Does income inequality modify the association between air pollution and health?

BACKGROUND: It has been hypothesized that socioeconomic status may act as an effect modifier of the association between air pollution and health. In this study, we investigated whether income inequality may modify the association between fine particulate pollution and self-reported health. METHODS: We combined several different sources of data. Demographic and socio-economic data, at the individual level, were drawn from the 2001 US Behavioral Risk Factor Surveillance System (BRFSS). County-level particulate pollution data for the year 2001 were provided by the US Environmental Protection Agency. State-level income inequality was measured by the Gini index using US census data from the year 2000. We used a hierarchical logistic regression to model the association between general self-reported health and fine particulate pollution accounting for income inequality as an effect modifier and controlling for the usual confounders. RESULTS: We found that when income inequality is low (10th percentile of the Gini distribution), the odds of reporting fair or poor health for a 10microg/m3 increase in particulate pollution is 1.34 (95% confidence interval 1.21-1.48). The analogous odds ratio for higher income inequality (60th percentile of the Gini distribution) is 1.11 (95% confidence interval 1.06-1.16). CONCLUSIONS: Income inequality was found to be an effect modifier of the association between general self-reported health and particulate pollution. However, these findings challenged our hypothesis that people living in higher income inequality areas are more vulnerable to the impact of air pollution. We discuss the factors driving these results.     

Income inequality and limitations in activities of daily living: a multilevel analysis of the 2003 American Community Survey

OBJECTIVES: This study examined whether state income inequality was associated with an individual's limitations in activities of daily living (ADL) when controlling for the individual's demographic and socio-economic characteristics. STUDY DESIGN AND METHODS: The study was based on secondary analyses of data collected in the 2003 American Community Survey (ACS). The ACS is a national survey of Americans with a 96.7% response rate. The sample used for this research included 645,835 participants aged 25 years and older. A multilevel model with a non-linear logit link function was used. RESULTS: A 0.05 increase in the Gini coefficient (a measure of state level income inequality) was associated with an increase of 11% in the odds of ADL limitations [odds ratio (OR) 1.11, 95% confidence intervals 1.01-1.22] even after controlling for the individual's demographic and socio-economic characteristics. These elevated odds are comparable with those associated with women in comparison with men (OR 1.12). A separate analysis indicated that individuals in the three least equitable states had consistently higher probabilities of ADL limitations across the whole economic spectrum when compared with individuals in the three most equitable states. CONCLUSIONS: State-level income inequality and individual income levels were significant independent predictors of ADL limitations. The impact of any future changes in state-level income inequality or shifts in individual income levels in the USA could be used to further investigate if this relationship is causal.     

膳食和环境因素与我国城乡居民超重、肥胖关系的研究

目的探讨我国成年人体质指数(BMI)与膳食和环境因素之间的关系。方法利用"中国居民健康与营养调查"资料,18~60岁参加2000年调查并且2004年调查被随访到者3284人作为研究对象,考察BMI的变化情况以及BMI与膳食和环境因素之间的关系。结果2000年平均BMI为22.8 kg/m2,2004年为23.2kg/m2,同期超重和肥胖的比例(BMI24 kg/m2)从31.6%增加到36.5%。4年间总能量摄入量减少,但脂肪供能增加;与农村居民相比,城市居民消费的脂肪更多、BMI更高;高家庭收入与高脂肪摄入量和高BMI有关联;高脂肪、高能量摄入量与高BMI有关联,男性更明显;高体力活动水平与低BMI有关联。结论明确膳食和环境因素与人群BMI之间的关联对控制人群的超重和肥胖有着重要的指导意义。     

医院业务收入全增量因素分析

目的：探讨门诊及住院工作量,业务收入和病种构成间的影响因素。方法：多元函数全增量因素和病种构成因数分析。结果：门诊人次,住院人次数量的增加（参考医疗费用支出大的危重病种的变化）影响业务收入最大,门诊人均费用最小,平均住院日缩短,使检查治疗时间集中,导致住院日均费用增高。结论：通过多因素分析,可以找出变量之间的影响程度,为管理和决策提供依据。     

Income-related health inequalities in the Nordic countries: examining the role of education, occupational class, and age

Numerous studies have concluded that people's socioeconomic position is related to mortality and morbidity, but that the strength of this association varies considerably both within and between European regions. This has spurred several researchers to more closely examine educational and occupational gradients in health in the Nordic countries to clarify the causes of cross-national differences. However, comparable studies using income as an indicator of socioeconomic position are still lacking. This study uses recent and highly comparable data to fill this gap. The aim of this study is threefold. First, we ask to what extent there is an income gradient in health in the Nordic countries, and to what extent the association differs between these countries. Second and third, we examine whether differences in the attenuation of the income gradient by education and occupational class, and age-specific differences between countries, may act as explanations for differences in the income gradient between the Nordic countries. The data source are three waves of the European Social Survey (ESS, 2002/2004/2006), which included 17,801 people aged 25 and over from Denmark, Finland, Norway, and Sweden. Two subjective health measures (physical/mental self reported health and limiting longstanding illness) were analysed by means of logistic regression. The results show that, in all countries, people reported significantly better health and were less likely to suffer from longstanding illness as they had a higher income. This association is strongest in Norway and Finland and weakest in Denmark. The income gradient in health, but not country differences in this gradient, is partly explained by education and occupational class. Additionally, the strength of the income gradient in health varies between age groups. The relatively high health inequalities between income groups in Norway and Finland are already visible in the youngest age groups. The results imply that the socioeconomic gradient in health will arguably not be strongly reduced in the near future as a result of cohort replacement, as has been suggested in previous studies. Health policy interventions may be particularly important five to ten years prior to retirement and in early adulthood.     

Income inequality and health: Importance of a cross-country perspective

This paper uses a unique dataset-containing information collected in 2006 on individuals aged 40–79 in 21 countries throughout the world to examine whether individual income, relative income in a reference group, and income inequality are related to health status across middle/low and high-income countries. The dependent variable is self-assessed health (SAH), and as a robustness check, activities of daily living (ADL) are considered. The focus is particularly on assumptions regarding an individual's reference group and on how the estimated relationships depend on the level of economic development. Correcting for national differences in health reporting behavior, individual absolute income is found to be positively related to individual health. Furthermore, in the high-income sample, there is strong evidence that average income within a peer-age group is negatively related to health, thus supporting the relative income hypothesis. In middle/low-income countries, it is instead average regional income that is negatively associated with health. Finally, there is evidence of a negative relationship between income inequality and individual health in high-income countries. Overall, the results suggest that there might be important differences in these relationships between high-income and middle/low-income countries.     

Self-reported hypertension prevalence and income among older adults in Canada and the United States

Hypertension is one of the most common chronic conditions worldwide. There is strong evidence that low socioeconomic status is associated with elevated rates of blood pressure-related cardiovascular disease. Few studies have examined the association between socioeconomic circumstances and hypertension among people aged 65 years and older. The purpose of this study was to examine the relationship between household income and self-reported hypertension prevalence among persons aged 65 and older in the United States and Canada. Data were obtained from the 2002–2003 Joint Canada/United States Survey of Health for 755 Canadian and 1151 US adults aged 65 and older. Aggregate hypertension prevalence rates in the United States and Canada were generally similar (53.8% versus 48.0%). We found a significant inverse linear relationship between household income and the hypertension prevalence rate in the United States, but no evidence of such a relationship in Canada. In Canada, unlike the United States, the burden of hypertension is approximately equal for socioeconomically advantaged and disadvantaged older adults. It is important to consider these findings in the context of long-term and broader institutional policies. Social disparities and barriers to health care access and primary prevention among non-elderly persons in the United States may play a role in the higher hypertension prevalence rate among low-income older adults.     

The associations of household wealth and income with self-rated health – A study on economic advantage in middle-aged Finnish men and women

The economic resources available to an individual or a household have been hypothesised to affect health through the direct material effects of living conditions as well as through social comparison and experiences of deprivation. The focus so far has been mainly on current individual or household income, and there is a lack of studies on wealth, a potentially relevant part of household resources. We studied the associations of household wealth and household income with self-rated health, and addressed some theoretical issues related to economic advantage and health. The data were from questionnaire survey of Finnish men and women aged from 45 to 67 years, who were employed by the City of Helsinki from five to seven years before the collection of the data in 2007. We found household wealth to have a strong and consistent association with self-rated health, poor health decreasing with increasing wealth. The relationship was only partly attributable to the association of wealth with employment status, household income, work conditions and health-related behaviour. In contrast, the association of household income with self-rated health was greatly attenuated by taking into account employment status and wealth, and even further attenuated by work conditions. The results suggested a significant contribution of wealth differentials to differences in health status. The insufficiency of current income as the only measure of material welfare was demonstrated. Conditions associated with long-term accumulation of material welfare may be a significant aspect of the causal processes that lead to socioeconomic inequalities in ill health.     

价格与收入对中国居民卷烟需求和烟草控制的影响

[目的]估计最新的中国居民卷烟需求,以此为政府决策者制定政策时提供可靠的依据。[方法]利用1990~2005年的全国时间序列集合数据,建立卷烟需求函数,采用对数-线性回归模型估计卷烟需求的价格弹性和收入弹性。[结果]卷烟需求的价格弹性和收入弹性分别为-0.23和0.58。[结论]通过提高烟税来控烟是一个双赢的方法,既可以减少烟草消费对健康造成的负面影响,又可以增加政府的总税收。     

我国城乡居民医疗保健支出现状分析

目的 了解我国城乡居民卫生费用及医疗保健支出情况,为完善卫生系统筹资战略提供客观依据.方法 采用1999年至2007年统计年鉴数据,对我国城乡居民卫生费用及医疗保健支出现状及变化趋势进行分析.结果 城乡卫生费用筹资额定比增长了200%;城乡居民人均医疗保健支出增长幅度差异明显(城市为152.86%,农村为172.77%);居民医疗保健支出随人均收入变化而稳步增长,但健康消费总体水平仍很低,尤其是农村居民;2003年以来农村居民医疗保健支出收入弹性比城镇居民大,相对差距正逐步缩小.结论 应重点增加农村居民收入,提高社会边际医疗保健支出倾向;改善医疗卫生服务条件,扩大医疗保障覆盖面,带动城乡居民医疗保健的合理消费;重视文化因素的作用,提高全民健康投资意识和自我保健能力.