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nullPoverty and HealthPoverty and HealthJennifer Madans, Kimberly Lochner, and Diane Makuc National Center for Health Statistics Centers for Disease Control and Prevention March 8, 2005OverviewOverviewNCHS 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 indicatorshttp://www.tjshiqiu.com 高压油管 金属软管 液压接头 http://www.u51688.com http://www.qiwhy.comOverview (con’t)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 Why is NCHS Interested in Poverty?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 Focus on HealthFocus on HealthEducationIncomeEarly life experiencesEnvironment/ Living conditionsHuman biology/ geneticsHealth behaviorsHealth insurance/ Health carePsychological/ PsychosocialHealth statusFocus on HealthFocus on HealthEducationIncomeEarly life experiencesEnvironment/ Living conditionsHuman biology/ geneticsHealth behaviorsHealth insurance/ Health carePsychological/ PsychosocialHealth statusFocus on HealthFocus on HealthEducationIncomeEarly life experiencesEnvironment/ Living conditionsHuman biology/ geneticsHealth behaviorsHealth insurance/ Health carePsychological/ PsychosocialHealth statusSelection of Health IndicatorsSelection of Health IndicatorsNational 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 availableCollection of Income in NHANES and NHISCollection of Income in NHANES and NHISIndividual 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 participationHealth IndicatorsHealth IndicatorsMeasured health indicators Hypertension Serum cholesterol Obesity Untreated dental caries Blood lead levels Self reported health indicators Activity limitation Self-rated health status Health care utilizationnullLife Expectancy at Birth and at 65 Years of Age by SexLife expectancy in yearsLife Expectancy Among the Poor?Life Expectancy Among the Poor?XnullInfant Mortality Rates by Years of Maternal Educationnull Data Source: National Vital Statistics System Chronic Disease Death Rates Among Adults 25-64 Years by EducationnullYear Data Source: National Vital Statistics System Communicable Disease Death Rates Among Adults 25-64 Years by Educationnull Hypertension Among Adults 20-74 Years by Percent of Poverty ThresholdData Source: National Health and Nutrition Examination SurveyYearnull Elevated Serum Cholesterol Among Adults 20-74 Years by Percent of Poverty ThresholdData Source: National Health and Nutrition Examination SurveyYearnull Obesity Among Adults 20-74 Years by Percent of Poverty ThresholdData Source: National Health and Nutrition Examination SurveyYearnullData Source: National Health and Nutrition Examination SurveyOverweight Among Childrenby Percent of Poverty ThresholdnullYearUntreated Dental Caries by Percent of Poverty ThresholdData Source: National Health and Nutrition Examination SurveynullElevated Blood Lead Levels Among Children 1-5 Years by Percent of Poverty ThresholdData Source: National Health and Nutrition Examination SurveynullPercent of Persons with Activity Limitation by Percent of Poverty ThresholdData Source: National Health Interview SurveynullADL Limitation for Medicare Beneficiaries 65 and Older by Percent of Poverty Threshold Data Source: Medicare Current Beneficiary SurveynullPercent of Persons in Fair/Poor Health by Percent of Poverty ThresholdData Source: National Health Interview SurveynullPercent of Children Under 18 Years Without a Health Care Visit in the Past Year by Percent of Poverty ThresholdData Source: National Health Interview SurveynullPercent of Persons Without a Health Care Visit in the Past 2 Years by Percent of Poverty ThresholdData Source: National Health Interview SurveySummarySummaryImprovements in health for everyone Exceptions, obesity and overweight Generally worse health outcomes for poor people Notable exceptions, especially among men Data IssuesData IssuesSurveys 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 levelData Issues (cont)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 lifetime may have stronger impact than income level on health Conclusion: NCHS’s FocusConclusion: NCHS’s FocusNeed 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