Socioeconomic Inequalities Research Articles

Navigating the Global Dietary Transition and Its Impact on Planetary and Human Health: The Role of Middle-Income Countries

Abstract This case study examines global dietary transitions and their impact on environmental sustainability, nutritional well-being, and socio-economic inequalities, focusing on middle-income countries (MICs) like China, India, Brazil, Turkey, and Mexico. As economic expansion, urbanization, and cultural shifts drive changes in eating habits, MICs encounter both advantages and disadvantages. The study explores how socio-economic transformation influences dietary preferences, resulting in increased consumption of processed foods and animal-based products, linked to rising non-communicable diseases and environmental impacts such as greenhouse gas emissions and resource depletion. It delves into the influence of cultural heritage and social norms on dietary practices, alongside the impact of Western dietary patterns and media. Additionally, the case study underscores the role of governmental strategies in fostering sustainable and nutritious diets through policies that support local agriculture and public health. It also investigates contributions from the private sector and emphasizes the significance of community-driven and grassroots movements in promoting sustainable dietary habits and reinforcing food security. This study aims to provide insights into the interconnection between dietary transitions, their environmental and nutritional impacts, and the socio-economic drivers and disparities within and across MICs, offering guidance for sustainable development and public health improvement. Information © The Author 2024

Enacting the socio-economic duty: inequalities of outcome and section 1 Equality Act 2010

The first section of the landmark Equality Act 2010 has been lying dormant for 14 years. The ‘public sector duty regarding socio-economic inequalities’ – passed by the Labour government in 2010 – was never brought into force in England by the Conservative-led coalition that replaced them. The new Labour government has committed to its resurrection. Drawing on evidence from Scotland and Wales, where the ‘socio-economic duty’ has been in force since April 2018 and March 2021 respectively, this article offers three reflections for policy makers and those who will be tasked with its implementation in England: the promise of its ‘holistic’ incorporation into the Equality Act 2010 of impact assessment processes; the ongoing necessity for support with evidence collection and data sharing; and the duty’s potential as a catalyst for broader organisational change far beyond a strict interpretation of its legal remit. Although (very) far from a panacea, if coupled with well-executed guidance, training and oversight, its commencement could help to encourage greater consideration and transparency of evidence on socio-economic inequalities in key areas of public sector decision making.

Colonial continuities under scrutiny: an institutional ethnography of intercultural education in Chile

ABSTRACT Chile is a well-known country for its socio-economic and racial inequalities, especially in education. Despite it being prolific, research on educational inequalities has neglected the question about the persistence of colonial dynamics in the educational sphere and how the experience of colonisation has shaped contemporary social relations. Informed by the field of Decolonial Studies and by using institutional ethnography, this research sheds light onto the social (ruling) relations that sustain colonial continuities in the current Chilean school system. By starting from experiential accounts of Mapuche Indigenous educators who teach their ancestral language in the school system, this research provides evidence of an institutional apparatus sustaining forms of domination and reproduction of material and subjective inequalities.

Women's attitudes towards intimate partner violence in Guyana: a population-based study

Intimate partner violence (IPV) against women is a global health issue and a breach of human rights. However, the literature lacks understanding of how socioeconomic and geographic disparities influence women's attitudes toward IPV in Guyana over time. This study aimed to assess trends in women's attitudes about IPV in Guyana. Data from three nationally representative surveys from 2009, 2014 to 2019 were analysed. The prevalence of women's attitudes about IPV was assessed, specifically in response to going out without telling their partners, neglecting their children, arguing with their partner, refusing sex with their partner, or burning food prepared for family meals. A series of stratified subgroup analyses were also completed. We assessed trends in IPV using the slope index of inequality (SII) and the concentration index of inequality (CIX). We used multilevel mixed-effects logistic regression to assess factors associated with women's attitudes justifying IPV. The prevalence of women's attitudes justifying IPV for any of the five reasons declined from 16.4% (95% CI: 15.1-17.8) in 2009 to 10.8% (95% CI: 9.7-12.0) in 2019. Marked geographic and socioeconomic inequalities were observed among subgroups. The SII for any of the five reasons decreased from-20.02 to-14.28, while the CIX remained constant over time. Key factors associated with women's attitudes about IPV were area of residence, sex of the household head, marital status, respondent's level of education, wealth index quintile, and the frequency of reading newspapers/magazines. From 2009 to 2019, Guyana was able to reduce women's attitudes justifying IPV against women by 34.1% and shortened subgroup inequalities. However, the prevalence remained high in 2019, with persisted inequalities among subgroups. Effective strategies, including the use of media to raise awareness, promotion of community-based approaches, and educational campaigns focusing on geographic and socioeconomic disparities, are essential for continuing to reduce the prevalence of IPV and associated inequalities. The study was funded in part by the National Institutes of Health, Fogarty International Center grant number D43TW012189.

Socioeconomic inequalities and dyslipidaemia in adult population of the Ravansar Non-Communicable Disease Cohort Study: the role of sex and age

ObjectivesThis study represents a pioneering attempt to quantify the contribution of age, sex and socioeconomic status (SES) to the observed inequalities in lipid profile components.DesignCross-sectional study.SettingThe data from the Ravansar...

Assessment of socio-economic strategies for managing regional flood risk in an urban coastal catchment

With the cascading flooding events over the past decades, several structural and non-structural measures have been effectively implemented for improved flood management. However, the uneven impacts of the flooding events have highlighted that socio-economic inequality amongst the community needs to be addressed along with hazards to devise long term and sustainable flood management strategies. This study aims to evaluate the impact of socio-economic adaptive scenarios over an urban coastal catchment for reduction in flood risk. Flood risk is estimated utilizing socio-economic aspects (vulnerability) and flood inundation (hazard), for the highly flood-prone coastal city of Mumbai, India. A multivariate approach is used for assessing socio-economic vulnerability, starting with Principal Component Analysis followed by Data Envelopment Analysis, for various socio-economic scenarios, i.e., by reducing percentage of certain feasible socio-economic sensitivity indicators, to identify the key indicators, which contribute to significant change in vulnerability. The flood hazard is assessed through a comprehensive hydrodynamic flood modelling approach to quantify the flood inundation depth and extent. The flood risk is, thereafter, evaluated by combining socio-economic vulnerability and flood hazard using bivariate risk mapping approach. The results indicate that, with the decrease in alteration percentage of certain feasible socio-economic sensitivity indicators, the overall vulnerability and flood risk may be reduced. The areas under very high and high vulnerability classes reduce gradually for all scenarios as the percentage reduction for various indicators is varied from 5 % to 15 %, total illiteracy being the most significant indicator. This study marks the first effort to discern socio-economic vulnerability indicators that have the potential to significantly diminish flood risk, thereby constituting a viable long-term flood risk mitigation strategy. This novel framework is generic and applicable to any flood prone catchments, to devise appropriate long-term flood management measures.

Socioeconomic inequalities linked to the transitioning to neurocognitive disorders and mortality

Research on socioeconomic position (SEP) and mild neurocognitive impairment, considered a transient state between normal cognitive function and dementia is limited. The purpose of this study was to determine the role of SEP in transitioning between different cognitive states and mortality risk. Using nationally representative English data and utilising a multistate model association between SEP and the risk of transitioning from no cognitive impairment (NOCI) to Cognitive impairment no dementia (CIND), dementia and death were investigated. The potential reverse transition from CIND to NOCI was also explored. The probabilities of transitioning between cognitive states and time spent in each state differed significantly between those with lower and higher levels of SEP. Higher wealth was associated with a reverse transition from CIND to NOCI [HR = 1.56, CI (1.42,1.72)]. Socioeconomic advantage might protect against the progression to the early stages of neurocognitive disorders (CIND) and facilitate the potential reversion from mild cognitive impairment to a healthy cognitive state in later life. Lower levels of education affect the risk of mortality after the onset of dementia.

Accessing the Impact of Policy Reforms on the Rights to Education: A Comparative Study of Emerging and Developed Economies (Nigeria and the U.S. )

This study examined the impact of education policy reforms on the right to education in emerging and developed economies, focusing on Nigeria and the United States. It analyzed how policy interventions shaped access to education, the quality of educational outcomes, and equity in both countries. The key research questions investigated the effectiveness of education reforms in improving access, addressing regional and socioeconomic disparities, and ensuring quality education. The study adopted a comparative case study methodology, analyzing secondary data, policy documents, and education statistics from both nations. Theoretical frameworks such as Human Capital Theory and a rights-based approach to education were used to evaluate the policies' impact. Findings revealed that while Nigeria made significant strides in increasing school enrollment through policies like the Universal Basic Education (UBE) program, it struggled with quality, funding, and regional disparities. In contrast, the U.S. achieved widespread access to education but faced persistent challenges related to racial and socioeconomic inequities, influenced by the shortcomings of standardized testing and uneven funding allocation. The study’s implications suggested that addressing policy implementation, funding, and equity issues is essential for advancing the right to education. Recommendations were provided to strengthen reforms, improve funding mechanisms, and promote equitable access to quality education in both contexts.

Language-in-Education Planning for Foreign Languages in Morocco: Analyzing the Historical and Structural Impacts of History, Social Class, Ideology, and Power Dynamics

The present paper analyzes language-in-education planning for foreign languages within the Moroccan educational system. These policies have been adopted and/or implemented as part of three successive educational reforms that the state has undergone in the last 25 years (e.g., the National Charter 1999, the Emergency Program 2008, and the Strategic Vision 2015). Despite the state’s advocacy for varying foreign language instruction, these policies have been marked by a consolidation of French instruction as a primary foreign language and a shift to using it as a medium of instruction for science and technology subjects in middle and secondary education as part of language alternation pedagogy. The study adopts Tollefson’s (1991) Historical-Structural Approach as a conceptual framework to analyze how the constructs of history, class structures, ideology, and power dynamics have influenced language-in-education planning to perpetuate the social, economic, and political privileges of a francophone-oriented elite. The latter have employed their economic and political power to influence the indecisive aspect of the language-in-education policies—both covertly and overtly—to increase socioeconomic inequalities and injustices, including linguistic disparities between the elite and lower social classes. This dominant position of French within the educational system has also been motivated by external influences, manifested in the heavy political and economic relationship with France, the former colonizer.

Swift action: scrutinizing emergency measures from the COVID-19 pandemic

This manuscript evaluates India’s emergency measures during the COVID-19 pandemic. Key actions including a nationwide lockdown to curb virus spread and strengthen healthcare infrastructure are thoroughly studied and its effects analysed. Healthcare responses included scaling up testing, medical supplies, and using the “Aarogya Setu” app for contact tracing are briefly looked at to assess effectiveness of the policies implemented by the government. The largest vaccination drive in the world which covered the vast population was no mean feat and worth applauding. Challenges included supply chain disruptions, healthcare disparities, and socio-economic inequalities. Comparisons with global practices highlighted areas for improvement. The evaluation underscores the importance of swift, adaptable, and inclusive policy measures, offering valuable lessons for future pandemic preparedness. The article aims to outline the various measures undertaken by the government and determine the effectiveness of them in controlling the outbreak of COVID-19 in the country.

Psychosocial factors mediate social inequalities in health-related quality of life among children and adolescents

BackgroundThe present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents.MethodsCross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents’ highest education, household financial situation) with HRQoL, psychosocial (parent–child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL.ResultsOf 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96–7.36 and aOR: 3.66; 95%CI: 2.06–6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5–70%) and 40% (95%CI: 18–63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL.ConclusionsThese findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities.

Addressing the Anthropocene from the Global South: integrating paleoecology, archaeology and traditional knowledge for COP engagement

The triple planetary crisis of climate change, pollution, and biodiversity loss necessitates more holistic, comprehensive, and integrated public policy approaches. Within the United Nations Framework Convention on Climate Change, this crisis highlights significant conflicts over forms of knowledge and conceptualization, affecting how international policies are formed. Indigenous knowledge systems have become increasingly acknowledged for their vital role in addressing the challenges of the Anthropocene. Conferences of the Parties institutions like the International Indigenous Peoples Forum on Climate Change emphasize the critical, although not always recognized, importance of Indigenous territories, which contain eighty percent of the world’s biodiversity. Here, we show that research in paleoecology, archaeology and history demonstrates the long-term significance of traditional knowledge and Indigenous land management practices for contemporary ecosystem dynamics. Drawing from these varied studies and perspectives also reveal the socio-economic inequalities resulting from centuries of European colonialism. We showcase three case studies on; (i) pastoralism in eastern Africa, (ii) natural resource management in southeast Asia and (iii) adaptation to sea level rise in the Caribbean, which touch upon highly diverse human resilience strategies across space and time. Despite efforts at the COP28 to accelerate climate action and incorporate diverse knowledge systems, significant challenges remain. The need for a pluralistic knowledge, rather than a one-size-fits-all approach, blending scientific language with artistic and narrative forms, is proposed as critical for fostering effective communication and developing more effective and equitable solutions for global environmental governance.

Rural-urban differentials in undernutrition among women in India: Evidence from a decomposition approach.

Background: Global healthcare and nutrition policies have not eliminated the pressing public health issue of undernutrition, which remains a paramount public health concern in countries like India, coinciding with overweight and obesity, in the form of dual burden of malnutrition. Aim: This study delves into the rural-urban differential in undernutrition among reproductive-aged women in India for targeted policy interventions and to achieve universal health coverage. Methods: Data from the recent iteration of the National Family Health Survey (NFHS-5; 2019-21) were utilized to examine the factors influencing rural-urban differentials in women's undernutrition. A set of logistic regression and Fairlie's decomposition analysis are employed to identify the associated covariates and understand the factors driving these differentials. Results: The analysis reveals that rural women are significantly more vulnerable to undernutrition compared to urban counterparts, with factors such as education, wealth status, age, and dietary diversity playing key roles. The decomposition analysis of the rural-urban gap revealed that the variables considered in the study accounted for approximately 75% of the disparity. The difference in household wealth between rural and urban areas contributed about 63% of the explained gap, followed by educational status (16%), age group (11%), dietary diversity (8%), religion (5%), and media exposure (4%). Conclusion: The findings underscore the importance of targeted interventions addressing socio-economic inequalities to mitigate undernutrition among women in India. Enhancing access to education, improving economic opportunities, promoting dietary diversity, and challenging cultural norms are crucial steps towards achieving equitable nutritional outcomes and reducing the existing rural-urban disparity.

Socioeconomic inequalities in cervical cancer screening in sub-Saharan Africa: Decomposition analysis

Abstract Background Cervical cancer remains prevalent in sub-Saharan Africa (SSA). Despite global efforts to eliminate this disease, its incidence continues to rise due to barriers in screening, vaccination, and treatment access. While studies address access barriers, little has explored inequality, often limited to single countries. Here, we examine socioeconomic inequalities in cervical cancer screening in SSA. Methods Data from the Demographic and Health Surveys of 10 SSA countries was used for the analysis. We stratified the study by wealth index and educational attainment as a measure of socioeconomic status. Socioeconomic status inequalities in cervical cancer screening were constructed using concentration curves. We then computed the concentration index to quantify socioeconomic inequality. To examine the factors associated with high socioeconomic inequality in cervical cancer screening, a decomposition analysis was conducted. Results Concentration curves showed screening uptake skewed towards the wealthy and educated across all countries, reflected by positive concentration indices (CIX=0.21; p-value<0.0001) except in Burkina Faso and Mauritius. Decomposition analysis revealed significant positive concentration indices for women with complete secondary (CIX=0.74) and higher education (CIX=0.91), those in the richest wealth index (CIX=0.35), separated women (CIX=0.08), currently working women (CIX=0.02), as well as those who were exposed to reading newspaper/magazine (CIX=0.19), listening to radio (CIX=0.10), and watching TV (CIX=0.44). Conclusions Cervical cancer screening in SSA exhibits pro-rich and pro-higher educational inequalities. Urgent interventions are needed to restructure existing screening programs to prioritize accessibility and inclusion, particularly for women from poorer households and with a lower level of education. These findings are vital for policymakers and public health practitioners to address cervical cancer screening disparities in SSA. Key messages • Addressing socioeconomic inequalities in cervical cancer screening is crucial for improving public health in sub-Saharan Africa. • Combatting socioeconomic disparities in cervical cancer screening is critical for achieving health equity in sub-Saharan Africa.

7.X.1. Providing BoD estimates on a regional level – necessity in assessing health inequalities

Abstract Burden of disease indicators, such as Disability-adjusted life years (DALY), Years lost due to disability (YLD) and Years lost due to death (YLL) have become standard indicators in public health reporting systems. Due to the combination of morbidity and mortality, the DALY provides valuable information on the burden due to specific diseases. These tools are employed by policymakers to devise intervention programs with the objective of enhancing the collective health of the population. Studies at the subnational level offer a greater added value to the public health information systems. Identifying variations in health outcomes and disease burden across different regions is a key factor when introducing targeted interventions and allocating resources. Health inequalities persist also in countries with good health systems and well-developed welfare state. There are notable contrasts in the political, economic and social environments across Europe. Moreover, the European countries are at different stages of the epidemiological transition, which encompasses a range of factors influencing health and modifiable risk behaviours. These differences are determined by socioeconomic inequalities at national and sub-national level, such as municipalities, counties and others. It is therefore imperative to provide BoD indicators at the most possible detailed regional-level and to link this information with further indicators such as deprivation indexes or Gini coefficients. Obtaining regional-level data for BoD analysis and health inequalities is not straightforward and can pose many challenges. Data availability is usually scarce and may involve significant resources in collecting it. Data quality and data completeness can also pose challenges in the reporting systems, which can result in under-reporting of certain diseases and overlooking health problems in the population. Also, countries with smaller populations are confronted with the challenge of a limited number of cases, which poses difficulties in obtaining regional estimates. The following workshop presents examples from European BoD studies, that have analysed health inequalities at regional level. The first presentation shows a country comparison study of the overall YLL and their association with socioeconomic and geographical inequalities. The second is from an Estonian study, representing a country with a small population that has developed its own methodology for assessing regional health issues. The third presentation from the German BoD study presents results on 96 spatial planning regions, which have been combined with the German index of socioeconomic deprivation. The final presentation brings example from Norway, where the association between YLL and education and income is examined at municipality level. Key messages • By comparing BoD estimates at the regional level, policymakers and public health officials can identify areas with higher disease burdens, indicating potential health inequalities. • Linking information on BoD indicators with data on regional and socioeconomic inequalities is essential when monitoring developments and tailoring strategies in public health outcomes.

Do poor psychosocial resources mediate health inequalities in type 2 diabetes? The Maastricht Study

Abstract Low socioeconomic position (SEP) has been identified as a risk factor for type 2 diabetes mellitus (T2DM). A potential pathway of this association is psychosocial resources. Disadvantageous environmental conditions result in low control beliefs through adverse resources and inferiority beliefs through social comparison for people with a low SEP. We examined two poor psychosocial resources, low control beliefs and inferiority beliefs, to explain socioeconomic inequalities in T2DM. We analysed mediating roles of low control beliefs and inferiority beliefs by using counterfactual mediation analysis. 8293 participants aged 40-75 living in Limburg, the Netherlands participated in The Maastricht Study starting from September 2010 to October 2020 and were followed up to 10 years with annual questionnaires with a median follow-up time of 7.18 years. SEP (education, income, occupation), control and inferiority beliefs, and (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum. 3.2%(N = 203) of the participants without T2DM at baseline reported incident T2DM. People with low SEP had more often prevalent and incident T2DM (e.g., low education:HR=2.13, 95%CI:1.53-2.97). Lower control beliefs and higher inferiority beliefs were more common among people with low SEP than people with high SEP. Moreover, lower control beliefs and higher inferiority beliefs were risk factors for T2DM (e.g., low control beliefs: HR = 1.50, 95%CI:1.08-2.09). The relationship between SEP and T2DM was partially mediated by control beliefs (7.98-13.56%) and inferiority beliefs (2.16-4.53%). Poor psychosocial resources are important in socioeconomic inequalities in diabetes. Researchers and practitioners should consider the psychosocial profile of people with lower SEP might differ from those with higher SEP and this might interfere with the development, treatment, and prevention of T2DM. We should aim to work with such beliefs, instead of against it. Key messages • Socioeconomic health inequalities in diabetes has many underlying mechanism including psychosocial pathways. • Interventions and research should consider the different environment of low SEP and psychosocial profiles of people. We should aim to work with it, instead of against it.

The role of class stigma in socioeconomic inequalities in type 2 diabetes: The Maastricht Study

Abstract Background Low socioeconomic position (SEP) is a risk factor for type 2 diabetes mellitus (T2DM). An underlying mechanism behind socioeconomic health inequalities can be stigma, particularly classism. Studying the influence of class stigma in the context of (pre)diabetes and socioeconomic inequalities may shed light on the societal factors influencing diabetes. Methods Data from 1947 participants aged 49-88 who participated in the second phase of The Maastricht Study starting between November 2020 and April 2023 were used. SEP (education, income, occupation) and 6-item classism scale were measured through self-reported questionnaires. (Pre)diabetes was measured through an oral glucose tolerance test. We conducted multinomial logistic regression analyses to investigate the associations between SEP, classism, and diabetes status. Results 20.9% (N = 406) of the study sample had T2DM (Mage=69.8(±6.8) years; 31.3% women). People with low SEP had more often T2DM (e.g., income OR = 2.13, 95%CI:1.54-2.82) and reported perceived classism (e.g., education OR = 2.07, 95%CI:1.33-3.21) than people with high SEP. Classism was not statistically significantly associated with T2DM (OR = 0.78, 95%CI:0.48-1.29). Conclusions Social health inequalities are apparent in T2DM; however, our results suggest that class stigma might not be a major factor in underlying processes. Further research can investigate the role of chronic stress and intersection of multiple stigmas. Key messages • The underlying factors behind socioeconomic health disparities are complex. Social and psychological environment in low SEP should be investigated carefully. • Although low SEP is strongly associated with T2DM and perceived classism, class stigma might not be a major target in explaining socioeconomic pathways in diabetes.

Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022

Abstract Background Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents. Methods This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p < 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period. Conclusions Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors. Key messages • The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls. • While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.

Narrowing socioeconomic inequalities in coronary heart disease: insight from Mendelian randomization

Abstract Background Socioeconomic inequalities in coronary heart disease (CHD) represent a pressing global public health concern. However, which dimensions of socioeconomic status (SES) affect CHD and the potential modifiable mediators remain elusive. Methods We performed two-sample Mendelian randomization (MR) analyses based on summary data from large-scale genome-wide association studies in populations of European ancestry. Specifically, by applying bidirectional univariable MR (UVMR) and multivariable MR (MVMR), we investigated the causal relationships of education, occupation, income, Townsend deprivation index (TDI) with CHD and the independent effects of these SES indicators. We further employed a two-step MR to comprehensively profile the mediating effects of 23 behavioral, 3 psychological and 5 biological factors in the relationships. Results An independent causal association was observed between genetically predicated education and CHD, with a 30% lower risk of CHD (OR: 0.70; 95% CI: 0.53-0.93) for each 4.2-year of schooling. Each one-s.d. higher household income was causally, but not independently, associated with a 39% lower risk of CHD (OR: 0.61; 95% CI: 0.49-0.77). No significant causal association was suggested for occupation and TDI with CHD, and no reverse causal effect was observed for CHD on the SES indicators. Of 31 candidate mediators, nine factors mediated the effect of education on CHD significantly, with an individual mediation proportion of 33.5% for smoking, 29.2% for sedentary behaviour, 14.4% for blood lipids, 13.4% for BMI, 11.7% for systolic blood pressure, 9.5% for diastolic blood pressure, 7.8% for well-being spectrum, 6.4% for depression and 2.8% for blood glucose. Conclusions This study highlights that education was the primary SES indicator affecting CHD with considerable mediation by a number of modifiable risk factors. These findings inform policies to mitigate disparities of CHD risk attributable to socioeconomic inequalities. Key messages • Education can be prioritized over other common SES indicators as an essential strategy to reduce the burden of CHD. • Interventions for narrowing socioeconomic inequalities in CHD could focus on more easily modifiable mediating factors.

Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries

Abstract Aim To evaluate the association between welfare regimes with edentulism and to investigate if it modifies the magnitude of socioeconomic inequalities in edentulism. Methods We analysed data from 40 high-, middle- and low-income countries collected between 2007 and 2018, encompassing 117397 individuals 20 years or older. The main outcome was edentulism and welfare regimes were the main exposure and effect modifier. Individual level variables were sex, age and quintiles of the wealth score. Multilevel logistic regression was used to estimate the odds of being edentulous and cross-level interaction terms between individual wealth and country factors were tested. Findings Individuals at the lowest wealth quintile had a consistently higher prevalence of edentulism. The highest age-sex standardised prevalence of edentulism was found in Eastern European countries (9.9%) followed by Informal Security (9.4%), while the lowest was among the Insecurity regime (1.4%) followed by the Social Democratic regime (4.7%). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 16.7 (95%CI: 10.5-26.5) times more chances of being edentulous and 14.4 percentage points higher prevalence. Low-income countries in the Insecurity Regime in social and labour market presented the lowest level of inequalities. Among HIC and upper-middle income countries, Social Democratic regime had the lowest absolute inequalities (4.0 percentage points difference between highest and lowest quintiles) and the Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 3.21, 95%CI: 2.83-3.63). Interpretation Our findings suggest that policies in some welfare regimes might improve oral health while reducing inequalities. High and upper-middle-income countries presented a high level of edentulism and inequalities. Key messages • Larger socioeconomic inequalities in edentulism were found in high-income countries with liberal policies. • A possible benefit of welfare policies on prevalence and inequalities in edentulism may be only evident among industrialised countries.