Greater Inequality Research Articles

Multiple disadvantages: class, social capital, and well-being of ethnic minority groups in the UK during the COVID-19 pandemic.

The COVID-19 pandemic has caused untold damage to the socio-economic lives of people all over the world. Research has also demonstrated great inequality in the pandemic experience. In the UK as in many other countries, people from ethnic minority backgrounds and in working-class positions have suffered disproportionately more than the majority group and those in salariat positions in terms of income loss, financial difficulty, and vulnerability to infection. Yet little is known about how people coped in the daily lives and tried to maintain their well-being during the most difficult days of the pandemic through social capital. In this paper, we draw data from the COVID-19 Survey in Five National Longitudinal Studies to address these questions. The survey covered the period from May 2020 to February 2021, the height of the pandemic in the UK. It contains numerous questions on contact, help and support among family, friends, community members, socio-political trust, and physical and mental health. We conceptualise three types of social capital and one type of overall well-being and we construct latent variables from categorical indicator variables. We analyse the ethnic and socio-economic determinants of the three types of social capital and their impacts on well-being. Our analysis shows that social capital plays very important roles on well-being, and that ethnic minority groups, particularly those of Pakistani/Bangladeshi and Black heritages, faced multiple disadvantages: their poorer socio-economic positions prevented them from gaining similar levels of social capital to those of the white group. However, for people with the same levels of social capital, the effects on well-being are generally similar. Socio-economic (class) inequality is the root cause for ethnic differences in social capital which in turn affects people's well-being.

Foreign language education in Louisiana: A cluster analysis

AbstractLouisiana is currently the only state in the United States that requires foreign language (FL) study for some, but not all of their high school students, and these requirements are undergoing seismic changes. Considering that geographic, economic, and integration factors contribute to whether a school can provide FL at all—and biased counseling dissuades minoritized students from taking FL—this study asks: has FL education been equitably accessible to all Louisiana high school students who want to pursue it, regardless of race or economic background? To address this question, this paper presents results from two analyses. First, program‐internal equity variables (e.g., [dis]similarity between school‐wide and FL student demographics) were clustered to produce “profiles” of FL programs. Next, a multinomial logistic regression using program‐external factors (e.g., federal funding status, desegregation orders) was conducted to isolate the factors impacting equity. Federal funding and rurality were both found to be significant, with schools receiving federal Title I funds and rural schools being much more likely to exhibit inequitable access to FL courses. In (a) identifying schools with enrollment inequities and (b) the outside factors associated with greater inequity, this paper aims to provide policymakers with empirically based tools to address (in)equity in Louisiana high school FL education. These findings can be especially helpful in light of the state's recent (2023‐2024 school year) expansion of FL requirements to accept computer science courses.

Developing and sustaining high-quality care for children with cancer: the WHO Global Initiative for Childhood Cancer.

Cancer is a major public health concern, impacting nearly 20 million people each year, and it is responsible for 1 in 6 deaths worldwide. The burden of cancer is increasing rapidly, straining health systems that are unable to prevent and manage the disease. Childhood cancer constitutes a significant and relevant public health challenge; it was the ninth leading cause of childhood disease globally, according to findings by the Global Burden of Disease 2017 study. Almost 80% of all children diagnosed with cancer live in low- and middle-income countries where treatment is often unavailable or unaffordable. As a result, only about 15-45% of these children survive compared with more than 80% in high-income countries. This represents a great health inequity. Delivering on the mandate provided by World Health Assembly resolution 70.12, WHO together with St. Jude Children's Research Hospital and other global partners launched the Global Initiative for Childhood Cancer at the United Nations General Assembly during the third High-level Meeting on the prevention and control of noncommunicable diseases in September 2018. The Initiative aims to increase global survival for children with cancer to at least 60% by 2030, while reducing suffering for all children with cancer. Five years after launching the Initiative, more than 70 countries across the World Health Organization's 6 regions have advanced to different phases of action through implementation of the Initiative's CureAll framework for action. Many successful approaches to implementing the CureAll pillars and enablers have demonstrated that improving care for children with cancer in low- and middle-income countries is possible as long as there is strong political will, multisectoral commitments and strategic investment.

Urban projects, stigmatization, and territorial disputes in the Independencia neighborhood of Monterrey, Nuevo León, México

The city of Monterrey has become a space of great inequalities and increasingly notorious socio-spatial phenomena. Its different problems have been used by the government and the private sector to justify interventions in working-class neighborhoods, as is the case of the “Independencia” neighborhood. This article looks to analyze the aspects that turn this neighborhood into a disputed space and identify how this is reflected in the territory through the (in)action of public and private actors. It uses a qualitative methodology supported by interviews, informal talks, and non-participant observations that were made in 2019 and 2020. The paper shows how abandonment and a lack of government investment in working-class neighborhoods is part of an urban revaluation process that seeks to attract private investment to these sectors and end the presence of those "others" who are considered a threat to the urban order.

Dravidar Iyakkam Advocated by Thanthai Periyar Contains Nuances of Karl Marx’s Communist Manifesto; - Peraringer Anna Embraced it as Legislature and Bharat Ratna Marudhur Gopalamenon Ramachandran Propagated it in his Films and Formalized it as Annaism; thereafter Dr. Jayaraman Jayalalita carried it forward to uphold the Concept of Equity and Social Justice in Tamil Nadu Governance - A Retrospective Reflection

Right to live, equity and social justice are watch words that determine quality of life in a society. But Tamil Society witnessed harassment by handful of men who branding themselves as the higher social hierarchy dominated the rest for decades resulting great social inequality. Devaneya Pavanar in his forward to his book entitled “Tamilar Varalaru” published by Poompuhar Pathippagam, states that “there is a concept revolving in the country for the past three thousand years that Brahmins are inherited from God, sanscrit is the mother of all languages and it is the language of Gods and Tamil had lost its rationality; self-respet and self-confidence. Pavanar also states that though British Rule developed the country; the Justice Party uplifted the coman man; the research in language unravels the truth; Periyar however cautioned Tamils; however Maraimalai Adigal taught the Tamils for their emancipation they remain the same. After the Britishers left India the minority Muslims attain separate nation but not the Tamils.

Papanicolaou test in Brazil: analysis of the National Health Survey of 2013 and 2019.

To compare the coverage of cervical cancer screening in Brazil in 2013 and 2019, investigating the factors associated with having the test performed and the reasons given for not doing it. Additionally, a comparison is made concerning the time taken to receive the test result in SUS (Sistema Único de Saúde) and in the private health services. Using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), prevalence rates and corresponding confidence intervals were calculated to determine the frequency of recent cervical cancer screenings among women aged between 25 and 64 years old in Brazil, for both 2013 and 2019. Poisson regression models were employed to compare the prevalence of the outcome according to sociodemographic characteristics. The reasons for not having the test and the time between performing and receiving the result were also analyzed. The findings revealed an increase in the coverage of preventive cervical cancer exams in Brazil from 78.7% in 2013 to 81.3% in 2019. Additionally, there was a decline in the proportion of women who had never undergone the exam, from 9.7% to 6.1%. Prevalence of test uptake was higher among white women, those with higher levels of education and income, and those residing in the South and Southeast regions of the country. The most commonly cited reasons for not taking the test were the impression it was unnecessary (45% in both 2013 and 2019) and never having been asked to undergo the test (20.6% in 2013 and 14.8% in 2019). Despite the high coverage of screening achieved in the country, there is great inequality in access to the test, and a non-negligible number of women are at greater risk of dying from a preventable disease. Efforts must be made to structure an organized screening program that identifies and captures the most vulnerable women.

Substantial difference between private and public pensions in Mexico 2018-2021

The objective of this article is to analyse the pensions of private sector workers, comparing them with those of the public sector. The work is framed under the deductive method, with a hermeneutic paradigm and with a quantitative approach. By 2018 in Mexico, of the total number of pensioners of the Mexican Social Security Institute (IMSS), 1.5 million received less than 5,000 pesos per month (69.8% of the IMSS and 46.7% of the national total); while the Institute of Security and Social Services of State Workers had 1.7% of its retirees in that segment; the IMSS-employer 0.4%; Federal Electricity Commission (CFE) and Petroleum Mexicans (PEMEX) 0%. This great inequality is further accentuated when the IMSS-insurer has 2,270 pensioners with incomes of 60-80 thousand pesos per month, while the CFE has 16,707 pensioners earning 60-200 thousand pesos (7.3 times more with 51 times fewer pensioners than the IMSS-insurer).

Oral health profile of Australian children from different immigrant backgrounds.

To profile the oral health of Australian children from different immigrant backgrounds. Cross-sectional data for Australian children were obtained from the 2012-14 National Child Oral Health Study (NCOHS). Three categories of immigrant status were created based on parents' country of birth and language (non-immigrant, non-visible immigrant, and visible immigrant). Descriptive analyses reported weighted estimates for experience of dental caries, self-rated oral health, and dental services utilisation separately for children aged 5-9 years and 10-14 years. The sample comprised 10,610 children aged 5-9 years (3,605 from immigrant backgrounds), and 8,741 children aged 10-14 years (3,074 from immigrant backgrounds). Children from non-visible immigrant backgrounds presented worse dental service utilisation and poorer self-rated oral health than children from non-immigrant and visible immigrant families. Greater inequalities in dental caries experience were observed in the 5-9-year-olds. Untreated caries was substantially higher among visible immigrant children aged 5-9 years (38.8%, 95% CI: 35.5-42.3) than non-immigrant (24.9%, 95% CI: 23.4-26.6) and non-visible immigrant children (21.0%, 95% CI: 17.7-24.7). Australian children from immigrant families constitute a highly heterogeneous group with substantial discrepancies in oral health outcomes.

Green Hydrogen: Resources Consumption, Technological Maturity, and Regulatory Framework

Current climate crisis makes the need for reducing carbon emissions more than evident. For this reason, renewable energy sources are expected to play a fundamental role. However, these sources are not controllable, but depend on the weather conditions. Therefore, green hydrogen (hydrogen produced from water electrolysis using renewable energies) is emerging as the key energy carrier to solve this problem. Although different properties of hydrogen have been widely studied, some key aspects such as the water and energy footprint, as well as the technological development and the regulatory framework of green hydrogen in different parts of the world have not been analysed in depth. This work performs a data-driven analysis of these three pillars: water and energy footprint, technological maturity, and regulatory framework of green hydrogen technology. Results will allow the evaluation of green hydrogen deployment, both the current situation and expectations. Regarding the water footprint, this is lower than that of other fossil fuels and competitive with other types of hydrogen, while the energy footprint is higher than that of other fuels. Additionally, results show that technological and regulatory framework for hydrogen is not fully developed and there is a great inequality in green hydrogen legislation in different regions of the world.

Monogamy as a Force of Social Progress and Women’s Empowerment

Abstract Monogamy in Western countries has recently undergone criticisms, because it is perceived as an oppressive institution, adjacent to reactionary cultural values. In this article, I argue that monogamy is in fact a force of social progress and women’s empowerment. I point out that, given our natural tendencies, the most likely alternative to monogamy is polygyny. By its very nature, polygyny faces a numerical difficulty, to the extent that (given the equitable male to female ratio) when one man engages in romantic or sexual relationships with multiple female partners, inequality and social conflict ensues. I present historical and sociological data that sustains the argument that polygyny is associated with greater inequality, violence, poverty and women’s vulnerability. Nevertheless, while monogamy can be considered a force of social progress, I argue that the State is not morally entitled to prosecute non-monogamous lifestyles, but there may still be non-coercive ways to promote monogamy.

Global Inequities in COVID-19 Vaccination: Associated Factors and Tools to Measure Inequality.

Socioeconomic factors have been recognized by the WHO as determinants of health, and it is important to consider these factors in decision making to curb existing inequality in vaccination for SARS-CoV-2, which causes COVID-19. We aimed to determine whether there is a correlation between socioeconomic factors and vaccination worldwide and measure inequality. A study of secondary sources was carried out to assess inequality in vaccination against COVID-19 worldwide and its association with socioeconomic factors. For this assessment, 169 countries were chosen from January 2020 to March 2022 using LibreOffice and JASP 0.16.1.10. Several mathematical models and statistical tests were used, including a normality test, an analysis of frequencies and proportions, a Kruskal-Wallis test, Spearman's correlations, a Lorenz curve, a Concentration Index, and a slope. Correlations were found between socioeconomic factors and vaccination with one, two, and three doses. As the GDP showed correlations of 0.71 for one dose and 0.82 for three doses, we found that the greater the competitiveness of the countries, the higher the percentage of vaccinated individuals in their populations. According to the Concentration Index, there was greater inequality in vaccination with regard to receiving a higher number of doses, as reflected in the life expectancy indices of 0.16-0.19 and 0.50. The continent with the highest degree of inequality was Africa, and the continent with the lowest degree was America. South Americans were vaccinated with two doses at a rate of 6.19%/month, which was 4.3 times faster than Africans, with 72% of the population being vaccinated in South America, compared to only 16% in Africa. There is inequality in vaccination against COVID-19 with one, two, and three doses, which is associated with socioeconomic factors.

Hypertension management in primary health care: a survey in eight regions of Sweden

Purpose To explore hypertension management in primary healthcare (PHC). Design Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021. Setting Seventy-six PHCCs in eight regions of Sweden. Main outcome measures Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up. Results The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p < 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300–11300) patients. Conclusions The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension.

Inequality in the Face of Death under Covid-19 in Ukraine

If there is a decline in mortality, it is mainly in younger age groups. As a result, more and more deaths are occurring in older age groups. In advanced societies, therefore, people are becoming “more equal in the face of death”. A sharp increase in mortality, such as that caused by the Covid-19 pandemic, affects different age groups of the population to different degrees. It is therefore relevant to study the change in inequality of life expectancy under the conditions of a sudden shock. The purpose of this paper is to analyse the inequality of lifespan variation in Ukraine in 2020—2021 and to compare it with countries with different levels of mortality. Previous studies of lifespan variation specifically devoted to Ukraine, or those that used data for Ukraine, were conducted or related to the pre-Covid period. The novelty of this work is the study of the behaviour of indicators characterising the inequality of lifespan before and during the two years of the epidemic, for which data are available. The demographic me t hod for constructing life tables and statistical methods for calculating lifespan variation indicators were used. Those are: Gini coefficient, average inter-individual difference in length of life, lifespan disparity, entropy of the life table, standard deviation of age at death, coefficient of variation. These indicators were calculated for the period 1989—2021 for Ukraine, Poland, Sweden, Spain, Japan, and England and Wales. It was confirmed that life expectancy is generally inversely related to inequality in the life table. It was found that this rule can be violated during mortality shocks such as the Covid-19 pandemic. It is shown that male life expectancy and lifespan inequality in Ukraine decreased in 2020—2021. Average inter-individual difference in length of life and lifespan disparity have decreased by 6.6—6.9 %. On the other hand, almost all indicators of inequality for women have increased. The life expectancy elasticity indicator (entropy of the life table) turned out to be the most sensitive, increasing to 4.9 %. At the same time, it is interesting to note that the standard deviation of age at death for women in Ukraine decreased by 1.8 %. The Covid-19 pandemic has affected inequality depending on sex and the country’s pre-Covid level. Inequality indicators in Japan have hardly changed. Inequality rates rose in Spain and Sweden before returning to their previous downward trend. Available data for England and Wales suggest a continued slow trend towards greater inequality.

Denaturalizing climate change: Environmental injustice and social vulnerability in contexts of socio-spatial segregation in Mexico

In this article, I present a deep description to the great inequality in terms of exposure and social vulnerability to flood risk, from the context of El Colli, a territory with a high socio-spatial segregation in the municipality of Zapopan, Mexico. El Colli presents three diverse ways of inhabiting the space (informal settlements, consolidated popular neighborhoods, and closed subdivisions). Also, El Colli shows that the increasingly occurrence of risks such as floods is immersed not only in climate change but also in the processes of transformation and degradation of the territory linked to urbanization patterns. That said, the question that guides the research is, how is social vulnerability to climate change configured from the experience of families that live in contexts of socio-spatial segregation? To provide an answer, I carried out an ethnographic study guided by the differences in social vulnerability to flood risk. Furthermore, I propose a theoretical framework aimed at denaturalizing climate change. For this, the contributions of studies on the social construction of risk from the social vulnerability approaches were taken as a reference. In conclusion, the case of El Colli shows that ignoring the structural causes of social vulnerability to risk events, such as floods, can promote situations of environmental injustice, especially for indigenous and migrant populations residing in irregular settlements.

The impact of the COVID-19 pandemic on inequalities in lifestyle behaviours and mental health and wellbeing of elementary school children in northern Canada

ObjectivesThe COVID-19 pandemic has negatively affected children's lifestyle behaviours and mental health and wellbeing, and concerns have been raised that COVID-19 has also increased health inequalities. No study to date has quantified the impact of COVID-19 on health inequalities among children. We compared pre-pandemic vs. post-lockdown inequalities in lifestyle behaviours and mental health and wellbeing among children living in rural and remote northern communities. MethodsWe surveyed 473 grade 4–6 students (9–12 years of age) from 11 schools in rural and remote communities in northern Canada in 2018 (pre-pandemic), and 443 grade 4–6 students from the same schools in 2020 (post-lockdown). The surveys included questions on sedentary behaviours, physical activity, dietary intake, and mental health and wellbeing. We measured inequality in these behaviors using the Gini coefficient, a unitless measure ranging from 0 to 1 with a higher value indicating greater inequality. We used temporal changes (2020 vs. 2018) in Gini coefficients to assess the impact of COVID-19 on inequalities in lifestyle behaviours and mental health and wellbeing separately among girls and boys. ResultsInequalities in all examined lifestyle behaviours increased between 2018 and 2020. Inequalities in watching TV, playing video games, and using a cell phone increased among girls, while inequalities in playing video games, using computers and tablets, and consumption of sugar, salt, saturated fat and total fat increased among boys. Changes in inequalities in mental health and wellbeing were small and not statistically significant. ConclusionThe findings suggest that the COVID-19 pandemic has exacerbated inequalities in lifestyle behaviours among children living in rural and remote northern communities. If not addressed, these differences may translate into exacerbated inequalities in future health. The findings further suggest that school health programs can help mitigate the negative impact of the pandemic on lifestyle behaviours and mental health and wellbeing.

Impact of the COVID-19 Pandemic on the Socioeconomic Inequalities in Mortality in Spanish Provinces

BackgroundAlthough many studies have assessed the socioeconomic inequalities caused by COVID-19 in several health outcomes, there are numerous issues that have been poorly addressed. For instance, have socioeconomic inequalities in mortality from COVID-19 increased? What impact has the pandemic had on inequalities in specific causes of mortality other than COVID-19? Are the inequalities in COVID-19 mortality different from other causes? In this paper we have attempted to answer these questions for the case of Spain.MethodsWe used a mixed longitudinal ecological design in which we observed mortality from 2005 to 2020 in the 54 provinces into which Spain is divided. We considered mortality from all causes, not excluding, and excluding mortality from COVID-19; and cause-specific mortality. We were interested in analysing the trend of the outcome variables according to inequality, controlling for both observed and unobserved confounders.ResultsOur main finding was that the increased risk of dying in 2020 was greater in the Spanish provinces with greater inequality. In addition, we have found that: (i) the pandemic has exacerbated socioeconomic inequalities in mortality, (ii) COVID-19 has led to gender differences in the variations in risk of dying (higher in the case of women) and (iii) only in cardiovascular diseases and Alzheimer did the increased risk of dying differ between the most and least unequal provinces. The increase in the risk of dying was different by gender (greater in women) for cardiovascular diseases and cancer.ConclusionOur results can be used to help health authorities know where and in which population groups future pandemics will have the greatest impact and, therefore, be able to take appropriate measures to prevent such effects.

The health gap and HRQoL inequalities in Greece before and during the economic crisis.

The aim of this study was twofold: (i) to assess the health gap among young socio-economic groups generated by the economic crisis in Greece and (ii) to investigate HRQoL (Health Related Quality of Life) inequalities using the Theil index. The EQ-5D-5L instrument was administered to a sample of 4,177 young individuals in Greece, mean age 22.3 (±SD 4.8) and 53.8% males, and 46.2% females. The Greek version of the EQ-5D-5L instrument was used in a web-based questionnaire to collect data. Subjects were asked to assess their subjective health status during the economic crisis of 2016 using the EQ-5D-5L instrument, and to recall their health before the crisis of 2009. The health gap was assessed on a Visual Analogue Scale (EQ-VAS), the EQ-5D-5L Index, and the five dimensions of the EQ-5D-5L instrument. Regression analysis was employed to measure the effects of the economic crisis on age, sex, education, and income on the EQ-VAS and EQ-5D-5L. Theil index was used to assess HRQoL inequalities. The economic crisis brought a significant deterioration in the HRQoL of young Greeks. The EQ-VAS was reduced during the crisis by -10.05% (p < 0.001) and the EQ-5D-5L index declined by -19.61% (p < 0.001). The prevalence of the health gap in each dimension of the EQ-5D-5L was also significant in terms of deterioration of Mobility [change by 66.8% (p < 0.001)], Self-care [change by 61.0% (p < 0.001)], Usual activities [change by 97.1% (p < 0.001)], Pain/discomfort [change by 65.0% (p < 0.001)], and Anxiety/depression [change by 70.5% (p < 0.001)]. Significant reductions in EQ-5D-5L indices were also associated with greater inequalities in the distribution of health among age, gender, income, and educational groups. The EQ-5D-5L health gap among the poor was much greater (0.198), in comparison to richer (0.128) classes. Similar gaps were also found in terms of educational inequalities. The EQ-5D-5L health gap among those with primary education was 0.211, whereas for those with tertiary education it was 0.16. The Theil index indicated an increase in income-related HRQoL inequalities by 222.3% for the EQ-5D-5L index and by 124.2% for the EQ-VAS. The effects of demographic and socioeconomic variables on the EQ-VAS were found statistically significant: sex (p < 0.05), age (p < 0.001), education (p < 0.001), and income (p < 0.001). The EQ-5D-5L instrument appears to be a powerful tool in assessing the health gap and the HRQoL inequalities among young people in Greece. The findings indicate the importance of developing effective health policies to combat inequalities and mitigate the impact of austerity measures on the quality of life of the young.

Economic inequality and the long-term future

Why, if at all, should we object to economic inequality? Some central arguments – the argument from decreasing marginal utility for example – invoke instrumental reasons and object to inequality because of its effects. Such instrumental arguments, however, often concern only the static effects of inequality and neglect its intertemporal consequences. In this article, we address this striking gap and investigate income inequality's intertemporal consequences, including its potential effects on humanity's (very) long-term future. Following recent arguments around future generations and so-called longtermism, those effects might arguably matter more than inequality's short-term consequences. We assess whether we have instrumental reason to reduce economic inequality based on its intertemporal effects in the short, medium, and the very long term. We find a good short and medium-term instrumental case for lower economic inequality. We then argue, somewhat speculatively, that we have instrumental reasons for inequality reduction from a longtermist perspective too, primarily because greater inequality could increase existential risk. We thus have instrumental reasons to reduce inequality, regardless of which time-horizon we take. We then argue that from most consequentialist perspectives, this pro tanto reason also gives us all-things-considered reason. And even across most non-consequentialist views in philosophy, this argument gives us either an all-things-considered or at least weighty pro tanto reason against inequality.

Correlates of stress are interactive and not unidimensional: Evidence from U.S. college students early in the COVID-19 pandemic.

Studies have investigated various aspects of how the COVID-19 pandemic has impacted college students' well-being. However, the complex relationships between stress and its correlates have received limited attention. Thus, the main objective of this study is to evaluate multiplicative associations between stress and demographic, lifestyle, and other negative emotion factors during the pandemic. We used data from a survey with 2,534 students enrolled in seven U.S. universities and analyzed such data with generalized additive Tobit models and pairwise interaction terms. The results highlighted associations and interactions between myriad factors such as students' social class, income, parental education, body mass index (BMI), amount of exercise, and knowing infected people in the student's communities. For instance, we found that the associations between feeling irritable and sad due to the pandemic were interactive, resulting in higher associated stress for students with higher levels of parents' education. Furthermore, associations between taking precautionary actions (i.e., avoiding travel and large gatherings) and stress varied with the intensity of negative feelings (i.e., sadness and irritability). Considering these interaction terms, the results highlighted a great inequality in pandemic-related stress within low income, lower social class, and higher BMI students. This study is among the earliest that employed a stratified approach with numerous interaction terms to better understand the multiplicative associations between different factors during the COVID-19 pandemic.

The trend of unintentional injury-related mortality among children aged under-five years in China, 2010–2020: a retrospective analysis from a national surveillance system

BackgroundIn this study, we estimated the trend of unintentional injury mortality among children aged under-five years in China during 2010–2020.MethodsData were obtained from China’s Under 5 Child Mortality Surveillance System (U5CMSS). The total unintentional injury mortality and all specific-causes unintentional injury mortality was calculated, annual numbers of deaths and live births were adjusted by a 3-year moving average under-reporting rate. The Poisson regression model and the Cochran-Mantel-Haenszel method were used to calculate the average annual decline rate (AADR) and the adjusted relative risk (aRR) of the unintentional injury mortality.ResultsIn 2010–2020, a total of 7,925 unintentional injury-related deaths were reported in U5CMSS, accounting for 18.7% of all reported deaths. The overall proportion of unintentional injury-related deaths to total under-five children deaths has increased from 15.2% to 2010 to 23.8% in 2020 (χ2 = 227.0, p < 0.001), the unintentional injury mortality significantly decreased from 249.3 deaths per 100,000 live births in 2010 to 178.8 deaths per 100,000 live births in 2020, with an AADR 3.7% (95%CI 3.1–4.4). The unintentional injury mortality rate decreased from 2010 to 2020 in both urban (from 68.1 to 59.7 per 100,000 live births) and rural (from 323.1 to 230.0 per 100,000 live births) areas (urban: χ2 = 3.1, p < 0.08; rural: χ2 = 113.5, p < 0.001). The annual rates of decline in rural areas and urban areas were 4.2% (95%CI 3.4–4.9) and 1.5% (95%CI 0.1–3.3), respectively. The leading causes of unintentional injury mortality were suffocation (2,611, 32.9%), drowning (2,398, 30.3%), and traffic injury (1,428, 12.8%) in 2010–2020. The cause-specific of unintentional injury mortality rates decreased with varying AADRs in 2010–2020, except for traffic injury. The composition of unintentional injury-related deaths also varied by age group. Suffocation was the leading cause in infants, drowning and traffic injury were the leading causes in children aged 1–4 years. Suffocation and poisoning has high incidence in October to March and drowning has high in June to August.ConclusionThe unintentional injury mortality rate of children aged under-five years decreased significantly from 2010 to 2020 in China, but great inequity exists in unintentional injury mortality in urban and rural areas. Unintentional injuries are still an important public health problem affecting the health of Chinese children. Effective strategies should be strengthened to reduce unintentional injury in children and these policies and programmes should be targeted to more specific populations, such as rural areas and males.