Income inequality, the psychosocial environment, and health: comparisons of wealthy nations

Lynch, John; Smith, George Davey; Hillemeier, Marianne M.; Shaw, Mary; Raghunathan, Trivellore E.; Kaplan, George A.

doi:10.1016/s0140-6736(01)05407-1

Cited by 376 publications

(283 citation statements)

References 37 publications

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“…We did not observe an association between social trust and country-level variation in TB, a finding in agreement with some previous studies [15,47]. Although it has been suggested elsewhere that income inequality leads to more violence, less social cohesion and lower levels of social trust [20], it appears that the mechanism, through which income inequality influences TB outcomes, is not related to social trust.…”

Section: Discussionsupporting

confidence: 89%

Social determinants of tuberculosis in Europe: a prospective ecological study

et al. 2012

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Tuberculosis (TB) is considered to be a disease of poverty, since its incidence is exacerbated by socioeconomic factors, inconsistent or partial treatment practices, and immigration from endemic countries.A prospective country level study, using a comprehensive dataset of TB incidence and prevalence taken from countries within the World Health Organization (WHO) European region, was conducted. We employed quintile regression to investigate the prospective association between baseline (measured in 2000) and a nation's wealth, level of egalitarianism, migration rate, health-related lifestyle and social capital with TB incidence and prevalence over a 10-yr period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009).We found that ,50% of TB variation is accounted for by a nation's wealth and level of egalitarianism. We observed a negative prospective association between logged gross domestic product and TB rates, and a positive prospective association between income inequality and TB.National income levels per capita and income inequality are important predictors for TB incidence and prevalence in the WHO European region. They account for 50% of country-level variation, indicating the importance of a combined absolute and relative socioeconomic disadvantage in the development of TB. These findings also provide a tool for forecasting potential fluctuations in the level of TB epidemics in the WHO European region, with respect to socioeconomic changes.

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Section: Discussionsupporting

confidence: 89%

Social determinants of tuberculosis in Europe: a prospective ecological study

et al. 2012

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“…25,26,29,30 In comparison with wealthy nations, associations between neighborhood characteristics and different health outcomes were inconsistent. 31 This implies that neighborhood determinants of health are complex. Such determinants may include access to healthcare, education and social services.…”

Section: Discussionmentioning

confidence: 99%

Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden

Sundquist

2011

Prostate Cancer Prostatic Dis

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in patients aged 25-74 years (a total of 73 159 patients). Multilevel logistic regression analyses were performed with individual-level characteristics at the first level and level of neighborhood deprivation at the second level. RESULTS:The age-standardized prostate cancer mortality rate was 1.5 times higher in men living in high-deprivation neighborhoods than in those living in the most affluent neighborhoods. Mortality rates were also associated with certain individual-level characteristics, that is, age, marital status, family income, educational attainment, immigration status, urban/rural status, mobility and comorbidity. For example, there was a strong relationship between prostate cancer mortality and being unmarried, having a low income or educational attainment, and hospitalization for chronic obstructive pulmonary disease. In the full model, the risk of prostate cancer mortality was 25% higher in men living in the most deprived neighborhoods than in those living in the most affluent neighborhoods.CONCLUSIONS: High level of neighborhood deprivation independently predicts prostate cancer mortality. This raises important clinical and public health concerns. Both individual-and neighborhood-level approaches are important in healthcare policies.

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“…The nature and meaning of this association continues to be vigorously debated (Gravelle, 1998) (Wolfson, Kaplan, Lynch, Ross & Backlund, 1999) (Wilkinson, 1999) (Lynch et al, 2000) (Marmot & Wilkinson, 2001) (Lynch, Davey Smith, Hillemeier, Shaw, Raghunathan & Kaplan, 2001) (Mackenbach, 2002) (Lynch, Davey Smith, Harper, Hillemeier, Ross, Kaplan & Wolfson, 2004).…”

Section: Objective or Subjective Status -Empirical Evidencementioning

confidence: 99%

Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

Macleod

Smith

Metcalfe

et al. 2005

Social Science & Medicine

118

114

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were asked whether they saw themselves as "employees", "foremen" or "managers").Compared to foremen, employees had a small and imprecisely estimated increased risk of all cause mortality (age adjusted hazard ratio 1.11 (0.96, 1.30)), whereas managers had a more marked decreased risk (age adjusted hazard ratio 0.75 (0.62, 0.90)). The strongest predictors of increased mortality were father's manual as opposed to non-manual occupation (fully adjusted hazard ratio 1.16 (1.03-1.31)); lack of car access (fully adjusted hazard ratio 1.12 (1.02-1.23)) and shorter stature, (an 2 indicator of material deprivation in childhood, fully adjusted hazard ratio 1.09 (1.02-1.16) per 10cm decrease). In the fully adjusted analyses, perceived work-place status was only weakly associated with mortality (hazard ratio for employees compared to foremen 1. 09 (0.93, 1.27), managers compared to foremen 0.91 (0.74, 1.10)). In this population it appears that objective material circumstances, particularly in early life, are a more important determinant of health than perceptions of relative status.Conversely, higher perceived stress was not associated with poorer health, presumably because, in this population, higher stress was not associated with material disadvantage. Together these findings suggest that, rather than targeting perceptions of disadvantage and associated negative emotions, interventions to reduce health inequalities should aim to reduce objective material disadvantage, particularly that experienced in early life.

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Income inequality, the psychosocial environment, and health: comparisons of wealthy nations

Cited by 376 publications

References 37 publications

Social determinants of tuberculosis in Europe: a prospective ecological study

Social determinants of tuberculosis in Europe: a prospective ecological study

Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden

Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

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