Inequalities In Health Outcomes Research Articles

Trends in deprivation in hospitalisations of Indigenous children and young people in Aotearoa New Zealand

AimTo examine the 20‐year trends in socio‐economic inequities in hospitalisations of Māori and non‐Māori non‐Pacific (NMNP) under‐25‐year olds in Aotearoa New Zealand.MethodsHospital discharge data for Māori and NMNP taitamariki aged under‐25 years were extracted from the National Minimum Dataset for the period 2000–2019. Acute or arranged admissions to hospital were included where the primary diagnosis was for a medical condition. Age‐ and gender‐standardised rates (per 1000, 0–24‐year old) were calculated for both ethnic groups by area deprivation using the 2013 NZ census estimated resident population. For each ethnic group, inequity indices of socio‐economic deprivation (Slope Index of Inequality and Relative Index of Inequality) were computed, using regression modelling, to quantify inequity of medical condition‐related hospitalisations and its changes over time.ResultsHospitalisation rates for medical conditions were consistently higher for Māori than for NMNP under‐25‐year olds from 2000 to 2019. Māori taitamariki residing in the most deprived (quintile 5) areas were more likely than NMNP to be hospitalised for a medical condition at each time point. Deprivation inequities existed for both ethnic groups and were greater for Māori. Despite reducing deprivation inequities over time, ethnic differences persist on both absolute and relative scales.ConclusionDeprivation inequities in hospitalisation for medical conditions persist for Māori taitamariki compared with NMNP and highlights society's tolerance of enduring inequity in health outcomes.

Racial Differences in Diagnosis of Overweight and Obesity: Results from the National Health and Nutrition Examination Survey (NHANES) 2009-2016.

Diagnostic standards and codes related to excessive weight exist so that clinicians may inform patients that they are overweight: a status which may be a harbinger of more severe obesity and negative health outcomes. Equipped with this knowledge, patients may pursue medical interventions or behavioral changes to reduce their risk. However, diagnoses of overweight are unequally applied in the United States along racial lines. Binary logistic regression was used to analyze National Health and Nutrition Examination Survey (NHANES) 2009-2016 data from 7460 participants to examine the relationship between race of non-Hispanic White and non-Hispanic Black Americans and having ever been told that one is overweight by a clinician when controlling for demographic and socioeconomic factors. The body mass index (BMI) of participants along with obesity-associated comorbidities was then incorporated into the model to see if physical size or disease status mediated the primary relationship. Black Americans are significantly less likely to report being told that they are overweight by a clinician than are White Americans regardless of clinical weight status and weight-associated comorbidities. We find that these racial differences are greatest when respondents' BMIs approach the lower threshold for clinical obesity. Our findings suggest that the lower likelihood of Black Americans to be told they are overweight compared to their White counterparts can result in serious health implications. We posit that implicit biases among clinicians may partly explain this disparity, which may exacerbate health outcome inequalities.

Global Rural and Remote Patients With Rheumatoid Arthritis: A Systematic Review.

ObjectiveRural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and health care access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes, and health service use reported for global populations with RA residing in rural and remote locations.MethodsMedline, Embase, HealthStar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched from inception to June 2019 using librarian‐developed search terms for RA and rural and remote populations. Peer‐reviewed published manuscripts were included if they reported on epidemiologic, clinical, or health service use outcomes.ResultsFifty‐four articles were included for data synthesis, representing studies from all continents. In 11 studies in which there was an appropriate urban population comparator, rural and remote populations were not at increased risk for RA; 1 study reported increased prevalence, and 5 studies reported decreased prevalence in rural and remote populations. Clinical characteristics of rural and remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but 1 study reported worse physical function and health‐related quality of life in rural and remote populations. Studies reporting on health service use provided evidence that rural and remote residence adversely impacts diagnostic time, ongoing follow‐up, access to RA‐care–related practitioners and services, and variation in medication access and use, with prominent heterogeneity noted between countries.ConclusionRA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations within countries. Rural and remote patients face greater barriers to care, which increases the risk for inequities in outcomes.

Systematic screening for anxiety and depression in cardiac rehabilitation – are we there yet?

BackgroundAnxiety and depression are prevalent in 20% of patients with acute coronary syndrome (ACS) and associated with poor outcomes. Guidelines recommend screening for these conditions in cardiac rehabilitation (CR) however, clinical practice is inconsistent. Sparse knowledge exists on determinants for screening. MethodsThis observational study used data from the National Audit of Cardiac Rehabilitation from January 2016–December 2019. A multivariate logistic regression model was performed to analyze patient- and provider level determinants for screening for anxiety and depression among patients with ACS. ResultsThe population consisted of 138,018 patients, where 82,507 (59.8%) were screened and 55,511 (40.2%) were not. Younger age, non-white ethnicity, living in areas of social deprivation, current smoking, body mass index>30, and physical activity<150 min per week were negatively correlated with patients being screened. Compared to patients having a percutaneous coronary intervention, patients undergoing coronary artery bypass grafting or medical treatment were less likely to be screened. History of anxiety, depression, osteoporosis, chronic back problems, and asthma were positively correlated with screening, while chronic obstructive pulmonary disease, diabetes, hypertension, and stroke were negatively correlated with screening. Regarding provider level, certification of CR centers was positively associated with screening, while looking over time data showed an incremental negative trend in screening from 2016 to 2019. ConclusionWe found both patient and provider level determinants of screening for anxiety and depression. Clinical practice is still inconsistent especially for high-risk groups. We recommend systematic screening to enable tailored interventions which in turn may mitigate inequity in health outcomes.

Equity-Oriented Healthcare: What It Is and Why We Need It in Oncology

Alarming differences exist in cancer outcomes for people most impacted by persistent and widening health and social inequities. People who are socially disadvantaged often have higher cancer-related mortality and are diagnosed with advanced cancers more often than other people. Such outcomes are linked to the compounding effects of stigma, discrimination, and other barriers, which create persistent inequities in access to care at all points in the cancer trajectory, preventing timely diagnosis and treatment, and further widening the health equity gap. In this commentary, we discuss how growing evidence suggests that people who are considered marginalized are not well-served by the cancer care sector and how the design and structure of services can often impose profound barriers to populations considered socially disadvantaged. We highlight equity-oriented healthcare as one strategy that can begin to address inequities in health outcomes and access to care by taking action to transform organizational cultures and approaches to the design and delivery of cancer services.

Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016 Madhumita Bango

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Bango M. Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016. Journal of Health Inequalities. 2022;8(2):155-162. doi:10.5114/jhi.2022.122112. APA Bango, M. (2022). Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016. Journal of Health Inequalities, 8(2), 155-162. https://doi.org/10.5114/jhi.2022.122112 Chicago Bango, Madhumita. 2022. "Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016". Journal of Health Inequalities 8 (2): 155-162. doi:10.5114/jhi.2022.122112. Harvard Bango, M. (2022). Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016. Journal of Health Inequalities, 8(2), pp.155-162. https://doi.org/10.5114/jhi.2022.122112 MLA Bango, Madhumita. "Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016." Journal of Health Inequalities, vol. 8, no. 2, 2022, pp. 155-162. doi:10.5114/jhi.2022.122112. Vancouver Bango M. Explaining the social gradient in health: inequality in health outcomes in selected states of India, 2015‑2016. Journal of Health Inequalities. 2022;8(2):155-162. doi:10.5114/jhi.2022.122112.

Community Health Improvement: Social Care Is Healthcare.

Like many communities across the United States, St. Louis, Missouri, faces stark inequities in health outcomes, including wellness, quality of life, and life expectancy. These inequities are the result of social systems and policies that have robbed generations of St. Louisans of opportunity. BJC HealthCare's (BJC's) commitment to becoming a catalyst for community health by helping to eliminate health disparities led to the launch of its community health improvement strategy. This article details the community-driven and evidence-informed process that BJC used to create a multiyear, proactive approach to addressing the social and economic factors that are the root causes of health inequities. It examines areas of opportunity through which the strategy will drive change and explores lessons learned and promising practices for other healthcare institutions to consider as they advance health equity.

DMF (different, missed, forgotten): oral health inequalities experienced by people with severe mental illness

In England, there are over half a million people living with severe mental illness (SMI) such as schizophrenia and bipolar disorder. These people die on average up to 20 years earlier than the general population and 2 in 3 deaths are from physical illnesses that can be prevented. Recent government publications such as the NHS Long Term Plan and NHS England's mental health implementation plan have highlighted the need to address the physical health needs of people with SMI in order to reduce the serious inequality of health outcomes experienced. Disappointingly, however, neither document mentions the poor oral health experienced by this cohort of the population, nor do they recognise the link between poor oral health and poor general health. This article examines the available literature and results from a recent survey that explored the oral health behaviours of service users at a secure mental health facility to raise awareness of the oral health needs of this population. Oral health is an integral aspect of general health and can positively influence wellbeing. A healthy mouth ensures individuals can eat, speak and interact socially, free from pain and embarrassment. Poor oral health can therefore not only have a profound impact on a person's quality of life (QoL) but it can also have wider implications for systemic disease.

Housing and Neighborhoods as Root Causes of Child Poverty.

Understanding how housing inequities among families with children are rooted in structural racism is important for identifying opportunities to engage in ongoing and collective work as pediatricians to lift children out of poverty. This article discusses the complex mechanisms between housing and child and family health outcomes, and offers potential solutions linking housing, health programs, and policy solutions. Beginning with a review of historical antecedents of housing policy and their impact on health inequities, the authors outlines policies and structures directly linked to disproportionate housing instability and inequities in health outcomes among children. This article examines four key domains of housing - affordability, stability, quality, and neighborhood - and their relationship to child and family health. Finally, the authors present multidimensional solutions for advancing health equity.

HIV, migration, gender, and drug addiction: A qualitative study of intersectional stigma towards Afghan immigrants in Iran

HIV-related stigma has been identified as a major barrier to the diagnosis, prevention, and treatment of HIV among immigrants. The intersection of HIV with other forms of stigma can lead to greater inequality in health outcomes and access to health services. This study aimed to improve the understanding of HIV stigma towards Afghan immigrants in Iran through an intersectional perspective. The data were collected using 25 semi-structured interviews with the following three groups: Afghan immigrants who were diagnosed with or at risk of HIV infection due to injection drug addiction or having multiple sexual partners (n=8), HIV service providers (n=8), and policymakers/managers/experts (n=9). Thematic analysis was used for data analysis. The participants described different manifestations of stigma (internalized, anticipated, perceived, experienced stigma, and discrimination) associated with HIV and interlocked with other aspects of stigma, including migration, gender, and drug addiction. According to the results, the intersection of different layers of stigma should be taken into account while designing and implementing HIV prevention and treatment programmes. It was also recommended to conduct the necessary interventions such as comprehensive HIV education, social support, as well as peer and outreach services to reduce stigma and discrimination based on the immigrants' needs as well as cultural and social values.

Mindfulness in Pregnancy: A Brief Intervention for Women at Risk.

The U.S. has the highest rate of preterm birth (PTB), of all developed countries, especially among African American women. Social determinants of health and inequalities in health outcomes are understudied areas. The intersectionality of race and socioeconomic status has been shown to contribute to chronic stress, stress has been shown to be associated with PTB, yet the mechanisms that affect pregnancy outcomes have not been explicit. Mindfulness-based Interventions that address stress reduction during pregnancy may improve quality of life during pregnancy, perhaps enhancing resilience, and be on the pathway to reducing the risk of negative pregnancy outcomes such as PTB. We over-enrolled African American women and those covered by Medicaid to reach women at higher risk for PTB and included women in substance use treatment. Participants were enrolled in a 6-week mindfulness in pregnancy (MIP) intervention at the obstetric clinic. Sociodemographic characteristics and psychosocial assessments were obtained at three time points. We enrolled 35 women who self-identified as: non-white, Medicaid recipients, aged 25-35years, with high school or less education. We found reductions in perceived stress, pregnancy specific stress, trait anxiety and depression and increases in mindfulness that sustained post-intervention at 2 and 7months. Social determinants and stress in particular have been associated with negative birth outcomes. This paper describes a brief intervention and results of MIP tailored to women who have significantly more stress due to race, poverty, homelessness, substance use treatment and other comorbid health risks including PTB.

Culture-centred approach to digital health communication: Sustaining health, addressing inequalities, transforming structures

This essay examines critically the hegemonic discourses of digital health communication, attending to the role of digital technologies in expanding the reach of digital technologies while exacerbating inequalities in health outcomes. Drawing on a culture-centred approach, it foregrounds the role of communication infrastructures for voices at the margins of neo-liberal economies. These voices put forth an organizing logic of care that dismantle the ideology of neo-liberalism.

DISCOVERIES FROM THE USE OF POLYGENIC SCORES IN AN ELECTRONIC HEALTH RECORD RESEARCH SETTING

The causes and consequences of health inequalities (and their implications for research and practice) have not, it is fair to say, been a notable feature of the body of work that we refer to as social pharmacy. By contrast, the previous three decades have witnessed a burgeoning number of empirical studies, numerous reviews, and growing political awareness about the social determinants of health inequalities. The field of epidemiology and public health, focusing on health inequalities, has risen in prominence with a finding that an individual's social position (whether this is measured by social class, education, or deprivation) profoundly shapes their health outcomes. To illustrate this using deprivation as a marker of social position, the recent Global Burden of Disease study showed that males who lived in the most deprived areas of England in 2013 could expect to have a life expectancy which was 8.2 years shorter than those living in the least deprived areas. If we were to look at social class or education, we would also see wide differences in health outcomes. There are, of course, huge inequalities in health outcomes when we compare health outcomes within and between different countries. For those who want to know more about this literature, there are numerous reviews.

Global Rural and Remote Patients with Rheumatoid Arthritis

Introduction: Rural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and healthcare access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes and health service use reported for global populations with RA residing in rural/remote locations.&#x0D; Methods: Medline, EMBASE, Healthstar, CINAHL and Cochrane were searched from inception to June 2019 using librarian-developed search terms for RA and rural/remote populations. Peer-reviewed published manuscripts were included if they reported on any of an epidemiology, clinical or health service use outcomes.&#x0D; Results: 54 articles were included for data synthesis, representing studies from all continents. In 11 studies where there was an appropriate urban population comparator, rural/remote populations were not at increased risk for RA, 1 study reported increased and 5 studies reported decreased prevalence in rural/remote populations. Clinical characteristics of rural/remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but with 1 study reporting worse physical function and health-related quality of life in rural/remote populations. Studies reporting on health service use provided evidence that rural/remote residence impacts diagnostic time, ongoing follow-up, access to RA-care related practitioners and services, and with variation in medication access and use.&#x0D; Conclusion: This synthesis highlights that RA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations, however rural/remote patients face greater barriers to care which increases the risk for inequities in outcomes. From a public health perspective, we need leadership to implement structures and policies to support better outcomes in rural and remote populations. Access to health services is a recognized determinant of health, which presents the opportunity for actionable strategies and approaches to resolve inequities in care delivery.

Self-Care Capacity and Its Relationship to Age, Disability, and Perceived Well-Being in Medicare Beneficiaries.

Self-care is a multicomponent set of capacities that influence beliefs about health and well-being. We examined the relationship between self-care capacity, age, and disability status with two perceptions of well-being in a cohort of Medicare beneficiaries. The current study is part of a multisite research project to determine factors associated with cross-sectional and longitudinal morbidity and mortality trajectories observed in Medicare beneficiaries. Variable selection was informed by the health disparities and outcomes model. Using data from the 2013 Medicare Current Beneficiary Survey and logistic regression models, we determined associations between self-care capacity, including indicators of self-care ability and self-care agency and two perceptions of well-being. Participants were divided into four groups based on how they qualified for Medicare: (a) over 65 years of age, and below 65 years of age and disabled because of (b) physical or (c) mental disorder, or (d) disabled and could not be classified as physically or mentally disabled as the primary cause of eligibility. Self-care ability limitations in activities of daily living (ADL), instrumental activities of living (IADL), and social activity participation were associated with both health perceptions. Those with physical disabilities reported more ADL and IADL limitations when compared with the other eligibility groups and were significantly more likely to have negative health perceptions. Those with serious mental illness were most likely to report the most severe IADL limitations. The over 65 years of age group reported less self-care incapacity than the other three eligibility types. Other components of self-care, including health literacy, agency, and health behaviors, significantly influenced perceptions of health. Women and people identifying as non-Whites were more likely to have negative health perceptions. Self-care capacity is a complex construct, and its varied elements have differential relationships with perceptions of well-being. Those with physical disabilities reported more self-care limitations, poorer perceived health, and more health worries than the other groups. Still, there were different patterns of self-care capacities in the serious mental illness type-especially in IADL limitations. The study adds empirical evidence to previous research documenting inequities in health outcomes for women and non-Whites. Findings provide empirical support for the health disparities and outcomes model.

Dynamics of inequality in child under-nutrition in Ethiopia

IntroductionAlthough Ethiopia has already achieved a remarkable progress in reducing under-five mortality in the last decades, undernutrition among children is still a common problem in this country. Socioeconomic inequalities in health outcomes in Ethiopia have been thus of focus in academia and policy spheres for a while now. This study provides new evidence on child undernutrition inequalities in Ethiopia using longitudinal perspective.MethodUsing three round of household panel survey (from 2012 to 2016), we use concentration index (associated curve), different mobility index approaches for measuring inequalities and its dynamics, and decomposition method to identify contributing factors.ResultsIn all concentration index computing approaches and socioeconomic status ranking variables, the concentration indices are significant with negative value. This implies that in either of short-run or long-run inequality estimates, the burden of unequal distribution of undernutrition remains on the poor with significant difference across regions. While employing different SES ranking variables, the difference in the concentration indices is only found significant in case of Height-for-age Z-score. It signifies that relatively higher inequality is measured using consumption as ranking variable. Significant difference in inequality is also shown across regions. With respect to dynamics of inequalities, results on mobility indices computed based on Allanson et al. (Longitudinal analysis of income-related health inequality. Dundee Discussion Working Paper No. 214, 2010) approach show that inequality remain stable (persistent) in Height-for- age Z-score, and reduction of inequality in Weight-for- age Z-score while in case of Weight-for- height Z-score, there is no clear trend over subsequent waves. Results on decomposition of inequalities show that the major contributors are wealth index, consumption and mother’s education.ConclusionThe argument of the choice of welfare indicator can have a large and significant impact on measured socioeconomic inequalities in a health variable which it depends on the variable examined. Employing longitudinal perspective rather than weighted average of cross-sectional data is justifiable to see the dynamic of inequality in child malnutrition. In both socioeconomic status ranking variables, the bulk of inequality in malnutrition is caused by inequality in socioeconomic status in which it disfavours the poor in both cases. This calls for enhancing the policy measures that narrow socioeconomic gaps between groups in the population and targeting on early childhood intervention and nutrition sensitive.

A Consideration of Racism in Pediatric Epidemiologic Studies

A Consideration of Racism in Pediatric Epidemiologic Studies

Impact of remoteness on patient outcomes for people with multiple sclerosis in Australia

BackgroundLittle is known about whether living in remote areas is associated with worse health outcomes in Australians with MS. ObjectivesTo evaluate whether living in remote areas was associated with worse health outcomes, employment outcomes and different disease modifying therapy (DMTs) utilisation among Australians with MS. MethodsWe included 1,611 participants from the Australian MS Longitudinal Study. Level of remoteness (major cities, inner regional, outer regional, remote, and very remote Australia) was determined using postcode. Data were analysed using linear, log-binomial, log-multinomial and negative binomial regression. ResultsLiving in more remote areas was not associated with substantial worse health/employment outcomes. There was a consistent pattern of those living in inner regional areas having worse outcomes, but the effect sizes were relatively small with no clear dose-response relationships with increasing remoteness. Those living in more remote areas were less likely to use high efficacy DMTs. Adjusting for age, disease duration, and education level only marginally reduced the associations. ConclusionsThere is no large inequity in health outcomes in the Australian MS population due to remoteness. However, modest and consistent differences in health outcomes and DMTs treatment are likely to have a substantial cumulative impact at an individual level.

Support policies that foster a healthy food environment and incentivize healthy food purchases to mitigate cancer inequities.

The COVID-19 pandemic has highlighted the inequitable access to resources, leading to a disproportionate burden of disease in vulnerable communities in the USA. However, these inequities in health outcomes are not limited to COVID-19. Approximately 18% of cancers are related to dietary behaviors and excess body weight. Underserved communities, such as minority racial/ethnic groups living in neighborhoods of low socioeconomic status, experience barriers to healthy eating including lack of access to high-quality healthy foods and higher availability of unhealthy foods and beverages in local retail food outlets. Strikingly, these same populations are more likely to die from cancers related to dietary intake and obesity like colorectal, liver, and pancreatic cancers. To reduce cancer inequities, policy makers can act by supporting programs that incentivize healthy food purchases and improve the local food environment in underserved communities.

Child Health Outcome Inequalities in Low and Middle Income Countries

ABSTRACT Prior to the Sustainable Development Goals (SDG) era, considerable progress was made toward the Millennium Development Goals (MDGs) health indicators. Despite these achievements, many countries failed to meet the MDG target levels, between-country inequalities in health outcomes did not improve, and many countries making progress in average indicator levels did so while at the same time seeing increasing within-country inequalities. We build on the existing literature documenting levels and trends in health inequalities by expanding the number of data-points under focus, and we contribute to this literature by analyzing the extent to which inequalities in child health outcomes are related to socioeconomic inequalities, and to aggregate income growth. The objective of this paper is to examine long-run trends in average population levels and within-country inequalities for two child health outcomes—the under-five mortality rate (U5MR) and stunting—in 102 countries across 6 regions. We find that only about a third of countries in our sample managed to both reduce U5MR levels and inequalities, and only a quarter did so for stunting. The fact that inequality in service coverage seems to follow a more favorable trend than inequality in health outcomes suggests that policies aiming to reduce health inequities should not only foster more equitable service coverage but also focus on the social determinants of health. Moreover, there is no strong correlation between changes in health inequalities and income growth, suggesting that income generating development policies alone will typically not suffice to improve health outcomes and reduce health inequalities.