Oaxaca-Blinder Decomposition Research Articles

Educational inequalities and decomposition of the urban-rural disparities in maternal health care utilization in Ethiopia: further analysis of 2019 intermediate Ethiopian demography and health survey

IntroductionThe utilization of maternal health services is vital to prevent maternal and child health problems. However, there is limited evidence as to why rural women have lower utilization and educational inequality in maternal health services utilization in Ethiopia. Identifying the causes is the first step to achieving maternal and child health initiatives.ObjectiveThe objective of this study was to decompose the urban-rural disparities and educational inequalities in maternal health care utilization in Ethiopia.MethodsThe study used the 2019 Ethiopian Demography Health Survey. Blinder-Oaxaca decomposition and multivariate decomposition analyses were done on a weighted 3,926.7 women to see the urban-rural differences in maternal health service utilization by using Stata 17.0. For the educational inequality of maternal health service utilization, concentration curve and concentration index were used by using conindex. P value < 0.005 was used to declare association.Result84.89% of urban and 70.75% of rural residents use antenatal care and 73% of urban and 44% rural use institutional delivery. There was no urban-rural difference in postnatal care utilization. There was educational inequality in antenatal care (CIx 0.0926; p < 0.001), delivery care (CIx 0.2137; p < 0.001 and postnatal care (CIx 0.1272; p < 0.001) utilization in Ethiopia. 83.3% of antenatal care urban-rural difference was explained by women’s characteristics difference. Secondary (16.51%) and higher (23.01%) educational level difference of urban and rural women widening antenatal care utilization. Living regions (-1.33%) difference of urban and rural women mitigated antenatal care utilization. About 76.07% of the urban-rural difference in institutional delivery was explained by differences in the characteristics of women. Attending primary (3.76%), secondary (11.83%), and higher (8.44%) education, antenatal care (15.81%) difference of urban and rural women were widening institutional delivery utilization.ConclusionThe urban-rural disparity in antenatal care and delivery care utilization is significant in the country. There were educational inequalities in maternal health service utilization. Attending, Secondary, higher, educational levels widening antenatal care and institutional delivery care utilization. Living regions mitigated antenatal care utilization. Antenatal care utilization widening institutional delivery utilization. Special attention is needed for rural women to improve maternal health service utilization through health extension workers and the women’s developmental army.

Racial Disparities in Cesarean Section Rates Between Non-Hispanic Black and Non-Hispanic White Populations in the United States

AbstractThis study uses national natality data from the National Vital Statistics System, provided by the National Center for Health Statistics, covering the years 2011 to 2018 (N = 23,810,031) to investigate racial disparities in cesarean section (C-section) rates between non-Hispanic Black and non-Hispanic White mothers in the United States. This analysis offers a comprehensive perspective on the factors contributing to C-section disparities by considering mothers' demographic characteristics, health conditions, and infant health status. Using multivariable logistic regression, the findings reveal consistently higher C-section rates for non-Hispanic Black mothers compared to non-Hispanic White mothers, with the gap widening over time. Even after adjusting for sociodemographic and health-related factors, non-Hispanic Black mothers remained more likely to undergo C-sections. Using Blinder-Oaxaca decomposition methods, key factors contributing to this C-section rates disparity include maternal age, the source of delivery payment, and fetal presentation. This study highlights the pressing need for further investigation into healthcare system factors and racial inequities driving these disparities, alongside the growing urgency for policy and practical interventions to reduce unnecessary C-sections.

Unveiling the shadows: School bullying and students' ability erosions in Chinese compulsory schools

Drawing upon data from the National Children's Study of China, this research investigates the school bullying victimization and its associations with the ability erosions among students in Chinese schools. Three key findings emerge. First, results suggest that the primary factors affecting bullying victimization mainly include authoritarian parenting, limited positive social interactions on campus, adverse experiences, and exposure to teacher and peer smoking. Second, estimates indicate that bullying victimization is significantly associated with ability erosions, particularly among students from relatively advantaged backgrounds. The further Oster's test, falsification test, and reverse causality check confirm the validity of the associations and suggest some causal effect of victimization on the student outcomes. Lastly, the Oaxaca-Blinder decomposition shows that lower human capital investments derived from social interactions are the most significant contributors to the ability erosion linked to bullying victimization. These findings highlight the critical importance of social interactions both at home and in schools.

How Locus of Control Predicts Subjective Well-Being and its Inequality: The Moderating Role of Social Values

AbstractPrevious research has established the central role of an individuals’ locus of control (LoC) in influencing subjective well-being. However, earlier studies have predominantly omitted an exploration of potential moderating factors at the country-level and have rarely delved into the influence of LoC on an important yet often-overlooked dimension of well-being—namely, subjective well-being inequality. Addressing these gaps, this study examines the association between individuals’ LoC and subjective well-being, considering both the mean and inequality aspects. Additionally, it explores the moderating influence of country’s social values, particularly the individualism-collectivism dimension. Utilizing data from the Integrated Values Survey, comprising 170,000 observations across 37 countries from 1996 to 2022, our study confirms a strong positive relationship between LoC and subjective well-being while also unveiling a strong negative relationship with subjective well-being inequality. Moreover, it demonstrates that country’s social values exert significant moderation effects on the relationship between LoC and subjective well-being, affecting both the mean level and inequality aspects, albeit in opposing directions. By employing the Oaxaca-Blinder decomposition, our findings support the importance of structural effects. Understanding how increasing LoC shapes people’s wellbeing in a society holds implications for policymaking and contributes to ongoing discussions on collective choice and inequality.

Oral health inequities over time among older adults of different racial/ethnic backgrounds: a comparative decomposition analysis across Australia and the United States

BackgroundAlthough the prevalence of poor oral health among older populations in Australia and the United States is higher, the contribution of ethnicity status is unknown. We aimed to estimate the contribution of social inequalities in oral health among older populations in Australia and the United States.MethodsCross-sectional study design using data from Australia’s National Survey of Adult Oral Health (NSAOH 2004–06 and 2017–18) and the United States’ National Health and Nutrition Examination Survey (NHANES 2003–04 and 2011–16). Participants included in the analysis were aged 65 + years. Oaxaca-Blinder type decomposition analysis was used to assess the contribution of demographic (age, sex), socioeconomic position (educational attainment, household income) and dental behaviors (last dental visit) to changes in prevalence of edentulism and non-functional dentition, and mean number of missing teeth by ethnicity status over time in Australia and the United States.ResultsThe number of participants aged 65 + years who provided clinical and sociodemographic/dental behaviour data was 1043 and 1269 in NSAOH 2004–06 and 2017–18, and 1372 and 1328 in NHANES 2003–04 and 2011–16 respectively. The prevalence of edentulism was from 13 percent (NHANES 2011–16) to 28 percent (NSAOH 2004–06), while the prevalence of non-functional dentition was from 41 percent (NSAOH 2017–18 and NHANES 2011–16) to 61 percent (NHANES 2003–04). The mean number of missing teeth was from 11 (NSAOH 2017–18) to 18 (NHANES 2003–04). The prevalence of edentulism and non-functional dentition, and the mean number of missing teeth were higher among older Australians identifying as White and the opposite results were observed among older Americans identifying as Non-White. For older adults in Australia, risk factors with the greatest impact on oral health outcomes by ethnicity status were educational attainment and household income. For older adults in the United States, the most dominant risk factor for non-optimal oral health outcomes by ethnicity status was last dental visit.ConclusionsThere are important policy translation implications from our findings, as they indicate that social and structural systems in Australia and the United States operate differently in the context of oral health over time among culturally diverse older citizens. This information will help inform initiatives that both target effective oral health promotion for older, culturally-diverse populations and provide evidence for the distribution of resources in the public dental health setting for this age group and cultural demographic.

Disentangling the gender-differentiated determinants of home-based self-employment choices in Nigeria

Abstract Understanding gender disparities in home-based self-employment (HBS) and their links to homeownership and socioeconomic factors is crucial for advancing sustainable development goals (SDGs) in Sub-Saharan Africa, especially Nigeria. This study uses data from the 2010/2011, 2012/13, 2015/16, and 2018/19 waves of the Nigerian General Household Survey (GHS). It employs random effect probit regression, the LASSO method for identifying predictors, and the Blinder–Oaxaca decomposition technique to analyse gender differences in nonlinear binary outcomes. The results show that female business owners are more likely to engage in HBS compared to males, highlighting the importance of gender equality (SDG 5) and decent work (SDG 8). While male entrepreneurs are mainly driven by profit, females prioritise balancing paid and unpaid work, reflecting motivations beyond profit within heterodox economics. Significant gender-differentiated impacts are observed in relation to monthly rent, post-secondary education, dwelling space, energy, and regional locations. Notably, the presence of children significantly increases female involvement in HBS, a trend not seen among males. Marriage also influences female participation, suggesting that marital circumstances and economic benefits play a role. These findings highlight the need for policies addressing gender-specific constraints, challenging traditional gender roles, and promoting inclusive human development within the SDG framework.

Importance of Modifiable Factors to Infant Health in the Context of Prenatal Opioid Use Disorder.

The aim of the study is to estimate the contributions of common and modifiable risk factors to birth outcomes of individuals with prenatal opioid use disorder (OUD). We conducted an observational cohort study of all Wisconsin Medicaid-covered singleton live births from 2011-2019. Using Blinder-Oaxaca decomposition for continuous, and the Fairlie extension for categorical outcomes, we estimated the contributions of comorbidities, tobacco use, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) to birthweight for gestational age (BW-GA) percentile associated with prenatal OUD and the risk of small for gestational age (SGA), net of other factors. Among 216,684 births, the 5184 (2.4%) with OUD had greater prevalence of tobacco use, a lower average pre-pregnancy BMI (26.7 kg/m2, SD = 0.09 versus 28.4 kg/m2, SD = 0.02), and on average 2.0 pounds less GWG, when compared to those without OUD. The predicted mean BW-GA percentile among infants with OUD exposure was 11.2 (95% CI 10.5, 11.9) points lower than those without; 62.3% (95% CI 57.4, 67.1) of this difference could be explained by the variables included in the full model and the largest contribution of the explained portion came from the higher prevalence of tobacco use followed by the contributions of comorbidities, GWG, and pre-pregnancy BMI. More than half of the difference in BW-GA percentile, and risk of SGA associated with prenatal OUD, could be attributed to modifiable factors and not opioids. Moreover, potentially modifiable factors including tobacco use and measures reflecting nutritional status contributed to a majority of the explained portion.

Application of The Blinder-Oaxaca Decomposition Method to Analyze The Unemployment Gap Between Gender in Riau Province in 2022

Gender equality is one of the goals of SDG, so every country needs to make efforts so that gender equality can be realized. Gender inequality is calculated using the Gender Inequality Index (GII). One of the components in preparing the Gender Inequality Index is labor force participation rate. Within the population included in the labor force, some people are employed and unemployed. In this study, gender inequality in terms of unemployment will be calculated using Blinder-Oaxaca decomposition with three calculation stages. The first is probit regression analysis, the second is marginal effects and the third is Oaxaca blinder decomposition. The results of the probit regression analysis show that all observed independent variables significantly effect on unemployment for both men and women. Meanwhile, the marginal effect results show that this variable’s influence is quite small, only 0.1 - 2 percent. The results of Oaxaca blinder decomposition show that the inequality between male and female unemployment is 1.42%, of which 29.88% is influenced by, observed factors and unobserved factors influence the remaining. There are only three variables that influence the gender gap, namely marital status, number of household members and household income 70.12%.

Predictors of adolescent well-being around the globe: are students from Confucian East Asia different?

Using rich data from nearly 400,000 15-year-olds across 70 middle- and high-income countries and economies participating in PISA 2018, this study investigates (1) global predictors of adolescent subjective well-being (SWB), and (2) differences in adolescent life satisfaction, its predictors and endowments with predictors across world regions and cultures. A particular focus lies on comparing Confucian East Asia (CEA) with other world regions. Data were analyzed using multiple linear regressions and Blinder-Oaxaca decomposition. As measures of adolescent well-being, this study employs life satisfaction, affective well-being, and meaning in life. Globally, adolescent well-being outcomes are found to be most strongly linked to gender, personality, relative SES, relationship quality, peer SWB, autonomy and the learning environment, as well as local cultural factors. Estimations by world region reveal several culture-specific explanations for interregional well-being gaps. In particular, notoriously low levels of life satisfaction among students from CEA countries are found to be associated with low self-efficacy, low peer well-being, as well as with high emotional interdependence compared to other world regions. Emotional interdependence is more strongly experienced among CEA adolescents compared to adolescents from any other world region. Moreover, it is found to be more strongly associated with life satisfaction in the CEA region than in any other region. In line with the former, CEA students show stronger links between other relational factors (parents' emotional support; sense of belonging at school) and life satisfaction compared to most other regions. This study suggests that among the environmental factors that shape the experience of adolescent lives, relationship and cultural factors play key roles and are closely intertwined. Parents, educators and policymakers around the world should focus on creating a positive school environment that promotes well-being, student self-efficacy, a sense of belonging, and a safe space in which failure is accepted as part of the learning process. This is particularly needed in Confucian East Asian countries.

Determinants of rural‑urban child malnutrition disparities in Ethiopia

Child malnutrition is a significant issue in Ethiopia, with high prevalence rates. However, there is limited information on the rural‑urban disparities in child malnutrition of all its forms (stunting, wasting, and underweight) in the country. Therefore, this study aimed to address this gap by analysing data from the 2019 Ethiopian Demographic Health Survey (EDHS). This study examined the rural‑urban child malnutrition gaps in Ethiopia using an extended Oaxaca-Blinder decomposition technique. The analysis reveals significant ruralurban disparities in prevalence rates of wasting, underweight, and stunting. The findings highlighted that children in rural areas are more malnourished than their urban counterparts. Additionally, the study identified key determinants of these disparities, including maternal and parental education, household economic status, women’s age at first birth, childbirth size, and working status of women. The results also indicate that institutional delivery, household size, and dependency ratio contribute to widening the rural‑urban disparities in child malnutrition. This study highlighted the importance of targeted policies and interventions to address these disparities and reduce child malnutrition at the national level.

Labor income gap by gender in the Dominican Republic: An analysis of its evolution in the period 2000–2021

The labor income gap between men and women in Latin America remains a barrier to achieving gender equality and sustainable development. In the Dominican Republic, this gap is particularly prevalent in the informal sector, among self employed workers, and in regions with higher female labor participation. Despite women often having a better job profile than men, the gap persists, pointing to the presence of gender biases. This paper aims to analyze the gender-based labor income gap in the Dominican Republic from 2000 to 2021, using data from the National Labor Force Surveys conducted by the National Statistics Office (ONE) and harmonized by the Inter- American Development Bank (IDB). Two models are employed for this analysis: the Blinder-Oaxaca decomposition and the Ñopo decomposition. The primary contribution of this paper lies in its long-term analysis of the gap, which provides insight into how it has evolved over time. The findings reveal a significant and statistically substantial labor income gap that cannot be explained by factors such as work experience or economic sector, suggesting that the causes are likely normative or discriminatory. The gap is most pronounced in the informal sector, among self-employed workers, and in regions with higher female labor participation. Although the analysis spans two decades, no clear trend of increase or decrease in the gap was observed. However, the unexplained portion of the gap has widened considerably, indicating a need for further investigation to understand and address this disparity.

Explaining socioeconomic inequality in food consumption patterns among households with women of childbearing age in South Africa.

The changing food environment shifts peoples' eating behaviour toward unhealthy food, including ultra-processed food (UPF), leading to detrimental health outcomes like obesity. This study examines changes in socioeconomic inequalities in food consumption spending between 2005/06 and 2010/11 in South African households with women of childbearing age (15 to 49) (WCBA). Data come from the 2005/06 and 2010/11 Income and Expenditure Surveys. The distribution of spending according to the NOVA food classification system groupings (unprocessed or minimally processed foods, processed culinary ingredients, processed and UPF products) was analysed using standard methodologies. Changes in spending inequalities between 2005/06 and 2010/11 were assessed using the concentration index (C), while the factors explaining the changes in spending inequalities were identified using the Oaxaca decomposition approach. The Kakwani index (K) was used to assess progressivity. Results show that average real spending on all food categories, including UPF, increased between 2005/06 and 2010/11. Socioeconomic inequality in UPF consumption spending decreased (C = 0.498 in 2005/06 and C = 0.432 in 2010/11), and spending on processed foods (C = 0.248 in 2005/06 and C = 0.209 in 2010/11). Socioeconomic status, race, and urban residence contributed to overall socioeconomic inequality and changes in UPF consumption inequality between 2005/06 and 2010/11. Spending on all food categories was regressive in 2005/06 (K = -0.173 for UPF and -0.425 for processed foods) and 2010/11 (K = -0.192 for UPF and -0.418 for processed foods) because such spending comprises a larger share of poorer household's income than their wealthier counterparts. The government should address these contributors to inequality to mitigate the risks associated with UPF consumption, especially among less affluent households.

Income and education disparities in childhood malnutrition: a multi-country decomposition analysis

IntroductionChildhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition.MethodsThis study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors.ResultsWe examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child’s age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries.ConclusionThe prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country’s specific context.

The gender achievement gap in grades and standardised tests-what accounts for gender inequality?

We studied the gender achievement gap in grades and standardised test scores in Finland, where the gender differences are largest among OECD countries. We compared the gender achievement gap in standardised test scores from PISA surveys and grades from high-quality school registers in literacy. Furthermore, we analysed how grades differ from standardised test scores by family background and students' SES composition of the schools. By using the Blinder-Oaxaca decomposition method, we explored how different characteristics between girls and boys explain gender differences in grading. Our findings indicate that boys' grades were lower than can be expected based on standardised test scores. The gender gap in grades was explained by boys' lower reading interests, effort put into schoolwork, and conscientiousness on homework. However, even adjusting for schooling characteristics and competence, boys have lower grades than test scores in schools that have low SES student composition.

Decomposition of Economic Inequality in Age-Related Macular Degeneration by Using Oaxaca-Blinder Decomposition: Tehran Geriatric Eye Study

ABSTRACT Purpose To investigate economic inequality in age-related macular degeneration (AMD) and decompose it into its determinants using Oaxaca-Blinder decomposition (OBD). Methods The Tehran Geriatric Eye Study was a cross-sectional study conducted on individuals aged 60 years and older, utilizing stratified random cluster sampling. Each participant received a comprehensive optometric, and slit-lamp examination. Diagnosis and classification of AMD were conducted utilizing fundus camera images. Results The data of the 3268 participants were analyzed. According to OBD, a significant difference was found in AMD between the rich and poor groups (8.36%) disfavoring the poor (p < 0.001). The explained and unexplained portions comprised 93.37% and 6.63% of the difference (p < 0.001 and p = 0.405, respectively). Among study variables, age (coefficient = 4.70; p < 0.001), economic status (coefficient = 3.58; p = 0.004), and myopia (coefficient = 0.73; p = 0.001) were significant determinants of inequality in the explained portion. Conclusion A significant disparity in the prevalence of AMD was observed between individuals of different socioeconomic statuses, primarily attributed to the explained factors. Factors such as age, economic status, and myopia were found to have the most substantial impact in exacerbating the inequality that disadvantaged the poor group (contributing percentages: 52.17%, 39.73%, and 8.10%, respectively). The findings of this research can be valuable for health policymakers in prioritizing and addressing the determinants of inequality within the population.

Gender differences in the association between inter-generational interaction and depressive symptoms among Chinese older adults

BackgroundInter-generational interaction is a carrier of Chinese traditional culture, and it can exert important influence on the depressive symptoms on Chinese older adults. The study aims to analyze gender differences in the association between inter-generational interaction and depressive symptoms among Chinese older adults and explore factors contributing to the differences.MethodData from China Family Panel Studies in 2020 were used. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. The latent class analysis was applied to identify patterns of inter-generational interaction of older adults (aged 60 and above). Before the comparison between older man and older woman, we used Coarsened Exact Matching to control confounding factors and improve causal inferences. Multiple linear regression was conducted to explore the association between inter-generational interaction and depression symptoms. Oaxaca-blinder decomposition method was used to analyze the gender difference and the sources.ResultOur study identified three types of inter-generational interaction: detached, nearby but discordant and two-way tight-knit. Analysis indicated that most of older man (54.39%) and older woman (49.78%) were in the type of nearby but discordant. Older man and older woman who in detached type had higher depression scores than other types, and the depression score of two-way tight-knit type accounted for 12.42 and 13.77 respectively. Our findings demonstrated that two-way tight-knit type (-11.89%) significantly decreased the gender differences in the depression symptoms. Other major contributors also included living without spouse (20.56%), primary school and junior middle school (15.95%), higher middle school and above (9.50%) and no illness for two weeks (47.70%).ConclusionOur study highlighted three patterns of inter-generational interaction, and most of older man and older woman were in the pattern of nearby but discordant. In addition, the two-way tight-knit pattern significantly can decrease gender differences in depression symptoms. The contributors should be taken into account in more targeted intervention strategies for narrowing gender differences in the depression symptoms, which could achieve a gender dividend in the era of China's aging population.

Closing the employment gap: Estimations of Indigenous employment in Indigenous- and non-Indigenous-owned businesses in Australia

Abstract Indigenous-owned businesses in Australia are strong employers of Indigenous people, maintaining rates of Indigenous employment that are not seen across the breadth of the Australian economy. Despite an increasing focus from governments and private organisations to improve rates of Indigenous employment, there is limited evidence to suggest that substantial improvements are being made. Despite acknowledgement from government of the crucial role played by Indigenous employers in creating Indigenous employment, there has been little focus on what may be learned from the Indigenous business sector in informing public and private Indigenous workplace and recruitment policies. Given the significantly strong levels of Indigenous employment in Indigenous-owned businesses, it is important to interrogate the extent to which this employment differs from that in non-Indigenous businesses and the potential explanations for such divergence. Using data from Supply Nation (2,291 Indigenous-owned businesses) and a survey of 680 non-Indigenous businesses, this paper finds that Indigenous businesses employ Indigenous people at a rate 12 times higher than non-Indigenous businesses. Regression analyses and Oaxaca–Blinder decompositions reveal that these divergent employment outcomes cannot be explained by the broad characteristics of the two sectors (such as industry, location, or profit status). These findings help confirm that the unique workplace practices of Indigenous businesses may explain their strong Indigenous employment and, therefore, provide the template for all Australian businesses to be better employers of Indigenous people.

Evolving trends, regional differences, determinants, and disease sources of provincial-level health inequalities in china 1990–2019: a temporal convergence and novel triple decomposition analysis

BackgroundPromoting health equity has been a worldwide goal, but serious challenges remain globally and within China. Multiple decomposition of the sources and determinants of health inequalities has significant implications for narrowing health inequalities and improve health equity.MethodsLife expectancy (LE), healthy life expectancy (HALE), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rates in 31 provinces of mainland China were selected as health status indicators, obtained from the Global Burden of Disease (GBD) database. Temporal convergence analysis was used to test the evolving trends of health status. Dagum’s Gini coefficient decomposition was used to decompose the overall Gini coefficient based on intraregional and interregional differences. Oaxaca-Blinder decomposition was used to calculate contributions of determinants to interregional differences. The factor-decomposed Gini coefficient was used to analyze the absolute and marginal contribution of each component to overall Gini coefficients.ResultsFrom 1990-2019, China witnessed notable improvements in health status measured by LE, HALE, ASMR and age-standardized DALY rates.Nevertheless, the three regions (East, Central and West) exhibited significant inter-regional differences in health status, with the differences between the East and West being the largest. The adjusted short-term conditional β-convergence model indicated that the inter-provincial differences in LE, HALE, ASMR, and age-standardized DALY rates significantly converged at annual rates of 0.31%, 0.35%, 0.19%, and 0.28% over 30 years. The overall Gini coefficients of LE, HALE, and age-standardized DALY rates decreased, while the ASMR exhibited an opposite trend. Inter-regional and intra-regional differences accounted for >70% and<30% of overall Gini coefficients, respectively. Attribution analysis showed that socioeconomic determinants explained 85.77% to 91.93% of the eastern-western differences between 2010-2019, followed by health system determinants explaining 7.79% to 11.61%. The source-analysis of Gini coefficients of ASMR and age-standardized DALY rates revealed that noncommunicable diseases (NCDs) made the largest and increasing absolute contribution, while communicable, maternal, neonatal, and nutritional diseases (CMNNDs) had a diminishing and lower impact. However, NCDs exerted a negative marginal effect on the Gini coefficient, whereas CMNNDs exhibited a positive marginal effect, indicating that controlling CMNNDs may be more effective in reducing health inequities.ConclusionsRegional differences are a major source of health inequities in China. Prioritizing prevention and control of CMNNDs, rather than NCDs, may yield more pronounced impacts on reducing health inequalities from the perspective of marginal effect, although NCDs remain the largest absolute contributor to health inequalities.

Imbalances in the oral health workforce: a Canadian population-based study

BackgroundIn Canada, a new federal public dental insurance plan, being phased in over 2022–2025, may help enhance financial access to dental services. However, as in many other countries, evidence is limited on the supply and distribution of human resources for oral health (HROH) to meet increasing population needs. This national observational study aimed to quantify occupational, geographical, institutional, and gender imbalances in the Canadian dental workforce to help inform benchmarking of HROH capacity for improving service coverage.MethodsSourcing microdata from the 2021 Canadian population census, we described workforce imbalances for three groups of postsecondary-qualified dental professionals: dentists, dental hygienists and therapists, and dental assistants. To assess geographic maldistribution relative to population, we linked the person-level census data to the geocoded Index of Remoteness for all inhabited communities. To assess gender-based inequities in the dental labour market, we performed Blinder-Oaxaca decompositions for examining differences in professional earnings of women and men.ResultsThe census data tallied 3.4 active dentists aged 25–54 per 10,000 population, supported by an allied workforce of 1.7 dental hygienists/therapists and 1.6 dental assistants for every dentist. All three professional groups were overrepresented in heavily urbanized communities compared with more rural and remote areas. Almost all dental service providers worked in ambulatory care settings, except for male dental assistants. The dentistry workforce was found to have achieved gender parity numerically, but women dentists still earned 21% less on average than men, adjusting for other characteristics. Despite women representing 97% of dental hygienists/therapists, they earned 26% less on average than men, a significant difference that was largely unexplained in the decomposition analysis.ConclusionsAccelerating universal coverage of oral healthcare services is increasingly advocated as an integral, but often neglected, component toward achieving the health-related Sustainable Development Goals. In the Canadian context of universal coverage for medical (but not dentistry) services, the oral health workforce was found to be demarcated by considerable geographic and gendered imbalances. More cross-nationally comparable research is needed to inform innovative approaches for equity-oriented HROH planning and financing, often critically overlooked in public policy for health systems strengthening.

Decomposing the Gender Wage Gap in the Urban Labor Market in Kenya

Abstract Legislation and regulation have been effective in reducing the gender wage gap in developed countries; however, the gap still exists globally, and progress towards narrowing the gap has been unacceptably slow even in regions where it is improving. This study presents the analysis of gender wage gap in Kenya’s urban labor market by using the World Bank Skills Towards Employability and Productivity Survey (WBSTEPS). This study employed Mincer earnings regressions with Heckman selection correction and the Blinder-Oaxaca and Neumark decomposition procedures to answer the research questions. The results of the wage determination and participation in the labor market show that there is no selectivity-bias problem. Personal characteristics such as education and age, as well as work-related characteristics, are important factors in determining earnings. The magnitude of the gender wage gap varies across the wage distribution, and the results of the wage decomposition reveal that women in urban Kenya earn 84.5-to-86% of men’s earnings. The earnings gap is overwhelmingly due to differences in returns to endowments, which account for between 70% and 94.7% of the total earnings gap. Admittedly, the study found evidence of discrimination against women in the returns to endowments, but also observed pronounced favoritism towards men. However, discrimination against women is more pronounced than favoritism towards men. Addressing the gender wage gap in Kenya requires a multifaceted approach that tackles both systemic biases against women and structural barriers that hinder women from accessing equal opportunities in education, training, and career advancement and government policies that minimize favoritism towards men.