Socioeconomic inequalities in self-rated health among middle-aged and older adults

Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females' decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.     

Socioeconomic inequality in catastrophic health expenditure in Brazil

OBJECTIVE

To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families.

METHODS

Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family’s capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index.

RESULTS

The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated.

CONCLUSIONS

There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.     

Income inequality,area-level poverty,perceived aversion to inequality,and self-rated health in Japan

In this study we conduct a multilevel analysis to investigate the association between regional income inequality and self-rated health in Japan, based on two nationwide surveys. We confirm that there is a significant association between area-level income inequality and individual-level health assessment. We also find that health assessment tends to be more sensitive to income inequality among lower income individuals, and to degree of area-level poverty, than income inequality for the society as a whole. In addition, we examine how individuals are averse to inequality, based on the observed association between inequality and self-rated health.     

Social capital, income inequality, and self-rated health in 45 countries

There has been growing interest in the relationship between the social environment and health. Among the concepts that have emerged over the past decade to examine this relationship are socio-economic inequality and social capital. Using data from the World Values Survey and the World Bank, we tested the hypothesis that self-rated health is affected by social capital and income inequality cross-nationally. The merit of our approach was that we used multilevel methods in a larger and more diverse sample of countries than used previously. Our results indicated that, for a large number of diverse countries, commonly used measures of social capital and income inequality had strong compositional effects on self-rated health, but inconsistent contextual effects, depending on the countries included. Cross-level interactions suggested that contextual measures can moderate the effect of compositional measures on self-rated health. Sensitivity tests indicated that effects varied in different subsets of countries. Future research should examine country-specific characteristics, such as differences in cultural values or norms, which may influence the relationships between social capital, income inequality, and health.     

Socioeconomic disadvantage within a neighborhood, perceived financial security and self-rated health

We examine whether perceived financial security mediates the association between social deprivation and self-rated health, using data from a 2004 survey of residents of one neighborhood in Calgary (N=441) and 2001 Census data on the 26 Census Dissemination Areas (DAs) that make up this neighborhood. Net of sociodemographic characteristics of residents, DA disadvantage had significant associations with being in fair/poor or very good health as compared to excellent health. Perceived financial security explained part of this association and influenced health over and above individual- and DA-level sociodemographic characteristics. These findings suggest social deprivation and perceptions of financial security are potentially useful intervention targets.     

Income inequality and self-rated health in US metropolitan areas: A multi-level analysis

Income inequality has been found to affect health in a number of international and cross-national studies. Using data from a telephone survey of adults in the United States, this study analyzed the effect of metropolitan level income inequality on self-rated health. It combined individual data from the 2000 Behavioral Risk Factor Surveillance System with metropolitan level income data from the 2000 Census. After controlling for smoking, age, education, Black race, Hispanic ethnicity, sex, household income, and metropolitan area per capita income, this study found that for each 1 point rise in the GINI index (on a hundred point scale) the risk of reporting Fair or Poor self-rated health increased by 4.0% (95% confidence interval 1.6–6.5%). Given that self-rated health is a good predictor of morbidity and mortality, this suggests that metropolitan area income inequality is affecting the health of US adults.     

Socioeconomic status and health behaviors as predictors of changes in self-rated health among older persons in Israel

There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009–2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.     

Socioeconomic status, social support and self-rated health among lone mothers in South Korea

Objectives  

This study examined the association of socioeconomic status and social support with the differences in self-rated health between lone and partnered mothers in South Korea.     

Income inequality, social capital and self-rated health and dental status in older Japanese

The erosion of social capital in more unequal societies is one mechanism for the association between income inequality and health. However, there are relatively few multi-level studies on the relation between income inequality, social capital and health outcomes. Existing studies have not used different types of health outcomes, such as dental status, a life-course measure of dental disease reflecting physical function in older adults, and self-rated health, which reflects current health status. The objective of this study was to assess whether individual and community social capital attenuated the associations between income inequality and two disparate health outcomes, self-rated health and dental status in Japan. Self-administered questionnaires were mailed to subjects in an ongoing Japanese prospective cohort study, the Aichi Gerontological Evaluation Study Project in 2003. Responses in Aichi, Japan, obtained from 5715 subjects and 3451 were included in the final analysis. The Gini coefficient was used as a measure of income inequality. Trust and volunteering were used as cognitive and structural individual-level social capital measures. Rates of subjects reporting mistrust and non-volunteering in each local district were used as cognitive and structural community-level social capital variables respectively. The covariates were sex, age, marital status, education, individual- and community-level equivalent income and smoking status. Dichotomized responses of self-rated health and number of remaining teeth were used as outcomes in multi-level logistic regression models. Income inequality was significantly associated with poor dental status and marginally significantly associated with poor self-rated health. Community-level structural social capital attenuated the covariate-adjusted odds ratio of income inequality for self-rated health by 16% whereas the association between income inequality and dental status was not substantially changed by any social capital variables. Social capital partially accounted for the association between income inequality and self-rated health but did not affect the strong association of income inequality and dental status.     

Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden

BACKGROUND: Socioeconomic conditions and lifestyle factors have been found to be related to self-rated health, which is an established predictor of morbidity and mortality. Few studies, however, have investigated the independent effect of material and psychosocial conditions as well as lifestyle factors on self-rated health. METHODS: The association between socioeconomic conditions, lifestyle factors, and self-rated health was investigated using a postal survey questionnaire sent to a random population sample of men and women aged 18-79 years during March-May 2000. The overall response rate was 65%. The area investigated covers 58 municipalities in the central part of Sweden. Multivariate odds ratios for poor self-rated health were calculated for a range of variables. A total of 36 048 subjects with full data were included in the analysis. Similar analyses of the influence of working conditions were conducted among those employed aged 18-64 years (17 820 subjects). RESULTS: The overall prevalence of poor self-rated health was 7% among men and 9% among women. Poor self-rated health was most common among persons who had been belittled, who had experienced economic hardship, who lacked social support, or who had retired early. A low educational level was independently associated with poor self-rated health among men, but not among women. Physically inactive as well as underweight and obese subjects were more likely to have poor self-rated health than other subjects. Working conditions associated with poor self-rated health were dissatisfaction with work, low job control and worry about losing one's job. CONCLUSION: While a cross-sectional study does not allow definite conclusions as to which factors are determinants and which are consequences of poor self-rated, the present findings support the notion that both psychosocial and material conditions as well as lifestyle factors are independently related with poor self-rated health.     

Socioeconomic position,gender, and inequalities in self-rated health between Roma and non-Roma in Serbia

Objective  

Roma experience high levels of discrimination and social exclusion. Our objective was to examine differences in self-rated health (SRH) between Roma and non-Roma in Serbia.     

Socioeconomic status, self-rated health, and mortality in a multiethnic sample of US adults

Objective

To examine the association between socioeconomic status (SES), self-rated health (SRH), and mortality separately by race-ethnicity in a nationally representative sample of US adults.

Methods

We analyzed data from 16 716 adult women and men who were followed up for mortality for up to 12 years as part of the third National Health and Nutrition Examination survey (NHANES III). Poverty-income ratio (PIR) and education were assessed as measures of SES. All-cause mortality (n = 2850) was recorded from the NHANES III linked mortality file.

Results

Lower PIR was associated with mortality after adjustment for lifestyle, clinical risk factors, and SRH in all racial-ethnic groups (P-trend <0.005). In contrast, after adjusting for lifestyle and clinical risk factors, lower education was not associated with all-cause mortality in non-Hispanic whites (P-trend = 0.16), whereas the association remained significant after adjustment for SRH and lifestyle and clinical risk factors in other race-ethnicities (P-trend = 0.005; P-interaction between education categories and race-ethnicity was 0.02).

Conclusions

Our results suggest that lower PIR was associated with mortality in all racial-ethnic groups. In contrast, lower education was significantly associated with mortality only in racial-ethnic groups other than non-Hispanic whites. Our results indicate that, beyond lifestyle and clinical risk factors, adjusting for SRH resulted in only a modest change in the association of SES and mortality.Key words: education, income, self-rating of health, ethnicity, mortality, United States     

Socioeconomic inequality and meningococcal disease

Incidence of meningococcal disease was associated with socioeconomic deprivation across a rural English region. In young children the incidence was twice as high in the most deprived compared with the least deprived electoral wards. By addressing social inequalities the incidence of this serious infection could be reduced.     

Socioeconomic inequalities in self-rated health: role of work-to-family conflict in married Korean working women

Little evidence exists on the role of work-to-family conflict (WFC) in explaining socioeconomic inequality in self-rated health (SRH). We examined the association between socioeconomic status (SES) and SRH and tested the mediating effect of WFC in the association between SES and SRH among married Korean working women. A cross-sectional study was conducted using data from the 2014 Korean Longitudinal Survey of Women and Family. Participants were 3,226 women. Three SES indicators were used: income as measured by income-to-needs ratio; education categorized into college vs. noncollege education levels; and occupation classified by white vs. pink/blue-collar occupations. Lower levels of all the SES indicators were significantly associated with poor SRH and higher levels of WFC. The higher levels of WFC were also significantly associated with poor SRH. In the relation between SES and SRH, WFC showed a partial mediating effect for income (z = ?4.13, p < .001) and full mediating effects for education (z = ?3.79, p < .001) and occupation (z = ?4.59, p < .001). WFC played a mediating role in explaining socioeconomic health inequality among married Korean working women. Workplace strategies focused on alleviating the WFC levels of socioeconomically disadvantaged married women may be crucial for improving their health status.     

Socioeconomic disadvantage, social participation and networks and the self-rated health of English men and women with mild and moderate intellectual disabilities: cross sectional survey

BACKGROUND: Extremely high rates of mortality and morbidity have been reported among people with intellectual disabilities. Virtually no research has addressed the potential social determinants of health status within this very vulnerable population. METHOD: Cross-sectional survey of self-reported health status and indicators of socioeconomic disadvantage and social connectedness in 1273 English adults with mild or moderate intellectual disabilities. RESULTS: Indicators of socioeconomic disadvantage accounted for a statistically significant proportion of variation in health status, over and above any variation attributable to the personal characteristics and living circumstances of participants. Indicators of social participation and networks did not add to the explanatory power of the model. Among the indicators of socioeconomic disadvantage, hardship was more strongly associated with variation in health status than either employment status or area-level deprivation. CONCLUSION: As in the general population, self-reported health was associated with indicators of socioeconomic disadvantage, especially hardship. In contrast, there was no evidence of any association between health status and social participation and networks.     

An investigation of the longitudinal relationship between neighbourhood income inequality and individual self-rated health in England

There are mixed findings on whether neighbourhood income inequality leads to better self-rated health (SRH) or not. This study considers two hypotheses: individuals living in more unequal neighbourhoods have better SRH and the level of neighbourhood income inequality and its impact on SRH is moderated by household and neighbourhood level income related variables. Data from Waves 8–10 of the UK Household Longitudinal Study for respondents living in England at wave 8 were used. Neighbourhood income inequality was measured using Gini coefficients of household income from the Pay As You Earn and benefits systems for Lower Super Output Areas. Longitudinal ordinal multilevel models predicted self-rated health in 2016–18, 2017–19 and 2019-20 by income inequality and its interaction with household income, neighbourhood median income and neighbourhood deprivation, conditional on individual educational attainment, age, sex, ethnic group, years lived in current residence, region of residence and study wave. There were 24,889 respondents analysed over three waves. SRH was worse for those living in more income equal neighbourhoods. There was no indication that neighbourhood inequality was moderated by household income, neighbourhood median income or neighbourhood deprivation. These findings are in line with the balance of existing evidence and support policy interventions that aim to create mixed communities for the purpose of improving population health.     

Socioeconomic status, working conditions and self-rated health in Switzerland: explaining the gradient in men and women

Objectives:  Epidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. Methods:  A representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme. Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. Results:  Data show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. Conclusion:  The study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studies. Submitted: 24 August 2007; revised: 06 May 2008, 11 August 2008; accepted: 19 October 2008     

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.