Inequality Research Research Articles

An analysis of the burden of migraine and tension-type headache across the global, China, the United States, India and Japan

BackgroundRecurrent headaches in headache disorders adversely impact quality of life and job. Migraines and tension-type headache TTH) are the most common primary headaches and a prominent cause of disability globally. However, few research compare headache illness burden in China, India, the United States (US), and Japan.MethodsGlobal and Chinese, the US, Indian, and Japanese migraine and TTH incidence, prevalence, and disability-adjusted life years were taken from the GBD database for 1990–2021. The data is studied utilizing decomposition analysis, health inequality research, joinpoint regression model, and Bayesian Average Annual Percentage Change (BAPC) model.ResultsThe study found that migraine mostly affects women aged 15–49, while TTH are evenly distributed across gender and age. The worldwide average annual percentage change (AAPC) in disease-adjusted life years (DALYs) for migraine and TTH from 1990 to 2021 was 0.0357, a statistically significant trend (p < 0.001), as determined using joinpoint analysis. China exhibited the quickest rise in migraine and TTH incidence and prevalence, as well as the age-standardized rate (ASR) of DALYs, of the four nations analyzed. The US had the highest value of these indicators. Forecasting models reveal that without policy action, migraine prevalence will grow but TTH prevalence would stay unchanged. Decomposition research showed that population expansion is the major cause of migraines and TTH, which will be slightly alleviated by population aging. Health disparities across economic growth areas lessened between 1990 and 2021, according to the report.ConclusionGlobally and in China, migraine and TTH incidence and burden have increased since 1990. Migraines are becoming more common in young and middle-aged women, so headache treatment professionals should invest more in patient education to raise awareness and improve self-management to reduce disease burden and medical costs.

Hidden Heterogeneity: How the White Racial Category Masks Interethnic Health Inequality.

Inequality research has often used non-Hispanic Whites as the reference category in measuring U.S. racial and ethnic health disparities, with less attention paid to diversity among Whites. Immigration patterns over the last several decades have led to greater ethnic heterogeneity among Whites, which could be hidden by the aggregate category. Using data from the National Health Interview Survey (2000-2018), we disaggregate non-Hispanic Whites by nativity status (U.S.- and foreign-born) and foreign-born region of birth (Europe, Former Soviet Union, and the Middle East) to examine diversity in health among adults aged 30+ (n = 290,361). We find that foreign-born Whites do not have a consistent immigrant health advantage over U.S.-born Whites, and the presence of an advantage further varies by birth region. Immigrants from the Former Soviet Union (FSU) are particularly disadvantaged, reporting worse self-rated health and higher rates of hypertension (high blood pressure) than U.S.-born and European-born Whites. Middle Eastern immigrants also fare worse than U.S.-born Whites but have health outcomes more similar to European immigrants than to immigrants from the FSU. These findings highlight considerable diversity in health among White subgroups that is masked by the aggregate White category. Future research must continue to monitor growing heterogeneity among Whites and consider more carefully their use as an aggregate category for gauging racial inequality.

Hermite–Hadamard-Type Inequalities for Harmonically Convex Functions via Proportional Caputo-Hybrid Operators with Applications

In this paper, we aim to establish new inequalities of Hermite–Hadamard (H.H) type for harmonically convex functions using proportional Caputo-Hybrid (P.C.H) fractional operators. Parameterized by α, these operators offer a unique flexibility: setting α=1 recovers the classical inequalities for harmonically convex functions, while setting α=0 yields inequalities for differentiable harmonically convex functions. This framework allows us to unify classical and fractional cases within a single operator. To validate the theoretical results, we provide several illustrative examples supported by graphical representations, marking the first use of such visualizations for inequalities derived via P.C.H operators. Additionally, we demonstrate practical applications of the results by deriving new fractional-order recurrence relations for the modified Bessel function of type-1, which are useful in mathematical modeling, engineering, and physics. The findings contribute to the growing body of research in fractional inequalities and harmonic convexity, paving the way for further exploration of generalized convexities and higher-order fractional operators.

Revealing the Complex Dynamics of Social Disparities in Personal Transit Availability Considering Human Mobility and Neighborhood Effect Averaging

Research on inequalities in transit availability typically focuses on fixed residential neighborhoods, ignoring the dynamic exposure caused by people’s daily mobility. In addition, the neighborhood effect averaging problem (NEAP), as a major methodological issue in mobility-dependent exposures, could lead to erroneous conclusions on the assessments of personal transit availability and social disparities. To address these limitations, this study uses large-scale travel survey data of 26,626 participants in the Chicago Metropolitan Area to evaluate personal transit availability in people’s daily lives and examine the dynamic social disparities across varying geographic contexts by considering human mobility and the NEAP. For the first time, we observe the presence of the NEAP in personal transit availability: Individual transit availability tends toward the average level of the study area when people’s daily mobility is considered. We also find that personal transit availability experienced by different social groups might exhibit varying extents of neighborhood effect averaging owing to differences in their mobility levels. This further contributes to the complex dynamics of social disparities in transit availability during their daily mobility, with some residential disparities being exacerbated (e.g., between gender groups, African American and White individuals), some maintained (e.g., between age groups, low- and middle-income groups, employed and unemployed individuals, Asian and White individuals), and some changing direction (e.g., between high- and middle-income groups). Our findings emphasize the importance of considering human mobility and the NEAP in mobility-dependent environmental inequality research and the formulation of related policies.

Bootstrapping the digital divide: a situational analysis of digital demands and collective capabilities in low-income households

ABSTRACT This paper examines intersections between social disadvantage and digital inequality in low-income household settings using situational analysis. Partnering with social service organisations, we conducted qualitative fieldwork research over 12 months with low-income households in disadvantaged suburbs in Tasmania, Australia. The research involved home visits, phone interviews, technology tours, and learning biographies with members of households. Findings emphasise the way outcomes of digital connectivity and internet use are not only individual – they are also shared and collective, and this has been a blind spot for digital inequality research framed by methodological individualism. We emphasise the need to shift attention from individual digital skills to collective digital capabilities, emphasising sociotechnical functions embedded in networks of shared resources and practices. Situational analysis revealed digital capabilities as collective investments and workarounds, as participants responded to expanding digital and life management demands. The study contributes to understanding the interaction between digital and social inclusion in low-income household contexts. It highlights the way collective capabilities and ‘digital bootstrapping’ operate in resource-scare environments, providing potential points of intervention beyond individualised notions of digital self-reliance.

Is economic inequality in maternal and child healthcare decreasing in India? Trends between 2005–2006, 2015–2016 and 2019–2021

ObjectiveThis study examined economic inequality in coverage of selected maternal and child healthcare (MCH) indicators in India and its states over the last 15 years.DesignThe study analysed last three rounds...

Extending Fundamental Cause Theory to Holistic Health.

Fundamental Cause Theory (FCT) offers a unique middle range and longitudinal understanding of the lasting social causational relationships between certain social conditions and disease/death. In this research note, I argue that FCT should extend its outcome measures beyond physical disease and death into holistic health. I briefly review how FCT is evaluated, explore the proposed extension and discuss some operational and conceptual challenges using mental illness and positive mental health outcomes as exemplars. I conclude by discussing the benefits of extending FCT for 1) the theory's own validity, 2) social health inequalities research more broadly, and 3) public health policy.

Stratification of educational quality judgments: Insights from two factorial survey experiments on socioeconomic differences in student and parent evaluations

Stratification of educational quality judgments: Insights from two factorial survey experiments on socioeconomic differences in student and parent evaluations

Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: qualitative evidence from Austria

BackgroundLong COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.MethodsApplying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive ‘access to health care’ model.ResultsBased on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.ConclusionsThe findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.

Beauty pays, but not under all circumstances: Evidence on gendered hiring discrimination from a novel experimental treatment using deepfakes

Beauty pays, but not under all circumstances: Evidence on gendered hiring discrimination from a novel experimental treatment using deepfakes

A Critical Commentary on Lisl Fenwick’s Research in Curriculum Reform and Reproducing Inequality in Upper-secondary Education

A Critical Commentary on Lisl Fenwick’s Research in Curriculum Reform and Reproducing Inequality in Upper-secondary Education

A roadmap for the nursing scientific workforce to eliminate health and healthcare inequities

The National Academies of Sciences, Engineering, and Medicine's Ending Unequal Treatment report emphasizes immediate actions to eliminate health inequities (i.e., solutions-oriented health inequity research), versus incrementally advancing health equity. Nurse scientists are uniquely positioned to lead national efforts to eliminate health inequities. To outline nursing science's contributions to solutions-oriented health inequity research, highlight opportunities and challenges for nursing leadership, and key competencies for which workforce support infrastructure is needed. We draw on the landmark 2024 Ending Unequal Treatment report, supplemented by a review of the literature on scientific nursing-specific workforce challenges. We identify strategies for sustaining and advancing nursing science's leadership in solutions-oriented health inequity research, including objectives, competencies, and programmatic elements needed to support current and future nurse investigators. Bolstering the nursing scientific workforce in solutions-oriented health inequity will elevate the critical role of nursing science in eliminating health inequities and improving population health.

Artificial Intelligence in Socioeconomic Research: Identifying Key Drivers of Unemployment Inequality in the U.S

Unemployment inequality remains one of the most vexing socioeconomic quagmires confronting the United States. This research project aimed to pinpoint how AI can be applied in the enumeration of key drivers of unemployment inequality in the United States and set a framework for further research and policy development. In this study, the researcher has drawn a massive volume dataset from the Economic Policy Institute's State of Working America Data Library, along with research performed by the Federal Reserve Bank of St. Louis. The unemployment incidents data was classified in terms of age, education level, gender, race, and other demographic factors. Subsequently, the analyst employed Linear Regression from the Scikit-learn library. Overall performance evaluation showcased that linear regression performed excellently with the least error in MSE and RMSE and, hence, was the best in terms of accurately predicting unemployment indicators. Accurate prediction of the unemployment rate using the proposed linear regression model can help the U.S. government proactively warn against economic downturns by deploying the. Besides, by executing the Linear Regression, government officials can influence favorable policies through tax incentives or labor laws. Evidently, the linear regression framework is a powerful AI tool that can help bring huge enhancements to unemployment inequality research and policy development in the future. This model not only provides a quantification of the relationships but allows for the making of predictions, thus making it useful for evaluating the possible results of different policy scenarios. Furthermore, the Linear Regression framework can also be used in the assessment of the effectiveness of pre-existing policies aimed at reducing unemployment.

Enhancing the usability of health data for inequalities research: a UK quality improvement project and code list curation.

Objective and ApproachPrimary care datasets provide a rich source of information for inequalities research; however, the value derived from these depends largely on the comprehensiveness of the code lists used by researchers. To date, no standardised code list for inequalities research has been developed. The aim of this project was to develop a comprehensive code list for groups of interest to inequalities research, namely: people with learning disabilities (LDs), people with severe mental illness (SMI), people from ethnic minority groups, and people who are transgender. Existing code lists were extracted from the Clinical Practice Research Datalink (CPRD) Bibliography (the largest research dataset in the UK), and four UK code list repositories: OpenCodelists, Health Data Research UK, University of Cambridge, and London School of Hygiene and Tropical Medicine. Comprehensive code lists were then curated through collation and removal of duplicates. Results16 code lists were identified for LDs, 18 for SMI, 16 for ethnicity, and 2 for transgender. From these, 661, 733, 346 and 68 unique codes were identified, respectively. Preliminary testing of the curated code lists, in a CPRD dataset, indicated that the number of individuals belonging to these groups was increased by 90% (compared to the original code list). Conclusions and ImplicationsOur findings suggest that the curated code lists improved data capture. These lists now need to be validated by healthcare specialists, before being made publicly available. The inclusion of code-specific definitions will enable international researchers to adapt the code lists to their medical systems.

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

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

Parental Educational Homogamy and Children’s Tertiary Education in Europe

In this paper, we examine (1) whether parental educational homogamy is associated with children’s tertiary educational attainment in different European countries and (2) whether this association is moderated by families’ educational backgrounds. Using data from the European Social Survey and multilevel logistic regression models, we find that parental homogamy is important for children’s tertiary educational attainment. In particular, children of more highly educated homogamous parents are more likely to obtain a tertiary degree themselves. This parental homogamy association varies across countries. While the association is below the European average in Czechia, Austria, Hungary, Italy, Switzerland, and Germany, it is equal or close to average in Slovenia, Estonia, France, Poland, Ireland, Sweden, and Lithuania, and above average in Spain, Finland, the Netherlands, Portugal, the United Kingdom, Norway, and Belgium. Our findings suggest that parental educational constellations should be examined more closely in further education inequality research. * This article belongs to a special issue on “Changes in Educational Homogamy and Its Consequences”.

Associations of schooling type, qualification type and subsequent health in mid-adulthood: evidence from the 1970 British Cohort Study

BackgroundEducation is thought to benefit health. However, existing studies have predominantly focused on educational attainment—the type of institution attended has been overlooked, despite being an important indicator of education resources,...

Physical Activity in Underserved Preadolescents

Drawing insights from the theory of fundamental causes of disease, this study examined the relationships between socioeconomic status (SES) and selected risk factors in transitional urban China. Specifically, under China’s distinct institutional and sociocultural environment, we examined how contextualized SES (i.e., party membership, hukou status, housing ownership, and subjective social status) and conventional SES indicators (i.e., education, income, and occupation) were associated with physical inactivity and body mass index (BMI). Utilizing the urban subsample of the 2017 Chinese General Social Survey (CGSS), we found that individuals with higher education, income, Communist Party membership, and urban hukou status had lower risks of physical inactivity. However, higher SES with Community party membership, urban hukou, and government jobs also increased the risks of being overweight, which may be explained by potential countervailing mechanisms. These findings revealed intricate relationships among SES and risk factors in China. Our study helped contextualize the theory of fundamental causes, furnished new empirical evidence, and served as a useful reference for future health inequality research in non-Western societies.

Mapping four decades of housing inequality research: Trends, insights, knowledge gaps, and research directions

Mapping four decades of housing inequality research: Trends, insights, knowledge gaps, and research directions

“Power, control, strain”: Lay perceptions of health inequalities across England's ‘North South divide’

People in the North of England live shorter, less healthy lives than those in the South. Despite the significance of this 'North South health divide', regional health inequalities in England are under-researched qualitatively. Existing literature on geographical inequalities in health is largely confined to the neighbourhood level, is quantitative, and consists of very little lay knowledge. The current study is the first to examine lay perspectives of health inequalities on a regional level: exploring how people living in two urban areas of the North and South of England experience and perceive the North South health divide - including its causes and solutions. Using three focus group discussions with a total of 34 participants, and conducting participatory analysis, we identified three key themes: 'inequalities of power', 'lack of control over lived environment' and 'communities under strain'. Findings align with existing research on lay perspectives of health inequalities at the neighbourhood level - identifying a network of material-structural and psychosocial factors. Participants across both regions discussed political and economic structures as central to understanding regional health inequalities, supporting calls to adopt a political economy approach in understanding health and place. Deindustrialisation, unemployment, loss of community facilities, and disengagement from politics were more present in Northern narratives than Southern. Findings add important 'social meaning' to emerging research on the North South health divide, reinforcing the urgency of public health professionals' recommendations for fair redistribution of power, wealth and resources to reduce regional health inequalities. In the context of government policy which diverges from public health evidence, this study sparks questions of how health inequalities research can intersect with wider social and political movements organising for systemic change.