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Income inequality and health: multilevel analysis of Chilean communities
Open accessAbstract
Study objective: The evidence supporting the effect of income inequality on health has been largely observed in societies far more egalitarian than the US. This study examines the cross sectional multilevel associations between income inequality and self rated poor health in Chile; a society more unequal than the US. Design: A multilevel statistical framework of 98 344 people nested within 61 978 households nested within 285 communities nested within 13 regions. Setting: The 2000 National Socioeconomic Characterization Survey (CASEN) data from Chile. Participants: Adults aged 18 and above. The outcome was a dichotomised self rated health (0 if very good, good or average; 1 if poor, or very poor). Individual level exposures included age, sex, ethnicity, marital status, education, employment status, type of health insurance, and household level exposures include income and residential setting (urban/rural). Community level exposures included the Gini coefficient and median income. Main results: Controlling for individual/household predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (OR: 2.94) followed by poor (OR: 2.77), low (OR: 2.06), middle (OR: 1.73), high (OR: 1.38) as compared with the very high income earners. Controlling for household and community effects of income, a significant effect of community income inequality was observed (OR:1.22). Conclusions: Household income does not explain any of the between community differences; neither does it account for the effect of community income inequality on self rated health, with more unequal communities associated with a greater probability of reporting poor health.
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“Second, more vulnerable communities may experience a higher prevalence of the comorbidities (31) that are associated with more severe presentations of COVID-19.”
From Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile (2021) · cites this paper as [31]
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Metadata
- Authors
- Subramanian, S. V., Delgado, I., Jadue, L., Vega, J., & Kawachi, I.
- Affiliations
- Harvard University (US)
- Gobierno de Chile (CL)
- Corresponding author
- Subramanian, S V
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2003-11
- Volume
- 57
- Issue
- 11
- Pages
- 844-848
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC1732331
- OpenAlex
- W2073956826
- Cited by
- 179
- References
- 36
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 2 · 2022: 7 · 2021: 4 · 2020: 22 · 2019: 6 · 2018: 5 · 2017: 7 · 2016: 5 · 2015: 6 · 2014: 8 · 2013: 6 · 2012: 11
- FWCI
- 8.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Epidemiology & Community Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Social Sciences › Sociology and Political Science › Income, Poverty, and Inequality
- Keywords
- income inequality, self-rated health, Gini coefficient, household income, socioeconomic status, health disparities, Chile, urban-rural differences, health insurance
- MeSH terms
- Adolescent, Adult, Aged, Chile, Female, Health Services Accessibility, Health Status Indicators, Health Surveys, Humans, Income, Male, Middle Aged, Poverty, Self-Assessment, Socioeconomic Factors
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