Highest Income Quintile Research Articles

Socioeconomic differences in mortality amenable to health care among Finnish adults 1992-2003: 12 year follow up using individual level linked population register data

BackgroundFinland decentralised its universal healthcare system and introduced market reforms in the 1990s. Despite a commitment to equity, previous studies have identified persistent socio-economic inequities in healthcare, with patterns of service use that are more pro-rich than in most other European countries. To examine whether similar socio-economic patterning existed for mortality amenable to intervention in primary or specialist care, we investigated trends in amenable mortality by income group from 1992-2003.MethodsWe analysed trends in all cause, total disease and mortality amenable to health care using individual level data from the National Causes of Death Register for those aged 25 to 74 years in 1992-2003. These data were linked to sociodemographic data for 1990-2002 from population registers using unique personal identifiers. We examined trends in causes of death amenable to intervention in primary or specialist healthcare by income quintiles.ResultsBetween 1992 and 2003, amenable mortality fell from 93 to 64 per 100,000 in men and 74 to 54 per 100,000 in women, an average annual decrease in amenable mortality of 3.6% and 3.1% respectively. Over this period, all cause mortality declined less, by 2.8% in men and 2.5% in women. By 2002-2003, amenable mortality among men in the highest income group had halved, but the socioeconomic gradient had increased as amenable mortality reduced at a significantly slower rate for men and women in the lowest income quintile. Compared to men and women in the highest income quintile, the risk ratio for mortality amenable to primary care had increased to 14.0 and 20.5 respectively, and to 8.8 and 9.36 for mortality amenable to specialist care.ConclusionsOur findings demonstrate an increasing socioeconomic gradient in mortality amenable to intervention in primary and specialist care. This is consistent with the existing evidence of inequity in healthcare use in Finland and provides supporting evidence of changes in the socioeconomic gradient in health service use and in important outcomes. The potential adverse effect of healthcare reform on timely access to effective care for people on low incomes provides a plausible explanation that deserves further attention.

History, haldanes and health inequities: exploring phenotypic changes in body size by generation and income level in the US-born White and Black non-Hispanic populations 1959-1962 to 2005-2008

Most public health literature on trends in population health and health inequities pertains to observed or targeted changes in rates or proportions per year or decade. We explore, in novel analyses, whether additional insight can be gained by using the 'haldane', a metric developed by evolutionary biologists to measure change in traits in standard deviations per generation, thereby enabling meaningful comparisons across species and time periods. We analysed the phenotypic embodied traits of body height, weight and body mass index of US-born White and Black non-Hispanic adults ages 20 to 44 as measured in six large nationally representative population samples spanning from the 1959-1962 National Health Examination Survey I to the 2005-2008 National Health and Nutrition Examination Survey. Setting the former as baseline, we computed the haldane for each outcome for each racial/ethnic group for each survey, overall and stratified by family income quintile. For height, high rates of phenotypic change (haldane ≥ 0.3) occurred chiefly between 1960 and 1980, especially for the Black population in the higher income quintiles. By contrast, for weight, high rates of phenotypic change became evident for both the White and Black populations in the late 1980s and increased thereafter; for body mass index, the shift to high rates of change started in both groups in the late 1990s, especially in the middle income quintiles. Our results support use of the haldane as a supplemental metric to place changes in population health and health inequities in a larger biological and historical context.

A welfare measure of consumer vulnerability to rising prices of food imports in the UAE

The recent and expected continuing rise in food prices has re-ignited concern and discussion in the United Arab Emirates about the country’s vulnerability to food supply shocks. Defining vulnerability as the compensating variation relative to household income, we find that although UAE households in the lowest income quintile spend on food on average less than a quarter of what households in the highest income quintile spend, the former are 3.5 times more vulnerable to rising prices of food imports than the latter.

Promoting Wealth Building Through Homeownership

Current tax policies, while commonly thought to promote homeownership, have generally left low-income homeowners behind other homeowners. Using a number of simplifying assumptions, our estimates of lifetime homeowner tax subsidies suggest that the average homeowner in the lowest-income quintile may receive cumulative tax subsidies that are roughly one-thirteenth the size of those received by someone in the highest-income quintile. From an asset- and wealth-building perspective, the tax system thus places low-income households at a very large disadvantage - both in their quest to become homeowners and in what happens after they achieve homeownership status. About the Authors: Kenneth Spong is in the Banking Research Department at the Federal Reserve Bank of Kansas City. Spong has been with the Federal Reserve since 1973 and is engaged in research on a variety of topics related to the regulation, supervision, and performance of banks and other financial institutions. This research includes: the ownership and management structure of banks and the effect on bank performance, industrial loan companies and the public policy issues, small business lending, and the differential impact on low- and high-income households and neighborhoods from the tax deductibility of mortgage interest and property taxes. This research has been published in a wide variety of Federal Reserve, academic and banking trade publications. In addition, Spong has written a book on bank regulation - Banking Regulation: Its Purposes, Implementation, and Effects - which is now in its fifth edition. Ken Spong has a MA in economics from the University of Chicago and a BA in mathematics and economics from the University of Kansas. Kelly D. Edmiston is a Senior Economist in the Regional, Public, and Community Affairs Division of the Federal Reserve Bank of Kansas City. There he conducts research on issues involving regional economic growth, economic development, community development, consumer finance, and public finance. His research has been published in several leading economics and policy journals, and he has presented his research findings at numerous national conferences and professional meetings. Prior to joining the Federal Reserve Bank of Kansas City, Kelly was Assistant Professor of Economics and Senior Associate at the Fiscal Research and International Studies Centers at the Andrew Young School of Policy Studies at Georgia State University and served as a consultant for the World Bank. He holds BA and PhD degrees from the University of Tennessee.

Influences on infant feeding decisions of first-time mothers in five European countries

Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours. First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007-2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests. In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P<0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P=0.002), and a tendency to introduce foods other than milk later (P=0.079) than mothers relying most on personal or professional contacts. Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups.

The role of care home fees in the public costs and distributional effects of potential reforms to care home funding for older people in England

In England, Local Authorities (LAs) contribute to the care home fees of two-thirds of care home residents aged 65+ who pass a means test. LAs typically pay fees below those faced by residents excluded from state support. Most proposals for reform of the means test would increase the proportion of residents entitled to state support. If care homes receive the LA fee for more residents, they might increase fees for any remaining self-funders. Alternatively, the LA fee might have to rise. We use two linked simulation models to examine how alternative assumptions on post-reform fees affect projected public costs and financial gains to residents of three potential reforms to the means test. Raising the LA fee rate to maintain income per resident would increase the projected public cost of the reforms by between 22% and 72% in the base year. It would reduce the average gain to care home residents by between 8% and 12%. Raising post-reform fees for remaining self-funders or requiring pre-reform self-funders to meet the difference between the LA and self-funder fees, reduces the gains to residents by 28-37%. For one reform, residents in the highest income quintile would face losses if the self-funder fee rises.

Abstract P155: Low Socioeconomic Status Relates to Short-term Mortality Risk After Acute Myocardial Infarction, Especially in Men: Results From a Nationwide Study

Introduction Previous studies show poorer short-term prognosis after an acute myocardial infarction (AMI) in subjects with a low socioeconomic status (SES). Yet, the magnitude of these relations may differ by age and sex. Data on these issues are however scarce. Methods A nationwide Dutch cohort of first AMI patients between January 1 st 1998 and December 31 st 2007 was identified through linkage of national registers. SES was defined as the standardized disposable income on household level in 1997. For every SES quintile, age- and sex- specific short-term mortality rates were quantified. Logistic regression models were used to estimate differences between SES quintiles in out-of-hospital mortality and 28-day case-fatality. Results We identified 70.368 first AMI patients with income data available, of which 55.860 were men and 14.508 were women. There were strong inverse associations between SES and both short-term mortality outcomes when comparing the lowest with the highest income quintile (out-of-hospital mortality: Odds Ratio (OR) 1.26; 95% Confidence Interval (95% CI) 1.18–1.34), 28-day case-fatality: OR 1.26; 95% CI 1.15–1.37). For men graded relations were found across quintiles of SES, whereas for women only differences between the lowest and the highest quintile were seen. These relations remained consistent across all age categories, except for women below 55 years of age. Conclusion The results from our nationwide study show an increased risk of short-term mortality after a first AMI in subjects with a low SES of all ages, which is most pronounced in men.

Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary

BackgroundAt the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services.ObjectiveThe objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services.MethodsWe use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005–2008): before, during and after the implementation of the health care reforms.ResultsWe find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of −0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6–7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index −0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78–85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index −0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from −0.20/-0.18 to −0.12.)ConclusionsMore attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing.

Social, cultural and economical determinants of diabetes mellitus in Kalutara district, Sri Lanka: a cross sectional descriptive study

IntroductionSri Lanka is a country that is expected to face a high burden of diabetes mellitus (DM). There is a paucity of data on social and demographic determinants of DM, especially in the plantation sector.AimsTo describe social and economic correlates and inequalities of DM in Kalutara District.MethodsA cross sectional descriptive study was carried out among adults over the age of 35 years. A sample of 1300 individuals was selected using stratified random cluster sampling method from 65 Grama Niladari Divisions (GND), which were representative of urban, rural and plantation sectors. Twenty households were randomly selected from each division and one adult was randomly selected from each household. Data were collected using a pre-tested questionnaire. Fasting plasma blood sugar of ≥126mg/dl was used to define DM. Significance of prevalence of diseases and risk factors across different socio-economic strata were determined by chi square test for trend.ResultsOf 1234 adults who were screened (628 males), 202 (14.7%) had DM. Higher DM proportions (16.1%) were seen in the highest income quintile and in those educated up to Advanced Levels (AL) and above (17.3%). Prevalence in the urban, rural and plantation sectors were 23.6%, 15.5% and 8.5% respectively. Prevalence among Sinhalese, Tamils and Muslims were 14.4%, 29.0% and 20.0% respectively. There was a gradient in prevalence according to the unsatisfactory basic needs index of the GND with the highest proportion (20.7%) observed in the richest GND. The highest social status quintile demonstrated the highest proportion (17.4%) with diabetes mellitus.ConclusionThere is a higher prevalence of diabetes mellitus in the more affluent and educated segments of society. There is also a higher prevalence among urban compared to rural and estates. Sri Lanka is in an early stage of the epidemic where the wealthy people are at a higher risk of DM.

Socioeconomic status and elderly adult mortality inrural Ghana: evidence from the Navrongo Dss.

Elderly adult health and issues affecting them in Africa have not been adequately addressed by research. This study explored the relationship between socioeconomic status and elderly adult mortality in the Kassena-Nnakana District (KND) of northern Ghana using data from the Navrongo Health and Demographic Surveillance System (HDSS) in 2005-2006. 15,030 adults aged 60 years and over were included in the study, of whom 1315 died. Using Cox proportional hazards regression, we found that socioeconomic status (SES) was not a determinant of elderly mortality. Compared to the lowest SES quintile, the adjusted hazards ratios were: 0.94 (95%CI: 0.79–1.12) for second quintile, 0.91 (95%CI: 0.76– 1.08) for third quintile, 0.89 (95%CI: 0.75–1.07) for fourth quintile and 1.02 (95%CI: 0.86–1.21) for the highest income quintile. However, living without a spouse [HR=1.98, 95%CI: 1.74–2.25], being male [HR=1.80, 95%CI: 1.59– 2.04] and age [HR=1.05, 95%CI: 1.04–1.05] were significant factors for elderly adult mortality. This shows that companionship and social/family ties are of more importance than household socioeconomic status in determining elderly adult mortality. Efforts should therefore be made to introduce programs and policies to support the elderly, especially those living alone.

Diabetes screening with hemoglobin A1c prior to a change in guideline recommendations: prevalence and patient characteristics.

BackgroundIn January 2010, the American Diabetes Association recommended the use of hemoglobin A1c (Hgb A1c) to screen and diagnose diabetes. This study explored the prevalence and clinical context of Hgb A1c tests done for non-diabetic primary care patients for the three years prior to the release of the new guidelines. We sought to determine the provision of tests in non-diabetic patients age 19 or over, patients age 45 and over (eligible for routine diabetes screening), the annual change in the rate of this screening test, and the patient characteristics associated with the provision of Hgb A1c screening.MethodsWe conducted a retrospective study using data routinely collected in Electronic Medical Records. The participants were thirteen community-based family physicians in Toronto, Ontario. We calculated the proportion of non diabetic patients who had at least one Hbg A1c done in three years. We used logistic generalized estimating equation with year treated as a continuous variable to test for a non-zero slope in yearly Hbg A1c provision. We modelled screening using multivariable logistic regression.ResultsThere were 11,792 non-diabetic adults. Of these, 1,678 (14.2%; 95%CI 13.6%-14.9%) had at least one Hgb A1c test done; this was higher for patients 45 years of age or older (20.2%; 95% CI 19.3% - 21.2%). The proportion of non-diabetic patients with an A1c test increased from 5.2% in 2007 to 8.8% in 2009 (p < 0.0001 for presence of slope). Factors associated with significantly greater adjusted odds ratios of having the test done included increasing diastolic blood pressure, increasing fasting glucose, increasing body mass index, increasing age, as well as male gender and presence of hypertension, but not smoking status or LDL cholesterol. Patients living in the highest income quintile neighbourhoods had significantly lower odds ratios of having this test done than those in the lowest quintile (p < 0.001).ConclusionsA large and increasing proportion of the non-diabetic patients we studied have had an Hgb A1c for screening prior to guidelines recommending the test for this purpose. Several risk factors for cardiovascular disease or diabetes were associated with the provision of the Hgb A1c. Early uptake of the test may represent appropriate utilization.

Assessing effects of alternative food subsidy reform in Iran

The food subsidy programs and its long-term effects have emerged as major developmental issues in many developing countries. The programs might increase social welfare to individuals but they pose both an unnecessary burden on the public budget and are economically inefficient because their benefits are often not received by the poor. Furthermore, due to improper targeting, a large part of food subsidies is “leaked” to high-income people. This study aims to investigate the effects of alternative food subsidy reforms on households’ welfare and government expenditure in Iran. For this purpose, computable general equilibrium (CGE) model was applied. The scenarios consist of, gradual omission of subsidy during 3 and 5 years period and instant complete omission of food subsidy. The results indicated that in these polices government expenditure decreases by 5.8%, and resulting to decrease in import and export of agricultural and non-agricultural goods, but decreases in import exceeds the export reduction. In addition, results showed that the welfare of households’ decreases for all scenarios, since decreases in urban households is greater than as rural households. Furthermore, between quintiles groups, decreases among welfare in high income quintiles are greater than the lower income ones groups. Based on the result, it is recommended to implement the food subsidy reform in 5 years period and targeted to lower income segments of the society. The most important policy implication of this study is the reallocation of food subsidy gradually among lower income quintiles groups.

Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation

Objective To understand the association between neighborhood and individual characteristics in determining whether or not bystanders perform cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest (OHCA). Methods Between October 1, 2005 to November 30, 2008, 1108 OHCA cases from Fulton County (Atlanta), GA, were eligible for bystander CPR. We conducted multi-level non-linear regression analysis and derived Empirical Bayes estimates for bystander CPR by census tract. Results 279 (25%) cardiac arrest victims received bystander CPR. Provision of bystander CPR was significantly more common in witnessed events (odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21–2.22, p < 0.001) and those that occurred in public locations (OR 1.67; 95% CI 1.16–2.40, p < 0.001). Other individual-level characteristics were not significantly associated with bystander CPR. Cardiac arrests in the census tracts that rank in the highest income quintile, as compared to the lowest income quintile were much more likely (OR 4.98; 95% CI 1.65–15.04) to receive bystander CPR. Conclusion Cardiac arrest victims in the highest income census tracts were much more likely to receive bystander CPR than in the lowest income census tracts, even after controlling for individual and arrest characteristics. Low-income neighborhoods may be particularly appropriate targets for community-based CPR training and awareness efforts.

Influences of income and employment on psychological distress and depression treatment in Japanese adults

Psychological distress is a health issue of critical importance, especially in people of working age in developed countries, including Japan. This study examined the relationships of income and employment arrangement with psychological distress and treatment of depression in a national sample of Japanese adults. Data for 10,959 men and 11,655 women 25-59 years of age, obtained from the Comprehensive Survey of the Living Conditions of People on Health and Welfare in 2007, were examined. Health outcomes were psychological distress measured by the Japanese version of the K6, subjective complaints and medical treatment of depression. Explanatory variables included marital status, employment arrangement, and household income. The relationships between health outcomes and explanatory variables were examined using multiple logistic regression analyses. Lower income and unemployment were associated with a higher prevalence of psychological distress and treatment of depression. The association between psychological distress and income showed a threshold: the lowest income quintile had an especially high prevalence, while other quintiles had similar prevalences. The prevalence of depression treatment in those with psychological distress was significantly lower in the highest income quintile than in all the other income groups, and the prevalence was also significantly lower in employed than in unemployed respondents. This study showed clear relationships of lower income and unemployment with psychological distress and depression treatment. It has been suggested that people with higher socioeconomic status and full-time work may be reluctant to consult professionals and receive medical treatment, despite their psychological distress. Comprehensive mental health interventions are required to prevent psychological distress in all socioeconomic strata of the population.

Prevalence of cardiovascular disease risk factors among UK commercial pilots

This study is one of the largest ever completed to examine the prevalence of cardiovascular disease (CVD) risk factors among commercial aircrew. A retrospective cross-sectional study comparing prevalence of CVD risk factors age, body mass index (BMI), overweight and obesity, current smoking status, hypertension, and diabetes among commercial aircrew and the UK general population. A total of 14,379 subject records were eligible for the study. The age-sex group mean BMI was significantly lower in almost all pilot age groups compared to the general population. Overweight age-sex group prevalence was significantly higher in the <25, 35-44, 45-54, 55-64 age groups for male pilots, and lower for female pilots in the 25-34 and 45-54 age groups. Male and female pilots had significantly lower age-sex-group prevalence of obesity and current smoking compared to the general population. For hypertension, the male <25 and 35-44 year age groups had significantly higher prevalence, and the 45-54 and 55-64 year age groups had significantly lower prevalence than the general population. Age-standardised mean BMI and prevalence of overweight and hypertension were not significantly different from the highest income quintile of the general population. Age-standardised obesity and current smoking prevalence were significantly lower in pilots compared to the highest socio-economic quintile of the general population. Even when comparisons were made with the highest income quintile of the general population to control for socio-economic status, pilots had a significantly lower prevalence of obesity and smoking. This finding is consistent with a strong 'healthy worker effect'.

Income, relational goods and happiness

Our empirical analysis on the determinants of self-declared happiness on more than 100 000 individuals from representative samples in 82 world countries does not reject the hypothesis that the time spent for relationships has a significant and positive impact on happiness. This basic nexus helps to understand new unexplored paths in the so-called ‘happiness-income paradox’. To illustrate them we show that personal income has two main effects on happiness. The first is a positive effect which depends on individual's ranking within domestic income quintiles. The second is determined by the relationship between income and relational goods. In principle, more productive individuals may substitute (if the income effect prevails over the substitution effect) worked hours with the nonworking time made free for enjoying relationships, when they have strong preferences for them. The problem is that these individuals tend to have ties with their income class peers who share with them a high opportunity cost for the time spent for relationships. Hence, a coordination failure may reduce the joint investment in relational goods (local public goods which need to be co-produced in order to be enjoyed together) and, through this effect, individuals in the highest income quintiles may end up with poorer relational goods. The indirect impact of personal income on happiness through this channel is therefore expected to be negative.

Global income-related inequalities in HIV testing

Voluntary counseling and testing (VCT) is an important prevention initiative in reducing HIV/AIDS transmission. Despite current global prevention efforts, many low- and middle-income countries continue reporting low VCT levels. Little is known about the association of within- and between-country socioeconomic inequalities and VCT. Based on the 'inverse equity hypothesis,' this study examines the degree to which low socioeconomic groups in developing countries are disadvantaged in VCT. Using recently released data from the 2002 to 2003 World Health Survey (WHS) for 106 705 individuals in 49 countries, this study used multilevel logistic regression to examine the association of individual- and national-level factors with VCT, and whether national economic development moderated the association between individual income and VCT. Individual income was based on country-specific income quintiles. National economic development was based on national gross domestic product per capita (GDP/c). Effect modification was evaluated with the likelihood ratio test (G(2)). Individuals eligible for the VCT question of the WHS were adults between the ages of 18-49 years; women who had given birth in the last 2 years were excluded from this question. VCT was more likely among higher income quintiles and in countries with higher GDP/c. GDP/c moderated the association between individual income and VCT whereby relative income differences in VCT were greater in countries with lower GDP/c (G(2)= 9.21; P= 0.002). Individual socio-demographic characteristics were also associated with the likelihood of a person having VCT. Relative socioeconomic inequalities in VCT coverage appear to decline when higher SES groups reach a certain level of coverage. These findings suggest that changes to international VCT programs may be necessary to moderate the relative VCT differences between high- and low-income individuals in lower GDP/c nations.

Income inequities in end-of-life health care spending in British Columbia, Canada: A cross-sectional analysis, 2004-2006

BackgroundThis study aimed to measure the income-related inequalities and inequities - the inequalities that remain after accounting for differences in health need - in expenditure on fully publicly covered (hospital and ambulatory) and partially publicly covered (prescription drugs) services for those in their last year of life in the province of British Columbia (B.C.), Canada. We focused on a decedent population for three reasons: to minimize unmeasured need differences among our cohort and therefore isolate income effects; to explore inequities for a high-spending window of health care use; and, because previous studies have found conflicting relationships between income and decedent health care spending, to further quantify this relationship.MethodsWe used linked administrative databases to describe spending on health services by income for all 58,820 deaths of B.C. residents 65 and older from 2004 to 2006. Regression analyses examined the association between income and health care spending, adjusting for age, sex, health status, cause of death, and other relevant factors. We then used concentration indexes to measure both inequalities and inequities separately for three key types of services. Analyses were also run separately for men and women.ResultsOn average, per capita expenditure on acute health care in the last year of life was $20,705 (CDN2006). In need-adjusted regression analyses, we found decedents in the highest income quintile had 11% lower hospital expenditures, 15% higher specialist expenditures and 23% higher prescription drug expenditures than decedents in the lowest income quintile. Concentration index analysis suggested that spending for all types of care was concentrated among those with higher income before adjusting for need. Need-adjusted equity results mirrored regression findings and suggested patterns of inequities that were more pronounced among male decedents than females.ConclusionsDespite the universal health care system in B.C., we found patterns of inequity in spending by income in the last year of life, even for fully publicly covered services. These results, parallel to relationships between income and spending from previous studies of the B.C. population, suggest persistent income-related inequities in the health care Canadians receive throughout their lives.

Neighborhood social capital and individual health

Neighborhood social capital is increasingly considered to be an important determinant of an individual's health. Using data from the Netherlands we investigate the influence of neighborhood social capital on an individual's self-reported health, while accounting for other conditions of health on both the level of the neighborhood and the individual. We use national representative data ('The Housing and Living Survey', 2006) on the Netherlands with 61,235 respondents in 3273 neighborhoods. The cross-sectional data were combined with information provided by Statistics Netherlands on neighborhoods, i.e., the percentage of residents in the highest income quintile per neighborhood and the municipality's degree of urbanity. The association of neighborhood social capital with individual health was assessed by multilevel logistic regression analysis. Our results show that neighborhood social capital is positively associated with health. Interestingly, residents in urban neighborhoods benefit particularly from their neighborhood social capital.

Socioeconomic status and risk of hospitalization among individuals with cystic fibrosis in Ontario, Canada

Socioeconomic status (SES) is a strong predictor of outcomes in cystic fibrosis (CF); however, there are no published studies evaluating this relationship in Canadians with CF. The objective of this study was to assess the effect of SES on annual hospitalization rates in a large cohort of pediatric and adult CF subjects under a universal health care system. A population-based longitudinal study was completed in Ontario from 1993 to 2002 using a comprehensive CF registry containing patient-level data, linked to provincial health care administrative databases. Income quintiles were derived at the neighborhood level using postal code information and Statistics Canada census data. The effect of income quintile on the annual hospitalization rate for respiratory-related illness was estimated by Poisson regression using generalized estimating equations, and was expressed as a rate ratio (RR) and 95% confidence interval (CI). The analysis was adjusted for age, sex, lung function, nutritional status, the presence of diabetes, area of residence, and distance between the subject's residence and the reporting CF centre. A total of 1,174 participants over the age of 6 years contributed 8,444 patient-years of data. No statistically significant differences in annual hospitalization rates for respiratory-related causes were found between the lowest and highest income quintiles (adjusted RR 1.17 [95% CI 0.96-1.43]). The effect of income quintile remained non-significant across a majority of markers of CF disease severity and across a range of subgroups. After adjusting for important covariates, no SES-disparities in hospitalization rates were found in a large Canadian pediatric and adult CF cohort. It may be the distinctive combination of universal health care, a national network of specialty CF clinics, and drug and travel coverage available in Ontario that results in similar hospitalization rates regardless of SES.