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Rajkumar RP. The association between nation-level social and economic indices and suicide rates: A pilot study. FRONTIERS IN SOCIOLOGY 2023; 8:1123284. [PMID: 37066069 PMCID: PMC10102579 DOI: 10.3389/fsoc.2023.1123284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.
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Benny C, Smith BT, Hyshka E, Senthilselvan A, Veugelers PJ, Pabayo R. Investigating the association between income inequality in youth and deaths of despair in Canada: a population-based cohort study from 2006 to 2019. J Epidemiol Community Health 2022; 77:jech-2022-219630. [PMID: 36323502 DOI: 10.1136/jech-2022-219630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Deaths due to suicide, drug overdose and alcohol-related liver disease, collectively known as 'deaths of despair', have been markedly increasing since the early 2000s and are especially prominent in young Canadians. Income inequality has been linked to this rise in deaths of despair; however, this association has not yet been examined in a Canadian context, nor at the individual level or in youth. The study objective was to examine the association between income inequality in youth and deaths of despair among youth over time. METHODS We conducted a population-based longitudinal study of Canadians aged 20 years or younger using data from the Canadian Census Health and Environment Cohorts. Baseline data from the 2006 Canadian Census were linked to the Canadian Vital Statistics Database up to 2019. We employed multilevel survival analysis models to quantify the association between income inequality in youth and time-to deaths of despair. RESULTS The study sample included 1.5 million Canadians, representing 7.7 million Canadians between the ages of 0 and 19 at baseline. Results from the weighted, adjusted multilevel survival models demonstrated that income inequality was associated with an increased hazard of deaths of despair (adjusted HR (AHR) 1.35; 95% CI 1.04 to 1.75), drug overdose (AHR 2.38; 95% CI 1.63 to 3.48) and all-cause deaths (AHR 1.10; 95% CI 1.04 to 1.18). Income inequality was not significantly associated with suicide deaths (AHR 1.23, 95% CI 0.93 to 1.63). CONCLUSION The results show that higher levels of income inequality in youth are associated with an increased hazard of all-cause death, deaths of despair and drug overdose in young Canadians. This study is the first to reveal the association between income inequality and deaths of despair in youth and does so using a population-based longitudinal cohort involving multilevel data. The results of this study can inform policies related to income inequality and deaths of despair in Canada.
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Affiliation(s)
- Claire Benny
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | | | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Centre for Healthy Communities, University of Alberta School of Public Health, Edmonton, Alberta, Canada
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Effect of Income Inequality on Health in Quebec: New Insights from Panel Data. SUSTAINABILITY 2019. [DOI: 10.3390/su11205700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the relationship between income inequality and all-cause mortality in 87 regional county municipalities (RCMs) of Quebec (Canada) while accounting for time lags and effects of other socioeconomic variables. We presumed to be true that income inequality entails stress and depression. Thus, these phenomena were tested as mediating factors. The data used consist of eight (8) area-based chronological variables: mortality rate, Gini index, disposable income, criminality rate, number of physicians, density of population, and the proportion of people reporting feeling stressed or depressed. The association between income inequality and mortality was analyzed using the generalized method of moments (GMM) approach with local fixed effects to control unobservable characteristics. Our results show that higher income inequality led to a significant increase of mortality rate with a time lag of 5 years when socioeconomic characteristics were held constant. As expected, households’ disposable income and mortality rate were negatively associated. Moreover, mortality rate was positively associated with population density and negatively associated with the number of physicians. Finally, only depression showed the potential to act as a mediating factor. Based on our findings, we suggest that, over time, income inequality, by amplifying depression phenomena, increases the mortality rate in Quebec’s RCMs.
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Kazemi-Galougahi MH, Mansouri A, Akbarpour S, Bakhtiyari M, Sartipi M, Moradzadeh R. Income-related inequality in completed suicide across the provinces of Iran. Epidemiol Health 2018; 40:e2018012. [PMID: 29642654 PMCID: PMC6004429 DOI: 10.4178/epih.e2018012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/31/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this study was to measure income-related inequality in completed suicide across the provinces of Iran. METHODS This ecological study was performed using data from the Urban and Rural Household Income and Expenditure Survey-2010 conducted by the Iranian Center of Statistics, along with data on completed suicide from the Iranian Legal Medicine Organization in 2012. We calculated the Gini coefficient of per capita income and the completed suicide rate, as well as the concentration index for per capita income inequality in completed suicide, across the provinces of Iran. RESULTS The Gini coefficients of per capita income and the completed suicide rate in the provinces of Iran were 0.10 (95% confidence interval [CI], 0.06 to 0.13) and 0.34 (95% CI, 0.21 to 0.46), respectively. We found a trivial decreasing trend in the completed suicide incidence rate according to income quintile. The poorest-to-richest ratio in the completed suicide rate was 2.01 (95% CI, 1.26 to 3.22). The concentration index of completed suicide in the provinces of Iran was -0.12 (95% CI, -0.30 to 0.06). CONCLUSIONS This study found that lower income might be considered as a risk factor for completed suicide. Nonetheless, further individual studies incorporating multivariable analysis and repeated cross-sectional data would allow a more fine-grained analysis of this phenomenon.
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Affiliation(s)
| | - Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samaneh Akbarpour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Bakhtiyari
- Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Majid Sartipi
- Department of Epidemiology and Biostatistics, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Rahmatollah Moradzadeh
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
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Fan JX, Wen M, Kowaleski-Jones L. Tract- and county-level income inequality and individual risk of obesity in the United States. SOCIAL SCIENCE RESEARCH 2016; 55:75-82. [PMID: 26680289 PMCID: PMC4684591 DOI: 10.1016/j.ssresearch.2015.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/16/2015] [Accepted: 09/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES We tested three alternative hypotheses regarding the relationship between income inequality and individual risk of obesity at two geographical scales: U.S. Census tract and county. METHODS Income inequality was measured by Gini coefficients, created from the 2000 U.S. Census. Obesity was clinically measured in the 2003-2008 National Health and Nutrition Examination Survey (NHANES). The individual measures and area measures were geo-linked to estimate three sets of multi-level models: tract only, county only, and tract and county simultaneously. Gender was tested as a moderator. RESULTS At both the tract and county levels, higher income inequality was associated with lower individual risk of obesity. The size of the coefficient was larger for county-level Gini than for tract-level Gini; and controlling income inequality at one level did not reduce the impact of income inequality at the other level. Gender was not a significant moderator for the obesity-income inequality association. CONCLUSIONS Higher tract and county income inequality was associated with lower individual risk of obesity, indicating that at least at the tract and county levels and in the context of cross-sectional data, the public health goal of reducing the rate of obesity is in line with anti-poverty policies of addressing poverty through mixed-income development where neighborhood income inequality is likely higher than homogeneous neighborhoods.
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Affiliation(s)
- Jessie X Fan
- Department of Family and Consumer Studies, University of Utah, 225 S 1400 E, AEB 228, Salt Lake City, UT 84112-0080, USA.
| | - Ming Wen
- Department of Sociology, University of Utah, 380 S 1530 E, Rm 301, Salt Lake City, UT 84112-0250, USA.
| | - Lori Kowaleski-Jones
- Department of Family and Consumer Studies, University of Utah, 225 S 1400 E, AEB 228, Salt Lake City, UT 84112-0080, USA.
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Park J, Ryu SY, Han MA, Choi SW. The association between income inequality and all-cause mortality across urban communities in Korea. BMC Public Health 2015; 15:574. [PMID: 26092295 PMCID: PMC4474447 DOI: 10.1186/s12889-015-1924-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Korea has achieved considerable economic growth more rapidly than most other countries, but disparities in income level have increased. Therefore, we sought to assess the association between income inequality and mortality across Korean cities. METHODS Data on household income were obtained from the 2010-2012 Korean Community Health Survey and data on all-cause mortality and other covariates were obtained from the Korean Statistical Information Service. The Gini coefficient, Robin Hood index, and income share ratio between the 80th and 20th percentiles of the distribution were measured for each community. After excluding communities affected by changes in administrative districts between 2010 and 2012, a total of 157 communities and 172,398 urban residents were included in the analysis. RESULTS When we graphed income inequality measures versus all-cause mortality as scatter plots, the R square values of the regression lines for GC, RHI, and 80/20 ratios relative to mortality were 0.230, 0.238, and 0.152, respectively. After adjusting for other covariates and median household income, mean all-cause mortality increased significantly with increasing GC (P for trend = 0.014) and RHI (P for trend = 0.031), and increased marginally with 80/20 ratio (P for trend = 0.067). CONCLUSIONS Our data demonstrate that income inequality measures are significantly associated with all-cause mortality rate after adjustment for covariates, including median household income across urban communities in Korea.
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Affiliation(s)
- Jong Park
- Department of Preventive Medicine, Chosun University Medical School, 309, Pilmun-daero, Gwangju, 501-759, Republic of Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, 309, Pilmun-daero, Gwangju, 501-759, Republic of Korea
| | - Mi-ah Han
- Department of Preventive Medicine, Chosun University Medical School, 309, Pilmun-daero, Gwangju, 501-759, Republic of Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, 309, Pilmun-daero, Gwangju, 501-759, Republic of Korea.
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Spence ND. Does Social Context Matter? Income Inequality, Racialized Identity, and Health Among Canada's Aboriginal Peoples Using a Multilevel Approach. J Racial Ethn Health Disparities 2015; 3:21-34. [PMID: 26896102 DOI: 10.1007/s40615-015-0108-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/01/2015] [Accepted: 03/16/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Debates surrounding the importance of social context versus individual level processes have a long history in public health. Aboriginal peoples in Canada are very diverse, and the reserve communities in which they reside are complex mixes of various cultural and socioeconomic circumstances. The social forces of these communities are believed to affect health, in addition to individual level determinants, but no large scale work has ever probed their relative effects. One aspect of social context, relative deprivation, as indicated by income inequality, has greatly influenced the social determinants of health landscape. An investigation of relative deprivation in Canada's Aboriginal population has never been conducted. This paper proposes a new model of Aboriginal health, using a multidisciplinary theoretical approach that is multilevel. METHODS This study explored the self-rated health of respondents using two levels of determinants, contextual and individual. Data were from the 2001 Aboriginal Peoples Survey. There were 18,890 Registered First Nations (subgroup of Aboriginal peoples) on reserve nested within 134 communities. The model was assessed using a hierarchical generalized linear model. RESULTS There was no significant variation at the contextual level. Subsequently, a sequential logistic regression analysis was run. With the sole exception culture, demographics, lifestyle factors, formal health services, and social support were significant in explaining self-rated health. CONCLUSIONS The non-significant effect of social context, and by extension relative deprivation, as indicated by income inequality, is noteworthy, and the primary role of individual level processes, including the material conditions, social support, and lifestyle behaviors, on health outcomes is illustrated. It is proposed that social structure is best conceptualized as a dynamic determinant of health inequality and more multilevel theoretical models of Aboriginal health should be developed and tested.
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Affiliation(s)
- Nicholas D Spence
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, T6G1C9, Canada.
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Craig SL, Bejan R, Muskat B. Making the invisible visible: are health social workers addressing the social determinants of health? SOCIAL WORK IN HEALTH CARE 2013; 52:311-331. [PMID: 23581836 DOI: 10.1080/00981389.2013.764379] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study explored the ways in which health social workers (HSW) address the social determinants of health (SDH) within their social work practice. Social workers (n = 54) employed at major hospitals across Toronto had many years of practice in health care (M = 11 years; SD = 10.32) and indicated that SDH were a top priority in their daily work; with 98% intentionally intervening with at least one and 91% attending to three or more. Health care services were most often addressed (92%), followed by housing (72%), disability (79%), income (72%), and employment security (70%). Few HSW were tackling racism, Aboriginal status, gender, or social exclusion in their daily practice.
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Affiliation(s)
- Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
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Bando DH, Brunoni AR, Benseñor IM, Lotufo PA. Suicide rates and income in São Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008. BMC Psychiatry 2012; 12:127. [PMID: 22928689 PMCID: PMC3502157 DOI: 10.1186/1471-244x-12-127] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 08/16/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of São Paulo (SP), and City of SP, considering geographical area and temporal trends. METHODS Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. RESULTS Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). CONCLUSIONS Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted.
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Affiliation(s)
- Daniel H Bando
- Doctoral Program of Sciences, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Andre R Brunoni
- Doctoral Program of Sciences, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil,Department of Neurosciences and Behavior, Instituto de Psicologia, University of São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Doctoral Program of Sciences, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil,Clinical and Epidemiological Research Center, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Doctoral Program of Sciences, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil,Clinical and Epidemiological Research Center, Hospital Universitário, University of São Paulo, São Paulo, Brazil,Clinical and Epidemiological Research Center, Hospital Universitário, Av Lineu Prestes 2565, 3° andar – Centro de Pesquisas Clínicas, Cidade Universitária, São Paulo, SP, Brazil
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Belon AP, Barros MB, Marín-León L. Mortality among adults: gender and socioeconomic differences in a Brazilian city. BMC Public Health 2012; 12:39. [PMID: 22251614 PMCID: PMC3328284 DOI: 10.1186/1471-2458-12-39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 01/17/2012] [Indexed: 11/10/2022] Open
Abstract
Background Population groups living in deprived areas are more exposed to several risk factors for diseases and injuries and die prematurely when compared with their better-off counterparts. The strength and patterning of the relationships between socioeconomic status and mortality differ depending on age, gender, and diseases or injuries. The objective of this study was to identify the magnitude of social differences in mortality among adult residents in a city of one million people in Southeastern Brazil in 2004-2008. Methods Forty-nine health care unit areas were classified into three homogeneous strata using 2000 Census small-area socioeconomic indicators. Mortality rates by age group, sex, and cause of death were calculated for each socioeconomic stratum. Mortality rate ratios (RR) and 95% confidence intervals were estimated for the low and middle socioeconomic strata compared with the high stratum. Results In general, age-specific mortality rates showed a social gradient of increasing risks of death with decreasing socioeconomic status. The highest mortality rate ratios between low and high strata were observed in the 30-39 age group for males (RR = 1.74, 95% CI 1.59-1.89), and females (RR = 1.90, 95% CI 1.65-2.15). Concerning specific diseases and injuries, the greatest inequalities between low and high strata were found for homicides (RR = 2.44, 95% CI 2.27-2.61) and traffic accidents (RR = 1.64, 95% CI 1.45-1.83) among males. For women, the highest inequalities between the low and high strata were for chronic respiratory diseases (RR = 2.19, 95% CI 1.94-2.45) and acute myocardial infarction (RR = 1.93, 95% CI 1.79-2.07). Only breast cancer showed a reversed social gradient (RR = 0.70, 95% CI 0.48-0.92). Inequalities in circulatory and respiratory diseases mortality were greater among females than among males. Conclusions Substandard living conditions are related to unhealthy behaviors, as well as difficulties in accessing health care. Therefore, the Brazilian Health System (SUS) must ensure greater access to primary and hospital care, and develop programs that promote healthier lifestyles among vulnerable groups to reduce social inequalities in mortality. Moreover, because deaths from external causes are concentrated in poor areas, cooperative and coordinated intersectoral actions should be taken to combat the deadly violence cycle.
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Affiliation(s)
- Ana Paula Belon
- Department of Collective Health, School of Medical Sciences, State University of Campinas, São Paulo, Brazil.
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Elstad JI. Does the socioeconomic context explain both mortality and income inequality? Prospective register-based study of Norwegian regions. Int J Equity Health 2011; 10:7. [PMID: 21291530 PMCID: PMC3041666 DOI: 10.1186/1475-9276-10-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/03/2011] [Indexed: 11/12/2022] Open
Abstract
Background Studies from various countries have observed worse population health in geographical areas with more income inequality. The psychosocial interpretation of this association is that large income disparities are harmful to health because they generate relative deprivation and undermine social cohesion. An alternative explanation contends that the association between income inequality and ill health arises because the underlying social and economic structures will influence both the level of illness and disease and the size of income differences. This paper examines whether the observed association between mortality and income inequality in Norwegian regions can be accounted for by the socioeconomic characteristics of the regions. Methods Norwegian register data covering the entire population were utilised. An extensive set of contextual and individual predictors were included in multilevel Poisson regression analyses of mortality 1994-2003 among 1.6 millions individuals born 1929-63, distributed across 35 residential regions. Results Mean income, composition of economic branches, and percentage highly educated in the regions were clearly connected to the level of income inequality. These social and economic characteristics of the regions were also markedly related to regional mortality levels, after adjustment for population composition, i.e., the individual-level variables. Moreover, regional mortality was significantly higher in regions with larger income disparities. The regions' social and economic structure did not, however, account for the association between regional income inequality and mortality. A distinct independent effect of income inequality on mortality remained after adjustment for regional-level social and economic characteristics. Conclusions The results indicate that the broader socioeconomic context in Norwegian regions has a substantial impact both on mortality and on the level of income disparities. However, the results also suggest, in a way compatible with the psychosocial interpretation, that on top of the general socioeconomic influences, a higher level of income inequality adds independently to higher mortality levels. Previous publication This article is a reworked version of the study 'Er inntektsforskjeller dødelige?' [Are income inequalities lethal?] which was published in Norwegian in Tidsskrift for velferdsforskning [Journal for welfare research], Vol. 13 (4), 2010.
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Auger N, Alix C, Zang G, Daniel M. Sex, age, deprivation and patterns in life expectancy in Quebec, Canada: a population-based study. BMC Public Health 2010; 10:161. [PMID: 20338059 PMCID: PMC2859396 DOI: 10.1186/1471-2458-10-161] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 03/25/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research has evaluated disparities in life expectancy according to material deprivation taking into account differences across the lifespan between men and women. This study investigated age- and sex-specific life expectancy differentials related to area-level material deprivation for the province of Québec, Canada from 1989-2004. METHODS Age- and sex-specific life expectancy across the lifespan was calculated for three periods (1989-1992, 1995-1998, and 2001-2004) for the entire Québec population residing in 162 community groupings ranked according to decile of material deprivation. Absolute and relative measures were calculated to summarize differences between the most and least deprived deciles. RESULTS Life expectancy differentials between the most and least deprived deciles were greatest for men. Over time, male differentials increased for age 20 or more, with little change occurring at younger ages. For women, differentials increased across the lifespan and were comparable to men at advanced ages. Despite gains in life expectancy among men relative to women, differentials between men and women were greater for most deprived relative to least deprived deciles. CONCLUSIONS Similar to the US, differentials in life expectancy associated with area-level material deprivation increased steadily in Québec from 1989-2004 for males and females of all ages. Differentials were comparable between men and women at advanced ages. Previous research indicating that life expectancy differentials between most and least deprived areas are greater in men may be due to a focus on younger age groups.
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Affiliation(s)
- Nathalie Auger
- Études et analyses de l'état de santé de la population, Institut national de santé publique du Québec, Montréal, Québec, Canada
- Research Centre of the University of Montreal Hospital Centre, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada
| | - Carolyne Alix
- Études et analyses de l'état de santé de la population, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Geng Zang
- Research Centre of the University of Montreal Hospital Centre, Montréal, Québec, Canada
| | - Mark Daniel
- Research Centre of the University of Montreal Hospital Centre, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada
- School of Health Sciences, University of South Australia, Adelaide, Australia
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Burrows S, Auger N, Roy M, Alix C. Socio-economic inequalities in suicide attempts and suicide mortality in Québec, Canada, 1990-2005. Public Health 2010; 124:78-85. [PMID: 20181370 DOI: 10.1016/j.puhe.2010.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 11/30/2009] [Accepted: 01/13/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Little research has evaluated changes in the association between area deprivation and suicidal behaviour over time. This study investigated patterns in suicide attempts and suicide mortality according to material deprivation in the province of Québec, Canada between 1990 and 2005. STUDY DESIGN Ecological analysis. METHODS Data on suicide attempts were extracted from the hospital discharge summary database (n=47,516) and data on suicides were extracted from the Québec death file (n=20,851). Gender- and age-specific (10-24, 25-44, 45-64 and > or = 65 years) suicide attempt and mortality rates were calculated for four time periods (1990-1993, 1994-1997, 1998-2001 and 2002-2005) for the entire Québec population aged 10 years and older residing in 162 communities ranked by decile of material deprivation. Absolute and relative measures of inequality were calculated to summarize differences between the most and least materially deprived areas. Commonly used methods of suicidal behaviour were examined. RESULTS Differentials in suicide attempt hospitalization between the most and least deprived areas were present for all age groups, and these decreased slightly among males and increased among females over time. Inequalities in suicide attempts were greatest among young adults (age 25-44 years) for both genders, and were smallest among the elderly (> or = 65 years). For suicide mortality, differentials increased among females but not males; these differentials were greatest among males and 25-44 year olds, and smallest among the elderly. Differentials in commonly used methods were evident for poisoning hospitalizations in both genders and for hanging deaths among males. CONCLUSIONS In Québec, differences in suicide attempts and mortality between the most and least materially deprived areas persisted or even increased over time. Inequalities were more pronounced for suicide attempts than for suicide mortality, and were greatest among adults of working age. Strategies to reduce socio-economic differences in suicidal behaviour may be important.
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Affiliation(s)
- S Burrows
- Research Centre of the University of Montreal Hospital Centre, 1301 rue Sherbrooke Est, Montréal, Québec, H2L 1M3, Canada. stephanie.burrows. [corrected]
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