National-level Differences Research Articles

Myocardial Infarction Quality of Care and Outcomes in Asian Ethnic Groups in the United States.

National-level differences in myocardial infarction (MI) quality of care among Asian patients in the United States are unclear. We assessed the quality of MI care in the 6 largest US Asian ethnic groups. Patients aged ≥18 years with ST-segment-elevation MI or non-ST-segment-elevation MI in the Get With The Guidelines-Coronary Artery Disease registry (711 US hospitals, 2015-2021) were assessed. The odds of MI-related quality of care and process outcomes were evaluated in Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asian adults compared with non-Hispanic White adults. Sex-stratified logistic regression models were adjusted for age and clinical characteristics. There were 5691 Asian patients (1520 Asian Indian, 422 Chinese, 430 Filipino, 114 Japanese, 283 Korean, 553 Vietnamese, and 2369 other Asian) and 141 271 non-Hispanic White patients, overall 30% female, and mean age of 66.5 years. Relative to non-Hispanic White adults, among patients with ST-segment-elevation MI, door-to-ECG time ≤10 minutes was less likely in Asian Indian (adjusted odds ratio [aOR], 0.64 [95% CI, 0.50-0.82]), Chinese (aOR, 0.65 [95% CI, 0.46-0.93]), and Korean (aOR, 0.57 [95% CI, 0.33-0.97]) men and in other Asian women (aOR, 0.61 [95% CI, 0.41-0.90]). Door-to-balloon time ≤90 minutes was less likely in Asian Indian men (aOR, 0.71 [95% CI, 0.56-0.90]) and Filipina women (aOR, 0.48 [95% CI, 0.24-0.98]). In patients with ST-segment-elevation MI or non-ST-segment-elevation MI, optimal medical therapy for MI was less likely in Korean men (aOR, 0.65 [95% CI, 0.47-0.90]) and more likely in Asian Indian men (aOR, 1.22 [95% CI, 1.06-1.40]) and women (aOR, 1.32 [95% CI, 1.04-1.67]) and Filipina women (aOR, 1.84 [95% CI, 1.27-2.67]). MI quality of care varies among US Asian patients with ST-segment-elevation MI and non-ST-segment-elevation MI. Quality improvement programs must identify and address the factors that result in suboptimal MI quality of care among US Asian patients.

The Geography of Racially Polarized Voting: Calibrating Surveys at the District Level

Debates over racial voting, and over policies to combat vote dilution, turn on the extent to which groups’ voting preferences differ and vary across geography. We present the first study of racial voting patterns in every congressional district (CD) in the United States. Using large-sample surveys combined with aggregate demographic and election data, we find that national-level differences across racial groups explain 60% of the variation in district-level voting patterns, whereas geography explains 30%. Black voters consistently choose Democratic candidates across districts, whereas Hispanic and white voters’ preferences vary considerably across geography. Districts with the highest racial polarization are concentrated in the parts of the South and Midwest. Importantly, multiracial coalitions have become the norm: in most CDs, the winning majority requires support from non-white voters. In arriving at these conclusions, we make methodological innovations that improve the precision and accuracy when modeling sparse survey data.

The global belief that "life gets better and better": National differences in recollected past, present, and anticipated future life satisfaction around the world, across time, and in relation to societal functioning.

National-level differences in individuals' ratings of their recollected past, current, and anticipated future life satisfaction (LS) were examined using results from two pioneering projects comprising national-level results for 14 countries (Cantril, 1965) and 15 regions of the world (Gallup International Research Institutes & Charles F. Kettering Foundation, 1976; Study 1), as well as sequential results from the Gallup World Poll based on 137 countries representing a broad range of nations from around the world surveyed from 2005 to 2018 (Study 2). Results from both studies revealed a robust belief that "life gets better" over time (i.e., recollected past < current < anticipated future LS) in nations around the world. Such beliefs were examined in relation to objective and subjective indicators of societal-level functioning. Results replicated across studies in showing that nations with less positive societal functioning and prosperity were characterized by less recollected past improvements in LS, and yet greater anticipated future improvements in LS. Results from Study 2 also revealed that such expectations were positively biased compared to changes over time in national levels of LS; further, greater bias was related to less positive societal-level functioning. In conclusion, examining national-level differences in LS from a subjective temporal perspective provides valuable new insights concerning human development and prosperity across countries, over time, and around the world. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Broadened embedded autonomy and Latin America’s Pink Tide: towards the neo-developmental state

ABSTRACT A central issue in the scholarly literature on the Latin American Pink Tide is the renewal of state-led development, or neo-developmentalism, and dependence on primary resources or the so-called resource curse. In this article, we consider the question of neo-developmentalism during the Pink Tide and state capacity, analyzing whether the three ‘radical’ Pink Tide governments in Ecuador, Venezuela, and Bolivia were able to achieve their respective neo-developmental political objectives. We employ a comparative approach building on the theory of ‘broadened embedded autonomy’ as conceptualized by Peter Evans. We argue that while reliance on resource extraction posed a challenge for the construction of state capacity for Pink Tide governments, national-level differences help explain why some governments were relatively more successful than others at inducing neo-developmentalism. A comparative approach focused on the politics of state-society thus provides a promising analytical framework for interpreting variations across cases.

Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical Outcomes and Predictors of Management Strategy

ObjectivesTo examine national-level differences in management strategies and outcomes in patients with autoimmune rheumatic disease (AIRD) with acute myocardial infarction (AMI) from 2004 through 2014. MethodsAll AMI hospitalizations were analyzed from the National Inpatient Sample, stratified according to AIRD diagnosis into 4 groups: no AIRD, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSC). The associations between AIRD subtypes and (1) receipt of coronary angiography and percutaneous coronary intervention (PCI) and (2) clinical outcomes were examined compared with patients without AIRD. ResultsOf 6,747,797 AMI hospitalizations, 109,983 patients (1.6%) had an AIRD diagnosis (RA: 1.3%, SLE: 0.3%, and SSC: 0.1%). The prevalence of RA rose from 1.0% (2004) to 1.5% (2014), and SLE and SSC remained stable. Patients with SLE were less likely to receive invasive management (odds ratio [OR] [95% CI]: coronary angiography—0.87; 0.84 to 0.91; PCI—0.93; 0.90 to 0.96), whereas no statistically significant differences were found in the RA and SSC groups. Subsequently, the ORs (95% CIs) of mortality (1.15; 1.07 to 1.23) and bleeding (1.24; 1.16 to 1.31) were increased in patients with SLE; SSC was associated with increased ORs (95% CIs) of major adverse cardiovascular and cerebrovascular events (1.52; 1.38 to 1.68) and mortality (1.81; 1.62 to 2.02) but not bleeding or stroke; the RA group was at no increased risk for any complication. ConclusionIn a nationwide cohort of AMI hospitalizations we found lower use of invasive management in patients with SLE and worse outcomes after AMI in patients with SLE and SSC compared with those without AIRD.

Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19

PurposeThe coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR).MethodsWe examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The cross-sectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level.ResultsWe found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = − 0.57; p < 0.001).ConclusionGeographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving severely ill patients to facilities with available beds.

Institutional Distance on International Joint Ventures: An Expansion of Cultural Dimensions

Previous studies have primarily focused on cultural distance to explain the underling incongruences between national and cultural values between home and host operations. Empirical studies investigating the relationship between cultural distance and performance result in mixed conclusions on how these national-level differences affect the success of IJVs. Cultural distance, however, is only one dimension which does not fully encompass the complexity of international distance. This paper builds upon this same fundamental principle, but proposes a more complete set of multi-dimensional attributes that more completely incorporate the diversity in which firms of different countries vary.

A Decade of Analysis: Household Food Insecurity Among Low-Income Immigrant Children

Our study advances literature on immigrant food insecurity by examining whether national-level differences in immigrant and nonimmigrant families’ risk of food insecurity persist across time and for different ethnic/racial groups. Using data from the Current Population Survey Food Security Supplement for low-income households with children aged 0 to 17 years, we examine trends (2003-2013) in immigrant and nonimmigrant food insecurity overall and for different ethnic/racial groups. We also assess how immigrant families are faring compared with their nonimmigrant peers in the wake of the Great Recession and its prolonged recovery period. We find that among low-income households with children, noncitizen immigrant households and their U.S.-born household counterparts experience similar levels of food insecurity, while citizen immigrant households demonstrate the lowest levels of food insecurity. Citizen immigrant households, however, appear to have been most affected by the Great Recession and the protective influences of citizenship status do not appear to extend to Hispanic immigrants.

What Drives National Differences in Intensive Grandparental Childcare in Europe?

Objectives. Grandparents play an important role in looking after grandchildren, although intensive grandparental childcare varies considerably across Europe. Few studies have explicitly investigated the extent to which such cross-national variations are associated with national level differences in individual demographic and socio-economic distributions along with contextual-structural and cultural factors (e.g., variations in female labor force participation, childcare provision, and cultural attitudes). Methods. We used multilevel models to examine associations between intensive grandparental childcare and contextual-structural and cultural factors, after controlling for grandparent, parent, and child characteristics using nationally representative data from the Survey of Health, Ageing and Retirement in Europe. Results. Even controlling for cross-national differences in demographic and socio-economic distributions, contextual-structural factors play an important role in explaining grandparental childcare variations in Europe. In particular, higher levels of intensive grandparental childcare are found in countries with low labor force participation among younger and older women, and low formal childcare provision, where mothers in paid work largely rely on grandparental support on an almost daily basis. Discussion. Encouraging older women to remain in paid work is likely to have an impact on grandchild care which in turn may affect mothers’ employment, particularly in Southern European countries where there is little formal childcare.

What Drives National Differences in Intensive Grandparental Childcare in Europe?

Objectives.Grandparents play an important role in looking after grandchildren, although intensive grandparental childcare varies considerably across Europe. Few studies have explicitly investigated the extent to which such cross-national variations are associated with national level differences in individual demographic and socio-economic distributions along with contextual-structural and cultural factors (e.g., variations in female labor force participation, childcare provision, and cultural attitudes).Methods.We used multilevel models to examine associations between intensive grandparental childcare and contextual-structural and cultural factors, after controlling for grandparent, parent, and child characteristics using nationally representative data from the Survey of Health, Ageing and Retirement in Europe.Results.Even controlling for cross-national differences in demographic and socio-economic distributions, contextual-structural factors play an important role in explaining grandparental childcare variations in Europe. In particular, higher levels of intensive grandparental childcare are found in countries with low labor force participation among younger and older women, and low formal childcare provision, where mothers in paid work largely rely on grandparental support on an almost daily basis.Discussion.Encouraging older women to remain in paid work is likely to have an impact on grandchild care which in turn may affect mothers’ employment, particularly in Southern European countries where there is little formal childcare.

Is There a North–South Divide in Integration Outcomes? A Comparison of the Integration Outcomes of Immigrants in Southern and Northern Europe

Integration models are often viewed as a necessary tool for framing integration policies, and for measuring integration efficiency. While “old” European immigration countries in Europe account for a systematic framework of integration policies embedded in a given integration philosophy, new immigration countries (particularly Italy, Greece, Portugal and Spain) have lacked a coherent set of integration policies and practices and, it goes without saying, a philosophical approach to integration. This vacuum has often been seen as a source of marginalization and ‘differential exclusion’, suggesting the existence of a North–South divide in integration matters, and more importantly, outcomes. However, there is still a striking lack of appropriate comparative empirical evidence backing or dismissing this divide. The objective of this article is to explore national-level differences in the real performance of immigrants in selected European countries of immigration along key indicators of integration outcomes, including school attainment and labor market participation. We here discuss the position of Italy, Spain, Greece and Portugal as a coherent cluster of countries and compare the performance of their migrants with that of other foreign-born workers settled in the West of Europe. Our evidence provides little support for the idea that the Southern countries are a unique cluster and that they homogeneously lag behind in terms of integration outcomes.

Int'l Accountability Standards Across National Business Systems: A Neo-Institutional Perspective

We explore the debates around Corporate Social Responsibility (CSR) as a mechanism of Global Corporate Governance in an age of growing globalization. Previous research has looked at how differences in National Business Systems (NBS) can affect national level differences in CSR but has neglected to investigate how these mechanisms can account for the gap between the differential national commitment to, and achievement of, the objectives related to CSR. We theorize about the potential to discover NBS characteristics that can explain the extent of the ‘gap’ between the commitment to, and achievement of, objectives related to CSR and how this can inform future research and policy making.

National-level differences in the adoption of environmental health technologies: a cross-border comparison from Benin and Togo

Environmental health problems such as malaria, respiratory infections, diarrhoea and malnutrition pose very high burdens on the poor rural people in much of the tropics. Recent research on key interventions-the adoption and use of relatively cheap and effective environmental health technologies-has focused primarily on the influence of demand-side household-level drivers. Relatively few studies of the promotion and use of these technologies have considered the role of contextual factors such as governance, the enabling environment and national policies because of the challenges of cross-country comparisons. We exploit a natural experimental setting by comparing household adoption across the Benin-Togo national border that splits the Tamberma Valley in West Africa. Households across the border share the same culture, ethnicity, weather, physiographic features, livelihoods and infrastructure; however, they are located in countries at virtually opposite ends of the institutional spectrum of democratic elections, voice and accountability, effective governance and corruption. Binary choice models and rigorous non-parametric matching estimators confirm that households in Benin are more likely than households in Togo to plant soybeans, build improved cookstoves and purchase mosquito nets, ceteris paribus. Although we cannot identify the exact mechanism for the large and significant national-level differences in technology adoption, our findings suggest that contextual institutional factors can be more important than household characteristics for technology adoption.

Support for Nuclear Energy in the Context of Climate Change

The relatively low carbon impact of nuclear power plants and the concern over global warming have renewed both interest in and controversy over expanding nuclear energy. This study uses survey data from nations of the European Union to examine sociodemographic differences among individuals and national differences in levels and processes of support for nuclear energy. Results based on multilevel models for 27 to 29 European nations reveal relatively low support for nuclear energy, even among those concerned about climate change, but consistent patterns of determinants. At the individual level, high socioeconomic status tends to increase support for nuclear energy. At the national level, the presence of operating nuclear power plants in a country leads to higher public support. Both these results more strongly support arguments focusing on the importance of familiarity with the technology than arguments focusing on postmaterialist values. In addition, rightist political views increase support for nuclear energy, but political divisions prove particularly important in high-income nations with postmaterialist values.

Contribution of problem drug users’ deaths to excess mortality in Scotland: secondary analysis of cohort study

Objectives To examine the “Scottish effect”—namely, the growing divergence between mortality in Scotland and England that is not explained by national differences in levels of deprivation—and, more specifically, to examine...

The importance in accounting of ambiguity tolerance at the national level

PurposeThe aim of the research is to examine potential differences in the levels of ambiguity tolerance between Australian and Chinese accountants at the national, rather than individual, level.Design/methodology/approachAmbiguity tolerance levels of final year accounting students (proxying for entry level accountants) and first year accounting students from Australia and China were measured using the MacDonald AT‐20 Ambiguity Tolerance Index. Comparisons were made across the four subject pools with a view to identifying national level differences suggested by the cultural, sociological, historical, and contemporary issues impacting on the accounting profession in the two countries.FindingsEntry level accountants in China are less tolerant of ambiguity than their Australian counterparts. There are, however, no statistically significant differences in the levels of ambiguity tolerance between first year accounting students in China and Australia.Research limitations/implicationsThe research employed final year accounting students as surrogates for entry level accountants. Future research could usefully extend this research to practicing accountants at different ranks.Practical implicationsGiven the central role of ambiguity in contemporary accounting practice, the potential implications are broad. This is particularly the case with regard to the harmonization of accounting practices in that accountants with different tolerances for ambiguity might make different decisions in the face of similar accounting standards and circumstances. Interestingly, the results from the research suggest that differences in ambiguity tolerance are attributable to events occurring while students are studying.Originality/valueThis research examines ambiguity tolerance at the national level (rather than the individual level), thereby allowing practical implications to be prescribed.

Phobic anxiety in 11 nations: part II. Hofstede’s dimensions of national cultures predict national-level variations

Hofstede’s dimensions of national cultures termed Masculinity–Femininity (MAS) and Uncertainty Avoidance (UAI) ( Hofstede, 2001) are proposed to be of relevance for understanding national-level differences in self-assessed fears. The potential predictive role of national MAS was based on the classical work of Fodor ( Fodor, 1974). Following Fodor, it was predicted that masculine (or tough) societies in which clearer differentiations are made between gender roles (high MAS) would report higher national levels of fears than feminine (or soft/modest) societies in which such differentiations are made to a clearly lesser extent (low MAS). In addition, it was anticipated that nervous-stressful-emotionally-expressive nations (high UAI) would report higher national levels of fears than calm-happy and low-emotional countries (low UAI), and that countries high on both MAS and UAI would report the highest national levels of fears. A data set comprising 11 countries ( N > 5000) served as the basis for analyses. As anticipated, (a) high MAS predicted higher national levels of Agoraphobic fears and of Bodily Injury–Illness–Death fears; (b) higher scores on both UAI and MAS predicted higher national scores on Bodily Injury–Illness–Death fears, fears of Sexual and Aggressive Scenes, and Harmless Animals fears; (c) higher UAI predicted higher national levels of Harmless Animals, Bodily Injury–Illness–Death, and Agoraphobic fears.

Masculinity–femininity as a national characteristic and its relationship with national agoraphobic fear levels: Fodor’s sex role hypothesis revitalized

Hofstede’s dimension of national culture termed Masculinity–Femininity [ Hofstede (1991). Cultures and organizations: software of the mind. London: McGraw-Hill] is proposed to be of relevance for understanding national-level differences in self-assessed agoraphobic fears. This prediction is based on the classical work of Fodor [ Fodor (1974). In: V. Franks & V. Burtle (Eds.), Women in therapy: new psychotherapies for a changing society. New York: Brunner/Mazel]. A unique data set comprising 11 countries (total N=5491 students) provided the opportunity of scrutinizing this issue. It was hypothesized and found that national Masculinity (the degree to which cultures delineate sex roles, with masculine or tough societies making clearer differentiations between the sexes than feminine or modest societies do) would correlate positively with national agoraphobic fear levels (as assessed with the Fear Survey Schedule—III). Following the correction for sex and age differences across national samples, a significant and large effect-sized national-level (ecological) r=+0.67 ( P=0.01) was found. A highly feminine society such as Sweden had the lowest, whereas the champion among the masculine societies, Japan, had the highest national Agoraphobic fear score.

Resemblance and Relief: National Clustering and Social Assistance Provision—A Subnational Comparison

Social assistance--cash and in-kind benefits provided to those deemed to be without the means for an adequate level of subsistence--has been a point of constant comparison between the United States and Canada. These comparisons have generally tended to point to Canada's generosity in contrast to the meager levels of assistance provided in the United States.(1) Not only is Canada's social safety net widely accepted as more generous than that found in the U.S., but Canadians are also generally thought to be more favorable toward social welfare per se than Americans.(2) Without debating the accuracy of such generalizations qua generalizations, they overlook important variations both among states and among provinces. In doing so, they also overstate the differences between the American states as a group and the Canadian provinces as a group. Broadly stated, Canadian provinces are far stronger political actors than are the American states. However, both states and provinces exercise important responsibilities in the provision of social assistance. In policy areas where states and provinces are significant actors, it is logically necessary, prior to making generalizations about national differences, to examine whether there is in fact some significant level of national clustering--whether policies in the various states tend to look more like policy in other states than in the Canadian provinces and vice versa. In the absence of strong consistent national clustering among subnational jurisdictions, differences in public policies across provinces and states cannot be meaningfully explained by reference to national or system-level characteristics.(3) An examination of social assistance provision in the states and provinces reveals that rather than one country being consistently more generous than the other, an alternative characterization emphasizes the continuing lack of strong national clustering. This paper, therefore, illustrates the need for considerable caution in overemphasizing national-level differences between social assistance provision in the two countries. Central Government Programs for Social Assistance Provision of social assistance by states and provinces has taken place within each country's respective federal framework and the differences in these frameworks have been significant. However, distinctive federal arrangements do not constitute presumptive evidence of national clustering among states and provinces in terms of how social assistance is actually provided. Under both federal systems, states and provinces continue to retain considerable latitude to provide assistance in the manner they see fit. This flexibility contributes to making careful consideration of national clustering among states and provinces necessary. In both the United States and Canada, jurisdiction over the provision of last resort aid to the needy is granted to the states and provinces. Provinces have jurisdiction over social assistance by virtue of the constitutional provision granting them exclusive jurisdiction over hospitals, asylums, charities and eleemosynary institutions [S.97, 7] which was buttressed by powers over `all matters of a merely local or private nature' (S.92, 16).(4) In the U.S., social assistance falls under the range of activities not expressly assigned to the federal government by the constitution and thus remains the prerogative of the states. Despite these similarities, there are significant differences between the jurisdictional frameworks in the two countries as they have evolved. While the federal governments in both countries have asserted their constitutional capacity to provide income-tested benefits directly to individuals by virtue of the federal spending power, the two countries differ regarding means-tested (income and asset-tested) benefits. Direct federal provision of means-tested benefits existing in the U.S. (for example, Supplemental Security Income for the aged, blind, and disabled) would not be constitutionally legal in Canada. …

The effect of national culture on the choice between licensing and direct foreign investment

AbstractThis paper argues that national differences in levels of trust impact perceptions of transactions costs and thereby influence the desirability of internalization and the choice of foreign market entry mode. The paper tests this framework on industry level data from the United States Commerce Department's Benchmark Survey of operations of U.S. ‐based manufacturing multinational corporations in 1977 and 1982, and shows that cultural differences in trust do influence perceptions of transaction costs and the preference for direct foreign investment across countries.