Level Of Wealth Research Articles

On penalized goal-reaching probability minimization under borrowing and short-selling constraints

Abstract We consider a robust optimal investment–reinsurance problem to minimize the goal-reaching probability that the value of the wealth process reaches a low barrier before a high goal for an ambiguity-averse insurer. The insurer invests its surplus in a constrained financial market, where the proportion of borrowed amount to the current wealth level is no more than a given constant, and short-selling is prohibited. We assume that the insurer purchases per-claim reinsurance to transfer its risk exposure to a reinsurer whose premium is computed according to the mean–variance premium principle. Using the stochastic control approach based on the Hamilton–Jacobi–Bellman equation, we derive robust optimal investment–reinsurance strategies and the corresponding value functions. We conclude that the behavior of borrowing typically occurs with a lower wealth level. Finally, numerical examples are given to illustrate our results.

Can E-Commerce Policies Drive Common Wealth Levels —— A Study Based on County-Level Data in China, 2012-2020

Based on national county panel data from 2012 to 2020, this study systematically examines the impact of the comprehensive e-commerce into rural areas demonstration project implemented in rural China on promoting the level of common wealth by applying the multi-period double-difference method (DID). It is found that the e-commerce policy significantly enhances the level of common wealth. Further analysis of the impact mechanism shows that the policy effectively promotes the goal of common prosperity by enhancing the level of rural employment. In addition, the positive effect of the e-commerce policy is strengthened by the increase in the level of local government fiscal expenditure, however, the driving effect of the policy is weakened by the higher level of social consumption. Heterogeneity analyses indicate that the policy's promotional effect is particularly significant in the demonstration counties of the Yangtze River Economic Belt. This paper fills the research gap on the relationship between rural e-commerce policy and the level of common wealth, and provides empirical evidence and policy recommendations for related policy formulation.

Associations between socioeconomic status and dynamic development of physical,psychological and cognitive degenerative multimorbidity among middle aged and older adults in China

Objective: To analyze the dynamic development of physical, psychological, and cognitive degenerative multimorbidity among middle-aged and older Chinese adults (≥45 years old) while estimating the longitudinal association between socioeconomic status (SES) and the progression of multimorbidity. Methods: Based on data from the China Health and Retirement Longitudinal Study (2011-2020), the Sankey diagram was used to show the dynamic development of physical, psychological, and cognitive degenerative multimorbidity from 2011 to 2020. SES was constructed based on the level of education and total household wealth. Logistic regression was used to estimate OR and 95%CI to evaluate the association between SES and the progression of multimorbidity. Results: Of the 5 393 participants included, 4 484 (83.14%) of them developed new diseases, and the prevalence of physical, psychological, and cognitive degenerative multimorbidity increased from 38.04% to 74.23%. Compared to those with no reported disorders at baseline, participants with psychological disorder (for newly developed physical-cognitive multimorbidity: OR=4.59,95%CI: 2.89-7.29), cognitive disorder (for newly developed physical-psychological multimorbidity: OR=2.24,95%CI: 1.40-3.60), or their multimorbidity at baseline were more likely to progress to physical, psychological, and cognitive degenerative multimorbidity. After adjusting covariates, individuals with low SES were more likely to develop physical diseases (OR=1.45, 95%CI: 1.11-1.89), cognitive disorder (OR=1.84, 95%CI: 1.16-2.91), physical-psychological multimorbidity (OR=1.87, 95%CI: 1.37-2.56), physical-cognitive multimorbidity (OR=3.58, 95%CI: 2.54-5.06), psychological-cognitive multimorbidity (OR=5.66, 95%CI: 3.04-10.55), and physical-psychological-cognitive multimorbidity (OR=3.21, 95%CI: 2.06-5.01) in comparison to those with high SES. There is a dose-response relationship between SES and the multimorbidity progression (all trend P<0.001). Conclusions: The prevalence of physical, psychological, and cognitive degenerative multimorbidity increased significantly among middle-aged and older Chinese adults. Lower SES was associated with multiple patterns of physical, psychological, and cognitive disorders progression.

Sociodemographic factors associated with knowledge and adequate attitudes about HIV in women of reproductive age from Peru

BACKGROUND: To determine the sociodemographic factors associated with knowledge and adequate attitudes about HIV in women of reproductive age from Peru in 2021. MATERIALS AND METHODS: Analytical cross-sectional study. We analyzed a demographic and family health survey (ENDES) 2021 carried out in women of reproductive age (12 to 49 years of age). The dependent variables were the adequate level of knowledge and adequate attitudes about HIV, the independents were sociodemographic variables. The statistical analysis was carried out with a Poisson regression model with robust variance obtaining the adjusted prevalence ratio (PRa) and confidence intervals. RESULTS: Thirty-four percent (CI 95%: 32,9–35,1) had an adequate level of knowledge about HIV and 32,9% (CI 95%: 31,7–34,0) had adequate attitudes. In the multivariate analysis, the main variables associated with the adequate level of knowledge about HIV were the higher level of education (PRa = 1,19; CI 95%: 1,15–1,23) and very rich wealth quintile (PRa = 1,15; CI 95%: 1,01–1,20); while the main variables associated with adequate attitudes on HIV were higher level of education (PRa = 1,44; CI 95%: 1,40–1,48), high-school education level (PRa = 1,21; CI 95%; 1,18–1,24), very rich wealth quintile (PRa = 1,18; CI 95%: 1,14–1,22), and age range between 35 and 49 years (PRa = 1,18; CI 95%: 1,15–1,21). CONCLUSIONS: The sociodemographic factors associated with knowledge and adequate attitudes about HIV in Peruvian women of reproductive age were mainly higher level of wealth, higher level of education, and a higher age range. Other sociodemographic variables presented a weak association with knowledge and adequate attitudes about HIV.

Measuring speculation beyond day trading and bets on lottery-like stocks

We offer a new metric of stock market speculative intensity: the proportion of share purchases that are swiftly reversed, i.e., sold within a short time window. An example of this metric is a 14-day trading horizon. We use it to identify retail traders who aim for quick profits. Based on a vast set of trading accounts in Belgium (2003−2012), we observe that the scale of quick round-trip trading is far above what would be seen with a single focus on day trading. Simply put, amateur speculation is not limited to day traders. Measuring speculative trading through quick round-trip transactions delivers a variety of insights. Amateur speculators are more likely to be male, younger, with lower sophistication and lower levels of wealth. They hold concentrated portfolios and focus their efforts on only a few stocks at a time. They earn low returns, and they are prone to the disposition effect. They are liable to bet on lottery-like stocks, and their passion for trading is persistent.

Spatial Differentiation in the Use of Rural Development Programme Funds for the Environment in Poland for the Periods 2007–2013 and 2014–2020

The purpose of this paper is to assess the changes in agricultural producers’ use of funds allocated for environmental measures under the 2007–2013 RDP (Rural Development Program) and 2014–2020 RDP in Poland. The extent to which environmental CAP (Common Agricultural Policy) funds are used was examined on a geographic basis, so as to take account of socioeconomic and environmental characteristics of districts. Correlation analysis and a cartographic method were used. The study found growing differences in how the funds are used between territorial units. The analysis of correlation provided grounds for concluding that a relationship exists between the share of environmental funds used in total RDP payments and environmental conditions, mostly including the share of permanent pasture in the structure of agricultural land (0.515 in 2014–2020). Conversely, no relationship was discovered between the level of wealth and the local agrarian structure (0.249 and 0.327 in 2014–2020). The analysis of differences between territorial units revealed that in some geographic areas that had the potential for being granted environmental funds, the farmers decided not to apply for them. Based on the above, it was concluded that the potential beneficiaries’ activity in that respect is largely impacted not only by their environmental awareness and attitude but also by historical events.

Medical Mistrust Among Black Patients with Serious Illness: A Mixed Methods Study.

Medical mistrust among Black patients has been used to explain the existence of well-documented racial inequities at the end of life that negatively impact this group. However, there are few studies that describe patient perspectives around the impact of racism and discriminatory experiences on mistrust within the context of serious illness. To better characterize experiences of racism and discrimination among patients with serious illness and its association with medical mistrust. Seventy-two Black participants with serious illness hospitalized at an academic county hospital. This is a convergent mixed methods study using data from participant-completed surveys and existing semi-structured interviews eliciting participants' perspectives around their experiences with medical racism, communication, and decision-making. The experience of medical racism and its association with Group-Based Medical Mistrust (GBMM) scale scores, a validated measure of medical mistrust. Of the 72 Black participants, 35% participated in interviews. Participants were mostly men who had significant socioeconomic disadvantage, including low levels of wealth, income, and educational attainment. There were reported high levels of race-based mistrust in the overall GBMM scale score (mean [SD], 36.6 [9.9]), as well as high scores within the suspicion (14.2 [5.0]), group disparities in healthcare (9.9 [2.8]), and lack of support (9.1 [2.7]) subscales. Three qualitative themes aligned with the GBMM subscales. Participants expressed skepticism of healthcare workers (HCWs) and modern medicine, recounted personal experiences of discrimination in the medical setting, and were frustrated with poor communication from HCWs. This study found high levels of mistrust among Black patients with serious illness. Suspicion of HCWs, disparities in healthcare by race, and a lack of support from HCWs were overarching themes that influenced medical mistrust. Critical, race-conscious approaches are needed to create strategies and frameworks to improve the trustworthiness of healthcare institutions and workers.

Overnutrition and associated factors among women of reproductive age in Sub-Saharan Africa: A hierarchical analysis of 2019–2023 standard demographic and health survey data

ObjectivesOvernutrition, a leading cause of global mortality, has seen a significant rise in low- and middle-income countries, including sub-Saharan Africa. Despite emerging evidence linking overnutrition to non-communicable diseases, limited action has been taken to address this issue. While undernutrition studies have received more attention, research on overnutrition and women's health remains scarce in sub-Saharan Africa. Our study aims to assess the prevalence and associated factors of overnutrition among reproductive women in this region MethodsWe conducted a secondary analysis of 2019–2023 Demographic and Health Survey datasets in sub-Saharan Africa. Our study included a weighted sample of 65,161 women aged 15–49 y. Using a multilevel mixed-effects logistic regression model, we identified factors associated with overnutrition. The adjusted odds ratio, along with a 95% confidence interval and a significance level of p < 0.05, determined the statistical significance of the explanatory variables. ResultsThe pooled prevalence of overnutrition among women of reproductive age in sub-Saharan Africa was 34.79% (95% CI: 34.42–35.16). Specifically, the prevalence of overweight and obesity was 21.81% and 12.99%, respectively. Women's educational status, age, media use, household wealth, urbanization, community poverty, and country income level were significantly associated with higher odds of overnutrition. ConclusionsThe prevalence of overnutrition among women of reproductive age in sub-Saharan Africa is relatively high. Key factors associated with this issue include women's educational status, age, media utilization, household wealth, place of residence, community poverty level, and national income status. These multilevel determinants highlight the need for a comprehensive, evidence-based approach to address overnutrition in this population. Effective strategies should target individual behaviors while considering broader social, economic, and environmental contexts. Integrating overnutrition prevention into maternal and reproductive health services, as well as strengthening social protection measures, are recommended steps to tackle this growing challenge in sub-Saharan Africa.

Socioeconomic determinants of child malnutrition: Evidence from Ethiopia

In this research, I examined the role of socioeconomic variations in the prevalence of stunting and underweight among children in Ethiopia. The study aimed to identify key health factors contributing to these disparities in child malnutrition by utilizing concentration indices, concentration curves, and regression-based decomposition analysis. Despite a notable decline in the average rates of stunting and underweight prevalence, the relative and absolute gaps between different demographic and socioeconomic groups have widened in Ethiopia. The empirical analysis revealed that higher levels of maternal education and household wealth significantly benefited children from better socioeconomic backgrounds, making them less likely to experience malnutrition. The disparity in socioeconomic status is the primary driver of inequalities in child malnutrition. The findings suggest that to reduce these disparities, national health policies should focus on promoting maternal literacy and targeting interventions for underprivileged groups.

Relative risk aversion must be close to 1

AbstractAny utility function that is unbounded either from below or from above implies paradoxical behavior. However, these paradoxes may be regarded as irrelevant if they involve wealth levels that are realistically meaningless. Employing real-world constraints on wealth reveals that CRRA utility with relative risk aversion outside of the range 0.75–1.15 yields paradoxical choices that very few individuals, if any, would ever make. Thus, relative risk aversion must be close to 1, the value corresponding to log preferences. These results shed new light on the longstanding debate about the geometric-mean criterion and the argument of stocks for the long-run.

Association between internet exclusion and depressive symptoms among older adults: panel data analysis of five longitudinal cohort studies

Internet exclusion and depressive symptoms are prevalent phenomena among older adults; however, the association between internet exclusion and depressive symptoms remains limited. This study aims to investigate the association between internet exclusion and depressive symptoms among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs). We conducted a comprehensive longitudinal, cross-cultural analysis, and the participants were adults aged 60 years and older from 32 countries participating in five nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Ageing Study (MHAS). Internet exclusion was defined as the self-reported absence from internet use. Depressive symptoms were evaluated using the Centre for Epidemiologic Studies of Depression scale (CES-D) or the Euro-Depression scale (Euro-D). These five cohorts, being heterogeneous, were respectively conducted with panel data analysis. Logistic regression, implemented within the generalized estimating equations framework, was used to examine the association between internet exclusion and the likelihood of experiencing depressive symptoms, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age, education, labour force status, household wealth level, marital status, co-residence with children, residence status, cognitive impairment, and functional ability. Our study included a total of 129,847 older adults during the period from 2010 to 2020, with a median follow-up of 5 (2, 7) years. The pooled proportion of internet exclusion was 46.0% in HRS, 32.6% in ELSA, 54.8% in SHARE, 92.3% in CHARLS, and 65.3% in MHAS. Internet exclusion was significantly associated with depressive symptoms across all cohort studies: HRS (OR=1.13, 95% CI 1.07-1.20), ELSA (OR=1.22, 95% CI 1.11-1.34), SHARE (OR=1.55, 95% CI 1.47-1.62), CHARLS (OR=1.49, 95% CI 1.26-1.77), and MHAS (OR=1.48, 95% CI 1.39-1.58). Moreover, internet exclusion was found to be associated with all dimensions of depression in the SHARE, MHAS, and ELSA cohorts (except for sleep and felt sad) cohorts. A considerable proportion of older adults experienced internet exclusion, particularly those in LMICs. Internet exclusion among older adults, irrespective of their geographic location in HICs or LMICs, was associated with a higher likelihood of experiencing depressive symptoms, which demonstrated the importance of addressing barriers to internet access and promoting active participation in the internet society among older adults. National Key R&D Program of China (grant number 2022ZD0160704), the Scientific Research and Innovation Team of The First Affiliated Hospital of Zhengzhou University (grant number ZYCXTD2023005), the Collaborative Innovation Major Project of Zhengzhou (grant number 20XTZX08017), the Joint Project of Medical Science and Technology of Henan Province (grant number LHGJ20220428), and National Natural Science Foundation of China (grant number 82373341).

Dynamic mean-variance portfolio selection under factor models

Utilizing insights from financial literature and empirical financial data, we introduce a comprehensive system of factor models designed to capture both return and risk dynamics. Our focus extends to addressing the multi-period mean-variance portfolio selection challenge within the framework of these proposed factor models. Through rigorous analysis, we formulate a semi-analytical optimal portfolio policy, characterized by a linear relationship with the current wealth level. The coefficients of this optimal policy are intricately linked to a specific stochastic process known as the future investment opportunity (FIO), reflecting the investor's anticipation of future investment prospects. Furthermore, empirical examination within the U.S. market context underscores the efficacy of our approach. By incorporating the factor models for return and risk, our optimal portfolio policy exhibits superior out-of-sample Sharpe ratio compared to benchmark policies.

Africa must create centres of educational excellence for innovation and development.

This paper explores the following development questions that perplex most Africans: "Why do African countries rely on foreign companies and foreign experts for almost all our development projects? Why can't we build our own roads, process our own food, and mine our own minerals, oil, and gas? Why don't we have world-class hospitals and industries? How can we have so much natural wealth and yet be so poor? Why do we invent so little?" The answer lies in our failure to implement idea number two. There are two major ideas in educational policy. Idea number one is the obligation to educate all children because it is their fundamental human right as enshrined in the 1948 United Nations Declaration of Human Rights. Idea number two is the strategy of establishing and sustaining world class schools and universities for the education of the most highly gifted and highly talented citizens. Developed countries deploy both ideas aggressively. Underdeveloped countries in Africa have not implemented idea number two. Countries that have deployed idea number two have at least one university ranked among the top 200 in the world. The presence of great universities (top 200) in a country is a 21st century indicator of the presence of high levels of innovation, technology, development and wealth in that country. According to the three major rankings of world universities (Shanghai-ARWU, THE, and QS-topuniversities.com), none of the world's top 100 great universities is in Africa. Although Africa was a pioneer among the continents in innovations such as human language, domestication of fire, making of tools, invention of agriculture, development of writing, and creation of great centers of learning in ancient times, it has fallen behind other continents over the last 500 years and it has been disrupted by enslavement and colonization, and the structural adjustment programs (SAPs) of the IMF and the World Bank. Ancient African centers of innovation included the Ancient City of Benin and Timbuktu in Western Africa, the Kingdom of Kush and ancient Egypt in northern Africa, Axum in Eastern Africa, Mapungubwe and Great Zimbabwe in Southern Africa, and the Kingdom of Kongo in central-Africa. An African renaissance will only occur when we implement idea number two by establishing world class schools and at least one great university per African country.

Brand Image and Consumer Perceived Values on Purchase Intention of Organic Food: A Conceptual Study

Organic food is quickly developing in China as consumer wealth and consumption levels have grown in recent years; the Chinese government's "Healthy China Action (2019-2030)" promotes a balanced diet and works to raise the standard of agricultural output and food safety. Even though China has Asia's largest organic food market, organic food has a small market share and low consumer expenditure. As a result, decisive steps to boost the growth of China's organic food market are urgently needed. This study aims to explore the factors related to Chinese people’s purchase intention of organic food using the S-O-R model. Brand image and consumer perceived values are crucial because they influence customer purchase behavior. This study emphasizes brand image, perceived functional, emotional and social values on consumer purchase intention. Epistemic value and conditional value were excluded because they have detrimental impacts on consumer choice behavior. The contribution of this study is to enrich the existing literature by providing a deeper understanding of organic food consumer purchase intention in China through the application of brand image and consumer perceived values using the S-O-R model. It also provides Chinese policymakers and organic food suppliers with solutions to increase organic food sales to expand the Chinese organic food market.

Race and ethnic inequalities

Abstract This article considers inequalities across racial and ethnic groups in the UK and finds that there is no single story of advantage or disadvantage. Racial and ethnic inequalities are complex and characterized simultaneously by continuity rooted in historical origins and conditions and rapid change fuelled by new and changing populations and opportunities. Continuity and change are also reflected in very different patterns of inequality across (and within) minority groups, generations and outcomes. Some groups are characterized by high levels of average qualifications, income and wealth, while others are persistently disadvantaged, faced with elevated levels of poverty and unemployment. Alongside different levels in outcomes are varied trajectories, both within and across generations. Within groups, there are less-explored, intersectional contours of difference, along the lines of gender, geography and class. Research and policy must acknowledge this diversity and complexity to inform effective policy prescriptions going forwards.

Heterogenous Rates of Return on Homes: Do The Rich Do Better?

AbstractRecent work on wealth inequality using the capitalization method wherein aggregate wealth totals are distributed proportionately to property income like dividends motivates concern about whether rates of return on assets vary across the income or wealth distribution. Here I use accrued capital gains and imputed rent on homes estimated from the Survey of Consumer Finances to address this issue. Both capital gains and imputed rent form part of total income. I find strong econometric evidence that returns vary directly with wealth level and are considerably higher for very wealthy compared to poorer households. However, I do not find evidence that higher income households receive higher returns once controlling for overall market house price trends. Returns are also strongly related to overall market house price movements, suggesting that timing the market is a key determinant. However, paradoxically, adding housing returns to baseline household wealth reduces overall wealth inequality.

Are spatial imbalances in industrial structural change widening the common wealth gap?

The evolution of China's industrial structure from 2010 to 2021 is assessed based on the rationalization and sophistication of its industries. The Theil index quantifies spatial variability, while the Quadratic Assignment Procedure (QAP) investigates if changes in industrial structure imbalance will increase wealth disparity. The study's findings indicate a noticeable spatial imbalance in industrial structure change. The overall level of common wealth is low but steadily increasing, following a stepped-down structure of "east-center-west." Additionally, the north and south regions exhibit a pattern of "high in the north and low in the south." There is a pattern of higher values in the north and lower values in the south. In terms of common wealth and its dimensions, there is a ladder-like pattern with high values at the core decreasing towards the west. Between 2010 and 2021, the common wealth development shifted from a lower level to a higher one. Beijing, Jiangsu, and Shanghai constantly ranked in the top echelon, while Guangxi remained in the fifth echelon. The speed and difficulty of transitioning between echelons vary. Moving from the fourth echelon to the third echelon takes longer, while transitioning from the third echelon to higher echelons presents tougher challenges. Spatial imbalances in industrial structure changes widen the gap in common wealth. In particular, the impact of the gap in the advanced industrial structure on the common wealth gap is significantly higher than that of the gap in industrial rationalization. Reducing disparities in advanced industrial structure is more effective in reducing the overall wealth gap.

HANK Comes of Age

We study the aggregate and distributional effects of monetary policy in a heterogeneous agent New Keynesian model that explicitly represents the life cycle of households. The model matches the age patterns in the level and dispersion of labor income and financial wealth in the U.S. despite the absence of preference heterogeneity and portfolio adjustment costs. Monetary policy affects the consumption of young households mainly through labor income and the consumption of old households mainly through asset returns. More than half of the aggregate consumption response to an expansionary monetary policy shock comes from those below the age of 40. The shock redistributes welfare from the wealthiest old to the poorest young and increases average welfare of most cohorts.

Understanding Contraceptive Utilisation Patterns in Kerala: Insights from NFHS-5

Background: In the past decade, Kerala has witnessed an increase in the number of sexually transmitted diseases and unmet family planning needs. This study examines the knowledge of modern contraceptives, their use, and the current use of modern Keralite contraceptives against selected indicators. Methodology: The dataset from the fifth round of the National Family Health Survey was used for this study (N=10969). To analyse the factors associated with and affecting knowledge and use of contraceptives (current use of modern and ever use of any), chi-square test and binary logistic regression were used. Results: Wealth, age, and education level were positively associated with knowledge of modern contraceptives, whereas tribals were less aware than other castes. Wealthier, older, and less educated individuals had higher odds of using any/modern contraceptives than poor, younger, and higher educated individuals (odds&lt;1). Muslims are likely to use contraceptives but are less likely to use modern methods than other religions (odds ratio: 1.67 and 0.78). Tribals had higher odds of using contraceptives (odds: 2.13). Urban respondents had lower odds of using modern contraceptives than rural respondents (odds: 0.751). Conclusions: The higher odds of older, less-educated respondents using sterilisation over reversible contraceptives are likely due to social insecurities and misconceptions. Awareness and promotion of contraceptive use at the government level would help boost its use.

Dementia severity at incident diagnosis in a population representative sample of older Americans.

We provide the first analysis of distribution of dementia severity at incident diagnosis for a population representative sample of older Americans. Using data from the Aging, Demographics, and Memory Study (ADAMS), the Health Retirement Study (HRS), and traditional Medicare claims, we estimated the Clinical Dementia Rating Scale for ADAMS respondents and applied parameter estimates to predict dementia severity for HRS respondents with claims-based incident dementia diagnosis. Seventy percent of older adults received a dementia diagnosis of mild cognitive impairment or mild dementia (early stages). Fewer individuals were diagnosed at early stages in years 2000 to 2008 (65%) compared to years 2009 to 2016 (76%). About 72% of non-Hispanic white persons were diagnosed at early stages, compared to 63% non-Hispanic black and 59% Hispanic persons. More males than females were diagnosed at early stages (75%vs 67%). These data linkages allow population surveillance of early and equitable dementia detection in the older US population to assess clinical and policy levers to improve detection. For the US population 70 and older, 30% were diagnosed with dementia at a moderate or severe stage.Fewer were diagnosed at early stages in years 2000 to 2008 compared to 2009 to 2016 (65%vs 76%).A total of 72% of white persons were diagnosed at early stages, compared to 63% black and 59% Hispanic persons.More males than females were diagnosed at early stages (75%vs 67%).High wealth and education level were associated with diagnosis at early stages disease.