Individual-level Income Research Articles

Metropolitan area income inequality and self-rated health—a multi-level study

We examined the association of income inequality measured at the metropolitan area (MA) and county levels with individual self-rated health. Individual-level data were drawn from 259,762 respondents to the March Current Population Survey in 1996 and 1998. Income inequality and average income were calculated from 1990 census data, the former using Gini coefficients. Multi-level logistic regression models were used. Controlling for sex, age, race, and individual-level household income, respondents living in high, medium–high, and medium–low income inequality MAs had odds ratios of fair/poor self-rated health of 1.20 (95% confidence interval 1.04–1.38), 1.07 (0.95–1.21), and 1.02 (0.91–1.15), respectively, compared to people living in the MAs with the lowest income inequality. However, we found only a small association of MA-level income inequality with fair/poor health when controlling further for average MA household income: odds ratios were 1.10 (0.95–1.28), 1.01 (0.89–1.14), and 1.00 (0.89–1.12), respectively. Likewise, we found only a small association of county-level income inequality with self-rated health—although only 40.7% of the sample had an identified county on CPS data. Regarding the association of state-level income inequality with fair/poor health, we found the association to be considerably stronger among non-metropolitan (i.e. rural) compared to metropolitan residents.

Neighborhoods and Guns in Middle America

The objective of this research is to see whether characteristics of the neighborhood in which a person lives influence the likelihood of having a gun in the household. I use my 1995 “Community, Crime and Health” multilevel data set, a survey of a probability sample of 2,482 Illinois adults with linked census information on the respondent's census tract, zip code, city and county from the STF3 of the 1990 Census. Logistic regression shows that gun ownership is low in neighborhoods where a high percentage of adults are college-educated. Adjustment for individual-level race, ethnicity, sex, age, education, income, and household structure indicates that the presence of well-educated neighbors affects the likelihood of gun ownership, over and above individual characteristics. This relationship appears to be due to the normative climate, not to perceived threat, since neighborhood disorder does not significantly affect the likelihood of having a gun in the house. Previous victimization, however, is positively associated with having a gun in the household. In addition, people who are college-educated themselves are less likely to have a gun in the household.

Area Characteristics and Individual-Level Socioeconomic Position Indicators in Three Population-Based Epidemiologic Studies

PURPOSE: There is growing interest in incorporating area indicators into epidemiologic analyses. Using data from the 1990 U.S. Census linked to individual-level data from three epidemiologic studies, we investigated how different area indicators are interrelated, how measures for different sized areas compare, and the relation between area and individual-level social position indicators. METHODS: The interrelations between 13 area indicators of wealth/income, education, occupation, and other socioenvironmental characteristics were investigated using correlation coefficients and factor analyses. The extent to which block-group measures provide information distinct from census tract measures was investigated using intraclass correlation coefficients. Loglinear models were used to investigate associations between area and individual-level indicators. RESULTS: Correlations between area measures were generally in the 0.5–0.8 range. In factor analyses, six indicators of income/wealth, education, and occupation loaded on one factor in most geographic sites. Correlations between block-group and census tract measures were high (correlation coefficients 0.85–0.96). Most of the variability in block-group indicators was between census tracts (intraclass correlation coefficients 0.72–0.92). Although individual-level and area indicators were associated, there was evidence of important heterogeneity in area of residence within individual-level income or education categories. The strength of the association between individual and area measures was similar in the three studies and in whites and blacks, but blacks were much more likely to live in more disadvantaged areas than whites. CONCLUSIONS: Area measures of wealth/income, education, and occupation are moderately to highly correlated. Differences between using census tract or block-group measures in contextual investigations are likely to be relatively small. Area and individual-level indicators are far from perfectly correlated and provide complementary information on living circumstances. Differences in the residential environments of blacks and whites may need to be taken into account in interpreting race differences in epidemiologic studies.

Income inequality and the prevalence of common mental disorders in Britain.

It has been hypothesised that the association between greater income inequality and increased mortality is mediated by poor psychosocial health. To test the hypothesis that individuals in regions of Britain with the highest income inequality have a higher prevalence of the common mental disorders, after adjusting for individual income. Cross-sectional survey of 8191 adults aged 16-75 in private households in England, Wales and Scotland. The prevalence of common mental disorders was assessed using the General Health Questionnaire. The association between income inequality and prevalence of the common mental disorders varied with individual income level. Among persons with the highest incomes, common mental disorders were more frequent in regions with greater income inequality (as indicated by high Gini coefficient) (adjusted OR 1.31,95% C1 1.05-1.65; P: = 0.02). The opposite was true for those with the lowest incomes. Income inequality was associated with worse mental health among the most affluent individuals.

Neighboorhood Effects in Community Trials for Cardiovascular Disease

P89 BACKGROUND:Cluster-randomized community trials are critically important to cardiovascular (CVD) epidemiology. While studies evaluating the effect of community education programs report favorable risk factor changes, including the Pawtucket Heart Health Program (PHHP), changes in hard CVD endpoints have been less common. Few have examined the effect of neighborhood on endpoints, especially controlling for individual characteristics. In short, overall effects may be confounded with neighborhood. METHODS:In the first study of this type, we geocoded PHHP neighborhoods to 1990 Census tracts, and randomly sampled 50% (n=521) of the observations from the 6th PHHP cross-sectional survey. Endpoints included CVD knowledge (number of correct risk factors mentioned), and total serum cholesterol. Income and percent working poor (households in a tract with income < 150% of the poverty-line) served as individual- and neighborhood-level SES, respectively. SAS Proc Mixed was used to fit multilevel models. Geographic Information Systems (GIS) methods map empirical Bayes estimates. RESULTS:Choropleth maps show variation in CVD knowledge and cholesterol across the 22 tracts of Pawtucket. Multilevel models reveal that income accounts for most of this neighborhood-level variation. However, a significant negative interaction between individual- and neighborhood-level SES (p < 0.10) was observed for CVD knowledge. Predicted values for CVD knowledge show that persons with a moderate income (level 5) living in a neighborhood with a large proportion (65%) of working poor would be expected to have a knowledge score of 2.34. This same person living in a neighborhood with a small proportion of working poor (15%) would be expected to have a knowledge score of 3.19. This represents a 14% difference due to the neighborhood effect. COMMENT: These results suggest that having more individual-level income is positively related to CVD knowledge; such effects are muted if one resides in a neighborhood with a larger proportion of working poor. It may be that future community trials for CVD may benefit by targeting, or concentrating more heavily on, not only poor persons but persons living in poor neighborhoods.

State-level income inequality and individual mortality risk: a prospective, multilevel study.

Previous studies have linked state-level income inequality to mortality rates. However, it has been questioned whether the relationship is independent of individual-level income. The present study tests whether state-level income inequality is related to individual mortality risk, after adjustment for individual-level characteristics. In this prospective, multilevel study design, the vital status of National Health Interview Survey (NHIS) respondents was ascertained by linkage to the National Death Index, with additional linkage of state-level data to individuals in the NHIS. The analysis included data for 546,888 persons, with 19,379 deaths over the 8-year follow-up period. The Gini coefficient was used as the measure of income inequality. Individuals living in high-income-inequality states were at increased risk of mortality (relative risk = 1.12; 95% confidence interval = 1.04, 1.19) compared with individuals living in low-income-inequality states. In stratified analyses, significant effects of state income inequality on mortality risk were found, primarily for near-poor Whites. State-level income inequality appears to exert a contextual effect on mortality risk, after income is adjusted for, providing further evidence that the distribution of income is important for health.

Neighborhood Disadvantage and Adult Depression

Using multilevel data, Ifind that residents of poor, mother-only neighborhoods have higher levels of depression than residents of more advantaged neighborhoods. My data arefrom the 1995 Community, Crime and Health survey, a probability sample of 2,482 adults in Illinois with linked information about the respondents' census tract. Adjustment for individual-level race, ethnicity, sex, age, education, employment, income, household structure, and urban residence indicates that more than half of apparent contextual effect is really compositional, due to the fact that residents of disadvantaged neighborhoods tend to be disadvantaged themselves; however, a significant contextual effect survives. All of the distressing effects offemale headship and poverty in the neighborhood are mediated by perceived neighborhood disorder The daily stress of living in a neighborhood where social order has broken down is associated with depression.

A multilevel analysis of income inequality and cardiovascular disease risk factors

Recent research has suggested that inequality in the distribution of income is associated with increased mortality, even after accounting for average income levels. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), we investigated whether inequality in the distribution of income within US states is related to the prevalence of four cardiovascular disease risk factors (body mass index (BMI), history of hypertension, sedentarism, and smoking). Multilevel models (including both state-level and individual-level variables) were used to examine associations of state inequality with risk factor levels before and after adjustment for individual-level income. For three of the four risk factors investigated (BMI, hypertension, and sedentarism), state inequality was associated with increased risk factor levels, particularly at low income levels (annual household incomes <$25,000), with associations persisting after adjustment for individual-level income. Inequality was also positively associated with smoking, but associations were either stronger or only present at higher income levels. Associations of inequality with the outcomes were statistically significant in women but not in men. Although not conclusive, findings for three of the four risk factors are suggestive of a contextual effect of income inequality, particularly among persons with lower incomes.

Assessing ecologic proxies for household income: a comparison of household and neighbourhood level income measures in the study of population health status

This paper examines the validity of using ecologic measures of socioeconomic status as proxies for individual-level measures in the study of population health. Based on a representative 5% sample of households in a Canadian province, the study integrated three sources of information: administrative records of individual health care utilization, records of deaths and 1986 census records which contained information on household income and average neighbourhood income. Thirteen measures of health status were developed from these sources of information. The hypothesis that risk estimates derived from ecologic income measures will be attenuated relative to estimates obtained from household income was not supported. These results provide evidence for the use of ecologic-level measures of income in studies which do not have access to individual-level income measures.

Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study.

Recent reports suggest the importance of associations between residential area characteristics and health status, but most research uses only census data to measure these characteristics. The current research examined the effect of overall neighborhood social environment on 11-year risk of death. On the basis of data, the authors developed a three-component neighborhood social environment scale: 1) commercial stores; 2) population socioeconomic status; and 3) environment/housing. Data from the 1983 wave of the Alameda County Study (n = 1,129) and deaths over 11 years were analyzed with two-level logistic regression models. Age- and sex-adjusted risk of death was higher for residents in low social environment neighborhoods (odds ratio = 1.58, 95% confidence interval 1.15-2.18). Mortality risks were significantly higher in neighborhoods with a low social environment, even after account was taken of individual income level, education, race/ethnicity, perceived health status, smoking status, body mass index, and alcohol consumption. When each component of the neighborhood social environment characteristics score was examined separately, each was found to be associated with higher risk for mortality, independent of individual risk factors. These findings demonstrate the role of area characteristics as a health risk factor and point to the need for more focused attention to the meaning and measurement of neighborhood quality.

Neighbourhood differences in diet: the Atherosclerosis Risk in Communities (ARIC) Study.

STUDY OBJECTIVE: To investigate whether neighbourhood characteristics are related to dietary patterns independently of individual level variables. DESIGN: A cross sectional analysis of the relation between neighbourhood median household income...

Off course: Education spending in Germany

According to the indicators used here, the German population has a particularly high level of education in international comparison and thus is likely to continue to earn high incomes in international competition. However, this standing will be jeopardised if education policy in Germany does not stand up to the challenges. There is a serious need for action. What is needed is a twofold strategy consisting of reforms to increase efficiency and higher funding to further improve the performance of the education system. A policy of this kind would lead the way to long-term growth opportunities and could even be cost neutral if the required extra spending were financed by reducing the subsidies which conserve the present structure9. However, a higher deficit in public budgets would also be acceptable as a means to finance additional spending on education, training and further training, given that these are investments which will pay off in later years. Discussions on the wage dispersion by level of education in Germany often overlook the fact that it corresponds to the average for OECD countries. The greater the influence of additional education on individual income levels, the greater is the justification for private funding of the costs of education. This applies in particular to third-level education. Third-level graduates who were able to study free of charge in the past and are now earning high incomes could participate during a transition period in financing the costs of third-level education today.

Prostate-Specific Antigen Levels are Higher in African-American Than in White Patients in a Multicenter Registration Study: Results of RTOG 94-12

Purpose: To compare serum prostate-specific antigen (PSA) levels in a national sample of African-American and white men with prostate cancer, and to attempt to explain any differences by using self-reported individual-level socioeconomic status adjustments. Methods and Materials: During 4 1 2 months in 1994–95, 709 patients with nonmetastatic prostate cancer were enrolled in this prospective study; 17.5% were African-American and 82.5% were white. Information about clinical stage, tumor grade, pretreatment PSA, type of insurance, and educational and income status was obtained. Serum PSA levels were measured and racial differences were found; how the differences were influenced by other patient- or tumor-related factors and if the differences could be explained by socioeconomic status disparities were determined. In univariate analyses, factors associated with the mean PSA levels were studied; log-converted values were used to yield a normal distribution. Multivariate analyses were done on log-linear models for description of association patterns among various categorical variables; a perfectly fitted model should have a correlation value (CV) of 1.0. Results: The mean PSA level was higher in African-Americans (14.68 ng/ml) than in whites (9.82 ng/ml) ( p = 0.001). Clinical stage ( p = 0.001), Gleason sum tumor grade ( p = 0.0001), educational level ( p = 0.001), and household income ( p = 0.03) were also associated with mean PSA levels; age, type of biopsy, and insurance status were not. Disease stage ( p = 0.0001), grade ( p = 0.0001), education ( p = 0.07), and income ( p = 0.02) were all associated with PSA levels for whites, but none of these factors were important for African-Americans (all p values > 0.1). The best fitted log-linear model (CV = 0.99) contained PSA (< 10, 10–20, and > 20), Gleason sum grade (2–5, 6–7, and 8–10), race, and two interactions: PSA by race ( p = 0.0012) and PSA by Gleason sum ( p = 0.0001). Models replacing race for either income (CV = 0.82) or education (CV = 0.82) or both (CV = 0.78) did not fit as well. Conclusions: African-Americans with nonmetastatic prostate cancer have higher serum PSA levels at diagnosis than whites, implying a higher tumor cell burden. Individual-level household income, education, or insurance status alone or in combination account for racial differences, but only partially.

Commentary: Income inequality summarises the health burden of individual relative deprivation

Fiscella and Franks claim that the relation between societal mortality and income inequality is an ecological fallacy, but in fact their data makes a useful contribution wholly consistent with that...

Planning Retirement Income in Australia: Routes through the Maze

AbstractIndividual retirees face a daunting task when they consider how best to invest their accumulated superannuation account and non‐superannuation savings. This article highlights the fact that there is rarely an obvious decision in this choice and that the optimal decision depends on a number of factors. These factors include the valuation criterion adopted, the level of benefits, the individual's income level, the means‐tests, the tax rates on income and superannuation benefits and the person's life expectancy. The optimal behaviour at retirement is significantly affected by the individual characteristics of relative lifetime earnings and post‐retirement rates of mortality.

Dual Pareto Efficiency

Consider an economy with d commodities and n individuals. A pair (p, M), where p is a price vector and M = (m1, m2, ..., mn) is a set of n individual income levels, defines a set of individual budget constraints. It is known that such pairs provide a framework for duality-based investigations of Pareto efficient allocations and of equilibria. This paper employs this framework in a general setting, not requiring smoothness or boundedness of budget sets, to develop duals of the first and second theorems of welfare economics. Namely, under suitable assumptions: (1) the price-income pair associated with any equilibrium is dual Pareto efficient, and (2) corresponding to any dual Pareto-efficient pair, there is an allocation which together with the given prices forms an equilibrium. Journal of Economic Literature Classification Number(s): D00, D50, D51, D6l.

The nature of moral thinking

<h3>Background</h3> Little is known about how diet-related and activity-related amenities relate to residential location behaviour. Understanding these relationships is essential for addressing residential self-selection bias. <h3>Methods</h3> Using 25 years (6 examinations) of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study (n=11 013 observations) and linked neighbourhood-level data from the 4 CARDIA baseline cities (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; Oakland, California, USA), we characterised participants’ neighbourhoods as having low, average or high road connectivity and amenities using non-hierarchical cluster analysis. We then used repeated measures multinomial logistic regression with random effects to examine the associations between individual-level sociodemographics and neighbourhood-level characteristics with residential neighbourhood types over the 25-year period, and whether these associations differed by individual-level income. <h3>Results</h3> Being female was positively associated with living in neighbourhoods with low (vs high) road connectivity and activity-related and diet-related amenities among high-income individuals only. At all income levels, a higher percentage of neighbourhood white population and neighbourhood population &lt;18 years were associated with living in neighbourhoods with low (vs high) connectivity and amenities. Individual-level race; age; and educational attainment, neighbourhood socioeconomic status and housing prices did not influence residential location behaviour related to neighbourhood connectivity and amenities at any income level. <h3>Conclusions</h3> Neighbourhood-level factors appeared to play a comparatively greater role in shaping residential location behaviour than individual-level sociodemographics. Our study is an important step in understanding how residential locational behaviour relates to amenities and physical activity opportunities, and may help mitigate residential self-selection bias in built environment studies.

The Impact of Homeownership and Capital Gains upon Class and Consumption Sectors

The debate about the impact of homeownership and capital gains upon class and consumption-sector formation is reviewed, from the work of Rex and Moore in 1967 to that of Saunders and Harris in 1988. A theme noted is that homeownership is seen as a base for class membership in the earlier work but by the most recent work this has shifted to a base for the formation of consumption sectors. Much of the debate has been centred upon the English case and the rise in homeownership over the postwar years. A wider comparative perspective is required for further elaboration within this debate. The main critique attempted within this paper is one developed around the empirical debate regarding returns to homeowners and whether these result in a redistribution or a concentration of wealth, and consequently whether homeownership serves to create a base for political and social action or whether it contributes to the present fragmenting tendencies within capitalist societies. Evidence is reviewed from Britain and New Zealand on the questions of whether real gains are made through property ownership and the author assesses the extent of variability created by such factors as the time period when the property was acquired, regional variations, the links between the property and the labour markets, household structures, and gender divisions within wealth generation and dispersal. It is concluded that homeownership constitutes a base for real accumulation but the rate and extent of this process is not an even one. The ability to gain wealth varies considerably by time, location, level of individual and family income, employment level, and household type. Consequently, the wealth generated through homeownership is a factor fragmenting rather than uniting social groups and, therefore, is unlikely in itself to be a basis of political mobilisation.

A Structural Equation Investigation of the Pay Satisfaction-Valence Relationship among Salespeople

This study investigates the relationship between salespeople's level of pay, satisfaction with pay, and valence for more pay using structural equation models with unobserved variables. The results suggest that (1) greater satisfaction with pay is associated with lower valences attached to it, (2) those who are most highly paid are most dissatisfied with their pay level, and (3) there is no direct relationship between an individual's income level and the person's valence for more pay.

A Structural Equation Investigation of the Pay Satisfaction-Valence Relationship among Salespeople

This study investigates the relationship between salespeople's level of pay, satisfaction with pay, and valence for more pay using structural equation models with unobserved variables. The results suggest that (1) greater satisfaction with pay is associated with lower valences attached to it, (2) those who are most highly paid are most dissatisfied with their pay level, and (3) there is no direct relationship between an individual's income level and the person's valence for more pay.