Lower Income Levels Research Articles

Cardiovascular health awareness, risk perception, behavioural intention and INTERHEART risk stratification among middle-aged adults in Malaysia

Objective: To investigate the interrelationship between cardiovascular health awareness, risk perception, behavioural intention, and INTERHEART risk stratification in a middle-aged adult population in Malaysia. Methods: A cross-sectional survey with convenience sampling was conducted during November 2022 and January 2023. Participants completed validated questionnaires assessing cardiovascular health awareness, risk perception of cardiovascular diseases, behavioural intention towards adopting healthy habits, and INTERHEART risk stratification score (IHRS) based on established risk factors. A total of 602 respondents were included in the final analysis. Data were analysed with independent t-test/one-way ANOVA or Mann- Whitney/Kruskai-Wailis to test the differences, Pearson correlation or linear regression test to analyze the association of independent and dependent variables. Results: There was a significant positive correlation between medical knowledge related to cardiovascular disease (CVD) and knowledge related to CVD risk prevention, risk perception, behavioural intention and IHRS (P<0.05, Pearson correlation). Notably, individuals with higher IHRS tended to have lower knowledge related to CVD and CVD risk prevention, risk perception, and behavioural intention. Males, laborers, active/former smokers, individuals with lower household income and educational levels, those involved in occupations not related to the healthcare sector, and those who did not receive the CVD health brochure or are unaware of health self-assessment tools are likely to have lower levels of knowledge, risk perception, and poorer behavioural intention regarding cardiovascular health (P<0.05, one-way ANOVA). While educational level, smoking status, awareness about CVD poster, self-assessment tools were repeatedly significantly associated with knowledge related to CVD and CVD risk prevention, risk perception, behavioral intention and/or IHRS (P<0.05, linear regression). Conclusions: These findings underscore the importance of promoting cardiovascular health awareness and risk perception among middle-aged adults to foster positive BI and reduce CVD risk. Tailored interventions targeting specific risk factors identified by INTERHEART may enhance risk stratification accuracy and facilitate targeted preventive strategies.

Educational field, economic uncertainty, and fertility decline in Finland in 2010-2019.

Fertility declined sharply and unexpectedly in Finland in the 2010s across educational levels. Using Finnish register data, we calculated total fertility rates (TFRs) and the proportion of women expected to have a first birth in 2010-2019 for 153 educational groups-reflecting field and level-and estimated how the characteristics of a group predicted its decline. As the educational field predicts factors related to economic uncertainty, heterogeneity in fertility decline across fields could shed light on the role of economic uncertainty behind the recent fertility decline. In general, women with the highest initial fertility levels (health, welfare, and education) and women in agriculture experienced weaker fertility declines (around -20% or less), while women with the lowest initial levels (ICT, arts and humanities) experienced stronger declines (around -40% or more). The extent of the fertility decline increased with higher unemployment and lower income levels in the field and with a lower share employed in the public sector. These uncertainty measures together explained one-fourth of the decline in TFR and two-fifths of the decline in first births. The results imply that fertility declined across all groups, but those with stable job prospects escaped very strong declines. Objective economic uncertainty is one aspect that mattered for the recent fertility decline.

지역문화정책 대상범위에 관한 연구

The purpose of this study is to investigate the scope of local cultural policies through an empirical study on the cultural enjoyment gap. For this purpose, the cultural enjoyment status of culturally marginalized groups derived from the review of previous studies was compared and analyzed within the same basic local government. In addition, the experience level of each cultural genre was investigated and analyzed by dividing cultural enjoyment into viewing, participation, and education stages. The results of the analysis showed that, first, when it comes to leisure time for cultural enjoyment, those in their 60s and older, those with lower income levels, and those living in towns and villages have more leisure time on an average weekday. Second, 25% of all respondents have experienced veiwing cultural events. Movies and museums were found to be universal cultural enjoyment genres, and in most genres, the underrepresented groups were found to be real. Third, direct participation in cultural events was lower among those under the age of 50, those with lower median income, and those living in the urban. Fourth, the experience of cultural education was also low, with significant mean differences by class.

Socioeconomic inequality of health-related quality of life in cancer survivors in South Korea.

We investigated the inequalities in health-related quality of life (HRQoL) among cancer survivors in Korea, focusing on income and education levels. The slope index of inequality (SII) and relative index of inequality (RII) were utilized to analyze these disparities. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2021 was analyzed. The HRQoL was assessed using the EQ-5D questionnaire, which included five problem areas: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Logistic regression was employed to calculate the odds ratios (ORs) for each education and income level, indicating the probability of reporting problems. Furthermore, the slope index of inequality (SII) and relative index of inequality (RII) were calculated to evaluate the inequalities in HRQoL. Among the 3396 cancer survivors, a considerable proportion reported pain/discomfort (29.6%) and mobility problems (21.1%). The logistic regression results demonstrated a higher likelihood of experiencing problems in all five EQ-5D items among individuals with lower income or education levels. Specifically, compared to the high-income group, the adjusted ORs for mobility problems were 2.19, 1.64, and 1.08 for the low, low-medium, and medium-high-income groups, respectively (p-value < 0.05). Notably, significant income inequalities in HRQoL problems were observed, with the greatest disparities seen in self-care and usual activity problems, as indicated by the SII and RII values. Socioeconomic disparities in HRQoL exist among cancer survivors in Korea, particularly related to income levels. Addressing the financial burdens of cancer treatment for individuals with low-income levels may help improve their HRQoL and mitigate these inequalities.

Solid fuel use, socioeconomic status and depression: a cross-study of older adults in China

BackgroundIndoor air pollution causes severe psychological stress and promotes depression. A better understanding of the impact of solid fuel consumption and socioeconomic indicators on mental health is critical to promote successful aging. In this study, we analyzed the relationship of depression with socioeconomic status (SES) and solid fuel use, and illustrated the mediating role of solid fuel use in the relationship between SES and depression.Methods9250 participants from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey were included in this study. A logistic regression analysis was used to calculate odds ratio (OR) and 95% confidence interval (CI) of depression for different types of fuel consumption. The stepwise approach and the Sobel test were used to test the mediation effect.ResultsOlder people who reported the consumption of solid fuels showed higher odds of having depressive symptoms (OR = 1.16, 95% CI:1.03, 1.31). In model with depression as the outcome variable, the ORs of low education level and low annual household income level were 1.30 (95% CI: 1.15, 1.47) and 1.43 (95% CI: 1.28, 1.59) respectively. Solid fuel consumption accounted for 38.40% of the effect of a low education level and 54.73% of the effect of low income on depression.ConclusionsSolid fuel use and SES are associated with depression, and solid fuel use may act as a potential mediator connecting socioeconomic indicators and depression.

Assessment of osteoporosis knowledge and its determinants among tuberculosis patients in tertiary care hospital Malaysia: A prospective study

ObjectiveOsteoporosis self-care knowledge is essential to encourage the patient’s contribution towards controlling the disease. Osteoporosis incidence with various infectious diseases prompts us to conduct a study on osteoporosis knowledge among Tuberculosis (TB) patients. This study aimed to assess osteoporosis-related knowledge and its influencing factors among TB patients. MethodsA prospective cross-sectional study was conducted in the TB clinic of Hospital Pulau Pinang, Malaysia, and an osteoporosis knowledge test (OKT), a structured questionnaire, was used to collect data. TB patients aged 18 years and above with compromised bone health were included in the present study. Overall knowledge scores were dichotomized, calculating the mean score, descriptive statistics, and multivariate regression analysis was used to determine the influence of risk factors on knowledge scores. ResultsOf 337 patients, 129(38.28 %) had good osteoporosis knowledge and 208(61.72 %) had poor knowledge. Among them, 231(68.54 %) were males, and 106(31.45 %) were females, with a mean age of 46.5 ± 17.1 years. The mean ± SD of OKT total score was 10.5 ± 2.0. The mean ± SD of the exercise knowledge score was 5.3 ± 3.4, while the nutrition knowledge score was 5.0 ± 3.2. Male gender (OR 3.86, 95 % CI 1.98–7.53), low-income level (OR 1.92, 95 % CI 1.12–3.30), rural residents (OR 2.49, 95 % CI 1.46–4.27) and participants with no formal education (OR 4.34, 95 % CI 1.11–16.84) or ≤12 years of education (OR 3.63, 95 % CI 1.52–8.65) were significantly responsible for poor OKT score. ConclusionThe results indicated that most TB patients had a poor perception of osteoporosis. More extensive strategies should be developed to enhance the campaign of awareness programs among TB patients to improve preventive measures of osteoporosis, such as calcium intake and exercise.

Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary.

Spatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities. We used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems. A cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI). Broad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending. Adults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.

Association between multimorbidity and periodontal disease in Korean adults: A nationwide cross-sectional cohort study.

This study aimed to investigate the association between multimorbidity, which refers to the presence of two or more chronic diseases, and periodontal disease in Korean adults using national survey data. A total of 12,440 Korean adults aged ≥19 years were selected from the seventh Korea National Health and Nutrition Examination Survey (KNHANES). We investigated periodontal disease status based on various variables, including the gender, age, educational level, income level, smoking and alcohol drinking status, frequency of daily toothbrushing, and unmet dental treatment needs. Furthermore, periodontal status according to diagnosed chronic diseases, including hypertension, dyslipidaemia, stroke, myocardial infarction, angina pectoris, and diabetes, was investigated, and the association between multimorbidity and periodontal disease was analysed through multiple logistic regression using SAS 9.4. According to the general characteristics of the study participants, the prevalence of periodontal disease was higher in males, smokers, older age, and lower educational and income levels (p < 0.001). Moreover, as the frequency of daily toothbrushing increased, the distribution of periodontal disease decreased (p < 0.001). The prevalence of periodontal disease was higher in those with chronic diseases than in those without chronic diseases and was statistically significantly higher as the number of diagnosed chronic diseases increased (p < 0.001). Additionally, an increase in the number of chronic diseases was observed to increase the prevalence and risk of periodontal disease. These results suggest that multimorbidity significantly affects the prevalence of periodontal disease.

Consumer energy efficiency gap and the rebound effect across households income groups

The paper sets up a model which reconciles the energy efficiency gap and the decline of the rebound effect with households’ income. It is shown that the two phenomena can be explained in a framework with a utility-maximizing household that enjoys an income-independent endowment of energy services. Energy service endowment is a barrier against the adoption of the most energy-efficient appliances and leads to the so-called energy efficiency gap. Low-income households only use endowments and do not use energy-consuming appliances (cars, wall insulation, etc.). Higr-income households buy an appliance whose energy efficiency depends on the household’s income. Only households with income above a threshold buy the most efficient appliance. For households that replace their appliance with a more efficient one, there will be a rebound effect (the realized energy saving is less than the presumed one). It is shown that the rebound effect is higher at lower income levels because income and substitution effects from a decline in energy service prices are stronger. These stronger effects come from the endowment of energy services. The numerical example shows that the model can reproduce the patterns for the rebound effects of household income groups and their expenditure shares. It is also shown that other causes of the energy efficiency gap, such as credit constraints, do not lead to higher rebound effects at lower income levels.

Contribution of causes of death to changing inequalities in life expectancy by income in Finland, 1997–2020

BackgroundSocioeconomic inequalities in mortality originate from different causes of death. Alcohol-related and smoking-related deaths are major drivers of mortality inequalities across Europe. In Finland, the turn from widening to narrowing...

Prevalence of Toxoplasma gondii IgG Antibodies and Associated Risk Factors in Psychiatric Patients from Western Romania: A Cross-Sectional Study.

Infection with the coccidian parasite Toxoplasma gondii was associated with an increased risk of several mental disorders. We conducted a case-control study of 464 consecutive psychiatric patients and assessed the prevalence of IgG antibodies against T. gondii and the potential risk factors associated with infection. T. gondii-specific antibodies were determined using a chemiluminescence assay. A questionnaire was utilized to assess the potential correlation between risk factors and Toxoplasma gondii seropositivity. IgG antibodies were found in 325 (70.04%) of the patients. We observed a higher likelihood of positive IgG antibodies against Toxoplasma gondii in older individuals, patients residing in rural areas, and females. We also noted associations between Toxoplasma gondii infection and certain risk factors, like activities that involve contact with soil, low-income levels, and limited educational attainment. Our findings indicate a high prevalence of T. gondii infection among psychiatric patients from Western Romania and provide new information regarding the potential risk factors associated with T. gondii in this population group. This study may serve as a foundation for future research and the development of preventive strategies.

Association between long working hours and the development of suicidal ideation among female workers: An 8-year population-based study using the Korean Longitudinal Survey of Women & Family (2012–2020)

Long working hours and overwork have recently emerged as pressing public health concerns. We explored the association between long working hours and suicidal ideation in female workers. A total of 8017 women (24,331 observations) from the fourth to eighth waves of the Korean Longitudinal Survey of Women and Families (2012–2020) were analyzed. To address the repeated measurements within each participant, we employed a generalized estimating equation to estimate the odds ratio (OR) and 95% confidence intervals (CIs). The prevalence of suicidal ideation was 1.9% for those working 35–40 h/week and 4.4% for those working ≥55 h/week. Compared to individuals working 35–40 h/week, those working ≥55 h/week were more likely to experience concurrent suicidal ideation (OR [95% CI]:1.85 [1.43–2.39]). The OR (95% CI) of the association between long working hours and onset of suicidal ideation in the subsequent wave was 1.69 (1.20–2.38) for ≥55 h/week. In subgroup analysis, this association was pronounced among workers with low-income levels (OR [95% CI]: 1.97 [1.29–3.02]) and blue-collar occupations (OR [95% CI]: 2.27 [1.41–3.66]). Policy efforts are required to protect the mental health of female workers exposed to long working hours.

Local governments and aging policies: An analysis of municipalities in the region of Madrid

Local governments are increasing their efforts to provide services to older adults ranging from health and care for dependents to leisure and cultural activities. Despite the widespread adoption of the active aging paradigm, the intensity of the aging process and the capacity and preferences of local governments to address the consequences of aging are not uniformly distributed. This study examines variations in local government responses to aging based on a survey conducted between October 2018 and February 2019 among government officials and political representatives in municipalities in the Community of Madrid with a population exceeding 10,000 inhabitants. A descriptive exploration of the survey responses suggests variability in local governments’ approach to aging, which is associated with factors such as the concentration of older adults in the municipality and differences in available income levels. In municipalities that prioritize resource-intensive policies, such as health care and programs targeting poverty and the prevention of social exclusion, there is a higher concentration of older adults and lower levels of available income. Conversely, wealthier municipalities tend to focus on policies aimed at promoting leisure and culture. This divergence in local policy responses highlights the heterogeneity within the active aging paradigm. Furthermore, it provides a nuanced understanding of how these policies can be adapted and responsive to the specific needs of each municipality.

Mitigating role of financial inclusion on the perceived difficulties, concerns, and borrowing for medical expenses in Saudi Arabia

Access to convenient quality healthcare at all times is considered a basic human right; however, many countries are still striving to achieve this goal for their populations. The persistent rise in healthcare expenditure remains a significant obstacle in achieving universal health coverage on a global scale. The aim of this study was to investigate the role of financial inclusion in addressing the financial hardship related to health and medical expense concerns in the Kingdom of Saudi Arabia. Probit models were applied to analyse nationally representative data from the Global Financial Inclusion (Global Findex) database. The results showed that financial inclusion had a significant impact on reducing the hardship associated with obtaining money for emergency expenses within 30 days as indicated by a significant coefficient of -0.262. Additionally, Financial inclusion substantially increases the likelihood of borrowing money for health or medical purposes in the past 12 months, with a coefficient of 0.585. Moreover, correlations were identified between low income levels and decreased likelihood of borrowing for health/medical purposes, increased difficulty in obtaining money for emergency expenses, and heightened concern regarding the ability to afford medical costs in the event of serious illness or accidents. These findings highlight the need for policy makers and health providers to prioritize financial inclusion and support programs for low-income individuals to achieve equity in health treatment for all in Saudi Arabia.

Strategi Mitigasi Dampak Kejadian Banjir di Kecamatan Rumbai Pesisir Kota Pekanbaru

Rumbai pesisir is one of the districts that is often affected by flooding in the city of Pekanbaru. This research was carried out to formulate mitigation strategies from ecological, social, and economic perspectives to minimize the impacts of floods in the Rumbai sub-district of Pekanbaru City. The data obtained from questionnaires, interviews, direct field observations, and also literature reviews are analyzed descriptively and plotted into a SWOT diagram. From the ecological perspective, Pekanbaru has a medium to high category of rainfall with a high frequency of flood. Many of the drainage channels in Sri Meranti area are unmaintained and clogged. The social conditions show that the majority of Sri Meranti population have productive age and intermediate education so that they can be more educated in terms of mitigation. The economic conditions show that there is a low-income level of the Sri Meranti population which is below the UMK. Of Pekanbaru. Government contributions in handling floods are needed but the budget is insufficient. The resulting strategy in mitigating the flood impact in Rumbai is the S-O (Strength-Opportunities) strategy which supports an aggressive strategy in taking advantage of all the strengths and opportunities that exist.

Does improving basic public health services promote household consumption of rural migrant workers? Evidence from China.

Transforming rural migrant workers' consumption potential into a consumption booster requires ensuring their equal rights as urban residents. The adequate access to Basic Public Health Services (BPHS) help effectively tackle rural migrant workers' health challenges and promote the well-being of this vulnerable population. Assessing the welfare effects of BPHS through a consumption perspective offers valuable insights and provides policy implications for enhancing the equity of BPHS and achieving common prosperity. Utilizing the household-level data from China Migrants Dynamic Survey 2017 (CMDS 2017), this study comprehensively evaluated the effects of BPHS on rural migrant workers' household consumption by combining the methods of OLS, PSM, and IV. The enhancement of BPHS promotes rural migrant workers' household consumption even after considering endogeneity problems. Mechanism analysis indicates that BPHS imposes its positive effects on rural migrant workers through improving health literacy and increasing citizenization willingness. Furthermore, we identified heterogeneous effects across individual and household characteristics of rural migrant workers, and their flow patterns. Our analysis indicates that BPHS plays a greater role in promoting household consumption of socially vulnerable groups, such as trans-provincial migration, rural migrant workers in old generations, and with lower-level income. Overall, these results suggest that the welfare effects of BPHS are inclusive in China.

Societal determinants of flood-induced displacement.

What explains human consequences of weather-related disaster? Here, we explore how core socioeconomic, political, and security conditions shape flood-induced displacement worldwide since 2000. In-sample regression analysis shows that extreme displacement levels are more likely in contexts marked by low national income levels, nondemocratic political systems, high local economic activity, and prevalence of armed conflict. The analysis also reveals large residual differences across continents, where flood-induced displacement in the Global South often is much more widespread than direct human exposure measures would suggest. However, these factors have limited influence on our ability to accurately predict flood displacement on new data, pointing to important, hard-to-operationalize heterogeneity in flood impacts across contexts and critical data limitations. Although results are consistent with an interpretation that the sustainable development agenda is beneficial for disaster risk reduction, better data on societal consequences of natural hazards are critically needed to support evidence-based decision-making.

Flood exposure and pregnancy loss in 33 developing countries

Floods have affected billions worldwide. Yet, the indirect health impacts of floods on vulnerable groups, particularly women in the developing world, remain underexplored. Here, we evaluated the risk of pregnancy loss for women exposed to floods. We analyzed 90,465 individual pregnancy loss records from 33 developing countries, cross-referencing each with spatial-temporal flood databases. We found that gestational flood exposure is associated with increased pregnancy loss with an odds ratio of 1.08 (95% confidence interval: 1.04 - 1.11). This risk is pronounced for women outside the peak reproductive age range (<21 or >35) or during the mid and late-stage of pregnancy. The risk escalated for women dependent on surface water, with lower income or education levels. We estimated that, over the 2010s, gestational flood events might be responsible for approximately 107,888 (CIs: 53,944 - 148,345) excess pregnancy losses annually across 33 developing countries. Notably, there is a consistent upward trend in annual excess pregnancy losses from 2010 to 2020, and was more prominent over Central America, the Caribbean, South America, and South Asia. Our findings underscore the disparities in maternal and child health aggravated by flood events in an evolving climate.

Assessing Teachers’ Readiness for Mathematics Instruction: Insights from Student Perspectives

This study evaluated the perceived readiness of Mathematics teachers at Luuk National High School from the perspective of their students. Utilizing a descriptive-correlational research design, the study included 100 student respondents selected through purposive sampling. Key findings are as follows: The majority of the 100 student respondents are female, within the typical age range for junior high school, and evenly distributed across the four grade levels. Their parents generally have average educational attainment and low-income levels. Students perceive their teachers as frequently prepared to teach Mathematics across three main areas: understanding of student needs in Mathematics, strategies for engaging students, and the implementation of instructional practices. No significant differences were observed in perceived teacher readiness based on students' age, gender, parental education, or family income, except grade level. There is a significant positive correlation among the subcategories of teacher readiness, except between understanding student needs in Mathematics and engagement strategies. The study offers several recommendations: School administrators should enhance support and resources for Mathematics teachers through professional development, mentoring, feedback, and recognition. Mathematics teachers are encouraged to deepen their understanding of student needs, refine their instructional strategies, and collaborate with colleagues to share best practices. Parents should actively support their children's Mathematics education, especially given the low income and educational levels within the community. Students should value and leverage the readiness and resources provided by their teachers. Future research should investigate additional factors influencing teacher readiness, such as school culture, curriculum, assessment methods, and technological integration.

The illness trap: The impact of disability benefits on willingness to receive HCV treatment

Health care is assumed to be a primary good, implying that patients should always demand or accept treatments that may enhance their life expectancy and quality of life, especially if the risks associated with the treatment are low. We argue that, especially in countries with a well-developed welfare state, treating an invalidating condition may lead to opportunity costs in terms of reduced disability allowances that may represent a barrier to treatment for low-income individuals. We test this hypothesis by applying a recursive bivariate probit approach to population data from an ad hoc administrative database for Liguria (an Italian administrative region). The dataset includes data for more than 8 thousand people affected by hepatitis C Virus (HCV) infection between 2013 and 2020. After the discovery of new direct-acting antivirals (DAAs) in 2014, HCV eradication may now be possible. However, despite the national and international efforts, several patients diagnosed with HCV choose not to undergo drug therapy despite the adverse consequences for their personal health and relevant costs to the national health system. We show that five years after the implementation of the new drugs, approximately 41 % of the diagnosed population in Liguria remains untreated. This percentage increases to 64 % within the subgroup entitled to disability benefits and characterized by lower income levels. The “illness trap” effect is more substantial for older people but also low-income patients. Moreover, we find that this effect is higher in patients with an intermediate range of comorbidities; indeed, these patients are at a higher risk of losing economic benefits if they recover from HCV. These results suggest the need for healthcare policies addressing this distorting effect when designing benefit programs and granting financial benefits to patients.