Healthcare system and the wealth–health gradient: A comparative study of older populations in six countries

Maskileyson, Dina

doi:10.1016/j.socscimed.2014.08.013

Cited by 39 publications

(27 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies that compare SES disparities in health across countries have found that SES gradients in all-cause mortality ( Riva et al, 2007 , Mackenbach et al, 2008 , Meijer et al, 2012 ) and self-reported health ( Riva et al, 2007 , Maskileyson, 2014 ) exist across a range of health systems, and that the steepness of these gradients is largely comparable across countries despite differences in the universality of their publically funded health care ( Maskileyson, 2014 ). The important role of neighborhood and associated behavioral determinants of health in creating “health-wealth” gradients in mortality ( Stringhini et al, 2010 , Nandi et al, 2014 , Jonker et al, 2015 ) and survival ( Southern et al, 2005 , Shaw et al, 2014 ) has also been well-established across a range of settings.…”

Section: Discussionmentioning

confidence: 99%

Absence of a Socioeconomic Gradient in Older Adults' Survival with Multiple Chronic Conditions

et al. 2015

View full text Add to dashboard Cite

BackgroundIndividuals of low socioeconomic status experience a disproportionate burden of chronic conditions; however it is unclear whether chronic condition burden affects survival differently across socioeconomic strata.MethodsThis retrospective cohort study used health administrative data from all residents of Ontario, Canada aged 65 to 105 with at least one of 16 chronic conditions on April 1, 2009 (n = 1,518,939). Chronic condition burden and unadjusted mortality were compared across neighborhood income quintiles. Multivariable Cox proportional hazards models were used to examine the effect of number of chronic conditions on two-year survival across income quintiles.FindingsPrevalence of five or more chronic conditions was significantly higher among older adults in the poorest neighborhoods (18.2%) than the wealthiest (14.3%) (Standardized difference > 0·1). There was also a socioeconomic gradient in unadjusted mortality over two years: 10.1% of people in the poorest neighborhoods died compared with 7.6% of people in the wealthiest neighborhoods. In adjusted analyses, having more chronic conditions was associated with a statistically significant increase in hazard of death over two years, however the magnitude of this effect was comparable across income quintiles. Individuals in the poorest neighborhoods with four chronic conditions had 2.07 times higher hazard of death (95% CI: 1.97–2.19) than those with one chronic condition, but this was comparable to the hazard associated with four chronic conditions in the wealthiest neighborhoods (HR: 2.29, 95% CI: 2.16–2.43).InterpretationAmong older adults with universal access to health care, the deleterious effect of increasing chronic condition burden on two-year hazard of death was consistent across neighborhood income quintiles once baseline differences in condition burden were accounted for. This may be partly attributable to equal access to, and utilization of, health care. Alternate explanations for these findings, including study limitations, are also discussed.

show abstract

Section: Discussionmentioning

confidence: 99%

Absence of a Socioeconomic Gradient in Older Adults' Survival with Multiple Chronic Conditions

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Household wealth was calculated as a summary of all assets (the value of home and other real estate assets, minus any mortgage, owned share of own business, owned cars and the values of financial assets – bank accounts, government and corporate bonds, stocks, mutual funds, individual retirement accounts and contractual savings for housing and life insurance policies owned by the household) minus liabilities (Allin et al . , Maskileyson ). Non‐Euro values were converted.…”

Section: Methodsmentioning

confidence: 99%

“…It has been shown that in later life, income and occupational status lose their significance, and wealth (i.e., accumulated economic assets) becomes a more important measure of economic capital (Alessie et al 1997, Miilunpalo et al 1997. Household wealth was calculated as a summary of all assets (the value of home and other real estate assets, minus any mortgage, owned share of own business, owned cars and the values of financial assetsbank accounts, government and corporate bonds, stocks, mutual funds, individual retirement accounts and contractual savings for housing and life insurance policies owned by the household) minus liabilities (Allin et al 2009, Maskileyson 2014. Non-Euro values were converted.…”

Section: Economic Capital Indexmentioning

confidence: 99%

A Bourdieusian approach to class‐related inequalities: the role of capitals and capital structure in the utilisation of healthcare services in later life

Paccoud

Nazroo

Leist

2019

Sociology Health & Illness

View full text Add to dashboard Cite

This paper draws on Bourdieu's theory of economic, social and cultural capital to understand the relative effect of the volume and the composition of these capitals on healthcare service use in later life. Based on data from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (n = 64,840), we first look at the contribution of each capital in the use of three healthcare services (general practitioner, dentist and hospital). Using cluster analysis, we then mobilise Bourdieu's concept of habitus to explain how the unequal distribution of material and non‐material capitals acquired in childhood lead to different levels of health and hospital care utilisation in later life. After controlling for demographic and health insurance variables, our results show that economic capital has the strongest individual association among the three capitals. However, the results of a cluster analysis used to distinguish between capital structures show that those with high non‐material capital and low material capital have higher levels of primary healthcare utilisation, and in turn lower levels of hospital use. Bourdieu's approach sheds light on the importance of capitals in all forms and structures to understand the class‐related mechanisms that contribute to different levels of healthcare use.

show abstract

“…Third, while evidence exists that wealth may be a better indicator of socioeconomic well-being as compared with income, especially among persons aged 65 years and older, the NHANES only included income-related items 2829 Wealth may be more strongly linked to health and mortality than income, and therefore our results might underestimate the true impact of wealth on the burden of disease in the USA. The association between wealth and health also has been shown to be stronger in the USA compared with many other countries with state-based healthcare systems 29…”

Section: Discussionmentioning

confidence: 99%

Burden of disease associated with lower levels of income among US adults aged 65 and older

Lubetkin

Jia

2017

BMJ Open

View full text Add to dashboard Cite

BackgroundPersons aged 65 years and older represent a heterogeneous group whose prevalence in the USA is expected to markedly increase. Few investigations have examined the total burden of disease attributable to lower levels of income in a single number that accounts for morbidity and mortality.MethodsWe ascertained respondents' health-related quality of life (HRQOL) scores and mortality status from the 2003 to 2004, 2005 to 2006, 2007 to 2008 and 2009 to 2010 cohorts of the National Health and Nutrition Examination Survey (NHANES) with mortality follow-up through 31 December 2011. A mapping algorithm based on respondents' age and answers to the 4 core Healthy Days questions was used to obtain values of a preference-based measure of HRQOL, the EuroQol five dimensions questionnaire (EQ-5D) index, which enables quality-adjusted life years (QALYs) to be calculated. We included only respondents aged 65 years and older at the baseline, yielding a total sample size of 4952. We estimated mean QALYs according to different categories of income based on the percentage of Federal Poverty Level (FPL).ResultsAfter adjusting for age, gender and education, the remaining QALYs decreased with each successive decrement of category of income, ranging from 18.4 QALY (≥500% FPL) to 8.6 QALY (<100% FPL). Compared with participants with a mean income of ≥250% FPL, participants with an income <250% FPL had significant losses in QALY for most of the sociodemographic groups examined. In contrast, persons with a lower educational attainment did not show a corresponding loss in QALY according to income category.ConclusionsThis study confirmed the association between lower income category and greater burden of disease, as measured by QALYs lost, among the US population aged 65 years and older. Our findings provide additional evidence of the role played by other key determinants of health and how factors not traditionally addressed by the healthcare system impact the life cycle of individuals and communities.

show abstract

Healthcare system and the wealth–health gradient: A comparative study of older populations in six countries

Cited by 39 publications

References 35 publications

Absence of a Socioeconomic Gradient in Older Adults' Survival with Multiple Chronic Conditions

Absence of a Socioeconomic Gradient in Older Adults' Survival with Multiple Chronic Conditions

A Bourdieusian approach to class‐related inequalities: the role of capitals and capital structure in the utilisation of healthcare services in later life

Burden of disease associated with lower levels of income among US adults aged 65 and older

Contact Info

Product

Resources

About