Is Exposure to Income Inequality a Public Health Concern? Lagged Effects of Income Inequality on Individual and Population Health

Objective. To examine the health consequences of exposure to income inequality.
Data Sources. Secondary analysis employing data from several publicly available sources. Measures of individual health status and other individual characteristics are obtained from the March Current Population Survey (CPS). State-level income inequality is measured by the Gini coefficient based on family income, as reported by the U.S. Census Bureau and Al-Samarrie and Miller (1967) . State-level mortality rates are from the Vital Statistics of the United States ; other state-level characteristics are from U.S. census data as reported in the Statistical Abstract of the United States .
Study Design. We examine the effects of state-level income inequality lagged from 5 to 29 years on individual health by estimating probit models of poor/fair health status for samples of adults aged 25–74 in the 1995 through 1999 March CPS. We control for several individual characteristics, including educational attainment and household income, as well as regional fixed effects. We use multivariate regression to estimate the effects of income inequality lagged 10 and 20 years on state-level mortality rates for 1990, 1980, 1970, and 1960.
Principal Findings. Lagged income inequality is not significantly associated with individual health status after controlling for regional fixed effects. Lagged income inequality is not associated with all cause mortality, but associated with reduced mortality from cardiovascular disease and malignant neoplasms, after controlling for state fixed-effects.
Conclusions. In contrast to previous studies that fail to control for regional variations in health outcomes, we find little support for the contention that exposure to income inequality is detrimental to either individual or population health.     

Health Literacy,Depression Literacy,and Depression among Older Korean Americans

The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.     

Socioeconomic indicators as predictors of smoking cessation among Spanish-Speaking Mexican Americans

Objective: Smoking-related illnesses are the leading cause of death among Latinos, and within this ethnic group, Mexican Americans are the largest subgroup in the U.S. Understanding the factors associated with successful smoking cessation could inform interventions for this population. Although socioeconomic status (SES) is a powerful predictor of cessation outcomes in the general U.S. population, it has generally been a poor predictor of quitting smoking among Latinos. Within a sample of Spanish-speaking Mexican Americans (n?=?199), this study examined a broad array of objective and subjective indicators of SES (i.e. income, education, employment, subjective social status, financial strain, insurance status) as predictors of smoking cessation.

Design: Data for the current study came from a longitudinal cohort study examining the pathways linking the social determinants of health with smoking cessation. Generalized estimating equation modeling examined the association of each predictor variable with smoking abstinence across quit day, and the 3 and 26-weeks post-quit time points.

Results: Results indicated that both low financial strain and insurance status predicted an increased likelihood of abstinence when controlling for covariates in the intention-to-treat analyses (p?=?.02 and p?=?.01, respectively). However, these models only approached significance in the multiple imputation analyses (all ps?>?.05). Other indicators of SES (i.e. income, education, employment) that have been predictive of cessation in other populations were not predictive of abstinence in this sample.

Conclusions: These findings suggest that SES may indeed influence smoking cessation among Spanish-speaking Mexican Americans similarly to its influence in other populations, but that capturing the construct of SES may require assessing a broader range of SES indicators. Specifically, low financial strain and having insurance predicted a greater likelihood of achieving smoking abstinence, whereas other indicators of SES (i.e. income, education) were not predictive.     

Ecological Analysis of Teen Birth Rates: Association with Community Income and Income Inequality

Objectives: To examine whether per capita income and income inequality are independently associated with teen birth rate in populous U.S. counties. Methods: This study used 1990 U.S. Census data and National Center for Health Statistics birth data. Income inequality was measured with the 90:10 ratio, a ratio of percent of cumulative income held by the richest and poorest population deciles. Linear regression and analysis of variance were used to assess associations between county-level average income, income inequality, and teen birth rates among counties with population greater than 100,000. Results: Among teens aged 15–17, income inequality and per capita income were independently associated with birth rate; the mean birth rate was 54 per 1,000 in counties with low income and high income inequality, and 19 per 1,000 in counties with high income and low inequality. Among older teens (aged 18–19) only per capita income was significantly associated with birth rate. Conclusions: Although teen childbearing is the result of individual behaviors, these findings suggest that community-level factors such as income and income inequality may contribute significantly to differences in teen birth rates.     

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.     

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.     

基于第4次国家卫生服务调查的家庭收入不平等指数与人群健康状况的关系分析

目的探讨家庭收入不平等性与人群健康状况的关系。方法本研究利用第四次国家卫生服务调查数据,基于基尼系数的计算原理计算家庭收入不平等指数(HII)。以调查人口占该县区总人口比例的倒数作为权重,拟合标化患病率与HII的加权线性回归方程,并不断加入其他变量探讨其影响是否会被剥夺。结果加权线性回归模型表现出HII与标化患病率的相关关系有统计学意义,且统计学意义不会随着其他变量的剔除与加入而被剥夺。由于标化患病率的分布为偏态分布,拟合对数转换回归模型后其拟合效果有所增加。结论收入不平等性对人群健康状况存在负面影响,应逐步缩小家庭收入不平等,以改善人群健康。     

The role of feature-based discrimination in driving health disparities among Black Americans

ABSTRACT

Objective: A growing body of research finds that darker skin tone is often associated with poorer physical and mental health in Blacks. However, the psychosocial mechanisms underlying the skin tone-health link remain elusive. The present study seeks to address this knowledge gap by investigating the direct and indirect (through perceived discrimination, socioeconomic status, and self-esteem) effects of skin tone on self-reported physical and mental health.

Design: An urban sample of 130 Blacks aged 35 and above completed a self-administered computerized survey as a part of larger cross-sectional study.

Results: Self-esteem played a particularly important role in mediating the associations between skin tone and self-reported physical and mental health. This suggests that self-esteem could be a point of intervention to help Blacks with darker skin tone achieve better health.

Conclusion: The present study highlights the important role feature-based discrimination plays in determining mental and physical health outcomes among Blacks.     

Prevalence and predictors of depressive symptoms among rural older Australians and Americans

OBJECTIVE: To examine the predictors of depressive symptoms among older married rural Australian and American men and women, using comparable measures from two separate studies. DESIGN: Postal survey for Australians; telephone interviews for Americans. SETTING: Rural Australia (six states and two territories) and America (Virginia). PARTICIPANTS: Older married rural men and women, aged 65 years and over, in Australia (n = 216) and America (n = 156). MAIN OUTCOME MEASURES: Whether predictors of depressive symptoms, specifically demographic factors, health, pain, functional limitations and social networks, differed according to nationality or sex. RESULTS: Approximately one-third of older rural Australian (37%) and Americans (28%) reported recently experiencing depressive symptoms. For Australian men and women, pain was the strongest predictor of depressive symptoms. For American women, dissatisfaction with social support predicted depressive symptoms, whereas no variable predicted depressive symptoms in American men. CONCLUSIONS: In the context of a globally ageing population, the fact that nearly one in three older rural people on two continents described themselves as recently feeling depressed is a troubling finding of considerable importance to both practitioners and policy-makers. The findings raise questions about the cultural acceptance, definition and manifestations of symptoms of depression in rural communities, as well as the role of different public health and support systems in the two countries.     

Permanent emergency: Inequality in access to hospitalisation among urban elderly Chinese

The phenomenon of elderly patients staying in hospital emergency department observation units for extended time in urban China poses a challenge to China’s healthcare system and presents a social problem of inequality. In this paper, we analyse statistics collected from 16 major public hospitals in Beijing to assess the extent and intensity of the problem and examine interviews of medical professionals to understand the mechanisms linking the issue to the Chinese healthcare system. We study the issue with the literature on market transition theory and on China’s recent healthcare reforms and view this age-based inequality as an outcome of the economic and social transformations in China. We make a few policy recommendations including using age-specific bed turnover and mortality rates for evaluating performance, employing three different release-status dependent mortality rates of emergency department patients for the evaluation of hospitals, and improving the capacity of post-acute, ambulatory care and geriatric care services in urban China.     

Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis

OBJECTIVES: To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. DESIGN: Multilevel analysis of cross-sectional data. SETTING: 13 Countries from Central and Eastern Europe and the former Soviet Union. PARTICIPANTS: Population samples aged 18+ years (a total of 15 331 respondents). MEAN OUTCOME MEASURES: Poor self-rated health. RESULTS: There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the age- and sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r = -0.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. CONCLUSION: Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual-level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty.     

杭州市流动老年人抑郁现状及影响因素分析

目的 了解流动老年人抑郁状况以及社会人口学特征、生活方式、生活满意度、居住安排、健康状况和社会支持对流动老年人抑郁的影响。方法 2014年7-9月,采用多阶段分层随机抽样方法抽取浙江省杭州市1 378名流动老年人,采用老年抑郁量表（GDS-30）对流动老年人的抑郁状况进行评估,应用二分类logistic回归分析抑郁症状的相关影响因素。结果 流动老年人中抑郁的发生率为36%;单因素分析结果显示,年龄、教育程度、婚姻状况、职业状况、家庭年收入、户口类型、当前社区居住时间、居住安排、自评健康状况、日常沟通问题、生活满意度、睡眠质量、体育锻炼时间和社会支持对流动老年人的抑郁症状的发生有影响（P<0.05）;多因素分析结果显示,年龄为70~79岁（OR=1.827）和≥80岁（OR=4.148）、婚姻状况为离异（OR=4.051）、当前居住时间<5年（OR=1.733）、睡眠质量一般（OR=1.677）和差（OR=3.029）是抑郁症状的危险因素;与配偶、子女、孙子女其中一类及以上居住在一起（OR=0.376~0.459）、家庭年收入为≥75 000元（OR=0.341）、自评健康棒极了（OR=0.268）和非常好（OR=0.222）以及好（OR=0.272）和一般（OR=0.401）、每天体育锻炼时间越长（OR=0.831）、社会支持越多（OR=0.931）是抑郁症状的保护因素。结论 流动老年人抑郁现象问题严重,年龄、婚姻状况、家庭年收入、当前社区居住时间、居住安排、健康状况、睡眠质量、体育锻炼时间和社会支持是流动老年人抑郁症状发生的主要影响因素。     

Inequality aversion in income,health, and income-related health

Based on a survey of a sample of the general public, we estimate inequality aversion across income, health, and bivariate income-health. Inequality aversion is domain specific: mean inequality aversion is greater for income than for health, but the underlying distributions of aversion attitudes differ, with a highly bi-modal distribution of inequality-aversion values for health in which nearly half the participants display very low aversion and nearly half display very high aversion. Aversion to income-related health inequality is greater than that to income or health alone. Consistent with previous literature, we find only weak associations between aversion attitudes and individual characteristics. The magnitude of the estimates implies potentially large gains in welfare from reducing inequality in these domains.     

Is educational differentiation associated with smoking and smoking inequalities in adolescence? A multilevel analysis across 27 European and North American countries

This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO‐Collaborative ‘Health Behaviour in School‐aged Children (HBSC)’ study 2005/2006, which included 48,025 15‐year‐old students (N_boys = 23,008, N_girls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country‐level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.     

Consumption of Sugar-and Fat-Modified Foods Among Rural Older Adults

Abstract

This study examines the levels of and factors associated with consumption of sugar-and fat-reduced foods in sample of rural, ethnically diverse older adults. Data were collected from 122 older adults, including demographic and health characteristics and six 24-hour recalls over 16-month period. About one-quarter of sweetened foods were modified, while intake of fat-modified foods ranged from 4.4 to 76.1%. Few differences in intake of modified foods were observed by gender and ethnic groups. Diabetes status was associated with higher use of sugar-modified foods. This study shows high level of acceptance of sugar-and fat-modified foods among rural older adults across variety of demographic and health characteristics.     

Socioeconomic Health Differences among Children aged 10-11 in the Netherlands

The magnitude of socioeconomic health differences is not thesame in each age-group. During childhood and adolescence inequitiesin health according to socioeconomic level are relatively small.We studied the relationships among socioeconomic indicators(fathers' and mothers' educational and occupational level) andseveral health indicators in a population of children aged 10–11.Children of lower socioeconomic status were less healthy thanchildren from parents with a higher socioeconomic status. Thestrength of the relationship depended on the socioeconomic andhealth indicators used. Fathers' occupational level was a strongercorrelate of health status than was mothers' occupational level.Mothers' or fathers' educational level was correlated equallywith health status. Every health indicator had a specific patternwith respect to its relation with the different socioeconomicindicators. This could be indicative of the existence of severalmechanisms underlying socioeconomic health differences.     

Diet Quality and Health in Older Americans

Adequate nutrition is an essential component of healthy ageing. This study documents the quality of diets among older Americans and implications of healthy eating for their physical and mental health. Using a nationally representative longitudinal sample of adults aged ≥50 years, from the Health and Retirement Study (HRS) 2010–2016 and food intake data from the 2013 Health Care and Nutrition Study (HCNS), the study evaluates the onset of health problems along the spectrum of diet quality measured by the Healthy Eating Index (HEI)-2015. Older adults adhering to healthier diets, in the high HEI group, have a significantly lower risk of developing limitations in activities of daily living (15.2% vs. 19.6%, p < 0.01) and depression (11.8% vs. 14.9%, p < 0.01), as compared to participants with low HEI scores. Consuming healthier diets also predicts more favorable health outcomes, as measured by blood-based biomarkers, including C-reactive protein (3.3 vs. 3.8, p < 0.05), cystatin C (1.1 vs. 1.2, p < 0.1), total cholesterol (192.1 vs. 196.4, p < 0.1), and high-density lipoprotein (57.2 vs. 53.8, p < 0.01). Most older Americans can benefit from improving diet to reduce their risk of disability, chronic disease, and depression.     

Racial Segregation,Income Inequality,and Mortality in US Metropolitan Areas

Evidence of the association between income inequality and mortality has been mixed. Studies indicate that growing income inequalities reflect inequalities between, rather than within, racial groups. Racial segregation may play a role. We examine the role of racial segregation on the relationship between income inequality and mortality in a cross-section of US metropolitan areas. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10% black (N = 107). Deaths for the time period 1991–1999 were used to calculate age-adjusted all-cause mortality rates for each metropolitan statistical area (MSA) using direct age-adjustment techniques. Multivariate least squares regression was used to examine associations for the total sample and for blacks and whites separately. Income inequality was associated with lower mortality rates among whites and higher mortality rates among blacks. There was a significant interaction between income inequality and racial segregation. A significant graded inverse income inequality/mortality association was found for MSAs with higher versus lower levels of black–white racial segregation. Effects were stronger among whites than among blacks. A positive income inequality/mortality association was found in MSAs with higher versus lower levels of Hispanic–white segregation. Uncertainty regarding the income inequality/mortality association found in previous studies may be related to the omission of important variables such as racial segregation that modify associations differently between groups. Research is needed to further elucidate the risk and protective effects of racial segregation across groups.