206 lines
6.3 KiB
YAML
206 lines
6.3 KiB
YAML
abstract: 'Background
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By improving two social determinants of health (poverty and
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unemployment) in low-and middle-income families on or at risk of
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welfare, in-work tax credit for families (IWTC) interventions could
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impact health status and outcomes in adults.
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Objectives
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To assess the effects of IWTCs on health outcomes in working-age adults
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(18 to 64 years).
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Search methods
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We searched 16 electronic academic databases, including the Cochrane
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Public Health Group Specialised Register, Cochrane Database of
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Systematic Reviews (The Cochrane Library 2012, Issue 7), MEDLINE and
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EMBASE, as well as six grey literature databases between July and
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September 2012 for records published between January 1980 and July 2012.
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We also searched key organisational websites, handsearched reference
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lists of included records and relevant journals, and contacted academic
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experts.
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Selection criteria
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We included randomised and quasi-randomised controlled trials and
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cohort, controlled before-and-after (CBA) and interrupted time series
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(ITS) studies of IWTCs in working-age adults. Included primary outcomes
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were: self rated general health; mental health/psychological distress;
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mental illness; overweight/obesity; alcohol use and tobacco use.
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Data collection and analysis
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Two review authors independently extracted data and assessed the risk of
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bias in included studies. We contacted study authors to obtain missing
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information.
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Main results
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Five studies (one CBA and four ITS) comprising a total of 5,677,383
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participants (all women) fulfilled the inclusion criteria and were
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synthesised narratively. The in-work tax credit intervention assessed in
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all included studies is the permanent Earned Income Tax Credit in the
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United States, established in 1975. This intervention distributed nearly
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USD 62 billion to over 27 million individuals in 2011, and its
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administration costs were less than one per cent of its total costs. All
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included studies carried a high risk of bias (especially from
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confounding and insufficient control for underlying time trends). Due to
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the small number of (observational) studies and their high risk of bias,
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we judged this body of evidence to have very low overall quality.
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One study found that IWTC had no detectable effect on self rated general
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health and mental health/psychological distress five years after its
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implementation (i.e. a considerable change in the generosity of the
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permanent IWTC) and on overweight/obesity eight years after
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implementation. One study found no effect of IWTC on tobacco use five
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years after implementation, one a moderate reduction in tobacco use one
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year after implementation (odds ratio 0.95, 95\% confidence interval
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(CI) 0.94 to 0.96), and one differential effects, with no effect in
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African-Americans and a large reduction in European-Americans two years
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after implementation (risk difference -11.1\%, 95\% CI -20.9\% to
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-1.3\%). No evidence was available for the effect of IWTC on mental
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illness and alcohol use. No adverse effects of IWTC were identified. One
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study also found no detectable effect of IWTC on the number of bad
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physical health days and of risky biomarkers for inflammation,
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cardiovascular disease and metabolic conditions eight years after
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implementation.
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One study found that IWTC had a large, positive effect on income from
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wages or salaries one year after implementation. Two studies found no
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effect on employment two and five years after implementation, whereas
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two found a moderate increase five and eight years after implementation
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and one a large increase in employment due to IWTC one year after
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implementation.
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No differences in outcomes between groups with different educational
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status were found for self rated health and mental health/psychological
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distress. In one study European-American women with lower levels of
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education were more likely to reduce tobacco use, while tobacco use did
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not change among African-American women with lower levels of education.
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However, no differences in tobacco use by educational status were
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observed in a second study. Two studies found that the intervention may
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have reduced inequity with respect to employment, where women with less
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education were more likely to move into employment (although one did not
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establish whether this difference was statistically significant), while
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two studies found no such difference and no studies found differences by
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ethnic group on employment rates.
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Authors'' conclusions
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In summary, the small and methodologically limited existing body of
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evidence with a high risk of bias provides no evidence for an effect of
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in-work tax credit for families interventions on health status (except
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for mixed evidence for tobacco smoking) in adults.'
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affiliation: 'Pega, F (Corresponding Author), Univ Otago, Dept Publ Hlth, Wellington,
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New Zealand.
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Pega, Frank; Carter, Kristie; Blakely, Tony, Univ Otago, Dept Publ Hlth, Wellington,
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New Zealand.
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Pega, Frank, Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA.
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Lucas, Patricia J., Univ Bristol, Sch Policy Studies, Bristol, Avon, England.'
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article-number: CD009963
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author: Pega, Frank and Carter, Kristie and Blakely, Tony and Lucas, Patricia J.
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author-email: frank.pega@otago.ac.nz
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author_list:
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- family: Pega
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given: Frank
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- family: Carter
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given: Kristie
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- family: Blakely
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given: Tony
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- family: Lucas
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given: Patricia J.
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da: '2023-09-28'
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doi: 10.1002/14651858.CD009963.pub2
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eissn: 1361-6137
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files: []
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issn: 1469-493X
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journal: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
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keywords-plus: 'SOCIAL-POLICY PROGRAMS; EMPLOYMENT CONDITIONS; INCOME; WELFARE;
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UNEMPLOYMENT; POVERTY; INEQUALITIES; BENEFITS; MOTHERS; PEOPLE'
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language: English
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number: '8'
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number-of-cited-references: '88'
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orcid-numbers: 'Blakely, Tony/0000-0002-6995-4369
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Lucas, Patricia Jane/0000-0002-0469-8085'
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papis_id: 13d7a5334bb8d20be3c15a30386305a0
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ref: Pega2013inworktax
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researcherid-numbers: 'Lucas, Patricia/HNJ-0065-2023
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'
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tags:
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- review
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times-cited: '40'
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title: In-work tax credits for families and their impact on health status in adults
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type: article
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unique-id: WOS:000323928900036
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usage-count-last-180-days: '1'
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usage-count-since-2013: '6'
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web-of-science-categories: Medicine, General \& Internal
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year: '2013'
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