Slope Index Research Articles

A composite index; socioeconomic deprivation and coverage of reproductive and maternal health interventions.

To examine inequalities in the coverage of reproductive and maternal health interventions in low- and middle-income countries and territories using a composite index of socioeconomic deprivation status. We obtained data on education and living standards from national household surveys conducted between 2015 and 2019 to calculate socioeconomic deprivation status. We assessed the coverage of reproductive and maternal health interventions, using three indicators: (i)demand for family planning satisfied with modern methods; (ii)women who received antenatal care in at least four visits; and (iii)the presence of a skilled attendant at delivery. Absolute and relative inequalities were evaluated both directly and using the slope index of inequality and the concentration index. In the 73 countries and territories with available data, the median proportions of deprivation were 41% in the low-income category, 11% in the lower-middle-income category and less than 1% in the upper-middle-income category. The coverage analysis, conducted for 48 countries with sufficient data, showed consistently lower median coverage among deprived households across all health indicators. The coverage of skilled attendant at delivery showed the largest inequalities, where coverage among the socioeconomically deprived was substantially lower in almost all countries. Antenatal care visits and demand for family planning satisfied with modern methods also showed significant disparities, favouring the less deprived population. The findings highlight persistent disparities in the coverage of reproductive and maternal health interventions, requiring efforts to reduce those disparities and improve coverage, particularly for skilled attendant at delivery.

Burden of pancreatic cancer in older adults globally, regionally, and in 204 countries: 1990-2019 and projections to 2030

Global aging is increasing; however, the epidemiologic characteristics of pancreatic cancer in older adults have not been systematically studied. This study used data on pancreatic cancer in older adults from the Global Burden of Disease 2019 project. Temporal trends were measured using average annual percentage change and predicted using a Bayesian age-period-cohort model. In addition, the inequality slope index and the health concentration index scores were calculated to quantify the unequal distribution of the burden of pancreatic cancer in older adults. Between 1990 and 2019, the number of pancreatic cancer deaths in older adults, age-standardized death rate (ASDR), disability-adjusted life years (DALYs), and age-standardized DALY rate increased globally. In 2019, ASDR and age-standardized DALY rate for pancreatic cancer in older adults were the highest in Southern Latin America, whereas the burden has grown the fastest over the past 30 years in the Caribbean. The burden is predominantly distributed among those aged 65 to 74 years, with males having a higher burden than that of females. The global proportion of pancreatic cancer deaths in older adults attributed to smoking, high fasting plasma glucose, and high body mass index were 21.7%, 10.3%, and 5.8%, respectively. Both absolute and relative cross-national inequalities declined over the past 30 years but remained at medium-high levels of relative inequality. Deaths from pancreatic cancer among older adults are expected to continue to increase over the next 11 years. The global burden of pancreatic cancer among older adults has continued to rise over the past 30 years, and cross-national health inequalities remain high. Therefore, targeted measures must be taken to address this inequality.

Socioeconomic inequality of health-related quality of life in cancer survivors in South Korea.

We investigated the inequalities in health-related quality of life (HRQoL) among cancer survivors in Korea, focusing on income and education levels. The slope index of inequality (SII) and relative index of inequality (RII) were utilized to analyze these disparities. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2021 was analyzed. The HRQoL was assessed using the EQ-5D questionnaire, which included five problem areas: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Logistic regression was employed to calculate the odds ratios (ORs) for each education and income level, indicating the probability of reporting problems. Furthermore, the slope index of inequality (SII) and relative index of inequality (RII) were calculated to evaluate the inequalities in HRQoL. Among the 3396 cancer survivors, a considerable proportion reported pain/discomfort (29.6%) and mobility problems (21.1%). The logistic regression results demonstrated a higher likelihood of experiencing problems in all five EQ-5D items among individuals with lower income or education levels. Specifically, compared to the high-income group, the adjusted ORs for mobility problems were 2.19, 1.64, and 1.08 for the low, low-medium, and medium-high-income groups, respectively (p-value < 0.05). Notably, significant income inequalities in HRQoL problems were observed, with the greatest disparities seen in self-care and usual activity problems, as indicated by the SII and RII values. Socioeconomic disparities in HRQoL exist among cancer survivors in Korea, particularly related to income levels. Addressing the financial burdens of cancer treatment for individuals with low-income levels may help improve their HRQoL and mitigate these inequalities.

All-cause, premature, and cardiovascular death attributable to socioeconomic and ethnic disparities among New Zealanders with type 1 diabetes 1994–2019: a multi-linked population-based cohort study

BackgroundNew Zealand (NZ) research into type 1 diabetes mellitus (T1DM) mortality can inform policy and future research. In this study we aimed to quantify the magnitude to which ethnicity and socioeconomic disparities influenced mortality at the population level among people with Type 1 diabetes (T1DM) in Auckland, New Zealand (NZ).MethodsThe cohort data were derived from the primary care diabetes audit program the Diabetes Care Support Service (DCSS), and linked with national primary care, pharmaceutical claims, hospitalisation, and death registration databases. People with T1DM enrolled in DCSS between 1994–2018 were included. All-cause, premature, and cardiovascular mortalities were estimated by Poisson regression models with adjustment for population-level confounders. The mortality rates ratio (MRR) was standardized against the DCSS type 2 diabetes population. Mortality rates were compared by ethnic group (NZ European (NZE) and non-NZE) and socioeconomic deprivation quintile. The population attributable fraction (PAF) was estimated for ethnic and socioeconomic disparities by Cox regression adjusting for demographic, lifestyle, and clinical covariates. The adjusted slope index inequality (SII) and relative index of inequality (RII) were used to measure the socioeconomic disparity in mortalities.ResultsOverall, 2395 people with T1DM (median age 34.6 years; 45% female; 69% NZE) were enrolled, among whom the all-cause, premature and CVD mortalities were 6.69 (95% confidence interval: 5.93–7.53), 3.30 (2.77–3.90) and 1.77 (1.39–2.23) per 1,000 person-years over 25 years. The overall MRR was 0.39 (0.34–0.45), 0.65 (0.52–0.80), and 0.31 (0.24–0.41) for all-cause, premature and CVD mortality, respectively. PAF attributable to ethnicity disparity was not significantly different for mortality. The adjusted PAF indicated that 25.74 (0.84–44.39)% of all-cause mortality, 25.88 (0.69–44.69)% of premature mortality, 55.89 (1.20–80.31)% of CVD mortality could be attributed to socioeconomic inequality. The SII was 8.04 (6.30–9.78), 4.81 (3.60–6.02), 2.70 (1.82–3.59) per 1,000 person-years and RII was 2.20 (1.94–2.46), 2.46 (2.09–2.82), and 2.53 (2.03–3.03) for all-cause, premature and CVD mortality, respectively.ConclusionsOur results suggest that socioeconomic disparities were responsible for a substantial proportion of all-cause, premature and CVD mortality in people with T1DM in Auckland, NZ. Reducing socioeconomic barriers to management and self-management would likely improve clinical outcomes.

Trends of inequality in DPT3 immunization services utilization in Ethiopia and its determinant factors: Evidence from Ethiopian demographic and health surveys, 2000-2019.

Low levels of diphtheria, tetanus toxoid, pertussis (DPT3) immunization services utilization and high deaths among under five children are concentrated in economically and socially disadvantaged groups, especially in low and middle-income countries, including Ethiopia. Hence, the aim of this study is to assess levels and trends in DPT3 immunization services utilization in Ethiopia and identify inequalities. This study used data from 2000, 2005, 2011, 2016, and 2019 Ethiopian Demographic Health Surveys (EDHSs). The 2019 updated version of the world health organization (WHO's) Health Equity Assessment Toolkit (HEAT) software was used to analyze the data. Six measure of inequality was calculated: ratio (R), differences (D), relative index of inequality (RII), slope index of inequality (SII), population attributable fraction (PAF) and population attributable risk (PAR). The findings were disaggregated by the five equity stratifiers: economic status, education, place of residence, regions and sex of the child. This study showed an erratic distribution of DPT3 immunization services utilization in Ethiopia. The trends in national DPT3 immunization coverage increased from 21% in (2000) to 62% in (2019) (by 41 percentage points). Regarding economic inequality, DPT3 immunization coverages for the poorest quintiles over 20 years were 15.3% (2000), and 47.7% (2019), for the richest quintiles coverage were 43.1 (2000), and 83.4% (2019). However, the service utilization among the poorest groups were increased three fold compared to the richest groups. Regarding educational status, inequality (RII) show decreasing pattern from 7.2% (2000) to 1.5% in(2019). Concerning DPT3 immunization inequality related to sex, (PAR) show that, sex related inequality is zero in 2000, 2005 and in 2019. However, based on the subnational region level, significance difference (PAR) was found in all surveys: 59.7 (2000), 51.1 (2005), 52.2 (2011), 42.5 (2016) and 30.7 (2019). The interesting point of this finding was that, the value of absolute inequality measures (PAR) and (PAF), are shown a decreasing trends from 2000 to 2019, and the gap among the better of regions and poor regions becoming narrowed over the last 20 years. Concerning individual and community level factors, household wealth index, education of the mother, age of respondent, antenatal care, and place of delivery show statically significant with outcome variable. Keeping the other variables constant the odds of an average child in Amhara Region getting DPT3 immunization was 54% less than for a child who lived in Addis Ababa (OR: 0.46, 95% CI: 0.34 - 0.63). Respondents from households with the richest and richer wealth status had 1.21, and 1.26 times higher odds of DPT3 immunization services utilization compared to their counterpart (OR: 1.21, 95% CI: 1.04 -1.41) and (OR: 1.26, 95% CI: 1.13 - 1.40) respectively. We conclude that DPT3 immunization coverage shows a growing trend over 20 years in Ethiopia. But inequalities in utilization of DPT3 immunization services among five equality stratifies studied persisted. Reasons for this could be complex and multifactorial and depending on economic, social, maternal education, place of residence, and healthcare context. Therefore, policy has to be structured and be implemented in a ways that address context specific barriers to achieving equality among population sub-groups and regions.

Trends of socioeconomic and geographic inequalities in severe wasting among under-five children in Ethiopia from 2000 to 2019: using the WHO Health Equity Assessment Toolkit

Severe wasting is the deadliest form of wasting caused by a lack of nutritious food and repeated attacks of illness. The World Health Assembly has agreed to reduce severe wasting to less than 5% and 3% by the end of 2025 and 2030. Significant disparities were observed worldwide in progress towards the goal. However, limited evidence of disparity in severe wasting was available in Ethiopia. Therefore, this study aimed to assess trends in socioeconomic and geographic inequalities in severe wasting among under-five children in Ethiopia between 2000 and 2019. The trend in socioeconomic and geographic inequality was assessed using the World Health Organization Health Equity Assessment Toolkit, employing both absolute and relative measures of inequality. Difference (D), ratio (R), slope index inequality (SII), relative concentration index (RCI), and population attributable ratio (PAR) were utilized to assess disparity across wealth, education, residence, and subnational regions. The 95% uncertainty interval (UI) was used to declare the significant change in inequality through time. The proportion of severe wasting increased from 3.8% to 4.7% between 2000 to 2005 and dropped to 2.9% in 2011 to remain constant until 2016. However, the proportion of severe wasting significantly declined to 1.1% in 2019. As indicated by RCI, significant fluctuation in wealth-related inequality was observed in all five survey years but a significant change in wealth-related inequality was observed in 2005 and 2019. Whereas the education-related inequality in RCI of severe wasting steadily increased from −8.8% in 2005 to −24.3% in 2019. And the change was significantly widened from 2011 to 2019. On the other hand, residence-related inequality of severe wasting was observed in 2000 in ratio, difference and PAR summary measures but disappeared in 2019. Between 2000 and 2016, regional inequalities in severe wasting fluctuated between 8.7 in 2005 to 5.9 in 2016 taking the difference as a measure of inequality. Overall, Wealth-related inequality has significantly widened over time with under five children from the richest households being less affected by severe wasting. Education-related inequality was not changed with under five children whose mothers had not attended formal education highly affected by severe wasting. Regional disparity in severe wasting is also exhibited in Ethiopia in all-round surveys with children from Addis Ababa being least affected whereas children from Somalia were highly affected by severe wasting. However, no significant disparity in the type of residence in severe wasting was revealed in Ethiopia. Therefore, special attention should be paid to under-five children living in the poorest households, whose mothers did not attend formal education and children living in Somalia region.

Group-based trajectory models of integrated vaccine delivery and equity in low- and middle-income countries

BackgroundIntegrated vaccine delivery – the linkage of routine vaccination with provision of other essential health services – is a hallmark of robust primary care systems that has been linked to equitable improvements in population health outcomes.MethodsWe gathered longitudinal data relating to routine immunization coverage and vaccination equity in 78 low- and middle-income countries that have ever received support from Gavi, the Vaccine Alliance, using multiple imputation to handle missing values. We then estimated several group-based trajectory models to describe the relationship between integrated vaccine delivery and vaccination equity in these countries. Finally, we used multinomial logistic regression to identify predictors of group membership.ResultsWe identified five distinct trajectories of geographic vaccination equity across both the imputed and non-imputed datasets, along with two and four trajectories of socioeconomic vaccination equity in the imputed and non-imputed datasets, respectively. Integration was associated with reductions in the slope index of inequality of measles vaccination in the countries analyzed. Integration was also associated with an increase in the percentage of districts reporting high measles vaccination coverage.ConclusionsIntegrated vaccine delivery is most strongly associated with improvements in vaccination equity in settings with high baseline levels of inequity. Continued scholarship is needed to further characterize the relationship between integration and health equity, as well as to improve measurement of vaccination coverage and integration.

Trends in the use of complementary and alternative medicine between 1987 and 2021 in Denmark

BackgroundComplementary and alternative medicine (CAM) has been widely and increasingly used worldwide during the past decades. Nevertheless, studies in long-term trends of CAM use are limited. The aim of this study was to assess long-term trends in the prevalence of CAM use (both overall and for specific CAMs) between 1987 and 2021 in the adult Danish population and to examine certain sociodemographic characteristics of CAM users.MethodsData derived from nationally representative health surveys in the general adult population (≥ 16 years) in Denmark (the Danish Health and Morbidity Surveys) conducted in 1987, 1994, 2000, 2005, 2010, 2013, 2017, and 2021. The response proportion declined from 79.9% in 1987 to 45.4% in 2021. CAM use was assessed by questions on ever use of specific types of CAMs and overall use within the past 12 months. Differences in use of CAMs across educational levels were assessed using the Slope Index of Inequality (SII).ResultsAn overall increase in the prevalence of CAM use within the past 12 months was found between 1987 (10.0%) and 2021 (24.0%). However, a stagnation was observed between 2010 and 2017, after which the prevalence decreased in 2021. In all survey waves, the prevalence was higher among women than men. For both sexes, the prevalence tended to be highest among respondents aged 25–44 years and 45–64 years. The group with 13–14 years of education had the highest prevalence of CAM use compared to the other educational groups (< 10 years, 10–12 years, and ≥ 15 years). SII values for both men and women increased between 1987 and 2021, which indicates an increase in differences of CAM use across educational groups. In all survey waves the most frequently used CAMs included massage and other manipulative therapies, acupuncture, and reflexology.ConclusionsThe use of CAM has increased markedly within the last decades and recently stagnated at high levels, which underlines the importance of securing high quality information and education for the public, health professionals, and legislators to ensure and promote safe use of CAMs.

Persistence of severe global inequalities in the burden of Hypertension Heart Disease from 1990 to 2019: findings from the global burden of disease study 2019

AimsAssessing the global burden and health inequalities of Hypertension Heart Disease (HHD) during the period from 1990 to 2019.MethodsSecondary analysis of the Global Burden of Disease (GBD) study in 2019, focusing on the burden of diseases, injuries, and risk factors worldwide. Disability-Adjusted Life Years (DALYs) data related to HHD are extracted from the 2019 GBD. Inequality Slope Index (SII) and Concentration Index are calculated to assess health inequalities across regions and countries.ResultsThe total DALYs for HHD reached 21.51 million, demonstrating a substantial increase of 54.25% compared to the figures recorded in 1990, while the age-standardized DALY rates per 100,000 population for HHD in 2019 showed a notable decline to 268.19 (95% UI 204.57, 298.07), reflecting a significant decrease of 26.4% compared to the rates observed in 1990. The DALYs rate of hypertensive heart disease increases with age. Countries with moderate SDI accounted for 38.72% of the global burden of HHD in terms of DALYs. The highest age-standardized DALY rates (per 100,000) are predominantly concentrated in underdeveloped areas. In 1990 and 2019, the SII (per 100,000 population) for DALYs were − 121.6398 (95% CI -187.3729 to -55.90684) and − 1.592634 (95% CI -53.11027 to 49.925) respectively. The significant decline suggests a reduction in the inequality of age-standardized burden of HHD between high-income and low-income countries during this period.ConclusionThe unequal prevalence of HHD across different populations can hinder the achievement of the “health for all” objective. Persistent disparities in HHD have been observed globally over the past thirty years. It is crucial to prioritize efforts towards reducing avoidable health inequalities associated with hypertension-related heart disease, particularly in low-income and middle-income countries.

Spatial distribution of northern shrimp Pandalus eous in the Sea of Japan in relation to the seafloor environment

Abstract To explore relationships between spatial distributions of northern shrimp Pandalus eous and environmental factors along the coastline of Honshu Island in the Sea of Japan, we built delta-type two-step generalized additive models (delta-GAM) based on bottom trawl surveys conducted in 2013–2022. The models provide the first quantitative analysis of the species’ habitat, showing that its distribution is associated with bottom sediment type, depth, slope and topographic position index (TPI) alongside the effects of year and region. From the delta-GAM response plots, species habitat preferences in the Sea of Japan were estimated as follows: seafloor deeper than 283 m; muddy rather than sandy bottoms; gently sloped to flat bottoms (&lt;0.8° in slope); and valleys rather than ridges (TPI &lt; 0.9). These results were reviewed in detail along with previously reported distribution records of northern shrimp. Standardized density (s-density) per fishing grid cell (10′ square latitude–longitude mesh) estimated from the delta-GAM results indicated that this species is widely distributed on the continental slope along the coast of Honshu Island. To test plausibility of the s-density analysis, we compared s-density per fishing grid cell with nominal CPUE (kg per haul) per fishing grid cell based on official logbook data from large offshore trawl fisheries. The two were generally positively correlated by year, and the delta-GAM results were assumed to be fairly robust. Finally, potential fishing grounds were explored based on the delta-GAM results.

Leisure-Time Physical Activity in a Southern Brazilian City (2004-2021): Applying an Equity Lens to Time-Trend Analyses.

This study aimed to verify leisure-time physical activity trends over 15years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity. Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression. We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = -11.1 [95% confidenceinterval, CI, -14.4 to -7.8], SII2021 = -10.7 [95% CI, -13.7 to -7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was -24.5 (95% CI, -31.1 to -17.9) in 2004 and -18.8 in 2021 (95% CI, -24.2 to -13.4). Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.

Changes in Municipal-Level Social Capital and Socioeconomic Inequalities in Sports Group Participation and Walking Time Among Older Adults

Background: This study aimed to examine trends in socioeconomic inequalities in sports group participation and daily walking time among older adults in Japan from 2016 to 2019, and to elucidate the association of municipal-level social capital in these trends. Methods: Using data from the Japan Gerontological Evaluation Study across 2 waves (2016 and 2019), this repeated cross-sectional ecological study included 50 municipalities with 102,575 and 94,022 participants, respectively. We investigated inequalities in sports group participation, and daily walking time by income and education, using the slope index of inequality and relative index of inequality with municipal-level social capital variables, such as civic participation, reciprocity, social cohesion, and social network. Results: From 2016 to 2019, all slope index of inequalities showed a decreasing trend (−4.2 to − 0.5), whereas relative index of inequalities maintained or decreased (−0.10 to 0.00). Increases in municipal-level social capital particularly civic participation and social networks with friends were associated with reduced inequalities in both sports group participation and walking time. For example, increased civic participation scores were associated with reduced relative index of inequalities, which assessed inequalities in sports group participation by income (B = −0.13, 95% CI, −0.24 to − 0.03) and in walking time by education (B = −0.06, 95% CI, −0.11 to − 0.01). Conclusions: Enhancements in municipal social capital can reduce socioeconomic inequalities in sports group participation and daily walking among older adults, highlighting the importance of fostering civic participation, social networks, and cohesion in public health strategies aimed at reducing inequalities in sports and walking.

Regional variations and inequalities in testing for early detection of breast and cervical cancer: evidence from a nationally representative survey in India.

The burden of cancer in India has been rising, yet testing for early detection remains low. This study explored inequalities in the uptake of breast cancer (BC) examination and cervical cancer (CC) among Indian women, focusing on socioeconomic, regional, and educational differences. Data from the 2019-21 National Family Health Survey (n=353,518) were used to assess the uptake of BC examination and CC testing. Inequalities were quantified using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). SII measured absolute inequality, while RII and RCI assessed relative inequality between disadvantaged and advantaged groups. The ever uptake of tests for early detection of BC and CC were low at 9 and 20 per 1,000 women, respectively. Higher uptake was observed among women from the richest households compared to the poorest (SII: 1.1 for BC and 1.8 for CC). The magnitude of relative socioeconomic inequalities was more pronounced in rural areas (RCI: 22.5 for BC and 21.3 for CC) compared to urban areas. Similarly, higher-educated women were 4.84 times (RII: 4.84) and 2.12 times (RII: 2.12) more likely to undergo BC examination and CC testing, respectively, compared to non-educated women. The northeastern region exhibited greater socioeconomic inequality, while the western region showed more education-based inequality. The lower uptake of BC examination and CC testing and the marked inequalities underscore the need for targeted interventions to improve access and utilization of testing services, especially among lower-educated women, and those in rural areas.

Detection of Low Resilience Using Data-Driven Effective Connectivity Measures.

Conventional thresholding techniques for graph theory analysis, such as absolute, proportional and mean degree, have often been used in characterizing human brain networks under different mental disorders, such as mental stress. However, these approaches may not always be reliable as conventional thresholding approaches are subjected to human biases. Using a mental resilience study, we investigate if data-driven thresholding techniques such as Global Cost Efficiency (GCE-abs) and Orthogonal Minimum Spanning Trees (OMSTs) could provide equivalent results, whilst eliminating human biases. We implemented Phase Slope Index (PSI) to compute effective brain connectivity, and applied data-driven thresholding approaches to filter the brain networks in order to identify key features of low resilience within a cohort of healthy individuals. Our dataset encompassed resting-state EEG recordings gathered from a total of 36 participants (31 females and 5 males). Relevant features were extracted to train and validate a classifier model (Support Vector Machine, SVM). The detection of low stress resilience among healthy individuals using the SVM model scores an accuracy of 80.6% with GCE-abs, and 75% with OMSTs, respectively.

Socioeconomic inequalities in health problems in the first two years of life: Pelotas (Brazil) birth cohort, 2015.

Brazil is characterized by an unfinished agenda of health inequalities, which impact health problems in the childhood. This study aimed to evaluate the socioeconomic inequalities of health problems in the early childhood. This is a prospective study, using data from the birth cohort carried out in the city of Pelotas (Rio Grande do Sul State, Brazil) in 2015. The outcomes were health problems presented at 12 and 24 months: cough, breathing difficulty, diarrhea, ear pain, pneumonia, urinary infection, hospitalization, and other health problems. Socioeconomic inequalities were measured applying the slope index of inequality (SII) and the concentration index (CIX), with wealth index and maternal schooling being the socioeconomic variables. The inequalities in the number of health problems were evaluated by Poisson regression. The perinatal sample comprised 4,275 children. At 12 months approximately 74% of the children presented 1 or more health problems, while at 24 months, approximately 44% presented 2 or more health problems. For all period, the mean number of health problems was 2.9 (standard deviation = 2.0). Higher frequencies were observed for children belonging to the poorest income quintile and with lower maternal education, except for 1 or more health problems at 24 months. The greatest absolute and relative inequality was observed for 2 or more health problems at 12 months (SII: -0.23, 95%CI: -0.29; -0.18 and CIX: -0.19, 95%CI: -0.25; -0.14). There is an opposite dose-response relation for the risk of accumulation of health problems according to maternal schooling (1.07, 95%CI: 1.04; 1.09) and wealth categories (1.03, 95%CI: 1.01; 1.04), in the full adjusted models. The study confirms inequalities due to health problems in Brazilian children, especially in the first year of life.

Changing Trends in Child Welfare Inequalities in Northern Ireland

Abstract Longitudinal research in England and Wales has identified increasing inequality in child welfare interventions, particularly with respect to children in the poorest areas coming into care. Although previous cross-sectional research has shown associations between area level deprivation and child welfare interventions to be weakest in Northern Ireland (NI), it remains unknown if this reflects wider trends over time. This study uses longitudinal administrative data to investigate the relationship between area level deprivation and the (1) referral, (2) investigation, (3) registration and (4) looked after stages of children’s contact with child and family social work from 2010 to 2017 (stages 1–3) and 2020 (stage 4). Both relative and absolute measures of inequality (Ratio of Inequality, Slope Index of Inequality and Relative Index of Inequality) were calculated to examine trends. The results highlight a clear and increasing social gradient in child welfare interventions in NI over time, particularly at the higher levels of intervention and those involving children aged 0–4 years. Routine analysis of children’s social care caseloads by deprivation is highlighted as a means of focusing attention on poverty and material inequality, prompting practitioners, managers and policy makers to consider the drivers of such inequality and how this might be addressed.

Costs of major depression covered / not covered in British Columbia, Canada

BackgroundMajor depressive disorder (MDD) is one of the world’s leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness.MethodsWe performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions.ResultsThere were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53–104 unless MDD was refractory to treatment ($125/week between week 12–52 and $101/week over weeks 53–104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached − 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII − 0.07 to 0.6).ConclusionsMDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.

Disparities in Cancer Incidence across Income Levels in South Korea.

Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea. This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis. The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q. Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.

The impact of land cover change on the carbon stock of moist afromontane forests in the Majang Forest Biosphere Reserve

BackgorundForest plays an important role in the global carbon cycle by sequestering carbon dioxide and thereby mitigating climate change. In this study, an attempt was made to investigate the effects of land use/land cover (LULC) change (1989–2017) on carbon stock and its economic values in tropical moist Afromontane forests of the Majang Forest Biosphere Reserve (MFBR), south-west Ethiopia. Systematic sampling was conducted to collect biomass and soil data from 140 plots in MFBR. The soil data were collected from grassland and farmland. InVEST modelling was employed to investigate the spatial and temporal distribution of carbon stocks. Global Voluntary Market Price (GVMP) and Tropical Economics of Ecosystems and Biodiversity (TEEB) analysis was performed to estimate economic values (EV) of carbon stock dynamics. Correlation and regression analyses were also employed to identify the relationship between environmental and anthropogenic impacts on carbon stocks.ResultsThe results indicated that the above-ground carbon and soil organic carbon stocks were higher than the other remaining carbon pools in MFBR. The mean carbon stock (32.59 M tonne) in 2017 was lower than in 1989 (34.76 Mt) of MFBR. Similarly, the EV of carbon stock in 2017 was lower than in 1989. Elevation, slope, and harvesting index are important environmental and disturbance factors resulting in major differences in carbon stock among study sites in MFBR.ConclusionsTherefore, the gradual reduction of carbon stocks in connection with LULC change calls for urgent attention to implement successful conservation and sustainable use of forest resources in biosphere reserves.

A quantitative review of competing learning slope metrics: effects of age, sex, and clinical diagnosis

ABSTRACT Introduction In learning and memory tests that involve multiple presentations of the same material, learning slope refers to the degree to which examinees improve performances over successive learning trials. We aimed to quantitatively review the traditional raw learning slope (RLS), and the newly created learning ratio (LR) to understand the effects of demographic variables and clinical diagnoses on learning slope (e.g., limited improvement over multiple trials), and to develop demographically sensitive norms. Method A systematic literature search was conducted to evaluate the potential for these aims to be examined across the most popular contemporary multi-trial learning tests. Two databases were searched. Following this, hierarchical linear modeling was used to examine how demographic variables predict learning slope indices. These results were in turn used to contrast the performance of clinical groups with the predicted performance of demographically similar healthy controls. Finally, preliminary normative estimates for learning slope indices were presented. Results A total of 82 studies met criteria for inclusion in this study. However, the Rey Auditory Verbal Learning Test (RAVLT) was the only test to have sufficient trial-level learning and demographic data. Fifty-eight samples from 19 studies were quantitatively examined. Hierarchical linear models provided evidence of sex differences and a curvilinear decline in learning slope with age, with strongest and most consistent effects for LR relative to RLS. Regression-based norms for demographically corrected RLS and LR scores for the RAVLT are presented. The effect of clinical diagnoses was consistently stronger for LR, and Alzheimer’s disease had the strongest effect, followed by invalid performances, severe traumatic brain injury, and seizures/epilepsy. Conclusion Overall, LR enjoys both conceptual and demonstrated psychometric advantages over RLS. Replication of these findings can be completed by reanalyzing existing datasets. Further work may focus on the utility of using LR in diagnosis and prediction of clinical prognosis.