Socioeconomic Inequalities Research Articles

Decrease in Socioeconomic Disparities in Self-Rated Oral Health among Brazilian Adults between 2013 and 2019: Results from the National Health Survey.

This cross-sectional study assessed the magnitude of inequalities in self-rated oral health (SROH) among different socioeconomic groups in Brazil. Secondary data from interviews with a sample of adults (≥18 years) from the national health survey 2013 (n = 64,308) and 2019 (n = 88,531) were analyzed. Positive SROH was considered when participants selected the good or very good options. Socioeconomic indicators were monthly household income and years of education. The magnitude of inequalities among socioeconomic groups was estimated using the Slope (SII) and Relative Index of Inequality (RII). Interaction term assessed changes in SII/RII over time. Estimates were adjusted for sex and age. The prevalence of SROH was 67.50% in 2013 and 69.68% in 2019. Individuals with lower socioeconomic indicators had a lower prevalence of positive SROH. Significant reductions in the magnitude of the education-based RII between 2013 (1.58) and 2019 (1.48) in Brazil, as well as in north (1.70; 1.45) and northeast (1.50; 1.41) regions and reduction in the income-based RII in the north (1.71; 1.51) were observed. Socioeconomic inequalities in SROH persist across different Brazilian regions, although there was a reduction in disparities among education groups in 2019 compared with 2013. The findings of this study suggest that equitable Brazilian oral health policies may have contributed to reducing SROH inequality over time.

Financial struggles and coping with the aftermath of breast cancer care: An ethnographic study in Vietnam

Breast cancer, the most common cancer diagnosed among women, disproportionately affects low- and middle-income countries (LMICs). Based on an ethnographic study conducted in Central Vietnam in 2019, including observation and interviews with 33 women patients, we investigate how women and their families managed the financial burden of breast cancer care. Our findings suggest that in a context where health-related risk protection is poorly organised and out-of-pocket expenses are burdensome, despite the presence of universal health coverage, patients must rely heavily on informal arrangements to finance their treatment. They proactively researched available information and undertook extensive and ramified work to prove their deservingness for some types of assistance, including strategically disclosing their cancer status or using tactics to accelerate the process of applying for state welfare. Affected families must make hard calculations to prioritise the pressing health need of a member diagnosed with cancer and in many circumstances, forfeited the education of their young children. We offer theoretical understanding of ‘patient work’ beyond the routine management of the biological aspects of an illness. In addition, we demonstrate how engaging in those various coping practices can reinforce one's vulnerability to a vicious cycle of illness and poverty and amplify socio-economic inequalities among the affected community and the larger society. We argue this situation, if not tackled urgently and appropriately, can impede the progress towards achieving Sustainable Development Goal 3 (Good Health and Wellbeing) and Goal 10 (Reduced Inequalities) in LMICs amidst the non-communicable disease epidemic.

Greenness moderates the relationship between self-rated social standing and depression among older adults in the Canadian longitudinal study on aging

IntroductionGreenness is considered to be a health-promoting feature of both natural and built environments and has the potential to influence mental health outcomes. However, most studies to date have neglected to address whether greenness differentially affects mental health outcomes for individuals across the socioeconomic spectrum. Our study explored if greenness is a moderating factor in the relationship between socioeconomic status (SES) and mental health using data from the Canadian Longitudinal Study on Aging (CLSA).MethodsA cross-sectional design was used to compare mental health outcomes between individuals with different levels of SES and residential greenness. We used self-rated social standing as a measure of SES and depression score measured using the Centre for Epidemiologic Studies 10-Item Depression Scale (CESD-10) as a measure of mental health. Greenness was measured using the annual maximum Normalized Difference Vegetation Index (NDVI) within a 1,000 m buffer area of participants' residential postal code locations.ResultsThere was a statistically significant moderating effect of greenness for the relationship between self-rated social standing and depression score. As greenness increased, individuals with lower self-rated social standing had the greatest decreases in depression score.DiscussionThe results of our study suggests that targeting greening interventions at individuals and communities with low SES may reduce depressive symptoms overall, as well as decrease socioeconomic inequalities in depression.

"I probably shouldn't go in today": Inequitable access to paid sick leave and its impacts on health behaviors during the emergence of COVID-19 in the Seattle area.

This study examines inequities in access to paid sick leave (PSL) by race/ethnicity, income, and sex and the role of PSL access on leave-taking and care-seeking behaviors among Seattle-area workers in the months leading up to and during the emergence of COVID-19 in the region. Survey responses were collected online and in-person from individuals experiencing acute respiratory illness symptoms between November 2019 and March 2020 as part of a community-based respiratory viral surveillance study. Chi-square tests and log-binomial models were used to assess the association between PSL access and various socioeconomic indicators. A total of 66.6% (n = 2,276) respondents reported access to PSL. Proportionally, access to PSL was highest in respondents identifying as Asian (70.5%), followed by White (68.7%), Latine (58.4%), Multiracial (57.1%), Black (47.1%), and Other (43.1%). Access to PSL increased with household income. Eighty three percent of high-income respondents reported access compared to 52.9% of low-income households. Only 23.3% of the lowest-income households reported access to PSL. Fewer females (65.2%) than males (70.7%) reported access to PSL. Access to PSL is inequitably distributed across income, race/ethnicity, and sex. This study reinforces the vast body of knowledge on how socioeconomic inequalities increase individual and community-level vulnerability to the impacts of infectious disease outbreaks. It also supports the role of labor and economic policy in mitigating (or exacerbating) these impacts. Exemplified by the COVID-19 pandemic, universal access to PSL, especially for marginalized populations, benefits all.

Inequalities in the demand and unmet need for contraception among women in four regions of Ethiopia.

Unmet need for family planning is a major cause of unwanted pregnancies, which may contribute to the death of mothers and children. The aim of this study is to examine inequalities in the demand and unmet need for contraception among women in four regions (i.e., Afar, Benishangul-Gumzu, Gambela and Somali regions) of Ethiopia. The study utilized data from the 2016 Ethiopian Demographic Health Survey (EDHS), collected from 3,343 women of reproductive age 15-49 years situated in these study regions. Multilevel binary and multivariable logistic regression analysis, concentration index, and multivariate decomposition analysis were employed. The study revealed that women's employment status, education level, household wealth index, total number of children ever born, and husband's working status had a statistically significant association with the demand for contraception. Furthermore, women's educational level, household size, wealth index and husband's working status had statistically significant association with unmet need for contraception. The results of the concentration index indicated that illiteracy among respondents (56%), being in the richest economic status/ wealth index (41%) and non-working status of respondents (21%) contributed substantially to the inequality in the demand for contraception use. Illiteracy of the husband (197%) and the household size less than or equal to five (184%) contributed positively, but illiteracy of respondent (-249%) and unemployment status of respondents (-119%) contributed negatively to the existing inequality in unmet need for contraception. The findings of this study highlight the presence of unacceptably high inequality in the demand and unmet need for contraception among women in the four study regions. Policymakers should give due attention to reducing existing socio-economic inequality to address the high unmet need for family planning and increase demand for contraception in these regions. The study strongly recommends implementing multidimensional and multisectoral approaches, which will significantly reduce inequalities in the outcome variables.

Demographic and socio-economic inequalities in subjective wellbeing: analysis of repeated cross-sectional health surveys in England 2010-2019.

Good subjective wellbeing (SWB) is a key societal aspiration. The study of SWB determinants is of increasing interest. The present study aimed to examine national inequalities in SWB, and trends in these inequalities, for England across five demographic (sex and age) and socio-economic (educational level, household income and living alone) characteristics. The relative index of inequalities (RII) and slope index of inequalities (SII) were calculated from repeated cross-sectional data from the Health Survey for England from 2010 to 2019 (excluding 2017 and 2018 as our outcome variable was not collected in these years), in a total of 90 236 participants aged 16+. SWB was assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), treated as a dichotomous variable with high and low levels of SWB>40 and≤40, respectively. There were significant inequalities in SWB by income (RII from 1.086 to 1.116), educational level (RII from 0.893 to 0.941) and between people living alone or not (RII from 0.908 to 0.937). The RII and SII trends were not statistically significant. Higher socio-economic status could play a protective role for SWB, and people in the most deprived socio-economic positions may be at higher risk for low SWB. These associations have remained stable over time.

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

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

Water and socioeconomic inequalities: spatial analysis of water consumption in Brazil

ABSTRACT To achieve equitable water access, it is necessary to understand and quantify the heterogeneity of water consumption. Thus, this study assessed the spatial dependence of water consumption for Brazil and an urban center. Two spatial autocorrelation tests were applied: the Global Moran’s Index (I) and the Local Indicator of Spatial Association (LISA). It was found that, both at the national and municipal scales, water consumption is not uniformly distributed in space, indicating the formation of clusters of regions with High-High, High-Low, Low-High, and Low-Low aggregation patterns. In this way, water and socioeconomic inequalities in Brazil are highlighted, emphasizing the gap between the Center-South and the North-Northeast regions. Additionally, water and socioeconomic disparities within the city of Fortaleza are also observed, resulting from its urbanization process. Finally, the spatial autocorrelation between water consumption and per capita income is strongly evident at both the national and municipal levels.

Socioeconomic inequalities in uptake of outreach mammography before and after accessibility improvement of Taiwan’s national universal breast cancer screening policy

BackgroundTaiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005–2009) and post-CAQIP (2010–2014).MethodWe conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values.ResultsUtilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was − 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively.ConclusionsOur study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.

Inadequação de domicílios no Brasil: uma reflexão sobre seus conceitos e indicadores

Research related to Brazil's housing deficit and inadequate housing conditions has been conducted for nearly 30 years with the aim of revealing housing-related deficiencies. While many authors focus on the housing deficit, this research concentrates on housing inadequacy, an index that reveals deficiencies preventing a residence from providing a high quality of life to its occupants. Such quality is measured by the building itself, the infrastructure of its urban area, and the legal title of the residence. This article proposes a brief historical context, demonstrating that the housing issue is deeply rooted in the country's socioeconomic inequalities, which have been perpetuated over the years by insufficient policies and challenges faced in urban planning. Furthermore, significant milestones in the history of the Fundação João Pinheiro (João Pinheiro Foundation - FJP) and the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics - IBGE) related to the collection, organization, and dissemination of data on housing conditions in Brazil were identified, with both institutions being crucial in this regard. Therefore, the aim was to discuss the habitability of Brazilian households by presenting concepts, indicators, and data from the most recent FJP publication on housing inadequacy from 2019. These data were systematized and presented in graphs, allowing for visualization and analysis. In conclusion, it was determined that the data released by the FJP are essential for diagnosing the housing scenario, are directly related to the literature review conducted, and provide crucial data for public policy formulation.

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

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

Challenges of Malaria Control in Northern Uganda: Infrastructure, Access, and Healthcare Delivery

Malaria remained a significant public health challenge in sub-Saharan Africa, with Uganda, particularly its northern region, bearing a high burden of the disease. This article examined the persistent malaria crisis in Northern Uganda, focusing on the interplay between inadequate healthcare infrastructure, limited access to medical services, and systemic inefficiencies in healthcare delivery. Northern Uganda’s healthcare infrastructure, weakened by historical conflicts, poverty, and underdevelopment, presents significant barriers to effective malaria control. Geographic isolation, socioeconomic inequities, and cultural practices further constrained access to healthcare, while human resource shortages, supply chain disruptions, and fragmented health services undermined the quality and continuity of care. The article utilized a comprehensive review of existing literature and data to analyze these challenges and proposed potential solutions. Strategies such as strengthening healthcare infrastructure, enhancing access to care, improving healthcare delivery, and fostering collaboration among stakeholders were essential for reducing the malaria burden and improving health outcomes in the region. Keywords: Malaria Control, Healthcare Infrastructure, Northern Uganda, Access to Care, Systemic Inefficiencies

Horizontal Inequality in Healthcare Utilisation in Rural Sabah, Malaysia

Ensuring universal access to healthcare is essential for societal equity. However, significant inequalities exist within global healthcare systems, resulting in unequal access to services and divergent health outcomes. Socioeconomic inequity, poor living conditions, and inadequate healthcare infrastructure perpetuate poor health among poor communities. Despite greater healthcare needs, economically disadvantaged populations face substantial barriers to obtaining necessary services. This research evaluates the equitable aspect of healthcare utilisation in Sabah’s rural areas to guide policy formulation. Nabawan, a rural area in Sabah with high poverty rates, was selected to assess income-related inequality and inequity in healthcare utilisation. Using the horizontal equity index and decomposition analysis, it was found that economic status significantly influences healthcare distribution, typically favouring the affluent. Central to this analysis is the concept of “equal treatment for equal need,” ensuring individuals with similar healthcare needs receive similar care regardless of economic status. Results indicate that wealthier individuals are slightly more likely to utilise healthcare services, although the difference is minimal. To address disparities, enhancing targeted financial assistance programs like PeKa B40 could reduce out-of-pocket expenses for low-income households. Additionally, increasing healthcare funding for rural infrastructure and training local healthcare workers can ensure equitable access for all households.

Community-led vs. subsidised housing. Lessons from informal settlements in Durban

Rapid urbanization, poverty and socio-economic inequalities are causes of the backlog of informal settlements in South Africa, as dwellers cannot access formal housing schemes. Such unplanned settlements often need more basic services, social facilities and adequate housing. Nevertheless, informal settlements are core parts of the urban form rather than places for eradication. This article examines self-building and community-led upgrading practices in three case studies of partially and non-serviced informal settlements in Durban. It adopts action research participatory methods to coproduce knowledge and map various perspectives around community-led housing upgrading, building materials and construction skills in an effort to enhance community resilience and self-reliance. The findings reveal the key drivers and challenges associated with self-building, informal procurement and overall project management of the housing process. Successful grassroots practices demonstrate community ownership and dweller control beyond the physical upgrading per se. The lessons learned call for inclusive, participatory, and incremental approaches for effective community organization, self-reliance, social capital and livelihood development.

Equity And Inclusion For Access To The Brazilian Unified Health System (SUS)

The concept of equity in the Unified Health System (SUS) is crucial for ensuring a fair distribution of resources and health opportunities, taking into account the specific needs of different population groups. This principle aims not only to ensure universal access to health services but also to adjust these services to address socioeconomic, geographic, and cultural inequalities. Equity in SUS involves providing additional support to the most vulnerable populations, such as individuals with low income, those living in remote areas, and groups facing cultural and language barriers. Significant challenges include regional disparities, with inadequate health infrastructure in rural and peripheral areas, and socioeconomic inequalities that hinder access to care due to indirect costs and lack of information. To address these challenges, SUS must adopt multifaceted strategies, including increased funding and resources for underserved areas, public policies to reduce socioeconomic inequalities, and investments in transportation and health education. Inclusion in SUS is equally fundamental, requiring the removal of physical and social barriers, the promotion of a culture of respect and cultural competence among health professionals, and the active participation of diverse groups in health policy formulation. Additional strategies involve interinstitutional collaboration, community engagement, and the collection and analysis of disaggregated data to inform targeted policies. These approaches aim to create a fairer and more inclusive health system capable of meeting the needs of the entire Brazilian population

Challenges And Strategies In Healthcare Confronting Population Aging In Brazil

The concept of equity in the Unified Health System (SUS) is essential for ensuring a fair distribution of resources and health opportunities, taking into account the specific needs of different population groups. Equity goes beyond universal access to healthcare services, encompassing the adaptation of these services to address socioeconomic, geographic, and cultural inequalities. In SUS, this means providing additional support to vulnerable populations, such as low-income individuals, residents of remote areas, and groups with cultural and linguistic barriers. Key challenges include regional disparities, such as inadequate healthcare infrastructure in rural and peripheral areas, and socioeconomic inequalities that hinder access due to indirect costs and lack of information. To overcome these challenges, SUS should adopt comprehensive strategies, such as increasing funding and resources for underserved areas, implementing public policies that address socioeconomic inequalities, and investing in transportation and health education. Inclusion is equally crucial, requiring the removal of physical and social barriers, the promotion of a culture of respect and cultural competence among healthcare professionals, and the active participation of diverse groups in policy formulation. Furthermore, promoting interinstitutional collaboration, community participation, and the collection and analysis of disaggregated data to guide targeted policies is important. These strategies aim to create a fairer and more inclusive health system, capable of adequately serving the entire Brazilian population

Economic Disparities, Life Events, and the Gender Mental Health Gap

This paper studies factors explaining the gender mental health gap using Australian data. We show that men have significantly higher mean outcomes and the left tail of the combined distribution is disproportionately female. Using regression-based decompositions, we examine the degree that both socioeconomic inequalities and life experience account for this phenomenon. We find that disparities in income play a substantial role, and subject to an assumption of exogeneity, would be enough to account for the gender gap amongst individuals with very poor psychological wellbeing. We also examine the mental health effects of various negative life experience, such as the death of a family member or being a victim of violence. At the individual level, these variables have large effect sizes but are not strongly correlated with gender to explain our mental health disparities.

54468 Racial and socioeconomic inequities in atopic dermatitis care: A study of price and pharmacy deserts for recommended skincare products

54468 Racial and socioeconomic inequities in atopic dermatitis care: A study of price and pharmacy deserts for recommended skincare products

Bulgaria’s regional policy: Analysing paradigm shifts and dynamics of territorial inequalities

Abstract Domestic regional policies are increasingly expected to tackle significant spatial disparities, promote territorial justice, and ensure equal opportunities, thereby supporting various aspects of sustainability. This article focuses on the case of Bulgaria, serving a dual purpose: it outlines the emergence and evolution of contemporary regional policy in the country and measures the extent and dynamics of socio-economic inequalities at different territorial levels. The conceptualization of a comprehensive regional policy framework following the socialist era was largely driven by top-down Europeanization impulses, which catalysed political debates on the transformed roles of the regions and the necessity for effective decentralisation. However, despite years of domestic regional policy implementation, socio-economic inequalities in Bulgaria remain substantial, with certain peripheral regions notably trailing behind. The comprehensive assessments conducted in this study include primarily descriptive statistics, regression and correlation analyses, time series analyses, and classification/categorization of territorial units. They indicate significant spatial heterogeneity and the prevalence of pronounced ‘centre-periphery’ patterns, which pose a serious threat to the long-term sustainable development of the country.

Optional Exam Retakes Reduce Anxiety but may Exacerbate Score Disparities Between Students with Different Social Identities.

Use of high-stakes exams in a course has been associated with gender, racial, and socioeconomic inequities. We investigated whether offering students the opportunity to retake an exam makes high-stakes exams more equitable. Following the control value theory of achievement emotions, we hypothesized that exam retakes would increase students' perceived control over their performance and decrease the value of a single exam attempt, thereby maximizing exam performance. We collected data on exam scores and experiences with retakes from three large introductory biology courses and assessed the effect of optional exam retakes on gender, racial/ethnic, and socioeconomic disparities in exam scores. We found that Black/African American students and those who worked more than 20 h a week were less likely to retake exams. While exam retakes significantly improved student scores, they slightly increased racial/ethnic and socioeconomic disparities in scores partly because of these differences in participation rates. Most students reported that retake opportunities reduced their anxiety on the initial exam attempt. Together our results suggest that optional exam retakes could be a useful tool to improve student performance and reduce anxiety associated with high-stakes exams. However, barriers to participation must be examined and reduced for retakes to reduce disparities in scores.