Social inequalities in indicators of use of healthcare services by adolescents in Campinas, São Paulo, Brazil.

This study aimed to analyze the prevalence of indicators of use of healthcare services according to sex, income and race/skin color, in adolescents (aged 10-19 years old) based on data from the Health Survey of the Municipality of Campinas (ISACamp), carried out in 2014/2015 in Campinas, São Paulo, Brazil. The chi-square test was used to evaluate the differences between the outcome variables (indicators of use of healthcare service) and sex, income and race/skin color. Adjusted prevalence ratios (PR) were estimated using Poisson multiple regression models. The demand for medical care was high in the last year of the interview (79.2%), mostly attended by the Brazilian Unified National Health System (65.2%), with routine consultations being more prevalent for females (PR = 1.17; 95%CI: 1.01-1.34) and injury for the male population (PR = 0.47; 95%CI: 0.26-0.84). Economic and racial differences were found in the evaluation of the last medical consultation, with a higher prevalence of worse care among those with lower income (PR = 1.46; 95%CI: 1.14-1.87) and black people (PR = 1.27; 95%CI: 1.01-1.61). Inequalities remained for delay or failure to carry out exams (PR = 1.64; 95%CI: 1.02-2.64) and worse quality of dental care (PR = 2.10; 95%CI: 1.38-3.21) in those with lower income. Also, black people had fewer appointments with dentists (PR = 0.90; 95%CI: 0.82-0.99).

Socioeconomic impact and sufficiency of government financial support during COVID-19 pandemic: A retrospective study.

This study examines the socioeconomic impact of the COVID-19 pandemic and the sufficiency of government support. Based on an online survey with 920 respondents, the cross-tabulation and binary logistic regression results show: firstly, in terms of loss of income, male respondents are more likely to have a loss of income as compared to female counterparts, and secondly, among different categories of employment status, the self-employed respondents are the most vulnerable group, given that more than 20 percent of them experienced loss of income due to the COVID-19 pandemic. Moreover, respondents working in small-and-medium enterprises (SMEs) and the informal sector are more likely to face loss of income as compared to respondents working in other sectors of employment. Likewise, respondents without tertiary education level are more likely to have a loss of income as compared to respondents with university certification. The baseline results highlight the insufficiency of government financial support programs based on the perspective of Malaysians from different demographic backgrounds. As a policy implication, the findings could guide the State in formulating the right policies for target groups who need more assistance than others in the community.

The Gender Wage Gap Among Early-Career Family Physicians.

PURPOSE: Numerous studies have documented salary differences between male and female physicians. For many specialties, this wage gap has been explored by controlling for measurable factors that influence pay such as productivity, work-life balance, and practice patterns. In family medicine where practice activities differ widely between physicians, it is important to understand what measurable factors may be contributing to the gender wage gap, so that employers and policymakers and can address unjust disparities. METHODS: We used data from the 2017 to 2020 American Board of Family Medicine (ABFM) National Graduate Survey (NGS) which is administered to family physicians 3 years after residency (n = 8608; response rate = 63.9%, 56.2% female). The survey collects clinical income and practice patterns. Multiple linear regression analysis was performed, which included variables on hours worked, degree type, principal professional activity, rural/urban, and region. RESULTS: Although early-career family physician incomes averaged $225,278, female respondents reported incomes that were $43,566 (17%) lower than those of male respondents (P = .001). Generally, female respondents tended toward lower-earning principal professional activities and US regions; worked fewer hours (2.9 per week); and tended to work more frequently in urban settings. However, in adjusted models, this gap in income only fell to $31,804 (13% lower than male respondents, P = .001). CONCLUSION: Even after controlling for measurable factors such as hours worked, degree type, principal professional activity, population density, and region, a significant wage gap persists. Interventions should be taken to eliminate gender bias in wage determinations for family physicians.

Association between family income to poverty ratio and nocturia in adults aged 20 years and older: A study from NHANES 2005-2010.

BACKGROUND: Nocturia, the most common lower urinary tract symptom (LUTS), significantly impacts socioeconomic factors and individuals' quality of life and is closely related to many diseases. This study utilized data from NHANES 2005-2010 to explore the relationship between family income to poverty ratio (PIR) and the presence of nocturia symptoms in adults aged 20 or older in the United States. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) in 2005-2010, including 6,662 adults aged 20 or older, were utilized for this cross-sectional study. The baseline data was used to display the distribution of each characteristic visually. Multiple linear regression and smooth curve fitting were used to study the linear and non-linear correlations between PIR and nocturia. Subgroup analysis and interaction tests were conducted to examine the stability of intergroup relationships. RESULTS: Out of the 6,662 adult participants aged 20 or older, 1,300 households were categorized as living in poverty, 3,671 households had a moderate income, and 1,691 households were classified as affluent. Among these participants, 3,139 individuals experienced nocturia, representing 47.12% of the total, while 3,523 individuals were nocturia-free, constituting 52.88% of the total population. After adjusting for all other covariates, it was found that PIR was significantly negatively correlated with nocturia (OR: 0.875, 95%CI: 0.836-0.916 P<0.0001). This trend persisted when PIR was divided into three groups (PIR <1, PIR 1-4, PIR > 4) or quartiles. There was a non-linear negative correlation between PIR and nocturia. CONCLUSION: Our findings indicated that lower PlR was associated with a higher risk of nocturia in adults aged 20 or older in the United States. These findings highlight the importance of considering socioeconomic factors in preventing and managing nocturia. Nonetheless, further exploration of the causal nexus between these factors was precluded due to the constraints of a cross-sectional design.

Inequality of the crowding-out effect of tobacco expenditure in Colombia.

In recent decades, policy initiatives involving increases in the tobacco tax have increased pressure on budget allocations in poor households. In this study, we examine this issue in the context of the expansion of the social welfare state that has taken place over the last two decades in several emerging economies. This study explores the case of Colombia between 1997 and 2011. In this period, the budget share of the poorest expenditure quintile devoted to tobacco products of smokers' households doubled. We analyse the differences between the poorest and richest quintiles concerning the changes in budget shares, fixing a reference population over time to avoid demographic composition confounders. We find no evidence of crowding-out of education or healthcare expenditures. This is likely to be the result of free universal access to health insurance and basic education for the poor. For higher-income households, tobacco crowds out expenditures on entertainment, leisure activities, and luxury expenditures. This finding should reassure policymakers who are keen to impose tobacco taxes as an element of their public health policy.

In flux: Associations of substance use with instability in housing, employment, and income among young adults experiencing homelessness.

Young adults experiencing homelessness (YAEH) are faced with instabilities in many areas of their lives, including their living situation, employment, and income. Little is known about how the experience of instability in these different domains might be associated with substance use. Leveraging data collected on 276 YAEH in Los Angeles County, regression analyses examine associations between three distinct types of instability (housing, employment, income) and participants' self-reported alcohol use, alcohol consequences, non-cannabis drug use, and substance use symptoms. Results indicated that recent instability in income, employment, and secure housing for those with access to it (but not housing in general or non-secure housing) were significantly associated with greater alcohol/drug use or substance use symptoms. Depression was also found to moderate the association between employment instability and alcohol use. Our findings suggest that efforts to reduce instability in income, employment, and secure housing may have positive benefits for substance using YAEH, especially those with depressive symptoms.

Height & income: Labor returns of health in Mexico from 2000 to 2018.

Investment in health has been proposed as a mechanism to promote upward social mobility. Previous analyses have reported inconsistent estimates of the returns to investment in health in Mexico based on different models for different years. We aim to estimate returns for Mexico using data from four time points Adult height and labor income are drawn from the periodical national health and nutrition surveys-a group of relatively standardized surveys-that are representative of individuals living in the country in 2000, 2006, 2012 & 2018. These surveys collect anthropometric measurements and information on individuals' labor income. We estimated Mincerian models separately for men and women using OLS, Heckman, instrumental variables, and Heckman with instrumental variables models. Our results indicate significant and positive returns to health for the four surveys, similar in magnitude across years for women and with variations for men. By 2018, returns to health were about 7.4% per additional centimeter in height for females and 9.3% for males. Investments in health and nutrition during childhood and adolescence that increase health capital-measured as adult height-may promote social mobility in Mexico and similar countries to the extent that these investments differentially increase health capital among the poor.

Long-term health conditions and UK labour market outcomes during the COVID-19 pandemic.

BACKGROUND: Long-term health conditions can affect labour market outcomes. COVID-19 may have increased labour market inequalities, e.g. due to restricted opportunities for clinically vulnerable people. Evaluating COVID-19's impact could help target support. AIM: To quantify the effect of several long-term conditions on UK labour market outcomes during the COVID-19 pandemic and compare them to pre-pandemic outcomes. METHODS: The Understanding Society COVID-19 survey collected responses from around 20,000 UK residents in nine waves from April 2020-September 2021. Participants employed in January/February 2020 with a variety of long-term conditions were matched with people without the condition but with similar baseline characteristics. Models estimated probability of employment, hours worked and earnings. We compared these results with results from a two-year pre-pandemic period. We also modelled probability of furlough and home-working frequency during COVID-19. RESULTS: Most conditions (asthma, arthritis, emotional/nervous/psychiatric problems, vascular/pulmonary/liver conditions, epilepsy) were associated with reduced employment probability and/or hours worked during COVID-19, but not pre-pandemic. Furlough was more likely for people with pulmonary conditions. People with arthritis and cancer were slower to return to in-person working. Few effects were seen for earnings. CONCLUSION: COVID-19 had a disproportionate impact on people with long-term conditions' labour market outcomes.

Equity implications of tobacco taxation: results from WHO FCTC investment cases.

BACKGROUND: Across time, geographies and country income levels, smoking prevalence is highest among people with lower incomes. Smoking causes further impoverishment of those on the lower end of the income spectrum through expenditure on tobacco and greater risk of ill health. METHODS: This paper summarises the results of investment case equity analyses for 19 countries, presenting the effects of increased taxation on smoking prevalence, health and expenditures. We disaggregate the number of people who smoke, smoking-attributable mortality and cigarette expenditures using smoking prevalence data by income quintile. A uniform 30% increase in price was applied across countries. We estimated the effects of the price increase on smoking prevalence, mortality and cigarette expenditures. RESULTS: In all but one country (Bhutan), a one-time 30% increase in price would reduce smoking prevalence by the largest percent among the poorest 20% of the population. All income groups in all countries would spend more on cigarettes with a 30% increase in price. However, the poorest 20% would pay an average of 12% of the additional money spent. CONCLUSIONS: Our results confirm that health benefits from increases in price through taxation are pro-poor. Even in countries where smoking prevalence is higher among wealthier groups, increasing prices can still be pro-poor due to variable responsiveness to higher prices. The costs associated with higher smoking prevalence among the poor, together with often limited access to healthcare services and displaced spending on basic needs, result in health inequality and perpetuate the cycle of poverty.

Modelling for disability: How does artificial intelligence affect unemployment among people with disability? An empirical analysis of linear and nonlinear effects.

There is a growing debate among scholars regarding the impact of artificial intelligence (AI) on the employment opportunities and professional development of people with disability. Although there has been an increasing body of empirical research on the topic, it has generally yielded conflicting findings. This study contributes to the ongoing debate by examining the linear and nonlinear effects of AI on the unemployment of people with disability in 40 countries between 2007 and 2021. Using the system Generalized Methods of Moments and panel smooth transition regression, the main conclusions are as follows. First, AI reduces the unemployment of people with disability in the full sample. Second, upon disaggregating the sample based on income level (high income/non-high income) and gender (men/women), the linear model only detects an inverse correlation between AI and unemployment among people with disability in high-income countries and among men, whereas it does not influence unemployment in non-high-income countries and women. Third, the panel smooth transition regression model suggests that the effects of AI on the unemployment of people with disability and among women are only observed once artificial intelligence interest search exceeds a specific threshold level. The effects of AI in non-high-income economies and among women are not significant in the lower regime, which confirms the nonlinear association between AI and the unemployment rate of people with disability. These findings have important policy implications for facilitating the integration of people with disability into the labor market.

Predictors of fuel poverty and the equity of local fuel poverty support: secondary analysis of data from Bradford, England.

AIMS: Addressing fuel poverty is a critical public health issue given its recent rise in prevalence across Europe. Although previous research identifies national risk markers of fuel poverty, evidence is lacking on whether these are consistent across local geographies, and the equity of local interventions. In the UK's current economic climate, it is more crucial than ever that services benefit households in greatest need. This study aimed to determine significant predictors of fuel poverty among households in Bradford, England, comparing them to national-level predictors, and evaluate if households possessing significant fuel poverty predictors were equitably referred to a local fuel poverty service (Warm Homes Healthy People, WHHP). METHODS: A multivariate logistic regression model determined significant fuel poverty predictors in Bradford using household-level data from the Energy Saving Trust and the Low Income High Costs fuel poverty definition. Statistical testing highlighted significant differences in predictors of fuel poverty between households referred to WHHP and all Bradford households. RESULTS: Significant (p < .05) predictors of fuel poverty included: living in an area with lower average household incomes and higher proportion of ethnic minority individuals, and living in a property with a lower energy efficiency rating. Households living in a detached or older property, and homeowners were more likely to be fuel poor. Differences in the direction of the relationship with fuel poverty were identified between some national and local predictors. Most predictors were significantly (p < .05) overrepresented among WHHP households, suggesting equitable service reach. Ethnic minorities, younger people, and multiperson households were underrepresented. CONCLUSIONS: Local fuel poverty predictors were similar to many national-level predictors, but identified differences in the direction of the relationship between some national and local predictors reaffirm the value of locally focused research. WHHP successfully targeted households possessing key predictors, but should ensure that ethnic minorities, younger people, and multiperson households are equitably referred.

The effect of actual and expected income shocks on mental wellbeing: Evidence from three East Asian countries during COVID-19.

This paper evaluates the effects of economic shocks to current and expected income reduction on mental wellbeing. We use individual-level data from three East Asian countries; China, Japan, and South Korea, during the early phases of the pandemic when the COVID-induced economic shocks were severe. The findings reveal significant causal effects from current and expected income reduction on different aspects of mental health deterioration, including anxiety, trouble sleeping, boredom, and loneliness. Interestingly, we found that expectations of future income loss have a significantly larger effect on people's mental wellbeing compared to current falls in income. This has significant implications for the design of policies to support income during pandemics.

How an increase in income affects the use of dental care services among a low-income population: evidence from the Finnish basic income experiment.

BACKGROUND: Previous research has shown that the use of dental care services has a significant socioeconomic gradient. Lower income groups tend to use dental care services less, and they often have poorer dental health than higher income groups. The purpose of this study is to evaluate how an increase in income affects the use of dental care services among a low-income population. METHODS: The study examines the causal effect of increasing cash transfers on the use of dental care services by utilizing unique register-based data from a randomized field experiment conducted in Finland in 2017-2018. The Finnish basic income experiment introduced an exogenous increase in the income of persons who previously received basic unemployment benefits. Register-based data on the study population's use of public and private dental care services were collected both for the treatment group (N = 2,000) and the control group (N = 173,222) of the experiment over a five-year period 2015-2019: two years before, two years during, and one year after the experiment. The experiment's average treatment effect on the use of dental care services was estimated with OLS regressions. RESULTS: The Finnish basic income experiment had no detectable effect on the overall use of dental care services. However, it decreased the probability of visiting public dental care (-2.7% points, -4.7%, p =.017) and increased the average amount of out-of-pocket spending on private care (12.1 euros, 29.8%, p =.032). The results suggest that, even in a country with a universal public dental care coverage, changes in cash transfers do affect the dental care patterns of low-income populations.

Impact of health investment on household income distribution: insights from China's longitudinal survey data.

This paper investigates the impact of health investment on household income distribution, drawing from data spanning over 10 years from the China Nutrition and Health Survey. The study aims to contribute to the literature by examining the nuanced pathways through which health investment influences income distribution. Utilizing a rich dataset, rigorous empirical methods including quantile regression and cross-sectional data modeling are employed to explore the relationship between health investment and income distribution. The analysis reveals a robust positive association between health investment and both absolute and relative income levels across various demographic and occupational groups. Additionally, the study elucidates the pathways through which health investment influences income, including its effects on illness duration, employment opportunities, effective working time, and educational attainment. The findings demonstrate the dynamic nature of the relationship, indicating that as income levels rise, the impact of health investment on income becomes more pronounced. Moreover, the analysis highlights the role of health investment in facilitating upward income mobility, particularly for low-income households. Overall, these findings provide valuable insights for policymakers, suggesting that strategic health investment initiatives can contribute to achieving more equitable income distribution.

[What does the Brazilian National Health Survey have to say about the influence of cigarette spending on household income?] / O que a Pesquisa Nacional de Saúde tem a dizer sobre a influência do gasto com cigarro no rendimento domiciliar?

In a country whose indicators of population impoverishment continue to increase, it is concerning that individuals spend money to buy cigarettes instead of using this resource in actions that strengthen aspects of the well-being of their lives and that of their families. Based on the Brazilian National Health Survey conducted in 2019, the influence of spending on manufactured cigarettes on the family budget in households with at least one smoker was estimated, stratified by sociodemographic characteristics. Brazilian smokers allocated around 8% of their average per capita monthly household income to the purchase of manufactured cigarettes. The percentage of average monthly expenditure on cigarettes reached almost 10% of this income among smokers aged 15 to 24 and was even higher for those with incomplete elementary education (approximately 11%). In the North and Northeast regions of the country, this expenditure exceeded 9%. The state with the most significant impact on household income was Acre (13.6%), followed by Alagoas (11.9%), Ceará, Pará, and Tocantins (all with approximately 11%). Our findings, therefore, reinforce the importance of strengthening the implementation of effective measures, such as tax policy, to reduce the proportion of smokers. Thus, the money that individuals currently allocate to purchase cigarettes can be used to meet their basic needs, contributing to the promotion of health and improving the quality of life.

Em um Brasil no qual os indicadores de empobrecimento da população seguem aumentando, preocupa o fato de que indivíduos gastem dinheiro para comprar cigarro em vez de usarem esse recurso em ações que fortaleçam aspectos do bem-estar de suas jornadas de vida e de suas famílias. Estimou-se, a partir da Pesquisa Nacional de Saúde de 2019, a influência que o gasto com cigarro industrializado teve no orçamento familiar nos domicílios com pelo menos um fumante, estratificada por características sociodemográficas. Os fumantes brasileiros destinaram cerca de 8% do rendimento médio mensal domiciliar per capita para a compra de cigarros industrializados. O percentual do gasto médio mensal chegou a quase 10% desse rendimento, entre os fumantes de 15 a 24 anos, e foi ainda maior para aqueles com Ensino Fundamental incompleto (aproximadamente 11%). Nas regiões Norte e Nordeste do país, esse gasto ultrapassou os 9%. O estado com o maior comprometimento da renda domiciliar foi o Acre (13,6%), seguido por Alagoas (11,9%), Ceará, Pará e Tocantins (todos com aproximadamente 11%). Nossos achados reforçam, portanto, a importância de fortalecer a implementação de medidas efetivas de redução da proporção de fumantes, tal como a política tributária. Dessa forma, o dinheiro que atualmente é destinado pelos indivíduos à compra de cigarros poderá ser revertido no atendimento de suas necessidades básicas, contribuindo para a promoção da saúde e melhoria da qualidade de vida.

En un Brasil donde los indicadores de empobrecimiento de la población siguen aumentando, es preocupante el hecho de que las personas gasten dinero para comprar cigarrillo en lugar de usarlo en acciones para fortalecer los aspectos del bienestar de sus vidas y la de sus familias. A partir de la Encuesta Nacional de Salud brasileña realizada en 2019, se estimó la influencia del gasto en cigarrillo industrializado en el presupuesto familiar de los hogares donde vivía al menos un fumador, estratificado por características sociodemográficas. Los fumadores brasileños destinaron alrededor del 8% del ingreso per cápita mensual promedio del hogar para la compra de cigarrillos industrializados. El porcentaje del gasto mensual promedio en cigarrillos alcanzó casi el 10% de este ingreso entre los fumadores de 15 a 24 años y fue aún mayor para los que tenían educación primaria incompleta (aproximadamente el 11%). En el Norte y Nordeste del país, ese gasto superó el 9%. El estado con un mayor compromiso con los ingresos del hogar fue Acre (el 13,6%), seguido por Alagoas (el 11,9%), Ceará, Pará y Tocantins (todos con aproximadamente el 11%). Por lo tanto, nuestros resultados resaltan la importancia de fortalecer la implementación de medidas efectivas para reducir la proporción de fumadores, tal como la política tributaria. Así, el dinero que actualmente las personas destinan a la compra de cigarrillos podría utilizarse en la atención de sus necesidades básicas, contribuyendo a promover la salud y la mejora de la calidad de vida.

Associations between Rat Infestations and Mental Health Vary by Gender, Race, and Income in Chicago.

Rats are an understudied stressor for people in urban environments around the world but the effects may not be distributed equally among residents. In this study, we examined associations between residential rat sightings and mental health in Chicago, where rat complaints are the highest of any American city. We examined how this relationship varied by frequency of rat sightings, race, ethnicity, income, home ownership, and gender and explored potential psychosocial pathways (e.g., feelings about the home) between rat sightings and mental distress. We conducted a randomized household survey along an income gradient in 2021 and asked about depressive symptoms in the past week (i.e., Center for Epidemiologic Studies Depression scale), frequency of rat sightings in/around the home, perceptions of rats, neighborhood conditions, and socio-demographic characteristics. We used logistic regression to assess relationships among these variables for our entire sample and for specific demographics using stratified models. Respondents (n = 589; 409 complete cases) who saw rats in/around the home daily/almost daily had 5.5 times higher odds of reporting high depressive symptoms relative to respondents who saw rats less frequently after accounting for socio-demographics and neighborhood conditions. This relationship was significant for men and respondents with lower incomes or race or ethnicity other than white. Our results show that rat infestations should be considered a threat to mental health among urban residents. Increased mental health support for residents living in rat-infested housing may improve public health in cities.

Health shocks, health and labor market dynamics, and the socioeconomic-health gradient in older Singaporeans.

Health disparities by socioeconomic status (SES) are potentially shaped by how an individual's health status and work capacity are affected by the incidence of illness, and how these effects vary across SES groups. We examine the impact of illness on the dynamics of health status, work activity and income in older Singaporeans to gain new insights on how ill health shapes the socioeconomic health gradient. Our data comprise of 60 monthly waves (2015-2019) of panel survey data containing 445,464 person-observations from 11,827 unique respondents from Singapore. We apply a matched event-study difference-in-differences research design to track how older adults' health and work changes following the diagnosis of heart disease and cancer. Our focus is how the dynamics of health and work differ for different SES groups, which we measure by post-secondary education attainment. We find that the dynamics of how self-assessed health recovers following the diagnosis of a new heart disease or cancer do not vary significantly across SES groups. Work activity however varies significantly, with less well-educated males and females being significantly less likely to be in active employment and have income from work, and are marginally more likely to be in retirement following the onset of ill health. By contrast, more well-educated males work more, and earn more a year after the health shock than they did before they fell ill. Occupational differences likely played a role in how work activity of less well-educated men decline more after an acute health event compared with more well-educated men. Understanding the drivers of the socioeconomic health gradient necessitates a focus on individual-level factors, as well as system-level influences, that affect health and work.

Financial toxicity, family resilience and negative emotions among young and middle-aged breast cancer patients: A multicentre cross-sectional study.

PURPOSE: To determine financial toxicity in young and middle-aged women with breast cancer and examine the associations between family resilience and negative emotions. METHODS: A multicentre cross-sectional study was conducted, 538 women with breast cancer were recruited from four hospitals. FT, family resilience, and negative emotions were collected using the Comprehensive Score for FT, the Chinese version of the Family Resilience Assessment in Breast Cancer Patients, Patient Health Questionnaire-9 item, and Generalized Anxiety Disorder-7. This study adhered to the STROBE guidelines. RESULTS: The valid response rate was 96.8 % (N = 521). Overall, the score for FT was 19.63 ± 10.13. FT was significantly correlated with family resilience (r = 0.30, p < 0.010) and depression (r = -0.11, p < 0.050). The hierarchical multiple linear regression analysis showed that career status, monthly income, religion, and family resilience were the main factors influencing FT in patients with breast cancer (R2 = 0.37; F = 6.83; p < 0.001). CONCLUSIONS: FT was more prevalent among women from low-income career. Women with poor family resilience, no religious also suffer greater financial toxicity. It is necessary to pay more attention of the financial toxicity of female' low-income career, no religious belief and poor family resilience. Developing effective interventions based on family resilience might be helpful in promoting their well-being.

Impact of income and financial subsidies on oral health care utilization among persons with disabilities in Singapore.

BACKGROUND/AIM(S): Globally, studies have shown that the dental disease burden among persons with intellectual and/or developmental disabilities (IDD) is high and can be attributed to lower utilization levels of dental services. The aim of the study was to assess the influence of income and financial subsidies on the utilization of dental care services among persons with IDD in Singapore. METHODS: Between August 2020 and August 2021, a cross-sectional study was conducted via centres offering Early Intervention Programme for Infants and Children, special education schools and adult associations in Singapore serving persons with IDD. A sample of 591 caregivers of children and adults with IDD completed the survey. Data on sociodemographic information, oral health behaviours and dental utilization were collected. Financial subsidy status was assessed by the uptake of a government-funded, opt-in Community Health Assist Scheme (CHAS) for low-income families that provided a fixed subsidy amount for dental services in the primary care setting. Statistical analysis was carried out using univariable, multiple logistic regression and modified Poisson regression. Propensity score matching was carried out in R version 4.0.2 to assess the impact of financial subsidies on oral health care utilization among persons with IDD. RESULTS: Compared to those with lower gross monthly household incomes, the adjusted prevalence ratios of having at least one dental visit in the past year, having at least one preventive dental visit in the past year, and visiting the dentist at least once a year for persons with IDD with gross monthly household incomes of above SGD$4000 were 1.28 (95% CI 1.08-1.52), 1.48 (95% CI 1.14-1.92) and 1.36 (95% CI 1.09-1.70), respectively. Among those who were eligible for CHAS Blue subsidies (247 participants), 160 (62.0%) took up the CHAS Blue scheme and 96 (35.4%) visited the dentist at least yearly. There was no statistically significant difference in the utilization of dental services among individuals enrolled in the CHAS Blue subsidy scheme among those eligible for CHAS Blue subsidies. CONCLUSION: Higher household income was associated with a higher prevalence of dental visits in the past year, preventive dental visits in the past year, and at least yearly dental visits. CHAS Blue subsidies alone had limited impact on dental utilization among persons with IDD who were eligible for subsidies.

The great Indian demonetization and gender gap in health outcomes: Evidence from two Indian states.

We utilize the timing of India's 2016 demonetization policy to examine whether a negative macroeconomic shock disproportionately affects women's health outcomes relative to men's. Our empirical framework considers women as the treated group and men as the comparison group. Using data from the National Family Health Survey-4 and a household fixed effects model, we find that the induced income shock leads to a 4% decline in hemoglobin for women as compared to the pre-demonetization level. This corresponds to a 21% increase in the gender gap in hemoglobin. The result is further validated with an event study and a variety of robustness checks. An examination of food consumption suggests that this pattern is possibly driven by a widening male-female gap in the consumption of iron-rich foods.