Income Strata Research Articles

Boosting domestic rice production in Ghana: Analysis of consumer opinions, purchasing behavior and determinants among different income strata

Despite the fact that domestic rice production contributes significantly to the livelihood of millions of people in Ghana, it has been observed that consumers show a strong preference for expensive and imported rice over locally produced rice. The purpose of this study was to investigate the perception, purchasing behaviour and determinants of local rice consumption across three income households in the Kumasi Metropolis, Ghana. A total of 414 rice consumers were selected through a multi-stage sampling technique. Descriptive and inferential techniques, including perception analysis and ordered probit model, were used to analyse the data. The overall perception index of 3.61 denotes that consumers generally have a positive perception of local rice regarding health benefits (index = 4.44), affordability (index = 3.86), and cooking attributes (index = 3.48), despite its poor appearance (index = 2.80). The ordered probit model depicted heterogeneity of covariates as determinants of local rice consumption-based income strata of the household. For instance, various factors, including gender, age, occupation, and attributes of local rice such as affordability, nutrition, cooking attributes, and appearance, have a notable impact on the consumption of local rice among low-income households. In contrast, education, household decision-making, the place of purchasing local rice, and three perception attributes, namely affordability, nutrition, and cooking attributes, were found to be significant determinants of local rice consumption among middle-income households. According to the data, local rice consumption among high-income families was significantly predicted by gender, occupation, household size, and two perception attributes—affordability and nutrition. The study has practical implications for improving the competitiveness of local rice to increase its acceptance and consumption among consumers in the country.

Heterogeneous Trajectories in Post-Disaster Drug Use Across Different Race/Ethnicity and Income Strata: Focus on Natural Hazards During COVID-19.

During the COVID-19 pandemic, climate-related natural hazards, such as wildfires, storms/hurricanes, and others (e.g., earthquakes, tornadoes), further disrupted the normal functioning of US residents. The co-occurrence of natural disasters and COVID-19 created unprecedentedly elevated levels of stress, especially to the racial/ethnic minorities and lower-income households. This study examines how natural disasters related to recreational drug use during COVID-19 and whether the relation is heterogeneous across different subgroups categorized by race/ethnicity and household income. This study used the data from the biweekly online surveys of the Understanding America Study (UAS) and analyzed the drug use behaviors of 966 US adults between April 29 and December 31, 2020. This study found that middle-income adults (household income ranging from $50,000 to $149,999), serving as the reference group, generally exhibited a significant reduction in drug consumption during or after disaster events. However, compared to the middle-income group, White and Black adults with household income lower than $50,000 showed 142% and 88% more frequent drug use when experiencing storms/hurricanes. This disparity widened in the following weeks. Additionally, lower-income Hispanics showed 74% more frequent drug use compared to the middle-income group in the weeks following wildfire incidents. The study's findings shed light on the risk of drug misuse during the co-occurrence of climate and public health crises, emphasizing the disproportionate risk among lower-income racial/ethnic minorities amid the pandemic and natural disasters.

Factors Associated with the Practice of Low-Carb and Low-Fat Diets among Participants of the Longitudinal Study of Adult Health (ELSA-Brasil).

In the field of nutrition, both low-carbohydrate (LCD) and low-fat (LFD) diets were initially intended for specific subgroups but are now being embraced by the broader population for various purposes, including aesthetics and overall health. This study aims to assess sociodemographic, health, and lifestyle factors influencing diet choices among public servants in the ELSA-Brasil cohort. Diets were classified as LCD or LFD based on the Brazilian Diabetes Society (<45%) and WHO guidelines (<30%) respectively. A total of 11,294 participants were evaluated (45.3% men; 54.7% women) with a mean age of 52 ± 0.08 years. Having overweight, altered waist circumference, and a history of smoking confers higher chances of adopting an LCD compared to the usual diet, while being over 52 years, non-White race/skin color, in a lower income stratum, and having diagnosis of hypertension and/or diagnosis of diabetes mellitus decrease these chances. Regarding LFDs, belonging to the non-White race/skin color, being over 52 years old, being divorced, and practicing low physical activity decrease the chances of following such a diet compared to the usual diet. In conclusion, factors like age, socioeconomic status, health, and physical activity levels can be the key to understanding why individuals choose restrictive diets beyond clinical advice.

Race and Sex Differences in the Association of Bystander CPR for Cardiac Arrest.

Bystander cardiopulmonary resuscitation (CPR) is associated with higher survival for out-of-hospital cardiac arrest, but whether its association with survival differs by patients' sex and race and ethnicity is less clear. Within a large US registry, we identified 623 342 nontraumatic out-of-hospital cardiac arrests during 2013 to 2022 for this observational cohort study. Using hierarchical logistic regression, we examined whether there was a differential association between bystander CPR and survival outcomes by patients' sex and race and ethnicity, overall and by neighborhood strata. Mean age was 62.1±17.1 years, and 35.9% were women. Nearly half of patients (49.8%) were non-Hispanic White; 20.6% were non-Hispanic Black; 7.3% were Hispanic; 2.9% were Asian; and 0.4% were Native American. Overall, 58 098 (9.3%) survived to hospital discharge. Although bystander CPR was associated with higher survival in each race and ethnicity group, the association of bystander CPR compared with patients without bystander CPR in each racial and ethnic group was highest in individuals who were White (adjusted odds ratio [OR], 1.33 [95% CI, 1.30-1.37]) and Native American (adjusted OR, 1.40 [95% CI, 1.02-1.90]) and lowest in individuals who were Black (adjusted OR, 1.09 [95% CI, 1.04-1.14]; Pinteraction<0.001). The adjusted OR for bystander CPR compared with those without bystander CPR for Hispanic patients was 1.29 (95% CI, 1.20-1.139), for Asian patients, it was 1.27 (95% CI, 1.12-1.42), and for those of unknown race, it was 1.31 (95% CI, 1.25-1.36). Similarly, bystander CPR was associated with higher survival in both sexes, but its association with survival was higher in men (adjusted OR, 1.35 [95% CI, 1.31-1.38]) than women (adjusted OR, 1.15 [95% CI, 1.12-1.19]; Pinteraction<0.001). The weaker association of bystander CPR in Black individuals and women was consistent across neighborhood race and ethnicity and income strata. Similar results were observed for the outcome of survival without severe neurological deficits. Although bystander CPR was associated with higher survival in all patients, its association with survival was weakest for Black individuals and women with out-of-hospital cardiac arrest.

Geographic and economic influences on benralizumab prescribing for severe asthma in Japan

Benralizumab, a monoclonal antibody targeting IL-5 receptors, reduces exacerbations and oral corticosteroid requirements for severe, uncontrolled eosinophilic asthma. In Japan, geographic disparities in asthma outcomes suggest differential prescribing and access. This study aimed to quantify regional prescribing variations for benralizumab nationwide. Using Japan’s National Database (NDB) of insurance claims (2009–2019), benralizumab standardized claim ratios (SCRs) were calculated for 47 prefectures. Correlations between SCRs and other biologics’ SCRs, economic variables like average income, and physician densities were evaluated through univariate analysis and multivariate regressions. Income-related barriers to optimal prescribing were examined. Wide variation emerged in benralizumab SCRs, from 40.1 to 184.2 across prefectures. SCRs strongly correlated with omalizumab (r = 0.61, p < 0.00001) and mepolizumab (r = 0.43, p = 0.0024). Average monthly income also positively correlated with benralizumab SCRs (r = 0.45, p = 0.0016), whereas lifestyle factors were insignificant. Respiratory specialist density modestly correlated with SCRs (r = 0.29, p = 0.047). In multivariate regressions, average income remained the most robust predictor (B = 0.74, p = 0.022). Benralizumab SCRs strongly associate with income metrics more than healthcare infrastructure/population factors. Many regions show low SCRs, constituting apparent prescribing gaps. Access barriers for advanced asthma therapies remain inequitable among Japan’s income strata. Addressing affordability alongside specialist allocation can achieve better prescribing quality and asthma outcomes.

Warming climate apathy to mitigate the disparity in climate policy support across distinct income strata

Worldwide, nations strive to curtail carbon emissions, but income disparities create challenges in climate policy support. While the Chinese government has employed economic incentives to mitigate the financial burden of green energy transition, these measures may not fully address the underlying issue of climate apathy, wherein individuals prioritize immediate interests over long-term climate concerns. Using a three-year online tracking sample of Chinese adults (n = 4,699), this study investigates the enduring predictive role of income poverty on climate policy support (e.g., green energy transition), alongside the explanatory power of climate apathy and economic burden for this effect. The research reveals that income poverty results in lower climate policy support, with climate apathy explaining 38.29% of this effect, while economic burden accounts for only 8%. Moreover, compared to economic burden, climate apathy has a stronger impact on policy support in regions with different levels of economic development. These findings underscore the potential of addressing climate apathy as a non-economic approach to enhance support for climate policies among low-income groups, offering a cost-effective and stable strategy to bridge the policy support gap caused by income disparity and regional economic imbalances.

Unveiling disparities: Metastatic lung cancer incidence across income strata in metropolitan residencies.

e20616 Background: Over recent years, there has been growing interest in the field of lung cancer. Great efforts have been invested in recent years to improve screening and mortality outcomes with respect to lung cancer, particularly metastatic lung cancer (mLC). In the dynamic landscape of metropolitan residencies (MR), this study delves into the impact of household income (HI) on the occurrence of mLC. Unraveling the intricacies of these disparities is crucial for advancing our understanding of healthcare access and outcomes in urban settings. Methods: Appropriating data from the Surveillance, Epidemiology, and End Results (SEER) database, we looked at the incidence rates of mLC among adults aged 55-80 years by HI levels ( &lt; $35,000, $45,000-49,999, $55,000-$59,999, $65,000-69,999 and $75,000+) in MR from 2004 to 2017. Age-adjusted rates were calculated, and joinpoint regression models were used to estimate the average annual percentage change (AAPC) in incidence across different subgroups. Results: The study population included a total of 321,281 individuals diagnosed with mLC. The incidence of mLC declined rapidly from 2004 to 2017 across all HI groups in metropolitan residence; the AAPC for HIs $45,000-49,999 was -0.70%, $55,000-59,999 was -2.11%, $65,000-69,999 was -4.32% and $75,000+ was -3.72%. Of note, there was not enough data to characterize the trend for HIs &lt; $35,000. Conclusions: Our study revealed an overall decline in the incidence of mLC since 2004 across all HI groups in MRs. Although the trend is one of diminution across all groups, there is however, still some differences in incidence rates amongst different HI groups. This study elucidates the vital role HI plays in influencing the landscape of mLC in metropolitan areas. Recognizing and addressing these disparities is crucial for developing comprehensive public health strategies aimed at reducing the burden of advanced lung cancer and promoting equal access to quality healthcare.

A community evaluation of post-partum quality of life using a locally adapted mother-generated-index: the Delhi Delivery Care (DELCARE) Survey (2009-2011)

ABSTRACT Post-partum quality of life is an inadequately studied and poorly understood outcome of delivery care, especially in low- and middle-income countries. Hence, we evaluated the postpartum quality of life and its clinic-demographic context as part of a 3-stage cluster randomized community survey (DECLARE; covered quality of care as primary outcome) conducted in 2009–2011 in Delhi. In stage 1 of participant selection(sampling), 20 wards (of 150; geographically defined administrative units) were selected using a probability-proportionate-to-size systematic method. In stage 2, one from each income stratum (high, middle, and low; multiple colonies within each ward) was selected from each ward by simple random sampling (total 60 colonies of 2311). In stage 3, a house-to-house survey was conducted to recruit ~1800 recently delivered women for the multidimensional work, which included quality-of-care, cost-of-care, and PPQOL. Among the participants, those with high school or above education were invited to administer the Mother-Generated Index and calculate the primary and secondary index scores (PIS and SIS). A total of 794 (of 857 eligible; 118846 households) women were administered MGI. The mean PIS was 4.6[95 percent CI 4.4–4.7] while the average SIS was 4.0[95 percent CI 3.8–4.2]. The PIS was worse for primiparous vs. multiparous mothers. On multivariate analysis, poorer psychological state, obstetric complications, and premature delivery correlated with poorer QOL scores, while better gestational weight gain, higher age, and labor-pain relief correlated with better QOL scores. The study benchmarks the poor status of post-partum quality-of-life and documents the spectrum, severity, and complexity of its key social, psychological, physical, and demographic determinants.

Understanding the Influence of Single Payer Health Insurance on Socioeconomic Disparities in Total Hip Arthroplasty (THA) Utilization: A Transnational Analysis.

Access to care varies between countries. It is theorized that income-based disparities in access may be reduced in countries with universal health insurance relative to the United States, but data are currently limited. We hypothesized that income-based differences in total hip arthroplasty (THA) utilization and outcomes would be larger in the United States than in Canada. We retrospectively compared all patients undergoing THA from 2012 to 2018 in Pennsylvania, the United States, and Ontario, Canada. We compared age-standardized and sex-standardized per-capita THA utilization in the United States and Canada overall and across different income strata, where income strata were defined by neighborhood income quintile. We also examined income-based differences in rates of 1-year revision, 90-day mortality, and 90-day readmission. Overall THA utilization per 10,000 people per year was higher across all income groups in Pennsylvania compared with Ontario (15.1 versus 8.8, P < 0.001 in lowest-income quintile; 21.4 versus 12.6, P < 0.001 in highest-income quintile). Income-based differences in utilization in the highest-income vs lowest-income quintile groups were greater in Ontario (43.2%) than Pennsylvania (41.7%). The adjusted odds for the lowest-income group compared with the highest-income group of 1-year revision were greater in Ontario compared with Pennsylvania ( P = 0.03), and risk of 90-day mortality and 90-day readmission was similar between the regions. Income-based differences in THA utilization were more notable in Ontario than in Pennsylvania. In addition, patients in low-income communities in Ontario were at equal or greater risk relative to high-income community patients for adverse outcomes compared with patients in Pennsylvania. Income-based disparities in THA utilization and outcomes were smaller in the United States than in Canada, in contrast to what might be expected. III.

Examining the influence of global smoking prevalence on stroke mortality: insights from 27 countries across income strata

BackgroundThis study investigates the influence of Global Smoking Prevalence (GSP) on Stroke Death Rates (SDR) across 27 countries categorized into High-Income Countries (HIC), Upper Middle-Income Countries (UMIC), Lower Middle-Income Countries (LMIC), and Low-Income Countries (LIC).MethodsAnalysing data from two distinct periods (1990–1999 and 2010–2019), countries exhibiting an increased SDR were selected. The study uses a polynomial regression model, treating income groups as cross-sectional and years as time series data.ResultsResults from the regression model reveal that 17 countries observed a significant impact of GSP on SDR, with only Turkey, Solomon Islands, and Timor-Leste resulting in negative values. However, the study emphasises that out of all 27 countries, the highest occurrence of the impact of GSP on SDR has been reported in the LMIC stratum for the period under review.ConclusionIt is evident that GSP affects the risk of incidence of stroke death, specifically in the LMIC stratum. Furthermore, it has been identified that GSP is a major preventable risk factor affecting global mortality. To mitigate the risk of stroke death attributable to smoking prevalence, necessary preventive steps should be adopted to encourage smoking cessation, and essential policies should be implemented to reduce the burden of SDR.

Prevalence trends and racial-ethnic disparities of diabetes and prediabetes among children and adolescents in the United States from 2019 to 2021

ObjectiveThis study investigated disparities in diabetes and prediabetes prevalence among US children and adolescents using 2019–2021 National Health Interview Survey (NHIS) data. With rising trends in diabetes, understanding prevalence rates and associated disparities is crucial for targeted interventions. MethodsAnalyzing a cross-sectional sample of 19,490 participants aged 3–17, we employed NHIS data to calculate prevalence rates. Stratification by sociodemographic factors, race/ethnicity, and family income allowed for in-depth analyses. ResultsBetween 2019 and 2021, overall diabetes prevalence was 1.18%, comprising 0.87% prediabetes and 0.46% diabetes rates. Disparities were evident, with higher prediabetes rates in non-Hispanic black and Hispanic children and elevated diabetes rates in non-Hispanic white and Hispanic children. Subgroup analyses revealed associations within age, gender, education, and income strata. ConclusionsThe study highlighted potential increases in diabetes prevalence from 2017 to 2021 and persistent racial/ethnic disparities. The 12–17 age subgroup exhibited significant disparities, emphasizing the need for early intervention. Targeted strategies were imperative to mitigate diabetes and prediabetes prevalence in vulnerable populations, particularly non-Hispanic black and Hispanic children. This study underscored the urgency of addressing health disparities for improved overall well-being and healthcare outcomes.

Reinvestigating the environmental Kuznets curve (EKC) of carbon emissions and ecological footprint in 147 countries: a matter of trade protectionism

Environmental degradation has profoundly impacted both human society and ecosystems. The environmental Kuznets curve (EKC) illuminates the intricate relationship between economic growth and environmental decline. However, the recent surge in trade protectionism has heightened global economic uncertainties, posing a severe threat to global environmental sustainability. This research aims to investigate the intricate pathways through which trade protection, assessed by available trade openness data, influences the nexus between economic growth and environmental degradation. Leveraging comprehensive global panel data spanning 147 countries from 1995 to 2018, this study meticulously examines the non-linear dynamics among trade, economy, and the environment, with a particular emphasis on validating the EKC hypothesis. This study encompasses exhaustive global and panel data regressions categorized across four income groups. The research substantiates the validity of the EKC hypothesis within the confines of this investigation. As income levels rise, the impact of economic growth on environmental degradation initially intensifies before displaying a diminishing trend. Additionally, trade protection manifests as a detriment to improving global environmental quality. The ramifications of trade protectionism display nuanced variations across income strata. In high-income nations, trade protection appears to contribute to mitigating environmental degradation. Conversely, within other income brackets, the stimulating effect of trade protection on environmental pressure is more conspicuous. In other words, trade protectionism exacerbates environmental degradation, particularly affecting lower-income countries, aligning with the concept of pollution havens. The study’s results illuminate nuanced thresholds in the relationship between trade, economic growth, and environmental degradation across income groups, emphasizing the heterogeneous impact and underlying mechanisms. These findings provide valuable insights for policymakers, urging collaborative efforts among nations to achieve a harmonious balance between economic advancement and environmental preservation on a global scale.

Impact of Social Assistance Programs on Family Economic Welfare in Urban Environments: An Analysis of Equity and Community Engagement

This research investigates the impact of social assistance programs on the economic welfare of families within urban settings. It aims to discern the relationship between the utilization of social assistance programs and economic conditions, explore disparities in impact across socioeconomic strata, delve into the lived experiences of program beneficiaries, and provide recommendations for more equitable and effective policy implementation. A mixed-methods approach is employed, combining quantitative and qualitative methods. Quantitative data is collected through surveys and government records, while qualitative data is gathered via interviews and focus groups. The analysis encompasses statistical techniques and thematic coding. The research reveals a positive correlation between social assistance programs and economic improvements in urban households. It uncovers disparities in impact across income strata, with a more pronounced effect on lower-income families. Qualitative insights validate the experiences of program beneficiaries, emphasizing the programs' importance in providing essential resources and education support. The study's findings have substantial implications for policymakers, program administrators, and urban communities. Policymakers are urged to create more targeted, nuanced, and adaptive programs, administrators should streamline administrative processes and support adequacy, and communities are empowered to engage in program design. This research underscores the potential for a more responsive, equitable, and inclusive social assistance framework

Risk factors for severe respiratory syncytial virus infection during the first year of life: development and validation of a clinical prediction model

Novel immunisation methods against respiratory syncytial virus (RSV) are emerging, but knowledge of risk factors for severe RSV disease is insufficient for optimal targeting of interventions against them. Our aims were to identify predictors for RSV hospital admission from registry-based data and to develop and validate a clinical prediction model to guide RSV immunoprophylaxis for infants younger than 1 year. In this model development and validation study, we studied all infants born in Finland between June 1, 1997, and May 31, 2020, and in Sweden between June 1, 2006, and May 31, 2020, along with the data for their parents and siblings. Infants were excluded if they died or were admitted to hospital for RSV within the first 7 days of life. The outcome was hospital admission due to RSV bronchiolitis during the first year of life. The Finnish study population was divided into a development dataset (born between June 1, 1997, and May 31, 2017) and a temporal hold-out validation dataset (born between June 1, 2017, and May 31, 2020). The development dataset was used for predictor discovery and selection in which we screened 1511 candidate predictors from the infants', parents', and siblings' data, and developed a logistic regression model with the 16 most important predictors. This model was then validated using the Finnish hold-out validation dataset and the Swedish dataset. In total, there were 1 124 561 infants in the Finnish development dataset, 130 352 infants in the Finnish hold-out validation dataset, and 1 459 472 infants in the Swedish dataset. In addition to known predictors such as severe congenital heart defects (adjusted odds ratio 2·89, 95% CI 2·28-3·65), we confirmed some less established predictors for RSV hospital admission, most notably oesophageal malformations (3·11, 1·86-5·19) and lower complexity congenital heart defects (1·43, 1·25-1·63). The prediction model's C-statistic was 0·766 (95% CI 0·742-0·789) in Finnish data and 0·737 (0·710-0·762) in Swedish validation data. The infants in the highest decile of predicted RSV hospital admission probability had 4·5 times higher observed risk compared with others. Calibration varied according to epidemic intensity. The model's performance was similar to a machine learning (XGboost) model using all 1511 candidate predictors (C-statistic in Finland 0·771, 95% CI 0·754-0·788). The prediction model showed clinical utility in decision curve analysis and in hypothetical number needed to treat calculations for immunisation, and its C-statistic was similar across different strata of parental income. The identified predictors and the prediction model can be used in guiding RSV immunoprophylaxis in infants, or as a basis for further immunoprophylaxis targeting tools. Sigrid Jusélius Foundation, European Research Council, Pediatric Research Foundation, and Academy of Finland.

Environmental exposure disparities in ultrafine particles and PM2.5 by urbanicity and socio-demographics in New York state, 2013–2020

BackgroundThe spatiotemporal and demographic disparities in exposure to ultrafine particles (UFP; number concentrations of particulate matter (PM) with diameter ≤0.1 μm), a key subcomponent of fine aerosols (PM2.5; mass concentrations of PM ≤ 2.5 μm), have not been well studied. ObjectiveTo quantify and compare the aerosol pollutant exposure disparities for UFP and PM2.5 by socio-demographic factors in New York State (NYS). MethodsAmbient atmospheric UFP and PM2.5 were quantified using a global three-dimensional model of chemical transport with state-of-the-science aerosol microphysical processes validated extensively with observations. We matched these to U.S. census demographic data for varied spatial scales (state, county, county subdivision) and derived population-weighted aerosol exposure estimates. Aerosol exposure disparities for each demographic and socioeconomic (SES) indicator, with a focus on race-ethnicity and income, were quantified for the period 2013–2020. ResultsThe average NYS resident was exposed to 4451 #·cm−3 UFP and 7.87 μg·m−3 PM2.5 in 2013–2020, but minority race-ethnicity groups were invariably exposed to greater daily aerosol pollution (UFP: +75.0% & PM2.5: +16.2%). UFP has increased since 2017 and is temporally and seasonally out-of-phase with PM2.5. Race-ethnicity exposure disparities for PM2.5 have declined over time; by −6% from 2013 to 2017 and plateaued thereafter despite its decreasing concentrations. In contrast, these disparities have increased (+12.5–13.5%) for UFP. The aerosol pollution exposure disparities were the highest for low-income minorities and were more amplified for UFP than PM2.5. DiscussionWe identified large disparities in aerosol pollution exposure by urbanization level and socio-demographics in NYS residents. Jurisdictions with higher proportions of race-ethnicity minorities, low-income residents, and greater urbanization were disproportionately exposed to higher concentrations of UFP and PM2.5 than other NYS residents. These race-ethnicity exposure disparities were much larger, more disproportionate, and unabating over time for UFP compared to PM2.5 across various income strata and levels of urbanicity.

Geographic disparities in trends of thyroid cancer incidence and mortality from 1990 to 2019 and a projection to 2030 across income-classified countries and territories.

The rising incidence of thyroid cancer (TC) has generated growing concern globally; yet there are no studies examining whether this incidence was followed by a rise in related mortality. We aimed to comprehensively quantify current trends and future projections of TC incidence and mortality, and to explore the association between the TC burden and socioeconomic inequality in different income strata. We obtained incidence and mortality data on TC and population from the 2019 Global Burden of Disease (GBD) study and the United Nations' World Population Prospects 2022. We applied an age-period-cohort (APC) model to estimate the overall annual percentage change (net drift) and age, period, and cohort effects from 1990 to 2019, and also constructed a Bayesian APC model to predict the TC burden through 2030. Over a third of global TC cases belonged to the high-income group. From 1990 to 2019, net drifts of TC incidence were >0 in all income groups, while a modest reduction (net drift <0) in mortality was observed in most income groups, except for the lower-middle-income group. Unfavourable age, period, and cohort effects were most notable in Vietnam, China, and Korea. The age-standardised incidence rate (ASIR) is predicted to increase whereas the age-standardized mortality rate (ASMR) is expected to decrease globally between 2020 and 2030, with geographic heterogeneity being detected across income groups. We observed a positive correlation between ASIR and universal health coverage index and health worker density, but a negative one between ASMR and the two indicators, primarily in upper-middle-income and high-income countries. Opposite patterns in incidence and mortality of TC raise concerns about overdiagnosis, particularly in upper-middle-income and high-income countries. Discrepancies in the distribution of health service accessibility, including diagnostic techniques and therapeutic care, should be addressed by narrowing health inequalities in the TC burden across countries.

Framing energy-efficiency programs: A survey experiment

In the U.S., many low- and moderate-income households live in energy-inefficient homes and are burdened by energy bills. Although energy-efficiency home improvement programs are long-term solutions for home energy problems, the take-up of income-eligible energy-efficiency programs can be low. This study investigates how information framing affects low- and moderate-income individuals' willingness to participate in energy-efficiency programs in the U.S. as informed by prospect theory and regulatory focus theory. The author used a survey experiment to test how framing free energy-efficiency programs as helping homeowners avoid monetary losses versus framing programs as providing energy savings affects respondents' interest in program participation. Results from a national sample of homeowners pre-stratified by income (N = 1590) suggest that gain-framed messages are more effective in encouraging take-up willingness among moderate-income homeowners than loss-framed messages. At the same time, framing's effect on take-up willingness is statistically insignificant among low-income homeowners. Stress about paying energy bills also predicts willingness to take up energy-efficiency programs with statistical significance. This study contributes to helping policymakers customize information about energy-efficiency programs with different framings for individuals across the income strata.

The impact of sanctions on household welfare and employment in Iran

ABSTRACT Wide-ranging US sanctions against Iran in the past decade were in large part imposed to harm the living standards of ordinary Iranians in the hope that their leaders would submit to US demands to limit their nuclear program. In this study, I use extensive survey data to assess the impact of sanctions on household consumption and employment. Unsurprisingly, reduction in Iran's export of oil, which dealt a large negative blow to the economy, reduce household expenditures across income strata, raising poverty rates despite government attempts to assist the poor. By contrast, employment did not suffer as devaluation and falling real wages helped local production to substitute for imports that had been previously paid for by oil income. Probit analysis of panel data shows that, all else equal, living in urban areas, in households with older and female heads, and lack of health insurance increase the chance of falling into poverty after the 2018 shock of the US maximum pressure campaign.

Does Being Poor and Sick Modify the Effect of Individuals on High-Deductible Health Plan (HDHP) Reporting Delayed/Foregone Care?

To assess the influence of being both poor and sick on the association of high-deductible health plans (HDHPs) with delayed/forgone care. In this cross-sectional study that included 14,203 respondents, representing 120 million Americans, individuals insured by HDHPs had 2.23 times the odds of delayed/foregone care compared with non-HDHP insureds. When examined across strata of income and health status, the association yielded similar odds of delayed/foregone care. Additionally, the interaction of being poor and sick on the association of HDHPs to delayed/foregone care was not statistically significant. Meaning. Being insured on a HDHP affected delayed/foregone care largely consistently, regardless of health, income, or combined health/income category.

Roles of Income and Acculturation in the Hispanic Paradox: Breastfeeding Among Hispanic Women.

Despite Hispanics' high prevalence of breastfeeding compared to other racial/ethnic groups, contributing factors remain unclear. This study examines the complex relationship among Hispanic nativity, acculturation, income, and breastfeeding. The Fragile Families Child Wellbeing Study baseline (1998-2000) and Year 1 data (1999-2001) were used, including 4,077 women (933 non-Hispanic white, 2,046 non-Hispanic Black, 352 US-born Mexicans [USM], 299 US-born other Hispanics [USH], 302 foreign-born Mexicans [FBM], and 145 foreign-born other Hispanics [FBH]). Logistic regression estimated odds ratios(OR) and 95% confidence intervals(CI) for associations between Hispanic nativity and breastfeeding initiation and 4-month and 6-month breastfeeding, accounting for acculturation (Spanish language use, cultural engagement, religiosity, and traditional gender role attitudes), demographics, income, and health factors. Models were run for the overall sample and stratified by low vs. high income (above median: $21,600). FBM(OR:2.35, 95%CI 1.33,4.15) and FBH(OR:2.28, 95%CI 1.23,4.24) had higher odds, while USM(OR:0.55, 95%CI 0.41,0.73) and USH(OR:0.50, 95%CI 0.37,0.67) had lower odds of breastfeeding initiation, compared to white women. USM had lower odds of 4-month(OR:0.53, 95%CI 0.36,0.80) and 6-month breastfeeding(OR:0.38, 95%CI 0.23,0.63), as did USH for 4-month(OR:0.64, 95%CI 0.42,0.99) and 6-month breastfeeding(OR:0.50, 95%CI 0.30,0.85). In stratified models, low-income (vs. high-income) FBH had higher odds of breastfeeding initiation(OR:3.73 95%CI 1.43,9.75) and 4-month(OR:3.01 95%CI 1.12,8.04) and 6-month breastfeeding(OR:3.08 95%CI 1.07,8.88), yet effects of acculturation across income strata are inconsistent. The Hispanic paradox operates differentially due to nativity, income, and acculturation. Breastfeeding intervention and promotion may require tailored approaches to Hispanic subgroups.