Social disparities and cause-specific mortality during economic development
Li Ka Shing Faculty of Medicine, The University of Hong Kong, School of Public Health, Pokfulam, Hong Kong.Social Science [?] Medicine (Impact Factor: 2.89). 02/2010; 70(10):1550-7. DOI: 10.1016/j.socscimed.2010.01.015
Social patterning of disease is pervasive and persistent. Disease patterns change with economic development and the attendant epidemiological transition. It is becoming evident that social patterns of disease are epidemiologically stage specific. In a population with a recent history of rapid economic development we examined social patterns of all-cause and cause-specific mortality over time to elucidate how economic development impacts disparities in health. We used concentration indices to provide a summary measure of disparities by income in potential years of life lost (PYLL) for the Hong Kong population from 1976 to 2006. For all-cause mortality and for each of the specific causes considered the concentration curve in 2006 dominated the 1976 concentration curve. The concentration index for all-cause PYLL was negligible in 1976, but increased over the period. PYLL attributable to injury and poisoning was fairly consistently associated with lower income, but PYLL attributable to cardiovascular diseases and cancer reversed from an association with higher income in 1976 to an association with lower income in 2006. Social disparities in health are not universal or homogeneous in origin. Attention should be focused on disease-specific causes of disparities, so that contextually specific prevention strategies can be implemented. This is of particular relevance to China and other emerging economies where there may be a window of opportunity to prevent disparities in cancer and cardiovascular diseases occurring.
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- "As developing countries undergo the epidemiological transition and socioeconomic development, the etiology of diseases also becomes increasingly similar to that of Western societies. It is the transition to Western lifestyle and the attendant increase in the risk of chronic diseases like diabetes and heart failure, both of which normally occur initially among the more affl uent, that may render the SES-health gradient in a society ambiguous (Schooling et al. 2010). 15 In what follows, a statistically signifi cant UCOD coeffi cient will be interpreted as evidence of a causal relationship between parental loss and educational outcome; whereas a statistically signifi cant difference between the UCOD and the ICOD coeffi cients will be interpreted as evidence that the ICOD parameter is subject to omitted variables bias. "
ABSTRACT: This paper identifies the effects of parental death on children’s well-being using six administrative data sets from Taiwan. Information collected at different points in children’s lives and detailed parental mortality records are used to show that parental death has significant long-term implications for human capital accumulation: the quality of education of high income children is significantly reduced; the impact of a father’s death on his son’s probability of acquiring higher education increases with income; children are more likely to substitute an income earning occupation in place of higher education; low-income girls are also more likely to marry during their teenage years.Journal of Human Resources 01/2013; 48(4):1035-1071. DOI:10.1353/jhr.2013.0028
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ABSTRACT: Life expectancy is strongly related to national income, whether there is an additional contribution of income inequality is unclear. We used negative binomial regression to examine the association of neighborhood-level Gini, adjusted for age, sex, and income, with mortality rates in Hong Kong from 1976 to 2006. The association of neighborhood Gini with all-cause mortality varied over time (p-value for interaction < .01). Neighborhood Gini was positively associated with nonmedical mortality in 1976 to 1986; incident rate ratio (IRR) 1.09, 95% confidence interval (95% CI) 1.02-1.16 per 0.1 change and in 1991 to 2006, IRR 1.24, 95% CI 1.13-1.36, adjusted for age, sex and absolute income. Similarly adjusted, Gini was not associated with all-cause mortality in 1976 to 1986 (IRR 0.96, 95% CI 0.93-1.00) but was in 1991 to 2006 (IRR 1.25, 95% CI 1.20-1.29), when Gini was also positively associated with death from cardiovascular diseases, respiratory diseases and some cancers. Independent of income, income inequality was positively associated with nonmedical mortality rates at a low level of spatial aggregation, indicating the consistent harms of social disharmony. However, the impact on medical mortality was less consistent, suggesting the relevance of contextual factors.Annals of epidemiology 04/2012; 22(4):285-94. DOI:10.1016/j.annepidem.2012.01.009 · 2.00 Impact Factor
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ABSTRACT: We established a working group to examine the burden of atherothrombotic and musculoskeletal diseases in Asia and made recommendations for safer prescribing of nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin. By using a modified Delphi process, consensus was reached among 12 multidisciplinary experts from Asia. Statements were developed by the steering committee after a literature review, modified, and then approved through 3 rounds of anonymous voting by using a 6-point scale from A+ (strongly agree) to D+ (strongly disagree). Agreement (A+/A) by ≥ 80% of panelists was defined a priori as consensus. We identified unique aspects of atherothrombotic and musculoskeletal diseases in Asia. Asia has a lower prevalence of degenerative arthritis and coronary artery disease than Western countries. The age-adjusted mortality of coronary artery disease is lower in Asia; cerebrovascular accident has higher mortality than coronary artery disease. Ischemia has replaced hemorrhage as the predominant pattern of cerebrovascular accident. Low-dose aspirin use is less prevalent in Asia than in Western countries. Traditional Chinese medicine and mucoprotective agents are commonly used in Asia, but their efficacy is not established. For Asian populations, little is known about complications of the lower gastrointestinal tract from use of NSAIDs and underutilization of gastroprotective agents. Our recommendations for preventing ulcer bleeding among users of these drugs who are at high risk for these complications were largely derived from Asian studies and are similar to Western guidelines. By using an evidence-based, multidisciplinary approach, we have identified unique aspects of musculoskeletal and atherothrombotic diseases and strategies for preventing NSAID-related and low-dose aspirin-related gastrointestinal toxicity in Asia.Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2012; 10(7):753-60. DOI:10.1016/j.cgh.2012.03.027 · 7.90 Impact Factor
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