Dementia and disadvantage in the USA and England: population-based comparative study

ObjectivesTo compare dementia prevalence and how it varies by socioeconomic status (SES) across the USA and England.DesignPopulation-based comparative study.SettingNon-Hispanic whites aged over 70 population in the USA and England.ParticipantsData from the Health and Retirement Study and the English Longitudinal Study of Ageing, which are harmonised, nationally representative panel studies. The sample includes 5330 and 3147 individuals in the USA and England, respectively.Main outcome measuresBetween country differences in age-gender standardised dementia prevalence, across the SES gradient. Dementia prevalence was estimated in each country using an algorithm based on an identical battery of demographic, cognitive and functional measures.ResultsDementia prevalence is higher among the disadvantaged in both countries, with the USA being more unequal according to four measures of SES. Overall prevalence was lower in England at 9.7% (95% CI 8.9% to 10.6%) than the USA at 11.2% (95% CI 10.6% to 11.8%), a difference of 1.4 percentage points (pp) (p=0.0055). Most of the between country difference is driven by the bottom of the SES distribution. In the lowest income decile individuals in the USA had 7.3 pp (p<0.0001) higher prevalence than in England. Once past health factors and education were controlled for, most of the within country inequalities disappeared; however, the cross-country difference in prevalence for those in lowest income decile remained disproportionately high.ConclusionsThere is inequality in dementia prevalence according to income, wealth and education in both the USA and England. England has lower dementia prevalence and a less steep SES gradient. Most of the cross-country difference is concentrated in the lowest SES group, which provides evidence that disadvantage in the USA is a disproportionately high risk factor for dementia.

The Income Gradient in Mortality during the Covid-19 Crisis: Evidence from Belgium

We use population-wide data from linked administrative registers to study the distributional pattern of mortality before and during the first wave of the Covid-19 pandemic in Belgium. Over the March-May 2020 study period, excess mortality is only found among those aged 65 and over. For this group, we find a significant negative income gradient in excess mortality, with excess deaths in the bottom income decile more than twice as high as in the top income decile for both men and women. However, given the high inequality in mortality in normal times, the income gradient in all-cause mortality is only marginally steeper during the peak of the health crisis when expressed in relative terms. Leveraging our individual-level data, we gauge the robustness of our results for other socioeconomic factors and decompose the role of individual vs. local effects. We provide direct evidence that geographic location effects on individual mortality are particularly strong during the first wave of the Covid-19 pandemic, channeling through the local number of Covid infections. This makes inference about the income gradient in excess mortality based on geographic variation misguided.

The role of automatic stabilizers and emergency tax–benefit policies during the COVID-19 pandemic in Ecuador

This paper makes use of tax–benefit microsimulation techniques to quantify the distributional effects of COVID-19 in Ecuador and the role of tax–benefit policies in mitigating the immediate impact of the economic shocks. Our results show a dramatic increase in income poverty and inequality between December 2019 and June 2020. The poverty rate, measured with the national poverty line, goes up from 25.7 to 58.2 per cent over this period and extreme poverty increases from 9.2 to 38.6 per cent. Inequality measured by the Gini coefficient increases substantially from 0.461 to 0.592. On average, household disposable income drops by 41 per cent. The new Family Protection Grant provides income protection for the poorest income decile. However, overall tax–benefit policies do little to mitigate the losses in household incomes due to the pandemic.

Income Inequality and Food Insecurity in Russia

The transition in Russia to a partially market-driven economy has failed to produce sustained and broad-based economic growth. The gains of economic growth are concentrated at the top of the income distribution, leaving a sizable part of the population trapped in conditions of low incomes. While abject poverty has largely been eliminated, around 40% of the population struggle to purchase more than basic consumer necessities. Spending on food occupies nearly half of household budgets for the lowest income decile. State social spending, which constitutes an increasing share of total income, is relatively non-progressive. Most is not means-based, but preserves the categorical benefits structure of the Soviet era. A combination of the bureaucratic-authoritarian institutional framework for decision-making and the strongly rent-based relationship between economic and political elites, severely limits policy options.

Global patterns in price elasticities of sugar-sweetened beverage intake and potential effectiveness of tax policy: a cross-sectional study of 164 countries by sex, age and global-income decile

ObjectiveTo quantify global relationships between sugar-sweetened beverage (SSB) intake and prices and examine the potential effectiveness of tax policy.DesignSSB intake data by country, age and sex from the Global Dietary Database were combined with gross domestic product and price data from the World Bank. Intake responsiveness to income and prices was estimated accounting for national income, age and sex differences.Setting164 countries.PopulationFull adult population in each country.Main outcome measuresA consumer demand modelling framework was used to estimate the relationship between SSB intake and prices and derive own-price elasticities (measures of percentage changes in intake from a 1% price change) globally by age and sex. We simulated how a 20% tax would impact SSB intake globally. Tax policy outcomes were examined across countries by global income decile for representative age and sex subgroups.ResultsOwn-price responsiveness was highest in lowest income countries, ranging from −0.70 (p<0.100) for women, age 50, to −1.91 (p<0.001) for men, age 80. In the highest income countries, responsiveness was as high as −0.49 (p<0.001) (men, age 20), but was mostly insignificant for older adults. Overall, elasticities were strongest (more negative) at the youngest and oldest age groups, and mostly insignificant for middle-aged adults, particularly in middle-income and high-income countries. Sex differences were mostly negligible. Potential intake reductions from a 20% tax in lowest income countries ranged from 14.5% (95% CI: 29.5%, −0.4%) in women, 35 ≤ age < 60, to 24.9% (44.4%, 5.3%) in men, age ≥60. Intake reductions decreased with country income overall, and were mostly insignificant for middle-aged adults.ConclusionsThese findings estimate the global price-responsiveness of SSB intake by age and sex, informing ongoing policy discussions on potential effects of taxes.

Economic modeling of touristic services demand in the regions

Considering the important role of tourism in the socio-economic development of regions, the need for information and modeling of ways to increase demand for tourism services and tourism development is being updated. The article uses methods of analytical, logical, comparative analysis and systematic approach to study trends in demand for tourist services in Ukraine. Econometric modeling analyzes the demand for tourism services by the level of income and expenditures of the population in 2018. Trends in demand for tourism services in 2018 in terms of income and expenditure of the population with the use of the Tornquist econometric model have been analyzed. It is proposed to use the decile groups of the population for analyzing income and expenditure by the level of income, total income per capita, the level of household expenditure relative to income, the percentage of tourism expenditure by households, the expenditure on tourism and the elasticity of tourism demand. Average values of the population’s expenditures on tourism were established, which helped to determine the elasticity of effective demand for each decile group. The more than one unit of elasticity of effective tourism demand for each decile group indicated that tourism services for domestic households belong to the group of luxury goods and services. It should be noted that in the following decile income groups of households there is a decrease in elasticity. It means that when income tends to increase indefinitely, elasticity coefficients fall, and this indicates a stabilization of costs of this type. In this case, the percentage of households in each decile group that recorded the costs of organized tourism in their budgets and the value of the probability of household participation in this form of recreation was determined based on an estimated probability model. An analysis of the values of income elasticity indicators in each income decile group has shown that increasing household incomes contribute to increased demand for tourism services and an increase in the share of expenditures for these purposes in household budgets.

MARKET SEGMENTATION IN HEALTHCARE

The share of healthcare expenditure in the first income decile in their income is higher in comparison with other deciles, however, their expenditure is the lowest. The main purpose of the research is to show the availability of healthcare in different income groups of households. Literature sources indicate that some specific household social classes face problems with access to healthcare because of low income. Firstly, public healthcare expenditure is evaluated. The low share of research and development expenditure in healthcare is alarming. Investigation continues in the accessibility of healthcare and medicines in households. The paper reveals segments of endangered low-income households with insufficient healthcare that decrease their living standard. The main data source for conducted analyses of household situations is primary data from Household Budget Survey and primary data from EU-Statistics on Income and Living Conditions survey in four years 2007, 2010, 2014 and 2016 in the Czech Republic. The paper presents the results of an analysis of households which showed that first low-income decile has the lowest healthcare payments in absolute expression but the relative number of healthcare expenditure confirms that low-income households spend the most of their income on healthcare in the comparison with other households. The first income decile is mainly composed of old-age pensioners and unemployed consumers. The structure of household healthcare expenditure according to expenditure categories shows that all consumers pay the most for non-prescription drugs followed by prescription drugs, orthopaedic and therapeutic aids, ambulatory dental care and ambulatory medical care. The research confirms that specific groups of households cannot afford appropriate healthcare. The constructed Health Poverty Index expresses that low-income households would need their income to be higher by at least 4.36 % to be able to afford average healthcare expenditure and appropriate healthcare.