Pattern Of Socioeconomic Inequalities Research Articles

Making the case for a new typology of dental care systems.

Dental care systems have the potential to influence population oral health and patterns of socioeconomic inequalities. Therefore, understanding the impact of the ways in which countries fund, provide, and organize their dental care services is key in the analysis of determinants of oral health. In this commentary we offer a synopsis of recent typologies of healthcare systems, based on a rapid review, and highlight that none of them fit dental care services given the separation of dental care from general healthcare provision in many countries. The paper also summarizes evidence on dental care systems as determinants of population oral health and argues why a new typology of dental care systems is needed. We argue that a typology must consider institutional arrangements, structures, and processes behind the provision of dental care, and that specific dimensions/variables that inform the typology should result from a process of discussion and consensus. Some methodological considerations for developing typologies are also discussed, including the challenges in the collection and analysis of data followed by an advanced cluster analysis. Despite their limitations, typologies have evolved into an essential tool for comparing the similarities and differences of healthcare systems across countries. Therefore, a dental specific typology for health systems will be useful for researchers, policymakers, and dental professionals to characterize the provision of dentalcare services in different countries. This will also enable examining their potential role as determinants of population oral health and inequalities.

The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020\u20132021

BackgroundIn Belgium, current research on socio-economic inequalities in the coronavirus disease 2019 (COVID-19) crisis has mainly focused on excess mortality and data from the first epidemiological wave. The current study adds onto this by examining the association between COVID-19 incidence and area deprivation during the first five wave and interwave periods, thus adding a temporal gradient to the analyses.MethodsWe use all confirmed COVID-19 cases between March 2020 and June 2021 in Belgium, aggregated at the municipality-level. These data were collected by the national laboratory-based COVID-19 surveillance system. A level of area deprivation was assigned to each Belgian municipality using data of three socio-economic variables: the share of unemployed persons in the active population, the share of households without a car and the share of low-educated persons. The spatio-temporal association between COVID-19 incidence and area deprivation was assessed by performing multivariate negative-binomial regression analyses and computing population attributable fractions.ResultsA significant association between COVID-19 incidence and area deprivation was found over the entire study period, with the incidence in the most deprived areas predicted to be 24% higher than in the least deprived areas. This effect was dependent on the period during the COVID-19 crisis. The largest socio-economic inequalities in COVID-19 infections could be observed during wave 2 and wave 3, with a clear disadvantage for deprived areas.ConclusionOur results provide new insights into spatio-temporal patterns of socio-economic inequalities in COVID-19 incidence in Belgium. They reveal the existence of inequalities and a shift of these patterns over time.

COVID Health Structure Index: The Vulnerability of Brazilian Microregions

Many developing countries have highly unequal health systems across their regions. The pandemic of COVID-19 brought an additional challenge, as hospital structures equipped with doctors, intensive care units and respirators are not available to a sufficient extent in all regions. Using Data Envelopment Analysis, we create a COVID Index to verify whether the hospital structures in 543 Brazilian microregions are adequate to deal with COVID-19 and to verify whether public policies were implemented in the right direction. The results indicate that hospital structures in the poorest microregions were the most vulnerable, although the peak of COVID-19 occurred in the richest microregions (Sao Paulo). The Southeast states could relocate hospital resources or even patients between their regions. The relocation was not possible in many states in the Northeast, as the health system poorly assisted the interior of these states. These findings reveal that the heterogeneity of microregions’ hospital structures follows the patterns of socioeconomic inequalities. We conclude that it is easier for the wealthier regions to reallocate hospital resources internally than for the poorest regions. By using the COVID Index, policymakers and hospital managers have straightforward information to decide which regions must receive new investments and reallocate underutilized resources.

Socio-economic inequality in the City of Tshwane, South Africa: a multivariable spatial analysis at the neighborhood level

The premise of this paper arose from negative spatial legacies, a global and regional focus on inequality and questions about the success of spatial transformation in post-apartheid South Africa. This paper responds by filling a gap in representing the spatial dimensions of socio-economic inequality on a local level. The aim is to describe the spatial patterns of socio-economic inequality in the City of Tshwane, South Africa, through a relative socio-economic classification (comprising multiple variables) and identify underlying influences to enduring socio-economic inequality. The results show the enduring spatial legacies of socio-economic status and segregation in the study area. There is a strong mutually reinforcing relationship between median household income, unemployment levels and concentrations of tertiary education qualifications which constitute underlying influences to socio-economic inequality and segregation. High and low socio-economic status is spatially polarised and high socio-economic status is concentrated in a small area of the city. The central parts of the study area and the fringes of heritage townships experienced declines in socio-economic status between 2001 and 2011. When considered along with changes in the racial make-up of neighbourhoods there is evidence of class segregation replacing racial segregation, but historical patterns of race and class remain significant. Future spatial transformation efforts should consider a variety of spatial trends (including housing development and economic restructuring), but should target the inner city and also focus on tertiary education attainment and improving access to employment opportunities to encourage greater social equality in the study area.

COVID Index: Vulnerability of the Hospital Structure in Brazilian Microregions

Many developing countries, such as Brazil, have highly unequal health systems across their regions. The pandemic of the new coronavirus (COVID-19) brought an additional challenge, as hospital structures equipped with doctors, intensive care units (ICUs) and respirators are not available to a sufficient extent in all regions. We create a COVID Index to verify whether the hospital structures in 27 states and 543 Brazilian microregions are adequate to deal with COVID-19 and to verify whether public policies were implemented in the right direction. We use Data Envelopment Analysis (DEA) and advance with the metafrontier technique. The results indicate that hospital structures in the poorest microregions (North and Northeast) were the most vulnerable, although the peak of COVID-19 occurred in the richest microregions (Sao Paulo) in Southeast Brazil. The Southeast states could relocate hospital resources or even patients between their regions. However, relocation was not possible in many states in the Northeast, as the health system poorly assisted the interior of these states. These findings reveal that the heterogeneity of microregions’ hospital structures follows the patterns of socioeconomic inequalities. We conclude that it is easier for the wealthier regions to reallocate hospital resources internally than for the poorest regions. During the pandemic, Brazil’s policy intervention did not seem adequate. By using the COVID Index, policymakers and hospital managers have straightforward information to decide which regions must receive new investments and reallocate underutilized resources.

An Assessment of Magnitudes and Patterns of Socioeconomic Inequalities across Various Health Problems: A Large National Cross-Sectional Survey in Korea.

Magnitudes of health inequalities present consequences of socioeconomic impact on each health problem. To provide knowledge on the size of health problems in terms of socioeconomic burden, we examined the magnitudes and patterns of health inequalities across 12 health problems. A total of 17,292 participants older than 30 years were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES, 2010–2012). The age-adjusted prevalence ratios were compared across socioeconomic positions (SEPs) based on income, education, and occupation. The magnitudes of socioeconomic inequalities varied across 12 health problems and, in general, the patterns of socioeconomic inequalities were similar among groups of health problems (i.e., non-communicable diseases (NCDs), mental health, and subjective health states). Significant health inequalities across NCDs, such as diabetes, hypertension, ischemic heart disease, and arthritis, were observed mainly in women. Socioeconomic inequalities in mental health problems, such as depression, suicidal ideation, and suicide attempts, were profound for both genders and across SEP measures. Significant socioeconomic inequalities were also observed for subjective health. No or weak associations were observed for injury and HBV infection. The patterns of socioeconomic inequalities were similar among groups of health problems. Mental illnesses appeared to require prioritization of socioeconomic approaches for improvement in terms of absolute prevalence and relative socioeconomic distribution.

Abstract C72: Changing patterns of socioeconomic inequalities in women cancer screening in South Korea with ten years follow-up of nationwide cross-sectional study

Abstract C72: Changing patterns of socioeconomic inequalities in women cancer screening in South Korea with ten years follow-up of nationwide cross-sectional study

Socioeconomic inequalities in health in the context of multimorbidity: A Korean panel study.

Socioeconomic inequalities in health are commonly known to decrease at late age. Yet, it remains unclear whether socioeconomic inequalities in health at late age appear in relation to multimorbidity, particularly in Korea where social support remains unsatisfactory for older people. Using three waves of Korea Health Panel, data of 19,942 observations with repeated measure were constructed to ensure a temporal sequence between three socioeconomic measures (i.e., poverty, employment status, and education) and multimorbidity with a t to t+1 year transition. A multilevel multinomial model was applied to quantify the socioeconomic impact across different age, diseases and disease groups, both separately and in combination. There were associations between socioeconomic position (SEP) and multimorbidity, and increasing trends of socioeconomic inequalities not only with greater number of morbidity but also with age. The latter result was only observed with employment status through mid-to-early old age; i.e., between the 40s (odds ratio (OR) = 2.45, 95% confidence interval (CI):1.08–5.57) and 70s (OR = 3.48, 95%CI: 1.24–9.74). The patterns of socioeconomic inequalities in multimorbidity varied for particular pairs of diseases and were stronger in the disease pairs co-occurring with mental and cardiovascular diseases but weaker in the disease pairs co-occurring with cancer. Accumulation of adversity tended to intensify with increase in number of diseases and older age, though this finding was not consistently supported. The labour market should be encouraged to actively participate in actions to promote healthy aging needs to be complemented by the provision of more generous and universal income support to the elderly in Korea.

Patterns of Socioeconomic Inequality in Adolescent Health Differ According to the Measure of Socioeconomic Position

Socioeconomic differences in health are ubiquitous across age groups, cultures, and health domains. However, variation in the size and pattern of health inequalities appears to relate to the measure of socioeconomic position (SEP) applied. Little attention has been paid to these differences in adolescents and their implications for health surveillance and policy. We examined health inequalities in 1371 adolescents in seven European countries using four measures of SEP: youth-reported material assets and subjective social status and parent-reported material assets and household income. For each SEP variable, we estimated risk ratios, risk differences, concentration curves, and concentration indices of inequality for fair/poor self-rated health and low life satisfaction. Results showed that inequalities in health and life satisfaction were largest when subjective social status was used as the SEP variable. Moreover, health inequalities defined by subjective social status did not change after differences in assets and income were statistically controlled. Although material assets yielded similar health inequalities as household income, the results suggest that subjective and objective SEP relate differently to adolescent health and are not equivalent indicators of the same construct. In addition, possible bidirectional effects on health and wellbeing may inflate health inequalities defined by subjective social status. These results indicate that SEP differences in adolescent health are relate more closely to psychosocial processes than to material inequality.

Can Data Disaggregation Resolve Blind Spots in Policy Making? Examining a Case for Native Hawaiians

Abstract This study addressed whether or not the increasing reliance on data-driven decision making stands to improve policy efforts to address challenges faced by Asian American and Pacific Islander communities. In doing this, this study examined those who identified as Native Hawaiian in the U.S. Census data and further disaggregated this sample by ancestry and geographic location to test whether there are variations within this population across socioeconomic indicators. The findings suggest that while further data disaggregation can sharpen policy making to address patterns of socioeconomic inequalities, disaggregation alone is still insufficient for fully capturing the complexity of human experiences that reinforce those disparities.

Socioeconomic inequality in malnutrition in developing countries.

The objectives of this study were to report on socioeconomic inequality in childhood malnutrition in the developing world, to provide evidence for an association between socioeconomic inequality and the average level of malnutrition, and to draw attention to different patterns of socioeconomic inequality in malnutrition. Both stunting and wasting were measured using new WHO child growth standards. Socioeconomic status was estimated by principal component analysis using a set of household assets and living conditions. Socioeconomic inequality was measured using an alternative concentration index that avoids problems with dependence on the mean level of malnutrition. In almost all countries investigated, stunting and wasting disproportionately affected the poor. However, socioeconomic inequality in wasting was limited and was not significant in about one third of countries. After correcting for the concentration index's dependence on mean malnutrition, there was no clear association between average stunting and socioeconomic inequality. The latter showed different patterns, which were termed mass deprivation, queuing and exclusion. Although average levels of malnutrition were higher with the new WHO reference standards, estimates of socioeconomic inequality were largely unaffected by changing the growth standards. Socioeconomic inequality in childhood malnutrition existed throughout the developing world, and was not related to the average malnutrition rate. Failure to tackle this inequality is a cause of social injustice. Moreover, reducing the overall rate of malnutrition does not necessarily lead to a reduction in inequality. Policies should, therefore, take into account the distribution of childhood malnutrition across all socioeconomic groups.

Work and Family Characteristics as Determinants of Socioeconomic and Sex Inequalities in Sleep: The Japanese Civil Servants Study

To clarify whether socioeconomic and sex inequalities in poor sleep quality are explained by socioeconomic and sex differences in work and family characteristics. A cross-sectional study. Three thousand five hundred fifty-six employees (2397 men and 1159 women) aged 20 to 65 years in local government in Japan. Respondents completed a self-administered questionnaire that asked about sleep quality, as measured by the Pittsburgh Sleep Quality Index; work characteristics, as measured by the job-demand-control-support model, work hours, and shift work; and family characteristics, such as family structure and family-work conflicts. Lower control at work, higher work demands, lower social support, shorter and longer working hours, shift work, being single, higher family-to-work conflict, and higher work-to-family conflict were independently associated with poorer sleep quality in both men and women. In men, the age-adjusted odds ratio (OR) of low-grade employees for poor sleep quality was 1.64 (95% confidence interval: 1.14-2.36) in comparison with high-grade employees. The difference in sleep was attenuated when work and family characteristics were adjusted for (OR=1.25 [0.84-1.86]). Among women, there was no significant grade difference in sleep. Women tended to have poorer sleep quality than men (the age-adjusted OR=1.75 [1.49-2.06]). The sex difference was attenuated and no longer significant when adjustments were made for work and family characteristics (OR=1.04 [0.85-1.27]). The results of this study suggest that work and family characteristics may be important for reducing socioeconomic and sex inequalities in sleep. Sex differences in the pattern of socioeconomic inequalities in sleep deserve further research.

Cerebral palsy, low birthweight and socio-economic deprivation: inequalities in a major cause of childhood disability.

There is currently little and conflicting evidence concerning the existence of socio-economic inequalities in cerebral palsy prevalence, or the extent to which this is influenced by socio-economic inequalities in low birthweight, a strong risk factor for cerebral palsy. The study is based on 753 children registered with cerebral palsy, resident in the former Oxford Regional Health Authority area and born in the years 1984-90. Two population definitions were used: 1. Children with cerebral palsy resident at birth in the area, with resident births as denominator, 2. Children with cerebral palsy resident at age 5 in the area, with children of ages 1-7 resident in the area in the 1991 census as denominator. Children with cerebral palsy and all births/children were classified according to the Carstairs area deprivation index (grouped into quintiles) of their ward of residence. The prevalence among residents at birth varied from 2.08 per 1000 births in the most affluent quintile to 3.33 in the most deprived quintile (trend P < 0.001). Although there was a tendency for children to move to more affluent areas during early childhood, the socio-economic gradient was similar at age 5. A greater proportion of births in the more deprived quintiles were of low or very low birthweight, the proportion rising from 5.6% in the most affluent quintile to 8.2% in the most deprived. Within the normal birthweight category there was a trend for higher prevalence of cerebral palsy in more deprived quintiles, from 1.29 per 1000 in the most affluent quintile to 2.42 in the most deprived quintile (trend P < 0.001). Within the low birthweight and very low birthweight groups, separately or combined, there was no evidence of any relationship between cerebral palsy prevalence and deprivation. We estimate that up to 17% of cerebral palsy cases might be "preventable" in terms of the reduction to be expected if the whole population had the rate of cerebral palsy of the most affluent quintile. Although the strong socio-economic gradient for cerebral palsy was restricted to the normal birthweight category, we estimate that two-thirds of the excess cases in the population associated with greater socio-economic deprivation were normal birthweight cases, and one-third were low birthweight cases owing to the greater prevalence of low birthweight in more deprived populations. The pattern of socio-economic inequalities should be further explored in other regions, and should be taken into account in aetiological research, and in the effective delivery and evaluation of services.

Language Equity and the Politics of Representation in South African Media Reform

This paper examines how debates on language-equity and identity have helped to shape South African broadcasting reform in the 1990s. The broadcasting sector is of interest as an example of how patterns of institutional transformation give concrete form to constitutionally protected citizenship rights. The politics of language-equity in broadcasting reform has been shaped by conflicts over the legitimacy of who is represented, by what means, by whom, and for what purposes in processes of policy-deliberation and decision-making. The role of public agencies (including the South African Broadcasting Corporation and the Independent Broadcasting Authority), private capital, civil society organisations and the state in shaping the significance ascribed to language-equity in the transformation of radio and television services is considered in detail. I argue that entrenched patterns of socio-economic inequality, social relations of ownership and control, and the existing structures of markets for broadcasting services have all constrained attempts to deploy broadcasting as an instrument for fostering more equitable treatment of diverse languages in the public sphere.