Abstract
BackgroundThe term 'inequities' refers to avoidable differences rooted in injustice. This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Asthma was chosen because recent decades have seen strong increases in asthma prevalence in many international settings, and inequalities in risk factors and related outcomes.MethodsA review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence).ResultsOf the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level.ConclusionsWithout more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health.
Highlights
The term ‘inequities’ refers to avoidable differences rooted in injustice
Eligibility criteria Eligibility criteria were: 1) published in English during the years 2005-2009; 2) primary research study or previously unpublished secondary analysis of existing data; 3) outcome variables included health outcomes and/or health care utilization patterns directly related to asthma in adult populations with asthma or at risk of developing asthma; 4) data analysis demonstrated inequalities with respect to the outcome variables measured; 5) analysis of inequalities compared respondents on the basis of SES, and/or gender, and/or race/ethnicity, and/or place of work, and/or place of residence
Subjective data Subjective information was extracted by a single reviewer (HLG), based on consultations with the research supervisor (NE) and guided by the question: without using the terms ‘equity’ or ‘inequity’, do the authors implicitly raise equity issues? The definitions of equity used to guide the extraction suggested important questions for unravelling pathways to health equity: What is unfair or unjust in the context of a given society [1]? What can be done to change the social conditions that shape disadvantage [3,22]? While recognizing the subjectivity inherent in our analysis, we aimed to present a set of issues that were illustrative of health inequities when considered carefully in their social, political, and economic contexts
Summary
This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Inequalities in health are only considered health inequities if they are deemed unjust and avoidable. While inequities in health are inequalities in that they reflect differences in status, capacity, or opportunity that shape risk factors and affect health outcomes, not all inequalities are inequities. While ‘health disparities’ may incorporate inequities, not all disparities are inequitable [2]. These distinctions have important consequences for the way differences in health are understood and interventions are designed and measured [2,3,4].
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