Inequality

The relationship between primary care, income inequality, and mortality in US States, 1980-1995.

The relationship between primary care, income inequality, and mortality in US States, 1980-1995.
Journal of the American Board of Family Practice Volume 16, Number 5 Sep-Oct 2003; pages 412-22.

Shi, L., Macinko, J., Starfield, B., Wulu, J., Regan, J. & Politzer, R.
09/01/2003

OBJECTIVES: This study tests the robustness of the relationships between primary care, income inequality, and population health by (1) assessing the relationship during 4 time periods-1980, 1985, 1990 and 1995; (2) examining the independent effect of components of the primary care physician supply; (3) using 2 different measures of income inequality (Robin Hood index and Gini coefficient); and (4) testing the robustness of the association by using 5-year time-lagged independent variables. DATA SOURCES/STUDY SETTING: Data are derived from the Compressed Mortality Files, the US Department of Commerce and the Census Bureau, the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the American Medical Association Physician Master File. The unit of analysis was the 50 US states over a 15-year period. STUDY DESIGN: Ecological, cross-sectional design for 4 selected years (1980, 1985, 1990, 1995), and incorporating 5-year time-lagged independent variables. The main outcome measure is age-standardized, all-cause mortality per 100,000 population in all 50 US states in all 4 time periods. DATA COLLECTION/EXTRACTION METHODS: The study used secondary data from publicly available data sets. The CDC WONDER/PC software was used to obtain mortality data and directly standardize them for age to the 1980 US population. Data used to calculate the income inequality measure came from the US census population and housing summary tapes for the years 1980 to 1995. Counts of the number of households that fell into each income interval along with the total aggregate income and the median household income were obtained for each state. The Gini coefficient for each state was calculated using software developed for this purpose. RESULTS: In weighted multivariate regressions, both contemporaneous and time-lagged income inequality measures (Gini coefficient, Robin Hood Index) were significantly associated with all-cause mortality (P <.05 for both measures for all time periods). Contemporaneous and time-lagged primary care physician-to-population ratios were significantly associated with lower all-cause mortality (P <.05 for all 4 time periods), whereas specialty care measures were associated with higher mortality (P <.05 for all time periods, except 1990, where P <.1). Among primary care subspecialties, only family medicine was consistently associated with lower mortality (P <.01 for all time periods). CONCLUSIONS: Enhancing primary care, particularly family medicine, even in states with high levels of income inequality, could lead to lower all-cause mortality in those states.

Functional Outcomes of Pediatric Liver Transportation

Functional Outcomes of Pediatric Liver Transportation
Journal of Pediatric Gastroenterology & Nutrition, 37(2), 155-60.

Alonso, E.M. Neighbors, K., Mattson, C., Sweet, E., Ruch-Ross, H., Berry, C. & Sinacore, J.
08/01/2003

The functional status and health-related quality of life (HRQOL) of children who survive liver transplantation (LT) have not been well documented. The purpose of this study was to determine the functional status and HRQOL in this population using a validated measure for children, the Child Health Questionnaire-Parent Form 50 (CHQ-PF50).

Methods: The CHQ-PF50 instrument was completed by the parents of 55 children who agreed to participate in a mailing survey. Subscale scores for the sample were compared with those of a published normal population (n = 391).

Results: Study sample characteristics were: 87% Caucasian, 54.5% female, mean age at survey was 9.6 years (range, 5-17 years). Responding caregivers were 95% biologic parents and 93% female. Compared with the normal population, LT recipients had lower subscale scores for general health perceptions (P < 0.0005), emotional impact on parents (<0.0005) and disruption of family activities (0.0005). The mean physical summary score of the LT recipients was lower than that of the normal population 48.1 /- 12.1 (P = 0.005), but the mean psychosocial summary score was similar 48.8 /- 11.9 (P = 0.156). Within the LT population, the original diagnosis (biliary atresia vs. other), type of LT (living donor vs. cadaveric), age at LT, z score for height, and hospital days did not significantly influence any of the subscale scores.

Conclusions: Children who have survived LT have functional outcomes in the physical domain that are lower than those of normal children. Self-esteem and mental health in this group appeared normal. The parents in this sample experienced more emotional stress and disruption of family activities than did parents in a normal population.

Gender, Race,Class and Welfare Reform

Gender, Race,Class and Welfare Reform
State of Black America. National Urban League, Aug

Stafford, W.W. with Salas, D. & Mendez, M.
08/01/2003

This study on welfare reform contends that race and gender coalesce through historic and contemporary government, policy and market failures to deny benefits and jobs to women of color while blaming them for their condition. It is divided into three sections: the first addresses national policy trends with an emphasis on race and gender, the second looks at New York City, and the third offers recommendations. The report was published in the National Urban League's State of Black America, 2003.

Using Administrative Data to Monitor Access, Identify Disparities, and Assess Performance of the Safety Net

Using Administrative Data to Monitor Access, Identify Disparities, and Assess Performance of the Safety Net
In Billings, J. and Weinick, R. Eds., A Took Kit for Monitoring the Local Safety Net, Agency for Health Care Research and Quality, July

Billings, J.
07/01/2003

Second Annual Status of Women of Color Report: Women of Color in New York City: Still Invisible in Policy

Second Annual Status of Women of Color Report: Women of Color in New York City: Still Invisible in Policy
Women of Color Policy Network Roundtable of Institutions of People of Color

Stafford, Walter & Salas, Diana
03/01/2003

Demography is not destiny. While groups of color - Asians, Blacks, Latinos, and Native Americans - have emerged as New York City's new majority, large segments of the groups remain burdened by many of the historical problems associated with disadvantaged minorities. This report highlights the problems faced by lower-income women of color, especially single mothers. Often bypassed during the economic boom of the 1990s, these women have found that employment opportunities have all but evaporated in the current economic malaise. The elimination of federal welfare entitlements have only served to exacerbate these problems. To read more click on the link below.

Women Of Color In New York City:Still Invisible In Policy

Women Of Color In New York City:Still Invisible In Policy
Second Annual Status of Women of Color Report.

Stafford, W.W. & Salas, D.
03/01/2003

Demography is not destiny. While groups of color - Asians, Blacks, Latinos, and Native Americans - have emerged as New York City's new majority, large segments of the groups remain burdened by many of the historical problems associated with disadvantaged minorities. This report highlights the problems faced by lower-income women of color, especially single mothers. Often bypassed during the economic boom of the 1990s, these women have found that employment opportunities have all but evaporated in the current economic malaise. The elimination of federal welfare entitlements have only served to exacerbate these problems. To read more click on the link below.

Income inequality, primary care, and health outcomes�a critical review of the literature

Income inequality, primary care, and health outcomes�a critical review of the literature
Medical Care Research and Review Volume 60 Number 4, pages 407-52.

Macinko, J., Shi, L., Starfield, B. & Wulu, J.
01/01/2003

This article critically reviews published literature on the relationship between income inequality and health outcomes. Studies are systematically assessed in terms of design, data quality, measures, health outcomes, and covariates analyzed. At least 33 studies indicate a significant association between income inequality and health outcomes, while at least 12 studies do not find such an association. Inconsistencies include the following: (1) the model of health determinants is different in nearly every study, (2) income inequality measures and data are inconsistent, (3) studies are performed on different combinations of countries and/or states, (4) the time period in which studies are conducted is not consistent, and (5) health outcome measures differ. The relationship between income inequality and health is unclear. Future studies will require a more comprehensive model of health production that includes health system covariates, sufficient sample size, and adjustment for inconsistencies in income inequality data.

Primary Care, Social Inequality, and Stroke Mortality in U.S. States--a Longitudinal Analysis, 1985-1995

Primary Care, Social Inequality, and Stroke Mortality in U.S. States--a Longitudinal Analysis, 1985-1995
Stroke Volume 34 Number 8, pages 1958-64.

Shi, L., Macinko, J., Starfield, B. & Politzer, R.
01/01/2003

BACKGROUND AND PURPOSE: The goal of this study was to test whether primary care reduces the impact of income inequality on stroke mortality. METHODS: This study used pooled time-series cross-sectional analysis of 11 years of state-level data (n=549). Analyses controlled for education levels, unemployment, racial/ethnic composition, and percent urban. Contemporaneous and time-lagged covariates were modeled. RESULTS: Primary care was negatively associated with stroke mortality in models including all covariates (P<0.0001). The impact of income inequality on stroke mortality was reduced in the presence of primary care (P<0.0001) but disappeared with the addition of covariates (P>0.05). CONCLUSIONS: In the absence of social policy that addresses sociodemographic determinants of health, primary care promotion may serve as a palliative strategy for combating stroke mortality and reducing the adverse impact of income inequality on health.

Reader in Gender, Work and Organization

Reader in Gender, Work and Organization
Blackwell Publishers,

Ely, R., Foldy, E.G. & Scully, M.
01/01/2003

This reader uses an alternative approach to gender at work to provoke new thinking about traditional management topics, such as leadership and negotiation. Presents students with an alternative conceptual approach to gender in the workplace. Connects gender with other dimensions of difference such as race and class for a deeper understanding of diversity in organizations. Illustrates how traditional images of competence and the ideal worker result in narrow ways of thinking about work, limiting both opportunity and organizational effectiveness. Provokes new ways of thinking about leadership, human resource management, negotiation, globalization and organizational change.

Test Score Gaps in New York State Schools: What do Fourth and Eighth Grade Results Show?

Test Score Gaps in New York State Schools: What do Fourth and Eighth Grade Results Show?
Condition Report, Education Finance Research Consortium, New York State Education Department, Fall

Chellman, C., Schwartz, A.E. & Stiefel, L.
01/01/2003

This report analyzes performance gaps by race/ethnicity, income and gender in New York State schools using fourth and eighth grade math and English language test results. Their results highlight the legacy of racial segregation where many schools have too few whites or non-whites to allow a meaningful calculation of the subgroup test performance or test score ‘gap’ between schools. Even with a minimum sub-group size of six, only 45.7% of elementary schools had enough whites or non-whites to calculate gaps. Findings indicate that the gaps do differ substantially; gaps between racially segregated schools are over 2.5 times greater than gaps in mixed schools.

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