National Inequality Research Articles

Global, regional, and national burden inequality of chronic kidney disease, 1990–2021: a systematic analysis for the global burden of disease study 2021

BackgroundChronic kidney disease (CKD) is a significant global health issue, often linked to diabetes, hypertension, and glomerulonephritis. However, aggregated statistics can obscure heterogeneity across subtypes, age, gender, and regions. This study aimed to analyze global CKD trends from 1990 to 2021, focusing on age, gender, socio-demographic index (SDI), and regional variations.MethodsData were extracted from the Global Burden of Disease (GBD) 2021 database, covering prevalence, incidence, mortality, and disability-adjusted life years (DALYs). These were presented as counts per 100,000 population and age-standardized rates, with uncertainty intervals (UIs) to highlight variability. Joinpoint regression was used to assess trends over the 30-year period.ResultsIn 2021, global CKD prevalence was 359 million, with 11.13 million new cases, 1.53 million deaths, and 44.45 million DALYs—up 92, 156, 176, and 114% since 1990. While prevalence slightly declined, incidence, mortality, and DALYs increased significantly. CKD burden varied by region and age, with notable gender disparities.ConclusionThe study highlights a dramatic rise in CKD burden linked to population growth and aging, emphasizing the need for targeted treatment and effective global healthcare policies.

Examining National and Regional Inequalities in Cultural Fiscal Expenditure using the Entropy Index

Examining National and Regional Inequalities in Cultural Fiscal Expenditure using the Entropy Index

Supporting equitable cervical cancer elimination for Australia's culturally and linguistically diverse communities: A call for intersectoral action.

Cervical cancer is a preventable disease and is related to persistent health equities. Whilst several priority populations face health inequities related to cervical cancer prevention, my co-authors and I bring special attention to those who identify as culturally and linguistically diverse (CALD). By reflecting on some of our research and work experiences, we propose four ways that governments and policymakers can enact the community engagement goals of the published and proposed cervical cancer prevention and treatment strategies for CALD communities. This includes: (1) Developing a culturally appropriate approach to collecting and interpreting cultural, ethnic and linguistic data; (2) Building and adapting the effective multicultural community policies and partnerships developed during COVID-19; (3) Incorporating national strategy recommendations across all relevant government policies and (4) Sustainably resourcing and supporting participatory health promotion activities and interventions. By implementing the recommendations above, Australia will continue to lead the elimination of cervical cancer as a public health problem. It will demonstrate how genuine and authentic CALD partnerships and collaborations can reduce national CALD health inequities.

Global, regional, and national pancreatitis burden and health inequality of pancreatitis from 1990 to 2019 with a prediction from 2020 to 2034

BackgroundPancreatitis is a digestive system disease that imposes a significant burden on society. However, there is a lack of comprehensive research on the incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of pancreatitis, as well as on health inequalities and future trends.MethodsPancreatitis burden data, including the number and age-standardized rates (ASR) of incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were collected from the Global Burden of Diseases 2019 (GBD 2019). SDI and HDI were used to analyze the influence of societal development on the burden of pancreatitis in the population. Additionally, the Gini coefficient and the Concentration index were used to assess health inequalities in the burden of pancreatitis. Global population data from 1990 to 2034 was obtained from WHO. Based on the population data and pancreatitis burden data, a prediction model of the burden was constructed to calculate the number and ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs from 2019 to 2034 using the BAPC package and the Nordpred package.ResultsFrom 1990 to 2019, there has been a decreasing trend in the ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs in pancreatitis. However, despite this decline, the number of cases has been on the rise. Furthermore, pancreatitis imposes a higher burden on males in comparison to females, and there exists a negative correlation between pancreatitis burden and both the Social Development Index (SDI) and the Human Development Index (HDI). Additionally, health inequalities have progressively worsened globally between 1990 and 2019, particularly concerning the burden of pancreatitis in countries with low Social Development Index (SDI). Looking to the future, it is projected that the number of deaths and new cases will continue to increase from 2020 to 2034.ConclusionsPancreatitis remains a mounting worldwide burden. In order to alleviate this challenge, preventive strategies should focus on males and middle-aged or older individuals, specifically in countries with a low SDI. Pancreatitis is expected to predominantly impact Eastern Europe, characterized by a high ASR of incidence, and Asia, boasting a substantial population.

Educational Inequality and Its Political and Economic Consequences: A Case Study of Nigeria and Kenya

Two of the most populous and economically varied countries in Africa, Nigeria and Kenya, continue to face significant obstacles to their development: educational inequality. The article examines the various facets of educational inequality in different nations, emphasizing the effects on the political and economic spheres. Differences in educational accessibility and quality between rural and urban regions, as well as between the north and the south, have contributed to social discontent, political disenfranchisement, and economic stagnation in Nigeria. In a similar vein, while there has been improvement in Kenya regarding educational access, notable inequalities still exist, especially in disadvantaged areas, which fuels political polarization and increases the economic divide. This article highlights effective solutions meant to solve these issues while examining the effects of unequal educational resource distribution on political polarization, economic development, and national stability. This study offers important insights into the larger consequences of educational disparity for sustainable development in sub-Saharan Africa by contrasting the educational systems of Nigeria and Kenya.

Demographic and socio-economic inequalities in subjective wellbeing: analysis of repeated cross-sectional health surveys in England 2010-2019.

Good subjective wellbeing (SWB) is a key societal aspiration. The study of SWB determinants is of increasing interest. The present study aimed to examine national inequalities in SWB, and trends in these inequalities, for England across five demographic (sex and age) and socio-economic (educational level, household income and living alone) characteristics. The relative index of inequalities (RII) and slope index of inequalities (SII) were calculated from repeated cross-sectional data from the Health Survey for England from 2010 to 2019 (excluding 2017 and 2018 as our outcome variable was not collected in these years), in a total of 90 236 participants aged 16+. SWB was assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), treated as a dichotomous variable with high and low levels of SWB>40 and≤40, respectively. There were significant inequalities in SWB by income (RII from 1.086 to 1.116), educational level (RII from 0.893 to 0.941) and between people living alone or not (RII from 0.908 to 0.937). The RII and SII trends were not statistically significant. Higher socio-economic status could play a protective role for SWB, and people in the most deprived socio-economic positions may be at higher risk for low SWB. These associations have remained stable over time.

DIEP backlog: Mission impossible?

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic caused global challenges, including the restriction of surgical options for women with breast cancer. Autologous reconstruction availability has still not returned to pre-COVID-19 levels. This study aimed to collect data about waiting lists for autologous breast reconstruction and is the first of its kind. A total of 31 units were approached and asked to complete a study specific questionnaire. In total, there are at least 2255 patients on a waiting list, which equates to a 2-year and 5-month backlog at the current level of provision, without the inclusion of new referrals. Alarmingly, 40 women reportedly developed breast cancer whilst on the waiting list. The impact of COVID-19 has been significant, revealing national inequity in reconstruction provision and long waiting lists. Recommendations include increasing theatre capacity, optimising plastic surgeons' job plans to prevent waiting lists from growing as well as training more surgeons in autologous reconstruction.

How does information about inequality shape voting intentions and preferences for redistribution? Evidence from a randomized survey experiment in Indonesia

We test the elasticity of people's voting intentions and preferences for redistribution to information about inequality through a large-scale, randomised survey experiment in Indonesia. Respondents received information about either (1) the level of national inequality, (2) the level of national inequality in combination with the degree of intergenerational mobility, (3) their position in the national income distribution, or no information. The first two treatments raised people's concern about inequality and mobility. The first treatment also increased the likelihood they would vote against the President. The third treatment lowered richer respondents’ support for redistribution. These findings provide new insights about the challenges of increasing public support for government-led redistribution, such as tax increases and greater spending on social protection, in middle-income country settings.

Dynamic impact of shadow economy and corruption on environmental sustainability: What role renewable energy consumption play in case of South Asian Economies

The South Asian region has a wide range of problems that significantly influence its path towards environmental sustainability. The region's rapid population expansion, rising urbanization rates, rising industry, and increasing resource demands primarily determine these challenges. The quest for environmental sustainability in this setting is complex and multidimensional, made more difficult by the shadow economy, corruption, and the need to improve renewable energy alternatives. Therefore, the current study examines the multifaceted and interrelated dynamics of the shadow economy, corruption, economic inequality, and environmental sustainability in South Asian nations from 2004 to 2018. We have used sophisticated methodological strategies to tackle cross-section dependence, non-stationarity, and heterogeneity issues by employing a pooled mean group (PMG). However, we use panel FMOLS and DOLS techniques for robustness checks. The findings of the PMG analysis show that the shadow economy, corruption, and industrialization significantly negatively impact environmental sustainability. On the other hand, renewable energy consumption and urbanization are positive and substantial elements that lead to improved environmental sustainability. The robust procedures applied to check the consistency of the estimators also confirmed the long-run relationship among variables. Research findings suggest that reinforcing legal frameworks for environmental rules is crucial for adherence. Incentives such as legal protection and financial rewards can encourage environmental responsibility among businesses, reducing shadow economy operations and risks. Promoting renewable energy resources and urbanization helps to support a sustainable green economy.

Global, regional, and national health inequalities of Alzheimer’s disease and Parkinson’s disease in 204 countries, 1990–2019

BackgroundAlzheimer’s disease and related dementias (ADRD) and Parkinson’s disease (PD), pose growing global health challenges. Socio-demographic and economic development acts paradoxically, complicating the process that determines how governments worldwide designate policies and allocate resources for healthcare.MethodsWe extracted data on ADRD and PD in 204 countries from the Global Burden of Disease 2019 database. Health disparities were estimated using the slope index of inequality (SII), and concentration index (CIX) based on the socio-demographic index. Estimated annual percentage changes (EAPCs) were employed to evaluate temporal trends.ResultsGlobally, the SII increased from 255.4 [95% confidence interval (CI), 215.2 to 295.5)] in 1990 to 559.3 (95% CI, 497.2 to 621.3) in 2019 for ADRD, and grew from 66.0 (95% CI, 54.9 to 77.2) in 1990 to 132.5 (95% CI, 118.1 to 147.0) in 2019 for PD; CIX rose from 33.7 (95% CI, 25.8 to 41.6) in 1990 to 36.9 (95% CI, 27.8 to 46.1) in 2019 for ADRD, and expanded from 22.2 (95% CI, 21.3 to 23.0) in 1990 to 29.0 (95% CI, 27.8 to 30.3) in 2019 for PD. Age-standardized disability-adjusted life years displayed considerable upward trends for ADRD [EAPC = 0.43 (95% CI, 0.27 to 0.59)] and PD [0.34 (95% CI, 0.29 to 0.38)].ConclusionsGlobally, the burden of ADRD and PD continues to increase with growing health disparities. Variations in health inequalities and the impact of socioeconomic development on disease trends underscored the need for targeted policies and strategies, with heightened awareness, preventive measures, and active management of risk factors.

Evolution and driving factors of inequality in CO2 emissions from agricultural energy consumption in China

The inequality in CO2 emissions from agricultural energy consumption is a major challenge for coordinating low-carbon agricultural development across regions in China. However, the evolutionary characteristics and driving factors of inequality in China’s agricultural energy-related CO2 emissions are poorly understood. In response, the Kaya–Theil model was adopted to examine the three potential factors influencing CO2 emission inequality in China’s agricultural energy consumption. The results revealed that, from 1997 to 2021, agricultural energy-related CO2 emissions per capita showed a significant upward trend, with prominent polarization and right-tailing phenomena. Overall, the inequality was on a downward trend, with the Theil index falling from 0.4109 in 1997 to 0.1957 in 2021. Meanwhile, the decomposition of the national inequality revealed that the within-group inequality declined from 0.3991 to 0.1634, which was greater than between-group inequality, based on zoning the 28 provinces into three grain production functional areas. As for the three kaya factors, the energy intensity contributed the most to the overall inequality, followed by the agricultural economic development and CO2 emission intensity. Based on these results, this study provided some potential strategies to reduce agricultural-related CO2 emissions.

The impact of the English national health inequalities strategy on inequalities in mortality at age 65: a time-trend analysis.

During the 1997-2010 Labour government, several policies were implemented to narrow health inequalities as part of a national health inequalities strategy. Many of these policies are likely to have had a disproportionately large impact on people aged 65 and over. We aimed to understand the association between the health inequalities strategy period and inequalities in mortality at age 65-69. We use population at risk and mortality data covering 1991-2019 to calculate mortality rate at age 65-69 at the Local Authority level. We use the 2019 Index of Multiple Deprivation to examine geographical inequalities. We employ segmented linear regression models with marginal spline terms for the strategy period and interact these with an indicator of deprivation to understand how inequalities changed before, during and after the strategy. The reporting of this study adheres to STROBE guidelines. Mortality rates in each deprivation quintile improved continuously throughout the period of study. Prior to the programme (1991-9) there was no significant change in absolute inequalities. However, during the strategy (2000-10) there was a significant decrease in absolute inequalities of -9.66 (-17.48 to -1.84). The period following the strategy (2011-19) was associated with a significant increase in absolute inequalities of 12.84 (6.60 to 19.08). Our results were robust to a range of sensitivity tests. The English health inequalities strategy was associated with a significant reduction in absolute inequality in mortality age 65-69. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach.

Examining the income gap-gender inequality nexus in Africa using bi-wavelet and partial wavelet coherence analysis

The eradication of gender discrimination traditions and the reduction of income disparities are vital global objectives outlined in Sustainable Development Goals 4 and 10, particularly in African nations where gender and income gaps persist. In alignment with these goals, this study employs wavelet techniques to investigate the relationship between income inequality and gender equality in 31 selected African countries, utilizing available data spanning from 1998 to 2020. Analysis of the co-movement between gender equality and income gap reveals that gender equality plays a crucial role in narrowing the income disparity in African countries. Expanding the analysis to control for the impact of economic growth through the implementation of partial wavelet tools, does not change these results. Further dissemination of our findings reveals that improved gender equality has a more pronounced impact on reducing income inequality in anglophone nations compared to their francophone counterparts, given variations in legal frameworks and religious practices. This emphasizes the importance of gender-sensitive policies in effectively addressing income inequality in Africa and suggests that policymakers should tailor country-specific policies to account for differences in gender laws, cultures, and religious beliefs. Overall, our study presents novel evidence linking income and gender inequality in Africa at country level.

Tracing environmental Kuznets curves: unveiling the interplay of inequality, urbanization, GDP and emissions in BRICS nations

In light of environmental challenges, the BRICS countries have stepped to the forefront of economic progress versus environmental sustainability debate. Not only has energy consumption increased rapidly in these countries, but the economic progress and urbanization, mainly driven by intensive fossil fuel production, have also led to higher levels of income inequality. The dynamics of the interplay between economic growth, urbanization, and income inequality on the one hand and environmental sustainability on the other have yet to be fully understood in the BRICS context. This paper aims to contribute to the ongoing debate by assessing a combination of three Environmental Kuznets Curves (EKC) based on the GDPpc-emissions nexus, the income inequality- emissions nexus, and the urbanization-emissions nexus. Using the Autoregressive Distributed Lag (ADRL) and Panel Fully Modified Least Squares (FMOLS) models, we find an inverted U-shape EKC between GDP and carbon emissions, an inverted U-shaped EKC between income inequality and carbon emissions, and a U-shaped EKC between urbanization and carbon emissions. The inverted EKC between GDPpc and carbon emissions suggests that in the long run sustainable carbon reduction is possible alongside economic growth, but urbanization’s U-shaped impact on emissions might hinder this. Moreover, the inverted U-shaped relationship between income inequality and carbon emissions indicates a potential long-run trade-off between reducing both inequality and carbon emissions. Factors behind this relationship may vary significantly and include institutions- and country-specific factors, yet policymakers in the BRICS countries will do well attempting to better understand the dynamics behind urbanization and inequality as it will enable them to adopt more effective holistic policies aiming to improve energy efficiency, reduce fossil fuel dependence, and build economic systems contributing to faster economic growth, lower inequality and greater environmental sustainability.

Income Inequality and External Wealth of Nations

Abstract We study the relationship between income inequality and external wealth using dynamic panel data models with 5-years average observations to consider the slow motion of available data in the case of 88 emerging and developing economies for the period 1970–2020. We find evidence of a significant positive association between inequality indicators and net external wealth. This relationship is statistically significant for all income inequality measures and net external wealth variables. If the Top 1 of the richest individuals in a given country increments their share by 1 % point this will produce an average same-year increment in net foreign assets of 0.45 % in terms of the country’s GDP. The long-run effect is more than double in magnitude (1.05 % of GDP). For the Top 10, the long-run effect increases tenfold (11.6 % of GDP). When disaggregated into foreign assets and liabilities, we find a heterogeneous behavior of the financial elites. These findings reveal that financialized elites have a greater propensity to accumulate external wealth than the rest of the population.

Educational inequalities in all-cause and cause-specific mortality in Japan: national census-linked mortality data for 2010-15.

Due to the lack of a national mortality inequality monitoring framework, the overall picture in Japan remains unclear. Here, we investigated educational inequalities in mortality and their cause-specific contribution in Japan. Data were obtained by linking the 2010 Japanese population census and death records between 1 October 2010 and 30 September 2015. We included 7 984 451 Japanese people aged 30-79 years who had a unique 'matching key' generated by sex, birth year/month, address (municipality), marital status and age of spouse (9.9% of the total census population). We computed population-weighted all-cause and cause-specific age-standardized mortality rates (ASMRs) by education level. In addition, we calculated the slope index of inequality (SII), relative index inequality (RII) by education level, and population attributable fraction (PAF) referenced with the highest education (e.g. university graduation). Individuals with less education had higher all-cause and cause-specific ASMRs than highly educated individuals. All-cause SII (per 100 000 person-years) values were 433 (95% CI: 410-457) for men and 235 (95% CI: 217-252) for women. RII values were 1.48 (95% CI: 1.45-1.51) for men and 1.47 (95% CI: 1.43-1.51) for women. Estimated PAFs, excess premature deaths caused by educational inequalities, were 11.6% for men and 16.3% for women, respectively. Cerebrovascular diseases, ischaemic heart diseases and lung cancer were the major contributors to mortality inequalities for both sexes. This first census-based comprehensive report on cause-specific educational mortality inequalities suggested that differences in unfavourable health risk factors by educational background might be associated with these inequalities in Japan.

The Relationship Between Informal Economy and Income Inequality: An Econometric Analysis for BRICS Countries

This research investigates the intricate relationship between the informal economy and income inequality in BRICS nations from 2000 to 2018. Defining the informal economy as economic activities outside the formal sector contributing to GDP, the study addresses a gap in existing literature that tends to overlook this sector's impact on income distribution. Utilizing panel unit root and panel cointegration tests, the findings reveal a significant and direct correlation between income inequality, the informal economy, and GDP in BRICS countries. The study uncovers a noteworthy revelation: a 1% increase in the informal economy leads to a substantial 3.24% rise in the GINI coefficient, showcasing the informal sector's profound influence on income inequality. Country-specific analyses identify India and Russia as frontrunners in this correlation, with China, Brazil, and South Africa following suit. Intriguingly, the analysis indicates that while a 1% rise in official GDP slightly worsens income distribution, the informal economy exerts a disproportionately negative impact on income inequality. This research provides valuable insights for policymakers, emphasizing the need to consider the informal economy's role in crafting effective strategies for mitigating income inequality within the BRICS context.

Evolving Barriers to Clinical Trial Enrollment and Clinical Care in Neuro-oncology in the Face of COVID-19.

The lack of treatments with durable response in neuro-oncology highlights the critical need for clinical trials to advance patient care. The intersection of relatively low incidence, evolving classification schema, and entrenched community, healthcare provider, and organizational factors have been historic challenges against successful trial enrollment and implementation. The additional need for multidisciplinary, often tertiary-level care, further magnifies latent national and international health inequities with rural and under-served populations. The COVID-19 pandemic both unveiled fundamental weaknesses in historical approaches and prompted the necessity of new approaches and systems for conducting clinical trials. Here, we provide an overview of traditional barriers to clinical trial enrollment in neuro-oncology, the effect of COVID-19 on these barriers, and the discovery of additional systemic weaknesses. Finally, we discuss future directions by reflecting on lessons learned with strategies to broaden access of care and streamline clinical trial integration into clinical practice.

Juan José Arévalo 1945 to 1951: legacies and lessons for the current democracy movement in Guatemala

Juan José Arévalo and the “revolutionaries” brought tremendous change to Guatemala. But well before Arévalo left office, the Revolution was already in the crosshairs of US military might. At least three challenges threatened the government of Arévalo: the ultra conservatives or the “anti-revolutionaries”; competitive aspirations of the revolutionaries; and the overarching power of the US businesses and US government. Arévalo encountered these challenges from the first day of his presidency, and thereafter. Bernardo Arévalo, Guatemala’s recently elected president, faces similar dangers: a powerful opposition from an entrenched civilian and military oligarchy, urban and rural disconnections, foreign economic power and influences, national inequality and corruption, and indigenous and ladino/Hispanic conflicting aspirations. The 78 years spread between 1945 and 2023 means that the details are different, but similarities testify to continuing troubles in Guatemala. A major difference is the 21st century power of indigenous peoples, and Bernardo Arévalo’s pledge to honor and work for the concerns of the indigenous peoples as well as all Guatemalans. This contrasts with the revolutionaries of the 1940s who classified indigenous peoples as peasants requiring education and uplifting through assimilation into the national Hispanic “culture”. In an apparent second difference, currently the United States has been a strong supporter of the new president and the democracy movement. In 1945, the US also appeared to favor Juan José Arévalo, and then soon turned against him.

National and regional economic inequalities in first- and second-hand tobacco consumption among women of reproductive ages in Iran

IntroductionThe epidemic of tobacco consumption is one of the major public health threats the world has been facing so far. This study was performed to investigate the economic inequalities in tobacco consumption among women of reproductive ages at national and regional levels in Iran.MethodsWe used data from 10,339 women of reproductive ages (18–49 years) who participated in Iran’s 7th Non-Communicable Disease Risk Factor Surveillance (STEPS). Wagstaff normalized concentration index and decomposition method were applied to measure economic inequalities in first- and second-hand tobacco consumption and determine their corresponding contributory factors, respectively.ResultsThe prevalence of women’s first-hand tobacco consumption, and their exposure to second-hand smoke in the home, and workplace were 3.6%, 28.3%, and 8.4%, respectively. First- and second-hand tobacco consumption was significantly more concentrated among low-economic women. Exposure to home second-hand smoke, education, and economic status had the largest contributions to the measured inequality in first-hand tobacco consumption (48.9%, 38.9%, and 30.8%, respectively). The measured inequality in women’s secondhand smoke exposure at home was explained by their level of education (43.8%), economic status (30.3%), and residency in rural areas (18%), and at work by residency in rural areas (42.2%), economic status (38.8%), and level of education (32%). Our results also revealed diversity in the geographical distribution of inequalities in rural and urban areas and five regions of the country.ConclusionThe present study highlighted the need for more enforcement of tobacco control rules and increasing tobacco taxes as general measures. Furthermore, there is a need for gender-sensitive initiatives at national and regional levels to educate, support, and empower low-economic women and households for tobacco cessation, and complying with restrictive smoking rules.