Relative Index Of Inequality Research Articles

Socioeconomic inequality in compliance with precautions and health behavior changes during the COVID-19 outbreak: an analysis of the Korean Community Health Survey 2020.

OBJECTIVESThis study examined socioeconomic inequalities in compliance with precautions and health behavior changes during the coronavirus disease 2019 (COVID-19) outbreak using a representative Korean sample.METHODSThis exploratory study utilized around 210,000 participants aged ≥25 years in the Korean Community Health Survey 2020. Socioeconomic status was measured with educational attainment and household income. Outcomes included non-compliance with 8 precaution measures and deterioration in 6 health behaviors. The relative inequality index (RII) was calculated to quantify the degree of inequality by education and income level. RII values >1.0 indicate that deprived people have a higher frequency of health problems, and RII values <1.0 conversely indicate a higher frequency of health problems in more advantaged groups.RESULTSPeople with lower education or income levels tended to have higher rates of non-compliance with COVID-19 safety precautions (RII range, 1.20 to 3.05). Lower education and income levels were associated with an increased smoking amount (RII=2.10 and 1.67, respectively) and sleep duration changes (RII=1.21 and 1.36, respectively). On the contrary, higher education and income levels were associated with decreased physical activity (RII=0.59 and 0.77, respectively) and increased delivery food consumption (RII=0.27 and 0.37, respectively). However, increased alcohol drinking was associated with lower education and income levels in younger men (RII=1.73 and 1.31, respectively), but with higher levels in younger women (RII=0.73 and 0.68, respectively).CONCLUSIONSOur findings suggest the need to develop customized strategies, considering the characteristics of the target population, to decrease the burden and impact of the COVID-19 outbreak.

Educational level and tuberculosis mortality in Colombia: growing inequalities and stagnation in reduction.

We aim to describe the role of educational inequalities, for sex and age groups, in adult tuberculosis (TB) mortality in Colombia, 1999-2017. We linked mortality data to data estimation of the national population based on censuses and surveys to obtain primary, secondary, and tertiary adult (25+ years of age) age-standardized mortality rates (ASMR) by educational level. Thus, a population-based study was conducted using national secondary mortality data between 1999 and 2017. Tuberculosis age-standardized mortality rates were calculated separately by educational level, sex, and age groups, using Poisson regression models. Educational relative inequalities in adult mortality were evaluated by calculating the rate ratio, and the relative index of inequality (RII). Trends and joinpoints were evaluated by annual percentage change (APC). We found that, out of the 19,720 TB deaths reported, 69% occurred in men, and 45% in older adults (men and women, aged 65+). Men presented higher TB mortality rates than women (ASMR men = 7.1/100,000 inhabitants, ASMR women = 2.7/100,000 inhabitants). As mortality was consistently higher in the lowest educational level for both sexes and all age groups, inequalities in TB mortality were found to be high (RII = 9.7 and 13.4 among men and women, respectively) and growing at an annual rate of 8% and 1%. High and increasing inequalities, regarding educational level, in TB mortality in Colombia suggest the need to comprehensively address strategies for reducing TB by considering social determinants and including health education strategies throughout the country.

Inequidades relacionadas à escolaridade na prevalência de doenças crônicas não transmissíveis: uma análise da Pesquisa Nacional de Saúde, 2013 e 2019

This study assesses changes in the prevalence and distribution of noncommunicable diseases (NCDs) and related risk factors among Brazilian adults from the 2013 and 2019 Brazilian National Health Surveys (PNS). It is based on the hypothesis that deteriorating socioeconomic conditions over this period would lead to increased NCDs among the least advantaged populations. We estimated adjusted prevalence ratios by education category and three inequality measures - the slope index of inequality (SII), the relative index of inequality (RII), and population attributable fraction (PAF) - for obesity, hypertension, arthritis, asthma, cancer, depression, diabetes, heart disease, having any chronic condition, and multimorbidity by survey year. We also estimated the 27 Brazilian Federative Units RII and prevalence rates for diabetes and multimorbidity per year and plotted the RII against prevalence by year. Results showed that all NCDs increased over the period observed, ranging from an 8% increase in the adjusted prevalence of arthritis to a 24% increase in the adjusted prevalence of obesity. Measures of inequality showed that most conditions exhibited significant educational inequities in both 2013 and 2019. However, on average, education-based inequities did not significantly change between the two periods. Considering the deterioration of the socioeconomic conditions of most Brazilians, the erosion of social protections, and the continuing economic, political, and health crises occurring in the nation, we observed an urgent need for discussion about the best way to adopt equity-promoting health policies and programs and action to reduce socioeconomic and geographic inequalities in NCDs throughout the country.

Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe

Background We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions. Methods: We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance. We estimated the relative index of inequality (RII) for all-cause mortality among hazardous drinkers and non-hazardous drinkers using Cox proportional hazards regression models and for each region (North, South, East and West). Results: In men, educational inequalities in hazardous drinking were not observed (PRmedium = 1.09 [95%CI: 0.98–1.21] and PRhigh = 0.99 [95%CI: 0.88–1.10], ref. low), while in they were observed in women, having the highest hazardous drinking prevalence in the highest educational levels (PRmedium = 1.28 [95%CI: 1.15–1.42] and PRhigh = 1.53 [95%CI: 1.36–1.72]). Overall, the Relative Index of Inequality (RII) in all-cause mortality among hazardous drinkers was 1.12 [95%CI: 1.03–1.22] among men and 1.10 [95%CI: 0.97–1.25] among women. Educational inequalities among hazardous drinkers were observed in Eastern Europe for both men (RIIhazardous = 1.21 [95%CI: 1.01–1.45]) and women (RIIhazardous = 1.46 [95%CI: 1.13–1.87]). Educational inequalities in mortality among non-hazardous drinkers were observed in Southern, Western and Eastern Europe among men, and in Eastern Europe among women. Conclusions: Higher educational attainment is positively associated with hazardous drinking prevalence among women, but not among men in most of the analyzed European countries. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and inequalities in all-cause mortality in different regions is needed.

Unequal opportunity and growth in India: A dynamic panel analysis by using survey data

This study analyses the lack of robust conclusions about the association between inequality and economic growth. On the basis of ex-ante concept of inequality of opportunity, the parametric measure of unequal opportunity is used by partitioning the total sample in to 16 mutually exclusive circumstance groups. Theil's T index of monthly per capita consumption expenditure in household survey conducted by the NSSO in different rounds since the early 1980s is used to measure overall inequality and unequal opportunity. The relative index of inequality of opportunity is used as explanatory variable in the growth regression equation. To find out the direction of causality, we also estimate inequality equation by taking growth as an explanatory variable in presence of some control variables. Empirical findings of this study suggest that overall inequality and inequality of opportunity have negative effects on subsequent growth, while initial growth has no significant effect overall inequality and has a significant positive effect on inequality of opportunity.

Income-Related Mortality Inequalities and Its Social Factors among Middle-Aged and Older Adults at the District Level in Aging Seoul: An Ecological Study Using Administrative Big Data.

This study investigated income-related health inequality at sub-national level, focusing on mortality inequality among middle-aged and older adults (MOAs). Specifically, we examined income-related mortality inequality and its social factors among MOAs across 25 districts in Seoul using administrative big data from the National Health Insurance Service (NHIS). We obtained access to the NHIS’s full-population micro-data on both incomes and demographic variables for the entire residents of Seoul. Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated. The effects of social attributes of districts on SIIs and RIIs were examined through ordinary least squares and spatial regressions. There were clear income-related mortality gradients. Cross-district variance of mortality rates was greater among the lowest income group. SIIs were smaller in wealthier districts. Weak spatial correlation was found in SIIs among men. Lower RIIs were linked to lower Gini coefficients of income for both genders. SIIs (men) were associated with higher proportions of special occupational pensioners and working population. Lower SIIs and RIIs (women) were associated with higher proportions of female household heads. The results suggest that increasing economic activities, targeting households with female heads, reforming public pensions, and reducing income inequality among MOAs can be good policy directions.

Trend of asthma prevalence among children based on regional urbanization level in Japan; 2006-2019.

Although it has been known that the prevalence of asthma tends to be higher among children in the metropolitan areas of Japan, trends of the prevalence with respect to the regional urbanization level has not been investigated in recent years. We investigated trends in the prevalence of asthma among children and air pollutant concentrations by regional urbanization levels using data from the School Health Statistics Survey in Japan from 2006 to 2019. We calculated the age-standardized prevalence of asthma for each year, gender, regional urbanization level, and annual percent change (APC). In addition, the slope index of inequality (SII) and relative index of inequality (RII) were calculated for evaluating disparity in age-standardized asthma prevalence depending on regional urbanization levels. Moreover, we calculated the mean of the annual average values by regional urbanization levels for sulfur dioxide (SO2), nitrogen dioxide (NO2), suspended particulate matter (SPM), carbon monoxide (CO), and photochemical oxidant (Ox) from 2006 to 2018. We found that the age-standardized prevalence significantly decreased in the periods in the metropolis for males and females, and the degree of the decrease was largest in the metropolis. Conversely, the age-standardized prevalence increased in towns and villages, and the APC was greater than zero. In addition, both the SII and RII showed significant decreasing trends in the study period, and the regional disparity shrank over the years. Moreover, concentrations of the air pollutants were highest in the metropolis throughout the years except for Ox, whereas the difference in the concentrations of NO2, SPM, and CO decreased between the metropolis and the other areas over the years. In conclusion, disparity in asthma prevalence depending on regional urbanization level decreased from 2006 to 2019, and there is a possibility that regional difference in trend of the air pollutants is related to the result.

Trends in Socioeconomic Inequities in Diet Quality between 2004 and 2015 among a Nationally Representative Sample of Children in Canada

BackgroundDietary inequities in childhood may shape dietary and health inequities across the life course. Quantifying the magnitude and direction of trends in absolute and relative gaps and gradients in diet quality according to multiple indicators of socioeconomic position (SEP) can inform strategies to narrow these inequities. ObjectivesWe examined trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among a nationally representative sample of children in Canada. MethodsData from children (aged 2–17 y; n = 18,670) who participated in the cross-sectional Canadian Community Health Survey–Nutrition in 2004 or 2015 were analyzed. SEP was based on total household income, household educational attainment, and neighborhood deprivation. Dietary intake data from 1 interviewer-administered 24-h dietary recall were used to derive a Healthy Eating Index–2015 (HEI-2015) score for each participant as a measure of diet quality. Inequities in diet quality were quantified using 4 indices: absolute and relative gaps (between highest and lowest SEP) and absolute (Slope Index of Inequality) and relative gradients (Relative Index of Inequality). Overall and age-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. ResultsAlthough mean HEI-2015 total scores improved from 52.3 to 57.3 (maximum 100 points; P < 0.001), absolute and relative gaps and gradients in diet quality remained mostly stable for all 3 SEP indicators. However, among children aged 6–11 y, absolute and relative gradients in diet quality according to household educational attainment and neighborhood deprivation widened. ConclusionsThe diet quality of children in Canada was poor and inequitably patterned in 2004 and 2015. Although mean diet quality improved between 2004 and 2015, absolute and relative gaps and gradients in diet quality persisted, with some evidence of widening absolute and relative gradients among 6- to 11-y-olds.

Trend and Inequality in Episiotomy in Southern Brazil, 2007-2016: Evidence of Reduced Abusive Practice.

This study aimed to measure the prevalence, to describe the trend over time, and to evaluate socioeconomic inequalities in the occurrence of episiotomies in 2007, 2010, 2013, and 2016 in the municipality of Rio Grande, in Southern Brazil. We included all women who had vaginal delivery in each of the studied years. All the information was obtained through a questionnaire applied at maternity wards within 48h after delivery. The outcome consisted of episiotomy. A chi-square test was used to evaluate the linear trend. Absolute and relative inequalities were assessed from household income and schooling of the women through the Slope Index of Inequality and Relative Index of Inequality, respectively. This study included 4,521 parturients. The episiotomy rate in the period fell from 71.0% (95%CI: 68.4-73.5) in 2007 to 40.1% (95%CI: 37.3-42.8) in 2016, and it was more frequent among women with higher income and higher schooling. We observed a reduction in the rate of episiotomy in all income and schooling levels, and this was more evident among women in the lowest socioeconomic levels. Absolute inequality declined, while relative inequality remained unchanged. Despite the significant reduction in the rate of episiotomy, its occurrence remains high. Women with higher income and education, therefore with lower risk for complications during childbirth, were the most frequently submitted to this procedure. Routine use of episiotomy must be reevaluated, especially among pregnant women with better socioeconomic status.

Comparing the magnitude of oral health inequality over time in Canada and the United States.

To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

Trends in socioeconomic inequalities in smoking in Turkey from 2008 to 2016

BackgroundSmoking inequalities in Turkey were previously demonstrated in an early stage of the smoking epidemic model. This paper aimed to assess the trends for socioeconomic inequalities in smoking in Turkey over the years in the context of the smoking epidemic model using data from the Global Adult Tobacco Survey (GATS) Turkey 2008–2012-2016.MethodsCross-sectional data were analyzed to calculate the association of smoking with, wealth, education, occupation and place of residence using age-standardized prevalence rates, odds ratios, relative index of inequality (RII) and slope index of inequality (SII). The analysis was performed separately for age groups (younger: 20–39 years/older: 40 and above years) and sex.ResultsYounger women with higher wealth and older women with higher wealth and education smoked more. For both age groups, smoking was increased for working class and urban women. Relative wealth inequalities in smoking narrowed and then showed a reversal for younger women (RII2008 = 3.37; 95% CI:1.64–3.40; RII2012 = 2.19; 95% CI:1.48–3.24; RII2016 = 0.80; 95% CI:0.58–1.10, p-for trend < 0.0001). Relative educational inequalities in smoking for older women also showed a narrowing (RII2008 = 21.45; 95% CI:11.74–39.19; RII2012 = 15.25; 95% CI:9.10–25.55; and RII2016 = 5.48; 95% CI:3.86–7.78, p-for trend < 0.0001). For older women, a similar narrowing was observed for wealth (RII2008 = 3.94; 95% CI:2.38–6.53; RII2012 = 2.79; 95% CI:1.80–4.32; and RII2016 = 1.34; 95% CI:0.94–1.91, p-for trend = 0.0001). The only significant trend for absolute inequalities was for younger women by wealth. This trend showed a narrowing and then a reversal (SII2008 = 0.14; 95% CI:0.09–1.20; SII2012 = 0.12; 95% CI:0.06–0.18; and SII2016 = -0.05; 95% CI:-0.12–0.02, p-for trend = 0.0001). Unlike women, smoking in men showed inverse associations for wealth and education, although not statistically confirmed for all years. Smoking was increased in working classes and unemployed men in 2012 and 2016. Inequalities did not show a trend in relative and absolute terms for men.ConclusionsFor smoking inequalities in Turkey, a transition to the next stage was observed, although the previously defined Southern European pattern also existed. Low socioeconomic women deserve special attention as well as stressors at work and drivers of smoking at urban settings.

Level of inequality and the role of governance indicators in the coverage of reproductive maternal and child healthcare services: Findings from India.

BackgroundDiligent monitoring of inequalities in the coverage of essential reproductive, maternal, new-born and child health related (RMNCH) services becomes imperative to smoothen the journey towards Sustainable Development Goals (SDGs). In this study, we aim to measure the magnitude of inequalities in the coverage of RMNCH services. We also made an attempt to divulge the relationship between the various themes of governance and RMNCH indices.MethodsWe used National Family Health Survey dataset (2015–16) and Public Affairs Index (PAI), 2016 for the analysis. Two summative indices, namely Composite Coverage Index (CCI) and Co-Coverage (Co-Cov) indicator were constructed to measure the RMNCH coverage. Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were employed to measure inequality in the distribution of coverage of RMNCH. In addition, we have used Spearman’s rank correlation matrix to glean the association between governance indicator and coverage indices.Results & conclusionsOur study indicates an erratic distribution in the coverage of CCI and Co-Cov across wealth quintiles and state groups. We found that the distribution of RII values for Punjab, Tamil Nadu, and West Bengal hovered around 1. Whereas, RII values for Haryana was 2.01 indicating maximum inequality across wealth quintiles. Furthermore, the essential interventions like adequate antenatal care services (ANC4) and skilled birth attendants (SBA) were the most inequitable interventions, while tetanus toxoid and Bacilli Calmette- Guerin (BCG) were least inequitable. The Spearman’s rank correlation matrix demonstrated a strong and positive correlation between governance indicators and coverage indices.

Association of spousal violence and women's empowerment status among the rural women of sub-Saharan Africa.

Spousal violence (SV) is a global problem for women and its elimination is one of the prime targets of Sustainable Development Goal-5. Data from the Demographic and Health Surveys of seventeen countries, representing two sub-Saharan Africa (SSA) regions (East and Southern Africa [ESA] and West and Central Africa [WCA]), were used to examine the relationship between all types of SV and women's empowerment status among rural married women aged 15-49 years. Multivariate logistic regression analysis was used to explore adjusted associations, and a relative index of inequality (RII) and slope index of inequality (SII) were used to measure the inequality in experiencing SV by rural women based on their overall empowerment position. Within the period 2015-2019, the reported rate of SV was higher in the ESA (physical SV: 33.55%; sexual SV: 16.96%; any type of SV: 46.14%) than the WCA countries (physical SV: 27.80%; sexual SV: 7.63%; any type of SV: 40.83%), except for emotional SV (WCA: 31.28% vs ESA: 29.35%). In terms of overall empowerment status, rural WCA women were slightly ahead of their counterparts in the ESA region (46.09% and 44.64%, respectively). For both ESA and WCA countries, women who didn't justify violence and who had access to health care (except physical SV in WCA) showed negative but significant association with all types of SV in the adjusted analysis. Conversely, economic empowerment significantly increased the odds of experiencing physical and any type of SV in both regions. The significant risk ratios obtained from RII, for any SV were 0.83 and 1.09, and the β-coefficients from SII were -0.082 and 0.037 units, respectively, in ESA and WCA. Multi-sectoral microfinance-based intervening programmes and policies should be implemented regionally to empower women, especially in the economic, socio-culture, health care accessibility dimensions, and this will eventually reduce all types of spousal violence in rural SSA.

Trends in absolute and relative educational inequalities in health during times of labour market restructuring in coastal areas: The HUNT Study, Norway

BackgroundRestructuring labour markets offers natural population-level experiments of great social epidemiological interest. Many coastal areas have endured substantial restructuring of their local labour markets following declines in small-scale fishing and transitions to new employment opportunities. It is unknown how educational inequalities in health have developed in formerly fishery-dependent communities during such restructuring. In this study, we compare trends in social inequalities in health in Norwegian coastal areas with adjacent geographical areas between 1984 and 2019. MethodsWe used cross-sectional population-based data from the Trøndelag Health Study (HUNT), collected four times: HUNT1 (1984–86), HUNT2 (1995–97), HUNT3 (2006–08) and HUNT4 (2017–19). Adults above 30 years of age were included. Using Poisson regression, we calculated absolute and relative educational inequalities in self-rated health, using slope (SII) and relative (RII) indices of inequality. ResultsTrends in absolute and relative inequalities in rural coastal health were generally more favourable than in adjacent geographical areas. We found a statistically significant trend of declining relative educational inequalities in self-rated health in the rural coastal population from HUNT1 to HUNT4. Absolute inequalities overall increased from HUNT1 to HUNT4, although a declining trend followed HUNT2. Nonetheless, the rural coastal population exhibited the highest prevalence of poor self-rated health across the four decades. ConclusionsAlthough absolute educational inequalities in self-rated health widened in all geographical areas, the smallest increase was in rural coastal areas. Relative educational inequalities narrowed in this rural coastal population. Considering the concurrent processes of large-scale investments in the Norwegian public sector and welfare schemes, increased fishing fleet safety, and employment opportunities in aquaculture, our findings do not suggest that potential positive effects on public health of this restructuring have benefitted inhabitants with higher educational attainment more than inhabitants with lower educational attainment in this rural coastal population.

Regional and socioeconomic disparities in cardiovascular disease in Canada during 2005–2016: evidence from repeated nationwide cross-sectional surveys

IntroductionThe objective of this study is to examine the temporal trends and patterns of regional and socioeconomic disparities in cardiovascular disease (CVD) in Canada during 2005–2016.MethodsA total of 670 000...

COVID-19 and prepandemic all-cause inequalities in disability-adjusted life-years due to multiple deprivation: a Scottish Burden of Disease study

BackgroundCOVID-19 has caused major social, environmental, and economic changes. The mechanisms that shape health inequalities have resulted in COVID-19 outcomes following the same pattern. We aimed to estimate overall, and inequalities in, COVID-19 disability-adjusted life-years (DALYs) in Scotland during 2020. These were scaled against prepandemic DALYs due to inequalities in multiple deprivation combined across all causes. MethodsDALYs were estimated with an international consensus model with Scottish national deaths and daily cases as data inputs. Health loss valuation was defined with the aspirational reference life table and disability weights from the Global Burden of Disease Study 2019. Years of life lost were estimated for each area-based deprivation quintile of the Scottish population. Years lived with disability were distributed to deprivation quintiles, based on the distribution of estimates of years of life lost. Inequalities in rates were measured by the relative index of inequality (RII); slope index of inequality (SII); and attributable DALYs, with the least deprived quintile as a reference category. Prepandemic estimates were for 2018, derived from the Scottish Burden of Disease study. Permissions were granted by the Privacy Advisory Committee, National Health Service, National Services Scotland. FindingsMarked inequalities were observed across several measures in 2020 (Jan 1 to Dec 31). The SII was 2048–2289 COVID-19 DALYs per 100 000 people. The COVID-19 DALYs rate in the most deprived areas (2748–3067 per 100 000 people) was around 58% higher than the mean population rate (RII=1·16), with 40% (n=38 925–43 284) of COVID-19 DALYs attributed to inequalities in multiple deprivation. In the wider context, overall COVID-19 DALYs (n=96 519–108 243) were approximately a fifth of the annual prepandemic DALYs (n=535 298) attributable to inequalities in multiple deprivation. InterpretationThe impact of COVID-19 in Scotland was not shared equally across areas experiencing different levels of deprivation. The extent of COVID-19 inequality was similar to annual DALYs due to diabetes. Implementing effective policy interventions to reduce health inequalities must be at the forefront of plans to recover and improve population health. Communicating the effect of pre-existing inequalities by scaling against COVID-19 could be a useful means to retaining, and increasing, both policy and public engagement and response over tackling inequality. FundingNone.

Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015

Socioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position (SEP) have not yet been used, and can inform strategies to narrow dietary inequities. We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among adults in Canada. Adults (≥18 y old) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n=20,880) or 2015 (n=13,970) were included. SEP was classified using household income (quintiles), education (5 categories), and neighborhood deprivation (quintiles). Dietary intake data from 24-h recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between the most and least disadvantaged) and absolute [Slope Index of Inequality (SII)] and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum: 100); however, these trends were not consistently equitable. Whereas inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [from 1.60 (95% CI: 0.09, 3.10) to 4.27 (95% CI: 2.20, 6.34)] and gradient [from SII=2.09 (95% CI: 0.45, 3.73) to SII=4.84 (95% CI: 2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [from SII=8.06 (95% CI: 6.41, 9.71) to SII=10.52 (95% CI: 8.73, 12.31)], increased in males. Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.

Changes in oral health inequalities in adults in Chile.

A secondary analysis of data from 2003 and 2016-2017National Health Surveys (NHS) in Chile was performed on seven oral health outcomes in adults: prevalence of untreated caries, prevalence of severe untreated caries, number of teeth with untreated caries, prevalence of functional dentition, prevalence of edentulism, number of remaining natural teeth and utilization of dental services. Inequalities were measured with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) by education level. A decrease of caries inequalities measured with SII was observed from 2003 to 2016-17NHS but an increase of remaining teeth inequalities was measured. The SII of the remaining teeth increased from 6.6 [95% CI=5.0, 8.2] in 2003 to 8.8 [95% CI=7.3, 10.3] in 2016-17. The SII of functional dentition by education increased from 29.0 [95% CI=22.0, 36.0] in 2003 to 38.8 [95% CI=32.6, 45.0]) in 2016-17. The utilization of dental services ≤1year was the only outcome that showed a decrease in absolute and relative inequality, the SII was 33.9 [95% CI=23.3, 45.6] in 2003 and 26.2 [95% CI=16.6, 35.8] in 2016-17 and the RII decreased from 2.5 [95% CI=1.7, 3.3] in 2003 to RII=1.8 [95% CI=1.4, 2.3] in 2016-17. The increase of tooth loss inequalities in contrast to the decrease of inequalities in dental services utilization show the need to re-evaluate the current dental programmes for adults in Chile. This may include establishing a stronger oral health promotion strategy and greater dental treatment coverage focusing on avoiding tooth extractions in vulnerable social groups.

Socioeconomic inequalities in COVID-19 DALYs in Scotland, 2020

AimOur aim was to estimate the overall, and inequalities in the, population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020.MethodsNational deaths and daily case data were input into the consensus model outlined by the European Burden of Disease Network, to estimate DALYs. Total Years of Life Lost (YLL) were estimated, and for each deprivation quintile of the Scottish population. Years Lived with Disability (2% of all DALYs) were proportionately distributed to deprivation quintiles, based on YLL estimates. Socioeconomic inequalities were measured by the Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. Results were presented as a range, using a sensitivity based on YLL estimates using: cause-specific; and COVID-19 related deaths.ResultsCOVID-19 DALYs ranged from 96,500 to 108,200 in 2020, representing the second leading cause of disease/injury in Scotland, in 2020. Marked socioeconomic inequalities were observed across several measures. The difference between the most and least deprived areas, measured by SII, was 2,048 to 2,289 DALYs per 100,000. The RII was 1.16, meaning that the rate in the most deprived areas was around 58% higher than the mean rate of the population. DALYs attributable to differences in socioeconomic status accounted for 40% of total COVID-19 DALYs.ConclusionsThe direct population health impact of COVID-19 in 2020 was substantial. Despite unprecedented mitigation efforts, in Scotland, a single case in early 2020 developed to having an impact second only to ischaemic heart disease. This impact was not shared equally, and socioeconomically deprived areas were hit hardest, a result confirmed across all measures of inequality. DALY estimation on both the ongoing direct, and indirect, pandemic harms will evidence the extent of impact on overall, and inequalities in, population health.Key messages The population impact of COVID-19 has been highly damaging. When measured by DALYs, the population health impact of COVID-19 in Scotland, during 2020, was second only to ischaemic heart disease.The population health impact of COVID-19 has not been shared equally, a result confirmed across all measures of socioeconomic inequality.

Inequalities in non-communicable diseases across the European Union: current state and trends from 2000 to 2019

Abstract Background Non-communicable diseases (NCDs) remain the leading cause of disease burden in the European Union (EU). However, this burden varies across Member States, driven by the socioeconomic and demographic structure of the populations, as well as health care and social support systems in each country. This geographical gradient in the burden of NCDs represents health inequalities that may have expanded as a result of population ageing, migration, and economic crisis, and historic backgrounds. Methods Using data from the GBD 2019 study, we quantify the inequality gap between EU countries, characterize the geographical gradient of total and individual NCDs, and analyze the trends over the last 20 years. Results A considerable gap exists in the rates of NCD-related DALYs between the country with the lowest burden (Slovenia in 2019) and the highest (Bulgaria in 2019), with a constant (p-trend &amp;gt; 0.05) ratio of 1.6 (95%CI, 1.57; 1.64) since the year 2000. The largest inequality was observed for the burden of stroke between the lowest (France in 2019) and the highest (Bulgaria in 2019) with a ratio of 7.47 (6.78; 8.24) Increasing steadily (p-trend &amp;lt; 0.001) since 2000. Using the relative index of inequality to characterize the gradient of inequalities across the EU, a decreasing trend (p &amp;lt; 0.001) can be observed for NCD-related DALYs rates from 1.56 (1.44; 1.7) in 2000 to in 1.42 (1.33; 1.52) 2019. Conclusions Despite overall improvements in health, spatial disparities related to NCDs in the EU persist. Our estimates provide a baseline to inform future equitable health policies.