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The presence of pronounced inequalities in mortality and life expectancy across income, education and social groups has long been a "stylized fact" of demography. Research across a large number of developed and wealthy countries, including Ireland, has shown that those with fewer resources, less education or a lower occupational class have higher standardised mortality rates (SMRs) than more advantaged individuals. The last analysis of Irish adult mortality differentials across social classes, carried out by the Central Statistics Office (CSO) and based on data for 2006, found that men in the unskilled manual social class had an SMR that was 1.8 times higher than males in the professional social class. However, little is known about how socio-economic inequalities in mortality in Ireland have changed since the mid-1990s, a period characterised by an unprecedented boom and bust in economic activity. In addition, previous analyses have made no attempt to adjust the SMRs to take account of those reporting missing or "unknown" occupation/socio-economic group (SEG). Using annual mortality data from the CSO over the period 1984-2008, a period of economic recovery and boom, this paper examines whether the general downward trend in mortality observed over this period was experienced equally by all SEGs. We find that the SMR for all groups fell between the 1980s and 2000s but that the extent of this fall was largest for Employer and Manager and Professional SEGs leading to a growing differential between these groups and all others. [ABSTRACT FROM AUTHOR]

In 2010, 46 per cent of Irish-born mothers were breastfeeding at hospital discharge, in comparison with 84 per cent of non-Irish-born mothers. Using data from the Irish National Perinatal Reporting System, we find that maternal country of birth is a large and highly significant predictor of breastfeeding at hospital discharge in Ireland over the period 2004-2010. Furthermore, we find that most of the difference in breastfeeding rates between Irish-born and non-Irish-born mothers is unexplained, i.e., not due to differences in observable characteristics. Our findings suggest that there are strong cultural/attitudinal differences in breastfeeding behaviour between Irish-born and non-Irish-born mothers. [ABSTRACT FROM AUTHOR]

In the literature on the links between socio-economic status (SES) and child health, there is evidence that the SES gradient is weaker for objective indicators of child health (e.g., height) than for subjective indicators (e.g., parental-assessed health). In this paper, we use cross-sectional micro-data from the Growing Up in Ireland study to examine the SES gradient in height, weight, general health status and chronic illness incidence. Using household income and mother's education as indicators of SES, we find only limited support for the contention that the SES gradient in child health in Ireland is stronger for more subjective indicators of child health. [ABSTRACT FROM AUTHOR]

In health care, there is extensive empirical evidence that the behaviour of both providers and users is affected by the financial incentives that they face. In this paper, we adopt a system-wide perspective and develop a conceptual framework to examine how current financial incentives in Irish health care conflict along four dimensions: provider versus user, user across type of provider, provider versus provider, and provider across type of user. We highlight areas within each of these four dimensions where current financial incentive structures are incompatible with existing policy priorities. The analysis in the paper also provides a framework to assess the effects of proposed policy changes on financial incentives within the health-care system using a joint analytic approach. [ABSTRACT FROM AUTHOR]

Rapid economic and demographic change in Ireland over the last decade, with associated increases in car dependence and congestion, has focused policy on encouraging more sustainable forms of travel. In this context, knowledge of current travel patterns and their determinants is crucial. In this paper, we extend earlier Irish research to examine the joint decision of car ownership and mode of transport to work. We employ cross-section micro-data from the 2006 Census of Population to estimate discrete choice models of car ownership and commuting mode choice for four sub-samples of the Irish population, based on residential location. Empirical results suggest that travel and supply-side characteristics such as travel time, costs, work location and public transport availability, as well as demographic and socio-economic characteristics such as age and household composition have significant effects on these decisions. [ABSTRACT FROM AUTHOR]

Objective: While there is a broad consensus that barriers to access in the utilisation of healthcare exist for immigrants in the US, European evidence exploring this issue paints a mixed picture, with studies from a variety of European jurisdictions presenting different conclusions. In this context, Ireland, a European country with substantial private involvement in healthcare delivery, and, a largely young immigrant population, provides an opportunity to investigate the healthcare utilisation of immigrants compared to natives in a European country with mixed private-public healthcare provision., Design: The healthcare utilisation patterns of immigrants (defined as residents with a foreign country of birth) and native-born participants were analysed from a nationally representative health survey of 6,326 adults, carried out in Ireland in 2016. An array of socio-economic and health information was collected such that regression analysis on healthcare consultations accounted for confounding factors., Results: Non-native residents of Ireland born outside the UK were less likely to have attended a General Practitioner (Odds ratio (OR): 0.62 [95% Confidence Interval (CI): 0.51-0.74]; p <0.001) or consultant doctor (OR: 0.60 [95% CI: 0.47-0.76]; p <0.001) in the previous year, relative to Irish-born individuals. UK-born residents of Ireland displayed similar utilisation patterns to those of the native population in terms of GP visitation, but a higher likelihood of having attended a consultant (OR: 1.44 [95% CI: 1.14-1.816]; p  = 0.004)., Conclusions: Lower use of healthcare by those born outside Ireland and the UK relative to the native Irish population may be due to different approaches to healthcare utilisation or obstacles to healthcare utilisation. The findings suggest that the utilisation of healthcare by immigrants merits continued policy attention to respond to the needs of these key groups in society and facilitate integration., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Background: Links between air pollution and asthma are less well established for older adults than some younger groups. Nitrogen dioxide (NO2) concentrations are widely used as an indicator of transport-related air pollution, and some literature suggests NO2 may directly affect asthma., Methods: This study used data on 8162 adults >50 years old in the Republic of Ireland to model associations between estimated annual outdoor concentration of NO2 and the probability of having asthma. Individual-level geo-coded survey data from The Irish Longitudinal Study on Ageing (TILDA) were linked to model-based estimates of annual average NO2 at 50 m resolution. Asthma was identified using two methods: self-reported diagnoses and respondents' use of medications related to obstructive airway diseases. Logistic regressions were used to model the relationships., Results: NO2 concentrations were positively associated with the probability of asthma [marginal effect (ME) per 1 ppb of airborne NO2 = 0.24 percentage points asthma self-report, 95% confidence interval (CI) 0.06-0.42, mean asthma prevalence 0.09; for use of relevant medications ME = 0.21 percentage points, 95% CI 0.049-0.37, mean prevalence 0.069]. Results were robust to varying model specification and time period. Respondents in the top fifth percentile of NO2 exposure had a larger effect size but also greater standard error (ME = 2.4 percentage points asthma self-report, 95% CI -0. 49 to 5.3)., Conclusions: Associations between local air pollution and asthma among older adults were found at relatively low concentrations. To illustrate this, the marginal effect of an increase in annual average NO2 concentration from sample minimum to median (2.5 ppb) represented about 7-8% of the sample average prevalence of asthma., (© The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

The period from 1996 to 2008 was one of rapid economic and social change in Ireland, with one of the most significant changes being the transition from a situation of net emigration to one of substantial net immigration. Although research on the impact of immigration on Irish society, as well as the labour market characteristics and experiences of immigrants in Ireland has increased in recent years, comparatively little is known about the health status of immigrants to Ireland. An extensive international literature has documented a 'healthy immigrant' effect for large immigrant-receiving countries such as the United States, Canada and Australia, whereby the health status of immigrants is better than comparable native-born individuals. There is also evidence to suggest that immigrants' health status deteriorates with time spent in the host country. However, the Irish immigration experience differs considerably from that of countries that have been the focus of research on the 'healthy immigrant' effect. Using microdata from a nationally representative survey of the population in 2007, this paper finds only limited evidence in favour of a 'healthy immigrant' effect for Ireland, although the distinctive features of the Irish immigrant population, and the nature of the data available, may partly explain the results.

Internationally, there is extensive empirical evidence that a strong primary care-led health system is associated with improved health outcomes, increased quality of care, decreased health inequalities and lower overall health-care costs. Within primary care, factors influencing access to, and utilisation of, general practitioner (GP) services have been widely examined and this paper focuses on the role of user financial incentives. In particular, user charges for health care have been observed to deter health-care utilisation. Relative to other countries, the Irish health-care system is unusual in that the majority of the population are required to pay out-of-pocket for GP care. However, in 2005 the Irish government extended eligibility for free GP care to a further small subset of the population. Using micro-data from a nationally representative survey of the population in 2007, this paper analyses the impact of differential coverage of free GP services on GP utilisation in Ireland. Results from multivariate regression analysis indicate that GP utilisation is significantly more likely in the context of free GP care, controlling for a range of demographic, socio-economic and health factors. Interpretation of the results for the new category of coverage is complicated by possible pent-up demand and selection effects., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

In the Republic of Ireland, approximately 30 per cent of the population ('medical card patients') are entitled to free GP services. Eligibility is determined primarily on the basis of an income means test. The remaining 70 per cent of the population ('private patients') must pay the full cost of GP consultations. In July 2001, eligibility for a medical card was extended to all those over 70 years of age, regardless of income. This extension in eligibility provides a natural experiment whereby we can examine the influence of access to free GP services on avoidable hospitalisations. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services or that can be treated more appropriately in a primary care setting. Using hospital discharge data for the period 1999-2004, the purpose of this paper is to test the proposition that enhanced access to GP services for the over 70s after July 2001 led to a decline in avoidable hospitalisations among this group. The results indicate that while avoidable hospitalisations for the over 70s did decline after 2001, they also fell for the under 70s, meaning that a significant difference-in-difference effect could not be identified., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

In the Republic of Ireland, approximately 30% of the population ('medical card patients') are entitled to free general practice services. Eligibility is determined primarily on the basis of an income means test. The remaining 70% of the population ('private patients') must pay the full cost of all general practitioner (GP) consultations. From July 2001, all those over 70 years of age are also entitled to a medical card, regardless of income. This change in the pricing of GP services in the Republic of Ireland in 2001 provides a natural experiment that allows for an examination of the influence of economic incentives on GP visiting behaviour. The purpose of this paper is to examine whether this change in pricing for GP care for those over 70 years of age in Ireland led to an increase in the utilisation of GP services among this group. Using data from two nationally representative surveys of the population over the age of 65 before and after the policy change, difference-in-difference two-step models of GP visiting behaviour are estimated. The results indicate that, while there is some limited evidence in favour of an increase in the probability of seeking GP care among those over 70 years of age after the policy change, there is no significant effect on the frequency of visits. Differences in the incentives facing both patients and GPs after the policy change can explain the latter result.

Objectives: To examine the extent to which proximity to the income threshold for free GP care results in significant differences in GP visiting. Approximately 30% of the Irish population receives free GP care (medical card patients), while the remaining 70% pays in full (private patients). Medical card eligibility exerts a significant influence on GP visiting, but how do GP visiting rates differ among private patients on differing incomes, and has the differential in visiting among private patients changed over time?, Methods: Using micro-data from three nationally representative surveys of the Irish population undertaken in 1987, 1995 and 2001, multivariate models of GP utilization are estimated., Results: There is little evidence that proximity to the income threshold results in significant differences in GP visiting. The most significant difference is between medical card and private patients, rather than between private patients on differing incomes. There is also little evidence that the differential in GP visiting between private patients on different incomes changed over time., Conclusions: While recent commentary has focused on the plight of individuals just above the income threshold for free GP care, these results suggest that the key difference in GP visiting is between those with, and without, eligibility for free care. If private patients are prevented from accessing GP care due to cost, this is as much an issue for those at the top of the income distribution as for those at the bottom.

This paper draws on two reviews commissioned by the UK Department for International Development in 2006-2007 that explore progress in linking HIV prevention and maternity services in sub-Saharan Africa. Although pilot and demonstration projects have been successful, progress in scaling up PMTCT has been slow, reaching just 11% of pregnant HIV positive women in much of Africa, less than half the percentage of coverage achieved by antiretroviral treatment programmes for adults in need. Despite ongoing efforts to promote comprehensive approaches, significant policy, financing and institutional barriers, and weak co-ordination and leadership, continue to hamper progress. Maternal health services face human and financial resource shortages which affect their capacity to integrate HIV prevention. Both HIV and maternal health programmes often receive targeted financial and technical assistance that does not take the other into account. However, proposals in 2007 from a number of countries to the Global Fund to Fight AIDS, TB and Malaria incorporate sexual and reproductive health programming that will have an impact on HIV, including certain maternity services. Moreover, Botswana, Kenya and Rwanda have shown that progress can be made where national commitment and increased resources are enabling maternal and newborn care to address HIV.