Equal dependence of the high prevalence of health problems on age and family income in rural southern areas

Background. People who have periods of low family income are at risk for increased health problems in the future, even if they present a similar clinical picture before the reduction in family income. The association between low income and health status was studied in residents of an area with relatively lo iu-average family income and with a historically unstable economy. Methods. We surveyed a stratified, clustered sample of residents of Johnson County, Tennessee, using a structured interview. The responses were analyzed in conjunction with national and regional data (National Health Interview Survey). Results. Residents of the geographic area under study had a markedly higher prevalence of self-reported health problems than either the national average or rural areas in the southeast United Stares. The higher prevalence was accounted for by the combination of age and family income, which had equal effects on health status, but not by age differences alone. Conclusions. Family income and economic development are critically important to improving community health. Sensible capitation rates in managed care arrangements can be obtained only if the income distribution of an insured population is considered along with their age, sex, and physical health status.