Woolf Steven H, Johnson Robert E, Geiger H Jack
Department of Family Medicine, Virginia Commonwealth University, Richmond, Virginia 23298-0251, USA.
Am J Prev Med. 2006 Oct;31(4):332-341. doi: 10.1016/j.amepre.2006.06.022.
The U.S. poverty rate has increased since 2000, but the depth of poverty experienced by Americans has been inadequately studied. Of particular concern is whether severe poverty is increasing, a trend that would carry important public health implications.
Income-to-poverty (I/P) ratios and income deficits/surpluses were examined for the 1990-2004 period. The severely poor, moderately poor, and near-poor were classified as those with I/P ratios of less than 0.5, 0.5 to 1.0, or 1.0 to 2.0, respectively. Income deficits/surpluses were classified relative to the poverty threshold as Tier I (deficit Dollars 8000 or more), Tier II (deficit or surplus less than Dollars 8000), or Tier III (surplus more than Dollars 8000). Odds ratios for severe poverty and Tier I were also calculated.
Severe poverty increased between 2000 and 2004-those with I/P ratios of less than 0.5 grew by 20%, and Tier I grew by 45% to 55%-while the prevalence of higher levels of income diminished. The population in severe poverty was over-represented by children (odds ratio [OR] = 1.69, confidence interval [CI] = 1.63-1.75), African Americans (OR = 2.84, CI = 2.74-2.95), and Hispanics (OR = 1.64, CI = 1.58-1.71).
From 2000 to 2004, the prevalence of severe poverty increased sharply while the proportion of Americans in higher income tiers diminished. These trends have broad societal implications. Likely health consequences include a higher prevalence of chronic illnesses, more frequent and severe disease complications, and increased demands and costs for healthcare services. Adverse effects on children warrant special concern. The growth in the number of Americans living in poverty calls for the re-examination of policies enacted in recent years to foster economic progress.
自2000年以来，美国的贫困率有所上升，但美国人所经历的贫困深度尚未得到充分研究。特别令人担忧的是严重贫困是否正在加剧，这一趋势将产生重要的公共卫生影响。
对1990 - 2004年期间的收入与贫困（I/P）比率以及收入赤字/盈余进行了研究。严重贫困人口、中度贫困人口和接近贫困人口分别被定义为I/P比率小于0.5、0.5至1.0或1.0至2.0的人群。收入赤字/盈余相对于贫困线被分为一级（赤字8000美元或更多）、二级（赤字或盈余小于8000美元）或三级（盈余超过8000美元）。还计算了严重贫困和一级的比值比。
2000年至2004年期间，严重贫困现象加剧——I/P比率小于0.5的人群增加了20%，一级人群增加了45%至55%——而高收入水平人群的患病率下降。严重贫困人口中儿童（比值比[OR]=1.69，置信区间[CI]=1.63 - 1.75）、非裔美国人（OR = 2.84，CI = 2.74 - 2.95）和西班牙裔（OR = 1.64，CI = 1.58 - 1.71）的占比过高。
从2000年到2004年，严重贫困的患病率急剧上升，而高收入阶层的美国人比例下降。这些趋势具有广泛的社会影响。可能的健康后果包括慢性病患病率更高、疾病并发症更频繁和严重，以及医疗服务需求和成本增加。对儿童的不利影响值得特别关注。生活在贫困中的美国人数量的增长要求重新审视近年来为促进经济发展而制定的政策。
