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Sample records for income inequality mortality

  1. Income inequality and socioeconomic gradients in mortality.

    PubMed

    Wilkinson, Richard G; Pickett, Kate E

    2008-04-01

    We investigated whether the processes underlying the association between income inequality and population health are related to those responsible for the socioeconomic gradient in health and whether health disparities are smaller when income differences are narrower. We used multilevel models in a regression analysis of 10 age- and cause-specific US county mortality rates on county median household incomes and on state income inequality. We assessed whether mortality rates more closely related to county income were also more closely related to state income inequality. We also compared mortality gradients in more- and less-equal states. Mortality rates more strongly associated with county income were more strongly associated with state income inequality: across all mortality rates, r= -0.81; P=.004. The effect of state income inequality on the socioeconomic gradient in health varied by cause of death, but greater equality usually benefited both wealthier and poorer counties. Although mortality rates with steep socioeconomic gradients were more sensitive to income distribution than were rates with flatter gradients, narrower income differences benefit people in both wealthy and poor areas and may, paradoxically, do little to reduce health disparities.

  2. Social capital, income inequality, and mortality.

    PubMed Central

    Kawachi, I; Kennedy, B P; Lochner, K; Prothrow-Stith, D

    1997-01-01

    OBJECTIVES: Recent studies have demonstrated that income inequality is related to mortality rates. It was hypothesized, in this study, that income inequality is related to reduction in social cohesion and that disinvestment in social capital is in turn associated with increased mortality. METHODS: In this cross-sectional ecologic study based on data from 39 states, social capital was measured by weighted responses to two items from the General Social Survey: per capita density of membership in voluntary groups in each state and level of social trust, as gauged by the proportion of residents in each state who believed that people could be trusted. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state. RESULTS: Income inequality was strongly correlated with both per capita group membership (r = -.46) and lack of social trust (r = .76). In turn, both social trust and group membership were associated with total mortality, as well as rates of death from coronary heart disease, malignant neoplasms, and infant mortality. CONCLUSIONS: These data support the notion that income inequality leads to increased mortality via disinvestment in social capital. PMID:9314802

  3. Racial segregation, income inequality, and mortality in US metropolitan areas.

    PubMed

    Nuru-Jeter, Amani M; LaVeist, Thomas A

    2011-04-01

    Evidence of the association between income inequality and mortality has been mixed. Studies indicate that growing income inequalities reflect inequalities between, rather than within, racial groups. Racial segregation may play a role. We examine the role of racial segregation on the relationship between income inequality and mortality in a cross-section of US metropolitan areas. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10% black (N = 107). Deaths for the time period 1991-1999 were used to calculate age-adjusted all-cause mortality rates for each metropolitan statistical area (MSA) using direct age-adjustment techniques. Multivariate least squares regression was used to examine associations for the total sample and for blacks and whites separately. Income inequality was associated with lower mortality rates among whites and higher mortality rates among blacks. There was a significant interaction between income inequality and racial segregation. A significant graded inverse income inequality/mortality association was found for MSAs with higher versus lower levels of black-white racial segregation. Effects were stronger among whites than among blacks. A positive income inequality/mortality association was found in MSAs with higher versus lower levels of Hispanic-white segregation. Uncertainty regarding the income inequality/mortality association found in previous studies may be related to the omission of important variables such as racial segregation that modify associations differently between groups. Research is needed to further elucidate the risk and protective effects of racial segregation across groups.

  4. Education, income inequality, and mortality: a multiple regression analysis.

    PubMed

    Muller, Andreas

    2002-01-05

    To test whether the relation between income inequality and mortality found in US states is because of different levels of formal education. Cross sectional, multiple regression analysis. All US states and the District of Columbia (n=51). US census statistics and vital statistics for the years 1989 and 1990. Multiple regression analysis with age adjusted mortality from all causes as the dependent variable and 3 independent variables-the Gini coefficient, per capita income, and percentage of people aged >/=18 years without a high school diploma. The income inequality effect disappeared when percentage of people without a high school diploma was added to the regression models. The fit of the regression significantly improved when education was added to the model. Lack of high school education accounts for the income inequality effect and is a powerful predictor of mortality variation among US states.

  5. Race, Neighborhood Economic Status, Income Inequality and Mortality.

    PubMed

    Mode, Nicolle A; Evans, Michele K; Zonderman, Alan B

    2016-01-01

    Mortality rates in the United States vary based on race, individual economic status and neighborhood. Correlations among these variables in most urban areas have limited what conclusions can be drawn from existing research. Our study employs a unique factorial design of race, sex, age and individual poverty status, measuring time to death as an objective measure of health, and including both neighborhood economic status and income inequality for a sample of middle-aged urban-dwelling adults (N = 3675). At enrollment, African American and White participants lived in 46 unique census tracts in Baltimore, Maryland, which varied in neighborhood economic status and degree of income inequality. A Cox regression model for 9-year mortality identified a three-way interaction among sex, race and individual poverty status (p = 0.03), with African American men living below poverty having the highest mortality. Neighborhood economic status, whether measured by a composite index or simply median household income, was negatively associated with overall mortality (p<0.001). Neighborhood income inequality was associated with mortality through an interaction with individual poverty status (p = 0.04). While racial and economic disparities in mortality are well known, this study suggests that several social conditions associated with health may unequally affect African American men in poverty in the United States. Beyond these individual factors are the influences of neighborhood economic status and income inequality, which may be affected by a history of residential segregation. The significant association of neighborhood economic status and income inequality with mortality beyond the synergistic combination of sex, race and individual poverty status suggests the long-term importance of small area influence on overall mortality.

  6. Race, Neighborhood Economic Status, Income Inequality and Mortality

    PubMed Central

    Mode, Nicolle A; Evans, Michele K; Zonderman, Alan B

    2016-01-01

    Mortality rates in the United States vary based on race, individual economic status and neighborhood. Correlations among these variables in most urban areas have limited what conclusions can be drawn from existing research. Our study employs a unique factorial design of race, sex, age and individual poverty status, measuring time to death as an objective measure of health, and including both neighborhood economic status and income inequality for a sample of middle-aged urban-dwelling adults (N = 3675). At enrollment, African American and White participants lived in 46 unique census tracts in Baltimore, Maryland, which varied in neighborhood economic status and degree of income inequality. A Cox regression model for 9-year mortality identified a three-way interaction among sex, race and individual poverty status (p = 0.03), with African American men living below poverty having the highest mortality. Neighborhood economic status, whether measured by a composite index or simply median household income, was negatively associated with overall mortality (p<0.001). Neighborhood income inequality was associated with mortality through an interaction with individual poverty status (p = 0.04). While racial and economic disparities in mortality are well known, this study suggests that several social conditions associated with health may unequally affect African American men in poverty in the United States. Beyond these individual factors are the influences of neighborhood economic status and income inequality, which may be affected by a history of residential segregation. The significant association of neighborhood economic status and income inequality with mortality beyond the synergistic combination of sex, race and individual poverty status suggests the long-term importance of small area influence on overall mortality. PMID:27171406

  7. Income inequality and cause-specific mortality during economic development.

    PubMed

    Lau, Elaine W; Schooling, C Mary; Tin, Keith Y; Leung, Gabriel M

    2012-04-01

    Life expectancy is strongly related to national income, whether there is an additional contribution of income inequality is unclear. We used negative binomial regression to examine the association of neighborhood-level Gini, adjusted for age, sex, and income, with mortality rates in Hong Kong from 1976 to 2006. The association of neighborhood Gini with all-cause mortality varied over time (p-value for interaction < .01). Neighborhood Gini was positively associated with nonmedical mortality in 1976 to 1986; incident rate ratio (IRR) 1.09, 95% confidence interval (95% CI) 1.02-1.16 per 0.1 change and in 1991 to 2006, IRR 1.24, 95% CI 1.13-1.36, adjusted for age, sex and absolute income. Similarly adjusted, Gini was not associated with all-cause mortality in 1976 to 1986 (IRR 0.96, 95% CI 0.93-1.00) but was in 1991 to 2006 (IRR 1.25, 95% CI 1.20-1.29), when Gini was also positively associated with death from cardiovascular diseases, respiratory diseases and some cancers. Independent of income, income inequality was positively associated with nonmedical mortality rates at a low level of spatial aggregation, indicating the consistent harms of social disharmony. However, the impact on medical mortality was less consistent, suggesting the relevance of contextual factors. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. For whom is income inequality most harmful? A multi-level analysis of income inequality and mortality in Norway.

    PubMed

    Dahl, Espen; Ivar Elstad, Jon; Hofoss, Dag; Martin-Mollard, Melissa

    2006-11-01

    This study investigates the degree to which contextual income inequality in economic regions in Norway affected mortality during the 1990s, above the effects of mean regional income and individual-level confounders. A further objective is to explore whether income inequality effects on mortality differed between socioeconomic groups. Data were constructed by linkages of administrative registers encompassing all Norwegian inhabitants. The outcome variable was all-cause mortality during 6 years (i.e., died 1994-1999 or alive end of 1999). Men and women aged 25-66 in 1993 were analysed. Regions' mean income and income inequality (in terms of gini coefficients) were calculated from consumption-units-adjusted family disposable income. Individual-level variables included sex, age, marital status, individual income, education, and being a recipient of health-related welfare benefits. Multilevel logistic regression models were fitted for 2,197,231 individuals nested within 88 regions. After adjusting for regional mean income and individual-level variables, the odds ratio (OR) for mortality 1994-1999 was 1.028 (95% CI 1.023-1.033) on the gini variable multiplied by 100. Analyses of cross-level interactions indicated some, albeit modest, income inequality effects on mortality in the upper income and educational categories. Among those with low individual income, low education, and among recipients of health-related welfare benefits, mortality effects of higher regional income inequality were significantly stronger than among those more advantageously placed in the social structure. The results of this study differ from previous studies which have suggested that contextual income inequality has a minor impact on population health in egalitarian countries. The results indicate that in Norway, neither a comparatively egalitarian income distribution nor generous and comprehensive welfare institutions hindered the emergence of regional-level income inequality effects on mortality

  9. Inequality in income and mortality in the United States: analysis of mortality and potential pathways.

    PubMed

    Kaplan, G A; Pamuk, E R; Lynch, J W; Cohen, R D; Balfour, J L

    1996-04-20

    To examine the relation between health outcomes and the equality with which income is distributed in the United States. The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. Age adjusted mortality from all causes. There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.

  10. Income inequality and mortality in metropolitan areas of the United States.

    PubMed Central

    Lynch, J W; Kaplan, G A; Pamuk, E R; Cohen, R D; Heck, K E; Balfour, J L; Yen, I H

    1998-01-01

    OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority. Images FIGURE 1 PMID:9663157

  11. Income Inequality and Child Mortality in Wealthy Nations.

    PubMed

    Collison, David

    2016-01-01

    This chapter presents evidence of a relationship between child mortality data and socio-economic factors in relatively wealthy nations. The original study on child mortality that is reported here, which first appeared in a UK medical journal, was undertaken in a school of business by academics with accounting and finance backgrounds. The rationale explaining why academics from such disciplines were drawn to investigate these issues is given in the first part of the chapter. The findings related to child mortality data were identified as a special case of a wide range of social and health indicators that are systematically related to the different organisational approaches of capitalist societies. In particular, the so-called Anglo-American countries show consistently poor outcomes over a number of indicators, including child mortality. Considerable evidence has been adduced in the literature to show the importance of income inequality as an explanation for such findings. An important part of the chapter is the overview of a relatively recent publication in the epidemiological literature entitled The Spirit Level: Why Equality Is Better for Everyone, which was written by Wilkinson and Pickett. © 2016 S. Karger AG, Basel.

  12. Macro-to-micro links in the relation between income inequality and mortality.

    PubMed

    Daly, M C; Duncan, G J; Kaplan, G A; Lynch, J W

    1998-01-01

    A growing literature points to links between income inequality and mortality. Any examination of the link should distinguish, both theoretically and empirically, between shifts in inequality that result from changes in the bottom and top of the income distribution. When state-level data from the U.S. censuses of 1980 and 1990 were used to measure differences in mortality, the results indicated that inequality measures reflecting depth of poverty show stronger correlations with mortality than do inequality measures reflecting heights of affluence. In addition, longitudinal data from the Panel Study of Income Dynamics were used to related state-level inequality measures to individual-level data on mortality. This comparison revealed significant associations between degree of income inequality in state of residence and individual risk of death only for nonelderly individuals with middle-class incomes in 1990.

  13. Poverty or income inequality as predictor of mortality: longitudinal cohort study.

    PubMed Central

    Fiscella, K.; Franks, P.

    1997-01-01

    OBJECTIVE: To determine the effect of inequality in income between communities independent of household income on individual all cause mortality in the United States. DESIGN: Longitudinal cohort study. SUBJECTS: A nationally representative sample of 14,407 people aged 25-74 years in the United States from the first national health and nutrition examination survey. SETTING: Subjects were followed from initial interview in 1971-5 until 1987. Complete follow up information was available for 92.2% of the sample. MAIN OUTCOME MEASURES: Relation between both household income and income inequality in community of residence and individual all cause mortality at follow up was examined with Cox proportional hazards survival analysis. RESULTS: Community income inequality showed a significant association with subsequent community mortality, and with individual mortality after adjustment for age, sex, and mean income in the community of residence. After adjustment for individual household income, however, the association with mortality was lost. CONCLUSIONS: In this nationally representative American sample, family income, but not community income inequality, independently predicts mortality. Previously reported ecological associations between income inequality and mortality may reflect confounding between individual family income and mortality. PMID:9185498

  14. The relationship of income inequality to mortality: does the choice of indicator matter?

    PubMed

    Kawachi, I; Kennedy, B P

    1997-10-01

    Ecologic studies in the U.S. and elsewhere in the world have demonstrated that income inequality is strongly related to mortality and life expectancy: the greater the dispersion of income within a given society, the lower the life expectancy. However, these empirical studies have been criticized on the grounds that the choice of indicator may have influenced positive findings. Using a cross-sectional, ecologic design, we tested the relationships of six different income inequality indicators to total mortality rates in the 50 U.S. states. The following summary measures of income distribution were examined: the Gini coefficient; the decile ratio; the proportions of total income earned by the bottom 50%, 60%, and 70% of households; the Robin Hood Index; the Atkinson Index; and Theil's entropy measure. All were highly correlated with each other (Pearson r > or = 0.94), and all were strongly associated with mortality (Pearson r ranging from 0.50 to 0.66), even after adjustment for median income and poverty. Thus, the choice of income distribution measure does not appear to alter the conclusion that income inequality is linked to higher mortality. Furthermore, adjustment for taxes and transfers, as well as household size (using equivalence scales), made no difference to the income inequality/mortality association. From a policy perspective, the alternative income distribution measures perform differently under varying types of income transfers, so that theoretical considerations should guide the selection of an indicator to assess the impact of social and economic policies that address income inequality.

  15. Income Inequality, Economic Growth and Stroke Mortality in Brazil: Longitudinal and Regional Analysis 2002-2009

    PubMed Central

    2015-01-01

    Background and Purpose Stroke accounts for more than 10% of all deaths globally and most of it occurs in low- and middle-income countries (LMIC). Income inequality and gross domestic product (GDP) per capita has been associated to stroke mortality in developed countries. In LMIC, GDP per capita is considered to be a more relevant health determinant than income inequality. This study aims to investigate if income inequality is associated to stroke mortality in Brazil at large, but also on regional and state levels, and whether GDP per capita modulates the impact of this association. Methods Stroke mortality rates, Gini index and GDP per capita data were pooled for the 2002 to 2009 period from public available databases. Random effects models were fitted, controlling for GDP per capita and other covariates. Results Income inequality was independently associated to stroke mortality rates, even after controlling for GDP per capita and other covariates. GDP per capita reduced only partially the impact of income inequality on stroke mortality. A decrease in 10 points in the Gini index was associated with 18% decrease in the stroke mortality rate in Brazil. Conclusions Income inequality was independently associated to stroke mortality in Brazil. PMID:26352415

  16. Income Inequality, Economic Growth and Stroke Mortality in Brazil: Longitudinal and Regional Analysis 2002-2009.

    PubMed

    Vincens, Natalia; Stafström, Martin

    2015-01-01

    Stroke accounts for more than 10% of all deaths globally and most of it occurs in low- and middle-income countries (LMIC). Income inequality and gross domestic product (GDP) per capita has been associated to stroke mortality in developed countries. In LMIC, GDP per capita is considered to be a more relevant health determinant than income inequality. This study aims to investigate if income inequality is associated to stroke mortality in Brazil at large, but also on regional and state levels, and whether GDP per capita modulates the impact of this association. Stroke mortality rates, Gini index and GDP per capita data were pooled for the 2002 to 2009 period from public available databases. Random effects models were fitted, controlling for GDP per capita and other covariates. Income inequality was independently associated to stroke mortality rates, even after controlling for GDP per capita and other covariates. GDP per capita reduced only partially the impact of income inequality on stroke mortality. A decrease in 10 points in the Gini index was associated with 18% decrease in the stroke mortality rate in Brazil. Income inequality was independently associated to stroke mortality in Brazil.

  17. Income related inequalities in avoidable mortality in Norway: A population-based study using data from 1994-2011.

    PubMed

    Kinge, Jonas Minet; Vallejo-Torres, Laura; Morris, Stephen

    2015-07-01

    The aim of this study was to measure income-related inequalities in avoidable, amenable and preventable mortality in Norway over the period 1994-2011. We undertook a register-based population study of Norwegian residents aged 18-65 years between 1994 and 2011, using data from the Norwegian Income Register and the Cause of Death Registry. Concentration indices were used to measure income-related inequalities in avoidable, amenable and preventable mortality for each year. We compared the trend in income-related inequality in avoidable mortality with the trend in income inequality, measured by the Gini coefficient for income. Avoidable, amenable and preventable deaths in Norway have declined over time. There were persistent pro-poor socioeconomic inequalities in avoidable, amenable and preventable mortality, and the degree of inequality was larger in preventable mortality than in amenable mortality throughout the period. The income-avoidable mortality association was positively correlated with income inequalities in avoidable mortality over time. There was little or no relationship between variations in the Gini coefficient due to tax reforms and socioeconomic inequalities in avoidable mortality. Income-related inequalities in avoidable, amenable and preventable mortality have remained relatively constant between 1994 and 2011 in Norway. They were mainly correlated with the relationship between income and avoidable mortality rather than with variations in the Gini coefficient of income inequality. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Income inequality and mortality: a multilevel prospective study of 521 248 individuals in 50 US states.

    PubMed

    Backlund, Eric; Rowe, Geoff; Lynch, John; Wolfson, Michael C; Kaplan, George A; Sorlie, Paul D

    2007-06-01

    Some of the most consistent evidence in favour of an association between income inequality and health has been among US states. However, in multilevel studies of mortality, only two out of five studies have reported a positive relationship with income inequality after adjustment for the compositional characteristics of the state's inhabitants. In this study, we attempt to clarify these mixed results by analysing the relationship within age-sex groups and by applying a previously unused analytical method to a database that contains more deaths than any multilevel study to date. The US National Longitudinal Mortality Study (NLMS) was used to model the relationship between income inequality in US states and mortality using both a novel and previously used methodologies that fall into the general framework of multilevel regression. We adjust age-sex specific models for nine socioeconomic and demographic variables at the individual level and percentage black and region at the state level. The preponderance of evidence from this study suggests that 1990 state-level income inequality is associated with a 40% differential in state level mortality rates (95% CI = 26-56%) for men 25-64 years and a 14% (95% CI = 3-27%) differential for women 25-64 years after adjustment for compositional factors. No such relationship was found for men or women over 65. The relationship between income inequality and mortality is only robust to adjustment for compositional factors in men and women under 65. This explains why income inequality is not a major driver of mortality trends in the United States because most deaths occur at ages 65 and over. This analysis does suggest, however, the certain causes of death that occur primarily in the population under 65 may be associated with income inequality. Comparison of analytical techniques also suggests coefficients for income inequality in previous multilevel mortality studies may be biased, but further research is needed to provide a definitive

  19. Does higher income inequality adversely influence infant mortality rates? Reconciling descriptive patterns and recent research findings.

    PubMed

    Siddiqi, Arjumand; Jones, Marcella K; Erwin, Paul Campbell

    2015-04-01

    As the struggle continues to explain the relatively high rates of infant mortality (IMR) exhibited in the United States, a renewed emphasis is being placed on the role of possible 'contextual' determinants. Cross-sectional and short time-series studies have found that higher income inequality is associated with higher IMR at the state level. Yet, descriptively, the longer-term trends in income inequality and in IMR seem to call such results into question. To assess whether, over the period 1990-2007, state-level income inequality is associated with state-level IMR; to examine whether the overall effect of income inequality on IMR over this period varies by state; to test whether the association between income inequality and IMR varies across this time period. IMR data--number of deaths per 1000 live births in a given state and year--were obtained from the U.S. Centers for Disease Control Wonder database. Income inequality was measured using the Gini coefficient, which varies from zero (complete equality) to 100 (complete inequality). Covariates included state-level poverty rate, median income, and proportion of high school graduates. Fixed and random effects regressions were conducted to test hypotheses. Fixed effects models suggested that, overall, during the period 1990-2007, income inequality was inversely associated with IMR (β = -0.07, SE (0.01)). Random effects models suggested that when the relationship was allowed to vary at the state-level, it remained inverse (β = -0.05, SE (0.01)). However, an interaction between income inequality and time suggested that, as time increased, the effect of income inequality had an increasingly positive association with total IMR (β = 0.009, SE (0.002)). The influence of state income inequality on IMR is dependent on time, which may proxy for time-dependent aspects of societal context. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Social inequality in infant mortality: what explains variation across low and middle income countries?

    PubMed

    Hajizadeh, Mohammad; Nandi, Arijit; Heymann, Jody

    2014-01-01

    Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household samples (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality.

  1. Decreasing income inequality and emergence of the association between income and premature mortality: Spain, 1970-2010.

    PubMed

    Regidor, Enrique; Santos, Juana M; Ortega, Paloma; Calle, María E; Astasio, Paloma; Martínez, David

    2014-05-01

    This study evaluates the relationship between income and mortality in Spain over a long period of declining in income inequality. The ratio between income in the richest and poorest provinces was 2.74 in 1970 and 2.10 in 2010. Pearson correlation coefficients for the association between provincial income and the measures of mortality were estimated, as well as absolute and relative differences between the mortality rates of the poorest and richest provinces. The correlation coefficient between income and infant mortality decreased from -0.59 in 1970 to -0.17 in 2010, and lost significance from 1995 onwards. The coefficient for premature all-cause mortality increased from -0.04 in 1970 to -0.40 in 2010, and acquired significance beginning in 2005. The coefficient also increased in mortality from cardiovascular, respiratory and digestive diseases. No association was found between provincial income and cancer mortality or mortality from injuries. The findings on premature mortality do not support the theory that decreasing income inequality will lead to reduced inequalities in mortality. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Is Income Inequality a Determinant of Population Health? Part 2. U.S. National and Regional Trends in Income Inequality and Age- and Cause-Specific Mortality

    PubMed Central

    Lynch, John; Smith, George Davey; Harper, Sam; Hillemeier, Marianne

    2004-01-01

    This article describes U.S. income inequality and 100-year national and 30-year regional trends in age- and cause-specific mortality. There is little congruence between national trends in income inequality and age- or cause-specific mortality except perhaps for suicide and homicide. The variable trends in some causes of mortality may be associated regionally with income inequality. However, between 1978 and 2000 those regions experiencing the largest increases in income inequality had the largest declines in mortality (r= 0.81, p < 0.001). Understanding the social determinants of population health requires appreciating how broad indicators of social and economic conditions are related, at different times and places, to the levels and social distribution of major risk factors for particular health outcomes. PMID:15225332

  3. Housing, income inequality and child injury mortality in Europe: a cross-sectional study.

    PubMed

    Sengoelge, M; Hasselberg, M; Ormandy, D; Laflamme, L

    2014-03-01

    Child poverty rates are compared throughout Europe to monitor how countries are caring for their children. Child poverty reduction measures need to consider the importance of safe living environments for all children. In this study we investigate how European country-level economic disparity and housing conditions relate to one another, and whether they differentially correlate with child injury mortality. We used an ecological, cross-sectional study design of 26 European countries of which 20 high-income and 6 upper-middle-income. Compositional characteristics of the home and its surroundings were extracted from the 2006 European Union Income Social Inclusion and Living Conditions Database (n = 203,000). Mortality data of children aged 1-14 years were derived from the World Health Organization Mortality Database. The main outcome measure was age standardized cause-specific injury mortality rates analysed by income inequality and housing and neighbourhood conditions. Nine measures of housing and neighbourhood conditions highly differentiating European households at country level were clustered into three dimensions, labelled respectively housing, neighbourhood and economic household strain. Income inequality significantly and positively correlated with housing strain (r = 0.62, P = 0.001) and household economic strain (r = 0.42, P = 0.009) but not significantly with neighbourhood strain (r = 0.34, P = 0.087). Child injury mortality rates correlated strongly with both country-level income inequality and housing strain, with very small age-specific differences. In the European context housing, neighbourhood and household economic strains worsened with increasing levels of income inequality. Child injury mortality rates are strongly and positively associated with both income inequality and housing strain, suggesting that housing material conditions could play a role in the association between income inequality and child health. © 2013 John Wiley & Sons Ltd.

  4. The association between income inequality and all-cause mortality across urban communities in Korea.

    PubMed

    Park, Jong; Ryu, So-Yeon; Han, Mi-ah; Choi, Seong-Woo

    2015-06-20

    Korea has achieved considerable economic growth more rapidly than most other countries, but disparities in income level have increased. Therefore, we sought to assess the association between income inequality and mortality across Korean cities. Data on household income were obtained from the 2010-2012 Korean Community Health Survey and data on all-cause mortality and other covariates were obtained from the Korean Statistical Information Service. The Gini coefficient, Robin Hood index, and income share ratio between the 80th and 20th percentiles of the distribution were measured for each community. After excluding communities affected by changes in administrative districts between 2010 and 2012, a total of 157 communities and 172,398 urban residents were included in the analysis. When we graphed income inequality measures versus all-cause mortality as scatter plots, the R square values of the regression lines for GC, RHI, and 80/20 ratios relative to mortality were 0.230, 0.238, and 0.152, respectively. After adjusting for other covariates and median household income, mean all-cause mortality increased significantly with increasing GC (P for trend = 0.014) and RHI (P for trend = 0.031), and increased marginally with 80/20 ratio (P for trend = 0.067). Our data demonstrate that income inequality measures are significantly associated with all-cause mortality rate after adjustment for covariates, including median household income across urban communities in Korea.

  5. A Swiss paradox? Higher income inequality of municipalities is associated with lower mortality in Switzerland.

    PubMed

    Clough-Gorr, Kerri M; Egger, Matthias; Spoerri, Adrian

    2015-08-01

    It has long been surmised that income inequality within a society negatively affects public health. However, more recent studies suggest there is no association, especially when analyzing small areas. This study aimed to evaluate the effect of income inequality on mortality in Switzerland using the Gini index on municipality level. The study population included all individuals >30 years at the 2000 Swiss census (N = 4,689,545) living in 2,740 municipalities with 35.5 million person-years of follow-up and 456,211 deaths over follow-up. Cox proportional hazard regression models were adjusted for age, gender, marital status, nationality, urbanization, and language region. Results were reported as hazard ratios (HR) with 95% confidence intervals. The mean Gini index across all municipalities was 0.377 (standard deviation 0.062, range 0.202-0.785). Larger cities, high-income municipalities and tourist areas had higher Gini indices. Higher income inequality was consistently associated with lower mortality risk, except for death from external causes. Adjusting for sex, marital status, nationality, urbanization and language region only slightly attenuated effects. In fully adjusted models, hazards of all-cause mortality by increasing Gini index quintile were HR = 0.99 (0.98-1.00), HR = 0.98 (0.97-0.99), HR = 0.95 (0.94-0.96), HR = 0.91 (0.90-0.92) compared to the lowest quintile. The relationship of income inequality with mortality in Switzerland is contradictory to what has been found in other developed high-income countries. Our results challenge current beliefs about the effect of income inequality on mortality on small area level. Further investigation is required to expose the underlying relationship between income inequality and population health.

  6. Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis.

    PubMed

    McKinnon, Britt; Harper, Sam; Kaufman, Jay S; Bergevin, Yves

    2014-03-01

    Neonatal mortality rates (NMRs) in countries of low and middle income have been only slowly decreasing; coverage of essential maternal and newborn health services needs to increase, particularly for disadvantaged populations. Our aim was to produce comparable estimates of changes in socioeconomic inequalities in NMR in the past two decades across these countries. We used data from Demographic and Health Surveys (DHS) for countries in which a survey was done in 2008 or later and one about 10 years previously. We measured absolute inequalities with the slope index of inequality and relative inequalities with the relative index of inequality. We used an asset-based wealth index and maternal education as measures of socioeconomic position and summarised inequality estimates for all included countries with random-effects meta-analysis. 24 low-income and middle-income countries were eligible for inclusion. In most countries, absolute and relative wealth-related and educational inequalities in NMR decreased between survey 1 and survey 2. In five countries (Cameroon, Nigeria, Malawi, Mozambique, and Uganda), the difference in NMR between the top and bottom of the wealth distribution was reduced by more than two neonatal deaths per 1000 livebirths per year. By contrast, wealth-related inequality increased by more than 1·5 neonatal deaths per 1000 livebirths per year in Ethiopia and Cambodia. Patterns of change in absolute and relative educational inequalities in NMR were similar to those of wealth-related NMR inequalities, although the size of educational inequalities tended to be slightly larger. Socioeconomic inequality in NMR seems to have decreased in the past two decades in most countries of low and middle income. However, a substantial survival advantage remains for babies born into wealthier households with a high educational level, which should be considered in global efforts to further reduce NMR. Canadian Institutes of Health Research. Copyright © 2014 Mc

  7. Income inequality, life expectancy and cause-specific mortality in 43 European countries, 1987-2008: a fixed effects study.

    PubMed

    Hu, Yannan; van Lenthe, Frank J; Mackenbach, Johan P

    2015-08-01

    Whether income inequality is related to population health is still open to debate. We aimed to critically assess the relationship between income inequality and mortality in 43 European countries using comparable data between 1987 and 2008, controlling for time-invariant and time-variant country-level confounding factors. Annual data on income inequality, expressed as Gini index based on net household income, were extracted from the Standardizing the World Income Inequality Database. Data on life expectancy at birth and age-standardized mortality by cause of death were obtained from the Human Lifetable Database and the World Health Organization European Health for All Database. Data on infant mortality were obtained from the United Nations World Population Prospects Database. The relationships between income inequality and mortality indicators were studied using country fixed effects models, adjusted for time trends and country characteristics. Significant associations between income inequality and many mortality indicators were found in pooled cross-sectional regressions, indicating higher mortality in countries with larger income inequalities. Once the country fixed effects were added, all associations between income inequality and mortality indicators became insignificant, except for mortality from external causes and homicide among men, and cancers among women. The significant results for homicide and cancers disappeared after further adjustment for indicators of democracy, education, transition to national independence, armed conflicts, and economic freedom. Cross-sectional associations between income inequality and mortality seem to reflect the confounding effects of other country characteristics. In a European context, national levels of income inequality do not have an independent effect on mortality.

  8. Longitudinal Relation of Community-Level Income Inequality and Mortality in Costa Rica

    PubMed Central

    Modrek, Sepideh; Ahern, Jennifer

    2011-01-01

    The controversy regarding the direct relationship between income distribution and health remains unresolved. Empirical evidence has often failed to advance our understanding because in the countries studied there was limited ability to distinguish hypotheses. This study examines the relation between inequality and mortality in the context of Costa Rica. Costa Rica’s unique social and political structure makes confounding through resource and political channels less likely, thus any effects would work predominantly through direct psychosocial channels. Using mortality data extracted from the Vital Statistics Registry, we evaluate the longitudinal relations between income inequality and cause-specific mortality in Costa Rica from 1989–2005. For those aged 15–60, results indicate that there is a significant adverse relation between increases in lagged inequality and mortality from liver disease, and marginal adverse relations with mortality from diabetes and suicide. For those aged 60 and over, there is a limited evidence of a relation between inequality and health. These results suggest increases in inequality may impact health behavior of the working aged population in Costa Rica. PMID:21873102

  9. The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities.

    PubMed

    Ronzio, C R; Pamuk, E; Squires, G D

    2004-03-01

    To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities. Cross sectional ecological study. All cause death rates and death rates attributable to preventable or immediate causes for people under age 75. PREDICTOR MEASURES: Income inequality, city spending, and social factors. All central cities in the US with population equal to or greater than 100 000. Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads. Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time.

  10. The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities

    PubMed Central

    Ronzio, C; Pamuk, E; Squires, G

    2004-01-01

    Objective: To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities. Design: Cross sectional ecological study. Outcome measures: All cause death rates and death rates attributable to preventable or immediate causes for people under age 75. Predictor measures: Income inequality, city spending, and social factors. Setting: All central cities in the US with population equal to or greater than 100 000. Results: Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads. Conclusions: Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time. PMID:14966226

  11. The relationship between primary care, income inequality, and mortality in US States, 1980-1995.

    PubMed

    Shi, Leiyu; Macinko, James; Starfield, Barbara; Wulu, John; Regan, Jerri; Politzer, Robert

    2003-01-01

    This study tests the robustness of the relationships between primary care, income inequality, and population health by (1) assessing the relationship during 4 time periods-1980, 1985, 1990 and 1995; (2) examining the independent effect of components of the primary care physician supply; (3) using 2 different measures of income inequality (Robin Hood index and Gini coefficient); and (4) testing the robustness of the association by using 5-year time-lagged independent variables. Data are derived from the Compressed Mortality Files, the US Department of Commerce and the Census Bureau, the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the American Medical Association Physician Master File. The unit of analysis was the 50 US states over a 15-year period. Ecological, cross-sectional design for 4 selected years (1980, 1985, 1990, 1995), and incorporating 5-year time-lagged independent variables. The main outcome measure is age-standardized, all-cause mortality per 100,000 population in all 50 US states in all 4 time periods. The study used secondary data from publicly available data sets. The CDC WONDER/PC software was used to obtain mortality data and directly standardize them for age to the 1980 US population. Data used to calculate the income inequality measure came from the US census population and housing summary tapes for the years 1980 to 1995. Counts of the number of households that fell into each income interval along with the total aggregate income and the median household income were obtained for each state. The Gini coefficient for each state was calculated using software developed for this purpose. In weighted multivariate regressions, both contemporaneous and time-lagged income inequality measures (Gini coefficient, Robin Hood Index) were significantly associated with all-cause mortality (P <.05 for both measures for all time periods). Contemporaneous and time-lagged primary care physician-to-population ratios

  12. Do racial inequities in infant mortality correspond to variations in societal conditions? A study of state-level income inequality in the U.S., 1992-2007.

    PubMed

    Siddiqi, Arjumand; Jones, Marcella K; Bruce, Donald J; Erwin, Paul C

    2016-09-01

    Prior studies have examined the association between income inequality and overall infant mortality rates (IMR). We examine effects of income inequality on racial inequities in IMR over the period 1992-2007 in the U.S. Race-specific state IMR data were obtained from 1992 to 2007, from which absolute and relative IMR inequities were calculated. Fixed and random effects models, adjusted for state-level median income, percent poverty, percent high school graduates, and unemployment rate, were used to determine contemporaneous and lagged state-level associations between income inequality and racial IMR inequities. Racial IMR inequities varied significantly across the U.S. Contemporaneous income inequality was negatively associated with white IMR only. Two-year lagged income inequality was negatively associated with black IMR and had the most pronounced effect on racial inequities in IMR. Future studies should consider lagged effects of income inequality on IMR and other health outcomes, and should examine other potential societal conditions that may account for state-level variations in racial IMR inequities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Distinguishing the race-specific effects of income inequality and mortality in U.S. metropolitan areas.

    PubMed

    Nuru-Jeter, Amani M; Williams, T; LaVeist, Thomas A

    2014-01-01

    In the United States, the association between income inequality and mortality has been fairly consistent. However, few studies have explicitly examined the impact of race. Studies that have either stratified outcomes by race or conducted analyses within race-specific groups suggest that the income inequality/mortality relation may differ for blacks and whites. The factors explaining the association may also differ for the two groups. Multivariate ordinary least squares regression analysis was used to examine associations between study variables. We used three measures of income inequality to examine the association between income inequality and age-adjusted all-cause mortality among blacks and whites separately. We also examined the role of racial residential segregation and concentrated poverty in explaining associations among groups. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10 percent black. There was a positive income inequality/mortality association among blacks and an inverse association among whites. Racial residential segregation completely attenuated the income inequality/mortality relationship for blacks, but was not significant among whites. Concentrated poverty was a significant predictor of mortality rates in both groups but did not confound associations. The implications of these findings and directions for future research are discussed.

  14. Income inequality and income segregation.

    PubMed

    Reardon, Sean F; Bischoff, Kendra

    2011-01-01

    This article investigates how the growth in income inequality from 1970 to 2000 affected patterns of income segregation along three dimensions: the spatial segregation of poverty and affluence, race-specific patterns of income segregation, and the geographic scale of income segregation. The evidence reveals a robust relationship between income inequality and income segregation, an effect that is larger for black families than for white families. In addition, income inequality affects income segregation primarily through its effect on the large-scale spatial segregation of affluence rather than by affecting the spatial segregation of poverty or by altering small-scale patterns of income segregation.

  15. Does the socioeconomic context explain both mortality and income inequality? Prospective register-based study of Norwegian regions

    PubMed Central

    2011-01-01

    Background Studies from various countries have observed worse population health in geographical areas with more income inequality. The psychosocial interpretation of this association is that large income disparities are harmful to health because they generate relative deprivation and undermine social cohesion. An alternative explanation contends that the association between income inequality and ill health arises because the underlying social and economic structures will influence both the level of illness and disease and the size of income differences. This paper examines whether the observed association between mortality and income inequality in Norwegian regions can be accounted for by the socioeconomic characteristics of the regions. Methods Norwegian register data covering the entire population were utilised. An extensive set of contextual and individual predictors were included in multilevel Poisson regression analyses of mortality 1994-2003 among 1.6 millions individuals born 1929-63, distributed across 35 residential regions. Results Mean income, composition of economic branches, and percentage highly educated in the regions were clearly connected to the level of income inequality. These social and economic characteristics of the regions were also markedly related to regional mortality levels, after adjustment for population composition, i.e., the individual-level variables. Moreover, regional mortality was significantly higher in regions with larger income disparities. The regions' social and economic structure did not, however, account for the association between regional income inequality and mortality. A distinct independent effect of income inequality on mortality remained after adjustment for regional-level social and economic characteristics. Conclusions The results indicate that the broader socioeconomic context in Norwegian regions has a substantial impact both on mortality and on the level of income disparities. However, the results also suggest

  16. Income inequality and happiness.

    PubMed

    Oishi, Shigehiro; Kesebir, Selin; Diener, Ed

    2011-09-01

    Using General Social Survey data from 1972 to 2008, we found that Americans were on average happier in the years with less national income inequality than in the years with more national income inequality. We further demonstrated that this inverse relation between income inequality and happiness was explained by perceived fairness and general trust. That is, Americans trusted other people less and perceived other people to be less fair in the years with more national income inequality than in the years with less national income inequality. The negative association between income inequality and happiness held for lower-income respondents, but not for higher-income respondents. Most important, we found that the negative link between income inequality and the happiness of lower-income respondents was explained not by lower household income, but by perceived unfairness and lack of trust.

  17. Propensity score matching approach to test the association of income inequality and mortality in Sao Paulo, Brazil.

    PubMed

    Chiavegatto Filho, Alexandre Dias Porto; Kawachi, Ichiro; Gotlieb, Sabina Léa Davidson

    2012-01-01

    Support for the adverse effect of high income inequality on population health has come from studies that focus on larger areas, such as the US states, while studies at smaller geographical areas (eg, neighbourhoods) have found mixed results. We used propensity score matching to examine the relationship between income inequality and mortality rates across 96 neighbourhoods (distritos) of the municipality of São Paulo, Brazil. Prior to matching, higher income inequality distritos (Gini ≥ 0.25) had slightly lower overall mortality rates (2.23 per 10,000, 95% CI -23.92 to 19.46) compared to lower income inequality areas (Gini <0.25). After propensity score matching, higher inequality was associated with a statistically significant higher mortality rate (41.58 per 10,000, 95% CI 8.85 to 73.3). In São Paulo, the more egalitarian communities are among some of the poorest, with the worst health profiles. Propensity score matching was used to avoid inappropriate comparisons between the health status of unequal (but wealthy) neighbourhoods versus equal (but poor) neighbourhoods. Our methods suggest that, with proper accounting of heterogeneity between areas, income inequality is associated with worse population health in São Paulo.

  18. Dimensions of Social Inequality in the Third World: A Cross-National Analysis of Income Inequaltiy and Mortality Decline.

    ERIC Educational Resources Information Center

    Crenshaw, Edward; Ameen, Ansari

    1993-01-01

    This cross-national assessment of the empirical determinants of income inequality and infant mortality employs policy-relevant variables suggested by the major macrosocial theory of development and stratification. Findings indicate that modernization and ecological-evolutionary theories provide more consistent explanations of social inequalities…

  19. Dimensions of Social Inequality in the Third World: A Cross-National Analysis of Income Inequaltiy and Mortality Decline.

    ERIC Educational Resources Information Center

    Crenshaw, Edward; Ameen, Ansari

    1993-01-01

    This cross-national assessment of the empirical determinants of income inequality and infant mortality employs policy-relevant variables suggested by the major macrosocial theory of development and stratification. Findings indicate that modernization and ecological-evolutionary theories provide more consistent explanations of social inequalities…

  20. Do Socioeconomic Inequalities in Neonatal Mortality Reflect Inequalities in Coverage of Maternal Health Services? Evidence from 48 Low- and Middle-Income Countries.

    PubMed

    McKinnon, Britt; Harper, Sam; Kaufman, Jay S

    2016-02-01

    To examine socioeconomic and health system determinants of wealth-related inequalities in neonatal mortality rates (NMR) across 48 low- and middle-income countries. We used data from Demographic and Health Surveys conducted between 2006 and 2012. Absolute and relative inequalities for NMR and coverage of antenatal care, facility-based delivery, and Caesarean delivery were measured using the Slope Index of Inequality and Relative Index of Inequality, respectively. Meta-regression was used to assess whether variation in the magnitude of NMR inequalities was associated with inequalities in coverage of maternal health services, and whether country-level economic and health system factors were associated with mean NMR and socioeconomic inequality in NMR. Of the three maternal health service indicators examined, the magnitude of socioeconomic inequality in NMR was most strongly related to inequalities in antenatal care. NMR inequality was greatest in countries with higher out-of-pocket health expenditures, more doctors per capita, and a higher adolescent fertility rate. Determinants of lower mean NMR (e.g., higher government health expenditures and a greater number of nurses/midwives per capita) differed from factors associated with lower NMR inequality. Reducing the financial burden of maternal health services and achieving universal coverage of antenatal care may contribute to a reduction in socioeconomic differences in NMR. Further investigation of the mechanisms contributing to these cross-national associations seems warranted.

  1. Stagnant Neonatal Mortality and Persistent Health Inequality in Middle-Income Countries: A Case Study of the Philippines

    PubMed Central

    Kraft, Aleli D.; Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Hodge, Andrew

    2013-01-01

    Background The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality. Methodology Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Findings Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. Conclusion The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child

  2. Growing gaps: The importance of income and family for educational inequalities in mortality among Swedish men and women 1990-2009.

    PubMed

    Östergren, Olof

    2015-08-01

    Although absolute levels of mortality have decreased among Swedish men and women in recent decades, educational inequalities in mortality have increased, especially among women. The aim of this study is to disentangle the role of income and family type in educational inequalities in mortality in Sweden during 1990-2009, focusing on gender differences. Data on individuals born in Sweden between the ages of 30 and 74 years were collected from total population registries, covering a total of 529,275 deaths and 729 million person-months. Temporary life expectancies (age 30-74 years) by education were calculated using life tables, and rate ratios were estimated with Poisson regression with robust standard errors. Temporary life expectancy improved among all groups except low educated women. Relative educational inequalities in mortality (RRs) increased from 1.79 to 1.98 among men and from 1.78 to 2.10 among women. Variation in family type explained some of the inequalities among men, but not among women, and did not contribute to the trend. Variation in income explained a larger part of the educational inequalities among men compared to women and also explained the increase in educational inequalities in mortality among men and women. Increasing educational inequalities in mortality in Sweden may be attributed to the increase in income inequalities in mortality. © 2015 the Nordic Societies of Public Health.

  3. The associations between US state and local social spending, income inequality, and individual all-cause and cause-specific mortality: The National Longitudinal Mortality Study.

    PubMed

    Kim, Daniel

    2016-03-01

    To investigate government state and local spending on public goods and income inequality as predictors of the risks of dying. Data on 431,637 adults aged 30-74 and 375,354 adults aged 20-44 in the 48 contiguous US states were used from the National Longitudinal Mortality Study to estimate the impacts of state and local spending and income inequality on individual risks of all-cause and cause-specific mortality for leading causes of death in younger and middle-aged adults and older adults. To reduce bias, models incorporated state fixed effects and instrumental variables. Each additional $250 per capita per year spent on welfare predicted a 3-percentage point (-0.031, 95% CI: -0.059, -0.0027) lower probability of dying from any cause. Each additional $250 per capita spent on welfare and education predicted 1.6-percentage point (-0.016, 95% CI: -0.031, -0.0011) and 0.8-percentage point (-0.008, 95% CI: -0.0156, -0.00024) lower probabilities of dying from coronary heart disease (CHD), respectively. No associations were found for colon cancer or chronic obstructive pulmonary disease; for diabetes, external injury, and suicide, estimates were inverse but modest in magnitude. A 0.1 higher Gini coefficient (higher income inequality) predicted 1-percentage point (0.010, 95% CI: 0.0026, 0.0180) and 0.2-percentage point (0.002, 95% CI: 0.001, 0.002) higher probabilities of dying from CHD and suicide, respectively. Empirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, particularly from CHD and all causes combined. State-level income inequality predicted higher risks of dying from CHD and suicide. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.

  4. Regional differences of standardised mortality rates for ischemic heart diseases in the Slovak Republic for the period 1996-2013 in the context of income inequality.

    PubMed

    Gavurová, Beáta; Vagašová, Tatiana

    2016-12-01

    The aim of paper is to analyse the development of standardised mortality rates for ischemic heart diseases in relation to the income inequality in the regions of Slovakia. This paper assesses different types of income indicators, such as mean equivalised net income per household, Gini coefficient, unemployment rate, at risk of poverty threshold (60 % of national median), S80/S20 and their effect on mortality. Using data from the Slovak mortality database 1996-2013, the method of direct standardisation was applied to eliminate variances resulted from differences in age structures of the population across regions and over time. To examine the relationships between income indicators and standardised mortality rates, we used the tools of descriptive statistics and methods of correlation and regression analysis. At first, we show that Slovakia has the worst values of standardised mortality rates for ischemic heart diseases in EU countries. Secondly, mortality rates are significantly higher for males compared with females. Thirdly, mortality rates are improving from Eastern Slovakia to Western Slovakia; additionally, high differences in the results of variability are seen among Slovak regions. Finally, the unemployment rate, the poverty rate and equivalent disposable income were statistically significant income indicators. Main contribution of paper is to demonstrate regional differences between mortality and income inequality, and to point out the long-term unsatisfactory health outcomes.

  5. Income inequality in today's China.

    PubMed

    Xie, Yu; Zhou, Xiang

    2014-05-13

    Using multiple data sources, we establish that China's income inequality since 2005 has reached very high levels, with the Gini coefficient in the range of 0.53-0.55. Analyzing comparable survey data collected in 2010 in China and the United States, we examine social determinants that help explain China's high income inequality. Our results indicate that a substantial part of China's high income inequality is due to regional disparities and the rural-urban gap. The contributions of these two structural forces are particularly strong in China, but they play a negligible role in generating the overall income inequality in the United States, where individual-level and family-level income determinants, such as family structure and race/ethnicity, play a much larger role.

  6. Global variance in female population height: the influence of education, income, human development, life expectancy, mortality and gender inequality in 96 nations.

    PubMed

    Mark, Quentin J

    2014-01-01

    Human height is a heritable trait that is known to be influenced by environmental factors and general standard of living. Individual and population stature is correlated with health, education and economic achievement. Strong sexual selection pressures for stature have been observed in multiple diverse populations, however; there is significant global variance in gender equality and prohibitions on female mate selection. This paper explores the contribution of general standard of living and gender inequality to the variance in global female population heights. Female population heights of 96 nations were culled from previously published sources and public access databases. Factor analysis with United Nations international data on education rates, life expectancy, incomes, maternal and childhood mortality rates, ratios of gender participation in education and politics, the Human Development Index (HDI) and the Gender Inequality Index (GII) was run. Results indicate that population heights vary more closely with gender inequality than with population health, income or education.

  7. Educational Inequality and Income Inequality: An Empirical Study on China

    ERIC Educational Resources Information Center

    Yang, Jun; Huang, Xiao; Li, Xiaoyu

    2009-01-01

    Based on the endogenous growth theory, this paper uses the Gini coefficient to measure educational inequality and studies the empirical relationship between educational inequality and income inequality through a simultaneous equation model. The results show that: (1) Income inequality leads to educational inequality while the reduction of…

  8. Educational Inequality and Income Inequality: An Empirical Study on China

    ERIC Educational Resources Information Center

    Yang, Jun; Huang, Xiao; Li, Xiaoyu

    2009-01-01

    Based on the endogenous growth theory, this paper uses the Gini coefficient to measure educational inequality and studies the empirical relationship between educational inequality and income inequality through a simultaneous equation model. The results show that: (1) Income inequality leads to educational inequality while the reduction of…

  9. Standardised mortality rate for cerebrovascular diseases in the Slovak Republic from 1996 to 2013 in the context of income inequalities and its international comparison.

    PubMed

    Gavurová, Beáta; Kováč, Viliam; Vagašová, Tatiana

    2017-12-01

    Non-communicable diseases represent one of the greatest challenges for health policymakers. The main objective of this study is to analyse the development of standardised mortality rates for cerebrovascular disease, which is one of the most common causes of deaths, in relation to income inequality in individual regions of the Slovak Republic. Direct standardisation was applied using data from the Slovak mortality database, covering the time period from 1996 to 2013. The standardised mortality rate declined by 4.23% in the Slovak Republic. However, since 1996, the rate has been higher by almost 33% in men than in women. Standardised mortality rates were lower in the northern part of the Slovak Republic than in the southern part. The regression models demonstrated an impact of the observed income-related dimensions on these rates. The income quintile ratio and Gini coefficient appeared to be the most influencing variables. The results of the analysis highlight valuable baseline information for creating new support programmes aimed at eliminating health inequalities in relation to health and social policy.

  10. Regional inequalities in mortality.

    PubMed Central

    Illsley, R; Le Grand, J

    1993-01-01

    STUDY OBJECTIVE--To examine the hypothesis of sustained and persistent inequalities in health between British regions and to ask how far they are a consequence of using standardised mortality ratios as the tool of measurement. DESIGN, SETTING AND PARTICIPANTS--Data are regional, age specific death rates at seven points in time from 1931 to 1987-89 for the British regions, reconstructed to make them comparable with the 1981 regional definitions. Log variance is used to measure inequality; regional rankings are also used. MEASUREMENTS AND MAIN RESULTS--There has been a substantial convergence in age specific death rates between regions in younger but not in older age groups. In younger age groups the historic north/south gradient has disappeared; it persists in older groups. CONCLUSIONS--Use of standardised mortality ratios obscures differences in the convergence rates of age specific death rates between regions. Simple conclusions about the persistence of a north/south divide are not justified. Different processes of change seem to be at work in different age groups. PMID:8120497

  11. Retirement Patterns and Income Inequality

    ERIC Educational Resources Information Center

    Fasang, Anette Eva

    2012-01-01

    How do social policies shape life courses, and which consequences do different life course patterns hold for individuals? This article engages the example of retirement in Germany and Britain to analyze life course patterns and their consequences for income inequality. Sequence analysis is used to measure retirement trajectories. The liberal…

  12. Retirement Patterns and Income Inequality

    ERIC Educational Resources Information Center

    Fasang, Anette Eva

    2012-01-01

    How do social policies shape life courses, and which consequences do different life course patterns hold for individuals? This article engages the example of retirement in Germany and Britain to analyze life course patterns and their consequences for income inequality. Sequence analysis is used to measure retirement trajectories. The liberal…

  13. Do people die from income inequality of a decade ago?

    PubMed

    Zheng, Hui

    2012-07-01

    The long-term impact of income inequality on health has not been fully explored in the current literature. Until now, 4 studies have examined the lagged effect on population/group mortality rate at the aggregate level, and 7 studies have investigated the effect of income inequality on subsequent individual mortality risk within a restricted time period. These 11 studies suffer from the same limitation: they do not simultaneously control for a series of preceding income inequalities. The results of these studies are also mixed. Using the U.S. National Health Interview Survey data 1986-2004 with mortality follow-up data 1986-2006 (n = 701,179), this study investigates the lagged effects of national-level income inequality on individual mortality risk. These effects are tested by using a discrete-time hazard model where contemporaneous and preceding income inequalities are treated as time-varying person-specific covariates, which then track a series of income inequalities that a respondent faces from the survey year until s/he dies or is censored. Findings suggest that income inequality did not have an instantaneous detrimental effect on individual mortality risk, but began exerting its influence 5 years later. This effect peaked at 7 years, and then diminished after 12 years. This pattern generally held for three measures of income inequality: the Gini coefficient, the Atkinson index, and the Theil entropy index. The findings suggest that income inequality has a long-term detrimental impact on individual mortality risk. This study also explains discrepancies in the existant literature. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Income inequality, trust, and population health in 33 countries.

    PubMed

    Elgar, Frank J

    2010-11-01

    I examined the association between income inequality and population health and tested whether this association was mediated by interpersonal trust or public expenditures on health. Individual data on trust were collected from 48 641 adults in 33 countries. These data were linked to country data on income inequality, public health expenditures, healthy life expectancy, and adult mortality. Regression analyses tested for statistical mediation of the association between income inequality and population health outcomes by country differences in trust and health expenditures. Income inequality correlated with country differences in trust (r = -0.51), health expenditures (r = -0.45), life expectancy (r = -0.74), and mortality (r = 0.55). Trust correlated with life expectancy (r = 0.48) and mortality (r = -0.47) and partly mediated their relations to income inequality. Health expenditures did not correlate with life expectancy and mortality, and health expenditures did not mediate links between inequality and health. Income inequality might contribute to short life expectancy and adult mortality in part because of societal differences in trust. Societies with low levels of trust may lack the capacity to create the kind of social supports and connections that promote health and successful aging.

  15. The Relationship between Income Inequality and Inequality in Schooling

    ERIC Educational Resources Information Center

    Mayer, Susan E.

    2010-01-01

    Children of affluent parents get more schooling than children of poor parents, which seems to imply that reducing income inequality would reduce inequality in schooling. Similarly, one of the best predictors of an individual's income is his educational attainment, which seems to imply that reducing inequality in schooling will reduce income…

  16. The Relationship between Income Inequality and Inequality in Schooling

    ERIC Educational Resources Information Center

    Mayer, Susan E.

    2010-01-01

    Children of affluent parents get more schooling than children of poor parents, which seems to imply that reducing income inequality would reduce inequality in schooling. Similarly, one of the best predictors of an individual's income is his educational attainment, which seems to imply that reducing inequality in schooling will reduce income…

  17. The role of city income inequality, sex ratio and youth mortality rates in the effect of violent victimization on health-risk behaviors in Brazilian adolescents.

    PubMed

    Ramos, Dandara de Oliveira; Daly, Martin; Seidl-de-Moura, Maria Lucia; Nadanovsky, Paulo

    2017-03-27

    This study integrates insights from evolutionary psychology and social epidemiology to present a novel approach to contextual effects on health-risk behaviors (unprotected sex, drunkenness episodes, drugs and tobacco experimentation) among adolescents. Using data from the 2012 Brazilian National Survey of Adolescent Health (PeNSE), we first analyzed the effects of self-reported violent victimization on health-risk behaviors of 47,371 adolescents aged 10-19 nested in the 26 Brazilian state capitals and the Federal District. We then explored whether the magnitude of these associations was correlated with cues of environmental harshness and unpredictability (youth external mortality and income inequality) and mating competition (sex ratio) from the city level. Results indicated that self-reported violent victimization is associated with an increased chance of engagement in health-risk behaviors in all Brazilian state capitals, for both males and females, but the magnitude of these associations varies in relation to broader environmental factors, such as the cities' age-specific mortality rates, and specifically for females, income inequality and sex ratio. In addition to introducing a novel theoretical and empirical approach to contextual effects on adolescent health-risk behaviors, our findings reinforce the need to consider synergies between people's life experiences and the conditions where they live, when studying health-risk behaviors in adolescence.

  18. Growing Income Inequality Threatens American Education

    ERIC Educational Resources Information Center

    Duncan, Greg J.; Murnane, Richard J.

    2014-01-01

    The first of two articles in consecutive months describes the origins and nature of growing income inequality, and some of its consequences for American children. It documents the increased family income inequality that's occurred over the past 40 years and shows that the increased income disparity has been more than matched by an expanding…

  19. Income Inequality and the Education Divide.

    ERIC Educational Resources Information Center

    Welch, Mary A., Ed.

    1998-01-01

    The economics of the decision to go to college or obtain technical training is discussed in this booklet. To stay competitive in the job market requires constant educational updating. The following questions are discussed: (1) how income inequality is measured; (2) how income is distributed in the United States; (3) why income inequality is…

  20. Growing Income Inequality Threatens American Education

    ERIC Educational Resources Information Center

    Duncan, Greg J.; Murnane, Richard J.

    2014-01-01

    The first of two articles in consecutive months describes the origins and nature of growing income inequality, and some of its consequences for American children. It documents the increased family income inequality that's occurred over the past 40 years and shows that the increased income disparity has been more than matched by an expanding…

  1. Income inequality and population health: correlation and causality.

    PubMed

    Babones, Salvatore J

    2008-04-01

    A large literature now exists on the cross-national correlation between income inequality and population health, but existing studies suffer from sparse data, poor operationalization of income inequality, and the use of low-power statistical models. This paper sets out to estimate the ecological correlation between income inequality and indicators of population health in a very broad panel of countries, to demonstrate that this relationship is largely non-artifactual, and to test whether this relationship might be causal. Gini coefficients of national income inequality in 1970 and 1995 are correlated with life expectancy, infant mortality rates, and murder rates, controlling for national income per capita. In cross-sectional analyses, inequality is significantly correlated with life expectancy, infant mortality, and (inconsistently) the murder rate. The health correlations are shown to be not primarily due to the "convexity effect" of the non-linear relationship between individual income and individual health, which seems to account for no more than one-third of the relationship between inequality and health, and likely much less. Change in inequality 1970-1995 is significantly related to change in life expectancy and infant mortality, suggesting a causal relationship, but these correlations are not robust with respect to sample or controls. It can be concluded that there is a strong, consistent, statistically significant, non-artifactual correlation between national income inequality and population health, but though there is some evidence that this relationship is causal, the relative stability of income inequality over time in most countries makes causality difficult to test.

  2. Health and social cohesion: why care about income inequality?

    PubMed Central

    Kawachi, I.; Kennedy, B. P.

    1997-01-01

    Throughout the world, wealth and income are becoming more concentrated. Growing evidence suggests that the distribution of income-in addition to the absolute standard of living enjoyed by the poor-is a key determinant of population health. A large gap between rich people and poor people leads to higher mortality through the breakdown of social cohesion. The recent surge in income inequality in many countries has been accompanied by a marked increase in the residential concentration of poverty and affluence. Residential segregation diminishes the opportunities for social cohesion. Income inequality has spillover effects on society at large, including increased rates of crime and violence, impeded productivity and economic growth, and the impaired functioning of representative democracy. The extent of inequality in society is often a consequence of explicit policies and public choice. Reducing income inequality offers the prospect of greater social cohesiveness and better population health. PMID:9112854

  3. Correlations between Income Inequality and Antimicrobial Resistance

    PubMed Central

    Kirby, Andrew; Herbert, Annie

    2013-01-01

    Objectives The aim of this study is to investigate if correlations exist between income inequality and antimicrobial resistance. This study’s hypothesis is that income inequality at the national level is positively correlated with antimicrobial resistance within developed countries. Data collection and analysis Income inequality data were obtained from the Standardized World Income Inequality Database. Antimicrobial resistance data were obtained from the European antimicrobial Resistance Surveillance Network and outpatient antimicrobial consumption data, measured by Defined daily Doses per 1000 inhabitants per day, from the European Surveillance of antimicrobial Consumption group. Spearman’s correlation coefficient (r) defined strengths of correlations of: > 0.8 as strong, > 0.5 as moderate and > 0.2 as weak. Confidence intervals and p values were defined for all r values. Correlations were calculated for the time period 2003-10, for 15 European countries. Results Income inequality and antimicrobial resistance correlations which were moderate or strong, with 95% confidence intervals > 0, included the following. Enterococcus faecalis resistance to aminopenicillins, vancomycin and high level gentamicin was moderately associated with income inequality (r= ≥0.54 for all three antimicrobials). Escherichia coli resistance to aminoglycosides, aminopenicillins, third generation cephalosporins and fluoroquinolones was moderately-strongly associated with income inequality (r= ≥0.7 for all four antimicrobials). Klebsiella pneumoniae resistance to third generation cephalosporins, aminoglycosides and fluoroquinolones was moderately associated with income inequality (r= ≥0.5 for all three antimicrobials). Staphylococcus aureus methicillin resistance and income inequality were strongly associated (r=0.87). Conclusion As income inequality increases in European countries so do the rates of antimicrobial resistance for bacteria including E. faecalis, E. coli, K. pneumoniae

  4. American Higher Education and Income Inequality

    ERIC Educational Resources Information Center

    Hill, Catharine B.

    2016-01-01

    This paper demonstrates that increasing income inequality can contribute to the trends we see in American higher education, particularly in the selective, private nonprofit and public sectors. Given these institutions' selective admissions and commitment to socioeconomic diversity, the paper demonstrates how increasing income inequality leads to…

  5. Income Inequality, Global Economy and the State

    ERIC Educational Resources Information Center

    Lee, Cheol-Sung; Nielsen, Francois; Alderson, Arthur S.

    2007-01-01

    We investigate interrelationship among income inequality, global economy and the role of the state using an unbalanced panel data set with 311 observations on 60 countries, dated from 1970 to 1994. The analysis proceeds in two stages. First, we test for effects on income inequality of variables characterizing the situation of a society in the…

  6. American Higher Education and Income Inequality

    ERIC Educational Resources Information Center

    Hill, Catharine B.

    2016-01-01

    This paper demonstrates that increasing income inequality can contribute to the trends we see in American higher education, particularly in the selective, private nonprofit and public sectors. Given these institutions' selective admissions and commitment to socioeconomic diversity, the paper demonstrates how increasing income inequality leads to…

  7. Income Inequality, Global Economy and the State

    ERIC Educational Resources Information Center

    Lee, Cheol-Sung; Nielsen, Francois; Alderson, Arthur S.

    2007-01-01

    We investigate interrelationship among income inequality, global economy and the role of the state using an unbalanced panel data set with 311 observations on 60 countries, dated from 1970 to 1994. The analysis proceeds in two stages. First, we test for effects on income inequality of variables characterizing the situation of a society in the…

  8. Hispanic Population Growth and Rural Income Inequality

    ERIC Educational Resources Information Center

    Parrado, Emilio A.; Kandel, William A.

    2010-01-01

    We analyze the relationship between Hispanic population growth and changes in U.S. rural income inequality from 1990 through 2000. Applying comparative approaches used for urban areas we disentangle Hispanic population growth's contribution to inequality by comparing and statistically modeling changes in the family income Gini coefficient across…

  9. Hispanic Population Growth and Rural Income Inequality

    ERIC Educational Resources Information Center

    Parrado, Emilio A.; Kandel, William A.

    2010-01-01

    We analyze the relationship between Hispanic population growth and changes in U.S. rural income inequality from 1990 through 2000. Applying comparative approaches used for urban areas we disentangle Hispanic population growth's contribution to inequality by comparing and statistically modeling changes in the family income Gini coefficient across…

  10. Socioeconomic inequalities and mortality trends in BRICS, 1990–2010

    PubMed Central

    Mújica, Oscar J; Vázquez, Enrique; Duarte, Elisabeth C; Cortez-Escalante, Juan J; Molina, Joaquin

    2014-01-01

    Abstract Objective To explore the presence and magnitude of – and change in – socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – between 1990 and 2010. Methods Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics. Findings Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially. Conclusion Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed – within Brazil and China – in the inequalities in income-related levels of infant mortality are encouraging. PMID:24940014

  11. Inequality, income, and poverty: comparative global evidence.

    PubMed

    Fosu, Augustin Kwasi

    2010-01-01

    Objectives. The study seeks to provide comparative global evidence on the role of income inequality, relative to income growth, in poverty reduction.Methods. An analysis-of-covariance model is estimated using a large global sample of 1980–2004 unbalanced panel data, with the headcount measure of poverty as the dependent variable, and the Gini coefficient and PPP-adjusted mean income as explanatory variables. Both random-effects and fixed-effects methods are employed in the estimation.Results. The responsiveness of poverty to income is a decreasing function of inequality, and the inequality elasticity of poverty is actually larger than the income elasticity of poverty. Furthermore, there is a large variation across regions (and countries) in the relative effects of inequality on poverty.Conclusion. Income distribution plays a more important role than might be traditionally acknowledged in poverty reduction, though this importance varies widely across regions and countries.

  12. Income inequality in the developing world.

    PubMed

    Ravallion, Martin

    2014-05-23

    Should income inequality be of concern in developing countries? New data reveal less income inequality in the developing world than 30 years ago. However, this is due to falling inequality between countries. Average inequality within developing countries has been slowly rising, though staying fairly flat since 2000. As a rule, higher rates of growth in average incomes have not put upward pressure on inequality within countries. Growth has generally helped reduce the incidence of absolute poverty, but less so in more unequal countries. High inequality also threatens to stall future progress against poverty by attenuating growth prospects. Perceptions of rising absolute gaps in living standards between the rich and the poor in growing economies are also consistent with the evidence. Copyright © 2014, American Association for the Advancement of Science.

  13. Income inequality, poverty and crime across nations.

    PubMed

    Pare, Paul-Philippe; Felson, Richard

    2014-09-01

    We examine the relationship between income inequality, poverty, and different types of crime. Our results are consistent with recent research in showing that inequality is unrelated to homicide rates when poverty is controlled. In our multi-level analyses of the International Crime Victimization Survey we find that inequality is unrelated to assault, robbery, burglary, and theft when poverty is controlled. We argue that there are also theoretical reasons to doubt that the level of income inequality of a country affects the likelihood of criminal behaviour.

  14. Income and health inequality across Canadian provinces.

    PubMed

    Safaei, Jalil

    2007-09-01

    This paper uses the aggregate data from the Public Use Microdata Files (PUMF) of Canadian National Population Health Survey to estimate income related health inequalities across the ten Canadian provinces. The unique features of the PUMF allow for a meaningful cross-provincial comparison of health indices and their measured inequalities. It concludes that health inequalities favouring the higher income people do exist in all provinces when health status is either self assessed or measured by the health utility index. Moreover, it finds considerable variations in measured health inequalities across the provinces with consistent rankings for certain provinces.

  15. Income inequality in today’s China

    PubMed Central

    Xie, Yu; Zhou, Xiang

    2014-01-01

    Using multiple data sources, we establish that China's income inequality since 2005 has reached very high levels, with the Gini coefficient in the range of 0.53–0.55. Analyzing comparable survey data collected in 2010 in China and the United States, we examine social determinants that help explain China’s high income inequality. Our results indicate that a substantial part of China’s high income inequality is due to regional disparities and the rural-urban gap. The contributions of these two structural forces are particularly strong in China, but they play a negligible role in generating the overall income inequality in the United States, where individual-level and family-level income determinants, such as family structure and race/ethnicity, play a much larger role. PMID:24778237

  16. Preterm Birth in the Context of Increasing Income Inequality.

    PubMed

    Wallace, Maeve E; Mendola, Pauline; Chen, Zhen; Hwang, Beom Seuk; Grantz, Katherine L

    2016-01-01

    Preterm birth is a leading cause of infant morbidity and mortality. Little is known about the contextual effect of U.S. income inequality on preterm birth, an issue of increasing concern given that the current economic divide is the largest since 1928. We examined changes in inequality over time in relation to preterm birth among singleton deliveries from an electronic medical record-based cohort (n = 223,512) conducted in 11 U.S. states and the District of Columbia from 2002 to 2008. Increasing income inequality was defined as a positive change in state-level Gini coefficient from the year prior to birth. Multi-level models estimated the independent effect of increasing inequality on preterm birth (>22 and <37 weeks) controlling for maternal demographics, health behaviors, insurance status, chronic medical conditions, and state-level poverty and unemployment during the year of birth. The preterm birth rate was 12.3% where inequality increased and 10.9% where it did not. After adjustment, increasing inequality remained significantly associated with preterm birth (adjusted odds ratio 1.07, 95% confidence interval 1.04, 1.11). We observed no significant interaction by insurance status or race, suggesting that increasing inequality had a broad effect across the population. The contextual effect of increasing income inequality on preterm birth risk merits further study.

  17. Income Inequality and Intergenerational Income Mobility in the United States.

    PubMed

    Bloome, Deirdre

    2015-03-01

    Is there a relationship between family income inequality and income mobility across generations in the United States? As family income inequality rose in the United States, parental resources available for improving children's health, education, and care diverged. The amount and rate of divergence also varied across US states. Researchers and policy analysts have expressed concern that relatively high inequality might be accompanied by relatively low mobility, tightening the connection between individuals' incomes during childhood and adulthood. Using data from the Panel Study of Income Dynamics, the National Longitudinal Survey of Youth, and various government sources, this paper exploits state and cohort variation to estimate the relationship between inequality and mobility. Results provide very little support for the hypothesis that inequality shapes mobility in the United States. The inequality children experienced during youth had no robust association with their economic mobility as adults. Formal analysis reveals that offsetting effects could underlie this result. In theory, mobility-enhancing forces may counterbalance mobility-reducing effects. In practice, the results suggest that in the US context, the intergenerational transmission of income may not be very responsive to changes in inequality.

  18. Income Inequality and Intergenerational Income Mobility in the United States

    PubMed Central

    Bloome, Deirdre

    2015-01-01

    Is there a relationship between family income inequality and income mobility across generations in the United States? As family income inequality rose in the United States, parental resources available for improving children’s health, education, and care diverged. The amount and rate of divergence also varied across US states. Researchers and policy analysts have expressed concern that relatively high inequality might be accompanied by relatively low mobility, tightening the connection between individuals’ incomes during childhood and adulthood. Using data from the Panel Study of Income Dynamics, the National Longitudinal Survey of Youth, and various government sources, this paper exploits state and cohort variation to estimate the relationship between inequality and mobility. Results provide very little support for the hypothesis that inequality shapes mobility in the United States. The inequality children experienced during youth had no robust association with their economic mobility as adults. Formal analysis reveals that offsetting effects could underlie this result. In theory, mobility-enhancing forces may counterbalance mobility-reducing effects. In practice, the results suggest that in the US context, the intergenerational transmission of income may not be very responsive to changes in inequality. PMID:26388653

  19. Ecological analysis of the health effects of income inequality in Argentina.

    PubMed

    De Maio, Fernando G

    2008-05-01

    Despite a large body of empirical literature, a consensus has not been reached concerning the health effects of income inequality. This study contributes to ongoing debates by examining the robustness of the income inequality-population health relationship in Argentina, using five different income inequality indexes (each sensitive to inequalities in differing parts of the income spectrum) and five measures of population health. Cross-sectional, ecological study. Income and self-reported morbidity data from Argentina's 2001 Encuesta de Condiciones de Vida (Survey of living conditions) were analysed at the provincial level. Provincial rates of male/female life expectancy and infant mortality were drawn from the Instituto Nacional de Estadistica y Censos database. Life expectancy was correlated in the expected direction with provincial-level income inequality (operationalized as the Gini coefficient) for both males (r=-0.55, P<0.01) and females (r=-0.61, P<0.01), but this association was not robust for all five income inequality indexes. In contrast, infant mortality, self-reported poor health and self-reported activity limitation were not correlated with any of the income inequality indexes. This study adds further complexity to the literature on the health effects of income inequality by highlighting the important effects of operational definitions. Mortality and morbidity data cannot be used as reasonably interchangeable variables (a common practice in this literature), and the choice of income inequality indicator may influence the results.

  20. Income inequality and health: pathways and mechanisms.

    PubMed Central

    Kawachi, I; Kennedy, B P

    1999-01-01

    The relationship between income and health is well established: the higher an individual's income, the better his or her health. However, recent research suggests that health may also be affected by the distribution of income within society. We outline the potential mechanisms underlying the so-called relative income hypothesis, which predicts that an individual's health status is better in societies with a more equal distribution of incomes. The effects of income inequality on health may be mediated by underinvestment in social goods, such as public education and health care; disruption of social cohesion and the erosion of social capital; and the harmful psychosocial effects of invidious social comparisons. PMID:10199670

  1. Can Education Expenditures Reduce Income Inequality?

    ERIC Educational Resources Information Center

    Sylwester, Kevin

    2002-01-01

    Examines whether devoting more resources to education can positively affect the distribution of income within a country. Finds that public-education expenditures appear to be associated with a subsequent decrease in the level of income inequality. Finding is robust to the inclusion of various control variables and appears to be larger in…

  2. Income inequality and health: a causal review.

    PubMed

    Pickett, Kate E; Wilkinson, Richard G

    2015-03-01

    There is a very large literature examining income inequality in relation to health. Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. More recent studies, not included in those reviews, provide substantial new evidence. Our purpose in this paper is to assess whether or not wider income differences play a causal role leading to worse health. We conducted a literature review within an epidemiological causal framework and inferred the likelihood of a causal relationship between income inequality and health (including violence) by considering the evidence as a whole. The body of evidence strongly suggests that income inequality affects population health and wellbeing. The major causal criteria of temporality, biological plausibility, consistency and lack of alternative explanations are well supported. Of the small minority of studies which find no association, most can be explained by income inequality being measured at an inappropriate scale, the inclusion of mediating variables as controls, the use of subjective rather than objective measures of health, or follow up periods which are too short. The evidence that large income differences have damaging health and social consequences is strong and in most countries inequality is increasing. Narrowing the gap will improve the health and wellbeing of populations.

  3. Impact of income and income inequality on infant health outcomes in the United States.

    PubMed

    Olson, Maren E; Diekema, Douglas; Elliott, Barbara A; Renier, Colleen M

    2010-12-01

    The goal was to investigate the relationships of income and income inequality with neonatal and infant health outcomes in the United States. The 2000-2004 state data were extracted from the Kids Count Data Center. Health indicators included proportion of preterm births (PTBs), proportion of infants with low birth weight (LBW), proportion of infants with very low birth weight (VLBW), and infant mortality rate (IMR). Income was evaluated on the basis of median family income and proportion of federal poverty levels; income inequality was measured by using the Gini coefficient. Pearson correlations evaluated associations between the proportion of children living in poverty and the health indicators. Linear regression evaluated predictive relationships between median household income, proportion of children living in poverty, and income inequality for the 4 health indicators. Median family income was negatively correlated with all birth outcomes (PTB, r = -0.481; LBW, r = -0.295; VLBW, r = -0.133; IMR, r = -0.432), and the Gini coefficient was positively correlated (PTB, r = 0.339; LBW, r = 0.398; VLBW, r = 0.460; IMR, r = 0.114). The Gini coefficient explained a significant proportion of the variance in rate for each outcome in linear regression models with median family income. Among children living in poverty, the role of income decreased as the degree of poverty decreased, whereas the role of income inequality increased. Both income and income inequality affect infant health outcomes in the United States. The health of the poorest infants was affected more by absolute wealth than relative wealth.

  4. [Income inequality and health: the case of Rio de Janeiro].

    PubMed

    Szwarcwald, C L; Bastos, F I; Esteves, M A; de Andrade, C L; Paez, M S; Medici, E V; Derrico, M

    1999-01-01

    This ecological analysis addresses the association between income inequality and health status in the municipality of Rio de Janeiro. Data were analyzed using geo-processing and multiple regression techniques. The following health indicators were used: infant mortality rate; standardized mortality rate; life expectancy at birth; and homicide rate among 15-29-year-old males. Patterns of income inequality were assessed through income distribution indicators: Gini index, Robin Hood index, and top 10 %/bottom 40% average income ratio. The results indicate significant correlations between income distribution indicators and health indicators, providing additional empirical evidence of the association between health status and income inequality. For the homicide rate, the effect of the indicator "density of slum residents" was also relevant, suggesting that further deterioration in health standards may be due to social disruption of deprived communities and the resultant increase in criminal activity. The geo-epidemiological analysis presented here highlights the association between adverse health outcomes and residential concentration of poverty. Social policies focused on slum residents are needed to reduce the harmful effects of relative deprivation.

  5. Countries with women inequalities have higher stroke mortality.

    PubMed

    Kim, Young Dae; Jung, Yo Han; Caso, Valeria; Bushnell, Cheryl D; Saposnik, Gustavo

    2017-10-01

    Background Stroke outcomes can differ by women's legal or socioeconomic status. Aim We investigated whether differences in women's rights or gender inequalities were associated with stroke mortality at the country-level. Methods We used age-standardized stroke mortality data from 2008 obtained from the World Health Organization. We compared female-to-male stroke mortality ratio and stroke mortality rates in women and men between countries according to 50 indices of women's rights from Women, Business and the Law 2016 and Gender Inequality Index from the Human Development Report by the United Nations Development Programme. We also compared stroke mortality rate and income at the country-level. Results In our study, 176 countries with data available on stroke mortality rate in 2008 and indices of women's rights were included. There were 46 (26.1%) countries where stroke mortality in women was higher than stroke mortality in men. Among them, 29 (63%) countries were located in Sub-Saharan African region. After adjusting by country income level, higher female-to-male stroke mortality ratio was associated with 14 indices of women's rights, including differences in getting a job or opening a bank account, existence of domestic violence legislation, and inequalities in ownership right to property. Moreover, there was a higher female-to-male stroke mortality ratio among countries with higher Gender Inequality Index (r = 0.397, p < 0.001). Gender Inequality Index was more likely to be associated with stroke mortality rate in women than that in men (p < 0.001). Conclusions Our study suggested that the gender inequality status is associated with women's stroke outcomes.

  6. Income Inequality and Economic Development, A Case Study: Japan.

    ERIC Educational Resources Information Center

    Watanabe, Tsunehiko

    The changes in income inequality during the post-war period in Japan are investigated quantitatively and extensively in order to shed some light on the relationship between income inequality and the rapid economic development experienced in Japan. Following a presentation of some summary pictures on income inequality in the Japanese society the…

  7. Income Inequality and U.S. Tax Policy

    ERIC Educational Resources Information Center

    Crocco, Margaret S.; Marri, Anand R.; Wylie, Scott

    2011-01-01

    Many social scientists have recently commented on the high levels of income inequality in the United States. Indeed, the last time income inequality was as great as it is today was 1928, the year before the stock market crash ushered in the Great Depression. In this article, the authors offer a historical look at income inequality and taxation in…

  8. Income Inequality and Economic Development, A Case Study: Japan.

    ERIC Educational Resources Information Center

    Watanabe, Tsunehiko

    The changes in income inequality during the post-war period in Japan are investigated quantitatively and extensively in order to shed some light on the relationship between income inequality and the rapid economic development experienced in Japan. Following a presentation of some summary pictures on income inequality in the Japanese society the…

  9. Income Inequality and U.S. Tax Policy

    ERIC Educational Resources Information Center

    Crocco, Margaret S.; Marri, Anand R.; Wylie, Scott

    2011-01-01

    Many social scientists have recently commented on the high levels of income inequality in the United States. Indeed, the last time income inequality was as great as it is today was 1928, the year before the stock market crash ushered in the Great Depression. In this article, the authors offer a historical look at income inequality and taxation in…

  10. Income inequality, poverty, and population health: evidence from recent data for the United States.

    PubMed

    Ram, Rati

    2005-12-01

    In this study, state-level US data for the years 2000 and 1990 are used to provide additional evidence on the roles of income inequality and poverty in population health. Five main points are noted. First, contrary to the suggestion made in several recent studies, the income inequality parameter is observed to be quite robust and carries statistical significance in mortality equations estimated from several observation sets and a fairly wide variety of specificational choices. Second, the evidence does not indicate that significance of income inequality is lost when education variables are included. Third, similarly, the income inequality parameter shows significance when a race variable is added, and also when both race and urbanization terms are entered. Fourth, while poverty is seen to have some mortality-increasing consequence, the role of income inequality appears stronger. Fifth, income inequality retains statistical significance when a quadratic income term is added and also if the log-log version of a fairly inclusive model is estimated. I therefore suggest that the recent skepticism articulated by several scholars in regard to the robustness of the income inequality parameters in mortality equations estimated from the US data should be reconsidered.

  11. Inequalities of Income and Inequalities of Longevity: A Cross-Country Study

    PubMed Central

    Plümper, Thomas

    2016-01-01

    Objectives. We examined the effects of market income inequality (income inequality before taxes and transfers) and income redistribution via taxes and transfers on inequality in longevity. Methods. We used life tables to compute Gini coefficients of longevity inequality for all individuals and for individuals who survived to at least 10 years of age. We regressed longevity inequality on market income inequality and income redistribution, and we controlled for potential confounders, in a cross-sectional time-series sample of up to 28 predominantly Western developed countries and up to 37 years (1974–2011). Results. Income inequality before taxes and transfers was positively associated with inequality in the number of years lived; income redistribution (the difference between market income inequality and income inequality after taxes and transfers were accounted for) was negatively associated with longevity inequality. Conclusions. To the extent that our estimated effects derived from observational data are causal, governments can reduce longevity inequality not only via public health policies, but also via their influence on market income inequality and the redistribution of incomes from the relatively rich to the relatively poor. PMID:26562120

  12. Education's Effect on Income Inequality: An Economic Globalisation Perspective

    ERIC Educational Resources Information Center

    Wells, Ryan

    2006-01-01

    Utilising a globalisation framework this study contributes to discussions concerning inequality, education, and development by re-examining the effects of educational and economic variables on income inequality. This research shows that the effects of education on income inequality are affected by the level of economic freedom in a country, and…

  13. Education's Effect on Income Inequality: An Economic Globalisation Perspective

    ERIC Educational Resources Information Center

    Wells, Ryan

    2006-01-01

    Utilising a globalisation framework this study contributes to discussions concerning inequality, education, and development by re-examining the effects of educational and economic variables on income inequality. This research shows that the effects of education on income inequality are affected by the level of economic freedom in a country, and…

  14. Income inequality and periodontal diseases in rich countries: an ecological cross-sectional study.

    PubMed

    Sabbah, Wael; Sheiham, Aubrey; Bernabé, Eduardo

    2010-10-01

    There are adverse effects of income inequality on morbidity and mortality. This relationship has not been adequately examined in relation to oral health. To examine the relationship between income inequality and periodontal disease in rich countries. Adults aged 35-44 years in 17 rich countries with populations of more than 2 million. National level data on periodontal disease, income inequality and absolute national income were collected from 17 rich countries with populations of more than 2m. Pearson and partial correlations were used to examine the relationship between income inequality and percentage of 35-44-year-old adults with periodontal pockets > or = 4 mm and > or = 6 mm deep, adjusting for absolute national income. Higher levels of income inequality were significantly associated with higher levels of periodontal disease, independently of absolute national income. Absolute income was not associated with levels of periodontal disease in these 17 rich countries. Income inequality appears to be an important contextual determinant of periodontal disease. The results emphasise the importance of relative income rather than absoluteincome in relation to periodontal disease in rich countries.

  15. Income inequality: A complex network analysis of US states

    NASA Astrophysics Data System (ADS)

    Gogas, Periklis; Gupta, Rangan; Miller, Stephen M.; Papadimitriou, Theophilos; Sarantitis, Georgios Antonios

    2017-10-01

    This study performs a long-run, inter-temporal analysis of income inequality in the US spanning the period 1916-2012. We employ both descriptive analysis and the Threshold-Minimum Dominating Set methodology from Graph Theory, to examine the evolution of inequality through time. In doing so, we use two alternative measures of inequality: the Top 1% share of income and the Gini coefficient. This provides new insight on the literature of income inequality across the US states. Several empirical findings emerge. First, a heterogeneous evolution of inequality exists across the four focal sub-periods. Second, the results differ between the inequality measures examined. Finally, we identify groups of similarly behaving states in terms of inequality. The US authorities can use these findings to identify inequality trends and innovations and/or examples to investigate the causes of inequality within the US and implement appropriate policies.

  16. Income inequality, trust and homicide in 33 countries.

    PubMed

    Elgar, Frank J; Aitken, Nicole

    2011-04-01

    Theories of why income inequality correlates with violence suggest that inequality erodes social capital and trust, or inhibits investment into public services and infrastructure. Past research sensed the importance of these causal paths but few have examined them using tests of statistical mediation. We explored links between income inequality and rates of homicide in 33 countries and then tested whether this association is mediated by an indicator of social capital (interpersonal trust) or by public spending on health and education. Survey data on trust were collected from 48 641 adults and matched to country data on per capita income, income inequality, public expenditures on health and education and rate of homicides. Between countries, income inequality correlated with trust (r = -0.64) and homicide (r = 0.80) but not with public expenditures. Trust also correlated with homicides (r = -0.58) and partly mediated the association between income inequality and homicide, whilst public expenditures did not. Multilevel analysis showed that income inequality related to less trust after differences in per capita income and sample characteristics were taken into account. Results were consistent with psychosocial explanations of links between income inequality and homicide; however, the causal relationship between inequality, trust and homicide remains unclear given the cross-sectional design of this study. Societies with large income differences and low levels of trust may lack the social capacity to create safe communities.

  17. Educational assortative mating and income inequality in Denmark.

    PubMed

    Breen, Richard; Andersen, Signe Hald

    2012-08-01

    Many writers have expressed a concern that growing educational assortative mating will lead to greater inequality between households in their earnings or income. In this article, we examine the relationship between educational assortative mating and income inequality in Denmark between 1987 and 2006. Denmark is widely known for its low level of income inequality, but the Danish case provides a good test of the relationship between educational assortative mating and inequality because although income inequality increased over the period we consider, educational homogamy declined. Using register data on the exact incomes of the whole population, we find that change in assortative mating increased income inequality but that these changes were driven by changes in the educational distributions of men and women rather than in the propensity for people to choose a partner with a given level of education.

  18. Global variations in health: evaluating Wilkinson's income inequality hypothesis using the World Values Survey.

    PubMed

    Jen, Min Hua; Jones, Kelvyn; Johnston, Ron

    2009-02-01

    This international comparative study analyses individual-level data derived from the World Values Survey to evaluate Wilkinson's [(1996). Unhealthy societies: The afflictions of inequality. London: Routledge; (1998). Mortality and distribution of income. Low relative income affects mortality [letter; comment]. British Medical Journal, 316, 1611-1612] income inequality hypothesis regarding variations in health status. Random-coefficient, multilevel modelling provides a direct test of Wilkinson's hypothesis using micro-data on individuals and macro-data on income inequalities analysed simultaneously. This overcomes the ecological fallacy that has troubled previous research into links between individual self-rated health, individual income, country income and income inequality data. Logic regression analysis reveals that there are substantial differences between countries in self-rated health after taking account of age and gender, and individual income has a clear effect in that poorer people report experiencing worse health. The Wilkinson hypothesis is not supported, however, since there is no significant relationship between health and income inequality when individual factors are taken into account. Substantial differences between countries remain even after taking account of micro- and macro-variables; in particular the former communist countries report high levels of poor health.

  19. Income inequality and schizophrenia: increased schizophrenia incidence in countries with high levels of income inequality.

    PubMed

    Burns, Jonathan K; Tomita, Andrew; Kapadia, Amy S

    2014-03-01

    Income inequality is associated with numerous negative health outcomes. There is evidence that ecological-level socio-environmental factors may increase risk for schizophrenia. The aim was to investigate whether measures of income inequality are associated with incidence of schizophrenia at the country level. We conducted a systematic review of incidence rates for schizophrenia, reported between 1975 and 2011. For each country, national measures of income inequality (Gini coefficient) along with covariate risk factors for schizophrenia were obtained. Multi-level mixed-effects Poisson regression was performed to investigate the relationship between Gini coefficients and incidence rates of schizophrenia controlling for covariates. One hundred and seven incidence rates (from 26 countries) were included. Mean incidence of schizophrenia was 18.50 per 100,000 (SD = 11.9; range = 1.7-67). There was a significant positive relationship between incidence rate of schizophrenia and Gini coefficient (β = 1.02; Z = 2.28; p = .02; 95% CI = 1.00, 1.03). Countries characterized by a large rich-poor gap may be at increased risk of schizophrenia. We suggest that income inequality impacts negatively on social cohesion, eroding social capital, and that chronic stress associated with living in highly disparate societies places individuals at risk of schizophrenia.

  20. Income inequality and child maltreatment in the United States.

    PubMed

    Eckenrode, John; Smith, Elliott G; McCarthy, Margaret E; Dineen, Michael

    2014-03-01

    To examine the relation between county-level income inequality and rates of child maltreatment. Data on substantiated reports of child abuse and neglect from 2005 to 2009 were obtained from the National Child Abuse and Neglect Data System. County-level data on income inequality and children in poverty were obtained from the American Community Survey. Data for additional control variables were obtained from the American Community Survey and the Health Resources and Services Administration Area Resource File. The Gini coefficient was used as the measure of income inequality. Generalized additive models were estimated to explore linear and nonlinear relations among income inequality, poverty, and child maltreatment. In all models, state was included as a fixed effect to control for state-level differences in victim rates. Considerable variation in income inequality and child maltreatment rates was found across the 3142 US counties. Income inequality, as well as child poverty rate, was positively and significantly correlated with child maltreatment rates at the county level. Controlling for child poverty, demographic and economic control variables, and state-level variation in maltreatment rates, there was a significant linear effect of inequality on child maltreatment rates (P < .0001). This effect was stronger for counties with moderate to high levels of child poverty. Higher income inequality across US counties was significantly associated with higher county-level rates of child maltreatment. The findings contribute to the growing literature linking greater income inequality to a range of poor health and well-being outcomes in infants and children.

  1. Income inequality and mental health--empirical evidence from Australia.

    PubMed

    Bechtel, Lucy; Lordan, Grace; Rao, D S Prasada

    2012-06-01

    The causal association between absolute income and health is well-established; however, the relationship between income inequality and health is not. The conclusions from the received studies vary across the region or country studied and/or the methodology employed. Using the Household, Income and Labour Dynamics in Australia panel survey, this paper investigates the relationship between mental health and inequality in Australia. A variety of income inequality indices are calculated to test both the income inequality and relative deprivation hypotheses. We find that mental health is only adversely affected by the presence of relative deprivation to a very small degree. In addition, we do not find support for the income inequality hypothesis. Importantly, our results are robust to a number of sensitivity analyses. Copyright © 2012 John Wiley & Sons, Ltd.

  2. Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries.

    PubMed

    Mackenbach, Johan P; Bopp, Matthias; Deboosere, Patrick; Kovacs, Katalin; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Regidor, Enrique; de Gelder, Rianne

    2017-09-01

    The magnitude of socioeconomic inequalities in mortality differs importantly between countries, but these variations have not been satisfactorily explained. We explored the role of behavioral and structural determinants of these variations, by using a dataset covering 17 European countries in the period 1970-2010, and by conducting multilevel multivariate regression analyses. Our results suggest that between-country variations in inequalities in current mortality can partly be understood from variations in inequalities in smoking, excessive alcohol consumption, and poverty. Also, countries with higher national income, higher quality of government, higher social transfers, higher health care expenditure and more self-expression values have smaller inequalities in mortality. Finally, trends in behavioral risk factors, particularly smoking and excessive alcohol consumption, appear to partly explain variations in inequalities in mortality trends. This study shows that analyses of variations in health inequalities between countries can help to identify entry-points for policy. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Does Income Inequality Harm Health? New Cross-National Evidence

    ERIC Educational Resources Information Center

    Beckfield, Jason

    2004-01-01

    The provocative hypothesis that income inequality harms population health has sparked a large body of research, some of which has reported strong associations between income inequality and population health. Cross-national evidence is frequently cited in support of this important hypothesis, but the hypothesis remains controversial, and the…

  4. Does Income Inequality Harm Health? New Cross-National Evidence

    ERIC Educational Resources Information Center

    Beckfield, Jason

    2004-01-01

    The provocative hypothesis that income inequality harms population health has sparked a large body of research, some of which has reported strong associations between income inequality and population health. Cross-national evidence is frequently cited in support of this important hypothesis, but the hypothesis remains controversial, and the…

  5. Does income inequality have lasting effects on health and trust?

    PubMed

    Rözer, Jesper Jelle; Volker, Beate

    2016-01-01

    According to the income inequality hypothesis, income inequality is associated with poorer health. One important proposed mechanism for this effect is reduced trust. In this study, we argue that income inequality during a person's formative years (i.e., around age 16) may have lasting consequences for trust and health. Multilevel analyses of data from the combined World Values Survey and European Values Study that were collected between 1981 and 2014 support our prediction and show that income inequality is associated with ill health in young adults, in part because it reduces their social trust. The negative consequences of income inequality remain stable for a substantial period of life but eventually fade away and have no effect after age 36. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Racial Inequality and Child Mortality in Brazil.

    ERIC Educational Resources Information Center

    Wood, Charles H.; Lovell, Peggy A.

    1992-01-01

    In 1980 urban Brazil, race of mother significantly affected child mortality after controlling for region, income, and parent education, with a mortality gap of 6.7 years between the whites and Afro-Brazilians. Parent education, indoor plumbing, access to public health care, and presence of adult females significantly reduced the probability of…

  7. Income inequality in Romania: The exponential-Pareto distribution

    NASA Astrophysics Data System (ADS)

    Oancea, Bogdan; Andrei, Tudorel; Pirjol, Dan

    2017-03-01

    We present a study of the distribution of the gross personal income and income inequality in Romania, using individual tax income data, and both non-parametric and parametric methods. Comparing with official results based on household budget surveys (the Family Budgets Survey and the EU-SILC data), we find that the latter underestimate the income share of the high income region, and the overall income inequality. A parametric study shows that the income distribution is well described by an exponential distribution in the low and middle incomes region, and by a Pareto distribution in the high income region with Pareto coefficient α = 2.53. We note an anomaly in the distribution in the low incomes region (∼9,250 RON), and present a model which explains it in terms of partial income reporting.

  8. Widening Income Inequalities: Higher Education's Role in Serving Low Income Students

    ERIC Educational Resources Information Center

    Dalton, Jon C.; Crosby, Pamela C.

    2015-01-01

    Many scholars argue that America is becoming a dangerously divided nation because of increasing inequality, especially in income distribution. This article examines the problem of widening income inequality with particular focus on the role that colleges and universities and their student affairs organizations play in serving low income students…

  9. Widening Income Inequalities: Higher Education's Role in Serving Low Income Students

    ERIC Educational Resources Information Center

    Dalton, Jon C.; Crosby, Pamela C.

    2015-01-01

    Many scholars argue that America is becoming a dangerously divided nation because of increasing inequality, especially in income distribution. This article examines the problem of widening income inequality with particular focus on the role that colleges and universities and their student affairs organizations play in serving low income students…

  10. Changes in income inequality and the health of immigrants

    PubMed Central

    Hamilton, Tod G.; Kawachi, Ichiro

    2016-01-01

    Research suggests that income inequality is inversely associated with health. This association has been documented in studies that utilize variation in income inequality across countries or across time from a single country. The primary criticism of these approaches is their inability to account for potential confounders that are associated with income inequality. This paper uses variation in individual experiences of income inequality among immigrants within the United States (U.S.) to evaluate whether individuals who moved from countries with greater income inequality than the U.S. have better health than those who migrated from countries with less income in equality than the U.S. Utilizing individual-level (March Current Population Survey) and country-level data (the United Nations Human Development Reports), we show that among immigrants who have resided in the U.S. between 6 and 20 years, self-reported health is more favorable for the immigrants in the former category (i.e., greater income inequality) than those in the latter (i.e., lower income inequality). Results also show that self-reported health is better among immigrants from more developed countries and those who have more years of education, are male, and are married. PMID:23352417

  11. Changes in income inequality and the health of immigrants.

    PubMed

    Hamilton, Tod G; Kawachi, Ichiro

    2013-03-01

    Research suggests that income inequality is inversely associated with health. This association has been documented in studies that utilize variation in income inequality across countries or across time from a single country. The primary criticism of these approaches is their inability to account for potential confounders that are associated with income inequality. This paper uses variation in individual experiences of income inequality among immigrants within the United States (U.S.) to evaluate whether individuals who moved from countries with greater income inequality than the U.S. have better health than those who migrated from countries with less income in equality than the U.S. Utilizing individual-level (March Current Population Survey) and country-level data (the United Nations Human Development Reports), we show that among immigrants who have resided in the U.S. between 6 and 20 years, self-reported health is more favorable for the immigrants in the former category (i.e., greater income inequality) than those in the latter (i.e., lower income inequality). Results also show that self-reported health is better among immigrants from more developed countries and those who have more years of education, are male, and are married. Copyright © 2012. Published by Elsevier Ltd.

  12. [Inequalities at the source of infant mortality in Peru].

    PubMed

    Orihuela-Egoavil, E F

    2006-03-01

    The principal aim of this paper is to analyze the relationship between social disparities and infant mortality. This research is based on the secondary analysis of the official data concerning socioeconomic and mortality rates for the end of the 1960's and for the mid of 1990's. The infant mortality rate is twice higher amongst the Andean population, particularly true for those living in the South of the Andes, than the average population. In contrast, the babies born in Lima metropolitan area benefit a probability of survival in their first year of life twice higher than the typical Peruvian new born. These inequalities are the result of social exclusion that restrict participation in economic, cultural and political institutions to different social groups in Peruvian society. Illiteracy and distribution of income play a decisive role in the increase of infant mortality rates.

  13. Income inequality, alcohol use, and alcohol-related problems.

    PubMed

    Karriker-Jaffe, Katherine J; Roberts, Sarah C M; Bond, Jason

    2013-04-01

    We examined the relationship between state-level income inequality and alcohol outcomes and sought to determine whether associations of inequality with alcohol consumption and problems would be more evident with between-race inequality measures than with the Gini coefficient. We also sought to determine whether inequality would be most detrimental for disadvantaged individuals. Data from 2 nationally representative samples of adults (n = 13,997) from the 2000 and 2005 National Alcohol Surveys were merged with state-level inequality and neighborhood disadvantage indicators from the 2000 US Census. We measured income inequality using the Gini coefficient and between-race poverty ratios (Black-White and Hispanic-White). Multilevel models accounted for clustering of respondents within states. Inequality measured by poverty ratios was positively associated with light and heavy drinking. Associations between poverty ratios and alcohol problems were strongest for Blacks and Hispanics compared with Whites. Household poverty did not moderate associations with income inequality. Poverty ratios were associated with alcohol use and problems, whereas overall income inequality was not. Higher levels of alcohol problems in high-inequality states may be partly due to social context.

  14. Income Inequality, Alcohol Use, and Alcohol-Related Problems

    PubMed Central

    C. M. Roberts, Sarah; Bond, Jason

    2013-01-01

    Objectives. We examined the relationship between state-level income inequality and alcohol outcomes and sought to determine whether associations of inequality with alcohol consumption and problems would be more evident with between-race inequality measures than with the Gini coefficient. We also sought to determine whether inequality would be most detrimental for disadvantaged individuals. Methods. Data from 2 nationally representative samples of adults (n = 13 997) from the 2000 and 2005 National Alcohol Surveys were merged with state-level inequality and neighborhood disadvantage indicators from the 2000 US Census. We measured income inequality using the Gini coefficient and between-race poverty ratios (Black–White and Hispanic–White). Multilevel models accounted for clustering of respondents within states. Results. Inequality measured by poverty ratios was positively associated with light and heavy drinking. Associations between poverty ratios and alcohol problems were strongest for Blacks and Hispanics compared with Whites. Household poverty did not moderate associations with income inequality. Conclusions. Poverty ratios were associated with alcohol use and problems, whereas overall income inequality was not. Higher levels of alcohol problems in high-inequality states may be partly due to social context. PMID:23237183

  15. [Mental income inequality: a "virus" which affects health and happiness].

    PubMed

    Bouffard, Léandre; Dubé, Micheline

    2013-01-01

    The purpose of this paper is to demonstrate the impact of income inequality on various indexes of mental health and on happiness in wealthy nations. Initially, the unequal distribution of income is documented in wealthy nations, especially in the United States of America. After the World War II, income equality was at a level never reached before, but since the eighties, income inequality has raised dramatically in many industrialized countries. The 2008 crisis has worsened the situation in many of them, particularly in the United States. Furthermore, prejudices have increased against women, Blacks, Spanish-speakers and those who receive social welfare. A selective review of the literature is made in order to document the impact of income inequality on a few indicators of mental health (from WHO, UN, UNICEF, OCDE and World Bank) and on happiness, defined here as life satisfaction. Income inequality is positively related to the following indexes: Index of Mental Illness from the WHO (0.73), Index of the United Nations' Office on Drug Consumption (0.63) and a composite Index of ten psychosocial problems, constituted by Wilkinson and Pickett, 2013 (0.87). On the other hand, income inequality is negatively associated to the UNICEF Index of Child Well-Being (-0.71). Furthermore, the level of anxiety and of depression is higher in countries where income inequality is greater. The correlation between happiness and income inequality in the 23 wealthy nations is -0.48; this correlation becomes -0.41 after control of the effect of the GNP (Gross National Product). These results support the idea that it is relative income - not absolute income - which matters in the evaluation of our life and of our happiness. In underdeveloped nations, any increase in GNP promotes the well-being of the citizens; whereas in wealthy nations, it is the equality of the distribution that is more important. Many arguments supporting the causal relation from income inequality to psychosocial

  16. Income inequality and obesity prevalence among OECD countries.

    PubMed

    Su, Dejun; Esqueda, Omar A; Li, Lifeng; Pagán, José A

    2012-07-01

    Using recent pooled data from the World Health Organization Global Infobase and the World Factbook compiled by the Central Intelligence Agency of the United States, this study assesses the relation between income inequality and obesity prevalence among 31 OECD countries through a series of bivariate and multivariate linear regressions. The United States and Mexico well lead OECD countries in both obesity prevalence and income inequality. A sensitivity analysis suggests that the inclusion or exclusion of these two extreme cases can fundamentally change the findings. When the two countries are included, the results reveal a positive correlation between income inequality and obesity prevalence. This correlation is more salient among females than among males. Income inequality alone is associated with 16% and 35% of the variations in male and female obesity rates, respectively, across OECD countries in 2010. Higher levels of income inequality in the 2005-2010 period were associated with a more rapid increase in obesity prevalence from 2002 to 2010. These associations, however, virtually disappear when the US and Mexico have been excluded from the analysis. Findings from this study underscore the importance of assessing the impact of extreme cases on the relation between income inequality and health outcomes. The potential pathways from income inequality to the alarmingly high rates of obesity in the cases of the US and Mexico warrant further research.

  17. Better off than we know: distorted perceptions of incomes and income inequality in America.

    PubMed

    Chambers, John R; Swan, Lawton K; Heesacker, Martin

    2014-02-01

    Three studies examined Americans' perceptions of incomes and income inequality using a variety of criterion measures. Contrary to recent findings indicating that Americans underestimate wealth inequality, we found that Americans not only overestimated the rise of income inequality over time, but also underestimated average incomes. Thus, economic conditions in America are more favorable than people seem to realize. Furthermore, ideological differences emerged in two of these studies, such that political liberals overestimated the rise of inequality more than political conservatives. Implications of these findings for public policy debates and ideological disagreements are discussed.

  18. The Health Effects of Income Inequality: Averages and Disparities.

    PubMed

    Truesdale, Beth C; Jencks, Christopher

    2016-01-01

    Much research has investigated the association of income inequality with average life expectancy, usually finding negative correlations that are not very robust. A smaller body of work has investigated socioeconomic disparities in life expectancy, which have widened in many countries since 1980. These two lines of work should be seen as complementary because changes in average life expectancy are unlikely to affect all socioeconomic groups equally. Although most theories imply long and variable lags between changes in income inequality and changes in health, empirical evidence is confined largely to short-term effects. Rising income inequality can affect individuals in two ways. Direct effects change individuals' own income. Indirect effects change other people's income, which can then change a society's politics, customs, and ideals, altering the behavior even of those whose own income remains unchanged. Indirect effects can thus change both average health and the slope of the relationship between individual income and health.

  19. Accounting for the dead in the longitudinal analysis of income-related health inequalities

    PubMed Central

    Petrie, Dennis; Allanson, Paul; Gerdtham, Ulf-G.

    2011-01-01

    This paper develops an accounting framework to consider the effect of deaths on the longitudinal analysis of income-related health inequalities. Ignoring deaths or using Inverse Probability Weights (IPWs) to re-weight the sample for mortality-related attrition can produce misleading results. Incorporating deaths into the longitudinal analysis of income-related health inequalities provides a more complete picture in terms of the evaluation of health changes in respect to socioeconomic status. We illustrate our work by investigating health mobility from 1999 till 2004 using the British Household Panel Survey (BHPS). We show that for Scottish males explicitly accounting for the dead rather than using IPWs to account for mortality-related attrition changes the direction of the relationship between relative health changes and initial income position, from negative to positive, while for other groups it significantly increases the strength of the positive relationship. Incorporating the dead may be vital in the longitudinal analysis of health inequalities. PMID:21820193

  20. National Income, Inequality and Global Patterns of Cigarette Use

    ERIC Educational Resources Information Center

    Pampel, Fred

    2007-01-01

    Declining tobacco use in high-income nations and rising tobacco use in low- and middle-income nations raises questions about the sources of worldwide patterns of smoking. Theories posit a curvilinear influence of national income based on the balance of affordability and health-cost effects. In addition, however, economic inequality, gender…

  1. Income inequality and population health: an analysis of panel data for 21 developed countries, 1975-2006.

    PubMed

    Torre, Roberta; Myrskylä, Mikko

    2014-03-01

    The relative income-health hypothesis postulates that income distribution is an important determinant of population health, but the age and sex patterns of this association are not well known. We tested the relative income-health hypothesis using panel data collected for 21 developed countries over 30 years. Net of trends in gross domestic product per head and unobserved period and country factors, income inequality measured by the Gini index is positively associated with the mortality of males and females at ages 1-14 and 15-49, and with the mortality of females at ages 65-89 albeit less strongly than for the younger age groups. These findings suggest that policies to decrease income inequality may improve health, especially that of children and young-to-middle-aged men and women. The mechanisms behind the income inequality-mortality association remain unknown and should be the focus of future research.

  2. Impact of Income Inequality on the Nation's Health.

    PubMed

    López, Diego B; Loehrer, Andrew P; Chang, David C

    2016-10-01

    Income inequality in the United States has been increasing in recent decades. It is unclear whether income inequality has an independent effect on health outcomes, or whether it simply correlates with increasing levels of poverty. The goal of this study was to evaluate whether income inequality is significantly associated with US county health care expenditures and health care use. Cross-sectional analysis of county health expenditure data from the Health Resources and Services Administration's Area Resources File, county income inequality measures (Gini coefficient) from the Census' American Community Survey, and estimates of potentially preventable admissions and potentially discretionary procedures from the Nationwide Inpatient Sample (1998 to 2011). Datasets were linked via county Federal Information Processing Standard codes. Multivariable linear and Poisson regression analyses were performed at the county level adjusting for county characteristics. A total of 1,237 counties (of 3,144) were included. Income inequality was associated with higher health care expenditures, with each 1 percentage-point increase in county Gini coefficient associated with a US$40,008 increase in annual county Medicare cost (p = 0.003), and an increase of 174.7 total county Medicare inpatient days per year (p < 0.001). Even after accounting for poverty level and county characteristics, counties with higher inequality had higher potentially preventable admission (eg 4.86 rate ratio for low-birth-weight hospital admissions in the top income inequality quartile compared with bottom quartile; p < 0.001) and a higher incidence of potentially discretionary procedures (eg 1.79 rate ratio for prostatectomy for benign prostatic hyperplasia in the top income inequality quartile compared with bottom quartile; p < 0.001). Income inequality is independently associated with higher health care expenditures and more health care use, with increases in both potentially discretionary procedures and in

  3. Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities.

    PubMed

    Coburn, David

    2004-01-01

    This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. It is argued that global and national socio-political-economic trends have increased the power of business classes and lowered that of working classes. The neo-liberal policies accompanying these trends led to increased income inequality but also poverty and unequal access to many other health-relevant resources. But international pressures towards neo-liberal doctrines and policies are differentially resisted by various nations because of historically embedded variation in class and institutional structures. Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to "go beyond" the income inequality hypothesis towards consideration of a broader set of the social determinants of health.

  4. Income inequality and fear of crime across the European region.

    PubMed

    Vauclair, Christin-Melanie; Bratanova, Boyka

    2017-03-01

    This paper aims to take a holistic approach to studying fear of crime by testing predictors at multiple levels of analyses. Data from the European Social Survey (N = 56,752 from 29 countries) were used to test and extend the Income Inequality and Sense of Vulnerability Hypotheses. The findings confirm that (1) individuals in societies with greater income inequalities are more fearful of crime, and (2) older or disabled people as well as women report greater fear of crime. Contrary to the hypotheses, ethnic majority and not ethnic minority members report greater fear of crime, if they reside in high income inequality countries. It is further demonstrated that fear of crime explains the inverse association between income inequality and subjective well-being in this particular subsample.

  5. Income inequality and fear of crime across the European region

    PubMed Central

    Vauclair, Christin-Melanie; Bratanova, Boyka

    2016-01-01

    This paper aims to take a holistic approach to studying fear of crime by testing predictors at multiple levels of analyses. Data from the European Social Survey (N = 56,752 from 29 countries) were used to test and extend the Income Inequality and Sense of Vulnerability Hypotheses. The findings confirm that (1) individuals in societies with greater income inequalities are more fearful of crime, and (2) older or disabled people as well as women report greater fear of crime. Contrary to the hypotheses, ethnic majority and not ethnic minority members report greater fear of crime, if they reside in high income inequality countries. It is further demonstrated that fear of crime explains the inverse association between income inequality and subjective well-being in this particular subsample. PMID:28579924

  6. Income Mobility Breeds Tolerance for Income Inequality: Cross-National and Experimental Evidence.

    PubMed

    Shariff, Azim F; Wiwad, Dylan; Aknin, Lara B

    2016-05-01

    American politicians often justify income inequality by referencing the opportunities people have to move between economic stations. Though past research has shown associations between income mobility and resistance to wealth redistribution policies, no experimental work has tested whether perceptions of mobility influence tolerance for inequality. In this article, we present a cross-national comparison showing that income mobility is associated with tolerance for inequality and experimental work demonstrating that perceptions of higher mobility directly affect attitudes toward inequality. We find support for both the prospect of upward mobility and the view that peoples' economic station is the product of their own efforts, as mediating mechanisms. © The Author(s) 2016.

  7. Income inequality, area-level poverty, perceived aversion to inequality, and self-rated health in Japan.

    PubMed

    Oshio, Takashi; Kobayashi, Miki

    2009-08-01

    In this study we conduct a multilevel analysis to investigate the association between regional income inequality and self-rated health in Japan, based on two nationwide surveys. We confirm that there is a significant association between area-level income inequality and individual-level health assessment. We also find that health assessment tends to be more sensitive to income inequality among lower income individuals, and to degree of area-level poverty, than income inequality for the society as a whole. In addition, we examine how individuals are averse to inequality, based on the observed association between inequality and self-rated health.

  8. Long-Term Association of Economic Inequality and Mortality in Adult Costa Ricans

    PubMed Central

    Modrek, Sepideh; Dow, William H.; Rosero-Bixby, Luis

    2011-01-01

    Despite the large number of studies, mostly in developed economies, there is limited consensus on the health effects of inequality. Recently a related literature has examined the relationship between relative deprivation and health as a mechanism to explain the economic inequality and health relationship. This study evaluates the relationship between mortality and economic inequality, as measured by area-level Gini coefficients, as well as the relationship between mortality and relative deprivation, in the context of a middle-income country, Costa Rica. We followed a nationally representative prospective cohort of approximately 16,000 individuals aged 30 and over who were randomly selected from the 1984 census. These individuals were then linked to the Costa Rican National Death Registry until Dec. 31, 2007. Hazard models were used to estimate the relative risk of mortality for all-cause and cardiovascular disease mortality for two indicators: canton-level income inequality and relative deprivation based on asset ownership. Results indicate that there was an unexpectedly negative association between canton income inequality and mortality, but the relationship is not robust to the inclusion of canton fixed-effects. In contrast, we find a positive association between relative deprivation and mortality, which is robust to the inclusion of canton fixed-effects. Taken together, these results suggest that deprivation relative to those higher in a hierarchy is more detrimental to health than the overall dispersion of the hierarchy itself, within the Costa Rican context. PMID:22240449

  9. Educational inequalities in tuberculosis mortality in sixteen European populations

    PubMed Central

    Álvarez, J. L.; Kunst, A. E.; Leinsalu, M.; Bopp, M.; Strand, B. H.; Menvielle, Gwenn; Lundberg, O.; Martikainen, P.; Deboosere, P.; Kalediene, R.; Artnik, B.; Mackenbach, J. P.; Richardus, J. H.

    2011-01-01

    Objective We aim to describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban, and rural populations in several European countries. Design Data were obtained from the Eurothine project covering 16 populations between 1990 and 2003. Age- and sex-standardized mortality rates, the Relative Index of Inequality, and the slope index of inequality were used to assess educational inequalities. Results The number of TB deaths reported was 8530, with a death rate of 3 per 100 000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were larger than in total mortality. Relative and absolute inequalities were large in Eastern Europe, and Baltic countries but relatively small in Southern countries and in Norway, Finland, and Sweden. Mortality inequalities were observed among both men and women, and in both rural and urban populations. Conclusions Socioeconomic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve vulnerable groups’ access to treatment and thereby reduce TB mortality. PMID:22008757

  10. How Can Inequalities in Mortality Be Reduced? A Quantitative Analysis of 6 Risk Factors in 21 European Populations

    PubMed Central

    Eikemo, Terje A.; Hoffmann, Rasmus; Kulik, Margarete C.; Kulhánová, Ivana; Toch-Marquardt, Marlen; Menvielle, Gwenn; Looman, Caspar; Jasilionis, Domantas; Martikainen, Pekka; Lundberg, Olle; Mackenbach, Johan P.

    2014-01-01

    Background Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Interpretation Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk

  11. Socio-economic transition, inequality, and mortality in Lithuania.

    PubMed

    Kalediene, Ramune; Petrauskiene, Jadvyga

    2004-03-01

    The study assessed inequalities in mortality of Lithuanian urban and rural populations throughout the period of socio-economic transition (1990-2000). Mortality from major causes of death, except cancers in females, was higher among the rural population. Inequality in mortality increased during the period of transition, especially among males, mainly due to more rapidly improving health of the urban population. Cardiovascular diseases and external causes made the largest contribution to the inequality. Differences in mortality of urban and rural populations point to greater social and psychological stress affecting the rural population, unhealthy life styles, inequities in accessibility of health care and lack of preventive programs in rural areas.

  12. Common mental disorders, neighbourhood income inequality and income deprivation: small-area multilevel analysis.

    PubMed

    Fone, David; Greene, Giles; Farewell, Daniel; White, James; Kelly, Mark; Dunstan, Frank

    2013-04-01

    Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known. To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health. Multilevel analysis of population data from the Welsh Health Survey, 2003/04-2010. A total of 88,623 respondents aged 18-74 years were nested within 50,587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a 'case' of common mental disorder. High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. = 0.33), P = 0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88-0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate -1.35 (s.e. = 0.54), P = 0.012; OR = 1.13, 95% CI 1.04-1.22). The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level.

  13. Common mental disorders, neighbourhood income inequality and income deprivation: small-area multilevel analysis

    PubMed Central

    Fone, David; Greene, Giles; Farewell, Daniel; White, James; Kelly, Mark; Dunstan, Frank

    2013-01-01

    Background Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known. Aims To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health. Method Multilevel analysis of population data from the Welsh Health Survey, 2003/04–2010. A total of 88 623 respondents aged 18–74 years were nested within 50 587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a ‘case’ of common mental disorder. Results High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. = 0.33), P = 0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88–0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate -1.35 (s.e. = 0.54), P = 0.012; OR = 1.13, 95% CI 1.04–1.22). Conclusions The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level. PMID:23470284

  14. Income inequality, race, and child well-being: an aggregate analysis in the 50 United States.

    PubMed

    McLeod, Jane D; Nonnemaker, James M; Call, Kathleen Thiede

    2004-09-01

    Interest in income inequality as a predictor of health has exploded since the mid-1990s. Recent analyses suggest, however, that the effect of income inequality on population health is not robust to a control for the racial composition of the population. That observation raises two interpretational questions. First, does income inequality have an independent effect on population health? Second, what does the effect of racial composition on population health mean? We use data from the Urban Institute's Assessing the New Federalism project and the Kids Count Databook to evaluate the aggregate effects of income inequality on diverse measures of child well-being (e.g., infant mortality, high school drop-out rates) in the 50 U.S. states. We replicate the finding that, net of the racial/ethnic composition of the population, the effects of income inequality are not significant. Moreover, the effects of racial composition on child well-being appear to be compositional (i.e., they reflect the less positive outcomes observed among racial/ethnic minorities) rather than contextual (i.e., representing the independent influence of social context). Whereas cross-level effects are still possible, our results cast doubt on the health relevance of these aggregate characteristics of the population.

  15. Publicly financed healthcare and income inequality in Canada.

    PubMed

    Corscadden, Lisa; Allin, Sara; Wolfson, Michael; Grignon, Michel

    2014-01-01

    Income inequality is currently the focus of considerable public and policy attention. Public services such as healthcare and education play a role in reducing income inequality in the population. This study looks at how healthcare affects the distribution of income across five income groups. Specifically, it estimates the tax contributions and the value of benefits received from physician services, drugs and hospital services over a person's lifetime. We found that benefits received from publicly funded healthcare in Canada reduce the income gap between the highest- and lowest-income groups by 16%. This analysis provides a starting point for future research to explore the distributional effects of different options for financing healthcare. Copyright © 2014 Longwoods Publishing.

  16. Is wealthier always healthier? The impact of national income level, inequality, and poverty on public health in Latin America.

    PubMed

    Biggs, Brian; King, Lawrence; Basu, Sanjay; Stuckler, David

    2010-07-01

    Despite findings indicating that both national income level and income inequality are each determinants of public health, few have studied how national income level, poverty and inequality interact with each other to influence public health outcomes. We analyzed the relationship between gross domestic product (GDP) per capita in purchasing power parity, extreme poverty rates, the gini coefficient for personal income and three common measures of public health: life expectancy, infant mortality rates, and tuberculosis (TB) mortality rates. Introducing poverty and inequality as modifying factors, we then assessed whether the relationship between GDP and health differed during times of increasing, decreasing, and decreasing or constant poverty and inequality. Data were taken from twenty-two Latin American countries from 1960 to 2007 from the December 2008 World Bank World Development Indicators, World Health Organization Global Tuberculosis Database 2008, and the Socio-Economic Database for Latin America and the Caribbean. Consistent with previous studies, we found increases in GDP have a sizable positive impact on population health. However, the strength of the relationship is powerfully influenced by changing levels of poverty and inequality. When poverty was increasing, greater GDP had no significant effect on life expectancy or TB mortality, and only led to a small reduction in infant mortality rates. When inequality was rising, greater GDP had only a modest effect on life expectancy and infant mortality rates, and no effect on TB mortality rates. In sharp contrast, during times of decreasing or constant poverty and inequality, there was a very strong relationship between increasing GDP and higher life expectancy and lower TB and infant mortality rates. Finally, inequality and poverty were found to exert independent, substantial effects on the relationship between national income level and health. Wealthier is indeed healthier, but how much healthier depends on how

  17. Income redistribution is not enough: income inequality, social welfare programs, and achieving equity in health.

    PubMed

    Starfield, Barbara; Birn, Anne-Emanuelle

    2007-12-01

    Income inequality is widely assumed to be a major contributor to poorer health at national and subnational levels. According to this assumption, the most appropriate policy strategy to improve equity in health is income redistribution. This paper considers reasons why tackling income inequality alone could be an inadequate approach to reducing differences in health across social classes and other population subgroups, and makes the case that universal social programs are critical to reducing inequities in health. A health system oriented around a strong primary care base is an example of such a strategy.

  18. The Fall and Rise of US Inequities in Premature Mortality: 1960–2002

    PubMed Central

    Krieger, Nancy; Rehkopf, David H; Chen, Jarvis T; Waterman, Pamela D; Marcelli, Enrico; Kennedy, Malinda

    2008-01-01

    Background Debates exist as to whether, as overall population health improves, the absolute and relative magnitude of income- and race/ethnicity-related health disparities necessarily increase—or derease. We accordingly decided to test the hypothesis that health inequities widen—or shrink—in a context of declining mortality rates, by examining annual US mortality data over a 42 year period. Methods and Findings Using US county mortality data from 1960–2002 and county median family income data from the 1960–2000 decennial censuses, we analyzed the rates of premature mortality (deaths among persons under age 65) and infant death (deaths among persons under age 1) by quintiles of county median family income weighted by county population size. Between 1960 and 2002, as US premature mortality and infant death rates declined in all county income quintiles, socioeconomic and racial/ethnic inequities in premature mortality and infant death (both relative and absolute) shrank between 1966 and 1980, especially for US populations of color; thereafter, the relative health inequities widened and the absolute differences barely changed in magnitude. Had all persons experienced the same yearly age-specific premature mortality rates as the white population living in the highest income quintile, between 1960 and 2002, 14% of the white premature deaths and 30% of the premature deaths among populations of color would not have occurred. Conclusions The observed trends refute arguments that health inequities inevitably widen—or shrink—as population health improves. Instead, the magnitude of health inequalities can fall or rise; it is our job to understand why. PMID:18303941

  19. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries.

    PubMed

    Devaux, Marion

    2015-01-01

    A key policy objective in OECD countries is to achieve adequate access to health care for all people on the basis of need. Previous studies have shown that there are inequities in health care services utilisation (HCSU) in the OECD area. In recent years, measures have been taken to enhance health care access. This paper re-examines income-related inequities in doctor visits among 18 selected OECD countries, updating previous results for 12 countries with 2006-2009 data, and including six new countries. Inequalities in preventive care services are also considered for the first time. The indirect standardisation procedure is used to estimate the need-adjusted HCSU and concentration indexes are derived to gauge inequalities and inequities. Overall, inequities in HCSU remain present in OECD countries. In most countries, for the same health care needs, people with higher incomes are more likely to consult a doctor than those with lower incomes. Pro-rich inequalities in dental visits and cancer screening uptake are also found in nearly all countries, although the magnitude of these varies among countries. These findings suggest that further monitoring of inequalities is essential in order to assess whether country policy objectives are achieved on a regular basis.

  20. Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study.

    PubMed

    Lindenauer, Peter K; Lagu, Tara; Rothberg, Michael B; Avrunin, Jill; Pekow, Penelope S; Wang, Yongfei; Krumholz, Harlan M

    2013-02-14

    To examine the association between income inequality and the risk of mortality and readmission within 30 days of hospitalization. Retrospective cohort study of Medicare beneficiaries in the United States. Hierarchical, logistic regression models were developed to estimate the association between income inequality (measured at the US state level) and a patient's risk of mortality and readmission, while sequentially controlling for patient, hospital, other state, and patient socioeconomic characteristics. We considered a 0.05 unit increase in the Gini coefficient as a measure of income inequality. US acute care hospitals. Patients aged 65 years and older, and hospitalized in 2006-08 with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia. Risk of death within 30 days of admission or rehospitalization for any cause within 30 days of discharge. The potential number of excess deaths and readmissions associated with higher levels of inequality in US states in the three highest quarters of income inequality were compared with corresponding data in US states in the lowest quarter. Mortality analyses included 555,962 admissions (4348 hospitals) for acute myocardial infarction, 1,092,285 (4484) for heart failure, and 1,146,414 (4520); readmission analyses included 553,037 (4262), 1,345,909 (4494), and 1,345,909 (4524) admissions, respectively. In 2006-08, income inequality in US states (as measured by the average Gini coefficient over three years) varied from 0.41 in Utah to 0.50 in New York. Multilevel models showed no significant association between income inequality and mortality within 30 days of admission for patients with acute myocardial infarction, heart failure, or pneumonia. By contrast, income inequality was associated with rehospitalization (acute myocardial infarction, risk ratio 1.09 (95% confidence interval 1.03 to 1.15), heart failure 1.07 (1.01 to 1.12), pneumonia 1.09 (1.03 to 1.15)). Further adjustment for individual income

  1. The Inequality Footprints of Nations: A Novel Approach to Quantitative Accounting of Income Inequality

    PubMed Central

    Alsamawi, Ali; Murray, Joy; Lenzen, Manfred; Moran, Daniel; Kanemoto, Keiichiro

    2014-01-01

    In this study we use economic input-output analysis to calculate the inequality footprint of nations. An inequality footprint shows the link that each country's domestic economic activity has to income distribution elsewhere in the world. To this end we use employment and household income accounts for 187 countries and an historical time series dating back to 1990. Our results show that in 2010, most developed countries had an inequality footprint that was higher than their within-country inequality, meaning that in order to support domestic lifestyles, these countries source imports from more unequal economies. Amongst exceptions are the United States and United Kingdom, which placed them on a par with many developing countries. Russia has a high within-country inequality nevertheless it has the lowest inequality footprint in the world, which is because of its trade connections with the Commonwealth of Independent States and Europe. Our findings show that the commodities that are inequality-intensive, such as electronic components, chemicals, fertilizers, minerals, and agricultural products often originate in developing countries characterized by high levels of inequality. Consumption of these commodities may implicate within-country inequality in both developing and developed countries. PMID:25353333

  2. The inequality footprints of nations: a novel approach to quantitative accounting of income inequality.

    PubMed

    Alsamawi, Ali; Murray, Joy; Lenzen, Manfred; Moran, Daniel; Kanemoto, Keiichiro

    2014-01-01

    In this study we use economic input-output analysis to calculate the inequality footprint of nations. An inequality footprint shows the link that each country's domestic economic activity has to income distribution elsewhere in the world. To this end we use employment and household income accounts for 187 countries and an historical time series dating back to 1990. Our results show that in 2010, most developed countries had an inequality footprint that was higher than their within-country inequality, meaning that in order to support domestic lifestyles, these countries source imports from more unequal economies. Amongst exceptions are the United States and United Kingdom, which placed them on a par with many developing countries. Russia has a high within-country inequality nevertheless it has the lowest inequality footprint in the world, which is because of its trade connections with the Commonwealth of Independent States and Europe. Our findings show that the commodities that are inequality-intensive, such as electronic components, chemicals, fertilizers, minerals, and agricultural products often originate in developing countries characterized by high levels of inequality. Consumption of these commodities may implicate within-country inequality in both developing and developed countries.

  3. Wage inequality, the health system, and infant mortality in wealthy industrialized countries, 1970-1996.

    PubMed

    Macinko, James A; Shi, Leiyu; Starfield, Barbara

    2004-01-01

    This pooled, cross-sectional, time-series study assesses the impact of health system variables on the relationship between wage inequality and infant mortality in 19 OECD countries over the period 1970-1996. Data are derived from the OECD, World Value Surveys, Luxembourg Income Study, and political economy databases. Analyses include Pearson correlation and fixed-effects multivariate regression. In year-specific and time-series analyses, the Theil measure of wage inequality (based on industrial sector wages) is positively and statistically significantly associated with infant mortality rates--even while controlling for GDP per capita. Health system variables--in particular the method of healthcare financing and the supply of physicians--significantly attenuated the effect of wage inequality on infant mortality. In fixed effects multivariate regression models controlling for GDP per capita and wage inequality, variables generally associated with better health include income per capita, the method of healthcare financing, and physicians per 1000 population. Alcohol consumption, the proportion of the population in unions, and government expenditures on health were associated with poorer health outcomes. Ambiguous effects were seen for the consumer price index, unemployment rates, the openness of the economy, and voting rates. This study provides international evidence for the impact of wage inequalities on infant mortality. Results suggest that improving aspects of the healthcare system may be one way to partially compensate for the negative effects of social inequalities on population health.

  4. Income inequality, distributive fairness and political trust in Latin America.

    PubMed

    Zmerli, Sonja; Castillo, Juan Carlos

    2015-07-01

    In the wake of rising levels of income inequality during the past two decades, widespread concerns emerged about the social and political consequences of the widening gap between the poor and the rich that can be observed in many established democracies. Several empirical studies substantiate the link between macro-level income inequality and political attitudes and behavior, pointing at its broad and negative implications for political equality. Accordingly, these implications are expected to be accentuated in contexts of high inequality, as is the case in Latin America. Despite these general concerns about the consequences of income inequality, few studies have accounted for the importance of individual perceptions of distributive fairness in regard to trust in political institutions. Even less is known about the extent to which distributive fairness perceptions co-vary with objective indicators of inequality. Moreover, the research in this area has traditionally focused on OECD countries, which have lower indexes of inequality than the rest of the world. This study aims at filling this gap by focusing on the relevance of distributive fairness perceptions and macro-level inequality for political trust and on how these two levels interact in Latin American countries. The analyses are based on the Latinobarometer survey 2011, which consists of 18 countries. Multilevel estimations suggest that both dimensions of inequality are negatively associated with political trust but that higher levels of macro-level inequality attenuate rather than increase the strength of the negative association between distributive fairness perceptions and political trust. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Income inequalities in unhealthy life styles in England and Spain.

    PubMed

    Costa-Font, Joan; Hernández-Quevedo, Cristina; Jiménez-Rubio, Dolores

    2014-03-01

    Health inequalities in developed societies are persistent. Arguably, the rising inequalities in unhealthy lifestyles might underpin these inequality patterns, yet supportive empirical evidence is scarce. We examine the patterns of inequality in unhealthy lifestyles in England and Spain, two countries that exhibit rising obesity levels with a high prevalence of smoking and alcohol use. This study is unique in that it draws from health survey data spanning over a period in which major contextual and policy changes have taken place. We document persistent income-related inequalities in obesity and smoking; both unhealthy lifestyles appear to be disproportionately concentrated among the relatively poor in recent decades. In contrast, alcohol use appears to be concentrated among richer individuals in both periods and countries examined. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Income inequality and alcohol attributable harm in Australia.

    PubMed

    Dietze, Paul M; Jolley, Damien J; Chikritzhs, Tanya N; Clemens, Susan; Catalano, Paul; Stockwell, Tim

    2009-02-25

    There is little research on the relationship between key socioeconomic variables and alcohol related harms in Australia. The aim of this research was to examine the relationship between income inequality and the rates of alcohol-attributable hospitalisation and death at a local-area level in Australia. We conducted a cross sectional ecological analysis at a Local Government Area (LGA) level of associations between data on alcohol caused harms and income inequality data after adjusting for socioeconomic disadvantage and remoteness of LGAs.The main outcome measures used were matched rate ratios for four measures of alcohol caused harm; acute (primarily related to the short term consequences of drinking) and chronic (primarily related to the long term consequences of drinking) alcohol-attributable hospitalisation and acute and chronic alcohol-attributable death. Matching was undertaken using control conditions (non-alcohol-attributable) at an LGA level. A total of 885 alcohol-attributable deaths and 19467 alcohol-attributable hospitalisations across all LGAs were available for analysis. After weighting by the total number of cases in each LGA, the matched rate ratios of acute and chronic alcohol-attributable hospitalisation and chronic alcohol-attributable death were associated with the squared centred Gini coefficients of LGAs. This relationship was evident after adjusting for socioeconomic disadvantage and remoteness of LGAs. For both measures of hospitalisation the relationship was curvilinear; increases in income inequality were initially associated with declining rates of hospitalisation followed by large increases as the Gini coefficient increased beyond 0.15. The pattern for chronic alcohol-attributable death was similar, but without the initial decrease. There was no association between income inequality and acute alcohol-attributable death, probably due to the relatively small number of these types of death. We found a curvilinear relationship between income

  7. Education and Income Inequality among Asian Americans.

    ERIC Educational Resources Information Center

    Macaranas, Federico M.

    The reduction of social inequalities through education is widely believed to be possible. In the past decade however, social scientists have increasingly questioned the posited conventional relationship between education and socio-economic equality. Factors other than the number of years and/or the quality of schooling have to be considered in…

  8. Socioeconomic inequalities in mortality in 16 European cities.

    PubMed

    Borrell, Carme; Marí-Dell'olmo, Marc; Palència, Laia; Gotsens, Mercè; Burström, B O; Domínguez-Berjón, Felicitas; Rodríguez-Sanz, Maica; Dzúrová, Dagmar; Gandarillas, Ana; Hoffmann, Rasmus; Kovacs, Katalin; Marinacci, Chiara; Martikainen, Pekka; Pikhart, Hynek; Corman, Diana; Rosicova, Katarina; Saez, Marc; Santana, Paula; Tarkiainen, Lasse; Puigpinós, Rosa; Morrison, Joana; Pasarín, M Isabel; Díez, Èlia

    2014-05-01

    To explore inequalities in total mortality between small areas of 16 European cities for men and women, as well as to analyse the relationship between these geographical inequalities and their socioeconomic indicators. A cross-sectional ecological design was used to analyse small areas in 16 European cities (26,229,104 inhabitants). Most cities had mortality data for a period between 2000 and 2008 and population size data for the same period. Socioeconomic indicators included an index of socioeconomic deprivation, unemployment, and educational level. We estimated standardised mortality ratios and controlled for their variability using Bayesian models. We estimated relative risk of mortality and excess number of deaths according to socioeconomic indicators. We observed a consistent pattern of inequality in mortality in almost all cities, with mortality increasing in parallel with socioeconomic deprivation. Socioeconomic inequalities in mortality were more pronounced for men than women, and relative inequalities were greater in Eastern and Northern European cities, and lower in some Western (men) and Southern (women) European cities. The pattern of excess number of deaths was slightly different, with greater inequality in some Western and Northern European cities and also in Budapest, and lower among women in Madrid and Barcelona. In this study, we report a consistent pattern of socioeconomic inequalities in mortality in 16 European cities. Future studies should further explore specific causes of death, in order to determine whether the general pattern observed is consistent for each cause of death.

  9. Using quantile regression to examine the effects of inequality across the mortality distribution in the U.S. counties

    PubMed Central

    Yang, Tse-Chuan; Chen, Vivian Yi-Ju; Shoff, Carla; Matthews, Stephen A.

    2012-01-01

    The U.S. has experienced a resurgence of income inequality in the past decades. The evidence regarding the mortality implications of this phenomenon has been mixed. This study employs a rarely used method in mortality research, quantile regression (QR), to provide insight into the ongoing debate of whether income inequality is a determinant of mortality and to investigate the varying relationship between inequality and mortality throughout the mortality distribution. Analyzing a U.S. dataset where the five-year (1998–2002) average mortality rates were combined with other county-level covariates, we found that the association between inequality and mortality was not constant throughout the mortality distribution and the impact of inequality on mortality steadily increased until the 80th percentile. When accounting for all potential confounders, inequality was significantly and positively related to mortality; however, this inequality–mortality relationship did not hold across the mortality distribution. A series of Wald tests confirmed this varying inequality–mortality relationship, especially between the lower and upper tails. The large variation in the estimated coefficients of the Gini index suggested that inequality had the greatest influence on those counties with a mortality rate of roughly 9.95 deaths per 1000 population (80th percentile) compared to any other counties. Furthermore, our results suggest that the traditional analytic methods that focus on mean or median value of the dependent variable can be, at most, applied to a narrow 20 percent of observations. This study demonstrates the value of QR. Our findings provide some insight as to why the existing evidence for the inequality–mortality relationship is mixed and suggest that analytical issues may play a role in clarifying whether inequality is a robust determinant of population health. PMID:22497847

  10. Are health inequalities rooted in the past? Income inequalities in metabolic syndrome decomposed by childhood conditions

    PubMed Central

    San Sebastian, Miguel; Ivarsson, Anneli; Weinehall, Lars; Gustafsson, Per E.

    2017-01-01

    Abstract Background: Early life is thought of as a foundation for health inequalities in adulthood. However, research directly examining the contribution of childhood circumstances to the integrated phenomenon of adult social inequalities in health is absent. The present study aimed to examine whether, and to what degree, social conditions during childhood explain income inequalities in metabolic syndrome in mid-adulthood. Methods: The sample (N = 12 481) comprised all 40- and 50-year-old participants in the Västerbotten Intervention Program in Northern Sweden 2008, 2009 and 2010. Measures from health examinations were used to operationalize metabolic syndrome, which was linked to register data including socioeconomic conditions at age 40–50 years, as well as childhood conditions at participant age 10–12 years. Income inequality in metabolic syndrome in middle age was estimated by the concentration index and decomposed by childhood and current socioeconomic conditions using decomposition analysis. Results: Childhood conditions jointed explained 7% (men) to 10% (women) of health inequalities in middle age. Adding mid-adulthood sociodemographic factors showed a dominant contribution of chiefly current income and educational level in both gender. In women, the addition of current factors slightly attenuated the contribution of childhood conditions, but with paternal income and education still contributing. In contrast, the corresponding addition in men removed all explanation attributable to childhood conditions. Conclusions: Despite that the influence of early life conditions to adult health inequalities was considerably smaller than that of concurrent conditions, the study suggests that early interventions against social inequalities potentially could reduce health inequalities in the adult population for decades to come. PMID:27744345

  11. The Widening Divide: Income Inequality and Poverty in Los Angeles.

    ERIC Educational Resources Information Center

    Castellanos, Eulalio; And Others

    This document summarizes findings from the Research Project on Income Inequality and Poverty in Los Angeles. The figures reported are based on an analysis of published and unpublished data sets, including the Public Use Microdata Sets for the 1970 and 1980 decennial Census of Population, the Current Population Surveys, and the American Housing…

  12. The Widening Divide: Income Inequality and Poverty in Los Angeles.

    ERIC Educational Resources Information Center

    Castellanos, Eulalio; And Others

    This document summarizes findings from the Research Project on Income Inequality and Poverty in Los Angeles. The figures reported are based on an analysis of published and unpublished data sets, including the Public Use Microdata Sets for the 1970 and 1980 decennial Census of Population, the Current Population Surveys, and the American Housing…

  13. Income Inequality, Race, and Child Well-Being: An Aggregate Analysis in the 50 United States

    ERIC Educational Resources Information Center

    McLeod, Jane D.; Nonnemaker, James M.; Call, Kathleen Thiede

    2004-01-01

    Interest in income inequality as a predictor of health has exploded since the mid-1990s. Recent analyses suggest, however, that the effect of income inequality on population health is not robust to a control for the racial composition of the population. That observation raises two interpretational questions. First, does income inequality have an…

  14. Income Inequality, Race, and Child Well-Being: An Aggregate Analysis in the 50 United States

    ERIC Educational Resources Information Center

    McLeod, Jane D.; Nonnemaker, James M.; Call, Kathleen Thiede

    2004-01-01

    Interest in income inequality as a predictor of health has exploded since the mid-1990s. Recent analyses suggest, however, that the effect of income inequality on population health is not robust to a control for the racial composition of the population. That observation raises two interpretational questions. First, does income inequality have an…

  15. Meeting the Educational Challenges of Income Inequality

    ERIC Educational Resources Information Center

    Duncan, Greg J.; Murnane, Richard J.

    2014-01-01

    Can the nation's schools meet today's challenge of providing all students with the skills they will need to thrive in the rapidly changing economy and society of the 21st century? The authors point out in this article that a large percentage of children, overwhelmingly from low-income families, end their formal schooling without the…

  16. Meeting the Educational Challenges of Income Inequality

    ERIC Educational Resources Information Center

    Duncan, Greg J.; Murnane, Richard J.

    2014-01-01

    Can the nation's schools meet today's challenge of providing all students with the skills they will need to thrive in the rapidly changing economy and society of the 21st century? The authors point out in this article that a large percentage of children, overwhelmingly from low-income families, end their formal schooling without the…

  17. Inequality in the Distribution of Personal Income.

    ERIC Educational Resources Information Center

    Shannon, Robin

    The major purpose of this paper are to survey the published data on the size distribution of personal income in a number of countries belonging to the Organization for Economic Co-operation and Development (OECD), to point out the shortcomings of currently collected data, and to propose improvements. An important conclusion concerning the first…

  18. Inequalities in child mortality in ten major African cities

    PubMed Central

    2014-01-01

    Background The existence of socio-economic inequalities in child mortality is well documented. African cities grow faster than cities in most other regions of the world; and inequalities in African cities are thought to be particularly large. Revealing health-related inequalities is essential in order for governments to be able to act against them. This study aimed to systematically compare inequalities in child mortality across 10 major African cities (Cairo, Lagos, Kinshasa, Luanda, Abidjan, Dar es Salaam, Nairobi, Dakar, Addis Ababa, Accra), and to investigate trends in such inequalities over time. Methods Data from two rounds of demographic and health surveys (DHS) were used for this study (if available): one from around the year 2000 and one from between 2007 and 2011. Child mortality rates within cities were calculated by population wealth quintiles. Inequality in child mortality was assessed by computing two measures of relative inequality (the rate ratio and the concentration index) and two measures of absolute inequality (the difference and the Erreyger’s index). Results Mean child mortality rates ranged from about 39 deaths per 1,000 live births in Cairo (2008) to about 107 deaths per 1,000 live births in Dar es Salaam (2010). Significant inequalities were found in Kinshasa, Luanda, Abidjan, and Addis Ababa in the most recent survey. The difference between the poorest quintile and the richest quintile was as much as 108 deaths per 1,000 live births (95% confidence interval 55 to 166) in Abidjan in 2011–2012. When comparing inequalities across cities or over time, confidence intervals of all measures almost always overlap. Nevertheless, inequalities appear to have increased in Abidjan, while they appear to have decreased in Cairo, Lagos, Dar es Salaam, Nairobi and Dakar. Conclusions Considerable inequalities exist in almost all cities but the level of inequalities and their development over time appear to differ across cities. This implies that

  19. Increase income and mortality of colorrectal cancer in Brazil, 2001-2009.

    PubMed

    Guimarães, Raphael Mendonça; Rocha, Paulo Guilherme Molica; Muzi, Camila Drumind; Ramos, Raquel de Souza

    2013-01-01

    Several international studies have observed a correlation between the improvement of socio-demographic indicators and rates of incidence and mortality from cancer of the colon and rectum. The objective of this study is to estimate the correlation between average per capita income and the rate of colorectal cancer mortality in Brazil between 2001 and 2009. We obtained data on income inequality (Gini index), population with low incomes (½ infer the minimum wage/month), average family income, per capita ICP and mortality from colon cancer and straight between 2001-2009 by DATASUS. A trend analysis was performed using linear regression, and correlation between variables by Pearson's correlation coefficient. There was a declining trend in poverty and income inequality, and growth in ICP per capita and median family income and standardized mortality rate for colorectal cancer in Brazil. There was also strong positive correlation between mortality from this site of cancer and inequality (men r = -0.30, P = 0.06, women r = -0.33, P = 0.05) income low income (men r = -0.80, P<0.001, women r = -0.76, P<0.001), median family income (men r = 0.79, P = 0.06, women r = 0.76, P<0.001) and ICP per capita (men r = 0.73, P<0.001, women r = 0.68, P<0.001) throughout the study period. The increase of income and reducing inequality may partially explain the increased occurrence of colorectal cancer and this is possibly due to differential access to food recognized as a risk factor, such as red meat and high in fat. It is important therefore to assess the priority of public health programs addressing nutrition in countries of intermediate economy, as is the case of Brazil.

  20. Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA.

    PubMed

    Hoffmann, Rasmus

    2011-06-01

    Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. The effect of private tubewells on income and income inequality in rural Pakistan

    NASA Astrophysics Data System (ADS)

    Wang, Zhiyu; Huang, Qiuqiong; Giordano, Mark

    2015-08-01

    Since the introduction of private tubewells in rural Pakistan, farmers have increasingly used groundwater to supplement canal water for irrigation and improve the reliability of the water supply. Farmers obtain groundwater either from their own tubewells or from other well owners. This paper examines the effect of private tubewells on rural income, both in terms of income level and income distribution since it may differ across farmers with different irrigation status (only canal water, canal water and groundwater from own tubewell, and canal water and purchased groundwater). The results show that private tubewells work to enhance rural income and reduce income inequality in rural Pakistan.

  2. Increasing Inequality in Parent Incomes and Children's Schooling.

    PubMed

    Duncan, Greg J; Kalil, Ariel; Ziol-Guest, Kathleen M

    2017-08-01

    Income inequality and the achievement test score gap between high- and low-income children increased dramatically in the United States beginning in the 1970s. This article investigates the demographic (family income, mother's education, family size, two-parent family structure, and age of mother at birth) underpinnings of the growing income-based gap in schooling using data from the Panel Study of Income Dynamics. Across 31 cohorts, we find that increases in the income gap between high- and low-income children account for approximately three-quarters of the increasing gap in completed schooling, one-half of the gap in college attendance, and one-fifth of the gap in college graduation. We find no consistent evidence of increases in the estimated associations between parental income and children's completed schooling. Increasing gaps in the two-parent family structures of high- and low-income families accounted for relatively little of the schooling gap because our estimates of the (regression-adjusted) associations between family structure and schooling were surprisingly small for much of our accounting period. On the other hand, increasing gaps in mother's age at the time of birth accounts for a substantial portion of the increasing schooling gap: mother's age is consistently predictive of children's completed schooling, and the maternal age gap for children born into low- and high-income families increased considerably over the period.

  3. Is income inequality related to childhood dental caries in rich countries?

    PubMed

    Bernabé, Eduardo; Hobdell, Martin H

    2010-02-01

    The aim of this study was to assess the correlates of income and income inequality with dental caries in a sample of all countries, as well as in rich countries alone. In this ecological study, the authors analyzed national data on income, income inequality and dental caries from 48 countries. Of them, 22 were rich countries (according to World Bank criteria). The authors determined income by gross national income (GNI) per capita (formerly known as gross national product) and income inequality by the Gini coefficient (a measure of income inequality on a scale between 0 and 1). They assessed dental caries according to the decayed, missing, filled teeth (dmft) index in 5- to 6-year-old children. The authors used Pearson and partial correlation coefficients to examine the linear associations of income and income inequality with dental caries. GNI per capita, but not the Gini coefficient, was inversely correlated with the dmft index in the 48 countries. However, the results showed an opposite pattern when analyses were restricted to rich countries (that is, the dmft index was significantly correlated with the Gini coefficient but not with GNI per capita). These findings support the income inequality hypothesis that beyond a certain level of national income, the relationship between income and the population's health is weak. Income inequality was correlated more strongly with dental caries than was income in rich countries. Among rich countries, income inequality is a stronger determinant of childhood dental caries than is absolute income.

  4. [Socioeconomic inequalities and infant mortality in Bolivia].

    PubMed

    Maydana, Edgar; Serral, Gemma; Borrell, Carme

    2009-05-01

    To evaluate socioeconomic inequalities and its relation to infant mortality in Bolivia's municipalities in 2001. An ecological study based on data from the 2001 National Census on Population and Housing (Censo Nacional de Población y Vivienda) covering the 327 municipalities in Bolivia's nine departments. The dependent variable was the infant mortality rate (IMR); the independent variables were indirect socioeconomic indicators (the percentage of illiterates older than 15 years of age, and the building materials and sanitation features of the houses). The geographic distribution of each indicator was determined and the associations between IMR and each socioeconomic indicator were calculate using Spearman's rank correlation coefficient and adjusted with Poisson regression models. The resulting IMR for Bolivia in 2001 was 67 per 1000 live births. Rates ranged from <0.1 per 1000 live births in the Magdalena municipality, Beni department, to 170.0 per 1000 live births in the Caripuyo municipality, Potosí department. The mean rate of illiteracy per municipality was 17.5%; the mean percentage of houses without running water was 90.4%, and for those lacking sanitation services, 67.6%. The IMR was inversely associated with all of the socioeconomic indicators studied. The highest relative risk was found in housing without sanitation services. Multifactorial models adjusted for illiteracy showed that the following indicators were still strongly associated with the IMR: no sanitation services (Relative risk (RR)=1.54; 95% Confidence Interval (95%CI)=1.38-1.66); adobe, stone, or mud walls (RR=1.54; 95%CI: 1.43-1.67); and, corrugated metal, straw, or palm branch roof (RR=1.34; 95%CI: 1.26-1.43). A significant association was found between poor socioeconomic status and high IMR in Bolivia's municipalities in 2001. The municipalities in the country's central and southeastern areas had lower socioeconomic status and higher IMR. The lack of education, absence of basic sanitation

  5. Accounting for the dead in the longitudinal analysis of income-related health inequalities.

    PubMed

    Petrie, Dennis; Allanson, Paul; Gerdtham, Ulf G

    2011-09-01

    This paper develops an accounting framework to consider the effect of deaths on the longitudinal analysis of income-related health inequalities. Ignoring deaths or using Inverse Probability Weights (IPWs) to re-weight the sample for mortality-related attrition can produce misleading results. Incorporating deaths into the longitudinal analysis of income-related health inequalities provides a more complete picture in terms of the evaluation of health changes in respect to socioeconomic status. We illustrate our work by investigating health mobility from 1999 till 2004 using the British Household Panel Survey (BHPS). We show that for Scottish males explicitly accounting for the dead rather than using IPWs to account for mortality-related attrition changes the direction of the relationship between relative health changes and initial income position, from negative to positive, while for other groups it significantly increases the strength of the positive relationship. Incorporating the dead may be vital in the longitudinal analysis of health inequalities. Copyright © 2011 Elsevier B.V. All rights reserved.

  6. Income inequality is associated with stronger social comparison effects: The effect of relative income on life satisfaction.

    PubMed

    Cheung, Felix; Lucas, Richard E

    2016-02-01

    Previous research has shown that having rich neighbors is associated with reduced levels of subjective well-being, an effect that is likely due to social comparison. The current study examined the role of income inequality as a moderator of this relative income effect. Multilevel analyses were conducted on a sample of more than 1.7 million people from 2,425 counties in the United States. Results showed that higher income inequality was associated with stronger relative income effects. In other words, people were more strongly influenced by the income of their neighbors when income inequality was high. (c) 2016 APA, all rights reserved).

  7. Income Inequality Is Associated with Stronger Social Comparison Effects: The Effect of Relative Income on Life Satisfaction

    PubMed Central

    Cheung, Felix; Lucas, Richard E.

    2015-01-01

    Previous research has shown that having rich neighbors is associated with reduced levels of subjective well-being, an effect that is likely due to social comparison. The current study examined the role of income inequality as a moderator of this relative income effect. Multilevel analyses were conducted on a sample of over 1.7 million people from 2,425 counties in the United States. Results showed that higher income inequality was associated with stronger relative income effects. In other words, people were more strongly influenced by the income of their neighbors when income inequality was high. PMID:26191957

  8. Inequality and mortality: long-run evidence from a panel of countries.

    PubMed

    Leigh, Andrew; Jencks, Christopher

    2007-01-01

    We investigate whether changes in economic inequality affect mortality in rich countries. To answer this question we use a new source of data on income inequality: tax data on the share of pretax income going to the richest 10% of the population in Australia, Canada, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK, and the US between 1903 and 2003. Although this measure is not a good proxy for inequality within the bottom half of the income distribution, it is a good proxy for changes in the top half of the distribution and for the Gini coefficient. In the absence of country and year fixed effects, the income share of the top decile is negatively related to life expectancy and positively related to infant mortality. However, in our preferred fixed-effects specification these relationships are weak, statistically insignificant, and likely to change their sign. Nor do our data suggest that changes in the income share of the richest 10% affect homicide or suicide rates.

  9. Socioeconomic Inequality in mortality using 12-year follow-up data from nationally representative surveys in South Korea.

    PubMed

    Khang, Young-Ho; Kim, Hye-Ryun

    2016-03-22

    Investigations into socioeconomic inequalities in mortality have rarely used long-term mortality follow-up data from nationally representative samples in Asian countries. A limited subset of indicators for socioeconomic position was employed in prior studies on socioeconomic inequalities in mortality. We examined socioeconomic inequalities in mortality using follow-up 12-year mortality data from nationally representative samples of South Koreans. A total of 10,137 individuals who took part in the 1998 and 2001 Korea National Health and Nutrition Examination Surveys were linked to mortality data from Statistics Korea. Of those individuals, 1,219 (12.1 %) had died as of December 2012. Cox proportional hazard models were used to estimate the relative risks of mortality according to a wide range of socioeconomic position (SEP) indicators after taking into account primary sampling units, stratification, and sample weights. Our analysis showed strong evidence that individuals with disadvantaged SEP indicators had greater all-cause mortality risks than their counterparts. The magnitude of the association varied according to gender, age group, and specific SEP indicators. Cause-specific analyses using equivalized income quintiles showed that the magnitude of mortality inequalities tended to be greater for cardiovascular disease and external causes than for cancer. Inequalities in mortality exist in every aspect of SEP indicators, both genders, and age groups, and four broad causes of deaths. The South Korean economic development, previously described as effective in both economic growth and relatively equitable income distribution, should be scrutinized regarding its impact on socioeconomic mortality inequalities. Policy measures to reduce inequalities in mortality should be implemented in South Korea.

  10. Income inequality, parental socioeconomic status, and birth outcomes in Japan.

    PubMed

    Fujiwara, Takeo; Ito, Jun; Kawachi, Ichiro

    2013-05-15

    The purpose of this study was to investigate the impact of income inequality and parental socioeconomic status on several birth outcomes in Japan. Data were collected on birth outcomes and parental socioeconomic status by questionnaire from Japanese parents nationwide (n = 41,499) and then linked to Gini coefficients at the prefectural level in 2001. In multilevel analysis, z scores of birth weight for gestational age decreased by 0.018 (95% confidence interval (CI): -0.029, -0.006) per 1-standard-deviation (0.018-unit) increase in the Gini coefficient, while gestational age at delivery was not associated with the Gini coefficient. For dichotomous outcomes, mothers living in prefectures with middle and high Gini coefficients were 1.24 (95% CI: 1.05, 1.47) and 1.23 (95% CI: 1.02, 1.48) times more likely, respectively, to deliver a small-for-gestational-age infant than mothers living in more egalitarian prefectures (low Gini coefficients), although preterm births were not significantly associated with income distribution. Parental educational level, but not household income, was significantly associated with the z score of birth weight for gestational age and small-for-gestational-age status. Higher income inequality at the prefectural level and parental educational level, rather than household income, were associated with intrauterine growth but not with shorter gestational age at delivery.

  11. The global burden of child burn injuries in light of country level economic development and income inequality.

    PubMed

    Sengoelge, Mathilde; El-Khatib, Ziad; Laflamme, Lucie

    2017-06-01

    Child burn mortality differs widely between regions and is closely related to material deprivation, but reports on their global distribution are few. Investigating their country level distribution in light of economic level and income inequality will help assess the potential for macro-level improvements. We extracted data for child burn mortality from the Global Burden of Disease study 2013 and combined data into 1-14 years to calculate rates at country, region and income levels. We also compiled potential lives saved. Then we examined the relationship between country level gross domestic product per capita from the World Bank and income inequality (Gini Index) from the Standardized World Income Inequality Database and child burn mortality using Spearman coefficient correlations. Worldwide, the burden of child burn deaths is 2.5 per 100,000 across 103 countries with the largest burden in Sub-Saharan Africa (4.5 per 100,000). Thirty-four thousand lives could be saved yearly if all countries in the world had the same rates as the best performing group of high-income countries; the majority in low-income countries. There was a negative graded association between economic level and child burns for all countries aggregated and at regional level, but no consistent pattern existed for income inequality at regional level. The burden of child burn mortality varies by region and income level with prevention efforts needed most urgently in middle-income countries and Sub-Saharan Africa. Investment in safe living conditions and access to medical care are paramount to achieving further reductions in the global burden of preventable child burn deaths.

  12. [Income inequality, corruption, and life expectancy at birth in Mexico].

    PubMed

    Idrovo, Alvaro Javier

    2005-01-01

    To ascertain if the effect of income inequality on life expectancy at birth in Mexico is mediated by corruption, used as a proxy of social capital. An ecological study was carried out with the 32 Mexican federative entities. Global and by sex correlations between life expectancy at birth were estimated by federative entity with the Gini coefficient, the Corruption and Good Government Index, the percentage of Catholics, and the percentage of the population speaking indigenous language. Robust linear regressions, with and without instrumental variables, were used to explore if corruption acts as intermediate variable in the studied relationship. Negative correlations with Spearman's rho near to -0.60 (p < 0.05) and greater than -0.66 (p < 0.05) between life expectancy at birth, the Gini coefficient and the population speaking indigenous language, respectively, were observed. Moreover, the Corruption and Good Government Index correlated with men's life expectancy at birth with Spearman's rho -0.3592 (p < 0.05). Regressions with instruments were more consistent than conventional ones and they show a strong negative effect (p < 0.05) of income inequality on life expectancy at birth. This effect was greater among men. The findings suggest a negative effect of income inequality on life expectancy at birth in Mexico, mediated by corruption levels and other related cultural factors.

  13. Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers

    PubMed Central

    Mackenbach, Johan P.; Kulhánová, Ivana; Bopp, Matthias; Borrell, Carme; Deboosere, Patrick; Kovács, Katalin; Looman, Caspar W. N.; Leinsalu, Mall; Mäkelä, Pia; Martikainen, Pekka; Menvielle, Gwenn; Rodríguez-Sanz, Maica; Rychtaříková, Jitka; de Gelder, Rianne

    2015-01-01

    Background Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time. Methods and Findings We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3–4.0) and the slope index of inequality is 112.5 (95% CI 106.2–118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of

  14. Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform.

    PubMed

    Raittio, Eero; Kiiskinen, Urpo; Helminen, Sari; Aromaa, Arpo; Suominen, Anna Liisa

    2015-06-01

    In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform. Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them. Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years. It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru.

    PubMed

    Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S

    2017-01-11

    Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population. © The American Society of Tropical Medicine and Hygiene.

  16. Association between gender inequality index and child mortality rates: a cross-national study of 138 countries.

    PubMed

    Brinda, Ethel Mary; Rajkumar, Anto P; Enemark, Ulrika

    2015-03-09

    Gender inequality weakens maternal health and harms children through many direct and indirect pathways. Allied biological disadvantage and psychosocial adversities challenge the survival of children of both genders. United Nations Development Programme (UNDP) has recently developed a Gender Inequality Index to measure the multidimensional nature of gender inequality. The global impact of Gender Inequality Index on the child mortality rates remains uncertain. We employed an ecological study to investigate the association between child mortality rates and Gender Inequality Indices of 138 countries for which UNDP has published the Gender Inequality Index. Data on child mortality rates and on potential confounders, such as, per capita gross domestic product and immunization coverage, were obtained from the official World Health Organization and World Bank sources. We employed multivariate non-parametric robust regression models to study the relationship between these variables. Women in low and middle income countries (LMICs) suffer significantly more gender inequality (p < 0.001). Gender Inequality Index (GII) was positively associated with neonatal (β = 53.85; 95% CI 41.61-64.09), infant (β = 70.28; 95% CI 51.93-88.64) and under five mortality rates (β = 68.14; 95% CI 49.71-86.58), after adjusting for the effects of potential confounders (p < 0.001). We have documented statistically significant positive associations between GII and child mortality rates. Our results suggest that the initiatives to curtail child mortality rates should extend beyond medical interventions and should prioritize women's rights and autonomy. We discuss major pathways connecting gender inequality and child mortality. We present the socio-economic problems, which sustain higher gender inequality and child mortality in LMICs. We further discuss the potential solutions pertinent to LMICs. Dissipating gender barriers and focusing on social well-being of women may augment the survival of

  17. Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: The double burden of non-communicable diseases and injuries

    PubMed Central

    Arroyave, Ivan; Burdorf, Alex; Cardona, Doris; Avendano, Mauricio

    2014-01-01

    Objectives Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. Methods Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. Results Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2·60, 95% confidence interval [CI]:2·56, 2·64; RRwomen=2·36, CI:2·31, 2·42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55·1% of male inequalities while non-communicable diseases explained 62·5% of female inequalities and 27·1% of male inequalities. Infections explained a small proportion of inequalities in mortality. Conclusion Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities. PMID:24674854

  18. Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study.

    PubMed

    Skalická, Vera; van Lenthe, Frank; Bambra, Clare; Krokstad, Steinar; Mackenbach, Johan

    2009-10-01

    Previous studies have assessed the relative importance of material, psychosocial and behavioural factors in the explanation of relative socio-economic inequalities in mortality, but research into the contribution of biomedical factors has been limited. Our study examines the relative contribution of (i) material, (ii) psychosocial, (iii) behavioural and (iv) biomedical factors in the explanation of relative socio-economic (educational and income) inequalities in mortality. Cohort study--baseline data from the Norwegian total county population-based HUNT 2 study linked to mortality data (1995/97 to 2003). In this analysis, 18 247 men and 18 278 women aged 24-80 without severe chronic disease at baseline were eligible. No socio-economic inequalities in mortality among women were found. In men, educational- and income-related inequalities in mortality were found with a relative risk for the lowest educational group of 1.67 (1.29-2.15) and the lowest income quartile of 2.03 (1.57-2.70). Together, the four explanatory factors reduced the relative risk of mortality of the lowest educational group to 1.18 (0.90-1.55) and the relative risk of mortality in the lowest income quartile was attenuated to 1.17 (0.83-1.63). Known biomedical factors contributed least to both educational and income inequalities in mortality. Material factors were the most important in explaining income inequalities in mortality amongst men, whereas psychosocial and behavioural factors were the most important in explaining educational inequalities. This suggests that improving the material, psychosocial and behavioural circumstances of men might bring more substantial reductions in relative socio-economic inequalities in mortality.

  19. Income Inequality and the Developing Child: Is It All Relative?

    PubMed Central

    Odgers, Candice L.

    2016-01-01

    Children from low-income families are at heightened risk for a number of poor outcomes, including depression, antisocial behavior, poor physical health and educational failure. Growing up in poverty is generally seen as toxic for children’s development. However, less is known about how the “economic distance” between children and their peers influences behavior and health. This paper examines how both poverty and the growing divide between low-income children and their peers may be influencing low-income children’s life chances. Among wealthy nations, children growing up in countries with higher levels of income inequality consistently fare worse on multiple indices of health, educational attainment and wellbeing. Although evidence has been mixed, new research suggests that low-income children may be experiencing worse outcomes, and a form of “double disadvantage”, when they live and attend school alongside more affluent versus similarly positioned peers. The role that subjective social status (SSS) may play in understanding why some low-income children appear to be suffering in the shadow of wealth is explored, alongside a call for additional research focused on how children come to understand, and respond to, their perceived social status. PMID:26618957

  20. Income inequality and the developing child: Is it all relative?

    PubMed

    Odgers, Candice L

    2015-11-01

    Children from low-income families are at heightened risk for a number of poor outcomes, including depression, antisocial behavior, poor physical health, and educational failure. Growing up in poverty is generally seen as toxic for children. However, less is known about how the "economic distance" between children and their peers influences behavior and health. This article examines how both poverty and the growing divide between low-income children and their peers may be influencing low-income children's life chances. Among wealthy nations, children in countries with higher levels of income inequality consistently fare worse on multiple indices of health, educational attainment, and well-being. New research also suggests that low-income children may be experiencing worse outcomes, and a form of "double disadvantage," when they live and attend school alongside more affluent versus similarly positioned peers. The role of subjective social status in explaining why some low-income children appear to suffer when growing up alongside more affluent peers is explored, alongside a call for additional research focused on how children come to understand, and respond to, their perceived social status. (PsycINFO Database Record

  1. Socioeconomic hierarchy and health gradient in Europe: the role of income inequality and of social origins.

    PubMed

    Chauvel, Louis; Leist, Anja K

    2015-11-14

    Health inequalities reflect multidimensional inequality (income, education, and other indicators of socioeconomic position) and vary across countries and welfare regimes. To which extent there is intergenerational transmission of health via parental socioeconomic status has rarely been investigated in comparative perspective. The study sought to explore if different measures of stratification produce the same health gradient and to which extent health gradients of income and of social origins vary with level of living and income inequality. A total of 299,770 observations were available from 18 countries assessed in EU-SILC 2005 and 2011 data, which contain information on social origins. Income inequality (Gini) and level of living were calculated from EU-SILC. Logit rank transformation provided normalized inequalities and distributions of income and social origins up to the extremes of the distribution and was used to investigate net comparable health gradients in detail. Multilevel random-slope models were run to post-estimate best linear unbiased predictors (BLUPs) and related standard deviations of residual intercepts (median health) and slopes (income-health gradients) per country and survey year. Health gradients varied across different measures of stratification, with origins and income producing significant slopes after controls. Income inequality was associated with worse average health, but income inequality and steepness of the health gradient were only marginally associated. Linear health gradients suggest gains in health per rank of income and of origins even at the very extremes of the distribution. Intergenerational transmission of status gains in importance in countries with higher income inequality. Countries differ in the association of income inequality and income-related health gradient, and low income inequality may mask health problems of vulnerable individuals with low status. Not only income inequality, but other country characteristics such

  2. Income Inequality and Its Consequences for Life Satisfaction: What Role Do Social Cognitions Play?

    ERIC Educational Resources Information Center

    Schneider, Simone M.

    2012-01-01

    While it is generally agreed that income inequality affects an individual's well-being, researchers disagree on whether people living in areas of high income disparity report more or less happiness than those in more equal environments, thereby indicating the need to study how and why income inequality matters to the individual's well-being.…

  3. Income Inequality and Its Consequences for Life Satisfaction: What Role Do Social Cognitions Play?

    ERIC Educational Resources Information Center

    Schneider, Simone M.

    2012-01-01

    While it is generally agreed that income inequality affects an individual's well-being, researchers disagree on whether people living in areas of high income disparity report more or less happiness than those in more equal environments, thereby indicating the need to study how and why income inequality matters to the individual's well-being.…

  4. Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India.

    PubMed

    Rajan, Keertichandra; Kennedy, Jonathan; King, Lawrence

    2013-07-01

    Standard policy prescriptions for improving public health in less developed countries (LDCs) prioritise raising average income levels over redistributive policies since it is widely accepted that 'wealthier is healthier'. It is argued that income inequality becomes a significant predictor of public health only after the 'epidemiological transition'. This paper tests this theory in India, where rising income levels have not been matched by improvements in public health. We use state-, district-, and individual-level data to investigate the relationship between infant and under-five mortality, and average income, poverty, income inequality, and literacy. Our analysis shows that at both state- and district-level public health is negatively associated with average income and positively associated with poverty. But, at both levels, controlling for poverty and literacy renders average income statistically insignificant. At state-level, only literacy remains a significant and negative predictor. At the less aggregated district-level, both poverty and literacy predict public health but literacy has a stronger effect than poverty. Inequality does not predict public health at state- or district-levels. At the individual-level, however, it is a strong predictor of self-reported ailment, even after we control for district average income, individual income, and individual education. Our analysis suggests that wealthier is indeed healthier in India - but only to the extent that high average incomes reflect low poverty and high literacy. Furthermore, inequality has a strong effect on self-reported health. Standard policy prescriptions, then, need revision: first, alleviating poverty may be more effective than raising average income levels; second, non-income goods like literacy may make an important contribution to public health; and third, policy should be based on a broader understanding of societal well-being and the factors that promote it. Copyright © 2013 Elsevier Ltd. All

  5. Socio-economic inequalities in all-cause mortality in Europe: an exploration of the role of heightened social mobility.

    PubMed

    Simons, Audrey M W; Groffen, Daniëlle A I; Bosma, Hans

    2013-12-01

    The larger than expected socio-economic inequalities in health in more egalitarian countries might be explained by a heightened social mobility in these countries. Therefore, the aim of this explorative study was to examine the associations between country-level social mobility, income inequality and socio-economic differences in all-cause mortality, using country-level secondary data from 12 European countries. Both income equality and social mobility were found to be associated with larger socio-economic differences in mortality, particularly in women. These findings suggest that social mobility and income equality, beside their shiny side of improving population health, might have a shady side of increasing socio-economic health inequalities.

  6. Does government provision of healthcare explain the relationship between income inequality and low birthweight?

    PubMed

    Lhila, Aparna

    2009-10-01

    This paper estimates the relationship between state and county income inequality and low birthweight (LBW) in the U.S. It examines whether more unequal societies are also less healthy because such societies have lower investment in population health. The model includes an extensive list of community and individual controls and community fixed-effects. Results show that unequal states in fact have greater social investments, and absent these investments children born in such states would be more likely to be LBW. Using alternate measures of inequality reveals that income inequality in the upper tail of the income distribution is not related to LBW; but inequality in the lower tail of the income distribution is associated with increased LBW where the supply of healthcare mitigates the effect of income inequality. Consistent with prior findings, county income inequality is not significantly related to LBW.

  7. Is Income Inequality a Determinant of Population Health? Part 1. A Systematic Review

    PubMed Central

    Lynch, John; Smith, George Davey; Harper, Sam; Hillemeier, Marianne; Ross, Nancy; Kaplan, George A; Wolfson, Michael

    2004-01-01

    This article reviews 98 aggregate and multilevel studies examining the associations between income inequality and health. Overall, there seems to be little support for the idea that income inequality is a major, generalizable determinant of population health differences within or between rich countries. Income inequality may, however, directly influence some health outcomes, such as homicide in some contexts. The strongest evidence for direct health effects is among states in the United States, but even that is somewhat mixed. Despite little support for a direct effect of income inequality on health per se, reducing income inequality by raising the incomes of the most disadvantaged will improve their health, help reduce health inequalities, and generally improve population health. PMID:15016244

  8. Neo-materialist theory and the temporal relationship between income inequality and longevity change.

    PubMed

    Clarkwest, Andrew

    2008-05-01

    This study uses a neo-materialist perspective to develop theoretical predictions regarding temporal ties between income inequality and change in population health. The argument focuses on the relationship between income inequality and adoption of longevity-enhancing innovations. It asserts that longevity change should be influenced by preexisting levels of income inequality and that, consequently, income inequality can cause differential longevity improvement across jurisdictions even if inequality levels remain unchanged. State-level U.S. data from 1970 to 2000 are used to jointly model the effects of initial levels and change in income inequality on 10-year life expectancy change. Results confirm that states with higher levels of inequality experienced less subsequent improvement in life expectancy. Contrary to findings from prior research, analyses also reveal a strong negative association between change in inequality and change in longevity once initial levels of inequality and other state characteristics are controlled. Finally, direct tests of the relationship between income inequality and the adoption of innovations in quality of medical care indicate that the two are highly related and that differences in the average quality of care can account for the negative cross-sectional association between income inequality and life expectancy.

  9. Oil and gas development and coastal income inequality: A comparative analysis. Final report

    SciTech Connect

    Tolbert, C.M.

    1994-11-30

    This research employed parish-and county-level data from the 1970, 1980, and 1990 censuses in a comparative analysis of family income inequality. We examined inequality trends in coastal Louisiana parishes and in Florida panhandle counties where there has been no significant onshore or offshore development. The analysis framework spanned key decades that correspond to expansion and subsequent contraction in oil and gas industry activity. A comparative inequality analysis revealed very different patterns of income inequality for Florida and Louisiana. While Florida inequality primarily trended downward across time, inequality in Louisiana exhibited a great deal of volatility and, by 1990, was higher than in 1970 in several cases.

  10. Are health inequalities really not the smallest in the Nordic welfare states? A comparison of mortality inequality in 37 countries.

    PubMed

    Popham, Frank; Dibben, Chris; Bambra, Clare

    2013-05-01

    Research comparing mortality by socioeconomic status has found that inequalities are not the smallest in the Nordic countries. This is in contrast to expectations given these countries' policy focus on equity. An alternative way of studying inequality has been little used to compare inequalities across welfare states and may yield a different conclusion. We used average life expectancy lost per death as a measure of total inequality in mortality derived from death rates from the Human Mortality Database for 37 countries in 2006 that we grouped by welfare state type. We constructed a theoretical 'lowest mortality comparator country' to study, by age, why countries were not achieving the smallest inequality and the highest life expectancy. We also studied life expectancy as there is an important correlation between it and inequality. On average, Nordic countries had the highest life expectancy and smallest inequalities for men but not women. For both men and women, Nordic countries had particularly low younger age mortality contributing to smaller inequality and higher life expectancy. Although older age mortality in the Nordic countries is not the smallest. There was variation within Nordic countries with Sweden, Iceland and Norway having higher life expectancy and smaller inequalities than Denmark and Finland (for men). Our analysis suggests that the Nordic countries do have the smallest inequalities in mortality for men and for younger age groups. However, this is not the case for women. Reducing premature mortality among older age groups would increase life expectancy and reduce inequality further in Nordic countries.

  11. Income inequality, social cohesion and the health status of populations: the role of neo-liberalism.

    PubMed

    Coburn, D

    2000-07-01

    There has been a recent upsurge of interest in the relationship between income inequality and health within nations and between nations. On the latter topic Wilkinson and others believe that, in the advanced capitalist countries, higher income inequality leads to lowered social cohesion which in turn produces poorer health status. I argue that, despite a by-now voluminous literature, not enough attention has been paid to the social context of income inequality--health relationships or to the causes of income inequality itself. In this paper I contend that there is a particular affinity between neo-liberal (market-oriented) political doctrines, income inequality and lowered social cohesion. Neo-liberalism, it is argued, produces both higher income inequality and lowered social cohesion. Part of the negative effect of neo-liberalism on health status is due to its undermining of the welfare state. The welfare state may have direct effects on health as well as being one of the underlying structural causes of social cohesion. The rise of neo-liberalism and the decline of the welfare state are themselves tied to globalization and the changing class structures of the advanced capitalist societies. More attention should be paid to understanding the causes of income inequalities and not just to its effects because income inequalities are neither necessary nor inevitable. Moreover, understanding the contextual causes of inequality may also influence our notion of the causal pathways involved in inequality-health status relationships (and vice versa).

  12. A matter of perception: exploring the role of income satisfaction in the income-mortality relationship in German survey data 1995-2010.

    PubMed

    Miething, Alexander

    2013-12-01

    Individual- and community-level income has been shown to be linked to social inequalities in health and mortality. On the individual level, social comparisons and relative deprivation resulting from them have been identified as relevant mechanisms involved in the relationship between income and health, but it is mainly income-based measures of relative deprivation that have been considered in previous studies. Using income satisfaction, this study employs a perception-based indicator of relative deprivation. The study, covering the period between 1995 and 2010, utilized the German Socio-Economic Panel. The follow-up included 11,056 men and 11,512 women at employment age 25-64. Discrete-time survival analysis with Cox regression was performed to estimate the effects of relative income position and income satisfaction on all-cause mortality. The univariate analysis revealed an income gradient on mortality and further showed a strong association between income satisfaction and survival. After education and employment status were adjusted for, the effect of discontent with income on mortality was still present in the female sample, whereas in the male sample only the income gradient prevailed. When self-rated health was controlled for, the hazard ratios of income satisfaction attenuated and turned non-significant for both men and women while the effects of income position remained stable. In conclusion, the findings suggest that income satisfaction and income position measure different aspects of income inequality and complement one another. Income satisfaction appeared to be a possible contributing component to the causal pathway between income and mortality.

  13. Does grassroots democracy reduce income inequality in China?

    PubMed

    Shen, Yan; Yao, Yang

    2008-10-01

    Using village and household survey data collected from 48 villages of eight Chinese provinces for the period 1986-2002, this paper studies how the introduction of village elections affects income distribution at the village level. We estimate both a static fixed-effect panel model and a dynamic panel model for the within-village Gini coefficient and take care of the endogeneity of the introduction of elections. The dynamic panel model shows that having elections reduces the Gini coefficient by 0.04, or 14.3% of the sample average. We also find that elections tend to increase the income shares of poorer portions of the population. Further econometric analysis based on dynamic panel models shows that elections increase per-capita public expenditures by 271 Yuan, but do not increase the level or progressiveness of net or total income transfer in a village. Therefore, elections' positive role in reducing income inequality is not played through more income redistribution, but through more pro-poor public investment.

  14. The Dynamics of Wealth Inequality and the Effect of Income Distribution

    PubMed Central

    Berman, Yonatan; Shapira, Yoash

    2016-01-01

    The rapid increase of wealth inequality in the past few decades is one of the most disturbing social and economic issues of our time. Studying its origin and underlying mechanisms is essential for policy aiming to control and even reverse this trend. In that context, controlling the distribution of income, using income tax or other macroeconomic policy instruments, is generally perceived as effective for regulating the wealth distribution. We provide a theoretical tool, based on the realistic modeling of wealth inequality dynamics, to describe the effects of personal savings and income distribution on wealth inequality. Our theoretical approach incorporates coupled equations, solved using iterated maps to model the dynamics of wealth and income inequality. Notably, using the appropriate historical parameter values we were able to capture the historical dynamics of wealth inequality in the United States during the course of the 20th century. It is found that the effect of personal savings on wealth inequality is substantial, and its major decrease in the past 30 years can be associated with the current wealth inequality surge. In addition, the effect of increasing income tax, though naturally contributing to lowering income inequality, might contribute to a mild increase in wealth inequality and vice versa. Plausible changes in income tax are found to have an insignificant effect on wealth inequality, in practice. In addition, controlling the income inequality, by progressive taxation, for example, is found to have a very small effect on wealth inequality in the short run. The results imply, therefore, that controlling income inequality is an impractical tool for regulating wealth inequality. PMID:27105224

  15. The Dynamics of Wealth Inequality and the Effect of Income Distribution.

    PubMed

    Berman, Yonatan; Ben-Jacob, Eshel; Shapira, Yoash

    2016-01-01

    The rapid increase of wealth inequality in the past few decades is one of the most disturbing social and economic issues of our time. Studying its origin and underlying mechanisms is essential for policy aiming to control and even reverse this trend. In that context, controlling the distribution of income, using income tax or other macroeconomic policy instruments, is generally perceived as effective for regulating the wealth distribution. We provide a theoretical tool, based on the realistic modeling of wealth inequality dynamics, to describe the effects of personal savings and income distribution on wealth inequality. Our theoretical approach incorporates coupled equations, solved using iterated maps to model the dynamics of wealth and income inequality. Notably, using the appropriate historical parameter values we were able to capture the historical dynamics of wealth inequality in the United States during the course of the 20th century. It is found that the effect of personal savings on wealth inequality is substantial, and its major decrease in the past 30 years can be associated with the current wealth inequality surge. In addition, the effect of increasing income tax, though naturally contributing to lowering income inequality, might contribute to a mild increase in wealth inequality and vice versa. Plausible changes in income tax are found to have an insignificant effect on wealth inequality, in practice. In addition, controlling the income inequality, by progressive taxation, for example, is found to have a very small effect on wealth inequality in the short run. The results imply, therefore, that controlling income inequality is an impractical tool for regulating wealth inequality.

  16. Income inequality and school bullying: multilevel study of adolescents in 37 countries.

    PubMed

    Elgar, Frank J; Craig, Wendy; Boyce, William; Morgan, Antony; Vella-Zarb, Rachel

    2009-10-01

    To examine the association between income inequality and school bullying in an international sample of preadolescents and to test for mediation of this association by the availability of social support from families, peers, and schools. The study used economic data from the 2006 United Nations Development Program Human Development Report and survey data from the 2005/2006 Health Behavior in School-aged Children (HBSC) study which included 66,910 11-year-olds in 37 countries. Ecological correlations tested associations between income inequality and bullying among countries. Multilevel linear and ordinal regression analyses tested the effects of income inequality on perceived social support and bullying others at school. Income inequality was associated with rates of bullying among the 37 countries (r = .62). Multilevel analyses indicated that each standard deviation increase in income inequality corresponded with more frequent bullying by males (odds ratio = 1.17) and females (odds ratio = 1.24), less family support and school support but more peer support. Social support from families and schools was associated with less bullying after differences in wealth were taken into account; however, social support did not account for the association between income inequality and bullying. Countries with high income inequality have more school bullying among preadolescents than countries with low income inequality. Further study is needed to understand the mechanisms that account for this association. Findings suggest that adolescents in areas of wide income inequality-not only those in deprived schools and neighborhoods- should be a focus of anti-bullying campaigns.

  17. Social Class and Income Inequality in the United States: Ownership, Authority, and Personal Income Distribution from 1980 to 2010.

    PubMed

    Wodtke, Geoffrey T

    2016-03-01

    This study outlines a theory of social class based on workplace ownership and authority relations, and it investigates the link between social class and growth in personal income inequality since the 1980s. Inequality trends are governed by changes in between-class income differences, changes in the relative size of different classes, and changes in within-class income dispersion. Data from the General Social Survey are used to investigate each of these changes in turn and to evaluate their impact on growth in inequality at the population level. Results indicate that between-class income differences grew by about 60% since the 1980s and that the relative size of different classes remained fairly stable. A formal decomposition analysis indicates that changes in the relative size of different social classes had a small dampening effect and that growth in between-class income differences had a large inflationary effect on trends in personal income inequality.

  18. Social Class and Income Inequality in the United States: Ownership, Authority, and Personal Income Distribution from 1980 to 2010

    PubMed Central

    Wodtke, Geoffrey T.

    2016-01-01

    This study outlines a theory of social class based on workplace ownership and authority relations, and it investigates the link between social class and growth in personal income inequality since the 1980s. Inequality trends are governed by changes in between-class income differences, changes in the relative size of different classes, and changes in within-class income dispersion. Data from the General Social Survey are used to investigate each of these changes in turn and to evaluate their impact on growth in inequality at the population level. Results indicate that between-class income differences grew by about 60 percent since the 1980s and that the relative size of different classes remained fairly stable. A formal decomposition analysis indicates that changes in the relative size of different social classes had a small dampening effect and that growth in between-class income differences had a large inflationary effect on trends in personal income inequality. PMID:27087695

  19. Population health in an era of rising income inequality: USA, 1980-2015.

    PubMed

    Bor, Jacob; Cohen, Gregory H; Galea, Sandro

    2017-04-08

    Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution-ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Beyond the income inequality hypothesis and human health: a worldwide exploration.

    PubMed

    Idrovo, Alvaro J; Ruiz-Rodríguez, Myriam; Manzano-Patiño, Abigail P

    2010-08-01

    To analyze whether the relationship between income inequality and human health is mediated through social capital, and whether political regime determines differences in income inequality and social capital among countries. Path analysis of cross sectional ecological data from 110 countries. Life expectancy at birth was the outcome variable, and income inequality (measured by the Gini coefficient), social capital (measured by the Corruption Perceptions Index or generalized trust), and political regime (measured by the Index of Freedom) were the predictor variables. Corruption Perceptions Index (an indirect indicator of social capital) was used to include more developing countries in the analysis. The correlation between Gini coefficient and predictor variables was calculated using Spearman's coefficients. The path analysis was designed to assess the effect of income inequality, social capital proxies and political regime on life expectancy. The path coefficients suggest that income inequality has a greater direct effect on life expectancy at birth than through social capital. Political regime acts on life expectancy at birth through income inequality. Income inequality and social capital have direct effects on life expectancy at birth. The "class/welfare regime model" can be useful for understanding social and health inequalities between countries, whereas the "income inequality hypothesis" which is only a partial approach is especially useful for analyzing differences within countries.

  1. Squeezing Blood From a Stone: How Income Inequality Affects the Health of the American Workforce

    PubMed Central

    Rosenstock, Linda

    2015-01-01

    Income inequality is very topical—in both political and economic circles—but although income and socioeconomic status are known determinants of health status, income inequality has garnered scant attention with respect to the health of US workers. By several measures, income inequality in the United States has risen since 1960. In addition to pressures from an increasingly competitive labor market, with cash wages losing out to benefits, workers face pressures from changes in work organization. We explored these factors and the mounting evidence of income inequality as a contributing factor to poorer health for the workforce. Although political differences may divide the policy approaches undertaken, addressing income inequality is likely to improve the overall social and health conditions for those affected. PMID:25713936

  2. Squeezing blood from a stone: how income inequality affects the health of the American workforce.

    PubMed

    Williams, Jessica Allia R; Rosenstock, Linda

    2015-04-01

    Income inequality is very topical-in both political and economic circles-but although income and socioeconomic status are known determinants of health status, income inequality has garnered scant attention with respect to the health of US workers. By several measures, income inequality in the United States has risen since 1960. In addition to pressures from an increasingly competitive labor market, with cash wages losing out to benefits, workers face pressures from changes in work organization. We explored these factors and the mounting evidence of income inequality as a contributing factor to poorer health for the workforce. Although political differences may divide the policy approaches undertaken, addressing income inequality is likely to improve the overall social and health conditions for those affected.

  3. Mortality inequality in two native population groups.

    PubMed

    Saarela, Jan; Finnäs, Fjalar

    2005-11-01

    A sample of people aged 40-67 years, taken from a longitudinal register compiled by Statistics Finland, is used to analyse mortality differences between Swedish speakers and Finnish speakers in Finland. Finnish speakers are known to have higher death rates than Swedish speakers. The purpose is to explore whether labour-market experience and partnership status, treated as proxies for measures of variation in health-related characteristics, are related to the mortality differential. Persons who are single, disability pensioners, and those having experienced unemployment are found to have substantially higher death rates than those with a partner and employed persons. Swedish speakers have a more favourable distribution on both variables, which thus notably helps to reduce the Finnish-Swedish mortality gradient. A conclusion from this study is that future analyses on the topic should focus on mechanisms that bring a greater proportion of Finnish speakers into the groups with poor health or supposed unhealthy behaviour.

  4. Tract- and county-level income inequality and individual risk of obesity in the United States.

    PubMed

    Fan, Jessie X; Wen, Ming; Kowaleski-Jones, Lori

    2016-01-01

    We tested three alternative hypotheses regarding the relationship between income inequality and individual risk of obesity at two geographical scales: U.S. Census tract and county. Income inequality was measured by Gini coefficients, created from the 2000 U.S. Census. Obesity was clinically measured in the 2003-2008 National Health and Nutrition Examination Survey (NHANES). The individual measures and area measures were geo-linked to estimate three sets of multi-level models: tract only, county only, and tract and county simultaneously. Gender was tested as a moderator. At both the tract and county levels, higher income inequality was associated with lower individual risk of obesity. The size of the coefficient was larger for county-level Gini than for tract-level Gini; and controlling income inequality at one level did not reduce the impact of income inequality at the other level. Gender was not a significant moderator for the obesity-income inequality association. Higher tract and county income inequality was associated with lower individual risk of obesity, indicating that at least at the tract and county levels and in the context of cross-sectional data, the public health goal of reducing the rate of obesity is in line with anti-poverty policies of addressing poverty through mixed-income development where neighborhood income inequality is likely higher than homogeneous neighborhoods. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Tract- and County-Level Income Inequality and Individual Risk of Obesity in the United States

    PubMed Central

    Fan, Jessie X.; Wen, Ming; Kowaleski-Jones, Lori

    2015-01-01

    Objectives We tested three alternative hypotheses regarding the relationship between income inequality and individual risk of obesity at two geographical scales: U.S. Census tract and county. Methods Income inequality was measured by Gini coefficients, created from the 2000 U.S. Census. Obesity was clinically measured in the 2003–2008 National Health and Nutrition Examination Survey (NHANES). The individual measures and area measures were geo-linked to estimate three sets of multi-level models: tract only, county only, and tract and county simultaneously. Gender was tested as a moderator. Results At both the tract and county levels, higher income inequality was associated with lower individual risk of obesity. The size of the coefficient was larger for county-level Gini than for tract-level Gini; and controlling income inequality at one level did not reduce the impact of income inequality at the other level. Gender was not a significant moderator for the obesity-income inequality association. Conclusions Higher tract and county income inequality was associated with lower individual risk of obesity, indicating that at least at the tract and county levels and in the context of cross-sectional data, the public health goal of reducing the rate of obesity is in line with anti-poverty policies of addressing poverty through mixed-income development where neighborhood income inequality is likely higher than homogeneous neighborhoods. PMID:26680289

  6. The Dynamics of Income-related Health Inequality among US Children

    PubMed Central

    Chatterji, Pinka; Lahiri, Kajal; Song, Jingya

    2012-01-01

    SUMMARY We estimate and decompose income-related inequality in child health in the US and analyze its dynamics using the income-related health mobility index recently introduced by Allanson et al., 2010. Data come from the 1997, 2002, and 2007 waves of the Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID). The findings show that income-related child health inequality remains stable as children grow up and enter adolescence. The main factor underlying income-related child health inequality is income itself, although other factors, such as maternal education, also play a role. Decomposition of income-related health mobility indicates that health changes over time are more favorable to children with lower initial family incomes vs. children with higher initial family incomes. However, offsetting this effect, our findings also suggest that changes in income ranking over time are positively related to children’s subsequent health status. PMID:22514158

  7. Socioeconomic Inequalities in Mortality and Repeated Measurement of Explanatory Risk Factors in a 25 Years Follow-Up

    PubMed Central

    Skalická, Věra; Ringdal, Kristen; Witvliet, Margot I.

    2015-01-01

    Background Socioeconomic inequalities in mortality can be explained by different groups of risk factors. However, little is known whether repeated measurement of risk factors can provide better explanation of socioeconomic inequalities in health. Our study examines the extent to which relative educational and income inequalities in mortality might be explained by explanatory risk factors (behavioral, psychosocial, biomedical risk factors and employment) measured at two points in time, as compared to one measurement at baseline. Methods and Findings From the Norwegian total county population-based HUNT Study (years 1984–86 and 1995–1997, respectively) 61 513 men and women aged 25–80 (82.5% of all enrolled) were followed-up for mortality in 25 years until 2009, employing a discrete time survival analysis. Socioeconomic inequalities in mortality were observed. As compared to their highest socioeconomic counterparts, the lowest educated men had an OR (odds ratio) of 1.41 (95% CI 1.29–1.55) and for the lowest income quartile OR = 1.59 (1.48–1.571), for women OR = 1.35 (1.17–1.55), and OR = 1.40 (1.28–1.52), respectively. Baseline explanatory variables attenuated the association between education and income with mortality by 54% and 54% in men, respectively, and by 69% and 18% in women. After entering time-varying variables, this attainment increased to 63% and 59% in men, respectively, and to 25% (income) in women, with no improvement in regard to education in women. Change in biomedical factors and employment did not amend the explanation. Conclusions Addition of a second measurement for risk factors provided only a modest improvement in explaining educational and income inequalities in mortality in Norwegian men and women. Accounting for change in behavior provided the largest improvement in explained inequalities in mortality for both men and women, as compared to measurement at baseline. Psychosocial factors explained the largest share of income

  8. Income-related inequalities in inadequate dentition over time in Australia, Brazil and USA adults.

    PubMed

    Peres, Marco A; Luzzi, Liana; Peres, Karen G; Sabbah, Wael; Antunes, Jose L; Do, Loc G

    2015-06-01

    To assess changes over time of the absolute and relative household income-related inequalities in inadequate dentition (ID) among Australians, Brazilians and USA adults. This study used nationwide oral health survey data from Australia (n = 1200 in 1999; n = 2729 in 2005), Brazil (n = 13 431 in 2003; n = 9779 in 2010) and USA (n = 2542 in 1999; n = 1596 in 2005). Absolute income inequalities were calculated using Absolute Concentration Index (ACI) and Slope Index of Inequality (SII), while relative inequalities were calculated using Relative Concentration Index (RCI) and Relative Index of Inequality (RII). Prevalence of ID in the studied period dropped from 8.7% to 3.1% in Australia; from 42.1% to 22.4% in Brazil; and remained stable in USA, nearly 8.0%. Absolute income inequalities were highest in Brazil, followed by the USA and Australia; relative inequalities were lower in Brazil than in Australia and the USA. ID was higher among Brazilian females (2010) and for the poorest group in all countries and periods. A remarkable reduction in absolute inequalities were found in Australia [Slope Index of Inequality (SII) and AIC 60%] and in Brazil (SII 25%; ACI 33%) while relative inequalities increased both in Australia (RCI and RII 40%) and in Brazil (RCI 24%; RII 38%). No changes in absolute and relative income inequalities were found in the USA. There were still persistent absolute and relative income inequalities in ID in all examined countries. There has been a reduction in absolute income inequalities in ID but an increase in relative income inequalities. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. [Infant mortality and socioeconomic inequality in Argentina: temporal trends].

    PubMed

    Buchbinder, Marcos

    2008-06-01

    This study analyzes temporal trends in infant, neonatal and postneonatal mortality rates in Argentine in two periods (1995 to 1997, and 2003 to 2005) and the association with a poverty index. A poverty index was associated with infant, neonatal and postneonatal mortality rates of each department of the country. Birth and infant mortality data by department, published by Ministerio de Salud de la Nación, were used. As socioeconomic level of each area was used an index of Unsatisfied Basic Needs (NBI), according to 2001 National Census. Five clusters (quintiles) were organized according to socioeconomic level. We estimated the Relative Risk for infant, neonatal and postneonatal mortality. Even if infant, neonatal and postneonatal mortality rates decreased between both periods of study (1995-1997, and 2003-2005), risk of infant death remained higher for clusters with higher NBI incidence. Neonatal mortality risk between both periods keeps in high level for clusters with greater incidence of poverty. Post neonatal mortality risk between both periods and for the same clusters had decreased, but his level was high. It must take into consideration that inside these variations the risk is high and evidences the persistence between both periods of inequality and higher risk for the clusters with higher incidence of poverty. In the framework of infant mortality (and its components) decrease in Argentine, socioeconomic inequality in infant death persists between both study periods.

  10. Low mortality in the poorest areas of Spain: adults residing in provinces with lower per capita income have the lowest mortality.

    PubMed

    Regidor, Enrique; Vallejo, Fernando; Giráldez-García, Carolina; Ortega, Paloma; Santos, Juana M; Astasio, Paloma; de la Fuente, Luis

    2015-08-01

    The objective of this study is to ascertain whether income inequality and per capita income of area of residence show a relationship with mortality in Spain. Data are from a nation-wide prospective study with a 7-year mortality follow-up covering all persons living in Spain's 50 provinces in 2001. In total 28,944,854 subjects aged 25 years or over at baseline were studied. Rate ratio for total mortality and cause-specific mortality, according to provincial income inequality and per capita income in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). Provincial income inequality was not related to total mortality or cause-specific mortality. Total mortality rate ratios among residents of the poorest versus the richest provinces were 0.89 (95% CI 0.95-0.93) in men and 0.91 (0.87-0.96) in women, among the adult population; and 1.02 (0.97-1.08) in men and 1.08 (1.02-1.16) in women, among the elderly population. With the exception of cardiovascular-disease mortality for which no association with per capita income was observed, adult residents of the poorest provinces registered the lowest mortality rate ratio for other causes of death. Elderly residents of the poorest provinces registered the highest mortality rate ratio for cardiovascular disease and the lowest mortality rate ratio for cancer and external causes. Aside from cardiovascular-disease mortality, the lowest mortality for most causes of death was registered by residents of the poorest provinces. Nevertheless, these findings need to be confirmed by similar studies using smaller areas as the unit of analysis.

  11. Educational Inequality in Obesity-Related Mortality in Korea

    PubMed Central

    2017-01-01

    The prevalence of obesity has been increasing worldwide, which raises concerns about the disease burden associated with obesity. Socioeconomic status (SES) has been suggested to be associated with obesity and obesity related diseases. This study aimed to evaluate the time trend in socioeconomic inequality in obesity-related mortality over the last decade in Korean population. We evaluated the influence of education level, as an indicator of SES, on obesity-related mortality using death data from the Cause of Death Statistics and the Korean Population and Housing Census databases. The rate ratio of the mortality of people at the lowest education level as compared with those at the highest education level (relative index of inequality [RII]) was estimated using Poisson regression analysis. Between 2001 and 2011, RII (95% confidence interval) for overall obesity-related disease mortality increased from 2.10 (2.02–2.19) to 6.50 (6.19–6.82) in men, and from 1.94 (1.79–2.10) to 3.25 (3.05–3.45) in women, respectively. Cause-specifically, the same trend in RII was found for cardiovascular mortality and mortality from diabetes mellitus, whereas the RII of mortality from obesity-related cancers in men did not show the similar trend. Subgroup analysis stratified by age revealed that the RII of obesity-related mortality was much higher in younger people than in older people. In conclusion, there has been persistent socioeconomic inequality in obesity-related mortality in Korea, which was more evident in younger people than in older people and has been deepened over the last decade especially for cardiovascular disease and diabetes. PMID:28145639

  12. Educational Inequality in Obesity-Related Mortality in Korea.

    PubMed

    Kim, Mi Hyun; Jung-Choi, Kyunghee; Ko, Hyeonyoung; Song, Yun Mi

    2017-03-01

    The prevalence of obesity has been increasing worldwide, which raises concerns about the disease burden associated with obesity. Socioeconomic status (SES) has been suggested to be associated with obesity and obesity related diseases. This study aimed to evaluate the time trend in socioeconomic inequality in obesity-related mortality over the last decade in Korean population. We evaluated the influence of education level, as an indicator of SES, on obesity-related mortality using death data from the Cause of Death Statistics and the Korean Population and Housing Census databases. The rate ratio of the mortality of people at the lowest education level as compared with those at the highest education level (relative index of inequality [RII]) was estimated using Poisson regression analysis. Between 2001 and 2011, RII (95% confidence interval) for overall obesity-related disease mortality increased from 2.10 (2.02-2.19) to 6.50 (6.19-6.82) in men, and from 1.94 (1.79-2.10) to 3.25 (3.05-3.45) in women, respectively. Cause-specifically, the same trend in RII was found for cardiovascular mortality and mortality from diabetes mellitus, whereas the RII of mortality from obesity-related cancers in men did not show the similar trend. Subgroup analysis stratified by age revealed that the RII of obesity-related mortality was much higher in younger people than in older people. In conclusion, there has been persistent socioeconomic inequality in obesity-related mortality in Korea, which was more evident in younger people than in older people and has been deepened over the last decade especially for cardiovascular disease and diabetes.

  13. Socioeconomic inequalities in child mortality: comparisons across nine developing countries.

    PubMed Central

    Wagstaff, A.

    2000-01-01

    This paper generates and analyses survey data on inequalities in mortality among infants and children aged under five years by consumption in Brazil, Côte d'Ivoire, Ghana, Nepal, Nicaragua, Pakistan, the Philippines, South Africa, and Viet Nam. The data were obtained from the Living Standards Measurement Study and the Cebu Longitudinal Health and Nutrition Survey. Mortality rates were estimated directly where complete fertility histories were available and indirectly otherwise. Mortality distributions were compared between countries by means of concentration curves and concentration indices: dominance checks were carried out for all pairwise intercountry comparisons; standard errors were calculated for the concentration indices; and tests of intercountry differences in inequality were performed. PMID:10686730

  14. Should Less Inequality in Education Lead to a More Equal Income Distribution?

    ERIC Educational Resources Information Center

    Foldvari, Peter; van Leeuwen, Bas

    2011-01-01

    In this paper, we revisit the question whether inequality in education and human capital is closely related to income inequality. Using the most popular functional forms describing the relationship between, first, output and human capital and, second, education and human capital, we find that the effect of inequality in schooling on income…

  15. Employment status and income as potential mediators of educational inequalities in population mental health

    PubMed Central

    Niedzwiedz, Claire L.; Popham, Frank

    2016-01-01

    We assessed whether educational inequalities in mental health may be mediated by employment status and household income. Poor mental health was assessed using General Health Questionnaire ‘caseness’ in working age adult participants (N = 48 654) of the Health Survey for England (2001–10). Relative indices of inequality by education level were calculated. Substantial inequalities were apparent, with adjustment for employment status and household income markedly reducing their magnitude. Educational inequalities in mental health were attenuated by employment status. Policy responses to economic recession (such as active labour market interventions) might reduce mental health inequalities but longitudinal research is needed to exclude reverse causation. PMID:27593454

  16. Early-life income inequality and adolescent health and well-being.

    PubMed

    Elgar, Frank J; Gariépy, Geneviève; Torsheim, Torbjørn; Currie, Candace

    2017-02-01

    A prevailing hypothesis about the association between income inequality and poor health is that inequality intensifies social hierarchies, increases stress, erodes social and material resources that support health, and subsequently harms health. However, the evidence in support of this hypothesis is limited by cross-sectional, ecological studies and a scarcity of developmental studies. To address this limitation, we used pooled, multilevel data from the Health Behaviour in School-aged Children study to examine lagged, cumulative, and trajectory associations between early-life income inequality and adolescent health and well-being. Psychosomatic symptoms and life satisfaction were assessed in surveys of 11- to 15-year-olds in 40 countries between 1994 and 2014. We linked these data to national Gini indices of income inequality for every life year from 1979 to 2014. The results showed that exposure to income inequality from 0 to 4 years predicted psychosomatic symptoms and lower life satisfaction in females after controlling lifetime mean income inequality, national per capita income, family affluence, age, and cohort and period effects. The cumulative income inequality exposure in infancy and childhood (i.e., average Gini index from birth to age 10) related to lower life satisfaction in female adolescents but not to symptoms. Finally, individual trajectories in early-life inequality (i.e., linear slopes in Gini indices from birth to 10 years) related to fewer symptoms and higher life satisfaction in females, indicating that earlier exposures mattered more to predicting health and wellbeing. No such associations with early-life income inequality were found in males. These results help to establish the antecedent-consequence conditions in the association between income inequality and health and suggest that both the magnitude and timing of income inequality in early life have developmental consequences that manifest in reduced health and well-being in adolescent girls.

  17. Rising U.S. income inequality, gender and individual self-rated health, 1972-2004.

    PubMed

    Zheng, Hui

    2009-11-01

    The effect of income inequality on health has been a contested topic among social scientists. Most previous research is based on cross-sectional comparisons rather than temporal comparisons. Using data from the General Social Survey and the U.S. Census Bureau, this study examines how rising income inequality affects individual self-rated health in the U.S. from 1972 to 2004. Data are analyzed using hierarchical generalized linear models. The findings suggest a significant association between income inequality and individual self-rated health. The dramatic increase in income inequality from 1972 to 2004 increases the odds of worse self-rated health by 9.4 percent. These findings hold for three measures of income inequality: the Gini coefficient, the Atkinson Index, and the Theil entropy index. Results also suggest that overall income inequality and gender-specific income inequality harm men's, but not women's, self-rated health. These findings also hold for the three measures of income inequality. These findings suggest that inattention to gender composition may explain apparent discrepancies across previous studies.

  18. Changes in mortality by income in urban Canada from 1971 to 1986.

    PubMed

    Wilkins, R; Adams, O; Brancker, A

    1989-01-01

    The reduction of socio-economic inequities in health is now an explicit objective of health policy in Canada. This study examines changes in mortality by income in urban Canada from 1971 to 1986 in terms of both relative and absolute differences between income groups. Street address information as shown on death certificates was used to code census tract of usual place of residence for deaths occurring to residents of Canada's Census Metropolitan Areas (CMAs) in 1971 and 1986. After exclusion of residents of health care institutions, 73,995 deaths were included in the study for 1971, and 88,129 for 1986. These deaths were analyzed by income quintile (based on census tract incidence of low income), age, sex, and cause of death. In 1971, the difference in life expectancy at birth between the highest and lowest income quintiles was 6.3 years for men and 2.8 years for women. By 1986, these differences had decreased to 5.6 years for men and 1.8 years for women. However, relative mortality (lowest compared to highest income quintile) at most ages changed only slightly over the 15 years. Relative infant mortality, for example, was 1.97 in 1971 and 1.82 in 1986. In 1986, 21% of total potential years of life lost (PYLL) prior to age 75 could be attributed to differences in quintile death rates compared to rates for the highest income quintile. Approximately 45% of this "excess" PYLL was for persons under 45 years of age. In 1971, the comparable figure was 67%. In 1986, the major causes of death contributing to income inequalities in mortality were: circulatory diseases, accounting for 25% of excess PYLL related to quintile differences; accidents, poisonings and violence, accounting for about 17%; and neoplasms, accounting for 15%. Respiratory diseases, ill-defined conditions, metabolic diseases and perinatal conditions each contributed 6-7% of excess PYLL. From 1971 to 1986, in terms of age-standardized morality rates (ASMRs) for all ages, certain causes of death showed

  19. The dynamics of income-related health inequality among American children.

    PubMed

    Chatterji, Pinka; Lahiri, Kajal; Song, Jingya

    2013-05-01

    We estimate and decompose income-related inequality in child health in the USA and analyze its dynamics using the recently introduced health mobility index. Data come from the 1997, 2002, and 2007 waves of the Child Development Supplement of the Panel Study of Income Dynamics. The findings show that income-related child health inequality remains stable as children grow up and enter adolescence. The main factor underlying income-related child health inequality is income itself, although other factors, such as maternal education, also play a role. Decomposition of income-related health mobility indicates that health changes over time are more favorable to children with lower initial family incomes versus children with higher initial family incomes. However, offsetting this effect, our findings also suggest that changes in income ranking over time are positively related to children's subsequent health status. Copyright © 2012 John Wiley & Sons, Ltd.

  20. Income Inequality in America: Nonmetro Income Levels Lower Than Metro, but Income Inequality Did Not Increase as Fast.

    ERIC Educational Resources Information Center

    McLaughlin, Diane K.

    2002-01-01

    The gap in household income between nonmetro households and those in other locations increased between 1979 and 1999, as did disparities by race and ethnicity across residence. Industrial restructuring, increased demand for more-educated workers, changing household structure, and women's labor force participation may influence income levels and…

  1. Examining the lag time between state-level income inequality and individual disabilities: a multilevel analysis.

    PubMed

    Gadalla, Tahany M; Fuller-Thomson, Esme

    2008-12-01

    State-level income inequality has been found to have an effect on individual health outcomes, even when controlled for important individual-level variables such as income, education, age, and gender. The effect of income inequality on health may not be immediate and may, in fact, have a substantial lag time between exposure to inequality and eventual health outcome. We used the 2006 American Community Survey to examine the association of state-level income inequality and 2 types of physical disabilities. We used 6 different lag times, ranging between 0 and 25 years, on the total sample and on those who resided in their state of birth. Income inequality in 1986 had the strongest correlation with 2006 disability levels. Odds ratios were consistently 10% higher for those born in the same state compared with the total population.

  2. Income Inequality, Income, and Internet Searches for Status Goods: A Cross-National Study of the Association Between Inequality and Well-Being.

    PubMed

    Walasek, Lukasz; Brown, Gordon D A

    2016-01-01

    Is there a positive association between a nation's income inequality and concerns with status competition within that nation? Here we use Google Correlate and Google Trends to examine frequency of internet search terms and find that people in countries in which income inequality is high search relatively more frequently for positional brand names such as Prada, Louis Vuitton, or Chanel. This tendency is stronger among well-developed countries. We find no evidence that income alone is associated with searches for positional goods. We also present evidence that the concern with positional goods does not reflect non-linear effects of income on consumer spending, either across nations or (extending previous findings that people who live in unequal US States search more for positional goods) within the USA. It is concluded that income inequality is associated with greater concerns with positional goods, and that this concern is reflected in internet searching behaviour.

  3. Income inequality and educational assortative mating: Evidence from the Luxembourg Income Study.

    PubMed

    Monaghan, David

    2015-07-01

    Though extensive research has explored the prevalence of educational assortative mating, what causes its variation across countries and over time is not well understood. Using data from the Luxembourg Income Study Database, I investigate the hypothesis that assortative mating by income is influenced by income inequality between educational strata. I find that in countries with greater returns to education, the odds of any sort of union that crosses educational boundaries is substantially reduced. However, I do not find substantial evidence of an effect of changes in returns to education on marital sorting within countries. Educational and labor market parity between males and females appear to be negatively related to marital sorting. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Cross-national income inequality: how great is it and what can we learn from it?

    PubMed

    Smeeding, T M; Gottschalk, P

    1999-01-01

    In recent years there has been increasing interest in the topic of income distribution in a cross-national context. A secular growth of income inequality has taken place over the past two decades affecting almost every rich nation, matched by the growth in comparable household income inequality data which makes these types of comparisons possible. While clear patterns of disposable income inequality differences are found in both level and trend, we are still a long way from explaining why these differences came about, whether they will continue to grow or stabilize, and what the social consequences of these changes might be.

  5. Income Inequality and Use of Dental Services in 66 Countries.

    PubMed

    Bhandari, B; Newton, J T; Bernabé, E

    2015-08-01

    This study explored the association between income inequality and use of dental services and the role that investment in health care plays in explaining that association. We pooled individual-level data from 223,299 adults, 18 years or older, in 66 countries, who participated in the World Health Organization (WHO) World Health Surveys with country-level data from different international sources. Income inequality was measured at the national level using the Gini coefficient, and use of dental services was defined as having received treatment to address problems with mouth and/or teeth in the past year. The association between the Gini coefficient and use of dental services was examined in multilevel models controlling for a standard set of individual- and country-level confounders. The individual and joint contributions of 4 indicators of investment in health care were evaluated in sequential modeling. The Gini coefficient and use of dental services were inversely associated after adjustment for confounders. Every 10% increase in the Gini coefficient corresponded with a 15% lower odds of using dental services (odds ratio: 0.85; 95% confidence interval: 0.70-0.99). The association between the Gini coefficient and use of dental services was attenuated and became nonsignificant after individual adjustment for total health expenditure, public expenditure on health, health system responsiveness, or type of dental health system. The 4 indicators together explained 80% of the association between the Gini coefficient and use of dental services. This study suggests that more equal countries have greater use of dental services. It also supports the mediating role of investment in health care in explaining that association.

  6. Changing socioeconomic inequalities in cancer incidence and mortality: Cohort study with 54 million person-years follow-up 1981-2011.

    PubMed

    Teng, Andrea M; Atkinson, June; Disney, George; Wilson, Nick; Blakely, Tony

    2017-03-15

    Cancer is increasingly responsible for the mortality gap between high and low socioeconomic position groups in high-income countries. This study investigates which cancers are contributing more to socioeconomic gaps in mortality and how this changes over time.New Zealand census data from 1981, 1986, 1991, 1996, 2001 and 2006, were linked to three to five years of subsequent mortality and cancer registrations, resulting in 54 and 42 million years of follow-up cancer incidence and mortality, respectively. Age- and ethnicity-standardised cancer mortality rates and the slope index of inequality (SII) by income were calculated.The contribution of cancer to absolute inequalities (SII) in mortality increased from 16 to 27% for men and from 12 to 31% for women from 1981-84 to 2006-11, peaking in 1991-94 for men and in 1996-99 for women and then levelling off, parallel to peaks in lung cancer inequalities. Lung cancer was the largest driver of cancer inequality trends (49% of the cancer mortality gap in 1981-84 to 33% in 2006-11 for men and 32 to 33% for women) followed by colorectal cancer in men (2 to 11%) and breast cancer in women (declining from 44 to 13%). Women in the lowest income quintile experienced no decline in cancer mortality.The contribution of cancer to income inequalities in all-cause mortality has expanded in this high-income country. Action to address socioeconomic inequalities should prioritise equitable tobacco control, obesity control and improved access to cancer screening, early diagnosis and high quality treatment for those with the lowest incomes.

  7. Income Inequality or Performance Gap? A Multilevel Study of School Violence in 52 Countries.

    PubMed

    Contreras, Dante; Elacqua, Gregory; Martinez, Matias; Miranda, Álvaro

    2015-11-01

    The purpose of the study was to examine the association between income inequality and school violence and between the performance inequality and school violence in two international samples. The study used data from Trends in International Mathematics and Science Study 2011 and from the Central Intelligence Agency of United States which combined information about academic performance and students' victimization (physical and social) for 269,456 fourth-grade students and 261,747 eighth-grade students, with gross domestic product and income inequality data in 52 countries. Ecological correlations tested associations between income inequality and victimization and between school performance inequality and victimization among countries. Multilevel ordinal regression and multilevel regression analyses tested the strength of these associations when controlling for socioeconomic and academic performance inequality at school level and family socioeconomic status and academic achievement at student level. Income inequality was associated with victimization rates in both fourth and eighth grade (r ≈ .60). Performance inequality shows stronger association with victimization among eighth graders (r ≈ .46) compared with fourth graders (r ≈ .30). Multilevel analyses indicate that both an increase in the income inequality in the country and school corresponds with more frequent physical and social victimization. On the other hand, an increase in the performance inequality at the system level shows no consistent association to victimization. However, school performance inequality seems related to an increase in both types of victimizations. Our results contribute to the finding that income inequality is a determinant of school violence. This result holds regardless of the national performance inequality between students. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  8. The link between inequality and population health in low and middle income countries: policy myth or social reality?

    PubMed

    van Deurzen, Ioana; van Oorschot, Wim; van Ingen, Erik

    2014-01-01

    An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women' experience of child mortality. Based on multi-level analyses, we found that higher levels of household wealth inequality related to worse health, but this effect was strongly reduced when we took into account the level of individuals' wealth. However, even after accounting for the differences between individuals in terms of household wealth and other characteristics, in those LMICs with higher household wealth inequality more women experienced child mortality and more children were tested with anemia. This effect was partially mediated by the country's level and coverage of the health services and infrastructure. Furthermore, we found higher inequality to be related to a larger health gap between the poor and the rich in only one of the three examined samples. We conclude that an effective way to improve the health in the LMICs is to increase the wealth among the poor, which in turn also would lead to lower overall inequality and potential investments in public health infrastructure and services.

  9. The Link between Inequality and Population Health in Low and Middle Income Countries: Policy Myth or Social Reality?

    PubMed Central

    van Deurzen, Ioana; van Oorschot, Wim; van Ingen, Erik

    2014-01-01

    An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women' experience of child mortality. Based on multi-level analyses, we found that higher levels of household wealth inequality related to worse health, but this effect was strongly reduced when we took into account the level of individuals' wealth. However, even after accounting for the differences between individuals in terms of household wealth and other characteristics, in those LMICs with higher household wealth inequality more women experienced child mortality and more children were tested with anemia. This effect was partially mediated by the country's level and coverage of the health services and infrastructure. Furthermore, we found higher inequality to be related to a larger health gap between the poor and the rich in only one of the three examined samples. We conclude that an effective way to improve the health in the LMICs is to increase the wealth among the poor, which in turn also would lead to lower overall inequality and potential investments in public health infrastructure and services. PMID:25501652

  10. Impact of national income and inequality on sugar and caries relationship.

    PubMed

    Masood, M; Masood, Y; Newton, T

    2012-01-01

    The aim of this study was to examine the impact that national income and income inequality in high and low income countries have on the relationship between dental caries and sugar consumption. An ecological study design was used in this study of 73 countries. The mean decayed, missing, or filled permanent teeth (DMFT) for 12-year-old children were obtained from the WHO Oral Health Country/Area Profile Programme. United Nations Food and Agricultural Organization data were used for per capita sugar consumption. Gross national incomes per capita based on purchasing power parity and the Gini coefficient were obtained from World Bank data. Bivariate and multivariate linear regression analysis was performed to estimate the associations between mean DMFT and per capita sugar consumption in different income and income inequality countries. Bivariate and multivariate regression analysis showed that countries with a high national income and low income inequality have a strong negative association between sugar consumption and caries (B = -2.80, R2 = 0.17), whereas countries with a low income and high income inequality have a strong positive relationship between DMFT and per capita sugar consumption (B = -0.89, R2 = 0.20). The relationship between per capita consumption of sugar and dental caries is modified by the absolute level of income of the country, but not by the level of income inequality within a country. Copyright © 2012 S. Karger AG, Basel.

  11. Trends in infant mortality inequalities in the Americas: 1955–1995

    PubMed Central

    Schneider, M; Castillo-Salgado, C; Loyola-Elizondo, E; Bacallao, J; Mujica, O; Vidaurre, M; Alleyne, G

    2002-01-01

    Design: Infant mortality rates (IMRs) were computed and their trends assessed by ordinary least squares. Overall trends in IMR inequalities among countries were analysed by comparing 10 year period IMRs, Gini coefficients, and Lorenz curves. Income related trends in IMR inequalities were assessed using 10 year period IMR ratios between the highest and the lowest quintiles of the per capita gross national product (GNP) distributions (adjusted for purchasing power). Setting: Aggregated country data were used for all countries with over 200 thousand inhabitants (33 geopolitical units). The 10 year period midpoint IMR estimates used for the 1955–1995 time series were those published by the United Nations in 1997. Main results: IMRs decreased from 90.34 to 31.31 per 1000 live births between 1955 and 1995 at an average of 15.3 every 10 years. In contrast, Lorenz curves and Gini coefficients were similar for the five 10 year periods. After grouping by adjusted GNP distribution, a similar decreasing trend of IMR was observed in all groups. The rate ratio between the group at the lowest quintile and that at the highest quintile ranged from 4 to 5. The analysis of variance for repeated observations showed that there is a significant reduction in the IMR (F=130.18; p<0.01), that trends did not differ significantly among groups (F=1.16; p=0.32), and that they were approximately linear (F=155.83; p<0.01). Conclusions: Despite a sizable reduction in the infant mortality, whether or not income related, levels of IMR inequality among countries have remained almost constant between 1955 and 1995 in the Region of the Americas. Further analysis and focused interventions are needed to tackle the challenges of reducing these persistent mortality inequalities. PMID:12080163

  12. The effects of individual taxable income, household taxable income, and household disposable income on mortality in Finland, 1998-2004.

    PubMed

    Martikainen, Pekka; Valkonen, Tapani; Moustgaard, Heta

    2009-07-01

    To improve our understanding of the association between income and mortality, we analysed prospective record linkage data on Finns aged 30 and over in 1997. The results show a weaker association of mortality with household disposable income-the measure that best captures consumption potential-than with individual income, particularly above age 65 when the ability to work does not bias the associations. The association between income and mortality is greatly weakened by adjustment for socio-economic status and economic activity, and there is also weak evidence of curvature in the relationship with household disposable income. Among younger participants, social characteristics of the family of origin and early career incomes have a very limited effect on the association between adult income and mortality. The causal effects of income on mortality remain difficult to establish with certainty, and may easily be overestimated. Causal explanations based solely on material factors should be treated with scepticism.

  13. Income inequality, social capital and self-rated health and dental status in older Japanese.

    PubMed

    Aida, Jun; Kondo, Katsunori; Kondo, Naoki; Watt, Richard G; Sheiham, Aubrey; Tsakos, Georgios

    2011-11-01

    The erosion of social capital in more unequal societies is one mechanism for the association between income inequality and health. However, there are relatively few multi-level studies on the relation between income inequality, social capital and health outcomes. Existing studies have not used different types of health outcomes, such as dental status, a life-course measure of dental disease reflecting physical function in older adults, and self-rated health, which reflects current health status. The objective of this study was to assess whether individual and community social capital attenuated the associations between income inequality and two disparate health outcomes, self-rated health and dental status in Japan. Self-administered questionnaires were mailed to subjects in an ongoing Japanese prospective cohort study, the Aichi Gerontological Evaluation Study Project in 2003. Responses in Aichi, Japan, obtained from 5715 subjects and 3451 were included in the final analysis. The Gini coefficient was used as a measure of income inequality. Trust and volunteering were used as cognitive and structural individual-level social capital measures. Rates of subjects reporting mistrust and non-volunteering in each local district were used as cognitive and structural community-level social capital variables respectively. The covariates were sex, age, marital status, education, individual- and community-level equivalent income and smoking status. Dichotomized responses of self-rated health and number of remaining teeth were used as outcomes in multi-level logistic regression models. Income inequality was significantly associated with poor dental status and marginally significantly associated with poor self-rated health. Community-level structural social capital attenuated the covariate-adjusted odds ratio of income inequality for self-rated health by 16% whereas the association between income inequality and dental status was not substantially changed by any social capital

  14. Association of Income Inequality With Pediatric Hospitalizations for Ambulatory Care-Sensitive Conditions.

    PubMed

    Bettenhausen, Jessica L; Colvin, Jeffrey D; Berry, Jay G; Puls, Henry T; Markham, Jessica L; Plencner, Laura M; Krager, Molly K; Johnson, Matthew B; Queen, Mary Ann; Walker, Jacqueline M; Latta, Grant M; Riss, Robert R; Hall, Matt

    2017-06-05

    The level of income inequality (ie, the variation in median household income among households within a geographic area), in addition to family-level income, is associated with worsened health outcomes in children. To determine the influence of income inequality on pediatric hospitalization rates for ambulatory care-sensitive conditions (ACSCs) and whether income inequality affects use of resources per hospitalization for ACSCs. This retrospective, cross-sectional analysis used the 2014 State Inpatient Databases of the Healthcare Cost and Utilization Project of 14 states to evaluate all hospital discharges for patients aged 0 to 17 years (hereafter referred to as children) from January 1 through December 31, 2014. Using the 2014 American Community Survey (US Census), income inequality (Gini index; range, 0 [perfect equality] to 1.00 [perfect inequality]), median household income, and total population of children aged 0 to 17 years for each zip code in the 14 states were measured. The Gini index for zip codes was divided into quartiles for low, low-middle, high-middle, and high income inequality. Rate, length of stay, and charges for pediatric hospitalizations for ACSCs. A total of 79 275 hospitalizations for ACSCs occurred among the 21 737 661 children living in the 8375 zip codes in the 14 included states. After adjustment for median household income and state of residence, ACSC hospitalization rates per 10 000 children increased significantly as income inequality increased from low (27.2; 95% CI, 26.5-27.9) to low-middle (27.9; 95% CI, 27.4-28.5), high-middle (29.2; 95% CI, 28.6-29.7), and high (31.8; 95% CI, 31.2-32.3) categories (P < .001). A significant, clinically unimportant longer length of stay was found for high inequality (2.5 days; 95% CI, 2.4-2.5 days) compared with low inequality (2.4 days; 95% CI, 2.4-2.5 days; P < .001) zip codes and between charges ($765 difference among groups; P < .001). Children living in areas of high income

  15. Are health inequalities really not the smallest in the Nordic welfare states? A comparison of mortality inequality in 37 countries

    PubMed Central

    Popham, Frank; Dibben, Chris; Bambra, Clare

    2013-01-01

    Background Research comparing mortality by socioeconomic status has found that inequalities are not the smallest in the Nordic countries. This is in contrast to expectations given these countries’ policy focus on equity. An alternative way of studying inequality has been little used to compare inequalities across welfare states and may yield a different conclusion. Methods We used average life expectancy lost per death as a measure of total inequality in mortality derived from death rates from the Human Mortality Database for 37 countries in 2006 that we grouped by welfare state type. We constructed a theoretical ‘lowest mortality comparator country’ to study, by age, why countries were not achieving the smallest inequality and the highest life expectancy. We also studied life expectancy as there is an important correlation between it and inequality. Results On average, Nordic countries had the highest life expectancy and smallest inequalities for men but not women. For both men and women, Nordic countries had particularly low younger age mortality contributing to smaller inequality and higher life expectancy. Although older age mortality in the Nordic countries is not the smallest. There was variation within Nordic countries with Sweden, Iceland and Norway having higher life expectancy and smaller inequalities than Denmark and Finland (for men). Conclusions Our analysis suggests that the Nordic countries do have the smallest inequalities in mortality for men and for younger age groups. However, this is not the case for women. Reducing premature mortality among older age groups would increase life expectancy and reduce inequality further in Nordic countries. PMID:23386671

  16. Nations' income inequality predicts ambivalence in stereotype content: how societies mind the gap.

    PubMed

    Durante, Federica; Fiske, Susan T; Kervyn, Nicolas; Cuddy, Amy J C; Akande, Adebowale Debo; Adetoun, Bolanle E; Adewuyi, Modupe F; Tserere, Magdeline M; Ramiah, Ananthi Al; Mastor, Khairul Anwar; Barlow, Fiona Kate; Bonn, Gregory; Tafarodi, Romin W; Bosak, Janine; Cairns, Ed; Doherty, Claire; Capozza, Dora; Chandran, Anjana; Chryssochoou, Xenia; Iatridis, Tilemachos; Contreras, Juan Manuel; Costa-Lopes, Rui; González, Roberto; Lewis, Janet I; Tushabe, Gerald; Leyens, Jacques-Philippe; Mayorga, Renée; Rouhana, Nadim N; Castro, Vanessa Smith; Perez, Rolando; Rodríguez-Bailón, Rosa; Moya, Miguel; Morales Marente, Elena; Palacios Gálvez, Marisol; Sibley, Chris G; Asbrock, Frank; Storari, Chiara C

    2013-12-01

    Income inequality undermines societies: The more inequality, the more health problems, social tensions, and the lower social mobility, trust, life expectancy. Given people's tendency to legitimate existing social arrangements, the stereotype content model (SCM) argues that ambivalence-perceiving many groups as either warm or competent, but not both-may help maintain socio-economic disparities. The association between stereotype ambivalence and income inequality in 37 cross-national samples from Europe, the Americas, Oceania, Asia, and Africa investigates how groups' overall warmth-competence, status-competence, and competition-warmth correlations vary across societies, and whether these variations associate with income inequality (Gini index). More unequal societies report more ambivalent stereotypes, whereas more equal ones dislike competitive groups and do not necessarily respect them as competent. Unequal societies may need ambivalence for system stability: Income inequality compensates groups with partially positive social images.

  17. Nations’ Income Inequality Predicts Ambivalence in Stereotype Content: How Societies Mind the Gap

    PubMed Central

    Durante, Federica; Fiske, Susan T.; Kervyn, Nicolas; Cuddy, Amy J. C.; Akande, Adebowale (Debo); Adetoun, Bolanle E.; Adewuyi, Modupe F.; Tserere, Magdeline M.; Ramiah, Ananthi Al; Mastor, Khairul Anwar; Barlow, Fiona Kate; Bonn, Gregory; Tafarodi, Romin W.; Bosak, Janine; Cairns, Ed; Doherty, Claire; Capozza, Dora; Chandran, Anjana; Chryssochoou, Xenia; Iatridis, Tilemachos; Contreras, Juan Manuel; Costa-Lopes, Rui; González, Roberto; Lewis, Janet I.; Tushabe, Gerald; Leyens, Jacques-Philippe; Mayorga, Renée; Rouhana, Nadim N.; Castro, Vanessa Smith; Perez, Rolando; Rodríguez-Bailón, Rosa; Moya, Miguel; Morales Marente, Elena; Palacios Gálvez, Marisol; Sibley, Chris G.; Asbrock, Frank; Storari, Chiara C.

    2013-01-01

    Income inequality undermines societies: the more inequality, the more health problems, social tensions, and the lower social mobility, trust, life expectancy. Given people’s tendency to legitimate existing social arrangements, the Stereotype Content Model (SCM) argues that ambivalence—perceiving many groups as either warm or competent, but not both—may help maintain socio-economic disparities. The association between stereotype ambivalence and income inequality in 37 cross-national samples from Europe, the Americas, Oceania, Asia, and Africa investigates how groups’ overall warmth-competence, status-competence, and competition-warmth correlations vary across societies, and whether these variations associate with income inequality (Gini index). More unequal societies report more ambivalent stereotypes, while more equal ones dislike competitive groups and do not necessarily respect them as competent. Unequal societies may need ambivalence for system stability: income inequality compensates groups with partially positive social images. PMID:23039178

  18. The stability of income inequality in Brazil, 2006-2012: an estimate using income tax data and household surveys.

    PubMed

    Medeiros, Marcelo; de Souza, Pedro Herculano Guimarães Ferreira; de Castro, Fábio Ávila

    2015-04-01

    the level and evolution of income inequality among adults in Brazil between 2006 and 2012. to calculate the level of inequality, its trend over the years and the share of income growth appropriated by different social groups. We combined tax data from the Annual Personal Income Tax Returns (Declaração Anual de Ajuste do Imposto de Renda da Pessoa Física - DIRPF) and the Brazilian National Household Survey (Pesquisa Nacional por Amostra de Domicílios - PNAD) to construct a complete distribution of total income among adults in Brazil. We applied Pareto interpolations to income tax tabulations to arrive at the distribution within income groups. We tested the results, comparing the PNAD to the Brazilian Consumption and Expenditure Survey (Pesquisa de Orçamentos Familiares - POF) and to data from the Census Subsample Survey (Census. We found evidence that income inequality in Brazil is higher than previously thought and that it remained stable between 2006 and 2012; in making these findings, we thus diverged from most studies on the dynamics of inequality in Brazil.. There was income growth, but the top incomes have appropriated most of this growth.

  19. Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities.

    PubMed

    Aguilar-Palacio, I; Martinez-Beneito, M A; Rabanaque, M J; Borrell, C; Cirera, L; Daponte, A; Domínguez-Berjón, M F; Gandarillas, A; Gotsens, M; Lorenzo-Ruano, P; Marí-Dell'Olmo, M; Nolasco, A; Saez, M; Sánchez-Villegas, P; Saurina, C; Martos, C

    2017-10-01

    To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions. Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  20. Inequalities in oral health: Understanding the contributions of education and income.

    PubMed

    Farmer, Julie; Phillips, Rebecca C; Singhal, Sonica; Quiñonez, Carlos

    2017-09-14

    To quantify the extent to which income and education explain gradients in oral health outcomes. Using data from the Canadian Community Health Survey (CCHS 2003), binary logistic regression models were constructed to examine the relationship between income and education on self-reported oral health (SROH) and chewing difficulties (CD) while controlling for age, sex, ethnicity, employment status and dental insurance coverage. The relative index of inequality (RII) was utilized to quantify the extent to which income and education explain gradients in poor SROH and CD. Income and education gradients were present for SROH and CD. From fully adjusted models, income inequalities were greater for CD (RIIinc = 2.85) than for SROH (RIIinc = 2.75), with no substantial difference in education inequalities between the two. Income explained 37.4% and 42.4% of the education gradient in SROH and CD respectively, whereas education explained 45.2% and 6.1% of income gradients in SROH and CD respectively. Education appears to play a larger role than income when explaining inequalities in SROH; however, it is the opposite for CD. In this sample of the Canadian adult population, income explained over one third of the education gradient in SROH and CDs, whereas the contribution of education to income gradients varied by choice of self-reported outcome. Results call for stakeholders to improve affordability of dental care in order to reduce inequalities in the Canadian population.

  1. High economic inequality leads higher-income individuals to be less generous.

    PubMed

    Côté, Stéphane; House, Julian; Willer, Robb

    2015-12-29

    Research on social class and generosity suggests that higher-income individuals are less generous than poorer individuals. We propose that this pattern emerges only under conditions of high economic inequality, contexts that can foster a sense of entitlement among higher-income individuals that, in turn, reduces their generosity. Analyzing results of a unique nationally representative survey that included a real-stakes giving opportunity (n = 1,498), we found that in the most unequal US states, higher-income respondents were less generous than lower-income respondents. In the least unequal states, however, higher-income individuals were more generous. To better establish causality, we next conducted an experiment (n = 704) in which apparent levels of economic inequality in participants' home states were portrayed as either relatively high or low. Participants were then presented with a giving opportunity. Higher-income participants were less generous than lower-income participants when inequality was portrayed as relatively high, but there was no association between income and generosity when inequality was portrayed as relatively low. This research finds that the tendency for higher-income individuals to be less generous pertains only when inequality is high, challenging the view that higher-income individuals are necessarily more selfish, and suggesting a previously undocumented way in which inequitable resource distributions undermine collective welfare.

  2. High economic inequality leads higher-income individuals to be less generous

    PubMed Central

    Côté, Stéphane; House, Julian; Willer, Robb

    2015-01-01

    Research on social class and generosity suggests that higher-income individuals are less generous than poorer individuals. We propose that this pattern emerges only under conditions of high economic inequality, contexts that can foster a sense of entitlement among higher-income individuals that, in turn, reduces their generosity. Analyzing results of a unique nationally representative survey that included a real-stakes giving opportunity (n = 1,498), we found that in the most unequal US states, higher-income respondents were less generous than lower-income respondents. In the least unequal states, however, higher-income individuals were more generous. To better establish causality, we next conducted an experiment (n = 704) in which apparent levels of economic inequality in participants’ home states were portrayed as either relatively high or low. Participants were then presented with a giving opportunity. Higher-income participants were less generous than lower-income participants when inequality was portrayed as relatively high, but there was no association between income and generosity when inequality was portrayed as relatively low. This research finds that the tendency for higher-income individuals to be less generous pertains only when inequality is high, challenging the view that higher-income individuals are necessarily more selfish, and suggesting a previously undocumented way in which inequitable resource distributions undermine collective welfare. PMID:26598668

  3. 'Fundamental causes' of inequalities in mortality: an empirical test of the theory in 20 European populations.

    PubMed

    Mackenbach, Johan P; Looman, Caspar W N; Artnik, Barbara; Bopp, Matthias; Deboosere, Patrick; Dibben, Chris; Kalediene, Ramune; Kovács, Katalin; Leinsalu, Mall; Martikainen, Pekka; Regidor, Enrique; Rychtaříková, Jitka; de Gelder, Rianne

    2017-09-01

    The 'fundamental causes' theory stipulates that when new opportunities for lowering mortality arise, higher socioeconomic groups will benefit more because of their greater material and non-material resources. We tested this theory using harmonised mortality data by educational level for 22 causes of death and 20 European populations from the period 1980-2010. Across all causes and populations, mortality on average declined by 2.49 per cent (95%CI: 2.04-2.92), 1.83% (1.37-2.30) and 1.34% (0.89-1.78) per annum among the high, mid and low educated, respectively. In 69 per cent of cases of declining mortality, mortality declined faster among the high than among the low educated. However, when mortality increased, less increase among the high educated was found in only 46 per cent of cases. Faster mortality decline among the high educated was more manifest for causes of death amenable to intervention than for non-amenable causes. The difference in mortality decline between education groups was not larger when income inequalities were greater. While our results provide support for the fundamental causes theory, our results suggest that other mechanisms than the theory implies also play a role. © 2017 Foundation for the Sociology of Health & Illness.

  4. An exploratory multilevel analysis of income, income inequality and self-rated health of the elderly in China

    PubMed Central

    Feng, Zhixin; Wang, Wenfei Winnie; Jones, Kelvyn; Li, Yaqing

    2013-01-01

    In the last three decades, China has experienced rapid economic development and growing economic inequality, such that economic disparities between rural and urban areas, as well as coastal and interior areas have deepened. Since the late 1990s China has also experienced an ageing population which has attracted attention to the wellbeing of the rapidly growing number of elderly. This research aims to characterise province differences in health and to explore the effects of individual income and economic disparity in the form of income inequality on health outcomes of the elderly. The study is based on the Chinese Longitudinal Healthy Longevity Survey data collected in 2008 for 23 provinces. Multilevel logistic models are employed to investigate the relationship between income, income inequality and self-rated health for the elderly using both individual and province-level variables. Results are presented as relative odds ratios, and for province differentials as Median Odds Ratios. The analysis is deliberately exploratory so as to find evidence of income effects if they exist and particular attention is placed on how province-level inequality (contemporaneous and lagged) may moderate individual relationships. The results show that the health of the elderly is not only affected by individual income (the odds of poor health are 3 times greater for the elderly with the lowest income compared to those at the upper quartile) but also by a small main effect for province-level income inequality (odds ratio of 1.019). There are significant cross-level interactions such that where inequality is high there are greater differences between those with and without formal education, and between men and women with the latter experiencing poorer health. PMID:23063218

  5. Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey

    PubMed Central

    Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

    2012-01-01

    Objectives To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries. Methods We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied. Results In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups. Conclusion Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population. PMID:22952617

  6. Socioeconomic inequality in smoking in low-income and middle-income countries: results from the World Health Survey.

    PubMed

    Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

    2012-01-01

    To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries. We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied. In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups. Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population.

  7. Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States.

    PubMed

    Kennedy, B P; Kawachi, I; Prothrow-Stith, D

    1996-04-20

    To determine the effect of income inequality as measured by the Robin Hood index and the Gini coefficient on all cause and cause specific mortality in the United States. Cross sectional ecological study. Households in the United States. Disease specific mortality, income, household size, poverty, and smoking rates for each state. The Robin Hood index was positively correlated with total mortality adjusted for age (r = 0.54; P < 0.05). This association remained after adjustment for poverty (P < 0.007), where each percentage increase in the index was associated with' an increase in the total mortality of 21.68 deaths per 100,000. Effects of the index were also found for infant mortality (P = 0.013); coronary heart disease (P = 0.004); malignant neoplasms (P = 0.023); and homicide (P < 0.001). Strong associations were also found between the index and causes of death amenable to medical intervention. The Gini coefficient showed very little correlation with any of the causes of death. Variations between states in the inequality of income were associated with increased mortality from several causes. The size of the gap between the wealthy and less well off--as distinct from the absolute standard of living enjoyed by the poor--seems to matter in its own right. The findings suggest that policies that deal with the growing inequities in income distribution may have an important impact on the health of the population.

  8. Health-income inequality: the effects of the Icelandic economic collapse

    PubMed Central

    2014-01-01

    Introduction Health-income inequality has been the focus of many studies. The relationship between economic conditions and health has also been widely studied. However, not much is known about how changes in aggregate economic conditions relate to health-income inequality. Nevertheless, such knowledge would have both scientific and practical value as substantial public expenditures are used to decrease such inequalities and opportunities to do so may differ over the business cycle. For this reason we examine the effect of the Icelandic economic collapse in 2008 on health-income inequality. Methods The data used come from a health and lifestyle survey carried out by the Public Health Institute of Iceland in 2007 and 2009. A stratified random sample of 9,807 individuals 18–79 years old received questionnaires and a total of 42.1% answered in both years. As measures of health-income inequality, health-income concentration indices are calculated and decomposed into individual-level determinants. Self-assessed health is used as the health measure in the analyses, but three different measures of income are used: individual income, household income, and equivalized household income. Results In both years there is evidence of health-income inequality favoring the better off. However, changes are apparent between years. For males health-income inequality increases after the crisis while it remains fairly stable for females or slightly decreases. The decomposition analyses show that income itself and disability constitute the most substantial determinants of inequality. The largest increases in contributions between years for males come from being a student, having low education and being obese, as well as age and income but those changes are sensitive to the income measure used. Conclusions Changes in health and income over the business cycle can differ across socioeconomic strata, resulting in cyclicality of income-related health distributions. As substantial fiscal

  9. Health-income inequality: the effects of the Icelandic economic collapse.

    PubMed

    Asgeirsdóttir, Tinna Laufey; Ragnarsdóttir, Dagný Osk

    2014-07-25

    Health-income inequality has been the focus of many studies. The relationship between economic conditions and health has also been widely studied. However, not much is known about how changes in aggregate economic conditions relate to health-income inequality. Nevertheless, such knowledge would have both scientific and practical value as substantial public expenditures are used to decrease such inequalities and opportunities to do so may differ over the business cycle. For this reason we examine the effect of the Icelandic economic collapse in 2008 on health-income inequality. The data used come from a health and lifestyle survey carried out by the Public Health Institute of Iceland in 2007 and 2009. A stratified random sample of 9,807 individuals 18-79 years old received questionnaires and a total of 42.1% answered in both years. As measures of health-income inequality, health-income concentration indices are calculated and decomposed into individual-level determinants. Self-assessed health is used as the health measure in the analyses, but three different measures of income are used: individual income, household income, and equivalized household income. In both years there is evidence of health-income inequality favoring the better off. However, changes are apparent between years. For males health-income inequality increases after the crisis while it remains fairly stable for females or slightly decreases. The decomposition analyses show that income itself and disability constitute the most substantial determinants of inequality. The largest increases in contributions between years for males come from being a student, having low education and being obese, as well as age and income but those changes are sensitive to the income measure used. Changes in health and income over the business cycle can differ across socioeconomic strata, resulting in cyclicality of income-related health distributions. As substantial fiscal expenditures go to limiting the relationship

  10. Income-related inequality in health and health care utilization in Chile, 2000-2009.

    PubMed

    Vásquez, Felipe; Paraje, Guillermo; Estay, Manuel

    2013-02-01

    To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the

  11. The relative contribution of income inequality and imprisonment to the variation in homicide rates among Developed (OECD), South and Central American countries.

    PubMed

    Nadanovsky, Paulo; Cunha-Cruz, Joana

    2009-11-01

    Homicide rates vary widely across and within different continents. In order to address the problem of violence in the world, it seems important to clarify the sources of this variability. Despite the fact that income inequality and imprisonment seem to be two of the most important determinants of the variation in homicide rates over space and time, the concomitant effect of income inequality and imprisonment on homicide has not been examined. The objective of this cross-sectional ecological study was to investigate the association of income inequality and imprisonment with homicide rates among Developed (OECD), South and Central American countries. A novel index was developed to indicate imprisonment: the Impunity Index (the total number of homicides in the preceding decade divided by the number of persons in prison at a single slice in time). Negative binomial models were used to estimate rate ratios of homicides for young males and for the total population in relation to Gini Index and Impunity Index, controlling for infant mortality (as a proxy for poverty levels), Gross Domestic Product per-capita, education, percentage of young males in the population and urbanization. Both low income inequality and low impunity (high imprisonment of criminals) were related to low homicide rates. In addition, we found that countries with lower income inequality, lower infant mortality (less poverty), higher average income (GDP per-capita) and higher levels of education had low impunity. Our results are compatible with the hypothesis that both low income inequality and imprisonment of criminals, independent of each other and of other social-structural circumstances, may greatly contribute to the reduction in homicide rates in South and Central American countries, and to the maintenance of low levels of homicides in OECD countries. The Impunity Index reveals that countries that show greater commitment to education and to distribution of income also show greater commitment to

  12. The Kids are All Right? Income Inequality and Civic Engagement among Our Nation's Youth.

    PubMed

    Godfrey, Erin B; Cherng, Hua-Yu Sebastian

    2016-11-01

    Prior work suggests that income inequality depresses civic participation among adults. However, associations between income inequality and youth civic engagement have not been assessed. This is true despite evidence that other features of communities influence youth civic development. To fill the gap, we examine associations between county-level income inequality and civic engagement among a nationally representative sample of 12,240 15-year-olds (50 % female). We find opposite patterns than those suggested by the adult literature. Higher county-level income inequality is associated with slightly more civic engagement (greater importance of helping others, higher rates of volunteering often), and this is particularly true for low-socioeconomic status and racial/ethnic minority youth. Potential developmental and structural explanations for these differences are offered. In addition, practical implications of these findings are drawn, and future research directions for scholars studying youth are proposed.

  13. Income Inequality, the Median Voter, and the Support for Public Education. NBER Working Paper No. 16097

    ERIC Educational Resources Information Center

    Corcoran, Sean; Evans, William N.

    2010-01-01

    Using a panel of U.S. school districts spanning 1970-2000, we examine the relationship between income inequality and fiscal support for public education. In contrast with recent theoretical and empirical work suggesting a negative relationship between inequality and public spending, we find results consistent with a median voter model, in which…

  14. Income Inequality, the Median Voter, and the Support for Public Education. NBER Working Paper No. 16097

    ERIC Educational Resources Information Center

    Corcoran, Sean; Evans, William N.

    2010-01-01

    Using a panel of U.S. school districts spanning 1970-2000, we examine the relationship between income inequality and fiscal support for public education. In contrast with recent theoretical and empirical work suggesting a negative relationship between inequality and public spending, we find results consistent with a median voter model, in which…

  15. Income Inequality across Micro and Meso Geographic Scales in the Midwestern United States, 1979-2009

    ERIC Educational Resources Information Center

    Peters, David J.

    2012-01-01

    This article examines the spatial distribution of income inequality and the socioeconomic factors affecting it using spatial analysis techniques across 16,285 block groups, 5,050 tracts, and 618 counties in the western part of the North Central Region of the United States. Different geographic aggregations result in different inequality outcomes,…

  16. Income Inequality across Micro and Meso Geographic Scales in the Midwestern United States, 1979-2009

    ERIC Educational Resources Information Center

    Peters, David J.

    2012-01-01

    This article examines the spatial distribution of income inequality and the socioeconomic factors affecting it using spatial analysis techniques across 16,285 block groups, 5,050 tracts, and 618 counties in the western part of the North Central Region of the United States. Different geographic aggregations result in different inequality outcomes,…

  17. Province-level income inequality and health outcomes in Canadian adolescents.

    PubMed

    Quon, Elizabeth C; McGrath, Jennifer J

    2015-03-01

    To examine the effects of provincial income inequality (disparity between rich and poor), independent of provincial income and family socioeconomic status, on multiple adolescent health outcomes. Participants (aged 12-17 years; N = 11,899) were from the Canadian National Longitudinal Survey of Children and Youth. Parental education, household income, province income inequality, and province mean income were measured. Health outcomes were measured across a number of domains, including self-rated health, mental health, health behaviors, substance use behaviors, and physical health. Income inequality was associated with injuries, general physical symptoms, and limiting conditions, but not associated with most adolescent health outcomes and behaviors. Income inequality had a moderating effect on family socioeconomic status for limiting conditions, hyperactivity/inattention, and conduct problems, but not for other outcomes. Province-level income inequality was associated with some physical and mental health outcomes in adolescents, which has research and policy implications for this age-group. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Province-Level Income Inequality and Health Outcomes in Canadian Adolescents

    PubMed Central

    McGrath, Jennifer J.

    2015-01-01

    Objective To examine the effects of provincial income inequality (disparity between rich and poor), independent of provincial income and family socioeconomic status, on multiple adolescent health outcomes. Methods Participants (aged 12–17 years; N = 11,899) were from the Canadian National Longitudinal Survey of Children and Youth. Parental education, household income, province income inequality, and province mean income were measured. Health outcomes were measured across a number of domains, including self-rated health, mental health, health behaviors, substance use behaviors, and physical health. Results Income inequality was associated with injuries, general physical symptoms, and limiting conditions, but not associated with most adolescent health outcomes and behaviors. Income inequality had a moderating effect on family socioeconomic status for limiting conditions, hyperactivity/inattention, and conduct problems, but not for other outcomes. Conclusions Province-level income inequality was associated with some physical and mental health outcomes in adolescents, which has research and policy implications for this age-group. PMID:25324533

  19. Income-related inequalities in diseases and health conditions over the business cycle.

    PubMed

    Ásgeirsdóttir, Tinna Laufey; Jóhannsdóttir, Hildur Margrét

    2017-12-01

    How business cycles affect income-related distribution of diseases and health disorders is largely unknown. We examine how the prevalence of thirty diseases and health conditions is distributed across the income spectrum using survey data collected in Iceland in 2007, 2009 and 2012. Thus, we are able to take advantage of the unusually sharp changes in economic conditions in Iceland during the Great Recession initiated in 2008 and the partial recovery that had already taken place by 2012 to analyze how income-related health inequality changed across time periods that can be described as a boom, crisis and recovery. The concentration curve and the concentration index are calculated for each disease, both overall and by gender. In all cases, we find a considerable income-related health inequality favoring higher income individuals, with a slight increase over the study period. Between 2007 and 2009, our results indicate increased inequality for women but decreased inequality for men. Between 2009 and 2012 on the contrary, men's inequality increases but women's decreases. The overarching result is thus that the economic hardship of the crisis temporarily increased female income-related health inequality, but decreased that of men.

  20. Inequality in mortality decreased among the young while increasing for older adults, 1990–2010

    PubMed Central

    Currie, J.; Schwandt, H.

    2016-01-01

    Many recent studies point to increasing inequality in mortality in the United States over the past 20 years. These studies often use mortality rates in middle and old age. We used poverty level rankings of groups of U.S. counties as a basis for analyzing inequality in mortality for all age groups in 1990, 2000, and 2010. Consistent with previous studies, we found increasing inequality in mortality at older ages. For children and young adults below age 20, however, we found strong mortality improvements that were most pronounced in poorer counties, implying a strong decrease in mortality inequality. These younger cohorts will form the future adult U.S. population, so this research suggests that inequality in old-age mortality is likely to decline. PMID:27103667

  1. Are manual workers at higher risk of death than non-manual employees when living in Swedish municipalities with higher income inequality?

    PubMed

    Henriksson, Göran; Allebeck, Peter; Weitoft, Gunilla Ringbäck; Thelle, Dag

    2007-04-01

    To test the hypothesis that manual workers are at higher risk of death than are non-manual employees when living in municipalities with higher income inequality. Hierarchical regression was used for the analysis were individuals were nested within municipalities according to the 1990 Swedish census. The outcome was all-cause mortality 1992-1998. The income measure at the individual level was disposable family income weighted against composition of family; the income inequality measure used at the municipality level was the Gini coefficient. The study population consisted of 1 578 186 people aged 40-64 years in the 1990 Swedish census, who were being reported as unskilled or skilled manual workers, lower-, intermediate-, or high-level non-manual employees. There was no significant association between income inequality at the municipality level and risk of death, but an expected gradient with unskilled manual workers having the highest risk and high-level non-manual employees having the lowest. However, in the interaction models the relative risk (RR) of death for high-level non-manual employees was decreasing with increasing income inequality (RR = 0.77; 95% CI, 0.63-0.93), whereas the corresponding risk for unskilled manual workers increased with increasing income inequality (RR = 1.24; 95% CI, 1.06-1.46). The RRs for skilled manual, low- and medium- level non-manual employees were not significant. Controlling for income at the individual level did not substantially alter these findings, neither did potential confounders at the municipality level. The findings suggest that there could be a differential impact from income inequality on risk of death, dependent on individuals' social position.

  2. Green space, social inequalities and neonatal mortality in France

    PubMed Central

    2013-01-01

    Background Few studies have considered using environmental amenities to explain social health inequalities. Nevertheless, Green spaces that promote good health may have an effect on socioeconomic health inequalities. In developed countries, there is considerable evidence that green spaces have a beneficial effect on the health of urban populations and recent studies suggest they can have a positive effect on pregnancy outcomes. To investigate the relationship between green spaces and the spatial distribution of infant mortality taking account neighborhood deprivation levels. Methods The study took place in Lyon metropolitan area, France. All infant deaths that occurred between 2000 and 2009 were geocoded at census block level. Each census block was assigned greenness and socioeconomic deprivation levels. The spatial–scan statistic was used to identify high risk cluster of infant mortality according to these neighborhood characteristics. Results The spatial distribution of infant mortality was not random with a high risk cluster in the south east of the Lyon metropolitan area (p<0.003). This cluster disappeared (p=0.12) after adjustment for greenness level and socioeconomic deprivation, suggesting that these factors explain part of the spatial distribution of infant mortality. These results are discussed using a conceptual framework with 3 hypothetical pathways by which green spaces may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway. Conclusions These results add some evidence to the hypothesis that there is a relationship between access to green spaces and pregnancy outcomes but further research is required to confirm this. PMID:24139283

  3. Educational inequalities in diabetes mortality across Europe in the 2000s: the interaction with gender.

    PubMed

    Vandenheede, Hadewijch; Deboosere, Patrick; Espelt, Albert; Bopp, Matthias; Borrell, Carme; Costa, Giuseppe; Eikemo, Terje Andreas; Gnavi, Roberto; Hoffmann, Rasmus; Kulhanova, Ivana; Kulik, Margarete; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Rodriguez-Sanz, Maica; Rychtarikova, Jitka; Mackenbach, Johan P

    2015-05-01

    To evaluate educational inequalities in diabetes mortality in Europe in the 2000s, and to assess whether these inequalities differ between genders. Data were obtained from mortality registries covering 14 European countries. To determine educational inequalities in diabetes mortality, age-standardised mortality rates, mortality rate ratios, and slope and relative indices of inequality were calculated. To assess whether the association between education and diabetes mortality differs between genders, diabetes mortality was regressed on gender, educational rank and 'gender × educational rank'. An inverse association between education and diabetes mortality exists in both genders across Europe. Absolute educational inequalities are generally larger among men than women; relative inequalities are generally more pronounced among women, the relative index of inequality being 2.8 (95 % CI 2.0-3.9) in men versus 4.8 (95 % CI 3.2-7.2) in women. Gender inequalities in diabetes mortality are more marked in the highest than the lowest educated. Education and diabetes mortality are inversely related in Europe in the 2000s. This association differs by gender, indicating the need to take the socioeconomic and gender dimension into account when developing public health policies.

  4. Why does Spain have smaller inequalities in mortality? An exploration of potential explanations.

    PubMed

    Kulhánová, Ivana; Bacigalupe, Amaia; Eikemo, Terje A; Borrell, Carme; Regidor, Enrique; Esnaola, Santiago; Mackenbach, Johan P

    2014-06-01

    While educational inequalities in mortality are substantial in most European countries, they are relatively small in Spain. A better understanding of the causes of these smaller inequalities in Spain may help to develop policies to reduce inequalities in mortality elsewhere. The aim of the present study was therefore to identify the specific causes of death and determinants contributing to these smaller inequalities. Data on mortality by education were obtained from longitudinal mortality studies in three Spanish populations (Barcelona, Madrid, the Basque Country), and six other Western European populations. Data on determinants by education were obtained from health interview surveys. The Spanish populations have considerably smaller absolute inequalities in mortality than other Western European populations. This is due mainly to smaller inequalities in mortality from cardiovascular disease (men) and cancer (women). Inequalities in mortality from most other causes are not smaller in Spain than elsewhere. Spain also has smaller inequalities in smoking and sedentary lifestyle and this is due to more smoking and physical inactivity in higher educated groups. Overall, the situation with regard to health inequalities does not appear to be more favourable in Spain than in other Western European populations. Smaller inequalities in mortality from cardiovascular disease and cancer in Spain are likely to be related to its later socio-economic modernization. Although these smaller inequalities in mortality seem to be a historical coincidence rather than the outcome of deliberate policies, the Spanish example does suggest that large inequalities in total mortality are not inevitable. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  5. Reducing Income Inequalities in Food Consumption: Explorations With an Agent-Based Model.

    PubMed

    Blok, David J; de Vlas, Sake J; Bakker, Roel; van Lenthe, Frank J

    2015-10-01

    Individual and environmental factors dynamically interact in shaping income inequalities in healthy food consumption. The agent-based model, Health Behaviors Simulation (HEBSIM), was developed to describe income inequalities in healthy food consumption. It simulates interactions between households and their environment. HEBSIM was used to explore the impact of interventions aimed at reducing food consumption inequalities. HEBSIM includes households and food outlets. Households are characterized by location, composition, income, and preference for food. Decisions about where to shop for food (fruit/vegetable stores, supermarkets, or discount supermarkets) and whether to visit fast food outlets are based on distance, price, and food preference. Food outlets can close and new food outlets can enter the system. Three interventions to reduce healthy food consumption inequalities were tested: (1) eliminating residential segregation; (2) lowering the prices of healthy food; and (3) providing health education. HEBSIM was quantified using data from Statistics Netherlands, Statistics Eindhoven, and the GLOBE study (2011). The model mimicked food consumption in Eindhoven. High-income households visited healthy food shops more often than low-income households. Eliminating residential segregation had the largest impact in reducing income inequalities in food consumption, but resulted partly from a worsening in healthy food consumption in high-income households. Lowering prices and health education could also substantially reduce inequalities. Most interventions took 5-10 years to reach their (almost) full effects. HEBSIM is a promising tool for studying dynamic interactions between households and their environment and for assessing the impact of interventions on income inequalities in food consumption. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  6. Is the relative increase in income inequality related to tooth loss in middle-aged adults?

    PubMed

    Goulart, Mariél de Aquino; Vettore, Mario Vianna

    2016-01-01

    To assess whether Brazilian middle-aged adults living in cities that experienced a relative increase on income inequality were more likely to have severe tooth loss and lack a functional dentition. Data on Brazilian adults aged 35-44 years from state capitals and Federal District from the 2010 Brazilian Oral Health Survey (SBBrasil 2010) were analyzed. Clinically assessed tooth loss outcomes were severe tooth loss (<9 remaining natural teeth) and lack of functional dentition (<21 natural teeth). Income inequality was assessed by Gini Index in 1991, 2000, and 2003 using tertiles of distribution. Variation in Gini Index was assessed by changes in the tertiles distribution between years. Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) between variation in income inequality and tooth loss outcomes adjusting for individual socio-demographic characteristics. Prevalence of severe tooth loss and lack of functional dentition was 4.8 percent and 21.2 percent, respectively. Individuals living in cities with moderate and high increase in income inequality between 1991 and 2003 were more likely to have severe tooth loss and lack a functional dentition in 2010 compared with those living in cities with stable income inequality in the same period. Relationships between low family income and both tooth loss outcomes were significantly attenuated by relative increases in income inequality. Relative increases in income inequality were significantly associated with severe tooth loss and lack of a functional dentition in Brazilian middle-aged adults. © 2015 American Association of Public Health Dentistry.

  7. The role of neighborhood income inequality in adolescent aggression and violence.

    PubMed

    Pabayo, Roman; Molnar, Beth E; Kawachi, Ichiro

    2014-10-01

    Being a perpetrator or victim of assaults can have detrimental effects on the development and health of adolescents. Area-level income inequality has been suggested to be associated with crime and aggressive behavior. However, most prior research on this association has been ecological. Therefore, the purpose of this investigation was to describe the association between neighborhood-level income inequality and aggression and violence outcomes. Data were collected from a sample of 1,878 adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey. We used multilevel logistic regression models to estimate the association between neighborhood income inequality and attacking someone with a weapon, being attacked by someone with a weapon, being physically assaulted, being shown a gun by someone in the neighborhood, shot at by someone in the neighborhood, witnessing someone getting murdered in the past year, and having a close family member or friend murdered. Race and income inequality cross-level interactions were tested. Analyses were stratified by sex. Among nonblack boys, after adjusting for nativity, age, neighborhood-level income, crime, disorder, and proportion of the neighborhood that is black, income inequality was associated with an increased risk for committing acts of aggression and being a victim of violence. Among nonblack girls, those living in neighborhoods with high-income inequality were more likely to witness someone die a violent death in the previous year, in comparison to those in more equal neighborhoods. Income inequality appears to be related to aggression and victimization outcomes among nonblack adolescents living in Boston. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  8. Rural household income and inequality under the Sloping Land Conversion Program in western China

    PubMed Central

    Li, Jie; Feldman, Marcus W.; Li, Shuzhuo; Daily, Gretchen C.

    2011-01-01

    As payment for ecosystem services (PES) programs proliferate globally, assessing their impact upon households’ income and livelihood patterns is critical. The Sloping Land Conversion Program (SLCP) is an exceptional PES program, in terms of its ambitious biophysical and socioeconomic objectives, large geographic scale, numbers of people directly affected, and duration of operation. The SLCP has now operated in the poor mountainous areas in China for 10 y and offers a unique opportunity for policy evaluation. Using survey data on rural households’ livelihoods in the southern mountain area in Zhouzhi County, Shaanxi Province, we carry out a statistical analysis of the effects of PES and other factors on rural household income. We analyze the extent of income inequality and compare the socio-demographic features and household income of households participating in the SLCP with those that did not. Our statistical analysis shows that participation in SLCP has significant positive impacts upon household income, especially for low- and medium-income households; however, participation also has some negative impacts on the low- and medium-income households. Overall, income inequality is less among households participating in the SLCP than among those that do not after 7 y of the PES program. Different income sources have different effects on Gini statistics; in particular, wage income has opposite effects on income inequality for the participating and nonparticipating households. We find, however, that the SLCP has not increased the transfer of labor toward nonfarming activities in the survey site, as the government expected. PMID:21518856

  9. [Health expenditures, income inequality, and the marginalization index in Mexico's health system].

    PubMed

    Pinzón Florez, Carlos Eduardo; Reveiz, Ludovic; Idrovo, Alvaro J; Reyes Morales, Hortensia

    2014-01-01

    Evaluate the effect of the relationship among public health expenditures, income inequality, and the marginalization index on maternal and child mortality in Mexico, to determine the effect of these factors on health system performance from a technical efficiency perspective. An ecological study of 32 Mexican states. Correlations were estimated between maternal and infant mortality and public health expenditures in total per capita, federal per capita, and state per capita for the years 2000, 2005, and 2010 (Gini coefficient and marginalization index). Linear regressions were used to explore the association of these variables with health indicators in the state systems. Negative correlations were observed for the marginalization index and Gini coefficient with regard to life expectancy at birth (-0.62 and -0.28 respectively). Furthermore, there was a positive correlation of 0.59 between the marginalization index and infant mortality (P <0.05). Multiple linear regression models revealed a negative effect of the marginalization index and Gini coefficient on health out-comes. Federal funding had a positive effect on system performance in terms of health indicators. Health system reform in Mexico has had a positive impact on the country's health indicators; federal financial investment seems to be effective in this regard. Social determinants have an important effect on health system performance, and analysis using multisectoral and multidisciplinary approaches are needed in addressing them.

  10. Intermetropolitan Differences in Family Income Inequality: An Ecological Analysis of Total White and Nonwhite Patterns in 1960

    ERIC Educational Resources Information Center

    Dowdall, George W.

    1977-01-01

    A path model is presented which views income level and inequality as caused by ecological structure (age, racial composition, and regional location), industry mix (manufacturing and agricultural employment), and human capital factors (educational inequality and female labor force participation). (Author)

  11. Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950–2014: Over Six Decades of Changing Patterns and Widening Inequalities

    PubMed Central

    Jemal, Ahmedin

    2017-01-01

    We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979–2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment. PMID:28408935

  12. Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950-2014: Over Six Decades of Changing Patterns and Widening Inequalities.

    PubMed

    Singh, Gopal K; Jemal, Ahmedin

    2017-01-01

    We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979-2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment.

  13. Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998–2007

    PubMed Central

    de Vries, Esther; Arroyave, Ivan; Pardo, Constanza; Wiesner, Carolina; Murillo, Raul; Forman, David; Burdorf, Alex; Avendaño, Mauricio

    2015-01-01

    Background There is paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and a rapid expansion of health insurance coverage. Methods Population mortality data (1998–2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25–64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the Slope Index of Inequality in cancer mortality. Results We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (RR primary versus tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities, and RR=1.98 for females, contributing 14% to total cancer inequalities), and lung (RR=1.64 for males contributing 17% of total cancer inequalities, and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups. Conclusion There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reducing cervical cancer through reducing HPV infection, early detection and improved access to treatment of preneoplasic lesions. Reinforcing anti-tobacco measures may be particularly important to curb inequalities in cancer mortality. PMID:25492898

  14. Does personality explain social inequalities in mortality? The French GAZEL cohort study

    PubMed Central

    Nabi, Hermann; Kivimäki, Mika; Marmot, Michael G.; Ferrie, Jane; Zins, Marie; Ducimetière, Pierre; Consoli, Silla M.; Singh-Manoux, Archana

    2008-01-01

    Background The “indirect-selection” hypothesis proposes that some quality of the individual, a personality characteristic or intelligence, leads to both socioeconomic position (SEP) and health. We aim to quantify the contribution of personality measures to the associations between SEP and mortality. Methods 14 445 participants of the GAZEL cohort, aged 39–54 years in 1993 and followed-up over 12.7 years, completed the Bortner-Type-A-scale, the Buss-Durkee-Hostility-Inventory, and the Grossarth-Maticek and Eysenck-Personality-Stress-Inventory. Indicators of SEP, such as father’s social class, education, occupational grade and income, were assessed at baseline. Relative indices of inequality in Cox regression models were used to estimate associations. Results In age-adjusted-analyses, risk of death was inversely associated with SEP among men and women. Among men, the attenuation in this association depended on the measures of SEP and was 28–29% for “neurotic-hostility”, 13–22% for “anti-social” and 13–16% for “CHD-prone” personality. In women, the attenuation was evident only for type-A-behaviour, by 11%. After controlling simultaneously for all personality factors that predicted mortality, associations between SEP and mortality were attenuated in men: by 34% for education, 29% for occupational position and 28% for income; but were only attenuated by 11% for income in women. For cardiovascular mortality, the corresponding percentages of reduction were 42%, 31% and 44% after adjustment for “CHD-prone” personality in men. Conclusions Personality measures explained some of the mortality gradients observed for measures of adult socioeconomic position in men, but had little explanatory power in women. Whether personality represents a predictor or an outcome of social circumstances needs further research. PMID:18276626

  15. Not just smoking and high-tech medicine: socioeconomic inequities in U.S. mortality rates, overall and by race/ethnicity, 1960-2006.

    PubMed

    Krieger, Nancy; Chen, Jarvis T; Kosheleva, Anna; Waterman, Pamela D

    2012-01-01

    Recent research on the post-1980 widening of U.S. socioeconomic inequalities in mortality has emphasized the contribution of smoking and high-tech medicine, with some studies treating the growing inequalities as effectively inevitable. No studies, however, have analyzed long-term trends in U.S. mortality rates and inequities unrelated to smoking or due to lack of basic medical care, even as a handful have shown that U.S. socioeconomic inequalities in overall mortality shrank between the mid-1960s and 1980. The authors accordingly analyzed U.S. mortality data for 1960-2006, stratified by county income quintile and race/ethnicity, for mortality unrelated to smoking and preventable by 1960s' standards of medical care. Key findings are that relative and absolute socioeconomic inequalities in U.S. mortality unrelated to smoking and preventable by 1960s' medical care standards shrank between the 1960s and 1980 and then increased and stagnated, with absolute rates on a par with several leading causes of death, and with the burden greatest for U.S. populations of color. None of these findings can be attributed to trends in smoking-related deaths and access to high-tech medicine, and they also demonstrate that socioeconomic inequities in mortality can shrink and need not inevitably rise.

  16. Income Inequality and Health Status in the United States: Evidence from the Current Population Survey.

    ERIC Educational Resources Information Center

    Mellor, Jennifer M.; Milyo, Jeffrey

    2002-01-01

    Current Population Survey data on self-reported health status and income for the general population and those in poverty were analyzed. No consistent association was found between income inequality and individual health status. Previous findings of such an association were attributed to ecological fallacy or failure to control for individual…

  17. Trends and socioeconomic inequalities in amenable mortality in Switzerland with international comparisons.

    PubMed

    Feller, Anita; Schmidlin, Kurt; Clough-Gorr, Kerri M

    2017-08-14

    Amenable mortality is a composite measure of deaths from conditions that might be avoided by timely and effective healthcare. It was developed as an indicator to study health care quality. We calculated mortality rates for the population aged 0-74 years for the time-period 1996-2010 and the following groups of causes of death: amenable conditions, ischaemic heart diseases (IHD, defined as partly amenable) and remaining conditions. We compared the Swiss results with those published for 16 other high-income countries. To examine the association between amenable mortality and socioeconomic position, we calculated hazard ratios (HRs) by using Cox regression. Amenable mortality fell from 49.5 (95% confidence interval [CI] 48.2-51.0) to 35.7 (34.6-36.9) in males and from 55.0 (53.6-56.4) to 43.4 (42.2-44.6) per 100 000 person-years in females, when 1996-1998 was compared with 2008-2010. IHD mortality declined from 64.7 (95% CI 63.1-66.3) to 33.8 (32.8-34.8) in males and from 18.0 (17.2-18.7) to 8.5 (8.0-9.0) in females. However, between 1996-1998 and 2008-2010 the proportion of all-cause mortality attributed to amenable causes remained stable in both sexes (around 12% in males and 26% in females). Compared with 16 other high-income countries, Switzerland had the lowest rates of amenable mortality and ranked among the top five with the lowest ischaemic heart disease mortality. HRs of amenable causes in the lowest socioeconomic position quintile were 1.77 (95% CI 1.66-1.90) for males and 1.78 (1.47-2.16) for females compared with 1.62 (1.58-1.66) and 1.38 (1.33-1.43) for unamenable mortality. For ischaemic heart disease, HRs in the lowest socioeconomic position quintile were 1.76 (95% CI 1.66-1.87) for males and 2.33 (2.07-2.62) for females. Amenable mortality declined substantially in Switzerland with comparably low death rates for amenable causes. Similar to previous international studies, these Swiss results showed substantial socioeconomic inequalities in amenable

  18. Socioeconomic inequalities in homicide mortality: a population-based comparative study of 12 European countries.

    PubMed

    Stickley, Andrew; Leinsalu, Mall; Kunst, Anton E; Bopp, Matthias; Strand, Bjørn Heine; Martikainen, Pekka; Lundberg, Olle; Kovács, Katalin; Artnik, Barbara; Kalediene, Ramune; Rychtaříková, Jitka; Wojtyniak, Bogdan; Mackenbach, Johan P

    2012-11-01

    Recent research has suggested that violent mortality may be socially patterned and a potentially important source of health inequalities within and between countries. Against this background the current study assessed socioeconomic inequalities in homicide mortality across Europe. To do this, longitudinal and cross-sectional data were obtained from mortality registers and population censuses in 12 European countries. Educational level was used to indicate socioeconomic position. Age-standardized mortality rates were calculated for post, upper and lower secondary or less educational groups. The magnitude of inequalities was assessed using the relative and slope index of inequality. The analysis focused on the 35-64 age group. Educational inequalities in homicide mortality were present in all countries. Absolute inequalities in homicide mortality were larger in the eastern part of Europe and in Finland, consistent with their higher overall homicide rates. They contributed 2.5% at most (in Estonia) to the inequalities in total mortality. Relative inequalities were high in the northern and eastern part of Europe, but were low in Belgium, Switzerland and Slovenia. Patterns were less consistent among women. Socioeconomic inequalities in homicide are thus a universal phenomenon in Europe. Wide-ranging social and inter-sectoral health policies are now needed to address the risk of violent victimization that target both potential offenders and victims.

  19. Divergence in age patterns of mortality change drives international divergence in lifespan inequality.

    PubMed

    Gillespie, Duncan O S; Trotter, Meredith V; Tuljapurkar, Shripad D

    2014-06-01

    In the past six decades, lifespan inequality has varied greatly within and among countries even while life expectancy has continued to increase. How and why does mortality change generate this diversity? We derive a precise link between changes in age-specific mortality and lifespan inequality, measured as the variance of age at death. Key to this relationship is a young-old threshold age, below and above which mortality decline respectively decreases and increases lifespan inequality. First, we show for Sweden that shifts in the threshold's location have modified the correlation between changes in life expectancy and lifespan inequality over the last two centuries. Second, we analyze the post-World War II (WWII) trajectories of lifespan inequality in a set of developed countries-Japan, Canada, and the United States-where thresholds centered on retirement age. Our method reveals how divergence in the age pattern of mortality change drives international divergence in lifespan inequality. Most strikingly, early in the 1980s, mortality increases in young U.S. males led to a continuation of high lifespan inequality in the United States; in Canada, however, the decline of inequality continued. In general, our wider international comparisons show that mortality change varied most at young working ages after WWII, particularly for males. We conclude that if mortality continues to stagnate at young ages yet declines steadily at old ages, increases in lifespan inequality will become a common feature of future demographic change.

  20. Rising inequalities in income and health in China: Who is left behind?

    PubMed Central

    Baeten, Steef; Van Ourti, Tom; van Doorslaer, Eddy

    2013-01-01

    In recent decades, China has experienced double-digit economic growth rates and rising inequality. This paper implements a new decomposition approach using the China Health and Nutrition Survey (1991–2006) to examine the extent to which changes in level and distribution of incomes and in income mobility are related to health disparities between rich and poor. We find that health disparities in China relate to rising income inequality and in particular to the adverse health and income experience of older (wo)men, but not to the growth rate of average incomes over the last decades. These findings suggest that replacement incomes and pensions at older ages may be one of the most important policy levers for reducing health disparities between rich and poor Chinese. PMID:24189450

  1. Income Inequities in Health Care Utilization among Adults Aged 50 and Older.

    PubMed

    Penning, Margaret J; Zheng, Chi

    2016-03-01

    Equitable access to and utilization of health services is a primary goal for many health care systems, particularly in countries with universal publicly funded systems. Despite concerns regarding potentially adverse implications of the 1990s' health care policy and other reforms, whether and how income inequalities in service utilization changed remains unclear. This study addressed the impact of income on physician and hospital utilization from 1992-2002 among adults aged 50 and older in British Columbia. Those with lower incomes were found less likely to access general practitioner and specialist services but more likely to access hospital services. Income-related disparities in physician care increased over time; hospital care declined. Volume of GP and hospital care was inversely associated with income; these differences increased regarding GP services only. Findings of declines in hospital-care access, accompanied by increasing income-related disparities in physician-services access, show that inequities are increasing within Canada's health care system.

  2. Socio-economic Inequality in the Use of Procedures and Mortality Among AMI Patients: Quantifying the Effects Along Different Paths.

    PubMed

    Hagen, Terje P; Häkkinen, Unto; Iversen, Tor; Klitkou, Søren Toksvig; Moger, Tron Anders

    2015-12-01

    It is not known whether inequality in access to cardiac procedures translates into inequality in mortality. In this paper, we use a path analysis model to quantify both the direct effect of socio-economic status on mortality and the indirect effect of socio-economic status on mortality as mediated by the provision of cardiac procedures. The study links microdata from the Finnish and Norwegian national patient registers describing treatment episodes with data from prescription registers, causes-of-death registers and registers covering education and income. We show that socio-economic variables affect access to percutaneous coronary intervention in both countries, but that these effects are only moderate and that the indirect effects of the socio-economic factors on mortality through access to percutaneous coronary intervention are minor. The direct effects of income and education on mortality are significantly larger. We conclude that the socio-economic gradient in the use of percutaneous coronary intervention adds to socio-economic differences in mortality to little or no extent. Copyright © 2015 John Wiley & Sons, Ltd.

  3. Joint Effects of Structural Racism and Income Inequality on Small-for-Gestational-Age Birth

    PubMed Central

    Wallace, Maeve E.; Liu, Danping; Grantz, Katherine L.

    2015-01-01

    Objectives. We examined potential synergistic effects of racial and socioeconomic inequality associated with small-for-gestational-age (SGA) birth. Methods. Electronic medical records from singleton births to White and Black women in 10 US states and the District of Columbia (n = 121 758) were linked to state-level indicators of structural racism, including the ratios of Blacks to Whites who were employed, were incarcerated, and had a bachelor’s or higher degree. We used state-level Gini coefficients to assess income inequality. Generalized estimating equations models were used to quantify the adjusted odds of SGA birth associated with each indicator and the joint effects of structural racism and income inequality. Results. Structural racism indicators were associated with higher odds of SGA birth, and similar effects were observed for both races. The joint effects of racial and income inequality were significantly associated with SGA birth only when levels of both were high; in areas with high inequality levels, adjusted odds ratios ranged from 1.81 to 2.11 for the 3 structural racism indicators. Conclusions. High levels of racial inequality and socioeconomic inequality appear to increase the risk of SGA birth, particularly when they co-occur. PMID:26066964

  4. Joint Effects of Structural Racism and Income Inequality on Small-for-Gestational-Age Birth.

    PubMed

    Wallace, Maeve E; Mendola, Pauline; Liu, Danping; Grantz, Katherine L

    2015-08-01

    We examined potential synergistic effects of racial and socioeconomic inequality associated with small-for-gestational-age (SGA) birth. Electronic medical records from singleton births to White and Black women in 10 US states and the District of Columbia (n = 121 758) were linked to state-level indicators of structural racism, including the ratios of Blacks to Whites who were employed, were incarcerated, and had a bachelor's or higher degree. We used state-level Gini coefficients to assess income inequality. Generalized estimating equations models were used to quantify the adjusted odds of SGA birth associated with each indicator and the joint effects of structural racism and income inequality. Structural racism indicators were associated with higher odds of SGA birth, and similar effects were observed for both races. The joint effects of racial and income inequality were significantly associated with SGA birth only when levels of both were high; in areas with high inequality levels, adjusted odds ratios ranged from 1.81 to 2.11 for the 3 structural racism indicators. High levels of racial inequality and socioeconomic inequality appear to increase the risk of SGA birth, particularly when they co-occur.

  5. Has the National Cancer Screening Program reduced income inequalities in screening attendance in South Korea?

    PubMed

    Kim, Sujin; Kwon, Soonman; Subramanian, S V

    2015-11-01

    In 1999, the Korean government introduced the National Cancer Screening Program (NCSP) to increase the cancer-screening rate, particularly among the low-income population. This study investigates how the NCSP has decreased both relative and absolute income inequalities in the uptake of cancer screening in South Korea. A nationally representative cross-sectional repeated data from the Korea National Health and Nutrition Examination Survey 1998-2012, managed by the Ministry of Health and Welfare, was used to assess changes over time and the extent of discontinuity at the NCSP-recommended initiation age in the uptake of screening for breast, colorectal, and gastric cancers across income quartiles. Relative inequalities in the uptake of screening for all cancers decreased significantly over the policy period. Absolute inequalities did not change for most cancers, but marginally increased from 9 to 14% points in the uptake of screening for colorectal cancer among men. At the recommended initiation age, absolute inequalities did not change for breast and colorectal cancers but increased from 5 to 16% points for gastric cancer, for which relative inequality significantly decreased. The NCSP, which reduced out-of-pocket payment, may not decrease absolute gap although it leads to overall increases in the uptake of cancer screening and decreases in relative inequalities. Further investigations are needed to understand barriers that prevent the low-income population from attending cancer screening.

  6. Social class, politics, and the spirit level: why income inequality remains unexplained and unsolved.

    PubMed

    Muntaner, Caries; Rai, Nanky; Ng, Edwin; Chung, Haejoo

    2012-01-01

    Richard Wilkinson and Kate Pickett's latest book, The Spirit Level: Why Equality is Best for Everyone, has caught the attention of academics and policymakers and stimulated debate across the left-right political spectrum. Interest in income inequality has remained unabated since the publication of Wilkinson's previous volume, Unhealthy Societies: The Afflictions of Inequality. While both books detail the negative health effects of income inequality, The Spirit Level expands the scope of its argument to also include social issues. The book, however, deals extensively with the explanation of how income inequality affects individual health. Little attention is given to political and economic explanations on how income inequality is generated in the first place. The volume ends with political solutions that carefully avoid state interventions such as limiting the private sector's role in the production of goods and services (e.g., non-profit sector, employee-ownership schemes). Although well-intentioned, these alternatives are insufficient to significantly reduce the health inequalities generated by contemporary capitalism in wealthy countries, let alone around the world.

  7. The less healthy urban population: income-related health inequality in China.

    PubMed

    Yang, Wei; Kanavos, Panos

    2012-09-18

    Health inequality has been recognized as a problem all over the world. In China, the poor usually have less access to healthcare than the better-off, despite having higher levels of need. Since the proportion of the Chinese population living in urban areas increased tremendously with the urbanization movements, attention has been paid to the association between urban/rural residence and population health. It is important to understand the variation in health across income groups, and in particular to take into account the effects of urban/rural residence on the degree of income-related health inequalities. This paper empirically assesses the magnitude of rural/urban disparities in income-related adult health status, i.e., self-assessed health (SAH) and physical activity limitation, using Concentration Indices. It then uses decomposition methods to unravel the causes of inequalities and their variations across urban and rural populations. Data from the China Health and Nutrition Survey (CHNS) 2006 are used. The study finds that the poor are less likely to report their health status as "excellent or good" and are more likely to have physical activity limitation. Such inequality is more pronounced for the urban population than for the rural population. Results from the decomposition analysis suggest that, for the urban population, 76.47 per cent to 79.07 per cent of inequalities are driven by non-demographic/socioeconomic-related factors, among which income, job status and educational level are the most important factors. For the rural population, 48.19 per cent to 77.78 per cent of inequalities are driven by non-demographic factors. Income and educational attainment appear to have a prominent influence on inequality. The findings suggest that policy targeting the poor, especially the urban poor, is needed in order to reduce health inequality.

  8. The less healthy urban population: income-related health inequality in China

    PubMed Central

    2012-01-01

    Background Health inequality has been recognized as a problem all over the world. In China, the poor usually have less access to healthcare than the better-off, despite having higher levels of need. Since the proportion of the Chinese population living in urban areas increased tremendously with the urbanization movements, attention has been paid to the association between urban/rural residence and population health. It is important to understand the variation in health across income groups, and in particular to take into account the effects of urban/rural residence on the degree of income-related health inequalities. Methods This paper empirically assesses the magnitude of rural/urban disparities in income-related adult health status, i.e., self-assessed health (SAH) and physical activity limitation, using Concentration Indices. It then uses decomposition methods to unravel the causes of inequalities and their variations across urban and rural populations. Data from the China Health and Nutrition Survey (CHNS) 2006 are used. Results The study finds that the poor are less likely to report their health status as “excellent or good” and are more likely to have physical activity limitation. Such inequality is more pronounced for the urban population than for the rural population. Results from the decomposition analysis suggest that, for the urban population, 76.47 per cent to 79.07 per cent of inequalities are driven by non-demographic/socioeconomic-related factors, among which income, job status and educational level are the most important factors. For the rural population, 48.19 per cent to 77.78 per cent of inequalities are driven by non-demographic factors. Income and educational attainment appear to have a prominent influence on inequality. Conclusion The findings suggest that policy targeting the poor, especially the urban poor, is needed in order to reduce health inequality. PMID:22989200

  9. Income inequality among American states and the incidence of major depression.

    PubMed

    Pabayo, Roman; Kawachi, Ichiro; Gilman, Stephen E

    2014-02-01

    Although cross-sectional and ecological studies have shown that higher area-level income inequality is related to increased risk for depression, few longitudinal studies have been conducted. This investigation examines the relationship between state-level income inequality and major depression among adults participating in a population-based, representative longitudinal study. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=34 653). Respondents completed structured diagnostic interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modelling was used to determine if U.S. state-level income inequality (measured by the Gini coefficient) was a significant predictor of depression at baseline and at follow-up, while controlling for individual-level and state-level covariates. We also repeated the longitudinal analyses, excluding those who had a history of depression or at baseline, in order to test whether income inequality was related to incident depression. State-level inequality was associated with increased incidence of depression among women but not men. In comparison to women residing in states belonging to the lowest quintile of income inequality, women were at increased risk for depression in the second (OR=1.18, 95% CI 0.86 to 1.62), third (OR=1.22, 95% CI 0.91 to 1.62), fourth (OR=1.37, 95% CI 1.03 to 1.82) and fifth (OR=1.50, 95% CI 1.14 to 1.96) quintiles at follow-up (p<0.05 for the linear trend). Living in a state with higher income inequality increases the risk for the development of depression among women.

  10. School bullying, homicide and income inequality: a cross-national pooled time series analysis.

    PubMed

    Elgar, Frank J; Pickett, Kate E; Pickett, William; Craig, Wendy; Molcho, Michal; Hurrelmann, Klaus; Lenzi, Michela

    2013-04-01

    To examine the relation between income inequality and school bullying (perpetration, victimisation and bully/victims) and explore whether the relation is attributable to international differences in violent crime. Between 1994 and 2006, the Health Behaviour in School-aged Children study surveyed 117 nationally representative samples of adolescents about their involvement in school bullying over the previous 2 months. Country prevalence rates of bullying were matched to data on income inequality and homicides. With time and country differences held constant, income inequality positively related to the prevalence of bullying others at least twice (b = 0.25), victimisation by bullying at least twice (b = 0.29) and both bullied and victimisation at least twice (b = 0.40). The relation between income inequality and victimisation was partially mediated by country differences in homicides. Understanding the social determinants of school bullying facilitates anti-bullying policy by identifying groups at risk and exposing its cultural and economic influences. This study found that cross-national differences in income inequality related to the prevalence of school bullying in most age and gender groups due, in part, to a social milieu of interpersonal violence.

  11. Inequalities in premature mortality in Britain: observational study from 1921 to 2007

    PubMed Central

    Dorling, Danny; Smith, George Davey

    2010-01-01

    Objective To report on the extent of inequality in premature mortality as measured between geographical areas in Britain. Design Observational study of routinely collected mortality data and public records. Population subdivided by age, sex, and geographical area (parliamentary constituencies from 1991 to2007, pre-1974 local authorities over a longer time span). Setting Great Britain. Participants Entire population aged under 75 from 1990 to 2007, and entire population aged under 65 in the periods 1921-39, 1950-3, 1959-63, 1969-73, and 1981-2007. Main outcome measure Relative index of inequality (RII) and ratios of inequality in age-sex standardised mortality ratios under ages 75 and 65. The relative index of inequality is the relative rate of mortality for the hypothetically worst-off compared with the hypothetically best-off person in the population, assuming a linear association between socioeconomic position and risk of mortality. The ratio of inequality is the ratio of the standardised mortality ratio of the most deprived 10% to the least deprived 10%. Results When measured by the relative index of inequality, geographical inequalities in age-sex standardised rates of mortality below age 75 have increased every two years from 1990-1 to 2006-7 without exception. Over this period the relative index of inequality increased from 1.61 (95% confidence interval 1.52 to 1.69) in 1990-1 to 2.14 (2.02 to 2.27) in 2006-7. Simple ratios indicated a brief period around 2001 when a small reduction in inequality was recorded, but this was quickly reversed and inequalities up to the age of 75 have now reached the highest levels reported since at least 1990. Similarly, inequalities in mortality ratios under the age of 65 improved slightly in the early years of this century but the latest figures surpass the most extreme previously reported. Comparison of crudely age-sex standardised rates for those below age 65 from historical records showed that geographical inequalities in

  12. Income inequality and traumatic dental injuries in 12-year-old children: A multilevel analysis.

    PubMed

    Vettore, Mario Vianna; Efhima, Salma; Machuca, Carolina; Lamarca, Gabriela de Almeida

    2017-10-01

    Contextual socio-economic factors have been associated with traumatic dental injuries (TDIs). However, evidence concerning the role of income inequality on TDIs in children is scarce. The aim of this study was to investigate the association between contextual income inequality over a 10-year period and TDIs in Brazilian children. The study population comprised a representative sample of 5027 children aged 12 years who participated in the Brazilian oral health survey in 2010. City-level Gini Index was used to measure contextual income inequality in the years 2000 and 2010, as well as the variation in income inequality between 2000 and 2010. Covariates were gender, ethnicity, family income, number of people per room and incisal overjet. Clinical examinations were used to assess TDIs. Multivariable multilevel ordered multinomial logistic regression was used to estimate cumulative Odds Ratio (OR) and 95% confidence intervals between income inequality and TDIs. The prevalence of children who had one tooth with TDI and two or more teeth with TDIs was 15.2% and 6.4%, respectively. The maxillary central and left lateral incisors were the teeth most affected by TDIs. Gini coefficient reduction between the years 2000 and 2010 decreased the odds of TDIs even after adjustment for demographic and socio-economic characteristics, and incisal overjet. The likelihood of more TDIs decreased 21% for each 0.05 unit decrease in the Gini coefficient between the years 2000 and 2010. Boys, brown skin colour, overcrowding and incisal overjet greater than 5 mm remained statistically associated with TDIs in the final model. The decrease in income inequality over a 10-year period was inversely associated with TDIs among Brazilian children aged 12 years. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988-1993.

    PubMed

    Peña, R; Wall, S; Persson, L A

    2000-01-01

    This study assessed the effect of poverty and social inequity on infant mortality risks in Nicaragua from 1988 to 1993 and the preventive role of maternal education. A cohort analysis of infant survival, based on reproductive histories of a representative sample of 10,867 women aged 15 to 49 years in León, Nicaragua, was conducted. A total of 7073 infants were studied; 342 deaths occurred during 6394 infant-years of follow-up. Outcome measures were infant mortality rate (IMR) and relative mortality risks for different groups. IMR was 50 per 1000 live births. Poverty, expressed as unsatisfied basic needs (UBN) of the household, increased the risk of infant death (adjusted relative risk [RR] = 1.49; 95% confidence interval [CI] = 1.15, 1.92). Social inequity, expressed as the contrast between the household UBN and the predominant UBN of the neighborhood, further increased the risk (adjusted RR = 1.74; 95% CI = 1.12, 2.71). A protective effect of the mother's educational level was seen only in poor households. Apart from absolute level of poverty, social inequity may be an independent risk factor for infant mortality in a low-income country. In poor households, female education may contribute to preventing infant mortality.

  14. The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988-1993.

    PubMed Central

    Peña, R; Wall, S; Persson, L A

    2000-01-01

    OBJECTIVES: This study assessed the effect of poverty and social inequity on infant mortality risks in Nicaragua from 1988 to 1993 and the preventive role of maternal education. METHODS: A cohort analysis of infant survival, based on reproductive histories of a representative sample of 10,867 women aged 15 to 49 years in León, Nicaragua, was conducted. A total of 7073 infants were studied; 342 deaths occurred during 6394 infant-years of follow-up. Outcome measures were infant mortality rate (IMR) and relative mortality risks for different groups. RESULTS: IMR was 50 per 1000 live births. Poverty, expressed as unsatisfied basic needs (UBN) of the household, increased the risk of infant death (adjusted relative risk [RR] = 1.49; 95% confidence interval [CI] = 1.15, 1.92). Social inequity, expressed as the contrast between the household UBN and the predominant UBN of the neighborhood, further increased the risk (adjusted RR = 1.74; 95% CI = 1.12, 2.71). A protective effect of the mother's educational level was seen only in poor households. CONCLUSIONS: Apart from absolute level of poverty, social inequity may be an independent risk factor for infant mortality in a low-income country. In poor households, female education may contribute to preventing infant mortality. PMID:10630139

  15. Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing.

    PubMed

    Ransome, Yusuf; Kawachi, Ichiro; Braunstein, Sarah; Nash, Denis

    2016-11-01

    In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Population increase, economic growth, educational inequality, and income distribution: some recent evidence.

    PubMed

    Ram, R

    1984-04-01

    The relationship between population increase, economic growth, education and income inequality was examined in a cross-section study based on data from 26 developing and 2 developed countries. As other studies have noted, high population growth is associated with a less equal income distribution. A 1 percentage point reduction in the rate of population growth tends to raise the income share of the poorest 80% in the less developed world by almost 5 percentage points and is associated with a 1.7 percentage point increase in the income share of the poorest 40%. The relationship between short-run income growth and equality, on the other hand, is strong and positive. Estimates suggest that a 1 percentage point increase in the short-run rate of growth of the gross domestic product (GDP) increases the income share of the bottom 80% by about 2 percentage points and that of the poorest 40% by almost 1 percentage point. Although higher mean schooling appears to be a mild equalizer, educational inequality does not appear to have an adverse effect on income distribution. Overall, these results challenge the widely held belief that there must be a growth-equity trade-off. Moreover, they suggest that the impact of educational inequality on income distribution may be different from that observed in earlier studies, implying a need for caution in using these earlier results as a basis for educational policy development.

  17. The ethical and policy implications of research on income inequality and child well-being.

    PubMed

    Pickett, Kate E; Wilkinson, Richard G

    2015-03-01

    Child well-being is important for lifelong health and well-being. Although there is a robust evidence base linking social determinants of health (eg, relative poverty and income inequality) to child well-being, social and public health policy tends to focus on interventions to mitigate their effects, rather than remove the root causes. The goal of this study was to examine associations between child well-being and income inequality. We compared reported rates of childhood well-being in the 2007 and 2013 UNICEF reports on child well-being in wealthy countries. Twenty indicators of child well-being (excluding child poverty) were defined consistently in both the 2007 and 2013 reports. These variables were used to create an indicator of change in child well-being over the approximate decade 2000 to 2010. For our analyses of income inequality, we used the Organization for Economic Cooperation and Development Gini coefficient of income inequality for 2009 and change between 2000 and 2009, respectively. The overall index of child well-being in 2013 was closely and negatively correlated with income inequality (r = -0.60, P = .004) but not with average income (r = -0.3460, P = .12). Adjustment for income inequality, children in relative poverty, and the child poverty gap did not change the lack of association between average income and child well-being in 2013 in wealthy countries. Between 2000 and 2010, child well-being scores improved most in Italy, Norway, Portugal, the United Kingdom, and Germany. The biggest declines were seen in Sweden, Canada, Japan, Switzerland, and France. Countries that experienced the largest increases in income inequality had significantly greater declines in child well-being (r = -0.51, P = .02). Children born into socioeconomically disadvantaged families suffer worse child well-being and its lifelong implications, in all societies, worldwide. Our analyses show, however, that some wealthy societies are able to mitigate these inequalities; these

  18. Ethnic Inequalities in Mortality: The Case of Arab-Americans

    PubMed Central

    El-Sayed, Abdulrahman M.; Tracy, Melissa; Scarborough, Peter; Galea, Sandro

    2011-01-01

    Background Although nearly 112 million residents of the United States belong to a non-white ethnic group, the literature about differences in health indicators across ethnic groups is limited almost exclusively to Hispanics. Features of the social experience of many ethnic groups including immigration, discrimination, and acculturation may plausibly influence mortality risk. We explored life expectancy and age-adjusted mortality risk of Arab-Americans (AAs), relative to non-Arab and non-Hispanic Whites in Michigan, the state with the largest per capita population of AAs in the US. Methodology/Principal Findings Data were collected about all deaths to AAs and non-Arab and non-Hispanic Whites in Michigan between 1990 and 2007, and year 2000 census data were collected for population denominators. We calculated life expectancy, age-adjusted all-cause, cause-specific, and age-specific mortality rates stratified by ethnicity and gender among AAs and non-Arab and non-Hispanic Whites. Among AAs, life expectancies among men and women were 2.0 and 1.4 years lower than among non-Arab and non-Hispanic White men and women, respectively. AA men had higher mortality than non-Arab and non-Hispanic White men due to infectious diseases, chronic diseases, and homicide. AA women had higher mortality than non-Arab and non-Hispanic White women due to chronic diseases. Conclusions/Significance Despite better education and higher income, AAs have higher age-adjusted mortality risk than non-Arab and non-Hispanic Whites, particularly due to chronic diseases. Features specific to AA culture may explain some of these findings. PMID:22216204

  19. Child mortality inequalities and linkage with sanitation facilities in Bangladesh.

    PubMed

    Halder, Amal K; Kabir, M

    2008-03-01

    Principal component analysis (PCA) was applied to assets and other household data, collected as part of the Bangladesh Demographic and Health Survey (BDHS) in 2004, to rank individuals according to a household socioeconomic index and to investigate whether this predicts access to the sanitation system or outcomes. PCA was used for determining wealth indices for 11,440 women in 10,500 households in Bangladesh. The index was based on the presence or absence of items from a list of 13 specific household assets and three housing characteristics. PCA revealed 35 components, of which the first component accounted for 18% of the total variance. Ownership of assets and housing features contributed almost equally to the variance in the first component. In this study, ownership of latrines was examined as an example of sanitation-intervention access, and rates of mortality of neonates, infant, and children aged less than five years (under-five mortality) as examples of health outcomes. The analysis demonstrated significant gradients in both access and outcome measures across the wealth quintiles. The findings call for more attention to approaches for reducing health inequalities. These could include reforms in the health sector to provide more equitable allocation of resources, improvement in the quality of health services offered to the poor, and redesigning interventions and their delivery to ensure that they are more pro-poor.

  20. Income Inequality Explains Why Economic Growth Does Not Always Translate to an Increase in Happiness.

    PubMed

    Oishi, Shigehiro; Kesebir, Selin

    2015-10-01

    One of the most puzzling social science findings in the past half century is the Easterlin paradox: Economic growth within a country does not always translate into an increase in happiness. We provide evidence that this paradox can be partly explained by income inequality. In two different data sets covering 34 countries, economic growth was not associated with increases in happiness when it was accompanied by growing income inequality. Earlier instances of the Easterlin paradox (i.e., economic growth not being associated with increasing happiness) can thus be explained by the frequent concurrence of economic growth and growing income inequality. These findings suggest that a more even distribution of growth in national wealth may be a precondition for raising nationwide happiness.

  1. Decomposing income-related inequality in cervical screening in 67 countries.

    PubMed

    McKinnon, Brittany; Harper, Sam; Moore, Spencer

    2011-04-01

    The development of successful policies to reduce income-related inequalities in cervical cancer screening rates requires an understanding of the reasons why low-income women are less likely to be screened. We sought to identify important determinants contributing to inequality in cervical screening rates. We analyzed data from 92,541 women aged 25-64 years, who participated in the World Health Survey in 2002-2003. Income-related inequality in Pap screening was measured using the concentration index (CI). Using a decomposition method for the CI, we quantified the contribution to inequality of age, education level, marital status, urbanicity and recent health-care need. There was substantial heterogeneity in the contributions of different determinants to inequality among countries. Education generally made the largest contribution (median = 15%, interquartile range [IQR] = 23%), although this varied widely even within regions (e.g., 5% in Austria, 28% in Hungary). The contribution of rural residence was greatest in African countries (median = 10%, IQR = 13%); however, there was again substantial within-region variation (e.g., 26% in Zambia, 2% in Kenya). Considerable heterogeneity in the contributions of screening determinants among countries suggests interventions to reduce screening inequalities may require country-specific approaches.

  2. Income-related inequalities and inequities in health and health care utilization in Mexico, 2000-2006.

    PubMed

    Barraza-Lloréns, Mariana; Panopoulou, Giota; Díaz, Beatriz Yadira

    2013-02-01

    To measure income-related inequalities and inequities in the distribution of health and health care utilization in Mexico. The National Health Survey (NHS) 2000 and the National Health and Nutrition Survey (NHNS) 2006 were used to estimate concentration indices for health outcomes and health care utilization variables before and after standardization. The study analyzed 110 460 individuals 18 years or older for NHS 2000 and 124 149 individuals for NHNS 2006. Health status variables were self-assessed health, physical limitations, and chronic illness. Health care utilization included curative visits and dental, hospital, and preventive care. Individuals were ranked by three standard-of-living measures: household income, wealth, and expenditure. Other independent variables were area of residence, geographic region, education, employment, ethnicity, and health insurance. Decomposition analysis allowed for assessing the contributions of independent variables to the distribution of health care among individuals. The worse-off population reports less good self-assessed health and more physical limitations, whereas better-off individuals report more chronic illnesses. Utilization of curative visits and hospitalization is more concentrated among the better-off population. No significant changes in these results can be established between 2000 and 2006. According to available evidence, standard of living, health insurance, and education largely contribute to the inequitable distribution of health care. Despite improvements in health care utilization patterns, income-related health and health care inequities prevail. Equity remains a challenge for Mexico.

  3. Income-related inequality in health and health-related behaviour: exploring the equalisation hypothesis

    PubMed Central

    Vallejo-Torres, Laura; Hale, Daniel; Morris, Stephen; Viner, Russell M

    2014-01-01

    Background Previous studies have found the socioeconomic gradient in health among adolescents to be lower than that observed during childhood and adulthood. The aim of this study was to examine income-related inequalities in health and health-related behaviour across the lifespan in England to explore ‘equalisation’ in adolescence. Methods We used five years of data (2006–2010) from the Health Survey for England to explore inequalities in six indicators: self-assessed general health, longstanding illness, limiting longstanding illness, psychosocial wellbeing, obesity and smoking status. We ran separate analyses by age/gender groups. Inequality was measured using concentration indices. Results Our findings for longstanding illnesses, psychosocial wellbeing and obesity were consistent with the equalisation hypothesis. For these indicators, the extent of income-related inequality was lower among late adolescents (16–19 years) and young adults (20–24 years) compared to children and young adolescents (under 15 years), mid- and late-adults (25–44 and 45–64 years) and the elderly (65+ years). The remaining indicators showed lower inequality among adolescents compared to adults, but higher inequality when compared with children. Conclusions Our work shows that inequalities occur across the life-course but that for some health issues there may be a period of equalisation in late adolescence and early adulthood. PMID:24619989

  4. Income-related inequality in health and health-related behaviour: exploring the equalisation hypothesis.

    PubMed

    Vallejo-Torres, Laura; Hale, Daniel; Morris, Stephen; Viner, Russell M

    2014-07-01

    Previous studies have found the socioeconomic gradient in health among adolescents to be lower than that observed during childhood and adulthood. The aim of this study was to examine income-related inequalities in health and health-related behaviour across the lifespan in England to explore 'equalisation' in adolescence. We used five years of data (2006-2010) from the Health Survey for England to explore inequalities in six indicators: self-assessed general health, longstanding illness, limiting longstanding illness, psychosocial wellbeing, obesity and smoking status. We ran separate analyses by age/gender groups. Inequality was measured using concentration indices. Our findings for longstanding illnesses, psychosocial wellbeing and obesity were consistent with the equalisation hypothesis. For these indicators, the extent of income-related inequality was lower among late adolescents (16-19 years) and young adults (20-24 years) compared to children and young adolescents (under 15 years), mid- and late-adults (25-44 and 45-64 years) and the elderly (65+ years). The remaining indicators showed lower inequality among adolescents compared to adults, but higher inequality when compared with children. Our work shows that inequalities occur across the life-course but that for some health issues there may be a period of equalisation in late adolescence and early adulthood. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Changes in mortality inequalities over two decades: register based study of European countries

    PubMed Central

    Kulhánová, Ivana; Artnik, Barbara; Bopp, Matthias; Borrell, Carme; Clemens, Tom; Costa, Giuseppe; Dibben, Chris; Kalediene, Ramune; Lundberg, Olle; Martikainen, Pekka; Menvielle, Gwenn; Östergren, Olof; Prochorskas, Remigijus; Rodríguez-Sanz, Maica; Strand, Bjørn Heine; Looman, Caspar W N; de Gelder, Rianne

    2016-01-01

    Objective To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. Design Register based study. Data source Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively). Setting All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania. Results Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations. Conclusions Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably

  6. Adult children's socioeconomic positions and their parents' mortality: a comparison of education, occupational class, and income.

    PubMed

    Torssander, Jenny

    2014-12-01

    Recent research has shown that the parents of well-educated children live longer than do other parents and that this association is only partly confounded by the parent's own socioeconomic position. However, the relationships between other aspects of children's socioeconomic position (e.g., occupational class and economic resources) and parental mortality have not been examined. Using the Swedish Multi-generation Register that connects parents to their children, this paper studies the associations of children's various socioeconomic resources (education, occupation, and income) and parents' mortality. The models are adjusted for a range of parental socioeconomic resources and include the resources of the parents' partners. In addition to all-cause mortality, five causes of death are analyzed separately (circulatory disease mortality, overall cancer, lung cancer, breast cancer, and prostate cancer). The results show net associations between all included indicators of children's socioeconomic position and parents' mortality risk, with the clearest association for education. Children's education is significantly associated with all of the examined causes of death except prostate cancer. Breast cancer mortality is negatively related to offspring's education but not the mothers' own education. To conclude, children's education seems to be a key factor compared with other dimensions of socioeconomic position in the offspring generation. This finding suggests that explanations linked to behavioral norms or knowledge are more plausible than those linked to access to material resources. However, it is possible that children's education - to a greater degree than class and income - captures unmeasured parental characteristics. The cause-specific analyses imply that future research should investigate whether offspring's socioeconomic position is linked to the likelihood of developing diseases and/or the chances of treating them. A broader family perspective in the description

  7. Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States.

    PubMed

    Subramanian, S V; Kawachi, Ichiro

    2006-06-01

    The empirical relationship between income inequality and health has been much debated and discussed. Recent reviews suggest that the current evidence is mixed, with the relationship between state income inequality and health in the United States (US) being perhaps the most robust. In this paper, we examine the multilevel interactions between state income inequality, individual poor self-rated health, and a range of individual demographic and socioeconomic markers in the US. We use the pooled data from the 1995 and 1997 Current Population Surveys, and the data on state income inequality (represented using Gini coefficient) from the 1990, 1980, and 1970 US Censuses. Utilizing a cross-sectional multilevel design of 201,221 adults nested within 50 US states we calibrated two-level binomial hierarchical mixed models (with states specified as a random effect). Our analyses suggest that for a 0.05 change in the state income inequality, the odds ratio (OR) of reporting poor health was 1.30 (95% CI: 1.17-1.45) in a conditional model that included individual age, sex, race, marital status, education, income, and health insurance coverage as well as state median income. With few exceptions, we did not find strong statistical support for differential effects of state income inequality across different population groups. For instance, the relationship between state income inequality and poor health was steeper for whites compared to blacks (OR=1.34; 95% CI: 1.20-1.48) and for individuals with incomes greater than $75,000 compared to less affluent individuals (OR=1.65; 95% CI: 1.26-2.15). Our findings, however, primarily suggests an overall (as opposed to differential) contextual effect of state income inequality on individual self-rated poor health. To the extent that contemporaneous state income inequality differentially affects population sub-groups, our analyses suggest that the adverse impact of inequality is somewhat stronger for the relatively advantaged socioeconomic

  8. Socioeconomic inequality in infant mortality in Iran and across its provinces.

    PubMed

    Hosseinpoor, Ahmad Reza; Mohammad, Kazem; Majdzadeh, Reza; Naghavi, Mohsen; Abolhassani, Farid; Sousa, Angelica; Speybroeck, Niko; Jamshidi, Hamid Reza; Vega, Jeanette

    2005-11-01

    To measure the socioeconomic inequality in infant mortality in Iran (the Islamic Republic of Iran). We analysed data from the provincially representative Demographic and Health Survey, which was done in Iran in 2000. We used a dichotomous hierarchical ordered probit model to develop an indicator of socioeconomic status of households. We assessed the inequality in infant mortality by using the odds ratio of infant mortality between the lowest and highest socioeconomic quintiles at both the provincial and national levels, and the concentration index, an inequality measure based on the entire socioeconomic distribution. We found a decreasing trend in the infant mortality rate in relation to socioeconomic quintiles. The poorest to richest odds ratio was 2.34 (95% CI = 1.78-3.09). The concentration index of infant mortality in Iran was -0.1789 (95% CI = -0.2193--0.1386). Furthermore, the inequality of infant mortality between the lowest and highest quintiles was significant and favoured the better-off in most of the provinces. However, this inequality varied between provinces. Socioeconomic inequality in infant mortality favours the better-off in the country as a whole and in most of its provinces, but the degree of this inequality varies between the provinces. As well as its national average, it is important to consider the provincial distribution of this indicator of population health.

  9. The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults.

    PubMed

    Celeste, Roger Keller; Nadanovsky, Paulo; Ponce de Leon, Antonio; Fritzell, Johan

    2009-11-01

    We evaluate the association between income inequality (Gini index) and oral health and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oral health survey in Brazil in 2002-2003. Our analysis included 23,568 15-19 and 22,839 35-44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individual income in the point beyond which it showed roughly no association with oral health. Adjusted rate ratio of mean untreated dental caries, respectively for the 15-19 and 35-44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15-19 year-old having at least one missing tooth or a 35-44 year-old being edentulous was, respectively, 1.19 and 1.01. High income inequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of income inequality at the municipal level were associated with worse oral health and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level income inequality had a similar, detrimental effect, among individuals with lower or higher income.

  10. Income inequality and status seeking: searching for positional goods in unequal U.S. States.

    PubMed

    Walasek, Lukasz; Brown, Gordon D A

    2015-04-01

    It is well established that income inequality is associated with lower societal well-being, but the psychosocial causes of this relationship are poorly understood. A social-rank hypothesis predicts that members of unequal societies are likely to devote more of their resources to status-seeking behaviors such as acquiring positional goods. We used Google Correlate to find search terms that correlated with our measure of income inequality, and we controlled for income and other socioeconomic factors. We found that of the 40 search terms used more frequently in states with greater income inequality, more than 70% were classified as referring to status goods (e.g., designer brands, expensive jewelry, and luxury clothing). In contrast, 0% of the 40 search terms used more frequently in states with less income inequality were classified as referring to status goods. Finally, we showed how residual-based analysis offers a new methodology for using Google Correlate to provide insights into societal attitudes and motivations while avoiding confounds and high risks of spurious correlations. © The Author(s) 2015.

  11. Racial Inequality Trends and the Intergenerational Persistence of Income and Family Structure

    PubMed Central

    Bloome, Deirdre

    2015-01-01

    Racial disparity in family incomes remained remarkably stable over the past 40 years in the United States despite major legal and social reforms. Previous scholarship presents two primary explanations for persistent inequality through a period of progressive change. One highlights continuity: because socioeconomic status is transmitted from parents to children, disparities created through histories of discrimination and opportunity denial may dissipate slowly. The second highlights change: because family income results from joining individual earnings in family units, changing family compositions can offset individuals’ changing economic chances. I examine whether black-white family income inequality trends are better characterized by the persistence of existing disadvantage (continuity) or shifting forms of disadvantage (change). I combine cross-sectional and panel analysis using Current Population Survey, Panel Study of Income Dynamics, Census, and National Vital Statistics data. Results suggest that African Americans experience relatively extreme intergenerational continuity (low upward mobility) and discontinuity (high downward mobility); both helped maintain racial inequality. Yet, intergenerational discontinuities allow new forms of disadvantage to emerge. On net, racial inequality trends are better characterized by changing forms of disadvantage than by continuity. Economic trends were equalizing but demographic trends were disequalizing; as family structures shifted, family incomes did not fully reflect labor-market gains. PMID:26456973

  12. Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003

    PubMed Central

    Mortensen, Laust H; Rehnberg, Johan; Dahl, Espen; Diderichsen, Finn; Elstad, Jon Ivar; Martikainen, Pekka; Rehkopf, David; Tarkiainen, Lasse; Fritzell, Johan

    2016-01-01

    Objectives Prior work has examined the shape of the income–mortality association, but work has not compared gradients between countries. In this study, we focus on changes over time in the shape of income–mortality gradients for 4 Nordic countries during a period of rising income inequality. Context and time differentials in shape imply that the relationship between income and mortality is not fixed. Setting Population-based cohort study of Denmark, Finland, Norway and Sweden. Participants We collected data on individuals aged 25 or more in 1995 (n=12.98 million individuals, 0.84 million deaths) and 2003 (n=13.08 million individuals, 0.90 million deaths). We then examined the household size equivalised disposable income at the baseline year in relation to the rate of mortality in the following 5 years. Results A steep income gradient in mortality in men and women across all age groups except the oldest old in Denmark, Finland, Norway and Sweden. From the 1990s to 2000s mortality dropped, but generally more so in the upper part of the income distribution than in the lower part. As a consequence, the shape of the income gradient in mortality changed. The shift in the shape of the association was similar in all 4 countries. Conclusions A non-linear gradient exists between income and mortality in most cases and because of a more rapid mortality decline among those with high income the income gradient has become steeper over time. PMID:28011804

  13. The role of geographic scale in testing the income inequality hypothesis as an explanation of health disparities.

    PubMed

    Chen, Zhuo; Gotway Crawford, Carol A

    2012-09-01

    This study re-examined the role of geographic scale in measuring income inequality and testing the income inequality hypothesis (IIH) as an explanation of health disparities. We merged Behavioral Risk Factor Surveillance System (BRFSS) 2000 data with income inequality indices constructed at different geographic scales to test the association between income inequality and four different health indicators, i.e., self-assessed health status as a morbidity measure, vaccination against influenza as a measure of use of preventive healthcare, having any kind of health insurance as a measure of access, and obesity as a modifiable health risk factor measure. Multilevel models are used in our regression of the health indicators on measures of income inequalities and control variables. Our analysis suggests that because income inequality is a contextual variable, income inequalities measured at different geographic scales have different interpretations and relate to societal characteristics at different levels. Therefore, a rejection of the IIH at one level does not necessarily negate the possibility that income inequality affects health at another level. Assessment across a variety of scales is needed to have a comprehensive picture of the IIH in any given study. Empirical results also show that whether the IIH holds could depend on the sex group examined and the health indicator used, which implies different mechanisms of IIH exist for different sex groups and health indicators, in addition to the geographic scale. The role of geographic scale should be more rigorously considered in social determinants of health research. Published by Elsevier Ltd.

  14. Entrenched Geographical and Socioeconomic Disparities in Child Mortality: Trends in Absolute and Relative Inequalities in Cambodia

    PubMed Central

    Jimenez-Soto, Eliana; Durham, Jo; Hodge, Andrew

    2014-01-01

    Background Cambodia has made considerable improvements in mortality rates for children under the age of five and neonates. These improvements may, however, mask considerable disparities between subnational populations. In this paper, we examine the extent of the country's child mortality inequalities. Methods Mortality rates for children under-five and neonates were directly estimated using the 2000, 2005 and 2010 waves of the Cambodian Demographic Health Survey. Disparities were measured on both absolute and relative scales using rate differences and ratios, and where applicable, slope and relative indices of inequality by levels of rural/urban location, regions and household wealth. Findings Since 2000, considerable reductions in under-five and to a lesser extent in neonatal mortality rates have been observed. This mortality decline has, however, been accompanied by an increase in relative inequality in both rates of child mortality for geography-related stratifying markers. For absolute inequality amongst regions, most trends are increasing, particularly for neonatal mortality, but are not statistically significant. The only exception to this general pattern is the statistically significant positive trend in absolute inequality for under-five mortality in the Coastal region. For wealth, some evidence for increases in both relative and absolute inequality for neonates is observed. Conclusion Despite considerable gains in reducing under-five and neonatal mortality at a national level, entrenched and increased geographical and wealth-based inequality in mortality, at least on a relative scale, remain. As expected, national progress seems to be associated with the period of political and macroeconomic stability that started in the early 2000s. However, issues of quality of care and potential non-inclusive economic growth might explain remaining disparities, particularly across wealth and geography markers. A focus on further addressing key supply and demand side

  15. Entrenched geographical and socioeconomic disparities in child mortality: trends in absolute and relative inequalities in Cambodia.

    PubMed

    Jimenez-Soto, Eliana; Durham, Jo; Hodge, Andrew

    2014-01-01

    Cambodia has made considerable improvements in mortality rates for children under the age of five and neonates. These improvements may, however, mask considerable disparities between subnational populations. In this paper, we examine the extent of the country's child mortality inequalities. Mortality rates for children under-five and neonates were directly estimated using the 2000, 2005 and 2010 waves of the Cambodian Demographic Health Survey. Disparities were measured on both absolute and relative scales using rate differences and ratios, and where applicable, slope and relative indices of inequality by levels of rural/urban location, regions and household wealth. Since 2000, considerable reductions in under-five and to a lesser extent in neonatal mortality rates have been observed. This mortality decline has, however, been accompanied by an increase in relative inequality in both rates of child mortality for geography-related stratifying markers. For absolute inequality amongst regions, most trends are increasing, particularly for neonatal mortality, but are not statistically significant. The only exception to this general pattern is the statistically significant positive trend in absolute inequality for under-five mortality in the Coastal region. For wealth, some evidence for increases in both relative and absolute inequality for neonates is observed. Despite considerable gains in reducing under-five and neonatal mortality at a national level, entrenched and increased geographical and wealth-based inequality in mortality, at least on a relative scale, remain. As expected, national progress seems to be associated with the period of political and macroeconomic stability that started in the early 2000s. However, issues of quality of care and potential non-inclusive economic growth might explain remaining disparities, particularly across wealth and geography markers. A focus on further addressing key supply and demand side barriers to accessing maternal and child

  16. Impact of Income Inequality and Other Social Determinants on Suicide Rate in Brazil

    PubMed Central

    Machado, Daiane Borges; Rasella, Davide; dos Santos, Darci Neves

    2015-01-01

    Studies about suicide worldwide have mainly focused on individual-level psychiatric risk factors. In Brazil, suicide is an important public health problem. Brazil has evidenced important socioeconomic changes over the last decades, leading to decreasing income inequality. However, the impact of income inequality on suicide rate has never been studied in the country. Purpose To analyze whether income inequality and other social determinants are associated with suicide rate in Brazil. Method This study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed. Results The Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011–1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948–0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010–1.021). Conclusions Income inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population’s socioeconomic conditions and reduce income inequality in

  17. Inequality in child mortality across different states of India: a comparative study.

    PubMed

    De, Partha; Dhar, Arpita

    2013-12-01

    The burden of social inequality falls disproportionately on child health and survival. This inequality raises the question of how wide this gap is, or what its relation is with the level of child mortality. Whether these disparities are increasing or declining with the development and how they differ from region to region or from state to state within the country needs to be looked into. As a measure of inequality and to compare the disparities between different states of India, concentration curves and indices are constructed from infant and under five mortality data classified under different quintiles of wealth index from the National Family Health Survey (NFHS-3) data of India. Inequality measures indicate that inequality in child mortality is more concentrated in the comparatively developed states than the poorer states in India.

  18. Impact of income inequality and other social determinants on suicide rate in Brazil.

    PubMed

    Machado, Daiane Borges; Rasella, Davide; Dos Santos, Darci Neves

    2015-01-01

    To analyze whether income inequality and other social determinants are associated with suicide rate in Brazil. This study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed. The Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011-1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948-0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010-1.021). Income inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population's socioeconomic conditions and reduce income inequality in Brazil, and in other low and middle-income countries, can help to reduce suicide rates.

  19. Income inequality and sexually transmitted in the United States: who bears the burden?

    PubMed

    Harling, Guy; Subramanian, S V; Bärnighausen, Till; Kawachi, Ichiro

    2014-02-01

    Three causal processes have been proposed to explain associations between group income inequality and individual health outcomes, each of which implies health effects for different segments of the population. We present a novel conceptual and analytic framework for the quantitative evaluation of these pathways, assessing the contribution of: (i) absolute deprivation - affecting the poor in all settings - using family income; (ii) structural inequality - affecting all those in unequal settings - using the Gini coefficient; and (iii) relative deprivation - affecting only the poor in unequal settings - using the Yitzhaki index. We conceptualize relative deprivation as the interaction of absolute deprivation and structural inequality. We test our approach using hierarchical models of 11,183 individuals in the National Longitudinal Study of Adolescent Health (Add Health). We examine the relationship between school-level inequality and sexually transmitted infections (STI) - self-reported or laboratory-confirmed Chlamydia, Gonorrhoea or Trichomoniasis. Results suggest that increased poverty and inequality were both independently associated with STI diagnosis, and that being poor in an unequal community imposed an additional risk. However, the effects of inequality and relative deprivation were confounded by individuals' race/ethnicity. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States.

    PubMed Central

    Kennedy, B. P.; Kawachi, I.; Prothrow-Stith, D.

    1996-01-01

    OBJECTIVE--To determine the effect of income inequality as measured by the Robin Hood index and the Gini coefficient on all cause and cause specific mortality in the United States. DESIGN--Cross sectional ecological study. SETTING--Households in the United States. MAIN OUTCOME MEASURES--Disease specific mortality, income, household size, poverty, and smoking rates for each state. RESULTS--The Robin Hood index was positively correlated with total mortality adjusted for age (r = 0.54; P < 0.05). This association remained after adjustment for poverty (P < 0.007), where each percentage increase in the index was associated with' an increase in the total mortality of 21.68 deaths per 100,000. Effects of the index were also found for infant mortality (P = 0.013); coronary heart disease (P = 0.004); malignant neoplasms (P = 0.023); and homicide (P < 0.001). Strong associations were also found between the index and causes of death amenable to medical intervention. The Gini coefficient showed very little correlation with any of the causes of death. CONCLUSION--Variations between states in the inequality of income were associated with increased mortality from several causes. The size of the gap between the wealthy and less well off--as distinct from the absolute standard of living enjoyed by the poor--seems to matter in its own right. The findings suggest that policies that deal with the growing inequities in income distribution may have an important impact on the health of the population. PMID:8616345

  1. American income inequality across economic and geographic space, 1970-2010.

    PubMed

    Peters, David J

    2013-11-01

    This analysis examines the spatial clustering of income inequality and its socioeconomic correlates at the meso-scale over the past four decades. Cluster analysis is used to group N=3078 counties into five inequality clusters; and multinomial logistic regression is used to assess the effects of socioeconomic correlates. High and extreme inequality places are concentrated in large metropolitan centers, high amenity rural areas, and parts of the Great Plains and Mountain West. They tend to have better socioeconomic outcomes, with fewer at-risk populations, higher incomes, lower poverty, and greater economic participation. Unequal places are more specialized in high-skill finance and professional services, and in energy-based mining. By contrast, equality places are associated with low-skill services, education and health services, manufacturing, and stable farm economies. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. The role of ethnic and rural discrimination in the relationship between income inequality and health in Guatemala.

    PubMed

    Poder, Thomas G; He, Jie

    2015-01-01

    This article seeks to understand in the ways in which income inequality can affect children's health (z-score of stunting) in Guatemala. We postulate that there are several transmission channels through which income inequality can affect health and that the children's ethnic and rural origins influence the size and direction of this effect. The methodology employed is systems of simultaneous equations (three-stage least squares and generalized method of moments). Our results highlight the importance of rural and indigenous characteristics in the relationship between income inequality and child health and indicate that the most important transmission channels are household income levels and maternal education.

  3. How Socio-Economic Change Shapes Income Inequality in Post-Socialist Europe

    ERIC Educational Resources Information Center

    Bandelj, Nina; Mahutga, Matthew C.

    2010-01-01

    Although income inequality in Central and Eastern Europe was considerably lower during socialism than in other countries at comparable levels of development, it increased significantly in all Central and East European states after the fall of communist regimes. However, some of these countries managed to maintain comparatively low inequality…

  4. Work Units and Income Inequality: The Effect of Market Transition in Urban China.

    ERIC Educational Resources Information Center

    Wu, Xiaogang

    2002-01-01

    Analyzes the effect of the transition from a state socialist economy to a market-oriented economy on personal income inequality in urban China. Examines returns to human capital (educational attainment and work experience) in low-profit state firms, high-profit state firms, and market firms. (Contains 54 references.) (Author/SV)

  5. How Socio-Economic Change Shapes Income Inequality in Post-Socialist Europe

    ERIC Educational Resources Information Center

    Bandelj, Nina; Mahutga, Matthew C.

    2010-01-01

    Although income inequality in Central and Eastern Europe was considerably lower during socialism than in other countries at comparable levels of development, it increased significantly in all Central and East European states after the fall of communist regimes. However, some of these countries managed to maintain comparatively low inequality…

  6. A decomposition of income-related health inequality applied to EQ-5D.

    PubMed

    Gundgaard, Jens; Lauridsen, Jørgen

    2006-12-01

    Income-related inequality in health and its relationship to sociodemographic characteristics have received considerable attention in the health economic literature. Recently a method was suggested for decomposing income-related health inequality to contributions from individual characteristics via additive dimensions, and this was applied to a Finnish case based on 15D health scores, where health is considered to be a sum of 15 individual health dimensions. The present study adds to this literature in several ways. First, we apply the decomposition approach to a Danish case which can be benchmarked to the Finnish. Second, we show how to apply the method to EQ-5D scores, which deviate from 15D scores by expressing health as individual depreciations of an equal endowment of perfect health. Third, we add life-style factors to the determinants of income-related health inequality. The empirical part of the study reveals discrepancies which can be attributed to differences between Finland and Denmark and to differences between the construction of 15D and EQ-5D scores. Finally, evidence of impact of life-style factors on income-related health inequality is found.

  7. Neighborhood income inequality, social capital and emotional distress among adolescents: A population-based study.

    PubMed

    Vilhjalmsdottir, Arndis; Gardarsdottir, Ragna B; Bernburg, Jon Gunnar; Sigfusdottir, Inga Dora

    2016-08-01

    Theory holds that income inequality may harm adolescent mental health by reducing social capital within neighborhood communities. However, research on this topic has been very limited. We use multilevel data on 102 public schools and 5958 adolescents in Iceland (15 and 16 years old) to examine whether income inequality within neighborhoods is associated with emotional distress in adolescents. Moreover, we test whether indicators of social capital, including social trust and embeddedness in neighborhood social networks, mediate this contextual effect. The findings show that neighborhood income inequality positively influences emotional distress of individual adolescents, net of their personal household situations and social relations. However, although the indicators of social capital negatively influence emotional distress, they do not mediate the contextual effect of neighborhood income inequality. The study illustrates the role of economic disparities in adolescent mental health, but calls for more research on the underlying social and social-psychological mechanisms. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  8. Four Decades of Educational Inequalities in Hospitalization and Mortality among Older Swedes.

    PubMed

    Torssander, Jenny; Ahlbom, Anders; Modig, Karin

    2016-01-01

    The inverse association between education and mortality has grown stronger the last decades in many countries. During the same period, gains in life expectancy have been concentrated to older ages; still, old-age mortality is seldom the focus of attention when analyzing trends in the education-mortality gradient. It is further unknown if increased educational inequalities in mortality are preceded by increased inequalities in morbidity of which hospitalization may be a proxy. Using administrative population registers from 1971 and onwards, education-specific annual changes in the risk of death and hospital admission were estimated with complimentary log-log models. These risk changes were supplemented by estimations of the ages at which 25, 50, and 75% of the population had been hospitalized or died (after age 60). The mortality decline among older people increasingly benefitted the well-educated over the less well-educated. This inequality increase was larger for the younger old, and among men. Educational inequalities in the age of a first hospital admission generally followed the development of growing gaps, but at a slower pace than mortality and inequalities did not increase among the oldest individuals. Education continues to be a significant predictor of health and longevity into old age. That the increase in educational inequalities is greater for mortality than for hospital admissions (our proxy of overall morbidity) may reflect that well-educated individuals gradually have obtained more possibilities or resources to survive a disease than less well-educated individuals have the last four decades.

  9. Income Inequality and Adolescent Gambling Severity: Findings from a Large-Scale Italian Representative Survey

    PubMed Central

    Canale, Natale; Vieno, Alessio; Lenzi, Michela; Griffiths, Mark D.; Borraccino, Alberto; Lazzeri, Giacomo; Lemma, Patrizia; Scacchi, Luca; Santinello, Massimo

    2017-01-01

    Background: Studies have shown that problems related to adult gambling have a geographical and social gradient. For instance, adults experiencing gambling-related harms live in areas of greater deprivation; are unemployed, and have lower income. However, little is known about the impact of socioeconomic inequalities on adolescent problem gambling. The main purpose of the present study was to investigate the contextual influences of income inequality on at-risk or problem gambling (ARPG) in a large-scale nationally representative sample of Italian adolescents. A secondary aim was to analyze the association between perceived social support (from family, peers, teachers, and classmates) and ARPG. Methods: Data from the 2013–2014 Health Behavior in School-aged Children Survey (HBSC) Study was used for cross-sectional analyses of ARPG. A total of 20,791 15-year-old students completed self-administered questionnaires. Region-level data on income inequality (GINI index) and overall wealth (GDP per capita) were retrieved from the National Institute of Statistics (Istat). The data were analyzed using the multi-level logistic regression analysis, with students at the first level and regions at the second level. Results: The study demonstrated a North–South gradient for the prevalence of ARPG, with higher prevalence of ARPG in the Southern/Islands/Central Regions (e.g., 11% in Sicily) than in Northern Italy (e.g., 2% in Aosta Valley). Students in regions of high-income inequality were significantly more likely than those in regions of low-income inequality to be at-risk or problem gamblers (following adjustment for sex, family structure, family affluence, perceived social support, and regionale wealth). Additionally, perceived social support from parents and teachers were negatively related to ARPG. Conclusions: Income inequality may have a contextual influence on ARPG. More specifically, living in regions of highest income inequality appeared to be a potential factor

  10. Exploring the inequality-mortality relationship in the US with Bayesian spatial modeling

    PubMed Central

    Yang, Tse-Chuan; Jensen, Leif

    2014-01-01

    While there is evidence to suggest that socioeconomic inequality within places is associated with mortality rates among people living within them, the empirical connection between the two remains unsettled as potential confounders associated with racial and social structure are overlooked. This study seeks to test this relationship, to determine whether it is due to differential levels of deprivation and social capital, and does so with intrinsically conditional autoregressive Bayesian spatial modeling that effectively addresses the bias introduced by spatial dependence. We find that deprivation and social capital partly but not completely account for why inequality is positively associated with mortality and that spatial modeling generates more accurate predictions than does the traditional approach. We advance the literature by unveiling the intervening roles of social capital and deprivation in the inequality-mortality relationship and offering new evidence that inequality matters in US county mortality rates. PMID:26166920

  11. Income inequality is associated with adolescent fertility in Brazil: a longitudinal multilevel analysis of 5,565 municipalities.

    PubMed

    Chiavegatto Filho, Alexandre D P; Kawachi, Ichiro

    2015-02-07

    Brazil has one of the highest adolescent fertility rates in the world. Income inequality has been frequently linked to overall adolescent health, but studies that analyzed its association with adolescent fertility have been performed only in developed countries. Brazil, in the past decade, has presented a rare combination of increasing per capita income and decreasing income inequality, which could influence future desirable pathways for other countries. We analyzed every live birth from 2000 and from 2010 in each of the 5,565 municipalities of Brazil, a total of 6,049,864 births, which included 1,247,145 (20.6%) births from women aged 15 to 19. Income inequality was assessed by the Gini Coefficient and adolescent fertility by the ratio between the number of live births from women aged 15 to 19 and the number of women aged 15 to 19, calculated for each municipality. We first applied multilevel models separately for 2000 and 2010 to test the cross-sectional association between income inequality and adolescent fertility. We then fitted longitudinal first-differences multilevel models to control for time-invariant effects. We also performed a sensitivity analysis to include only municipality with satisfactory birth record coverage. Our results indicate a consistent and positive association between income inequality and adolescent fertility. After controlling for per capita income, college access, youth homicide rate and adult fertility, higher income inequality was significantly associated with higher adolescent fertility for both 2000 and 2010. The longitudinal multilevel models found similar results. The sensitivity analysis indicated that the results for the association between income inequality and adolescent fertility were robust. Adult fertility was also significantly associated with adolescent fertility in the cross-sectional and longitudinal models. Income inequality is expected to be a leading concern for most countries in the near future. Our results suggest

  12. Changing trends in indigenous inequalities in mortality: lessons from New Zealand.

    PubMed

    Tobias, Martin; Blakely, Tony; Matheson, Don; Rasanathan, Kumanan; Atkinson, June

    2009-12-01

    We describe trends from 1951 to 2006 in inequalities in mortality between the indigenous (Māori) and non-indigenous (non-Māori, mainly European-descended) populations of New Zealand. We relate these trends to the historical context in which they occurred, including major structural adjustment of the economy from the mid 1980s to the mid 1990s, followed by a retreat from neoliberal social and economic policies from the late 1990s onwards. This was accompanied by economic recovery and the introduction of health reforms, including a reorientation of the health system towards primary health care. Abridged period lifetables for Māori and non-Māori from 1951 to 2006 were constructed using standard demographic methods. Absolute [standardized rate difference (SRD)] and relative [standardized rate ratio (SRR)] mortality inequalities for Māori compared with European/Other ethnic groups (aged 1-74 years) were measured using the New Zealand Census-Mortality Study (an ongoing data linkage study that links mortality to census records) from 1981-84 to 2001-04. The SRDs were decomposed into their contributions from major causes of death. Poisson regression modelling was used to estimate the extent of socio-economic mediation of the ethnic mortality inequality over time. Life expectancy gaps and relative inequalities in mortality rates (aged 1-74 years) widened and then narrowed again, in tandem with the trends in social inequalities (allowing for a short lag). Among females, the contribution of cardiovascular disease to absolute mortality inequalities steadily decreased, but was partly offset by an increasing contribution from cancer. Among males, the contribution of CVD increased from the early 1980s to the 1990s, then decreased again. The extent of socio-economic mediation of the ethnic mortality inequality peaked in 1991-94, again more notably among males. Our results are consistent with a causal association between changing economic inequalities and changing health

  13. Does early-life income inequality predict self-reported health in later life? Evidence from the United States.

    PubMed

    Lillard, Dean R; Burkhauser, Richard V; Hahn, Markus H; Wilkins, Roger

    2015-03-01

    We investigate the association between adult health and the income inequality they experienced as children up to 80 years earlier. Our inequality data track shares of national income held by top percentiles from 1913 to 2009. We average those data over the same early-life years and merge them to individual data from the Panel Study of Income Dynamics data for 1984-2009. Controlling for demographic and economic factors, we find both men and women are statistically more likely to report poorer health if income was more unequally distributed during the first years of their lives. The association is robust to alternative specifications of income inequality and time trends and remains significant even when we control for differences in overall childhood health. Our results constitute prima facie evidence that adults' health may be adversely affected by the income inequality they experienced as children. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. [Fifty years of mortality or the result of social inequality].

    PubMed

    Jimenez Ornelas, R

    1993-01-01

    An average of 30 years has been added to Mexican life expectancy in the past five decades. Women and men born in 1940 had life expectancies of 41.5 and 39.5 years, respectively, compared to 72.8 and 66.7 in 1990. Mortality declined most sharply between 1940 and 1960, and declined at varying rates in the subsequent decades. In the decade from 1980 to 1990, the mortality decline slowed. The differential in life expectancy between men and women amounted to 6.2 years in 1980 and 6.1 in 1990. The high life expectancy of women means that future advances will be more difficult to achieve. The greater survival of Mexicans over the five decades is due to improvements in living conditions, advances in preventive and curative medicine, and social policy. The slower pace of mortality decline in the past decade may perhaps have been due to deteriorating living conditions, reduced priority accorded to social policies in the areas of health and education, and declining real incomes. Mexican health, education, and other social policies have favored the urban and industrial centers, increasing regional disparities. A comparison of life expectancies in Oaxaca, one of the most impoverished states of Mexico, and Puebla, which has somewhat better conditions, with life expectancies in the wealthy state of Nuevo Leon and the Federal District demonstrates the influence of the level of development on life expectancy. Life expectancy in 1990 in Oaxaca and Puebla was the equivalent of that for all of Mexico ten years earlier. Men in Oaxaca live five years less on average than men in Nuevo Leon. But the gain in life expectancy for males was higher in Oaxaca between 1980 and 1990 than in the other states.

  15. Education Expansion, Educational Inequality, and Income Inequality: Evidence from Taiwan, 1976-2003

    ERIC Educational Resources Information Center

    Lin, Chun-Hung A.

    2007-01-01

    The expansion of higher education in Taiwan starting from the late 1980s has successfully raised the average level of education. Using the concept of the education Gini, we find that the educational inequality declined as average schooling rose during the period of 1976-2003. The impacts of a rising average schooling and a declining educational…

  16. Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?

    PubMed Central

    2012-01-01

    Background Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Methods Cause-specific mortality data for people aged 30–74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30–74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients. Results In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. Conclusions We did not find evidence that inequalities in

  17. Is Inequality Inevitable in Society? Income Distribution as a Consequence of Resource Flow in Hierarchical Organizations

    NASA Astrophysics Data System (ADS)

    Sinha, Sitabhra; Srivastava, Nisheeth

    Almost all societies, once they attain a certain level of complexity, exhibit inequality in the income of its members. Hierarchical stratification of social classes may be a major contributor to such unequal distribution of income, with intra-class variation often being negligible compared to inter-class differences. In this paper, examples from different historical periods, such as 10th century Byzantium and the Mughal empire of India in the 15th century, and different kinds of organizations, such as a criminal gang in the USA and Manufacturing & IT Services companies in India, are shown to suggest a causal relation between the hierarchical structure of social organization and the observed income inequality in societies. Proceeding from the assumption that income inequality may be a consequence of resource flow in a hierarchically structured social network, we present a model to show that empirically observed long-tailed income distribution can be explained through a process of division of assets at various levels in a hierarchical organization.

  18. [Issues regarding the effects on health of income inequality: contextual mechanisms].

    PubMed

    Celeste, Roger Keller; Nadanovsky, Paulo

    2010-08-01

    Brazil is one of the most unequal countries in income distribution. The influence of this factor on people's health is controversial. This article reviews the contextual effects and possible pathways linking income inequality to health. Contextual effect studies need well-developed multilevel theories, identifying the roles of variables in the explaining model, especially the role of individual level variables and the level of aggregation of contextual variables. Four explanations for the relationship between income inequality and health were identified: (1) statistical artifact; (2) social comparison; (3) underinvestment in social police; (4) social capital. The relative contribution of each of these mechanisms has not been well evaluated yet. We concluded that part of the heterogeneity found in the studies results may be explained by different pathways. Alternatively, income inequality may be a proxy for social stratification and less investment in public policies, but the Gini coefficient may be an unsuitable marker for such constructs in certain circumstances. More powerful designs to ascertain cause relationship should be applied. One possibility is to study the effect of intervention policies aimed at income redistribution.

  19. Income inequality and elderly self-rated health in São Paulo, Brazil.

    PubMed

    Chiavegatto Filho, Alexandre Dias Porto; Lebrão, Maria Lúcia; Kawachi, Ichiro

    2012-12-01

    To test the association between income inequality and elderly self-rated health and to propose a pathway to explain the relationship. We analyzed a sample of 2143 older individuals (60 years of age and over) from 49 distritos of the Municipality of São Paulo, Brazil. Bayesian multilevel logistic models were performed with poor self-rated health as the outcome variable. Income inequality (measured by the Gini coefficient) was found to be associated with poor self-rated health after controlling for age, sex, income and education (odds ratio, 1.19; 95% credible interval, 1.01-1.38). When the practice of physical exercise and homicide rate were added to the model, the Gini coefficient lost its statistical significance (P > .05). We fitted a structural equation model in which income inequality affects elderly health by a pathway mediated by violence and practice of physical exercise. The health of older individuals may be highly susceptible to the socioeconomic environment of residence, specifically to the local distribution of income. We propose that this association may be mediated by fear of violence and lack of physical activity. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. The association of major depressive episodes with income inequality and the human development index.

    PubMed

    Cifuentes, Manuel; Sembajwe, Grace; Tak, SangWoo; Gore, Rebecca; Kriebel, David; Punnett, Laura

    2008-08-01

    The aim of this study was to estimate the association between country income distribution and human development with the 12-month occurrence of major depressive episodes across countries. A total of 251,158 people surveyed by the World Health Organization from 2002 to 2003 from 65 countries were included in the study. The survey contained items for identifying major depressive episodes (MDE) in the previous 12 months, attained education (used as an indicator of individual socioeconomic status) and other demographic information. Income inequality was measured with the Gini index, a national-level indicator; the United Nations human development index (HDI) measured overall country development. Country-level and multilevel linear regression models were utilized to study the associations. We found that moderately developed countries had the lowest adjusted prevalence of MDE followed by high and low developed countries. The Gini index was positively associated with major depressive episodes, but only among high HDI countries. After adjusting for age, gender, marital status, education and HDI, the multilevel prevalence ratio indicated a 4% increase in risk of MDE for a person living in a country associated with a 1% increment in income equality. This finding means, for example, that comparing two highly developed countries, one with low income inequality (Gini=0.25) with another with high income inequality (Gini=0.39), one would expect to see an increase in the prevalence of MDE from 4.0% to 6.2%. These findings raise important questions about the role of income inequality on social forces that can lead to depression.

  1. The Association of Geographic Coordinates with Mortality in People with Lower and Higher Education and with Mortality Inequalities in Spain.

    PubMed

    Regidor, Enrique; Reques, Laura; Giráldez-García, Carolina; Miqueleiz, Estrella; Santos, Juana M; Martínez, David; de la Fuente, Luis

    2015-01-01

    Geographic patterns in total mortality and in mortality by cause of death are widely known to exist in many countries. However, the geographic pattern of inequalities in mortality within these countries is unknown. This study shows mathematically and graphically the geographic pattern of mortality inequalities by education in Spain. Data are from a nation-wide prospective study covering all persons living in Spain's 50 provinces in 2001. Individuals were classified in a cohort of subjects with low education and in another cohort of subjects with high education. Age- and sex-adjusted mortality rate from all causes and from leading causes of death in each cohort and mortality rate ratios in the low versus high education cohort were estimated by geographic coordinates and province. Latitude but not longitude was related to mortality. In subjects with low education, latitude had a U-shaped relation to mortality. In those with high education, mortality from all causes, and from cardiovascular, respiratory and digestive diseases decreased with increasing latitude, whereas cancer mortality increased. The mortality-rate ratio for all-cause death was 1.27 in the southern latitudes, 1.14 in the intermediate latitudes, and 1.20 in the northern latitudes. The mortality rate ratios for the leading causes of death were also higher in the lower and upper latitudes than in the intermediate latitudes. The geographic pattern of the mortality rate ratios is similar to that of the mortality rate in the low-education cohort: the highest magnitude is observed in the southern provinces, intermediate magnitudes in the provinces of the north and those of the Mediterranean east coast, and the lowest magnitude in the central provinces and those in the south of the Western Pyrenees. Mortality inequalities by education in Spain are higher in the south and north of the country and lower in the large region making up the central plateau. This geographic pattern is similar to that observed in

  2. Income inequality and adult nutritional status: anthropometric evidence from a pre-industrial society in the Bolivian Amazon.

    PubMed

    Godoy, Ricardo; Byron, Elizabeth; Reyes-García, Victoria; Vadez, Vincent; Leonard, William R; Apaza, Lilian; Huanca, Tomás; Pérez, Eddy; Wilkie, David

    2005-09-01

    Evidence has been accumulated about the adverse effects of income inequality on individual health in industrial nations, but we know less about its effect in small-scale, pre-industrial rural societies. Income inequality should have modest effects on individual health. First, norms of sharing and reciprocity should reduce the adverse effects of income inequality on individual health. Second, with sharing and reciprocity, personal income will spill over to the rest of the community, attenuating the protective role of individual income on individual health found in industrial nations. We test these ideas with data from Tsimane' Amerindians, a foraging and farming society in the Bolivian Amazon. Subjects included 479 household heads (13+ years of age) from 58 villages. Dependent variables included anthropometric indices of short-run nutritional status (body-mass index (BMI), and age- and sex-standardized z-scores of mid-arm muscle area and skinfolds). Proxies for income included area deforested per person the previous year and earnings per person in the last 2 weeks. Village income inequality was measured with the Gini coefficient. Income inequality did not correlate with anthropometric indices, most likely because of negative indirect effects from the omission of social-capital variables, which would lower the estimated impact of income inequality on health. The link between BMI and income and between skinfolds and income resembled a U and an inverted U; income did not correlate with mid-arm muscle area. The use of an experimental research design might allow for better estimates of how income inequality affects social capital and individual health.

  3. Lagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study

    PubMed Central

    Kim, Daniel; Griffin, Beth Ann; Kabeto, Mohammed; Escarce, José; Langa, Kenneth M.; Shih, Regina A.

    2016-01-01

    Purpose Much variation in individual-level cognitive function in late life remains unexplained, with little exploration of area-level/contextual factors to date. Income inequality is a contextual factor that may plausibly influence cognitive function. Methods In a nationally-representative cohort of older Americans from the Health and Retirement Study, we examined state- and metropolitan statistical area (MSA)-level income inequality as predictors of individual-level cognitive function measured by the 27-point Telephone Interview for Cognitive Status (TICS-m) scale. We modeled latency periods of 8–20 years, and controlled for state-/metropolitan statistical area (MSA)-level and individual-level factors. Results Higher MSA-level income inequality predicted lower cognitive function 16–18 years later. Using a 16-year lag, living in a MSA in the highest income inequality quartile predicted a 0.9-point lower TICS-m score (β = -0.86; 95% CI = -1.41, -0.31), roughly equivalent to the magnitude associated with five years of aging. We observed no associations for state-level income inequality. The findings were robust to sensitivity analyses using propensity score methods. Conclusions Among older Americans, MSA-level income inequality appears to influence cognitive function nearly two decades later. Policies reducing income inequality levels within cities may help address the growing burden of declining cognitive function among older populations within the United States. PMID:27332986

  4. Lagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study.

    PubMed

    Kim, Daniel; Griffin, Beth Ann; Kabeto, Mohammed; Escarce, José; Langa, Kenneth M; Shih, Regina A

    2016-01-01

    Much variation in individual-level cognitive function in late life remains unexplained, with little exploration of area-level/contextual factors to date. Income inequality is a contextual factor that may plausibly influence cognitive function. In a nationally-representative cohort of older Americans from the Health and Retirement Study, we examined state- and metropolitan statistical area (MSA)-level income inequality as predictors of individual-level cognitive function measured by the 27-point Telephone Interview for Cognitive Status (TICS-m) scale. We modeled latency periods of 8-20 years, and controlled for state-/metropolitan statistical area (MSA)-level and individual-level factors. Higher MSA-level income inequality predicted lower cognitive function 16-18 years later. Using a 16-year lag, living in a MSA in the highest income inequality quartile predicted a 0.9-point lower TICS-m score (β = -0.86; 95% CI = -1.41, -0.31), roughly equivalent to the magnitude associated with five years of aging. We observed no associations for state-level income inequality. The findings were robust to sensitivity analyses using propensity score methods. Among older Americans, MSA-level income inequality appears to influence cognitive function nearly two decades later. Policies reducing income inequality levels within cities may help address the growing burden of declining cognitive function among older populations within the United States.

  5. Inequalities in full immunization coverage: trends in low- and middle-income countries

    PubMed Central

    Barros, Aluísio JD; Wong, Kerry LM; Johnson, Hope L; Pariyo, George; França, Giovanny VA; Wehrmeister, Fernando C; Victora, Cesar G

    2016-01-01

    Abstract Objective To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries. Methods In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries. Findings In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations. Conclusion Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported. PMID:27821882

  6. Gender differences in socioeconomic inequality of alcohol-attributable mortality: A systematic review and meta-analysis.

    PubMed

    Probst, Charlotte; Roerecke, Michael; Behrendt, Silke; Rehm, Jürgen

    2015-05-01

    The present analysis contributes to understanding the societal distribution of alcohol-attributable harm by investigating socioeconomic inequality and related gender differences in alcohol-attributable mortality. A systematic literature search was performed on Web of Science, MEDLINE, PsycINFO and ETOH from their inception until February 2013. Articles were included when they reported data on alcohol-attributable mortality by socioeconomic status (SES), operationalised as education, occupation, employment status or income. Gender-specific relative risks (RR) comparing low with high SES were pooled using random effects meta-analyses. Gender differences were additionally investigated in random effects meta-regressions. Nineteen articles from 14 countries were included. For women, significant RRs across all measures of SES, except employment status, were found, ranging between 1.75 [95% confidence interval (CI) 1.21-2.54; occupation] and 4.78 (95% CI 2.57-8.87; income). For men, all measures of SES showed significant RRs ranging between 2.88 (95% CI 2.45-3.40; income) and 12.25 (95% CI 11.45-13.10; employment status). While RRs for men were in general slightly higher, only for occupation this gender difference was above chance (P = 0.01). Results refer to deaths 100% attributable to alcohol. The results are predominantly based on data from high-income countries, limiting generalisability. Alcohol-attributable mortality is strongly distributed to the disadvantage of persons with a low SES. Marked gender differences in this inequality were found for occupation. Possibly male-dominated occupations of low SES were more strongly related to risky drinking cultures compared with female-dominated occupations of the same SES. © 2014 Australasian Professional Society on Alcohol and other Drugs.

  7. Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992–2003

    PubMed Central

    Puigpinós, Rosa; Borrell, Carme; Antunes, José Leopoldo Ferreira; Azlor, Enric; Pasarín, M Isabel; Serral, Gemma; Pons-Vigués, Mariona; Rodríguez-Sanz, Maica; Fernández, Esteve

    2009-01-01

    Background The objective of this study was to assess trends in cancer mortality by educational level in Barcelona from 1992 to 2003. Methods The study population comprised Barcelona inhabitants aged 20 years or older. Data on cancer deaths were supplied by the system of information on mortality. Educational level was obtained from the municipal census. Age-standardized rates by educational level were calculated. We also fitted Poisson regression models to estimate the relative index of inequality (RII) and the Slope Index of Inequalities (SII). All were calculated for each sex and period (1992–1994, 1995–1997, 1998–2000, and 2001–2003). Results Cancer mortality was higher in men and women with lower educational level throughout the study period. Less-schooled men had higher mortality by stomach, mouth and pharynx, oesophagus, larynx and lung cancer. In women, there were educational inequalities for cervix uteri, liver and colon cancer. Inequalities of overall and specific types of cancer mortality remained stable in Barcelona; although a slight reduction was observed for some cancers. Conclusion This study has identified those cancer types presenting the greatest inequalities between men and women in recent years and shown that in Barcelona there is a stable trend in inequalities in the burden of cancer. PMID:19166582

  8. Health inequalities by wage income in Sweden: the role of work environment.

    PubMed

    Hemström, Orjan

    2005-08-01

    The main aim of this study was to explore the mediating role made by work environment to health inequalities by wage income in Sweden. Gender differences were also analysed. Data from the Swedish Survey of Living Conditions for the years 1998 and 1999 were analysed. Employed 20-64-year olds with a registered wage were included (nearly 6000 respondents). Sex-specific logistic regressions in relation to global self-rated health were applied. Those in the lowest income quintile had 2.4 times (men) and 4.3 times (women) higher probability of less than good health than did those in the highest quintile (adjusted for age, family status, country of birth, education level, smoking and full-time work). The mediating contribution of work environment factors to the health gradient by income was 25 per cent (men) and 29 per cent (women), respectively. This contribution was observed mainly from ergonomic and physical exposure, decision authority and skill discretion. Psychological demands did not contribute to such inequalities because mentally demanding work tasks are more common in high income as compared with low income jobs. Using sex-specific income quintiles, instead of income quintiles for the entire sample, gave very similar results. In conclusion, work environment factors can be seen as important mediators for the association between wage income and ill health in Sweden. A larger residual effect of income on health for women as compared with men suggests that one's own income from work is a more important determinant of women's than men's ill health in Sweden.

  9. Relationships between income inequality and health: a study on rural and urban regions of Canada.

    PubMed

    Vafaei, Afshin; Rosenberg, Mark W; Pickett, William

    2010-01-01

    Many studies have demonstrated that health is a function of relative and not absolute income within populations. Canadian studies are not conclusive; most indicate that there is no relationship between income inequality and health within Canada. There is a need for further investigation into the validity of the 'relative income' hypothesis in the Canadian population. The primary objective of this research was to test the 'relative income' hypothesis across Canadian health regions. The second objective was to extend the hypothesis to consider rural versus urban populations. This research involved ecological analyses. The source of the data was the Canadian Community Health Survey, Cycle 3.1. The units of analysis were Canadian health regions. Health of a region was estimated as the percentage of people who rated their health as good or excellent. The primary exposure variable was the ratio of people whose personal income was less than $15,000 relative to those reporting more than $80,000 in the year preceding the survey. This ratio provided a measure of the distribution of income. The main covariates were ecological measures of socio-demographic variables, social capital, substance use behaviours (smoking and alcohol consumption), rural/urban status of the region, and absolute income in the region. Correlation analyses and multiple linear regressions were performed to ascertain the relationship between income inequality and population health, adjusting for important covariates. The measure of income inequality alone appeared to explain 18% of the variability in the measure of population health. However, after adding the measure of absolute income to the model, although 29% of the variability was explained, the independent contribution of the inequality measure became non-significant. Linear regression models suggested that the absolute income variable alone could explain 30% of the variance in the health status of populations. Other variables with a statistically

  10. Income inequality, disinvestment in health care and use of dental services.

    PubMed

    Bhandari, Bishal; Newton, Jonathan T; Bernabé, Eduardo

    2015-01-01

    To explore the interrelationships between income inequality, disinvestment in health care, and use of dental services at country level. This study pooled national estimates for use of dental services among adults aged 18 years or older from the 70 countries that participated in the World Health Survey from 2002 to 2004, together with aggregate data on national income (GDP per capita), income inequality (Gini coefficient), and disinvestment in health care (total health expenditure and dentist-to-population ratio) from various international sources. Use of dental services was defined as having had dental problems in the last 12 months and having received any treatment to address those needs. Associations between variables were explored using Pearson correlation coefficients and linear regression. Data from 63 countries representing the six WHO regions were analyzed. Use of dental services was negatively correlated with Gini coefficient (Pearson correlation coefficient -0.48, P < 0.001) and positively correlated with GDP per capita (0.40, P < 0.05), total health expenditure (0.45, P < 0.001), and dentist-to-population ratio (0.67, P < 0.001). The association between Gini coefficient and use of dental services was attenuated but remained significant after adjustments for GDP per capita, total health expenditure, and dentist-to-population ratio (regression coefficient -0.36; 95% CI -0.57, -0.15). This study shows an inverse relationship between income inequality and use of dental services. Of the two indicators of disinvestment in health care assessed, only dentist-to-population ratio was associated with income inequality and use of dental services. © 2014 American Association of Public Health Dentistry.

  11. How do people attribute income-related inequalities in health? A cross-sectional study in Ontario, Canada.

    PubMed

    Lofters, Aisha; Slater, Morgan; Kirst, Maritt; Shankardass, Ketan; Quiñonez, Carlos

    2014-01-01

    Substantive equity-focused policy changes in Ontario, Canada have yet to be realized and may be limited by a lack of widespread public support. An understanding of how the public attributes inequalities can be informative for developing widespread support. Therefore, the objectives of this study were to examine how Ontarians attribute income-related health inequalities. We conducted a telephone survey of 2,006 Ontarians using random digit dialing. The survey included thirteen questions relevant to the theme of attributions of income-related health inequalities, with each statement linked to a known social determinant of health. The statements were further categorized depending on whether the statement was framed around blaming the poor for health inequalities, the plight of the poor as a cause of health inequalities, or the privilege of the rich as a cause of health inequalities. There was high agreement for statements that attributed inequalities to differences between the rich and the poor in terms of employment, social status, income and food security, and conversely, the least agreement for statements that attributed inequalities to differences in terms of early childhood development, social exclusion, the social gradient and personal health practices and coping skills. Mean agreement was lower for the two statements that suggested blame for income-related health inequalities lies with the poor (43.1%) than for the three statements that attributed inequalities to the plight of the poor (58.3%) or the eight statements that attributed inequalities to the privilege of the rich (58.7%). A majority of this sample of Ontarians were willing to attribute inequalities to the social determinants of health, and were willing to accept messages that framed inequalities around the privilege of the rich or the plight of the poor. These findings will inform education campaigns, campaigns aimed at increasing public support for equity-focused public policy, and knowledge

  12. [Social inequalities and health. Socioeconomic level and infant mortality in Chile in 1985-1995].

    PubMed

    Hollstein, R D; Vega, J; Carvajal, Y

    1998-03-01

    The strong relationship between social inequalities and health have been extensively reported. To measure the effects of social inequalities, assessed through maternal educational level, on infant mortality in Chile. Using death and birth electronic databases of the Instituto Nacional de Estadisticas, the annual rates of infant mortality per years of approved studies of both parents and per cause were calculated. In the 1990-1995 period, there is a clear gradient of infant mortality according to the level of education of the mother (38.2 per 1000 born alive among those without education versus 7.8 per 1000 born alive among those with university education). The same tendency is maintained for neonatal and post-neonatal mortality. All groups of causes had a similar effect, standing out diseases of the respiratory system with a relative risk (RR) of 14.3 and a population attributable risk (PAR) of 73%, trauma with a RR of 11.3 and a PAR of 69% and infectious diseases with a RR of 10.8 and a PAR of 62%. Between 1985 and 1995, absolute inequalities decreased but relative inequalities remained constant. The great social inequality in infant mortality has persisted in Chile during the last years. To adequately assess the national progresses in population health using infant mortality as an indicator, the gaps between social groups must be born in mind.

  13. Widening social inequalities in mortality: the case of Barcelona, a southern European city.

    PubMed Central

    Borrell, C; Plasència, A; Pasarin, I; Ortún, V

    1997-01-01

    OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas. PMID:9519129

  14. State-level income inequality and family burden of U.S. families raising children with special health care needs.

    PubMed

    Parish, Susan L; Rose, Roderick A; Dababnah, Sarah; Yoo, Joan; Cassiman, Shawn A

    2012-02-01

    Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden.

  15. Neighbourhood income and neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality in Canada, 1991-2005.

    PubMed

    Gilbert, Nicolas L; Auger, Nathalie; Wilkins, Russell; Kramer, Michael S

    2013-03-07

    Rates of infant mortality declined in Canada in the 1990s and 2000s, but the extent to which all socio-economic levels benefitted from this progress is unknown. This study investigated differences and time trends in neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality across neighbourhood income quintiles among live births in Canada from 1991 through 2005. The Canadian linked live birth and infant death file was used, excluding births from Ontario, Yukon, Northwest Territories and Nunavut. Mortality rates for neonatal, postneonatal and sudden infant death syndrome (SIDS) were calculated by neighbourhood income quintile and period (1991-1995, 1996-2000, 2001-2005). Hazard ratios (HR) for neighbourhood income quintile and period were computed, adjusting for province of residence, maternal age, parity, infant sex and multiple birth. In urban areas, for the entire study period (1991-2005), the poorest neighbourhood income quintile had a higher hazard of neonatal death (adjusted HR 1.24, 95% CI 1.15-1.34), postneonatal death (adjusted HR 1.58, 95% CI 1.41-1.76) and SIDS (adjusted HR 1.83, 95% CI 1.49-2.26) compared to the richest quintile. Postneonatal and SIDS mortality rates declined by 37% and 57%, respectively, between 1991-1995 and 2001-2005 whereas no significant change was observed in neonatal mortality. The decrease in postneonatal and SIDS mortality rates occurred across all income quintiles. This study shows that despite a decrease in infant mortality and SIDS across all neighbourhood income quintiles over time in Canada, socio-economic inequalities persist. This finding highlights the need for effective infant health promotion strategies in vulnerable populations.

  16. Informal employment in high-income countries for a health inequalities research: A scoping review.

    PubMed

    Julià, Mireia; Tarafa, Gemma; O'Campo, Patricia; Muntaner, Carles; Jódar, Pere; Benach, Joan

    2015-01-01

    Informal employment (IE) is one of the least studied employment conditions in public health research, mainly due to the difficulty of its conceptualization and its measurement, producing a lack of a unique concept and a common method of measurement. The aim of this review is to identify literature on IE in order to improve its definition and methods of measurement, with special attention given to high-income countries, to be able to study the possible impact on health inequalities within and between countries. A scoping review of definitions and methods of measurement of IE was conducted reviewing relevant databases and grey literature and analyzing selected articles. We found a wide spectrum of terms for describing IE as well as definitions and methods of measurement. We provide a definition of IE to be used in health inequalities research in high-income countries. Direct methods such as surveys can capture more information about workers and firms in order to estimate IE. These results can be used in further investigations about the impacts of this IE on health inequalities. Public health research must improve monitoring and analysis of IE in order to know the impacts of this employment condition on health inequalities.

  17. Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities

    PubMed Central

    2011-01-01

    Background Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities. Methods It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation. Results In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women. Conclusion This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment. PMID:21232096

  18. Decomposing the Gini Inequality Index: An Expanded Solution with Survey Data Applied to Analyze Gender Income Inequality

    ERIC Educational Resources Information Center

    Larraz, Beatriz

    2015-01-01

    The aim of this article is to propose a new breakdown of the Gini inequality ratio into three components ("within-group" inequality, "between-group" inequality, and intensity of "transvariation" between groups to the total inequality index). The between-group inequality concept computes all the differences in salaries…

  19. Income Inequality, Socioeconomic Deprivation and Depressive Symptoms among Older Adults in Mexico

    PubMed Central

    Fernández-Niño, Julián Alfredo; Manrique-Espinoza, Betty Soledad; Bojorquez-Chapela, Ietza; Salinas-Rodríguez, Aarón

    2014-01-01

    Objective Depression is the second most common mental disorder in older adults (OA) worldwide. The ways in which depression is influenced by the social determinants of health – specifically, by socioeconomic deprivation, income inequality and social capital - have been analyzed with only partially conclusive results thus far. The objective of our study was to estimate the association of income inequality and socioeconomic deprivation at the locality, municipal and state levels with the prevalence of depressive symptoms among OA in Mexico. Methods Cross-sectional study based on a nationally representative sample of 8,874 OA aged 60 and over. We applied the brief seven-item version of the Center for Epidemiologic Studies Depression Scale (CES-D) to determine the presence of depressive symptoms. Additionally, to select the principal context variables, we used the Deprivation Index of the National Population Council of Mexico at the locality, municipal and state levels, and the Gini Index at the municipal and state levels. Finally, we estimated the association of income inequality and socioeconomic deprivation with the presence of depressive symptoms using a multilevel logistic regression model. Results Socioeconomic deprivation at the locality (OR = 1.28; p<0.10) and municipal levels (OR = 1.16; p<0.01) correlated significantly with the presence of depressive symptoms, while income inequality did not. Conclusions The results of our study confirm that the social determinants of health are relevant to the mental health of OA. Further research is required, however, to identify which are the specific socioeconomic deprivation components at the locality and municipal levels that correlate with depression in this population group. PMID:25250620

  20. Income inequality, socioeconomic deprivation and depressive symptoms among older adults in Mexico.

    PubMed

    Fernández-Niño, Julián Alfredo; Manrique-Espinoza, Betty Soledad; Bojorquez-Chapela, Ietza; Salinas-Rodríguez, Aarón

    2014-01-01

    Depression is the second most common mental disorder in older adults (OA) worldwide. The ways in which depression is influenced by the social determinants of health - specifically, by socioeconomic deprivation, income inequality and social capital - have been analyzed with only partially conclusive results thus far. The objective of our study was to estimate the association of income inequality and socioeconomic deprivation at the locality, municipal and state levels with the prevalence of depressive symptoms among OA in Mexico. Cross-sectional study based on a nationally representative sample of 8,874 OA aged 60 and over. We applied the brief seven-item version of the Center for Epidemiologic Studies Depression Scale (CES-D) to determine the presence of depressive symptoms. Additionally, to select the principal context variables, we used the Deprivation Index of the National Population Council of Mexico at the locality, municipal and state levels, and the Gini Index at the municipal and state levels. Finally, we estimated the association of income inequality and socioeconomic deprivation with the presence of depressive symptoms using a multilevel logistic regression model. Socioeconomic deprivation at the locality (OR = 1.28; p<0.10) and municipal levels (OR = 1.16; p<0.01) correlated significantly with the presence of depressive symptoms, while income inequality did not. The results of our study confirm that the social determinants of health are relevant to the mental health of OA. Further research is required, however, to identify which are the specific socioeconomic deprivation components at the locality and municipal levels that correlate with depression in this population group.

  1. Socioeconomic inequalities in mortality rates in old age in the World Health Organization Europe region.

    PubMed

    Huisman, Martijn; Read, Sanna; Towriss, Catriona A; Deeg, Dorly J H; Grundy, Emily

    2013-01-01

    Socioeconomic adversity is among the foremost fundamental causes of human suffering, and this is no less true in old age. Recent reports on socioeconomic inequalities in mortality rate in old age suggest that a low socioeconomic position continues to increase the risk of death even among the oldest old. We aimed to examine the evidence for socioeconomic mortality rate inequalities in old age, including information about associations with various indicators of socioeconomic position and for various geographic locations within the World Health Organization Region for Europe. The articles included in this review leave no doubt that inequalities in mortality rate by socioeconomic position persist into the oldest ages for both men and women in all countries for which information is available, although the relative risk measures observed were rarely higher than 2.00. Still, the available evidence base is heavily biased geographically, inasmuch as it is based largely on national studies from Nordic and Western European countries and local studies from urban areas in Southern Europe. This bias will hamper the design of European-wide policies to reduce inequalities in mortality rate. We call for a continuous update of the empiric evidence on socioeconomic inequalities in mortality rate.

  2. Labour Market Performance, Income Inequality and Poverty in OECD Countries. OECD Economics Department Working Papers, No. 500

    ERIC Educational Resources Information Center

    Burniaux, Jean-Marc; Padrini, Flavio; Brandt, Nicola

    2006-01-01

    There have been concerns that employment-enhancing reforms along the lines of the 1994 OECD Jobs Strategy could inadvertently lead to increased income inequality and poverty. This paper focuses on the impact of institutions and redistributive policies on inequality and poverty with the view of assessing whether a trade-off between better labour…

  3. Trends in educational inequalities in mortality, seven types of cancers, Norway 1971-2002.

    PubMed

    Elstad, Jon Ivar; Torstensrud, Rita; Lyngstad, Torkild Hovde; Kravdal, Oystein

    2012-12-01

    Knowledge about educational disparities in deaths from specific cancer sites is incomplete. Even more scant is information about time trends in educational patterns in specific cancer mortality. This study examines educational inequalities in Norway 1971-2002 for mortality in lung and larynx, colorectal, stomach, melanoma, prostate, breast and cervix uteri cancer. A data file encompassing all Norwegian inhabitants registered some time during 1971-2002 while aged 45-74 was constructed with linked information from administrative registers. During an exposure of more than 40 millions person-years, about 87,000 deaths in the analysed cancer types were registered. Absolute and relative inequalities during three periods were analysed by age-standardized deaths rates, hazard regression odds ratios and Relative Index of Inequality. Educational inequalities in lung and related cancer mortality widened considerably from the 1970s to the 1990s for both sexes. The moderate educational gradient for stomach and cervix uteri cancer persisted, as did the weak gradient for colorectal cancer. No educational differences in prostate cancer were observed in any of the time periods. The modest inverse educational gradients in deaths from breast cancer and melanoma remained at the same level. Among the seven cancer types examined in this study, only lung cancer mortality showed a clear widening in educational disparities. As lung cancer mortality constitutes a large proportion of all cancer deaths, this increase may result in larger disparities for overall cancer mortality. Some explanations for the observed patterns in cancer mortality are suggested.

  4. Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform.

    PubMed

    Raittio, Eero; Aromaa, Arpo; Kiiskinen, Urpo; Helminen, Sari; Suominen, Anna Liisa

    2016-07-01

    Objectives In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. The aim of this study was to investigate income-related inequality in the perceived oral health and its determinants among adult Finns before and after the reform. Materials and methods Three identical cross-sectional nationally representative postal surveys, concerning perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2157), in 2004 (n = 1814) and in 2007 (n = 1671). Three measures of perceived oral health were used: toothache or oral discomfort during the past 12 months, current need for dental care and self-reported oral health status. Concentration index was used to analyse the income-related inequalities. Its decomposition was used to study factors related to the inequalities. Results The proportion of respondents reporting need for dental care decreased from 2001 to 2007, while no changes were seen in reports of toothache or self-reported oral health status. Income-related inequalities in reports of toothache and perceived need for care widened, while the inequality in self-reported oral health remained stable. Most of the inequalities were related to income itself, perceived general health and the time since the last visit to dental care. Conclusions It seems that the income-related inequalities in perceived oral health remained or even widened after the reform.

  5. Early diffusion of gene expression profiling in breast cancer patients associated with areas of high income inequality.

    PubMed

    Ponce, Ninez A; Ko, Michelle; Liang, Su-Ying; Armstrong, Joanne; Toscano, Michele; Chanfreau-Coffinier, Catherine; Haas, Jennifer S

    2015-04-01

    With the Affordable Care Act reducing coverage disparities, social factors could prominently determine where and for whom innovations first diffuse in health care markets. Gene expression profiling is a potentially cost-effective innovation that guides chemotherapy decisions in early-stage breast cancer, but adoption has been uneven across the United States. Using a sample of commercially insured women, we evaluated whether income inequality in metropolitan areas was associated with receipt of gene expression profiling during its initial diffusion in 2006-07. In areas with high income inequality, gene expression profiling receipt was higher than elsewhere, but it was associated with a 10.6-percentage-point gap between high- and low-income women. In areas with low rates of income inequality, gene expression profiling receipt was lower, with no significant differences by income. Even among insured women, income inequality may indirectly shape diffusion of gene expression profiling, with benefits accruing to the highest-income patients in the most unequal places. Policies reducing gene expression profiling disparities should address low-inequality areas and, in unequal places, practice settings serving low-income patients. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Four Decades of Educational Inequalities in Hospitalization and Mortality among Older Swedes

    PubMed Central

    Torssander, Jenny; Ahlbom, Anders; Modig, Karin

    2016-01-01

    Background The inverse association between education and mortality has grown stronger the last decades in many countries. During the same period, gains in life expectancy have been concentrated to older ages; still, old-age mortality is seldom the focus of attention when analyzing trends in the education-mortality gradient. It is further unknown if increased educational inequalities in mortality are preceded by increased inequalities in morbidity of which hospitalization may be a proxy. Methods Using administrative population registers from 1971 and onwards, education-specific annual changes in the risk of death and hospital admission were estimated with complimentary log-log models. These risk changes were supplemented by estimations of the ages at which 25, 50, and 75% of the population had been hospitalized or died (after age 60). Results The mortality decline among older people increasingly benefitted the well-educated over the less well-educated. This inequality increase was larger for the younger old, and among men. Educational inequalities in the age of a first hospital admission generally followed the development of growing gaps, but at a slower pace than mortality and inequalities did not increase among the oldest individuals. Conclusions Education continues to be a significant predictor of health and longevity into old age. That the increase in educational inequalities is greater for mortality than for hospital admissions (our proxy of overall morbidity) may reflect that well-educated individuals gradually have obtained more possibilities or resources to survive a disease than less well-educated individuals have the last four decades. PMID:27031107

  7. Neonatal Mortality and Inequalities in Bangladesh: Differential Progress and Sub-national Developments.

    PubMed

    Minnery, Mark; Firth, Sonja; Hodge, Andrew; Jimenez-Soto, Eliana

    2015-09-01

    A rapid reduction in under-five mortality has put Bangladesh on-track to reach Millennium Development Goal 4. Little research, however, has been conducted into neonatal reductions and sub-national rates in the country, with considerable disparities potentially masked by national reductions. The aim of this paper is to estimate national and sub-national rates of neonatal mortality to compute relative and absolute inequalities between sub-national groups and draw comparisons with rates of under-five mortality. Mortality rates for under-five children and neonates were estimated directly for 1980-1981 to 2010-2011 using data from six waves of the Demographic and Health Survey. Rates were stratified by levels of rural/urban location, household wealth and maternal education. Absolute and relative inequalities within these groups were measured by rate differences and ratios, and where possible, slope and relative indices of inequality. National mortality was shown to have decreased dramatically although at differential rates for under-fives and neonates. Across all equity markers, a general pattern of declining absolute but constant relative inequalities was found. For mortality rates stratified by education and wealth mixed evidence suggests that relative inequalities may have also fallen. Although disparities remain, Bangladesh has achieved a rare combination of substantive reductions in mortality levels without increases in relative inequalities. A coalescence of substantial increases in coverage and equitable distribution of key child and neonatal interventions with widespread health sectoral and policy changes over the last 30 years may in part explain this exceptional pattern.

  8. Impact of income inequality on life expectancy in a highly unequal developing country: the case of Brazil.

    PubMed

    Rasella, Davide; Aquino, Rosana; Barreto, Mauricio Lima

    2013-08-01

    Few studies have analysed the effects of income inequality on health in developing countries, particularly during economic growth, reduction of social disparities and reinforcement of the welfare and healthcare system. We evaluated the association between income inequality and life expectancy in Brazil, including the effect of social and health interventions, in the period 2000-2009. A panel dataset was created for the 27 Brazilian states over the referred time period. Multivariable linear regressions were performed using fixed-effects estimation with heteroscedasticity and serial correlation robust SEs. Models were fitted for life expectancy as a dependent variable, using the Gini index or a percentile income dispersion ratio as the main independent variable, and for demographic, socioeconomic and healthcare-related determinants as covariates. The Gini index, as the other measure of income inequality, was negatively associated with life expectancy (p<0.05), even after adjustment for all the socioeconomic and health-related covariates. The Family Health Program, the main primary healthcare (PHC) programme of the country, was positively associated with life expectancy (p<0.05). In recent years, effective social policies have enabled Brazil to partially reduce absolute poverty and income inequality, contributing-together with PHC-to decreasing death rates in the population. Reducing income inequality may represent an important step towards improving health and increasing life expectancy, particularly in developing countries where inequalities are high.

  9. National Income and Income Inequality, Family Affluence and Life Satisfaction among 13 Year Old Boys and Girls: A Multilevel Study in 35 Countries

    ERIC Educational Resources Information Center

    Levin, Kate Ann; Torsheim, Torbjorn; Vollebergh, Wilma; Richter, Matthias; Davies, Carolyn A.; Schnohr, Christina W.; Due, Pernille; Currie, Candace

    2011-01-01

    Adolescence is a critical period where many patterns of health and health behaviour are formed. The objective of this study was to investigate cross-national variation in the relationship between family affluence and adolescent life satisfaction, and the impact of national income and income inequality on this relationship. Data from the 2006…

  10. National Income and Income Inequality, Family Affluence and Life Satisfaction among 13 Year Old Boys and Girls: A Multilevel Study in 35 Countries

    ERIC Educational Resources Information Center

    Levin, Kate Ann; Torsheim, Torbjorn; Vollebergh, Wilma; Richter, Matthias; Davies, Carolyn A.; Schnohr, Christina W.; Due, Pernille; Currie, Candace

    2011-01-01

    Adolescence is a critical period where many patterns of health and health behaviour are formed. The objective of this study was to investigate cross-national variation in the relationship between family affluence and adolescent life satisfaction, and the impact of national income and income inequality on this relationship. Data from the 2006…

  11. Socioeconomic inequalities in mortality in Barcelona: a study based on census tracts (MEDEA Project).

    PubMed

    Cano-Serral, Gemma; Azlor, Enric; Rodríguez-Sanz, Maica; Pasarín, M Isabel; Martínez, José Miguel; Puigpinós, Rosa; Muntaner, Carles; Borrell, Carme

    2009-03-01

    The aim of this study is to describe inequalities in socioeconomic indicators and in mortality by sex in the census tracts of Barcelona city during the period 1996-2003. The results show that there is excess mortality in coastal and northern areas. This distribution is similar to that of socioeconomic deprivation and therefore there is an association between mortality and socioeconomic indicators, not only for total mortality but also for the specific causes of death studied. This type of analysis can be useful for planning of public health policy since it allows small areas with high mortality risk to be detected.

  12. Educational Inequalities in Post-Hip Fracture Mortality: A NOREPOS Study.

    PubMed

    Omsland, Tone K; Eisman, John A; Naess, Øyvind; Center, Jacqueline R; Gjesdal, Clara G; Tell, Grethe S; Emaus, Nina; Meyer, Haakon E; Søgaard, Anne Johanne; Holvik, Kristin; Schei, Berit; Forsmo, Siri; Magnus, Jeanette H

    2015-12-01

    Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post-hip fracture mortality. Our objective was to investigate educational inequalities in post-hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register-based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post-hip fracture mortality in both sexes. Compared with those with primary education only, the age-adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77-0.87) in men and 0.79 (95% CI 0.75-0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1-year age-adjusted mortality was three- to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1-year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post-hip fracture mortality. © 2015 American Society for Bone and Mineral Research.

  13. Is economic inequality in infant mortality higher in urban than in rural India?

    PubMed

    Kumar, Abhishek; Singh, Abhishek

    2014-11-01

    This paper examines the trends in economic inequality in infant mortality across urban-rural residence in India over last 14 years. We analysed data from the three successive rounds of the National Family Health Survey conducted in India during 1992-1993, 1998-1999, and 2005-2006. Asset-based household wealth index was used as the economic indicator for the study. Concentration index and pooled logistic regression analysis were applied to measure the extent of economic inequality in infant mortality in urban and rural India. Infant mortality rate differs considerably by urban-rural residence: infant mortality in rural India being substantially higher than that in urban India. The findings suggest that economic inequalities are higher in urban than in rural India in each of the three survey rounds. Pooled logistic regression results suggest that, in urban areas, infant mortality has declined by 22 % in poorest and 43 % in richest. In comparison, the decline is 29 and 32 % respectively in rural India. Economic inequality in infant mortality has widened more in urban than in rural India in the last two decades.

  14. Inequalities in mortality by education and socio-economic transition in Lithuania: equal opportunities?

    PubMed

    Kalediene, R; Petrauskiene, J

    2005-09-01

    The aim of this study was to examine the changes in mortality differentials by level of education during the period of socio-economic transition in Lithuania. This analysis was based on routine mortality statistics and census data for 1989 and 2001 for the entire country. Despite a general improvement in the level of education in the Lithuanian population, some negative educational patterns were observed amongst its young members. Increasing inequalities in mortality by education have occurred due to a declining mortality rate in people with higher educational achievements and, conversely, an increasing mortality rate in people with a low level of education. Mortality inequalities by education amongst females exceeded those amongst males in 2001, particularly in middle-aged groups and due to external causes. The results of this survey predict an unfavourable forecast of increasing health inequalities in Lithuania in the near future. General policies for health promotion and disease prevention should be based on the realities faced by lower educated groups, rather than on experiences that are general for the total population or the class of society that has at least achieved an average education. Inequalities in health by the level of education should plateau as the society-at-large enters into a more stable stage of social and economic development.

  15. The Macro Model of the Inequality Process and the Surging Relative Frequency of Large Wage Incomes

    NASA Astrophysics Data System (ADS)

    Angle, John

    2008-03-01

    Particles are randomly paired in the Inequality Process (IP), a particle system scattering a positive quantity, wealth. Each particle has a parameter, φ, the fraction of wealth lost in a loss whose probability is 0.5. The stationary distribution of the wealth of particles with φψ is approximated by a γ pdf, the IP's macro model, with shape and scale parameters expressed in terms of φψ. The model's dynamics are driven by the product, φtμt, where φt is the harmonic mean of the φ's in the population at time t and μt, the population mean of wealth at time t. This γ pdf model fits the annual distribution of annual wage income in the U.S. 1961-2003. These data also confirm that the time-series of scalar statistics of wage income that labor economists think are produced by the U.S. distribution of wage income being ``hollowed out'' (bimodal), the increasing dispersion of wage income and the surging relative frequency of large wage incomes, are produced by the distribution being stretched over larger wage incomes, as implied by the IP's macro model when φtμt increases. The IP's macro model includes wage income distribution dynamics into statistical mechanics. To appear in The Econophysics of Markets and Business Networks.

  16. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries.

    PubMed

    Engle, Patrice L; Fernald, Lia C H; Alderman, Harold; Behrman, Jere; O'Gara, Chloe; Yousafzai, Aisha; de Mello, Meena Cabral; Hidrobo, Melissa; Ulkuer, Nurper; Ertem, Ilgi; Iltus, Selim

    2011-10-08

    This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children's educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate.

  17. The effects of community income inequality on health: Evidence from a randomized control trial in the Bolivian Amazon

    PubMed Central

    Undurraga, Eduardo A.; Behrman, Jere R.; Leonard, William R.; Godoy, Ricardo A.

    2015-01-01

    Research suggests that poorer people have worse health than the better-off and, more controversially, that income inequality harms health. But causal interpretations suffer from endogeneity. We addressed the gap by using a randomized control trial among a society of forager-farmers in the Bolivian Amazon. Treatments included one-time unconditional income transfers (T1) to all households and (T2) only to the poorest 20% of households, with other villages as controls. We assessed the effects of income inequality, absolute income, and spillovers within villages on self-reported health, objective indicators of health and nutrition, and adults’ substance consumption. Most effects came from relative income. Targeted transfers increased the perceived stress of participants in better-off households. Evidence suggests increased work efforts among better-off households when the lot of the poor improved, possibly due to a preference for rank preservation. The study points to new paths by which inequality might affect health. PMID:26706403

  18. The effects of community income inequality on health: Evidence from a randomized control trial in the Bolivian Amazon.

    PubMed

    Undurraga, Eduardo A; Behrman, Jere R; Leonard, William R; Godoy, Ricardo A

    2016-01-01

    Research suggests that poorer people have worse health than the better-off and, more controversially, that income inequality harms health. But causal interpretations suffer from endogeneity. We addressed the gap by using a randomized control trial among a society of forager-farmers in the Bolivian Amazon. Treatments included one-time unconditional income transfers (T1) to all households and (T2) only to the poorest 20% of households, with other villages as controls. We assessed the effects of income inequality, absolute income, and spillovers within villages on self-reported health, objective indicators of health and nutrition, and adults' substance consumption. Most effects came from relative income. Targeted transfers increased the perceived stress of participants in better-off households. Evidence suggests increased work efforts among better-off households when the lot of the poor improved, possibly due to a preference for rank preservation. The study points to new paths by which inequality might affect health.

  19. Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in The Netherlands.

    PubMed

    van Oort, Floor V A; van Lenthe, Frank J; Mackenbach, Johan P

    2005-03-01

    To assess the direct and indirect contributions of material, behavioural, and psychosocial factors to the explanation of educational inequalities in mortality simultaneously. Prospective observational study (1991-1998). General population from south east Netherlands. 3979 men and women aged 15-74 years without severe chronic disease at baseline (1991). Material factors (type of health insurance, financial problems, and housing tenure), psychosocial factors (life events and external locus of control), and behavioural factors (smoking habits and physical activity) together reduced the relative risk of mortality of the lowest educated group from 2.57 (95%CI 1.43 to 4.64) to 1.01 (95%CI 0.50 to 2.03). Of these three groups of factors, material factors contributed most to the educational inequalities. Part of the contribution of material factors was via psychosocial factors and part via behavioural factors. Psychosocial factors contributed to educational inequalities, partly via behavioural factors. Behavioural and psychosocial factors contributed only marginally to the explanation independent of material factors. Educational inequalities in mortality were explained by material, psychosocial, and behavioural factors. Material factors contributed most to the explanation, partly via psychosocial and behavioural factors. Improving the material situation of lower educated people may substantially reduce educational inequalities in mortality, partly via the psychosocial and behavioural consequences of improved material circumstances.

  20. Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis.

    PubMed

    Ribeiro, Wagner Silva; Bauer, Annette; Andrade, Mário César Rezende; York-Smith, Marianna; Pan, Pedro Mario; Pingani, Luca; Knapp, Martin; Coutinho, Evandro Silva Freire; Evans-Lacko, Sara

    2017-07-01

    Studies of the association between income inequality and mental health have shown mixed results, probably due to methodological heterogeneity. By dealing with such heterogeneity through a systematic review and meta-analysis, we examine the association between income inequality, mental health problems, use of mental health services, and resilience (defined as the ability to cope with adversity). We searched the Global Health, PsychARTICLES, PsycINFO, Social Policy and Practice, Embase and MEDLINE databases up to July 6, 2016, for quantitative studies of the association of income inequality with prevalence or incidence of mental disorders or mental health problems, use of mental health services, and resilience. Eligible studies used standardised instruments at the individual level, and income inequality at the aggregated, contextual, and ecological level. We extracted study characteristics, sampling, exposure, outcomes, statistical modelling, and parameters from articles. Because several studies did not provide enough statistical information to be included in a meta-analysis, we did a narrative synthesis to summarise results with studies categorised as showing either a positive association, mixed results, or no association. The primary outcome in the random-effects meta-analysis was mental health-related morbidity, defined as the prevalence or incidence of any mental health problem. This study is registered with PROSPERO, number CRD42016036377. Our search identified 15 615 non-duplicate references, of which 113 were deemed potentially relevant and were assessed for eligibility, leading to the inclusion of 27 studies in the qualitative synthesis. Nine articles found a positive association between income inequality and the prevalence or incidence of mental health problems; ten articles found mixed results, with positive association in some subgroups and non-significant or negative association in other subgroups; and eight articles found no association between income

  1. Community-level income inequality and HIV prevalence among persons who inject drugs in Thai Nguyen, Vietnam.

    PubMed

    Lim, Travis W; Frangakis, Constantine; Latkin, Carl; Ha, Tran Viet; Minh, Nguyen Le; Zelaya, Carla; Quan, Vu Minh; Go, Vivian F

    2014-01-01

    Socioeconomic status has a robust positive relationship with several health outcomes at the individual and population levels, but in the case of HIV prevalence, income inequality may be a better predictor than absolute level of income. Most studies showing a relationship between income inequality and HIV have used entire countries as the unit of analysis. In this study, we examine the association between income inequality at the community level and HIV prevalence in a sample of persons who inject drugs (PWID) in a concentrated epidemic setting. We recruited PWID and non-PWID community participants in Thai Nguyen, Vietnam, and administered a cross-sectional questionnaire; PWID were tested for HIV. We used ecologic regression to model HIV burden in our PWID study population on GINI indices of inequality calculated from total reported incomes of non-PWID community members in each commune. We also modeled HIV burden on interaction terms between GINI index and median commune income, and finally used a multi-level model to control for community level inequality and individual level income. HIV burden among PWID was significantly correlated with the commune GINI coefficient (r = 0.53, p = 0.002). HIV burden was also associated with GINI coefficient (β = 0.082, p = 0.008) and with median commune income (β = -0.018, p = 0.023) in ecological regression. In the multi-level model, higher GINI coefficient at the community level was associated with higher odds of individual HIV infection in PWID (OR = 1.46 per 0.01, p = 0.003) while higher personal income was associated with reduced odds of infection (OR = 0.98 per $10, p = 0.022). This study demonstrates a context where income inequality is associated with HIV prevalence at the community level in a concentrated epidemic. It further suggests that community level socioeconomic factors, both contextual and compositional, could be indirect determinants of HIV infection in PWID.

  2. Inequalities in health: living conditions and infant mortality in Northeastern Brazil

    PubMed Central

    Carvalho, Renata Alves da Silva; Santos, Victor Santana; de Melo, Cláudia Moura; Gurgel, Ricardo Queiroz; Oliveira, Cristiane Costa da Cunha

    2015-01-01

    OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting. METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test. RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions. CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue. PMID:25741650

  3. Extending the income inequality hypothesis: ecological results from the 2005 and 2009 Argentine National Risk Factor Surveys.

    PubMed

    De Maio, Fernando G; Linetzky, Bruno; Ferrante, Daniel; Fleischer, Nancy L

    2012-01-01

    A consensus on income inequality as a social determinant of health is yet to be reached. In particular, we know little about the cross-sectional versus lagged effect of inequality and the robustness of the relationship to indicators that are sensitive to varying parts of the income spectrum. We test these issues with data from Argentina's 2005 and 2009 National Risk Factor Surveys. Inequality was operationalised at the provincial level with the Gini coefficient and the Generalised Entropy (GE) index. Population health was defined as the age-standardised percentage of adults with poor/fair self-rated health by province. Our cross-sectional results indicate a significant relationship between inequality (Gini) and poor health (r=0.58, p<0.01) in 2005. Using the GE index, a gradient pattern emerges in the correlation, and the r values increase as the index becomes sensitive to the top of the distribution. The relationship between 2005 inequality and 2009 health displays a similar pattern, but with generally smaller correlations than the 2005 cross-sectional results. Further advances in the income inequality and health literature require new theoretical models to account for how inequalities in different parts of the income spectrum may influence population health in different ways.

  4. Income-related inequalities in the prevalence of depression and suicidal behaviour: a 10-year trend following economic crisis.

    PubMed

    Hong, Jihyung; Knapp, Martin; McGuire, Alistair

    2011-02-01

    The issue of health inequalities has steadily gained attention in South Korea, as income inequality widened and social polarization increased following the country's economic crisis in the late 1990s. While official figures indicate a general trend of worsening mental health, with rapidly rising rates of suicide and depression in particular, the extent of socio-economic inequality with respect to mental health problems has not been well elucidated. This study aimed to measure income-related inequalities in depression, suicidal ideation and suicide attempts in South Korea and to trace their changes over a 10-year period (1998-2007). The concentration index approach was employed to quantify the degree of income-related inequalities, using four waves of the Korea National Health and Nutrition Examination Survey data. The study found persistent pro-rich inequality in depression, suicidal ideation and suicide attempts over the past decade (i.e., individuals with higher incomes were less likely to have these conditions). The inequalities actually doubled over this period. These findings imply a need for expanded social protection policies for the less privileged in the population.

  5. Socioeconomic inequalities in expenditures and income committed to the purchase of medicines in Southern Brazil.

    PubMed

    Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Peres, Karen Glazer

    2011-10-01

    To describe socioeconomic inequalities regarding the use, expenditures and the income committed to the purchase of medicines. A cross-sectional population-based study was carried out with 1,720 adults living in the urban area of Florianópolis, Southern Brazil, in 2009. Cluster sampling was adopted and census tracts were the primary sampling units. Use of medicines and the expenditures incurred in their purchase in the past 30 days were investigated through interviews. Use, expenditures and the income committed concerning medicines were analyzed according to per capita family income, self-reported skin color, age and sex, adjusting for the complex sample. The prevalence of medicine use was 76.5% (95%CI: 73.8; 79.3), higher among women and in older individuals. The mean expenditure on medicine was R$ 46.70, with higher values among women, whites, older individuals and among richer people. While 3.1% of the richest committed more than 15% of their income to purchasing medicine, that figure reached 9.6% in the poorest group. The proportion of people that had to buy medicines after an unsuccessful attempt to obtain them in the public health system was higher among the poor (11.0%), women (10.2%) and the elderly (11.1%). A large part of the adults bought medicines contained in the National List of Essential Medicines (19.9%) or in the Municipal List of Essential Medicines (28.6%), with significant differences according to gender, age and income. There is socioeconomic, age and gender inequality in the income committed to the purchase of medicines, with worse conditions for the poor, older individuals and women.

  6. Socioeconomic inequalities in suicide mortality before and after the economic recession in Spain.

    PubMed

    Borrell, Carme; Marí-Dell'Olmo, Marc; Gotsens, Mercè; Calvo, Montse; Rodríguez-Sanz, Maica; Bartoll, Xavier; Esnaola, Santiago

    2017-10-04

    An increase in suicide mortality is often observed in economic recessions. The objective of this study was to analyse trends in socioeconomic inequalities in suicide mortality before and during the economic recession in two geographical settings in Spain. This study analyses inequalities in mortality according to educational level during 3 different time periods based on individual data from the Basque Country and Barcelona city. We analysed suicide mortality data for all residents over 25 years of age from 2001 to 2012. Two periods before the crisis (2001-2004 and 2005-2008) and another during the crisis (2009-2012) were studied. We performed independent analyses for sex, age group, and for the two geographical settings. We fit Poisson regression models to study the relationship between educational level and mortality, and calculated the relative index of inequality (RII) and the slope index of inequality (SII) as comparative measures. For men in the Basque Country, all RII values for the three time periods were similar and almost all were greater than 2; in Barcelona the RII values were generally lower. The SII values for Barcelona tended to decrease over time, whereas in the Basque Country they showed a U-shaped pattern. Among women aged 25-44 years we found an association between educational level and suicide mortality during the first time period; however, we found no clear association for other age groups or time periods. This study within two geographical settings in Spain shows that trends in inequalities in suicide mortality according to educational level remained stable among men before and during the economic recession.

  7. [Inequalities in mortality by cardiovascular diseases in the Colombian Coffee Growing Region, 2009-2011].

    PubMed

    Cardona, Dora; Cerezo, María Del Pilar; Parra, Hernán; Quintero, Liliana; Muñoz, Liliana; Cifuentes, Olga Lucía; Vélez, Silvia Clemencia

    2015-01-01

    The impact of mortality from cardiovascular diseases requires the measurement of the relationship between the local socioeconomic conditions and these death causes. To determine the inequality in mortality from cardiovascular diseases in the municipalities of the Colombian Coffee Growing Region (2009-2011). We conducted an ecological study to compare the mortality from cardiovascular diseases (hypertensive, ischemic, cerebrovascular) in municipalities and their economic situation. Mortality rates and the index of unsatisfied basic needs were obtained from the Colombian Departamento Administrativo Nacional de Estadística (DANE) vital statistics, while the municipal gross domestic product per capita was estimated for this study. The inequality indices were calculated using regression models, and concentration and Theil indices with Epidat 3.1. The death risk resulting from ischemic or hypertensive diseases was greater in those municipalities with a higher index of unsatisfied basic needs. Mortality due to hypertensive disease tended to concentrate in municipalities with a higher level of unsatisfied basic needs. The municipalities with a lower gross domestic product showed a higher rate of deaths due to hypertensive disease in years 2009 and 2010, and due to ischemic disease in years 2010 and 2011. Nevertheless, this indicator does not measure the gap existing among poor communities. Disaggregated inequality indicators at municipal level are lacking. Suggested indicators are estimated only for country and provincial levels and they do not favor the characterization of health social inequalities at territorial level.

  8. Recalibrating the spirit level: An analysis of the interaction of income inequality and poverty and its effect on health.

    PubMed

    Rambotti, Simone

    2015-08-01

    The publication of The Spirit Level (Wilkinson and Pickett, 2009) marked a paramount moment in the analysis of health and inequality, quickly attracting a remarkable degree of attention, both positive and negative, both in academic and in public discourse. Following at least 20 years of research, the book proposes a simple and powerful argument: inequality per se, more specifically income inequality, is harmful to every aspect of social life. In order to confirm this idea, the authors present a series of bivariate, cross-sectional associations showing comparisons across countries and within the United States. Despite the methodological limitations of this approach, the authors advance causal claims concerning the detrimental effects of income inequality. They also rule out poverty as a plausible alternative explanation, without directly measuring it. Meanwhile, over the last decade stratification scholars have demonstrated the nonlinear effect of economic factors, especially income, on health. The results suggest that a relative approach is best for analyzing dynamics at the top of the income distribution, whereas an absolute approach seems most appropriate for studying the bottom of the distribution. Consistent with this perspective, here I reanalyze data from The Spirit Level, adding a measure of poverty, in order to control the effect of inequality and explore its interaction with poverty. The findings show that inequality and poverty-which I contend are two interdependent but nonetheless distinct phenomena-interact across countries, such that the detrimental effects of inequality are present or stronger in countries with high poverty, and absent or weaker in countries with low poverty; poverty replaces inequality as the favored explanation of health and social ills across states. The new evidence suggests that income distributions are characterized by a complex interplay between inequality and poverty, whose interaction deserves further analysis.

  9. Subjective financial well-being, income and health inequalities in mid and later life in Britain.

    PubMed

    Arber, Sara; Fenn, Kirsty; Meadows, Robert

    2014-01-01

    The relationship between health and income is well established, but the link between subjective financial well-being and self-reported health has been relatively ignored. This study investigates the relationship between income, subjective financial well-being and health in mid-life and later life in Britain. Analysis of the General Household Survey for 2006 examined these relationships at ages 45-64 (n = 4639) and 65 and over (n = 3104). Logistic regression analysis was used to adjust for income and other socio-economic factors associated with self-reported health. Both income and subjective financial well-being are independently associated with health in mid-life; those with lower incomes and greater subjective financial difficulties had higher risk of reporting 'less than good' health. In contrast in later life, subjective financial well-being was associated with health, but the effect of income on health was mediated entirely through subjective financial well-being. The poorer health of the divorced/separated was also entirely mediated by differences in subjective financial well-being. Research on health inequalities should pay greater attention to the link between subjective financial hardship and ill-health, especially during periods of greater economic difficulties and financial austerity.

  10. Urbanization and Income Inequality in Post-Reform China: A Causal Analysis Based on Time Series Data

    PubMed Central

    Chen, Guo; Glasmeier, Amy K.; Zhang, Min; Shao, Yang

    2016-01-01

    This paper investigates the potential causal relationship(s) between China’s urbanization and income inequality since the start of the economic reform. Based on the economic theory of urbanization and income distribution, we analyze the annual time series of China’s urbanization rate and Gini index from 1978 to 2014. The results show that urbanization has an immediate alleviating effect on income inequality, as indicated by the negative relationship between the two time series at the same year (lag = 0). However, urbanization also seems to have a lagged aggravating effect on income inequality, as indicated by positive relationship between urbanization and the Gini index series at lag 1. Although the link between urbanization and income inequality is not surprising, the lagged aggravating effect of urbanization on the Gini index challenges the popular belief that urbanization in post-reform China generally helps reduce income inequality. At deeper levels, our results suggest an urgent need to focus on the social dimension of urbanization as China transitions to the next stage of modernization. Comprehensive social reforms must be prioritized to avoid a long-term economic dichotomy and permanent social segregation. PMID:27433966

  11. Urbanization and Income Inequality in Post-Reform China: A Causal Analysis Based on Time Series Data.

    PubMed

    Chen, Guo; Glasmeier, Amy K; Zhang, Min; Shao, Yang

    2016-01-01

    This paper investigates the potential causal relationship(s) between China's urbanization and income inequality since the start of the economic reform. Based on the economic theory of urbanization and income distribution, we analyze the annual time series of China's urbanization rate and Gini index from 1978 to 2014. The results show that urbanization has an immediate alleviating effect on income inequality, as indicated by the negative relationship between the two time series at the same year (lag = 0). However, urbanization also seems to have a lagged aggravating effect on income inequality, as indicated by positive relationship between urbanization and the Gini index series at lag 1. Although the link between urbanization and income inequality is not surprising, the lagged aggravating effect of urbanization on the Gini index challenges the popular belief that urbanization in post-reform China generally helps reduce income inequality. At deeper levels, our results suggest an urgent need to focus on the social dimension of urbanization as China transitions to the next stage of modernization. Comprehensive social reforms must be prioritized to avoid a long-term economic dichotomy and permanent social segregation.

  12. Preventable avoidable mortality: evolution of socioeconomic inequalities in urban areas in Spain, 1996-2003.

    PubMed

    Nolasco, Andreu; Melchor, Inmaculada; Pina, José A; Pereyra-Zamora, Pamela; Moncho, Joaquin; Tamayo, Nayara; García-Senchermes, Carmen; Zurriaga, Oscar; Martínez-Beneito, Miguel A

    2009-09-01

    This study describes the inequalities in preventable avoidable mortality in relation to socioeconomic levels and analyses their evolution during the period 1996-2003 in the cities of Alicante, Castellon and Valencia. Four causes of preventable avoidable mortality were analysed according to sex: malignant tumour of the trachea, bronchus and lung, cirrhosis and other chronic diseases of the liver, motor vehicle accidents and AIDS, which had caused the death of non-institutionalised residents in the three cities during the period 1996-2003. The different census tracts were grouped into three socioeconomic levels. In general, socioeconomic inequalities in preventable avoidable mortality remain constant in time, except the ones caused by AIDS in Valencia, where they increase for men. Some census tracts in the three cities where the study was carried out were found to have significantly higher preventable mortality rates, and therefore require intervention.

  13. Decomposing Wealth-Based Inequalities in Under-Five Mortality in West Africa

    PubMed Central

    BADO, Aristide Romaric; APPUNNI, Sathiya Susuman

    2015-01-01

    Background: This study aimed to analysis the inequalities of mortality of children under 5 years in West Africa by examining the determinants and contributing factors to the overall inequality concentration in these countries. Method: Data used came from the DHS surveys conducted in the six countries in West Africa: Burkina Faso (2010), Benin (2006), Cote d’Ivoire 2011), Ghana (2008), Mali (2006), Nigeria (2008) and Niger (2012). The concentration index (CI) and Generalized Linear Model (GLM) with logit link were used to access inequality. Results: The results show that in all countries, the poorest Q1 have the highest proportions of deaths: Nigeria (31.4%), Cote d’Ivoire (30.4%) and Ghana (36.4%), over 30% of deaths of children under 5 years are among the children of the poorest (Q1) and the absolute differences of proportions Q1–Q5 are more than 20 points (25.8 in Ghana and 23.6 in Nigeria). The contributing factors of inequalities of child mortality were birth order, maternal age, parity and household size. Our findings also showed that the intensity of inequality varies from one country to another. Conclusion: The most important conclusion of this study is to reduce mortality in children under 5 years, it is needed to reduce economic and social inequalities and improve the country’s economic and social condition. There is a need for monitoring and assessment inequalities by leading causes of death and morbidity among children in the region in order to advance in understanding the gaps and finding a way to reduce them in West Africa countries. PMID:26576370

  14. How much inequality in income is fair? A microeconomic game theoretic perspective

    NASA Astrophysics Data System (ADS)

    Venkatasubramanian, Venkat; Luo, Yu; Sethuraman, Jay

    2015-10-01

    The increasing inequality in income and wealth in recent years, and the associated excessive pay packages of CEOs in the US and elsewhere, is of growing concern among policy makers as well as the common person. However, there seems to be no satisfactory answer, in conventional economic theories and models, to the fundamental questions of what kind of income distribution we ought to see, at least under ideal conditions, in a free market environment, and whether this distribution is fair. We propose a novel microeconomic game theoretic framework that addresses these questions and proves that the lognormal distribution is the fairest inequality of pay in an organization comprising of homogeneous agents, under ideal free market conditions at equilibrium. We also show that for a population of two different classes of agents, the equilibrium distribution is a combination of two different lognormal distributions where one of them, corresponding to the top ˜3-5% of the population, can be misidentified as a Pareto distribution. We compare our predictions with empirical data on global income inequality trends provided by Piketty and others. Our analysis suggests that the Scandinavian countries, and to a lesser extent Switzerland, Netherlands and Australia, have managed to get close to the ideal distribution for the bottom ˜99% of the population, while the US and UK remain less fair at the other extreme. Other European countries such as France and Germany, and Japan and Canada, are in the middle. Our theory also shows the deep and direct connection between potential game theory and statistical mechanics through entropy, which we identify as a measure of fairness in a distribution. This leads us to propose the fair market hypothesis, that the self-organizing dynamics of the ideal free market, i.e., Adam Smith's "invisible hand", not only promotes efficiency but also maximizes fairness under the given constraints.

  15. Income inequality as a moderator of the relationship between psychological job demands and sickness absence, in particular in men: an international comparison of 23 countries.

    PubMed

    Muckenhuber, Johanna; Burkert, Nathalie; Großschädl, Franziska; Freidl, Wolfgang

    2014-01-01

    The aim of this study was to investigate whether more sickness absence is reported in countries with higher income inequality than elsewhere, and whether the level of income inequality moderates the association between psycho-social job demands and sickness absence. Our analysis is based on the Fifth European Working Conditions Survey that compared 23 European countries. We performed multi-level regression analysis. On the macro-level of analysis we included the Gini-Index as measure of inequality. On the micro-level of analysis we followed the Karasek-Theorell model and included three scales for psychological job demands, physical job demands, and decision latitude in the model. The model was stratified by sex. We found that, in countries with high income inequality, workers report significantly more sickness absence than workers in countries with low income inequality. In addition we found that the level of income inequality moderates the relationship between psychological job demands and sickness absence. High psychological job demands are significantly more strongly related to more days of sickness absence in countries with low income inequality than in countries with high income inequality. As the nature and causal pathways of cross-level interaction effects still cannot be fully explained, we argue that future research should aim to explore such causal pathways. In accordance with WHO recommendations we argue that inequalities should be reduced. In addition we state that, particularly in countries with low levels of income inequality, policies should aim to reduce psychological job demands.

  16. Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in Sao Paulo, Brazil.

    PubMed

    Chiavegatto Filho, Alexandre Dias Porto; Kawachi, Ichiro; Wang, Yuan Pang; Viana, Maria Carmen; Andrade, Laura Helena Silveira Guerra

    2013-11-01

    Test the original income inequality theory, by analysing its association with depression, anxiety and any mental disorders. We analysed a sample of 3542 individuals aged 18 years and older selected through a stratified, multistage area probability sample of households from the São Paulo Metropolitan Area. Mental disorder symptoms were assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Bayesian multilevel logistic models were performed. Living in areas with medium and high-income inequality was statistically associated with increased risk of depression, relative to low-inequality areas (OR 1.76; 95% CI 1.21 to 2.55, and 1.53; 95% CI 1.07 to 2.19, respectively). The same was not true for anxiety (OR 1.25; 95% CI 0.90 to 1.73, and OR 1.07; 95% CI 0.79 to 1.46). In the case of any mental disorder, results were mixed. In general, our findings were consistent with the income inequality theory, that is, people living in places with higher income inequality had an overall higher odd of mental disorders, albeit not always statistically significant. The fact that depression, but not anxiety, was statistically significant could indicate a pathway by which inequality influences health.

  17. Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007.

    PubMed

    Nolasco, Andreu; Quesada, José Antonio; Moncho, Joaquín; Melchor, Inmaculada; Pereyra-Zamora, Pamela; Tamayo-Fonseca, Nayara; Martínez-Beneito, Miguel Angel; Zurriaga, Oscar

    2014-04-01

    While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996-99, 2000-2003 and 2004-2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson's Regression models, adjusted for age and study period, and distinguishing between genders. Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action

  18. Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996–2007

    PubMed Central

    2014-01-01

    Background While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). Methods All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders. Results Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. Conclusions Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system

  19. The effects of US state income inequality and alcohol policies on symptoms of depression and alcohol dependence.

    PubMed

    Henderson, Claire; Liu, Xinhua; Diez Roux, Ana V; Link, Bruce G; Hasin, Deborah

    2004-02-01

    Mental health is likely to be influenced by contextual variables that emerge only at the level of the group. We studied the effect of two such group-level variables, within-state income inequality and alcohol tax policy, on symptoms of current depression and alcohol dependence in a US national sample, controlling for state-level and individual characteristics. A cross-sectional US national probability sample provided the individual-level data. State income data were obtained from the 1990 US census. The Gini coefficient (raw and adjusted) indicated income inequality. Outcome measures included current symptoms of depression and alcohol dependence. Controlling for individual-level variables and state median income, the odds of depressive symptoms was not positively associated with state income inequality. Controlling for individual-level variables, state median income and alcohol distribution method, a weak negative association between Gini and alcohol dependence was observed in women, but this association disappeared after additional adjustment for beer tax. No association was observed in men. Higher state beer tax was significantly associated with lower prevalence of alcohol dependence symptoms for both men and women. The results suggest that state income inequality does not increase the experience of alcohol dependence or depression symptoms. However, evidence was found for a protective effect of increased beer taxation against alcohol dependence symptoms, suggesting the need to further consider the impact of alcohol policies on alcohol use disorders.

  20. The impact of population heterogeneity and income inequality on homicide rates: a cross-national assessment.

    PubMed

    Chon, Don Soo

    2012-08-01

    The current research produces regression models with sample sizes from 127 to 131 by initially employing a data set of 170 nations. The current study finds that ethnic heterogeneity and linguistic heterogeneity lead to higher homicide rates. However, religious heterogeneity has no impact on homicide rates. The present article also tests an interaction effect between population heterogeneity and income inequality. Unlike J. R. Blau and Blau (1982) and Avision and Loring (1986) proposition, the interaction term is not related to national homicide rates. The current study also discusses the theoretical implications of those findings.

  1. The Chinese social benefit system in transition: reforms and impacts on income inequality.

    PubMed

    Gao, Qin

    2008-01-01

    Economic reforms since the late 1970s have made China one of the world's fastest growing economies but have also led to greater unmet social welfare needs and growing income inequality. This article describes social policy trends in urban and rural China and reviews recent empirical evidence on the transitions and impacts of its social benefit system. The evidence reveals that although urban social benefits experienced significant cutbacks, they are still much more generous than the minimal social benefits for rural residents and migrants. This extremely inequitable situation calls for a larger, progressive social benefit system in China.

  2. Rising inequality in mortality among working-age men and women in Sweden: a national registry-based repeated cohort study, 1990–2007

    PubMed Central

    Kondo, Naoki; Rostila, Mikael; Yngwe, Monica Åberg

    2014-01-01

    Background In the past two decades, health inequality has persisted or increased in states with comprehensive welfare. Methods We conducted a national registry-based repeated cohort study with a 3-year follow-up between 1990 and 2007 in Sweden. Information on all-cause mortality in all working-age Swedish men and women aged between 30 and 64 years was collected. Data were subjected to temporal trend analysis using joinpoint regression to statistically confirm the trajectories observed. Results Among men, age-standardised mortality rate decreased by 38.3% from 234.9 to 145 (per 100 000 population) over the whole period in the highest income quintile, whereas the reduction was only 18.3% (from 774.5 to 632.5) in the lowest quintile. Among women, mortality decreased by 40% (from 187.4 to 112.5) in the highest income group, but increased by 12.1% (from 280.2 to 314.2) in the poorest income group. Joinpoint regression identified that the differences in age-standardised mortality between the highest and the lowest income quintiles decreased among men by 18.85 annually between 1990 and 1994 (p trend=0.02), whereas it increased later, with a 2.88 point increase per year (p trend <0.0001). Among women, it continuously increased by 9.26/year (p trend <0.0001). In relative terms, age-adjusted mortality rate ratios showed a continuous increase in both genders. Conclusions Income-based inequalities among working-age male and female Swedes have increased since the late 1990s, whereas in absolute terms the increase was less remarkable among men. Structural and behavioural factors explaining this trend, such as the economic recession in the early 1990s, should be studied further. PMID:25143429

  3. The rich get richer and the poor get poorer: Country- and state-level income inequality moderates the job insecurity-burnout relationship.

    PubMed

    Jiang, Lixin; Probst, Tahira M

    2017-04-01

    Despite the prevalence of income inequality in today's society, research on the implications of income inequality for organizational research is scant. This study takes the first step to explore the contextual role of national- and state- level income inequality as a moderator in the relationship between individual-level job insecurity (JI) and burnout. Drawing from conservation of resource (COR) theory, we argue that income inequality at the country-level and state-level threatens one's obtainment of object (i.e., material coping) and condition (i.e., nonmaterial coping) resources, thus serving as an environmental stressor exacerbating one's burnout reactions to JI. The predicted cross-level interaction effect of income inequality was tested in 2 studies. Study 1 consisting of 23,778 individuals nested in 30 countries explored the moderating effect of country-level income inequality on the relationship between individual JI and exhaustion. Study 2 collected data from 402 employees residing in 48 states in the United States, and tested the moderating effect of state-level income inequality on the relationship between JI and burnout (i.e., emotional exhaustion and cynicism). Results of both studies converge to support the exacerbating role of higher-level income inequality on the JI -burnout relationship. Our findings contribute to the literature on psychological health disparities by exploring the contextual role of income inequality as a predictor of differential reactions to JI. (PsycINFO Database Record

  4. US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings

    PubMed Central

    Kawachi, Ichiro; Gilman, Stephen E.

    2015-01-01

    Objective To examine prospectively the association between US state income inequality and incidence of heart attack. Methods We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001–2002) and follow-up (2004–2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates. Results In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) =1.71, 95 % CI 1.16–2.53)], third (AOR = 1.81, 95 % CI 1.28–2.57), and fourth (AOR = 2.04, 95 % CI 1.26–3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline. Conclusions This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults. PMID:25981210

  5. US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings.

    PubMed

    Pabayo, Roman; Kawachi, Ichiro; Gilman, Stephen E

    2015-07-01

    To examine prospectively the association between US state income inequality and incidence of heart attack. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates. In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16-2.53)], third (AOR = 1.81, 95 % CI 1.28-2.57), and fourth (AOR = 2.04, 95 % CI 1.26-3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline. This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.

  6. Predicting Mortality in Low-Income Country ICUs: The Rwanda Mortality Probability Model (R-MPM)

    PubMed Central

    Kiviri, Willy; Fowler, Robert A.; Mueller, Ariel; Novack, Victor; Banner-Goodspeed, Valerie M.; Weinkauf, Julia L.; Talmor, Daniel S.; Twagirumugabe, Theogene

    2016-01-01

    Introduction Intensive Care Unit (ICU) risk prediction models are used to compare outcomes for quality improvement initiatives, benchmarking, and research. While such models provide robust tools in high-income countries, an ICU risk prediction model has not been validated in a low-income country where ICU population characteristics are different from those in high-income countries, and where laboratory-based patient data are often unavailable. We sought to validate the Mortality Probability Admission Model, version III (MPM0-III) in two public ICUs in Rwanda and to develop a new Rwanda Mortality Probability Model (R-MPM) for use in low-income countries. Methods We prospectively collected data on all adult patients admitted to Rwanda’s two public ICUs between August 19, 2013 and October 6, 2014. We described demographic and presenting characteristics and outcomes. We assessed the discrimination and calibration of the MPM0-III model. Using stepwise selection, we developed a new logistic model for risk prediction, the R-MPM, and used bootstrapping techniques to test for optimism in the model. Results Among 427 consecutive adults, the median age was 34 (IQR 25–47) years and mortality was 48.7%. Mechanical ventilation was initiated for 85.3%, and 41.9% received vasopressors. The MPM0-III predicted mortality with area under the receiver operating characteristic curve of 0.72 and Hosmer-Lemeshow chi-square statistic p = 0.024. We developed a new model using five variables: age, suspected or confirmed infection within 24 hours of ICU admission, hypotension or shock as a reason for ICU admission, Glasgow Coma Scale score at ICU admission, and heart rate at ICU admission. Using these five variables, the R-MPM predicted outcomes with area under the ROC curve of 0.81 with 95% confidence interval of (0.77, 0.86), and Hosmer-Lemeshow chi-square statistic p = 0.154. Conclusions The MPM0-III has modest ability to predict mortality in a population of Rwandan ICU patients. The R

  7. Physical capital and the embodied nature of income inequality: gender differences in the effect of body size on workers' incomes in Canada.

    PubMed

    Perks, Thomas

    2012-02-01

    This study assesses the effects of body size--measured using the body mass index--on the income attainment of female and male workers in Canada. Using data from a national representative sample of Canadians, multivariate analyses show that, for female workers, the body size-income relationship is negative. However, for male workers, the body size-income relationship is positive and nonlinear. Using Bourdieu's conceptualization of physical capital, and Shilling's extension of it, it is argued that these results are suggestive of the relative importance of body size to the production and continuation of gender income inequality in Canada.

  8. Data on Income inequality in Germany, France, Italy, Spain, the UK, and other affluent nations, 2012.

    PubMed

    Dorling, Danny

    2015-12-01

    This data article contains information on the distribution of household incomes in the five most populous European countries as surveyed in 2012, with data released in 2014 and published here aggregated and so further anonymized in 2015. The underlying source data is the already anonymized EU Statistics on Income and Living Conditions (EUSILC) Microdata. The data include the annual household income required in each country to fall within the best-off 1% in that country, median and mean incomes, average (mean) incomes of the best off 1%, 0.1% and estimates for the 0.01%, 0.001% and so on for the UK, and of the 90% and worse-off 10%, the best-off 10% and best-off 1% of households for all countries. Average income from the state is also calculated by these income categories and the number of people working in finance and receiving over €1,000,000 a year in income is reported from other sources (the European Banking Authority). Finally income distribution data is provided from the USA and the rest of Europe in order to allow comparisons to be made. The data revealed the gross household (simple unweighted) median incomes in 2012 to have been (in order from best-off country by median to worse-off): France €39,000, Germany: €33,400, UK: €36,300, Italy €33,400 and Spain €27,000. However the medians, once households are weighted to reflect the nation populations do differ although they are in the same order: France €36,000, Germany: €33,400, UK: €31,300, Italy €31,000 and Spain €23,700. Thus weighting to increase representativeness of the medians reduces each by €3000, €0, €5000, €3300 and €3300 respectively. In short, the middle (weighted median) French household is €4700 a year better off than the middle UK family, and that is before housing costs are considered. This Data in Brief article accompanies Dorling, D. (2015) Income Inequality in the UK: Comparisons with five large Western European countries and the USA [1].

  9. Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey.

    PubMed

    Hosseinpoor, Ahmad Reza; Bergen, Nicole; Kunst, Anton; Harper, Sam; Guthold, Regina; Rekve, Dag; d'Espaignet, Edouard Tursan; Naidoo, Nirmala; Chatterji, Somnath

    2012-10-28

    Monitoring inequalities in non communicable disease risk factor prevalence can help to inform and target effective interventions. The prevalence of current daily smoking, low fruit and vegetable consumption, physical inactivity, and heavy episodic alcohol drinking were quantified and compared across wealth and education levels in low- and middle-income country groups. This study included self-reported data from 232,056 adult participants in 48 countries, derived from the 2002-2004 World Health Survey. Data were stratified by sex and low- or middle-income country status. The main outcome measurements were risk factor prevalence rates reported by wealth quintile and five levels of educational attainment. Socioeconomic inequalities were measured using the slope index of inequality, reflecting differences in prevalence rates, and the relative index of inequality, reflecting the prevalence ratio between the two extremes of wealth or education accounting for the entire distribution. Data were adjusted for confounding factors: sex, age, marital status, area of residence, and country of residence. Smoking and low fruit and vegetable consumption were significantly higher among lower socioeconomic groups. The highest wealth-related absolute inequality was seen in smoking among men of low- income country group (slope index of inequality 23.0 percentage points; 95% confidence interval 19.6, 26.4). The slope index of inequality for low fruit and vegetable consumption across the entire distribution of education was around 8 percentage points in both sexes and both country income groups. Physical inactivity was less prevalent in populations of low socioeconomic status, especially in low-income countries (relative index of inequality: (men) 0.46, 95% confidence interval 0.33, 0.64; (women) 0.52, 95% confidence interval 0.42, 0.65). Mixed patterns were found for heavy drinking. Disaggregated analysis of the prevalence of non-communicable disease risk factors demonstrated different

  10. Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey

    PubMed Central

    2012-01-01

    Background Monitoring inequalities in non communicable disease risk factor prevalence can help to inform and target effective interventions. The prevalence of current daily smoking, low fruit and vegetable consumption, physical inactivity, and heavy episodic alcohol drinking were quantified and compared across wealth and education levels in low- and middle-income country groups. Methods This study included self-reported data from 232,056 adult participants in 48 countries, derived from the 2002–2004 World Health Survey. Data were stratified by sex and low- or middle-income country status. The main outcome measurements were risk factor prevalence rates reported by wealth quintile and five levels of educational attainment. Socioeconomic inequalities were measured using the slope index of inequality, reflecting differences in prevalence rates, and the relative index of inequality, reflecting the prevalence ratio between the two extremes of wealth or education accounting for the entire distribution. Data were adjusted for confounding factors: sex, age, marital status, area of residence, and country of residence. Results Smoking and low fruit and vegetable consumption were significantly higher among lower socioeconomic groups. The highest wealth-related absolute inequality was seen in smoking among men of low- income country group (slope index of inequality 23.0 percentage points; 95% confidence interval 19.6, 26.4). The slope index of inequality for low fruit and vegetable consumption across the entire distribution of education was around 8 percentage points in both sexes and both country income groups. Physical inactivity was less prevalent in populations of low socioeconomic status, especially in low-income countries (relative index of inequality: (men) 0.46, 95% confidence interval 0.33, 0.64; (women) 0.52, 95% confidence interval 0.42, 0.65). Mixed patterns were found for heavy drinking. Conclusions Disaggregated analysis of the prevalence of non

  11. Social and ethnic inequalities in infant mortality: a perspective from the United kingdom.

    PubMed

    Hollowell, Jennifer; Kurinczuk, Jennifer J; Brocklehurst, Peter; Gray, Ron

    2011-08-01

    Social inequalities in infant mortality can be clearly demonstrated in the countries of the United Kingdom with a social gradient between different groups. Marked variations in infant mortality between ethnic groups are also evident in England and Wales, with the highest rates seen in Pakistani and Caribbean infants and the lowest rates in the white and Bangladeshi groups. Although individual risk factors for infant mortality are well understood, the reasons why certain social and ethnic groups have higher rates remain to be fully elucidated. Policies and interventions to tackle these inequalities are likely to be most effective if they have both universal and targeted components to "level-up" rates to the rate of the most advantaged in society.

  12. Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study.

    PubMed

    Tjepkema, Michael; Wilkins, Russell; Long, Andrea

    2013-07-01

    People with lower incomes tend to have less favourable health outcomes than do people with higher incomes. Because death registrations in Canada do not contain information about the income of the deceased, vital statistics cannot be used to examine mortality by income at the individual level. However, through record linkage, information on the individual or family income of people followed for mortality can be obtained. Recently, a large, population-based sample of Canadian adults was linked to almost 16 years of mortality data. This study examines cause-specific mortality rates by income adequacy among Canadian adults. It is based on data from the 1991 to 2006 Canadian census mortality and cancer follow-up study, which followed 2.7 million people aged 25 or older at baseline, 426,979 of whom died during the 16-year period. Age-standardized mortality rates (ASMRs), rate ratios, rate differences and excess mortality were calculated by income adequacy quintile for various causes of death. For most causes examined, ASMRs were clearly graded by income: highest among people in the in the lowest income quintile, and lowest among people in the highest income quintile. Inter-quintile rate ratios (quintile 1/quintile 5) were greater than 2.00 for HIV/AIDS, diabetes mellitus, suicide, cancer of the cervix, and causes of death closely associated with smoking and alcohol. These individually based results provide cause-specific information by income adequacy quintile that was not previously available for Canada.

  13. The impacts of rapid demographic transition on family structure and income inequality in Brazil, 1981-2011.

    PubMed

    Maia, Alexandre Gori; Sakamoto, Camila Strobl

    2016-11-01

    This study analysed the impact of changing family structure on income distribution. Specifically, it analysed how changes in the proportions of different categories of family in the population contributed to increases in the income of the richest and poorest social strata in Brazil, and the consequent impacts on income inequality. Rural and urban families were compared in order to understand how these dynamics had different impacts on more developed (urban) and less developed (rural) areas. The results emphasize how changes observed in family structure are more pronounced among the richest families, contributing to an increase in (i) the income of the richest families and (ii) income inequality between the richest and poorest families, as well as between urban and rural areas.

  14. [Educational inequalities in mortality and survival of women and men in the Americas, 1990-2010].

    PubMed

    Haeberer, Mariana; Noguer, Isabel; Mújica, Oscar J

    2015-08-01

    Analyze magnitude and trends in educational inequality in mortality and survival of women and men in countries of the Americas. Gap and gradient metrics were used to calculate inequality between countries in adult mortality, average age of death, life expectancy, and healthy life expectancy, according to educational level in men and women for 1990 and 2010. Between 1990 and 2010, the average number of years of education increased from 8 to 10 with no difference between sexes. Adult mortality (15-59 years) did not change: 1.9 per 1 000 women and 3.7 per 1 000 men. The slope index of inequality (SII) increased from -1.0 to -2.0 per 1 000 women and from -1.2 to -4.4 per 1 000 men. Life expectancy increased from 75.6 to 78.7 years in women and from 68.9 to 72.4 in men; absolute inequality decreased from 7.8 to 7.2 years in women and increased from 7.2 to 9.2 years in men. Healthy life expectancy increased from 63.7 to 65.9 years in women and from 59.5 to 62.5 years in men; the SII declined from 6.9 to 5.8 years in women and increased from 6.9 to 7.8 years in men. In the countries of the Americas, men are at greater risk of dying, die earlier, and live fewer disease- and disability-free years than women; educational level is a determinant of mortality and survival in both sexes, and educational inequalities are more pronounced and increasing among men, and are disproportionately concentrated in the most socially disadvantaged populations.

  15. [Inequalities in mortality between Andalusia and Spain from 1990 to 2010].

    PubMed

    Ruiz-Ramos, Miguel; García León, Francisco Javier

    2013-01-01

    To describe inequalities in mortality between Andalusia and Spain as a whole by sex and age group between 1990 and 2010. Deaths in Andalusia and Spain were obtained from the Andalusian Mortality Registry and the National Institute of Statistics, respectively. Population data, classified by sex and age group, were obtained from the National Institute of Statistics. Crude and age- and sex-adjusted standardized mortality rates were calculated. Additionally, standardized rate ratios between Andalusia and Spain were estimated, and joinpoint regression models were built to assess trends. In both sexes and in all the years studied, mortality was higher in Andalusia than in Spain as a whole. Rate ratios increased from 11% of men in Andalusia in 1990 to 14% in 2010 and from 9% of women in 1990 to 11% in 2010. By age group, mortality was higher than the Spanish average in Andalusian men and women, except in those aged less than 45 years in the first few years of the series. In both sexes and in all age groups, there were downward trends in Andalusia and Spain. Mortality in Andalusia is higher than the Spanish average with a tendency to decrease at a slightly slower rate than in Spain, indicating that inequalities have increased. If this tendency continues, mortality in Andalusia will not converge with the Spanish average in the near future. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. [Self-rated health in adults: influence of poverty and income inequality in the area of residence].

    PubMed

    Caicedo, Beatriz; Berbesi Fernández, Dedsy

    2015-01-01

    To evaluate the influence of income inequality and poverty in the towns of Bogotá, Colombia, on poor self-rated health among their residents. The study was based on a multipurpose survey applied in Bogotá-Colombia. A hierarchical data structure (individuals=level1, locations=level 2) was used to define a logit-type multilevel logistic model. The dependent variable was self-perceived poor health, and local variables were income inequality and poverty. All analyses were controlled for socio-demographic variables and stratified by sex. The prevalence of self-reported fair or poor health in the study population was 23.2%. Women showed a greater risk of ill health, as well as men and women with a low educational level, older persons, those without work in the last week and persons affiliated to the subsidized health system. The highest levels of poverty in the city increased the risk of poor health. Cross-level interactions showed that young women and men with a low education level were the most affected by income inequality in the locality. In Bogotá, there are geographical differences in the perception of health. Higher rates of poverty and income inequality were associated with an increased risk of self-perceived poor health. Notable findings were the large health inequalities at the individual and local levels. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Flood Risk Management: Exploring the Impacts of the Community Rating System Program on Poverty and Income Inequality.

    PubMed

    Noonan, Douglas S; Sadiq, Abdul-Akeem A

    2017-06-27

    Flooding remains a major problem for the United States, causing numerous deaths and damaging countless properties. To reduce the impact of flooding on communities, the U.S. government established the Community Rating System (CRS) in 1990 to reduce flood damages by incentivizing communities to engage in flood risk management initiatives that surpass those required by the National Flood Insurance Program. In return, communities enjoy discounted flood insurance premiums. Despite the fact that the CRS raises concerns about the potential for unevenly distributed impacts across different income groups, no study has examined the equity implications of the CRS. This study thus investigates the possibility of unintended consequences of the CRS by answering the question: What is the effect of the CRS on poverty and income inequality? Understanding the impacts of the CRS on poverty and income inequality is useful in fully assessing the unintended consequences of the CRS. The study estimates four fixed-effects regression models using a panel data set of neighborhood-level observations from 1970 to 2010. The results indicate that median incomes are lower in CRS communities, but rise in floodplains. Also, the CRS attracts poor residents, but relocates them away from floodplains. Additionally, the CRS attracts top earners, including in floodplains. Finally, the CRS encourages income inequality, but discourages income inequality in floodplains. A better understanding of these unintended consequences of the CRS on poverty and income inequality can help to improve the design and performance of the CRS and, ultimately, increase community resilience to flood disasters. © 2017 Society for Risk Analysis.

  18. Inequality and inequity.

    PubMed

    Nielsen, François

    2017-02-01

    Kelley and Evans (2017) found that income inequality (measured at the societal level) did not affect individual well-being in advanced societies but increased individual well-being in developing societies. This paper discusses how this empirical patterning of the inequality-well-being relationship may arise from mechanisms related to the relationship of inequality with economic development (at the macro-sociological level) and to the evolution of emotional reactions to inequality (at the individual-psychological level).

  19. Educational inequality in cancer mortality: a record linkage study of over 35 million Italians.

    PubMed

    Alicandro, Gianfranco; Frova, Luisa; Sebastiani, Gabriella; El Sayed, Iman; Boffetta, Paolo; La Vecchia, Carlo

    2017-07-26

    Large studies are needed to evaluate socioeconomic inequality for site-specific cancer mortality. We conducted a longitudinal census-based national study to quantify the relative inequality in cancer mortality among educational levels in Italy. We linked the 2011 Italian census with the 2012 and 2013 death registries. Educational inequality in overall cancer and site-specific cancer mortality were evaluated by computing the mortality rate ratio (MRR). A total of 35,708,445 subjects aged 30-74 years and 147,981 cancer deaths were registered. Compared to the lowest level of education (none or primary school), the MRR for all cancers in the highest level (university) was 0.57 (95% CI 0.55; 0.58) in men and 0.84 (95% CI 0.81; 0.87) in women. Higher education was associated with reduced risk of mortality from lip, oral cavity, pharynx, oesophagus, stomach, colon and liver in both sexes. Higher education (university) was associated with decreased risk of lung cancer in men (MRR: 0.43, 95% CI 0.41; 0.46), but not in women (MRR: 1.00, 95% CI 0.92; 1.10). Highly educated women had a reduced risk of mortality from cervical cancer than lower educated women (MRR: 0.39, 95% CI 0.27; 0.56), but they had a similar risk for breast cancer (MRR: 1.01, 95% CI 0.94; 1.09). Education is inversely associated with total cancer mortality, and the association was stronger in men. Different patterns and trends in tobacco smoking in men and women account for at least most of the gender differences.

  20. Inequalities in mortality by social class in men in Barcelona, Spain.

    PubMed

    Puigpinós, R; Borrell, C; Pasarín, M I; Montellà, N; Pérez, G; Plasènci, A; Rué, M

    2000-01-01

    Most of the studies of inequalities in mortality carried out in Spain have been ecological, due to the difficulty of obtaining good quality socioeconomic information at individual level. The objective of this study was to describe inequalities in mortality by social class, based on occupation, among men residents of Barcelona in 1993. A representative sample was obtained of men residents of Barcelona who died during the year 1993, aged between 15 and 65 years. It was a retrospective interview given to relatives of the deceased, or other closely related persons. The variables analysed were: age, education level, underlying cause of death, and social class based on occupation (manual and non-manual workers). Rates, relative risks (RRs) and their 95% confidence intervals (95% CIs) are presented by age groups and cause of death. The main results show that among young people, the excess of mortality due to infectious diseases is notable (RR: 1.9; 95% CI: 1.6-2.2), and also due to external causes (RR: 2.1; 95% CI: 1.8-2.4) among manual workers with respect to non-manual workers, mainly due to AIDS and drug overdose. No significant differences were found in mortality due to tumours. For respiratory and cardiovascular causes, there is an increase in mortality in the less favoured social classes, as also occurs for mortality due to diseases of the digestive system, particularly among young manual workers, with an RR: 2.6 (95% CI: 1.5-3.6) compared to non-manual workers. This study shows that it is necessary to continue exploring inequalities in health, but above all it is necessary to implement efficient preventive measures addressed mainly at young people in situations of disadvantage, in order to avoid the excess of avoidable mortality which is found.

  1. [Trends in socioeconomic inequalities in general mortality in the city of Cadiz, Spain (1992-2007)].

    PubMed

    Rodríguez, Gabriel Jesús; Escolar-Pujolar, Antonio; Córdoba-Doña, Juan Antonio

    2014-01-01

    To analyze trends in socioeconomic inequality in mortality in the city of Cadiz (Spain) from 1992 to 2007. An ecological study was performed of trends over 3 cross-sections, with the census tract as the unit of analysis. Deaths were grouped into three periods: 1992-1996, 1997-2001 and 2002-2007 and were then classified according to a deprivation index of the census tract. We calculated adjusted rates by the direct method and three measures of health inequality. Of 18,586 deaths, 96.7% was geocoded to a census tract. The population-attributable risk decreased in men and women, respectively, from 15.4% and 12.2% in 1992-1996 to 9.3% and 5.6% in 2002-2007. The other measures, slope index and the relative index also showed a decline in inequality but only among women. Despite a decreasing trend, social inequalities are a substantial component in the distribution of overall mortality in the city of Cadiz. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  2. Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries.

    PubMed

    Muntaner, Carles; Lynch, John W; Hillemeier, Marianne; Lee, Ju Hee; David, Richard; Benach, Joan; Borrell, Carme

    2002-01-01

    This study tests two propositions from Navarro's critique of the social capital literature: that social capital's importance has been exaggerated and that class-related political factors, absent from social epidemiology and public health, might be key determinants of population health. The authors estimate cross-sectional associations between economic inequality, working-class power, and social capital and life expectancy, self-rated health, low birth weight, and age- and cause-specific mortality in 16 wealthy countries. Of all the health outcomes, the five variables related to birth and infant survival and nonintentional injuries had the most consistent association with economic inequality and working-class power (in particular with strength of the welfare state) and, less so, with social capital indicators. Rates of low birth weight and infant deaths from all causes were lower in countries with more "left" (e.g., socialist, social democratic, labor) votes, more left members of parliament, more years of social democratic government, more women in government, and various indicators of strength of the welfare state, as well as low economic inequality, as measured in a variety of ways. Similar associations were observed for injury mortality, underscoring the crucial role of unions and labor parties in promoting workplace safety. Overall, social capital shows weaker associations with population health indicators than do economic inequality and working-class power. The popularity of social capital and exclusion of class-related political and welfare state indicators does not seem to be justified on empirical grounds.

  3. Inequalities in mortality among refugees and immigrants compared to native Danes – a historical prospective cohort study

    PubMed Central

    2012-01-01

    Background Comparisons of mortality patterns between different migrant groups, and between migrants and natives, are relevant to understanding, and ultimately reducing, inequalities in health. To date, European studies on migrants’ mortality patterns are scarce and are based solely on country of birth, rather than migrant status. However, mortality patterns may be affected by implications in relation to migrant status, such as health hazards related to life circumstances before and during migration, and factors related to ethnic origin. Consequently, we investigated differences in both all-cause and cause-specific mortality from cancer and cardiovascular disease among refugees and immigrants, compared with the mortality among native Danes. Methods A register-based, historical prospective cohort design. All refugees (n = 29,139) and family-reunited immigrants (n = 27,134) who, between 1 January1993 and 31 December1999, were granted right of residence in Denmark were included and matched 1:4 on age and sex with native Danes. To identify deaths, civil registration numbers were cross-linked to the Register of Causes of Death (01.01.1994–31.12.2007) and the Danish Civil Registration System (01.01.1994–31.12.2008). Mortality rate ratios were estimated separately for men and women by migrant status and region of birth, adjusting for age and income and using a Cox regression model, after a median follow-up of 10–13 years after arrival. Results Compared with native Danes, all-cause mortality was significantly lower among female (RR = 0.78; 95%CI: 0.71;0.85) and male (RR = 0.64; 95%CI: 0.59-0.69;) refugees. The rates were also significantly lower for immigrants: women (RR = 0.44; 95%CI: 0.38;0.51) and men (RR = 0.43; 95%CI: 0.37;0.51). Both migrant groups also had lower cause-specific mortality from cancer and cardiovascular diseases. For both all-cause and cause-specific mortality, immigrants generally had lower mortality than refugees, and

  4. Inequalities in mortality among refugees and immigrants compared to native Danes--a historical prospective cohort study.

    PubMed

    Norredam, Marie; Olsbjerg, Maja; Petersen, Jorgen H; Juel, Knud; Krasnik, Allan

    2012-09-10

    Comparisons of mortality patterns between different migrant groups, and between migrants and natives, are relevant to understanding, and ultimately reducing, inequalities in health. To date, European studies on migrants' mortality patterns are scarce and are based solely on country of birth, rather than migrant status. However, mortality patterns may be affected by implications in relation to migrant status, such as health hazards related to life circumstances before and during migration, and factors related to ethnic origin. Consequently, we investigated differences in both all-cause and cause-specific mortality from cancer and cardiovascular disease among refugees and immigrants, compared with the mortality among native Danes. A register-based, historical prospective cohort design. All refugees (n = 29,139) and family-reunited immigrants (n = 27,134) who, between 1 January 1993 and 31 December 1999, were granted right of residence in Denmark were included and matched 1:4 on age and sex with native Danes. To identify deaths, civil registration numbers were cross-linked to the Register of Causes of Death (01.01.1994-31.12.2007) and the Danish Civil Registration System (01.01.1994-31.12.2008). Mortality rate ratios were estimated separately for men and women by migrant status and region of birth, adjusting for age and income and using a Cox regression model, after a median follow-up of 10-13 years after arrival. Compared with native Danes, all-cause mortality was significantly lower among female (RR = 0.78; 95%CI: 0.71;0.85) and male (RR = 0.64; 95%CI: 0.59-0.69;) refugees. The rates were also significantly lower for immigrants: women (RR = 0.44; 95%CI: 0.38;0.51) and men (RR = 0.43; 95%CI: 0.37;0.51). Both migrant groups also had lower cause-specific mortality from cancer and cardiovascular diseases. For both all-cause and cause-specific mortality, immigrants generally had lower mortality than refugees, and differences were observed according to ethnic origin

  5. Relative income inequality and selected health outcomes in urban Chinese youth.

    PubMed

    Sun, Ping; Unger, Jennifer B; Palmer, Paula; Ma, Huiyan; Xie, Bin; Sussman, Steve; Johnson, C Anderson

    2012-01-01

    Self reported cross-sectional data gathered in 2002 from 12,449 middle and high school students from seven major cities in China were examined to explore the association of self-perceived relative income inequality (SPRII) with general health status, depression, stress, and cigarette smoking. Two types of self-perceived relative income were evaluated: household income relative to peers (SPRII-S) and relative to their own past (SPRII-P). SPRII-S and SPRII-P were coded as three-level categorical variables: lower, equal, and higher. As hypothesized, the youth in the "Lower" SPRII-S or SPRII-P groups reported the worst general health and the highest levels of depression and stress; the youth in the "Higher" groups reported the best general health. Unexpectedly, the youth in the "Higher" groups did not report the lowest levels of depression and stress, and the relationship between SPRII and cigarette smoking was even less straightforward. The expected positive relationship between SPRII and the general health status is consistent with previous research, but the relationships between SPRII and depression, stress, and cigarette smoking behavior are not. Further studies are needed to elucidate the complex associations between SPRII and health outcomes in rapidly transforming economies such as China.

  6. Community-Level Income Inequality and HIV Prevalence among Persons Who Inject Drugs in Thai Nguyen, Vietnam

    PubMed Central

    Lim, Travis W.; Frangakis, Constantine; Latkin, Carl; Ha, Tran Viet; Minh, Nguyen Le; Zelaya, Carla; Quan, Vu Minh; Go, Vivian F.

    2014-01-01

    Socioeconomic status has a robust positive relationship with several health outcomes at the individual and population levels, but in the case of HIV prevalence, income inequality may be a better predictor than absolute level of income. Most studies showing a relationship between income inequality and HIV have used entire countries as the unit of analysis. In this study, we examine the association between income inequality at the community level and HIV prevalence in a sample of persons who inject drugs (PWID) in a concentrated epidemic setting. We recruited PWID and non-PWID community participants in Thai Nguyen, Vietnam, and administered a cross-sectional questionnaire; PWID were tested for HIV. We used ecologic regression to model HIV burden in our PWID study population on GINI indices of inequality calculated from total reported incomes of non-PWID community members in each commune. We also modeled HIV burden on interaction terms between GINI index and median commune income, and finally used a multi-level model to control for community level inequality and individual level income. HIV burden among PWID was significantly correlated with the commune GINI coefficient (r = 0.53, p = 0.002). HIV burden was also associated with GINI coefficient (β = 0.082, p = 0.008) and with median commune income (β = −0.018, p = 0.023) in ecological regression. In the multi-level model, higher GINI coefficient at the community level was associated with higher odds of individual HIV infection in PWID (OR = 1.46 per 0.01, p = 0.003) while higher personal income was associated with reduced odds of infection (OR = 0.98 per $10, p = 0.022). This study demonstrates a context where income inequality is associated with HIV prevalence at the community level in a concentrated epidemic. It further suggests that community level socioeconomic factors, both contextual and compositional, could be indirect determinants of HIV infection in PWID. PMID

  7. [Methods to smooth mortality indicators: application to analysis of inequalities in mortality in Spanish cities [the MEDEA Project

    PubMed

    Barceló, M Antònia; Saez, Marc; Cano-Serral, Gemma; Martínez-Beneito, Miguel Angel; Martínez, José Miguel; Borrell, Carme; Ocaña-Riola, Ricardo; Montoya, Imanol; Calvo, Montse; López-Abente, Gonzalo; Rodríguez-Sanz, Maica; Toro, Silvia; Alcalá, José Tomás; Saurina, Carme; Sánchez-Villegas, Pablo; Figueiras, Adolfo

    2008-01-01

    Although there is some experience in the study of mortality inequalities in Spanish cities, there are large urban centers that have not yet been investigated using the census tract as the unit of territorial analysis. The coordinated project inequalities in mortality in Spanish cities. The MEDEA project> was designed to fill this gap, with the participation of 10 groups of researchers in Andalusia, Aragon, Catalonia, Galicia, Madrid, Valencia, and the Basque Country. The MEDEA project has four distinguishing features: a) the census tract is used as the basic geographical area; b) statistical methods that include the geographical structure of the region under study are employed for risk estimation; c) data are drawn from three complementary data sources (information on air pollution, information on industrial pollution, and the records of mortality registrars), and d) a coordinated, large-scale analysis, favored by the implantation of coordinated research networks, is carried out. The main objective of the present study was to explain the methods for smoothing mortality indicators in the context of the MEDEA project. This study focusses on the methodology and the results of the Besag, York and Mollié model (BYM) in disease mapping. In the MEDEA project, standardized mortality ratios (SMR), corresponding to 17 large groups of causes of death and 28 specific causes, were smoothed by means of the BYM model; however, in the present study this methodology was applied to mortality due to cancer of the trachea, bronchi and lung in men and women in the city of Barcelona from 1996 to 2003. As a result of smoothing, a different geographical pattern for SMR in both genders was observed. In men, a SMR higher than unity was found in highly deprived areas. In contrast, in women, this pattern was observed in more affluent areas.

  8. Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses.

    PubMed

    Vapattanawong, Patama; Hogan, Margaret C; Hanvoravongchai, Piya; Gakidou, Emmanuela; Vos, Theo; Lopez, Alan D; Lim, Stephen S

    2007-03-10

    Thailand's progress in reducing the under-five mortality rate (U5MR) puts the country on track to achieve the fourth Millennium Development Goal (MDG). Whether this success has been accompanied by a widening or narrowing of the child mortality gap between the poorest and richest populations is unknown. We aimed to measure changes in child-mortality inequalities by household-level socioeconomic strata of the Thai population between 1990 and 2000. We measured changes in the distribution of the U5MR by economic strata using data from the 1990 and 2000 censuses. Economic status was measured using household assets and characteristics. The U5MR was estimated using the Trussell version of the Brass indirect method. Average household economic status improved and inequalities declined between the two censuses. There were substantially larger reductions in U5MR in the poorer segments of the population. Excess child mortality risk between the poorest and richest quintile decreased by 55% (95% CI 39% to 68%). The concentration index, measured using percentiles of economic status, in 1990 was -0.20 (-0.23 to -0.18), whereas in 2000 it had dropped to -0.12 (-0.15 to -0.08), a 43% (22% to 63%) reduction. These findings draw attention to the feasibility of incorporating equity measurement into census data. Thailand has achieved both an impressive average decrease in U5MR and substantial reductions in U5MR inequality over a 10 year period. Contributing factors include overall economic growth and poverty reduction, improved insurance coverage, and a scaling-up and more equitable distribution of primary health-care infrastructure and intervention coverage. Understanding the factors that have led to Thailand's success could help inform countries struggling to meet the fourth MDG and reduce inequality.

  9. Early childhood health, reproduction of economic inequalities and the persistence of health and mortality differentials

    PubMed Central

    Palloni, Alberto; Milesi, Carolina; White, Robert G; Turner, Alyn

    2009-01-01

    The persistence of adult health and mortality socioeconomic inequalities and the equally stubborn reproduction of social class inequalities are salient features in modern societies that puzzle researchers in seemingly unconnected research fields. Neither can be satisfactorily explained with standard theoretical frameworks. In the domain of health and mortality, it is unclear if and to what an extent adult health and mortality disparities across socioeconomic status (SES) are the product of attributes of the positions themselves, the partial result of health conditions established earlier in life that influence both adult health and economic success, or the outcome of the reverse impact of health status on SES. In the domain of social stratification, the transmission of inequalities across generations has been remarkably resistant to satisfactory explanations. Although the literature on social stratification is by and large silent about the role played by early health status in shaping adult socioeconomic opportunities, new research on human capital formation suggests this is a serious error of omission. In this paper we propose to investigate the connections between these two domains. We use data from male respondents of the 1958 British Cohort to estimate (a) the influence of early health conditions on adult SES and (b) the contribution of early health status to observed adult health differentials. The model incorporates early conditions as determinants of traits that enhance (inhibit) social mobility and also conventional and unconventional factors that affect adult health and socioeconomic status. Our findings reveal that early childhood health plays a small, but non-trivial role as a determinant of adult SES and the adult socioeconomic gradient in health. These findings enrich current explanations of SES inequalities and of adult health and mortality disparities. PMID:19269728

  10. Reducing regional inequality in mortality from road traffic injuries through enforcement of the mandatory motorcycle helmet law in Taiwan.

    PubMed

    Lu, Tsung-Hsueh; Lai, Ching-Huei; Chiang, Tung-Liang

    2012-06-01

    This study was conducted to examine whether passage of the mandatory motorcycle helmet law in 1997 reduced the regional inequality in mortality from road traffic injuries (RTIs) across 22 cities/counties in Taiwan. We calculated the absolute (between-group variance, BGV) and relative (rate ratio between the city/county with the highest and lowest rate, RR) terms of inequality for the overall and motorcycle-related RTI mortality rates, the rate of helmet use and three other explanatory factors associated with RTI mortality at the city/county level from 1997 through 2008. The BGV of the overall and motorcycle-related RTI mortality rates across the 22 cities/counties showed persistently decreasing trends from 1997 to 2008; however, the RR of RTI mortality first increased and then levelled off from 2002. The decreasing trend in inequality was most prominent in males aged 0-24 years. The BGV and RR of the rate of motorcycle helmet use decreased after passage of the law but increased from 2002 onwards. In Taiwan, passage of the mandatory motorcycle helmet law reduced the regional inequality in RTI mortality; however, a resurgence in regional inequality in the helmet use rate years after passage of the helmet law was noted. It is therefore necessary to monitor the helmet use rate after passage of such a law to ensure the effect of a reduction in regional inequality in RTI mortality.

  11. Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project).

    PubMed

    Borrell, Carme; Marí-Dell'olmo, Marc; Serral, Gemma; Martínez-Beneito, Miguel; Gotsens, Mercè

    2010-07-01

    The objectives of this study are to identify inequalities in mortality among census tracts of 11 Spanish cities in the period 1996-2003 and to analyse the relationship between these geographical inequalities and socioeconomic deprivation. It is a cross-sectional ecological study where the units of analysis are census tracts. We obtained an index of socioeconomic deprivation and estimated SMR by each census tract using hierarchical Bayesian models which take into account the spatial structure. In the majority of the cities geographical patterns in total mortality were found in both sexes, which were similar to those for the index of socioeconomic deprivation. Among men, four specific causes of death (lung cancer, ischemic heart diseases, respiratory diseases and cirrhosis) were positively associated with deprivation in the majority of cities. Among women the specific causes diabetes and cirrhosis were positively associated, while lung cancer was negatively associated with deprivation. The excess of mortality related with deprivation was 59,445 deaths among men and 23,292 among women. These results highlight the importance of intra-urban inequalities in health. 2010 Elsevier Ltd. All rights reserved.

  12. [Influence of income, income inequalities and social capital on the health of persons aged 65 and over in Spain in 2007].