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Irish AJ. State-Level Income Inequality as a Determinant of Suicide Mortality in the United States. SOCIAL WORK 2024; 69:339-346. [PMID: 39079045 DOI: 10.1093/sw/swae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 09/21/2024]
Abstract
Income inequality has been increasing for decades and is now known to be related to many downstream health outcomes, where greater inequality is a predictor of poorer health. Results of investigations into the relationship between income inequality and suicidality have been mixed. This study leverages the most recent data available from the National Longitudinal Mortality Study to investigate the relationship between state-level income inequality and suicide mortality. A series of rigorously controlled logistic regression models, employing multiple measures of inequality, and various suicide mortality case-control specifications are used to investigate the phenomenon. Results indicate that the odds of suicide mortality increase with inequality, and this result is invariant across all models. A reduction in the Gini coefficient from the highest to lowest values of income inequality observed in U.S. states may reduce the odds of suicide mortality by 20 percent to 55 percent or more. Findings have application for social workers and other mental health professionals with respect to clinical assessment and treatment. Likewise, community organizers, policy advocates, and legislators should be aware that policy solutions reducing income inequality in the United States are a mechanism for alleviating the suicide mortality burden.
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Akyuz M. The Impact of Social Expenditure on Sustainable Human Development: Empirical Evidence on the Suicide Deaths in a Developing Country. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241287816. [PMID: 39332824 DOI: 10.1177/00302228241287816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
Suicide has been a serious international public mental health problem and is one of the top twenty leading causes of death worldwide. This study aims to investigate the impact of social expenditure on suicide deaths in Turkiye as a developing country from 1982 to 2019. The Bounds Testing Approach to Cointegration and Autoregressive Distributed Lag (ARDL) methods were used. The results indicated that social expenditure has a statistically significant and negative effect on total suicide and female suicide deaths, but it has a statistically insignificant and negative impact on male suicide death. The contribution of this study is to examine for the first time whether social expenditure has an impact on total, female, and male suicide mortality in Turkiye. Policymakers should regard increasing social spending in the government budget to prevent suicide deaths in Turkiye.
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Affiliation(s)
- Mert Akyuz
- Department of Economics, Ankara Yildirim Beyazit University, Ankara, Turkey
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Gobaud AN, Morrison CN, Branas CC, Jacoby S, Kramer M, Adkins-Jackson PB. Measuring the effect of historical structural racism on community firearm violence in US cities. Soc Sci Med 2024; 361:117355. [PMID: 39321665 DOI: 10.1016/j.socscimed.2024.117355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/05/2024] [Accepted: 09/18/2024] [Indexed: 09/27/2024]
Affiliation(s)
- Ariana N Gobaud
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St Room 502, New York, NY, 10032, USA.
| | - Christopher N Morrison
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St Room 502, New York, NY, 10032, USA; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Charles C Branas
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St Room 502, New York, NY, 10032, USA
| | - Sara Jacoby
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Paris B Adkins-Jackson
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St Room 502, New York, NY, 10032, USA
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Sinyor M, Silverman M, Pirkis J, Hawton K. The effect of economic downturn, financial hardship, unemployment, and relevant government responses on suicide. Lancet Public Health 2024:S2468-2667(24)00152-X. [PMID: 39265607 DOI: 10.1016/s2468-2667(24)00152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 09/14/2024]
Abstract
Economic circumstances and related factors, including unemployment and poverty, can have substantial effects on suicide rates. This relationship applies in all countries, irrespective of their World Bank income status or level of development. Therefore, means of mitigating such influences are essential components of strategies to reduce suicides. In this Series paper, we consider examples of such initiatives, including national policies to try to reduce the effect of economic downturns, efforts to maintain employment and avoid damaging austerity measures, maintenance of reasonable minimum wage levels, and specific policies to assist those most affected by poverty. We also highlight upstream measures such as investment in transport infrastructure, industries, and retraining programmes. Positive public health messaging that encourages coping, together with discouragement of media stories with messages that could contribute to hopelessness in those experiencing economic difficulties, can also be important components of strategies to try to reduce the effect of economic downturn on suicide.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Morton Silverman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK.
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SHIMONOVICH MICHAL, CAMPBELL MHAIRI, THOMSON RACHELM, BROADBENT PHILIP, WELLS VALERIE, KOPASKER DANIEL, McCARTNEY GERRY, THOMSON HILARY, PEARCE ANNA, KATIKIREDDI SVITTAL. Causal Assessment of Income Inequality on Self-Rated Health and All-Cause Mortality: A Systematic Review and Meta-Analysis. Milbank Q 2024; 102:141-182. [PMID: 38294094 PMCID: PMC10938942 DOI: 10.1111/1468-0009.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 02/01/2024] Open
Abstract
Policy Points Income is thought to impact a broad range of health outcomes. However, whether income inequality (how unequal the distribution of income is in a population) has an additional impact on health is extensively debated. Studies that use multilevel data, which have recently increased in popularity, are necessary to separate the contextual effects of income inequality on health from the effects of individual income on health. Our systematic review found only small associations between income inequality and poor self-rated health and all-cause mortality. The available evidence does not suggest causality, although it remains methodologically flawed and limited, with very few studies using natural experimental approaches or examining income inequality at the national level. CONTEXT Whether income inequality has a direct effect on health or is only associated because of the effect of individual income has long been debated. We aimed to understand the association between income inequality and self-rated health (SRH) and all-cause mortality (mortality) and assess if these relationships are likely to be causal. METHODS We searched Medline, ISI Web of Science, Embase, and EconLit (PROSPERO: CRD42021252791) for studies considering income inequality and SRH or mortality using multilevel data and adjusting for individual-level socioeconomic position. We calculated pooled odds ratios (ORs) for poor SRH and relative risk ratios (RRs) for mortality from random-effects meta-analyses. We critically appraised included studies using the Risk of Bias in Nonrandomized Studies - of Interventions tool. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework and causality using Bradford Hill (BH) viewpoints. FINDINGS The primary meta-analyses included 2,916,576 participants in 38 cross-sectional studies assessing SRH and 10,727,470 participants in 14 cohort studies of mortality. Per 0.05-unit increase in the Gini coefficient, a measure of income inequality, the ORs and RRs (95% confidence intervals) for SRH and mortality were 1.06 (1.03-1.08) and 1.02 (1.00-1.04), respectively. A total of 63.2% of SRH and 50.0% of mortality studies were at serious risk of bias (RoB), resulting in very low and low certainty ratings, respectively. For SRH and mortality, we did not identify relevant evidence to assess the specificity or, for SRH only, the experiment BH viewpoints; evidence for strength of association and dose-response gradient was inconclusive because of the high RoB; we found evidence in support of temporality and plausibility. CONCLUSIONS Increased income inequality is only marginally associated with SRH and mortality, but the current evidence base is too methodologically limited to support a causal relationship. To address the gaps we identified, future research should focus on income inequality measured at the national level and addressing confounding with natural experiment approaches.
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Affiliation(s)
- MICHAL SHIMONOVICH
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - MHAIRI CAMPBELL
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - RACHEL M. THOMSON
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - PHILIP BROADBENT
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - VALERIE WELLS
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - DANIEL KOPASKER
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - GERRY McCARTNEY
- School of Social and Political SciencesUniversity of Glasgow
| | - HILARY THOMSON
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - ANNA PEARCE
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - S. VITTAL KATIKIREDDI
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
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Reynolds MM, Homan PA. Income Support Policy Packages and Birth Outcomes in U.S. States: An Ecological Analysis. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:73. [PMID: 38213513 PMCID: PMC10783327 DOI: 10.1007/s11113-023-09797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/09/2023] [Indexed: 01/13/2024]
Abstract
Research suggests that generous social welfare programs play a role in maternal and child health. However, most studies examine a single policy in isolation. Drawing from research documenting low-income families 'packaging' of social policies, we create a novel measure summarizing the value of a collection of income support policies for the working poor. This collection includes: the Supplemental Nutrition Assistance Program (SNAP), the Earned Income Tax Credit (EITC), the minimum wage, and the unemployment insurance (UI) program. Using U.S. state-level administrative data from 1996 to 2014, we estimate fixed effects regression models to examine the relationship between birth outcomes and income support policies (individually and combined). We find that increases in the combined value of the four income supports are significantly associated with reductions in preterm births and low birthweight births, but not infant mortality rates. States with the highest observed levels of combined income support had 14% fewer PTBs and 7% fewer LBWs than states with the lowest levels of income support. Of the four individual income support policies, only unemployment insurance has no significant independent effects. SNAP benefits have the largest and most consistent effects, reducing poor birth outcomes across all three indicators. An annual increase of $1000 in SNAP benefits is associated with a 3% decline in infant deaths, 5% decline in preterm births, and 2% decline in low birthweight births. These results suggest that increasing the generosity of income support policies may be a promising strategy for improving birth outcomes in the United States.
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Affiliation(s)
- Megan M. Reynolds
- Department of Sociology, University of Utah, Salt Lake City, UT 84121, USA
| | - Patricia A. Homan
- Department of Sociology, Center for Demography and Population Health, Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL 32306, USA
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Rowhani-Rahbar A, Schleimer JP, Moe CA, Rivara FP, Hill HD. Income support policies and firearm violence prevention: A scoping review. Prev Med 2022; 165:107133. [PMID: 35803348 PMCID: PMC10117288 DOI: 10.1016/j.ypmed.2022.107133] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 01/28/2023]
Abstract
Firearm violence is a major threat to global public health and safety. Several individual, family, peer, community, and societal risk and protective factors determine or modify the risk of firearm violence. Specifically, there is a strong relationship between poverty, income inequality, and firearm violence; as such, interventions that influence upstream determinants of health by providing income support may hold much promise in affecting multiple domains of risk that are on the causal pathway to firearm violence. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, we conducted a scoping review to examine the current state of evidence on the relationship between income support policies and risk of firearm violence. We searched 8 databases related to health and social sciences from inception through March 30, 2022, and placed no time, language, setting, or other publication restrictions on our search, as long as the study was quantitative or mixed-methods and addressed firearm violence specifically, rather than violence more broadly, as an outcome in relation to income support policies. We found 4 studies; of those, 3 were conducted in the United States and 1 in Brazil. All 4 found associations of policy-relevant magnitude between income support policies and reductions in risk of inter-personal firearm violence. We propose future opportunities to enhance the substantive scope and methodologic rigor of this field of research and inform policy and practice for greater impact.
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Affiliation(s)
- Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, USA; Firearm Injury & Policy Research Program, University of Washington, USA; Daniel J. Evans School of Public Policy & Governance, University of Washington, USA.
| | - Julia P Schleimer
- Department of Epidemiology, School of Public Health, University of Washington, USA; Firearm Injury & Policy Research Program, University of Washington, USA
| | - Caitlin A Moe
- Department of Epidemiology, School of Public Health, University of Washington, USA; Firearm Injury & Policy Research Program, University of Washington, USA
| | - Frederick P Rivara
- Department of Epidemiology, School of Public Health, University of Washington, USA; Firearm Injury & Policy Research Program, University of Washington, USA
| | - Heather D Hill
- Daniel J. Evans School of Public Policy & Governance, University of Washington, USA
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Rodríguez-García MJ, Navarro-Yáñez CJ, Zapata-Moya ÁR. Local Welfare Systems and Health Inequalities: The Effects of Institutional Overlapping and Local Variations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15447. [PMID: 36497519 PMCID: PMC9739049 DOI: 10.3390/ijerph192315447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
A growing research agenda shows the importance of local welfare systems in understanding socio-spatial inequalities in health. Welfare services provided by local governments overlap with those provided by other levels of government. Thus, differences in the provision of welfare services between municipalities could explain differences in residents' health, moderating the magnitude of health inequalities if local governments deploy actions capable of positively influencing the social determinants of health. This article attempts to analyse this idea in the Spanish case, exploring the influence of local policies according to the orientation of municipal spending on three indicators of the population's health status: self-perceived health, healthy practices and activity limitations due to health problems. A multilevel cross-sectional study was designed using information from two waves of the 2006-2007 and 2011-2012 National Health Survey for the population aged 15 years and older (N = 31,378) residing in Spanish municipalities of 20,000 inhabitants or over (N = 373). The results show that the magnitude of inequalities in self-perceived health, in the adoption of healthy practices and in daily activity limitations by social class are smaller as municipalities" spending was oriented towards policy areas considered as redistributive. Therefore, the proposed institutional overlap thesis could help understand the role of subnational governments on the magnitude of health inequalities, as well as in comparative analysis between countries with institutional systems in which local governments have a greater or lesser capacity to provide welfare services.
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Schnake-Mahl AS, Mullachery PH, Purtle J, Li R, Diez Roux AV, Bilal U. Heterogeneity in Disparities in Life Expectancy Across US Metropolitan Areas. Epidemiology 2022; 33:890-899. [PMID: 36220582 PMCID: PMC9574908 DOI: 10.1097/ede.0000000000001537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Life expectancy in the United States has declined since 2014 but characterization of disparities within and across metropolitan areas of the country is lacking. METHODS Using census tract-level life expectancy from the 2010 to 2015 US Small-area Life Expectancy Estimates Project, we calculate 10 measures of total and income-based disparities in life expectancy at birth, age 25, and age 65 within and across 377 metropolitan statistical areas (MSAs) of the United States. RESULTS We found wide heterogeneity in disparities in life expectancy at birth across MSAs and regions: MSAs in the West show the narrowest disparities (absolute disparity: 8.7 years, relative disparity: 1.1), while MSAs in the South (absolute disparity: 9.1 years, relative disparity: 1.1) and Midwest (absolute disparity: 9.8 years, relative disparity: 1.1) have the widest life expectancy disparities. We also observed greater variability in life expectancy across MSAs for lower income census tracts (coefficient of variation [CoV] 3.7 for first vs. tenth decile of income) than for higher income census tracts (CoV 2.3). Finally, we found that a series of MSA-level variables, including larger MSAs and greater proportion college graduates, predicted wider life expectancy disparities for all age groups. CONCLUSIONS Sociodemographic and policy factors likely help explain variation in life expectancy disparities within and across metro areas.
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Affiliation(s)
- Alina S Schnake-Mahl
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Health Management and Policy, Drexel University, Philadelphia, PA
| | - Pricila H Mullachery
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York University School of Global Public Health, New York, NY
| | - Ran Li
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Ana V Diez Roux
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Usama Bilal
- From the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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Avanceña ALV, Miller N, Kim DeLuca E, Iott B, Mauri A, Eisenberg D, Hutton DW. Estimation of Potential Deaths Averted From Hypothetical US Income Support Policies. JAMA HEALTH FORUM 2022; 3:e221537. [PMID: 35977246 PMCID: PMC9187947 DOI: 10.1001/jamahealthforum.2022.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/22/2022] [Indexed: 11/14/2022] Open
Abstract
Question How many deaths among working-age US adults can hypothetical income support policies, such as universal basic income, the modified LIFT Act, poverty alleviation, and negative income tax, potentially avert? Findings In this multicohort modeling study that simulated US adults age 18 to 64 years over 5 to 40 years, broad income support policies, like universal basic income, were estimated to avert the most deaths among working-age adults, although targeted approaches, like poverty alleviation, may also avert thousands of deaths among low-income populations. Results were sensitive to several inputs, primarily the income group–specific mortality rates used. Meaning The results of this study suggest that income support policies may prevent thousands of deaths among working-age US adults. Importance Income has a negative, nonlinear association with all-cause mortality. Income support policies may prevent deaths among low-income populations by raising their incomes. Objective To estimate the deaths that could be averted among working-age adults age 18 to 64 years with hypothetical income support policies in the US. Design, Setting, and Population An open, multicohort life-table model was developed that simulated working-age adults age 18 to 64 years in the US over 5 to 40 years. Publicly available household income data and previous estimates of the income-mortality association were used to generate mortality rates by income group. Deterministic sensitivity analyses were conducted to evaluate the effect of parameter uncertainty and various model assumptions on the findings. Interventions In addition to a no-intervention scenario, 4 hypothetical income support policies were modeled: universal basic income, modified LIFT Act, poverty alleviation, and negative income tax. Main Outcome and Measures The main outcome was the number of deaths averted, which was calculated by subtracting the number of deaths experienced in the no-intervention scenario from the number of deaths experienced with the various income support policies. Results Base-case assumptions used average mortality rates by age, sex, and income group, a 20-year time horizon, and a 3-year lag time. Universal basic income worth $12 000 per year per individual was estimated to avert the most deaths among working-age adults (42 000-104 000 per year), followed by a negative income tax that guaranteed an income of 133% of the federal poverty level (19 000-67 000 per year). A modified LIFT Act that provided $6000 to individuals with annual household incomes less than $100 000 was estimated to avert 17 000 to 52 000 deaths per year. A targeted approach that alleviated poverty was estimated to prevent 12 000 to 32 000 deaths among the lowest-income, working-age adult population. Results were most sensitive to several inputs and assumptions, primarily the income-based mortality rates, analytic time horizon, and assumed time lag between when a policy was implemented and when individuals experienced the mortality benefit of having higher incomes. Conclusions and Relevance In this modeling study, 4 hypothetical income support policies were estimated to avert thousands of deaths among working-age US adults every year. Additional research is needed to understand the true association of income gains with mortality. Discussions about the costs and benefits of income support policies should include potential gains in health.
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Affiliation(s)
- Anton L. V. Avanceña
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Nicholas Miller
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Ellen Kim DeLuca
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Bradley Iott
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- School of Information, University of Michigan, Ann Arbor
- Now with School of Medicine, University of California, San Francisco
| | - Amanda Mauri
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Political Science, University of Michigan, Ann Arbor
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - David W. Hutton
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Industrial and Operations Engineering, College of Engineering, University of Michigan, Ann Arbor
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Dunn JR, Park GR, Brydon R, Wolfson M, Veall M, Rolheiser L, Siddiqi A, Ross NA. Income inequality and population health: a political-economic research agenda. J Epidemiol Community Health 2022; 76:jech-2022-219252. [PMID: 35676074 DOI: 10.1136/jech-2022-219252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- James R Dunn
- Department of Health, Aging and Society, McMaster University Faculty of Social Sciences, Hamilton, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Robbie Brydon
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
| | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Veall
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Lyndsey Rolheiser
- Center for Real Estate and Urban Economic Studies, University of Connecticut School of Business, Storrs, Connecticut, USA
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy A Ross
- Department of Geography, McGill University, Montreal, Quebec, Canada
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Martínez-Alés G, Gimbrone C, Rutherford C, Kandula S, Olfson M, Gould MS, Shaman J, Keyes KM. Role of Firearm Ownership on 2001-2016 Trends in U.S. Firearm Suicide Rates. Am J Prev Med 2021; 61:795-803. [PMID: 34420829 PMCID: PMC8608719 DOI: 10.1016/j.amepre.2021.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. METHODS Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. RESULTS Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. CONCLUSIONS State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, La Paz University Hospital, Madrid, Spain.
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Caroline Rutherford
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Sasikiran Kandula
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Jeffrey Shaman
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
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13
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Kim DJ, Yoo JW, Chang JW, Yamashita T, Park EC, Han KT, Kim SJ, Kim SJ. Does low income effects 5-year mortality of hepatocellular carcinoma patients? Int J Equity Health 2021; 20:151. [PMID: 34465351 PMCID: PMC8408948 DOI: 10.1186/s12939-021-01498-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Background In Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality. Methods The Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated with the survival probability of HCC patients. Results From 2004 to 2008, there were 4658 new HCC cases among males and 2667 new cases among females. The 5-year survival proportion of males was 68%, and the incidence per person-year was 0.768; the female survival proportion was 78%, and the incidence per person-year was 0.819. Lower income was associated with higher hazard ratio (HR), and HCC patients with hepatitis B (HBV), alcoholic liver cirrhosis, and other types of liver cirrhosis had higher HRs than those without these conditions. Subgroup analyses showed that middle-aged men were most vulnerable to the effects of low income on 5-year mortality, and community-level characteristics were associated with survival of HCC patients. Conclusion Having a low income significantly affected the overall 5-year mortality of Korean adults who were newly diagnosed with HCC from 2004 to 2008. Middle-aged men were the most vulnerable. We believe our findings will be useful to healthcare policymakers in Korea as well as to healthcare leaders in countries with NHI programs who need to make important decisions about allocation of limited healthcare resources according to a consensually accepted and rational framework.
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Affiliation(s)
- Dong Jun Kim
- Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, Republic of Korea.,Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Jong Wha Chang
- Department of Health Administration, College of Business, Texas Women's University, Denton, TX, USA
| | - Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore, MD, USA
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Tae Han
- Division of Cancer Management Policy, National Cancer Center, Goyang, Republic of Korea
| | - Seung Ju Kim
- College of Nursing, Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Jung Kim
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea. .,Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, 22 Soonchunhyang-ro, Asan, 31538, Republic of Korea. .,Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea.
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14
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The influence of poverty attribution on attitudes toward suicide and suicidal thought: A cross-national comparison between South Korean, Japanese, and American populations. Compr Psychiatry 2021; 109:152259. [PMID: 34273607 DOI: 10.1016/j.comppsych.2021.152259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/22/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous studies report that income inequality is an important risk factor for depression and suicide, and an increasing income gap appears inevitable. However, little study to date has investigated associations between the attribution of poverty and suicide. Though we previously reported associations between socio-cultural factors, including income, and suicide, we tried to explore more focused associations between income, attribution of poverty (individualistic, societal), permissive attitude toward suicide, and suicidal thought using a structural equation model. METHODS A total of 2213 participants from each of three nations (South Korea, Japan, and the United States) completed an online survey. Participants without a history of psychological disorders or suicide attempts completed scales measuring attributions of poverty, attitudes toward suicide, and severity of suicidal thoughts. RESULTS We established a structural equation model, which exhibited a good fit for all nations, and compared significant path coefficients by country. South Korea had the highest severity of suicidal thought and societal attribution of poverty, followed by Japan and America. In all nations, a permissive attitude was positively related to the severity of suicidal thought and individualistic attribution of poverty was positively related to a permissive attitude toward suicide. Societal attribution of poverty was positively associated with a permissive attitude in Japan and the United States. Income was negatively associated with the severity of suicide in South Korea and the United States. CONCLUSION Through an established structural equation model, we found the influence of poverty on suicide and identify the common and distinctive factors associated with suicide in each country.
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15
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Rezaeiahari M. Moving Beyond Simple Risk Prediction: Segmenting Patient Populations Using Consumer Data. Front Public Health 2021; 9:716754. [PMID: 34336781 PMCID: PMC8319387 DOI: 10.3389/fpubh.2021.716754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mandana Rezaeiahari
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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16
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Woolhandler S, Himmelstein DU, Ahmed S, Bailey Z, Bassett MT, Bird M, Bor J, Bor D, Carrasquillo O, Chowkwanyun M, Dickman SL, Fisher S, Gaffney A, Galea S, Gottfried RN, Grumbach K, Guyatt G, Hansen H, Landrigan PJ, Lighty M, McKee M, McCormick D, McGregor A, Mirza R, Morris JE, Mukherjee JS, Nestle M, Prine L, Saadi A, Schiff D, Shapiro M, Tesema L, Venkataramani A. Public policy and health in the Trump era. Lancet 2021; 397:705-753. [PMID: 33581802 DOI: 10.1016/s0140-6736(20)32545-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/22/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Steffie Woolhandler
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - David U Himmelstein
- School of Urban Public Health, City University of New York at Hunter College, New York, NY, USA; Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Sameer Ahmed
- Harvard Immigration and Refugee Clinical Program, Harvard Law School, Harvard University, Boston, MA, USA
| | - Zinzi Bailey
- Medical Oncology Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary T Bassett
- Francois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | | | - Jacob Bor
- School of Public Health, Boston University, Boston, MA, USA
| | - David Bor
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Samantha Fisher
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | - Adam Gaffney
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | | | - Kevin Grumbach
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helena Hansen
- Research Theme in Translational Social Science and Health Equity, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Philip J Landrigan
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | | | - Martin McKee
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Danny McCormick
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Alecia McGregor
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Reza Mirza
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana E Morris
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Medicine and Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Joia S Mukherjee
- Harvard Medical School, Harvard University, Boston, MA, USA; Partners in Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marion Nestle
- Department of Nutrition and Food Studies, New York University, New York, NY, USA
| | - Linda Prine
- Department of Family and Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Altaf Saadi
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Davida Schiff
- Harvard Medical School, Harvard University, Boston, MA, USA; Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Martin Shapiro
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lello Tesema
- Department of Public Health, Los Angeles County, Los Angeles, CA, USA
| | - Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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17
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Komro KA, Dunlap P, Sroczynski N, Livingston MD, Kelly MA, Pepin D, Markowitz S, Rentmeester S, Wagenaar AC. Anti-poverty policy and health: Attributes and diffusion of state earned income tax credits across U.S. states from 1980 to 2020. PLoS One 2020; 15:e0242514. [PMID: 33216767 PMCID: PMC7678980 DOI: 10.1371/journal.pone.0242514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The U.S. federal Earned Income Tax Credit (EITC) is often considered the most effective antipoverty program for families in the U.S., leading to a variety of improved outcomes such as educational attainment, work incentives, economic activity, income, and health benefits for mothers, infants and children. State EITC supplements to the federal credit can significantly enhance the magnitude of this intervention. In this paper we advance EITC and health research by: 1) describing the diffusion of state EITC policies over 40 years, 2) presenting patterns in important EITC policy dimensions across space and time, and 3) disseminating a robust data set to advance future research by policy analysts and scientists. METHODS We used current public health law research methods to systematically collect, conduct textual legal analysis, and numerically code all EITC legislative changes from 1980 through 2020 in the 50 states and Washington, D.C. RESULTS First, the pattern of diffusion across states and time shows initial introductions during the 1990s in the Midwest, then spreading to the Northeast, with more recent expansions in the West and South. Second, differences by state and time of important policy dimensions are evident, including size of credit and refundability. Third, state EITC benefits vary considerably by household structure. CONCLUSION Continued research on health outcomes is warranted to capture the full range of potential beneficial effects of EITCs on family and child wellbeing. Lawyers and policy analysts can collaborate with epidemiologists and economists on other high-quality empirical studies to assess the many dimensions of policy and law that potentially affect the social determinants of health.
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Affiliation(s)
- Kelli A. Komro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Phenesse Dunlap
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Nolan Sroczynski
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Melvin D. Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Megan A. Kelly
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dawn Pepin
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sara Markowitz
- Department of Economics, Emory University, Atlanta, Georgia, United States of America
| | - Shelby Rentmeester
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Alexander C. Wagenaar
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Vennu V, Abdulrahman TA, Alenazi AM, Bindawas SM. Associations between social determinants and the presence of chronic diseases: data from the osteoarthritis Initiative. BMC Public Health 2020; 20:1323. [PMID: 32867751 PMCID: PMC7461338 DOI: 10.1186/s12889-020-09451-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Some studies investigated the relationship between musculoskeletal conditions and chronic diseases. However, no study examined the association between social determinants and chronic diseases among people at high risk for knee osteoarthritis. Thus, the current study was aimed to address this gap. METHODS A secondary data analysis was conducted on a total of 3280 men and women aged 45 to 79 who were recruited in the Osteoarthritis Initiative. RESULTS Multivariable logistic regression analyses show that age ≥ 65 years was associated with 1.98, 1.96, and 1.46 times odds of the presence of diabetes, heart attack, and multi-morbidity, respectively than age ≤ 64 years. Men were associated with 1.39, 1.41, 1.76, and 2.24 times odds of the presence of arthritis, cancer, diabetes, and heart attack, respectively than women. African American/Asian/ non-Caucasian was associated with 2.71, 2.56, and 1.93 times odds of the presence of arthritis, diabetes, and heart attack, respectively than Caucasian. Primary school/less education was associated with twice or more times the odds of arthritis and chronic obstructive pulmonary disease (COPD) than ≥high school education. Unemployment was associated with 1.41-, 1.73-, 1.58-, and 1.70-time odds of the presence of arthritis, cancer, COPD, and heart attack, respectively, then employed. Unmarried/widowed/separated was associated with 1.41, 1.75, 2.77, 2.76, 1.86, and 3.34 times odds of the presence of arthritis, asthma, cancer, COPD, diabetes, and heart attack, respectively than married. Annual income < 50,000 was associated with 1.33-, 1.44-, and 1.38-time odds of the presence of arthritis, diabetes, and multi-morbidity, respectively, then annual income ≥50,000. Overweight/obese was associated with 2.28 times the odds of the presence of diabetes than healthy weight. Current/former smoker was associated with 1.57, 2.47, 2.53, 1.63, and 1.24 times odds of the presence of arthritis, cancer, COPD, heart attack, and multi-morbidity, respectively than a nonsmoker. Consuming alcohol was associated with 1.32-, 1.65-, 1.50-, and 1.24-time odds of the presence of arthritis, COPD, diabetes, and multi-morbidity, respectively, then nonalcoholic. CONCLUSIONS Social determinants are associated with the presence of chronic diseases. Some of the social determinants are modifiable or treatable. Thus, these findings can inform public health strategies in the United States.
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Affiliation(s)
- Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 10219, Saudi Arabia.
| | - Tariq A Abdulrahman
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 10219, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Rehabilitation Sciences and Physical Therapy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 10219, Saudi Arabia
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19
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Reynolds MM, Fox AM, Wen M, Varner MW. Is less more? Examining the relationship between food assistance benefit levels and childhood weight. SSM Popul Health 2020; 11:100573. [PMID: 32490132 PMCID: PMC7252206 DOI: 10.1016/j.ssmph.2020.100573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/14/2020] [Accepted: 03/22/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Supplementary Nutrition Assistance Program (SNAP) is a critical lifeline for millions of low-income US families, but some studies suggests that it may inadvertently increase obesity risk. Building on research contesting the SNAP-obesity link, we examine the effect of SNAP participation on BMI among multiyear participants at varying levels of SNAP benefit levels to provide some of the first evidence on the relationship between SNAP participation, state-level SNAP resources, and body weight. We focus on children given the strong links between early-life obesity and later-life health. METHODS Linking state-level data on SNAP benefit levels with three waves of longitudinal individual-level data from the Child Development Supplement of the Panel Study of Income Dynamics, we use child- and state-level fixed effects to examine whether exogenous differences in SNAP benefit allotments influence the relationship between SNAP participation and weight gain. RESULTS Lower SNAP benefit levels were associated with only modest increases in BMI among children; higher benefit levels showed no association with BMI. CONCLUSIONS Although concerns that more food assistance promotes obesity have spurred calls for cuts in the SNAP program, we find the opposite - that SNAP participation is associated with an increase in childhood BMI only when benefit levels are low. This study adds to the mounting evidence suggesting that SNAP does not cause obesity. It also contributes to the literature on the political economy of health, especially that pertaining to social policy variation across US states.
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Affiliation(s)
| | - Ashley M. Fox
- Department of Public Administration and Policy, University at Albany, United States
| | - Ming Wen
- Department of Sociology, University of Utah, United States
| | - Michael W. Varner
- Department of Obstetrics/Gynecology, University of Utah, United States
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20
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Tran F, Morrison C. Income inequality and suicide in the United States: A spatial analysis of 1684 U.S. counties using geographically weighted regression. Spat Spatiotemporal Epidemiol 2020; 34:100359. [DOI: 10.1016/j.sste.2020.100359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
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O'Neil A, Thompson K, Russell JD, Norton R. Inequalities and Deteriorations in Cardiovascular Health in Premenopausal US Women, 1990-2016. Am J Public Health 2020; 110:1175-1181. [PMID: 32552022 PMCID: PMC7349459 DOI: 10.2105/ajph.2020.305702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 11/04/2022]
Abstract
Coronary heart disease (CHD) mortality rates in the United States have declined by up to two thirds in recent decades. Closer examination of these trends reveals substantial inequities in the distribution of mortality benefits. It is worrying that the uneven distribution of CHD that exists from lowest to highest social class-the social gradient-has become more pronounced in the United States since 1990 and is most pronounced for women.Here we consider ways in which this trend disproportionately affects premenopausal women aged 35 to 54 years. We apply a social determinants of health framework focusing on intersecting axes of inequalities-notably gender, class, ethnicity, geographical location, access to wealth, and class-among other power relations to which young and middle-aged women are especially vulnerable, and we argue that increasing inequalities may be driving these unprecedented deteriorations. We conclude by discussing interventions and policies to target and alleviate inequality axes that have potential to promote greater equity in the distribution of CHD mortality and morbidity gains.The application of this framework in the context of women's cardiovascular health can help shed light regarding why we are seeing persistently poorer outcomes for premenopausal US women.
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Affiliation(s)
- Adrienne O'Neil
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Kelly Thompson
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Josephine D Russell
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
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22
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Li M, Lakdawalla DN, Goldman DP. Association Between Spending and Outcomes for Patients With Cancer. J Clin Oncol 2020; 38:323-331. [PMID: 31804868 PMCID: PMC6994252 DOI: 10.1200/jco.19.01451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Meng Li
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Darius N. Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
- School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Dana P. Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
- School of Pharmacy, University of Southern California, Los Angeles, CA
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23
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Kim D. Bridging the epidemiology-policy divide: A consequential and evidence-based framework to optimize population health. Prev Med 2019; 129:105781. [PMID: 31330155 DOI: 10.1016/j.ypmed.2019.105781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/21/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022]
Abstract
Epidemiology is the scientific cornerstone of public health. Its traditional role has been to test scientific hypotheses on causal relationships of exposures with health outcomes, the results of which should in turn be synthesized and lead to evidence-based recommendations and the formation of policy. However, the messy truth is that the path from epidemiology to policy is frequently not a perfectly rational, linear one, and the choices of which scientific hypotheses are pursued and the ways in which they are tested, evaluated, and translated into policies do not occur systematically. One avenue for bridging this divide is widespread adoption and implementation of a consequential, evidence-based framework-whereby we can systematically facilitate the translation of epidemiology into policies and interventions to optimize population health. This paper describes the roadmap for a seven-step, outcomes-based consequential approach, that includes priority-setting of problems at both the federal and regional/state levels, and that proposes to strengthen alignment of public and private research funding and journals with these priorities. Over the long term, implementing this framework should help to bridge the divide between epidemiology and policy and optimize the use of increasingly constrained resources to reduce disease burden and promote the nation's health.
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Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, MA, United States of America.
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24
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Kim D. Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study. PLoS Med 2019; 16:e1002978. [PMID: 31846474 PMCID: PMC6917210 DOI: 10.1371/journal.pmed.1002978] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author's knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings. METHODS AND FINDINGS This study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health-social mobility, social capital, income inequality, racial and economic segregation, and social spending-with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1-standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73-0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73-0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66-0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67-0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%-27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity. CONCLUSIONS This study finds that the rich-poor gap, level of citizens' trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.
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Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
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Inequality within a community at the neighborhood level and the incidence of mood disorders in Japan: a multilevel analysis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1125-1131. [PMID: 30903241 DOI: 10.1007/s00127-019-01687-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
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.
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MacKenzie TA, Houle J, Jiang S, Onega T. Middle-aged death and taxes in the USA: Association of state tax burden and expenditures in 2005 with survival from 2006 to 2015. PLoS One 2019; 14:e0214463. [PMID: 30978199 PMCID: PMC6461276 DOI: 10.1371/journal.pone.0214463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/13/2019] [Indexed: 11/30/2022] Open
Abstract
Background Longevity in the United States ranks below most other Western nations despite spending more on healthcare per capita than any other country. Across the world, mortality has been declining, but in the USA the trend toward improvement has stalled in some middle-aged demographic groups. Cross-national studies suggest that social welfare is positively associated with longevity. The United States has less government sponsored welfare, education and healthcare than almost all other Western nations, but the level of this social welfare commitment varies across the states. In this study we examined the association of state tax burden and state government expenditures with subsequent middle-aged mortality. Methods The primary exposure was state tax burden in 2005, defined as proportion of all state income paid to the state. We also examined the impact of state expenditures per capita in 2005 for education, healthcare, welfare, police and highways. The dependent variable was mortality during the subsequent 10 years. Death counts and population sizes by sex, age group and race strata for 2006–2015 were abstracted from CDC WONDER. Binomial logistic regression was employed based on the number of deaths and underlying population within each county-sex-age-race bin. Results State tax burden in 2005 varied from 5.8% to 12.2%. An increase of 1.0 percentage point in state tax burden was associated with a 5.8% (SE = 0.1%) reduction in mortality adjusted for sex, age and race, but was associated with a 1.1% (SE = 0.1%) reduction when further adjusting for state income and education levels. Controlling for sex, age and race each type of state expenditures was associated with decreases in middle aged mortality, notably K-12 education (reduction of 4.7%, SE = 0.1%, per 10% expenditure increase) except healthcare but all types were associated with mortality decreases further controlling for state income and education. Conclusion The residents of states with higher state taxation and higher expenditures per capita have lower middle aged mortality rates.
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Affiliation(s)
- Todd A. MacKenzie
- Department of Biomedical Data Science, Dartmouth College, Lebanon, NH, United States of America
- * E-mail:
| | - Jason Houle
- Department of Sociology, Dartmouth College, Hanover, NH, United States of America
| | - Steven Jiang
- Department of Biomedical Data Science, Dartmouth College, Lebanon, NH, United States of America
| | - Tracy Onega
- Department of Biomedical Data Science, Dartmouth College, Lebanon, NH, United States of America
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Khullar N, Caseja AJ, Yoo JW, Ukken J, Froehlich M, Yamashita T, Liu X. Social Determinants of Mortality in US Lupus Patients: Comment on the Article by Yelin et al. Arthritis Care Res (Hoboken) 2019; 71:697-698. [DOI: 10.1002/acr.23565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nitasha Khullar
- University of Nevada Las Vegas School of Medicine Las Vegas NV
| | - A. Jeff Caseja
- University of Nevada Las Vegas School of Medicine Las Vegas NV
| | - Ji Won Yoo
- University of Nevada Las Vegas School of Medicine Las Vegas NV
| | - Johnson Ukken
- University of Nevada Reno School of Medicine Reno NV
| | | | | | - Xibei Liu
- University of Arizona College of Medicine Tuscon AZ
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Income Inequality and Outcomes in Heart Failure. JACC-HEART FAILURE 2019; 7:336-346. [DOI: 10.1016/j.jchf.2018.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 11/18/2022]
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Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1425. [PMID: 29986446 PMCID: PMC6068947 DOI: 10.3390/ijerph15071425] [Citation(s) in RCA: 658] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Abstract
Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.
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Affiliation(s)
- Silke Bachmann
- Clienia Littenheid AG, Hauptstrasse 130, 9573 Littenheid, Switzerland.
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University Halle (Saale), Julius-Kühn-Strasse 7, 6112 Halle (Saale), Germany.
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Kim D. Projected impacts of federal tax policy proposals on mortality burden in the United States: A microsimulation analysis. Prev Med 2018; 111:272-279. [PMID: 29066374 PMCID: PMC5911242 DOI: 10.1016/j.ypmed.2017.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/09/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022]
Abstract
The public health consequences of federal income tax policies that influence income inequality are not well understood. I aimed to project the impacts on mortality of modifying federal income tax structures based on proposals by two recent United States (U.S.) Presidential candidates: Donald Trump and Senator Bernie Sanders. I performed a microsimulation analysis using the latest U.S. Internal Revenue Service public-use tax file with state identifiers (2008 tax year), containing nationally-representative data from 139,651 tax returns. I considered five tax plan scenarios: 1) actual 2008 tax structures; proposals in 2016 by then-candidates 2) Trump and 3) Sanders; 4) a modified Sanders plan with higher top tax rates (75%); and 5) a modified Sanders plan with higher top rates plus revenue redistribution to lower-income households (<$40,000/year). I combined projected changes in income inequality with vital statistics data and past estimates of linkages between income inequality, income, and mortality. 29,689 (95% CI: 10,865-48,920) more deaths/year and 31,302 (95% CI: 11,455-51,577) fewer deaths/year from all causes are anticipated under the Trump and Sanders plans, respectively. Under the modified Sanders plan including higher top rates, 68,919 (95% CI: 25,221-113,561) fewer deaths/year are projected. Under the modified Sanders plan with redistribution, 333,504 (95% CI: 192,897-473,787) fewer deaths/year are expected. Policies that both raise federal income tax rates and redistribute tax revenue could confer large reductions in the total number of annual deaths among Americans. In this era of high income inequality and growing public support to address the rich-poor gap, policymakers should consider joint federal tax and redistributive policies as levers to reduce the burden of mortality in the United States.
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Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, United States; EHESP School of Public Health, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
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Economic Conditions May Contribute to Increased Violence toward Children: A Nationwide Population-Based Analysis of Pediatric Injuries in Taiwanese Emergency Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020182. [PMID: 29360765 PMCID: PMC5858257 DOI: 10.3390/ijerph15020182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 01/28/2023]
Abstract
Childhood injuries are unfortunately common. Analysis procedures may assist professionals who work with children with developing preventive measures for protecting children’s wellness. This study explores the causes of pediatric injuries presenting to an emergency department in Taiwan. This nationwide, population-based study was conducted using data from the National Health Insurance Research Database of Taiwan (NHIRD). Patients aged <18 years were identified from approximately one million individuals listed in the NHIRD. We followed up with these patients for nine years and analyzed the causes of injuries requiring presentation to an emergency department. Variables of interest were age, sex, injury mechanisms, and temporal trends. A total of 274,028 children were identified in our study. Between 2001 and 2009, the leading causes of pediatric injuries treated in emergency departments were motor vehicle injuries, falls, and homicide. The overall incidence of injuries declined over the course of the study because of reductions in motor vehicle accidents and falls. The incidence of homicide increased during the study period, particularly between 2007 and 2009. A moderately inverse correlation between homicide rate and economic growth was observed (correlation coefficient: −0.613, p = 0.041). There was a general decline in pediatric injuries between 2001 and 2009. Public policy changes, including motorcycle helmet laws and increases in alcohol taxes, may have contributed to this decline. Unfortunately, the incidence of homicide increased over the course of the study. Ongoing financial crises may have contributed to this increase. Multidisciplinary efforts are required to reduce homicide and reinforce the importance of measures that protect children against violence.
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Lago S, Cantarero D, Rivera B, Pascual M, Blázquez-Fernández C, Casal B, Reyes F. Socioeconomic status, health inequalities and non-communicable diseases: a systematic review. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2017; 26:1-14. [PMID: 29416959 PMCID: PMC5794817 DOI: 10.1007/s10389-017-0850-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/25/2017] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Santiago Lago
- GEN Governance and Economics Network-Spain, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
- Department of Applied Economics, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
| | - David Cantarero
- GEN Governance and Economics Network-Spain, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
- Department of Economics, Faculty of Business and Economics University of Cantabria, Avda. de los Castros, S/N, 39005 Santander, Spain
| | - Berta Rivera
- GEN Governance and Economics Network-Spain, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
- Department of Applied Economics, Faculty of Business and Economics University of A Coruña, Campus de Elviña, 15071 A Coruña, Spain
| | - Marta Pascual
- GEN Governance and Economics Network-Spain, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
- Department of Economics, Faculty of Business and Economics University of Cantabria, Avda. de los Castros, S/N, 39005 Santander, Spain
| | - Carla Blázquez-Fernández
- GEN Governance and Economics Network-Spain, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
- Department of Economics, Faculty of Business and Economics University of Cantabria, Avda. de los Castros, S/N, 39005 Santander, Spain
| | - Bruno Casal
- GEN Governance and Economics Network-Spain, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
- Department of Applied Economics, Faculty of Business and Economics University of A Coruña, Campus de Elviña, 15071 A Coruña, Spain
| | - Francisco Reyes
- GEN Governance and Economics Network-Spain, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
- Department of Applied Economics, Faculty of Business and Tourism University of Vigo, Campus Universitario As Lagoas s/n, 32004 Ourense, Spain
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Abuabara A, Abuabara A, Tonchuk CAL. Comparative analysis of death by suicide in Brazil and in the United States: descriptive, cross-sectional time series study. SAO PAULO MED J 2017; 135:150-156. [PMID: 28538868 PMCID: PMC9977338 DOI: 10.1590/1516-3180.2016.0207091216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/09/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: The World Health Organization recognizes suicide as a public health priority. Increased knowledge of suicide risk factors is needed in order to be able to adopt effective prevention strategies. The aim of this study was to analyze and compare the association between the Gini coefficient (which is used to measure inequality) and suicide death rates over a 14-year period (2000-2013) in Brazil and in the United States (US). The hypothesis put forward was that reduction of income inequality is accompanied by reduction of suicide rates. DESIGN AND SETTING: Descriptive cross-sectional time-series study in Brazil and in the US. METHODS: Population, death and suicide death data were extracted from the DATASUS database in Brazil and from the National Center for Health Statistics in the US. Gini coefficient data were obtained from the World Development Indicators. Time series analysis was performed on Brazilian and American official data regarding the number of deaths caused by suicide between 2000 and 2013 and the Gini coefficients of the two countries. The suicide trends were examined and compared. RESULTS: Brazil and the US present converging Gini coefficients, mainly due to reduction of inequality in Brazil over the last decade. However, suicide rates are not converging as hypothesized, but are in fact rising in both countries. CONCLUSION: The hypothesis that reduction of income inequality is accompanied by reduction of suicide rates was not verified.
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Affiliation(s)
- Alexander Abuabara
- PhD. Student at the Hazard Reduction & Recovery Center, Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station (TX), United States.
| | - Allan Abuabara
- DDS. Health Auditor, Healthcare Division, Joinville Municipal Authority, Joinville, Santa Catarina (SC), Brazil.
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Cockerham WC, Hamby BW, Oates GR. The Social Determinants of Chronic Disease. Am J Prev Med 2017; 52:S5-S12. [PMID: 27989293 PMCID: PMC5328595 DOI: 10.1016/j.amepre.2016.09.010] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022]
Abstract
This review article addresses the concept of the social determinants of health (SDH), selected theories, and its application in studies of chronic disease. Once ignored or regarded only as distant or secondary influences on health and disease, social determinants have been increasingly acknowledged as fundamental causes of health afflictions. For the purposes of this discussion, SDH refers to SDH variables directly relevant to chronic diseases and, in some circumstances, obesity, in the research agenda of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research. The health effects of SDH are initially discussed with respect to smoking and the social gradient in mortality. Next, four leading SDH theories-life course, fundamental cause, social capital, and health lifestyle theory-are reviewed with supporting studies. The article concludes with an examination of neighborhood disadvantage, social networks, and perceived discrimination in SDH research.
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Affiliation(s)
- William C Cockerham
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama;.
| | - Bryant W Hamby
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabriela R Oates
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Pereira FNA, Queiroz BL. Diferenciais de mortalidade jovem no Brasil: a importância dos fatores socioeconômicos dos domicílios e das condições de vida nos municípios e estados brasileiros. CAD SAUDE PUBLICA 2016; 32:e00109315. [DOI: 10.1590/0102-311x00109315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/02/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo: Neste artigo, analisou-se a relação entre o nível socioeconômico dos domicílios e das condições sociais locais com o risco de morte de jovens brasileiros. Foram utilizados os dados de óbitos ocorridos nos últimos 12 meses coletados pelo Censo Demográfico de 2010 para realizar a análise em nível local. A análise dos dados foi feita com base em modelos hierárquicos que possibilitaram identificar a contribuição das condições sociais dos domicílios, municípios e estado de residência na mortalidade de jovens no Brasil. Os resultados indicam que as diferenças nos níveis de status socioeconômico entre os domicílios são responsáveis por mais de 90% da variabilidade no risco de relato de óbito jovem pelo domicílio. Além disso, os resultados mostram que residir em uma localidade com baixo nível socioeconômico aumenta as chances de ocorrência de relato de óbito de jovens pelos domicílios de qualquer nível social no período.
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