High-income Groups Research Articles

Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008-2019.

Acute myocardial infarction (AMI) and stroke are leading global causes of death and can be used to assess acute care quality. We examined the 30-day mortality trends after emergency department admission for AMI and stroke in Korea from 2008 to 2019, focusing on regional and income disparities. The AMI and stroke patients admitted to hospitals in Korea were collected from the claims data. We analyzed age and sex-standardized 30-day mortality for AMI, as well as hemorrhagic and ischemic strokes. Disparities in mortality were analyzed using absolute differences and relative ratios between the Organization for Economic Cooperation Development (OECD) and Korea, and among income levels and regions in Korea. A 12-year joinpoint regression was used to determine the annual percent change and the average annual percent change. The trends in the 30-day AMI mortality of Korea were not significantly changed from 2008 to 2019; the gap remained at 1.2 between the OECD and Korea. Korea maintained lower mortality rates for hemorrhagic and ischemic stroke than the mean of OECD. In Korea, the 30-day hemorrhagic stroke mortality showed a constant decreasing trend for the higher-income group living in urban areas; it led to a widened gap based on income levels in urban areas. The 30-day mortality for ischemic stroke tended to decrease in the higher-income group and urban areas. National-level intervention is needed to manage regional and income-based disparities in AMI and stroke 30-day mortality. It is important to understand the variance in mortality rate by different geographical regions and income levels to establish an appropriate public health strategy.

Digital payments as an indicator of financial inclusion in Euro Area countries

The process of digitisation in the financial sector is developing through the systematic introduction of computer systems, the establishment of Internet connectivity and the use and ownership of various information and communication devices. Information and communication technologies can increase the desired degree of financial inclusion in a country by increasing the availability of various financial services. This study examines the individual attributes that can affect financial inclusion in the Euro Area countries in 2021. Our analysis applies a probit model to data from the World Bank Global Findex database, focusing on digital payments as a proxy for financial inclusion. The main finding highlights that higher income, higher education, female gender, and younger age groups are associated with an increased propensity to engage in digital payments. Notably, our expectation of a non-linear relationship between age and digital payments is confirmed, as evidenced by the application of the Robin Hood algorithm. Specifically, we observe a positive correlation between age and digital payment usage. However, this trend reverses beyond a specific breakpoint, approximately around the age of 40, leading to a subsequent decline in digital payment activity. Furthermore, our research shows that individuals who utilised alternative payment methods alongside cash before the COVID-19 pandemic are likelier to engage in higher digital payments. Additionally, a tendency for higher adoption of digital payments coincides with countries that achieved a higher Digital Access Index (DAI), an indicator assessing the degree of digitalisation in a country. Furthermore, it is associated with countries among the Euro Area’s founding members.

Revelando desigualdades espaciais de renda e raciais e padrões de segregação com um indicador configuracional de acessibilidade potencial.

Abstract Urban segregation has been a central challenge in the pursuit of equity and sustainability, especially in Latin American cities. The existing body of research on segregation, however, has predominantly focused on cities in the United States and Europe. Most existing metrics on segregation do not usually explicitly address the spatial dimension and diversity of cities’ spatial structures. As a result, there is still a gap in the methods to properly capture the spatial relationships implied in segregation. This paper proposes and applies a network-based method for assessing the inequalities in access to opportunities for different social groups (income and race), and the patterns of socio-spatial segregation based on urban accessibility levels. We apply the method to the city of Pelotas, Brazil, combining the street network configuration with population densities and spatial distribution of urban opportunities. Results revealed that high-income white groups dominate the accessibility levels, benefiting from a concentration of opportunities in the central district, while low-income non-white groups experience poorer accessibility. The method allowed to uncover a center-periphery segregation pattern, although more complex and spatially diversified, providing valuable insights that can inform urban planning and policy-making efforts at the intraurban scale.

Social Inequities in the Survival of Liver Cancer: A Nationwide Cohort Study in Korea, 2007-2017.

To analyze the effects of socioeconomic status (type of insurance and income level) and cancer stage on the survival of patients with liver cancer in Korea. A retrospective cohort study was constructed using data from the Healthcare Big Data Platform project in Korea between January 1, 2007, and December 31, 2017. A total of 143,511 patients in Korea diagnosed with liver cancer (International Classification of Diseases, 10th Revision [ICD-10] codes C22, C220, and C221) were followed for an average of 11 years. Of these, 110,443 died. The patient's insurance type and income level were used as indicators of socioeconomic status. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox proportional hazards regression model to analyze the relationship between the effects of sex, age, and cancer stage at first diagnosis (Surveillance, Epidemiology, and the End Results; SEER), type of insurance, and income level on the survival of patients with liver cancer. The interactive effects of the type of insurance, income level, and cancer stage on liver cancer death were also analyzed. The lowest income group (medical aid) showed a higher risk for mortality (HR (95% CI); 1.37 (1.27-1.47) for all patients, 1.44 (1.32-1.57) for men, and 1.16 (1.01-1.34) for women) compared to the highest income group (1-6) among liver cancer (ICD-10 code C22) patients. The risk of liver cancer death was also higher in the lowest income group with a distant cancer stage (SEER = 7) diagnosis than for any other group. Liver cancer patients with lower socioeconomic status and more severe cancer stages were at greater risk of death. Reducing social inequalities is needed to improve mortality rates among patients in lower social class groups who present with advanced cancer.

The differential role of socioeconomic status dimensions in depressive symptoms of aging adults: data from the Hamburg City Health cohort Study.

Socioeconomic status (SES) has consistently been associated with depressive symptoms, however, it remains unclear which subset of SES variables is most relevant to the development of depressive symptoms. This study determined a standardized SES-Index to test the relationship of its sub-dimensions with depressive symptoms. HCHS data (N = 10,000; analysis sample n = 8,400), comprising participants 45+ years of age, was used. A standardized approach to quantify SES was employed. Depressive symptoms were quantified using the Patient Health Questionnaire-9 (PHQ-9). Using multiple linear regression models, PHQ-9-scores were modeled as a function of age and sex, and (1a) total SES-Index score versus (1b) its three sub-dimension scores (education, occupational status, income). Models were compared on explained variance and goodness of fit. We determined risk ratios (RR, concerning a PHQ-9 sum score ≥ 10) based on (low, middle, high; 2a) SES-Index scores and (2b) the sub-dimension scores, with groups further differentiated by sex and age (45-64 versus 65+). We distinguished between the total SES-Index score and its three sub-dimension scores to identify relevant SES sub-dimensions in explaining PHQ-9-variability or risk of depression. Among all regression models (total explained variance 4-6%), income explained most variance, but performance of the SES-Index was comparable. Low versus high income groups showed the strongest differences in depressive trends in middle-aged females and males (RRs 3.57 and 4.91). In older age, this result was restricted to females (RR ≈ 2). Middle-aged males (versus females) showed stronger discrepancies in depressive trends pertaining to low versus high SES groups. In older age, the effect of SES was absent. Education was related to depressive trends only in middle-aged females and males. In an exploratory analysis, marital status and housing slightly increased model fit and explained variance while including somatic symptoms lead to substantial increases (R2 adj = 0.485). In line with previous research, the study provides evidence for SES playing a significant role in depressive symptoms in mid to old age, with income being robustly linked to depressive trends. Overall, the relationship between SES and depressive trends appears to be stronger in males than females and stronger in mid compared to old age.

Better Leverage the Role of Electricity in Supporting Common Prosperity

The electric power system has made a great contribution in the process of promoting common prosperity in China, but the current electricity regulatory system has weakened the full play of the function of supporting common prosperity in some aspects, including: rural residents have a heavy economic burden of electricity consumption, and some rural poor people still face “power poverty”; Underdeveloped areas subsidize developed areas in reverse, while developed areas often face the livelihood problems of power shortage; The contradiction of the existing electricity price cross-subsidy mechanism is becoming more and more prominent, and high-income groups enjoy more cross-subsidies. In view of the above problems, we put forward the following three suggestions: Exempt rural low-and middle-income residents from electricity charges by quota, and to support urban and rural residents to enjoy power public services more equally; Accelerate the marketization process of power generation resources and power pricing, and promote regional balanced development based on the comparative advantages of power resources; Add a higher-level residential electricity price ladder and promote cross-subsidies within residents to replace cross-subsidies between departments.

Access to DTP-Based Combination Vaccines in Asia-Pacific Countries between 2019 and 2022.

The Asia-Pacific countries are highly diverse in health and economic conditions that may impact vaccine access and uptake. Our study aimed to characterize patterns of health access to DTP-based combination vaccines in 10 countries from 2019 to 2022 using the IQVIA-MIDAS database. The availability, affordability, and accessibility were compared across countries by national health and economic performance indicators using Spearman's rank correlation coefficient. Our findings showed that the three aspects of access to DTP-based vaccines varied substantially in the Asia-Pacific region, with higher levels in countries with better health and economic performance. Affected by the COVID-19 pandemic, vaccine accessibility fluctuates significantly in lower-income countries, with DTP coverage rates falling by more than 14% in the Philippines and Indonesia between 2019 and 2021. For availability and affordability, Singapore and Malaysia from high-income groups were largely affected, which may be related to health expenditure as a percentage of gross domestic product (Coefficient = 0.39, p = 0.03). Our study indicates that greater attention needs to be paid to national health expenditure and routine immunization services to improve vaccine disparities and increase the robustness and resilience of the vaccine supply chain during public health emergencies.

Could information and communication technology (ICT) reduce carbon emissions? The role of trade openness and financial development

Information and communication technology (ICT) is one of the fastest growing new industries in the world. This study aims to understand the nonlinear impact of ICT on carbon emissions more systematically. To this end, a threshold panel regression model is developed based on panel data of 92 countries. ICT is the explanatory variable, carbon emission is the explained variable, and trade openness and financial development are the threshold variables. The results show that: (i) When taking trade openness as threshold variable, both low- and high-income group have passed the double threshold test, the negative regression coefficient of ICT and carbon emissions firstly decreases, and then turns into positive effect when crossing the second threshold value in low-income group. While in high-income group, this effect shows a sustained growing positive trend. (ii) Taking financial development as threshold variable, this negative effect firstly turns positive which then increases when passing the second threshold in low-income group. While in high-income group, the positive impact of ICT on CO2 shows a sustained growth which is similar to the situation when trade openness is taken as threshold variable. (iii) Income levels are set as a categorical variable, the impact of ICT on CO2 presents a "U" shape under the influence of financial development and trade openness. The "U"-shaped turning point occurs in the low-income band and when the level of trade development and financial development is low.

An Investigation of the Relationship Between Parents’ Socioeconomic Standards and their Children’s Online Safety; Perspective: Bangladesh

"The field of child-computer interaction has garnered significant interest from researchers worldwide. Nevertheless, the discourse around the protection of children’s digital safe, that includes privacy and security remains significantly underrepresented in both Bangladesh and the broader global south. In situations where a significant portion of senior and adult persons lack awareness regarding optimal strategies for effectively utilizing digital gadgets and tools, it is difficult to anticipate a higher level of proficiency among younger individuals. Privacy generally encompasses the capacity of individuals to exercise control over, get access to, and govern their personal data. In contrast, the security system serves to mitigate the risk of unauthorized access, data leakage, or cyber intrusions, therefore safeguarding the data from potential compromise. Previous studies have indicated that the responsibility for safeguarding the digital privacy and security of children lies with both parents and children themselves. Regrettably, a dearth of scholarly investigations exists within the domain, hindering the ability to systematically monitor and analyze the potential relationship between parental socioeconomic status and the privacy and safety of their offspring. This research aims to discover the correlation. This study employed semi-structured interviews with a sample of 48 parents and 42 children from diverse socioeconomic backgrounds, including high income, middle income, and low-income groups. The collected data were subjected to statistical analysis. The findings of this study indicate that children from high income families are more susceptible to online safety issues compared to their counterparts from low-income households. This vulnerability is attributed to factors such as the widespread availability of internet access and personal digital devices, greater purchasing power on online platforms, and a lack of parental monitoring. This study presents a limited number of recommendations for parents and children across various socioeconomic backgrounds in order to enhance the state of internet safety for children."

Analysing individuals' use of moped-sharing and their perception about future private car dependency

Moped-scooters are one of the latest services coming into the shared mobility ecosystem, which is why scientific contributions devoted to this actor are still scarce. This research explores two main questions. First, it analyses the determinants of the frequency of use of e-moped-sharing among adopters of these services. Second, it examines whether the use of e-moped-sharing may affect the individuals' perspective of the need to own a private vehicle in the future. To achieve this goal, we conducted a survey campaign in the four main cities of Spain (Madrid, Barcelona, Valencia and Seville) which gathered 3897 valid responses. This data was employed to build a Generalized Structural Equations Model that accounts for the influence of a variety of factors, including socio-economic characteristics, stated travel behaviour, and psychological preferences of the individuals. The results show that the frequency of use of electric shared-mopeds is higher among wealthier younger individuals and residents in the city centre. The modelling concludes that more frequent use of shared electric mopeds is negatively correlated with the belief that private vehicles will remain a necessity in the future. This effect seems to be more pronounced among high-income groups and those that combine e-moped-sharing with other shared services.

Postpartum Care by Midwives: Socioeconomic Status has a Strong Influence on the Amount of Care Received An Analysis with Routine Data from BARMER Health Insurance

Socio-economic situation is associated with inequalities in access to health care and health-related resources. This also applies to pregnancy, birth and the postpartum period. Compared to other European countries, Germany has very good care options for the postpartum period. It has an unique system of postpartum care, which comprises home visits by midwives for 12 weeks after birth and beyond in problem cases and thus has structurally good care options. So far, however, there are hardly any studies based on routine data that show which mothers receive homevisits in postpartum care and to what extent. The study population comprised 199,978 women insured with BARMER who gave birth to at least one child in the years 2017-2020. Some women were pregnant several times in this period of time. The services billed by freelance midwives for outreach midwifery care in the puerperium were considered for 227,088 births, taking into account the socioeconomic situation of the mothers. According to the definition of the German Institute for Economic Research, 26% of the mothers belonged to a low income group, 46% to a medium income group and 29% to a high income group. Similar to what was shown for midwifery care during pregnancy, large differences were also found with regard to postpartum care: While 90.5% of the women with a high income received home visits, only 83.5% of women with a medium income did so, and only 67.9% of women with a low income. The groups did not differ with regard to other characteristics such as rate of caesarean section, preterm births, twins, age or concomitant diseases to an extent that could explain the differences in care. Women who had received midwifery services in pregnancy were much more likely to receive home visits by a midwife in the postpartum period. Furthermore, there was a correlation with the density of midwives in the respective region. The results suggest that access to home-based postpartum care by freelance midwives is significantly limited for low-income women. In contrast to antenatal care, women in the postpartum period cannot switch to other service providers, as outreach postpartum care is a reserved activity of midwives. Women with low incomes thus receive less midwifery care, although they have a higher need for support (Eickhorst et al. 2016).

Prevalence of maternal depression and anxiety symptoms and associations with child mental health outcomes in rural Nepal.

This study describes the prevalence, associated factors and child mental health outcomes related to symptoms of maternal depression and anxiety within 5 years after childbirth in a rural district in Nepal. This association is not well-understood in rural, community-based settings in low- and middle-income countries (LMIC). A sample of 347 women with children under 5 years was recruited in September 2019 for a cross-sectional study in the rural Saptari district in Nepal. Multivariable logistic regression was used to investigate the association between maternal depressive or anxiety symptoms and children's experience and impact of emotional and behavioural difficulties. In total, 144 women (41.5%) had moderate or severe depression symptoms and 118 (34%) had anxiety symptoms. Mothers with a lower income were more likely to have anxiety symptoms than the highest income group (OR: 1.8, 95% CI: 1.1-3.0). An association existed between maternal depressive symptoms and the impact of emotional or behavioural difficulties in children (OR: 2.44, 95% CI: 1.02-5.84). In contrast, there was no association between maternal anxiety and child outcomes. Our findings suggest that the prevalence of probable maternal anxiety and depression symptoms was relatively high in this rural, low-resourced and community-based setting in Nepal. Maternal depressive symptoms were associated with the degree of impact on children's mental health post-infancy, emphasising the importance of improving maternal mental health in the early years of a child's life.

Ours to eat and own: assessing the feasibility of a cooperative meal-kit service to improve food access.

Although typically serving higher income and younger demographic groups, meal-kit subscription services have the potential to improve food availability and dietary quality in communities experiencing low food access due to systemic discrimination. This study describes the development and characteristics of a pilot community-led meal-kit service (SouthEats) and evaluates key implementation outcomes of adoption, acceptability, and feasibility among households experiencing less income. We utilised a mixed methods study design, including data from administrative records, customer surveys and worker interviews. Thematic qualitative analyses and descriptive quantitative analyses were conducted to illuminate the characteristics and extent the pilot meal-kit service was adopted, acceptable, and financially feasible among the target populations. The study took place in Washington DC, USA. Study participants included SouthEats consumers (n 35) and workers (n 3). During the pilot period, sixty-seven community members signed up for the meal-kit service, with 52 % making recurring purchases. Our results suggest that the meal-kit service is acceptable among people living in low food access areas. Our feasibility analysis indicates that, although not without challenges, the SouthEats model could be financially feasible. These preliminary insights can inform the scalability and potential replication of this service and provide foundational evidence for an approach that may be used to improve food access.

Oral COVID-19 Antiviral Uptake Among a Highly Vaccinated US Cohort of Adults With SARS-CoV-2 Infection Between December 2021 and October 2022.

We described the oral nirmatrelvir/ritonavir (NMV/r) and molnupiravir (MOV) uptake among a subgroup of highly vaccinated adults in a US national prospective cohort who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 12/2021 and 10/2022. We estimate antiviral uptake within 5 days of SARS-CoV-2 infection, as well as age- and gender-adjusted antiviral uptake prevalence ratios by antiviral eligibility (based on age and comorbidities), sociodemographic characteristics, and clinical characteristics including vaccination status and history of long coronavirus disease 2019 (COVID). NMV/r uptake was 13.6% (95% CI, 11.9%-15.2%) among 1594 participants, and MOV uptake was 1.4% (95% CI, 0.8%-2.1%) among 1398 participants. NMV/r uptake increased over time (1.9%; 95% CI, 1.0%-2.9%; between 12/2021 and 3/2022; 16.5%; 95% CI, 13.0%-20.0%; between 4/2022 and 7/2022; and 25.3%; 95% CI, 21.6%-29.0%; between 8/2022 and 10/2022). Participants age ≥65 and those who had comorbidities for severe COVID-19 had higher NMV/r uptake. There was lower NMV/r uptake among non-Hispanic Black participants (7.2%; 95% CI, 2.4%-12.0%; relative to other racial/ethnic groups) and among individuals in the lowest income groups (10.6%; 95% CI, 7.3%-13.8%; relative to higher income groups). Among a subset of 278 participants with SARS-CoV-2 infection after 12/2021 who also had a history of prior SARS-CoV-2 infection, those with (vs without) a history of long COVID reported greater NMV/r uptake (22.0% vs 7.9%; P = .001). Among those prescribed NMV/r (n = 216), 137 (63%; 95% CI, 57%-70%) reported that NMV/r was helpful for reducing COVID-19 symptoms. Despite proven effectiveness against severe outcomes, COVID-19 antiviral uptake remains low among those with SARS-CoV-2 infection in the United States. Further outreach to providers and patients to improve awareness of COVID-19 oral antivirals and indications is needed.

Costs of major depression covered / not covered in British Columbia, Canada

BackgroundMajor depressive disorder (MDD) is one of the world’s leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness.MethodsWe performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions.ResultsThere were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53–104 unless MDD was refractory to treatment ($125/week between week 12–52 and $101/week over weeks 53–104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached − 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII − 0.07 to 0.6).ConclusionsMDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.

Wage Differentials Among Reverse Migrants: Analyzing the Social Reproduction of Inequalities During the Post-COVID Recovery

Income inequalities that have traditionally been high in India, witnessed a widening of the wedge as the pandemic struck. Interestingly, this wedge widened further as the recovery began, those in high income groups reverted to their original income levels while those in low income groups were left struggling at decreased wages. This paper is an attempt to examine if the post pandemic economic recovery mirrored the existing pattern of inequalities amongst various social groups. The study is based on a case study of a small town in the Raebareli district of Uttar Pradesh, and the data is collected from a primary survey of the migrants who had returned back to their home town in the aftermath of pandemic. Hypothesis tested is that the rate of recovery from pandemic-induced income loss is consistent among similarly skilled workers, regardless of their social group affiliation.The results indicate that the loss of income is not uniform across categories, and that it is more severe in case of vulnerable groups. We argue that if there is no affirmative action, the inequalities will keep reproducing themselves and become more severe after every shock that the economy faces.

Disparities in Cancer Incidence across Income Levels in South Korea.

Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea. This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis. The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q. Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.

Before dinner: The health value of gaseous fuels

In this paper, we study the impact of gaseous fuels used for cooking on the middle-aged and elderly's health in China. By using 2011, 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), we find that gaseous fuel use reduces the probability of respiratory disease in middle-aged and elderly adults. Health effects are stronger for the people aged between 45 and 79, female, high-income, urban, and gas-importing province groups. The quantification of health benefits allows to find that from 2010 to 2018, the reduction in the number of respiratory illnesses due to gaseous fuel use ranges from 22.905 to 23.721 million people, resulting in treatment cost savings of between 9.29 and 14.47 billion RMB ($26.4 - $34.2 billion). The monetary valuation of indoor clean air according to self-rated health find that for each additional unit of indoor clean air, middle-aged and elderly adults are willing to pay a price of 4.5 RMB ($1.06). We provide new evidence of the considerable health and welfare effects of gaseous fuels.

Payout Phase of Defined Contribution Systems: the Case of Slovakia

The paper aims to assess various aspects concerning the payment phase of the old-age pension scheme, the socalled second pillar of the pension system in Slovakia. However, the conclusions may also be useful for other pension systems. Using the Lee-Carter model and standard actuarial methods, we conclude that the second pillar is advantageous for the high-income groups or in case of high performance of pension funds. We also address the issue of deferring the purchase of a lifetime annuity. Deferral can be beneficial when the yield of the pension fund exceeds a certain threshold value. This threshold usually raises with increasing age. We argue that the temporary pension is a disadvantageous product and its recent cancellation is correct. The main contribution of the paper subsists in a three-state model of long-term care insurance, using which we calculate corresponding replacement rates. Combined with a lifetime annuity, long-term care insurance can be beneficial.

Linkage, sectoral productivity, and employment spread

This study demonstrates how differences in the prefectural input–output (IO) multiplier and sectoral total factor productivity (TFP) translate into aggregate income differences across prefectures within a country. Furthermore, this study investigates the job creation generated from the IO multiplier and TFP relationship and considers expenditure in the high-income group.Our results show that aggregate multipliers substantially amplify average sectoral TFP by propagating through the IO network. However, as log TFP levels and multipliers are negatively correlated, sectors with high multipliers have below-average productivity levels, which reduces income per worker because key inputs to downstream sectors are expensive. The overall effect of the IO structure is dampened relative to the aggregate multiplier effect. For example, the commerce sector has large multipliers in many prefectures and is thus amplified through the IO network, but their TFPs are lower and do not significantly contribute to the increase in income. The TFPs of the information and communication equipment sector in certain prefectures are higher than those in Tokyo, but the benefits are not amplified well within the prefecture because their multipliers are low.Furthermore, sectors with high productivity generate fewer jobs than other sectors do. The sectors with a large influence on job creation in other sectors are not amplified well through the IO network because of the small multiplier. From the expenditure viewpoint, the high-income group increases their education consumption exponentially, but the multiplier is low and not widespread within the prefecture. The construction sector has a significant influence on job creation in other sectors. However, their economic activities do not spread widely within a prefecture, and the high-income group does not increase housing consumption in proportion to their income. Residents in prefectures with high multipliers tend to spend more money outside their residential prefectures, such as online shopping. Thus, expenditure outside residential prefectures reduces the effect of the multiplier that amplifies the average sectoral TFP and the difference in income across prefectures.This study contributes to the existing literature by providing an explicit understanding of these relationships. Our findings make people realize that promoting the industry alone is not enough to increase income and generate highly productive jobs. A spillover perspective is required.