title: Health and wealth in Mesoamerica: findings from Salud Mesomérica 2015.
abstract: BACKGROUND
  Individual income and poverty are associated with poor health outcomes. The poor face unique challenges related to access, education, financial capacity, environmental effects, and other factors that threaten their health outcomes.
  
  
  METHODS
  We examined the variation in the health outcomes and health behaviors among the poorest quintile in eight countries of Mesoamerica using data from the Salud Mesomérica 2015 baseline household surveys. We used multivariable logistic regression to measure the association between delivering a child in a health facility and select household and maternal characteristics, including education and measures of wealth.
  
  
  RESULTS
  Health indicators varied greatly between geographic segments. Controlling for other demographic characteristics, women with at least secondary education were more likely to have an in-facility delivery compared to women who had not attended school (OR: 3.20, 95 % confidence interval [CI]: 2.56-3.99, respectively). Similarly, women from households with the highest expenditure were more likely to deliver in a health facility compared to those from the lowest expenditure households (OR 3.06, 95 % CI: 2.43-3.85). Household assets did not impact these associations. Moreover, we found that commonly-used definitions of poverty do not align with the disparities in health outcomes observed in these communities.
  
  
  CONCLUSIONS
  Although poverty measured by expenditure or wealth is associated with health disparities or health outcomes, a composite indicator of health poverty based on coverage is more likely to focus attention on health problems and solutions. Our findings call for the public health community to define poverty by health coverage measures rather than income or wealth. Such a health-poverty metric is more likely to generate attention and mobilize targeted action by the health communities than our current definition of poverty.
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. mokdaa@uw.edu.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. gagnierm@uw.edu.
authors.forename: Marielle C
authors.initials: MC
authors.lastname: Gagnier
authors.affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, California. kecolson@berkeley.edu.
authors.forename: K Ellicott
authors.initials: KE
authors.lastname: Colson
authors.affiliation: Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá. mpzuniga@iadb.org.
authors.forename: Paola
authors.initials: P
authors.lastname: Zúñiga-Brenes
authors.affiliation: Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá. diegori@iadb.org.
authors.forename: Diego
authors.initials: D
authors.lastname: Ríos-Zertuche
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. ahaak@uw.edu.
authors.forename: Annie
authors.initials: A
authors.lastname: Haakenstad
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. palmie@uw.edu.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Palmisano
authors.affiliation: Pardee RAND Graduate School, 1776 Main Street, Santa Monica, California, 90401, USA. banderso@rand.org.
authors.forename: Brent W
authors.initials: BW
authors.lastname: Anderson
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. sdesai89@uw.edu.
authors.forename: Sima S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: AARP Public Policy Institute, 601 E Street NW, Washington, DC, USA. cgillespie@aarp.org.
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Gillespie
authors.affiliation: University of Washington School of Social Work, 4101 15th Avenue N, Seattle, WA, USA. tbmurphy@uw.edu.
authors.forename: Tasha
authors.initials: T
authors.lastname: Murphy
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. pnagh@uw.edu.
authors.forename: Paria
authors.initials: P
authors.lastname: Naghavi
authors.affiliation: Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá. jennifern@iadb.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nelson
authors.affiliation: George Washington University, 950 New Hampshire Ave, NW, Washington, DC, USA. dharanir@gwu.edu.
authors.forename: Dharani
authors.initials: D
authors.lastname: Ranganathan
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. amschae@uw.edu.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schaefer
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. u.gulnoza@gmail.com.
authors.forename: Gulnoza
authors.initials: G
authors.lastname: Usmanova
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. wilsos3@uw.edu.
authors.forename: Shelley
authors.initials: S
authors.lastname: Wilson
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. bhp3@uw.edu.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Hernandez
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. rlozano@uw.edu.
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
authors.affiliation: Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá. emmai@iadb.org.
authors.forename: Emma
authors.initials: E
authors.lastname: Iriarte
mesh_terms: D000328:Adult; D002489:Central America / Q000453:epidemiology; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D016015:Logistic Models; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011795:Surveys and Questionnaires