Health Equity Research Articles

Development and evaluation of an intervention designed to increase the prioritisation of health by professionals working in the private sector of urban development: study protocol

ABSTRACT The built environment is known to have a significant influence on population and planetary health, including the incidence of non-communicable disease, but evidence suggests that professionals in the land and development industries struggle to prioritise health and health equity when making urban development decisions amidst challenging structures and competing priorities. The aim of this study is to use a mixed-methods approach to develop, deliver, optimise, and evaluate an intervention for professionals working in the private sector of urban development to increase their intention to act on health and health equity where possible. This protocol describes four planned research activities that constitute this intervention’s development, delivery, and evaluation: 1) Intervention development using an iterative co-production process with non-academic industry partners using the Person-Based Approach and following Medical Research Council guidelines on the development of complex interventions; 2) Development of survey questions to assess intervention effectiveness; 3) Delivery and mixed-methods longitudinal evaluation of the intervention; and 4) Evaluation of the impact of co-production and delivery of the intervention with the project’s industry partners.

Ethical Principles Guiding Prioritization in Local Health Promotion and Prevention: Insights from Danish Municipalities

ABSTRACT Prioritization in public health has long been contentious, which necessitates ethical discussions. Despite efforts to develop frameworks that address these considerations, universally accepted models remain elusive, leaving decision-makers to manage independently. This study explores the previously underexplored topic of ethical principles guiding prioritization within different domains of health promotion and prevention at a local level. Interviews with decision-makers (n = 21) from Danish municipalities were analyzed thematically to uncover ethical dimensions of local prioritization of public health services. The study showed that when confronted with resource constraints, decision-makers tended to prioritize preventive services for patients, often at the expense of broader health promotional initiatives. This decision appears rooted in ethical principles of assisting individuals who are deemed to be in the most immediate need. Analyzed against principles of justice and the broader literature on prioritization, the results reflect a prioritization common in the hospital sector: the principle of need. This contrasts with broader societal discussions of public health that are often based on principles of maximization of health benefits and equity. The study highlights the importance of weighing diverse ethical principles when prioritizing among and within initiatives and of considering the purpose of different domains of prevention and health promotion.

The PAICE project: Integrating health and health equity into UK climate change policy

This paper announces a new initiative - the research project Policy and Implementation for Climate & Health Equity (PAICE), which aims to investigate the complex systemic connections between climate change action, health and health equity, for translation of evidence into policy and practice in the UK. Using transdisciplinary approaches, PAICE will: (1) co-develop a programme theory and linked monitoring and evaluation plan, (2) work with the UK Climate Change Committee (CCC) and the Greater London Authority (GLA) using system dynamics to analyse national and local policy opportunities, (3) build an integrated model of the effects of these policies on population health, health equity and greenhouse gas emissions, (4) apply the findings to the CCC monitoring framework and GLA policy development, and (5) use the programme theory to help evaluate achievement of PAICE processes and objectives. If successful, PAICE will have helped to establish a systems capability to (i) monitor whether Government plans are on track to deliver their climate targets and associated health impacts and (ii) understand how relevant policy and implementation approaches could be enhanced.

Priorities for Research, Education, Clinical Practice, and Policy From the Long COVID Physio International Forum

Purpose: Long COVID Physio (LCP) is an international peer support, education and advocacy, patient-led association of physiotherapists living with long COVID and allies. In 2022, LCP hosted an international forum. One of the aims of the forum was to identify priorities in long COVID and rehabilitation. Methods: We conducted an international consultation on priorities for long COVID and rehabilitation with people living with long COVID, clinicians, researchers, and other key interest-holders (referred to collectively as “consultants”) who registered for and attended the LCP International Forum. We collected feedback from consultants using web-based questionnaires, the Zoom chat from the forum, and posts on an online platform during the forum. We analyzed data using group-based content analytical techniques. Priorities were organized into 4 categories: research, practice, education, and policy. Results: There were 794 respondents for the consultation representing 34 countries, including 47% (n = 376) living with long COVID. Seventeen priorities for long COVID overlapped and spanned research (epidemiology, socioeconomics, pathophysiology, characterizing disability, health equity, establishing diagnostic criteria, intervention studies), education (for people living with long COVID, employers, policy makers, and health care professional students), clinical practice (safety, person-centered approaches), and policy (accessibility of care, supports for people living with long COVID and caregivers, public health messaging). Priorities were focused on long COVID and rehabilitation, but some extended beyond the scope of rehabilitation (eg, pharmacological interventions). Conclusions: These priorities can help to guide research, clinical practice, education, and policy, to advance health outcomes for people living with long COVID.

An Asset-Based Examination of Contextual Factors Influencing Nutrition Security: The Case of Rural Northern New England

Background/Objectives: Rural communities face a disproportionate burden in terms of diet-related health challenges and have been identified as a target for the U.S. Department of Agriculture’s nutrition security initiatives. In this paper, we adopt an asset-based approach and use the Community Capitals Framework to examine the characteristics that support nutrition security in rural communities, using rural northern New England as a case study. Methods: We conducted focus groups and interviews with 32 food and nutrition professionals in Maine, New Hampshire, and Vermont in 2023 and 2024 to explore the contextual factors that influence nutrition security in rural communities. We coded the data for community assets and mapped the identified assets into the seven dimensions of the Community Capitals Framework: built capital, cultural capital, financial capital, human capital, natural capital, political capital, and social capital. Results: The participants described assets in all dimensions of the Community Capitals Framework except built capital. The specific assets discussed were related to local food production (natural and cultural capital), coordination between food system stakeholders and strong social networks (human and social capital), regional political commitments to food security and nutrition (political capital), and the strong seasonal tourist economy present in some communities (financial capital). Conclusions: Rural communities remain under-studied in the literature regarding nutrition, and little is known about how to advance healthful eating in rural contexts. An asset-based approach was helpful for identifying existing resources that enhance rural nutrition security and may provide an opportunity to characterize and disseminate strategies to advance rural health equity.

Closing the Gap: Digital Innovations to Address Hypertension Disparities.

Significant inequities persist in hypertension detection and control, with minoritized populations disproportionately experiencing organ damage and premature death due to uncontrolled hypertension. Remote blood pressure monitoring combined with telehealth visits (RBPM) is proving to be an effective strategy for controlling hypertension. Yet there are challenges related to technology adoption, patient engagement and social determinants of health (SDoH), contributing to disparities in patient outcomes. This review summarizes the evidence to date for RBPM, focusing on the potential to advance health equity in blood pressure control and the existing levers for largescale implementation. Several studies demonstrate the promise of RBPM programs to address health disparities through: (1) the use of cellular-enabled blood pressure machines that do not require internet access or smart devices to connect readings into the medical record; (2) emphasis on home blood pressure monitoring to illuminate the daily factors that influence blood pressure control, thereby increasing patient empowerment; (3) adoption of standardized algorithms for hypertension management; and (4) integration of services to address SDoH. Multidisciplinary, non-physician care teams that include nurses, pharmacists, and community health workers are integral to this model. However, most studies have not embraced all aspects of RBPM, and implementation is challenging as current payment models do not support the digital components of RBPM or a diverse workforce of hypertension providers. To address hypertension disparities, RBPM programs need to integrate digital technology that is accessible to all users as well as multidisciplinary care teams that attend to the medical and social needs of populations experiencing health inequities.

Racial and ethnic discrimination and DSM-5 substance use disorders among U.S. adults.

Racial and ethnic discrimination is a risk factor for substance use among United States adults. However, whether discrimination is associated with substance use disorders (SUDs) overall and by race and ethnicity is less understood. We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n=35,355) and defined past-year discrimination as a summary scale (range: 0-4). Past-year SUDs included alcohol use disorder (AUD), tobacco use disorder (TUD), cannabis use disorder (CUD), and illicit drug use disorder (IDUD) based on DSM-5 criteria, and number of SUDs included one, two, or three or more SUDs. We estimated associations between discrimination and each SUD outcome using logistic and multinomial logistic regression and examined effect modification by race and ethnicity. Discrimination was associated with each substance-specific SUD (OR range: 1.36-1.78) and with one, two, and three or more number of SUDs (OR range: 1.34-2.19). Models stratified by race and ethnicity revealed that discrimination was associated with AUD among all groups (OR range: 1.42-1.52), with TUD only among adults who were non-Hispanic White, non-Hispanic Black and another non-Hispanic race, with CUD only among non-Hispanic White and non-Hispanic Black adults, and with only IDUD among Hispanic, non-Hispanic White, and non-Hispanic Black adults. In addition, discrimination was associated with three or more number of SUDs among all groups. Discrimination was associated with all SUD outcomes, with variation in these relationships by race and ethnicity. Understanding this heterogeneity can inform efforts to prevent problematic substance use and promote health equity.

Associations of Individual and Neighborhood Factors with Disparities in COVID-19 Incidence and Outcomes

Introduction: The disproportionate impact of coronavirus 2019 (COVID-19) on Black and Hispanic communities has been widely reported. Many studies have used neighborhood racial/ethnic composition to study such disparities, but less is known about the interplay between individual race/ethnicity and neighborhood racial composition. Therefore, our goal in this study was to assess the relative contributions of individual and neighborhood risk to disparities in COVID-19 incidence and outcomes. Methods: We performed a cross-sectional study of patients with emergency department (ED) and inpatient visits to an academic health system (12 hospitals; February 1–July 15, 2020). The primary independent variable was race/ethnicity; covariates included individual age, sex, comorbidity, insurance and neighborhood density, poverty, racial/ethnic composition, education and occupation. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity; secondary outcomes included admission and death after COVID-19. We used generalized estimating equations to assess whether race/ethnicity remained significantly associated with COVID-19 after adjustment for individual and neighborhood factors. Results: There were 144,982 patients; 5,633 (4%) were SARS-CoV-2 positive. Of those, 2,961 (53%) were admitted and 601(11%) died. Diagnosis of COVID-19, admission, and death were more common among non-Hispanic Black, Hispanic, Spanish-speaking patients, and those with public insurance. In the base model (adjusting for race/ethnicity, age, sex, and comorbidities), race/ethnicity was strongly associated with COVID-19 (non-Hispanic Black odds ratio [OR] 4.64 [95% confidence interval (CI) 4.18–5.14], and Hispanic OR 6.99 [CI 6.21–7.86]), which was slightly attenuated but remained significant after adjustment for neighborhood factors. Among patients with COVID-19, there was no significant association between race/ethnicity and hospital admission, other than for patients with unknown race. Conclusion: This data demonstrates a persistent association between race/ethnicity and COVID-19 incidence, with Black and Hispanic patients at significantly higher risk, which was not explained by measured individual or neighborhood factors. This suggests that using existing neighborhood factors in studies examining health equity may be insufficient, and more work is needed to quantify and address structural factors and social determinants of health to improve equity.

State-Level LGBTQ+ Policies and Health: The Role of Political Determinants in Shaping Health Equity

Abstract Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals in the United States experience higher rates of discrimination and stressors that negatively impact health compared to their straight, cisgender counterparts. Using 2022 Behavioral Risk Factor Surveillance Survey (BRFSS) data, estimating multilevel mixed-effects logistic regressions, we examined the relationship between state LGBTQ+ policies and health among LGBT people. Findings reveal a statistically significant inverse link between protective (high) state policy scores and poor self-rated health, poor mental health days, and poor physical health days. Specifically, with each one-point increase in policy score, the odds of poor self-rated health are reduced by 0.03%, high mental health burden by 0.02%, and high physical health burden by 0.02%. Inequalities in self-rated health, high mental health burden, and high physical health burden are greater in policy environments with fewer state-level protections, with LGBT individuals reporting better health where there are more protections. These results indicate that discriminatory state policies are linked to poorer health for LGBT individuals and suggest that protective policies could improve health. Further research with comprehensive data is needed to deepen understanding.

Telerehabilitation Policy Report: Interprofessional Policy Principles and Priorities

While the public health emergency is over, telehealth and telepractice will continue to play a pivotal role in supporting health equity for diverse and vulnerable individuals in underserved communities. The American Occupational Therapy Association, the American Physical Therapy Association, the American Speech-Language-Hearing Association, and the American Telemedicine Association are professional associations representing the interests of more than 564,000 rehabilitation services professionals in the United States. These organizations have shared priorities including legislative, regulatory, and state-based advocacy efforts. Continued advocacy and promotion by professional organizations, providers and patients alike is necessary to ensure that all rehabilitation providers are included in any telehealth lists of federally and state approved providers. In addition, key health care industry stakeholders want telehealth to be a permanent option for care delivery and ensure that telehealth will remain widely available to support health equity and access to critical rehabilitation services for all.

The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey

Background Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. Objective This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Methods Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. Results The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL score (5.8%), and cognition (7.5%). Similarly, internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL score (2.1%), instrumental ADL score (3.5%), and cognition (7.5%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8%) and cognition (12.8%). The robustness of the results was confirmed through propensity score–matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. Conclusions The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements.

Readmission and unplanned healthcare use after radical cystectomy are independent of discharge destination

Introduction: Our primary purpose was studying utilization rates of home nursing assistance (HNA) and skilled nursing facility (SNF) placement after radical cystectomy (RC) and evaluating if their use was associated with emergency department (ED) visits, hospital readmissions, or mortality. Secondarily, we evaluated if patient socioeconomic status was associated with these factors following RC. Methods: Patients who underwent RC for bladder cancer were retrospectively analyzed. Discharge destination was labeled as home, HNA, or SNF. The incidence of ED visits was recorded at 30 and 90 days after discharge from surgical admission. Readmissions were tracked similarly. Area Deprivation Index (ADI) was collected on each patient and organized in quartiles (ADIQ), with worsening socioeconomic status as ADIQ increased. Results: A total of 215 patients were discharged home, 148 to HNA and 25 to SNF. ED visits and readmissions after RC at the 30- and 90-day marks did not differ based on discharge destination (p>0.05). Home patients had a lower incidence of death after RC compared to HNA and SNF (p=0.037), but not overall survival time (p=0.572). Readmission to the hospital after 30 days of discharge was more likely as ADIQ increased (p=0.017). Discharge destination, ED visits, and readmission after 90 days of discharge from RC was not different based on patient ADIQ (p>0.05). Conclusions: Discharge to home after RC is associated with lower mortality rates. Rates of readmission and use of ED resources appear independent of discharge destination. A greater ADIQ may interact with likelihood of admission post-RC. Future efforts remain warranted to address disparities in postoperative management in the pursuit of health equity in urology.

Racial and ethnic disparities in liver transplant access vary within and across transplant referral regions.

Prior studies have demonstrated racial disparities in access to liver transplantation but determinants of these disparities remain poorly understood. We used geographic catchment areas for transplant centers (transplant referral regions, TRRs) to characterize transplant environment contributors to racial and ethnic disparities in liver transplant access. Data were obtained from the Scientific Registry for Transplant Recipients (SRTR) and the National Center for Health Statistics (NCHS) from 2015 to 2021. The primary outcome was the difference in the listing-to-ESLD death ratio (LDR) between Black, Hispanic, and non-Hispanic White patients for each TRR. We accounted for demographics, socioeconomic status, healthcare access, organ availability, and transplant center competition using multivariable linear regression. We examined intra-TRR differences in waitlist composition using Levene's test of variance. Across the 66 included TRRs, Black patients had lower LDRs than White patients in 80% of TRRs, while Hispanic patients had equal or higher LDRs compared to White patients in 56% of TRRs. The majority of variation in racial disparities across TRRs remained unexplained by multivariable models. Disparities were attenuated after excluding patients with HCC-associated mortality. Among the 27 TRRs that contained more than one transplant center, variance across TRRs was statistically significant for Black and Hispanic waitlist composition. We observed substantial geographic variation in the magnitude of racial disparities in liver transplant access across the United States. Findings highlight the need for targeted health equity interventions in regions with high disparities and the development of disparity-sensitive access metrics for transplant centers.

Lifetime risk and projected burden of dementia.

Understanding the lifetime risk of dementia can inform public health planning and improve patient engagement in prevention. Using data from a community-based, prospective cohort study (n = 15,043; 26.9% Black race, 55.1% women and 30.8% with at least one apolipoprotein E4 (APOE ε4) allele), we estimated the lifetime risk of dementia (from age 55 years to 95 years), with mortality treated as a competing event. We applied lifetime risk estimates to US Census projections to evaluate the annual number of incident dementia cases from 2020 to 2060. The lifetime risk of dementia after age 55 years was 42% (95% confidence interval: 41-43). Rates were substantially higher in women, Black adults and APOE ε4 carriers, with lifetime risks ranging from approximately 45% to 60% in these populations. The number of US adults who will develop dementia each year was projected to increase from approximately 514,000 in 2020 to approximately 1 million in 2060. The relative growth in new dementia cases was especially pronounced for Black adults. These results highlight the urgent need for policies that enhance healthy aging, with a focus on health equity.

Exploring Changing People's Perceptions on Local Elections

The article explores changing people perceptions of political parties during local elections in Nepal, highlighting the different factors of recent socio-political changes. Following the restructuring of local governance in the 2022 elections, political parties have increased direct involvement with their communities, changing public perceptions. Using a constructivist interpretivist paradigm with multiple realities ontology, the study employs both structured and unstructured questionnaires and interviews to gather narrative experiences from the public. The research utilizes a convergent design, integrating exploratory and descriptive methods, and employs both qualitative and quantitative techniques, including interviews and focus groups, to capture diverse people sentiments across various respondents. The sampling of 120 respondent in convenience sampling reveals that educational changes, political disillusionment, and grassroots engagement are key drivers of these changing perceptions. With all these changes the people are increasingly evaluating political parties based on local issues such as infrastructure, education, health, and social equity, rather than national political manifesto. The findings indicated a growing trend toward electing leaders who are less affiliated with traditional parties, often younger and perceived as neutral. This shift reflects declining trust in established political parties and highlights the need for greater accountability and transparency. The study underscores a pivotal moment in Nepal’s democratic institutionalization, urging political entities to adapt strategically to maintain their relevance. By exploring these changing voter perceptions, the article contributes to a deeper understanding of political accountability and voter behavior in developing democracies, offering insights for policymakers and political strategists.

Using Large Language Models to Promote Health Equity

Using Large Language Models to Promote Health Equity

The global, regional, and national patterns of change in the burden of bacterial pyoderma from 1990 to 2019 and the forecast for the next decade

Pyoderma, commonly known as impetigo, is a bacterial skin infection causing pus formation, prevalent globally, especially in resource-poor areas. It affects both children and adults, including those with conditions like diabetes. Despite its significant impact and economic burden, research on its global epidemiology is limited. This study aims to address this gap by analyzing pyoderma trends from 1990 to 2019 using GBD data. The study aims to analyze global trends in pyoderma epidemiology from 1990 to 2019 using GBD data. Specifically, it investigates Age-Standardized Incidence Rate (ASIR), Mortality Rate (ASMR), and Disability-Adjusted Life Years Rate (ASDR) across 204 countries. Additionally, it provides insights into demographic and socioeconomic factors influencing pyoderma prevalence. Furthermore, it forecasts pyoderma’s development trends for the next decade to inform public health strategies. Data were sourced from the GBD 2019 database, comprising various sources such as censuses, surveys, and registries. Estimates for pyoderma incidence, mortality, and DALYs, along with their 95% uncertainty intervals (UI), were retrieved. The Sociodemographic Index (SDI) was used to assess socioeconomic status, and statistical calculations were performed using the WHO Health Equity Assessment Toolkit and R software (v4.3.2). From 1990 to 2019, the Age-Standardized Incidence Rate (ASIR) and Age-Standardized Mortality Rate (ASMR) of impetigo increased, while the Age-Standardized Disability-Adjusted Life Years Rate (ASDR) declined. Significant global geographical heterogeneity persists, closely associated with the Sociodemographic Index (SDI). Children under 5 and the elderly are particularly at risk, with lower SDI nations bearing higher burdens. Population growth and aging contribute to this rise, with disparities in impetigo trends persisting among countries and regions with varying SDI levels, expected to continue until 2030. Pyoderma exhibits significant heterogeneity across age, gender, and geography, with pronounced disparities evident in underdeveloped regions or countries. Therefore, prioritizing policy formulation and implementing tailored prevention and treatment strategies for high-risk populations are imperative to alleviate the disease burden effectively. Such targeted approaches are crucial in addressing the global impact of pyoderma.

Family wealth and adolescent physical health.

Inequalities in the distribution of wealth among families with children may have deleterious health consequences, especially for adolescent children. Marked by significant psychosocial and physiological changes, adolescence is a period when socioeconomic differences in chronic disease risk factors are observed. Unfortunately, research on socioeconomic inequalities in adolescent health has overlooked wealth, focusing instead on differences in health based on household income and parental educational attainment. Expanding our knowledge of wealth's role in shaping adolescents' current and long-term health is of critical public health concern, especially as wealth is more unequally distributed than income. This review discusses what is known about wealth-related inequalities in adolescent physical health and proposes four psychosocial mechanisms that may explain how wealth shapes adolescent physical health including (1) serving as a stress-buffer; (2) enabling parents to invest in opportunities to support adolescent healthy development; (3) increasing families' access to social and cultural capital resources that may promote salutary health behaviours while mitigating experiences of social-class discrimination; (4) and supporting adolescents' future expectations. We end with a discussion of existing questions and suggestions for future research to add to our understanding of wealth-related inequalities in adolescent physical health, which could be used to inform health equity interventions.

Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage

BackgroundEthnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions (ECMH) for Indigenous women in Mexico. Documenting progress in reducing maternal health inequities, particularly given the disproportionate impact of the Covid-19 pandemic on ethnic minorities, is essential to improving equity in health systems.MethodsWe conducted a population-based, pooled cross-sectional, and retrospective analysis for 2009–2023, using data from the last three waves (2014, 2018, and 2023) of a nationally representative demographic survey (ENADID). Our study included n = 72,873 (N = 23,245,468) Mexican women aged 12–54 with recent live births. We defined ECMH as adequate antenatal care (ANC), skilled and/or institutional delivery care, timely postpartum care, and complication-free postpartum/puerperium. After describing sociodemographic characteristics and maternal health coverage by Indigenous status, we estimated a pooled fixed-effects multivariable regression model to adjust ECMH for relevant covariates. We used the Blinder-Oaxaca decomposition for nonlinear regression models to quantify inequities in ECMH due to ethnic-racial discrimination, defined as differences in outcomes attributable to differential treatment.FindingsIndigenous women had lower education, labor market participation, and socioeconomic position, higher parity, and more rural, poorer state residence than non-Indigenous women. They faced significant health coverage loss due to the dismantling of Seguro Popular, a public health insurance mechanism in place until the end of 2019, right before the start of the Covid pandemic. Adjusted ECMH was 25.3% for non-Indigenous women and 18.3% for Indigenous women, peaking at 28.8% and 21.2% in 2013–2018, declining to 25.7% and 18.7% pre-Covid (January 2019 to March 2020), and further declining to 24.0% and 17.4% during Covid, with an increase to 26.6% for non-Indigenous women post-Covid, while remaining similar for Indigenous women. Decomposition analyses revealed that during the analyzed period, 30.8% of the gap in ECMH was due to individual characteristics, 51.7% to ethnic-racial discrimination, and 17.5% to their interaction. From 2009 to 2012, 42.2% of the gap stemmed from observable differences, while 40.4% was due to discrimination. In the pre-Covid-19 phase, less than 1% was from observable characteristics, with 75.3% attributed to discrimination, which remained in the post-Covid-19 stage (78.7%).ConclusionsDespite modest health policy successes, the ethnic gap in ECMH remains unchanged, indicating insufficient action against inequity-producing structures. Ethnic and racial discrimination persists, exacerbated during the pandemic and coinciding with the government’s cancellation of targeted social programs and public health insurance focused on the poorest populations, including Indigenous peoples. Thus, prioritizing maternal and child health underscores the need for comprehensive policies, including specific anti-racist interventions. Addressing these inequities requires the recognition of both observable and unobservable factors driven by discriminatory ideologies and the implementation of targeted measures to confront the complex interactions driving discrimination in maternal health care services for Indigenous women.

Global and Regional Trends in Paediatric Neuroblastoma Incidence and Mortality, 1990-2021: An Inequality and Projection Analysis.

Neuroblastoma stands as the most prevalent extracranial solid tumour in children, yet its epidemiological profile on global, regional, and national scales remains insufficiently explored. Long-term trends in the incidence and mortality of paediatric neuroblastoma from 1990 to 2021 were analysed globally, regionally, and nationally using estimated annual percentage changes. Cross-national disparities in the burden of paediatric neuroblastoma were quantified through standard health equity methodologies, with projections of burden shifts extending to 2035. From 1990 to 2021, the global age-standardised death rate for paediatric neuroblastoma increased from 0.19 (95% UI, 0.16-0.23) to 0.21 (95% UI, 0.14-0.28) per 100 000 population, with an EAPC of 0.2. Regionally, both mortality and incidence rates were highest in low-middle SDI regions and lowest in Oceania. Mortality rates were highest among males aged 12-23 months and females aged 6-11 months, while incidence rates were most pronounced in children aged 2-4 years. Cross-country inequality analyses indicated a reduction in disparities between high and low SDI countries; however, the concentration index revealed an increase in the inequality of burden distribution. The global burden of paediatric neuroblastoma is projected to continue rising through 2035. Over the past 30 years, global incidence and mortality rates for paediatric neuroblastoma have risen, particularly in low-SDI regions, whereas high-SDI regions have witnessed a downward trend. Although disparities between high- and low-SDI countries have diminished, inequality in burden distribution has grown more pronounced. The global burden of paediatric neuroblastoma is expected to continue its upward trajectory over the next 15 years.