MSc (Med), Population-Based Epidemiology, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Introduction: Although socioeconomic inequality in health and mortality is currently on the top of the epidemiologic debate, studies however on the subject among adult population in Africa has been hampered due to the long absence of data in many countries. With the present reliable records of deaths from emerged demographic surveillance systems on the continent, adult mortality can now be accurately estimated. Objectives: The study‟s main objectives were 1. To calculate and show trend in adult mortality rate in ACDIS between 2001 and 2007. 2. To measure the association between mortality and individual‟s socio-economic status in the ACDIS. Methods: Individuals were selected based on age (15-64 yrs) and residency (Resident in the DSA on 1st January 2001). The total number of adults who met the criteria was 33,677; out of whom 4,058 died during the seven years follow up period. Mortality rates were computed using Kaplan-Meier survival estimates expressed per 1000 PYO. Household wealth index was constructed by use of PCA. The association between SES and adult mortality was assessed using Cox proportional Hazard model controlling for potential confounders such as age, sex and marital status. Results: The High group of the socioeconomic quintile had the highest mortality rate of 22.2 per 1000 PYO, 95% CI (20.7 - 23.7). There was no significant trend in the rates among the SES groups. After adjusting for the potential confounders; the effect of socioeconomic status in the highest SES category was 0.10 times less likelihood for death compared to the lowest SES group [HR=0.90, p=0.042, 95% CI (0.81 - 0.99)]. Conclusion: This study revealed that adult socioeconomic status is not significantly associated with adult mortality. Reducing the gap between the rich and the poor might not be the effective way in reducing adult mortality.

Public school finance and school accountability are highly contentious subjects. This correlational study illustrates campus level instructional spending efficiency by examining various input and output variables. The study utilizes data envelopment analysis of selected variables to compare elementary campuses and create instructional spending efficiency measures within purposively selected metropolitan educational service regions in Texas. The study analyzes elementary school instructional spending and student classification as economically disadvantaged compared to student achievement in English language arts. The study finds a direct relationship between instructional spending efficiency and student achievement. The relationship between the socioeconomic variable of economically disadvantaged status is inverse. This finding suggests that in depth examinations of highly inefficient, but relatively high academic performing cases, may uncover effective instructional or operational practices tailored to the needs of the sub-populations.

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This thesis concerns the modelling of individuals’ health over the life course, within the framework set by the now substantial international literature on the relationship between socioeconomic status and health. The focus is on people with long term illnesses and related disabilities, on inequalities in health by socioeconomic status (SES) and on the impact of health on employment.¶ The main tool of analysis is a dynamic microsimulation model of the Australian population which tracks the demographic, socioeconomic and financial characteristics of individuals and their families over the life course. Its original form, developed at the National Centre for Socioeconomic Modelling, University of Canberra, is based on a one per cent representative sample of the Australian population (around 150,000 individuals), with a series of life course events simulated for individuals and their families up to 2050 - such as births, deaths, migration, taxes, education, labour force participation, earned income, wealth accumulation and government transfers. The model is written in the C programming language and was initially used on a UNIX system. The dramatic increases in the speed and memory size of PCs over the past five years has led to a PC version now being available.¶ Despite their relatively short existence and long development phases, dynamic microsimulation models are now used in many developed countries – for example, the USA, UK, Canada, France, Sweden, Norway and Italy. In recognition of their ability to analyse distributional and financial issues in considerably greater depth than what is possible with traditional methods, their use by government for policy analysis is rapidly increasing.¶ In this thesis two new modules were added to the original Australian dynamic microsimulation model – namely: a Health_SES module and a Health State Transitions module. The former makes the study of health inequalities across socioeconomic groups possible. The latter provides a link between health status and the ability of individuals to carry out every day activities as the severity of their ill-health increases with age. A major advantage of adding these new modules to an existing main model is that it allows much more comprehensive studies over the life courses of individuals than the alternative would allow – that is the building of two stand-alone models developed exclusively for ‘health-SES’ and ‘health state transition’ types of applications.¶ The main data sources used to construct the two new modules were an extract from the Australian Institute of Health and Welfare’s Mortality database covering the 1995-97 period, and the Australian Bureau of Statistic’s 1998 survey of Disability, Ageing and Carers. The analysis of the mortality data was handled using EXCEL, and that of the much larger Disability survey unit record dataset - over 40,000 individuals and 100s of variables – using the SAS programming language.¶ While most of the methodologies used in constructing the new modules are in line with what became the norm for dynamic microsimulation model development, the thesis contains several innovations. The main ones are: a quantitative assessment of the suitability of different types of SES indicators for studies of health inequalities; the modelling of the progression of people’s health from illness-free status to mild and severe disability; the development of a methodology for estimating health state transition probabilities from cross-sectional data (in the absence of longitudinal data); and the linking of health status to individual’s ability to stay in the labour force.¶ As with most models, there are a number of limitations. These are discussed in the thesis, together with areas of possible future improvements.¶ The thesis also presents two novel and topical – though at this stage illustrative – applications of the enhanced dynamic microsimulation model. The first simulates the impact of a narrowing in health inequalities in Australia as health is lifted nationally to the level currently enjoyed by the most affluent 20% of the population. The findings are that, if such a policy change were implemented, close to half a million fewer Australians would be disabled, around 180,000 life years would be saved, health care costs would be around A$1 billion lower per year and the government could save close to A$700 million on the Disability Support Pension.¶ The second application quantifies the likely impacts of longer working lives in future, which may arise from changes such as: more favourable labour market conditions; government incentives to remain in the labour force longer (eg the lifting of the pension age); and general improvements in health. This application estimates the probability that Australians aged 65-70 would work more than 15 hours per week, had such changes eventuated. The decision to retire is modelled as a function of each individual’s own health, socioeconomic status, age, sex and family composition. The impacts are simulated in a world in which current patterns of health by age, sex and SES remain unchanged over time – the Base case; and a world replicating the narrower health inequalities scenario of the first application. Under the Base case an additional 450,000 persons aged 65-70 years were estimated to remain in the workforce - with the related earnings totalling up to $20 billion in 1998 ($35 billion in 2018) and savings by government on the age pension of around $2 billion ($4 billion in 2018). Under the narrower health inequalities scenario the numbers working, their earnings and the related savings on the age pension were estimated to be around 7% higher. Much of the original research carried out for this thesis has appeared, or is yet to appear, in refereed publications.¶

Thesis (Ph. D.)--University of Wisconsin--Madison, 1966. / Vita. Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

A popular belief in the exploding Pentecostal movement in the global South is the idea that if an individual has enough faith, God will bless them with financial prosperity. Although historically Pentecostalism has been identified as a religion of the poor, this study examines recent arguments that the current Pentecostal movement in Guatemala is a religion of the socially mobile middle and elite classes. Data from the Pew Forum on Religious and Public Life’s 2006 survey Spirit and Power: Survey of Pentecostals in Guatemala is used to conduct a logistic regression, in order to measure the effects of socioeconomic status on adherence to prosperity belief. Results suggest that, contrary to the current literature on Guatemalan Pentecostalism, prosperity belief is not necessarily concentrated among the upwardly mobile middle and upper classes, but rather is widely diffused across social strata, and in particular, among those that have lower levels of education. These findings have implications for the study of Pentecostalism in Guatemala and in the global South in general.

Antisocial behavior, both criminal and noncriminal, is a prominent yet poorly understood public health concern. Research on antisocial behavior typically focuses on either individual or environmental risk factors, rarely integrating risks across levels of analysis. Although low objective SES is clearly associated with antisocial behavior, the reasons why are unclear. Sociological theories suggest this relationship is due to neighborhood and environmental characteristics that create social disorganization and reduce informal social controls in the community. On the other hand, psychological theories suggest that elevated levels of psychological distress and psychopathic traits may influence individual risk for antisocial behavior. The purpose of this study was to integrate sociological and psychological models to examine how certain individual and environmental risk factors intersect in predicting antisocial behavior. In a demographically diverse adult male sample (N = 462), environmental (neighborhood distress) and individual (psychological distress) risk factors each mediated the SES – antisocial behavior relationship (as predicted), although findings depended on which definition of SES was used (objective versus subjective). In addition, psychopathic dimensions (specifically, meanness and disinhibition) were observed to exacerbate the effects of neighborhood and psychological distress on antisocial behavior, as hypothesized. Supplemental analyses also considered index variables comprising neighborhood disadvantage. Overall, results of this study help inform psychological and sociological theories of antisocial behavior, and may assist in clarifying potential neighborhood- and individual-level foci for interventions to prevent and reduce antisocial behavior in the community. / Ph. D. / Antisocial behavior is an important public health concern. Low SES is linked to antisocial behavior, but the reasons why are unclear. Sociological theories suggest this relationship is due to a person’s neighborhood and environment, while psychological theories suggest this relationship is due to individual distress and psychopathy. The purpose of this study was to look across sociological and psychological models to examine how risk factors intersect to predict antisocial behavior. Results found environmental (neighborhood distress) and individual (psychological distress) risk factors each mediated (significantly explained) the SES – antisocial behavior relationship. In addition, psychopathy strengthened the effects of environmental and individual distress on antisocial behavior. Results of this study can be used to identify potential environmental and individual mechanisms that can be targeted to prevent and reduce antisocial behavior in the community.

The purpose of this study was to determine if there was a relationship between the students to computer ratio and 6th grade student achievement in Math and Reading during the 2013-2014 and 2014-2015 school years as compared by socioeconomic status at each of 562 schools in Tennessee. The independent variables in the study were the ratio of students to computer (low/middle/high), the change in ratio of students to computer from 2013-2014 to 2014-2015, and socioeconomic status (low/non-low). The dependent variables in the study were 6th grade mean Reading scores for 2014-2015, 6th grade mean Reading gain scores from 2013-2014 to 2014-2015, 6th grade mean Math scores for 2014-2015, and 6th grade mean Math gain scores from 2013-2014 to 2014-2015. There was not a significant difference between the mean TCAP scores in Reading and Math and low, middle, or high technology schools. There was no correlation between the changes in ratios and TCAP Reading and Math scores. There was no significant difference between low, middle, and high technology schools as compared by their low or non-low SES. There was no significant difference in TCAP Reading or Math scores for low, middle, or high technology schools as compared by their low or non-low SES. There was no significant difference in the change in TCAP Reading and Math scores as compared by low, middle, or high technology and their low or non-low SES. There was no significant difference in TCAP Reading and Math achievement scores as compared by low, middle, or high technology in low SES schools. There was no significant difference in TCAP Reading and Math achievement scores as compared by low, middle, or high technology in non-low SES schools.

Compared to wealthy individuals, individuals with low socioeconomic status (SES) often receive health services of lower intensity or quality and have difficulty accessing care. This is particularly true in the area of inpatient surgery. Individuals with low socioeconomic status are often less likely than individuals associated with high socioeconomic status to receive timely surgical care, and less likely than high SES to receive evidence-based treatments for surgical care. Despite these large gaps, there is a lack of consensus whether disparities in surgical outcomes are primarily due to differences in patient characteristics such as acuity or whether they are attributable to disparities in the quality of surgical care among those with access. The overall goal of this dissertation is to illuminate the relationship between socioeconomic status and surgical outcomes. The project aims are: 1) classify trends in post-surgical quality and analyze data on the relationship between socioeconomic status and surgical outcomes; 2) to evaluate whether changes in access to care can eliminate disparities in outcomes by analyzing the impact of the Massachusetts health reform on socioeconomic disparities in inpatient surgery; and 3) to show the potential effects of SES on surgical outcomes by using the Theory of Fundamental Causes. To meet the study objectives, this study proposes to use data from the Nationwide Inpatient Sample (NIS) and the State Inpatient Database (SID). This approach uses socioeconomic information in the NIS and SID that is a quartile classification of the estimated median household income of residents in the patient’s ZIP Code. The outcomes of interest are widely used quality measures: post-surgery mortality and complications at the national level, post-surgical mortality in Massachusetts for select inpatient surgeries, and difference-in-difference estimates. The approach used to identify trends in post-surgical quality uses two analytical software products to analyze the NIS using a regression-based approach. Study findings will identify progress and gaps in the quality of inpatient surgical care over recent years and further determine whether improving access to care through policy design can eliminate or reduce disparities in surgical care outcomes. In the face of health reform, this research will offer important insight into the study of surgical disparities and potential impact following health policy changes such as the expansion of Medicaid, implementation of health insurance exchanges, and the individual mandate requiring individuals to obtain health coverage.

Inequality within the family (i.e. differential parenting) is associated with a variety of measures of child adjustment. To date there is no research examining the effects of this phenomenon on children’s physical health, or on the fashion in which this phenomenon may combine and interact with socioeconomic markers. The present study assessed 375 mothers and their children over a period of 18 months. Differential maternal negativity between siblings predicted change in child health, controlling for child gender, age, maternal education, income/assets, and absolute level of negativity in the household. The association between maternal education and change in child health was strongest when children were also exposed to high differential negativity, suggesting that these predictors combined in a cumulative fashion. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in combination with one another to predict change in child health.