Related Inequalities Research Articles

Fairness perceptions and payoff allocation preferences in the online food order and delivery industry: Evidence from a real experiment

Amid concern about the welfare implications of the revenue share model between food service establishments (FSEs) and food delivery companies (FDCs), academic contributions have been mostly theoretical. Within a conceptual framework of fairness, our empirical study provides a perspective from the third party in the multi-sided market: the consumer. Following an incentivized payoff allocation experiment with 500 English food consumers, we make three observations: (1) participants prefer to make allocations to FSEs as opposed to FDCs, (2) participants who perceive fairness as a social construct (honesty, responsibility) derive the most disutility from advantageous inequality and the least disutility from disadvantageous inequality in relation to FSEs, and (3) participants who perceive fairness as a structural construct (processes, outcomes) prefer more equal payoff allocations to FSEs and FDCs. The perception of price unfairness in the online food order and delivery industry is apparent, speaking to the need to find market and policy solutions.

Distribution of The Health Workers in The Tuberculosis Sector, Mongolia: Assessment Results Using the Gini Index

Background: Mongolia was classified as one of the 30 countries with the highest tuberculosis burden by World Health Organization in 2021 and tuberculosis is the first leading cause of mortality among deaths from all communicable diseases in the country. The number and distribution of health workers to provide tuberculosis healthcare services will play an important role in the fight against tuberculosis. However, there has been no quantitative evaluation of the distribution of tuberculosis health workers in Mongolia. Therefore, this study aimed to examine the distribution of health workers in the tuberculosis sector using the Gini index. The results provide quantifiable information for monitoring resource distribution and serve as a basis for informed decision-making on resource allocation, facilitating targeted interventions and equitable healthcare distribution in Mongolia. Methods: Data from the National Center for Communicable Diseases and the National Statistical Information Service of Mongolia was obtained and analyzed. The Gini coefficients were calculated to reflect the inequality of distributions. Results: Total number of health workers in the tuberculosis sector was only 1.29 per 10,000 population. The Gini index values for the distribution of tuberculosis doctors, assistant workers, nurses, and laboratory technicians were at 0.61, 0.67, 0.43, and 0.33 respectively, all showing a range from severe to relative inequality. Conclusions: Findings showed the number and distribution of tuberculosis health workers were both inadequate and unequal and ring the need for proper health system planning. To plan the tuberculosis control and address the high burden of the disease in the country, the human resources situation should be analyzed and handled regularly. Keywords: Mongolia, Tuberculosis, Health workers, Distribution, Gini index

Socioeconomic inequities in alcohol-attributable mortality by sex/gender and age in Canada: A 13-year population-representative cohort study.

Individuals with low socioeconomic position (SEP) experience greater rates of alcohol-attributable mortality, contributing to health inequities in mortality and life expectancy. We examined the association between SEP and alcohol-attributable mortality by sex/gender and age in Canada. Census records from the 2006 Canadian Census Health and Environment Cohort (ages 12+; n=5,038,790) were linked to mortality data from 2006-2019. SEP was measured by educational attainment and household income. Poisson and Fine and Gray sub-distribution hazard models estimated rate differences (RD) per 100,000 person-years and hazard ratios (HR). Both educational attainment and household income were inversely associated with alcohol-attributable mortality. Absolute SEP inequities were greater among men than women, with a RD of 30.81 (95% CI: 28.04, 33.57) for men and 9.86 (95% CI: 8.49, 11.22) for women when comparing the lowest to the highest income quintile. Age-stratified analyses showed absolute SEP inequities were most pronounced in middle and older adulthood, above age 30 for women and age 50 for men, with smaller RDs in ages 12-29. Relative SEP inequities were similar in women and men, with greater HRs at younger ages. Public health policies addressing social determinants and population-level alcohol policies should consider patterning of SEP inequities by sex/gender and age group.

Wealth-related inequality in vitamin A rich food consumption among children of age 6-23 months in Ethiopia; Wagstaff decomposition of the 2019 mini-DHS data.

Vitamin A (VA) cannot be made in the human body and thus foods rich in VA are the only sources of vitamin A for the body. However, ensuring availability in adequate amount of foods rich in VA remains a challenge, mainly in low-income counties including Ethiopia. In addition, children from the poorest and less educated families of same country have disproportionately limited consumptions of foods rich in VA. Therefore, the present study aimed assessing the wealth related inequality in vitamin A consumption (VAC) and decompose it to the various contributing factors. This study was conducted using the 2019 Ethiopian demographic and health survey data on a weighted sample of 1,497 children of age 6-23 months in Ethiopia. The wealth related inequality in VAC was quantified using concentration index and plotted using concentration curve. The Wagstaff decomposition analysis was performed to assess the relative contributions of each explanatory variable to the inequalities in the overall concentration index of VAC. The overall Wagstaff normalized concentration index (C) analyses of the wealth-related inequality in consumption of foods rich in VA among children aged 6-23 months was [C = 0.25; 95% C: 0.15, 0.35]. Further decomposition of the C by the explanatory variables reported the following contributions; primary level of women's education (7.2%), secondary and above (17.8%), having ANC visit during pregnancy (62.1%), delivery at a health institution (26.53%), living in the metropolis (13.7%), central region (34.2%), child age 18-23 months (4.7%) contributed to the observed wealth related inequality in the consumption of foods rich in vitamin A in Ethiopia. We found pro-rich wealth-related inequality in VAC among children of age 6-23 months in Ethiopia. Additionally, maternal education, region, ANC visit, and place of delivery were the significant contributors of wealth-related inequality of VAC. Nutritional related interventions should prioritise children from poorer households and less educated mothers. Moreover, enhancing access to ANC and health facilities delivery services through education, advocacy, and campaign programs is highly recommended in the study setting.

Reaching national Covid-19 vaccination targets whilst decreasing inequalities in vaccine uptake: Public health teams' challenges in supporting disadvantaged populations

BackgroundUK local authority public health teams (LAPHT) supported delivery of the Covid-19 vaccination programme, particularly to disadvantaged populations. We explored the challenges encountered and lessons learnt by LAPHTs in tackling low Covid-19 vaccine uptake. The aim of this study was to understand what works, and how, in addressing local inequalities in relation to uptake of the Covid-19 vaccination with a view to generalising insights to building back fairer after the pandemic and into the future. Study designQualitative. MethodWe conducted in-depth on-line interviews with Directors of Public Health or their representatives from 21 English local authorities covering a total population of over 8 million people. Data were analysed thematically. ResultsAccessing the requisite (and accurate) data, engaging with communities, and working with National Health Service (NHS) organisations presented challenges in delivering initiatives to improve vaccine uptake, particularly for disadvantaged groups. LAPHT’s assets beneficial to the programme - in-depth knowledge and experience of their communities and locality - were not considered in the national vaccination programme. Community engagement and relationships with local NHS featured heavily in the majority of LAPHTs responses to improving vaccine uptake rates. ConclusionsIncorporating local public health infrastructure, expertise and existing relationships into national vaccination planning during epidemics or pandemics is crucial. Community engagement and good relationships with NHS staff help to reach and serve disadvantaged populations. How these can be developed and maintained in the longer term without future investment was a concern. Future research should explore the design and implementation of PH and NHS joint service delivery models to tackle health inequalities, informed by experiences of the Covid-19 vaccination programme and with input from community partners.

Not all banking crises are alike: Assessing their distributional impacts relative to pre-crisis credit gaps

The empirical literature on the effects of banking crises on income inequality has yielded mixed findings. In this paper, we aim to reconcile these mixed results by evaluating the effects of banking crises on income inequality in relation to pre-crisis credit gaps. We apply the Local Projections methodology to a yearly panel of 68 banking crises that occurred in 59 countries over the period 1970–2017. Three key results emerge. First, banking crises lead to increased income inequality. Second, only those banking crises preceded by larger credit gaps show a significant increase in income inequality. Third, a deeper contraction in the credit supply and a higher unemployment rate are two channels that could potentially explain why inequality rises more after banking crises with larger pre-crisis credit gaps. These results underscore the importance of macroprudential policies that, as well as limiting the amplitude of the financial cycle and the associated risks of financial crises, could also play a key role in reducing the distributional consequences of banking crises.

Maternity and the Armed Struggle in the Global South

Abstract Studies on the participation of women in guerrilla conflicts suffer from an in-depth study of the key aspects of women’s lives, such as motherhood and relations between the sexes. The analysis focuses on the Central and South American guerrilla movements, although open to a comparative study with organizations from other geographical spaces. In these pages these issues are analyzed to consider to what extent the revolutionary objectives that in economic and political aspects are maximalist, forget to question the issue of motherhood and the co-responsibility for the maintenance of offspring that continues to fall exclusively on women. Using the testimonies of the guerrilla women, the helplessness of women in the guerrilla environment, the abuses and the situation of subjugation and inequality in relations between the sexes is observed.

The role of the European Union’s securitisation policies in exacerbating the intersectional vulnerability of refugees and asylum seekers

ABSTRACT This article compares the European Union's (EU) reception and resettlement of European and non-European refugees and asylum seekers from an intersectional viewpoint. It does so using data collected during fieldwork in Greece focusing on Sexual and Gender-Based Violence (SGBV). The goal is to examine, through an empirical and theoretical study, the gendered, racialised, national and religious nature of the EU's approach to its external policies, border security approaches and its constitutive nature based on contingent, relational and non-additive vulnerabilities and inequalities that have been inherited from the EU's colonial past. The study asks how the influx of refugees fleeing the Russian invasion of Ukraine exemplifies the gendered, racialised, national and religious dimension of the EU's approach to border security. It examines how the EU's approach showcases the paternalistic approach to refugees' vulnerability through essentialisation, which leads to their vulnerabilisation. It looks at the intersectional impact of the gendered, racialised, national and religious constitutive nature of non-European refugees, as well as the gendered, racialised, national and religious notion of ‘others'. Based on the comparison, the article contends that, theoretically, State or EU security and human security policies should not be mutually exclusive. However, as the empirical data illustrate, there are multiple competing ‘insecurities’ which are prioritised over others.

Inequalities in Water Insecurity in Kenya: A Multidimensional Approach

Water insecurity is a global concern likely to be compounded by increases in population and climate change. Existing water insecurity measurement methods capture multidimensional deprivation only at regional or sub-regional levels. Such estimates do not capture heterogeneous household experiences of water supply, proximity to water sources and affordability, which can vary substantially from regional averages. Accurate measurement requires a method that captures the incidence and intensity of a household’s simultaneous deprivation in dimensions of water accessibility, affordability, sufficiency and safety. We propose such a method and assess related inequalities using an approach analogous to the Alkire–Foster methodology for multidimensional poverty. Using household-level data from the Kenya Integrated Household Budget Survey 2015/16, we find that 63% of the Kenyan population experience multiple deprivation in water access. The dimensions of water affordability and sufficiency contribute most to multidimensional water insecurity, highlighting the need to ensure an adequate supply of affordable water. Disparities by household place of residence, dwelling type, and socio-economic status are evident. The estimates of multidimensional water insecurity are robust to different deprivation and poverty cutoffs. Our analysis is an invitation to rethink water insecurity metrics, allowing water deprivation to be measured more frequently and with greater precision to understand its impact clearly.

Inequalities in the use of dental services by people with and without disabilities in Brazil: a National Health Survey.

The present cross-sectional study aimed to evaluate if social, racial, and gender inequalities disproportionally affect the use of dental services by people with and without disabilities in Brazil in the year 2013. The study used data from the 2013 National Health Survey and the dependent variable was the use of dental services. The outcome was stratified by gender, race, and social variables. Descriptive analysis was represented by absolute and relative frequencies. Two inequality measures were used to investigate the inequalities: the Slope Index of Inequalities (SII) and the Concentration Index of Inequalities (CIX). The SII expresses the absolute difference and the CIX identifies the relative inequality. Of 145,580 adults evaluated, 7.7% reported disability. The proportion of adults without disabilities who used dental services in the last 12 months was higher (45.2%; 95%CI 44.2-46.1) than adults with disabilities (33.9%; 95%CI 32.0-35.9). There was an absolute difference of 40% points (SII 0.40; CI95% (0.36-0.45) in the use of dental services between poorer and richer people with disabilities. Absolute and relative inequalities were identified in the use of dental services, considering the education of the head of the family and family income, with similar results for people with and without disabilities. High inequality is observed concerning race. Racial minorities (Black, Brown, Yellow, and Indigenous) without disabilities presented a higher use of dental services in the last 12 months than racial minorities with disabilities. Our findings demonstrate that social and racial inequities negatively affect individuals with and without disabilities. Inequalities exist in the use of oral health services for people with and without disabilities.

Socioeconomic inequalities in adverse pregnancy outcomes in India: 2004-2019.

Although India has made substantial improvements in public health, it accounted for one-fifth of global maternal and neonatal deaths in 2015. Stillbirth, abortion, and miscarriage contribute to maternal and infant morbidity and mortality. There are known socioeconomic inequalities in adverse pregnancy outcomes. This study estimated changes in socioeconomic inequalities in rates of stillbirth, abortion, and miscarriage in India across 15 years. We combined data from three nationally representative health surveys. Absolute inequalities were estimated using the slope index of inequality and risk differences, and relative inequalities were estimated using the relative index of inequalities and risk ratios. We used household wealth, maternal education, and Scheduled Caste and Scheduled Tribe membership as socioeconomic indicators. We observed persistent socioeconomic inequalities in abortion and stillbirth from rates of 2004-2019. Women at the top of the wealth distribution reported between 2 and 5 fewer stillbirths per 1,000 pregnancies over the study time period compared to women at the bottom of the wealth distribution. Women who completed primary school, and those at the top of the household wealth distribution, had, over the study period, 5 and 20 additional abortions per 1,000 pregnancies respectively compared to women who did not complete primary school and those at the bottom of the wealth distribution. Women belonging to a Scheduled Caste or Scheduled Tribe had 5 fewer abortions per 1,000 pregnancies compared to other women, although these inequalities diminished by the end of the study period. There was less consistent evidence for socioeconomic inequalities in miscarriage, which increased for all groups over the study period. Despite targeted investments by the Government of India to improve access to health services for socioeconomically disadvantaged groups, disparities in pregnancy outcomes persist.

The gradient of social determinants of health and related inequalities and early childhood development: Analysis of two rounds of a cross-sectional survey.

Social determinants of health (SDH) have a critical role in child development. Yet these determinants are often overshadowed. This study examines the effect of composites of five SDH on early childhood development (ECD) of children of age 36-59 months. We used two 2013 and 2019 rounds of Multiple Indicator Cluster Survey Bangladesh data. The analytical sample included ECD data for 25 721 children. ECD was computed following United Nations International Children's Emergency Fund's psychometric approach. Three composite indices of SDH were developed to examine their gradient effects on ECD. Poisson regression with robust variance was used to examine the relationship between SDH indices and ECD. The concentration index was computed, and a concentration curve was developed to measure inequalities in being on track of ECD among children with various levels of SDH. Almost 69% of children were on track in their ECD, a higher percentage in 2019 (74.85%) than in 2017 (65.37%). The prevalence of children on track in their ECD significantly rises per unit in the score of three SDH composites (adjusted prevalence ratios are 1.04 (95% confidence interval (CI): 1.03-1.04) for summative and standardised indexes and 1.49 (95% CI: 1.41-1.58) for weighted index). There is almost a linear positive relationship between the SDH composite and ECD. Significant concentration indexes suggest SDH-related inequalities in ECD. Children's early development can be hampered due to unfavourable SDH. Although ECD plays a vital role in creating and maintaining socio-economic and health inequalities through to adulthood, favourable SDH needs to be ensured during childhood.

Trends in Norwegian adolescents’ substance use between 2014 and 2022: socioeconomic and gender differences

BackgroundSubstance use is a global health concern and early onset among adolescents increases health risks. We explore national overall trends in prevalence and trends in socioeconomic inequalities in past year alcohol intoxication, cannabis use, and use of other illicit drugs among Norwegian adolescents (ages ∼ 15–19 years of age) between 2014 and 2022.MethodThe present study builds on data from a nationwide repeated cross-sectional survey collected in 2014–2016 (T1), 2017–2019 (T2), 2021 (T3) and 2022 (T4). In total 415,560 adolescents (50.3% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).ResultsWhile the prevalence of alcohol intoxication remained fairly stable, the prevalence of cannabis and other illicit drug use increased between 2014 and 2022 among upper secondary school boys (13.3–17.6%, and 2.0–5.2%, respectively) and girls (8.8–12.8%, and 1.1–2.7%, respectively). Similar trends were observed among 10th-grade adolescents. Boys were more likely than girls to use cannabis or other illicit drugs, but the gender gap in cannabis use narrowed during the study period. Among upper secondary girls, use of cannabis and other illicit drugs was higher among those from less affluent backgrounds, with absolute and relative inequalities in cannabis use increasing between 2014 and 2022. Small inequalities in cannabis use and decreasing relative inequalities in the use of other illicit drug were observed among upper secondary boys.ConclusionsThe increasing use of cannabis and other illicit drugs among Norwegian adolescents is concerning. Future studies should explore the underlying causes of this rise and explore the complex factors influencing adolescent substance use behaviours. A comprehensive understanding of these factors is essential for developing targeted and effective interventions.

Inequalities in severe COVID-19 outcomes in Wales, UK

ObjectiveResearch evidence shows that COVID-19 has disproportionately affected people from more deprived backgrounds. In Wales (UK), there is strong evidence of a socioeconomic gradient in total hospitalisations, critical care admissions and deaths. This study focussed on a cohort of the Welsh population using anonymised individual-level linked population-scale data in the SAIL Databank. ApproachThis analysis examines the impact of confounding/mediating factors on severe health outcomes. We used logistic regression, considering the Welsh Index of Multiple Deprivation (WIMD) 2019 as a predictor, to investigate how the coefficient for WIMD is changed when other variables (such as comorbidities, smoking status, Body Mass Index) are added, aiming to understand whether inequalities are mediated by observed characteristics or related to other unobserved factors. ResultsInitial findings show that age-standardised rates of hospital admissions, Intensive Care Unit (ICU) admissions and deaths were roughly twice as high in the most deprived vs least deprived WIMD quintile in Wales. We estimated Years of Life Lost per 1,000 due to COVID-19 as 28.9, with variation between WIMD quintiles of 38.4 for the most deprived and 22.2 for the least deprived. The project also produced regression formulas to evaluate the contribution of the different confounding factors. ConclusionThis study built on existing research findings and further explored the potential reasons for known socioeconomic inequalities in relation to COVID-19 outcomes. Insights from this study have broadened the knowledge around the impact of mediating factors and may contribute to future pandemic preparedness and the formation of future policies.

Gradient flows of generalized relative entropy and functional inequalities on graphs

We derive the discrete forms of the porous medium equation and fast diffusion equation with drift terms on a finite graph as gradient flows of the m-relative entropy, with the global existence of solutions. We show the Łojasiewicz inequality to prove the convergence of solutions and some important functional inequalities. More specifically, the Łojasiewicz inequality holds near the stationary solution with exponent 12, which leads to the exactly exponential convergence rate with a finite trajectory length. It can also be applied to show the Talagrand-type inequality and the log-Sobolev-type inequality directly.

A microsimulation model of smoking prevalence in England: exploring potential impacts of ‘Tobacco 21’ and e-cigarette policy scenarios on socioeconomic and regional inequalities

Background The burden of morbidity and mortality in England, is greater among priority groups such as those with lower income or routine and manual occupations. Using a microsimulation model, we estimate projected changes in smoking prevalence according to socio-economic position under selected policy scenarios that are relevant to ongoing policy implementation and debate. Methods Initiated using real-world data from adult (16+) respondents to the Smoking Toolkit Study (STS), the ‘QuitSimX’ microsimulation model projects individual-level smoking uptake and cessation in England over time. The simulation was run under two separate policy scenarios, raising the age of sale of tobacco products to 21 (simulations run from 2013–2023), and moving a proportion of all individuals quitting using a certain method (such as over the counter nicotine replacement therapy), or no method, to using e-cigarettes instead (simulations run from 2015–2025). Under each scenario, the size of effect were specified, and the outcomes simulated and assessed by indicators of socio-economic position. Absolute and relative inequalities were examined by comparing at the initial and final timepoint the i) absolute difference in smoking prevalence between less and more advantaged groups subgroups and ii) the ratio of smoking prevalence. Results While absolute and relative inequalities in smoking prevalence declined across the simulated period under all policy scenarios and the counterfactual ‘no intervention’ scenario, at the final time point absolute and relative inequalities between social grades and regions were similar across all scenarios, with the exception that the relative (but not absolute) inequality under the most impactful tobacco 21 scenario as marginally higher than under the baseline scenario. Conclusion A microsimulation model of smoking in England illustrates that absolute inequalities are projected to decrease under a Tobacco 21 or quitting with e-cigarettes scenario but that some policy solutions (Tobacco 21) may result in an increase in relative inequalities.

Age- and gender-based social inequalities in palliative care for cancer patients: a systematic literature review.

Cancer is a major public health problem worldwide, given its magnitude and growing burden, in addition to the repercussions on health and quality of life. Palliative care can play an important role improving quality of life and it is cost-effective, but some population groups may not benefit from it or benefit less based on age and gender inequalities. The aim of this systematic review was to analyze the available evidence on age- and gender-based social inequalities in access to and use of palliative care in cancer patients. A systematic review was conducted following the PRISMA guidelines. An exhaustive literature research was performed in Pubmed, CINHAL and Embase until November 2022 and were not restricted by language or date of publication. Eligible studies were observational studies analyzing the access and use of palliative care in cancer patients. Fifty-three studies were included in the review. Forty-five analyzed age and 44 analyzed gender inequalities in relation to use of and access to palliative care. Our results show that older people receive poorer quality of care, worst symptom control and less preferences for palliative care. In relation to gender, women have a greater preference for the use of palliative care and generally have more access to basic and specialized palliative care services and palliative care facilities. This review reveals difficulties for older persons and men for access to key elements of palliative care and highlights the need to tackle access barriers for the most vulnerable population groups. Innovative collaborative services based around patient, family and wider community are needed to ensure optimal care.

Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California

Preterm birth (PTB) (gestational age <37 weeks) is a major cause of infant mortality and morbidity in the US and is marked by racial and ethnic and socioeconomic inequities. Further research is needed to elucidate the association of risk and protective factors with trends in PTB rates and with related inequities. To describe the association of PTB rates with inequities as well as related risk and protective factors over the past decade in a US population-based cohort. This retrospective cohort study of singleton live births in California from January 1, 2011, to December 31, 2022, was conducted using vital statistics records and hospital records. The cohort included births with a gestational age of 22 to 44 weeks. Preterm birth rates by racial and ethnic group and by public and nonpublic insurance (considered as a proxy for socioeconomic status) were studied across years. Log-linear regression (relative risks with 95% CIs) was used to evaluate risk and protective factors within groups. Associations of PTB rates with risk and protective factors were assessed. This study included 5 431 018 singleton live births to individuals who identified as American Indian or Alaska Native (0.3%), Asian (14.2%), Black (4.9%), Hispanic (47.8%), or White (27.0%). A total of 43.1% of births were to individuals with public health insurance. From 2011 to 2022, the overall PTB rate increased from 6.8% to 7.5% (change [SE], 10.6% [0.6%]; z score of 18.5; P < .001). Differences in PTB rates and associated changes were observed for racial and ethnic groups and insurance groups. For example, 2022 PTB rates ranged from 5.8% among White individuals with nonpublic insurance to 11.3% among Black individuals with public health insurance. From 2011 to 2022, PTB rates decreased from 9.1% to 8.8% (change [SE], -3.5% [4.2]; z score of -0.8; P = .42) among Black individuals with nonpublic insurance, whereas they increased from 6.4% to 9.5% (change [SE], 49.8% [16.0%]; z score of 3.1; P = .002) among American Indian or Alaska Native individuals with nonpublic insurance. Increases in some risk factors (eg, preexisting diabetes, sexually transmitted infections, mental health conditions) were observed in most groups, and decreases in some protective factors (eg, participation in the California Women, Infants, and Children program) (P for trend < .001 from 2011 to 2021) were observed mostly in low-income groups. In this cohort study of singleton live births in California, PTB rates increased in many groups. Persistent racial and ethnic and socioeconomic inequities were also observed. Changes in risk and protective factors provided clues to patterns of PTB. These data point to an urgent need to address factors associated with PTB at both the individual and population levels.

Variasjonar i psykisk helsevern – status og forklaringsfaktorar

Introduction: Reducing unwanted variation is one of the goals of Norwegian health policy. We mapped variations among municipalities in Health Region West in the use of specialist health services that fall under the chapter on mental health care and substance use in ICD-10, and looked at various variables that may be related to these. Method: Data were retrieved from the Samhandlingsbarometer, an online open-source portal, and systematized by the authors. The annual rate per 1,000 inhabitants of hospital admissions and outpatient/day treatments per municipality was used as the result variables. Bivariate and multivariable linear regression were useful for investigating the association between independent variables and outcome variables. Results: The results showed large differences in the use of specialist health services in the municipalities, with a factor of 6.7 (hospital admissions) and 8.3 (outpatient clinic contacts). In adjusted analyses, we found that higher overall costs for health and care services in the municipalities were associated with fewer hospital admissions (β –.378 – 95% CI –.616; –.142) and fewer outpatient/day treatments (β –.541 –.649; –.323). The number of users in municipal mental health services was associated with more hospital admissions (β .514 .298; .726) and more use of psychotropic drugs in connection with outpatient/day treatments (β .485 .263; .703). Home-based care for younger inhabitants (&lt; 67 years) was also positively associated with the use of both hospital admissions (β .494, .266; .724) and outpatient/day treatments (β .471 .239; .703). Both the prevalence of marginalisation (not in employment, education or training) and a high level of education were associated with higher use of outpatient clinics (β .355 .132; .577 and β .296 .064; .528), while a dispersed housing pattern was associated with fewer hospital admissions (β –.421 –.679; –.158) and outpatient day treatments (β –.386 –.627; –.145). The explained variance of the multivariable models was small to moderately high (R2 .07 – .51). Conclusion: Morbidity, use of resources for municipal health care, and sociodemographic differences are related to the rate of admissions and outpatient/day treatments. The findings do not unequivocally indicate that greater resource use in the municipalities covaries with less use of specialist health services, although some of the findings point in that direction. Relative inequalities in municipalities, where many inhabitants have a high level of education and where many experience marginalisation (not in employment, education or training) are associated with high consumption of specialist health services in mental health care. Keywords: practice variation, specialist health service, psychiatry, substance use treatment

Unbalanced burden is escalating: Urban inequality landscape under sudden shocks?

Sudden and unforeseen events, notably the COVID-19 pandemic has underscored and exacerbated pre-existing urban inequalities. These disruptions have disproportionately affected the most vulnerable sectors of society, thereby further aggravating existing inequalities. Addressing these inequality issues requires systematic research into academic community's response to significant global disturbances. Therefore, we have integrated bibliometric analysis with meta-analysis (quantitatively combines research results from systematic reviews) techniques, culminating in a research framework based on KNIME software (a software for creating data applications and services) and Python programming. Noteworthy for its open-source nature, scalability, and reproducibility, this framework tries to decode the developmental patterns and response characteristics of urban inequality research under sudden shocks. Additionally, it seeks to clarify its causal pathways, predict the emergence of new or strengthened inequalities, and provide effective suggestions to promote inclusive and sustainable urban development. Our findings indicate that the COVID-19 has exacerbated the existing urban inequality, attracting widespread attention in fields such as society and public health. Issues of fairness and justice of human health, resource allocation, urban resilience and vulnerability have become hot topics around COVID-19 related urban inequalities. Simultaneously, the sudden shocks have led to disparities in research areas and themes. Social, economic, and urban planning are the main drivers behind urban inequality, and particularly affecting vulnerable groups, including low-income populations and those living in remote regions. Before and after the COVID-19, the average global urban inequality are 0.57 and 0.61, respectively. Inequality issues are particularly severe in Africa and countries such as Afghanistan, Pakistan, and India. The pandemic changed the focus of urban inequality to health and social issues, worsening inequality performance in these regions and deepening global gaps. Additionally, countries with high urban inequality are more prone to large-scale outbreaks and higher mortality rates. To this end, we advocate academia for in-depth research and comprehensive evaluation, focusing on vulnerable groups, providing integrated policy recommendations, supporting interdisciplinary exchanges and cooperation, and committing to find long-term sustainable solutions. These efforts aim to propose more comprehensive and reasonable solutions to alleviate and address complex urban inequality issues under sudden shocks.