Country-level Socioeconomic Factors Research Articles

A systematic analysis of chronic kidney disease burden attributable to lead exposure based on the global burden of disease study 2019

AimAs an important toxic heavy metal, lead exposure can lead to the occurrence of chronic kidney disease (CKD). However, the analysis of its disease burden pattern on a global scale is lacking. This study aimed to analyze the CKD burden attributable to lead exposure globally, regionally and temporally, as well as to examine the role of socio-economic factors. MethodThis study used data from the Global Burden of Disease (GBD) study 2019. We obtained the global burden of CKD caused by lead exposure between 1990 and 2019, and stratified this burden according to factors such as gender, age, GBD regions, and countries. From 1990 to 2019, the changing trend of the disease burden of CKD attributed to lead exposure was estimated using Joinpoint regression model with the average annual percent change (AAPC) estimated. Finally, the relationship between country-level socio-economic factors and lead exposure related CKD burden was explored using a panel data model analysis. ResultsIn 2019, worldwide, there were 52.94 thousand deaths (95 % uncertainty interval (UI): 31.64, 76.23) and 1225.2 thousand disability-adjusted life years (DALYs) (95 % UI: 707.88, 1818) of CKD caused by lead exposure, accounting for 3.71 % of total CKD deaths and 2.95 % of total CKD DALYs. The age-standardized death and DALY rates per 100,000 population were 0.68 (95 % UI: 0.40, 0.98) and 15.02 (95 % UI: 8.68, 22.26) respectively, indicating an upward trend and stable trend between 1990 and 2019. However, the age-standardized rates attributed to lead exposure showed a wide variability across regions, with the highest rates in Central Latin America and the lowest in Eastern Europe. Moreover, the results of panel model analysis indicated that GDP growth was positively associated with lead exposure related CKD death rate and DALY rate. However, there were inverse associations between life expectancy at birth and hospital beds (per 1000 people) with lead exposure-related CKD DALY rate. ConclusionIn summary, a significant burden of CKD can be attributed to lead exposure, with noticeable regional discrepancies. Findings here are valuable to deploy efficient measures at curbing lead exposure worldwide.

Effect of air pollution on disease burden, mortality, and life expectancy in North Africa and the Middle East: a systematic analysis for the Global Burden of Disease Study 2019

Air pollution is the sixth highest risk factor for attributable disability-adjusted life-years (DALYs) in North Africa and the Middle East, but the relative importance of different subtypes of air pollution and any potential differences in their health effects by population demographics or country-level socioeconomic factors have not been fully explored. The objective of this study was to investigate the effect of high ambient particulate matter less than 2·5 μm in size (PM) and ambient ozone air pollution on disease burden, mortality, and life expectancy in 21 countries in the North Africa and the Middle East super-region from 1990 to 2019 using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. The study data were derived from GBD 2019, examining data from 1999 to 2019 in North Africa and the Middle East. In this study, the types of air pollution investigated included PM pollution and ambient ozone pollution. PM pollution itself was categorised as household air pollution from solid fuels and ambient PM pollution. The burden attributable to each risk factor, directly or indirectly, was incorporated in the population attributable fraction to estimate the total attributable deaths and DALYs. The summary exposure value (SEV) as the relative risk-weighted prevalence of exposure was extracted to compare the distribution of excess risk times the exposure level in a population where everyone is at maximum risk and ranges from zero (no excess risk exists in a population) to 100 (highest risk). The effect of air pollution on life expectancy was estimated via a cause-deleted life table analysis. The age-standardised DALYs rate attributable to air pollution declined by 44·5%, from 4884·2 (95% uncertainty interval 4381·5-5555·4) to 2710·4 (2317·3-3125·6) per 100 000 from 1990 to 2019. Afghanistan (6992·3, 5627·7-8482·7), Yemen (4212·4, 3241·3-5418·1), and Egypt (4034·8, 3027·7-5138·6) had the highest age-standardised DALYs rates attributable to air pollution in 2019 per 100 000, whereas Türkiye (1329·2, 1033·7-1654·7), Jordan (1447·3, 1154·2-1758·5), and Iran (1603·0, 1404·7-1813·8) had the lowest rates. During the study period, the age-standardised SEV of air pollution (PM and ambient ozone in total) decreased by 10·9% (5·8-17·7%) in the super-region, whereas the SEV of ambient ozone pollution alone increased by 7·7% (0·7-14·3%). Among the components of PM pollution, the SEV of ambient PM pollution increased by 40·1% (25·2-63·7%); however, the SEV of household air pollution from solid fuels decreased by 70·6% (64·1-77·0%). Among the investigated types of air pollution, 98·9% of the DALYs from air pollution in the super-region were attributable to PM pollution. If air pollution had been lowered to the theoretical minimum risk exposure levels for 2019, then the average life expectancy would have been 1·6 years higher. The burden attributable to air pollution substantially decreased in the study period across the super-region as a whole. Most of the burden from air pollution is attributed to PM pollution, the exposure to which has substantially increased in the past three decades. Interventions and policies that reduce population exposure to PM pollution could potentially increase the average life expectancy in the super-region. This finding calls for concerted efforts from governments and public health authorities in the super-region to tackle air pollution as an important threat to population health. Bill & Melinda Gates Foundation.

Self-reported dual sensory impairment and related factors: a European population-based cross-sectional survey

BackgroundData on population-based self-reported dual vision and hearing impairment are sparse in Europe. We aimed to investigate self-reported dual sensory impairment (DSI) in European population.MethodsA standardised questionnaire was used to...

Time trends and associated factors of global burden due to drug use disorders in 204 countries and territories, 1990–2019

BackgroundDrug use disorders (DUDs) have been a public health crisis which strongly impacted community health and socio-economic development. However, there are few studies based on the latest global data to show changes in the disease burden due to DUDs, specifically investigating associations between the country-level socio-economic factors and the burden of DUDs. MethodsData of DUDs were extracted from the Global Burden of Disease Study 2019 database to explore the trends of the disease burden due to DUDs from 1990 to 2019. Univariate linear regression and stepwise multiple linear regression analysis were performed to analyze the correlations between burden due to DUDs and country-level socio-economic factors. ResultsGlobally, the number of disability-adjusted life-years (DALYs) caused by DUDs approximately increased by 2.6% yearly from 1990 to 2019, though the age-standardized DALY rate has not changed significantly in the past 30 years. The age-standardized DALY rate of opioid use disorders showed an upward trend during the past 30 years and was highest among 5 types of DUDs in 2019. Inequality-adjusted human development index (β = 15.9, 95% confidence interval [CI]: 12.9–18.9, P < 0.001) was identified as the key risk factor associated with square-root transformed age-standardized DALY rate of DUDs. ConclusionsGlobal burden due to DUDs has increased significantly over the past 30 years. More effective targeted public health policies should be formulated to manage the public health challenge of DUDs, especially in developed countries and territories.

Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study.

DISCOVER is a 3-year observational study program of 15,983 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. We investigated the association between socioeconomic status and both the availability of a baseline glycated hemoglobin (HbA1c) measurement and poor glycemic control (HbA1c level ≥ 9.0%) in participants enrolled in DISCOVER. Factors associated with a lack of baseline HbA1c measurement or an HbA1c level ≥ 9.0% were assessed using three-level hierarchical logistic models. Overall, 19.1% of participants did not have a baseline HbA1c measurement recorded. Lower-middle country income (vs. high) and primary/no formal education (vs. university education) were independently associated with a reduced likelihood of having a baseline HbA1c measurement (odds ratio [95% confidence interval]: 0.11 [0.03–0.49] and 0.81 [0.66–0.98], respectively. Of the participants with an available HbA1c measurement, 26.9% had an HbA1c level ≥ 9.0%; 68.7% of these individuals were from lower- or upper-middle-income countries. Factors associated with an increased likelihood of poor glycemic control included low country income, treatment at a site with public and/or governmental funding (vs. private funding) and having public or no health insurance (vs. private). A substantial proportion of DISCOVER participants did not have an HbA1c measurement; more than one-quarter of these participants had poorly controlled type 2 diabetes. Both individual- and country-level socioeconomic factors are associated with the quality of care regarding glycemic control. Awareness of these factors could help improve the management of patients with type 2 diabetes.

Individual-level and country-level socio-economic factors and health outcomes in spondyloarthritis: analysis of the ASAS-perSpA study.

The aim of this study was to investigate the association between individual-level and country-level socio-economic (SE) factors and health outcomes across SpA phenotypes. Patients with axial SpA (axSpA), peripheral SpA (pSpA) or PsA from the ASAS-perSpA study (in 23 countries) were included. The effect of individual-level (age, gender, education and marital status) and country-level [e.g. Gross Domestic Product (GDP)] SE factors on health outcomes [Ankylosing Spondylitis Disease Activity Score (ASDAS) ≥ 2.1, ASDAS, BASFI, fatigue and the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI)] was assessed in mixed-effects models adjusted for potential confounders. Interactions between SE factors and disease phenotype were tested. A mediation analysis was conducted to explore whether the impact of country-level SE factors on ASDAS was mediated through biologic/targeted synthetic (b/ts) DMARD uptake. In total, 4185 patients (61% males, mean age 45) were included (65% axSpA, 25% PsA, 10% pSpA). Female gender [β= 0.14 (95% CI: 0.06, 0.23)], lower educational level [β = 0.35 (0.25, 0.45)) and single marital status [β = 0.09 (0.01, 0.17)] were associated with higher ASDAS. Living in lower GDP countries was also associated with higher ASDAS [β = 0.39 (0.16, 0.63)], and 7% of this association was mediated by b/tsDMARD uptake. Higher BASFI was similarly associated with female gender, lower education and living alone, without the effect of country-level SE factors. Female gender and lower educational level were associated with worse ASAS-HI, while more fatigue was associated with female gender and higher country-level SE factors [lower GDP, β = -0.46 (-0.89 to -0.04)]. No differences across disease phenotypes were found. Our study shows country-driven variations in health outcomes in SpA, independently influenced by individual-level and country-level SE factors and without differences across disease phenotypes.

Association between individual and country-level socioeconomic factors and work participation in spondyloarthritis including psoriatic arthritis: Analysis of the ASAS-perSpA study

ObjectiveTo examine whether associations between socioeconomic factors and work outcomes in spondyloarthritis (SpA) differ across axial (axSpA), peripheral SpA (pSpA) and psoriatic arthritis (PsA), and whether associations for individual-level socioeconomic factors are modified by country-level factors. MethodsPatients with a physician diagnosis of SpA within working age (18–65 years) were included. Associations between individual- (age, gender, education, marital status) and country-level factors (Human Development Index, Health Care Expenditure (HCE), Gross Domestic Product, percentage unemployed) with work outcomes (employment status, absenteeism, presenteeism) were assessed using multivariable mixed-effects models. Associations between individual factors and outcomes were compared according to SpA phenotypes and country-level factors using interaction terms. ResultsA total of 3835 patients (mean age 42 years, 61% males) from 23 countries worldwide were included (66% axSpA, 10% pSpA, 23% PsA). Being employed was associated with gender (male vs. female OR 2.5; 95%CI 1.9–3.2), education (university vs. primary OR 3.7; 2.9–4.7), marital status (married vs. single OR 1.3; 1.04–1.6), and age in a non-linear manner. University (vs primary) education was associated with lower odds of absenteeism (OR 0.7; 0.5–0.96) and presenteeism (OR 0.5; 0.3–0.7). Associations were similar across SpA phenotypes. Higher HCE was associated with more favourable work outcomes, e.g., higher odds of employment (OR 2.5; 1.5–4.1). Gender discrepancy in odds of employment was greater in countries with lower socioeconomic development. ConclusionHigher educational attainment and higher HCE were associated with more favourable work outcomes, independently of SpA phenotype. The disadvantageous effect of female gender on employment is particularly strong in countries with lower socioeconomic development.

The association between tobacco control policy implementation and country-level socioeconomic factors in 31 European countries

European countries have made significant progress in implementing tobacco control policies to reduce tobacco use; however, whether socioeconomic status (SES) of a country may influence the implementation of such policies is unknown. The aim of this study is to assess the association between country-level SES and the implementation level of tobacco control policies in 31 European countries. An ecological study using data from Eurostat, Human Development Reports on several SES indicators and the Tobacco Control Scale (TCS) of 2016 was conducted to measure country-level tobacco control policies. We analysed the relationship between SES indicators and the TCS by means of scatter-plots and Spearman’s rank correlation coefficients (rsp) and multivariable linear regression analysis. In Europe, no statistically significant association was found between SES factors and the level of implementation of tobacco control policies. Only public spending on tobacco control was associated with all SES factors, except for Gini Index (an income inequality index). The strongest associations of TCS scores for this policy domain were found with the Human Development Index (rsp = 0.586; p < 0.001) and the Gross Domestic Product per capita (in Euros) (rsp = 0.562; p = 0.001). The adjusted linear regression model showed an association of tobacco control policy implementation with countries’ geographical location (Western Europe, β = − 15.7; p = 0.009, compared to Northern Europe). In conclusion, no association was found between SES factors and the level of implementation of tobacco control policies in 31 European countries; policymakers should be aware that tobacco control policies could be successfully implemented despite socioeconomic constraints, especially when these policies are of low cost and cost-effective (i.e., smoke-free bans and taxation).

Dementia Research Productivity and Associations with Socioeconomic Factors and Burden of Disease in Southeast Asia.

Scientific output in Southeast Asia (SEA) on the topic of dementia is postulated to be low in quality and quantity. It is also speculated that certain socioeconomic variables and measures of disease burden for dementia may play a significant role in driving the research output of a particular country. This study aimed to determine the research impact of published journal articles on dementia in SEA and its association with country-level socioeconomic factors and measures of disease burden for dementia. A systematic search was conducted using electronic healthcare databases. We included articles published on dementia until August 2019 with at least 1 author affiliated with any SEA institution. We obtained bibliometric indices, relevant socioeconomic factors, and measures of disease burden for dementia from published sources. One thousand six articles fulfilled the inclusion criteria. The majority of publications were related to Alzheimer's disease (n = 775, 77.0%). Singapore contributed the highest number of publications (n = 457, 45.4%). Gross domestic product (GDP) per capita, % GDP for research and development, and total neurologists significantly correlated with several bibliometric indices. On the other hand, the measures of disease burden for dementia in SEA countries were not significantly associated with research productivity. Research productivity in SEA on dementia has substantially increased in recent years. Augmenting GDP per capita and expanding the apportionment of resources to research and development (R&D) may have a significant role in the advancement of dementia research in SEA.

Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study

ObjectivesTo explore the role of individual and country level socioeconomic (SE) factors on employment, absenteeism and presenteeism in patients with spondyloarthritis (SpA) across 22 countries worldwide.MethodsPatients with a clinical diagnosis...

Inequity in biological DMARD prescription for spondyloarthritis across the globe: results from the ASAS-COMOSPA study

ObjectivesThe value of biological disease-modifying antirheumatic drugs (bDMARDs) in spondyloarthritis (SpA) is well recognised, but global access to these treatments can be limited due to high costs and other factors....

Associations between national viral hepatitis policies/programmes and country-level socioeconomic factors: a sub-analysis of data from the 2013 WHO viral hepatitis policy report

BackgroundAs more countries worldwide develop national viral hepatitis strategies, it is important to ask whether context-specific factors affect their decision-making. This study aimed to determine whether country-level socioeconomic factors are associated with viral hepatitis programmes and policy responses across WHO Member States (MS).MethodsWHO MS focal points completed a questionnaire on national viral hepatitis policies. This secondary analysis of data reported in the 2013 Global Policy Report on the Prevention and Control of Viral Hepatitis in WHO Member States used logistic regression to examine associations between four survey questions and four socioeconomic factors: country income level, Human Development Index (HDI), health expenditure and physician density.ResultsThis analysis included 119 MS. MS were more likely to have routine viral hepatitis surveillance and to have a national strategy and/or policy/guidelines for preventing infection in healthcare settings if they were in the higher binary categories for income level, HDI, health expenditure and physician density. In multivariable analyses, the only significant finding was a positive association between having routine surveillance and being in the higher binary HDI category (adjusted odds ratio 26; 95% confidence interval 2.0–340).ConclusionCountries with differing socioeconomic status indicators did not appear to differ greatly regarding the existence of key national policies and programmes. A more nuanced understanding of the multifaceted interactions of socioeconomic factors, health policy, service delivery and health outcomes is needed to support country-level efforts to eliminate viral hepatitis.

Subjective Well-Being During the 2008 Economic Crisis: Identification of Mediating and Moderating Factors

We examine the effects of the 2008 economic crisis on the reported subjective well-being (SWB) of nationally representative samples in 36 mainly European countries between 2002 and 2013. We study how SWB fluctuates along the business cycle, and how it is mediated by individual and country-level socioeconomic factors. Our key finding is that the economic crisis had a negative and S-shaped effect on SWB, implying diminishing marginal sensitivity at higher income losses and gains. During the economic downturn, roughly half of individual-level and macro-level determinants exhibit notable changes in significance and/or magnitude of the effect on SWB. This is taken as an indication of psychological adaptation and shifting reference frames. Five factors display an augmented effect on happiness and life satisfaction during the crisis (below-average income, the Gini index, attitude towards income equality, religiosity, and conscientiousness), while two determinants exhibit attenuated impact on the SWB measures (relationship status and unemployment rate).

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

BackgroundPublic trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. MethodsWe perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey – which we believe represents the largest survey on confidence in immunization to date – examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. FindingsOverall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. ConclusionsRegular monitoring of vaccine attitudes – coupled with monitoring of local immunization rates – at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes.

Relationship Between the Remaining Years of Healthy Life Expectancy in Older Age and National Income Level, Educational Attainment, and Improved Water Quality.

The remaining years of healthy life expectancy (RYH) at age 65 years can be calculated as RYH (65) = healthy life expectancy-aged 65 years. This study confirms the associations between socioeconomic indicators and the RYH (65) in 148 countries. The RYH data were obtained from the World Health Organization. Significant positive correlations between RYH (65) in men and women and the socioeconomic indicators national income, education level, and improved drinking water were found. Finally, the predictors of RYH (65) in men and women were used to build a model of the RYH using higher socioeconomic indicators (R(2 )= 0.744, p < .001). Overall country-level educational attainment, national income level, and improved water quality influenced the RYH at 65 years. Therefore, policymaking to improve these country-level socioeconomic factors is expected to have latent effects on RYH in older age.

Erratum to: Country-Level Socioeconomic Indicators Associated with Healthy Life Expectancy: Income, Urbanization, Schooling, and Internet Users: 2000–2012

This study confirms the associations between healthy life expectancy (HLE) and country-level socioeconomic factors. Our analysis is based on HLE data of 178 countries obtained from the World Health Organization. Data on country-level socioeconomic indicators were obtained from the World Bank database and the United Nations. The associations between socioeconomic indicators and HLE are assessed using Pearson’s correlation coefficients and multiple regression models. Our findings show significant positive correlations between HLE and the following country-level socioeconomic factors: national income level (INI: r = 0.775, p = 0.001), urban population (UP: r = 0.711, p = 0.001), mean years of schooling (MYS: r = 0.756, p = 0.001), and internet users (IU: r = 0.795, p = 0.001). Predictors of female and male HLE are used to build a model that predicts HLE by overall higher levels of INI, UP, MYS, and IU (R2 = 0.724, p < 0.001). Based on our results, country-level socioeconomic indicators seem to have an important effect on healthy life expectancy.

Examining self-rated health of young Central and Eastern Europeans in the context of other world regions

Poor health is more prevalent in the east of Europe as compared with the west. This variation is often attributed to Soviet communism. Few studies investigate this health discrepancy within young adults who were children during this period. We studied the health of young adults by examining variations between world regions in general health between generations (18-65+). The individual and contextual mechanisms that might influence their health were also investigated. World Health Survey data were analysed on young adults aged 18-34 (n = 91,823) and their elders aged 35+ (n = 132 362) from 59 countries. Main outcome was self-reported general health. Multi-level logistic regression was used to assess associations between general health and regions, while accounting for individual- and country-level socio-economic factors across age ranges. The prevalence of poor health was much higher for young adults in the Former Soviet Union region than in Western Europe, with the central European region being in-between.This pattern remained even after full adjustments, for the Former Soviet Union citizens [odds ratio 4.26 (95% confidence interval 1.77-10.24)] and for Central Europeans [odds ratio 1.73 (95% confidence interval 0.90-3.32)] as compared with western Europe. Age-specific analyses showed East-West health differences usually being larger as age increases (up to 65+). This age pattern seemed reversed for the south-west divide. The East-West health gap seems more pronounced for the Former Soviet Union young adults, rather than Central Europeans. It appears as though young adults from Central Europe might have been somewhat insulated from the ill-health effects of communism.

Variations between world regions in individual health: a multilevel analysis of the role of socio-economic factors

Living in a particular region might affect health. We aimed to assess variations between regions in individual health. The role of socio-economic factors in the associations was also investigated. World Health Survey data were analysed on 220 487 individuals. Main outcomes included self-reported health, health complaints and disability. The main predictor variable was a modified regional classification of countries. Multilevel logistic regression was used to assess associations between individual health and regions, while accounting for individual and country-level socio-economic factors, notably occupation, education, national income and female literacy. Individual health varied significantly between regions. For instance, compared with Western Europeans, Southern Asians and Western Africans reported poorer health, the odds ratios (ORs) being 2.05 [95% confidence interval (CI) 1.31-3.23] and 1.88 (95% CI 1.26-2.81), respectively. Accounting for socio-economic factors attenuated or, in a few cases, reversed the associations. For example, the OR for Southern Asia and Western Africa respectively became 0.94 (95% CI 0.37-2.37) and 0.77 (95% CI 0.26-2.25). Individuals from Central Europe and the Former Soviet Union were the most likely to report poor health, OR 1.92 (95% CI 1.07-3.44) and OR 4.17 (95% CI 1.91-9.10) respectively. Overall, men were less likely than women to report poor health. Substantial regional variations in individual health exist, only partly explained by socio-economic factors. Additional policy and health research are needed to investigate Central Europe and Former Soviet Union rates that consistently lag behind Latin America, Asia and Africa.

Completion of the Statement of Fitness for Work: concise guidance

Doctors are required to issue Form Med 3 (the Statements of Fitness for Work, commonly known as the fit note) where appropriate to patients for whom they provide clinical care. Much sickness absence is attributed to mild or moderate mental ill health, musculoskeletal or cardiorespiratory conditions. The effects of these conditions and others can often be accommodated at work, with appropriate adjustments, adaptations or support if necessary. Employers have a crucial role in achieving this; however, they need advice on the functional effects of the condition to do so. Evidence shows that work can be therapeutic and help promote recovery and rehabilitation. Conversely, unemployment is generally harmful to health and can lead to increased morbidity and poorer physical and mental health, as well as poverty, health inequalities and social exclusion. This concise guideline has been developed to aid doctors in understanding when and how to issue a fit note to the greatest benefit for their patients.

Exploring the Digital Divide in Mobile-phone Adoption Levels across Countries

Although the adoption of mobile phones has been skyrocketing globally during the current decade, present adoption levels are quite uneven across countries. Such disparities are also found over a range of other information and communications technologies and have been characterized as a “digital divide.” Although the adoption of mobile phones has been the focus of numerous studies, relatively few have systematically and comprehensively investigated the adoption of this technological innovation at the country level of analysis and over a broad range of nations. This study addresses this research gap by examining the effects of three country-level socioeconomic factors paralleling the individual-level demographic traits that in past studies have predominantly predicted early adoption of innovations. We rely on secondary data obtained from several reputable sources to examine this phenomenon across 170 nations. Theoretical, managerial, and policy implications based on our empirical findings, along with directions for future research, are presented.