The purpose of this article is to analyse the available literature describing the economic burden of dementia and to compare costs between studies examining cost drivers. To shed light on this field, a systematic review is performed using PubMed, the Cochrane Library and Web of Science. An eight-year retrospective horizon was considered until 25 May 2018. Several papers were obtained from the database search (n = 23), being others (n = 3) identified through other sources (hand-searching) because we did not detect it through the three databases. The cost estimates were compared between three perspectives: state/publicly funded health services, third-party/private sector/not-for-profit organisations and patient and family and/or societal. The estimated total annual cost per person with dementia in Europe is on average €32,506.73 (n = 10), whereas for the United States, it gets €42,898.65 (n = 2). Furthermore, differences are appreciated by type of costs. Besides, differences by severity groups are also considered. Overall, the higher the severity the higher the associated costs. Dementia imposes a huge economic burden. The figures here presented provide a good framework to quantify these costs for both, economic experts and researchers, and policy decision makers.

Aim A comprehensive approach to health highlights its close relationship with the social and economic conditions, physical environment and individual lifestyles. However, this relationship is not exempt from methodological problems that may bias the establishment of direct effects between the variables studied. Thus, further research is necessary to investigate the role of socioeconomic variables, their composition and distribution according to health status, particularly on non-communicable diseases. Subjects and methods To shed light on this field, here a systematic review is performed using PubMed, the Cochrane Library and Web of Science. A 7-year retrospective horizon was considered until 21 July 2017. Results Twenty-six papers were obtained from the database search. Additionally, results from “hand searching” were also included, where a wider horizon was considered. Five of the 26 studies analyzed used aggregated data compared to 21 using individual data. Eleven considered income as a study variable, while 17 analyzed the effect of income inequality on health status (2 of the studies considered both the absolute level and distribution of income). The most used indicator of inequality in the literature was the Gini index. Conclusion Although different types of analysis produce very different results concerning the role of health determinants, the general conclusion is that income distribution is related to health where it represents a measure of the differences in social class in the society. The effect of income inequality is to increase the gap between social classes or to widen differences in status.

Different studies have found that socioeconomic determinants influence the prevalence of chronic diseases in older people. However, there has been relatively little research on the incidence of how social isolation may affect them. We suggest that social isolation is a serious concern for people living with chronic illnesses. In this paper, we examine whether there is an increase in the propensity of being diagnosed with chronic illnesses because of a decrease in social relations for elderly Europeans. We have used a panel data for Waves 1–6 (2004–2015) of Survey on Health, Ageing and Retirement in Europe (SHARE) and logistic regressions. Besides, we have studied three geographic macro-areas (Nordic, Continental and Southern). Being diagnosed with three or more chronic diseases is considered as a dependent variable, and as social control variables we have used three isolation proxies (living alone, providing help to family, friends or neighbours and participation-club activities). Other socio-demographic variables are included (gender, age, educational level, job situation, area of location and quality of life). Our results for the full sample indicate that people who participate in social activities have fewer probability of suffering from chronic diseases (OR = 0.70, 95% CI 0.54, 0.92). For people who live alone the reverse effect is observed (OR = 1.20, 95% CI 1.04, 1.39). Differences are shown by macro-areas, e.g. providing help (OR = 0.58, 95% CI 0.34, 0.97) isolation proxy is significant for the Nordic macro-area. Club-participation activities and living alone are significant for Continental and Southern macro-areas, respectively (OR = 0.65, 95% CI 0.55, 0.82; OR = 1.46, 95% CI 1.21, 1.77). Social isolation increases the risk of being diagnosed with chronic illnesses. That is, people with greater social participation have lower risk of suffering from multiple chronic diseases. This risk linked to isolation, together with the traditional one associated with lifestyles, should be considered in the development of new public policies.

The aim of this article is to explore the impact of decentralization on health care outcomes in Spain. We develop a model and use it to investigate empirically the hypothesis that shifts towards greater decentralization would be accompanied by improvements in population health in Spain between 1992 and 2003 by using infant mortality and life expectancy as dependent variables. The empirical analysis suggests that income, decentralization and health care resources in Spain did have an important influence on infant mortality and life expectancy.