. Income inequality and neighborhood walkability were not associated with different levels of physical activity in the rural sample.

CONCLUSIONS

Study findings contribute to limited knowledge on the relationship between neighborhood environmental contexts and physical activity among rural populations. The health effects of neighborhood social cohesion warrant more attention in health equity research and consideration when developing multilevel interventions to improve the health of rural populations.

The Gap Between Us: Income Inequality Reduces Social Affiliation in Dyadic Interactions

In this investigation, we tested the hypothesis that increased income inequality between individuals will reduce social affiliation within dyadic interactions. In three experiments, we examined the effects of income inequality on key indices of affiliation using semi-structured interactions. In the first two experiments, a participant and confederate were randomly assigned to a low- or high-power role and compensated mildly or extremely unequally. In Experiment 3, inequality and inequity were orthogonally manipulated to determine whether inequality's social consequences are moderated by the fairness of the income distribution. We demonstrated that greater inequality produced more negative emotional responses, reduced desire for closeness, and harsher evaluations of one's partner, regardless of one's power role and the equitability of the income distribution. We also obtained evidence that greater inequality reduces behavioral warmth, although this effect was less consistent. Our results begin to unpack the psychological processes through which income inequality worsens societal well-being.

Public debt and income inequality in an endogenous growth model with elastic labor supply

In this study, we examine the relationships among long-run public debt policy, economic growth, and income inequality by extending a representative consumer theory of distribution and using an endogenous growth model with a sustainable fiscal rule, elastic labor supply, and initial endowment of heterogeneous wealth. We show that fiscal policy with strict (loose) budgetary discipline decreases (increases) the economic growth rate in the short run. In contrast, it increases (decreases) the economic growth rate in the long run. Then, we show that fiscal policy with strict (loose) budgetary discipline decreases (increases) income inequality in both the short and long run. First, we show that a balanced growth path is a locally stable saddle point. Then, we consider the relationships among public debt, the economic growth rate, and income inequality. In this model, the average leisure and the public-debt-to-private-capital ratio determine the rate of return and wage rate, affecting both the economic growth rate and income distribution across agents. We conclude that there is a negative relation between the economic growth rate and the measure of income inequality in the long run by conducting numerical simulations using US data. The policy implication of this paper is that the government has a public debt policy that achieves both faster economic growth and the improvement of income inequality.

Income Inequality and Population Health: Examining the Role of Social Policy

Studies of the relationship between income inequality and life expectancy often speculate about the role of policy, but direct empirical research is limited. Drawing on the neo-materialist perspective, we examine whether the longitudinal association between income inequality and life expectancy is mediated and moderated by policy liberalism in U.S. states (2000-2014). More liberal policy contexts are characterized by greater efforts to regulate the economy, redistribute income, and protect vulnerable groups and lesser efforts to penalize deviant social behavior. We find that state-level income inequality is inversely associated with policy liberalism and life expectancy. The association between income inequality and life expectancy was not mediated by policy liberalism but was moderated by it. The association is attenuated in states with more liberal policy contexts, supporting the neo-materialist perspective. This finding illustrates how states like New York and California (with liberal policy contexts) can exhibit high income inequality and high life expectancy.

Income inequality, cultural capital, and high school students' academic achievement in OECD countries: A moderated mediation analysis

This study examines how social context, in this case, income inequality, shapes the role of cultural capital in educational success. First, we revisit the associations between (objectified) cultural capital and academic achievement, and cultural capital's role in mediating the relationship between family SES and academic achievement. More importantly, we explore how national-level income inequality moderates these two relationships. By analyzing a multilevel dataset of 32 OECD countries, a combination of PISA 2018 data and several national indexes, we find that: (1) cultural capital not only has a positive association with students' academic achievement but also acts as a significant mediator of the relationship between family SES and academic achievement in OECD countries; (2) both cultural capital's association with academic achievement and it's mediating role are stronger in more equal countries than in unequal ones. The findings shed new light on understanding how cultural capital shapes intergenerational education inequality across countries with different levels of inequality.

The Effects of Population Aging on Sports Industry Development: The Mediating Effect of Technological Innovation

It is of great practical significance to rationally formulate a development strategy for the sports industry to deeply understand and comprehensively grasp the impact of population aging on the development of the sports industry. To study the impact of population aging on the development of the sports industry, panel data at the provincial level in China from 2014 to 2020 are selected, and a mediation effect model is established to test how the aging of the population affects the development of the sports industry through technological innovation. The results show that technological innovation can explain 59.87% of the impact of population aging on the development of the sports industry without considering the control variables, and the impact of population aging on labor productivity through technological innovation is positive. Under the condition of considering the control variables, technological innovation can explain 56.74% of the impact of population aging on the development of the sports industry, and the impact of population aging on the development of the sports industry through technological innovation is positive. The proportion of the population aged 65 and above in the total population was used as a proxy variable for population aging to test the robustness test, and the impact of technological innovation on the development of the sports industry was positive without considering the control variables. In the robustness test considering the control variables, the impact of technological innovation on the development of the sports industry is positive.

Income inequality: a recipe for youth unemployment in Africa

Youth unemployment is a problem in Africa such that young people face almost double the unemployment rate as adults. With the booming population on the rise, youth unemployment can turn into a major catastrophe in the continent if not addressed. This study presents empirical evidence on how income inequality accelerates the problem. The study uses panel data from 42 African countries spanning 29 years from 1991 to 2020. The dependent variable is youth unemployment, and the independent variable is income inequality. The control variables are gross domestic product (GDP) per capita, population growth, political stability, foreign direct investment, gross capital formation, and political stability. The study employs the Generalized Method of Moment (GMM) model for estimations. The results imply that income inequality positively impacts African youth unemployment, which varies across different income levels. Therefore, measures must be formulated to combat income inequality, such as increasing productivity among small-scale farmers, robust social protection programs, minimum wages, and better access to financial services for young people on the continent.

Effects of Human Capital on Energy Consumption: The Role of Income Inequality

High-quality human capital (HC) development has a strong influence on achieving a win-win target of economic growth and energy consumption mitigation based on the background of the contemporary "carbon neutrality" constraints in China. We here aim to empirically assess the effect of HC on energy consumption (EC) in 30 provinces of China from 2000 to 2019. Moreover, we broaden the literature by discussing the effect of HC in terms of impact mechanism and nonlinear relationship. Based on methods of the augmented mean group (AMG), the estimation of long-term impacts indicates that the improvement of HC significantly discourages the increase in EC. The intrinsic mechanism shows that the accumulation of HC significantly promotes the decline of EC through economic structure adjustment and technological innovation. Moreover, the threshold model indicates that income equality lifts the inhibitory impact of HC on EC. Accordingly, the development of HC should be involved in the policy preference of China's provincial and national development strategies considering its effectiveness in stimulating the reduction of energy consumption.

Intergenerational Transmission of Obesity: Role of Education and Income

Based on the sixth round of the 2018 Chinese Household Income Project family income survey (CHIP) data, this study made use of the OLS estimation and transfer matrix method to measure and test the problem of obesity intergenerational transmission, analyze whether there is obesity intergenerational transmission as well as between urban and rural areas, gender, and the parental education level and income level on the suppression of the obesity intergenerational transmission effect. The empirical results draw the following main conclusions: obesity intergenerational transmission in Chinese families, the degree of parental obesity has a significant positive impact on the degree of offspring obesity; the higher the degree of parental obesity, the more it can promote the degree of obesity in the offspring. Moreover, the degree of obesity intergenerational transmission is heterogeneous in urban and rural areas and gender. At the same time, the degree of rural obesity intergenerational transmission is higher than that of urban areas, and the degree of male obesity intergenerational transmission is higher than that of women.

A Study of Cumulative COVID-19 Mortality Trends Associated with Ethnic-Racial Composition, Income Inequality, and Party Inclination among US Counties

This research analyzes the association between cumulative COVID-19 mortality and ethnic-racial composition, income inequality, and political party inclination across counties in the United States. The study extends prior research by taking a long view-examining cumulative mortality burdens over the first 900 days of the COVID-19 pandemic at five time points (via negative binomial models) and as trajectories of cumulative mortality trends (via growth curve models). The analysis shows that counties with a higher Republican vote share display a higher cumulative mortality, especially over longer periods of the pandemic. It also demonstrates that counties with a higher composition of ethnic-racial minorities, especially Blacks, bear a much higher cumulative mortality burden, and such an elevated burden would be even higher when a county has a higher level of income inequality. For counties with a higher proportion of Hispanic population, while the burden is lower than that for counties with a higher proportion of Blacks, the cumulative COVID-19 mortality burden still is elevated and compounded by income inequality, at any given time point during the pandemic.

"Digital Dividend" or "Digital Divide": What Role Does the Internet Play in the Health Inequalities among Chinese Residents?

With the vigorous development of the medical industry in China, residents' health has been significantly improved. However, along with the income gap, urban-rural gap, and healthcare resource gap caused by economic development, health inequality has become a fundamental barrier to the promotion of residents' health. The popularity of the Internet has helped close the gap to some extent, but it also has drawbacks. Using data from the China Family Panel Studies (CFPS) from 2014 to 2018, we evaluated the effects of Internet usage on health disparities among residents using fixed effect models, mediation effect models, and other methodologies. The findings indicate that Internet usage can help to minimize health inequality since it lowers income inequality, promotes health consciousness, and reduces depression. Furthermore, Internet usage plays a greater role on the health improvement of the middle-aged, the elderly, urban residents, and females. Although the Internet has brought "digital dividends" in general, the Internet usage rates among different groups also reveal that there is a clear "digital gap" among rural residents, elderly groups, and low-income groups. These results have significant implications for promoting healthcare equality.

Money and happiness: the income-happiness correlation is higher when income inequality is higher

Has the income-happiness correlation changed over time? If so, what predicts such changes? We tested these questions in diverse economic, political, and cultural contexts. Drawing on nationally representative data, we found that the income-happiness correlation has increased in the USA since 1972, as GDP per capita and income inequality increased (Study 1). Study 2 examined an income-life satisfaction correlation in nationally representative surveys between 1978 and 2011 in Japan. Unlike in the USA, there was no clear increase in the income-life satisfaction correlation over time. We next examined the income-life satisfaction correlations in 16 European countries and found that on average the income-life satisfaction correlation has increased since 1970, and it was particularly high in years of high GDP per capita and high-income inequality (Study 3). Finally, we found that among Latin American countries, the income-life satisfaction correlation has, on average, decreased since 1997, as income inequality has decreased (Study 4). Over the last 5 decades, the income-happiness correlation has increased, not decreased, in the USA and several European countries. The income-happiness correlation tends to get higher when both GDP per capita and income inequality are high, whereas it tends to get lower when GDP per capita and/or income inequality are low. These findings suggest the importance of accounting for income inequality as well as national wealth in understanding the role of money in happiness.

Relative Deprivation Leads to the Endorsement of "Anti-Chicken Soup" in China

"Anti-chicken soup" (ACS) persuades people to yield to reality and give up rather than encouraging people to work hard as "chicken soup" does. The current study explored whether people with a higher level of relative deprivation (RD) would be more likely to endorse ACS. We found that people with high-measured (Study 1) and manipulated (Study 2) RD were more likely to endorse ACS. Study 2 also suggested that the effect was mediated by self-handicapping. It seems that relatively deprived individuals may adopt the strategy of self-handicapping so that they could attribute their failure to external causes, which in turn leads to lower motivation to try their best and ultimately the endorsement of ACS.

Climate change and the nonlinear impact of precipitation anomalies on income inequality

Climate anomalies, such as floods and droughts, as well as gradual temperature changes have been shown to adversely affect economies and societies. Although studies find that climate change might increase global inequality by widening disparities across countries, its effects on within-country income distribution have been little investigated, as has the role of rainfall anomalies. Here, we show that extreme levels of precipitation exacerbate within-country income inequality. The strength and direction of the effect depends on the agricultural intensity of an economy. In high-agricultural-intensity countries, climate anomalies that negatively impact the agricultural sector lower incomes at the bottom end of the distribution and generate greater income inequality. Our results indicate that a 1.5-SD increase in precipitation from average values has a 35-times-stronger impact on the bottom income shares for countries with high employment in agriculture compared to countries with low employment in the agricultural sector. Projections with modeled future precipitation and temperature reveal highly heterogeneous patterns on a global scale, with income inequality worsening in high-agricultural-intensity economies, particularly in Africa. Our findings suggest that rainfall anomalies and the degree of dependence on agriculture are crucial factors in assessing the negative impacts of climate change on the bottom of the income distribution.

The Impacts of COVID-19 Shock on Intergenerational Income Mobility: Evidence from China

The COVID-19 crisis has caused a huge negative shock to economic activities worldwide, leading to a reduction in income and changes in income distribution. Intergenerational mobility is an important indicator of sustainable social development. This paper explores the short-term impacts of the sudden COVID-19 pandemic on intergenerational income mobility and personal income in China. Using the variation in the number of confirmed cases across provinces, we construct a province-level pandemic intensity index and combine it with individual data from the China Family Panel Studies (CFPS). We apply a general difference-in-difference strategy to identify the causal effect of the pandemic on intergenerational income mobility. We find that personal income is positively related to parental income, and that the COVID-19 crisis has caused a decline in individual income and exacerbated intergenerational income persistence. A more intense COVID-19 pandemic shock is associated with a larger increase in intergenerational income elasticity and intergenerational income rank-rank slope. We found that with one standard deviation increase in local pandemic intensity, the intergenerational income elasticity increases by 0.315 and the intergenerational income rank-rank slope increases by 0.198 on average. The mechanism testing suggests that heterogeneous effects among different groups are the force underlying the results. Low-income, low-skilled, and low-parental-income individuals have suffered a more severe impact from the pandemic shock.

Comprehensive metrological and content analysis of the income inequality research in health field: A bibliometric analysis

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.

The micro-macro interplay of economic factors in late-life loneliness: Evidence from Europe and China

Individual socioeconomic status has a significant impact on whether older adults can initiate and maintain social relationships and participate in society, hence it affects loneliness. At the macro level, income inequality is expected to increase the risk of loneliness by eroding social cohesion and trust, while welfare generosity might protect people from loneliness. The aim of the study is to explore whether income inequality and welfare generosity at the country level moderate the effect of socioeconomic status at the individual level on late-life loneliness. Data were obtained from the HRS family of surveys - the Survey of Health, Aging and Retirement in Europe (SHARE) (wave 5, 2011/12) and China Health and Retirement Longitudinal Study (CHARLS) (wave 2, 2012/13). Respondents aged 50 years and older from twelve European countries and China were included in the study. Logistic country fixed effect models were used in the analysis. The findings show a stronger effect of individual socioeconomic status on late-life loneliness in more income-unequal societies and a weaker effect in more welfare-generous societies. There is a need to consider the impact of income distribution and welfare spending on the risk of loneliness among those older adults with low socioeconomic status when tailoring preventive programs and interventions to reduce loneliness among this vulnerable group.

Income Inequality and Pregnancy-Associated Homicide in the US: A Longitudinal, State-Level Analysis

Pregnancy-associated homicide remains an understudied yet critical issue. Using restricted use mortality files provided by the National Center for Health Statistics and the National Violent Death Reporting System, annual state-level pregnancy-associated homicide ratios were estimated as the count of deaths divided by the number of live births. The exposure, the state Gini index, was categorized into tertiles to compare states by levels of income inequality. In the final adjusted longitudinal linear model, those who experienced the greatest amount of income inequality had a significant 1.28 per 100,000 homicide rate when compared to the lowest income inequality tertile.

Neighbourhood Income Inequality and General Psychopathology at 3-Years of Age

BACKGROUND

Several studies have linked neighbourhood environment to preschool-aged children's behavioural problems. Income inequality is an identified risk factor for mental health among adolescents, however, little is known as to whether this relationship extends to younger children.

OBJECTIVE

To explore the association between neighbourhood-level income inequality and general psychopathology problems among preschool-aged children.

METHODS

We analyzed data from the All Our Families (AOF) longitudinal cohort located in Calgary, Canada at 3-years postpartum. The analytical sample consisted of 1615 mother-preschooler dyads nested within 184 neighbourhoods. Mothers completed the National Longitudinal Survey of Children and Youth Child Behaviour Checklist (NLSCY-CBCL), which assessed internalizing and externalizing symptoms. Income inequality was assessed via the Gini coefficient, which quantifies the unequal distribution of income in society. Mixed effects linear regression assessed the relationship between neighbourhood income inequality and preschooler's general psychopathology.

RESULTS

The mean Gini coefficient across the 184 neighbourhoods was 0.33 (SD = 0.05; min, max: 0.20-0.56). In the fully adjusted model income inequality was not associated with general psychopathology in children β = 0.07 (95%CI: -0.29, 0.45). Neighbourhood environment accounted for 0.5% of the variance in psychopathology in children.

CONCLUSION

The lack of significant findings may be due to a lack of statistical power in the study. Future studies should investigate this relationship with appropriately powered studies, and over time, to assess if income inequality is a determinant of preschooler psychopathology in Canada.

Income inequality, social cohesion, and crime against businesses: Evidence from a global sample of firms

Rising inequality is one of the grand societal challenges of our time. Yet, its effects on firms - including multinational enterprises (MNEs) - and their operations have not been widely examined by IB scholars. In this study, we posit that income inequality within a country is positively associated with the incidence and severity of crime experienced by businesses. Further, we propose that this relationship will be negatively moderated by social cohesion (in the form of greater societal trust and lower ethno-linguistic fractionalization) in these countries, such that social cohesion helps to offset the negative impacts of inequality on crime against businesses. We test these hypotheses using a comprehensive data set of 114,000 firms from 122 countries and find consistent support for our theses. Our findings, which are robust to different alternative variables, model specifications, instrumentation, and estimation techniques, unpack the intricate ways through which inequality affects businesses worldwide and the associated challenges to MNEs. They also offer important managerial and policy insights regarding the consequences of inequality and potential mitigation mechanisms.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1057/s41267-022-00535-5.

Impacts of the Internet on Health Inequality and Healthcare Access: A Cross-Country Study

Access to information and resources through the Internet has become an increasingly critical aspect of contemporary life. Based on the WHO Health Equity Assessment Toolkit (HEAT) and cross-country panel data, this paper investigates the effect of Internet access on health inequality across different income groups. The results indicate that access to the Internet significantly improves the average health condition and alleviates health inequality. In addition, employing cross-country data from the Global Burden of Disease (GBD) database, this paper further examines the social and economic determinants of access to healthcare. Specifically, it is found that Internet access significantly facilitates healthcare access and mitigates the negative impact of income inequality on healthcare access. Considered together, these findings shed light on the importance of the Internet in reducing health inequality and improving healthcare access.

Income inequality and mobility in geometric Brownian motion with stochastic resetting: theoretical results and empirical evidence of non-ergodicity

We explore the role of non-ergodicity in the relationship between income inequality, the extent of concentration in the income distribution, and income mobility, the feasibility of an individual to change their position in the income rankings. For this purpose, we use the properties of an established model for income growth that includes 'resetting' as a stabilizing force to ensure stationary dynamics. We find that the dynamics of inequality is regime-dependent: it may range from a strictly non-ergodic state where this phenomenon has an increasing trend, up to a stable regime where inequality is steady and the system efficiently mimics ergodicity. Mobility measures, conversely, are always stable over time, but suggest that economies become less mobile in non-ergodic regimes. By fitting the model to empirical data for the income share of the top earners in the USA, we provide evidence that the income dynamics in this country is consistently in a regime in which non-ergodicity characterizes inequality and immobility. Our results can serve as a simple rationale for the observed real-world income dynamics and as such aid in addressing non-ergodicity in various empirical settings across the globe. This article is part of the theme issue 'Kinetic exchange models of societies and economies'.

Adults, Does Sex Matter: 2005-2016

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.

Workplace inequality is associated with status-signaling expenditure

SignificanceScholars have identified that inequality is a notable detriment to well-being. Status-signaling luxury expenditure is taken as a symptom of the reduced well-being associated with income inequality. Despite evidence that status-signaling luxury expenditure is higher in unequal regions, it remains unclear who is affected by inequality. We use payroll and daily spending data from 683,677 individuals in 32,008 precisely-defined workplace peer groups to show that workers at unequal firms spend significantly more on high-status, luxury goods. This is also seen in those with a high absolute salary, but low salary rank within their workplace. Compared to aggregated, regional data, financial data allow us to identify groups of workplace peers and offer precise measurements of status-signaling expenditure for each individual.

Diagnosed Incidence of Non-Affective Psychotic Disorders Amongst Adolescents in British Columbia and Sociodemographic Risk Factors: A Retrospective Cohort Study

OBJECTIVES

To estimate the diagnosed incidence of non-affective psychotic disorder between the ages of 13 and 19 years in South-Western British Columbia (BC) and to examine variation in risk by sex, family and neighbourhood income, family migration background, parent mental health contact and birth year.

METHODS

Linked individual-level administrative data were used to construct a cohort of individuals born in 1990-1998 and residing in South-Western BC (n = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits within 2 years with a primary diagnosis of a non-affective psychotic disorder (ICD-10: F20-29, ICD-9: 295, 297, 298). We estimated cumulative incidence, annual cumulative incidence and incidence rate between the ages of 13 and 19 years, and conducted Cox proportional hazards regression to estimate associations between sociodemographic factors and risk over the study period.

RESULTS

We found that 0.64% of females and 0.88% of males were diagnosed with a non-affective psychotic disorder between the ages of 13 and 19 years, with increasing risk observed over the age range, especially amongst males. Incidence rate over the entire study period was 106 per 100,000 person-years for females and 145 per 100,000 person-years for males. Risk of diagnosis was elevated amongst those in low-income families and neighbourhoods, those with a parent who had a health service contact for a mental disorder, and more recent birth cohorts. Risk was reduced amongst children of immigrants compared to children of non-migrants.

CONCLUSIONS

Findings from this study provide important information for health service planning in South-Western BC. Future work should examine whether variations in diagnosed incidence is driven by differences in health service engagement or reflect genuine differences in risk.