Changes In Health Disparities Research Articles

Educational expansion and health disparities in Ethiopia, 2005–2016

Research shows that basic education improves population health, yet it remains unclear whether the expansion of primary education decreases health disparities. In this paper, I assess whether disparities in healthcare utilization decreased in conjunction with educational expansion among women of reproductive age in Ethiopia. Healthcare utilization rates in low-resource countries are often confounded with simultaneous developments in education and access to basic healthcare. Using decomposition of rates, I first disentangle the changes in health disparities induced by educational expansion from the overall increase in healthcare utilization. Then, I use the Blinder-Oaxaca decomposition method to investigate the determinants of disparities in healthcare utilization and how these determinants changed over a 10-year period as primary education became more prevalent. Overall, disparities in healthcare utilization in Ethiopia decreased over time, yet the association between educational expansion and health disparities varies by region. Literacy explains much of the disparities in healthcare utilization, yet it loses significance over time as primary education becomes widespread. Economic factors remain persistent sources of disparities, and non-financial barriers such as the distance to travel and women's ability to travel alone become more significant. Heterogeneity in healthcare utilization across regions has distinct implications for how educational expansion may shift health disparities.

Protecting the gains: What changes are needed to prevent a reversal of the downward cardiovascular disease mortality trend?

Cardiovascular disease (CVD) mortality has decreased over 60% over the past 50 years in the United States; however, emerging data indicate CVD incidence may be rising because of shifting demographics, increasing risk factor prevalence, and competing needs for limited resources. We projected CVD mortality from 2015 to 2040 given varying informed assumptions regarding changes in risk factor prevalence, uptake of current therapeutic options, and future innovations. A microsimulation model was used to project US CVD mortality trends. National Health and Nutrition Examination Survey data were used to estimate population-level trends in CVD risk factors. Risk factors were used to generate Framingham Risk Scores for cohorts of 1 000 000 individuals from the general population to determine each individuals' CVD risk. Annual cardiovascular incidence, prevalence, and mortality were projected for scenarios differing by uptake of current therapies, anticipated pharmaceutical innovations with variable efficacy, risk factor prevalence, and changes in health disparities. When incorporating a demographic shift, continued changes in risk factors, current treatment utilization, and no major innovations, we predicted the CVD mortality rate would increase 41% by 2040. If innovations providing incremental benefits equal to those associated with the introduction of statins are identified and widely utilized, CVD mortality could remain constant through 2040. With more efficacious innovations, CVD mortality could be further reduced. Given demographic and risk prevalence changes, increasing access and adherence to current preventative therapeutics could slow the expected mortality increase, but new therapies may be needed to maintain the downward trend in CVD deaths.

Health Disparities by Income in Spain Before and After the Economic Crisis.

Little is known about how health disparities by income change during times of economic crisis. We apply a decomposition method to unravel the contributions of income growth, income inequality and differential income mobility across socio-demographic groups to changes in health disparities by income in Spain using longitudinal data from the Survey of Income and Living Conditions for the period 2004-2012. We find a modest rise in health inequality by income in Spain in the 5years of economic growth prior to the start of the crisis in 2008, but a sharp fall after 2008. The drop mainly derives from the fact that loss of employment and earnings has disproportionately affected the incomes of the younger and healthier groups rather than the (mainly stable pension) incomes of the groups over 65years. This suggests that unequal distribution of income protection by age may reduce health inequality in the short run after an economic recession. Copyright © 2016 John Wiley & Sons, Ltd.

A Review on School Based Interventions for Alcohol, Tobacco and Other Drugs (ATOD) in the United States: Can Developing Countries in Africa Adopt these Preventive Programs Based on ATOD Approaches?

Substance abuse problems have been a major concern of societies all over the world, including the United States, during last five decades. In the United States, the substance abuse epidemic has been changing its characteristics as to the major drugs of abuse and the populations abusing them and the overall magnitude of the problem can be best described as fluctuating only. Health disparities in drug use are a major public health concern as indicated in the NIDA Health Disparities Initiative. Despite evidence that racial/ethnic minorities are less likely than Whites to use drugs in childhood and adolescence, they are more likely to experience negative health outcomes related to drug use in adulthood, such as HIV/AIDS, intentional and unintentional injuries, overdose, incarceration, and emergency room visits. These changes in health disparities in drug use outcomes over the life course suggest a complex relationship between race/ethnicity and drug use, particularly during the transition from adolescence to adulthood. Further, it is likely that changing trends in drug over time can affect subgroups of the population differentially. In order to reduce health disparities related to drug use, it is necessary to characterize how they unfold over time, and to shed light on the processes and influences that increase the likelihood of negative health outcomes among minorities and disadvantaged groups. Further understanding of health disparities in drug use and use-related problems can provide clues for preventing negative drug use outcomes as well as estimate the need for services to reduce the public health burden related to drug use. The nature of health disparities is quite complex and varies considerably by type of drug and drug-related outcome, developmental stage, chronological time, community, and geographic region. However, these geographic changes are happening in both developed and developing countries where HIV/AIDS and illicit substance use continue to be on an increase especially in sub-Saharan Africa hence posing great threats of public health concern which calls for immediate effective interventions to be in places.

Composition and decomposition in US gender-specific self-reported health disparities, 1984–2007

Variance function regression models and demographic decomposition methods are applied to identify two dimensions of changes in health disparities (SES-demographic effects vs. compositional effects, between-group disparities vs. within-group disparities) in the US from 1984 to 2007. Using National Health Interview Survey data on self-reported health, we find that disparities in men’s health increased, while those of women decreased, for the whole period. Widening men’s health disparities are largely driven by increases in the effects of SES-demographic statuses on within-group disparities. These increases are moderated by increasing levels of men’s college attainment. But decreasing middle and upper income attainment and a decreasing employment rate further increase men’s health disparities. For women, the effects of SES-demographic statuses on health disparities also increased over time. This, however, was outweighed by increases in women’s college attainment, middle and upper income attainment, and employment rate. The result is overall declining self-reported health disparities for women.

Population-Based Assessment of Asthma Symptom Burden in Children

The Minneapolis and St. Paul Controlling Asthma in American Cities Project (CAACP) used a school-based symptom survey to inform community-based programming and provide an intermediate outcome measure of progress toward reducing the burden of asthma. In collaboration with the two school districts, the project mailed the Child Asthma Short Form, a validated health-related quality of life instrument to parents of children in grades K-8 every other school year from 2003 to 2007. The survey was mailed to a randomly selected sample in four languages (English, Spanish, Hmong, and Somali). The overall response rate was 47%, 41%, and 32% for years1, 3, and 5, respectively. Two out of three children for whom surveys were completed were children of minority populations; more than 50% were eligible for free or reduced-price meals. The changes in scores from the first round (2003-2004) to the third round (2007-2008) were statistically significant for daytime symptom burden (p < 0.05). Improvements were noted, but not statistically significant, for nighttime symptoms and functional limitations. Children of some racial/ethnic minority groups and children eligible for free or reduced-price meals had the highest symptom burden. Findings were used to guide CAACP's program development and delivery to populations in greatest need. CAACP's experience in Minneapolis and St. Paul demonstrates the feasibility of administering a symptom burden survey at low cost and in compliance with school system and institutional review board requirements to maintain confidentiality. The symptom-based survey may be a useful tool to track trends and changes in health disparities at a community and population level.

RE: "AN OVERVIEW OF METHODS FOR MONITORING SOCIAL DISPARITIES IN CANCER WITH AN EXAMPLE USING TRENDS IN LUNG CANCER INCIDENCE BY AREA-SOCIOECONOMIC POSITION AND RACE-ETHNICITY, 1992-2004"

The authors provide an overview of methods for summarizing social disparities in health using the example of lung cancer. They apply four measures of relative disparity and three measures of absolute disparity to trends in US lung cancer incidence by area-socioeconomic position and race-ethnicity from 1992 to 2004. Among females, measures of absolute and relative disparity suggested that area-socioeconomic and race-ethnic disparities increased over these 12 years but differed widely with respect to the magnitude of the change. Among males, the authors found substantial disagreement among summary measures of relative disparity with respect to the magnitude and the direction of change in disparities. Among area-socioeconomic groups, the index of disparity increased by 47% and the relative concentration index decreased by 116%, while for race-ethnicity the index of disparity increased by 36% and the Theil index increased by 13%. The choice of a summary measure of disparity may affect the interpretation of changes in health disparities. Important issues to consider are the reference point from which differences are measured, whether to measure disparity on the absolute or relative scale, and whether to weight disparity measures by population size. A suite of indicators is needed to provide a clear picture of health disparity change.

An overview of methods for monitoring social disparities in cancer with an example using trends in lung cancer incidence by area-socioeconomic position and race-ethnicity, 1992-2004.

The authors provide an overview of methods for summarizing social disparities in health using the example of lung cancer. They apply four measures of relative disparity and three measures of absolute disparity to trends in US lung cancer incidence by area-socioeconomic position and race-ethnicity from 1992 to 2004. Among females, measures of absolute and relative disparity suggested that area-socioeconomic and race-ethnic disparities increased over these 12 years but differed widely with respect to the magnitude of the change. Among males, the authors found substantial disagreement among summary measures of relative disparity with respect to the magnitude and the direction of change in disparities. Among area-socioeconomic groups, the index of disparity increased by 47% and the relative concentration index decreased by 116%, while for race-ethnicity the index of disparity increased by 36% and the Theil index increased by 13%. The choice of a summary measure of disparity may affect the interpretation of changes in health disparities. Important issues to consider are the reference point from which differences are measured, whether to measure disparity on the absolute or relative scale, and whether to weight disparity measures by population size. A suite of indicators is needed to provide a clear picture of health disparity change.

Conquering Cancer Disparities: New Opportunities for Cancer Epidemiology, Biomarker, and Prevention Research

Cancer disparities represent a significant public health problem in the United States. Inequity in cancer screening, incidence, treatment, prognosis, and mortality is a hallmark of many common cancers ([1][1]). These disparities exist across groups defined by race, ethnicity, gender, age, and

Social inequalities in disability-free life expectancy in the French male population, 1980-1991.

We calculate aggregate indicators of population health for occupational groups to gauge changes in health disparities during the 1980-1991 period. The study is based on the experiences of French adult men in three major occupational classes: managers, manual workers, and an intermediary occupational group. Life table models show that managers have longer life expectancy and disability-free life expectancy (DFLE) than manual workers, and a shorter life expectancy with disability. The concurrent increases in life expectancy and DFLE during the period maintained the occupational disparities in health; the years lived with disability, however, declined for all groups, as for the entire French population.