Measurement Of Socioeconomic Inequalities Research Articles

Socioeconomic inequalities in human papillomavirus knowledge and vaccine uptake: evidence from a cross-sectional study in China.

Providing the human papillomavirus (HPV) vaccine is effective to eliminate the disparity in HPV-related cancers. It is unknown regarding inequality in the distribution of HPV vaccination in China since the vaccine was licensed and approved for use in 2016. This study aimed to examine socioeconomic inequalities in HPV-related knowledge and vaccination and identified factors associated with such inequalities. Self-administered questionnaires measuring HPV-related knowledge and vaccine uptake were completed by 1,306 women through online survey platform. HPV knowledge was assessed using a 12-item question stem that covered the hazards of HPV infection, HPV vaccine dosage, benefits, and protection. Cluster analysis by combining monthly household income, educational level, and employment status was used to identify socioeconomic status (SES) class. The concentration index (CI) was employed as a measure of socioeconomic inequalities in HPV-related knowledge and vaccination. Linear regression and logistic regression were established to decompose the contributions of associated factors to the observed inequalities. The CI for HPV-related knowledge and vaccine uptake was 0.0442 and 0.1485, respectively, indicating the higher knowledge and vaccination rate were concentrated in groups with high SES. Education and household income made the largest contribution to these inequalities. Age, residency and cervical cancer screening were also important contributors of observed inequalities. Socioeconomic inequalities in HPV-related knowledge and vaccination uptake are evident in China. Interventions to diffuse HPV-related information for disadvantaged groups are helpful to reduce these inequalities. Providing low or no-cost HPV vaccination and ensuring accessibility of vaccines in rural areas are also considered to be beneficial.

Prevalence and intensity of cigarette smoking in Iranian households: measurement of socioeconomic inequality

ABSTRACT Background Cigarette smoking is one of the most important behavioral risk factors for chronic diseases. This study aimed to investigate socioeconomic inequalities in cigarette smoking (CS) among Iranian households. Methods Concentration index (C) was calculated to measure socioeconomic inequality in smoking and number of smoked cigarettes per month among households using data from the income-expenditure survey of the statistical center of Iran (SCI) in 2017. To identify the contribution of socioeconomic and demographic variables to the measured socioeconomic inequality, the C index was decomposed using Wagstaff method. Results The results indicated that 19.89% (N = 7547) of the households were smoking cigarettes with an average number of 87.91 (SD = 235.22) per month. The C index was −0.009 for smoking households (95% CI = −0.023, 0.006) and 0.004 (95% CI = −0.011, 0.019) for the number of cigarettes smoked per month and were not statistically significant. Most of provinces had pro-rich inequality in prevalence and intensity of CS. The province of residence had the highest contribution to inequality in smoking (66.82%) followed by SES and age of the household head. Conclusions The study concluded that the prevalence and intensity of cigarette smoking were more concentrated among low-SES groups. The strategies to control CS should be modified based on the province of residence, and socioeconomic inequalities in CS among households.

Ecological study of the association between socioeconomic inequality and food deserts and swamps around schools in Rio de Janeiro, Brazil

BackgroundPrevious research suggests that unhealthy community food environments around schools contribute to unhealthy eating habits and negative health outcomes among the youth. However, little is known about how socioeconomic inequalities in those community food environments are associated with food deserts and food swamps across schools’ neighborhoods.MethodsAn ecological study was carried out in all 3,159 public and private schools in Rio de Janeiro, Brazil. Three measures of socioeconomic inequality were evaluated: per capita income, segregation index and deprivation index. The community school food environment was analyzed by metrics of food swamps and food deserts.ResultsFood deserts and food swamps were simultaneously more prevalent in neighborhoods of the lowest income, high deprivation, and high segregation. Spatial socioeconomic disparities at the neighborhoods of schools were associated with food deserts and food swamps in Rio de Janeiro.ConclusionsOur results point to a spatial socioeconomic inequality of establishments that sell food around schools in a Brazilian metropolis, indicating that the areas of greatest deprivation of food services are also the areas with the worst socioeconomic characteristics.

Socio-economic inequality in reported dental self-care behaviour among Iranian households: A national pooled study.

Setting out effective prevention strategies in dental diseases needs recognition related factors of the prevention behaviours and targeting the most disadvantaged groups in the term of dental hygiene. This study aimed to investigate socio-economic inequality in the dental self-care status (DSS) of Iranian households and decompose the measured inequality into its contributors. In this cross-sectional study, pooled data were extracted from Households Income and Expenditure Surveys (HIESs) conducted in Iran from 2012 to 2017. The index of socio-economic status (SES) for each household was constructed using principal components analysis (PCA). We used Wagstaff normalized concentration index as a measure of socio-economic inequality in dental self-care. Decomposition analysis was applied to determine the main factors contributed to the measured inequality. The prevalence of dental self-care in the whole population was 40.56%. The total concentration index was 0.271 (CI: 0.266, 0.275). The results of decomposition analysis for the measured inequality showed that SES, was the highest positive contributors (90.19%) followed by sex of household's head (12.15%), place of residence (11.79%) and education level of household's head (11.71%). Furthermore, the province of residence had the highest negative contribution (-11.37) to the inequality. The findings of this study showed that a huge portion of the observed inequality was explained by SES that might give us a policy recommendation: There is room for improving dental health and reducing inequality in dental self-care by paying more attention to SES-disadvantaged households.

Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review

ObjectiveTo document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity.DesignScoping review.MethodsA search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo,...

Socioeconomic inequalities in COVID-19 DALYs in Scotland, 2020

AimOur aim was to estimate the overall, and inequalities in the, population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020.MethodsNational deaths and daily case data were input into the consensus model outlined by the European Burden of Disease Network, to estimate DALYs. Total Years of Life Lost (YLL) were estimated, and for each deprivation quintile of the Scottish population. Years Lived with Disability (2% of all DALYs) were proportionately distributed to deprivation quintiles, based on YLL estimates. Socioeconomic inequalities were measured by the Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. Results were presented as a range, using a sensitivity based on YLL estimates using: cause-specific; and COVID-19 related deaths.ResultsCOVID-19 DALYs ranged from 96,500 to 108,200 in 2020, representing the second leading cause of disease/injury in Scotland, in 2020. Marked socioeconomic inequalities were observed across several measures. The difference between the most and least deprived areas, measured by SII, was 2,048 to 2,289 DALYs per 100,000. The RII was 1.16, meaning that the rate in the most deprived areas was around 58% higher than the mean rate of the population. DALYs attributable to differences in socioeconomic status accounted for 40% of total COVID-19 DALYs.ConclusionsThe direct population health impact of COVID-19 in 2020 was substantial. Despite unprecedented mitigation efforts, in Scotland, a single case in early 2020 developed to having an impact second only to ischaemic heart disease. This impact was not shared equally, and socioeconomically deprived areas were hit hardest, a result confirmed across all measures of inequality. DALY estimation on both the ongoing direct, and indirect, pandemic harms will evidence the extent of impact on overall, and inequalities in, population health.Key messages The population impact of COVID-19 has been highly damaging. When measured by DALYs, the population health impact of COVID-19 in Scotland, during 2020, was second only to ischaemic heart disease.The population health impact of COVID-19 has not been shared equally, a result confirmed across all measures of socioeconomic inequality.

Socioeconomic Inequality in Colorectal Cancer Stage at Diagnosis Time in Qazvin City during 2014-2016: Concentration Curve Approach

Background: The impact of socioeconomic status on cancer survival has already been proven. Early diagnosis of cancer is one of the main reason of this improved survival among high socioeconomic status (SES) people. High SES people are more likely to take part in cancer screening programs for several reason and it seems that diagnosis of cancer is earlier among these people. Despite growing evidence on inequal in cancer survival, diagnosis, and treatment over the past decades there is a lack of evidence on volume and direction of socioeconomic inequality regarding early diagnosis of cancer in Iran. Objectives: To assess socioeconomic inequality in colorectal cancer stage at diagnosis time in Qazvin city, Iran during 2014 - 2016. Methods: A cross-sectional study was conducted on 200 patients who were diagnosed with colorectal cancer (CRC) at the Vellayat hospital of the Qazvin city. The Principal Component Analysis (PCA) approach was used to combine household assets as a proxy of SES. Cancer staging information was extracted from the patient's medical records and then a pathology specialist performed cancer staging. Descriptive statistics and a multiple logistic regression model were used to illustrate an association between CRC late diagnosis and socioeconomic status adjusted for age, sex, and residence of the area. We applied the standardized Concentration Index as a measure of socioeconomic inequality in CRC late diagnosis. Results: The overall percentage of late CRC diagnosis was 40.5% (95% confidence interval (CI) 33.8, 47.5), which was slightly higher among women (47.1%, 95% CI 36.8, 57.6) than men (35.4%, 95% CI, 27.0, 44.7). Logistic regression results spotted an association between SES and the late diagnosis of CRC. In Iranian women, CRC tended to be diagnosed at more advanced stages among the third (Odds Ratio (OR) = 7.68), forth (Low) (OR = 17.86) and fifth (Lowest) (OR = 25.60) SES quintiles, while in men it was only significant for the fifth quintiles (OR = 4.17). Furthermore, the concentration index implied that late CRC diagnosis is concentrated among deprived subgroups in Qazvin city, and it was statistically significant (Overall concentration index = -0.33, 95% CI -0.38, -0.28). It was estimated at -0.35 and -0.29 in Iranian women and men, respectively. Conclusions: According to this survey, CRC tends to be diagnosed at more advanced stages among low socioeconomic status groups, and the observed discrimination is more severe in Iranian women.

Income-Related Inequality in Traffic Accident Health Outcomes (Injury, Disability and Mortality): Evidence from the Nationwide Survey in Iran

Despite many efforts, Iran continues to have a high rate of traffic accidents and poor health outcomes. This study aimed to measure income-related inequality for traffic accident health outcomes in Iran, a country with one of the highest rates of traffic accidents and related health problems. The source of data was a national representative survey named the Iranian Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010). Monthly household income is obtained through self-report in different quarters. Disparity rate ratio (DRR), slop index of inequality (SII) and the population attributable risk percentage measure (PAR%) were calculated. The concentration index (CI) of RTIs was used as our measure of socioeconomic inequality and decomposed into its determining factors. Using the DRR index, in the lowest income group, the risk of death from an accident was 2.3 times, greater and the risk of accidental disability was 11.7 times greater than for the third income quartet. The slope index also shows that the rate of road traffic deaths, disability and injury per 100,000 individuals decreased by 28, 82, and 392 moving from lower to higher incomes. This decrease in injury was about 581 for motorcyclists. CI was -0.04078643 (SE=.01424828, P-value 0.004). Male sex (68.9%), 15-29 yr old age (9.4%), employed activity status (20.8%) has a positive contribution in the RTIs concentration index. In addition to intervention related to the road safety and vehicles and reducing human errors, prevention of the road traffic ill health outcomes requires attention to reduction of inequality in society.

Explaining Income-Related Inequalities in Dietary Knowledge: Evidence from the China Health and Nutrition Survey.

Lack of adequate dietary knowledge may result in poor health conditions. This study aims to measure income-related inequality in dietary knowledge, and to explain the sources of the inequality. Data were from the China Health and Nutrition Survey (CHNS) conducted in 2015. A summary of the dietary knowledge score and dietary guideline awareness was used to measure the dietary knowledge of respondents. The concentration index was employed as a measure of socioeconomic inequality and was decomposed into its determining factors. The study found that the proportion of respondents who correctly answered questions on dietary knowledge was significantly low for some questions. Compared to rural residents, urban residents had a higher proportion of correctly answered dietary knowledge questions. In addition, there are pro-rich inequalities in dietary knowledge. This observed inequality is determined not only by individual factors but also high-level area factors. Our study recommends that future dietary education programs could take different strategies for individuals with different educational levels and focus more on disadvantaged people. It would be beneficial to consider local dietary habits in developing education materials.

Comparing Cardinal and Ordinal Approaches to Measuring Socioeconomic Inequalities in Health

In the last decade, a literature has evolved showing that standard measures of inequality or probit regression are not well-suited for ordinal data such as self-reported health status. Conclusions may be easily reversed via different scaling of the ordinal indicator. This problem also concerns the measurement of socioeconomic inequalities by the concentration index (CI). Using the Survey of Health, Aging and Retirement in Europe (SHARE) we compare the performance of CI against the non-parametric method introduced by Duclos and Echevin (DE) to evaluate joint health-income distributions. We find that Poland is the worst country according to all three methods of computing CI, but it is the best country according to DE dominance curves. This indicates that when applied to ordinal health indicators, the CI approach relies on quite selective information about health-income distribution and should be treated with caution.

Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda

AimTo assess inequity in utilization of health care facilities during childbirth and factors associated with home births in Lira district, Northern Uganda.Subjects and methodsIn 2016, we surveyed 930 mothers with children under the age of 2 years in Lira district, Northern Uganda. We used multiple correspondence analysis to construct the wealth index in quintiles, based on household assets. The concentration index is the measure of socioeconomic inequality used in this article, which we calculated using the Stata DASP package. We also conducted multivariable logistic regression to assess factors associated with home births.ResultsA third of mothers (n = 308) gave birth from home [33%, 95% confidence interval (CI) (26%–41%)]. Giving birth at a health facility was pro-rich with a concentration index of 0.10 [95% CI (0.05–0.14)]. Upon decomposing the concentration index, the most important determinant of inequity was the mother's residence. Factors associated with home births in multivariable logistic regression included rural residence [adjusted odds ratio (AOR) 3.1, 95% CI (1.8–5.3)], precipitate labor [AOR 4.18, 95% CI (2.61–6.71)], and labor starting in the evening or at night. Mothers who had previously given birth from home were more likely to give birth at home again [AOR 40.70, 95% CI (18.70–88.61)], whereas mothers who had experienced a complication during a previous birth were less likely to give birth at home [AOR 0.45, 95% CI (0.28–0.95)].ConclusionThere was inequity in the utilization of health facilities for childbirth. Programs that promote health facility births should prioritize poorer mothers and those in rural areas.

A Note on the Measurement of Socioeconomic Inequalities in Life Years Lost by Cause of Death.

Quantifying socioeconomic inequalities in health in absolute terms is of prime interest for decision-making and for international comparisons. The Slope Index of Inequality (SII), an index that quantifies absolute socioeconomic inequalities, was recently formalized, particularly in the context of mortality differences measured in the rate or hazard scale. However, absolute inequalities using either rates or hazards do not translate into a time dimension, which makes their interpretation difficult for policymakers. We propose an extension of the (Equation is included in full-text article.)in terms of the expected number of life years lost before an upper age, as well as its decomposition by cause of death. The (Equation is included in full-text article.)in the life years lost metric quantifies the extent to which life expectancy is shortened when comparing the higher and lower ends of the socioeconomic scale. The methodology proposed builds on recent developments in survival analysis for decomposing the number of life years lost according to cause of death using a pseudo-value approach. We illustrate our proposal using a representative 1% sample of the French population. On average, the least educated men lost 7 years of life from age 30 up to age 90 compared to the most educated. The loss for women is twice as much with 3.5 years. The (Equation is included in full-text article.)in the life years lost metric is easily understood, and the decomposition of the all-cause mortality (Equation is included in full-text article.)into parts attributable to given causes provides a sound estimation of the burden of different causes of death on absolute socioeconomic inequalities in mortality.

Does selective migration alter socioeconomic inequalities in mortality in Wales?: a record-linked total population e-cohort study

Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.

Community Social Capital, Built Environment, and Income-Based Inequality in Depressive Symptoms Among Older People in Japan: An Ecological Study From the JAGES Project.

BackgroundAlthough reducing socioeconomic inequalities in depression is necessary, their associated factors have rarely been studied. This study aimed to screen the potential contextual factors associated with income-based inequality in older adults’ depression.MethodsUsing data from the Japan Gerontological Evaluation Study (JAGES) of 2013, we conducted an ecological study covering 77 communities in Japan. Our measures of socioeconomic inequalities in depression were the slope index of inequalities (SII) and the relative index of inequalities (RII) of the prevalence of depressive symptoms across three income levels. We categorized available community-level factors, including socio-demographic factors, social participation, social relationships, subjective changes in the residential area, and the built environment. These indicators were aggregated from individual responses of 51,962 and 52,958 physically independent men and women, respectively, aged 65 years or more. We performed multiple linear regression analyses to explore factors with statistical significance of a two-tailed P-value less than 0.05.ResultsFactors associated with shallower gradients in depression for men included higher participation in local activities and reception or provision of social support, which did not show significant association among women. Perceived increases in unemployment and economic inequalities were positively associated with larger inequalities in both genders (P < 0.05). The built environment did not indicate any significant association.ConclusionsA community environment fostering social activities and relationships might be associated with smaller income-based inequalities in depression. There is a need for more deterministic studies for planning of effective community interventions to address socioeconomic inequalities in depression.

Effect of internal migration on inequalities in mortality in Wales: an e-cohort study

BackgroundSelective migration is a process whereby individuals of poorer health move to areas with poorer health and social characteristics and vice versa, potentially affecting inequalities. Measures of socioeconomic inequalities in mortality or life expectancy are widely used by government and health services to track changes over time but do not consider migration. This study aimed to estimate the effect of migration on the mortality gradient. MethodsData for the entire population of Wales with a general practice registration on Jan 1, 2006, and follow-up for 24 quarters were record-linked by use of individual identifiers to the Office of National Statistics mortality files within the Secure Anonymised Information Linkage databank, a Welsh data linkage centre. Information included moves between lower super output areas (LSOAs) and associated fifths of deprivation (as defined by the Welsh Index of Multiple Deprivation 2008) at each quarter, age, sex, and, if relevant, date of death. Cox regression models were used to estimate the hazard ratios for the mortality gradient associated with area-level deprivation, adjusting for migration as time-varying covariates. Findings959 622 (30·6%) of 3 136 881 people had moved. 397 883 (34%) of all moves (1 171 361) were to increased and 415 008 (35·4%) to decreased deprivation. People in the most deprived fifth had a higher risk of death than those in the least deprived fifth (hazard ratio 1·57, 95% CI 1·55–1·60; p<0·001). There was little change in the hazard ratio after adjustment for moving and its interaction with age-group (1·54, 1·52–1·57; p<0·001). People aged 75 years and over had more than twice the risk of death after a move than non-movers. InterpretationDuring the study period, moving did not substantially alter the area deprivation gradient in mortality in Wales. The investigation of other health outcomes or longer follow-up could capture migration effects in younger people or mid-life. People moving to Wales during the time-period were not included, and moves within LSOAs were not represented in the data available. Although failure to de-register with their general practice after moving and delays in list cleaning might have affected our analysis, our interpretation is unlikely to change substantially. We did not consider individual socioeconomic characteristics such as employment. FundingPublic Health Wales, and the National Centre for Population Health and Wellbeing Research. Neither funder had a role in the writing of the abstract or the decision to submit it for publication.

Decomposition of Health Inequality Determinants in Shiraz, South-west Iran.

Despite the enhancement in health outcomes worldwide, health inequity and inequality is one of the most relevant topics both for health policy and public health. This research was designed to decompose the health inequality of people living in Shiraz, south-west Iran. Data were obtained from a multistage-sample survey conducted in Shiraz from April to May 2012, to find determinants of health related quality of life (HRQoL). General health (GH) and mental health (MH) were used as health status. As a measure of socioeconomic inequality, a concentration index of GH and MH was used and decomposed into its determinants. The overall concentration indices of MH and GH in Shiraz were 0.023 (95% CI: 0.015, 0.031) and 0.016 (95% CI: 0.009, 0.022), respectively. Decomposition of the concentration indices indicated that income made the largest contribution (39.92% for GH and 39.82% for MH) to income-related health inequality. Education (about 25% for GH and 34% for MH), insurance (about 14% for GH and 11% for MH), and occupation (about 12% for GH and 11% for MH) also proved important contributors to the health inequality in Shiraz. There exist MH and GH inequalities in Shiraz. Apart from insurance, most of the health inequalities in Shiraz can be explained through factors beyond the health sector. Hence, implementing redistributive policies and education expansion programs as well as providing an insurance scheme and secure career conditions could decrease these unethical health inequalities.

Evaluation of socio-economic inequalities in the use of maternal health services in rural western China

ObjectivesTo describe the use of maternal health services according to the standards of the Chinese Ministry of Health, and assess socio-economic inequalities in usage in rural Shaanxi province, western China. Study designCross-sectional survey. MethodsPrincipal components analysis was used to measure the economic status of households. A concentration index (CI) approach was used as a measure of socio-economic inequalities in the use of maternal health services, and a decomposable CI was used to identify the factors that contributed to the socio-economic inequalities in usage. ResultsIn total, 4760 women who had given birth in the preceding three years were selected at random to be interviewed in the five counties. Household wealth index was calculated by constructing a linear index from asset ownership indicators using principal components analysis to derive weights. The CI approach is a standard measure in the analysis of inequalities in health. If the CI for the use of maternal health services is positive, it is pro-rich; if it is negative, it is pro-poor. The decomposition method was used to estimate the contributions of individual factors to CI. The overall CI for five or more prenatal visits was 0.075. The household wealth index was found to make the greatest contribution to socio-economic inequalities for five or more prenatal visits (35.5%), followed by maternal education (28.8%), receipt of a health handbook during pregnancy (12.1%), age group (11.0%), distance from health facility (10.5%), family members (1.5%) and district of residence (0.6%). ConclusionsSocio-economic inequalities in the use of prenatal health services were pro-rich in rural western China. Socio-economic inequalities in hospital delivery and postnatal health check-ups were not evident. Improving household economic status, providing prenatal health services for women with low income and low educational level, providing health handbooks and improving traffic conditions should be promoted as methods to eliminate socio-economic inequalities in the use of maternal health services.

The relationship between socio-economic inequalities, intimate partner violence and economic abuse: A national study of women in the Philippines

Economic abuse against women has for too long remained a relatively ‘unseen’ part of interpersonal violence, in spite of intimate partner violence (IPV) being a public health problem. Most studies on economic abuse derive especially from the USA and amongst women in shelters, and their findings are not easily generalisable to low–middle-income countries. Socio-economic inequalities render women vulnerable to control and risk of abuse. We investigated the role of socio-economic inequalities in the association between IPV and economic abuse. Logistic regression analyses were performed on cross-sectional data from a nationally representative sample of 8478 women aged 15–49 years in the 2008 Philippines Demographic and Health Surveys. Results indicated strong positive associations between both physical IPV and emotional IPV and all four forms of economic abuse. Measures of socio-economic inequalities and other covariates such as no education, primary education, unemployment and justifying wife beating were also statistically significant. Findings suggest the increased need for health care practitioners to include economic abuse during the assessment of and response to IPV, the implementation of a multidimensional approach to providing tangible support and women-centred responses in reported cases of economic abuse, as well as measures that enhance socio-economic equality and increase economic opportunities for women.

Do socioeconomic inequalities lead to deceptive measurement of obstetric morbidity in India?

Background: The extent of maternal mortality is an indicator of disparity and inequity in access to appropriate health care and nutrition services throughout a lifetime, and particularly during pregnancy and childbirth. According to WHO, 99% of maternal deaths occur in developing countries. Three quarters of maternal mortalities result from the direct obstetric complications. However, the ambiguity and variability in existing literature on the magnitude of socio-economic inequality in obstetric morbidity is leading to complexity for priority setting in health policy. The present study aims at assessing how far self-reported obstetric morbidity misleads measurement of socio-economic inequalities in India and to assess whether refined inequality measures can help to overcome this problem. Methods: The study has used data from the most recent round of National Family Health Survey (NFHS-3). We have used concentration indices to access the socio-economic inequalities in self-reported obstetric morbidity and later implied regression based decomposition analysis to find out the contributions of socio-economic predictor. Results: Findings reveal that self-reporting obstetric morbidity survey data is potentially misleading in measuring socio-economic differentials with simple bivariate analysis as greater number of obstetric complications persists in socio-economically advantaged groups which may be not true in reality. However, application of sophisticated regression based decomposition analysis demonstrates that, to some extent, we can overcome the problem of measuring socio-economic inequality, as decomposition analysis shows incidence of obstetric complication are greater among disadvantaged groups. Conclusion: Primarily, the inequalities arise from poverty, education and residing in rural areas. However, the contribution of education to the incidence of obstetric morbidity is negative. This could be because of differences in the educational level of women that potentially affects their awareness and understanding about obstetric complications. The findings thus suggest that education is a key determinant of bias in self-reporting obstetric morbidity. Finally, we conclude that logical explanations of the results are needed when we infer these results for health policy interventions, as decomposition analysis has also failed to overcome the problem of self-reporting morbidities among illiterate women.

Measuring socio‐economic inequalities in edentate Scottish adults – cross‐sectional analyses using Scottish Health Surveys 1995–2008/09

To investigate the appropriateness of different measures of socio-economic inequalities, in relation to adult oral health in Scotland, utilizing data from a series of large, representative population surveys. The Scottish Health Surveys (SHeS) (1995; 1998; 2003; 2008/09) are cross-sectional national population-based surveys used to monitor health status in those living in private households. The age groups included in this study are as follows: 45-54; 55-64 years: all survey years; 65-74: 1998 onwards; 75+: 2003 onwards. Primary outcome was no natural teeth (edentulism). Three measures of socio-economic position: Occupational social class, Education, Carstairs deprivation score (2001) were used. Simple (absolute/relative differences) and complex measures (Slope Index, Relative Index, Concentration Index and c-index) of inequality were produced for each age group across all four surveys. Simple and complex (absolute) measures of inequality have both demonstrated narrowing disparities in edentulism over time in the 45- to 64-year-old group, a levelling off in those aged 65 and above, and a rise in those aged 75+. Complex relative measures (RII, Concentration Index and c-index), however, show an increasing trend in inequalities over time for all age groups, suggesting that rates of improvement in edentulism rates are not uniform across all social groups. Simple absolute inequality provides a quick and easy indication of the extent of disparities between extreme groups, whereas complex measures (absolute and relative) consider the gradient in health across all social groups. We have demonstrated that both are useful measures of inequality and should be considered complementary to one another. The appropriate choice of complex measure of inequality will depend on the audience to whom the results are to be communicated. This methodological approach is not confined to oral health but is applicable to other health outcomes that are socially patterned.