Low income, community poverty and risk of end stage renal disease

BACKGROUND: The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. However, few studies have examined the relation of both individual and community socioeconomic status (SES) with incident ESRD. METHODS: Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in Stroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier poverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier affluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household income and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a competing event using the Fine and Gray method. RESULTS: There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years (105 py) in high poverty outlier counties and were 76.3 /105 py in affluent outlier counties, p trend = 0.06. In unadjusted competing risk models, persons residing in high poverty outlier counties had higher incidence of ESRD (which was not statistically significant) when compared to those persons residing in counties with neither high poverty nor affluence [hazard ratio (HR) 1.54, 95% Confidence Interval (CI) 0.75-3.20]. This association was markedly attenuated following adjustment for socio-demographic factors (age, sex, race, education, and income); HR 0.96, 95% CI 0.46-2.00. However, in the same adjusted model, income was independently associated with risk of ESRD [HR 3.75, 95% CI 1.62-8.64, comparing the < $20,000 income group to the > $75,000 group]. There were no statistically significant associations of county measures of poverty with incident ESRD, and no evidence of effect modification. CONCLUSIONS: In contrast to annual family income, geospatially-linked measures of county poverty have little relation with risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the individual level.

Worlds of working poverty : Cross-national variation in the mechanisms that lead to poverty among workers

The objective of this paper is to distinguish between different types of working poverty, on the basis of the mechanisms that produce it. Whereas the poverty literature identifies a myriad of risk factors and of categories of disadvantaged workers, we focus on three immediate causes of working poverty, namely low wage rate, weak labour force attachment, and high needs, the latter mainly due to the presence of children (and sometimes to the increase in needs caused by a divorce). These three mechanisms are the channels through which macroeconomic, demographic and policy factors have a direct bearing on working households. The main assumption tested here is that welfare regimes strongly influence the relative weight of these three mechanisms in producing working poverty, and, hence, the composition of the working-poor population. Our figures confirm this hypothesis and show that low-wage employment is a key factor, but, by far, not the only one and that family policies broadly understood play a decisive role, as well as patterns of labour market participation and integration.

Alleviating Working Poverty in Postindustrial Economies

In order to identify the main social policy tools that can efficiently combat working poverty, it is essential to identify its main driving factors. More importantly, this work shows that all poverty factors identified in the literature have a direct bearing on working households through three mechanisms, namely being badly paid, having a below-average workforce participation, and high needs. One of the main purposes of this work is to assess whether the policies put forward in the specialist literature as potentially efficient really work. This is done in two ways. A first empirical prong provides an evaluation of the employment and antipoverty effects of these instruments, based on a meta-analysis of four instruments: minimum wages, tax credits for working households, family cash benefits and childcare policies. The second prong relies on a broader framework based on welfare regimes. This work contributes to the identification of a typology of welfare regimes that is suitable for the analysis of working poverty, and four countries are chosen to exemplify each regime: the US, Sweden, Germany, and Spain. It then moves on to show that the weight of the three working poverty mechanisms varies widely from one welfare regime to the other. This second empirical contribution clearly shows that there is no "one-size-fits-all" approach to the fight against working poverty. But none of this is possible without having properly defined the phenomenon. Most of the literature is characterized by a "definitional chaos" that probably does more harm than good to social policy efforts. Hence, this book provides a conceptual reflection pleading for the use of a very encompassing definition of being in work. It shows that "the working poor" is too broad a category to be used for meaningful academic or policy discussion, and that a distinction must be operated between different categories of the working poor. Failing to acknowledge this prevents the design of an efficient policy mix.

Poverty and marginalisation : challenges to poor women's leadership in urban India

This article examines the women's quota at the local governance level in urban India, using several case studies of women municipal councillors, to question the evidently low numbers of poor and marginalised women amongst them. It examines issues of class, caste, and religion that have a direct impact on the access of poor women to quotas reserved for them at the local government level. The objective of this work is to draw attention to the specific ways in which women are constrained at the pre-election stage, resulting in an elite capture of the women's quota in India, indicating the need for further research and study on this issue.