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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 : 

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

Overview (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 Health : 

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

Focus on Health : 

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

Focus on Health : 

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

Selection of Health Indicators : 

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

Collection of Income in NHANES and NHIS : 

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

Health Indicators : 

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

Slide 11: 

Life Expectancy at Birth and at 65 Years of Age by Sex Life expectancy in years

Life Expectancy Among the Poor? : 

Life Expectancy Among the Poor? X

Slide 13: 

Infant Mortality Rates by Years of Maternal Education

Slide 14: 

Data Source: National Vital Statistics System Chronic Disease Death Rates Among Adults 25-64 Years by Education

Slide 15: 

Year Data Source: National Vital Statistics System Communicable Disease Death Rates Among Adults 25-64 Years by Education

Slide 16: 

Hypertension Among Adults 20-74 Years by Percent of Poverty Threshold Data Source: National Health and Nutrition Examination Survey Year

Slide 17: 

Elevated Serum Cholesterol Among Adults 20-74 Years by Percent of Poverty Threshold Data Source: National Health and Nutrition Examination Survey Year

Slide 18: 

Obesity Among Adults 20-74 Years by Percent of Poverty Threshold Data Source: National Health and Nutrition Examination Survey Year

Slide 19: 

Data Source: National Health and Nutrition Examination Survey Overweight Among Children by Percent of Poverty Threshold

Slide 20: 

Year Untreated Dental Caries by Percent of Poverty Threshold Data Source: National Health and Nutrition Examination Survey

Slide 21: 

Elevated Blood Lead Levels Among Children 1-5 Years by Percent of Poverty Threshold Data Source: National Health and Nutrition Examination Survey

Slide 22: 

Percent of Persons with Activity Limitation by Percent of Poverty Threshold Data Source: National Health Interview Survey

Slide 23: 

ADL Limitation for Medicare Beneficiaries 65 and Older by Percent of Poverty Threshold Data Source: Medicare Current Beneficiary Survey

Slide 24: 

Percent of Persons in Fair/Poor Health by Percent of Poverty Threshold Data Source: National Health Interview Survey

Slide 25: 

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

Slide 26: 

Percent of Persons Without a Health Care Visit in the Past 2 Years by Percent of Poverty Threshold Data Source: National Health Interview Survey

Summary : 

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

Data Issues : 

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

Data 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 Focus : 

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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