Highest Income Quintile Research Articles

Parental income as a marker for socioeconomic position during childhood and later risk of developing a secondary care-diagnosed mental disorder examined across the full diagnostic spectrum: a national cohort study

BackgroundLinks between parental socioeconomic position during childhood and subsequent risks of developing mental disorders have rarely been examined across the diagnostic spectrum. We conducted a comprehensive analysis of parental income level, including income mobility, during childhood and risks for developing mental disorders diagnosed in secondary care in young adulthood.MethodsNational cohort study of persons born in Denmark 1980–2000 (N = 1,051,265). Parental income was measured during birth year and at ages 5, 10 and 15. Follow-up began from 15th birthday until mental disorder diagnosis or 31 December 2016, whichever occurred first. Hazard ratios and cumulative incidence were estimated.ResultsA quarter (25.2%; 95% CI 24.8–25.6%) of children born in the lowest income quintile families will have a secondary care-diagnosed mental disorder by age 37, versus 13.5% (13.2–13.9%) of those born in the highest income quintile. Longer time spent living in low-income families was associated with higher risks of developing mental disorders. Associations were strongest for substance misuse and personality disorders and weaker for mood disorders and anxiety/somatoform disorders. An exception was eating disorders, with low parental income being associated with attenuated risk. For all diagnostic categories examined except for eating disorders, downward socioeconomic mobility was linked with higher subsequent risk and upward socioeconomic mobility with lower subsequent risk of developing mental disorders.ConclusionsExcept for eating disorders, low parental income during childhood is associated with subsequent increased risk of mental disorders diagnosed in secondary care across the diagnostic spectrum. Early interventions to mitigate the disadvantages linked with low income, and better opportunities for upward socioeconomic mobility could reduce social and mental health inequalities.

Social Gain or Social Pain: Subjective Socio-economic Status, Income and Attitudes towards Social Relations

Social pain is usually defined as the experience of pain because of interpersonal rejection or loss. The aim ofthis study was to find out the peculiarities of attitudes towards social relations in different groups of incomeand perceived socio-economic status in a representative sample of Lithuanian population (n=1001). We havefound that mean ranks in the lowest-income quintile, agreeing that “my relationships are supportive andrewarding”, were almost twice lower than in the highest-income quintile. A similar tendency was observedwith the statements “I actively contribute to the happiness and well-being of others” and “People respectme”. Mean ranks in the subjectively poorest group regarding perceived respect from people were almostthree times lower than in the subjectively rich group. It appears that having low income and low subjectivesocio-economic status may harm psychological wellbeing. Our study raises concern regarding societalwellbeing: we suggest that in order to achieve the prosperity of society, it is necessary to reduce socioeconomicinequalities and through various programs and projects strengthen people’s ability to establish andmaintain supportive, compassionate social contacts.

Income inequalities in the risk of potentially avoidable hospitaliation and readmission for chronic obstructive pulmonary disease: a population data linkage analysis.

Hospitalizations for ambulatory care sensitive conditions, of which chronic obstructive pulmonary disease (COPD) is among the most common, represent an indirect measure of the healthcare system to manage chronic disease. Research has pointed to disparities in various COPD-related outcomes between persons of lower versus higher income; however, few studies have examined the influence of patients' social context on potentially avoidable COPD admissions. The research explores the use of linked population census and administrative health data to assess the influence of income inequalities on the risk of hospitalization and rehospitalization for COPD among Canadian adults. This analysis utilizes data from the 2006 Census linked longitudinally to the 2006/07-2008/09 Discharge Abstract Database. Multiple logistic regressions were conducted to assess the independent influence of income inequality on the risks of hospitalization and of six-month readmission due to COPD among the population aged 30-69, controlling for age, sex, education and other sociodemographic characteristics. Compared with adults in the most affluent income quintile, the adjusted odds of COPD hospitalization were significantly greater in the 4th highest income quintile (OR: 1.38; 95%CI: 1.30-1.47), and peaked for those in the least affluent quintile (OR: 2.92; 95%CI: 2.77-3.09). Among individuals who had been hospitalized at least once for COPD in the study period, and compared with the most affluent group, the adjusted odds of readmission were highest in the least affluent group (OR: 1.39; 95%CI: 1.22-1.58). Despite Canada's system of universal coverage for physician and hospital care, a clear income gradient in the risk of being hospitalized and, to some extent, rehospitalized for COPD, is found. Income inequalities may be contributing to excess hospitalizations, reinforcing the importance of integrating social and economic issues in primary care to meet the ambulatory needs of this population.

Income inequalities in the risk of potentially avoidable hospitalisation for chronic obstructive pulmonary disease

IntroductionHospitalizations for ambulatory care sensitive conditions, of which chronic obstructive pulmonary disease (COPD) is among the most common, represent an indirect measure of the healthcare system to manage chronic disease. Research has pointed to disparities in various COPD-related outcomes between persons of lower versus higher income; however, few studies have examined the influence of patients’ social context on potentially avoidable COPD admissions.ObjectiveThe research explores the use of linked population census and administrative health data to assess the influence of income inequalities on the risk of hospitalization and rehospitalization for COPD among Canadian adults.MethodsThis analysis utilizes data from the 2006 Census linked longitudinally to the 2006/07-2008/09 Discharge Database. Multiple logistic regressions were conducted to assess the independent influence of income inequality on the risks of hospitalization and of six-month readmission due to COPD among the population aged 30-69, controlling for age, sex, education and other sociodemographic characteristics.ResultsCompared with adults in the most affluent income quintile, the adjusted odds of COPD hospitalization were significantly greater in the 4th highest income quintile (OR: 1.38; 95%CI: 1.30–1.47), and peaked for those in the least affluent quintile (OR: 2.92; 95%CI: 2.77–3.09). Among individuals who had been hospitalized at least once for COPD in the study period, and compared with the most affluent group, the adjusted odds of readmission were highest in the least affluent group (OR: 1.39; 95%CI: 1.22–1.58).ConclusionsDespite Canada’s system of universal coverage for physician and hospital care, a clear income gradient in the risk of being hospitalized and, to some extent, rehospitalized for COPD, is found. Income inequalities may be contributing to excess hospitalizations, reinforcing the importance of integrating social and economic issues in primary care to meet the ambulatory needs of this population.

Socioeconomic Gradients in Mortality Following HF Hospitalization in a Country With Universal Health Care Coverage

ObjectivesThis study explored the association between socioeconomic position (SEP) and long-term mortality following first heart failure (HF) hospitalization. BackgroundIt is not clear to what extent education and income—individually or combined—influence mortality among patients with HF. MethodsThis study included 49,895 patients, age 35+ years, with a first HF hospitalization in Norway during 2000 to 2014 and followed them until death or December 31, 2014. The association between education, income, and mortality was explored using Cox regression models, stratified by sex and age group (35 to 69 years and 70+ years). ResultsCompared with patients with primary education, those with tertiary education had lower mortality (adjusted hazard ratio [HR]: 0.89; 95% confidence interval [CI]: 0.78 to 0.99 in younger men; HR: 0.57; 95% CI: 0.43 to 0.75 in younger women; HR: 0.90; 95% CI: 0.84 to 0.97 in older men, and HR: 0.87; 95% CI: 0.81 to 0.93 in older women). After adjusting for educational differences, younger and older men and younger women in the highest income quintile had lower mortality compared with those in the lowest income quintile (HR: 0.63; 95% CI: 0.55 to 0.72; HR: 0.78; 95% CI: 0.63 to 0.96, and HR: 0.91; 95% CI: 0.86 to 0.97, respectively). The association between income and mortality was almost linear. No association between income and mortality was observed in older women. ConclusionsDespite the well-organized universal health care system in Norway, education and income were independently associated with mortality in patients with HF in a clear sex- and age group-specific pattern.

UNEQUAL EXCHANGE RATE PASS-THROUGH ACROSS INCOME GROUPS

Exchange rate pass-through (ERPT) into prices and into income loss are shown to be enough to calculate ERPT into welfare loss using implications of a simple model. These ERPT measures are estimated at the good level using a unique micro-price data set from Turkey, and they are combined with income-group-specific expenditure shares at the good level to obtain aggregate-level ERPT measures for alternative income groups. An exchange rate shock resulting in a real depreciation of 1% is shown to decrease welfare by about 0.80% for the average-income consumer, while this estimate ranges between 0.73% and 0.83% for consumers in the lowest- and highest-income quintiles, respectively, suggesting evidence for redistributive effects of an exchange rate shock. Using micro prices has further resulted in showing that traded, nondurable, flexible-price, or income-elastic goods contribute more to ERPT into welfare loss for the average-income consumer, suggesting important policy implications for filtering out the noise in the measurement of aggregate-level prices.

Household disposable income and long-term survival after pulmonary resections for lung cancer

IntroductionSocioeconomic disparities have been linked to survival differences in patients with lung cancer. Swedish healthcare is tax-funded and provides equal access to care, therefore, survival following lung cancer surgery should...

Effect of financial stress on self-rereported health and quality of life among older adults in five developing countries: a cross sectional analysis of WHO-SAGE survey

In developing countries, older adults (65 years of age and above) share an increased vulnerability to catastrophic health expenditures and financial stress which can have significant bearing on their health and well-being. Currently, research evidence on how financial stress correlates with health and well-being among older adults in the developing countries is limited. Therefore, in this study, we aimed to assess the relationship between financial stress and subjective 1) health, 2) depression, 3) quality of life, and 4) life satisfaction among older adults in five developing countries.MethodsData used in this study were cross-sectional which were collected from the first wave of Study on Global AGEing and Health (SAGE) survey of World Health Organization. Sample population were 12,299 community dwelling men and women in China (n = 4548), Ghana (n = 1968), India (n = 2441), South Africa (n = 1924), and Russia (n = 1418). Using generalized linear models with logit links, we assessed the correlation between self-reported financial stress and income inequality with the four outcome measures by adjusting for various sociodemographic factors.ResultsOverall, the prevalence of good self-reported health, quality of life and positive life-satisfaction was 47.11, 79.25 and 44.40% respectively, while 20.13% of the participants reported having depression during past 12 months. Only about a fifth (18.67%) of the participants reported having enough money to meet daily their necessities completely, while more than quarter (28.45%) were in the lowest income quintile. With a few exceptions, the odds of reporting good self-reported health, quality of life, and life satisfaction were generally lower among those with varying degrees of financial stress, and larger among those in the higher income quintiles. Conversely, the likelihood of self-reported depression was significantly higher among those with any level of financial stress, and lower among those in the higher income quintiles.ConclusionThis study concludes that both subjectively and objectively measured financial stress are inversely associated with good self-reported health, quality of life, life satisfaction, and positively associated with self-reported depression among older adults.

Educación en tiempos de pandemia: Antecedentes y recomendaciones para la discusión en Chile

¿Cuáles son los costos de mantener cerrados los establecimientos escolares hasta 2021?; esta es la pregunta que motiva este artículo. En el último tiempo hemos presenciado el llamado de parte de autoridades a retrasar el retorno a clases presenciales hasta el próximo año. Sin embargo, dicho llamado parece ignorar los efectos adversos que tiene esta medida en la población infanto-juvenil de Chile, que afecta a más de 3,5 millones de niños y jóvenes. El presente artículo busca visibilizar los posibles efectos adversos de la prolongada suspensión de clases sobre los aprendizajes de los estudiantes y los riesgos derivados de ello, como el aumento de las brechas de aprendizaje y de la deserción escolar. Para ello, analizamos tres factores que la literatura considera clave en el aprendizaje a distancia: habilidades críticas para el aprendizaje a distancia, condiciones materiales de la vivienda y apoyo de la familia. A partir de la información disponible (CASEN 2017; SIMCE 2017, 2018, entre otros), encontramos que uno de cada cinco escolares presenta carencias importantes en las dimensiones analizadas. Sin embargo, mientras casi un tercio de los estudiantes del primer quintil de ingresos se encuentra en el grupo de mayor riesgo, solo el 6% de los escolares del quintil más rico se encuentra dentro de este grupo. La suspensión prolongada de clases presenciales afecta de forma más pronunciada a los niños y jóvenes más vulnerables del país, y puede tener efectos adversos de largo plazo si aumenta la deserción escolar y las brechas de aprendizaje.

Can household dietary diversity inform about nutrient adequacy? Lessons from a food systems analysis in Ethiopia

This study examined the use of the household dietary diversity score (HDDS) to assess household nutrient adequacy in Ethiopia. It also examined the correlates of HDDS following the food systems framework. Results show that the average nutrient consumption in Ethiopia varies by place of residence and by income profile, where households in urban areas and those in the higher income quintiles rank favorably. Among 13 nutrients under study, we found nutrient inadequacy for fat, calcium, zinc, riboflavin, niacin, folate, vitamin C and vitamin A ranging between 46% and 89%, and the prevalence of inadequacy for vitamin B12 to be up to 100%. Econometric results showed that HDDS is a strong predictor of a household’s mean probability of nutrient adequacy (MPA), and that an HDDS of 10 is the minimum threshold at which HDDS can improve household MPA. We found suggestive evidence within the food systems that improving household-incomes, access to health and transport services are beneficial to improve HDDS and nutrient consumption in Ethiopia.

Markov-Switching Model of Family Income Quintile Shares

This paper examines the impact of unemployment and inflation on family income shares. Unemployment and inflation are decomposed into their structural (long-term), cyclical (short-term), anticipated and unanticipated components, respectively. I propose a new framework to analyze family income quintile shares by using a two-state Markov-switching model, also known as Hamilton’s regime-switching model. The benefit of using a Markov-switching model is that it permits capturing complex dynamic behavior of non-linear time series macroeconomic variables. The switching mechanism follows a first-order Markov chain of unobservable state variables and subsequent estimated conditional transition probabilities. This paper applies a two-state regime-switching process to capture the asymmetrical effects of unemployment and inflation on family income shares. The two states of family income quintile shares are state 1 (lower income) and state 2 (upper income). This approach differs from previous studies because it examines income inequality within each quintile rather than between quintiles. It is well documented in the literature that there is income inequality between lower and higher income quintiles. Therefore, the analysis of income inequality within the quintile allows for greater insight into changes in family income share corresponding to changes in the state variables. The general findings are that unemployment has adverse effects on lower income shares while inflation acts like a progressive tax on higher income shares.

Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada’s Single-Payer Health System

Measuring health care utilization and costs before death has the potential to initiate health care improvement. To examine population-level trends in health care utilization and expenditures in the 2 years before death in Canada's single-payer health system. This population-based cohort included 966 436 deaths among adult residents of Ontario, Canada, from January 2005 to December 2015, linked to health administrative and census data. Data for deaths from 2005 to 2013 were analyzed from November 1, 2016, through January 31, 2017. Analyses were updated from May 1, 2019, to June 15, 2019, to include deaths from 2014 and 2015. Sociodemographic exposures included age, sex, and neighborhood income quintiles, which were obtained by linking decedents' postal codes to census data. Aggregated Diagnosis Groups were used as a general health service morbidity-resource measure. Health care services accessed for the last 2 years of life, including acute hospitalization episodes of care, intensive care unit visits, and emergency department visits. Total health care costs were calculated using a person-centered costing approach. The association of area-level income with high resource use 1 year before death was analyzed with Poisson regression analysis, controlling for age, sex, and Aggregated Diagnosis Groups. Among 966 436 decedents (483 038 [50.0%] men; mean [SD] age, 76.4 [14.96] years; 231 634 [24.0%] living in the lowest neighborhood income quintile), health care expenditures increased in the last 2 years of life during the study period (CAD$5.12 billion [US $3.83 billion] in 2005 vs CAD$7.84 billion [US $5.86 billion] in 2015). In the year before death, 758 770 decedents (78.5%) had at least 1 hospitalization episode of care, 266 987 (27.6%) had at least 1 intensive care unit admission, and 856 026 (88.6%) had at least 1 emergency department visit. Overall, deaths in hospital decreased from 37 984 (45.6%) in 2005 to 39 474 (41.5%) in 2015. Utilization in the last 2 years, 1 year, 180 days, and 30 days of life varied by resource utilization gradients. For example, the proportion of individuals visiting the emergency department was slightly higher among the top 5% of health care users compared with other utilization groups in the last 2 years of life (top 5%, 45 535 [94.2%]; top 6%-50%, 401 022 [92.2%]; bottom 50%, 409 469 [84.7%]) and 1 year of life (top 5%, 43 007 [89.0%]; top 6%-50%, 381 732 [87.8%]; bottom 50%, 380 859 [78.8%]); however, in the last 30 days of life, more than half of individuals in the top 6% to top 50% (223 262 [51.3%]) and bottom 50% (288 480 [59.7%]) visited an emergency department, compared with approximately one-third of individuals in the top 5% (16 916 [35.0%]). No meaningful associations were observed in high resource use between individuals in the highest income quintile compared with the lowest income quintile (rate ratio, 1.02; 95% CI, 0.99-1.05) after adjusting for relevant covariates. In this study, health care use and spending in the last 2 years of life in Ontario were high. These findings highlight a trend in hospital-centered care before death in a single-payer health system.

Socioeconomic Status and Days Alive and Out of Hospital after Major Elective Noncardiac Surgery: A Population-based Cohort Study.

Socioeconomic status is an important but understudied determinant of preoperative health status and postoperative outcomes. Previous work has focused on the impact of socioeconomic status on mortality, hospital stay, or complications. However, individuals with low socioeconomic status are also likely to have fewer supports to facilitate them remaining at home after hospital discharge. Thus, such patients may be less likely to return home over the short and intermediate term after major surgery. The newly validated outcome, days alive and out of hospital, may be highly suited to evaluating the impact of socioeconomic status on this postdischarge period. The study aimed to determine the association of socioeconomic status with short and intermediate term postoperative recovery as measured by days alive and out of hospital. The authors evaluated data from 724,459 adult patients who had one of 13 elective major noncardiac surgical procedures between 2006 and 2017. Socioeconomic status was measured by median neighborhood household income (categorized into quintiles). Primary outcome was days alive and out of hospital at 30 days, while secondary outcomes included days alive and out of hospital at 90 and 180 days, and 30-day mortality. Compared to the highest income quintile, individuals in the lowest quintile had higher unadjusted risks of postoperative complications (6,049 of 121,099 [5%] vs. 6,216 of 160,495 [3.9%]) and 30-day mortality (731 of 121,099 [0.6%] vs. 701 of 160,495 [0.4%]) and longer mean postoperative length of stay (4.9 vs. 4.4 days). From lowest to highest income quintile, the mean adjusted days alive and out of hospital at 30 days after surgery varied between 24.5 to 24.9 days. Low socioeconomic status is associated with fewer days alive and out of hospital after surgery. Further research is needed to examine the underlying mechanisms and develop posthospital interventions to improve postoperative recovery in patients with fewer socioeconomic resources.

The health and financial impacts of a sugary drink tax across different income groups in Canada

BackgroundOverconsumption of sugar-sweetened beverages (SSBs) contributes to childhood and adult obesity and numerous related diseases, including heart disease, strokes, cancers, and type 2 diabetes. It also increases healthcare costs. Sugary drink taxes have been implemented in several countries to curb sugar intake. However, there is a concern that sugary drink taxes are regressive. This study assessed the health and financial impacts of a simulated sugary drink tax across different income groups in Canada. MethodsA proportional multi-state life table-based Markov model simulated the 2016 Canadian population by income quintile. The model applied a 20 % tax on sugary drinks and determined the effects on type 2 diabetes and BMI-related diseases compared to no intervention. The income-specific parameters modelled included: population demographics; cross- and own-price elasticities; mean BMI; sugary drink consumption; mortality; and disease epidemiology. ResultsA 20 % sugary drink tax was estimated to reduce the consumption of sugary drinks by an average of around 15 %, with a greater reduction in the lowest income quintile. The estimated mean reduction in BMI ranged from 0.21 to 0.33, dependent upon sex and income quintile; these reductions were greater among the lower income quintiles for both females and males. The 20 % sugary drink tax was estimated to avert approximately 690,000 DALYs over a lifetime among the 2016 Canadian adult population; estimated DALYs averted were approximately 156,000, 140,000, 137,000, 134,000, and 125,000 for the lowest through to the highest income quintile, respectively. Lifetime health care savings were estimated to be $2.27bn, $2.16bn, $2.17bn, $2.12bn, and $1.98bn for the lowest through to the highest income quintile, respectively. The estimated annual tax burden for the 2016 Canadian population was $1.4bn. The average absolute tax burden was estimated to be $39.00 to $44.30 per person, with the middle-income quintile bearing the heaviest absolute tax burden. The lowest income quintile would pay the highest proportion of income in tax, implying that the tax is regressive. ConclusionsLow-income Canadians would gain the most health benefit from a sugary drinks tax. However, the lowest income quintile would also pay the largest proportion of income in tax. A tax on sugary drinks is therefore financially regressive but forecast to reduce health disparities across Canada.

Cost-effectiveness analysis of interventions to achieve universal health coverage for schizophrenia in Mexico

Introduction. To achieve universal coverage in mental health, it is necessary to demonstrate which interventions should be adopted. Objective. Analyze the alternatives of pharmacological and psychosocial treatment in Mexico for patients diagnosed with schizophrenia, as well as Early Intervention in Psychosis Program. Method. The Extended cost effectiveness analysis (ECEA), it is implemented under scenario the option of treatment in Mexico, which includes: typical or atypical antipsychotic medication plus psychosocial treatment, assuming that all the medications will be provided to the patient, a measure of effectiveness is the years of life adjusted to disability (DALYs). Results. The effect of Universal Public Financing (UPF) is reflected in avoiding 147 DALYs for every 1,000,000 habitants. In addition, has a positive effect in the avoided pocket expenditures from US $ 101,221 to US $ 787,498 according to the type of intervention. Increasing government spending has a greater impact on the poorest quintile, as a distributive effect of the budget is generated. Respect to the value of insurance, the quintile III is the one who is most willing to pay for having insurance, on the other hand, in the highest income quintile, the minimum assurance valuation was observed. Discussion and conclusion. The reduction in out-of-pocket spending is uniform across all quintiles; “Early Intervention in Psychosis Program” is not viable for middle income countries, as México. The ECEA is a convenient method to assess the feasibility and affordability of mental health interventions to generate information for decision makers.

Early experience with medical assistance in dying in Ontario, Canada: a cohort study.

Medical assistance in dying (MAiD) was legalized across Canada in June 2016. Some have expressed concern that patient requests for MAiD might be driven by poor access to palliative care and that social and economic vulnerability of patients may influence access to or receipt of MAiD. To examine these concerns, we describe Ontario's early experience with MAiD and compare MAiD decedents with the general population of decedents in Ontario. We conducted a retrospective cohort study comparing all MAiD-related deaths with all deaths in Ontario, Canada, between June 7, 2016, and Oct. 31, 2018. Clinical and demographic characteristics were collected for all MAiD decedents and compared with those of all Ontario decedents when possible. We used logistic regression analyses to describe the association of demographic and clinical factors with receipt of MAiD. A total of 2241 patients (50.2% women) were included in the MAiD cohort, and 186 814 in the general Ontario decedent cohort. Recipients of MAiD reported both physical (99.5%) and psychologic suffering (96.4%) before the procedure. In 74.4% of cases, palliative care providers were involved in the patient's care at the time of the MAiD request. The statutory 10-day reflection period was shortened for 26.6% of people. Compared with all Ontario decedents, MAiD recipients were younger (mean 74.4 v. 77.0 yr, standardized difference 0.18);, more likely to be from a higher income quintile (24.9% v. 15.6%, standardized difference across quintiles 0.31); less likely to reside in an institution (6.3% v. 28.0%, standardized difference 0.6); more likely to be married (48.5% v. 40.6%) and less likely to be widowed (25.7% v. 35.8%, standardized difference 0.34); and more likely to have a cancer diagnosis (64.4% v. 27.6%, standardized difference 0.88 for diagnoses comparisons). Recipients of MAiD were younger, had higher income, were substantially less likely to reside in an institution and were more likely to be married than decedents from the general population, suggesting that MAiD is unlikely to be driven by social or economic vulnerability. Given the high prevalence of physical and psychologic suffering, despite involvement of palliative care providers in caring for patients who request MAiD, future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to a MAiD request.

Inequality in Life Expectancy in Korea according to Various Categorizations of the National Health Insurance Premiums as a Marker of Income.

The purpose of this study was to examine the degree to which the magnitude of income inequality in life expectancy according to different categorization across beneficiary types under the National Health Insurance Service (NHIS) in Korea. We used population and death data in 2017 from the National Health Information Database of the NHIS. Income quintile groups were classified in four ways according to beneficiary type (employee insured, self-employed insured, and Medical Aid beneficiaries). Standard life table procedures were used to calculate life expectancy. The life expectancy gap between the lowest and highest income quintiles was the largest when the entire population was divided into quintiles without distinguishing among types of beneficiaries. In conclusion, we suggest that income quintile indicators in NHIS data, measured without distinguishing among types of beneficiaries, may best represent the magnitude of health inequalities in Korean society. This indicator could be used for future research on health inequalities, as well as for monitoring health inequalities in Korea.

Association Between Poverty and Appropriate Statin Prescription for the Treatment of Hyperlipidemia in the United States: An Analysis From the ACC NCDR PINNACLE Registry

BackgroundPoverty is associated with a higher risk of myocardial infarction and cardiac death, both of which are decreased by treatment of hyperlipidemia. There may be differences in the appropriate treatment of hyperlipidemia between richer and poorer Americans. In this study, we aimed to evaluate the association between income level and appropriate lipid-lowering therapy. MethodsWe identified outpatient visits in the National Cardiovascular Data Registry's Practice Innovation and Clinical Excellence (PINNACLE) Registry and determined appropriateness of lipid-lowering therapy among patients in different income quintiles (Quintile 5 being the highest income quintile). Logistic regression at the patient level was performed to evaluate the independent association of income and the primary outcome of appropriate statin therapy. The analysis was repeated before and after November 2013 given a change in guideline definitions. ResultsThe study included 1,655,723 patients. Overall, 68–73% of patients were treated appropriately under the ATP III Guidelines and 57–62% of patients were treated appropriately under the ACC/AHA Guidelines. Patients in the wealthiest quintile had higher odds of appropriate statin therapy under both guidelines relative to patients in the poorest quintile (OR 1.06 [1.05–1.07] for ATP III and OR 1.03 [1.01–1.04] for ACC/AHA). In the whole sample, patients with higher estimated income had a small but significant increased likelihood of appropriate statin therapy (point-biserial correlation 0.035 [p < 0.001] for ATP III and 0.026 [p < 0.001] for ACC/AHA). ConclusionsHere we describe a small association between appropriate statin use and income. Further investigation into barriers in the use of evidence-based therapies in poorer populations is needed.

Understanding the residential energy efficiency financing coverage gap and market potential

Access to upfront capital remains a primary barrier in residential energy efficiency adoption. Government-sponsored programs exist for low-income households while traditional financing serves creditworthy households. However, there remains a coverage gap for those with moderate incomes too high to qualify for low- income programs, but without access to friendly capital. With limited research in this space, this study aims to: (1) develop a model to estimate the number of households in the coverage gap; and (2) explore their spatial distribution. For the state of Michigan, we used data from the US Census Bureau and approximately 12,000 green bank loans to estimate the energy efficiency financing coverage gap across the state's 83 counties using a binomial mixed model. We found that credit score and income interacted to largely determine whether an applicant was approved. Households in the highest income quintile achieved a 50% chance of approval with a moderate credit score (662) while those in the lowest needed a very high credit score (715) for the same odds. Overall, this created an estimated 12% energy efficiency financing coverage gap of households statewide, with individual county levels between 0% and 24%. Broadly, understanding the market potential and spatial distribution of this coverage gap could allow impact-driven financiers such as green banks or community development financial institutions to expand programs that may offer alternative underwriting criteria. Expanding loan access to this underserved market can promote energy system improvements, policy goals, household living conditions, and an equitable clean energy transition.

Neighbourhood Income and Risk of Having an Infant With Concomitant Preterm Birth and Severe Small for Gestational Age Birth Weight

Socioeconomic position gradients have been individually demonstrated for preterm birth (PTB) at <37 weeks gestation and severe small for gestational age birth weight at <5th percentile (SGA). It is not known how neighbourhood income is related to the combination of PTB and severe SGA, a state reflective of greater placental dysfunction and higher risk of neonatal morbidity and mortality than PTB or severe SGA alone. This population-based study comprised all 1367656 singleton live births in Ontario from 2002 to 2011. Multinomial logistic regression was used to estimate the odds of PTB with severe SGA, PTB without severe SGA, and severe SGA without PTB, compared with neither PTB nor severe SGA, in relation to neighbourhood income quintile (Q). The highest income quintile, Q5, served as the exposure referent. Adjusted odds ratios (aORs) were adjusted for maternal age at delivery, parity, marital status, and world region of birth (Canadian Task Force Classification II-2). Relative to women residing in Q5 (2.3 per 1000), the rate of PTB with severe SGA was highest among those in Q1 (3.6 per 1000), with an aOR of 1.34 (95% confidence interval [CI] 1.20-1.50). The corresponding aORs were 1.23 (95% CI 1.09-1.37) for Q2, 1.14 (95% CI 1.02-1.28) for Q3, and 1.06 (95% CI 0.95-1.20) for Q4. Less pronounced aORs were seen for each individual outcome of PTB and severe SGA. Women residing in the lowest-income areas are at highest risk of having a fetus born too small and too soon. Future research should focus on identifying those women most predisposed to combined PTB and severe SGA.