The Income Gradient in Mortality during the Covid-19 Crisis: Evidence from Belgium

We use population-wide data from linked administrative registers to study the distributional pattern of mortality before and during the first wave of the Covid-19 pandemic in Belgium. Over the March-May 2020 study period, excess mortality is only found among those aged 65 and over. For this group, we find a significant negative income gradient in excess mortality, with excess deaths in the bottom income decile more than twice as high as in the top income decile for both men and women. However, given the high inequality in mortality in normal times, the income gradient in all-cause mortality is only marginally steeper during the peak of the health crisis when expressed in relative terms. Leveraging our individual-level data, we gauge the robustness of our results for other socioeconomic factors and decompose the role of individual vs. local effects. We provide direct evidence that geographic location effects on individual mortality are particularly strong during the first wave of the Covid-19 pandemic, channeling through the local number of Covid infections. This makes inference about the income gradient in excess mortality based on geographic variation misguided.

Socioeconomic and behavioural factors associated with access to and use of Personal Health Records

Background Access to and use of digital technology are more common among people of more advantaged socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. Methods A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. Results A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted models testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. Conclusion The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with less advantaged socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity.

Are Poor Parents Poor Parents? The Relationship between Poverty and Parenting among Mothers in the UK

Low-income parents have long been demonised in both political discourses and mainstream media, portrayed as lacking in parenting skills not just financial resources. Using the Millennium Cohort Study (MCS) this article examines to what extent there are differences in the parenting of low-income mothers by examining parenting behaviours of low-, middle- and high-income mothers. The findings show that where there are negative differences in the parenting of low-income mothers these are often part of a broader income gradient that extends all the way up the distribution, rather than unique to low-income mothers. Furthermore, there are some positive differences in parenting among low-income mothers compared to middle-income mothers. These findings have important implications: low-income parents are not an unusual or deviant group parenting differently to everyone else. The findings suggest more attention ought to be given to parenting differences higher up the income distribution. In focusing on low-income parents only, existing evidence exaggerates differences and wrongly identifies low-income parents as problematic.

A Poorly Understood Disease? The Unequal Distribution of Excess Mortality Due to COVID-19 Across French Municipalities

While COVID-19 was already responsible for more than 500,000 deaths worldwide as of July 3, 2020, very little is known on the socio-economic heterogeneity of its impact on mortality. In this paper, we combine several administrative data sources to estimate the relationship between mortality due to COVID-19 and poverty at a very local level (i.e. the municipality level) in France, one of the most severely hit country in the world. We find strong evidence of an income gradient in the impact of the pandemic on mortality: it is twice as large in the poorest municipalities compared to other municipalities. We then show that both poor housing conditions and higher occupational exposure are likely mechanisms. Overall, these mechanisms accounts for up to 60% of the difference observed between rich and poor municipalities.

Household income and child well-being in Japan: The role of grandparental coresidence and residential proximity

In this study, we examined whether and how the income gradient in child well-being may vary by grandparental coresidence and proximate residence in Japan, a country characterized by a high prevalence of intergenerational proximity and intensive family investment in children’s development. Using data from the Japan Child Panel Survey, we first demonstrated that household income is positively associated with multiple dimensions of children’s well-being, a relationship that was particularly strong for cognitive skills. We also found that children from lower-income families were more likely to coreside with grandparents than their counterparts from middle- and higher-income families, and that children from both lower- and higher-income families had similar likelihoods of living near their grandparents. However, children in lower- and higher-income families who coresided with grandparents had lower math and Japanese test scores than those living at a distance. These relationships resulted in smaller income gradients in test scores for children coresiding with grandparents and near their grandparents, relative to those whose grandparents lived farther away. International comparisons showed that the income gradient in children’s academic performance is largest in the US and smallest in urban China, with Japan being in the middle, and that multigenerational coresidence is generally associated with worse cognitive outcomes for children in both lower- and higher-income families across these three very different contexts. These findings provide new insights into the complex ways in which intergenerational proximity is related to economic disparities in children’s well-being.