Education-related Inequalities Research Articles

Income-related and educational inequality in small-for-gestational age and preterm birth in Denmark and Finland 1987—2003

In this paper, we examine income- and education-related inequality in small-for-gestational age (SGA) and preterm birth in Denmark and Finland from 1987 to 2003 using concentration indexes (CIXs). From the national medical birth registries we gathered information on all births from 1987 to 2003. Information on highest completed maternal education and household income in the year preceding birth of the offspring was obtained for 1,012,400 births in Denmark and 499,390 in Finland. We then calculated CIXs for income- and education-related inequality in SGA and preterm birth. The mean household income-related inequality in SGA was -0.04 (95% confidence interval: -0.05, -0.04) in Denmark and -0.03 (-0.04, -0.02) in Finland. The maternal education-related inequality in SGA was -0.08 (-0.10, -0.06) in Denmark and -0.07 (-0.08, -0.06) in Finland. The income-related inequality in preterm birth was -0.03 (-0.03, -0.02) in Denmark and -0.03 (-0.04, -0.02) in Finland. The education-related inequality in preterm birth was -0.05 (-0.07, -0.04) in Denmark and -0.04 (-0.05, -0.03) in Finland. In Denmark, the income-related and education-related inequity in SGA increased over time. In Finland, the income-related inequality in SGA birth increased slightly, while education-related inequalities remained stable. Inequalities in preterm birth decreased over time in both countries. Denmark and Finland are examples of nations with free prenatal care and publicly financed obstetric care of high quality. During the period of study there were macroeconomic shocks affecting both countries. However, only small income- and education-related inequalities in SGA and preterm births during the period were observed.

Prevalence of educational inequalities in obesity between 1970 and 2003 in France

This paper examines trends in obesity rates and education-related absolute and relative inequalities in obesity over the last 40 years in France. Data are drawn from the French Decennial Health Surveys of 1970, 1980, 1991 and 2003. The difference in obesity rates between the least- and most-educated, the Slope Index of Inequality, is used to estimate absolute inequalities in obesity. The ratio of the corresponding rates, the Relative Index of Inequality, reveals the relative inequalities in obesity. Obesity rates were similar in men and women, but educational inequalities were greater in women. Obesity rates were similar over the first three surveys but increased for all in the 2003 survey. This increase was accompanied by increases in absolute inequalities in men (P = 0.04) from a Slope Index of Inequality of 4.80% (95% confidence interval [CI] = 2.27, 7.32) to 8.64% (95% CI = 5.97, 11.32) and women (P = 0.004) from 8.90% (95% CI = 6.18, 11.63) to 14.57% (95% CI = 11.83, 17.32). Relative inequalities in obesity remained stable over the 40 years. Recent increase in obesity rates in France is accompanied by increases in absolute education-related inequalities, while relative inequalities have remained stable; this suggests that obesity rates have increased at a much faster rate in the low-education groups.

Patient educational level and use of newly marketed drugs: a register-based study of over 600,000 older people

To examine the association between educational level and the use of newly marketed drugs (NMD) among elderly persons. We conducted a register-based, retrospective, cross-sectional study of 626,258 people aged 75-89 years who filled at least one drug prescription from August to October 2005 and who, consequently, were registered in the Swedish Prescribed Drug Register (SPDR). Data from the SPDR were record-linked to the Swedish National Inpatient Register and the Education Register. Newly marketed drugs were defined as new chemical entities that had been approved in Sweden between 2000 and 2004. Overall, NMD were prescribed to 7.3% of the study population. The use of NMD increased with increasing educational level (6.9% for the lowest educated elderly and 8.1% for the highest educated elderly), and education was associated with NMD [odds ratio (OR) 0.82; 95% confidence interval (CI)] 0.80-0.88 for <9 compared with > or =13 years of education) after adjustment for age, sex, type of residential area and number of dispensed drugs. Decreasing educational level was associated with a lower probability of using most of the NMD, especially oseltamivir (adjusted OR 0.16; 95% CI 0.12-0.22 for <9 years of education compared with > or =13 years of education) and ezetimibe. This study suggests that education-related inequalities in NMD use may exist even in a healthcare system that claims to ensure a high degree of equity. Future research is required to explain why educational level influences the selection of new drugs and whether it has any impact on health outcomes.

Association of Education and the Occurrence of Low Birthweight in Rural Southern China During the Early and Late 1990s

We examined whether education-related inequalities were associated with the occurrence of low birthweight in 6 counties in southern China in the early and late 1990s. The study population consisted of 111,181 women (65,669 in the early 1990s and 45,482 in the late 1990s) in a population-based Perinatal Health Care Surveillance System. We used the chi(2) test, logistic regression, and concentration index for our analyses. From the early to late 1990s, the mean maternal education level increased significantly, and the percentage of low-birthweight births declined among all groups, for both male and female births, and at all levels of the mother's education. Relative to those with less than 9 years of formal education, there was a decreasing risk of low birthweight among those with 9 to 11 years of formal education (range in adjusted odds ratio=0.69-0.82) and with 12 or more years of formal education (range in adjusted odds ratio=0.51-0.74). Between the early and late 1990s, the concentration index changed from -0.0778 to -0.0656 for male births and from -0.0717 to -0.0813 for female births. Education-related inequalities associated with low birthweight persisted from the early to the late 1990s in surveyed areas.

Healthy Minds in Healthy Bodies; An International Comparison of Education-Related Inequality in Physical Health Among Older Adults

Education is arguably the most important correlate of health We study education-related inequality in the physical of older adults across 11 European countries and the US. Combining data from HRS 2002, ELSA 2002 and SHARE 2004, our results suggest that education is strongly correlated with health both across and within countries. Education-related inequality in health is larger in Mediterranean and Anglo-Saxon countries than in western European countries. We find no evidence of a trade-off between health levels and equity in health. Education-related inequality in health hardly driven by income or wealth effects (except in the US), and differences in health behaviors (smoking) by education level contribute surprisingly little health differences across education groups.

Education-Related Gender Differences in Health in Rural China

We investigated gender differences in education-related health inequalities in rural China. Household interview data were obtained from 6 provinces in 1993 and 2001. Remarkable health inequalities existed and favored the higher educational groups; among women, the inequalities were greater and health inequalities increased from 1993 to 2001. Education serves as a more powerful mediating factor for health inequalities among women than among men in rural China.

Socioeconomic inequality in blood pressure and its determinants: cross-sectional data from Trinidad and Tobago.

We evaluated income- and education-related inequalities in blood pressure, hypertension and hypertension treatment in the general population of Trinidad and Tobago. The design included survey of 300 households in north central Trinidad, including 631 adults in 2001. Measurements of blood pressure, weight, height, waist and hip circumferences, and educational attainment, household income and alcohol intake by questionnaire. The slope index of inequality (SII) was used to estimate the difference in blood pressure between those with highest, as compared to lowest, socioeconomic status. Complete measurements and questionnaires were obtained for 461 (73%) including 202 men and 259 women. In women, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -12.6, 95% confidence interval -22.6 to -2.6 mmHg (P=0.013); and -10.8 (-21.4 to -0.2) mmHg (P=0.045) by educational attainment. After additionally adjusting for body mass index, waist-hip circumference ratio and self-reported diabetes, the SII for income was -7.3 (-16.5 to 1.9) mmHg (P=0.120) and for educational attainment was -3.0 (-13.0 to 6.9) mmHg (P=0.551). In men, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -4.3 (-15.4 to 6.8) mmHg (P=0.447) and for education -8.1 (-19.0 to 2.8) (P=0.145). There is a negative association of systolic blood pressure with increasing income or education in women. This is associated with body mass index, abdominal obesity and diabetes. There is no consistent association between education or income and blood pressure in men.