(week5-7) STUDY PACKAGE SOC243.docx

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William Magee

1Week 5 Lecture Lecture 5 SOC 243 IHierarchical Social Position and HealthIIStress Processes an introductionI Hierarchical Social Position and Health What is hierarchical social position Focuses on socioeconomic status occupational status mixed with education and income oUseful summary for some things but research shows that different socioeconomic statuses have different associations oIe education associated stronger with other relations income other relationsCan rate economic groupsStatusone form occupational status people who are high statuses like doctors politicians Issues related to specification of socioeconomic position ieoIs education a continuous or ordinal measureOrdinal measurerankingContinuousa rational scale can use it so every single year of education has a different effect Cant study change in health as a function of change in educationso what is proximal what social factors are proximal in driving this what happened recently oFor which ages is income a good measure and for which is wealth a better measure Because older people retire and income comes from jobIf you study income and health older people have wealth they have houses bank accounts so may want to study home ownership or measures of wealth than income oShould poverty be specified as distinct issue Maybe its just having less money in some places but clearly the poor who are really hit hard like First Nations populationA lot of place have a poverty line they fall above and below the line But Canada doesnt have a poverty line they have low income cut offs2NeighbourhoodincomeandmortalityIf family is spending 20on basics then they meet this low income cut off its more contextual also based on kids impressive in terms of rate ratios from 197 in 1971Infantmortalityratesand how dependants etc to 161 in 1996The infant mortality rates deaths before age 1 in eachNevertheless the rate differences are more relevantof the income quintiles declined over the 25year studyto the public health impact of the changes observedThe issue of causal directionperiod Chart 3 Table 4 The interquintile rateIf the rate in the richest quintile had applied to all urbandifference quintile 5 minus quintile 1 fell from 98oCausation versus selection reverse causality causality may be difficult to Canada and the same relative rates had also beenper thousand in 1971 to 24 per thousand in 1996infer from correlation experienced by nonmetropolitan areas then thereThus the disparity between the poorest and the richestoFrom inside the health to the outside resources income education would have been approximately 2000 fewer infantquintiles diminished markedly in terms of rateoHealth influences education ie overweight among women deaths in 1971 compared to only about 500 fewer indifferences although the decline was much less351996oHealth selectionhealth leads you to select into a certain group class In 1996 infant mortality in Canadas poorestcategory neighbourhoods 64 deaths for every 1000 live birthsChart 3was considerably lower than the national rate for theInfant mortality rates by neighbourhood income quintileUnited States 78However the rate in Canadasurban Canada 1971 to 1996richest neighbourhoods was no better than Swedensnational rate 40Deaths per 100020Mortalityrateratiosatvariousages Q1RichestWith few exceptions the higher the percentage of low Q2income population in a quintile the higher the age Q316specific mortality rate data not shown In many Q4 Q5Poorestrespects trends in mortality rates by income at mostother ages were similar to those for infant mortality in12most income quintiles the mortality rate declined overtime but the interquintile rate ratios tended to diminishto a much lesser extent However the absoluteimprovements for the poorer quintiles were generally8greater than those for the other quintiles so the ratedifferences usually diminished over timeIn general the pattern of interquintile mortality rate4ratiosexpressed as the mortality rate in the poorestquintile divided by the rate in the richest quintilewassimilar over time Table 5 Disparities were largest in0infancy age less than 1 and during the prime working197119761981198619911996years ages 25 to 64 Disparities were smallest forages 15 to 24 and 75 or older There were exceptionsData sources Canadian Mortality Data Base and supplemental address filesspecial tabulations of census population datafor children ages 1 to 14 for whom rates wereextremely low and unstable and for men ages 35 to344 for whom rate ratios increased markedly from 1986Poorest group is steeper higher infant mortality rates Table 4Infant mortality rate per 1000 by neighbourhood income quintile urban Canada 1971 to 1996 95 confidence intervals in parentheses1971198619911996Total150145156757279585561514854Quintile 1 richest10291113585166454052403446Quintile 2124113131575065514558474154Quintile 3152140165776986504457494255Quintile 4166153179807289676075504457Quintile 5 poorest20018620510596116756783645771Rate difference Q5Q19881116483560291939241533Rate ratio Q5Q1197173223182156213164139194161134193Excess TotalQ149181211ExcessTotalQ1Total32232122Data sourceCanadian Mortality Data Base and supplemental address files special tabulations of census population dataNoteCensus population aged less than 1 used as denominator Rate differences and rate ratios calculated with unrounded dataStatisticsCanadaCatalogue82003SupplementtoHealthReportsvolume13200263NeighbourhoodincomeandmortalityChart 11Causes of death showing progress toward Health for All agestandardized mortality rates by neighbourhood income quintileurban Canada 1971 to 1996CInjuries except motor vehicletraffic accidents and suicideAIschemic heart disease malesBIschemic heart disease femalesASMR x 100000ASMR x 100000ASMR x 10000042017045 Q1Richest400160 Q1Richest Q1Richest Q240380 Q2 Q2 Q3150360 Q3 Q3 Q435140340 Q4 Q4 Q5Poorest320 Q5Poorest Q5Poorest1303030012028025110260240100202209020015801801607010140601205501000080400197119761981198619911996197119761981198619911996197119761981198619911996DCirrhosis of liver malesECirrhosis of liver femalesFUterine cancer femalesASMR x 100000ASMR x 100000ASMR x 100000 Q1Richest301214 Q1Richest Q2 Q1Richest28 Q2 Q31311 Q2 Q3 Q42612 Q310 Q4 Q5Poorest24 Q411 Q5Poorest922 Q5Poorest10208918781667146512510448336224112000197119761981198619911996197119761981198619911996197119761981198619911996HPedestrians struck by motor vehiclesGPerinatal conditionsASMR x 100000ASMR x 10000016615 Q1Richest Q1Richest14 Q2 Q2513 Q3 Q3 Q4 Q412 Q5Poorest Q5Poorest1141098376254312100197119761981198619911996197119761981198619911996Data sources Canadian Mortality Data Base and supplemental address files special tabulations of census population dataMaybe we should be tolerant of those kinds of inequalitiesStatisticsCanadaCatalogue82003SupplementtoHealthReportsvolume13200213If things are getting better for everybody economic situation so that the rich benefits the most but theyre driving the economy But if everyone is benefiting because the economic system is driving the health carepharmaceutical company
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