Related Inequalities Research Articles

The healthiness of Australian food outlets available through online delivery platforms, by level of socioeconomic disadvantage and remoteness

Online food delivery platforms are an emerging but poorly understood aspect of food retail environments. We collected data via web scraping methods from the two leading online food delivery platforms in Victoria, Australia, identifying 11,154 food outlets from Menulog, and 12,939 from Uber Eats (with 21,733 unique outlets available across both platforms). Outlets were classified according to their healthiness using a tool developed with Australian dietitians and public health nutritionists, and assigned a food environment score. Area level (suburb/neighbourhood) socioeconomic disadvantage was determined using the Socio-Economic Indexes for Areas Index of Relative Socio-economic Disadvantage, and relative remoteness was determined using both the Accessibility/Remoteness Index of Australia and the Modified Monash Model. Across both food delivery platforms, approximately 15% of food outlets were classified as "unhealthy", 82% were classified as "less healthy", and 3% were classified as "healthy". More food outlets were available in areas of socioeconomic advantage, and in metropolitan areas. Food environment scores indicated that unhealthy outlets were significantly more available in areas with higher socioeconomic disadvantage and greater relative remoteness. Disparities in the healthiness of food outlets available through online food delivery platforms may have a negative influence on the purchasing and dietary behaviours of residents in these areas, thereby widening diet related health inequalities. Further research is required to understand the potential influence of online food delivery platforms on inequities in population diets and health.

Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study

BackgroundAs prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in...

Global burden and cross-country inequalities in diseases associated with high body mass index from 1990 to 2019: Result from the Global Burden of Disease Study 2019.

High body mass index (BMI) has gradually become an increased risk factor for the global burden of diseases (GBD). As the disease burden and the number of elders globally increase, it is crucial for policymakers to realise the associations between high BMI and disease burden worldwide in a timely manner and to develop effective interventions for different countries and ages. We used the GBD 2019 database to analyse the deaths and disability-adjusted life-years (DALYs) in the disease burden associated with high BMI and indicated the health inequality at the global, regional, and national levels. We applied the slope index of inequality and concentration index, two standard metrics of absolute and relative gradient inequality recommended by the World Health Organization (WHO), to quantify the distributive inequalities in the burden of diseases associated with high BMI. These rates were reported per 100 000 population as crude incidence rates, death rates, and DALYs rates. All the estimates were generated with a 95% uncertainty interval (UIs). Globally, we revealed that an estimated age-standardised mortality rate associated with high BMI is 6.26 million (95% UIs = 3.99, 8.91). The age-standardised DALYs rate is 19.32 million (95% UIs = 12.77, 26.40), and the global population attributable fraction was 9% (95% UIs = 5, 12) in 2019. The largest number of high-BMI-related deaths in women mainly concentrated in the age group of 65-79 years, whereas the largest number in men was in the age group of 60-69 years. The age-standardised DALYs rate of diseases associated with high BMI was larger in the high-middle and middle socio-demographic index (SDI) (population attributable fraction (PAF) = 11 and PAF = 9) regions than those with high SDI (PAF = 1) and low SDI (PAF = 5) regions. In this study, our results showed that the disease burden of global deaths and DALYs associated with high BMI has substantially increased between 1990-2019. Furthermore, we demonstrated that countries with higher SDI development levels shoulders higher burden of diseases associated with high BMI. Future policies to prevent and reduce the burden should be developed and implemented based on country-specific development status.

Absolute versus Relative Poverty and Wealth: Cooperation in the Presence of Between-Group Inequality

Abstract While inequality in resource endowments has been shown to affect cooperation levels in groups, much of this evidence comes from studies of within-group inequality. In an online public goods experiment, we instead examine the effects of payoff-irrelevant inequality in resources between groups on cooperation within equal groups, i.e. the effect of mere exposure to inequality. When all groups are poor or rich, their contribution behaviour is very similar. Relative inequality, when poor and rich groups coexist, leads to lower contributions in rich groups. We find suggestive evidence that this may be related to stereotypes about the rich contributing less than the poor.

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

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

How do air pollution and population migration influence income inequality in China

This study aims to investigate the impacts of air quality and population migration on income inequality in China. It introduces a general equilibrium model that air pollution triggers population outflow. The findings reveal that both absolute and relative air pollution cause population outflow and exacerbate income inequality. Using panel data of 292 Chinese cities in 2001–2020, this study finds that deteriorations in air quality—both in absolute and relative terms—widen the income gap but can mitigate income inequality through population outflow. Robustness tests support these findings. This study also uses data from A-share listed companies in China from 2010 to 2020 to explore the nexus between air pollution, human capital, and income inequality. It finds that increased absolute and relative air pollution decrease human capital and increase income inequality. Furthermore, a decrease in employee human capital (non-talents outflow) reduces intra-company income gap. This decrease is caused by a decrease in senior executives’ earnings compared to an increase in general employees’ compensation. However, a reduction in the human capital of senior executives (talents outflow) increases income inequality by boosting the earnings of senior executives.

Territorial health inequalities in breast cancer mortality across France from 1968 to 2017

Abstract Background Territorial health inequalities are of growing concern in countries with universal health systems. From 2003, three successive national cancer plans were launched in France, aiming to improve prevention and treatment. Regions in France are responsible for strategic and financial management of healthcare within their boundaries, which, until 2016, included up to 8 departments. In this study, we analyze the evolution of between and within-region territorial inequalities in breast cancer mortality over 50 years. Methods We used direct and indirect standardization to analyze trends in breast cancer mortality for women aged 25 to 74 years between 1968 and 2017 in each department of metropolitan France. We analyzed the evolution of relative inequalities over time using standard errors of age-adjusted rates. We used multilevel Poisson regression to estimate how much the regional level contributed to territorial variation. Results Over the period 1968 to 1992, breast cancer standardized mortality ratios (SMRs) increased (+16%) while relative territorial inequalities decreased (-21%). After 1997, SMRs decreased (-23%) but territorial inequalities remained unchanged. In 18 out of 22 regions, inequalities were lower at the end than at the start of the study period. Period proved to be the most important determinant of variation in mortality. However, multilevel models also suggested that the regional level explained most of the remaining variation in each period (from 50% to over 80%). Conclusions Over the study period in most French regions, breast cancer mortality has decreased, and so have relative inequalities. Nevertheless, there is evidence that regions have performed differently. The proportion of variation explained by the regional level suggests the continued relevance of the health system on breast cancer mortality. Key messages • Territorial inequality in breast cancer mortality has decreased in France over the 1968-2017 period. • In most regions, disparities between departments have decreased.

Monitoring the level of health and inequality over time using the Population Health Performance Index

Abstract Background The Population Health Performance Index (PHPI) is a composite measure that combines average health outcomes and their distribution within a population, thereby allowing for a comprehensive assessment of population health and inequality. The aim of this study is to examine the extent to which the PHPI adds value to monitoring of health and inequality over time in comparison to absolute and relative inequality. Methods Data from the WHO Equity Monitor database on under-5 mortality disaggregated by wealth quintiles for Nepal, Ethiopia, Peru, Rwanda, and Zimbabwe were analysed using different years between 1994 and 2020. Descriptive comparative statistics were employed to assess trends in the PHPI and conventional pairwise measures of absolute and relative inequalities, with consideration of different weights for inequality aversion. Results PHPI trends correspond to the trend of absolute inequality in all five countries, although they exhibit less volatility over time. Relative inequality follows the trend of the PHPI in only two of the five countries (Ethiopia and Zimbabwe), reflecting the methodology utilised for the PHPI. PHPI scores vary based on different inequality aversion weights, highlighting the sensitivity of the index to methodological adjustments. Conclusions The PHPI demonstrates notable convergence of trends with conventional methods, thereby substantiating its utility as a comprehensive tool for the simultaneous measurement of health and inequality. As it is able to consider both absolute and relative inequality within its own calculations, the PHPI allows for independent analysis of its two key components. The PHPI facilitates a more nuanced understanding of population health and may be more easily understood by policymakers and other stakeholders. As it does not address the underlying causes of changes in health inequalities, further research is necessary to supplement monitoring activities. Key messages • PHPI is a valuable tool for health and inequality monitoring by integrating both average health and disparity in a single index, facilitating communication of trends over time. • The dual focus complements conventional methods with its multidimensionality and may enable stakeholders to assess health and inequalities in alignment with broader health policy objectives.

Are health inequalities decreasing in Sweden?

Abstract Background The overarching national goal for the Swedish public health policy is to create societal conditions for good and equitable health for all and to eliminate avoidable inequalities within a generation (until 2048). To know whether we are heading towards the public health policy goal, a surveillance system which follows a combination of several inequality measures over time, is needed. Methods All-cause mortality in age 25-64 and life expectancy at age 30, in the total population of Sweden, were used as measures of health and followed 2006-2022. Education (low, middle, high) was used to measure socioeconomic position. Both absolute and relative, and both simple and complex measures were used to analyse inequalities in mortality: rate difference (RD), relative risk (RR), population attributable fraction (PAF) and population attributable number (PIN). Life expectancy was analysed as absolute and relative difference in remaining number of years. Results Life expectancy has increased and mortality in age 25-64 have decreased in the Swedish general population. Comparing those with low and high education, both absolute and relative inequalities have increased, e.g. differences in life expectancy increased to > 6 years among men and almost 7 years among women, and relative inequality in mortality in age 25-64 increased to > 3 times higher risk (RR 3.1; CI 3.0-3.3). Inequality, measured with regard to all groups in the population, showed no noticeable changes over time. Conclusions The results show that Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25-64. To use a combination of health inequality measures strengthens the surveillance system and gives a more nuanced picture of the development. It enables, in parallel with universal health improving efforts, focus on the groups with the poorest health, where efforts have the greatest effect. Key messages • Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25–64. • A more nuanced picture of inequalities is crucial to be able to parallel universal health-improving efforts with a focus on the groups with the poorest health, where efforts have the greatest effect.

Regional inequalities in years of life lost within the European Economic Area: Using the Gini coefficient and slope index of inequality to assess spatial disparities

Abstract Background Health inequalities have been linked to reduced life expectations. This study aimed to investigate regional variations in all-cause years of life lost (YLLs) in European Economic Area (EEA) countries prior to the COVID-19 pandemic. Methods Demographic data were extracted from Eurostat for 1390 small regions 32 EEA countries. Age-standardised sex specific YLL rates per 100,000 population in 2019 were estimated for EEA regions (Eurostat NUTS level 3) using methodologies derived from the Global Burden of Disease study. Relative spatial disparities were evaluated using the Gini coefficient (GC) and absolute spatial disparities assessed using the slope index of inequality (SII). Results Between EEA countries, relative geographical inequality in age-standardized YLL rates was higher than within them, slightly more so for males (GC = 16.96% [95% CI = 16.26-17.65]) than females (14.22% [13.62-14.82]). Among females, the UK (11.21% [95% CI 10.11-12.30]), Greece, and Croatia had the highest relative spatial inequality, while Ireland (3.37% [2.26-4.48]), Slovakia, and the Netherlands had the lowest. For males, Belgium (10.76% [9.34-12.17]), the UK, and Croatia exhibited the highest relative spatial inequality, while Ireland (1.99% [1.18-2.81]), Lithuania, and Slovakia had the lowest. Germany had the largest absolute geographical inequality in YLLs among females (SII=16.86% [16.28 to 17.44]), followed by Estonia and the UK. Among males, Estonia had the largest absolute spatial inequality (36.60% [-10.88 to 84.07]), followed by Latvia and Hungary. Ireland had the lowest absolute spatial inequality for both females and males. Conclusions Relative and absolute disparities in premature mortality rates are evident across regions of the EEA, both within countries and across the entire region. These findings offer insights for national and local stakeholders, aiding them in customising public health interventions to target spatial health disparities.

Educational inequalities in cervical cancer mortality in the Baltic Sea region in 2008–2015

Abstract Background Reducing inequalities in cervical cancer mortality is a public health priority. This study aims to assess the absolute and relative educational inequalities in cervical cancer mortality in the Baltic countries and Finland in 2008-2015. Methods Data for Estonia, Latvia and Lithuania were obtained from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, and data for Finland from the longitudinal register-based population data file of Statistics Finland. Cervical cancer deaths (ICD-10 code C53) were linked from national mortality registries. Educational level was census- or registry-based. Absolute and relative educational inequalities in cervical cancer mortality were assessed in 2008-2015 for women aged 30-49 and 50-64, using age-standardized mortality rates (ASMRs) per 100 000 person-years and mortality rate ratios (RRs) with 95% confidence interval (CI). Results This study included 1724 cervical cancer deaths and about 22 million person-years. Absolute and relative educational inequalities in cervical cancer mortality were considerably larger in the Baltic countries compared to Finland. Among 30-49-year-olds, ASMRs for high educated ranged from 0.6 (95% CI: 0.4-1.0) in Finland to 3.6 (95% CI: 2.5-5.0) in Lithuania, and for low educated from 2.2 (95% CI: 1.2-3.7) in Finland to 24.6 (95% CI: 18.2-32.4) in Lithuania. RRs for low educated compared to high educated ranged from 3.51 (95% CI: 1.57-7.68) in Finland to 9.11 (95% CI: 4.28-19.32) in Estonia. Among 50-64-year-olds, ASMRs for high educated ranged from 1.3 (95% CI: 0.8-2.0) in Finland to 9.8 (95% CI: 7.2-13.1) in Estonia and for low educated from 2.9 (95% CI: 1.9-4.1) in Finland to 43.9 (95% CI: 34.4-55.1) in Lithuania. RRs for low educated compared to high educated ranged from 2.18 (95% CI: 1.20-4.05) in Finland to 6.32 (95% CI: 4.30-9.36) in Lithuania. Conclusions Equitable prevention is a key to reducing cervical cancer mortality in the Baltic countries. Key messages • Lower-educated women largely drive high cervical cancer mortality in the Baltic countries. • Equity-focused prevention is crucial for reducing cervical cancer mortality in the Baltic countries.

Malnutrition in infants aged 6-23 months in China’s poorest rural counties from 2016 to 2021: cross sectional study

ObjectivesTo assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China’s poorest rural counties.DesignSix consecutive cross sectional surveys were conducted annually.SettingThe study was...

Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries

Abstract Aim To evaluate the association between welfare regimes with edentulism and to investigate if it modifies the magnitude of socioeconomic inequalities in edentulism. Methods We analysed data from 40 high-, middle- and low-income countries collected between 2007 and 2018, encompassing 117397 individuals 20 years or older. The main outcome was edentulism and welfare regimes were the main exposure and effect modifier. Individual level variables were sex, age and quintiles of the wealth score. Multilevel logistic regression was used to estimate the odds of being edentulous and cross-level interaction terms between individual wealth and country factors were tested. Findings Individuals at the lowest wealth quintile had a consistently higher prevalence of edentulism. The highest age-sex standardised prevalence of edentulism was found in Eastern European countries (9.9%) followed by Informal Security (9.4%), while the lowest was among the Insecurity regime (1.4%) followed by the Social Democratic regime (4.7%). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 16.7 (95%CI: 10.5-26.5) times more chances of being edentulous and 14.4 percentage points higher prevalence. Low-income countries in the Insecurity Regime in social and labour market presented the lowest level of inequalities. Among HIC and upper-middle income countries, Social Democratic regime had the lowest absolute inequalities (4.0 percentage points difference between highest and lowest quintiles) and the Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 3.21, 95%CI: 2.83-3.63). Interpretation Our findings suggest that policies in some welfare regimes might improve oral health while reducing inequalities. High and upper-middle-income countries presented a high level of edentulism and inequalities. Key messages • Larger socioeconomic inequalities in edentulism were found in high-income countries with liberal policies. • A possible benefit of welfare policies on prevalence and inequalities in edentulism may be only evident among industrialised countries.

Analysis of (P,m)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$(P,\\mathrm{m})$\\end{document}-superquadratic function and related fractional integral inequalities with applications

In the present work we establish for the first time a class of (P,m)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$(P,\\mathrm{m})$\\end{document}-superquadratic functions and look into its features. Using them, we come up with the Jensen and Hermite–Hadamard inequalities, as well as the fractional versions of Hermite–Hadamard inequalities with respect to Riemann–Liouville fractional integral operators. The findings are confirmed by certain numerical calculations and graphical depictions that take a few appropriate examples into account. The study is enhanced by the addition of applications of special means, moments of random variables, and modified Bessel functions of the first kind. This is achieved by considering new functions pertaining to the uniform probability density function and taking the modified Bessel functions of the first kind into consideration. The new results clearly provide extensions and improvements of the work given in the literature.

Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022

Abstract Background Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents. Methods This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p < 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period. Conclusions Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors. Key messages • The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls. • While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.

Barriers and Boundaries: How Residents Make Meaning of Segregating Built Environments

Built environments have structured urban space in racist and classist ways, contributing to residential segregation and related inequalities. Previous research has examined how perceivable built environment features become symbolic boundaries that structure both socio-spatial division and meaning-making, but little research has examined how physical barriers—features that carry symbolic meaning and limit connectivity between nearby areas—may promote both symbolic “othering” and inhibit contact between residents on either side. Drawing on ethnographic fieldwork, we examine how residents interpret and experience physical barriers and symbolic boundaries in race-, income-, and race-and-income distinct areas in Houston, Texas. We describe three typologies of barriers/boundaries (unremarkable, intrusive, and hyper-salient), demonstrating how the same barrier or boundary can have different meanings for people on either side. For physical barriers, these meanings were often mediated by residents’ actions. Our findings extend theorization of how the built environment shapes interpretations and experiences of segregation, and vice versa.

ANALYSIS ON MULTIPLICATIVELY (P,m)-SUPERQUADRATIC FUNCTIONS AND RELATED FRACTIONAL INEQUALITIES WITH APPLICATIONS

In this work, we, for the first time, establish a class of multiplicatively [Formula: see text]-superquadratic function and look into its various features. In the light of these features, we come up with the several integer order integral inequalities in the frame of multiplicative calculus. Moreover, we develop the fractional version of Hermite–Hadamard’s type inequalities involving midpoints and end points for multiplicatively [Formula: see text]-superquadratic function with respect to multiplicatively [Formula: see text]-Riemann–Liouville fractional integrals. By choosing different values for the parameters of such integral operators, we acquire a simple version of integral inequalities of Hermite–Hadamard’s type as well as its fractional form via multiplicatively Riemann–Liouville fractional integrals for multiplicatively [Formula: see text]-superquadratic function. The findings are confirmed by graphical illustration by taking appropriate examples into account. The study is further enhanced by the addition of applications of special means and first-type modified Bessel functions. The new results clearly provide extensions and improvements of the work available in the literature.

New notes on the equation d(n) = d(φ(n)) and the inequality d(n) > d(φ(n))

Abstract Let d(n) and φ (n) denote the number of positive divisors of n and the Euler’s phi function of n, respectively. In this paper, we prove various (conditional and unconditional) results about the solvability of the Diophantine equation d(n) = d(φ(n)) and a related inequality. For further research, we present some open problems.

Relative importance of competing marketing strategies on different customer metrics: a meta-analytic review of customer equity drivers

Purpose This meta-analytic study aims to generalize the impacts of three customer equity drivers (CEDs), including value equity (VE), brand equity (BE) and relationship equity (RE), on different customer metrics (e.g. loyalty, word of mouth [WoM] and satisfaction); examine the relative importance of CEDs on customer metrics; and explore boundary conditions, considering geographic and methodological characteristics. Design/methodology/approach This study used a meta-analytic approach, collected and coded 85 articles published between 2001 and 2022. After some exclusions, the authors used 272 observations (average of individuals’ sample M = 1,015, min = 10, max = 8,924). Findings The generalized effects of VE, BE, and RE on the selected customer metrics are positive. However, the importance of each CED differs for WoM and social equity. Between VE and BE, BE correlates more with WoM. RE correlates more with social equity than VE and BE That is, RE is effective in both WoM and social equity. In addition, the impacts of the CEDs on customer loyalty vary across multiple geographic and methodological characteristics. For example, the impacts of VE and RE on loyalty are stronger in more individualistic, more masculine, long-term orientation or more restraint cultures. Research limitations/implications While the authors examined VE, BE and RE as the most important marketing strategies, there might be other types of CEDs, such as interactions with others (e.g. employees and customers). Interactions with others at any touchpoints along the customer journey are important experiences (Lemon and Verhoef, 2016). Second, the authors limited the customer metrics to customer loyalty, WoM, customer satisfaction, customer trust and social equity. Practical implications The magnitudes of VE, BE and RE differ across the three customer metrics. Compared with VE, BE symbolizes customers’ identity, status and extended self, which motivates WoM. Compared with VE and BE, RE convinces customers of companies’ actions in social equity such as corporate social responsibilities. Originality/value The meta-analysis resolves the issue of inconsistent impacts of CEDs across studies. Moreover, including CEDs in a model provides insight into these strategies’ relative importance when considering different marketing objectives. Finally, this study enriches understanding of the boundary conditions on the CEDs–loyalty link.

Resolution of the sec-max-product fuzzy relation inequalities system and its lexicographic minimum solution

Resolution of the sec-max-product fuzzy relation inequalities system and its lexicographic minimum solution