Measuring socioeconomic health inequalities in presence of multiple categorical information

While many of the measurement approaches in health inequality measurement assume the existence of a ratio-scale variable, most of the health information available in population surveys is given in the form of categorical variables. Therefore, the well-known inequality indices may not always be readily applicable to measure health inequality as it may result in the arbitrariness of the health concentration index's value. In this paper, we address this problem by changing the dimension in which the categorical information is used. We therefore exploit the multi-dimensionality of this information, define a new ratio-scale health status variable and develop positional stochastic dominance conditions that can be implemented in a context of categorical variables. We also propose a parametric class of population health and socioeconomic health inequality indices. Finally we provide a twofold empirical illustration using the Joint Canada/United States Surveys of Health 2004 and the National Health Interview Survey 2010.     

Self-reported health: reliability and consequences for health inequality measurement

Self-reported health (SRH) is one of the most frequently employed measures for assessing income-related health inequalities between counties. A previous study has shown that 28% of respondents changed their assessment of their health status when asked a SRH question on two occasions in the same survey (first as part of self-completed questionnaire and then in a personal interview). This study re-examines this issue using another survey where SRH was again asked twice of respondents, but this time the personal interview was first and self-completion second. We find the same variation in responses, but the predominant direction is away from the 'extreme' categories 'Excellent' and 'Poor' which is the opposite direction to the previous study. We therefore conclude that the most likely explanation is a mode of administration effect that makes people less likely to choose the extreme categories in a self-completion questionnaire, but not a personal interview. However, this effect has a relatively minor impact on measures of inequality. This is due to a large proportion of the movement (i.e. movement to the middle) not being related to income and hence does not systematically impact on the cumulative distribution of health across this measure of socio-economic status.     

Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations

This paper outlines a framework for comparing empirically overall health inequality and socioeconomic health inequality. The framework, which is developed for both individual-level data and grouped data, is illustrated using data on malnutrition amongst Vietnamese children and on health utility amongst Canadian adults. In both cases, the degree of socioeconomic inequality is estimated at around 25% of overall inequality.     

A direct regression approach to decomposing socioeconomic inequality of health

This paper presents a new regression‐based decomposition of socioeconomic inequality of health that is more direct than other approaches. The method can be applied to both rank‐dependent and level‐dependent indicators of inequality. The response variable of our regression model is a simple reformulation of the measure of overall performance of an individual in the health and socioeconomic domains. Regression results are described in terms of marginal effects of the explanatory variables, but also in terms of their logworths or importance values. We illustrate our method, and compare it with alternatives, using Australian health and income data.     

Inequalities in self-reported physical health in the United States, 1993-1999

This study investigated inequalities in physically healthy days in the United States during 1993-1999, by socioeconomic and demographic group. The generalized entropy GE(2) and other indices were computed using data from the Behavioral Risk Factor Surveillance System survey, 1993-1999. The results indicate that GE(2) for the US population increased by 17% during 1993-1999. Low-to-middle income groups had the highest increases in inequalities during this time (51-66%), whereas the least educated, Asian/Pacific Islanders, American Indians/Alaska Natives, the oldest, the youngest, and the richest had the lowest (-14-10%). In 1999, inequalities ranged from 0.0153 (income>or=$50 000) to 0.112 (income<$10 000). Inequalities have increased during 1993-1999 and vary substantially across groups. The American Indians/Alaska Natives experienced the highest inequalities whereas Asians/Pacific-Islanders exhibited the lowest inequalities. More attention should be given to within-group inequalities.     

Explaining the differences in income-related health inequalities across European countries

This paper provides new evidence on the sources of differences in the degree of income-related inequalities in self-assessed health in 13 European Union member states. It goes beyond earlier work by measuring health using an interval regression approach to compute concentration indices and by decomposing inequality into its determining factors. New and more comparable data were used, taken from the 1996 wave of the European Community Household Panel. Significant inequalities in health (utility) favouring the higher income groups emerge in all countries, but are particularly high in Portugal and - to a lesser extent - in the UK and in Denmark. By contrast, relatively low health inequality is observed in the Netherlands and Germany, and also in Italy, Belgium, Spain Austria and Ireland. There is a positive correlation with income inequality per se but the relationship is weaker than in previous research. Health inequality is not merely a reflection of income inequality. A decomposition analysis shows that the (partial) income elasticities of the explanatory variables are generally more important than their unequal distribution by income in explaining the cross-country differences in income-related health inequality. Especially the relative health and income position of non-working Europeans like the retired and disabled explains a great deal of 'excess inequality'. We also find a substantial contribution of regional health disparities to socio-economic inequalities, primarily in the Southern European countries.     

The contextual‐level effects of social trust on health in transitional countries: Instrumental variable analysis of 26 countries

We analyse the effect of contextual‐level social capital on health status in a sample of 26 transitional countries of Central and South Europe, Mongolia, and the former Soviet Union for 2006‐2010 (N = 51 911). Contextual‐level social capital is conceptualized as country‐level social trust, while health status is conceptualized as self‐rated health. We use ordinary least squares and instrumental variable regressions to address endogeneity and especially to rule out reverse causality. Both instrumental variable and ordinary least squares regressions suggest a strong positive effect of country‐level trust on health. This finding is consistent for the whole sample as well as separate regional estimations.     

社会医疗保险缓解了未成年人健康不平等吗

  目的  了解0～3岁儿童照顾模式与健康不平等的关系,为促进儿童健康发展提供参考依据。  方法   收集中国家庭追踪调查（CFPS）2018年全国数据,从中抽取1 837名0～3岁儿童,采用集中指数与分解的方法测量儿童健康不平等状况及相关贡献因素,重点分析照顾模式对儿童健康不平等的贡献。  结果  全国0～3岁儿童健康不平等指数为0.039,表明我国存在与社会经济地位相关的儿童健康不平等,来自高收入家庭的儿童普遍健康状况更好。儿童健康集中指数分解结果显示,隔代抚养与混合抚养对0～3岁儿童健康不平等的贡献率分别为4.99 %和8.04 %,一定程度造成了不平等。儿童的家庭规模（53.98 %）、年均家庭收入（38.81 %）和父亲的健康状况（23.63 %）是对儿童健康不平等贡献最大的3个要素。医疗保险和母乳喂养时长对儿童健康不平等的贡献率分别为 – 6.36 %和 – 7.56 %,有助于缩小儿童健康不平等。  结论  儿童照顾模式及相关家庭因素均对0～3岁儿童的健康有重要影响,并会造成儿童健康的不平等,应注意规避相关危险因素。     

社会经济地位对居民健康公平的影响

社会经济地位指个人或群体在阶级社会中的位置?社会经济地位是职业、教育、收入、财富以及居住地区等指标的综合反映。社会学家常用社会经济地位作为预测人们行为的一种手段与方式。据对社会经济地位与居民健康状况有关的研究发现：收入差距与健康密切相关；社会经济地位与健康之间有一个梯度关系，而且这并不是只发生在贫困层面；医疗保健服务对健康差距产生的作用比较小；社会经济因素通过多种渠道影响居民的健康状况。     

Primary care,self-rated health,and reductions in social disparities in health

OBJECTIVE: To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health. DATA SOURCES: Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care. STUDY DESIGN: Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States. DATA COLLECTION/EXTRACTION METHODS: Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health. PRINCIPAL FINDINGS: Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.     

Inequality of opportunities in health in France: a first pass

This article analyses the role played by childhood circumstances, especially social and family background in explaining health status among older adults. We explore the hypothesis of an intergenerational transmission of health inequalities using the French part of SHARE. As the impact of both social background and parents' health on health status in adulthood represents circumstances independent of individual responsibility, this study allows us testing the existence in France of inequalities of opportunity in health related to family and social background. Empirically, our study relies on tests of stochastic dominance at first order and multivariate regressions, supplemented by a counterfactual analysis to evaluate the long‐lasting impact of childhood conditions on inequality in health. Allocating the best circumstances in both parents' socioeconomic status and parents' health reduces inequality in health by an impressive 57% using the Gini coefficient. The mother's social status has a direct effect on the health of her offspring. By contrast, the effect on descendant's health from their father's social status is indirect only, which goes through the descendant's social status as an adult. There is also a strong effect of the father vital status on health in adulthood, revealing a selection effect. Copyright © 2009 John Wiley & Sons, Ltd.     

Predictors of elderly mortality: health status, socioeconomic characteristics and social determinants of health

This paper uses longitudinal survey data from Taiwan to investigate the predictors of elderly mortality. The empirical analysis confirms a relationship between socioeconomic characteristics and mortality, but this relationship weakens considerably when estimates are conditional on the health status at the time of the first wave survey. In terms of predictive power, the models with an activities of daily living index fare better (as opposed to models with self-evaluated health or self-reported illnesses). Having said that there is a payoff to the consideration of self-evaluated health jointly with other 'objective' health indicators. Other findings include a strong association between life satisfaction and survival, which prevails even after controlling for other explanatory variables.     

Measurement and explanation of socioeconomic inequality in health with longitudinal data

This paper presents a method to compare indices of inequality in health that are based on short-run and long-run measures of health and income. For pure health inequality (as measured by the Gini coefficient) and income-related health inequality (as measured by the concentration index), we show how measures derived from longitudinal data can be related to cross section Gini and concentration indices that have been typically reported in the literature to date, along with measures of health mobility inspired by the literature on income mobility. We also show how these measures of mobility can be usefully decomposed into the contributions of different factors. We apply these methods to investigate the degree of income-related mobility in the GHQ measure of psychological well-being in the first nine waves of the British Household Panel Survey (BHPS). This reveals that dynamics increase the absolute value of the concentration index of GHQ on income by 15%, or 1.7% per year on average, for men, and 5%, or 0.6% per year, for women.     

Income inequality,perceived happiness,and self-rated health: Evidence from nationwide surveys in Japan

In this study, we examined how regional inequality is associated with perceived happiness and self-rated health at an individual level by using micro-data from nationwide surveys in Japan. We estimated the bivariate ordered probit models to explore the associations between regional inequality and two subjective outcomes, and evaluated effect modification to their sensitivities to regional inequality using the categories of key individual attributes. We found that individuals who live in areas of high inequality tend to report themselves as both unhappy and unhealthy, even after controlling for various individual and regional characteristics and taking into account the correlation between the two subjective outcomes. Gender, age, educational attainment, income, occupational status, and political views modify the associations of regional inequality with the subjective assessments of happiness and health. Notably, those with an unstable occupational status are most affected by inequality when assessing both perceived happiness and health.     

Feeding inequality: food insecurity,social status and college student health

A growing but limited body of research has identified the college student population as one that is particularly vulnerable to food insecurity. Early estimates of food insecurity prevalence among college students range from 14 to 60 per cent. The present study utilises original survey data collected from a random sample (n = 300) of college students enrolled at an urban university in the Midwest region of the United States of America (USA). This study examines the impact of food insecurity on health outcomes and the mediation of this relationship by subjective social status among college students. Ordinary least squares (OLS) and logistic regression analyses find that food insecurity is related to worse self-rated, physical and mental health among college students, and Sobel-Goodman tests find that subjective social status plays a significant mediating role in the relationship between food insecurity and health among college students. The implications of these findings in a university context are discussed using a psychosocial framework and insights from the stress process model. In doing so, I discuss food insecurity among college students with an emphasis on the social significance of food and food insecurity.     

E‐learning and health inequality aversion: A questionnaire experiment

In principle, questionnaire data on public views about hypothetical trade‐offs between improving total health and reducing health inequality can provide useful normative health inequality aversion parameter benchmarks for policymakers faced with real trade‐offs of this kind. However, trade‐off questions can be hard to understand, and one standard type of question finds that a high proportion of respondents—sometimes a majority—appear to give exclusive priority to reducing health inequality. We developed and tested two e‐learning interventions designed to help respondents understand this question more completely. The interventions were a video animation, exposing respondents to rival points of view, and a spreadsheet‐based questionnaire that provided feedback on implied trade‐offs. We found large effects of both interventions in reducing the proportion of respondents giving exclusive priority to reducing health inequality, though the median responses still implied a high degree of health inequality aversion and—unlike the video—the spreadsheet‐based intervention introduced a substantial new minority of non‐egalitarian responses. E‐learning may introduce as well as avoid biases but merits further research and may be useful in other questionnaire studies involving trade‐offs between conflicting values.     

Racial and ethnic disparities in self‐assessed health status: Evidence from the national survey of families and households

We examined racial and ethnic disparities in global health assessment and functional limitations of daily activities among whites, blacks and Hispanics, and within the Hispanic origin among Mexicans, Puerto Ricans, Cubans, and ‘Others’. Logistic regressions were employed to estimate the log odds of reporting ‘poor health’ and ‘having functional limitations’ among 12 814 respondents from the 1987—1988 National Survey of Families and Households. Compared with whites, blacks had an increased risk of reporting poor health and functional limitations. Hispanics had even a higher risk of reporting poor health, but did not have an increased risk of reporting functional limitations. Among Hispanics, Mexicans were more likely than whites to report poor health, whereas Puerto Ricans were more likely than whites to experience functional limitations. Both race and ethnicity remain important factors in explaining the disparities in self‐assessed health status independent of socioeconomic status (SES). Meanwhile, the way self‐assessed health status varies with ethnicity is importantly stratified by SES as measured by income and education. These results suggest that future research should analyze the interplay between ethnicity and SES rather than assuming measuring either captures all the important variation.     

Decomposition of health inequality by determinants and dimensions

The study integrates two methodologies so that income-related inequality in general health can be decomposed into contributions from socio-demographic characteristics to each of the dimensions defining general health. It is found that these relative contributions vary substantially across dimensions. For policy purposes such information is valuable as it indicates at which population groups and at which aspects of health efforts to reduce inequalities in health should be targeted.     

Disability‐based discrimination and health: findings from an Australian‐based population study

Objective: Among working‐age Australian adults with a disability, we assess the association between disability‐based discrimination and both overall health and psychological distress. Methods: Using data from the 2015 Australian Bureau of Statistics Survey of Disability, Ageing and Carers we estimated the proportion of working‐age women and men (15–64 years) with disability who report disability‐based discrimination by socio‐demographic characteristics and assessed the association between disability‐based discrimination and self‐reported health and psychological distress. Results: Nearly 14% of Australians with disability reported disability‐based discrimination in the previous year. Disability‐based discrimination was more common among people living in more disadvantaged circumstances (unemployed, low income, lower‐status occupations), younger people and people born in English‐speaking countries. Disability‐based discrimination was associated with higher levels of psychological distress (OR: 2.53, 95%CI: 2.11, 3.02) and poorer self‐reported health (OR: 1.63, 95%CI: 1.37, 1.95). Conclusion: Disability‐based discrimination is a prevalent, important determinant of health for Australians with disability. Implications for public health: Disability‐based discrimination is an under‐recognised public health problem that is likely to contribute to disability‐based health inequities. Public health policy, research and practice needs to concentrate efforts on developing policy and programs that reduce discrimination experienced by Australians with disability.