Important Inequalities Research Articles

Colorectal cancer trends in Chile: A Latin-American country with marked socioeconomic inequities.

Colorectal cancer (CRC) is the third most frequent malignant disease in the world. In some countries with established screening programs, its incidence and mortality have decreased, and survival has improved. To obtain reliable data about the epidemiology of CRC in Chile, we analyzed the trends in the last ten years and the influence of observable factors on survival, including a nationwide health program for CRC treatment access (GES program). Publicly available data published by the Ministry of Health and National Institute of Statistics were used. Data were obtained from registries of mortality and hospital discharges, making follow-up of the individuals possible. Crude and age-standardized incidence and mortality rates were calculated, and individual survival was studied by constructing Kaplan-Meier curves. Finally, a Cox statistical model was established to estimate the impact of the observable factors. We found 37,217 newly identified CRC patients between 2008 and 2019 in Chile, corresponding to 103,239 hospital discharges. In the same period, 24,217 people died of CRC. A nearly linear, steady increase in crude incidence, mortality and prevalence was observed. CRC incidence was the lowest in the North of the country, increasing toward the South and reaching a maximum value of 34.6/100,000 inhabitants/year in terms of crude incidence and 20.7/100,000 inhabitants/year in terms of crude mortality in the XII region in 2018. We found that older patients had lower survival rates, as well as men compared to women. Survival was significantly better for patients with private insurance than those under the public insurance system, and the treating hospital also played a significant role in the survival of patients. Patients in the capital region survived longer than those in almost every other part of the country. We found no significant effect on survival associated with the GES program. We found important inequalities in the survival probabilities for CRC patients in Chile. Survival depends mainly on the type of insurance, access to more complex hospitals, and geographical location; all three factors correlated with socioeconomic status of the population. Our work emphasized the need to create specific programs addressing primary causes to decrease the differences in CRC survival.

The relative Alexandrov-Fenchel type inequalities

The Alexandrov-Fenchel inequality is one of the important inequalities in convex geometry, and its special form can be regarded as an isoperimetric inequality between higher-order quermassintegrals. In recent years, hypersurfaces with free or capillary boundaries have received much attention. In this paper, we will study a class of relative Alexandrov-Fenchel-type inequalities on convex hypersurfaces with free or capillary boundaries in the unit ball or in half-space from the perspective of differential geometry, and review its recent progress. First, we introduce the higher-order Minkowski-type integral formula for capillary hypersurfaces in the unit ball or half-space. From the first variational point of view, we give the definition of the quermassintegrals of the capillary hypersurfaces in the unit ball or half-space. After that, we use the Minkowski-type formula to construct a locally constrained curvature flow. By analyzing the long-time existence and convergence of the flow, we prove a class of relative Alexandrov-Fenchel-type inequalities in the unit ball and half-space.

Mortality Advantage Reversed: The Causes of Death Driving All-Cause Mortality Differentials Between Immigrants, the Descendants of Immigrants and Ancestral Natives in Sweden, 1997–2016

A small but growing body of studies have documented the alarming mortality situation of adult descendants of migrants in a number of European countries. Nearly all of them have focused on all-cause mortality to reveal these important health inequalities. This paper takes advantage of the Swedish population registers to study all-cause and cause-specific mortality among men and women aged 15–44 in Sweden from 1997 to 2016 to a level of granularity unparalleled elsewhere. It adopts a multi-generation, multi-origin and multi-cause-of-death approach. Using extended, competing-risks survival models, it aims to show (1) how the all-cause mortality of immigrants arriving as adults (the G1), immigrants arriving as children (the G1.5) and children of immigrants born in Sweden to at least one immigrant parent (the G2) differs versus ancestral Swedes and (2) what causes-of-deaths drive these differentials. For all-cause mortality, most G1 (not Finns or Sub-Saharan Africans) have a mortality advantage. This contrasts with a near systematic reversal in the mortality of the G1.5 and G2 (notably among men), which is driven by excess accident and injury, suicide, substance use and other external cause mortality. Given that external causes-of-death are preventable and avoidable, the findings raise questions about integration processes, the levels of inequality immigrant populations are exposed to in Sweden and ultimately, whether the legacy of immigration has been positive. Strengths of the study include the use of quality data and advanced methods, the granularity of the estimates, and the provision of evidence that highlights the precarious mortality situation of the seldom-studied G1.5.

COVID-19 vaccination uptake in Belgium: socioeconomic and sociodemographic disparities

Abstract Background Recent studies have identified important social inequalities in SARS-CoV-2 infection and related COVID-19 outcomes in the Belgian population. This study aims to investigate socioeconomic and -demographic characteristics associated with the uptake of COVID-19 vaccine in Belgium. Methods We conducted a retrospective analysis of the uptake of the first dose of COVID-19 vaccine among 5,341,584 adults (≥ 18 years) tested for COVID-19 in Belgium until August 31, 2021. We integrated four national data sources: the Belgian vaccine registry (vaccination status), COVID-19 Healthdata (laboratory test results), STATBEL (socioeconomic/-demographic data) and the Common Base Registry for HealthCare Actors (people licensed to practice a healthcare profession in Belgium). Unvaccinated and vaccinated people (with at least one dose) were compared using multivariate logistic regression analysis. Results During the study period, 53,887 people (10%) did not receive the first COVID-19 vaccine dose in Belgium. Migrant background was associated with vaccine uptake (e.g., non-Europeans were almost three times [2.96-3.00] more likely to be unvaccinated compared to Belgian nationals). Single parents (OR 1.27 [1.26-1.28]) and people living alone (OR 1.18 [1.17-1.19]) were more likely to be unvaccinated compared to couples with children. Having a low or moderate education level (OR 1.36 [1.35-1.38] for low; OR 1.30 [1.29-1.32] for moderate) and income (OR 2.36 [2.34-2.38] for low; OR 1.54 [1.52-1.55] for moderate), being unemployed, (OR 1.50 [1.49-1.51), and having low health literacy (OR 1.41 [1.39-1.43]) led to a greater likelihood of being unvaccinated. Conclusions Migrants, people living alone, single parents or socioeconomically disadvantaged groups have lower uptake of COVID-19 vaccine in Belgium. The identification of these socioeconomic and -demographic disparities is critical to develop strategies guaranteeing a more equitable COVID-19 vaccination coverage in Belgium. Key messages • The study highlight important determinants in the uptake of the first dose of COVID-19 vaccine in Belgium. • These results highlight the importance to focus efforts on socioeconomically disadvantaged groups currently under-represented in COVID-19 vaccination uptake in Belgium.

Health System Performance Assessment: how equitable is the Belgian health system?

Abstract Access to and delivery of effective, high quality and affordable healthcare are fundamental objectives that have shaped health policy and the universal health insurance system in Belgium. A health system should be evaluated against these objectives. Monitoring equity within a health system - an equitable distribution of healthcare use and of payments for healthcare - is a core component of a health system performance assessment. We use the horizontal equity principle to evaluate equity in healthcare use in Belgium. Unfair inequality in healthcare use is measured by the fairness gap, comparing actual use and expected use corrected for needs. The empirical analysis was conducted using a linked dataset which contains data from the European Union Statistics on Income and Living Conditions (EU-SILC) and administrative data. Two sets of results are reported for a selected set of indicators of use: the deviation between the average fairness gap in the population and the average fairness gap in a subgroup of interest and an assessment of systematic socioeconomic inequity in the fairness gap using the absolute concentration index. We show that important socioeconomic inequities in healthcare use exist. Inequities differ by type of care, e.g., the use of hospital care and medications is more equitable than the use of GP, outpatient specialist and dental care. When accounting for healthcare needs, we find that use among high-income groups and individuals with a high educational attainment is higher compared to financially vulnerable groups (individuals at risk of poverty or with severe material deprivation, unemployed, singles). Also, individuals who are entitled to an increased reimbursement of healthcare costs, show a lower use of outpatient specialist care than expected based on their care needs. On the other hand, increased reimbursement is effective in improving accessibility to GP care, while for other financially vulnerable individuals we find a lower use of GP care.

Uncertainty principles for the coupled fractional Wigner distribution

In continuation to the recent study “Coupled Fractional Wigner Distribution with Applications to LFM Signals” in [Fractals, World Scientific; 2022], we formulate some important uncertainty inequalities including, the Hausdorff–Young, Lieb’s and Pitts inequalities for the coupled fractional Wigner distribution. In the sequel, we also establish Heisenberg’s, logarithmic, Hardy’s and Beurling’s uncertainty principles. Towards the end, we derive some Sobolev-type inequalities for the coupled fractional Wigner distribution.

Responsibility in Medical Sociology: A Second, Reflexive Look.

Personal responsibility has emerged as an important element in many countries’ public health planning, and has attracted substantial debate in public health discourse. Contemporary medical sociology typically resists such “responsibilization” as victim-blaming, by privileged elites, that obscures important structural factors and inequities. This paper, based primarily on a broad review of how contemporary Anglophone medical sociology literatures treat responsibility and blame, points out advantages of taking responsibility seriously, particularly from the individual’s perspective. These advantages include: empowerment; responsibility-as-coping-mechanism; moral dignity; and the pragmatic logic of doing for oneself, rather than passively awaiting societal reforms. We also offer possible reasons why sociologists and their subjects view these issues so differently, and suggest some areas for future research.

INTERSECTIONALITY-BASED REVIEW OF HEART FAILURE TELEHEALTH/ REMOTE MONITORING INTERVENTIONS FOR VULNERABLE POPULATIONS

INTERSECTIONALITY-BASED REVIEW OF HEART FAILURE TELEHEALTH/ REMOTE MONITORING INTERVENTIONS FOR VULNERABLE POPULATIONS

Social inequalities in child pedestrian collisions: The role of the built environment

Important inequities in child pedestrian-motor vehicle collisions (PMVC) have been observed. The mechanism through which social dimensions influence child PMVC is not well understood, nor is the role of the roadway-built environment. The relationship between area-level social dimensions (material deprivation, proportion recent immigrants, proportion visible minority) and police-reported child PMVC between 2010 and 2018 in Toronto, Canada was examined using multivariable negative binomial regression models, controlling for built environment covariates. All social dimensions were significantly associated with child PMVC, including material deprivation (Incidence Rate Ratio (IRR –adjusted ): 1.31, 95 % Confidence Interval (CI): 1.22–1.40), recent immigrant proportion (IRR adjusted : 1.58, 95 %CI: 1.30–1.92, per 10 % increase), and visible minority proportion (IRR adjusted : 1.09, 95 %CI: 1.05–1.12, per 10 % increase). Built environment features did not attenuate these associations. This study provides evidence of social inequalities in child PMVC, suggesting a need to target traffic safety interventions towards the most socially marginalized areas.

Perspectives on Inequity and Health Disparities in Chile and Their Relationship to Microbial Ecology.

ABSTRACTAmong countries in the Organisation for Economic Cooperation and Development (OECD), Chile stands out as having important inequalities in income distribution, dietary quality, access to urban green spaces, and health outcomes. People in lower socioeconomic groups consistently show higher rates of noncommunicable chronic diseases and are being hit the hardest by the COVID-19 pandemic. These chronic conditions are increasingly considered to be shaped, or affected by, the human gut microbiome. Moreover, inequity as an overarching concept might also be associated with microbial patterns and if so, this may represent a novel pathway through which to address health and other disparities. Focusing on the case of Chile, our goal is to contribute to a critical discussion and motivate researchers and policymakers to consider the role of the microbiome in social equity in future endeavors.

Voting Behaviour and Health Among the Oldest-old in Germany: Results from a Population-Based Cross-Sectional Study

Background If voter turnout reflects social or health inequalities, then these inequalities can reduce equal political representation. Research suggests that poor health impedes voting and contributes to low turnout, especially among the oldest-old (80 years and older). Therefore, we examine the determinants of voting behaviour in more detail, with a special focus on the role of health status among the oldest-old. Methods The analysis was based on a population-based sample of older adults living in Germany’s largest federal state, North Rhine-Westphalia (n = 1826). The outcome was participation in the last federal election. As determinants, we included subjective, functional, mental, and cognitive health; mobility; institutional living; education; social embeddedness; party attachment; habituation; and conformist attitudes. We used logistic regression models to calculate odds ratios and 95% confidence intervals. Results The overall turnout rate was 84.6% (95%-CI:82.9–86.3), which shows that most of the oldest-old participate in elections. Results from logistic regressions revealed that lower formal education and limitations in functional, cognitive, and mental health were associated with lower odds of voting; while habituation, party attachment, and partnership were associated with higher odds of voting. Conclusion Most of the oldest-old in Germany participate in elections. Still, our results hint at the existence of important inequalities in turnout rates. Given that older adults constitute an increasing share of the electorate, and that those who are less likely to vote are often among those most directly affected by political decisions, all individuals who are willing and able to participate in elections should be given the necessary support to actually do so.

Association between drinking water arsenic and urinary inorganic arsenic in the US: NHANES 2003-2014

BACKGROUND AND AIM: Important inequalities exist in arsenic (As) in drinking water across US populations. A critical research gap is how water As corresponds to internal dose, measured by urinary biomarkers. We evaluated the association between assigned private well and regulated community water system (CWS) As and urinary As concentrations in the National Health and Nutrition Examination Survey (NHANES). METHODS: We assigned 13,163 NHANES 2003-2014 participants county-level population- weighted CWS concentrations (µg/L) and private well estimates (probability >10 µg/L) using published nationwide estimates from US Environmental Protection Agency and US Geological Survey datasets, respectively. The internal dose of inorganic As related to drinking water was estimated by recalibrating urine dimethylarsinate (DMA) concentrations to adjust for arsenobetaine, seafood, smoking status, and past 24-hour intake of rice and other dietary sources. We evaluated geometric mean ratios (GMRs) of DMA across tertiles of water As, the lowest tertile as reference, for all participants and stratified by census region and quartile of geologic risk of elevated water As. RESULTS: Among CWS users, participants in the highest tertile of CWS As had significantly higher DMA overall (GMR= 1.17, 95% CI 1.09, 1.26) and in the South (GMR =1.23, 95% CI 1.09, 1.38), compared to participants in the lowest tertile. Among private well users, participants in the highest tertile of private well As had significantly higher DMA overall (GMR = 1.23, 95% CI 1.01, 1.50) and in the West (GMR = 1.34, 95% CI 1.18, 1.53). CONCLUSIONS: Arsenic in private wells and CWSs contributes to As exposure, measured in urine, in general US populations. Water As and urine DMA were more strongly associated among private-well users compared to CWS users nationwide, with differences by region. Positive associations were also observed among CWS users in the highest two quartiles of geologic risk. KEYWORDS: arsenic, exposure, water quality

Energy and Randić index of directed graphs

The concept of Randić index has been extended recently for a digraph. We prove that , where G is a digraph, and denotes the Randić index, denotes the Nikiforov energy and denotes the maximum degree of G. Moreover, in both inequalities, we describe the graphs for which the equality holds. We also develop the concept of inner and outer energies of a vertex for directed graphs extending important inequalities known for the energy of a vertex for graphs.

Mediating Role of Fine Particles Abatement on Pediatric Respiratory Health During COVID-19 Stay-at-Home Order in San Diego County, California.

Lower respiratory tract infections disproportionately affect children and are one of the main causes of hospital referral and admission. COVID-19 stay-at-home orders in early 2020 led to substantial reductions in hospital admissions, but the specific contribution of changes in air quality through this natural experiment has not been examined. Capitalizing on the timing of the stay-at-home order, we quantified the specific contribution of fine-scale changes in PM2.5 concentrations to reduced respiratory emergency department (ED) visits in the pediatric population of San Diego County, California. We analyzed data on pediatric ED visits (n=72,333) at the ZIP-code level for respiratory complaints obtained from the ED at Rady Children's Hospital in San Diego County (2015-2020) and ZIP-code level PM2.5 from an ensemble model integrating multiple machine learning algorithms. We examined the decrease in respiratory visits in the pediatric population attributable to the stay-at-home order and quantified the contribution of changes in PM2.5 exposure using mediation analysis (inverse of odds ratio weighting). Pediatric respiratory ED visits dropped during the stay-at-home order (starting on 19 March 2020). Immediately after this period, PM2.5 concentrations, relative to the counterfactual values based in the 4-year baseline period, also decreased with important spatial variability across ZIP codes in San Diego County. Overall, we found that decreases in PM2.5 attributed to the stay-at-home order contributed to explain 4% of the decrease in pediatric respiratory ED visits. We identified important spatial inequalities in the decreased incidence of pediatric respiratory illness and found that brief decline in air pollution levels contributed to a decrease in respiratory ED visits.

A survey on an important inequality to Fractional Differential Equations

A survey on an important inequality to Fractional Differential Equations

Existence of infinitely many solutions of nonlinear fourth-order discrete boundary value problems

The fourth-order discrete Dirichlet boundary value problem is also a discrete elastic beam problem. In this paper, the existence of infinitely many solutions to this problem is investigated through the critical point theory. By an important inequality we established and the oscillatory behavior of f either near the origin or at infinity, we obtain the existence of infinitely many solutions, which either converge to zero or unbounded. In the end, two examples are presented to illustrate our results.

Proceeding With Caution: On a Thoughtful and Just Integration of Technology into Society

This symposium will explore, from various perspectives, what it might mean to thoughtfully integrate technology into our society. The first presentation (Cratsley, Fast, & Boykin) will highlight the ways in which augmentation of social-contextual information may encourage people to endorse the use of technological surveillance tools that they might have otherwise rejected. In illuminating these vulnerabilities, this project encourages more thoughtful deliberation about the use of surveillance technologies in society. The second presentation (Kozlowski, Larivière, Sugimoto, & Monroe-White) demonstrates how algorithms may be used to help us uncover important inequities in society. In doing so, it highlights the perils of algorithmic bias as well as the promise of un-biased algorithms. The final project (Boykin, Rice & Brown) will discuss varying notions of fairness, and offer new tools for teaching algorithmic fairness to diverse learners and assessing their preferences between fairness definitions in machine-learning applications. These tools provide opportunities for future research that may help us improve machine-learning algorithms to better serve the interests of society at large, with a focus on incorporating the perspectives of diverse populations. Befriending Big Brother: The Role of Social Context in Endorsement of Surveillance Presenter: Maya J. Cratsley; - Presenter: Nathanael Fast; U. of Southern California Presenter: C. Malik Boykin; Brown U. Addressing Algorithmic Bias in the Interrogation of Inequitable Patterns in Scientific Discourse Presenter: Diego Kozlowski; U. of Luxembourg Presenter: Vincent Larivière; U. of Montreal Presenter: Cassidy Sugimoto; Georgia Institute of Technology Presenter: Thema Monroe-White; Berry College-Campbell Sch. of Bus Teaching Algorithmic Literacy to Assess Preferences for Machine Learning Fairness Metrics Presenter: C. Malik Boykin; Brown U. Presenter: Vincent Rice; - Presenter: Thema Monroe-White; Berry College-Campbell Sch. of Bus Presenter: Sarah Brown; U. of Rhode Island

Socioeconomic and gender inequalities in mental disorders among adolescents and young adults

BackgroundSocioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry. Materials and methodsWe conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression. ResultsOverall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38). ConclusionsOur work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions.

The sensitivity of the Gini to changes in group sizes and mean incomes: an extension of ANOGI applied to Brazil

PurposeThe purpose of this paper is to first develop indicators for how total inequality, measured through the ANalysis Of GIni (ANOGI) framework, is mapped onto each group – i.e. indicators for each group's share of total inequality. Second, to develop indicators for the sensitivity of total inequality and its structure to changes in the composition of the population. Specifically, to develop indicators for how the Gini index and its ANOGI components react to (1) changes in the population-share of each group, (2) migration between groups, (3) changes in group incomes and (4) income transfers between groups.Design/methodology/approachFirst, the expressions for these indicators are derived analytically. Following this, the indicators are applied to labour-market data from Brazil, contrasting the results to others available in the literature.FindingsThe indicators described above are presented and their characteristics discussed. Empirically, it is illustrated how labour formalisation in Brazil was an inequality-reducing process between 2002 and 2011, contrary to previous incorrect measurements of the phenomenon based on income-source decompositions for Latin American countries.Originality/valueIndicators for how total inequality reacts to changes in group sizes and income were unavailable for the ANOGI framework, which this article provides. The empirical illustration shows how this leads to a reassessment of important inequality dynamics, using the example of labour formalisation in Brazil. Contrary to the existing literature, it is shown how this was a progressive development, with key implications for social and labour-market policy. This framework can be used to assess the impact of diverse processes in the ANOGI methodology.

On Some Important Dynamic Inequalities of Hardy–Hilbert-Type on Timescales

In this article, by using some algebraic inequalities, nabla Hölder inequalities, and nabla Jensen’s inequalities on timescales, we proved some new nabla Hilbert-type dynamic inequalities on timescales. These inequalities extend some known dynamic inequalities on timescales and unify some continuous inequalities and their corresponding discrete analogues. Symmetry plays an essential role in determining the correct methods to solve dynamic inequalities.