1. Epidemiology and Global Health
  2. Medicine
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Do wealth and inequality associate with health in a small-scale subsistence society?

  1. Adrian V Jaeggi  Is a corresponding author
  2. Aaron D Blackwell  Is a corresponding author
  3. Christopher von Rueden
  4. Benjamin C Trumble
  5. Jonathan Stieglitz
  6. Angela R Garcia
  7. Thomas Kraft
  8. Bret A Beheim
  9. Paul L Hooper
  10. Hillard Kaplan
  11. Michael D Gurven
  1. University of Zurich, Switzerland
  2. Washington State University, United States
  3. University of Richmond, United States
  4. Arizona State University, United States
  5. Universite Toulouse 1 Capitole, France
  6. University of California, Santa Barbara, United States
  7. Max Planck Institute for Evolutionary Anthropology, Germany
  8. University of New Mexico, United States
  9. Chapman University, United States
Research Article
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Cite this article as: eLife 2021;10:e59437 doi: 10.7554/eLife.59437

Abstract

In high-income countries, one's relative socio-economic position and economic inequality may affect health and well-being, arguably via psychosocial stress. We tested this in a small-scale subsistence society, the Tsimane, by associating relative household wealth (n=871) and community-level wealth inequality (n=40, Gini = 0.15 – 0.53) with a range of psychological variables, stressors, and health outcomes (depressive symptoms [n=670], social conflicts [n=401], non-social problems [n=398], social support [n=399], cortisol [n=811], BMI [n=9926], blood pressure [n=3195], self-rated health [n=2523], morbidities [n=1542]) controlling for community-average wealth, age, sex, household size, community size, and distance to markets. Wealthier people largely had better outcomes while inequality associated with more respiratory disease, a leading cause of mortality. Greater inequality and lower wealth were associated with higher blood pressure. Psychosocial factors didn't mediate wealth-health associations. Thus, relative socio-economic position and inequality may affect health across diverse societies, though this is likely exacerbated in high-income countries.

Data availability

All data and R code are available at https://doi.org/10.5281/zenodo.4567498 with any updates at https://github.com/adblackwell/wealthinequality

Article and author information

Author details

  1. Adrian V Jaeggi

    Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
    For correspondence
    adrian.jaeggi@iem.uzh.ch
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-1695-0388
  2. Aaron D Blackwell

    Department of Anthropology, Washington State University, Pulman, United States
    For correspondence
    aaron.blackwell@wsu.edu
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-5871-9865
  3. Christopher von Rueden

    Jepson School of Leadership Studies, University of Richmond, Richmond, United States
    Competing interests
    The authors declare that no competing interests exist.
  4. Benjamin C Trumble

    School of Human Evolution and Social Change, Arizona State University, Tempe, United States
    Competing interests
    The authors declare that no competing interests exist.
  5. Jonathan Stieglitz

    Institute for Advanced Study in Toulouse, Universite Toulouse 1 Capitole, Toulouse, France
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-5985-9643
  6. Angela R Garcia

    Center for Evolution & Medicine, Arizona State University, Tempe, United States
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-6685-5533
  7. Thomas Kraft

    Department of Anthropology, University of California, Santa Barbara, Santa Barbara, United States
    Competing interests
    The authors declare that no competing interests exist.
  8. Bret A Beheim

    Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
    Competing interests
    The authors declare that no competing interests exist.
  9. Paul L Hooper

    Anthropology, University of New Mexico, Albuquerque, United States
    Competing interests
    The authors declare that no competing interests exist.
  10. Hillard Kaplan

    Chapman University, Orange, United States
    Competing interests
    The authors declare that no competing interests exist.
  11. Michael D Gurven

    Department of Anthropology, University of California, Santa Barbara, Santa Barbara, United States
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-5661-527X

Funding

Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PBZHP3-133443)

  • Adrian V Jaeggi

National Science Foundation (BCS0136274)

  • Hillard Kaplan

National Science Foundation (BCS0422690)

  • Michael D Gurven

National Institutes of Health (R01AG024119)

  • Hillard Kaplan
  • Michael D Gurven

National Institutes of Health (RF1AG054442)

  • Hillard Kaplan
  • Michael D Gurven

National Institutes of Health (R56AG024119)

  • Hillard Kaplan
  • Michael D Gurven

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: Institutional Review Board approval was granted by UNM (HRRC # 07-157) and UCSB (# 3-16- 0766), as was informed consent at three levels: (1) Tsimane government that oversees research projects, (2) village leaders and community meetings, and (3) study participants.

Reviewing Editor

  1. Milagros Ruiz

Publication history

  1. Received: May 29, 2020
  2. Accepted: May 10, 2021
  3. Accepted Manuscript published: May 14, 2021 (version 1)

Copyright

© 2021, Jaeggi et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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Further reading

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    2. Medicine
    Eyad A Qunaibi et al.
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    Background:

    Vaccine hesitancy can limit the benefits of available vaccines in halting the spread of COVID-19 pandemic. Previously published studies paid little attention to Arab countries, which has a population of over 440 million. In this study, we present the results of the first large-scale multinational study that measures vaccine hesitancy among Arab-speaking subjects.

    Methods:

    An online survey in Arabic was conducted from 14 January 2021 to 29 January 2021. It consisted of 17 questions capturing demographic data, acceptance of COVID-19 vaccine, attitudes toward the need for COVID-19 vaccination and associated health policies, and reasons for vaccination hesitancy. R software v.4.0.2 was used for data analysis and visualization.

    Results:

    The survey recruited 36,220 eligible participants (61.1% males, 38.9% females, mean age 32.6 ± 10.8 years) from all the 23 Arab countries and territories (83.4%) and 122 other countries (16.6%). Our analysis shows a significant rate of vaccine hesitancy among Arabs in and outside the Arab region (83% and 81%, respectively). The most cited reasons for hesitancy are concerns about side effects and distrust in health care policies, vaccine expedited production, published studies and vaccine producing companies. We also found that female participants, those who are 30–59 years old, those with no chronic diseases, those with lower level of academic education, and those who do not know the type of vaccine authorized in their countries are more hesitant to receive COVID-19 vaccination. On the other hand, participants who regularly receive the influenza vaccine, health care workers, and those from countries with higher rates of COVID-19 infections showed more vaccination willingness. Interactive representation of our results is posted on our project website at https://mainapp.shinyapps.io/CVHAA.

    Conclusions:

    Our results show higher vaccine hesitancy and refusal among Arab subjects, related mainly to distrust and concerns about side effects. Health authorities and Arab scientific community have to transparently address these concerns to improve vaccine acceptance.

    Funding:

    This study received no funding.

    1. Epidemiology and Global Health
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    Background:

    The US Food and Drug Administration authorized COVID-19 convalescent plasma (CCP) therapy for hospitalized COVID-19 patients via the Expanded Access Program (EAP) and the Emergency Use Authorization (EUA), leading to use in about 500,000 patients during the first year of the pandemic for the USA.

    Methods:

    We tracked the number of CCP units dispensed to hospitals by blood banking organizations and correlated that usage with hospital admission and mortality data.

    Results:

    CCP usage per admission peaked in Fall 2020, with more than 40% of inpatients estimated to have received CCP between late September and early November 2020. However, after randomized controlled trials failed to show a reduction in mortality, CCP usage per admission declined steadily to a nadir of less than 10% in March 2021. We found a strong inverse correlation (r = −0.52, p=0.002) between CCP usage per hospital admission and deaths occurring 2 weeks after admission, and this finding was robust to examination of deaths taking place 1, 2, or 3 weeks after admission. Changes in the number of hospital admissions, SARS-CoV-2 variants, and age of patients could not explain these findings. The retreat from CCP usage might have resulted in as many as 29,000 excess deaths from mid-November 2020 to February 2021.

    Conclusions:

    A strong inverse correlation between CCP use and mortality per admission in the USA provides population-level evidence consistent with the notion that CCP reduces mortality in COVID-19 and suggests that the recent decline in usage could have resulted in excess deaths.

    Funding:

    There was no specific funding for this study. AC was supported in part by RO1 HL059842 and R01 AI1520789; MJJ was supported in part by 5R35HL139854. This project has been funded in whole or in part with Federal funds from the Department of Health and Human Services; Office of the Assistant Secretary for Preparedness and Response; Biomedical Advanced Research and Development Authority under Contract No. 75A50120C00096.