Socioeconomic Inequalities Research Articles

Children’s Health Lifestyles and the Perpetuation of Inequalities

Health lifestyles are a well-theorized mechanism perpetuating health and social inequalities, but empirical research has not yet documented crucial aspects: (1) health lifestyles’ collective nature or content beyond behaviors and (2) how people choose among available lifestyles in their social contexts. We conducted interviews, observations, and focus groups with families in two middle- to upper-middle-class communities. Contemporary class-privileged parenting involves constructing an individualized health lifestyle reliant on an expansive understanding of health and composed of parents’ identities and narratives, children’s health behaviors and identity expressions, and community norms. Children’s predominant health lifestyles in our sample vary by focus on parent versus child identity expression and on future achievements versus present well-being. Parents expect health lifestyles to influence future socioeconomic attainment and health inequalities. Understanding how health lifestyles encompass more than behaviors and are locally contextualized and how people choose them within structural constraints can inform research and policy.

Population-level normative models reveal race- and socioeconomic-related variability in cortical thickness of threat neurocircuitry

The inequitable distribution of economic resources and exposure to adversity between racial groups contributes to mental health disparities within the United States. Consideration of the potential neurodevelopmental consequences, however, has been limited particularly for neurocircuitry known to regulate the emotional response to threat. Characterizing the consequences of inequity on threat neurocircuitry is critical for robust and generalizable neurobiological models of psychiatric illness. Here we use data from the Adolescent Brain and Cognitive Development Study 4.0 release to investigate the contributions of individual and neighborhood-level economic resources and exposure to discrimination. We investigate the potential appearance of race-related differences using both standard methods and through population-level normative modeling. We show that, in a sample of white and Black adolescents, racial inequities in socioeconomic factors largely contribute to the appearance of race-related differences in cortical thickness of threat neurocircuitry. The race-related differences are preserved through the use of population-level models and such models also preserve associations between cortical thickness and specific socioeconomic factors. The present findings highlight that such socioeconomic inequities largely underlie race-related differences in brain morphology. The present findings provide important new insight for the generation of generalizable neurobiological models of psychiatric illness.

Magnitude and Temporal Variations of Socioeconomic Inequalities in the Quality of Life After Early Breast Cancer: Results From the Multicentric French CANTO Cohort.

Socioeconomic status (SES) influences the survival outcomes of patients with early breast cancer (EBC). However, limited research investigates social inequalities in their quality of life (QoL). This study examines the socioeconomic inequalities in QoL after an EBC diagnosis and their time trends. We used data from the French prospective multicentric CANTO cohort (ClinicalTrials.gov identifier: NCT01993498), including women with EBC enrolled between 2012 and 2018. QoL was assessed using the European Organisation for Research and Treatment of Cancer QoL Core 30 questionnaire (QLQ-C30). summary score at diagnosis and 1 and 2 years postdiagnosis. We considered three indicators of SES separately: self-reported financial difficulties, household income, and educational level. We first analyzed the trajectories of the QLQ-C30 summary score by SES group. Then, social inequalities in QLQ-C30 summary score and their time trends were quantified using the regression-based slope index of inequality (SII), representing the absolute change in the outcome along socioeconomic gradient extremes. The analyses were adjusted for age at diagnosis, Charlson Comorbidity Index, disease stage, and type of local and systemic treatment. Among the 5,915 included patients with data on QoL at diagnosis and at the 2-year follow-up, social inequalities in QLQ-C30 summary score at baseline were statistically significant for all SES indicators (SIIfinancial difficulties = -7.6 [-8.9; -6.2], SIIincome = -4.0 [-5.2; -2.8]), SIIeducation = -1.9 [-3.1; -0.7]). These inequalities significantly increased (interaction P < .05) in year 1 and year 2 postdiagnosis, irrespective of prediagnosis health, tumor characteristics, and treatment. Similar results were observed in subgroups defined by menopausal status and type of adjuvant systemic treatment. The magnitude of preexisting inequalities in QoL increased over time after EBC diagnosis, emphasizing the importance of considering social determinants of health during comprehensive cancer care planning.

Participation in a digital self-management intervention for osteoarthritis and socioeconomic inequalities in patient-related outcomes

Objective To investigate changes in socioeconomic inequalities in patient-related outcomes and pain medication use, following participation in a digital self-management intervention for osteoarthritis (OA) in Sweden. Method Participants with hip/knee OA enrolled in the digital intervention were included. Self-reported outcomes collected were the numerical rating scale (NRS) pain, activity impairment, general health, Knee/Hip injury and Osteoarthritis Outcome Score (KOOS-12, HOOS-12) Pain, Function, and Quality of Life subscales, 5-level EuroQol 5 Dimensions (EQ-5D-5L), Patient Acceptable Symptom State (PASS) for function, walking difficulties, fear of movement, wish for surgery, pain medication use, physical function measured by the 30s chair-stand test, and level of physical activity. Educational attainment was used as a socioeconomic measure and the concentration index was used to assess the magnitude of inequalities at baseline and 3 month follow-up. Results The study included 21,688 participants (mean ± sd age 64.1 ± 9.1 years, 74.4% females). All outcomes except for PASS demonstrated inequalities in favour of highly educated participants at both time-points, with highly educated participants reporting better outcomes. At 3 month follow-up, the magnitude of inequality widened for activity impairment, but narrowed for NRS pain, EQ-5D-5L, KOOS-12/HOOS-12 Pain and Function, physical function, and wish for surgery. There were no statistically conclusive changes in the magnitude of inequalities for the remaining outcomes. Conclusions There were inequalities in patient-related outcomes in favour of those with higher education among participants of a digital self-management intervention for OA, although the magnitude of these pre-existing inequalities generally narrowed after the 3 month intervention.

Inequalities in patients’ experiences with cancer care: the role of economic and health literacy determinants

BackgroundPatients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients’ experiences with cancer care.ObjectiveTo examine whether patients’ experiences with cancer care differ according to their economic status and health literacy.MethodsSecondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients’ economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors.ResultsAdjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of ‘respect for patients’ preferences’ and ‘physical comfort’ where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of ‘respect for patients’ preferences’, ‘physical comfort’ and ‘emotional support’ were associated with health literacy.DiscussionThis study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.

Sex difference and socioeconomic inequity in hypertension: a national survey study of 98,658 adults from 162 study sites (Preprint)

Sex difference and socioeconomic inequity in hypertension: a national survey study of 98,658 adults from 162 study sites (Preprint)

Socio-cultural transformations in modernity and household patterns: a study on local traditions housing and the impact and evolution of vernacular architecture in Yazd, Iran

The study investigates the impact of vernacular architecture in Yazd, Iran, focusing on traditional housing and its influence on the socio-physical aspects of homes. The central challenge lies in balancing cultural heritage preservation with the need for modern housing that promotes environmental sustainability and social well-being. Employing a qualitative approach, the study compares four historical houses to four modern homes in Yazd city. Its novelty lies in highlighting the importance of incorporating traditional elements into new developments. The research offers practical recommendations for achieving compatibility between house form and lifestyle, designing spaces for communication and social contact, and integrating cultural continuity with change. Additionally, it emphasizes the importance of considering architectural elements and environmental conditions during residential unit design and planning. The study reveals the negative effects of modernization on residential transformation, particularly in historical areas where rapid construction neglects cultural heritage. It recommends incorporating traditional architectural elements while adapting to current needs to achieve sustainable urban living. This contribution to the discourse on urban development provides nuanced insights into the complex dynamics shaping residential landscapes in the modern era. The study's findings suggest that traditional houses offer essential benefits often missing in modern homes, such as improved well-being, privacy, stability, and a stronger sense of community. This can lead to feelings of alienation, physical discontinuity, and socio-economic inequality in modern developments. The study concludes by recommending a reevaluation of housing dynamics and emphasizes the need for further research comparing traditional and modern houses.

Realist Approach to Social Policies (RASP) study to reduce socioeconomic health inequalities through systems change: protocol for a research project combining mixed-methods realist research with institutional action research

IntroductionHealth inequalities are rooted in inequality in vital resources for health, including financial resources, a supportive informal network, a stable living situation, work or daytime activities or education and literacy....

Out-of-hours emergent surgery for degenerative spinal disease in Canada: a retrospective cohort study from a national registry

BackgroundSpinal degenerative disease represents a growing burden on our healthcare system, yet little is known about longitudinal trends in access and care. Our goal was to provide an essential portrait of surgical volume trends for degenerative spinal pathologies within Canada. MethodsThe Canadian Institute for Health Information (CIHI) database was used to identify all patients receiving surgery for a degenerative spinal condition from 2006 to 2019. Trends in number of interventions, unscheduled vs. scheduled hospitalizations, in-hours vs. out-of-hours interventions, resource utilization and adverse events were analyzed retrospectively using linear regression models. Confidence intervals were reported in the expected count ratio scale (CR). FindingsA total of 338,629 spinal interventions and 256,360 hospitalizations between 2006-2019 were analyzed. The mean and SD of the annual mean age of patients was 55.5 (SD 1.6) for elective hospitalizations and 55.6 (SD 1.6) for emergent hospitalizations. The proportion of female patients was 47.8% (91,789/192,027) for elective hospitalizations and 41.4% (26,633/64,333) for emergent hospitalizations. Elective hospitalizations increased an average of 2.0% per year, with CR=1.020 (95%CI 1.017 – 1.023, p<0.0001) while emergent hospitalizations exhibited more rapid growth with an average 3.4% annually, with CR 1.034 (95%CI 1.027 – 1.040, p<0.0001). «In-hours» surgeries increased on average 2.7% per year, with CR 1.027 (95%CI 1.021-1.033, p<0.0001), while «out-of-hours» surgeries increased 6.1% annually, with CR 1.061 (95%CI 1.051-1.071, p<0.0001). The resource utilization for unscheduled hospitalizations approximates two and a half times that of scheduled hospitalizations. The proportions of spinal interventions with at least one adverse event increased on average 6.3% per year, with CR 1.063 (95%CI 1.049-1.077, p<0.0001). InterpretationThis study provides novel data critical for all providers and stakeholders. The rapid growth of emergent out-of-hours hospitalizations demonstrates that the needs of this growing patient population have far exceeded health-care resource allocations. Future studies will analyze the health-related quality of life implications of this system shift and identify demographic and socioeconomic inequities in access to surgical care.

Associations between childhood malnutrition, socioeconomic inequalities and sanitation in the coastal regions of Bangladesh

This study aimed to identify critical risk factors for childhood malnutrition and inform targeted interventions. Childhood malnutrition remains a pressing concern in the coastal regions of Bangladesh. Data were extracted from the latest Bangladesh Demographic and Health Survey 2017–2018 and children aged 0–59 months and their mothers aged 15–49 years from 17 coastal districts were included as study population in this study. We performed multivariable logistic regression model to determine the risk factors and a total 2153 children were eligible for the analysis. Stunting, wasting and underweight prevalence was 31.4%, 8.5% and 21.1% respectively. Stunting was more common in children aged 24–35 months with compared to their younger counterparts [adjusted odds ratio (AOR) = 3.32, 95% confidence interval (CI): 2.35–4.67]. Children to mothers with higher education exhibited 69% (AOR = 0.31, 95% CI: 0.18–0.52) lower risk of stunting compared to those with no education. Similarly, children in poorest and poorer households had 2.2 and 1.83 times higher odds of stunting respectively than those in the richest households. Children born to obese mothers (compared to normal) were 34% less likely to be stunted (AOR = 0.66, 95% CI: 0.51–0.85). Children who had fever and underweight mothers reported wasting. Increasing child age, low maternal education, poorest wealth index, unimproved toilet facilities and childhood morbidity were identified as significant risk factors for underweight. Results support the requirement of effective and appropriate interventions for this particular region considering the identified risk factors to reduce childhood malnutrition in Bangladesh.

The socioeconomic dimensions of racial inequality in South Africa: A social space perspective.

It is well evidenced that South Africa is characterised by extreme socioeconomic inequality, which is strongly racialised. We offer an original sociological perspective, which departs from established perspectives considering the dynamics of vulnerability and poverty to focus on the structuring of classed and racialised privilege. We map how stocks of economic, cultural, and social capital intersect to generate systematic and structural inequalities in the country and consider how far these are associated with fundamental racial divides. To achieve this, we utilise rich, nationally representative data from the National Income Dynamics Study and employ Multiple Correspondence Analysis to construct a model of South African 'social space'. Our findings underscore how entrenched racial divisions remain within South Africa, with White people being overwhelmingly located in the most privileged positions. However, our cluster analysis also indicates that forms of middle-class privilege percolate beyond a core of the 8% of the population that is white. We emphasise how age divisions are associated with social capital accumulation. Our cluster analysis reveals that trust levels increase with economic and cultural capital levels within younger age groups and could therefore come to intensify social and racial divisions.

Dynamics of Community Resilience in Flood-prone Areas of Southeast Asia: A Key Component of the Public Health Agenda

Communities across Southeast Asia face challenges posed by natural disasters, including floods, which disproportionately impact vulnerable populations. In light of the growing frequency and severity of extreme weather events attributed to climate change, there is a pressing need to explore and strengthen community flood resilience. Community resilience is pivotal in mitigating flood-related damages and fostering successful recovery efforts. This paper examines the socio-economic and environmental factors shaping community resilience in flood-prone areas of Southeast Asia. Socio-demographic determinants, exposure to floods, social cohesion, communication networks, socio-economic status, and cultural diversity significantly influence resilience capabilities, with disparities exacerbating socio-economic inequality. The interplay of these factors underscores the complexity of community disaster resilience, with some factors acting as moderators, mediators, or confounders in shaping outcomes. The paper highlights that understanding the dynamics of community resilience formation is imperative for informed policy interventions to enhance disaster preparedness and response in flood-prone areas of Southeast Asia. The contributors to flood resilience are interrelated with social determinants of health, underscoring the vital role of broader socio-economic and environmental factors in shaping community well-being. Future research should explore the relationships within these complex dynamics to guide effective resilience-building strategies tailored to local contexts.

Effect of social and behavioral change interventions on minimum dietary diversity among pregnant women and associated socio-economic inequality in Rajasthan, India

BackgroundMaternal dietary diversity is a key to improving the birth and child health outcomes. Besides socio-economic factors, the nutrition specific program- Social and Behavioural Change Communication (SBCC) interventions aimed to improve maternal dietary diversity has varied levels of impact on the socio-economic groups in poor resource setups.ObjectiveTo measure the factors associated with the minimum dietary diversity (MDD) among pregnant women in selected districts of Rajasthan with special emphasis on the SBCC components. Additionally, it measures the socio-economic gaps in the behaviour of consumption of diversified diet during pregnancy.MethodsData from a cross sectional survey of 6848 pregnant women, who have received a continuous SBCC counselling and registered under a state introduced conditional cash transfer program, during May to June, 2023, in five intervention districts -Banswara, Baran, Dunagrpur, Pratapgarh and Udaipur in Rajasthan was used. A 24 h recall based food consumption behaviour has been gathered to measure the MDD of pregnant women. Study has used descriptive statistics, multivariate regressions, and multivariate decomposition analysis to address the research objectives.ResultsStudy finds that only 55.2% of pregnant women are consuming diverse diet in the study duration with mean dietary diversity score is 4.8 (+/- 1.5). Logistic regression finds that SBCC components such as frontline workers (aOR = 1.3, CI: 1.1–1.4), community motivators (aOR = 1.9, CI: 1.7–2.1), and participation in MCHND (aOR = 1.0, CI: 0.9-1.2) have significant and higher likelihood on consumption of MDD food on previous day. A higher education and belonging from richer wealth quintile also show higher association for consumption of MDD. Multivariate decomposition shows, among richest and poorest wealth categories there is 19% point difference (58% difference due to coefficient vs. 42% difference due to composition) in MDD consumption. This is positively contributed by the caste and educational categories of women.ConclusionDespite a predominant vegetarian diet consuming population, better maternal dietary diversity was observed among those exposed to higher dose of SBCC intervention package. Educational status and caste of the respondent were significantly associated with minimum dietary diversity and contributed to the socio-economic inequality highlighting the importance of tailored and sustained SBCC interventions.

Measuring socioeconomic inequalities in postnatal health checks for newborns in Ethiopia: a decomposition analysis.

Addressing health inequity is a top priority for achieving sustainable development goals. The existing evidences in Ethiopia have shown that there are substantial inequalities in the use of health services among various socioeconomic strata. Therefore, the present study aimed to measure socioeconomic inequalities and the contributing factors in postnatal health checks for newborns in Ethiopia. We used a secondary data from the recent 2019 Ethiopia Mini Demographic and Health Survey dataset. The study includes a weighted sample of 2,105 women who gave birth in the 2 years preceding to the survey. The study participants were selected using two stage cluster sampling techniques. The socioeconomic inequality in postnatal health checks for newborns was measured using the Erreygers Normalized Concentration Index (ECI) and illustrated by the concentration curve. A decomposition analysis was done to identify factors contributing to the socioeconomic related inequality in postnatal health checks for newborns in Ethiopia. The concentration curve of postnatal health checks for newborns lay below the line of equality, and the Erreygers normalized concentration index was 0.133, with a standard error = 0.0333, and a p value <0.001; indicating that the postnatal health check for newborns was disproportionately concentrated among newborns with higher socioeconomic status. The decomposition analysis reported that antenatal care (ANC) visit (59.22%), household wealth index (34.43%), and educational level of the mother (8.58%) were the major contributors to the pro-rich socioeconomic inequalities in postnatal health checks for newborns. The finding revealed that there is a pro-rich inequality in postnatal health checks for newborns in Ethiopia. To reduce the observed socioeconomic health inequality, the government needs to improve ANC visits, implement strategies to access health service for economically disadvantaged groups, and increase educational attainment among women.

Beyond ‘Infodemic’: Complexity, Knowledge and Populism in COVID-19 Crisis Governance

ABSTRACT The concept of the ‘infodemic’ has become a popular explanation for the rejection of anti-COVID-19 crisis governance measures. In this paper, we argue that infodemic is an inherent property of society under free institutions misused to pursue an epistemically vicious political epistemology. Furthermore, we provide an alternative account of political epistemology of COVID-19 governance and popular resistance to it. Namely, we argue that 1) pandemics represent a complex problem, and some level of resistance to governance which restricts liberties while informed by ongoing scientific and political learning processes is inevitable, and 2) the resistance is exacerbated by the history of technocratization of governance and the exclusionary socio-economic inequalities which condition political and epistemic deficiencies easily exploitable by the political entrepreneurs of right-wing populism, particularly under the conditions of social media which gamifies public discourse. Thus, we argue, the correct response to the cultures of rejection of anti-COVID-19 measures is to change the underlying political and economic conditions and not to limit speech or restrict franchise as the infodemic diagnosis suggests.

Colorectal cancer screening with fecal immunochemical testing or primary colonoscopy: inequities in diagnostic yield.

Socioeconomic inequalities in the uptake of colorectal cancer screening are well documented, but the implications on inequities in health gain remain unclear. Sixty-year-olds were randomly recruited from the Swedish population between March 2014 and March 2020 and invited to undergo either 2 rounds of fecal immunochemical testing (FIT) 2 years apart (n = 60 137) or primary colonoscopy just once (n = 30 400). By linkage to Statistics Sweden's registries, we obtained socioeconomic data. In each defined socioeconomic group, we estimated the cumulative yield of advanced neoplasia in each screening arm (intention-to-screen analysis). In the biennial FIT arm, we predicted the probability of exceeding the yield in the primary colonoscopy arm by linear extrapolation of the cumulative yield to (hypothetical) additional rounds of FIT. In the lowest income group, the yield of advanced neoplasia was 1.63% (95% confidence interval [CI] = 1.35% to 1.93%) after 2 rounds of FIT vs 1.93% (95% CI = 1.49% to 2.40%) in the primary colonoscopy arm. Extrapolation to a third round of FIT implied a 86% probability of exceeding the yield in the primary colonoscopy arm. In the highest income group, we found a more pronounced yield gap between the 2 screening strategies-2.32% (95% CI = 2.15% to 2.49%) vs 3.71% (95% CI = 3.41% to 4.02%)- implying a low (2%) predicted probability of exceeding yield after a third round of FIT. Yield of advanced neoplasia from 2 rounds of FIT 2 years apart was poorer as compared with primary colonoscopy, but the difference was less in lower socioeconomic groups. ClinicalTrials.gov identifier NCT02078804.

International Political Dynamics and Islamic Jurisprudence: Understanding the Roots of Terrorism

This paper critically examines the intricate challenges involved in defining terrorism, emphasizing the political instrumentalization of Islam as a perceived threat. It delves into the multifaceted nature of terrorism by exploring various definitions and the underlying political motivations. The study then transitions to an in-depth analysis of Islamic jurisprudence's unequivocal stance against violence and terrorism, highlighting the consistent and unanimous condemnation by Islamic scholars. By scrutinizing the ethical principles that govern warfare in Islam, including the protection of non-combatants and the conditions under which violence is permissible, the paper offers a nuanced and comprehensive perspective on how Islamic teachings fundamentally oppose terrorism. This analysis is supported by references to primary Islamic texts (Quran and Hadith) and classical jurisprudential sources, ensuring a thorough understanding of Islamic legal principles. Furthermore, the paper addresses the broader socio-political implications of framing Islam as synonymous with terrorism. It examines the impact of this narrative on public perceptions, policy-making, and the rise of Islamophobia. The study also considers the strategic motivations behind this framing, particularly in the context of post-9/11 geopolitical dynamics and the subsequent "War on Terror." This paper aims to explore Islamic teachings that prohibit violence and terrorism, the debates among Islamic scholars regarding the punishment for such acts, and the geopolitical motivations behind portraying Islam as a threat. By doing so, it seeks to provide a comprehensive understanding of the impact of this framing on international relations, public perceptions, and counter-terrorism strategies. The paper concludes with a set of strategic recommendations aimed at promoting accurate representations of Islam. These recommendations emphasize the importance of nuanced and informed public discourse, the role of educational initiatives in dispelling myths and stereotypes, and the need for collaborative international efforts to enhance global counter-terrorism strategies. Additionally, the paper calls for fostering international cooperation to address the root causes of terrorism, such as political repression, socio-economic inequalities, and foreign interventions, thereby promoting a more just and peaceful global order.

Coverage and Socioeconomic Inequalities in Cervical Cancer Screening in Low- and Middle-Income Countries Between 2010 and 2019.

Cervical cancer screening is vital in addressing the global burden of cervical cancer. In this study, we describe the coverage and socioeconomic inequalities in the coverage of cervical cancer screening in low- and middle-income countries (LMICs). We analyzed data from the women's recode files of the Demographic and Health Surveys conducted in LMICs from 2010 to 2019 with variables on cervical cancer screening. We included women 21 years or older and determined the proportion of women who were screened for cervical cancer by age categories, wealth quintile, type of place of residence, level of education, and marital status. Socioeconomic inequality was measured using the concentration index (CIX) and the slope index of inequality (SII). A total of 269,506 women from 20 surveys in 16 countries were included in the survey. Generally, there was a low coverage of screening, with lower rates among women age 21-24 years, living in rural areas, in the poorest wealth quintile, with no formal education, and who have never been in union with or lived with a man. The CIX and SII values for screening for cervical cancer were positive (pro-rich) for all the countries except Tajikistan in 2012 where they were negative (pro-poor). The coverage of cervical cancer screening was low in LMICs with variations by the quintile of wealth (pro-rich) and type of place of residence (pro-urban). To achieve the desired impact of cervical cancer screening services in LMICs, the coverage of cervical cancer screening programs must include women irrespective of the type of place and wealth quintiles.

An evolution of socioeconomic inequalities in self-rated health in Korea: Evidence from Korea National Health and Nutrition Examination Survey (KNHANES) 1998–2018

Reducing socioeconomic inequalities in health has become an important health policy agenda. This study aimed to measure socioeconomic inequalities in health in Korea over the past two decades and identify the contributing factors to the observed inequalities. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016/2018 were utilized. The concentration index (CI) was calculated to measure health inequalities, and decomposition analysis was applied to identify and quantify the contributing factors to the observed inequalities in health. The results indicated that health inequalities exist, suggesting that poor health was consistently more concentrated among Korean adults with lower income (1998: −0.154; 2016/2018: −0.152). Gender-stratified analyses also showed that poor health was more concentrated in lower income women and men, with the degree of inequalities slightly more pronounced among women. The decomposition approach revealed that income and educational attainment were the largest contributors to the observed health inequalities as higher income and education associated with better self-rated health. These findings suggest the importance of considering socioeconomic determinants, such as income and education, in efforts to tackling health inequalities, particularly considering that self-rated health is a predictor of future mortality and morbidity. Furthermore, it is essential to implement more egalitarian social, labour market, and health policies in order to eliminate the existing socioeconomic inequalities in health in Korea.

Holistic exploration of reading comprehension skills, technology and socioeconomic factors in Spanish teenagers

The intricate relationship between teenagers' literacy and technology underscores the need for a comprehensive understanding, particularly in the Spanish context. This study employs explainable artificial intelligence (AI) to delve into this complex interplay, focusing on the pivotal role of reading comprehension skills in the personal and career development of Spanish teenagers. With a sample of 22,400 15-year-olds from the PISA dataset, we investigate the impact of socioeconomic factors, technology habits, parental education, residential location, and school type on reading comprehension skills. Utilizing machine learning techniques, our analysis reveals a nuanced connection between autonomy, technological proficiency, and academic performance. Notably, family oversight of technology use emerges as a crucial factor in managing the impact of digital technology and the Internet on reading comprehension skills. The study emphasizes the necessity for a balanced and supervised introduction to technology from an early age. Contrary to current trends, our findings indicate that online gaming may not contribute positively to reading comprehension skills, while moderate daily Internet use (1–4 h) proves beneficial. Furthermore, the study underscores the ongoing nature of acquiring reading comprehension and technological skills, emphasizing the need for continuous attention and guidance from childhood. Parental education levels are identified as partial predictors of children's performance, emphasizing the importance of a holistic educational approach that considers autonomy and technological literacy. This study advocates for addressing socio-economic and gender inequalities in education and highlights the crucial role of cooperation between schools and families, particularly those with lower educational levels.