Large Inequalities Research Articles

Global impact of PM2.5 on cardiovascular disease: Causal evidence and health inequities across region from 1990 to 2021.

PM2.5 is an important environmental risk factor for cardiovascular disease (CVD) and poses a threat to global health. This study combines bibliometric analysis, Mendelian randomization (MR), and Global Burden of Disease (GBD) data to comprehensively explore the relationship between PM2.5 exposure and CVD. MR analyses provided strong evidence for causality, reinforcing findings from traditional observational studies. The estimated global burden of PM2.5-related CVD indicated, that there exist significant impacts on the elderly, men, and populations in low and medium socio-demographic index (SDI) areas. This study further found that population growth and aging are the main drivers of this burden with large inequities, although medical advances have mitigated some of the effects. Overall, the opportunity to reduce the burden of CVD remains significant, particularly in medium SDI countries. Projections to 2045 suggested that the absolute burden will increase, while age-standardized rates will decline due to improvements in air quality and health care. These findings emphasized the urgent need for targeted interventions to mitigate the deleterious effects of PM2.5 on global cardiovascular health and to address health inequalities between regions.

Understanding barriers to young people’s utilisation of sexual and reproductive health services in Asia-Pacific countries: a qualitative systematic review and thematic synthesis

IntroductionBased on the United Nations’ sustainable development goals, universal access to sexual and reproductive health (SRH) services should be attained by 2030. Yet, large inequalities in adolescent SRH knowledge and...

Corrigendum to “Large inequalities in climate mitigation scenarios are not supported by theories of distributive justice” [Energy Res. Soc. Sci. 118 (2024) 103813

Corrigendum to “Large inequalities in climate mitigation scenarios are not supported by theories of distributive justice” [Energy Res. Soc. Sci. 118 (2024) 103813

Heterogeneities in landed costs of traded grains and oilseeds contribute to unequal access to food

Despite the growing accessibility of international grain and oilseed markets, high production costs and trade frictions are still prevalent, contributing to regional heterogeneities in the landed cost of grain imports. Here we quantify the landed cost for six grain commodities across 3,500 administrative regions, capturing regional cost differences to produce grain and transport it across international borders. We find large heterogeneities in the costs of imported grain, which are highest in Oceania, Central America and landlocked Africa. While some regions have uniform landed costs across sourcing locations, others face cost variations across trading partners, showing large inequalities in access. We find that most regions could benefit from a targeted approach to reduce landed cost while others benefit from a mixed strategies approach. Our results highlight that spatial information on production, trade and transport is essential to inform policies aiming to build an efficient and resilient global agricultural commodity trade system.

A NOTE ON THE LARGE SIEVE INEQUALITY FOR MODULI GENERATED BY A QUADRATIC

Abstract We develop a generalisation of the square sieve of Heath-Brown and use it to give an alternate proof of one of the large sieve inequalities in our previous paper [‘A large sieve inequality for characters to quadratic moduli’, Preprint, https://web.maths.unsw.edu.au/~ccorrigan/preprint6.pdf].

Inequities in Unmet Oral Care Needs after a Swedish Subsidization Reform: An Intersectional Analysis.

The main strategy to achieve equal provision of oral care in Sweden has been to offer partial subsidies for the adult population. However, their effects on unmet oral care needs (UOCNs) have not been extensively assessed. This study used an intersectionality framework to examine 1) the overall frequency of UOCNs, 2) single-indicator inequities, and 3) intersectional inequities in total UOCNs and financial-related UOCNs (FUOCNs) in Sweden before and after implementation of a partial subsidization reform in 2008. Data from 12 national surveys conducted over 2004 to 2018 were divided into 3 periods: prereform (2004 to 2007), early postreform (2008 to 2011), and late postreform (2012 to 2018). The analytic sample consisted of 98,177 respondents aged 24 to 84 y. Changes in the prevalence of UOCNs were estimated by inferential statistics. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy, across 48 strata defined by gender, age, educational level, income, and immigrant status. The prevalence of total UOCNs and FUOCNs decreased significantly early after the reform, followed by a slight rebound. Relative inequities increased by education, income, and immigrant status after the reform and decreased for age. The discriminatory accuracy for both types of UOCNs was moderate and improved marginally but significantly with the inclusion of the intersectional strata. Most intersectional strata showed greater FUOCN inequities after the reform. Contrary to expected, larger inequities in FUOCNs were identified in most intersectional strata after the reform. The moderate discriminatory accuracy suggested that Sweden could benefit from future strategies to foster equity that are universal but proportionately more intense among the intersectional strata with greater inequities (proportionate universalism). This analysis highlighted the benefit of adopting the principle of proportionate universalism as a strategy to reduce unmet oral care needs in Sweden. This would mean implementing universal strategies and specific support measures for the most vulnerable social groups as a future oral care policy change in Sweden.

Do executive functions and processing speed mediate the relationship between socioeconomic status and educational achievement? Analysis of an observational birth cohort study

BackgroundThere are large and persistent social inequalities in children’s educational attainment, with children from more socioeconomically disadvantaged families consistently having lower attainment. Despite this being widely reported, the mechanisms underlying the association between socioeconomic disadvantage and educational attainment are not well understood. It is important to understand the potential mechanisms by which socioeconomic disadvantage may impede on educational outcomes, as this knowledge could then be used to help target possible interventions to improve educational outcomes for socioeconomically disadvantaged children. Children’s executive functions (including working memory and inhibition) and processing speed abilities may underlie these inequalities, however, the previous literature regarding this is limited. This study examined longitudinal mediating mechanisms between socioeconomic status (SES) and educational achievement, using a socioeconomically deprived and ethnically diverse cohort.MethodsData from the Born in Bradford longitudinal cohort study was analysed using Structural Equation Modelling (n = 4201; 28% White British, 56% Pakistani heritage, 16% Other; 54% Female). SES was measured before birth, executive functions and processing speed were measured in middle childhood (Mage=8.45 years), and educational achievement was obtained through educational records (Mage=10.85 years). All models adjusted for child gender, age, language ability, ethnicity, and mother immigration status.ResultsExecutive functions significantly mediated the association between SES and educational achievement (B = 0.109), whilst processing speed did not. Examination of executive function components revealed that working memory significantly mediated the associated between SES and educational achievement (B = 0.100), whilst inhibition did not. Working memory appeared to account for a large proportion (39%) of the total effect of SES on educational achievement.ConclusionsThese results, and the theoretical mechanisms linking working memory to educational achievement, both indicate the importance of finding ways to support children with working memory difficulties in the classroom. This is an important avenue for future research and may be useful for closing the socioeconomic gap in educational achievement.

Coping Strategies and Inequalities during the COVID-19 Pandemic Period: Evidence from Kenya

Abstract Governments worldwide have implemented stringent lockdown measures in response to the COVID-19 pandemic outbreak, which had an adverse impact on employment, affecting people's public life, health and well-being. People have witnessed job losses, cuts in wages and a decline in their living standards. This study aims to estimate the inequalities and well-being costs, demonstrating the living standards necessary to make up for people's wage reduction or job losses. In particular, we aim to explore the coping strategies used to enhance their well-being compared to those of households without a coping strategy. We use food insecurity as a measure of well-being outcome. The empirical analysis relies on detailed household surveys from the World Bank Microdata Library. We use seven waves of the Panel COVID-19 Rapid Response Phone Survey with Households in 2020–2022 in Kenya. Also, the results highlight the potential inequalities of the COVID-19 pandemic across gender and types of workers, such as those employed in the informal sector and on temporary contracts. The findings show that specific coping strategies, such as delayed payment obligations, credit purchases and reduced non-food consumption, are associated with larger inequalities. Regarding the gender of the head of the household, the results suggest that the disparities between female-headed households that had to cope with income and employment loss and female-headed households that did not require to follow any strategy are significantly higher compared to their male counterparts. We derive similar concluding remarks when we consider households with social security coverage and the type of employment contract.

Examining the relationship between biomarkers of immune aging and prevalent physical disability in the health and retirement study.

Large social inequities have been repeatedly observed in physical disability. While inflammation has been identified as a potential underlying biological mechanism to proxy immune processes, the general inflammatory measures available in many population health studies lack specificity in capturing the complex nature of immune function. Therefore we sought to examine whether specific biomarkers of immune function are associated with the prevalence of physical disability. We leveraged data from 8,543 adults (mean age = 69 years, 54 % women) in the nationally-representative Health and Retirement Study and employed gender-stratified Poisson regression models to examine whether a more aged immune profile, indicated by higher values in each marker of immune aging (CD8+:CD4+, EMRA CD4+:Naïve CD4+, EMRA CD8+:Naïve CD8+, and CMV IgG), was associated with a higher prevalence of activities of daily living (ADL) disability. After adjustment, among women, one standard deviation (SD) increase in CMV IgG was associated with 12 % higher prevalence of ADL disability (PR: 1.12; 95 % CI: 1.04, 1.21). Similarly each 1-SD increase in the CD8 + CD4 + ratio was associated with a 9 % higher prevalence of ADL disability (PR: 1.09; 95 % CI: 1.03, 1.16). No associations were observed among men across any of the immune measures. Our findings provide initial support that biomarkers of immune aging may serve as an important mechanism in understanding physical disability, particularly among women.

All-cause and cause-specific mortality inequalities between people with and without disability: a nationwide data linkage study in Australia

Without high-quality statistics on mortality inequalities, designing policies to improve the health of people with disability is challenging. We aim to quantify mortality inequalities experienced by people with disability in Australia. In this nationwide, data linkage study we used Census mortality linked data (2011-20) to construct a cohort of Australians aged 0-74 years. Disability was measured as requiring assistance or supervision in core daily activities. We estimated age-standardised and age-specific mortality rates, and absolute and relative mortality inequalities between people with and without disability. 15 216 195 people were included in the study, comprising 7 763 047 females and 7 453 148 males. Of the participants, 258 109 (3·5%) males and 228 658 (2·9%) females reported disability, with 462 990 deaths occurring over 138 540 359 person-years of follow-up. Per 100 000 person-years, there were 2067 (95% CI 2043-2091) more deaths in males and 1697 (1677-1718) more deaths in females with disability (3·69 and 4·64 times higher, respectively) than those without disability. Cancer and cardiovascular disease had the highest absolute inequalities, with rate differences of 462 (95% CI 449-476) for males and 368 (356-379) for females for cancer, and 471 (95% CI 459-483) for males and 333 (324-342) for females for cardiovascular disease. Less common causes among people without disability-neurological conditions, chronic lung diseases, endocrine diseases, and digestive diseases-are relatively common among people with disability, translating to high relative mortality inequalities. The largest relative inequalities were from neurological conditions, with rate ratios of 9·66 (95% CI 9·31-10·02) for males and 11·61 (11·13-12·10) for females. Relative and absolute inequalities were also substantial for unintentional injury and for suicide mortality. Age-specific mortality was consistently higher in people with disability. The leading contributors to absolute inequalities shifted from neurological conditions in younger ages to cancer, cardiovascular diseases, and chronic lung diseases in older ages. People with disability experience large mortality inequalities. Identifying intervention-amenable factors contributing to these inequalities should be a priority. Targeted interventions and policy reforms to create a more inclusive social and health-care environment for people with disability might be necessary. The University of Melbourne.

A maternal and child health administrative cohort in Scotland: the utility of linked administrative data for understanding early years' outcomes and inequalities

IntroductionThe early years are considered one of the most impactful points in the life course to intervene to improve population health and reduce health inequalities because, for example, both ill health and social disadvantage can track into adulthood. Scotland's outstanding systems for data linkage offer untapped potential to further our understanding of when and why inequalities in child health, development and wellbeing emerge. This understanding is vital for the consideration of policy options for their reduction. MethodsBirth registrations, hospital episodes, dispensed community prescriptions, child health reviews and immunisation records were linked for 198,483 mother-child pairs for babies born in Scotland from October 2009 to the end of March 2013, followed up until April 2018 (average age 6 years). ResultsOutcomes include birthweight and newborn health, dispensed prescriptions for mental health medications, tobacco smoke exposure, infant feeding, immunisations, hospitalisation for unintentional injuries, socio-emotional, cognitive and motor development, and overweight and obesity. Several measures are repeated throughout childhood allowing examination of timing, change and persistence. Socio-economic circumstances (SECs) include neighbourhood deprivation, relationship status of the parents, and occupational status. Descriptive analyses highlight large inequalities across all outcomes. Inequalities are greater when measured by family-level as opposed to area-level, aspects of socio-economic circumstances and for persistent or more severe outcomes. For example, 41.4% of the most disadvantaged children (living with a lone, economically inactive mother in the most deprived fifth of areas) were exposed to tobacco smoke in utero and in infancy/toddlerhood compared to <1% in the least disadvantaged children (living with a married, managerial/professional mother in the least deprived quintile of areas). ConclusionThis novel linkage provides a longitudinal picture of health throughout the early years and how this varies according to family- and area-level measures of SECs. Future linkages could include other family members (e.g. siblings, grandmothers) and other sectors (e.g. education, social care). The creation of additional cohorts would allow for long-term and efficient evaluation of policies as natural experiments.

Cities beyond proximity.

The concept of 'proximity-based cities' has gained attention as a new urban organizational model. Most prominently, the 15-minute city contends that cities can function more effectively, equitably and sustainably if essential, everyday services and key amenities are within a 15-minute walk or cycle. However, focusing solely on travel time risks overlooking disparities in service quality, as the proximity paradigm tends to emphasize the mere presence of an element in a location rather than bringing up more complex questions of identity, diversity, quality, value or relationships. Transitioning to value-based cities by considering more than just proximity can enhance local identity, resilience and urban democracy. Fostering bottom-up initiatives can create a culture of local care and value, while predominantly top-down governing strategies can lead to large inequalities. Balancing these approaches can maximize resilience, health and sustainability. This equilibrium has the potential to accompany sustainable growth, by encouraging the creation of innovative urban solutions and reducing inequalities.This article is part of the theme issue 'Co-creating the future: participatory cities and digital governance'.

Perinatal Health Insurance And Health Care Use By Immigration Status In 6 US States, 2020-22.

Some noncitizens in the US are not eligible for public health insurance, potentially reducing access to preconception, prenatal, and postpartum care. We compared insurance coverage and health care use from the preconception period to the postpartum period by immigration status, using representative survey data collected from six US states between 2020 and 2022. Respondents were surveyed at two to six months postpartum and at twelve to fourteen months postpartum. Immigration status was classified in three categories: US citizen, permanent resident, and people who were neither citizens nor permanent residents. Compared with US citizens, fewer permanent residents had late postpartum insurance coverage, but coverage rates were otherwise similar. Coverage was lower among noncitizens/non-permanent residents compared with US citizens at every time point except pregnancy, with the largest differences at preconception (50.5percent and 90.5percent, respectively) and late postpartum (53.2percent and 95.1percent, respectively). Fewer permanent residents had health care visits before pregnancy compared with US citizens, but health care use was otherwise similar. Noncitizens/non-permanent residents had substantially lower rates of preconception health care, early and adequate prenatal care, postpartum visits, and having a usual source of care at one year postpartum. Expansion of public insurance to cover immigrants is needed to reduce large inequities in perinatal health insurance and health care use by immigration status.

8.E. Skills building seminar: Methods for measuring the true health cost of pollution

Abstract Healthy environments are essential for physical and mental wellbeing. Air pollution is considered to be one of the most significant environmental risk factors for ill health and premature death within the European Union. Poor air and noise quality have been linked to the exacerbation of symptoms, hospital admissions, and even premature deaths, especially for those with cardiorespiratory diseases. The associated medical costs and productivity losses therefore also impose a large economic cost. Exposure to environmental stressors disproportionately affects socially disadvantaged groups, and therefore contributes to the large socioeconomic inequities in health observed persistently in Europe. The EU has prioritised action on causes of pollution. For example, its Green Deal outlines ambitious plans to address climate challenges such as pollution and align air quality ambitions closer to the World Health Organization guidelines. Likewise, the European Environmental Agency routinely monitors the mortality burden associated with air pollution, while the impact of environmental noise on European citizens is examined through the Environmental Noise Directive. While in the political scene there is interest to advance the reduction of pollution, efforts are hindered by the lack of an harmonized methodology to quantify the socioeconomic cost of environmental stressors. Currently, researchers working with the burden of disease framework face many challenges in its application in the context of environmental stressors. Among others, these challenges include unmet data needs and major lack of transparency in methodological developments. In this skills-building seminar, we will outline an integrated approach for measuring the true health cost of pollution. This approach is currently being trialled in the EU-funded BEST-COST project, which sets out to improve methodologies for understanding the socioeconomic cost of environmental stressors, focusing on air and noise pollution. The project brings together a consortium of 17 partners from Europe and the USA, and is led by Sciensano, the Belgian institute for health. Through a synergy of theoretical outlines and real-life examples, seminar participants will gain methodological insights in the three key components of this integrated approach - i.e., the quantification of the health burden of environmental stressors via comparative risk assessment, the monetization of Disability-Adjusted Life Years to assess economic impact, and the quantification of environmental health inequalities via a novel area-level based framework. Key messages • There are significant unmet needs with respect to both data and methodologies for quantifying the socioeconomic cost of environmental stressors. • We outline an integrated approach for measuring the true health cost of pollution, combining health burden, economic burden, and environmental health inequalities.

Feasibility study to boost ascertainment of FH in diverse primary care populations using FAMCAT tool and pharmacist review

Abstract Background Familial Hypercholesterolaemia (FH) is a greatly underdiagnosed genetic lipid disorder with high risk of morbidity from premature cardiovascular disease. However, early diagnosis can significantly reduce cardiovascular risk with lipid-lowering medicines. Patients identified with high risk primary dyslipidaemia are recommended for lipid clinic referral to inform patient management. Improving FH identification and addressing ethnic disparities in dyslipidaemia management, is a current NHS priority in the UK. Aim We aimed to explore inequalities in the FH care pathway within and across areas with different socio-demographic UK populations. Methods The study was carried out in 6 general practices in the South East of England with divergent ethnic densities and socioeconomic status. Eligible patients aged 18 years or over, fulfilling the NICE (1), Simon-Broome (2) and current NHS Directed Enhanced Service criteria (3) for possible FH were screened using our previously validated PRIMIS FAMCAT2 tool (4) to prioritise those most likely to have FH. The PRIMIS FAMCAT2 tool generated a report highlighting patients with a "High Risk" of FH Tier 1 and a "Higher Risk if family history is positive" of FH- Tier 2. Tier 1 patients were assessed for FH using local lipid pathways. For the 243 Tier 2 patients, an online family history questionnaire/telephone enquiry was administered. The accuracy of the information collected was assessed by a practice-based clinical pharmacist (overseen by the GP). This included repeat testing for full lipid profile, excluding secondary causes of raised cholesterol. New patients meeting the criteria for FH were referred to a lipid/specialist clinic to assess for genetic testing. Patients who did not meet the FH criteria were managed accordingly to the local lipid pathways. Results 131,930 records from 6 general practices in South East England were screened using the PRIMIS FAMCAT tool. In total, the high priority list yielded 369 patients (126 Tier 1 and 243 Tier 2). Ethnicity breakdown was White (40%), Asian (8%), Black African/Caribbean (22%), Mixed (14%), Other (16%) NS (1%). A total of 25/369 (7%) patients were previously referred to lipid clinics (4 underwent genetic testing, 2 had confirmed FH, 12 did not have FH, and 7 were not seen/missed appointments). There were 14/244 (4%) new referrals to lipid clinics. Only 1 patient had received a coded FH diagnosis in the primary care record. For Tier 2 patients, 65/243 (27%) patients completed an online family history questionnaire, the remainder were ascertained by phone (75% response rate overall). Conclusion Incorporating enhanced case-finding from electronic medical records based on current guidelines, and online family history questionnaire can enhance FH identification. However large inequalities remain in referral, attendance and testing at lipid clinics, and further work is underway to evaluate the FH care pathway in diverse populations.

Spatial inequality in unsolved crimes: Evidence from small neighborhoods

AbstractUsing administrative data on the universe of police recorded crime linked to judicial outcomes for England and Wales from January 2013 to December 2018, we document—for the first time—large and persistent spatial inequalities in the proportion of solved and unsolved crimes across small neighborhoods covering a whole country. We find substantial differences across neighborhoods in the same municipality or police force. Fixed effects decompositions suggest that neighborhoods have different clearance rates across different crimes and that high‐crime neighborhoods also have high clearance rates, but with substantial heterogeneity across offences. Clearance rates correlate systematically with neighborhood composition.

Inclusion of disability in primary healthcare facilities and socioeconomic inequity in Brazil.

To describe disability-related performance and inequality nationwide in Brazil, and the changes that took place between 2012 and 2019 after the introduction of Programme for Improving Primary Care Access and Quality (PMAQ). We derived scores for disability-related care and accessibility of primary healthcare facilities from PMAQ indicators collected in round 1 (2011-2013), and round 3 (2015-2019). We assessed how scores changed after the introduction of PMAQ. We used census data on per capita income of local areas to examine the disability-specific care and accessibility scores by income group. We undertook ordinary least squares regressions to examine the association between PMAQ scores and per capita income of each local area across implementation rounds. Disability-related care scores were low in round 1 (18.8, 95%CI 18.3-19.3, out of a possible 100) and improved slightly by round 3 (22.5, 95%CI 22.0-23.1). Accessibility of primary healthcare facilities was also poor in round 1 (30.3, 95%CI 29.8-30.8) but doubled by round 3 (60.8, 95%CI 60.3-61.3). There were large socioeconomic inequalities in round 1, with both scores approximately twice as high in the richest compared to the poorest group. Inequalities weakened somewhat for accessibility scores by round 3. These trends were confirmed through regression analyses, controlling for other area characteristics. Disability-related and accessibility scores also varied strongly between states in both rounds. People with disabilities are being left behind by the Brazilian healthcare system, particularly in poor areas, which will challenge the achievement of universal health coverage.

Current challenges for plant biology research in the Global South.

In an attempt to address the large inequities faced by the plant biology communities from the Global South (i.e. countries located around the tropics and the Southern Hemisphere) at international conferences, this Viewpoint is the reflexive thinking arising from the concurrent session titled 'Arabidopsis and its translational research in the Global South' organized at the International Conference of Arabidopsis Research 2023 (ICAR 2023) in Chiba, Japan in June 2023. Here, we highlight the main obstacles plant biology communities in the Global South face in terms of knowledge production, as measured by the unequal production and citation of publications, investigating and advancing local plant genomics and biodiversity, combating disparities in gender and diversity, and current initiatives to break isolation of scientists.

A large deviation inequality for the rank of a random matrix

A large deviation inequality for the rank of a random matrix

Large sieve inequalities for periods of Maass forms

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