Income-equivalence scales (IES) provide distinct advantages over poverty indices to adjust family income for differences in family size, including improved specification of hypothesized causal relationships involving objective measures of economic well-being. In a novel IES application, cancer patients' out-of-pocket health costs are adjusted for differences in family income and size and, along with five other subindices, contribute to an overall index of "objective family financial stress." Age-related changes are modeled simultaneously within relationships between overall objective family financial stress and subjective patient perceptions about financial strain. Among the findings, the impact of age on one area of subjective financial strain, "difficulty paying bills," is negative and curvilinear. Regardless of adjusted out-of-pocket costs, as age advances, patients appear increasingly likely to accommodate to financial stress by reporting less difficulty paying bills. This phenomenon could serve to mask and isolate older adults who are foregoing needed yet unaffordable medical care and prescriptions.The use of income-equivalence scales (IES) to adjust family income for differences in family size is described, with a novel application to derive out-of-pocket health costs that are adjusted for family income and family size. IES provide distinct advantages over the use of poverty indices. One important empirical advantage pertains to improved specification of hypothesized functional causal relationships involving objective measures of economic well-being.Causal relationships involving social structural variables and measures of objective and subjective economic well-being will be our initial focus for discussion. This will lead to a discussion and derivation of IES, which are necessary to specify this causal relationship. Then, in a unique application of IES, out-of-pocket health costs incurred by patients with recurrent cancer are adjusted for differences in family size and income and will be incorporated into an even broader index of overall objective family financial stress. Finally, curvilinear and moderated relationships based on this overall index and adult patient age will be tested in simultaneous causal relationships to three measures, in addition to a latent construct, of "subjective patient financial strain."
Social Stratification as a Description of AccommodationAccording to social stratification theory and empirical findings, the social structural features reflected by demographic variables such as sex, race, and age interact over time to reflect different degrees of restrictions or barriers over access to economic resources and opportunities. This results in greater barriers within groups that are older, female, and/or a minority (Becker, 1971;Blau, 1977;Blau & Duncan, 1967;Chiswick & O'Neill, 1977;Corcoran & Duncan, 1978;Duncan, 1968;Foner, 1975;Lloyd & Niemi, 1979;Moody, 1994;Riley, Johnson, & Foner, 1972). Disadvantaged groups are more likely to experience fixed economic situations due ...