Higher Mean Income Research Articles

CHILDHOOD SOCIOECONOMIC STATUS GRADIENTS IN FUNCTIONAL LIMITATIONS: THE ROLE OF MACRO-ECONOMIC CONTEXT

Abstract A large number of studies have documented an association between childhood socioeconomic status (SES) and adult health or illness. However, relatively little is known about how this SES-health gradient varies across macro-economic contexts. The current study examined state-level mean income as a moderator of the association between the education level of a person’s parents and functional limitations in the United States (N = 10,685, Mean age = 47.7, SD = 13.6, 51% female, 86% White; 6% Black; 8% other or missing). Data were from an economic time series database (1917-2018) and the Midlife in the United States Study (MIDUS). Time series data were merged with MIDUS data (1995 core sample and 2012 refresher) by state of residence and year to determine exposure to state economic characteristics during three periods of the life span: prime working years (ages 30-55), early adulthood (20-25) and childhood (0-15). Results indicated that the SES-functional limitations gradient was attenuated for those who lived in a state with a higher mean income from ages 30-55, 20-25, and 0-15 (p’s < .05). The moderating role of state-level economic exposures between ages 30 and 55 (but not at earlier life stages) differed by gender such that the attenuation of the SES-functional limitations gradient in more affluent states was more strongly evident among females than males. Findings suggest that the role of childhood SES in later life health varies across state-level economic contexts with notable differences by gender and age group. Future directions and policy implications are discussed.

From research to practice: Incorporating consumer bankruptcy into community development initiatives

ABSTRACT This manuscript presents a case study illustrating how simple, visual analytics tools can be used to longitudinally assess consumer bankruptcy filings in a single community. In doing so, it provides a template for leaders in other communities to follow in conducting their own assessments. The case study focuses on the Logan neighborhood in Spokane, WA, a blue collar neighborhood which is home to Gonzaga University. This allows for simple comparisons to assess evolutionary changes in bankruptcy filings, within the Logan neighborhood over time, as well as comparisons to other Spokane neighborhoods that have less diversity and higher mean incomes.

Why poverty is higher in Spain: a comparison with the Czech Republic

ABSTRACT This paper estimates the poverty level in Spain and the Czech Republic during 2013–2016 and analyzes the reason why poverty in Spain is higher. The contribution of this paper lies in decomposing horizontal poverty disparities between countries with similar development level. We find that in Spain inequality is higher, and the poor (especially the ultrapoor) are poorer than those in the Czech Republic, which offsets the poverty reduction effect of Spain’s higher mean income and renders its poverty level higher.

Impact of an Asset Transfer Program for Income Generation and Food Security Among Ultra-Poor Households in Rural Bangladesh

ObjectivesAn economic development (ED) program, designed based on an ultra-poor graduation approach, was implemented to alleviate poverty and improve food security in rural Bangladesh through asset transfer. This study aims to compare income generation, consumption, and seasonal trends in asset management among ultra-poor households receiving different small assets. MethodsA total of 2960 poor or ultra-poor households received (1) 9–26 ducks (n = 2125), (2) 11 chickens (n = 872), and/or (3) vegetable seeds with garden training (n = 2407), depending on living environment. Indicators related to production of assets, income generation, and consumption of assets were collected quarterly over the course of Jan-Dec 2019. Changes in the amount of assets, income generated from assets and asset byproducts, and consumption of assets and asset byproducts were compared across time and asset group type. ResultsSignificant seasonal trends in the amount of production and income were found among all three asset groups over one year (all p < 0.001). The vegetable and duck groups reported their highest mean incomes at the Jan-Mar follow-up, and the chicken group reported its highest mean income at the July-Sept follow-up. A higher proportion of chicken households maintained their baseline asset provisions at one-year than duck households (29.2% vs. 18.2%, p < 0.001). The duck group reported higher average monthly income than the chicken group (811 TK vs. 480 TK; p < 0.001). The duck group consumed a greater number of eggs per month than the chicken group (55 eggs vs. 27 eggs; p < 0.001), while the chicken group consumed a greater number of poultry per month than the duck group (1.65 chickens vs. 0.95 ducks; p < 0.001). ConclusionsDuck assets are better short-term income sources for the poor and ultra-poor than chicken assets in rural Bangladesh. Our findings in asset management, income generation, and consumption provide evidence of the impact of the graduation approach on ultra-poor household economies and should be considered in future scale-up of the ED program. Funding SourcesWorld Vision Bangladesh, World Vision Korea, KOICA.

Your voice matters during COVID-19: Evaluation of digital divides across a tertiary cancer center.

e18768 Background: Virtual care (VC) and electronic patient-reported experience measures (ePREM) have been systemically adopted during the COVID-19 pandemic to facilitate continuity of cancer care and quality improvement. Digital divides, defined as differential access and benefit from these tools, may exacerbate existing health inequities among patients. We aimed to evaluate digital divides through ePREM access, use, and responses during the pandemic. Methods: Your Voice Matters (YVM), a provincially-mandated ePREM survey, was adapted to an online platform in September 2020 and emailed to patients after outpatient VC and in-person clinic visits at a tertiary cancer centre in Ontario. Age, gender, postal codes, and completed surveys from September-December 2020 were collated. Income was estimated using area-level averages from Statistics Canada 2016 census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation: residential instability (RI), economic dependency, ethnocultural composition (EC), situational vulnerability (SV). Higher factor scores per dimension correspond to greater marginalization. Two-sided Chi-squared and t-tests were used to compare demographics between VC and in-person patients with a significance threshold of p &lt; 0.001. Generalized estimating equations logistic regression models were used to assess associations between patient satisfaction and visit type, as well as demographics. Results: YVM was emailed to 28% (10625/37835) of patients with a response rate of 21.8% (2321/10625). Mean and minimum income (x $10,000) were highest among responders (6.6, 1.5) compared to non-responders (6.3, 1.3) and those without email (6.2, 1.1). Comparing responders with VC (n = 549) and in-person (n = 1719) visits, the former had higher mean income (6.9 vs 6.5, p &lt; 0.001) and lower mean EC factor score (0.2 vs 0.4, p &lt; 0.001). Satisfaction with care received was not associated with visit type and satisfaction with VC logistics was not associated with demographics. Patients with higher EC scores were more likely to rate low satisfaction in “culturally appropriate” (OR 0.69, 95% CI: 0.57-0.85) and “respect” (OR 0.69, 95% CI: 0.57-0.85) domains. Patients with higher SV scores were more likely to rate low satisfaction in the “physical symptoms” (OR 0.69, 95% CI: 0.51-0.94) domain, while patients with higher RI scores were more likely to rate low satisfaction in the “physical” (OR 0.82, 95% CI: 0.69-0.98) and “emotional symptoms” (OR 0.88, 95% CI: 0.79-0.98) domains. Conclusions: VC patients had positive experiences with visit logistics across demographics and their satisfaction with care was comparable to that of in-person patients. However, VC use and YVM access, use, and responses were associated with income and socioeconomic status. Identifying populations vulnerable to digital health inequities will guide strategies to bridge the divides.

Physical Activity Among Children with Visual Impairments, Siblings, and Parents: Exploring Familial Factors.

Moderate to vigorous physical activity (MVPA) is associated with positive physical and psychological health outcomes, yet youth with visual impairments tend to not to engage in sufficient MVPA. The purposes of this study were to (a) examine how familial factors were associated with MVPA among youth with visual impairments, their siblings, and parents and (b) examine the daily MVPA correlation among these family members. Twenty-two familial triads, including one child with a visual impairment, participated in this study. Accelerometers were used to measure MVPA and individual and familial factors were reported via questionnaire. Of the individual and familial factors measured, only family member role significantly predicted MVPA (β = .43, p < .01), as parents accumulated significantly more activity than their children (f2 = .22). The MVPA of children with visual impairments and their siblings were positively correlated (r = .39), while small negative relationships were found between MVPA of parents and children with and without visual impairments (r = -.16; r = -.33, respectively). In contrast with earlier findings, parents in the current study were significantly more active than their children with or without visual impairments. Potential reasons for this difference included the homogeneity of the sample, including a relatively high mean income level and parent education, which may have alleviated some typically reported barriers to parental MVPA. Future inquiries in this area should examine individual- and family-level factors concurrently to better understand their impact on MVPA within the familial triad.

Gender differences in the choice of field of study and the relevance of income information. Insights from a field experiment

Research consistently reports pronounced earnings differences between men and women, even among the highly educated. This article investigates whether students’ responsiveness to information on income returns relates to gender differences in major choices, which might contribute to the persistent gender wage gap. We use field-experimental panel data on students in Berlin (Germany), starting one year before high school graduation. Our intervention comprised information on major-specific returns to college and was provided to students in randomly selected schools. By comparing the major-specific application decisions of “treated” and “untreated” high school seniors, we examine whether, and why, male and female students respond differently to this information. As potential mechanisms behind a gender-specific treatment effect, we analyze the role of gender stereotypes and roles associated with certain job attributes. We find that providing income information on college majors only influences the major choices of male (not female) students with college intention: treated male students on average applied to majors associated with higher mean income. Further analyses suggest that this gender difference in the treatment effect cannot be explained by differential distributions or effects of preferred job attributes.

The Cost Variability of Orthobiologics

Objectives: Despite limited clinical data, many orthopedic practices offer orthobiologic injections. Such injections are not covered by insurance, and thus patients pay out of pocket for these treatments. The purpose of this study was to assess the variability in costs for platelet rich plasma (PRP) and stem cell (SC) injections across practices and evaluate for variables that influence pricing. Methods: A list of 1,345 orthopedic sports medicine practices across the United States was compiled. Calls were made inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, practice type (academic or private), number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables. Results: Of the contacted offices, 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only stem cell injections, and 487 (36.2%) did not offer either treatment. The mean (± SD) cost of a PRP injection was $707 ± $388 (range, $175 to $4,973), and the mean cost of a SC injection was $2,728 ± $1,584 (range, $300 to $12,000). Practices offering PRP and SC injections tended to be larger (for PRP - 11.6 physicians per practice vs. 8.1, P&lt;0.001; for SC - 12.3 vs. 9.7, P=0.006). In addition, practices that offered PRP injections were located in areas with higher mean income ($67,500 vs. $64,300, P=0.047). Variables associated with higher cost of PRP injection included city population (P&lt;0.001) and mean income of residents (P&lt;0.001). Conclusion: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections. The cost for PRP injections is higher in practices located in highly populated areas and in areas with greater mean incomes.

Are the Religiously Observant Discriminated Against in the Rental Housing Market? Experimental Evidence from Israel

AbstractIn this article, I test for discrimination against the religiously observant in the Israeli rental housing market. I perform a correspondence study where half of the requests have a religious signal (“basad” written at the top of the request), while the other half do not. Because the requests are identical otherwise, differences in call‐back rates represent the causal effect of writing “basad” at the top of the request. I find that requests with a religious signal receive 12 percent fewer positive responses than requests with no such signal, with this differential being greater with female landlords and in cities with more left‐leaning voters, higher mean incomes, and higher education levels.

Lifting the floor? Economic development, social protection and the developing World's poorest

It is theoretically ambiguous whether people in richer countries have a higher floor to their living standards. Nor is it clear whether social protection spending reaches the poorest and thus lifts the floor. Across countries, the paper finds that higher mean incomes come with a higher floor. The bulk of this is direct rather than via public spending on social protection. Social insurance (mainly public pensions) does the “heavy lifting” of the floor. Social assistance (mainly targeted cash-transfers) lifts the floor by only 1.5 cents per day on average, which is less than 10% of mean spending on social assistance.

A study on the model of economic growth convergence in developing regions: an empirical analysis from Henan Province, China

In this paper, an empirical analysis is proposed by employing a regression-based convergence test, which was first introduced by Phillips and Sul. Unlike most related studies, this approach allows examining for evidence of club convergence and enables to endogenously identify groups of counties that converge to different equilibria. The results obtained in this paper support the existence of convergence clubs, indicating that 108 counties of Henan Province in China form four separate groups within which income per capita dispersion is decreasing over time. Moreover, results from an ordered logit model suggest that differences in initial income, physical capital, government intervention, geographical agglomeration, and topography factor among these counties have played vital roles in determining club membership. The most important conclusion of this paper is that the structural characteristics and infrastructure level do not contribute to determining club membership, and neighbors’ effect is also not a decisive factor. Particularly, counties which belong to Central Henan Urban Agglomeration are more likely to fall into a club with a higher mean income per capita. The findings in this paper may have significant policy implications for developing regions.

Managing the water-climate- food nexus for sustainable development in Turkmenistan

The water–climate-food security nexus is uniquely vulnerable in Central Asia, a region replete with transboundary water conflicts, shortages in land and water resources and high sensitivity to climate change. Using a water balance for the Amu Darya River Basin, we present a synthetic evaluation of future water use, crop yields, land and water productivities for the period 2016 to 2055 in Ahal, Dashoguz, Lebap, and Mary provinces in Turkmenistan. Modeled fut socio-economic scenarios include food security and diet change (FSD), export-oriented sustainable adaptation (ESA) and business as usual (BAU). Results show that water requirements and water deficits during growing seasons will exhibit a decreasing trend from 2016 to 2055 in most provinces under all three scenarios. Crop yields and land and water productivities will likely increase in the four provinces under both the FSD and ESA scenarios. Mary province had the highest mean income and losses of irrigated agriculture, with an annual average value of about 7 × 108 USD/year and 1.5 × 103 USD/year, respectively. Ahral province showed the largest annual mean land and irrigation water productivities for all three scenarios, up to about 800 USD/ha/year and 0.40 USD/m3/year respectively. Results obtained from this study provide tools to assist resource managers to identify vulnerabilities in the nexus of water, land and climate to ensure food security, water management, and sustainable development.

Semiparametric inference for the dominance index under the density ratio model

SUMMARY An important and often discussed research problem in statistics is how to compare several populations; examples arise in medical science, engineering, finance and other fields. Often population means or medians are compared. However, one population may have a higher mean income, for example, because of a small number of super-rich individuals; the mean therefore may not reflect the wealth of the general population. Instead, an index of the degree of stochastic dominance of one population over another would better reflect their relative wealth. Currently, we can estimate such an index under restrictive conditions, but there is no generic estimator with a known asymptotic distribution. In this paper, we suggest linking the populations via the density ratio model. Under this model, we develop an empirical likelihood estimator and establish its asymptotic normality. In addition, we improve the estimation efficiency by examining the similarities between the populations. Furthermore, we provide a valid bootstrap method for hypothesis testing and the construction of confidence intervals. Simulation experiments show that the proposed estimator substantially improves the estimation efficiency and power of the test, and leads to confidence intervals with satisfactorily precise coverage probabilities. It is also robust with respect to mild model misspecification. Two examples are given to demonstrate the usefulness of both the method and the concept.

Lessons from Voluntary Compliance Window (Vcw): Malawi's Tax Amnesty Programme

The Malawi Revenue Authority (MRA) implemented the Voluntary Compliance Window (VCW) in 2013/2014 fiscal year as a means of bringing non-compliant taxpayers into the tax net. The programme was a huge success in terms of revenue and the cost of collection at 0.8% was by far below the 3% benchmark for the gross tax revenues of the Authority. However, the long-term compliance impact of the programme was not evaluated. Hence, the paper intends to bridge knowledge gap. Firstly, observing trends in debts and penalty payments covering and extending beyond the amnesty period, the paper finds that debts substantially declined after amnesty period while penalties rose sharply after VCW. Secondly, by constructing a counterfactual for large taxpayers, the paper finds that tax payments of participants significantly improved after the programme. Thirdly, the paper examines tax payment patterns by VCW participants one year after the programme. About 75 percent of amending filers subsequently paid their taxes one year after VCW with a higher mean income than the non-subsequent taxpayers. Lastly, the paper finds that smuggling remains high after observing variations in customs offences during VCW and a year later, in FY2015/16. The question remains “Should Malawi reconsider another Voluntary Compliance Window after 3 years?” The paper agrees with most previous studies by strongly discouraging another amnesty while encouraging post-amnesty enforcement efforts.

Access to prenatal care and quality of care in the Family Health Strategy: infrastructure, care, and management

This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of infrastructure characteristics in the health units, management, and supply of care provided by the teams, from the perspective of regional and state inequalities. A cross-sectional evaluative and normative study was performed, drawing on the external evaluation component of the second round of the Program for Improvement of Access and Quality of Primary Care, in 2013-2014. The results revealed the inadequacy of the primary healthcare network's infrastructure for prenatal care, low adequacy of clinical actions for quality of care, and the teams' low management capacity to guarantee access and quality of care. In the distribution according to geopolitical regions, the findings pertaining to the units' infrastructure indicate a direct relationship between the infrastructure's adequacy and social contexts with higher municipal human development indices and income. For the clinical actions in patient care, the teams in all the regions scored low on adequacy, with slightly better results in the North and South regions of the country. There were important differences between the states of the North, and the states with higher mean income and human development scored higher on adequacy. The results indicate important organizational difficulties in both access and quality of care provided by the health teams, in addition to visible insufficiency in management activities aimed to improve access and quality of prenatal care.

Children in disadvantaged neighbourhoods have more out-of-hospital emergencies: a population-based study

ObjectiveWe wanted to study whether the socioeconomic status of a neighbourhood can predict the incidence of paediatric out-of-hospital emergencies.MethodsWe conducted a population-based prospective study with all paediatric (0–15 years) out-of-hospital...

Income Generation in Recovering Heroin Users: A Comparative Analysis of Legal and Illegal Earnings

Research has shown employment to be a central mediator to sustained recovery and community reentry for substance abusers; however, heroin users have lower employment rates and report lower mean incomes than other drug users. The authors of the present study assessed income-generating behaviors of substance users recruited from substance abuse treatment facilities (N = 247). Heroin users had higher mean incomes from illegal sources. Further, logistic regression analysis found heroin use to increase the likelihood of engagement in illegal income generating behaviors. As these results increase the likelihood of involvement in the criminal justice system, the implications for heroin specific treatment and rehabilitation are discussed.

Gender differences in HIV risk behaviors in individuals recently released from prison: results of a pilot study

BackgroundIndividuals recently released from prison engage in risky behaviors that predispose them to contracting HIV. Women may be at increased risk in the immediate period post-release, given higher rates of poverty, food insecurity, and substance dependence and lower educational attainment compared with men.MethodsWe describe gender differences in HIV risk behaviors using validated measures and assess potential mediators of this relationship using data from a cross-sectional study of 109 individuals recently released from prison.ResultsWomen had higher rates of HIV drug-related risk behaviors compared with men (mean score 2.72 vs. 0.068; p = .003) and HIV sex-related risk behaviors (mean score 4.32 vs. 2.31; p = .016). Women also had higher mean incomes and severity of drug and alcohol use compared with men, but equally high rates of food insecurity and low levels of AIDS knowledge. In multivariate analysis, the relationship between gender and HIV drug-related and sex-related risk behaviors was attenuated by a greater monthly income ([drug] adjusted β 0.82, 95% CI -1.02 – 2.66, p = 0.38; [sex] adjusted β 0.75, 95% CI -1.04 – 2.54, p = 0.41), as well as severity of drug use ([drug] adjusted β 0.79, 95% CI -0.55 – 2.13, p = 0.24; [sex] adjusted β 0.09, 95% CI -1.17 – 1.35, p = 0.89).ConclusionsWomen had higher rates of HIV risk behaviors compared with men post-release. Gender specific interventions may be useful in reducing risky drug-related and sex-related behaviors in the period immediately following release.

Individual- and community-level social gradients of edentulousness.

BackgroundCommunity-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association.MethodsWe analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates.ResultsOf 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001).ConclusionsIndividual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.

Escalation of socioeconomic disparities among patients with colorectal cancer receiving advanced surgical treatment.

As tumor burden increases in colorectal cancer, treatment complexity progresses from colectomy to hepatectomy and lastly to cytoreductive surgery with heated intraperitoneal chemotherapy (CRS-HIPEC). The aim of this study was to evaluate whether disparities exist in the access to progressively more complex surgical treatment options. Patients undergoing surgery for colorectal cancer were grouped by treatment type: group 1 (n=224) underwent colectomy for nonmetastatic disease, group 2 (n=112) underwent hepatectomy for liver metastasis, and group 3 (n = 112) underwent CRS-HIPEC for carcinomatosis. Whites were predominant in the HIPEC group (71.4%) compared to the hepatectomy (67.9%) and colectomy (57.6%) groups (p=0.025). The majority of the privately insured patients were in the HIPEC group (70.5%) compared to the hepatectomy (56.2%) and colectomy (30.4%) groups (p < 0.0001). Distance traveled to the hospital was farthest on average in the HIPEC group (104.6±258.3km) compared to the hepatectomy (29.0±28.0km) or colectomy (26.4 ±66.2km) group (p<0.0001). Mean household income also varied between the three groups, with HIPEC patients earning $56,957 (±24,124), hepatectomy patients earning $56,999 (±28,588), and colectomy patients earning ($51,518±24,201) (p=0.0503) on average per year. The HIPEC cohort contained a higher proportion of English speakers (90.2%) than the other groups (hepatectomy 87.9%, colectomy 85.3%); however, this difference was not statistically significant (p=0.43). CRS-HIPEC is not accessed equally across all socioeconomic groups. Patients undergoing HIPEC were most often white, English speaking, and privately insured; had a higher mean income; and had traveled the greatest distances on average to access surgical care.