Income Group Differences Research Articles

Has socioeconomic equity increased in somatic specialist care: a register-based cohort study from Finland in 1995–2010

BackgroundEqual access to health care according to need is an important goal for health policy in Finland. Earlier research in Finland and elsewhere has mainly been cross-sectional, but the results have implied that the goal has not been fully realised in somatic specialist hospital care. This study examines trends in socioeconomic equity in use of somatic specialist hospital care.MethodsWe used register data on somatic specialist hospital admissions among 25–84 year-old persons in Finland in 1995–2010 with individually linked register-based socio-demographic information. We calculated age-standardised admission rates per 100,000 person years by income, examined risk ratios using Poisson regression models and computed concentration indices separately for men and women. Linear trends in the socioeconomic distribution of admissions and surgical procedures were estimated with linear regression models for annual concentration indices.ResultsOverall, use of somatic specialist hospital care decreased steadily throughout the study period. A stepwise inverse income pattern was found in hospitalisation risk and in non-surgical admissions: the lower the income group, the higher the risk. The relative admission risk was approximately two times higher in the lowest income group compared to the highest among both genders. Few differences were found in surgical admissions. Income group differences remained stable in hospitalisations and surgical admissions, but increased in non-surgical admissions during the study period. An inverse pattern of increasing operation rates with decreasing income was found in primary hip and knee replacement operations, and in lower limb amputations. A similar pattern emerged during the study period in coronary revascularisations. There were no differences were found in lumbar fusion or lumbar disc operations, prostatectomies or appendectomies. Income group differences in hysterectomies disappeared during the study period.ConclusionsWhile the results of the current study suggest that use of somatic specialist care declined in line with improving population health in 1995–2010, the increase of socioeconomic health differentials was only partly reflected in the distribution of somatic specialist hospital care. Further research is needed to evaluate the need to improve use and content of specialised hospital care among the low-income groups in order to improve equity in health care.

Financial Education Program Evaluation

This study illustrates the process of program evaluation using a logic model. Guided by the Transtheoretical Model of Change and a logic model, this study evaluated the effectiveness of a Retirement and Savings Seminar by measuring participant (n = 54) satisfaction, financial knowledge, financial confidence, and financial behavior change compared to a similar group of 134 non-participants. Participants were very satisfied with the seminar. Their financial knowledge and confidence scores significantly increased from pretest to posttest. Financial knowledge and confidence scores improved more than the comparison group while controlling for group differences in age, income, and pretest scores. Two months later, participants were more likely than the comparison group to have adopted positive financial behaviors as measured by the Financial Preparedness for Retirement Scale. Financial educators can use this study as a model for planning, conducting, and evaluating their programs

Welfare Costs of Inflation: Evidence from China

In this paper, we use the China General Social Survey 2010 data to estimate the impact of inflation on the welfare of residents. By using the happiness research approach, we find that on average, a 0.1 % rise in inflation rate will cause a welfare loss of about 73.0–164.1 RMB, mainly from unexpected inflation. Furthermore, welfare costs to different income groups vary significantly: for those whose household income reaches 100,000 RMB, the welfare loss resulted from a 0.1 % rise in inflation only reduces about 0.057 % of their income, while for the below 10 thousand income group, the cost is as high as 0.739 %. It also shows that there are substantial differences in different income groups’ sensitivities to different kinds of commodities. Specifically, low-income residents are seriously harmed by an increase in food and residence prices, whereas their middle-income counterparts are mainly affected by price changes in healthcare, personal articles, transportation, communication, recreation, and education. Besides, we find that subjective well-being of debtors are significantly boosted by inflation.

Nasoalveolar Molding: Prevalence of Cleft Centers Offering NAM and who Seeks It

Nasoalveolar molding (NAM) is a treatment option available for early cleft care. Despite the growing debate about the efficacy of nasoalveolar molding, questions remain regarding its prevalence and the demographic characteristics of families undergoing this technique prior to traditional cleft surgery. To determine the number of teams currently offering nasoalveolar molding and to identify salient clinical and sociodemographic variables in infants and families who choose nasoalveolar molding compared with those who choose traditional cleft care across three well-established cleft centers. Via phone surveys, 89% of the U.S. cleft teams contacted revealed that nasoalveolar molding is available at 37% of these centers. Chart reviews and phone correspondence with caregivers indicate that the average distance to the cleft center was 65.5 miles and caregiver age averaged 30.9 ± 5.7 years. Of families who chose nasoalveolar molding, 85% received total or partial insurance coverage. No difference in caregiver education, income, or distance to the clinic between treatment groups was found. On average, infants receiving nasoalveolar molding and cleft surgery had larger clefts and had more clinic visits than infants receiving traditional cleft surgery. Infants who were firstborn and those who did not have other siblings were more likely to receive nasoalveolar molding than were infants who were residing with other siblings. Currently more than one-third of U.S. cleft centers offer nasoalveolar molding. Although the cleft size was larger in the nasoalveolar molding group, no treatment group differences in education, income, and distance to the clinic were found.

Health Locus of Control Beliefs and Healthy Survival with AIDS

Health Locus of Control (HLOC) has been related to a number of psychosocial and medical variables in previous research in HIV. However, there is little information about its relationship to disease status, or about the Doctors subscale (DHLOC), in this population. The main purpose of the present study was to determine whether HLOC beliefs were related to "healthy survival with AIDS" status, and to do so with the DHLOC subscale in addition to the other HLOC subscales. Two HIV-positive groups, healthy survivors (HS; n = 70) who had experienced an asymptomatic period of ≥9months despite low CD4 cells (<50) without the aid of protease inhibitors and a matched control group (MC; n = 70) of individuals in the mid-range of disease progression were compared on the HLOC scales. Several factors were examined as potential mediators. The HS group had significantly higher DHLOC and lower Internal HLOC (IHLOC) than the MC group. Both DHLOC and IHLOC contributed unique variance in relationship to HS status. These findings were not due to group differences in age, gender, ethnicity, income, education, sexual orientation, or HIV viral load. HLOC may contribute to the particular psychosocial profile of this relatively "rare" group of HIV-positive individuals who remained asymptomatic despite very low CD4 cells. Higher DHLOC and lower IHLOC beliefs may be adaptive for HIV-positive individuals at an advanced stage of disease progression, and therefore modifying HLOC beliefs may be a worthwhile focus of future interventions.

Modelling income group differences in the health and economic impacts of targeted food taxes and subsidies

To examine the effects, by income group, of targeted food taxes and subsidies on nutrition, health and expenditure in the UK. A model based on consumption data and demand elasticity was constructed to predict the effects of four food taxation-subsidy regimens. Resulting changes in demand, expenditure, nutrition, cardiovascular disease (CVD) and cancer mortality were estimated. Data Expenditure data were taken from the Expenditure and Food Survey; estimates of price elasticities of demand for food were taken from a report based on the National Food Survey 1988-2000. Estimates of effect on CVD and cancer mortality of changing fat, salt, fruit and vegetable intake were taken from previous meta-analyses. (i) Taxing principal sources of dietary saturated fat is unlikely to reduce cardiovascular disease (CVD) or cancer mortality. (ii) Taxing 'less healthy' foods (defined by the WXYfm nutrient profiling model) could increase CVD and cancer deaths by 35-1300 yearly. (iii) Taxing 'less healthy' foods and subsidising fruits and vegetables by 17.5% could avert up to 2900 CVD and cancer deaths yearly. (iv) Taxing 'less healthy' foods and using all tax revenue to subsidize fruits and vegetables could avert up to 6400 CVD and cancer deaths yearly. Few obesity-related CVD deaths are averted by any of the regimens. All four regimens would be economically regressive and positive health effects will not necessarily be greater in lower-income groups where the need for dietary improvement is higher. A targeted food tax combined with the appropriate subsidy on fruits and vegetables could reduce deaths from CVD and cancer.

Understanding Immigrant-Native Differences in Financial Market Participation

The goal of this paper is to investigate access to financial services and prospects for the wealth assimilation of immigrants by studying the financial market behavior of U.S. immigrants, compared to the native-born. Compared to similar natives, immigrants are less likely to own a wide range of financial assets, including savings and checking accounts. We find that lower rates of financial market participation tend to persist even for immigrants who have lived in the U.S. for several years. Our results suggest that a large share of the immigrant-native gap in financial market participation is driven by group differences in education, income, and geographic location. For a given immigrant, the likelihood of financial market participation decreases with higher levels of ethnic concentration in the metropolitan area.

The Unequal Representation of Latinos and Whites

We compare the ideological proximity of Latinos and whites to their Members of Congress (MCs), demonstrating the degree to which Latinos are underrepresented compared to whites. We show how this representation gap varies with group differences in electoral turnout and income, district ethnic composition, and MCs' ethnicity and party affiliation. We find that Latinos' unequal representation is not simply a function of the group's numerical minority status. Concentrating Latinos in congressional districts does not necessarily translate into more equal representation. However, several factors can enhance the equality of Latinos' representation—participation in elections and representation by both Latinos and Democrats.

The socio‐economic circumstances of children at risk of disability in Britain

Our aims were to describe the socio‐economic circumstances faced by families supporting a child at risk of disability and to investigate the extent to which disability is associated with hardship once family income is held constant. We analysed data on 7070 family units containing 12,916 children aged under 17. Families supporting a child at risk of disability were significantly more disadvantaged across a wide range of indicators of socio‐economic position. The hardship experienced by these families was only partly accounted for by between group differences in income, debt and savings. Children who are already at risk of disability as a result of a range of physical and cognitive impairments are more likely than other children to live under conditions that have been repeatedly shown to impede development, increase the risk of poor health and (additional) disability and increase the risk of social exclusion.

INTER-RELATIONSHIPS OF INCOME, CHRONIC ENERGY DEFICIENCY, MORBIDITY AND HOSPITALIZATION AMONG ADULT MALE SLUM DWELLERS OF MIDNAPORE, WEST BENGAL, INDIA

A cross-sectional study of 212 adult (>18 years) male slum dwellers (mean age=34.6+/-14.4 years) of Midnapore town, West Bengal, India, was undertaken to study the inter-relationships of chronic energy deficiency (CED), monthly family income (MFI), self-reported morbidity and hospitalization due to severe illness. The mean height, weight and body mass index (BMI) of the subjects were 160.0 cm, 50.8 kg and 19.9 kg/m2, respectively. The overall frequencies of CED (BMI<18.5 kg/m2), morbidity and hospitalization were 38.2%, 34.4% and 13.7%, respectively. Based on the WHO classification, the prevalence of CED among this population was high (20-39%), indicating a serious situation. Overall, MFI was significantly (p<0.01) positively correlated with BMI (r=0.21). Linear regression analyses showed that MFI had a significant impact (t=3.08; p<0.002) on BMI. Overall, MFI explained 3.9% variation in BMI. Subjects belonging to the lowest family income group (FIG I) had the lowest mean BMI (19.1 kg/m2) and the highest rate of CED (46.3%) and morbidity (36.6%). Those in the highest family income group (FIG III) had the largest mean BMI (20.8 kg/m2) and lowest rate of CED (30.2%) and morbidity (30.2%). The highest rate (18.9%) of hospitalization was found in this group. There were significant family income group differences in mean BMI (F=3.134, p<0.05). The frequency of morbidity (24.6%) and hospitalization (11.9%) was lowest among normal BMI individuals. Morbidity was significantly higher (chi2=11.92, p=0.0026) among CED (48.2%) subjects compared with normal BMI individuals (OR=2.85; CI=1.49-5.46). Similarly, compared with normal BMI subjects, morbidity was higher (38.5%; OR=1.92; 95% CI=0.50-7.18) among overweight subjects. Hospitalization was more common among CED subjects (16.1%; OR=1.42; CI=0.58-3.45) compared with normal BMI subjects. Similarly, the frequency of hospitalization was more among overweight individuals (15.4%; OR=1.35; 95% CI=0.0-7.59). In conclusion, this study provides evidence that the frequency of CED among this population is high, indicating a serious situation. Moreover there exists strong inter-relationships between BMI, CED, MFI and morbidity.

Prospects for Immigrant-Native Wealth Assimilation: Evidence from Financial Market Participation

Because financial transactions are important for wealth accumulation, and rely on trust and confidence in institutions, the financial market behavior of immigrants can provide important insights into the assimilation process. Compared to the native-born, immigrants are less likely to own savings and checking accounts and these differences tend to persist over time. Our results suggest that a large share of the immigrant-native gap in financial market participation is driven by group differences in education, income, and geographic location. For a given immigrant, the likelihood of financial market participation decreases with higher levels of ethnic concentration in the metropolitan area.

Comparison of family stresses, strengths, and outcomes after trauma and surgery.

This study aimed to compare family stresses, strengths, and outcomes after motor vehicle crashes, gunshot wounds, and coronary artery bypass graft surgery. A multivariate descriptive design based on the resiliency model of family stress was used. A convenience sample of 127 family members participated within 2 days of admission to the intensive care unit. Family stresses were measured using the Family Inventory of Life Events and the Acute Physiology, Age, and Chronic Health Evaluation Scale (APACHE III). Family strengths were measured by the Family Hardiness Index and the Family Crisis Oriented Personal Evaluation Scale. Family outcomes were measured by the Family Member Well-Being Index and the Family Adaptation Scale. Family members ranged in age from 18 to 80 years (Mean, 42 years). Most of the participants in the study were women (64%) with previous intensive care unit experience (83%). The patients ranged in age from 19 to 78 years (Mean, 44 years). Multivariate analysis of variance was used to control for group differences in family member age, education, and income along with patient age and race. The results indicated that family members of patients who have experienced motor vehicle crashes, gunshot wounds, or coronary artery bypass graft surgery reported no significant differences in family strengths of hardiness and family outcomes of well-being and adaptation. However, families of patients with gunshot wounds reported significantly more stress (F = 7.94; P< 0.01) and less use of coping strategies (F = 4.33; P< 0.01) than families of patients who have experienced motor vehicle crashes or coronary artery bypass graft surgery. Interventions that address family stress and develop or mobilize coping are needed for selected families after admission of a family member to the intensive care unit.

Expenditure Patterns by Age and Income Among Mature Adults: Does Age Matter?

Using data from the 1984-85 Consumer Expenditure Survey (CES), we examined how expenditure patterns of elderly persons (aged 65-74 and 75 and over) at different income-to-needs levels differ from those of younger mature adults (aged 45-54 and 55-64) at similar income-to-needs levels. Patterns of spending are examined in a variety of areas within three domains--giving, recreation, and essentials. Several important differences exist in the ways that households headed by persons of different ages allocate their expenditures in the domains of essentials and recreation, but few differences exist in the domain of giving. Consistent income group differences exist in expenditure patterns across virtually every area within the three domains. Both age and income differences remain significant when multivariate analyses are performed; thus, the story told is one in which both age and income play important roles.

Development of calculation abilities in middle- and low-income children after formal instruction in school

This study provides follow-up data on the development of calculation abilities in middle- and low-income children after formal instruction in first grade. Two conventional verbal calculation tasks (story problems, number-fact problems) and one nonverbal calculation task were used. Before formal instruction, middle-income kindergarten children performed better than low-income kindergarten children on both verbal calculation task, but the two income groups did not differ in performance on the nonverbal calculation tasks (Jordan, Huttenlocher, & Levine, 1992). After formal instruction in first grade, there still were no income group differences on the nonverbal calculation tasks. Moreover, there no longer were income group differences on number-fact problems. This finding was associated with the development of more effective calculation strategies among the low-income children. However, on story problems low-income children still performed more poorly than middle-income children. The findings show that even after formal instruction low-income children have difficulties with certain verbal arithmetic tasks.

Generalized entropy measures of mobility for different sexes and income levels

A family of mobility measures is investigated using the Michigan panel data on income dynamics, These measures are decomposed in order to learn about components that are due to differences in gender and income groups, on the one hand, and within-group components which are free of such group characteristics. These measures compute the degree of equalization over time of the distribution of ‘permanent incomes’. Permanent or average income of an individual is computed over an increasing number of points within a time interval of interest. This degree of equality is compared (as a ratio) to the equality of incomes at any reference point of interest in order to give us a measure of stability in the size distribution of incomes. We take an average of inequality values over the time interval as our reference value for ‘short-run’ inequality. Mobility is greater the greater this degree of relative equalization. Several aggregator functions have been used to compute the ‘permanent income’ variable. Their justification and role in robustifying our inferences is briefly discussed. The mobility profiles here suggest that there has not been much equalization between different sexes, but there is not a lot of inequality between these groups in our sample. Most of the inequality is within groups where the annual distributional changes belie the relative stability of the permanent income distribution.

Trace nutrients. 5. Minerals and vitamins in the British household food supply.

1. The amounts of magnesium, copper, zinc, phosphorus, manganese, potassium, vitamin B6, vitamin B12, folate, pantothenic acid, biotin, vitamin E and dietary fibre in the British household diet were calculated by applying appropriate values from recent analytical studies to the amounts of foods recorded in the National Food Survey during 1986. 2. National average intakes were (mg/person per d): Mg 247, Cu 1.25, Zn 9.0, P 1249, Mn 3.43, K 2694, vitamin B6 1.73, vitamin B12 6.33 micrograms, folate 230 micrograms, pantothenic acid 6.07, biotin 35 micrograms, vitamin E 8.4. Regional and income-group differences were estimated, and found to be small. Additional contributions from alcoholic drinks and confectionery were also determined. 3. Dietary fibre was estimated both as unavailable carbohydrate and as non-starch polysaccharide. The national average intakes were 21.8 and 12.9 g/d respectively. 4. Intakes were compared with Canadian (Department of National Health and Welfare, 1983) and American (National Research Council, 1980) recommended dietary allowances (RDAs). With the exception of biotin, the Canadian RDAs were met by the household diet but the much higher American RDAs were only met for vitamin B12 and pantothenic acid.

Within‐ and across‐group dating in Hawaii

Abstract 224 subjects from 5 different racial/ethnic groups responded to a dating questionnaire. There are both sex and racial/ethnic differences in frequency of cross‐ethnic dating in Hawaii and in attitudes (as reported by Ss) of parents and close friends toward within‐and across‐ethnic dating. Females date within their own groups more frequently than males and also report stronger support of within‐ and lesser support of across‐group dating by significant others. Racial/ethnic differences are substantial, with groups higher in mean income being more supportive of within‐group dating, being more accepted by other groups, and being less accepting of dating other groups. Amount of actual intergroup dating was related, in part, to group differences in income, with the two groups lowest in income (Filipinos and Hawaiians/Part Hawaiians) showing the highest amount of cross‐ethnic dating, but with the association breaking down in the upper income groups, possibly because of group differences in group size and in length of residence. The results are remarkably similar to those reported earlier on within‐ and across‐group marriage in Hawaii.