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Poverty and Health

Poverty and Health. Jennifer Madans, Kimberly Lochner, and Diane Makuc National Center for Health Statistics Centers for Disease Control and Prevention March 8, 2005. Overview. NCHS interest in the definition of poverty HP 2010 context The poverty/health connection

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Poverty and Health

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  1. Poverty and Health Jennifer Madans, Kimberly Lochner, and Diane Makuc National Center for Health Statistics Centers for Disease Control and Prevention March 8, 2005

  2. Overview • NCHS interest in the definition of poverty • HP 2010 context • The poverty/health connection • What influences health • Why poverty/income are related to health? • Mechanisms and reverse causation • Selection of health indicators

  3. Overview (con’t) • How NCHS collects information on income/poverty • Selected health indicators by poverty status • Discussion of data issues/limitations • Recap of why NCHS is interested in poverty and how it is defined

  4. Why is NCHS Interested in Poverty? • Healthy People 2010 goal • Eliminate health disparities among Americans • Gender • Race/Ethnicity • Education • Income • Disability • Geographic location • Sexual orientation

  5. Focus on Health Income Health behaviors Education Health status Environment/ Living conditions Health insurance/ Health care Psychological/ Psychosocial Early life experiences Human biology/ genetics

  6. Focus on Health Income Health behaviors Education Health status Environment/ Living conditions Health insurance/ Health care Psychological/ Psychosocial Early life experiences Human biology/ genetics

  7. Focus on Health Income Health behaviors Education Health status Environment/ Living conditions Health insurance/ Health care Psychological/ Psychosocial Early life experiences Human biology/ genetics

  8. Selection of Health Indicators • National Health and Nutrition Examination Surveys (1971-74, 1976-80, 1988-94, 1999-2002) • Measured health outcomes • National Health Interview Survey (1984-2002) • Self-reported health outcomes • Health care utilization • Criteria for selection • Consistent data over long period of time • Range of indicators • Income data available

  9. Collection of Income in NHANES and NHIS • Individual earnings (NHIS) • Family income sources • Total family income amount • Follow-up questions ask income category for non-respondents • Unknown income imputed in 1990-2003 NHIS • Non-response lower in NHANES • Program participation

  10. Health Indicators • Measured health indicators • Hypertension • Serum cholesterol • Obesity • Untreated dental caries • Blood lead levels • Self reported health indicators • Activity limitation • Self-rated health status • Health care utilization

  11. Females Males Life Expectancy at birth Females Life expectancy at 65 years Males 1980 2001 1920 1910 1901 1990 1950 1960 1930 1940 1970 Year Life Expectancy at Birth and at 65 Years of Age by Sex Life expectancy in years

  12. Life Expectancy Among the Poor? X

  13. <12 years 12 years 13+ years 2002 1986 1990 1998 2000 1994 1996 1988 1992 1984 Year Note: Rates are for infants of mothers aged 20 years and over. Data Source: National Vital Statistics System: Linked Birth/Infant Death Data Set Infant Mortality Rates by Years of Maternal Education

  14. <12 years 12 years 13+ years Year Chronic Disease Death Rates Among Adults 25-64 Years by Education Data Source: National Vital Statistics System

  15. <12 years 12 years 13+ years Communicable Disease Death Rates Among Adults 25-64 Years by Education Year Data Source: National Vital Statistics System

  16. Men Women <100 <100 100-<200 100-<200 200+ 200+ 1999-02 1976-80 1988-94 1999-02 1971-74 1971-74 1976-80 1988-94 Year Hypertension Among Adults 20-74 Years by Percent of Poverty Threshold Year Data Source: National Health and Nutrition Examination Survey

  17. Men Women 200+ 100-<200 <100 <100 100-<200 200+ 1999-02 1976-80 1988-94 1999-02 1971-74 1971-74 1976-80 1988-94 Year Elevated Serum Cholesterol Among Adults 20-74 Years by Percent of Poverty Threshold Year Data Source: National Health and Nutrition Examination Survey

  18. Men Women <100 200+ 100-<200 100-<200 <100 200+ 1999-02 1976-80 1988-94 1999-02 1971-74 1971-74 1976-80 1988-94 Year Obesity Among Adults 20-74 Years by Percent of Poverty Threshold Year Data Source: National Health and Nutrition Examination Survey

  19. Ages 6-11 years Ages 12-19 years <100 <100 100-<200 100-<200 200+ 200+ 1988-94 1999-02 1976-80 1999-02 1971-74 1971-74 1976-80 1988-94 Year Year Overweight Among Children by Percent of Poverty Threshold Data Source: National Health and Nutrition Examination Survey

  20. Ages 6-17 years Ages 18-64 years <100 100-<200 <100% 100-<200% 200+% 200+ 1988-94 1971-74 1999-02 Year 1988-94 1999-02 1971-74 Untreated Dental Caries by Percent of Poverty Threshold Year Data Source: National Health and Nutrition Examination Survey

  21. Elevated Blood Lead Levels Among Children 1-5 Years by Percent of Poverty Threshold <100 200+ 100-<200 1999-02 1988-94 1976-80 Year Data Source: National Health and Nutrition Examination Survey

  22. Ages 5-17 years Ages 18-64 years <100 100 - <200 200+ 1998 1992 1998 2000 1986 1988 1990 1992 1994 2000 2002 1984 1988 1994 1996 1986 1990 1996 2002 1984 Year Year Percent of Persons with Activity Limitation by Percent of Poverty Threshold Data Source: National Health Interview Survey

  23. <100 100-<200 200+ 2001 1999 2000 1994 1996 1998 1995 1997 1992 1993 Year ADL Limitation for Medicare Beneficiaries 65 and Older by Percent of Poverty Threshold Data Source: Medicare Current Beneficiary Survey

  24. Ages 65 years and over Ages 18-64 years <100 100 - <200 <100 200+ 100 - <200 200+ 1982 1990 1992 2002 1984 2000 1994 1996 1986 1988 1998 1994 2000 1990 1992 1996 1998 1982 1984 2002 1986 1988 Year Year Percent of Persons in Fair/Poor Health by Percent of Poverty Threshold Data Source: National Health Interview Survey

  25. 1982 1990 1988 1994 1992 1998 1984 1986 2000 1996 2002 Year Percent of Children Under 18 Years Without a Health Care Visit in the Past Year by Percent of Poverty Threshold Data Source: National Health Interview Survey

  26. Ages 65 years and over Ages 18-64 years 1982 1984 1986 1990 1988 1992 1994 1996 1998 2000 2002 Year 1990 1996 1994 1998 2002 2000 1984 1992 1982 1988 1986 Year Percent of Persons Without a Health Care Visit in the Past 2 Years by Percent of Poverty Threshold Data Source: National Health Interview Survey

  27. Summary • Improvements in health for everyone • Exceptions, obesity and overweight • Generally worse health outcomes for poor people • Notable exceptions, especially among men

  28. Data Issues • Surveys cover civilian, non-institutionalized population • Insufficient numbers for reliable estimates for detailed subcategories • Income difficult to collect • Responses to health questions (particularly subjective health measures) influenced by income level

  29. Data Issues (cont) • When does income matter for health • Cross-sectional measurement of income may underestimate the effect of income on health • Income changes over lifetimemay have stronger impact than income level on health

  30. Conclusion: NCHS’s Focus • Need valid poverty measure that can be easily collected • Purpose as a classification variable to monitor health disparities • Increased reliance on data linkage to augment surveys and research

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