Magnitude Of Inequalities Research Articles

Inequalities in Complementary Feeding Programs in Randomized Intervention and Nonintervention Areas after Program Implementation in Bangladesh, Ethiopia, and Vietnam

BackgroundChildren in the 6–23-mo age group need to consume adequate energy and nutrients for healthy growth, brain development, cognition, and future productivity. Yet, large deficits remain. Complementary feeding practices can be improved on a large scale, but whether interventions reach and benefit disadvantaged mothers is not known. ObjectivesTo assess inequalities in complementary feeding practices and coverage following large-scale program implementation in 3 low- and middle-income countries. MethodsWe re-analyzed evaluation data from randomized controlled studies conducted in Bangladesh, Ethiopia, and Vietnam and calculated socioeconomic inequality using Erreygers index for intervention and nonintervention areas. Intervention coverage indicators were developed in each country for interpersonal communication, community mobilization, agricultural extension, and media. We compared the direction and magnitude of inequalities in intervention and nonintervention areas. ResultsAt the endline, coverage, and practices related to complementary feeding were better in intervention areas, but coverage and practices favored the better-off and more educated mothers. In Bangladesh, only 5, and in Vietnam, only 1 out of 16 coverage variables measured favored disadvantaged mothers or were neutral; in Ethiopia, out of 18 coverage variables measured, 11 favored disadvantaged mothers or were neutral, and in all 3 countries, only 5–6 variables out of 16 that were measured favored disadvantaged mothers or were neutral. ConclusionsInequalities exist both in how children in the 6–23-mo age group are fed and in programs aimed at improving complementary feeding practices. Programs favor the better-off and more educated mothers. We need to better understand context-specific program barriers and tailor targeted interventions to reach disadvantaged mothers.

Inequalities in non-communicable disease management in China and progress toward universal health coverage: an analysis of nationwide household survey data from 2004 to 2018

Prevention and control of non-communicable diseases (NCDs) become a policy priority in Universal Health Coverage (UHC) in China, while NCD management has never been comprehensively estimated at national and subnational levels. We aimed to assess NCD management in China nationally and in key subpopulations, investigate inequalities from multidimensions, and further examine its association with health financing and resources. Data included were from China Chronic Disease and Risk Factors Surveillance (CCDRFS) and China Health and Nutrition Survey (CHNS). Following the WHO recommended frameworks, we selected eight NCD health service and risk management indicators and used meta-analysis to construct the composite NCD index. We explored the trends in and projections of NCD management index and indicators at national and subnational levels by using Bayesian regression models with average annual percentage change (AAPC) from 2004 to 2018 and probability of reaching the UHC target by 2030. We further conducted comprehensive inequality analyses of NCD indicators from multidimensions with patterns of changes over time using absolute difference and relative ratio. Finally, we quantified the associations between NCD management performance with health financing and resources using stochastic frontier analysis. In China, the NCD management index increased slowly from 62.0% (95% CI 36.0 to 84.0) in 2004 to 64.3% (95% CI 44.0 to 82.2) in 2018, with lagging performance being observed in prevention domain (AAPC-0.1%, 95% CrI-1.0 to 0.8). And all management indicators presented low probabilities of accomplishing 2030 targets in China. Notably, based on subnational analysis, diverse tendency and magnitude of inequalities in multiple NCD indicators were identified with widening gaps between genders (non-overweight, diabetes treatment), age groups (non-use of tobacco), urban-rural areas (non-use of alcohol, non-use of tobacco), regions (sufficient physical activity), and wealth quintiles (non-overweight, sufficient physical activity). Additionally, it was observed that compared with urban area, rural area had constantly lower health resources and presented 2.2% lower NCD management performance in 2018. Importantly, we found that health financing and resources especially distributed in primary health care (PHC) facilities were closely and positively associated with NCD management performance. A 1000 yuan increase of government health expenditure (GHE) per capita and a 10 increase of medical beds per 1000 capita in PHC facilities were associated with a 4.0% (95% CI 2.0 to 6.0) and 6.8% (95% CI 0.2 to 13.5) increase of NCD management index, respectively. The progress towards NCD management is slow at national level and in key subpopulations in China, with great challenges of existing and widening inequalities between genders, age groups, urban-rural areas, regions and socioeconomic groups. Rural and old people were still vulnerable populations who were lagging behind in NCD prevention and control. Optimising resource allocation by strengthening PHC especially in rural area, developing tailor-made programmes targeting specific populations such as old individuals, simultaneously integrating gender, education, and economic interventions to reduce inequalities should be prioritised to help China tackle NCDs during the progress towards UHC. National Natural Science Foundation of China.

Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis.

BackgroundMaternal mortalities remain high in the Lao People’s Democratic Republic (Lao PDR). Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011–12 and 2011–12 to 2017.MethodsWe used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011–12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women’s age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots.ResultsThe coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011–12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values.ConclusionThere was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011–12 while between 2011–12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011–12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits.

Socioeconomic inequalities in physical activity among older adults before and during the COVID-19 pandemic: evidence from the English Longitudinal Study of Ageing

IntroductionThe influence of the COVID-19 pandemic on physical activity behaviour in older adults is of particular concern. However, little is yet known about how pre-existing socioeconomic inequalities in older adults’...

Inequalities in early initiation of breastfeeding in Bangladesh: an estimation of relative and absolute measures of inequality

BackgroundEvidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality.MethodsWe used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO’s Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported.ResultsAn uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child.ConclusionsThe highest attention should be placed in Bangladesh to attain the WHO’s 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations.

The socioeconomic distribution of life expectancy and healthy life expectancy in Chile

BackgroundLife expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population.MethodsBased on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs.ResultsLE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals.ConclusionThe distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.

The relationship between Quality and Outcomes Framework scores and socioeconomic deprivation: a longitudinal study.

The Quality Outcomes Framework (QOF) is a pay incentive scheme in England designed to improve and standardise general practice. QOF attainment has been used as a proxy for primary care quality in previous research. To investigate whether there is a relationship between socioeconomic deprivation and QOF attainment in primary care in England. Retrospective longitudinal study of primary care providers in England. QOF scores were obtained for individual general practices in England from between 2007-2019 and linked to practice-level Indices of Multiple Deprivation (IMD) scores derived from census data. Beta regression analyses were used to analyse the relationship with either percentage of total QOF attainment or of domain-specific attainment with multivariate analyses, adjusting for additional practice-level demographics. QOF attainment in the most affluent quintile was used as the reference group. General practices in less deprived areas have consistently outperformed those in more deprived areas in terms of QOF achievement. Initially, the gap between least and most deprived practices decreased, however since 2015 there has been relatively little change in comparative performance. The magnitude of inequality was reduced after adjusting for demographic factors. Of the independent variables analysed, the proportion of patients aged >65 years ('over 65s') had the strongest relationship with QOF attainment. There remains an inequality in primary care quality by socioeconomic deprivation in England, even after accounting for demographic differences.

Socioeconomic inequalities in patient-reported outcome measures of Dutch primary hip and knee arthroplasty patients for osteoarthritis

To study socio-economic inequalities in patient-reported outcomes in primary hip and knee arthroplasty (THA/TKA) patients for osteoarthritis, using two analytical techniques. We obtained data from 44,732 THA and 30,756 TKA patients with preoperative and 12-month follow-up PROMs between 2014 and 2020 from the Dutch Arthroplasty Registry. A deprivation indicator based on neighborhood income, unemployment rate, and education level was linked and categorized into quintiles. The primary outcome measures were the EQ-5D-3L index and Oxford Hip/Knee Score (OHS/OKS) preoperative, at 12-month follow-up, and the calculated change score between these measurements. We contrasted the most and least deprived quintiles using multivariable linear regression, adjusting for patient characteristics. Concurrently, we calculated concentration indices as a non-arbitrary tool to quantify inequalities. Compared to the least deprived, the most deprived THA patients had poorer preoperative (EQ-5D -0.03 (95%CI -0.02, -0.04), OHS -1.26 (-0.99, -1.52)) and 12-month follow-up health (EQ-5D -0.02 (-0.01, -0.02), OHS -0.42 (-0.19, -0.65)), yet higher mean change (EQ-5D 0.02 (0.01, 0.03), OHS 0.84 (0.52, 1.16)). The most deprived TKA patients had similar results. The higher mean change among the deprived resulted from lower preoperative health in this group (confounding). After accounting for this, the most deprived patients had a lower mean change. The concentration indices showed similar inequality effects and provided information on the magnitude of inequalities over the entire socio-economic range. The most deprived THA and TKA patients have worse preoperative health, which persisted after surgery. The concentration indices allow comparison of inequalities across different outcomes (e.g., revision risk).

Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades

BackgroundMaternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades.MethodsData from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO’s Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure.ResultsAn increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5–61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2–14.5), and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4–29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7–14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time.ConclusionTo increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation.

Socioeconomic disparities and concentration of the spread of the COVID-19 pandemic in the province of Quebec, Canada

BackgroundRecent studies suggest that the risk of SARS-CoV-2 infection may be greater in more densely populated areas and in cities with a higher proportion of persons who are poor, immigrant, or essential workers. This study examines spatial inequalities in SARS-CoV-2 exposure in a health region of the province of Quebec in Canada.MethodsThe study was conducted on the 1206 Canadian census dissemination areas in the Capitale-Nationale region of the province of Quebec. The observation period was 21 months (March 2020 to November 2021). The number of cases reported daily in each dissemination area was identified from available administrative databases. The magnitude of inequalities was estimated using Gini and Foster-Greer-Thorbecke (FGT) indices. The association between transmission and socioeconomic deprivation was identified based on the concentration of transmission in socially disadvantaged areas and on nonparametric regressions relating the cumulative incidence rate by area to ecological indicators of spatial disadvantage. Quantification of the association between median family income and degree of exposure of dissemination areas was supplemented by an ordered probit multiple regression model.ResultsSpatial disparities were elevated (Gini = 0.265; 95% CI [0.251, 0.279]). The spread was more limited in the less densely populated areas of the Quebec City agglomeration and outlying municipalities. The mean cumulative incidence in the subsample made up of the areas most exposed to the pandemic was 0.093. The spread of the epidemic was concentrated in the most disadvantaged areas, especially in the densely populated areas. Socioeconomic inequality appeared early and increased with each successive pandemic wave. The models showed that areas with economically disadvantaged populations were three times more likely to be among the areas at highest risk for COVID-19 (RR = 3.55; 95% CI [2.02, 5.08]). In contrast, areas with a higher income population (fifth quintile) were two times less likely to be among the most exposed areas (RR = 0.52; 95% CI [0.32, 0.72]).ConclusionAs with the H1N1 pandemics of 1918 and 2009, the SARS-CoV-2 pandemic revealed social vulnerabilities. Further research is needed to explore the various manifestations of social inequality in relation to the pandemic.

Inequalities in unmet need for health care services and medications in Brazil: a decomposition analysis

Unmet need is a metric used to assess the performance of health care systems throughout the world. One of the primary objectives of the Brazilian health care system is to identify ways to improve the health outcomes of all citizens. To accomplish this challenging goal, the health care system in Brazil will need to identify and eliminate barriers and provide timely and adequate access to health care services to all. This study assessed the performance of the Brazilian health care system by focusing on the unmet need for health care services and medications. We evaluated the Brazilian National Health Survey data collected in 2013 and 2019 to determine the magnitude of socioeconomic-related inequalities associated with unmet health care needs. Primary contributing factors were identified via decomposition analysis of the calculated concentration indices (CInds). Despite the availability of universal health care, 3.8% and 7.5% of the population in Brazil reported unmet needs for health care services and medications, respectively in the 2019 survey. Although the overall unmet need for medications remained unchanged between 2013 and 2019, CInd analysis revealed significant pro-poor inequalities with respect to unmet needs for both health care services and medications. The overall magnitude of these inequalities was higher in the poorer regions of the country. The use of private health insurance as well as individual health and socioeconomic status contributed significantly to the inequalities associated with unmet needs for health care services and medication throughout Brazil. Policy interventions should focus on improving access to health care services, extending coverage to include pharmaceuticals, and targeting both financial and non-financial barriers to obtaining care, particularly those experienced by the poor and vulnerable populations in Brazil. None.

Inequality and Welfare by Food Expenditure Components.

This paper examines inequality and welfare in food consumption expenditure in Pakistan. The indices are derived on the basis of Sen’s welfare function by employing HIES, 2005-06. The empirical results show that inequality and welfare varied widely in urban and rural areas. It can be seen that the concentration index of non essential/luxury food components are unevenly distributed over the total expenditure in favour of rich families. The price elasticity of welfare indicates that rising prices of food components have negative effect on the aggregate welfare. The present analysis provides a basis for determining the magnitude of inequality and welfare that can help in designing appropriate policies. JEL classification: D12, D13, D31, I31 Keywords: Food Consumption, Inequality, Welfare, Elasticity

Local Welfare Systems and Health Inequalities: The Effects of Institutional Overlapping and Local Variations.

A growing research agenda shows the importance of local welfare systems in understanding socio-spatial inequalities in health. Welfare services provided by local governments overlap with those provided by other levels of government. Thus, differences in the provision of welfare services between municipalities could explain differences in residents' health, moderating the magnitude of health inequalities if local governments deploy actions capable of positively influencing the social determinants of health. This article attempts to analyse this idea in the Spanish case, exploring the influence of local policies according to the orientation of municipal spending on three indicators of the population's health status: self-perceived health, healthy practices and activity limitations due to health problems. A multilevel cross-sectional study was designed using information from two waves of the 2006-2007 and 2011-2012 National Health Survey for the population aged 15 years and older (N = 31,378) residing in Spanish municipalities of 20,000 inhabitants or over (N = 373). The results show that the magnitude of inequalities in self-perceived health, in the adoption of healthy practices and in daily activity limitations by social class are smaller as municipalities" spending was oriented towards policy areas considered as redistributive. Therefore, the proposed institutional overlap thesis could help understand the role of subnational governments on the magnitude of health inequalities, as well as in comparative analysis between countries with institutional systems in which local governments have a greater or lesser capacity to provide welfare services.

Deprivation trends in potentially avoidable medical hospitalisations of under-25-year-old Māori and non-Māori non-Pacific in Aotearoa New Zealand: a 20-year perspective

ABSTRACT Unnecessary hospitalisations for preventable or treatable conditions provides an indication of the health of a country and its systems. We present data on potentially avoidable hospitalisations of Māori and non-Māori non-Pacific (NMNP) under-25-year-olds for medical conditions during the period 2000–2019, with particular focus on the magnitude of inequity by area deprivation. Potentially avoidable hospitalisation rates of under-25 years for medical conditions were consistently higher for Māori than for NMNP over the 20-year study period. The absolute difference in potentially avoidable hospitalisation rates between the most and least deprived areas were greater for Māori than for NMNP in all years of the study. Respiratory conditions and skin infections accounted for more than 60% of potentially avoidable hospitalisations of Māori under-25-year-olds. The persistent trends in deprivation-based inequities in health outcomes for Māori, on both absolute and relative scales, suggest greater attention needs to be paid to implementing effective policy focussed on reducing these deprivation-based inequities and on improving access to and quality of care.

Trends in, projections of, and inequalities in non-communicable disease management indicators in Vietnam 2010-2030 and progress toward universal health coverage: A Bayesian analysis at national and sub-national levels.

SummaryBackgroundMovement towards Universal Health Coverage (UHC) can improve health services, risk factor management, and inequality in non-communicable diseases (NCD); conversely, prioritizing and monitoring NCD management can support pathways to UHC in resource-limited settings. We aimed to estimate trends in NCD management indicators in Vietnam from 2010, and projections to 2030 at national and sub-national levels; compute the probability of reaching UHC targets; and measure inequalities in NCD management indicators at demographic, geographic, and socio-economic levels.MethodsWe included data of 37,595 households from four nationally representative surveys from 2010. We selected and estimated the coverage of NCD health service and risk management indicators nationally and by six sub-national groups. Using Bayesian models, we provided trends and projections and calculated the probability of reaching UHC targets of 80% coverage by 2030. We estimated multiple inequality indices including the relative index of inequality, slope index of inequality, and concentration index of inequality, and provided an assessment of improvement in inequalities over the study period.FindingsNationally, all indicators showed a low probability of achieving 2030 targets except sufficient use of fruit and vegetables (SUFV) and non-use of tobacco (NUT). We observed declining trends in national coverage of non-harmful use of alcohol (NHUA), sufficient physical activity (SPA), non-overweight (NOW), and treatment of diabetes (TOD). Except for SPA, no indicator showed the likelihood of achieving 2030 targets at any regional level. Our model suggested a non-achievement of 2030 targets for all indicators in any wealth quintile and educational level, except for SUFV and NUT. There were diversities in tendency and magnitude of inequalities with widening gaps between genders (SPA, TOD), ethnic groups (SUFV), urban-rural areas (TOH), wealth quintiles, and educational levels (TOD, NUT, NHUA).InterpretationOur study suggested slow progress in NCD management at the national level and among key sub-populations in Vietnam, together with existing and increasing inequalities between genders, ethnicities, geographic areas, and socioeconomic groups. We emphasised the necessity of continuously improving the healthcare system and facilities, distributing resources between geographic areas, and simultaneously integrating economic, education, and gender intervention and programs.FundingNone.

Income- and education-based inequalities of edentulism and dental services utilization in Brazil.

Tooth loss is a worldwide public health problem affecting mainly socioeconomically disadvantaged groups. Dental services utilization may increase access to preventive actions and conservative treatment, reducing the prevalence of tooth loss. This study evaluated the income- and education-based inequalities in edentulism according to the utilization of dental services among adults and older adults in Brazil. Data from the National Oral Health Survey (SB Brazil, 2010) of adults (ages 35-44 years, n=9779) and older adults (ages 65-74 years, n=7619) were analysed. Socioeconomic indicators (SES) included education and income. The magnitude of inequality in edentulism by education and income levels was estimated by the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). The changes in the RII and SII according to the utilization of dental services were estimated. Regression models estimated the association between SES and edentulism and whether dental services utilization modified this association. Higher edentulism prevalence was observed among those with lower education and income levels. The utilization of dental services changed the education-based inequality index in edentulism for adults, with percentage changes of 17.4% (RII) and 56.8% (SII). For adults with low education (0-4 years of study), the odds of edentulism were 80% (OR 0.2; 95% CI 0.1-0.6) and 90% (OR 0.1; 95% CI 0.01-0.2) lower for those who had used dental services within the preceding year and within 1-2 years compared with those who had used such services within the preceding 3 or more years, respectively. There was a social gradient in the prevalence of edentulism in adults and older adults, and the education-based inequalities in edentulism were lower among adults reporting utilization of dental services in the preceding year.

Associations between socioeconomic status and pregnancy outcomes: a greater magnitude of inequalities in perinatal health in Montreal than in Brussels

BackgroundComparing health inequalities between countries helps us to highlight some factors specific to each context that contribute to these inequalities, thus contributing to the identification of courses of action likely to reduce them. This paper compares the associations between socioeconomic status (SES) and 1) low birth weight (LBW) and 2) preterm birth, in Brussels and Montreal (in general population, natives-born mothers, and immigrant mothers).MethodsA population-based study examining associations between SES and pregnancy outcomes was conducted in each city, using administrative databases from Belgian and Quebec birth records (N = 97,844 and 214,620 births in Brussels and Montreal, respectively). Logistic regression models were developed in order to estimate the relationship between SES (maternal education and income quintile) and pregnancy outcomes, in each region. The analyses were first carried out for all births, then stratified according to the mother’s origin.ResultsFor the general population, SES is associated with LBW and preterm birth in both regions, except for income and preterm birth in Brussels. The association is stronger for mothers born in Belgium and Canada than for those born abroad. The main difference between the two regions concerns the magnitude of inequalities in perintal health, which is greater in Montreal than in Brussels among the general population. For native-born mothers, the magnitude of inequalities in perinatal health is also greater for mothers born in Canada than for those born in Belgium, except for the association between income and preterm birth. The socioeconomic gradient in perinatal health is less marked among immigrant mothers than native mothers.ConclusionSignificant differences in inequalities in perinatal health are observed between Brussels and Montreal. These differences can be explained by : on the one hand, the existence of greater social inequalities in Montreal than in Brussels and, on the other hand, the lower vulnerability of immigrants with low SES in Brussels. Future studies seeking to understand the mechanisms that lead to inequalities in health in different contexts should take into account a comparison of immigration and poverty contexts, as well as the public policies related to these factors.

Intersecting sex-related inequalities in self-reported testing for and prevalence of Non-Communicable Disease (NCD) risk factors in Kerala

BackgroundNon-Communicable Diseases (NCDs) are among India’s top burdens, particularly in states like Kerala, which is at an advanced stage of the epidemiological transition. Evidence in India points towards intersectional inequalities in risk factors of NCDs and testing, both of which are understudied in Kerala. We estimated the self-reported testing and prevalence of key NCD risk factors—blood pressure (BP) and blood glucose (BG) comparing Kerala men and women across educational, wealth, religion, as well as caste and tribal status subgroups.MethodA multistage random sample survey of 3398 women and 2982 men aged 30 years and over was administered in 4 districts of Kerala from July to October 2019. Descriptive analysis for men and women was undertaken using survey weights. Slope index of Inequality and Relative Concentration Index for wealth and education related inequalities, and, Weighted Mean Difference from Mean and Index of Disparity for caste and tribal status, as well as religion related inequalities were calculated using World Health Organisation’s Health Equity Assessment Toolkit Plus and Stata 12.ResultsA significantly higher proportion of women reported BP and BG testing by medical personnel in the previous year than men (BP Testing among Women (BPTw): 90.3% vs BP Testing among Men (BPTM):80.8%, BG Testing among Women (BGTw): 86.2% vs BG Testing among Women (BGTM):78.3%). Among those tested, more women (11.2%) than men (7.9%) reported High Blood Pressure (HBP) but not High Blood Glucose (HBG). Testing for BP was concentrated among less-educated women while BG testing was concentrated among both less educated women and men. HBP and HBG were concentrated among less educated and wealthier groups. Although sex differences were insignificant across caste and tribal status and religion subgroups, magnitude of inequalities was high for HBP and HBG.ConclusionDistinct patterns of sex inequalities were present in self-reported testing and prevalence of NCD risk factors in Kerala. Education and wealth seem to be associated with testing while prevalence appeared to vary by religious groups. Given the low rates of illiteracy, it is encouraging but maybe a data artefact that a small population of less-educated persons was getting tested; however, exclusion of poor groups and inequalities by other dimensions raise concerns. Further exploration is needed to understand underlying mechanisms of these inequalities to ensure we leave no one behind.

Assessing the social patterning and magnitude of inequalities in sexual violence among young women in Uganda: Findings from 2016 demographic and health survey

ABSTRACT Sexual violence (SV) is a significant global public health problem. To develop effectively targeted interventions to prevent SV and allocate resources equitably requires identifying the most vulnerable groups and the magnitude of these social inequities. However, these data are currently lacking. Using the Uganda Demographic and Health Survey, we examined SV among all young women and ever-married young women. We conducted univariate and bivariate analyses to characterise the prevalence and social patterning of SV, and then utilised the World Health Organization Health Equity Assessment Toolkit (HEAT) to assess the magnitude of social inequities in SV. At the national level, 5.5% among all young women and 20.5% of ever-married young women had experienced SV. For all young women, the largest inequities in SV were based on sub-national region of residence. Among the ever-married young women, we found profound education, wealth and place-based inequities in SV, which favoured young women with higher education, in wealthier households, and within central regions of Uganda. Our findings suggest a need for regionally targeted multi-sectoral interventions that take into consideration that multiple intersecting social dimensions such as education, poverty and the safe built environment, to address young women's risk for SV.

Assessing neo-natal mortality trends in Pakistan: an insight using equity lens

BackgroundAlmost 2.5 million neonates died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of 5 years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across several dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation.MethodsThe study was done using raw data from the last three Pakistan Demographic & Health Surveys (2017–18, 2012–13 and 2006–07). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24.ResultsThe situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist.ConclusionsPresentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.