Health Gap Research Articles

WHO Guidelines about Mental Health Gap Action Programme (mhGAP) for mental, neurological and substance use disorders: Review and Comments

Introduction: The World Health Organization (WHO) has been instrumental in developing evidence-based guidelines to address mental, neurological, and substance use disorders through its Mental Health Gap Action Programme (mhGAP). These guidelines provide essential recommendations for healthcare professionals to deliver effective care in non-specialized health settings. Aim: This article aims to review and analyze the updated WHO guidelines on the mhGAP intervention for mental, neurological, and substance use disorders, focusing on their significance, content, and implications for clinical practice. Methods: A comprehensive review of the WHO documents published in 2023, including the "mhGAP intervention guide for mental, neurological, and substance use disorders in non-specialized health settings" and the "Update of the Mental Health Gap Action Programme (mhGAP) guidelines for mental, neurological, and substance use disorders, 2015," was conducted. The review examines the scope of the guidelines, their recommendations, and the evidence supporting them. Results: The updated WHO guidelines cover a wide range of mental health conditions, including alcohol use disorders, anxiety disorders, depression, and more. Each guideline provides evidence-based recommendations for prevention, diagnosis, and treatment, with the aim of improving access to quality mental health care in diverse healthcare settings. The guidelines are freely accessible online through the WHO's mhGAP Evidence Resource Centre website, offering detailed evidence profiles and recommendations for healthcare professionals. Conclusions: The WHO guidelines on the mhGAP represent a critical resource for healthcare professionals worldwide, offering evidence-based guidance for the delivery of mental health care. By providing standardized recommendations informed by the best available evidence, these guidelines support the implementation of evidence-based practice and contribute to improved patient outcomes. The WHO's commitment to updating and disseminating these guidelines underscores its dedication to promoting mental health equity and advancing evidence-based care globally.

Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains

BackgroundAs patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression.MethodsThe study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean).ResultsObserved differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12.ConclusionsMen experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities.Trial registrationGerman Register for Clinical Trials, DRKS00019916, 26 November 2019.

Developing interventions to improve detection of depression in primary healthcare settings in rural Ethiopia.

The poor detection of depression in primary healthcare (PHC) in low- and middle-income countries continues to threaten the plan to scale up mental healthcare coverage. To describe the process followed to develop an intervention package to improve detection of depression in PHC settings in rural Ethiopia. The study was conducted in Sodo, a rural district in south Ethiopia. The Medical Research Council's framework for the development of complex interventions was followed. Qualitative interviews, observations of provider-patient communication, intervention development workshops and pre-testing of the screening component of the intervention were conducted to develop the intervention. A multicomponent intervention package was developed, which included (a) manual-based training of PHC workers for 10 days, adapted from the World Health Organization's Mental Health Gap Action Programme Intervention Guide, with emphasis on depression, locally identified depressive symptoms, communication skills, training by people with lived experience and active learning methods; (b) screening for culturally salient manifestations of depression, using a four-item tool; (c) raising awareness among people attending out-patient clinics about depression, using information leaflets and health education; and (d) system-level interventions, such as supportive supervision, use of posters at health facilities and a decision support mobile app. This contextualised, multicomponent intervention package may lead to meaningful impact on the detection of depression in PHC in rural Ethiopia and similar settings. The intervention will be pilot tested for feasibility, acceptability and effectiveness before its wider implementation.

Validation of an instrument to guide the implementation of strategies for mental health care in Colombia.

To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) - 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementation, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Readiness for Knowledge Translation scale as a comparative standard. The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

The progressive place paradox: Status-based health inequalities are magnified in more economically progressive Swiss localities

Low socioeconomic status (measured both objectively and subjectively) is systematically associated with worse health. Amid renewed interest in contextual influences on health inequalities, we ask whether variation in the prevailing ideological climate moderates the size of the health gap between low and high status individuals. Based on the minority stress hypothesis, we expect that living in an economically progressive place within Switzerland – places where more residents endorse the need for change to the economic status quo – will reduce the magnitude of the health gap. Multilevel modelling of MOSAiCH 2015–2020 data shows the opposite: low status individuals in progressive places report markedly lower subjective health and life satisfaction than similarly low status individuals in conservative places, such that status-based health inequalities are maximised in progressive places. We interpret this apparent progressive place paradox in terms of collective inefficacy and system frustration, which we argue is the corollary of system justification.

Internet use and difficulties in acquiring health resources among older adults with disabilities during the COVID-19 pandemic: a population-based cross-sectional study

BackgroundThe various restrictions caused by the COVID-19 pandemic may have worsened the digital divide and health inequality. However, research to ascertain the association between Internet use and difficulties in acquiring health resources among older adults with disabilities is scarce. This study aimed to explore the relationship between Internet use and difficulties in acquiring health resources among older adults with disabilities during the COVID-19 pandemic and explore the associated factors by disability severity.MethodsData from the 2020 survey of people with disabilities in South Korea were used. This secondary analysis study included 4,871 older adults aged 55 and above among 7,025 total responders. Complex sample logistic regression analyses were conducted to identify the association between Internet use and difficulties in acquiring health resources during the pandemic.ResultsOnly 23.66% of older adults with disabilities used the Internet. Internet non-users were more likely to experience difficulties in obtaining health resources than Internet users. The relationship between Internet non-use and difficulties in acquiring COVID-19-related information (OR 1.57, 95% CI 1.28–1.92) and buying and using personal protective equipment (OR 1.36, 95% CI 1.11–1.65) were statistically significant in the overall sample. Whereas, difficulties with using medical services were not statistically significantly associated with Internet use. Additionally, factors associated with difficulties in acquiring health resources differed by disability severity.ConclusionsConsidering that older adults with disabilities experience triple the burden amid COVID-19 due to old age, disabilities, and the digital divide, policymakers, healthcare professionals, and engineers should aim to narrow the gaps between Internet users and Internet non-users among this population. Narrowing the gaps will make decreasing health gaps and increasing well-being among older adults with disabilities more attainable.

Is neighbourhood deprivation in primary school-aged children associated with their mental health and does this association change over 30 months?

As both socioeconomic deprivation and the prevalence of childhood mental health difficulties continue to increase, exploring the relationship between them is important to guide policy. We aimed to replicate the finding of a mental health gap that widened with age between those living in the most and least deprived areas among primary school pupils. We used data from 2075 children aged 4-9 years in the South West of England recruited to the STARS (Supporting Teachers and childRen in Schools) trial, which collected teacher- and parent-reported Strength and Difficulties Questionnaire (SDQ) at baseline, 18-month and 30-month follow-up. We fitted multilevel regression models to explore the relationship between Index of Multiple Deprivation (IMD) quintile and SDQ total difficulties score and an algorithm-generated "probable disorder" variable that combined SDQ data from teachers and parents. Teacher- and parent-reported SDQ total difficulties scores indicated worse mental health in children living in more deprived neighbourhoods, which was attenuated by controlling for special educational needs and disabilities but remained significant by parent report, and there was no interaction year group status (age) at baseline. We did not detect an association between probable disorder and IMD although an interaction with time was evident (p = 0.003). Analysis by study wave revealed associations at baseline (odds ratio 1.94, 95% confidence interval 0.97-3.89) and 18 months (1.96, 1.07-3.59) but not 30 months (0.94, 0.54-1.57). These findings augment the existing, highly compelling evidence demonstrating worse mental health in children exposed to socioeconomic deprivation.

The Work/Care Interface and Parents’ Mid-pandemic Mental Health: Inequalities at the Intersection of Gender and High-risk Household Status

The COVID-19 pandemic generated mental health stressors for parents as they faced new health risks and navigated disruptions to employment, schooling, and care arrangements. Drawing on 2021 survey data from Canadian parents of children 10 years old and younger, we describe the relationship between work/care pandemic stressors and mental health, and employ Kitagawa-Oaxaca-Blinder decompositions to examine how these contribute to mental health gaps by gender and its intersection with having household members perceived to be at high risk in relation to COVID-19. We find that mothers’ mental health was more negatively affected than fathers’. Differences in exposure to work/care stressors help explain this gap, with the “mental load,” perceptions of inequity in how households responded to pandemic care demands, and greater reported deterioration in work-family balance and career prospects particularly salient. Mothers, but not fathers, with high-risk household members were also more exposed to key work/care stressors, contributing to the worst pandemic mental health for this group. While the relationship between stressors and mental health was similar for mothers and fathers overall, high-risk status moderated this relationship, with employment or care disruptions that reduced COVID-19 exposure less likely to be associated with poorer mental health for parents in high-risk families.

Understanding gender inequity in brain health outcomes: missed stroke as a case study for intersectionality.

Recent attention into sex and gender-based inequities surrounding outcomes for brain health disorders has generated momentum toward addressing what has been called the "brain health gap." Importantly though, "women" are not uniform demographic group. In this perspective piece, we discuss misdiagnosis in stroke as an aspect of access and quality of care within brain health. Drawing on narrative data from a mixed methods study of young stroke survivors we suggest that while missed stroke isn't only an issue of gender, if we are going to understand gender-based gaps in access and navigation through stroke care, we have to understand how intersections of gender with age, ethnoracial identity, nationality, language, (dis)ability, and other aspects of social identity come together to create affordances as well as biases that contribute to stroke outcomes.

Community-based models of care for adolescent and adult depression, suicidal behavior, anxiety, trauma, and substance use in Africa: a scoping review.

Community-based care (CBC), where care is delivered outside of the traditional health facility setting, has been proposed to narrow the mental health (MH) and substance use (SU) treatment gap in Africa. This scoping review aims to comprehensively summarize CBC models addressing adolescent and adult MH (depression, anxiety, trauma, suicidal behavior) and (non-tobacco) SU problems in Africa. We searched PsycINFO, Embase, Scopus, CINAHL, and Medline Ovid. Studies and protocols were included if they reported on CBC intervention's effects on MH or SU symptoms/ diagnoses, acceptability, feasibility, or patient engagement in care, regardless of whether the intervention itself was designed specifically for MH or SU. Among 11,477 screened publications, 217 were eligible. Of the unique intervention studies (n = 206), CBC models were classified into the following approaches (non-mutually exclusive): psychotherapeutic (n = 144), social (n = 81), lifestyle/physical health (n = 55), economic (n = 26), and psychopharmacological (n = 2). While quantitative results suggest possible efficacy of CBC models, description of CBC location was often poor. Fewer interventions addressed suicidal behavior (n = 12), the needs of adolescents (n = 49), or used traditional healers or religious figures as providers (n = 3). Many CBC models have been tested on MH and SU in Africa and should be critically appraised and meta-analyzed in subsequent reviews, where possible.

Pyrazoline Derivatives as Promising MAO-A Targeting Antidepressants: An Update.

Depression is one of the key conditions addressed by the Mental Health Gap Action Programme (mhGAP) of WHO that can lead to self-harm and suicide. Depression is associated with low levels of neurotransmitters, which eventually play a key role in the progression and development of mental illness. The nitrogen-containing heterocyclic compounds exhibit the most prominent pharmacological profile as antidepressants. Pyrazoline, a dihydro derivative of pyrazole, is a well-known five-membered heterocyclic moiety that exhibits a broad spectrum of biological activities. Many researchers have reported pyrazoline scaffold-containing molecules as potential antidepressant agents with selectivity for monoamine oxidase enzyme (MAO) isoforms. Several studies indicated a better affinity of pyrazoline-based moiety as (monoamine oxidase inhibitors) MAOIs. In this review, we have focused on the recent advancements (2019-2023) in the development of pyrazoline-containing derivatives exhibiting promising inhibition of MAO-A enzyme to treat depression. This review provides structural insights on pyrazoline-based molecules along with their SAR analysis, in silico exploration of binding interactions between pyrazoline derivatives and MAO-A enzyme, and clinical trial status of various drug molecules against depression. The in-silico exploration of potent pyrazoline derivatives at the active site of the MAOA enzyme will provide further insights into the development of new potential MAO-A inhibitors for the treatment of depression.

Interaction of social support and depressive symptoms on antiretroviral therapy adherence among people living with HIV in South Africa.

Depression consistently emerges as a significant predictor of poor antiretroviral therapy (ART) adherence among adult people living with human immunodeficiency virus (PLHIV). However, a gap exists regarding how social support and depressive symptoms can interact to influence ART adherence among adult PLHIV in South Africa (SA). To investigate the interaction between social support and depressive symptoms on ART adherence among adult PLHIV. A tertiary hospital in Durban, KwaZulu-Natal province of SA. Utilising a quantitative cross-sectional research design along with time location sampling technique (TLS); the study recruited 201 adult patients enrolled in an ART programme. The results indicated that depressive symptoms were significantly associated with ART adherence with and without the interaction (B = -0.105; odds ratios [OR] 0.901; 95% confidence intervals [CI] = 0.827, 0.981; p = 0.016), while social support was not significantly associated with ART adherence (B = 0.007; OR 1.007; 95%CI = 0.989, 1.025; p = 0.475). However, a statistically significant interaction was found between social support and depressive symptoms (B = -0.006; OR 0.994; 95%CI = 0.989, 1.000; p = 0.037) on ART adherence. Based on the results, depressive symptoms significantly influenced ART adherence. However, social support did not buffer the adverse effects of clinical depression associated with poor ART adherence. This study provides an evidence-based approach to address gaps in the mental health and social well-being of PLHIV in the context of ART adherence.

Leveraging Django and Machine Learning to Craft a Health Forecasting System, Tailoring Personalized Wellness Strategies

Abstract: The goal of this thesis is to develop a health forecasting system that combines Django with cutting-edge machine learning in order to customize wellness plans according to personal health information. The study addresses model selection, data preprocessing, and user interface creation as it investigates the potential synergies between machine learning and web development. Predictive health analytics potential and gaps are identified through a review of the literature. The goal of the project is to create a real-time, scalable health forecasting system while protecting user privacy. Neural networks and decision trees are two examples of machine learning methods that are utilized. The efficacy of the system in delivering precise health projections and augmenting user involvement in proactive wellness management is evaluated through empirical assessment and case studies. In order to further personalized healthcare solutions, practitioners, researchers, and developers can benefit greatly from the research's insightful contributions.

160. Self-Advocacy is not Enough to Get Prep: Gaps in Sexual and Reproductive Health For Young Sexual Minority Women and Gender Diverse Youth

160. Self-Advocacy is not Enough to Get Prep: Gaps in Sexual and Reproductive Health For Young Sexual Minority Women and Gender Diverse Youth

Nature-Based Interventions for Adults with Developmental Disabilities: A Scoping Review Centering Autistic Adults

Autistic adults often face higher levels of depression, anxiety, and stress and reduced levels of quality of life and employment in comparison to their neurotypical peers. Nature-based interventions (NBIs), which utilize outdoor environments and activities for health and wellbeing outcomes, could provide possibilities to meet these various needs. This study therefore aims to identify the extent of academic literature examining NBIs for autistic adults. A scoping review of peer-reviewed articles published between 1985 and 2023 was conducted. Ten databases were systematically searched, and additional hand searching was conducted. Studies involving substantial engagement with an NBI and involving autistic adults (age ≥ 18), or developmental disability if specific diagnosis was not identified, were included. A total of seven studies were identified; however, three studies did not refer to autism specifically, identifying developmental disability more broadly. NBIs were conducted in a variety of international locations and involved a diverse range of activities and outcomes. While NBIs can provide outcomes relevant to employment, health, and wellbeing, multiple limitations and literature gaps are noted. The findings indicate a strong need for further research specific to autism.

Exploring health equity in Lesotho's Child Grants Programme.

Despite their growing popularity, little is known about how cash transfers (CTs) can affect health equity in targeted communities. Lesotho's Child Grants Programme (CGP) is an unconditional CT targeting poor and vulnerable households with children. Started in 2009, the CGP is one of Lesotho's key programmes in developing the country's social protection system. Using the CGP's early phases as a case study, this research aims to capture how programme stakeholders understood and operationalized the concept of health equity in Lesotho's CGP. The qualitative analysis relied on the triangulation of findings from a desk review and semi-structured key informant interviews with programme stakeholders. The programme documents were coded deductively and the interview transcripts inductively. Both materials were analysed thematically before triangulating their findings. We explored determining factors for differences or disagreements within a theme according to the programme's chronology, the stakeholders' affiliations and their role(s) in the CGP. The definitions of health equity in the context of the CGP reflected an awareness among stakeholders of these issues and their determinants but also the challenges raised by the complex (or even debated) nature of the concept. The most common definition of this concept focused on children's access to health services for the most disadvantaged households, suggesting a narrow, targeted approach to health equity as targeting disadvantages. Yet, even the most common definition of this concept was not fully translated into the programme, especially in the day-to-day operations and reporting at the local level. This operationalization gap affected the study of selected health spillover effects of the CGP on health equity and might have undermined other programme impacts related to specific health disadvantages or gaps. As equity objectives become more prominent in CTs, understanding their meaning and translation into concrete, observable and measurable applications in programmes are essential to support impact.

Black and Asian American perceptions and experiences of racism in healthcare contexts: Consequences and solutions from qualitative data

ABSTRACT Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities. Extant research shows significant health inequities between White and Black people. However, little is known about health gaps between or among other racial groups. This study investigated how Blacks and Asian Americans perceive and experience racism in seeking healthcare, effects of such perceptions and experiences on health outcomes, and ways to reduce racism in healthcare contexts. Findings from 40 interviews suggest strong similarities and subtle differences between the two racial groups.

Pathways of depressive symptoms to self-harm and suicide warning signs during COVID-19 pandemic: The role of anxiety and related distress, dysfunction and somatization

BackgroundEarly in the COVID-19 pandemic, concern about widespread waves of depression and suicide emerged worldwide. Clarity on the relationship between mental health symptoms and warning signs of current self-harm or suicide thoughts and behaviors (ShSTB) in Mexican adults could be useful for designing effective public health policies and preventive strategies during health emergencies. ObjectiveThe present study uses a path model to explore the relationship between depressive symptoms, anxiety, and related distress, dysfunction, and somatization with ShSTB warning signs in Mexican adults during the COVID-19 pandemic. The study also describes the relative risks of these mental health variables for men and women, and for those who were seeking psychological care versus those who were not. MethodThe study was conducted with 18,449 Mexicans (M = 33 years, SD = 11.00, range = 18–59), including 12,188 women (66.10 %) and 2706 (14.67 %) who were seeking psychological care. A web-based application included two multidimensional screening scales to evaluate depression, anxiety and somatic symptoms and related distress/dysfunction, as well as past and current ShSTB. Based on the participants' sex, the entire sample was randomly divided into two sub-samples to compare and replicate the Confirmatory Factor Analysis (CFA) results, getting evidence of the multidimensionality of the scales. With the two sub-samples, we also tested the nested models from a structural equation model (SEM) to suggest a relationship between mental health and self-harm/suicide variables. FindingsOur findings suggest that 31 % of participants were at risk for depression, 42.30 % for anxiety, 38.30 % for Marked Distress, Dysfunction and Somatization (MDDS), 33.30 % for at least one ShSTB, and 4.20 % for Previous Self Harm Thoughts and Behaviors (PShTB) during the COVID-19 pandemic. A greater percentage of women and participants seeking psychological care showed high levels of mental health symptoms, PShTB, MDDS, and ShSTB. The path model suggested a direct influence of PShTB and MDDS on ShSTB. Depression symptoms lead to ShSTB in three possible ways: through PShTB, PShTB affecting MDDS, and generalized anxiety affecting MDDS. Discussion and outlookThe pandemic was accompanied by a high prevalence of depression-anxiety, marked distress, dysfunction and somatization and self-harm/suicide thoughts and behaviors. The findings of this study suggest evidence over the well-known association between depression and anxiety, and between depression, previous self-harm thoughts and behaviors, and self-harm/suicide. The evidence suggests to distinguish when participants were suffering from MDDS and anxious depression from those only suffering from depression. The methodological conditions of the study suggest a comprehensive model of ShSTB prevention. Findings also suggest the need to care for Mexicans with depressive symptoms and PShTB as well as those suffering from anxious depression with MDDS to prevent suicide, by implementing effective public health policies and preventive strategies to reduce the mental health gap during health emergencies. LimitationsThis research was a cross-sectional study, suggesting that future analyses should focus on the evaluation of its consistency with confirmed diagnoses of mental health disorders, self-harm/suicide risks, and the effect of remote psychological help to address these problems.

Decomposing differences in the chronic disease condition between rural and urban older adults in China: a cross-sectional analysis.

With the increasing in aging in China, there has been an increase in older adults suffering from chronic diseases. However, little is known about the differences in chronic disease conditions between rural and urban older adults. The objective of this study is to identify chronic disease conditions and investigate the factors that cause differences in chronic disease conditions between urban and rural older adults. The data are from the fourth wave of the China Health and Retirement Longitudinal Study. The coarsened exact matching (CEM) method was used to reduce the biases for a comparative study. After the CEM method, this study included 5,927 participants aged 60 and above. Chronic disease condition was used as the indicator to measure the health of older adults. Specifically, Fairlie's decomposition analysis was carried out to discover the differences in chronic disease conditions between urban and rural older adults. The study showed that the proportion of those suffering from chronic diseases was significantly higher among urban older adults (51.26%) than rural older adults (46.56%). In those suffering from chronic diseases, there were significant differences in gender, education level, minorities, religiosities, duration of sleep, drinking alcohol, social activity, insurance, and socioeconomic status between rural and urban older adults, while in those not suffering from chronic diseases, there were significant differences in age, education level, marital status, drinking alcohol, social activity, insurance, region, and socioeconomic status between rural and urban older adults. For rural older adults, those who were widowers [Odds ratios (OR): 1.267], who drink alcohol (OR: 1.421), and having government medical insurance (OR: 4.869) had higher odds of having chronic diseases. However, those who were in high school and above (OR: 0.802), reporting a duration of sleep of 4-8 h (OR: 0.745) or above 8 h (OR: 0.649), having social activity (OR: 0.778), and having the most affluent socioeconomic status (OR: 0.778) had lower odds of having chronic diseases. As for urban older adults, those who were aged 65-74 years (OR: 1.246) and had government medical insurance (OR: 2.362) had higher odds of having chronic diseases. Fairlie's decomposition analysis indicated that 23.57% of the differences in chronic diseases conditions could be traced to duration of sleep, drinking alcohol, social activity, and region. This study illustrated that the proportion of chronic diseases was higher among urban older adults than rural older adults. Considering duration of sleep, drinking alcohol, region, social activity, and region, the study demonstrated health differences between urban and rural older adults and provided evidence for policy-making to narrow the health gap between urban and rural areas.

Racial and ethnic variation in the relationship between parental educational similarity and infant health

Evidence suggests benefits of parental educational homogamy for infant and child well-being but ignores potential racial and ethnic variation in these benefits. Increasing disparities in infant health by maternal education and race, along with increasing educational sorting, raise questions about whether educational homogamy could contribute to these disparities. Drawing on a random sample of over 4 million live births in NVSS data from 2011 to 2020 and ordinary least squares regression, this study examines the relationship between infant health, parental educational similarity, and race and ethnicity. Our findings indicate a weak overall relationship between educational sorting and infant health at birth, with significant variation by race and ethnicity. In addition, absolute education levels and marital status more strongly predict infant health than educational assortative mating. Sensitivity analyses confirm the robustness of these findings across different modeling approaches and sample sizes. Our results indicate that parental educational sorting is only weakly related to infant health and cannot explain widening infant health gaps by race.