Estimating Interaction Effects With Panel Data

25 Background: Prostate Cancer, the third most commonly diagnosed cancer in 2020 and the fifth leading cause of cancer mortality worldwide, has exhibited significant disparities in global prevalence and impact over recent decades. This study assesses the trends in incidence, mortality, and disability-adjusted life years from prostate cancer in the World Bank regions based on country income levels from 1990 to 2019. Methods: The Global Burden of Disease Study database was used to extract Age-standardized incidence rates (ASIR), age-standardized (ASDR), and life years (DALYs) for prostate cancer from different World Bank regions based on income levels from 1990 to 2019. Annual percentage change was also acquired. Mortality-to-incidence ratios (MIR) were then computed. Trends were assessed using Joinpoint regression. Results: Between 1990 and 2019, ASIRs increased across all income levels, with the greatest growth in the upper middle income (+64.7%). While ASDRs decreased in high income, upper middle income, and lower middle income levels, they notably increased in low income levels (+14.3%). DALYs decreased in high income and upper middle income levels, primarily in the high income (-25.7%), and increased in lower middle and low income levels, primarily in the low income (+13.8%). MIRs decreased in all countries, with the largest decrease in high income levels (-50%). In the last 30 years, high income countries have consistently observed the highest ASIR (2019: 77.5/100,000). However, in 1990 high income countries also had the highest ASDRs and DALYs. Interestingly, by 2019 this pattern shifted, with low income surpassing high income countries in both. Conclusions: Over the last 30 years, the incidence of prostate cancer has been rising regardless of income level. Despite the universal decrease of MIRs implying improved outcomes, screening, and therapeutical strategies, the contrasting trends in ASDRs and DALYs across income levels underscore the disparities in health outcomes. Higher income countries experienced highest cancer incidence but also the highest decrease in the mortality rates while lower income countries faced the opposite challenges with lower increase but higher mortality rates. [Table: see text]

While migration from Africa to Europe is increasing, aspiring migrants from Africa are still less likely than those from other continents to migrate to their preferred destinations. An analysis of the reasons for this is needed. This paper investigates how individual‐level traits and country income levels influence intentions and abilities to migrate from Africa to Europe, while also exploring regional differences. It does so through an approach investigating the influence of both micro‐level factors and macro‐level factors, as well as their interactions. It first analyses migration intentions in 47 African countries in the Years 2010–2015, by investigating plans to migrate to Europe. It then analyses abilities to migrate from these countries to Europe in the Years 2011–2016, by exploring the proxy of the conversion of migration plans into flows. The analysis is based on Gallup World Poll, Eurostat, Organisation for Economic Co‐operation and Development, Frontex, and World Bank data and estimates. The paper finds that 1.4% of individuals in the African countries considered were planning to migrate to Europe in the Years 2010–2015, and an estimated 5.8% of these was able to migrate in 2011–2016. Migration intentions and abilities are shaped by a complex interplay of micro‐ and macro‐level factors. While some individual‐level traits have similar effects on migration intentions across country income levels, others increase the likelihood of planning to migrate to a stronger extent in countries of origin with higher income levels. Abilities to convert migration plans into actual migration, and to do so through regular channels, increase with higher country income levels. The influence of individual‐level traits and country income levels on migration intentions and abilities appears to vary across regions. Findings confirm the relevance of approaches investigating migration intentions and abilities by assessing both micro‐ and macro‐level factors, as well as their interactions. A more nuanced understanding of these interactions is crucial to inform migration policies that recognise the different needs and realities of aspiring migrants.

Subject. The article addresses public-private partnership (PPP) projects in the area of electric power and natural gas. Their specificities, like availability of many positive externalities, higher capital intensity, hidden risks, involvement of many diverse participants in implementation, enable to distinguish PPP projects in the green energy and energy-efficient technologies sector into a separate category, and to state the insufficient knowledge of the impact of macroeconomic factors on this category. Objectives. The aim is to study the most important macroeconomic factors (income level) on the intensity, technological structure, and effectiveness of PPP projects in the electricity and natural gas sector of developing countries. Methods. We employ methods of descriptive statistics, nonparametric statistics, and cluster analysis. Results. The findings show that the country's income level is an important macroeconomic factor influencing the number and volume of investments in PPP projects in the energy sector in developing countries, as well as the technological structure of the project portfolio. The influence of this factor on the number and volume of investments in PPP projects in the energy sector is nonlinear, and on the technological structure is linear. Conclusions. The highest intensity of investments in PPP projects in the energy sector is observed in lower-middle income countries. The impact of the country's income level on the technological structure of the PPP project portfolio is manifested in two aspects: an increase in the share of projects in the electric grid sector as the country's income level grows, and an increase in the share of wind projects as the country's income level grows.

ObjectivesStudies on sedentary behavior among adolescents in Africa are limited, hindering public health initiatives. The aim of this study was to examine the prevalence, age, gender, country's income level, and sub-regional disparities of sedentary behavior among adolescents in Africa. Study designCross sectional. MethodsAdolescents who participated in the Global School-based Student Health Survey from the 23 participating African countries were included in the study. Sedentary behavior was assessed with a self-reported questionnaire. A meta-analysis using random effect modeling was used to estimate the prevalence, age, gender, country's income level, and sub-regional disparities of sedentary behavior. ResultsSixty three thousand six hundred thirty five adolescents (12–17 years) were included in the analysis. The prevalence of sedentary behavior was 30% (95% CI: 27%–34%) and significantly higher among adolescents in Southern Africa and East Africa compared to adolescents in West Africa and North Africa (Q = 25.15; P < 0.001). No disparities were found for age (Q =1.51; P = 0.22), gender (Q = 0.10; P = 0.75), country's income level (Q = 4.37; P = 0.11), and survey year (Q = 1.03; P = 0.31). The results were heterogeneous between countries. ConclusionsThe results suggest that a significant proportion of adolescents in Africa engage in sedentary behavior, with the highest prevalence found in Southern Africa and East Africa. This highlights the need for context-specific policy design and interventions to increase physical activity engagement and limit sedentary behavior among adolescents in Africa.

Specific food supplements are essential during preconception and pregnancy to ensure adequate intake of vitamins and minerals to support fetal growth and development and metabolic changes in the maternal body. Our objective was to identify food supplement recommendations, particularly those of folic acid, iron, Vitamin D, and iodine, during preconception and/or pregnancy across a geographically diverse range of countries. Further, we investigated whether country location and income-level related to the recommendations. We performed an electronic search and identified country-specific preconception and pregnancy food supplement recommendations, policy documents, and official guidelines of national organizations informing recommendations. To ensure the data were as accurate as possible, country-specific experts were contacted. Data were collected in 2017 and reevaluated in 2022. Country income level was determined by the World Bank classification. Each inspected country (n = 43) recommended folic acid supplementation, typically 400 µg/day, before and during pregnancy. About half of the countries recommended an iron supplement (dose range, 16–195 mg/day) and one quarter Vitamin D (typically 10 µg/d in higher latitudes) and iodine (150–200 µg/day). Country location and income level had some influence on the recommendations. Vitamin D was more often recommended in higher latitude, high-income countries. Almost all upper-middle and lower-middle income countries recommended iron supplementation, whereas less than one third of high-income countries had a corresponding recommendation. Findings suggest that food supplement recommendations for pregnant women vary across countries, likely influenced by geographic location as well as income level. These data may be used in the harmonization of food supplement recommendations.

PURPOSEAuthorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution.METHODSThis retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by genderize.io. World Bank classification was used to categorize the country region and income level. Odds ratios were used to describe associations between female last authorship and representation in other authorship positions.RESULTSAlthough female authors were in the minority across all authorship positions, they were more under-represented in the last author position with 190 (32.1%) female, compared with 252 (41.4%) female first authors and 1,564 (38.1%) female middle authors. Female authors were most under-represented among authors from low-income countries, where they made up 21.6% of first authors and 9.1% of last authors. Of all the regions, sub-Saharan Africa and South Asia had the lowest percentage of female authors. Compared with articles with male last authors, those with female last authors had odds ratios (95% CI) of 2.2 (1.6 to 3.2) of having female first authors and 1.4 (0.9 to 2.1) of having 50% or more female middle authors.CONCLUSIONThere are wide regional variations in author gender distribution in global oncology. Female authors remain markedly under-represented, especially in lower-income countries, sub-Saharan Africa, and South Asia. Future interventions should be tailored to mitigate these disparities.

This study empirically analyzed the differences before and after COVID-19 in the effect of entrepreneurial attitude on entrepreneurship using the 2002-2022 national survey data of the Global Entrepreneurship Monitor (GEM). Entrepreneurial attitude indicators include ‘perceived opportunities rate’, ‘perceived capabilities rate’, ‘fear of failure’, and ‘entrepreneurial intentions rate’, and countries were classified into three different income groups according to GDP per capita. According to the results of a fixed-effect panel regression analysis, regardless of the country's income level, adults with entrepreneurial intentions participated more actively in entrepreneurial activities after the outbreak of COVID-19. In high-income countries with a GDP per capita of $40,000 or more, the possibility of adults with entrepreneurial skills becoming more involved in entrepreneurial activities increased after COVID-19. In middle-income countries with GDP per capita of $20,000 to $40,000, the share of adults who connect entrepreneurial opportunities to entrepreneurship has increased since COVID-19. Meanwhile, in high-income and middle-income countries, the proportion of adults who are reluctant to start a business due to fear of failure, but are forced to start a business, has increased after Corona 19. After all, the effect of entrepreneurial attitude on entrepreneurship has changed since COVID-19, but the effect of COVID-19 varies with the country's income level. The results of this study show that in order to improve the efficiency of entrepreneurship policies, the heterogeneous effects of COVID-19 by country should be reflected.

In “Ethical, palliative, and policy considerations in disorders of consciousness,” a complement to the American Academy of Neurology guideline on disorders of consciousness, authors Fins and Bernat reviewed (1) the nomenclature of disorders of consciousness, (2) the responsibilities that clinicians have to both patients and their families, and (3) the resources required and barriers to provision of care to patients with disorders of consciousness. Authors Fins and Bernat objected to the Guideline's use of the term “unresponsive wakefulness syndrome” because it relies on the bedside examination of consciousness while failing to allow for the possibility of covert consciousness detected only with functional neuroimaging. Dr. Sethi shares his reservations with this term, but his rationale differs, as he believes it could falsely suggest the possibility for improvement. He also voices concern that both a country's income level and a hospital's size could affect ability to implement this guideline. Authors Fins and Bernat respond that all patients with disorders of consciousness deserve consideration of rehabilitation and that rehabilitation may ultimately decrease longitudinal costs by leading to improvements in functional status, but prospective studies are needed. In “Ethical, palliative, and policy considerations in disorders of consciousness,” a complement to the American Academy of Neurology guideline on disorders of consciousness, authors Fins and Bernat reviewed (1) the nomenclature of disorders of consciousness, (2) the responsibilities that clinicians have to both patients and their families, and (3) the resources required and barriers to provision of care to patients with disorders of consciousness. Authors Fins and Bernat objected to the Guideline's use of the term “unresponsive wakefulness syndrome” because it relies on the bedside examination of consciousness while failing to allow for the possibility of covert consciousness detected only with functional neuroimaging. Dr. Sethi shares his reservations with this term, but his rationale differs, as he believes it could falsely suggest the possibility for improvement. He also voices concern that both a country's income level and a hospital's size could affect ability to implement this guideline. Authors Fins and Bernat respond that all patients with disorders of consciousness deserve consideration of rehabilitation and that rehabilitation may ultimately decrease longitudinal costs by leading to improvements in functional status, but prospective studies are needed.

Non-interest income, profitability, and risk in banking industry: A cross-country analysis

This study examined the factors related to eating behavior using the 2016 Community Health Survey data. The subjects of this study were 228,452 adults aged 19 years and over. The relationships between the general characteristics and breakfast, salt intake level, nutrition labeling recognition, reading, and utilization were investigated. The number of breakfast days was higher in rural areas than in urban areas and higher in women than in men. Those aged older than 70 years had more breakfast-eating days than the other age groups. Those who had a higher income level had fewer breakfast-eating days. The rates of people reducing salt intake were higher in those in urban areas and female subjects than those in rural areas and male subjects. Those who had a higher income level and education level consumed salt less. The rates of salt addition at the table were higher in people in rural areas and male subjects. The rates of adding soy sauce to fried food were higher in male subjects and those in urban areas, younger age, not being married, and with higher income and education levels. The rates of recognizing nutrition labels were higher in those in urban areas, female subjects, those not married, and those with higher income and education levels. The rates of reading nutrition labels were the same as those of recognizing nutrition labels. The use rates of nutrition labels were highest in those in urban areas, female subjects, those aged between 30 and 39, and married subjects and those with higher income and education levels. Therefore, it is necessary to provide nutrition education for rural areas, men, people with low income and education levels so that desirable and balanced health behaviors between the target and regions can be practiced.

Purpose: To evaluate the association of county level characteristics with the incidence of invasive squamous cell carcinoma of the cervix among Hispanic women. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program's 18 registries from 2000-2009 were queried and average annual age-adjusted incidence rates per 100,000 Hispanic women for invasive squamous cell carcinoma of the cervix (SCC) were calculated. Patients were stratified by residence in a county with high versus low percent language isolation, percent of Hispanics with less than a high school education and percent of Hispanic families below the poverty level. Results: Between 2000-2009, 5,534 Hispanic women were diagnosed with SCC in SEER. Incidence rates were highest among those living in counties with high levels of LI (8.9 v 10.7), or low levels of education (8.9 v 10.8) or income (8.7 v 11.0). The incidence of SCC was significantly less in women living in counties with higher levels of education and income and lower levels of LI than among those living in counties with lower levels of education and income and higher levels of LI (8.6 v. 11.3). Counties that have higher levels of income and education are less likely to be LI whereas counties with lower levels of income and education are more likely to be LI. Conclusions: Among Hispanic women, county level characteristics such as LI, education, and income have a complex interaction that appears to be associated with the incidence of SCC. Community level interventions need to be evaluated to decrease the high incidence of SCC in this population. Citation Format: Kristy K. Ward, Angelica M. Roncancio, Steven C. Plaxe. The association of county level characteristics with the incidence of squamous cell carcinoma of the cervix in Hispanic women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A54.

AimsTo (1) estimate the number of Parties to the Framework Convention on Tobacco Control (FCTC) providing tobacco dependence treatment in accordance with the recommendations of Article 14 and its guidelines; (2) assess association between provision and countries’ income level; and (3) assess progress over time.DesignCross‐sectional study.SettingOnline survey from December 2014 to July 2015.ParticipantsContacts in 172 countries were surveyed, representing 169 of the 180 FCTC Parties at the time of the survey.MeasurementsA 26‐item questionnaire based on the Article 14 recommendations including tobacco treatment infrastructure and cessation support systems. Progress over time was assessed for those countries that also participated in our 2012 survey and did not change country income level classification.FindingsWe received responses from contacts in 142 countries, an 83% response rate. Overall, 54% of respondents reported that their country had an officially identified person responsible for tobacco dependence treatment, 32% an official national treatment strategy, 40% official national treatment guidelines, 25% a clearly identified budget for treatment, 17% text messaging, 23% free national quitlines and 26% specialized treatment services. Most measures were associated positively and significantly with countries’ income level (P < 0.001). Measures not associated significantly with income level included mandatory recording of tobacco use (30% of countries), offering help to health‐care workers (HCW) to stop using tobacco (44%), brief advice integrated into existing services (44%), and training HCW to give brief advice (81%). Reporting having an officially identified person responsible for tobacco cessation was the only measure with a statistically significant improvement over time (P = 0.0351).ConclusionFewer than half of countries that are Parties to the Framework Convention on Tobacco Control have implemented the recommendations of Article 14 and its guidelines, and for most measures, provision was greater the higher the country's income. There was little improvement in treatment provision between 2012 and 2015 in all countries.

BackgroundDespite increasing vaccine availability and evidence and expert recommendations to support administration, some countries maintained restrictive policies regarding COVID-19 vaccination in pregnancy throughout the pandemic. This global analysis explores the role of gender equity, country income level, and vaccine availability in predicting national policies on COVID-19 vaccine administration in pregnancy.MethodsPolicies were collected from May 2021 to January 2023 from 224 countries/territories using publicly available information posted on national public health authority web pages. Policies were categorized into 6 types, representing different levels of permissiveness, from recommended for some or all to not recommended, and changes in national policies were captured over time. Outcomes were defined as: 1) prevalence of restrictive policies at a specific time point; 2) country-level change from restrictive policy/no position at an earlier time point to a permissive policy at a later timepoint. Simple and multivariable logistic regressions were performed to explore the association between the outcomes and potential policy predictors, including income level, mRNA vaccine availability, and the Global Gender Gap Index (GGGI).ResultsComplete cross-sectional data were available for 114 countries as of June 2021, 137 countries as of October 2021, and 142 countries as of March 2022. The number of maternal immunization policies increased and became steadily more permissive between 2021 and 2022. Availability of mRNA vaccines and higher income level were associated with reduced odds of a restrictive policy at the 2021 timepoints, and higher GGGI scores were associated with reduced odds of restrictive policies at all timepoints. After adjusting for income level and mRNA vaccine availability, higher GGGI scores reduced the relative odds of a restrictive COVID-19 vaccine policy by 10% (aOR: 0.90, 95CI: 0.81, 0.99) in October 2021 and 14% (aOR: 0.86, 95%CI: 0.76, 0.97) in March 2021. Higher GGGI scores were also associated with increased odds of a policy switch from restrictive/no position in June 2021 to permissive in October 2021 (aOR: 1.12, 95%CI: 1.00, 1.24).ConclusionsGender inequity was associated with greater odds of a restrictive policy for use of COVID-19 vaccines in pregnancy, suggesting that gender biases may influence fair policymaking for pregnant people in pandemic preparedness and response.

[Purpose] To determine the correlations of differences in the income level with the presence of metabolic syndrome (MetS), energy intake, and physical activity across Korean elderly populations.[Methods] We obtained data from 2,139 elderly individuals (aged >65 years) based on the Korea National Health and Nutrition Examination Survey (KNHANES) (2016‒2018). We analyzed the levels of physical activity (PA) and energy intake using the survey data. Moreover, we analyzed the differences in energy intake and PA levels according to the income level and MetS.[Results] Compared with the non-MetS group, the MetS group displayed significantly higher levels of waist circumference (p=0.000), triglycerides (p=0.000), systolic blood pressure (p=0.000), diastolic blood pressure (p=0.016), and fasting blood glucose (p=0.000) for both high and low income levels. However, the level of high-density lipoprotein cholesterol was significantly lower in the MetS group than that in the non-MetS group (p=0.000). The level of smoking in non-MetS men was significantly higher than that in MetS men across all participants (p=0.047). Except carbohydrate intake, the total energy intake (p=0.022), fat intake (p=0.009), and protein intake (p=0.005) were significantly lower in the MetS group than those in the non-MetS group for high income levels. We obtained similar results for low income levels. The two-way analysis of variance (ANOVA) did not identify an interaction between the income level and the presence of MetS; however, the total energy, i.e., the level of total energy intake, was significantly lower in participants with low income levels than in those with high income levels. For high income levels, transport PA (p=0.002), vigorous recreational PA (p=0.001), moderate recreational PA (p=0.001), and total PA (p=0.000) were significantly lower in the MetS group than those in the non-MetS group. For low income levels, moderate occupational PA (p=0.012), transport PA (p=0.018), and total PA ((p=0.000) were significantly lower in the MetS group than those in the non-MetS group. The total PA, i.e., the level of energy consumption, was significantly lower in the elderly with low income levels than in those with high income levels.[Conclusion] Regardless of the income level, the elderly with MetS exhibited low levels of energy intake and PA, compared with those without MetS. In addition, regardless of the presence of MetS, the elderly with low income levels exhibited lesser energy intake and PA. These findings implied the need for balanced nutrient intake and increased participation in PA as well as education and program development to prevent MetS in the elderly.

The World Health Organization (WHO)'s Mental Health Atlas series has established itself as the single most comprehensive and most widely used source of information on the global mental health situation. The data derived from the latest Mental Health Atlas survey carried out in 2014 describes the availability and delivery of mental health services in the WHO's Member States, focussing on differences by country's income level. The data contained in this paper are mainly derived from questions relating to mental health service availability and uptake, as well as on financial and human resources for mental health. Results are presented as median values and analysed by World Bank income group. Interquartile ranges are also provided as measures of statistical dispersion. In total, 171 out of WHO's 194 Member States were able to at least partially complete the Atlas questionnaire. The results highlight a wide gap between high and low-medium income countries in a number of areas: for example, high-income countries have 20 times more beds in community-based inpatient units and 30 times more admissions; the rate of patients cared by outpatient facilities is 40 times higher; and there are 66 times more community outpatient contacts and 15 times more mental health staff at outpatient level. Overall resources for mental health are not distributed efficiently: globally about 60% of financial resources and over two-thirds of all available mental health staff are concentrated in mental hospitals, which serve only a small proportion of patients. Results indicate that outpatient care is the only effective means of increasing the coverage for mental disorders and is expanding, but it is strongly influenced by country income level. Two elements of the network of mental health facilities are particularly scarce in low- and middle-income countries: day treatment facilities and community residential facilities. The WHO Mental Health Atlas 2014 survey provides basic mental health information at the level of WHO's Member States, concerning mental health resources and activities. Atlas promotes the use of information, usually underestimated not only in low- and middle-income countries but also in high-income countries. Information is needed not only for monitoring the scaling up of the mental health system at country level, but also for improving transparency and accountability for users, families and the public.