Socioeconomic Inequalities In Use Research Articles

Socioeconomic inequalities in modern contraceptive use among women in Benin: a decomposition analysis

BackgroundContraceptive use is crucial to achieving Sustainable Development Goal 3. Evidence of socioeconomic inequality in the use of modern contraceptives is essential to address the developing inequality in its utilisation given the low prevalence of contraceptive use among women in Benin. This study examined the socioeconomic inequalities in modern contraceptive use among women in Benin.MethodsWe performed a cross-sectional analysis of the 2017-18 Benin Demographic and Health Survey data. A weighted sample of 7,360 sexually active women of reproductive age was included in the study. We used a concentration curve to plot the cumulative proportion of women using modern contraception. Decomposition analysis was conducted to determine factors accounting for the socioeconomic disparities in modern contraceptive use.ResultsWe noted that the richest women had higher odds of modern contraceptive use (adjusted odds ratio [aOR] = 1.67, CI = 1.22–2.30) compared to the poorest women. Other factors that showed significant associations with modern contraception use were age, marital status, religious affiliation, employment status, parity, women’s educational level, and ethnicity. We found that modern contraceptive use is highly concentrated among the rich, with rich women having a higher propensity of using modern contraception relative to the poor. Also, the disadvantaged to modern contraceptive use included the poor, those aged 45–49, married women, those working, those with four or more live births, rural residents, and women of Bariba and related ethnicity. Conversely, favourable concentration in modern contraceptive use was found among the rich, women aged 20–24, the divorced, women with two live births, the highly educated, those with media exposure, and women of Yoruba and related ethnicity.ConclusionThe study has shown that wealthy women are more likely to utilize contraceptives than the poor. This is because wealthy women could afford both the service itself and the travel costs to the health facility, hence overcoming any economic barriers to using modern contraception. Other factors such as age, marital status, religion, employment status, parity, mother’s educational level, and ethnicity were associated with contraceptive use in Benin. The Benin government and other stakeholders should develop family planning intercession techniques that address both the supply and demand sides of the equation, with a focus on reaching the illiterate and under-resourced population without admittance to modern contraception.

Explanation of Socio-economic Inequality in Medicine Use: A Cross-sectional Analysis from Iran.

Despite the favorable progress in the production of medicines, there is no significant access to these important health inputs among different socio-economic groups. This study aimed to measure and explain socio-economic inequality in prescribed and non-prescribed medicine use in Iran. Data were obtained from a recent household survey on health services in Iran conducted in 2016. The Erreygers concentration index (ECI) was used to measure socio-economic inequality in the use of prescribed and non-prescribed medicines. In addition, Decomposition analysis was conducted to explain socio-economic inequality. The ECI revealed pro-rich socio-economic inequality in prescribed medicine use (ECI = 0.067, SE = 0.010), indicating that prescribed medicine use was concentrated on the better-offs. On the other hand, this index showed pro-poor inequality in non-prescribed medicine use (ECI = -0.064, SE = 0.009). Decomposition analysis showed that economic status and place of residence were the main determinants of socio-economic inequality in prescribing medicines. These factors and the number of health care needs explained the majority of socio-economic inequality in non-prescribed medicine use. Despite previous positive beliefs, we found remarkable socio-economic inequality in the use of medicines in Iran. Facilitating access to pharmaceutical services for disadvantaged households and rural residents and promoting of national essential medicines list could be recommended against socio-economic inequality in the pharmaceutical market of Iran.

Green Space Visits and Barriers to Visiting during the COVID-19 Pandemic: A Three-Wave Nationally Representative Cross-Sectional Study of UK Adults

Green spaces have been found to promote physical activity, social contact, and mental wellbeing, however, there are inequalities in the use and experience of green spaces. The United Kingdom’s (UK) response to the COVID-19 pandemic imposed very substantial changes on its citizens’ lives which could plausibly affect their willingness to visit green spaces. These sudden lifestyle changes severely affected the population’s mental health, leading to a greater dependency on the positive influence of nature in reducing stress and improving mood. Whilst early cross-sectional evidence suggested an increased orientation to nature and visits to green spaces as a response to COVID-19 ‘lockdowns’, there is little longitudinal evidence about how sustained and equal these changes may have been. This study explored green space visits, barriers to visiting, and the inequalities of both of those over an entire year of the pandemic in the UK. Three waves of nationally representative cross-sectional surveys were administered by YouGov in April 2020, November 2020, and April 2021 (N = 6713). Data included reported visits to green spaces and, for those with no or infrequent visiting, perceived barriers including those plausibly related to the risk of COVID-19. Green space visits increased over the year as lockdown restrictions were relaxed; 68% of respondents reported green space visits in April 2021, compared with 49% in April 2020. However, the socio-economic inequalities in use were sustained and increased. COVID-19 related barriers fell over time, but there were indications of increased interest in green spaces among younger people. Further action is required to ensure that the positive impacts of green spaces are experienced equally, and that good quality green space is accessible to all.

Exploring socioeconomic inequalities in the use of medicinal herbs among Iranian households: evidence from a national cross-sectional survey

BackgroundAssociation between socioeconomic status and medicinal herbs (MH) are rarely documented in Iran. Our goal was to measure and decompose socioeconomic inequalities in MH use among Iranian households.MethodsThe data used in this cross-sectional study were extracted from the 2018 Household Income and Expenditure Survey (HIES) (N = 38,859). Data on MH use, age, gender, and education status of the head of household; a constructed wealth index of household (as a proxy for household’s socioeconomic status); and place of residence (urban or rural) were obtained from the survey. Publicly available province-level data on Human Development Index (HDI) were obtained from the Institute for Management Research at Radbound University. We used the concentration curve and the normalized concentration index (Cn) to measure the magnitude of socioeconomic inequalities in MH among Iranian households. The Cn was decomposed to identify the main determinants of socioeconomic inequalities in MH in Iran.ResultsThe overall prevalence of MH use among Iranian households was 4.7% (95% confidence interval [CI]: 4.5 to 4.9%) in the last month before data collection. The Cn for MH use for the whole of samples was 0.1519; 95% CI = 0.1254 to 0.1784; suggesting a higher concentration of MH use among the households with high socioeconomic level. The decomposition analysis indicated that the main contributing factors to the concentration of MH use were the economic status of households, development status of the province, and education level of the household head.ConclusionsThis study demonstrated that MH use is more concentrated among socioeconomically advantaged households in Iran and its provinces. This finding might contrast with the widespread belief that wealthy and socioeconomically advantaged populations, compared to low SES groups, tend to seek disproportionately more modern medical treatments and medications than MH. Understanding the factors affecting MH use, socioeconomic inequality in use of MH and its determinants provide an opportunity for health policymakers to design effective evidence-based interventions among providers and consumers of MH.

Socioeconomic inequalities in use and non-use of dental services in Poland

ObjectivesTo assess the impact of classical socioeconomic factors on the use and non-use of dental services on a representative sample of Polish population.MethodsThe study was based on face-to-face surveys conducted by GUS (Statistics Poland) on 13,376 respondents in 2010 and 12,532 individuals in 2013.ResultsThe percentage of people using dental services in the highest income group was approximately twice as high as that in the lowest one (Q1: 7.0% vs. Q5: 16.4%), with the same being true for education (the lowest education group: 8.3% vs. the highest education group: 18.0%), and place of residence (inhabitants of rural areas: 9.2% vs. inhabitants of largest cities: 15.9%) in 2013. The analysis has shown the disparities in not using dental services when in need to be less clear-cut.ConclusionsThe conducted research, based on two independent periods, a representative population sample, univariate analysis and the multivariate regression model has revealed pronounced social inequalities in dental care use. It is a challenge to determine the factors which contribute most to health inequalities and the interventions which are most effective in reducing them.

Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data

BackgroundInappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it.MethodsData from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities.ResultsOut of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile .ConclusionsThis study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.

Use of antihypertensive and antidiabetic medications in Brazil: an analysis of socioeconomic differences. National Health Survey, 2013.

To analyze the socioeconomic and demographic differences in medication use to control hypertension and diabetes mellitus in Brazil. Data from the National Health Survey (Pesquisa Nacional de Saúde - PNS) performed in Brazil in 2013 with a representative sample of the population aged 18years old or older were analyzed. The use of medications for hypertension and diabetes according to income, education, race, possession of a private health insurance plan and region of household were estimated. Theprevalence ratios adjusted for sex and age were also estimated using Poisson regression. 81.4% of the hypertensive population used medication to control the disease. The use was higher among females, white/Caucasian individuals and those with a private health plan. In the case of diabetes mellitus, 80.2% of the population used medication to control the disease and the use was higher in elderly patients, patients with a higher level of education, patients with a private health plan, and patients in the Southeast region. Inequalities according to income and health plan were small even in the strata of sex, age and geographic region analyzed. We found a high use of medication to control hypertension and diabetes. Socioeconomic inequalities in use were not expressive, probably due to medication policies that promote greater and equitable access to medicines in Brazil.

The impact of ACA Medicaid expansion on socioeconomic inequality in health care services utilization.

ObjectiveWe examined whether the Affordable Care Act (ACA) Medicaid expansion reduced socioeconomic inequalities in health care utilization.MethodsWe used data from the Behavioral Risk Factor Surveillance System, covering the 50 U.S. states and the District of Columbia, between 2011 and 2016. We selected outcome indicators, viz. ability to afford needed health care, having a personal doctor, use of health services in the past year (routine check-up, flu shot and dental visits), and attending screenings for breast, cervical, and colon cancers. Socioeconomic status was measured by household income. We calculated two indices of inequality by household income for each outcome: Slope Index of Inequality (SII) and Relative Index of Inequality (RII). We estimated difference-in-differences models to examine the impact of ACA Medicaid expansion on socioeconomic inequality in use of health care services.ResultsThe ACA Medicaid expansion appeared to reduce the socioeconomic gap in individuals reporting financial ability in accessing health care (difference-in-differences estimators, -0.045 for SII and RII), having a personal doctor (-0.037 for SII and RII), and receiving routine check-ups (-0.027 for SII and -0.039 for RII). However, the expansion was not associated with reduction in the socioeconomic gap for preventive health care visits or dental care.ConclusionsThe ACA Medicaid expansion had mixed effects on socioeconomic disparities in health care utilization. Medicaid expansion may not be sufficient to address socioeconomic disparities in preventive services uptake.

Measuring socioeconomic inequalities in eye care services among patients with diabetes in Alberta, Canada, 1995-2009.

Diabetic retinopathy (DR) is a leading cause of blindness in Canada. Despite established comprehensive guidelines for routine DR screening, the rate of provision of diabetic eye care services by ophthalmologists in Alberta decreased in past years. The aim of this study was to examine socioeconomic status (SES)-related inequalities in the use of eye care services for patients with diabetes in Alberta, Canada. We used data from the Alberta Diabetes Surveillance System (ADSS), including visits to ophthalmologists over a 15-year period (1995-2009). Socioeconomic inequalities in the use of eye care services were assessed using the Relative Concentration Index (RCI). We used three different SES indicators: median household income and the Canadian material and social deprivation indices (MDI and SDI). Socioeconomic inequalities in use of eye care services exist in patients with diabetes, although the magnitudes of the inequalities were small and steadily decreased over time; income- and MDI-related RCI indicated that individuals with greater income or less material deprivation were more likely to use eye care services. However, for SDI-related RCI, socially deprived individuals were more likely to use eye care services (RCI: 1995: -0.066; 2002: -0.036; 2009: -0.028). Our findings suggest a need for attention to the potential impact of provincial policy on inequalities in eye care services among patients with diabetes, particularly as it relates to geographical differences across regional health zones.

Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation

BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Local level inequalities in the use of hospital-based maternal delivery in rural South Africa.

BackgroundThere is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services. Little is known, however, on how local-level socio-economic inequalities are related to the uptake of needed maternal health care. We conducted a study of relative socio-economic inequalities in use of hospital-based maternal delivery services within two rural sub-districts of South Africa.MethodsWe used both population-based surveillance and facility-based clinical record data to examine differences in the relative distribution of socio-economic status (SES), using a household assets index to measure wealth, among those needing maternal delivery services and those using them in the Bushbuckridge sub-district, Mpumalanga, and Hlabisa sub-district, Kwa-Zulu Natal. We compared the SES distributions in households with a birth in the previous year with the household SES distributions of representative samples of women who had delivered in hospitals in these two sub-districts.ResultsIn both sub-districts, women in the lowest SES quintile were significantly under-represented in the hospital user population, relative to need for delivery services (8% in user population vs 21% in population in need; p < 0.001 in each sub-district). Exit interviews provided additional evidence on potential barriers to access, in particular the affordability constraints associated with hospital delivery.ConclusionsThe findings highlight the need for alternative strategies to make maternal delivery services accessible to the poorest women within overall poor communities and, in doing so, decrease socioeconomic inequalities in utilisation of maternal delivery services.

Mental Health Service Use Among Chinese Adults With Mental Disabilities: A National Survey

Mental disability in China has become a significant public health problem. However, few studies have examined utilization of mental health services in China among people with mental disabilities. This study explored patterns of service use and associated socioeconomic factors among Chinese adults with mental disabilities. Data from a population-based survey representing approximately 75% of the Chinese population were analyzed. Mental disability was defined as having a mental disorder (cognitive, affective, or behavior disorder) lasting more than one year that limited daily life and social functioning. The study assessed use of any mental health specialty care and use of specific types: medical services only, rehabilitation services only, and medical and rehabilitation services. Standard weighting procedures were used. Population weighted numbers, weighted proportions, and the odd ratios (ORs) were calculated. A total of 1,909,199 noninstitutionalized adults (weighted N=984,698,518) age 18 and older were interviewed. The weighted prevalence rate of mental disability was .81%. More than 4.2 million adults with a mental disability (52%) had never used a mental health service. Several variables were associated with greater use of mental health services: urban residence (OR=1.65), high school education or higher (OR=1.66), being married (OR=1.12), medical insurance coverage (OR=1.39), and higher annual family income (OR=1.28). The findings indicate unmet needs for mental health services among Chinese adults with mental disabilities, as well as socioeconomic inequalities in use. Strategies are needed for enhancing community mental health service systems and reducing barriers to mental health service use in China.

Equity and efficiency in scaling up access to HIV-related interventions in resource-limited settings

The present review focuses on empirical studies examining equity and efficiency in scaling up access to HIV treatment in resource-limited settings. Key themes from reviewed papers are extracted and future research priorities are identified. Papers were found relating to three key themes. These were equity/efficiency trade-offs in the choice of treatment intervention(s); the implications of the model of care for equitable access; and socioeconomic inequalities in use, adherence and outcomes. Key findings include the need to implement or develop more cost-effective models of care as well as the importance of improving access for the poor. Increasing and sustaining access to HIV treatment is a key challenge in resource-limited settings, particularly those with a high HIV prevalence. It is, therefore, important that more efficient models of care are developed and implemented given that these should be able to achieve equitable access more quickly and at a lower overall cost. Another challenge is to ensure that interventions are designed to take the particular access barriers of the poor into account to guard against widening socioeconomic inequalities in the health of HIV-positive people.

Seat belt use and social inequality in Belgium.

To search for and quantify the importance of socio-economic inequality in seat belt use in young Belgians (15-24 years old). Using the data of the National Health Survey of Belgium (1997), socio-economic indicators were constructed combining characteristics of the individual and the household to which s/he 'belongs' (equivalent household income, employment, poverty, subjective poverty, and socio-economic insecurity) and the corresponding concentration curves and indices were calculated. Significant differences were found in seat belt use related to young people's socio-economic status. The failure to buckle up was concentrated most heavily in the least favoured socio-economic groups. Such inequality was a constant finding, although its magnitude varied according to the socio-economic indicator used, going from -0.142 for the variable 'occupational category of the household' to -0.028 for the variable 'poverty'. This finding of true socio-economic inequality in the use of seat belts by 15-24 year olds should prompt special vigilance in health promotion approaches aimed at changing behaviour. It also underlines the importance of being attentive to the socio-economic indicators that are chosen to quantify such inequality in intra- and inter-country comparisons.