Income group differences in relationships among survey measures of physical and mental health.
(25/2784)
The present research tested the hypothesis that the experience of health is hierarchically organized such that gratification of physical health needs must precede gratification of mental health needs. It was reasoned that because the nondisadvantaged possess greater resources for the gratification of health needs in general, symptoms of mental illness would be more salient for this group and thus better able to explain variance in both mental and physical illness. On the other hand, it was reasoned that symptoms of physical illness would be more salient and thus better able to explain variance in both mental and physical illness for the disadvantaged. Results of the study indicate income group differences in patterns of relationships among health variables, supporting the hypothesis and suggesting important differences in the validity of health measures across income groups. The results are related to previous findings in medical sociology, and suggestions for future research are made. (+info)
A higher prevalence of health problems in low income groups: does it reflect relative deprivation?
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STUDY OBJECTIVE: Although it has frequently been suggested that income affects health, there is hardly any research in which this issue has been explored directly. The aim of this study was, firstly, to examine whether income is independently associated with health, secondly, to assess the extent to which this association reflects high levels of deprivation in low income groups, and thirdly, to examine which specific components of deprivation contribute most to the link between income and health. Health indicators used were the prevalence of chronic conditions, health complaints and less than "good" perceived general health. SETTING: Region in the south east of the Netherlands. PARTICIPANTS: A population of 2567 men and women who participated in an oral interview, aged 15-74. DESIGN: Data were obtained from the baseline of a prospective cohort study aimed at the explanation of socioeconomic inequalities in health. RESULTS: Large inequalities in health by (equivalent) income after differences in other socioeconomic indicators had been controlled for were observed. For example, among those in the lowest income group the risk of bad perceived health was three times as high as among people in the highest income group. The prevalence of deprivation (basic, housing, social) increased with decreasing income to approximately 50-60% in the lowest income group. A substantial part of the increased health risks of the lowest income groups could statistically be accounted for by the higher prevalence of deprivation in these groups. The components that are likely to influence health indirectly, through a psychological or behavioural mechanism, accounted for most of the effect. CONCLUSIONS: These analyses provide evidence to suggest that a low income has detrimental health effects through relative deprivation. Moreover, the results indicate an indirect link between deprivation and health problems involving psychological or behavioural factors. (+info)
Social environment and year of birth influence type 1 diabetes risk for African-American and Latino children.
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OBJECTIVE: Credible epidemiological data, primarily from European-origin populations, indicate that environmental factors play an important role in the incidence of type 1 diabetes. RESEARCH DESIGN AND METHODS: A population-based registry of incident cases of type 1 diabetes among African-American and Latino children in Chicago was used to explore the influence of individual and neighborhood characteristics on diabetes risk. New cases of insulin-treated diabetes in African-American and Latino Chicagoans aged 0-17 years for 1985-1990 (n = 400) were assigned to one of 77 community areas based on street address. Census tables provided denominators, median household income, percentage of adults > or = 25 years old who had completed high school and college, and a crowding variable for each community area individual-level data were birth cohort, sex, and ethnicity. Outcomes in Poisson regression were sex-, ethnic-, and birth cohort-specific incidence rates. RESULTS: Significant univariate associations between diabetes risk and ethnicity, birth cohort, crowding, and the percentage of adults in each community area who had completed high school and college were observed. African-Americans had a relative risk (RR) of 1.42 (95% CI, 1.14-1.76) compared with Latinos. Risk varied significantly by birth cohort in both ethnic groups. For every 10% increase in the proportion of adults who completed college, the RR for diabetes increased by 25% (RR, 1.25 [95% CI, 1.09-1.44]). Social class variables were significant determinants of risk for African Americans, but not for Latinos. CONCLUSIONS: The strong birth cohort and social class associations observed in this study implicate an infectious exposure linked with age. (+info)
The hidden cost of 'free' maternity care in Dhaka, Bangladesh.
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We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51% of the families (and 74% of those having a caesarean delivery) did not have enough money to pay; of these, 79% had to borrow from a money lender or relative. Surprisingly, 72% of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section. (+info)
Increasing response rates for mailed surveys of Medicaid clients and other low-income populations.
(29/2784)
Mailing surveys to low-income populations is often avoided because of concern about low response rates. In this study, the authors used a mailed survey of a low-income population to test whether $1.00 or $2.00 cash-response incentives were worth the expense and whether 2-day priority mail ($2.90 postage) would yield a sufficiently higher response rate than certified mail ($1.52 postage) to justify its cost. In 1994, 2,243 randomly selected families in subsidized health care programs in Pierce County, Washington, were randomly sent no incentive, $1.00, or $2.00 in the first of three mailings. For the third mailing, nonrespondents were randomly assigned to receive either certified or 2-day priority mail. After 4 weeks, the response rates were 36.7%, 48.1%, and 50.3% for the no-incentive, $1.00, and $2.00 groups, respectively. After three mailings, the cost per response was the lowest for the group that received $1.00. The response rate for the certified mailing (28.1%) was significantly higher than the rate for the more expensive priority mailing (21.7%). No incentive-related bias was detected. The authors concluded that the most efficient protocol for this low-income population was to use a $1.00 incentive in the first mailing and a certified third mailing. (+info)
Income inequality and homicide rates in Rio de Janeiro, Brazil.
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OBJECTIVES: This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. METHODS: We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. RESULTS: For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P < .01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. CONCLUSIONS: The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate. (+info)
The prevalence of low income among childbearing women in California: implications for the private and public sectors.
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OBJECTIVES: This study examined the income distribution of childbearing women in California and sought to identify income groups at increased risk of untimely prenatal care. METHODS: A 1994/95 cross-sectional statewide survey of 10,132 postpartum women was used. RESULTS: Sixty-five percent of all childbearing women had low income (0%-200% of the federal poverty level), and 46% were poor (0%-100% of the federal poverty level). Thirty-five percent of women with private prenatal coverage had low income. Most low-income women with Medi-Cal (California's Medicaid) or private coverage received their prenatal care at private-sector sites. Compared with women with incomes over 400% of the poverty level, both poor and near-poor women were at significantly elevated risk of untimely care after adjustment for insurance, education, age, parity, marital status, and ethnicity (adjusted odds ratios = 5.32 and 3.09, respectively). CONCLUSIONS: This study's results indicate that low-income women are the mainstream maternity population, not a "special needs" subgroup; even among privately insured childbearing women, a substantial proportion have low income. Efforts to increase timely prenatal care initiation cannot focus solely on women with Medicaid, the uninsured, women in absolute poverty, or those who receive care at public-sector sites. (+info)
Health care coverage and use of preventive services among the near elderly in the United States.
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OBJECTIVES: It has been proposed that individuals aged 55 to 64 years be allowed to buy into Medicare. This group is more likely than younger adults to have marginal health status, to be separating from the workforce, to face high premiums, and to risk financial hardship from major medical illness. The present study examined prevalence of health insurance coverage by demographic characteristics and examined how lack of insurance may affect use of preventive health services. METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing telephone survey of adults conducted by the 50 states and the District of Columbia. RESULTS: Many near-elderly adults least likely to have health care coverage were Black or Hispanic, had less than a high school education and incomes less than $15,000 per year, and were unemployed or self-employed. Health insurance coverage was associated with increased use of clinical preventive services even when sex, race/ethnicity, marital status, and educational level were controlled. CONCLUSIONS: Many near-elderly individuals without insurance will probably not be able to participate in a Medicare buy-in unless it is subsidized in some way. (+info)