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Income-related health inequalities in Canada and the United States: A decomposition analysis

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  • McGrail, K.M.
  • Van Doorslaer, E.
  • Ross, N.A.
  • Sanmartin, C.

Abstract

Objectives. We examined income-related inequalities in self-reported health in the United States and Canada and the extent to which they are associated with individual-level risk factors and health care system characteristics. Methods. We estimated income inequalities with concentration indexes and curves derived from comparable survey data from the 2002 to 2003 Joint Canada-US Survey of Health. Inequalities were then decomposed by regression and decomposition analysis to distinguish the contributions of various factors. Results. The distribution of income accounted for close to half of incomerelated health inequalities in both the United States and Canada. Health care system factors (e.g., unmet needs and health insurance status) and risk factors (e.g., physical inactivity and obesity) contributed more to income-related health inequalities in the United States than to those in Canada. Conclusions. Individual-level health risk factors and health care system characteristics have similar associations with health status in both countries, but they both are far more prevalent and much more concentrated among lower-income groups in the United States than in Canada.

Suggested Citation

  • McGrail, K.M. & Van Doorslaer, E. & Ross, N.A. & Sanmartin, C., 2009. "Income-related health inequalities in Canada and the United States: A decomposition analysis," American Journal of Public Health, American Public Health Association, vol. 99(10), pages 1856-1863.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2007.129361_2
    DOI: 10.2105/AJPH.2007.129361
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    1. Alexandre Lebel & Yan Kestens & Christelle Clary & Sherri Bisset & S V Subramanian, 2014. "Geographic Variability in the Association between Socioeconomic Status and BMI in the USA and Canada," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-11, June.
    2. Jan Reinhardt & Ulrich Mansmann & Bernd Fellinghauer & Ralf Strobl & Eva Grill & Erik Elm & Gerold Stucki, 2011. "Functioning and disability in people living with spinal cord injury in high- and low-resourced countries: a comparative analysis of 14 countries," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(3), pages 341-352, June.
    3. Zhongliang Zhou & Yu Fang & Zhiying Zhou & Dan Li & Dan Wang & Yanli Li & Li Lu & Jianmin Gao & Gang Chen, 2017. "Assessing Income-Related Health Inequality and Horizontal Inequity in China," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 132(1), pages 241-256, May.
    4. Gerdtham, Ulf-G & Lundborg, Petter & Lyttkens, Carl Hampus & Nystedt, Paul, 2012. "Do Socioeconomic Factors Really Explain Income-Related Inequalities in Health? Applying a Twin Design to Standard Decomposition Analysis," Working Papers 2012:21, Lund University, Department of Economics.
    5. Chipo Mutyambizi & Frederik Booysen & Andrew Stokes & Milena Pavlova & Wim Groot, 2019. "Lifestyle and socio-economic inequalities in diabetes prevalence in South Africa: A decomposition analysis," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-21, January.
    6. Côté-Sergent, Aurelie & Fonseca, Raquel & Strumpf, Erin, 2020. "Comparing the education gradient in health deterioration among the elderly in six OECD countries," Health Policy, Elsevier, vol. 124(3), pages 326-335.
    7. Xin Xie & Qunhong Wu & Yanhua Hao & Hui Yin & Wenqi Fu & Ning Ning & Ling Xu & Chaojie Liu & Ye Li & Zheng Kang & Changzhi He & Guoxiang Liu, 2014. "Identifying Determinants of Socioeconomic Inequality in Health Service Utilization among Patients with Chronic Non-Communicable Diseases in China," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-14, June.
    8. Francesco Renna & Vasilios D. Kosteas & Kuchibhotla Dinkar, 2021. "Inequality in health insurance coverage before and after the Affordable Care Act," Health Economics, John Wiley & Sons, Ltd., vol. 30(2), pages 384-402, February.
    9. Heckley, Gawain A. & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2014. "A New Approach to Decomposition of a Bivariate Rank Dependent Index Using Recentered Influence Function Regression," Working Papers 2014:36, Lund University, Department of Economics, revised 01 Apr 2015.
    10. Batana, Yélé Maweki, 2010. "Evolution of social inequalities in health in Quebec?," MPRA Paper 20710, University Library of Munich, Germany.
    11. Prus, Steven G., 2011. "Comparing social determinants of self-rated health across the United States and Canada," Social Science & Medicine, Elsevier, vol. 73(1), pages 50-59, July.
    12. Sumedha Arya & Pamela Wilton & David Page & Laurence Boma-Fischer & Georgina Floros & Katie N Dainty & Rochelle Winikoff & Michelle Sholzberg, 2020. "Healthcare provider perspectives on inequities in access to care for patients with inherited bleeding disorders," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-10, February.
    13. Pauline Rebouillat & Sarah Bonin & Yan Kestens & Sarah Chaput & Louis Drouin & Geneviève Mercille, 2019. "Fruit and Vegetable Purchases in Farmer’s Market Stands: Analysing Survey and Sales Data," IJERPH, MDPI, vol. 17(1), pages 1-22, December.
    14. Hajizadeh, Mohammad & Hu, Min & Bombay, Amy & Asada, Yukiko, 2018. "Socioeconomic inequalities in health among Indigenous peoples living off-reserve in Canada: Trends and determinants," Health Policy, Elsevier, vol. 122(8), pages 854-865.
    15. Zajacova, Anna & Siddiqi, Arjumand, 2022. "A comparison of health and socioeconomic gradients in health between the United States and Canada," Social Science & Medicine, Elsevier, vol. 306(C).
    16. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.
    17. Hajizadeh, Mohammad & Mitnitski, Arnold & Rockwood, Kenneth, 2016. "Socioeconomic gradient in health in Canada: Is the gap widening or narrowing?," Health Policy, Elsevier, vol. 120(9), pages 1040-1050.
    18. Ana Stipčić & Tanja Ćorić & Marijan Erceg & Frane Mihanović & Ivana Kolčić & Ozren Polašek, 2015. "Socioeconomic inequalities show remarkably poor association with health and disease in Southern Croatia," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 60(4), pages 417-426, May.
    19. Kachi, Yuko & Inoue, Mariko & Nishikitani, Mariko & Tsurugano, Shinobu & Yano, Eiji, 2013. "Determinants of changes in income-related health inequalities among working-age adults in Japan, 1986–2007: Time-trend study," Social Science & Medicine, Elsevier, vol. 81(C), pages 94-101.

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