Persistent Socioeconomic Inequalities Research Articles

Observations on status and trends of agricultural extension and inequality in Uganda

The global pandemic has accentuated inequalities, with vulnerable populations in developing countries fairing worst. In rural sub-Saharan Africa, restrictions on mobility to limit the spread of COVID-19 negatively impacted access to extension services and inputs by farmers. In response, countries deployed digital technologies to meet some of these challenges in the context of existing income, gender and spatial inequalities and historic declines in funding for public extension. Focusing on Uganda, which had one of the longest and strictest lockdowns, the paper used panel datasets of farmers from 2005 to 2019/2020 and found persistent socio-economic and gender inequalities in access to extension. Data from rapid rural surveys from 2020 to 2021 and a review of recent literature suggest these inequalities increased during the pandemic. The paper then builds on the structure and reforms of the current extension system to assess the potential of the digital services and their added value given the inequalities observed. The paper finds that the ability of government-led, inclusive, digital extension services is limited unless investments in extension are increased. In light of long-term declines in funding for extension, future research should focus on the effectiveness of policies to encourage private sector-led digital extension efforts to strengthen the pro-poor nature of agricultural growth.

Socioeconomic inequalities in depressive symptoms in China: The role of social capital

This cohort study used the China Health and Retirement Longitudinal Study (CHARLS, 2015–2018) to investigate the effects of socioeconomic status and social capital to the incidence of depressive symptoms among middle-aged and older individuals in China, incorporating a sample size of 9949 participants. Socioeconomic status, social capital and other explanatory variables were collected in 2015, while depressive symptoms were assessed in 2018. Basic characteristics and social capital measures were compared between urban and rural residents using the chi-square test. Logistic regression was used to explore the relationship between socioeconomic status, social capital and depressive symptoms, and the Karlson, Holm, and Breen (KHB) method was employed to verify the mediating role of social capital. We reported persistent socioeconomic inequalities in depressive symptoms, with rural residents and the illiterate having 1.45 times and 1.34 times higher odds of depression. We ascertained social capital from both the cognitive and structural constructs, where we enriched the measurement of structural social capital from three specific dimensions, i.e., informal interaction, altruism, and formal social participation. We found that both cognitive and structural social capital were associated with lower incidence of depressive symptoms, where informal interaction had the largest effect. The mediation analysis further illustrated that informal interaction contributed most to explain 6 %–12 % of the socioeconomic inequalities in depressive symptoms. These results highlighted the unsatisfied mental wellbeing of the vulnerable older people living in rural areas. The finding suggested that older people may benefit more from personal interactions than formal participations. To fulfill the Health in All vision, government and social organizations should consider how to create opportunities to better integrate the older people into the community.

Trends in socioeconomic inequalities in behavioural non-communicable disease risk factors: analysis of repeated cross-sectional health surveys in England between 2003 and 2019

BackgroundPrevious studies have shown that those in lower socioeconomic positions (SEPs) generally have higher levels of behavioural non-communicable disease (NCD) risk factors. However, there are limited studies examining recent trends in inequalities. This study examined trends in socioeconomic inequalities in NCD behavioural risk factors and their co-occurrence in England from 2003–19.MethodsThis time-trend analysis of repeated cross-sectional data from the Health Survey for England examined the relative index of inequalities (RII) and slope index of inequalities (SII) in four NCD behavioural risk factors: smoking; drinking above recommended limits; insufficient fruit and vegetables consumption; and physical inactivity.FindingsPrevalence of risk factors has reduced over time, however, this has not been consistent across SEPs. Absolute and relative inequalities increased for physical inactivity; relative inequalities also increased for smoking; for insufficient fruit and vegetable consumption, the trends in inequalities depended on SEPs measure. Those in lower SEPs experienced persistent socioeconomic inequalities and clustering of behavioural risk factors. In contrast, those in higher SEPs had higher prevalence of excessive alcohol consumption; this inequality widened over the study period.InterpretationInequalities in smoking and physical inactivity are persisting or widening. The pattern of higher drinking in higher SEPs obscure the fact that the greatest burden of alcohol-related harm falls on lower SEPs. Policy attention is required to tackle increasing inequalities in smoking prevalence, low fruit and vegetable consumption and physical inactivity, and to reduce alcohol harm.

Effect of Socioeconomic Factors on the Choice of Health care Institutions for Delivery Care

During the past two decades, Pakistan witnessed a significant progress in maternal health outcomes. However, there exist persistent urban-rural and socio-economic inequalities in access and utilization of maternal healthcare services across the country. The overall objective of this research was to identify the significant socio-economic factors determining the choice of healthcare institutions for delivery care. This was a cross-sectional study conducted in Rajan Pur, a predominantly rural district in Punjab province. Using a multi-stage random sampling technique, 368 mothers who had childbirths from 1st October to 31st December 2020 in different healthcare institutions were interviewed. Data for the study was collected through a validated study instrument used by earlier studies on maternal healthcare utilization. The results of logistic regression analysis showed that use of public healthcare facilities for delivery care increases with increasing maternal education, monthly household income, and distance to healthcare facilities. The findings and recommendations drawn from the research would provide some insights to health policymakers and planners in developing an integrated and viable maternal healthcare program in Pakistan.

Socioeconomic inequalities and family planning utilization among female adolescents in urban slums in Nigeria.

Background/statement of problemFamily planning (FP) utilization is important for preventing unwanted pregnancy and achieving optimal reproductive health. However, the modern contraceptive prevalence rate (mCPR) among women of childbearing age is still low in many low- and middle-income countries (LMIC), particularly in Nigeria, despite interventions to increase access and utilization. The low mCPR has been associated with a high prevalence of unwanted pregnancy, unsafe abortion, sexually transmitted infections such as HIV/AIDS, and high maternal and infant mortality in LMIC. Despite existing studies associating high family planning utilization to urban settings relative to the rural areas, the socioeconomic inequality in urban settings, especially among adolescents in urban slums has been given less research attention. This study examines the role of socioeconomic inequality on family planning utilization among female adolescents of various ethnic backgrounds in urban slums in Nigeria.MethodsThe study utilized data from the Adolescent Childbearing Survey (2019). A total sample of 2,035 female adolescents of ages 14–19 years who were not pregnant at the time of the study and were resident in selected slums. Associations between socioeconomic inequalities—measured by wealth index, social status, and education—and modern contraceptive use were examined using relative and slope inequality indices, and logistic regression models.ResultsThe results show that only 15% of the female adolescents in the North, and 19% in the South reported modern contraceptive use. While wealth index and education were important predictors of FP use among adolescents in southern urban slums, only education was important in the North. However, the relative and slope inequality indices further indicate that adolescents with no education and those in the lowest social status group use much fewer contraceptives compared to their counterparts with higher wealth and social statuses. Those with secondary/higher education and the highest social status group, respectively, were more disadvantaged in terms of FP utilization (Education: RII = 1.86, p < 0.05; 95% C.I. = 1.02–2.71; Social Status: RII = 1.97, p < 0.05; 95% C.I. = 1.26–2.68) with results showing a more marked level of disparity when disaggregated by North and South.ConclusionThe persistent socioeconomic inequalities among female adolescents in Nigeria, especially those in the urban slums, have continued to limit their utilization. Policy measure in education, communication and subsidized contraceptives should be intensified for vulnerable female adolescents in the slums.

Exposure to Tobacco Smoking in Vehicles, Indoor, and Outdoor Settings in Germany: Prevalence and Associated Factors.

Little is known on whether secondhand smoke (SHS) exposure in vehicles, indoor, and outdoor settings is similarly patterned in terms of different socio-epidemiological indicators in Germany. This study aims to estimate the current national-level prevalence and associated socio-epidemiological indicators of SHS exposure in vehicles, indoor, and outdoor settings in the German population, using current data from a representative household survey. We used cross-sectional data (N = 3928 respondents aged 14–99 years) from two waves of the DEBRA survey (German Study on Tobacco Use), conducted between January and March 2020. The reported prevalence of SHS exposure during the last seven days was 19% in vehicles, 25% in indoor settings, and 43% in outdoor settings. We found that younger age and current smoking were consistently associated with higher SHS exposure. Furthermore, people with low education were more likely to be exposed to SHS in vehicles and indoor settings than people with high education. This study found that the prevalence of SHS exposure in vehicles, indoor, and outdoor settings is a relevant feature of everyday life in Germany, especially for younger people and people with lower education, leading to potentially persistent socioeconomic and tobacco-attributable inequalities in morbidity and mortality.

How can Disaster Risk Reduction Reduce Inequality? A Study on the Vulnerable Communities of Bangladesh

The present paper deals with the capacity issues of the vulnerable communities of Bangladesh where hazards accelerate the persistent situation on social inequalities. Bangladesh is prone to natural disasters and the persistent socio-economic inequalities tend to increase due to the disaster risks. Disaster risks then hinder the opportunities of the vulnerable communities to become resilient. In this research the researcher has used both secondary and primary data. The researcher has mainly used the secondary data to explore the link between disaster risk reduction and social inequalities. Moreover, the researcher has collected the primary data by using the key informant interview method to have insights of the experts who have shared their valuable views on the relationship between the effective DRR strategies and its potential to reduce the existing social inequalities. The result of the research reveals that the lack of capacity of the disaster vulnerable communities of Bangladesh traps them into further poverty where they buffer their loss and damages with their limited resources. In Bangladesh it is the poor who are the victims of socio-economic inequality and suffer worst from natural disasters. This situation of disaster and poverty becomes a cycle of trap in which the poor tend to suffer and becomes vulnerable. DRR strategies do have the potential to have a positive impact in this scenario. Effective DRR strategies might lead to increase the capacity of vulnerable communities of Bangladesh and the communities will be more resilient. The Dhaka University Journal of Earth and Environmental Sciences, Vol. 10(2), 2021, P 66-77

Persistent Socioeconomic Inequalities in Measles Vaccine Uptake in Ethiopia in the Period 2005 to 2016

ObjectiveThis study aims to quantify socioeconomic inequalities—and the factors contributing to these inequalities—in measles vaccine uptake among children aged 12 to 23 months in Ethiopia between 2005 and 2016. MethodsInequalities in measles vaccine uptake were investigated based on data from the Ethiopian Demographic and Health Surveys conducted in 2005, 2011, and 2016. Concentration curves and concentration indices were used to measure the degree of inequality, and decomposition analysis was used to identify factors contributing to these inequalities. ResultsThe overall level of national measles vaccine uptake in Ethiopia exhibited an increasing trend between 2005 and 2016. As indicated by the concentration index of measles vaccine uptake, however, which was estimated at 0.202 (P < .01) in 2005, 0.226 (P < .01) in 2011, and 0.223 (P < .01) in 2016, measles vaccine uptake became consistently more concentrated among children from more affluent households. The dominance test of the concentration curve further confirmed the persistence of inequalities in measles vaccine uptake over time. Various factors—including maternal educational level, antenatal care use, institutional delivery, and exposure to media—were identified as the most important contributors to the inequalities. ConclusionsAlthough the national measles vaccine uptake showed improvement between 2005 and 2016, socioeconomic inequalities in the uptake persisted over time. Efforts to improve the national immunization coverage should be accompanied by appropriate measures to address the inequalities.

Socioeconomic inequalities in self-assessed health and mental health in Barcelona, 2001-2016

ObjectivePrevious research has found persistent socioeconomic inequalities in health outcomes at the national level, with different patterns after the economic crisis. However, inequalities in urban areas are also important. This study analyses socioeconomic inequalities in self-assessed health and mental health in the city of Barcelona. MethodRepeated cross-sectional design using quinquennial data from the Barcelona Health Surveys carried out in 2001, 2006, 2011 and 2016 for the population older than 22 years. Robust Poisson regressions models were used to compute socioeconomic gradients and relative (RII) and slope indexes of inequality (SII) by occupational social class, with stratification by sex. RII and SII were also obtained with further adjustment by employment situation. ResultsA consistent socioeconomic gradient was found for all years except for 2011. Relative and absolute inequalities followed a V-shape, showing a drop during the economic crisis but widening thereafter to recover pre-crisis figures for self-assessed health and widening for mental health, in both relative and absolute terms in 2016. Adjustment for employment situation reduces inequalities but a large part of these inequalities remains, with variability across years. ConclusionsThe lasting effects of the 2008 economic crisis and the austerity programmes imposed since then may have contributed to the persistence of socioeconomic inequalities in self-assessed health and the widening of those for mental health.

Healthy eating: a matter of prioritisation by households or policymakers?

I reflect upon the potential reasons why American low-income households do not spend an optimal proportion of their food budgets on fruits and vegetables, even though this would allow them to meet the recommended levels of fruit and vegetable consumption. Other priorities than health, automatic decision-making processes and access to healthy foods play a role, but solutions for the persistent socio-economic inequalities in diet should be sought in the wider food system which promotes cheap, mass-produced foods. I argue that, ultimately, healthy eating is not a matter of prioritisation by individual households but by policymakers.

Socio-economic inequalities of child undernutrition in Gujarat: over-time change and inter-district disparities

In the discourse of the lopsided development trajectory of Gujarat in which social development could not keep pace with economic development, poor child nutritional status shares a significant space. The level of child undernutrition remains higher, and its over-time decline has been slower as compared to the economically similar ranked states. Following this on, this study aims to unravel the underlying causes of poor nutritional status by examining its socio-economic, inter-district and regional disparities using data from the NFHS-1 (1992–93) and NFHS-4 (2015–2016). As analysis suggests, the underlying causes appear to be wide and persistent socio-economic and inter-district inequalities in the level of child undernutrition and inter-district variation in the magnitude of socio-economic inequalities of child undernutrition resulting from possible differentials in resource endowment across the districts of Gujarat. The paper concludes by suggesting a need of programme and policy assessment to check its effectiveness, formulate an equity-based fund devaluation system and initiate an intervention programme for children those who are socio-economically deprived.

The Healthy Start scheme and its association with food expenditure in low-income families in the UK

Abstract Background The Healthy Start programme is a statutory benefit-in-kind in the United Kingdom (UK) which aims to enable low-income families to purchase fruit, vegetables, cow's milk and infant formula through the provision of vouchers. The scheme was introduced in 2006, however, the effect on food purchasing in participating households has not been evaluated within an eligible population. This study aimed to determine whether participation in the Healthy Start (HS) scheme is associated with differences in food purchasing in a representative sample of households in the United Kingdom. Methods Cross-sectional analysis of the Living Costs and Food Survey dataset (2010-2017). All households with a child (0-3 years) or pregnant woman were included in the analysis (n = 4,869). Multivariable quantile regression was used to compare the expenditure and quantity of fruit and vegetable, infant formula and total food purchases between Healthy Start participating, eligible non-participating, nearly-eligible and ineligible households. Results 54% (n = 475) of eligible households participated in Healthy Start. After accounting for covariates, no significant difference was found in the quantity or expenditure of fruit and vegetable purchases between Healthy Start participating and non-participating households. Fruit and vegetable expenditure (£/week) was found to be higher in nearly eligible (β1.60; 95% CI 0.79, 2.41) and ineligible households (β2.56; 95% CI 1.77, 3.35) compared to Healthy Start eligible households. Conclusions The present study did not demonstrate significant differences in the fruit and vegetable expenditure of HS participating and non-participating households. The analysis demonstrates that inequalities in fruit and vegetable purchasing persists in the UK. Improved participation and increased voucher value may be needed to promote well-being and counteract the harmful effect of poverty on fruit and vegetables purchasing. Key messages The study found no evidence of different food purchases between Healthy Start participating and non-participating households. Increased voucher value may be needed to counteract food-price inflation. The paper reflected persistent socioeconomic inequalities in the UK, indicating the Healthy Start scheme does not sufficiently counteract the harmful effects of poverty on food purchasing.

Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

Educational inequality in avoidable mortality in osteoarthritis: a test of fundamental causes theory

Purpose: Persistent socioeconomic inequalities in health across time and place led scholars to propose socioeconomic status (SES) as a fundamental cause of health inequalities. According to the “fundamental causes” theory people with higher SES have access to a broad range of resources that can be used to avoid poor health and hence the association between SES and risk of mortality should be stronger for avoidable causes of death than less avoidable causes. While this theory has been tested in the general population, there is little empirical evidence for specific diseases. We aimed to investigate the validity of this theory among people with osteoarthritis (OA). Methods: Using regional registers, we identified patients with a doctor-diagnosed OA (all sites; ICD-10 codes: M15-M19) during 1998-2013 (n=98,619) among people aged 35-75 on December 31st 2002 who lived in the Skåne region continuously from January 1st 1998 (n=525,829). We followed these from January 1st 2003 or date of first OA diagnosis (whichever occurred last) until death, relocation outside Skåne, or December 31st 2014 (whichever occurred first). Using the list developed by the UK Office for National Statistics (link), we divided avoidable causes of death in 3 categories: amenable to medical interventions (AMI), amenable to public health interventions (APHI), and amenable to both medical/public health interventions (AMPHI). Education was categorized in five levels based on years of schooling: 0-9 years, 10-11 years, 12 years, 13-14 years, and ≥15 years. Each level of education was assigned a fractional rank based on the mean proportion of the population with a lower level of education. We applied Cox regression with age as time scale to estimate relative index of inequality (RII). Results: A total of 94,210 patients (58.9% women) with mean (SD) age 62.5 (9.6) years at entry were included. During a mean follow-up of 6.5 years, there were 9,554 deaths, of these 62.3% were from avoidable causes. While for both avoidable and non-avoidable causes, there were educational inequalities in favour of high educated, the magnitude of relative educational inequality was greater for avoidable than non-avoidable causes (Figure 1). The difference was more profound for AMI, especially among women. Conclusions: The Results suggest that educational attainment is a fundamental cause of inequality in OA. Therefore, preventive and therapeutic interventions with sole focus on mortality risk factors will not lead to eliminating inequalities unless the underlying differences in educational attainment are addressed.

Measuring Income-Related Inequalities in Health in Multi-Country Analysis

Health inequalities remain a cause of concern for policymakers across the world. However, the measurement and monitoring of health inequalities over time and across countries remain a research challenge. The concentration index is one of the most popular measurement tools, however, it presents several drawbacks, especially for bounded variables, which are discussed in this study. Results from the European Community Household Panel dataset and the Statistics of Income and Living Conditions for Europe suggest that there is evidence of persistent socioeconomic inequalities in health in Europe. Further, results show the need of reporting both absolute and relative inequalities for appropriately monitoring and comparing trends in health inequalities across countries.

EMPLOYMENT DISCRIMINATION IN INDIAN MANUFACTURING INDUSTRIES: A LOGIT ANALYSIS

Persistent socioeconomic inequalities in a society reduce the chances of employment for its weaker sections. In India, those most affected by inequality and discrimination are women, people of lower castes, rural households and illiterate people. This necessitates an analysis of the levels of discrimination and favoritism working against female, lower caste, rural and illiterate individuals in different manufacturing industries. This study presents an in-depth picture of employment in each industry with regard to the four variables selected — gender, caste, location and education. Fourth (2013–2014) and fifth (2015–2016) annual Employment and Unemployment Surveys have been used for the analysis.

Persistent Socioeconomic Inequality in Child Dental Caries in England despite Equal Attendance.

Despite a decline in the prevalence of dental caries among children in England and ongoing arrangements for the provision of free dental care up to the age of 18 y, there is limited information on the pattern and trend of socioeconomic inequalities in dental caries and dental attendance. We estimated the magnitude of deprivation-related inequalities for dental caries and dental attendance in young children, using publicly available data and 2 regression-based summary measures of inequalities: slope index of inequality and relative index of inequality. We found no significant absolute or relative inequalities in dental attendance across English areas in the past decade, while there were persistent absolute and relative inequalities in dental caries. Socioeconomic inequalities in dental caries decreased between 2007 and 2012; thereafter, the relative inequalities increased. The apparent widening inequality in child dental caries in England despite equal access to dental care is a challenge for policy makers. While caries prevalence among English children has declined over the past decade, there has been an increase in socioeconomic inequalities in oral health despite there being no inequality in dental attendance. This has implications for the development of oral health strategy and planning dental services.

Socioeconomic inequalities in obesity: modelling future trends in Australia

ObjectivesTo develop a model to predict future socioeconomic inequalities in body mass index (BMI) and obesity.DesignMicrosimulation modelling using BMI data from adult participants of Australian Health Surveys, and published data...

The rise and fall of green growth: Korea's energy sector experiment and its lessons for sustainable energy policy

The idea of “green growth” has received international attention for more than a decade as a promising solution to a distinctly modern problem: a century of unparalleled increases in wealth based on equally unparalleled innovations in energy technology accompanied by global environmental threats such as climate change and persistent socioeconomic inequality. The green growth premise is that this problem can be solved without surrendering continued economic growth by a redirection of human effort to invent green energy technology, green energy markets, and green energy choice. Proponents have argued that green‐energy based economic growth represents a paradigm shift bringing forth sustainable and equitable relations between environment, economy, and society. The paper reviews a decade of green energy growth strategies and practices. The Korean Green Growth Initiative (KGGI) is investigated as a case study of green energy growth operationalization. Korea’s experiment was widely hailed by international bodies such as The Organization for Economic Cooperation and Development (OECD) and United Nations Department of Economic and Social Affairs (UNDESA) for its bold attempt at paradigm shift, with the hope that, if it succeeded, countries currently on the periphery of modern development would be able to overcome conditions of poverty, environmental degradation, and political dependency. But our analysis of the Korean case questions the idea and ideology of green energy growth, demonstrating instead that KGGI was quickly coopted by the paradigm it was supposed to supplant. In this respect, one contradiction in the strategy and practice of green energy growth has been its promise to change the trajectory of modern development without requiring serious changes in modern values and ideology.This article is categorized under: Energy and Climate &gt; Economics and Policy Energy and Development &gt; Climate and Environment Energy and Development &gt; Economics and Policy

Socioeconomic disparities associated with 29 common infectious diseases in Sweden, 2005–14: an individually matched case-control study

Although the association between low socioeconomic status and non-communicable diseases is well established, the effect of socioeconomic factors on many infectious diseases is less clear, particularly in high-income countries. We examined the associations between socioeconomic characteristics and 29 infections in Sweden. We did an individually matched case-control study in Sweden. We defined a case as a person aged 18-65 years who was notified with one of 29 infections between 2005 and 2014, in Sweden. Cases were individually matched with respect to sex, age, and county of residence with five randomly selected controls. We extracted the data on the 29 infectious diseases from the electronic national register of notified infections and infectious diseases (SmiNet). We extracted information on country of birth, educational and employment status, and income of cases and controls from Statistics Sweden's population registers. We calculated adjusted matched odds ratios (amOR) using conditional logistic regression to examine the association between infections or groups of infections and place of birth, education, employment, and income. We included 173 729 cases notified between Jan 1, 2005, and Dec 31, 2014 and 868 645 controls. Patients with invasive bacterial diseases, blood-borne infectious diseases, tuberculosis, and antibiotic-resistant infections were more likely to be unemployed (amOR 1·59, 95% CI 1·49-1·70; amOR 3·62, 3·48-3·76; amOR 1·88, 1·65-2·14; and amOR 1·73, 1·67-1·79, respectively), to have a lower educational attainment (amOR 1·24, 1·15-1·34; amOR 3·63, 3·45-3·81; amOR 2·14, 1·85-2·47; and amOR 1·07, 1·03-1·12, respectively), and to have a lowest income (amOR 1·52, 1·39-1·66; amOR 3·64, 3·41-3·89; amOR 3·17, 2·49-4·04; and amOR 1·2, 1·14-1·25, respectively). By contrast, patients with food-borne and water-borne infections were less likely than controls to be unemployed (amOR 0·74, 95% CI 0·72-0·76), to have lower education (amOR 0·75, 0·73-0·77), and lowest income (amOR 0·59, 0·58-0·61). These findings indicate persistent socioeconomic inequalities in infectious diseases in an egalitarian high-income country with universal health care. We recommend using these findings to identify priority interventions and as a baseline to monitor programmes addressing socioeconomic inequalities in health. The Public Health Agency of Sweden.