Related Inequalities Research Articles

Level of and trends in women’s empowerment inequalities in antenatal care services in Ethiopia: further analysis of the Ethiopia demographic and health surveys, 2000-16

BackgroundMaternal health care services and women’s empowerment have received attention in the Sustainable Development Goals. Limited evidence exists on the extent of distribution of antenatal care services across the ladder of women’s empowerment in Ethiopia. In this study, we sought to shed light on whether and how such disparities changed over time.MethodsData for the study came from the 2000 and 2016 Ethiopia Demographic and Health Surveys. The outcome variables were three measures of antenatal care services: quality antenatal care, early antenatal care, and four or more antenatal care services. Women’s empowerment was measured through a newly developed index, SWPER Global. Specifically, we used two domains of the measure: attitude to violence and social independence. Disparities in antenatal care services were measured using the Erreygers concentration index, Relative Index of Inequality, Average marginal effect, and second difference of the average marginal effects. We decomposed the concentration index to study the contributions of different factors to the empowerment disparities in the services in 2000 and 2016 as well as to the over-time change in the disparities. The Oaxaca-type decomposition technique was applied to investigate social determinants’ role on the change in the disparities between 2000 and 2016. A generalized linear regression model was used for the analyses.ResultsAccording to the concentration index, women’s empowerment disparities in the utilization of antenatal care services existed in both surveys, where the services were disproportionately concentrated among women with better levels of empowerment. By the measure of average marginal effect, there were disparities favoring empowered women based mainly on the point estimates, except that the attitude toward violence disparity in 2016 occurred to the advantage of poorly empowered women. However, the confidence intervals suggest mixed findings. The concentration indices showed that disparities mostly increased in 2016 and the change was underpinned by the changes in the inequalities of various factors and sensitivities of antenatal care services with respect to these variables, such as wealth, maternal education, media exposure, place of residence, and women’s empowerment itself. Overall, the results of the second difference showed no large change in the disparities between 2000 and 2016. However, relative disparities decreased substantially during the same time.ConclusionsWhile concentration index-based absolute inequalities increased, relative inequalities decreased, suggesting the importance of using both absolute and relative measures in a study. The decomposition analyses suggest that working on the equitable distribution of social determinants could improve empowerment disparities in antenatal care services.

The Boring of Hard Boards

If one social group has more of something because another has less we speak of relational inequality. The fight against relational inequalities is a tough, centuries-long battle characterized by trial and error. Results can be achieved only through very persistent pressure—what Max Weber described as “a strong and slow boring of hard boards.” The essays in the present issue discuss both obstacles that perpetuate inequality and forms of resistance to them. Some contributions focus more on top-down activities, while others emphasize the perspective from below. Taken together, they reveal that the struggle for more just and egalitarian societies is tough, but gradually making progress.

Socioeconomic inequalities in health behaviors in children and adolescents: evidence from an Australian cohort

BackgroundUnderstanding the association between socioeconomic inequalities and health behaviors is imperative for elucidating and effectively addressing health inequities among children and adolescents. Despite the wealth of literature on social gradients in health behaviors, longitudinal analyses of socioeconomic inequalities in the health behaviors of children and adolescents are relatively limited, particularly in the Australian literature. Therefore, this study aimed to investigate the association between socioeconomic inequalities and health behaviors among Australian children and adolescents.MethodsThis study utilized the secondary data from the Longitudinal Study of Australian Children (Waves 2–8), which included participants aged 2 to 15 years. Relative index inequality (RII) methods were used to investigate the associations between socioeconomic inequalities and the health behaviors of children and adolescents.ResultsCompared with their counterparts, children and adolescents with high socioeconomic status (SES) are 84% more likely to consume fruits and vegetables (RII = 1.84, 95% CI = 1.63–2.09) and 19% less likely to consume sugary beverages (RII = 0.81, 95% CI = 0.77–0.86), but more likely to consume sweet and savory foods (RII = 1.09, 95% CI = 1.01–1.19). Children and adolescents with high SES were less likely to spend their free time on screens (RII = 0.86, 95% CI = 0.81–0.91) and more inclined toward outdoor activities (RII = 1.75, 95% CI = 1.53–1.98).ConclusionThis study provides useful insight into socioeconomic inequalities and health behavior outcomes in children and adolescents. These findings stress the need for tailored interventions designed to improve the health behaviors of families from lower socioeconomic backgrounds. Additionally, addressing unhealthy dietary behaviors, such as the higher consumption of sweet and savory foods among children from higher SES backgrounds, is equally critical. Such comprehensive interventions have the potential to reduce socioeconomic disparities in health behaviors and improve the well-being of the broader population.

Social inequalities in youth mental health in Canada, 2007-2022: a population-based repeated cross-sectional study.

Rising concern surrounds youth mental health in Canada, with growing disparities between females and males. However, less is known about recent trends by other sociodemographic factors, including sexual orientation, ethnocultural background, and socioeconomic status. This study analyzed data from 96 683 youths aged 15-24 who participated in the nationally representative Canadian Community Health Survey (CCHS) between 2007 and 2022. Trends in absolute and relative inequalities in poor/fair self-rated mental health (SRMH) by sex, sexual orientation, racialized and Indigenous identity, and socioeconomic conditions were assessed. The percent of youths reporting poor/fair SRMH quadrupled from 4.3% in 2007-08 to 20.1% in 2021-22. During the same period, absolute inequalities in SRMH increased by 9.9% points (95% CI: 6.6, 12.9) for females compared to males, 11.4% points (95% CI: 4.6, 18.2) for Indigenous versus non-racialized youth, and 15.4% points (95% CI: 5.7, 25.1) for youth (aged 18-24) identifying as lesbian, gay, or bisexual (LGB) compared to heterosexual. The sustained deterioration in youth SRMH over the past decade and a half has been accompanied by widening inequalities across several dimensions important for health equity in Canada. Action is needed to identify and implement effective programs and policies to support youth mental health and address disparities.

Analysis of burden and equality of lower extremity peripheral artery disease in people aged 40 and above in the Belt and Road partner countries from 1990 to 2021.

To analyze the disease burden and inequalities of lower extremity peripheral artery disorders (LEPAD) among people aged 40 and above in the Belt and Road partner countries from 1990 to 2021. Data were retrieved from the Global Burden of Disease 2021 database. The age-standardized prevalence rates, mortality rates, and the annual rate of years lived with disability (YLDs) of LEPAD were analyzed. Trends were measured using the estimated annual percentage change (EAPC), and the slope index of inequality (SII) and concentration index were used to quantify the absolute and relative inequalities. In 2021, the age-standardized prevalence and mortality rates of LEPAD were 3168.26/105 and 3.09/105, increasing by 4.30% and 19.31% compared to 1990, and YLDs rates decreased by 4.00%. Females had higher age-standardized prevalence and YLDs rates, while males had higher mortality rates. The EAPC for prevalence rates was slightly higher in males (0.22%) than in females (0.17%); while the EAPC of age-standardized mortality rate was 2.02% for females, compared to 1.45% for males. From 1990 to 2021, the age-standardized YLDs rates decreased from 16.23/105 to 15.58/105, with a faster decline in females (－0.12%) than in males (－0.06%). LEPAD prevalence varied across countries, with higher burdens in Europe and faster growth in Gulf states. Higher socio-demographic index countries had higher prevalence. Inequity improved, with the SII at 52.90/105 and concentration index at 0.038 in 2021. Gender disparities persisted, with concentration index rising to 0.058 in females and falling to －0.026 in males. LEPAD prevalence and mortality among people aged 40 and above in the Belt and Road partner countries were risen, while YLDs rates were decreased from 1990 to 2021. Significant differences exist among peoples with different gender and countries, highlighting the need for enhanced screening, health education, and shared public health strategies across the Belt and Road partner countries.

Relative Price Shocks and Inequality: Evidence from Italy

Relative Price Shocks and Inequality: Evidence from Italy

Inequalities in utilization of maternal health services in Ethiopia: evidence from the PMA Ethiopia longitudinal survey.

Previous studies documented the existence of substantial inequalities in the utilization of maternal health services across different population subgroups in Ethiopia. Regularly monitoring the state of inequality could enhance efforts to address health inequality in the utilization of maternal health services. Therefore, this study aimed to measure the level of inequalities in the utilization of maternal health services in Ethiopia. The study used data from the Performance Monitoring for Action Ethiopia (PMA Ethiopia) dataset. Longitudinal data was collected from a weighted sample of 1966 postpartum women using multistage stratified cluster sampling techniques between November 2021 to October 2022. We assessed inequality in maternal health services using three indicators: antenatal care four (ANC), skilled birth attendants (SBA), and postnatal care (PNC). Age, economic status, education level, place of residence, and subnational regions were used as dimensions for measuring inequality. The analysis was conducted using Health Equity Assessment Toolkit Plus (HEAT Plus) software. We computed the summary measure of health inequality: Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF). The simple summary measures of inequality difference (D) reported a high level of inequality in the utilization of maternal health services in ANC four, SBA, and PNC across economic, education, residence, and subnational regions. The difference (D) in maternal health service utilization between advantaged and disadvantaged population groups exceeded 20 percentage points in all four dimensions of inequality for the three maternal health indicators. Similarly, the complex summary measures of inequality (PAR and PAF) also showed high levels of inequality in the utilization of ANC four, SBA, and PNC across all four dimensions of inequality. However, there was no age-related inequality in the use of maternal health services. A high level of socioeconomic and geographic area related inequality was observed in the utilization of ANC four, SBA, and PNC services in Ethiopia. Women from socioeconomically disadvantaged subgroups and women from disadvantaged geographic areas significantly lagged behind in the utilization of maternal health services. Therefore, implementing targeted interventions for the most disadvantaged groups can help to reduce inequality in accessing maternal health services.

A Nationwide Exploration of Social Inequalities in Cancer Mortality Amidst the COVID-19 Pandemic in Belgium.

The COVID-19 pandemic disrupted global health systems, impacting cancer care and potentially increasing cancer mortality, especially among socioeconomically disadvantaged individuals. We aimed to assess changes in cancer mortality from March 1 to December 31, 2020 relative to the same period in 2019, and to examine potential shifts in cancer mortality's social disparities during the same time frame. We used nationwide individually linked cancer mortality data from the Belgian National Register, the Census 2011, and the tax register. Analyses were stratified by age group (45-59 years, 60-74 years, 75+ years) and sex across all cancer types, including breast, colorectal, lung, pancreatic, and prostate. Direct age-standardized mortality rates were calculated in 2019 and 2020 to calculate absolute and relative changes in cancer mortality by social indicators. Relative inequalities in cancer mortality by social groups were calculated for both time frames using Poisson regression. Sensitivity analysis considered any mention of specified cancer groups on the Belgian death certificate. For both overall and site-specific cancers, our study found decreases in cancer mortality during the pandemic's early stages, particularly among individuals aged 75 and older. These changes did not significantly alter established socioeconomic patterns in cancer mortality. Reductions in reported cancer deaths in 2020 may reflect COVID-19 prioritization in cause-of-death coding and its role as a competing risk, rather than true declines. Persistent educational disparities emphasize the need for continued policy and healthcare collaboration, with future research focused on the pandemic's long-term effects on cancer mortality and social inequalities.

Aversion to income, ethnic, and geographic related health inequality: Evidence from Australia

This study investigated the Australian general public’s views on trade-offs between reducing health inequalities and improving total health. It elicited relative equity weights, comparing inequalities in life expectancy at birth across three equity-relevant dimensions: income (comparing poorest versus richest fifth), ethnic (comparing Indigenous versus non-Indigenous), and geographic (comparing rural/remote versus major cities). A benefit trade-off exercise was administered via online survey to a sample of Australian adults (n=3,105) using quota sampling to ensure population representativeness across key demographic variables (age, gender, state of residence, household income and education level). When comparing income groups, 88% (95% Confidence Interval (CI): 82% - 92%) of the respondents were health inequality averse, with 42% (95% CI: 34% - 51%) demonstrating extreme inequality aversion. When considering Indigenous status, 85% (95% CI: 79% - 90%) showed inequality aversion, and 40% (95% CI: 31% - 49%) displayed extreme aversion. Lastly, looking at different geographic locations, 74% (95% CI: 66% - 80%) of the respondents were inequality averse, with 37% (95% CI: 29% - 46%) showing extreme inequality aversion. The relative equity weights were calculated, allowing for varying baseline inequalities in life expectancy – proportional gaps of 10.8%, 5.1% and 6.3%, respectively. The results imply that the public is willing to weight incremental health gains to the poorest fifth five times more than to the richest fifth, six times more for Indigenous versus non-Indigenous, and four times more for people living in rural and remote areas compared to major cities.

Socioeconomic Inequalities in Diabetes Prevalence in Europe

Diabetes prevalence is steadily increasing in Europe. This study aims to compare diabetes prevalence and the existence of related socioeconomic inequalities between 19 European countries. Using data from The European Social Survey (ESS), there were 31,178 participants (53.06% women) aged 25+ years from Austria, Belgium, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Lithuania, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland and the United Kingdom. Education level and employment were used as indicators of socioeconomic inequalities. Logistic regression analyses were calculated to predict diabetes by controlling for age and gender. Differences in the effect size of education on diabetes prevalence between countries were then further examined. Overall diabetes prevalence in Europe was reported to be 6.12%, and was higher in participants from Eastern and Southern Europe than in Northern and Western Europe. Additionally, men in Western and Northern Europe had a higher risk of reporting having diabetes compared to women. Employment was identified as a protective factor against diabetes development across all European regions. Moreover, individuals with a tertiary level of education had a lower risk of reporting having diabetes in most European regions except for the Eastern region. Participants with lower education levels and the unemployed ones had a higher chance of reporting having diabetes. This was found across all European regions except for some countries from the Eastern region.

Subnational trends and inequalities of under-immunisation and zero-dose among children aged 12–23 months in Uganda: a national population-based cross-sectional study

ObjectiveDespite the Global Vaccine Action Plan’s goal of at least 90% vaccine coverage for all children, Uganda has made limited progress in vaccination over the past decade. The objective of...

Socioeconomic Inequities in the Age-Specific Burden of Severe Respiratory Syncytial Virus in Canada, 2016–2019

Abstract Background Limited attention has been given to social inequities in respiratory syncytial virus (RSV), particularly beyond childhood and neighborhood-level measures. This study aimed to quantify the burden of severe RSV disease across the age continuum by individual-level socioeconomic status (SES) indicators. Methods We conducted a longitudinal descriptive study of Canadians (excluding Québec) ≥6 months of age using the 2016 Canadian Census Health and Environment Cohort (2016–2019). International Classification of Diseases, 10th Revision–coded RSV-related hospitalization rates, rate ratios (RRs), and rate differences (RDs) per 100 000 person-years were estimated using Poisson regression. Results Rates of RSV-related hospitalization were greatest among Canadians with lower compared to higher SES, as indicated through income (RD, 11.7 [95% confidence interval {CI}, 10.1–13.3]; RR, 2.8 [95% CI, 2.4–3.2]), education (RD, 18.7 [95% CI, 16.6–20.9]; RR, 3.3 [95% CI, 2.9–3.7]), and measures of poorer housing conditions including unaffordable housing and apartment living. Inequities varied by measure and age group; while rates were highest among 6- to 59-month-olds and ≥80-year-olds overall, some of the greatest relative SES inequities were among other ages. Conclusions Understanding SES factors’ role in RSV-related hospitalization risk is necessary to inform equitable prevention efforts, including delivery of emerging RSV immunizations.

Gender differences in physical activity and sport participation in adults across 28 European countries between 2005 and 2022.

There is a lack of understanding of the specific types and intensities of physical activity driving the gender gap in overall levels of physical activity, and how these activities are changing over time. We examined the gender gap in specific types and intensities of physical activities in European adults from 2005-2022. This repeated cross-sectional study included data from adults from the Eurobarometer (2005-2022) from 28 European countries. Gender differences in meeting physical activity guidelines, sport, walking, moderate, and vigorous activity were examined using prevalence ratios (PR, relative inequalities) and mean differences (MD, absolute differences). Among 123,809 participants, there was no change in the gender gap in meeting physical activity guidelines from 2005 to 2022 (PR=1.10; 95% CIs 1.07, 1.14, PR=1.04; 95% CIs 1.01, 1.08, respectively). The gender gap in vigorous intensity activity decreased from 2005 to 2022 (MD=589; 95% CIs 545.7, 631.5, MD=399; 95% CIs 354.5, 444.3, respectively). The gender gap in moderate activity increased from 2005 to 2022 (MD=10.9; 95% CIs -14.2, 35.9, MD=104; 95% CIs 77.8, 130.1, respectively). The gender gap in sport and exercise increased from 2009 to 2022 (PR=1.14; 95% CIs 1.10, 1.19; PR=1.22; 95% CIs 1.17, 1.27, respectively). There was no gender gap in walking between 2005 and 2022 (MD=-1.4; 95% CIs -21.2, 18.4, MD=12.5; 95% CIs -4.9, 29.9, respectively). Sport remains an underutilized contributor to overall physical activity levels and could be promoted among women to reduce the overall gender gap in physical activity.

Trends of socioeconomic and geographic inequalities in COVID-19 vaccine uptake in Ethiopia: using the WHO Health Equity Assessment Toolkit

BackgroundEquity in COVID-19 vaccine uptake is the heart of managing the ongoing pandemic of COVID-19 disease. However, the evidence of inequality in COVID-19 vaccination in Ethiopia is limited. Therefore, this study investigated the trends of socioeconomic and geographic inequality of COVID-19 vaccine uptake in Ethiopia.MethodThis study used the Global COVID-19 trends and impact survey as part of the WHO Health Equity Assessment Toolkit software 2021 version. The trends of socioeconomic and geographic inequalities in COVID-19 vaccine uptake between surveys were calculated with a 95% confidence interval (CI). A 95% CI was calculated along with measures of inequality in COVID-19 vaccine uptake and statistical significance was declared if the 95% CI of absolute and relative measures of inequalities does not include 0 and 1 respectively.ResultThe COVID-19 vaccine uptake in the 45–65 age group significantly increased from 40.04%, 95% CI (32.49, 48.1) to 72.7%, 95%CI (63.7, 80.2) in 05/2021 to 03/2022 respectively. The absolute inequality of COVID-19 vaccine uptake among male vs female respondents was 3.6%, 95% CI (3.9, 11.2) in 08/2021 which was obtained by subtraction of the respecting proportion of vaccines uptakes 32.9% for males minus 29.28% for females and there was a significant more prevalence of vaccine uptake in males than in females. The absolute inequality in COVID-19 vaccine uptake among health workers vs non-health workers was 28.5%, 95% CI (17.8, 37.2), 03/2022 and there was a significantly higher prevalence of vaccine uptake in health workers than non-health workers in each survey. The relative measures of inequality in the ratios of COVID-19 vaccine uptake among urban vs rural was 0.85, 95%CI (0.7, 0.994) in 08/2021 which was obtained by dividing the respecting proportion of vaccine uptakes of urban by rural residents.ConclusionThe study showed that the proportion of COVID-19 vaccine uptake in Ethiopia significantly increased from 2021 to 2022 with distinct inequality. The study indicated there is significant absolute and relative inequality in COVID-19 vaccine uptake between health workers and non-health workers, male and female, and urban and rural residents in Ethiopia. Therefore, the effort should be geared towards reducing health workers vs non-health workers, urban vs rural, and gender inequalities in COVID-19 vaccine uptake through health literacy and recommend geographic and equity-oriented policies, to ensure effective pandemic management of COVID-19.

Inequities in Unmet Oral Care Needs after a Swedish Subsidization Reform: An Intersectional Analysis.

The main strategy to achieve equal provision of oral care in Sweden has been to offer partial subsidies for the adult population. However, their effects on unmet oral care needs (UOCNs) have not been extensively assessed. This study used an intersectionality framework to examine 1) the overall frequency of UOCNs, 2) single-indicator inequities, and 3) intersectional inequities in total UOCNs and financial-related UOCNs (FUOCNs) in Sweden before and after implementation of a partial subsidization reform in 2008. Data from 12 national surveys conducted over 2004 to 2018 were divided into 3 periods: prereform (2004 to 2007), early postreform (2008 to 2011), and late postreform (2012 to 2018). The analytic sample consisted of 98,177 respondents aged 24 to 84 y. Changes in the prevalence of UOCNs were estimated by inferential statistics. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy, across 48 strata defined by gender, age, educational level, income, and immigrant status. The prevalence of total UOCNs and FUOCNs decreased significantly early after the reform, followed by a slight rebound. Relative inequities increased by education, income, and immigrant status after the reform and decreased for age. The discriminatory accuracy for both types of UOCNs was moderate and improved marginally but significantly with the inclusion of the intersectional strata. Most intersectional strata showed greater FUOCN inequities after the reform. Contrary to expected, larger inequities in FUOCNs were identified in most intersectional strata after the reform. The moderate discriminatory accuracy suggested that Sweden could benefit from future strategies to foster equity that are universal but proportionately more intense among the intersectional strata with greater inequities (proportionate universalism). This analysis highlighted the benefit of adopting the principle of proportionate universalism as a strategy to reduce unmet oral care needs in Sweden. This would mean implementing universal strategies and specific support measures for the most vulnerable social groups as a future oral care policy change in Sweden.

Mixed singular value and phase majorization inequalities for accretive matrices

In this paper, we give a number of mixed singular value and phase majorization inequalities for a class of accretive matrices. The first group of inequalities is for a single matrix, the second group is for sums of matrices, and the third group is for matrix operations induced by network connections. The results in this paper provide improvements to some existing related inequalities.

Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies

ObjectiveTo examine the associations between maternal education and household income during early childhood with asthma-related outcomes in children aged 9–12 years in the UK, the Netherlands, Sweden, Australia, the USA...

Further refinements and reverses of squared Young-type inequalities with double weights

In this paper, we first present further improvement of squared Young-type inequalities with double weights and their reverses. As a consequence of our results, we show the reverses of main results obtained by Nasiri and Askari [Some refined Young-type inequalities using different weights, Asian-Eur. J. Math. 15 (2022) 7]. As a further application, we provide some related inequalities for unitarily invariant norms, traces, and determinants.

All-cause and cause-specific mortality inequalities between people with and without disability: a nationwide data linkage study in Australia

Without high-quality statistics on mortality inequalities, designing policies to improve the health of people with disability is challenging. We aim to quantify mortality inequalities experienced by people with disability in Australia. In this nationwide, data linkage study we used Census mortality linked data (2011-20) to construct a cohort of Australians aged 0-74 years. Disability was measured as requiring assistance or supervision in core daily activities. We estimated age-standardised and age-specific mortality rates, and absolute and relative mortality inequalities between people with and without disability. 15 216 195 people were included in the study, comprising 7 763 047 females and 7 453 148 males. Of the participants, 258 109 (3·5%) males and 228 658 (2·9%) females reported disability, with 462 990 deaths occurring over 138 540 359 person-years of follow-up. Per 100 000 person-years, there were 2067 (95% CI 2043-2091) more deaths in males and 1697 (1677-1718) more deaths in females with disability (3·69 and 4·64 times higher, respectively) than those without disability. Cancer and cardiovascular disease had the highest absolute inequalities, with rate differences of 462 (95% CI 449-476) for males and 368 (356-379) for females for cancer, and 471 (95% CI 459-483) for males and 333 (324-342) for females for cardiovascular disease. Less common causes among people without disability-neurological conditions, chronic lung diseases, endocrine diseases, and digestive diseases-are relatively common among people with disability, translating to high relative mortality inequalities. The largest relative inequalities were from neurological conditions, with rate ratios of 9·66 (95% CI 9·31-10·02) for males and 11·61 (11·13-12·10) for females. Relative and absolute inequalities were also substantial for unintentional injury and for suicide mortality. Age-specific mortality was consistently higher in people with disability. The leading contributors to absolute inequalities shifted from neurological conditions in younger ages to cancer, cardiovascular diseases, and chronic lung diseases in older ages. People with disability experience large mortality inequalities. Identifying intervention-amenable factors contributing to these inequalities should be a priority. Targeted interventions and policy reforms to create a more inclusive social and health-care environment for people with disability might be necessary. The University of Melbourne.

Attribute reduction method based on fuzzy relational equations and inequalities

Attribute reduction method based on fuzzy relational equations and inequalities