Widow(er) poverty and out-of-pocket medical expenditures near the end of life

OBJECTIVES: Elderly widows are three times as likely to live in poverty as older married people. This study investigates the gap in poverty, income, and wealth between these groups. Focus is placed on the role played by out-of-pocket medical expenditures spent on dying spouses. METHODS: A national panel survey of people age 70 and older in 1993 was used. Income, poverty, wealth, and out-of-pocket expenditures were examined before and after widowhood, with comparisons made with couples not experiencing a death. RESULTS: Forty-four percent of the difference in economic status between widow(er)s and married elderly persons was due to disparities in economic status that existed prior to widowhood. The remaining 56% was due to factors more directly related to the death of a spouse, including the loss of income and expenses associated with dying. On average, out-of-pocket medical expenditures in the final 2 years of life were equal to 30% of the couple's annual income. For couples in the bottom quarter of the income distribution, these expenditures were 70% of their income. DISCUSSION: As policy makers continue to debate expansions and reforms of Medicare, the potential effects of these reforms on economic well-being, particularly among widows, should be considered.     

The economic consequences of widowhood on elderly women in the United States and Germany

PURPOSE: Different countries have different goals for social welfare policy. Consequently, it is reasonable to expect different outcomes after certain events. This article examines changes in the economic well-being of elderly women at widowhood in the United States and Germany. DESIGN AND METHODS: Longitudinal data from the U.S. Panel Study of Income Dynamics and the German Socioeconomic Panel were used to prepare a sample of elderly widows. Economic wellbeing the year before the husband's death was compared with economic well-being the year after the husband's death. RESULTS: Although the prevalence of poverty is different in the two countries, most widows in both countries experienced a decline in living standards, and many actually fell into poverty at widowhood. A fall in Social Security and pension income was the largest contributor to the fall in living standards. IMPLICATIONS: The retirement income system in both countries seems to be adequate for married couples but appears to fail for widows.     

Low income,community poverty and risk of end stage renal disease

Background

The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. However, few studies have examined the relation of both individual and community socioeconomic status (SES) with incident ESRD.

Methods

Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in Stroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier poverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier affluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household income and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a competing event using the Fine and Gray method.

Results

There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years (10⁵ py) in high poverty outlier counties and were 76.3 /10⁵ py in affluent outlier counties, p trend?=?0.06. In unadjusted competing risk models, persons residing in high poverty outlier counties had higher incidence of ESRD (which was not statistically significant) when compared to those persons residing in counties with neither high poverty nor affluence [hazard ratio (HR) 1.54, 95% Confidence Interval (CI) 0.75-3.20]. This association was markedly attenuated following adjustment for socio-demographic factors (age, sex, race, education, and income); HR 0.96, 95% CI 0.46-2.00. However, in the same adjusted model, income was independently associated with risk of ESRD [HR 3.75, 95% CI 1.62-8.64, comparing the?<?$20,000 income group to the?>?$75,000 group]. There were no statistically significant associations of county measures of poverty with incident ESRD, and no evidence of effect modification.

Conclusions

In contrast to annual family income, geospatially-linked measures of county poverty have little relation with risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the individual level.

     

Gender differences in pension wealth: estimates using provider data.

Information from pension providers was examined to investigate gender differences in pension wealth at midlife. For full-time wage and salary workers approaching retirement age who had pension coverage, median pension wealth on the current job was 76% greater for men than women. Differences in wages, years of job tenure, and industry between men and women accounted for most of the gender gap in pension wealth on the current job. Less than one third of the wealth difference could not be explained by gender differences in education, demographics, or job characteristics. The less-advantaged employment situation of working women currently in midlife carries over into worse retirement income prospects. However, the gender gap in pensions is likely to narrow in the future as married women's employment experiences increasingly resemble those of men.     

Survival strategies of elderly women in Ngangelizwe Township,Mthatha, South Africa: Livelihoods,social networks and income

This study seeks to examine the critical issue of how the elderly women of Ngangelizwe, Mthatha, Eastern Cape, South Africa address the challenges they encounter in their attempts to provide for their needs and those of their dependants. These challenges include among others lack of education, access to resources, caring for their sick children suffering from AIDS related diseases as well as their orphaned grandchildren.MethodsIn-depth interviews were held with 15 retired women above 60 years old who are also heads of households, receiving or not receiving state pension, and/or a child support grant.ResultsThe study reveals that friendship-based ties, social networks and their impact on the livelihoods, health, survival and social adjustment of the elderly women are essential components of their lives.The study also reports on the strategies they employ to alleviate poverty through their own and school-going age grandchildren's participation in income generating activities.ConclusionThe study indicates that for most women, the inability to attain basic essentials of life leads to loss of self-dignity. Socio-economic factors such as low levels of education, unemployment, little or no income, poor access to resources, many dependants and looking after their children who are ill creates a situation where they operate within the “little opportunities” circle. The evidence in this study suggests that friendship-based ties, social groups, including social capital, pension grants, child support grants and remittances from their employed children help to mitigate some of the poverty experiences of the elderly women.     

Berufliche Aktivität im Ruhestand

Background

This article investigates employment of retired persons with different ethnic backgrounds, namely Germans, ethnic Germans and immigrants. The central issue of this paper addresses the influencing factors on employment during retirement.

Data and methods

A total of 25,304 recipients of statutory pension payments were analyzed using administrative data of the German Pension Insurance and the Federal Employment Agency. The parameters of being employed, whilst drawing statutory pension payments, were determined by means of a binary probability model.

Results

About 20% of the investigated pensioners hold an occupational activity. In the majority of cases this activity equates to part-time employment. Not only the amount of pension received, but also lack of continuous employment prior to retirement influence whether retirees stay in the labor force. Furthermore there are differences between Germans and immigrants.

Conclusion

The combination of the influencing parameters on working beyond retirement permits the conclusion that persons who face the risk of old-age poverty are more likely to work when they are retired.     

Anticipatory Socialization for Retirement: A Multilevel Dyadic Model

Role theory, widely used to examine human behavior, has often been used to describe the transition from work to retirement. Anticipatory socialization, a role theory concept, describes the process that occurs prior to role transitions and assists in that transition by helping individuals learn the norms for the new role. However, not all workers engage in retirement planning. Lack of retirement planning is of concern because those individuals who do not plan for major life transitions tend to be less successful in adjusting to role changes. Data from the Health and Retirement Study were used; selection criteria required participants to be age 45 or older, working full- or part-time, and have complete data for the study variables. Multilevel modeling results of dyadic data from the Health and Retirement Study (N?=?1,028 dual-earner couples) indicate that older age, being White, higher income, greater retirement wealth, and looking forward to retirement predicted greater anticipatory socialization (i.e., thinking about and discussing retirement) by both husbands and wives. For wives only, having a health problem limiting work, higher spouse occupational status, and having a spouse who was looking forward to retirement predicted more anticipatory socialization. For husbands only, higher education, higher depressive symptomatology, and lower occupational status predicted more anticipatory socialization. This study found evidence of spousal congruence, with husbands, on average, engaging in more anticipatory socialization than wives. These findings identify couples that could most benefit from targeted efforts to increase anticipatory socialization, which predicts better retirement adjustment and satisfaction.     

Estimating the proportion of Americans ever experiencing poverty during their elderly years

OBJECTIVES: This study estimates the age-specific and cumulative proportions of American adults who will experience poverty at some point during their elderly years. These life-span proportions represent a substantially different approach to understanding poverty than calculating either yearly cross-sectional rates or poverty spell durations. METHODS: Our estimations are derived through a series of life tables built upon 25 waves of the Panel Study of Income Dynamics (PSID). RESULTS: The analyses indicate that 40% of America's elderly population will experience a year below the poverty line at some point between the ages of 60 and 90, and 48% of elders will experience poverty at the 125% level. The data further reveal that this life-span risk of poverty has remained relatively stable throughout the period of data collection (1968-1992). Finally, the likelihood of elderly Americans ever encountering a year below the poverty line increases dramatically for those who are Black, not married, and/or who have less than 12 years of education. DISCUSSION: Our results suggest that in spite of relatively low cross-sectional rates of elderly poverty in America, the likelihood of impoverishment at some point during the later years of life remains a very real possibility.     

The vertical mosaic in later life: ethnicity and retirement in Canada

Given the distinctive historical experiences, cultural features, and status positions of the diverse ethnic groups in Canadian society, we anticipate that these differences will influence the retirement behavior and conditions of their members. This paper examines the effects of ethnic group membership for immigrants to Canada on the timing of retirement and the sources and amounts of retirement income using data from the Public Use Sample of the 1981 Census of Canada. Separate but parallel analyses are conducted for men and women to take into account their distinctive labor force experiences. We find that membership in Asian, African, or Latin American ethnic groups is associated with both later retirement and a lower probability of receiving social insurance and private pension benefits, as well as appreciably lower income among elderly men. This is likely the result of changes in pension legislation in the 1960s and 1970s reducing benefits to recent immigrants.     

Impact of moving into poverty on maternal and child mental health: longitudinal analysis of the Millennium Cohort Study

BackgroundThe UK Government has recently questioned whether relative measures of income poverty effectively reflect children's life chances. Although relative poverty is associated with poor maternal and child mental health, few studies have assessed the impact of moving into poverty on mental health outcomes. To inform this debate, we explored the association between transitions into poverty and mental health among children and their mothers using a nationally representative sample of children in the UK followed up between 2000 and 2012.MethodsOur analysis of the UK Millennium Cohort Study was based on 5877 singletons who participated in sweeps of the study at ages 9 months to 11 years and were not in relative poverty nor had maternal and child mental health problems when these measures were first recorded at 3 years old. The main outcomes were maternal psychological distress (Kessler Psychological Distress scale, K6) and child socioemotional behavioural problems (Strengths and Difficulties Questionnaire) at ages 5, 7, and 11 years. The main exposure of interest was moving into relative poverty, defined as household equivalised income less than 60% of median household income, according to the Organisation for Economic Co-operation and Development equivalence scale. Using discrete time-hazard models, we estimated odds ratios for subsequent maternal and child mental health of new transitions into poverty, while adjusting for baseline confounding. We further assessed how maternal mental health mediated any impact on child mental health.FindingsOverall 904 families (15·4%) experienced a new transition into poverty. After adjustment for confounders, transition into relative poverty increased the odds of maternal psychological distress (odds ratio 1·86, 95% CI 1·51–2·29) and socioemotional behaviour problems in children (1·37, 1·02–1·85). Controlling for maternal psychological distress reduced the odds of socioemotional behavioural problems in children, and rendered the association non significant (adjusted odds ratio 1·26, 95% CI 0·92–1·72).InterpretationIn this UK cohort, transitions into relative poverty, by use of the currently contested income-based definition, were associated with an increase in the risk of child and maternal mental health problems. Maternal mental health appeared to mediate the association between poverty transitions and child mental health. Actions to address child poverty are needed to tackle the mental health crisis in children in the UK.FundingSW, BB, and DT-R are funded by the Wellcome Trust.     

Economic status in later life among women who raised children outside of marriage

OBJECTIVE: Many single mothers are likely to face special economic challenges in old age, because they often have limited employment histories and cannot rely on husbands for financial support. This article examines the economic status of these women in later life. METHODS: The analysis uses nationally representative data from the Health and Retirement Study to estimate multivariate models of income, assets, and poverty rates for women aged 65-75 in 1999. RESULT: Controlling for education, current marital status, and race and ethnicity, the models indicate that women who spent > or =10 years raising dependent children outside of marriage are 55% more likely to live in poverty at ages 65-75 than women who were always married when their children were young. DISCUSSION: The financial difficulties confronting single mothers raising children persist into later life. Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for these vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.     

The transition to retirement: stages and factors that influence retirement adjustment

A set of older workers from the Raleigh-Durham-Chapel Hill, North Carolina metropolitan area were followed from pre-retirement to 24 months post-retirement in order to explore stages in retirement and the impact of social psychological, social background, and gender factors on the retirement adjustment. First, we found general support for Atchley's model of retirement adjustment (1976). Second, the factors that influence retirement adjustment in the data analysis revealed that: 1) pre-retirement self-esteem and friend identity meanings, as well as pension eligibility, increased positive attitudes toward retirement at six months, 12 months, and 24 months post-retirement; 2) retirement planning and voluntary retirement increased positive attitudes toward retirement earlier, but not later, in the first two years of retirement; 3) poor health decreased positive attitudes toward retirement later rather than earlier in the first two years of retirement; and 4) there were only limited gender effects.     

Quality of life among early retirees.

Explanatory variables concerning poor quality of life (QL) were established among disability pensioners with musculoskeletal disorders and a control group. In both groups health status, leisure time activities, and social network were important for QL. Among the retirees immigration, employment before retirement and a negative attitude to the disability pension were related to poor QL.     

Quality of Life Among Early Retirees

Explanatory variables concerning poor quality of life (QL) were established among disability pensioners with musculoskeletal disorders and a control group. In both groups health status, leisure time activities, and social network were important for QL. Among the retirees immigration, employment before retirement and a negative attitude to the disability pension were related to poor QL.     

Health care access,concentrated poverty,and pediatric asthma hospital care use in California's San Joaquin Valley: A multilevel approach

Background: California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. Objective: The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. Methods: This was a retrospective study based on secondary data from California hospital and ED records 2007–2012. Children who used services for asthma-related conditions, were aged 0–14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. Results: The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01–1.02; RR = 1.03, 95% CI = 1.02–1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. Conclusions: Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.     

Dimensions of poverty and inconsistent condom use among youth in urban Kenya

To date, research on the link between poverty and unsafe sexual behaviors has utilized limited measures of socioeconomic status and has overlooked key dimensions of poverty at the individual level. This study explored how various dimensions of socioeconomic status are associated with inconsistent condom use and how these associations vary by gender. We analyzed unique life history survey data from 261 young men and women in Kisumu, Kenya, and conducted analyses based on 959 person-months in which respondents had been sexually active in nonmarital relationships. Dependent variables were inconsistent condom use (not always using a condom) and never use of condoms. Condoms were used inconsistently in 57% of months and were never used in 31%. Corroborating existing literature, lower household wealth and lower educational attainment were associated with inconsistent condom use. Lower individual economic status (lower earned income, food insufficiency, and larger material transfers from partners) were also important determinants of inconsistent condom use. There were no significant differences in these associations by gender, with the exception of food insufficiency, which increased the risk of inconsistent condom use for young women but not for young men. None of these individual measures of socioeconomic status were associated with never use of a condom. The findings suggest that both household- and individual-level measures of socioeconomic status are important correlates of condom use and that individual economic resources play a crucial role in negotiations over the highest level of usage. The results highlight the importance of poverty in shaping sexual behavior, and, in particular, that increasing individual access to resources beyond the household, including ensuring access to food and providing educational and work opportunities, could prove to be effective strategies for decreasing the risk of HIV among youth.     

Economic situation of widows in West Germany

The distribution of old-age pensions in the Federal Republic is a very inequal one. Widows, who only get a pension from the social insurance are constituting the main potential of poverty: in 1977 more than 30% of them (i.e. more than 1/2 million) were in income level below 600 DM monthly. Consequently it is not only necessary to reform the pension insurance system for future cases, but also a general improvement of current widows' pensions has to be implemented.     

Pension decisions in a changing economy: gender, structure, and choice

OBJECTIVES: As responsibility for financial security in retirement becomes more individualized, understanding the distribution and determinants of savings behavior grows in importance. Employed men and women often gain access to their pension assets when they change jobs. In this study gender differences in pre-retirement access to and disposition of accumulated pension assets are examined. METHODS: The authors used data from the Health and Retirement Study to model pension participation, disposition of pension assets, and use of cash settlements derived from a pension plan in a previous job. Logit models provided estimates of gender differences in access to pensions and the preservation of pension funds for retirement. RESULTS: Women were less likely to have participated in employer-sponsored pension plans; more likely to cash out accumulated pension assets when they changed jobs; and, when job changes occurred at relatively young ages, equally likely to spend the settlement. However, by their late 40s, women were more likely to save the settlement, a net gender difference that increased with age at which the settlement was received. DISCUSSION: The structure of employment compensation continues to place women at a disadvantage. Gender differences in earnings and fringe benefits not only affect current financial status, but also cast a shadow over future financial security. Although the gender gap in pension coverage has been reduced, women with pensions have access to lower benefits and less in accumulated assets. As these continuing deficits are addressed, enhancing women's tendency to save pension assets for retirement can help them build financial security.     

Global variability in angina pectoris and its association with body mass index and poverty

In the absence of a previous global comparison, we examined the variability in the prevalence of angina across 52 countries and its association with body weight and the poverty index using data from the World Health Organization-World Health Survey. The participants with angina were defined as those who had positive results using a Rose angina questionnaire and/or self-report of a physician diagnosis of angina. The body mass index (BMI) was determined as the weight in kilograms divided by the square of the height in meters. The poverty index (a standard score of socioeconomic status for a given country) was extracted from the United Nations' statistics. The associations of angina with the BMI and poverty index were analyzed cross-sectionally using univariate and multivariate analyses. The results showed that the total participants (n = 210,787) had an average age of 40.64 years. The prevalence of angina ranged from 2.44% in Tunisia to 23.89% in Chad. Those participants with a BMI of <18.5 kg/m(2) (underweight), 25 to 29 kg/m(2) (overweight), or BMI ≥ 30 kg/m(2) (obese) had a significantly greater risk of having angina compared to those with a normal BMI (≥ 18.5 but <25 k/m(2)). The odds ratios of overweight and obese for angina remained significant in the multilevel models, in which the influence of the country-level poverty status was considered. A tendency was seen for underweight status and a poverty index >14.65% to be associated with the risk of having angina, although these associations were not statistically significant in the multilevel models. In conclusion, significant variations were found in the anginal rates across 52 countries worldwide. An increased BMI was significantly associated with the odds of having angina.