scholarly journals The economic burden of health disparities related to socioeconomic status in Israel

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Eran Politzer ◽  
Amir Shmueli ◽  
Shlomit Avni
Keyword(s):  
Socioeconomic Status ◽  
Health Disparities ◽  
Health Outcomes ◽  
Health Inequalities ◽  
Low Income ◽  
Health Care Expenditures ◽  
Low Ses ◽  
Disability Benefits ◽  
Excess Morbidity ◽  
Product Loss

Abstract Background Low socioeconomic status (SES) is often associated with excess morbidity and premature mortality. Such health disparities claim a steep economic cost: Possibly-preventable poor health outcomes harm societal welfare, impair the domestic product, and increase health care expenditures. We estimate the economic costs of health inequalities associated with socioeconomic status in Israel. Methods The monetary cost of health inequalities is estimated relative to a counterfactual with a more equal outcome, in which the submedian SES group achieves the average health outcome of the above-median group. We use three SES measures: the socioeceonmic ranking of localities, individuals’ income, and individuals’ education level. We examine costs related to the often-worse health outcomes in submedian SES groups, mainly: The welfare and product loss from excess mortality, the product loss from excess morbidity among workers and working-age adults, the costs of excess medical care provided, and the excess government expenditure on disability benefits. We use data from the Central Bureau of Statistics’ (CBS) surveys and socio-health profile of localities, from the National Insurance Institute, from the Ministry of Health, and from the Israel Tax Authority. All costs are adjusted to 2014 terms. Results The annual welfare loss due to higher mortality in socioeconomically submedian localities is estimated at about 1.1–3.1 billion USD. Excess absenteeism and joblessness occasioned by illness among low-income and poorly educated workers are associated with 1.4 billion USD in lost product every year. Low SES is associated with overuse of inpatient care and underuse of community care, with a net annual cost of about 80 million USD a year. The government bears additional cost of 450 million USD a year, mainly due to extra outlays for disability benefits. We estimate the total cost of the estimated health disparities at a sum equal to 0.7–1.6% of Israel’s GDP. Conclusions Our estimates underline the substantial economic impact of SES-related health disparities in Israel. The descriptive evidence presented in this paper highlights possible benefits to the economy from policies that will improve health outcomes of low SES groups.

scholarly journals Health Inequalities in the Diverse World of Self-Employment: A Swedish National Cohort Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12301
Author(s):  
Karl Gauffin ◽  
Andrea Dunlavy
Keyword(s):  
Health Outcomes ◽  
Health Inequalities ◽  
Low Income ◽  
Employment Status ◽  
The Self ◽  
Poor Health ◽  
Self Employment ◽  
Regular Employment ◽  
National Cohort ◽  
The Relationship

With labor being a central social determinant of health, there is an increasing need to investigate health inequalities within the heterogenous and growing population in self-employment. This study aimed to longitudinally investigate the relationship between income level, self-employment status and multiple work-related health indicators in a Swedish national cohort (n = 3,530,309). The study investigated the relationship between self-employment status and health outcomes later in life. All poor health outcomes, with the exception of alcohol-related disorders, were more common in the self-employed population, compared to the group in regular employment. The income gradient, however, was more pronounced in the group with regular employment than the groups in self-employment. The study found clear connections between low income and poor health in all employment groups, but the gradient was more pronounced in the group in regular employment. This suggests that income has a weaker connection to other types of health promoting resources in the self-employed population. Potentially, lacking social and public support could make it difficult for unhealthy individuals to maintain low-income self-employment over a longer time period.

Abstract MP47: The Association of Socioeconomic Status with Subclinical Myocardial Damage

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Anna E Fretz ◽  
Andrea L Schneider ◽  
John McEvoy ◽  
Ron Hoogeveen ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Low Income ◽  
Myocardial Damage ◽  
Low Ses ◽  
12Th Grade ◽  
Low Education ◽  
Prevalence Ratios

Background: The association between socioeconomic status (SES) and clinical cardiovascular events is well established. However, little is known about the relationship between SES and subclinical myocardial damage, as assessed by a novel highly sensitive assay for cardiac troponin T (hs-cTnT). Methods: We conducted a cross-sectional analysis of 11,411 participants from the ARIC Study with no history of cardiovascular disease who had hs-cTnT measured at visit 2 (1990-1992). SES was defined using either annual household income, categorized as: low (<$16,000), mid-level ($16,000 - $34,999), high (≥ $35,000), or lifetime educational attainment, categorized as: low (<12th grade), mid-level (12th grade/some college) and high (college degree or higher). hs-cTnT was categorized as non-elevated (<14 ng/L) and elevated (≥ 14ng/L). Poisson regression was used to generate prevalence ratios for elevated hs-cTnT, separately by level of income and education after adjusting for demographic, clinical, and behavioral factors. Results: Persons with low income or low education were more likely to have subclinical myocardial damage as assessed by elevated hs-cTnT (≥14ng/L). Adjusted prevalence ratios for elevated troponin comparing low to high levels of income and education were 1.74 (95% CI: 1.32, 2.29) and 1.54 (95% CI: 1.21, 1.97), respectively (Table, Model 1). These results were slightly attenuated, but remained statistically significant after adjusting for cardiovascular risk factors and health behaviors (Models 2 and 3). Race-stratified results demonstrate a somewhat stronger and only significant association of low education with subclinical myocardial damage in blacks compared to whites (PR 1.83 vs 1.05, p-interaction =0.08). There was no race interaction with income (p-interaction =0.33). Conclusions: Low SES was associated with elevated hs-cTnT, independent of cardiovascular risk factors, especially in blacks. Further research is needed to explore how low SES contributes to subclinical myocardial damage.

scholarly journals Impact of Socioeconomic Status and Race on Sepsis Epidemiology and Outcomes

2020 ◽  
Author(s):  
Emi Minejima ◽  
Annie Wong-Beringer
Keyword(s):  
Socioeconomic Status ◽  
Low Income ◽  
Formal Education ◽  
Geographic Location ◽  
The United States ◽  
Risk Scores ◽  
Low Ses ◽  
The Relationship ◽  
Poor Health Literacy ◽  
Hispanic White

Abstract Background Socioeconomic status (SES) is a complex variable that is derived primarily from an individual’s education, income, and occupation and has been found to be inversely related to outcomes of health conditions. Sepsis is the sixth most common admitting diagnosis and one of the most costly conditions for in-hospital spending in the United States. The objective of this review is to report on the relationship between SES and sepsis incidence and associated outcomes. Content Sepsis epidemiology varies when explored by race, education, geographic location, income, and insurance status. Sepsis incidence was significantly increased in individuals of Black race compared with non-Hispanic white race; in persons who have less formal education, who lack insurance, and who have low income; and in certain US regions. People with low SES are likely to have onset of sepsis significantly earlier in life and to have poorly controlled comorbidities compared with those with higher SES. Sepsis mortality and hospital readmission is increased in individuals who lack insurance, who reside in low-income or medically underserved areas, who live far from healthcare, and who lack higher level education; however, a person’s race was not consistently found to increase mortality. Summary Interventions to minimize healthcare disparity for individuals with low SES should target sepsis prevention with increasing measures for preventive care for chronic conditions. Significant barriers described for access to care by people with low SES include cost, transportation, poor health literacy, and lack of a social network. Future studies should include polysocial risk scores that are consistently defined to allow for meaningful comparison across studies.

The Impact of Socioeconomic Status on Perceived Barriers to Colorectal Cancer Testing

2008 ◽  
Vol 23 (2) ◽  
pp. 97-100 ◽  
Author(s):  
Aimee S. James ◽  
Sandra Hall ◽  
K. Allen Greiner ◽  
Dan Buckles ◽  
Wendi K. Born ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Socioeconomic Status ◽  
Low Income ◽  
Fecal Occult Blood ◽  
Low Ses ◽  
National Guidelines ◽  
Convenience Sample ◽  
Crc Screening ◽  
Screening Barriers ◽  
The Impact

Purpose. Colorectal cancer (CRC) screening is effective, but only one-half of age-eligible adults adhere to national guidelines. Lower socioeconomic status (SES) groups are less likely to be screened. Methods. Baseline data from a prospective study were used to examine the associations among CRC screening screening barriers, and SES. A convenience sample of adults (N = 291) aged 40 years and older was recruited from a federally qualified health center. Questionnaires were administered orally and included demographics, health, health behavior, and screening barriers. Results. In logistic regression, having health insurance was associated with greater odds of screening. Bivariate analyses detected few differences in fecal occult blood test (FOBT) barriers, but several endoscopy barriers were more common among the lowest SES groups. For example, fear of injury from endoscopy was more likely among low-income and uninsured participants. Discussion. The impact of SES on cancer screening is complex, but low-SES participants more often reported certain barriers than their higher-SES counterparts. This was more evident for endoscopy than for FOBT. Programs targeted at low-SES patients may need to focus on barriers that are not fully addressed in traditional promotion efforts.

scholarly journals Neighbourhood characteristics and health outcomes: evaluating the association between socioeconomic status, tobacco store density and health outcomes in Baltimore City

2017 ◽  
Vol 27 (e1) ◽  
pp. e19-e24 ◽  
Author(s):  
Panagis Galiatsatos ◽  
Cynthia Kineza ◽  
Seungyoun Hwang ◽  
Juliana Pietri ◽  
Emily Brigham ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Low Income ◽  
Household Income ◽  
Spatial Regression ◽  
Median Household Income ◽  
Baltimore City ◽  
Education Status ◽  
The Relationship

IntroductionSeveral studies suggest that the health of an individual is influenced by the socioeconomic status (SES) of the community in which he or she lives. This analysis seeks to understand the relationship between SES, tobacco store density and health outcomes at the neighbourhood level in a large urban community.MethodsData from the 55 neighbourhoods of Baltimore City were reviewed and parametric tests compared demographics and health outcomes for low-income and high-income neighbourhoods, defined by the 50th percentile in median household income. Summary statistics are expressed as median. Tobacco store density was evaluated as both an outcome and a predictor. Association between tobacco store densities and health outcomes was determined using Moran’s I and spatial regression analyses to account for autocorrelation.ResultsCompared with higher-income neighbourhoods, lower-income neighbourhoods had higher tobacco store densities (30.5 vs 16.5 stores per 10 000 persons, P=0.01), lower life expectancy (68.5 vs 74.9 years, P<0.001) and higher age-adjusted mortality (130.8 vs 102.1 deaths per 10 000 persons, P<0.001), even when controlling for other store densities, median household income, race, education status and age of residents.ConclusionIn Baltimore City, median household income is inversely associated with tobacco store density, indicating poorer neighbourhoods in Baltimore City have greater accessibility to tobacco. Additionally, tobacco store density was linked to lower life expectancy, which underscores the necessity for interventions to reduce tobacco store densities.

Does Socioeconomic Status Affect Outcomes in Early Inflammatory Arthritis? Data from a Canadian Multisite Suspected Rheumatoid Arthritis Inception Cohort

2014 ◽  
Vol 42 (1) ◽  
pp. 46-54 ◽  
Author(s):  
Grace Yang ◽  
Vivian P. Bykerk ◽  
Gilles Boire ◽  
Carol A. Hitchon ◽  
J. Carter Thorne ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Disease Activity ◽  
Low Income ◽  
Inflammatory Arthritis ◽  
Activity Index ◽  
Income Group ◽  
Joint Disease ◽  
Physical Component Score ◽  
Low Ses ◽  
Early Inflammatory Arthritis

Objective.To assess the effect of socioeconomic status (SES) on outcomes in patients with early inflammatory arthritis, using data from the Canadian Early Arthritis Cohort (CATCH) study.Methods.In an incident cohort, 2023 patients were recruited, and allocated to low SES or high SES groups based on education and income. Outcomes at baseline and 12 months were analyzed in relation to SES including the 28-joint Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), pain, patient’s global assessment scale (PtGA), the Health Assessment Questionnaire–Disability Index (HAQ-DI), and the SF12-v2 Health Survey, using the ANOVA, chi-squared test, and regression analyses.Results.The CATCH population had 43% with high school education or less and 37% in the low-income group (< 50,000 Can$ per annum household income). The low-education group had higher DAS28 at baseline (p = 0.045), becoming nonsignificant at 12 months and lower physical component score on SF12-v2 at baseline (p = 0.022). Patients in the low-income group presented with higher HAQ-DI (p = 0.017), pain (p = 0.035), PtGA (p = 0.004), and SDAI (p = 0.022). Low-income versus high-income groups were associated with an OR above the median for HAQ-DI (1.20; 95% CI 1.00–1.45), PtGA (1.27; 95% CI 1.06–1.53), and SDAI (1.25; 95% CI 1.02–1.52) at baseline. The association with low income persisted at 12 months for HAQ-DI (OR 1.30; 95% CI 1.02–1.67), but not for other variables.Conclusion.Low SES was initially associated with higher disease activity, pain, and PtGA, and poorer function. At 1 year, outcomes were similar to those with high SES, with the exception of HAQ-DI.

Uneven Neighborhood Recovery: Hurricane Damage and Neighborhood Change in the Houston–Galveston Region since 1970

2019 ◽  
Vol 18 (2) ◽  
pp. 689-709 ◽  
Author(s):  
Christopher K. Wyczalkowski ◽  
Eric J. van Holm ◽  
Ann–Margaret Esnard ◽  
Betty S. Lai
Keyword(s):  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Fixed Effects ◽  
Natural Hazard ◽  
Census Data ◽  
Neighborhood Change ◽  
Low Ses ◽  
The Impact ◽  
Rent Gap Theory

Despite the growing number of natural disasters around the globe, limited research exists on post–disaster patterns of neighborhood change. In this paper, we test two theories of neighborhood change, the “recovery machine” and “rent gap,” which predict opposing effects for low socioeconomic status (SES) neighborhoods following damage from hurricanes, tropical storms, and other natural hazard events. The recovery machine theory posits that after natural hazard events, local communities experience patterns of recovery based on their pre–disaster SES and access to resources, suggesting that wealthier neighborhoods will recover robustly while lower status neighborhoods languish. In contrast, the rent gap theory suggests that developers will identify a profit opportunity in the depressed values created by damage from natural hazard events, and seek to redevelop low SES areas. We use fixed effects models with census data from 1970 to 2015 to test the impact of damage from natural hazards on neighborhood change. We find substantial recovery and change in low–income neighborhoods, but not in the high–income neighborhoods supporting the rent gap theory. We conclude that natural hazard events resulting in damage produce uneven recovery by socioeconomic status of neighborhoods, potentially leading to displacement of low SES groups.

scholarly journals Cross-sectional study to measure household water insecurity and its health outcomes in urban Mexico

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e040825
Author(s):  
Wendy E Jepson ◽  
Justin Stoler ◽  
Juha Baek ◽  
Javier Morán Martínez ◽  
Felipe Javier Uribe Salas ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Health Outcomes ◽  
Dengue Fever ◽  
Perceived Stress ◽  
Low Income ◽  
Urban Areas ◽  
Short Form ◽  
Water Insecurity ◽  
Cross Sectional ◽  
Household Water

ObjectiveTo assess the links between structural and household determinants of household water insecurity and test three water insecurity measures against self-reported diarrhoea, dengue fever and perceived stress in the middle-income and low-income urban areas of Torreón, Mexico.DesignCross-sectional household survey conducted in two waves (rainy and dry seasons).Participants500 households selected via multistage cluster sample in selected communities. Socioeconomic status determined the selection of participant neighbourhoods; five were identified in low socioeconomic status neighbourhoods and five in low-medium socioeconomic status neighbourhoods. We examine how the context of urban water provision is related to a new cross-culturally valid Household Water Insecurity Experiences (HWISE) Scale.Primary outcome measuresThe HWISE Scale, self-reported diarrhoea, dengue fever and the Perceived Stress Scale.ResultsWater system intermittency (adjusted OR (AOR) 3.96, 95% CI 2.40 to 6.54, p<0.001), unpredictability (AOR 2.24, 95% CI 1.34 to 3.74, p=0.002) and the dry season (AOR 3.47, 95% CI 2.18 to 5.52, p<0.001) were structural correlates of the HWISE Scale. This study also found that the HWISE Scale was associated with two health outcomes, self-reported diarrhoea (AOR 1.09, 95% CI 1.03 to 1.15, p=0.002) and perceived stress (β=0.28, SE=0.07, t=4.30, p<0.001), but not self-reported dengue fever (AOR 1.02, 95% CI 0.98 to 1.06). A 3-item hygiene subscore and a 3-item water worry subscore were also both positively associated with self-reported diarrhoea and perceived stress.ConclusionShort-form screeners of water insecurity may be useful for assessing certain health risks by lay survey workers in settings with limited healthcare resources, particularly in lieu of more expensive microbiological tests that require specialised training and facilities.

scholarly journals Evaluation of Healthy South Texas Asthma Program on improving health outcomes and reducing health disparities among the underserved Hispanic population: using the RE-AIM model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Genny Carrillo ◽  
Taehyun Roh ◽  
Juha Baek ◽  
Betty Chong-Menard ◽  
Marcia Ory
Keyword(s):  
Health Disparities ◽  
Health Outcomes ◽  
Low Income ◽  
The United States ◽  
South Texas ◽  
Environmental Modification ◽  
Asthma Education ◽  
Individual Level ◽  
Children With Asthma ◽  
The Impact

Abstract Background In the United States, childhood asthma prevalence is higher among low-income communities and Hispanic populations. Previous studies found that asthma education could improve health and quality of life, especially in vulnerable populations lacking healthcare access. This study aims to describe Healthy South Texas Asthma Program (HSTAP), an evidence-based asthma education and environmental modification program in South Texas, and evaluate its associations with health-related outcomes among Hispanic children with asthma and their families. Methods The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework was used as an overarching tool to evaluate the impact of the HSTAP. This educational program included 451 children with asthma and their families living in South Texas, an impoverished area at the Texas-Mexico border. The program consisted of (a) the asthma education (2-h) for children with asthma provided by Respiratory Therapy students at the children’s schools and (b) the home visit Asthma and Healthy Homes education and walk-through sessions (at baseline and 3 months) for parents and two follow-up visits (6 and 9–12 months later) led by community health workers. The education was provided in either English or Spanish between September 2015 and August 2020 as part of the Healthy South Texas Initiative. A pre-and post-test design was implemented to assess the differences in health outcomes, knowledge, and behaviors using standardized self-reported surveys as reported by parents. Analyses included primary descriptive analyses, generalized estimating equation models, the Wilcoxon signed-rank test, and the McNemar test. Results The HSTAP was significantly associated with improved individual-level outcomes on the frequency of asthma-related respiratory symptoms, including shortness of breath, chest tightness, coughing, and sleep difficulty, among children with asthma, as well as an enhanced asthma knowledge in their family. This study also showed significant associations with children’s school attendance and participation in physical activities and family social events and decreased families’ worry about their asthma management. Conclusions The RE-AIM model was a helpful framework to assess the HSTAP on all its components. The results suggest that participation in an asthma education and environmental modification program was associated with improved individual-level health conditions and reduced health disparities among children with asthma in low-income communities.

Associations of rural residence and low socioeconomic status on the risk of new onset cardiovascular disease (CVD) in cancer patients.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 90-90
Author(s):  
Atul Batra ◽  
Shiying Kong ◽  
Rodrigo Rigo ◽  
Winson Y. Cheung
Keyword(s):  
Socioeconomic Status ◽  
Educational Attainment ◽  
Cancer Patients ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Low Ses ◽  
Rural Residence ◽  
Low Socioeconomic ◽  
Low Education

90 Background: Cancer patients are predisposed to CVD due to cancer treatments and shared risk factors (smoking/physical inactivity). We aimed to assess if rural residence and low socioeconomic status (SES) modify the risk of developing CVD. Methods: Patients diagnosed with non-metastatic solid organ cancers without baseline CVD in a large Canadian province from 2004 to 2017 were identified using the population-based registry. Postal codes were linked with Census data to determine rural residence as well as neighborhood-level income and educational attainment. Low income was defined as <46000 CAD/annum; low education was defined as a neighborhood in which <80% attended high school. Myocardial infarction, congestive heart failure, arrythmias and cerebrovascular accident constituted as CVD.We performed logistic regression analyses to examine the associations of rural residence and low SES with the development of CVD, adjusting for measured confounding variables. Results: We identified 81,275 patients diagnosed with cancer without pre-existing CVD. The median age was 62 years and 54.2% were women. The most prevalent cancer types included breast (28.6%), prostate (23.1%), and colorectal (14.9%). At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD was 29 months. Rural patients (32.3 vs 28.4%,P < .001) and those with low income (30.4% vs 25.9%,P < .001) or low educational attainment (30.7% vs 27.6%,P < .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio[OR], 1.07; 95% confidence interval[CI], 1.04-1.11;P < .001), low income (OR,1.17;95%CI,1.12-1.21;P < .001) and low education (OR,1.08;95%CI,1.04-1.11;P < .001) continued to associate with higher odds of CVD. Further, patients with colorectal cancer were more likely to develop CVD compared with other tumors (OR,1.12;95% CI,1.04-1.16;P = .001). A multivariate Cox regression model showed that patients with low SES were more likely to die, but patients residing rurally were not. Conclusions: Approximately one-third of cancer survivors develop CVD on follow-up. Despite universal healthcare, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs. [Table: see text]

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