Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep 'my home'

Background Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors.
Aims To analyse the probability of admission to residential and nursing home care according to housing tenure and house value.
Methods Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of approximate to 28% of the population of Northern Ireland.
Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters.
Conclusions The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.

Average household income, crime, and smoking behaviour in a local area: The Finnish 10-Town study

Social environments, like neighbourhoods, are increasingly recognised as determinants of health. While several studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour, little is known of the health effects of neighbourhood crime rates. Using the ongoing 10-Town study in Finland, we examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behaviour in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behaviour among women was substantially explained by the area-level crime rate. This study extends our knowledge of potential pathways through which social environmental factors may affect health. (c) 2007 Elsevier Ltd. All rights reserved.

Welfare regimes and household income packaging in the European Union

This paper uses harmonized data for the member states of the European Union to analyse household income packaging from a 'welfare regimes' perspective. Using data from the third wave of the ECHP, it looks at how the role of welfare transfers in the income package varies across countries and welfare regimes, and assesses whether this is consistent with the predictions of welfare regime theory, having first elaborated some specific hypotheses in that regard. It finds that when one focuses on averages across countries categorized into regimes, many of these hypotheses about the role of transfers are in broad terms borne out by the evidence. However, when one focuses on individual countries rather than regime averages the picture is a good deal more complex and consistency with the range of hypotheses more limited. It is essential that this variation across countries is taken into account in interpreting and using welfare regime theory and typologies.

Persistent income poverty and deprivation in the European Union: An analysis of the first three waves of the European Community Household Panel

Poverty research has increasingly focused on persistent income poverty, both as a crucial social indicator and as a target for policy intervention. Such an approach can lead to an identification of a sub-set of poor individuals facing particularly adverse circumstances and/or distinctive problems in escaping from poverty. Here we seek to establish whether, in comparison with cross-sectional measures, persistent poverty measures also provide a better measure of exclusion from a minimally acceptable way of life and relate with other important variables in a logical fashion. Our analysis draws upon the first three waves of the ECHP and shows that a persistent poverty measure does constitute a significant improvement over its cross-sectional counterpart in the explanation of levels of deprivation. Persistent poverty is related to life-style deprivation in a manner that comes close to being uniform across countries. The measure of persistence also conforms to our expectations of how a poverty measure should behave in that, unlike relative income poverty lines, defining the threshold level more stringently enables us to identify progressively groups of increasingly deprived respondents. Overall the persistent poverty measure constitutes a significant advance on cross-sectional income measures. However, there is clearly a great deal relating to the process of accumulation and of erosion of resources, which is not fully captured in the persistent poverty measure. In the absence of such information, there is a great deal to be said for making use of both types of indictors in formulating and evaluating policies while we continue to improve our understanding of longer-term processes.

Income, deprivation, and economic strain. An analysis of the European community household panel

This paper is concerned with the relationship between household income and life-style deprivation, and their combined impact on households' perceptions of economic strain. It takes as a point of departure findings from a number of European countries showing that the relationship between income and deprivation is weaker than widely assumed and that relative income poverty lines may perform poorly in terms of identifying the most deprived households. It proceeds to examine how far these conclusions about income and deprivation can be generalized to the countries included in the first wave of the European Community Household Panel. Results show that five distinct dimensions of deprivation emerge from an overall European analysis and that these are consistent across individual countries. While a good deal of similarity is observed in the income-deprivation relationship, countries differ in the strength of relationship between income and what is termed 'current liferstyle deprivation' with the relationship being generally weakest in the richer countries. The implications of these findings for the use of relative income poverty lines are developed. Extending this analysis to an assessment of how income and deprivation combine to influence perceptions of economic strain, we show that within-nation reference group processes operating in a uniform manner across countries can account for the bulk of the variation in strain. Cross-national differences can be accounted for by corresponding variation in income and deprivation levels.

Changing attitudes to gender roles: A longitudinal analysis of ordinal response data from the British household panel study

This article examines changes in attitudes to gender roles in contemporary Britain by using a first-order Markov process in which cumulative transition probabilities are logistic functions of a set of personal and socioeconomic characteristics of respondents. The data are taken from the British Household Panel Study (BHPS). The attitudinal responses examined take the form of ordinal responses concerning gender roles in 1991 and 2003. The likelihood function is partitioned to make possible the use of existing software for estimating model parameters. For the BHPS data, it was found that, depending on the value of the response in 1991, a variety of factors were important determinants of attitudes to gender roles by 2003.

Heterogeneity assumptions in the specification of bargaining models: a study of household level trade-offs between commuting time and salary

With many real world decisions being made in conjunction with other decision makers, or single agent decisions having an influence on other members of the decision maker's immediate entourage, there is strong interest in studying the relative weight assigned to different agents in such contexts. In the present paper, we focus on the case of one member of a two person household being asked to make choices affecting the travel time and salary of both members. We highlight the presence of significant heterogeneity across individuals not just in their underlying sensitivities, but also in the relative weight they assign to their partner, and show how this weight varies across attributes. This is in contrast to existing work which uses weights assigned to individual agents at the level of the overall utility rather than for individual attributes. We also show clear evidence of a risk of confounding between heterogeneity in marginal sensitivities and heterogeneity in the weights assigned to each member. We show how this can lead to misleading model results, and argue that this may also explain past results showing bargaining or weight parameters outside the usual [0,1] range in more traditional joint decision making contexts. In terms of substantive results, we find that male respondents place more weight on their partner's travel time, while female respondents place more weight on their partner's salary.