Socioeconomic Status and Health: A New Approach to the Measurement of Bivariate Inequality.
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ABSTRACT:
SUBMITTER: Erreygers G
PROVIDER: S-EPMC5551111 | biostudies-other | 2017 Jun
REPOSITORIES: biostudies-other
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Project description:BackgroundMonitoring health inequalities is an important task for health research and policy, to uncover who is being left behind - and where - and to inform effective and equitable policies and programmes to tackle existing inequities. The choice of which measure to use to monitor and analyse health inequalities is thereby not trivial. This article explores a new measure of socioeconomic deprivation status (SDS) to monitor health inequalities.MethodsThe SDS measure was constructed using the Alkire-Foster method. It includes eight indicators across two equally weighted dimensions (education and living standards) and specifies a four-level gradient of socioeconomic deprivation at the household-level. We conducted four exercises to examine the value-added of the proposed SDS measure, using Demographic and Health Surveys data. First, we examined the discriminatory power of the new measure when applied to outcomes in four select reproductive, maternal, neonatal, and child health (RMNCH) indicators across six countries: skilled birth attendance, stunting, U5MR, and DTP3 immunisation. Then, we analysed the behaviour and association of the new SDS measure vis-à-vis the DHS Wealth Index, including chi-squared test and Pearson correlation coefficient. Third, we analysed the robustness of the SDS measure results to changes in its structure, using pairwise comparisons and Kendal Tau-b rank correlation. Finally, we illustrated some of the advantageous properties of the new measure, disaggregation and decomposition, on Haitian data.Results1) Higher levels of socioeconomic deprivation are generally consistently associated with lower levels of achievements in the RMNCH indicators across countries. 2) 87% of all pairwise rank comparisons across a range of SDS measure structures were robust. 3) SDS and DHS Wealth Index are associated, but with considerable cross-country variation, highlighting their complementarity. 4) Haitian households in rural areas experienced, on average, more severe socioeconomic deprivation as well as lower levels of RMNCH achievement than urban households.ConclusionsThe proposed SDS measure adds analytical possibilities to the health inequality monitoring literature, in line with ethically and conceptually well-founded notions of absolute, multidimensional disadvantage. In addition, it allows for breakdown by its dimensions and components, which may facilitate nuanced analyses of health inequality, its correlates, and determinants.
| S-EPMC9034442 | biostudies-literature
Project description:The economic burden of brucellosis care on patients can lead to significant financial strain, despite partial coverage by medical insurance. However, there is limited research on the out-of-pocket costs faced by brucellosis patients. Therefore, our study aimed to investigate the costs and out-of-pocket expenses of brucellosis care, specifically examining the varying socioeconomic status of patients in Xinjiang, China. We collected cost and demographic data from 563 respondents and their hospital bills and employed latent variable analysis to assess socioeconomic status. The majority of patients belonged to the middle and lower socioeconomic status categories (85.97%), and they were primarily farmers and herders (82.77%). The median direct cost per brucellosis episode was USD 688.65, with out-of-pocket expenses amounting to USD 391.44. These costs exceeded both the 2020 Xinjiang and national per capita health expenditures (USD 233.66 and USD 267.21, respectively). Notably, the overall medical reimbursement rate was 48.60%, and for outpatient costs, it was merely 12.82%. Despite higher out-of-pocket costs among high socioeconomic status patients, the percentage of income spent was higher (37.23%) for patients in the lower socioeconomic status group compared to other groups (16.25% and 12.96%). In conclusion, our findings highlight that brucellosis patients are predominantly from the middle and lower socioeconomic status, with high out-of-pocket expenses placing them under significant financial pressure. Moreover, there is notable inequity in economic consequences across different socioeconomic status groups. These results call for policy interventions aimed at reducing brucellosis-related poverty and promoting equitable access to care.
| S-EPMC11316907 | biostudies-literature
Project description:Personality traits such as conscientiousness and impulsivity correlate with temporal discounting, the degree to which individuals discount the value of future relative to present rewards. These variables have, in turn, been hypothesized to relate to income inequality in the United States. A key but untested assumption of this hypothesis is that the association among these variables is distinct across socioeconomic classes. The purpose of the present research is to test that assumption. N = 1,100 adults with annual income ranging from at or below the poverty line ($0-$20,000) to upper-middle class ($200,000+) completed personality measures and a measure of temporal discounting. The results of our preregistered analyses indicated a positive association of income with trait planfulness, and a negative association with trait impulsivity and one parameter of temporal discounting that captures a bias to prefer sooner rewards to a greater degree if they are delivered that day. Our results can inform psychological theories of inequality and a broader conversation about effective public policy.
| S-EPMC6980415 | biostudies-literature
Project description:BackgroundThe negative association between income inequality and health has been known in the literature as the Income Inequality Hypothesis (IIH). Despite the multiple studies examining the validity of this hypothesis, evidence is still inconclusive, and the debate remains unsolved. In addition, relatively few studies have focused their attention on developing or emerging economies, where levels of inequality tend to be the highest in the world. This work examines the statistical association between income inequality and self-rated health status in Colombia, a highly unequal Latin American country.MethodsTo explore whether this association is present in the general population or whether it is only confined to the bottom of the income distribution, we use data from the 2011-2019 National Quality of Life Survey. Multiple probit estimations are considered for testing the robustness of the IIH.ResultsEvidence favouring the IIH was found, even after controlling for individual income levels, average regional income, and socioeconomic characteristics. The link between income inequality and the probability of reporting poor health seems to be present across all income quintiles. However, the magnitude of such association is considerably smaller when using inequality measures with relatively greater sensitivity to income differences among the rich.ConclusionsThe association between regional income inequality and individual's self-rated health status in Colombia is not only confined to low-income individuals but extends across all socioeconomic strata. This association is robust to the income inequality measure implemented, the income-unit of analysis, and changes in the sample. It is suggested that reducing income disparities can potentially contribute to improving individual's health.
| S-EPMC9108691 | biostudies-literature
Project description:ImportanceAir quality has improved and smoking rates have declined over the past half-century in the US. It is unknown whether such secular improvements, and other policies, have helped close socioeconomic gaps in respiratory health.ObjectiveTo describe long-term trends in socioeconomic disparities in respiratory disease prevalence, pulmonary symptoms, and pulmonary function.Design, setting, and participantsThis repeated cross-sectional analysis of the nationally representative National Health and Nutrition Examination Surveys (NHANES) and predecessor surveys, conducted from 1959 to 2018. included 160 495 participants aged 6 to 74 years.ExposuresFamily income quintile defined using year-specific thresholds; educational attainment.Main outcomes and measuresTrends in socioeconomic disparities in prevalence of current/former smoking among adults aged 25 to 74 years; 3 respiratory symptoms (dyspnea on exertion, cough, and wheezing) among adults aged 40 to 74 years; asthma stratified by age (6-11, 12-17, and 18-74 years); chronic obstructive pulmonary disease ([COPD] adults aged 40-74 years); and 3 measures of pulmonary function (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC<0.70) among adults aged 24 to 74 years.ResultsOur sample included 160 495 individuals surveyed between 1959 and 2018: 27 948 children aged 6 to 11 years; 26 956 children aged 12 to 17 years; and 105 591 adults aged 18 to 74 years. Income- and education-based disparities in smoking prevalence widened from 1971 to 2018. Socioeconomic disparities in respiratory symptoms persisted or worsened from 1959 to 2018. For instance, from 1971 to 1975, 44.5% of those in the lowest income quintile reported dyspnea on exertion vs 26.4% of those in the highest quintile, whereas from 2017 to 2018 the corresponding proportions were 48.3% and 27.9%. Disparities in cough and wheezing rose over time. Asthma prevalence rose for all children after 1980, but more sharply among poorer children. Income-based disparities in diagnosed COPD also widened over time, from 4.5 percentage points (age- and sex-adjusted) in 1971 to 11.3 percentage points from 2013 to 2018. Socioeconomic disparities in FEV1 and FVC also increased. For instance, from 1971 to 1975, the age- and height-adjusted FEV1 of men in the lowest income quintile was 203.6 mL lower than men in the highest quintile, a difference that widened to 248.5 mL from 2007 to 2012 (95% CI, -328.0 to -169.0). However, disparities in rates of FEV1/FVC lower than 0.70 changed little.Conclusions and relevanceSocioeconomic disparities in pulmonary health persisted and potentially worsened over the past 6 decades, suggesting that the benefits of improved air quality and smoking reductions have not been equally distributed. Socioeconomic position may function as an independent determinant of pulmonary health.
| S-EPMC8261605 | biostudies-literature
Project description:Individuals can experience a lack of economic resources compared to others, which we refer to as subjective experiences of economic scarcity. While such experiences have been shown to shift cognitive focus, attention, and decision-making, their association with human morality remains debated. We conduct a comprehensive investigation of the relationship between subjective experiences of economic scarcity, as indexed by low subjective socioeconomic status at the individual level, and income inequality at the national level, and various self-reported measures linked to morality. In a pre-registered study, we analyze data from a large, cross-national survey (N = 50,396 across 67 countries) allowing us to address limitations related to cross-cultural generalizability and measurement validity in prior research. Our findings demonstrate that low subjective socioeconomic status at the individual level, and income inequality at the national level, are associated with higher levels of moral identity, higher morality-as-cooperation, a larger moral circle, and increased prosocial intentions. These results appear robust to several advanced control analyses. Finally, exploratory analyses indicate that observed income inequality at the national level is not a statistically significant moderator of the associations between subjective socioeconomic status and the included measures of morality. These findings have theoretical and practical implications for understanding human morality under experiences of resource scarcity.
| S-EPMC10482940 | biostudies-literature
Project description:Subjective status, an individual's perception of her socioeconomic standing, is a robust predictor of physical health in many societies. To date, competing interpretations of this correlation remain unresolved. Using longitudinal data on 8430 older adults from the 2000 and 2007 waves of the Indonesia Family Life Survey, we test these oft-cited links. As in other settings, perceived status is a robust predictor of self-rated health, and also of physical functioning and nurse-assessed general health. These relationships persist in the presence of controls for unobserved traits, such as difficult-to-measure aspects of family background and persistent aspects of personality. However, we find evidence that these links likely represent bi-directional effects. Declines in health that accompany aging are robust predictors of declines in perceived socioeconomic status, net of observed changes to the economic profile of respondents. The results thus underscore the social value afforded good health status.
| S-EPMC4171062 | biostudies-literature
Project description:OBJECTIVE:Reduction of socioeconomic inequality in health requires appropriate evidence on health and its distribution based on socioeconomic indicators. The objective of this study was to assess socioeconomic inequality in various health domains and self-rated health (SRH). METHODS:This study was conducted using data collected in a survey in 2014 on a random sample of individuals aged 18 and above in the city of Tehran. The standardised World Health Survey Individual Questionnaire was used to assess different health domains. The age-adjusted prevalence of poor health was calculated for each health domain and SRH based on levels of education and wealth quintiles. Furthermore, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were applied to assess socioeconomic inequality in each of the health domains and SRH. RESULTS:The age-adjusted prevalence of poor health was observed in a descending order from the lowest to the highest wealth quintiles, and from the lowest level of education to the highest. RII also showed varying values of inequality among different domains, favouring rich subgroups. The highest wealth-related RII was observed in the 'Mobility' domain with a value of 4.16 (95% CI 2.01 to 8.62), and the highest education-related RII was observed in the 'Interpersonal Activities' domain with a value of 6.40 (95% CI 1.91 to 21.36). CONCLUSIONS:Substantial socioeconomic inequalities were observed in different health domains in favour of groups of better socioeconomic status. Based on these results, policymaking aimed at tackling inequalities should pay attention to different health domains as well as to overall health.
| S-EPMC5855251 | biostudies-literature
Project description:Using the 1957-2011 data from 10,317 participants in the Wisconsin Longitudinal Study, I examine how socioeconomic status (SES) at age 18 affects all-cause mortality between ages 18 and 72. Integrating fundamental cause theory, gender relations theory, and a life course perspective, I evaluate the cumulative advantage (CA) and age-as-leveler processes as well as gender differences in these processes. Findings indicate that higher early-life SES at age 18 is related to lower mortality over the life course, and the effect of early-life SES is not explained by socioeconomic achievement and health behaviors in adulthood. Consistent with the CA model, early-life SES generates increasing within-cohort inequality with age, and this CA process is stronger for women than men. Results also show that unequal selection by SES obscures the CA process and creates an illusion of the age-as-leveler process. This study calls for a lifelong gendered approach to socioeconomic health disparities.
| S-EPMC7416735 | biostudies-literature
Project description:Child health is fundamental to well-being and achievement throughout the life course. Prior research has demonstrated strong associations between familial socioeconomic resources and children's health outcomes, with especially poor health outcomes among disadvantaged youth who experience a concentration of risks, yet little is known about the influence of maternal health as a dimension of risk for children. This research used nationally representative U.S. data from the National Health Interview Surveys in 2007 and 2008 (N = 7,361) to evaluate the joint implications of maternal health and socioeconomic disadvantage for youth. Analyses revealed that maternal health problems were present in a substantial minority of families, clustered meaningfully with other risk factors, and had serious implications for children's health. These findings support the development of health policies and interventions aimed at families.
| S-EPMC3685849 | biostudies-literature