Impact Of Socioeconomic Differences Research Articles

Impact of Socioeconomic Differences on Distributional Cost-effectiveness Analysis.

Public health decision makers value interventions for their effects on overall health and health inequality. Distributional cost-effectiveness analysis (DCEA) incorporates health inequality concerns into economic evaluation by accounting for how parameters, such as effectiveness, differ across population groups. A good understanding of how and when accounting for socioeconomic differences between groups affects the assessment of intervention impacts on overall health and health inequality could inform decision makers where DCEA would add most value. We interrogated 2 DCEA models of smoking and alcohol policies using first national level and then local authority level information on various socioeconomic differences in health and intervention use. Through a series of scenario analyses, we explored the impact of altering these differences on the DCEA results. When all available evidence on socioeconomic differences was incorporated, provision of a smoking cessation service was estimated to increase overall health and increase health inequality, while the screening and brief intervention for alcohol misuse was estimated to increase overall health and reduce inequality. Ignoring all or some socioeconomic differences resulted in minimal change to the estimated impact on overall health in both models; however, there were larger effects on the estimated impact on health inequality. Across the models, there were no clear patterns in how the extent and direction of socioeconomic differences in the inputs translated into the estimated impact on health inequality. Modifying use or coverage of either intervention so that each population group matched the highest level improved the impacts to a greater degree than modifying intervention effectiveness. When local level socioeconomic differences were considered, the magnitude of the impacts was altered; in some cases, the direction of impact on inequality was also altered.

Understanding the impact of socioeconomic differences in colorectal cancer survival: potential gain in life-years

BackgroundColorectal cancer prognosis varies substantially with socioeconomic status. We investigated differences in life expectancy between socioeconomic groups and estimated the potential gain in life-years if cancer-related survival differences could be eliminated.MethodsThis population-based study included 470,000 individuals diagnosed with colon and rectal cancers between 1998 and 2013 in England. Using flexible parametric survival models, we obtained a range of life expectancy measures by deprivation status. The number of life-years that could be gained if differences in cancer-related survival between the least and most deprived groups were removed was also estimated.ResultsWe observed up to 10% points differences in 5-year relative survival between the least and most deprived. If these differences had been eliminated for colon and rectal cancers diagnosed in 2013 then almost 8231 and 7295 life-years would have been gained respectively. This results for instance in more than 1-year gain for each colon cancer male patient in the most deprived group on average. Cancer-related differences are more profound earlier on, as conditioning on 1-year survival the main reason for socioeconomic differences were factors other than cancer.ConclusionThis study highlights the importance of policies to eliminate socioeconomic differences in cancer survival as in this way many life-years could be gained.

Socioeconomic Differences and Lung Cancer Survival-Systematic Review and Meta-Analysis.

Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival.Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures.Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis.Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation.

Parental educational level and psychological positive health and health complaints in Spanish children and adolescents.

Interest on the impact of socioeconomic differences on youth's health is growing. The aim of the present study was to examine the association of parental educational level with psychological positive health and health complaints in Spanish children and adolescents. Parental educational level, psychological positive health indicators (perceived health status, life satisfaction, quality of family relationships, quality of peer relationships and academic performance) and health complaint index (headache, stomach ache, backache, feeling low, irritability or bad temper, feeling nervous, difficulties getting to sleep, feeling dizzy) were self-reported using the Health Behavior in School-aged Children questionnaire in 685 (366 boys and 319 girls) children and adolescents. Children reporting parents with non-university studies (father, mother or both) had significantly higher odd ratio of having lower academic performance, lower life satisfaction, perceiving their health status as otherwise (vs. excellent) and having health complaints sometime than their counterparts reporting parents with university studies (father, mother or both). Current results provide evidence that children having parents with a university degree (father, mother or both) are more likely to have higher psychological positive health and lower health complaints than children reporting parents with non-university studies. This is particularly important for the welfare policy that must pay attention for implementing programs for helping population to access to university studies by their impact on youth health.

Alcohol related harm in Slovenia.

Background: Alcohol consumption is one of the major avoidable risk factors for chronic diseases, injuries and violence. Overall there is a causal relationship between alcohol consumption and more than 60 types of disease and injury. For some of them alcohol is the only possible cause and so they are wholly (100 %) attributable to alcohol. Methods: We have analysed the data on mortality and hospitalisation of Slovenian citizens because of causes wholly attributable to alcohol. We used mortality and hospitalisation data from the National Institute of Public Health’s healthcare databases »Database of Death certificates« and »Data on in-hospital treatments for diseases, injuries and poisoning«. We present the situation in Slovenia in the period from 2007 to 2009 with gender and regional differences analysis. With the mortality data for the period from 2004 to 2008 we also present the impact of socio-economic differences on the mortality wholly attributable to alcohol consumption in Slovenia. For bivariate analysis of the connection between variables we used Chi-square test. Results: In the period from 2007 to 2009 there were on average 811 deaths, of which 509 were premature (4.4 % of all deaths and 12.3 % of all premature deaths), 3799 hospitalisations and 90,589 hospital days (1.3 % of all hospitalisations and 3.8 % of all hospital days in the country in a calendar year) because of causes wholly attributable to alcohol in Slovenia. Men have higher relative risk for death and for hospitalisation because of causes wholly attributable to alcohol than women, and also residents of Eastern Slovenia have higher relative risk than residents of Western Slovenia. Wholly alcohol-attributable mortality is the biggest among residents of the least developed municipalities and is decreasing with the increase of municipality development. Conclusions: Hazardous and harmful alcohol consumption is a big public health problem in Slovenia and it contributes to health inequalities, so activities to reduce its consequences should be increased.

The Dynamics of Education Finance in Federal Systems: Cross-time Analyses

This article is concerned with the cross-time patterns of relationships between education funding, social change, and intergovernmental relations in four federal systems. The basic hypothesis of the research reported here is that the policy processes of the four federations – Canada, the Federal Republic of Germany, Switzerland, and the United States – are essentially similar. That is, the determinants of certain fiscal outputs of the policy processes are the same across the set of four nations. Not only do we hypothesize that the determinants of levels of education expenditures will be the same across the systems, we also predict that expenditure changes over time will be produced by similar forces across the subnational jurisdictions of all four countries. The comparability hypothesis will be examined and tested in several ways. We are first interested in expenditure differentials across the subnational units (provinces, Länder, cantons, and states) and how these differentials have changed in recent years. Second, we shall examine the policy impact of socioeconomic differences and change in these differences across subnational units. Finally, we will explore the patterns of change in fiscal responsibility among subnational and local governments, along with the determinants and some of the effects of that change.