Socioeconomic Inequalities In Mortality Research Articles

Association between Socioeconomic Inequalities in Pain and All-cause Mortality in China: Evidence from the China Health and Retirement Longitudinal Study.

Fewer studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures. Our study aimed to investigate the association between inequalities in pain and all-cause mortality in China. Longitudinal cohort data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2013 (waves 1, wave 2) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequity of pain, and the association between pain and death was analyzed by cox proportional risk model. A total of 16747 participants were included, with an average age of 59.57±9.82 years old. The prevalence of pain was 32.54% (8196/16747). The main pain type was moderate pain (36.36%), and the common pain locations were waist (19.30%), leg (14.78%), and head (13.44%). We found that the prevalence of pain was concentrated in participant with poor economic status (concentration index: -0.066, 95%CI: -0.078, -0.054), and educational level (36.49%), location (36.87%) and economic status (25.05%) contributed significantly to the inequality of pain. In addition, cox regression found that participants with pain was associated with an increased risk of all-cause mortality (HR=1.30, 95%CI: 1.06, 1.61). The prevalence of pain in Chinese adults is concentrated among participants with poor economic conditions, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors to reduce deaths due to pain inequities by implementing targeted interventions to reduce pain inequities.

Trends in socioeconomic inequalities in pancreatic cancer mortality in Canada: Evidence from the Canadian Vital Statistics Death Database

BackgroundPancreatic cancer is one of the leading causes of death in Canada and is projected to be the second leading cause of cancer death by 2030. This study sought to evaluate education and income inequalities in pancreatic cancer mortality in Canada between 1990 and 2019. MethodsUsing a unique census division level dataset (n = 280) constructed from the Canadian Vital Statistics Death Database, Canadian Census of Population (1991, 1996, 2001, 2006, 2016), and National Household Survey (2011) we assess socioeconomic inequalities in pancreatic cancer in Canada. Age-standardized Concentration index was used to quantify income and education inequalities in pancreatic cancer mortality. Trends analyses were conducted to assess changes in income and education inequalities in pancreatic cancer mortality over time. ResultsOur results show that crude pancreatic cancer mortality in Canada increased significantly from 10.23 for males and 9.65 for females in 1990, to 15.99 for males and 14.28 for females in 2019, per 100,000 people. The statistically significant negative values of age-standardized Concentration indices suggest persistent income and education inequalities in pancreatic cancer mortality in Canada. Trend analyses indicates reductions in income and education inequalities in pancreatic cancer mortality over time, particularly among females. ConclusionsSignificant income and education inequalities in pancreatic cancer mortality in Canada warrant public policy concern and action. Further research is required to understand whether differential access to treatment across socioeconomic groups played a role in the observed socioeconomic inequalities.

Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019

Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. UK National Institute for Health and Care Research.

Increased mortality in socioeconomic disadvantaged municipalities during the first phase of the COVID-19 pandemic in Lombardy region.

Lombardy was the first European region most severely affected by the coronavirus disease 2019 pandemic in the spring of 2020. During that period, a substantial increase in socioeconomic inequality in total mortality was observed. This study aims to evaluate mortality data in the region up to September 2023 to verify whether the increased disparities between the poorest and the wealthiest municipalities persisted in the subsequent phases of the pandemic. This study analyzed mortality data from January 2019 to September 2023 in Lombardy's municipalities by month and pandemic phases characterized by the predominance of the different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Municipalities were grouped according to the average income or pension of their residents. Age-standardized mortality rates (ASMRs) and the ASMR ratio between the poorest and the wealthiest municipalities were compared throughout the study period. In the pre-pandemic period (January 2019 - February 2020), the ASMR ratio at all ages between the poorest and the wealthiest municipalities fluctuated between 1.12 [95% confidence interval (CI): 1.07-1.16] and 1.29 (95% CI: 1.25-1.34). In March 2020, the ASMR ratio increased to 1.49 (95% CI: 1.45-1.52 95%) and returned to values registered before the pandemic thereafter. A similar pattern was observed in the analysis of mortality ≥ 65, using the average pension for group municipalities. During the dramatic circumstances that the region faced in March 2020, pre-existing socioeconomic inequalities substantially widened. With the reorganization of the health system and the availability of vaccines, these disparities returned to the levels recorded before the pandemic.

Socioeconomic inequality in prostate cancer diagnostics, primary treatment, rehabilitation, and mortality in Sweden.

We designed a nationwide study to investigate the association between socioeconomic factors (household income and education) and different aspects of prostate cancer care, considering both individual- and neighbourhood-level variables. Data were obtained from Prostate Cancer data Base Sweden (PCBaSe), a research database with data from several national health care registers including clinical characteristics and treatments for nearly all men diagnosed with prostate cancer in Sweden. Four outcomes were analysed: use of pre-biopsy magnetic resonance imaging (MRI) in 2018-2020 (n = 11,843), primary treatment of high-risk non-metastatic disease in 2016-2020 (n = 6633), rehabilitation (≥2 dispensed prescriptions for erectile dysfunction within 1 year from surgery in 2016-2020, n = 6505), and prostate cancer death in 7770 men with high-risk non-metastatic disease diagnosed in 2010-2016. Unadjusted and adjusted odds and hazard ratios (OR/HRs) with 95% confidence intervals (CIs) were calculated. Adjusted odds ratio (ORs) comparing low versus high individual education were 0.74 (95% CI 0.66-0.83) for pre-biopsy MRI, 0.66 (0.54-0.81) for primary treatment, and 0.82 (0.69-0.97) for rehabilitation. HR gradients for prostate cancer death were significant on unadjusted analysis only (low vs. high individual education HR 1.41, 95% CI 1.17-1.70); co-variate adjustments markedly attenuated the gradients (low vs. high individual education HR 1.10, 95% CI 0.90-1.35). Generally, neighbourhood-level analyses showed weaker gradients over the socioeconomic strata, except for pre-biopsy MRI. Socioeconomic factors influenced how men were diagnosed with prostate cancer in Sweden but had less influence on subsequent specialist care. Neighbourhood-level socioeconomic data are more useful for evaluating inequality in diagnostics than in later specialist care.

Abstract 4826: Cancer mortality attributable to area-level socioeconomic inequalities in Japan from 2015 to 2020

Abstract Background: In the 3rd Healthy Japan 21 and the 4th National Cancer Plan, the government focused on reducing health inequalities. However, current monitoring of socioeconomic inequalities in cancer is still insufficient to set the targets for the plan. To prioritize strategy aimed at reducing socioeconomic inequalities in cancer mortality, we estimated the population attributable risk fraction (PAF) and excess death due to socioeconomic inequalities, by sex, age group and cancer site. Method: We used the areal deprivation index (ADI) to establish area-based socioeconomic status. We categorized municipalities to ADI quintile weighted by the size of population, Q1 is the least deprived and Q5 the most deprived group. Excess death due to socioeconomic inequalities was calculated by the difference between observed number of deaths and expected death of Q2 to Q5 group with Q1 as standard population. We used cancer mortality data obtained from vital statistics in 2015-2020. Results: In total, about 12000 male and 2800 female excess deaths per year due to socioeconomic inequalities were estimated; that is 5.5% and 1.8% as PAF. PAF due to socioeconomic inequalities limited to premature death, less than 75 years old, was estimated as 7.6% in men and 3.3% in women. By age group, the 0-39 years group showed the largest PAF at 15.7% in men and 16.6% in women. In men of all age groups, except 0-39 years, lung cancer was the highest excess death due to socioeconomic inequalities. For women, some cancer sites (breast, ovary, esophagus) showed an opposite association, Q1 was the highest mortality group. Therefore, total excess death was lower than in men. In women of all ages, the highest rate of excess death due to socioeconomic inequalities was gallbladder cancer. For the 0-39 years group, a high rate of excess death in stomach, leukemia, and cervical cancer was observed. Discussion: Excess death and PAF due to socioeconomic inequalities differed by sex and age group. A greater impact of socioeconomic inequality on cancer mortality was observed in men than in women. Among women, further attention should be paid to areal variation of cancer death related to socioeconomic inequalities, based on the different area-based indices. Citation Format: Yuri Ito, Tomoki Nakaya, Manami Inoue, Tomotaka Sobue, Hitoshi Nakagama. Cancer mortality attributable to area-level socioeconomic inequalities in Japan from 2015 to 2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4826.

Trends in socioeconomic inequalities in breast cancer mortality in Canada: 1992-2019.

Breast cancer is the second leading cause of death from cancer among Canadian females. This study aimed to quantify and assess trends in education and income inequalities in the mortality rate of breast cancer in Canada from 1992 to 2019. We constructed a census division-level dataset pooled from the Canadian Vital Death Statistics Database (CVSD), the Canadian Census of the Population (CCP), and the National Household Survey (NHS) to examine trends in education and income inequalities in the mortality rate of breast cancer in Canada over the study period. The age-standardized Concentration index (C) was used to quantify income and education inequalities in breast cancer mortality over time. The national crude mortality rate of breast cancer has decreased in Canada from 1992 to 2019, with Alberta, British Columbia, Manitoba, Ontario, Prince Edward Island, and Quebec having the greatest decreases in mortality rate. The age-standardized C for education and income inequalities were always negative for all the study years, meaning that the mortality rate of breast cancer was higher among less-educated and poorer females. Moreover, the results indicate a growing trend in the concentration of breast cancer mortality among females with lower income and education from 1992 to 2019. The increasing concentration of breast cancer mortality among low socioeconomic status females remains a challenge in Canada. Continuous efforts are needed within Canadian healthcare systemto improve the prevention and treatment of breast cancer for this population.

Socioeconomic inequalities in avoidable mortality in Italy: results from a nationwide longitudinal cohort

BackgroundDisparities in avoidable mortality have never been evaluated in Italy at the national level. The present study aimed to assess the association between socioeconomic status and avoidable mortality.MethodsThe nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012–2019 mortality. Outcomes of preventable and of treatable mortality were separately evaluated among people aged 30–74. Education level (elementary school or less, middle school, high school diploma, university degree or more) and residence macro area (North-West, North-East, Center, South-Islands) were the exposures, for which adjusted mortality rate ratios (MRRs) were calculated through multivariate quasi-Poisson regression models, adjusted for age at death. Relative index of inequalities was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes.ResultsThe cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65–74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). The greatest inequalities were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Excess risk of preventable and of treatable mortality were observed for the South-Islands.ConclusionsSocioeconomic inequalities in mortality persist in Italy, with an extremely varied response to policies at the regional level, representing a possible missed gain in health and suggesting a reassessment of priorities and definition of health targets.

Trends in socioeconomic inequalities in cause-specific premature mortality in Belgium, 1998–2019

BackgroundHigher levels of socioeconomic deprivation have been consistently associated with increased risk of premature mortality, but a detailed analysis by causes of death is lacking in Belgium. We aim to investigate the association between area deprivation and all-cause and cause-specific premature mortality in Belgium over the period 1998–2019.MethodsWe used the 2001 and 2011 Belgian Indices of Multiple Deprivation to assign statistical sectors, the smallest geographical units in the country, into deprivation deciles. All-cause and cause-specific premature mortality rates, population attributable fraction, and potential years of life lost due to inequality were estimated by period, sex, and deprivation deciles.ResultsMen and women living in the most deprived areas were 1.96 and 1.78 times more likely to die prematurely compared to those living in the least deprived areas over the period under study (1998–2019). About 28% of all premature deaths could be attributed to socioeconomic inequality and about 30% of potential years of life lost would be averted if the whole population of Belgium faced the premature mortality rates of the least deprived areas.ConclusionPremature mortality rates have declined over time, but inequality has increased due to a faster pace of decrease in the least deprived areas compared to the most deprived areas. As the causes of death related to poor lifestyle choices contribute the most to the inequality gap, more effective, country-level interventions should be put in place to target segments of the population living in the most deprived areas as they are facing disproportionately high risks of dying.

Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010–2016

IntroductionMental health inequalities across racial and ethnic groups are large and unjust in many countries, yet these inequalities remain under-researched, particularly in low-income and middle-income countries such as Brazil. This...

Widening area-based socioeconomic inequalities in cancer mortality in Germany between 2003 and 2019

Cancer mortality has declined in recent decades, but—due to a lack of national individual-level data—it remains unclear whether this applies equally to all socioeconomic groups in Germany. Using an area-based approach, this study investigated socioeconomic inequalities in cancer mortality and their secular trends on a German nationwide scale for the first time. Official cause-of-death data from 2003 to 2019 were linked to the district-level German Index of Socioeconomic Deprivation. Age-standardised mortality rates for all cancers combined and the most common site-specific cancers were calculated according to the level of regional socioeconomic deprivation. To quantify the extent of area-based socioeconomic inequalities in cancer mortality, absolute (SII) and relative (RII) indices of inequality were estimated using multilevel Poisson models. On average, cancer mortality was 50% (women) and 80% (men) higher in Germany’s most deprived than least deprived districts (absolute difference: 84 deaths per 100,000 in women and 185 deaths per 100,000 in men). As declines in cancer mortality were larger in less deprived districts, the socioeconomic gap in cancer mortality widened over time. This trend was observed for various common cancers. Exceptions were cancers of the lung in women and of the pancreas in both sexes, for which mortality rates increased over time, especially in highly deprived districts. Our study provides first evidence on increasing socioeconomic inequalities in cancer mortality on a nationwide scale for Germany. Area-based linkage allows to examine socioeconomic inequalities in cancer mortality across Germany and identify regions with high needs for cancer prevention and control.

Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?

This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19). From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea's cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities. All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased. In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.

Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation

BackgroundLung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation.MethodsWe analysed all registered deaths from lung cancer during the period 2011–2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex.ResultsWe observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas.ConclusionsSocio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.

Changes in Geographic Variation and Socioeconomic Inequalities in Esophageal Cancer Mortality in China, 1973-2017.

Geographic variability in esophageal cancer has been reported in China, but data are lacking at the local level. We aimed to investigate changes in disparities in esophageal cancer-related mortality among Chinese counties and whether county-level socioeconomic status was associated with this variation. We used data from a nationwide survey and population-based cancer registries to calculate esophageal cancer-related mortality rates for 782 Chinese counties for the periods of 1973-1975 and 2015-2017. We performed hotspot analysis to identify spatial clusters. We used a multivariable negative binomial regression model to estimate the associations between county-level socioeconomic factors and mortality. From 1973-1975 to 2015-2017, the age-standardized esophageal cancer-related mortality rate decreased from 27 to 8 per 100,000 person-years in China. By county, 577 (74%) of 782 counties experienced decreasing mortality. Geographic disparities in mortality substantially narrowed, with the gap in mortality rates between 90th and 10th percentile counties decreasing from 55 per 100,000 person-years in 1973-1975 to 16 in 2015-2017. However, clusters of elevated rates persisted across north-central China. Rurality [adjusted mortality rate ratio (MRR) 1.15; 95% confidence interval (CI), 1.10-1.21], per capita gross domestic product (adjusted MRR, 0.95; 95% CI, 0.91-0.98), and percentage of people with a high-school diploma (adjusted MRR, 0.86; 95% CI, 0.84-0.87) in a county were significantly associated esophageal cancer-related mortality rates. China has made substantial progress in reducing esophageal cancer-related mortality and disparities, but the intercounty differences remain large. Continued efforts are needed to address the geographical and socioeconomic disparities in esophageal cancer.

National estimates of occupation-related inequalities in all-cause mortality using linked Census-mortality data

ObjectiveThis report aims to provide national estimates of occupation-related inequalities in all-cause mortality for Australian residents aged 25–64 years. MethodData came from the 2016 Census linked to Deaths Registrations, available via the Multi-Agency Data Integration Project. Using negative binomial regression, we estimated age-adjusted relative and absolute inequalities in all-cause mortality rates in the 13 months following Census according to occupation, defined using the Australian and New Zealand Standard Classification of Occupations (eight major groups), using managers as the reference group. ResultsAmong 10.8M people, there were 20,987 deaths. Age-adjusted mortality rates were lowest among managers and professionals and were generally highest for manual occupations, for example, among men, relative risks (RR) for labourers ranged across age groups from 1.44 (95% CI 1.19–1.75, age 54–64) to 2.99 (1.93–4.65, age 25–34); among women, the RR for machine operators and drivers were 3.95 (1.39–11.21 in age 25–24 and 2.73 (1.66–4.49) in age 45–54, but there was relatively little variation by occupation in women aged 35–44 and 55–64. Around one in five deaths (23% for men, 17% for women) were associated with being in an occupation other than manager. ConclusionThese findings highlight that there is benefit in documenting national mortality inequalities according to occupation in addition to other measures of socioeconomic position. They provide further insights into socioeconomic inequalities in mortality. Implications for public healthMethods that aim to reduce mortality for those in manual occupations, particularly among young men, will reduce inequalities and improve population health.

Impact of the COVID-19 Pandemic on the Socioeconomic Inequalities in Mortality in Spanish Provinces

BackgroundAlthough many studies have assessed the socioeconomic inequalities caused by COVID-19 in several health outcomes, there are numerous issues that have been poorly addressed. For instance, have socioeconomic inequalities in mortality from COVID-19 increased? What impact has the pandemic had on inequalities in specific causes of mortality other than COVID-19? Are the inequalities in COVID-19 mortality different from other causes? In this paper we have attempted to answer these questions for the case of Spain.MethodsWe used a mixed longitudinal ecological design in which we observed mortality from 2005 to 2020 in the 54 provinces into which Spain is divided. We considered mortality from all causes, not excluding, and excluding mortality from COVID-19; and cause-specific mortality. We were interested in analysing the trend of the outcome variables according to inequality, controlling for both observed and unobserved confounders.ResultsOur main finding was that the increased risk of dying in 2020 was greater in the Spanish provinces with greater inequality. In addition, we have found that: (i) the pandemic has exacerbated socioeconomic inequalities in mortality, (ii) COVID-19 has led to gender differences in the variations in risk of dying (higher in the case of women) and (iii) only in cardiovascular diseases and Alzheimer did the increased risk of dying differ between the most and least unequal provinces. The increase in the risk of dying was different by gender (greater in women) for cardiovascular diseases and cancer.ConclusionOur results can be used to help health authorities know where and in which population groups future pandemics will have the greatest impact and, therefore, be able to take appropriate measures to prevent such effects.

The impact of the COVID-19 pandemic on inequalities in preventive health screenings: Trends and implications for U.S. population health

The COVID-19 pandemic has profoundly impacted population well-being in the United States, exacerbating existing racial and socioeconomic inequalities in health and mortality. Importantly, as the pandemic disrupted the provision of vital preventive health screenings for cardiometabolic diseases and cancers, more research is needed to understand whether this disruption had an unequal impact across racialized and socioeconomic lines. We draw on the 2019 and 2021 National Health Interview Survey to explore whether the COVID-19 pandemic contributed to racialized and schooling inequalities in the reception of preventive screenings for cardiometabolic diseases and cancers. We find striking evidence that Asian Americans, and to a lesser extent Hispanic and Black Americans, reported decreased reception of many types of cardiometabolic and cancer screenings in 2021 relative to 2019. Moreover, we find that across schooling groups, those with a bachelor's degree or higher experienced the greatest decline in screening reception for most cardiometabolic diseases and cancers, and those with less than a high school degree experienced the greatest decline in screening reception for diabetes. Findings have important implications for health inequalities and U.S. population health in the coming decades. Research and health policy attention should be directed toward ensuring that preventive health care is a key priority for public health, particularly among socially marginalized groups who may be at increased risk of delayed diagnosis for screenable diseases.

Estimation of socioeconomic inequalities in mortality in Japan using national census-linked longitudinal mortality data.

We aimed to develop census-linked longitudinal mortality data for Japan and assess its validity as a new resource for estimating socioeconomic inequalities in health. Using deterministic linkage, we identified, from national censuses for 2000 and 2010 and national death records, persons and deceased persons who had unique personal identifiers (generated using sex, birth year/month, address, and marital status). For the period 2010-2015, 1 537 337 Japanese men and women aged 30-79 years (1.9% in national census) were extracted to represent the sample population. This population was weighted to adjust for confounding factors. We estimated age-standardized mortality rates (ASMRs) by education level and occupational class. The slope index of inequality (SII) and relative index inequality (RII) by educational level were calculated as inequality measures. The reweighted sample population's mortality rates were somewhat higher than those of the complete registry, especially in younger age-groups and for external causes. All-cause ASMRs (per 100 000 person-years) for individuals aged 40-79 years with high, middle, and low education levels were 1078 (95% confidence interval: 1051-1105), 1299 (1279-1320), and 1670 (1634-1707) for men, and 561 (536-587), 601 (589-613), and 777 (745-808) for women, respectively, during 2010-2015. SII and RII by educational level increased among both sexes between 2000-2005 and 2010-2015, which indicates mortality inequalities increased. The developed census-linked longitudinal mortality data provide new estimates of socioeconomic inequalities in Japan that can be triangulated with estimates obtained with other methods.

Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries

BackgroundAcross Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term...

The Sensitivity of the Healthy Life Years Indicator: Approaches for Dealing with Age-Specific Prevalence Data

The Healthy Life Years (HLY) indicator is the official European Union indicator and a cornerstone of many health policies used in over 15 countries in the EU region to set national health plans and monitor targets. It is also used to investigate trends over time in the proportion of total life years spent in good or poor health, socioeconomic inequalities in health and mortality and the male-female health survival paradox. Based on the Global Activity Limitation Indicator (GALI) included in the European Union Statistics on Income and Living Conditions (EU-SILC), a great amount of effort has been directed at harmonising and making HLY comparable across countries. Nonetheless, the characteristics of the age-specific prevalence distribution are still rarely accounted for, regardless of the fact that patterns of prevalence often fluctuate considerably by age. In addition, the impact of assumptions used at very young ages on HLY estimates are seldom discussed, despite the fact that the majority of policies and initiatives at the EU level use HLY at birth, while data on health is only available after age 16. In this paper, we assess whether smoothing the age-specific prevalence distributions by different methods, extrapolating to older ages and changing assumptions at younger ages affect HLY estimates. Overall, assumptions made before age 15 are the most important and affect women and men differently, thus affecting HLY at birth for some countries. Estimates at age 65 are very slightly impacted. Generalised linear models (GAMs) seem promising for harmonising and extrapolating to older ages, while using polynomials or aggregating into 5-year age groups seem best for younger ages. As most EU policies use HLY at birth and by sex for developing and monitoring health policies, caution is needed when estimating HLY at birth.
 * This article belongs to a special issue on “Levels and Trends of Health Expectancy: Understanding its Measurement and Estimation Sensitivity”.