Income inequality, life expectancy and cause-specific mortality in 43 European countries, 1987-2008: a fixed effects study

Determinants of life-expectancy and disability-adjusted life years (DALYs) in European and Organisation for Economic Co-operation and Development (OECD) countries: A longitudinal analysis (1990-2019)

•We relate 68 factors to population health observed in 61 countries over 30 years.•Using random forests, multiple imputation and generalized estimating equations.•GDP per capita and demographics are key; income inequality is not.•Health and social expenditure are more influential than freedom and corruption.•On the macro-level, life-style effects appear to be mediated by cultural context.

Unequally Unequal? Contextual-level status inequality and social cohesion moderating the association between individual-level socioeconomic position and systemic chronic inflammation

BACKGROUND

Status inequality is hypothesised to increase socioeconomic inequalities in health by creating an environment in which social cohesion erodes and social comparisons intensify. Such an environment may cause systemic chronic inflammation. Although these are often-used explanations in social epidemiology, empirical tests remain rare.

METHODS

We analysed data from the West of Scotland Twenty-07 Study. Our sample consisted of 1977 participants in 499 small residential areas. Systemic chronic inflammation was measured by high-sensitivity C-reactive protein (hs-CRP; <10 mg/L). An area-level measurement of status inequality was created using census data and contextual-level social cohesion was measured applying ecometrics. We estimated linear multilevel models with cross-level interactions between socioeconomic position (SEP), status inequality, and social cohesion adjusted for age and gender. Our main analysis on postcode sector-level was re-estimated on three smaller spatial levels.

RESULTS

The difference in hs-CRP between disadvantaged and advantaged SEPs (0.806 mg/L; p = 0.063; [95%CI: -0.044; 1.656]) was highest among participants living in areas where most residents were in advantaged SEPs. In these status distributions, high social cohesion was associated with a shallower socioeconomic gradient in hs-CRP and low social cohesion was associated with a steeper gradient. In areas with an equal mix of SEPs or most residents in disadvantaged SEPs, the estimated difference in hs-CRP between disadvantaged and advantaged SEPs was -0.039 mg/L (p = 0.898; [95%CI: 0.644; 0.566]) and -0.257 mg/L (p = 0.568; [95%CI: 1.139; 0.625]) respectively. In these status distributions, the gradient in hs-CRP appeared steeper when social cohesion was high and potentially reversed when social cohesion was low. Results were broadly consistent when using area-levels smaller than postcode sectors.

CONCLUSIONS

Inequalities in hs-CRP were greatest among participants living in areas wherein a majority of residents were in advantaged SEPs and social cohesion was low. In other combinations of these contextual characteristics, inequalities in systemic chronic inflammation were not detectable or potentially even reversed.

Economic Growth, Income Inequality and Food Safety Risk

Food safety risk, as an implicit cost of social and economic development, endangers the health of global residents, including China. To systematically understand the impact of socioeconomic development on food safety risk and to establish a sound modern governance system of food safety in China, this paper uses provincial panel data from 2011 to 2020 to explore the relationship between food safety risk and socio-economic development factors such as economic growth and income inequality by employing a two-way fixed effect model and moderating effect model. The results show that the food safety risk is a Kuznets curve, and the turning point is about RMB 58,104.59 per capita GDP (based on prices in 2011). However, under the moderating effect of income inequality, the turning point of the Kuznets curve of food safety risk will shift to the right, and the curve will be flattened. In other words, income inequality has a negative moderating effect on the "inverted U-shaped" relationship between economic growth and food safety risk. When dealing with food safety problems, the goal of stable and sustained economic growth and common prosperity should be incorporated into policy formulation to enhance the governance effectiveness of food safety risk.

Income Inequality and Population Health: Examining the Role of Social Policy

Studies of the relationship between income inequality and life expectancy often speculate about the role of policy, but direct empirical research is limited. Drawing on the neo-materialist perspective, we examine whether the longitudinal association between income inequality and life expectancy is mediated and moderated by policy liberalism in U.S. states (2000-2014). More liberal policy contexts are characterized by greater efforts to regulate the economy, redistribute income, and protect vulnerable groups and lesser efforts to penalize deviant social behavior. We find that state-level income inequality is inversely associated with policy liberalism and life expectancy. The association between income inequality and life expectancy was not mediated by policy liberalism but was moderated by it. The association is attenuated in states with more liberal policy contexts, supporting the neo-materialist perspective. This finding illustrates how states like New York and California (with liberal policy contexts) can exhibit high income inequality and high life expectancy.

Comprehensive metrological and content analysis of the income inequality research in health field: A bibliometric analysis

The association between income inequality in a society and the poor health status of its people has attracted the attention of researchers from multiple disciplines. Based on the ISI Web of Science database, bibliometric methods were used to analyze 546 articles related to income inequality research in health field published between 1997 and 2021. We found that the USA contributed most articles, the Harvard Univ was the most influential institution, Social Science & Medicine was the most influential journal, and Kawachi I was the most influential author; the main hotspots included the income inequality, income, health inequality, mortality, socioeconomic factors, concentration index, social capital, self-rated health, income distribution, infant mortality, and population health in 1997-2021; the cardiovascular disease risk factor, social capital income inequality, individual mortality risk, income-related inequalities, understanding income inequalities, income inequality household income, and state income inequality had been the hot research topics in 1997-2003; the self-assessed health, achieving equity, income-related inequalities, oral health, mental health, European panel, occupational class, and cardiovascular diseases had been the hot research topics in 2004-2011; the adolescent emotional problem, South Africa, avoidable mortality, rising inequalities, results from world health survey, working-age adult, spatial aggregation change, prospective study, and mental health-empirical evidence had been the hot research topics in 2012-2021; there were 11 articles with strong transformation potential during 2012-2021. The research results of this paper are helpful to the scientific understanding of the current status of income inequality research in health field.

Income inequality and population health: a political-economic research agenda

There is more than 30 years of research on relationships between income inequality and population health. In this article, we propose a research agenda with five recommendations for future research to refine existing knowledge and examine new questions. First, we recommend that future research prioritise analyses with broader time horizons, exploring multiple temporal aspects of the relationship. Second, we recommend expanding research on the effect of public expenditures on the inequality-health relationship. Third, we introduce a new area of inquiry focused on interactions between social mobility, income inequality and population health. Fourth, we argue the need to examine new perspectives on 21st century capitalism, specifically the population health impacts of inequality in income from capital (especially housing), in contrast to inequality in income from labour. Finally, we propose that this research broaden beyond all-cause mortality, to cause-specific mortality, avoidable mortality and subcategories thereof. We believe that such a research agenda is important for policy to respond to the changes following the COVID-19 pandemic.

Analyzing the impact of energy consumption, the democratic process, and government service delivery on life expectancy: evidence from a global sample

Life expectancy is one of the crucial criteria for determining the quality of life in today's societies. As such, the study of factors affecting life expectancy is a key issue for policymakers. This study aims to investigate the impact of energy consumption, the democratic process, and government service delivery on life expectancy in 100 countries during 2000-2018, using panel quantile regression. The impact of these factors on life expectancy has been estimated in quantiles of 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, and 0.95. Also, the impact of GDP, CO₂ emission, and Gini coefficient variables has been explored as controlling variables on life expectancy. The results show that the impact of CO₂ emissions and the democratic process on life expectancy is negative in all quantiles, and the impact of GDP is negative in all quantiles except 0.95. Moreover, the relationship between hydroelectricity consumption and life expectancy in the 0.05, 0.1, 0.2, 0.8, and 0.9 quantiles is negative and significant. Accordingly, based on the results, the impact of petroleum and other liquids consumption, government service delivery, and Gini coefficient on life expectancy in all quantiles is positive and only the impact of the Gini coefficient on life expectancy in all quantiles is significant.

Gender Gap in Self-Rated Health: A Cohort Perspective in Eastern European Countries

Background: The relationship between self-rated health and gender differs across countries and generations. The aim of this study is to analyze the effect of socioeconomic conditions on self-rated health from a generational perspective, its differential effect on gender, and its influence on the gender gap in order to explore health diversity using a multidisciplinary approach and considering policy implications in Eastern European countries. Methods: We used data drawn from the European Health Interview Survey for eight Eastern European countries and EUROSTAT from 2006 through to 2009. We conducted multilevel analyses to understand the individual and national health determinants of self-rated health by gender and to determine whether national differences remain after controlling for micro variables. In order to analyze the role of equity (Gini quartile) in gender differences, Oaxaca analyses were used. Results: The self-rated health gender gap increases with age. Individual characteristics, such as educational level or smoking, influence citizens’ perceived health, and have a stronger effect on women than on men. Knowing both the characteristics (endowment effects) and the effects of individual characteristics (coefficient effects) on health is important in order to understand gender gaps among people from the silent generation. Conclusions: Our research indicates that random effects are greater for men than for women. Moreover, random effects might be explained to a certain extent by economic equity (Gini index). The combined effects of gender, cohort, and geographical differences on self-rated health have to be taken into account to develop public health policies.

Relative Deprivation, Income Inequality, and Cardiovascular Health: Observational and Mendelian Randomization Studies in Hong Kong Chinese

The associations between absolute vs. relative income at the household or neighborhood level and cardiovascular disease (CVD) risk remain understudied in the Chinese context. Further, it is unclear whether stress biomarkers, such as cortisol, are on the pathway from income to CVD risk. We examined the associations of absolute and relative income with CVD risk observationally, as well as the mediating role of cortisol, and validated the role of cortisol using Mendelian Randomization (MR) in Hong Kong Chinese. Within Hong Kong's FAMILY Cohort, associations of absolute and relative income at both the individual and neighborhood levels with CVD risk [body mass index (BMI), body fat percentage, systolic blood pressure, diastolic blood pressure, self-reported CVD and self-reported diabetes] were examined using multilevel logistic or linear models (n = 17,607), the mediating role of cortisol using the mediation analysis (n = 1,562), and associations of genetically predicted cortisol with CVD risk using the multiplicative generalized method of moments (MGMMs) or two-stage least squares regression (n = 1,562). In our cross-sectional observational analysis, relative household income deprivation (per 1 SD, equivalent to USD 128 difference in Yitzhaki index) was associated with higher systolic blood pressure (0.47 mmHg, 95% CI 0.30–0.64), but lower BMI (−0.07 kg/m², 95% CI −0.11 to −0.04), independent of absolute income. Neighborhood income inequality was generally unrelated to CVD and its risk factors, nor was absolute income at the household or neighborhood level. Cortisol did not clearly mediate the association of relative household income deprivation with systolic blood pressure. Using MR, cortisol was unrelated to CVD risk. Based on our findings, relative household income deprivation was not consistently associated with cardiovascular health in Hong Kong Chinese, nor were neighborhood income inequality and absolute income, highlighting the context-specific ways in which relative and absolute income are linked to CVD risk.

What have we learned about mortality patterns over the past 25 years?

In this paper, I examine progress in the field of mortality over the past 25 years. I argue that we have been most successful in taking advantage of an increasingly data-rich environment to improve aggregate mortality models and test pre-existing theories. Less progress has been made in relating our estimates of mortality risk at the individual level to broader mortality patterns at the population level while appropriately accounting for contextual differences and compositional change. Overall, I find that the field of mortality continues to be highly visible in demographic journals, including Population Studies. However much of what is published today in field journals could just as easily appear in neighbouring disciplinary journals, as disciplinary boundaries are shrinking.

Inequality in Place: Effects of Exposure to Neighborhood-Level Economic Inequality on Mortality

This study contributes to the debate on whether income inequality is harmful for health by addressing several analytical weaknesses of previous studies. Using the Panel Study of Income Dynamics in combination with tract-level measures of income inequality in the United States, we estimate the effects of differential exposure to income inequality during three decades of the life course on mortality. Our study is among the first to consider the implications of income inequality within U.S. tracts for mortality using longitudinal and individual-level data. In addition, we improve upon prior work by accounting for the dynamic relationship between local areas and individuals' health, using marginal structural models to account for changes in exposure to local income inequality. In contrast to other studies that found no significant relation between income inequality and mortality, we find that recent exposure to higher local inequality predicts higher relative risk of mortality among individuals at ages 45 or older.

Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017

Background

Income inequality can negatively affect population health by increasing social stress and conflict, and reducing trust, public goods and healthcare access. However there is limited evidence from low and middle-income countries (LMICs) with high levels of inequality. This study investigates the association between income inequality, morbimortality and risk factors of non-communicable diseases (NCDs) in 26 Brazilian states from 2002 to 2017.

Methods

Data was acquired for men and women from the Global Health Data Exchange, the Brazilian Institute of Geography and Statistics, and the Brazilian Ministry of Health, totalling 416 state-year observations. Disability-adjusted life years (DALYs) and risk factors of NCDs were the dependent variables. Gini Index was the main independent variable. Multivariate linear panel regressions were performed, controlling for state and time fixed effects, gross domestic product per capita, population ageing, poverty and access to healthcare.

Findings

A 1% increase in the Gini Index was associated with increases in alcohol abuse (of 923•4 DALYs per 100,000 people, 95%CI 217•6 to 1629•0) and diabetes mellitus morbidity (of 893•3 DALYs per 100,000 people, 95%CI 127•7 to 1659•0), and decreases in morbidity from attention disorder (of -4•0 DALYs per 100,000 people, 95%CI -7•4 to -0•5) and autism spectrum (of -2•4 DALYs per 100,000 people, 95%CI -4•3 to -0•5). These associations were greater for men, further supported by associations with alcohol use as a risk factor.

Interpretation

This study provides evidence from a highly unequal LMIC, Brazil, of negative associations between income inequality and NCDs, and the importance of addressing wider social determinants of health.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001 as a Brazilian CAPES scholarship to AZD and by the São Paulo Research Foundation (FAPESP), grant 2020/15944-8 to RSG.

Socioeconomic Factors Associated With Liver-Related Mortality From 1985 to 2015 in 36 Developed Countries

BACKGROUND & AIMS

There is increasing disparity in liver-related mortality worldwide. Although there are many biologic and lifestyle risk factors for liver-related mortality, the effects of inequalities in social and economic determinants of health have received little attention. We investigated changes in liver-related mortality from 1985 through 2015 in 36 countries, using 4 international health and economic databases, and searched for socioeconomic factors that might influence these trends.

METHODS

We collected information on sex- and country-specific liver-related mortality from countries with designated high-usability data from the World Health Organization mortality database. We obtained data on alcohol consumption per capita, the percentage of adults with a body mass index greater than 30 kg/m², health expenditure per capita, gross domestic product per capita, Gini index, national unemployment estimates, and diabetes prevalence from the World Health Organization global health observatory data repository, the World Bank database, and the International Diabetes Federation. We examined changes in mortality using Joinpoint regression analysis. Univariate analysis and a mixed-effects linear model were used to identify factors associated with liver-related mortality.

RESULTS

From 1985 to 2015, the mean liver-related deaths per 100,000 persons increased in men from 23.8 to 26.1, and in women from 9.7 to 11.9. Increased liver-related mortality was associated with male sex, a high level of alcohol consumption, obesity, and indicators of national wealth and government health expenditure gross domestic product or government expenditure on health.

CONCLUSIONS

In addition to established risk factors for liver mortality, this study identified addressable economic factors associated with liver-related mortality trends. Health care professionals and policy makers may wish to consider these factors to reduce liver-related mortality.

The great convergence? Mortality in Ireland and Europe, 1956-2014

BACKGROUND

Until recently, Irish age-standardized mortality rates (ASMRs) were amongst the highest in the EU-15. This study examines changes in ASMRs in Ireland from 1956 to 2014.

METHODS

Using data from the World Health Organization Mortality Database, we compare ASMRs in Ireland to other EU-15 countries from 1956 to 2014. ASMRS are used to plot the relative ranking of Ireland within the EU-15, and illustrate trends in which Ireland diverged with, and converged to, the EU-15 average. ASMRS are estimated across sex, age groups (15-64 and 65+ years) and cause of death.

RESULTS

Between 1956 and 1999, ASMRs in Ireland were amongst the highest in the EU-15. ASMRs in Ireland saw slower improvements during this period as compared to other EU-15 countries. However, post-2000, a sharp reduction in Irish ASMRs resulted in an accelerated convergence to the EU-15 average. As a consequence of improvements in ASMRs between 2000 and 2014, there were an estimated 15 300 fewer deaths in 2014. The majority of these averted deaths were due to lower mortality rates for diseases of the circulatory system and respiratory system.

CONCLUSIONS

Rather than converging to the EU-15 average during the latter half of the 20th century, there was a divergence in ASMRs between Ireland and the EU-15. However, in recent years, Ireland experienced accelerated improvements in mortality rates with large reductions in mortality observed for diseases of the circulatory system and respiratory system, especially amongst older people.

Recent quantitative research on determinants of health in high income countries: A scoping review

Background

Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature.

Methods

We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013—July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis.

Results

Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health.

Conclusions

We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants’ influence.

A "Swiss paradox" in the United States? Level of spatial aggregation changes the association between income inequality and morbidity for older Americans

Although a preponderance of research indicates that increased income inequality negatively impacts population health, several international studies found that a greater income inequality was associated with better population health when measured on a fine geographic level of aggregation. This finding is known as a “Swiss paradox”. To date, no studies have examined variability in the associations between income inequality and health outcomes by spatial aggregation level in the US. Therefore, this study examined associations between income inequality (Gini index, GI) and population health by geographic level using a large, nationally representative dataset of older adults. We geographically linked respondents’ county data from the 2012 Behavioral Risk Factor Surveillance System to 2012 American Community Survey data. Using generalized linear models, we estimated the association between GI decile on the state and county levels and five population health outcomes (diabetes, obesity, smoking, sedentary lifestyle and self-rated health), accounting for confounders and complex sampling. Although state-level GI was not significantly associated with obesity rates (b = − 0.245, 95% CI − 0.497, 0.008), there was a significant, negative association between county-level GI and obesity rates (b = − 0.416, 95% CI − 0.629, − 0.202). State-level GI also associated with an increased diabetes rate (b = 0.304, 95% CI 0.063, 0.546), but the association was not significant for county-level GI and diabetes rate (b = − 0.101, 95% CI − 0.305, 0.104). Associations between both county-level GI and state-level GI and current smoking status were also not significant. These findings show the associations between income inequality and health vary by spatial aggregation level and challenge the preponderance of evidence suggesting that income inequality is consistently associated with worse health. Further research is needed to understand the nuances behind these observed associations to design informed policies and programs designed to reduce socioeconomic health inequities among older adults.

Inequality within a community at the neighborhood level and the incidence of mood disorders in Japan: a multilevel analysis

PURPOSE

This study analyzes whether income inequality within a community at the neighborhood level is associated with incidence of mood disorder in Japan.

METHODS

A retrospective cohort study was performed using the data of 116,658 National Health Insurance beneficiaries aged between 20 and 69 in Chiba City, Japan. To evaluate income inequality within a community, the Gini coefficient within a 30-min walking distance from an individual's residence was calculated using income distribution estimated by the National Census and the Housing and Land Survey 2013. Incidence of mood disorder was determined through insurance claims submitted from April 1, 2013, to March 31, 2016. A multilevel logistic analysis with three levels-the individual, household, and residential district-was performed to evaluate the association.

RESULTS

Income inequality within a community at the neighborhood level was not associated with incidence of mood disorder in the models with and without equivalent household income (p for trend = 0.856 and 0.947, respectively). No difference was observed in the impact of the Gini coefficient among income levels, lower versus higher income groups (p for interaction between Gini coefficient and household income = 0.967). In contrast, lower equivalent income at the household level was significantly associated with higher incidence of mood disorder (p for trend < 0.001).

CONCLUSIONS

While we confirmed that lower income at the household level itself had an adverse effect on mental health, income inequality within a community at the neighborhood level was not a significant factor for incidence of mood disorder in Japan.

Satisfaction of physicians working in hospitals within the European Union: state of the evidence based on systematic review

BACKGROUND

Despite the wide range of studies concerning physician satisfaction in different European countries, there is a lack of literature reviews synthesizing and analyzing current evidence evaluating satisfaction of physicians working in European hospitals. The goal of our research was to provide a general overview of the studies in this area and their results.

METHODS

We searched MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library from January 2000 to January 2017 including both MESH/Emtree terms and free text words related to the subject with no language restrictions. The eligibility criteria included: (i) target population: physicians working in European hospitals, (ii) quantitative research aimed at assessing physician satisfaction and (iii) validated tools. We performed a narrative synthesis and meta-analysis.

RESULTS

A total of 8585 abstracts and 368 full text articles were independently screened by 2 reviewers against inclusion/exclusion criteria. Finally 61 studies were eligible for qualitative analysis. Included studies enrolled a total of 50 001 physicians from 17 countries. Sample sizes varied between 54 and 7090 participants (median: 336). According to our review ∼59% of physicians working in European hospitals are overall satisfied, 3.54 was the mean satisfaction among studies reporting data on a scale from 1 to 5, 4.81 for studies with a scale from 1 to 7, 6.12 among studies reporting data on a scale from 1 to 10, and 59.65 among studies with a scale from 0 to 100.

CONCLUSIONS

The level of physician satisfaction in Europe is moderate. There is a large variety of tools and scales used to assess it.

Socioeconomic inequality in non-communicable diseases in Europe between 2004 and 2015: evidence from the SHARE survey

Background

The scope of this work was to investigate socioeconomic inequalities among European adults aged 50 or older in chronic diseases and behavioural risk factors for these diseases, namely, smoking habits, obesity and physical inactivity, between 2004 and 2015.

Methods

Data for this study were drawn from the Survey of Health, Ageing and Retirement (SHARE) in Europe, which is a panel database of microdata on health, socioeconomic status and social and family networks of people aged 50 years or older, covering most of the European Union. The predicted number of non-communicable diseases (NCDs) was used to estimate the concentration index and to find the contributions of determinants to socioeconomic inequalities in chronic diseases.

Results

The inequality disfavoured the poor in both years, but the effect was stable from 2004 (C = -0.071) to 2015 (C = -0.081). Inequality was shown to be attributed mostly to physical inactivity and obesity and this contribution increased during the study period. Among socioeconomic status (SES) determinants, education and marital status were the most concentrated in both years, while physical inactivity and obesity were the most concentrated behavioural risk factors in both years.

Conclusions

To prevent chronic diseases, health policy should aim not only to improve individual health behaviours in the population, but also to reduce socioeconomic inequality. Our study suggests promoting a healthy lifestyle in the most disadvantaged socioeconomic classes as a strategy to improve the health conditions of the whole population.

Socioeconomic Differences and the Potential Role of Tribes in Young People's Food and Drink Purchasing Outside School at Lunchtime

Socioeconomic deprivation has been linked to food consumption practices, but studies investigating the food environment around schools provide mixed findings. Peer influence and marketing cues are considered important influencers of young people's behaviors. This study used a tribal theory lens to investigate the factors affecting pupils' purchasing and consumption of food/drinks outside schools at lunchtime. A survey was conducted with 243 pupils from seven UK secondary schools of differing socioeconomic status (SES). A purchasing recall questionnaire (PRQ) was developed and administered online at the participating schools to capture food and drink purchasing, intake, and expenditure. No significant differences were found in terms of energy and nutrients consumed or food/drink expenditure between pupils from schools of lower and higher SES. Enjoyment of food shopping with friends was linked with higher food energy intake and spend. Higher susceptibility to peer influence was associated with greater influence from food advertising and endorsements. Without ignoring the impact that SES can have on young people's food choices, we suggest that tribal theory can be additionally used to understand pupils' eating behaviors and we present implications for social marketers and policy makers.

Does Quality of Government Matter in Public Health?: Comparing the Role of Quality and Quantity of Government at the National Level

This study aims to examine the degree of direct or indirect impact of quality and quantity of government on public health. It is a very important topic in that previous studies did not consider the role of government; they focused on the impact of national economic, social, and political factors on public health, therefore, disregarding the governmental factors. We measured the quantity of government by public expenditure on heath (i.e., rate of share of government budget to gross domestic product (GDP)) and the quality of government by five variables such as corruption control, government effectiveness, regulatory quality, voice and accountability, and rule of law. Based on national-level panel data (three waves) that covered 148–194 countries, we examined how quality and quantity of government has an impact on four kinds of public health, i.e., infant mortality, under-five mortality, maternal mortality, and life expectancy. Results show that both the quality and quantity of government had a significant impact on public health. In the quality of government, government effectiveness has a positive impact on life expectancy and a negative influence on infant deaths. Moreover, the quality of government has a greater impact on public health than the quantity of government. Lastly, the quality of government plays a role in moderating the relationships between quantity of government and the predicted variables.

Socio-Economic Inequalities in Life Expectancy and Health Expectancy at Age 50 and over in European Countries

Abstract Based on the demographic ageing, many European governments have modified the statutory retirement age. However, in general, life expectancy (LE) and health expectancy (HE) are not uniformly distributed, being both lower among the least advantaged groups. Thus, a systematic search and review of the literature has been conducted to identify socioeconomic inequalities in LE and HE at age 50 and over in European countries. Twenty-nine studies were included in the review. Across Europe, people in a more advantaged position can expect to live longer, more years in good health and less in bad health, and therefore a lower percentage of their lives in bad health. Zusammenfassung: Sozioökonomische Ungleichheiten in der Lebens- und Gesundheitserwartung im Alter von 50 und älter in Europäischen Ländern. Erkenntnisse für die Debatte der Rentenpolitik Vor dem Hintergrund der demographischen Alterung haben viele europäische Regierungen das Renteneintrittsalter modifiziert. Allerdings sind Lebensund Gesundheitserwartungen nicht gleichmäßig verteilt, sondern sind in benachteiligten Bevölkerungsgruppen niedriger. Um sozioökonomische Ungleichheiten in der Lebens- und Gesundheitserwartung von Individuen im Alter von 50 Jahren und älter zu betrachten, wurde eine systematische Suche und Begutachtung der Literatur in den europäischen Ländern durchgeführt. Es wurden 29 Studien in der Begutachtung miteinbezogen. Es zeigt sich, dass Individuen in vorteilhaften Positionen erwarten können länger zu leben, länger gesund zu sein und weniger häufig einen schlechten Gesundheitszustand aufweisen, was der Grund dafür ist, dass sie auch einen geringeren Anteil ihrer Lebenszeit in schlechter Gesundheit verbringen.

Decreasing income inequality and adolescent emotional distress: a population-based case study of Icelandic adolescents 2006-2016

OBJECTIVES

In this study, we aim to test whether changes in community income inequality influence adolescent emotional distress. We take advantage of the unique combination of data and history available in Iceland. This affluent welfare society has experienced extreme shifts in income inequality, allowing us to test whether changes in community income inequality are related to changes in adolescent emotional distress.

METHODS

Combining adolescent survey data (n = 24,107) with tax registry data on 76 neighborhood communities, we used a multilevel approach to model the data as longitudinal in order to test whether changes in community income inequality are related to changes in symptoms of anxiety and depression among adolescents.

RESULTS

The results showed that, after adjusting for relevant individual and community covariates, decreases in community income inequality were associated with decreases in symptoms of anxiety among adolescents (b = - 0.367, p ≤ 0.001), but not with decreases in symptoms of depression.

CONCLUSIONS

While the results provide a partial support for the income inequality thesis, we call for replications from other cultures and studies exploring the mediating role of social psychological processes.

Risk factors for the ill-defined causes of death in the Brazilian states: a multilevel analysis

Abstract This study describes the spatial-temporal changes of the proportion of ill-defined causes of death in Brazil (1998-2012) and investigates which demographic and socioeconomic factors affect this proportion. We collected information of the proportion of ill-defined causes of death by age (15-59 years), sex, period, locality, and socioeconomic data. We used a multilevel Poisson model to investigate which factors affect the risk of ill-defined causes of death. Unlike states located in the South and Midwest, we detected clusters with high proportional levels of these deaths in states in the North and Northeast regions. A greater proportion occurred in 1998-2002 (0.09), in the North and Northeast (0.14 and 0.12, respectively), in older age groups (0.09), and in places with poor socioeconomic conditions. The adjusted analysis showed differences in proportion according to the region, age, period, schooling, social inequality, and income. The results indicate that the lower the age group and the better the socioeconomic situation, the lower the risk to register the cause of death as ill-defined. Although over the past years, the quality of Brazil’s mortality data has gradually increased, investments towards improving mortality registries cannot be discontinued.

Impacto Económico de la Medicina Familiar en los Sistemas de Salud de Iberoamérica

Son escasos los estudios que abordan la importancia, económica y sanitaria, que tiene el modelo organizativo de un nivel asistencial o la presencia de determinados profesionales. El objetivo del presente estudio, de carácter descriptivo y transversal, fue explorar y analizar las posibles asociaciones entre la especialidad de medicina familiar e indicadores económicos y sanitarios em 16 países de Iberoamérica. El procesamiento de datos fue realizado a través del programa R, um lenguaje de programación que muestra “un conjunto de funciones que mantiene algún tipo de relación entre ellas”. Se observa una asociación en positivo, del número de especialistas de medicina familiar con el PIB, la inversión en salud y la esperanza de vida y en negativo con el índice GINI, la anemia, la mortalidad en menores de 5 años, la razón de mortalidad materna y la mortalidad en acidentes en tránsito. El PIB per cápita se relaciona negativamente con la anemia, la mortalidad en menores de 5 años, razón de mortalidad materna y por accidentes y menos intensamente con la mortalidade cardiovascular y el suicidio. No se observan correlaciones con el gasto de bolsillo o la inversión em sanidad. A pesar de las diferentes realidades socio sanitarias de los países estudiados se objetiva uma relación favorable entre la disponibilidad de especialistas en Medicina Familiar y mejores resultados en salud lo que sugiere que puede ser una estrategia eficiente para los servicios sanitarios. Son necesarios más estudios que analicen el alcance estadístico de esta asociación.

Income inequality and cardiovascular disease risk factors in a highly unequal country: a fixed-effects analysis from South Africa

Background

Chronic stress associated with high income inequality has been hypothesized to increase CVD risk and other adverse health outcomes. However, most evidence comes from high-income countries, and there is limited evidence on the link between income inequality and biomarkers of chronic stress and risk for CVD. This study examines how changes in income inequality over recent years relate to changes in CVD risk factors in South Africa, home to some of the highest levels of income inequality globally.

Methods

We linked longitudinal data from 9356 individuals interviewed in the 2008 and 2012 National Income Dynamics Study to district-level Gini coefficients estimated from census and survey data. We investigated whether subnational district income inequality was associated with several modifiable risk factors for cardiovascular disease (CVD) in South Africa, including body mass index (BMI), waist circumference, blood pressure, physical inactivity, smoking, and high alcohol consumption. We ran individual fixed-effects models to examine the association between changes in income inequality and changes in CVD risk factors over time. Linear models were used for continuous metabolic outcomes while conditional Poisson models were used to estimate risk ratios for dichotomous behavioral outcomes.

Results

Both income inequality and prevalence of most CVD risk factors increased over the period of study. In longitudinal fixed-effects models, changes in district Gini coefficients were not significantly associated with changes in CVD risk factors.

Conclusions

Our findings do not support the hypothesis that subnational district income inequality is associated with CVD risk factors within the high-inequality setting of South Africa.

Electronic supplementary material

The online version of this article (10.1186/s12939-018-0741-0) contains supplementary material, which is available to authorized users.

The link between income inequality and health in Europe, adding strength dimensions of primary care to the equation

Income inequality has been clearly associated with reduced population health. A body of evidence suggests that a strong primary care system may mitigate this negative association. The aim of this study is to assess the strength of the primary care system's effect on the inverse association between income inequality and health in Europe. Health is operationalised using four cross-sectional outcomes: self-rated health, life expectancy, mental well-being, and infant mortality. Strength of the primary care system is measured using the framework of the Primary Health Care Activity Monitor Europe, and income inequality by the Gini coefficient. Multiple regression models with interaction terms were used. The results confirm that especially the structure and continuity dimension of primary care strength can buffer the inverse association between income inequality and health. European policymakers should therefore focus on strengthening primary care systems in order to reduce inequity in health.

Bring out your dead!: A study of income inequality and life expectancy in the United States, 2000-2010

We test whether income inequality undermines female and male life expectancy in the United States. We employ data for all 50 states and the District of Columbia and two-way fixed effects to model state-level average life expectancy as a function of multiple income inequality measures and time-varying characteristics. We find that state-level income inequality is inversely associated with female and male life expectancy. We observe this general pattern across four measures of income inequality and under the rigorous conditions of state-specific and year-specific fixed effects. If income inequality undermines life expectancy, redistribution policies could actually improve the health of states.

The mediating role of social capital in the association between neighbourhood income inequality and body mass index

Background

Neighbourhood income inequality may contribute to differences in body weight. We explored whether neighbourhood social capital mediated the association of neighbourhood income inequality with individual body mass index (BMI).

Methods

A total of 4126 adult participants from 48 neighbourhoods in France, Hungary, the Netherlands and the UK provided information on their levels of income, perceptions of neighbourhood social capital and BMI. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. Neighbourhood income inequality was defined as the ratio of the amount of income earned by the top 20% and the bottom 20% in a given neighbourhood. Two single mediation analyses-using multilevel linear regression analyses-with neighbourhood social networks and neighbourhood social cohesion as possible mediators-were conducted using MacKinnon's product-of-coefficients method, adjusted for age, gender, education and absolute household income.

Results

Higher neighbourhood income inequality was associated with elevated levels of BMI and lower levels of neighbourhood social networks and neighbourhood social cohesion. High levels of neighbourhood social networks were associated with lower BMI. Results stratified by country demonstrate that social networks fully explained the association between income inequality and BMI in France and the Netherlands. Social cohesion was only a significant mediating variable for Dutch participants.

Conclusion

The results suggest that in some European urban regions, neighbourhood social capital plays a large role in the association between neighbourhood income inequality and individual BMI.

Socioeconomic status, health inequalities and non-communicable diseases: a systematic review

AIM

A comprehensive approach to health highlights its close relationship with the social and economic conditions, physical environment and individual lifestyles. However, this relationship is not exempt from methodological problems that may bias the establishment of direct effects between the variables studied. Thus, further research is necessary to investigate the role of socioeconomic variables, their composition and distribution according to health status, particularly on non-communicable diseases.

SUBJECTS AND METHODS

To shed light on this field, here a systematic review is performed using PubMed, the Cochrane Library and Web of Science. A 7-year retrospective horizon was considered until 21 July 2017.

RESULTS

Twenty-six papers were obtained from the database search. Additionally, results from "hand searching" were also included, where a wider horizon was considered. Five of the 26 studies analyzed used aggregated data compared to 21 using individual data. Eleven considered income as a study variable, while 17 analyzed the effect of income inequality on health status (2 of the studies considered both the absolute level and distribution of income). The most used indicator of inequality in the literature was the Gini index.

CONCLUSION

Although different types of analysis produce very different results concerning the role of health determinants, the general conclusion is that income distribution is related to health where it represents a measure of the differences in social class in the society. The effect of income inequality is to increase the gap between social classes or to widen differences in status.

Mortality rates in OECD countries converged during the period 1990-2010

AIMS

Since the scientific revolution of the 18th century, human health has gradually improved, but there is no unifying theory that explains this improvement in health. Studies of macrodeterminants have produced conflicting results. Most studies have analysed health at a given point in time as the outcome; however, the rate of improvement in health might be a more appropriate outcome.

METHODS

Twenty-eight OECD member countries were selected for analysis in the period 1990-2010. The main outcomes studied, in six age groups, were the national rates of decrease in mortality in the period 1990-2010. The effects of seven potential determinants on the rates of decrease in mortality were analysed in linear multiple regression models using least squares, controlling for country-specific history constants, which represent the mortality rate in 1990.

RESULTS

The multiple regression analyses started with models that only included mortality rates in 1990 as determinants. These models explained 87% of the intercountry variation in the children aged 1-4 years and 51% in adults aged 55-74 years. When added to the regression equations, the seven determinants did not seem to significantly increase the explanatory power of the equations.

CONCLUSIONS

The analyses indicated a decrease in mortality in all nations and in all age groups. The development of mortality rates in the different nations demonstrated significant catch-up effects. Therefore an important objective of the national public health sector seems to be to reduce the delay between international research findings and the universal implementation of relevant innovations.

Equity and length of lifespan are not the same

Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries

Background

Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities.

Methods

We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35–79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality.

Results

The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance.

Conclusions

We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-016-0390-0) contains supplementary material, which is available to authorized users.

Neighborhood Predictors of Mammography Barriers Among US-Based Latinas

BACKGROUND

Little is known about how neighborhood factors are associated with Latinas' barriers to cancer screening, including mammography. To address this gap, we examined barriers to mammography by neighborhood racial/ethnic composition and socioeconomic status among a federally qualified health center (FQHC)-based sample of non-adherent Latinas in Western Washington State.

METHODS

Baseline data were drawn from a larger intervention study (n = 536 Latinas). Women indicated why they had not obtained a mammogram in the past 2 years (no reason, knowledge, psychocultural, economic). American Community Survey (2007-2011) data were used to calculate four neighborhood measures that were categorized in tertiles (T): socioeconomic-based concentration, socioeconomic-based segregation, Latino-based concentration, and Latino-based segregation.

RESULTS

The proportion of women reporting knowledge-, psychocultural-, and economic-based reasons for not obtaining mammograms in the past 2 years was, respectively, 0.35, 0.19, and 0.31. Approximately 14 % indicated no particular reason. Relative to women residing in areas with greater Latino-based segregation, women in areas with less Latino-based segregation were less likely to report knowledge-based and economic-based reasons for not obtaining a mammogram (p ≤ 0.05). Relative to women residing in areas with greater concentration of Latinos, women in areas with the lowest concentrations were less likely to report knowledge-based reasons for not obtaining a mammogram (p ≤ 0.05).

CONCLUSIONS

Our findings provide important information about the role of neighborhood characteristics and mammography use among Latinas obtaining care from FQHCs. Future research might examine the mediating role of neighborhood characteristics in the efficacy of mammography screening interventions.