Spatial Inequalities Research Articles

Timeliness of lung cancer care and area-level determinants in Victoria: A Bayesian spatio-temporal analysis.

It has been reported that the timeliness of lung cancer care varies significantly across different regions. According to the Victorian Lung Cancer Registry (VLCR) report, the timeliness of lung cancer care in Victoria has changed over time. Therefore, we aimed to quantify the extent of these spatial inequalities over time and to identify area-level determinants contributing to these changes. The study analysed lung cancer cases reported to the VLCR between 2011 and 2022. Bayesian spatio-temporal Conditional Autoregressive (CAR) models were fitted, incorporating spatial random effects, temporal random effects, as well as spatio-temporal interactions. The best-performing model was selected using the Deviance Information Criterion (DIC). For the final best-fit model, the adjusted Relative Risks (aRR) and their 95% Credible Interval (CrI) were reported. Over half (51.24%) of lung cancer patients experienced treatment delays, while approximately one-third (30.98%) encountered diagnostic delays. Moderate spatio-temporal variations were observed in both delayed diagnosis and treatment. In the final best-fit model for treatment delay, an increase in the percentage of smokers was significantly associated with a higher risk of treatment delay (RR = 2.13, 95% CrI: 1.13, 4.20). Identifying high-risk areas provides useful information for policymakers, helping in the reduction of delays in lung cancer diagnosis and treatment. This study has revealed spatio-temporal inequalities in diagnostic and treatment delays, providing valuable insights for identifying areas that should be prioritized to ensure timely care for lung cancer.

The Measurement of Intra-Distributional Mobility: An Investigation of District Long-Term Housing Vacancies

It is not unusual for government reports to place spatial inequalities into a league table, highlighting poorly performing jurisdictions in some form of yardstick competition. A case in point is long-term dwelling vacancies. Action on Empty Homes, which works closely with local governments in the UK, provides commentary about poor performance, including recording persistently higher rates in certain regions and mentioning the worst rankings at the local level. How the distribution of vacant dwellings changes is not well explored. How rigid this league is has been a feature of a discussion in the growth literature. A useful dynamic policy measure in this regard is how far the average jurisdiction changes its league position over a given period. A type of convergence proposed here, implied by Sala-i-Martin, features the time for the initial rankings to become discordant with the current order. One could see this sort of measure being used widely, wherever performances are judged relatively as a means of highlighting good practice. Using English data on vacant dwellings, this paper shows that there is a ‘long memory’ in long-term vacancy rates, both at the local and regional levels. The industrial and housing inheritances of districts in the North of England, evident in the league table in 2004, remain influential after 18 years, even with general population growth. Although the use of incentives to bring dwellings back into use is thought to be successful, it is suggested that the role of the buy-to-let investor may have been overlooked. Changes in the treatment of their rewards appear to coincide with a rise in long-term vacancies.

Exploring socioeconomic and environmental coordination in the Yangtze River Delta Region using a game theory stepwise-cluster factorial coupling coordination model

Economic growth has brought about escalating environmental challenges. The purist of socioeconomic and environmental coordination necessitates a deep understanding of their interplay. Therefore, a game theory stepwise-cluster factorial coupling coordination model (GSFCM) has been developed to investigate the spatial and temporal patterns and driving forces of socioeconomic and environmental coordination in the Yangtze River Delta Region. Results reveal an upward in socioeconomic and environmental status from 2015 to 2020. All 41 cities in the region show progress towards coordination, coupled with spatial inequalities. Hangzhou, Shanghai, and Zhoushan demonstrate the highest coupling coordination degree (CCD), while Bozhou, Suzhou, and Fuyang located in Anhui exhibit the lowest levels. Socioeconomic factors contribute 82.98% to the enhancement of CCD, environmental factors contribute 11.05%, and their interaction accounts for 5.92%. Main drivers influencing CCD include Gross Domestic Product (GDP) per capita, the proportion of the added value of tertiary industry, PM2.5 concentration, and their interactions. Policy related to regional collaboration, industrial upgrades, and investment in environmental infrastructure are recomended to achieve a harmonious balance between economic growth and environmental protection. These insights are expected to support policy decisions in sustainable development of the region.

Toward low-carbon transition: Does carbon regulation matter for spatial development inequality?

Toward low-carbon transition: Does carbon regulation matter for spatial development inequality?

Appealing for Local Control and Spatial Inequality: Reforming Governance and Development Rationalities in Southern California

Several limitations have thwarted the implementation of California housing law for over fifty years. This paper sheds light on the evolution of municipal-state relations at a period of reform by analyzing the contentious implementation of state housing law in Orange County, California, a region of concentrated affluence. Systemic privilege has historically allowed some jurisdictions to influence decision-making at higher levels, skewing housing policy and planning outcomes. Nonetheless, and despite contention between different government levels and localities, the leverage of reactionary local politics is weakening.

Potentials for Reducing Spatial Inequalities in Innovation: A Spatial Econometric Perspective

ABSTRACTThis study explains disparities in regional innovation through specific features of regional knowledge bases, including recently discussed concepts such as, technological relatedness, knowledge complexity, and technological complementarity among neighboring regions and regions connected in R&D networks. We employ a spatial autoregressive panel model for 405 European regions to estimate the effects of these characteristics. While being connected to complementary regions and having a high region‐internal technological relatedness are conducive to regional innovation, knowledge complexity has no positive effect interestingly. In illustrative convergence scenarios, we demonstrate the potential of increasing relatedness and complementarity to reduce inequalities in Europe, pointing to important policy implications.

Medical school service regions in Canada: exploring graduate retention rates across the medical education training continuum and into professional practice

ABSTRACT Purpose To create medical school service regions and examine national in-region graduate retention patterns across the medical education continuum and into professional practice as one approach to advancing social accountability in medical education. Methods Medical school service regions were created in Canada using publicly available data and mapped using Geographic Information System (GIS) software. Population size and density for each service region were calculated using census data. Retrospective data of medical graduates who completed their medical degrees between 2001–2015 (n = 19,971) were obtained from a centralized data repository and used to analyze in-region retention rates by medical specialty across the training continuum and five years into professional practice. Results Spatial inequities were observed across medical school service regions. Graduate retention patterns also varied across service region groups and medical specialties. Quebec (86.5%) and Ontario (80.4%) had above-average retention rates across the medical education continuum. Family medicine had the highest retention rates from undergraduate to postgraduate training (81.9%), while psychiatry had the highest retention rate across the training continuum and into professional practice (71.2%). The Alberta and British Columbia service region group demonstrated high retention rates across the training continuum and into professional practice and medical specialties, except for retention from undergraduate to postgraduate medical education. Conclusion This study highlights the importance of considering both medical specialty and practice location of graduates when planning and retaining the physician workforce. The observed retention patterns among graduates are a critical aspect of addressing societal needs and represent an intermediate step towards achieving health equity. Furthermore, graduate retention patterns serve as an outcome measure for schools to demonstrate their commitment to social accountability. Tracking and monitoring graduate outcomes may lead schools to actively collaborate with government agencies responsible for healthcare policy, which may ultimately improve physician workforce planning and promote more equitable healthcare access.

The evolution of inequality in Mozambique 1996/97–2019/20

ABSTRACT After decades of war, Mozambique experienced sustained economic growth and poverty reduction from the mid-1990s. However, these positive dynamics started to revert from 2015. Meanwhile, inequality stagnated in the period 1996/97–2008/09, before markedly increasing afterwards. In this study, we analyse some of the most relevant indicators of inequality for Mozambique and their trends over the last 25 years. Using real per capita consumption as the main welfare aggregate, we look at various indicators of inequality, including the consumption distribution, percentiles and percentile ratios, growth incidence curves, Lorenz curves, and Gini indices. In addition, we discuss spatial inequality. Overall, we find that until 2014/15, consumption increased for the whole population, but it did so much more for richer households; conversely, in the last few years, consumption has reduced across the distribution, but the relative consumption-gap between better- and worse-off people has continued to increase.

Sensing spatial inequality of socio-economic factors for deploying permanent deacons in the UK

Sensing spatial inequality of socio-economic factors for deploying permanent deacons in the UK

Analysis of Secondary School Infrastructure Distributions in Osogbo Metropolis, Nigeria

This study analysed the geospatial distribution of secondary schools infrastructure in the Osogbo metropolis, Nigeria, with a focus on evaluating accessibility and spatial patterns of school locations. By examining the spatial distribution, travel distances, and clustering of schools, this research offers a novel contribution to the educational planning literature. The data were collected through both primary and secondary sources, utilizing total enumeration for spatial data and a sampling frame of 17,595 students and 452 teachers across 120 public and private secondary schools. Using a balloting approach, at 15%, 19 schools were sampled, followed by a random sampling technique to choose 5% of students and staff, resulting in a total of 906 respondents (880 students and 26 teachers). The analysis, employing Moran's I Index, revealed a value of 0.75 and a p-value of 0.14, indicating a random distribution of schools with a z-score of 1.45, falling within the expected range. The average distance traveled to schools was 1.582 km, reflecting spatial inequities in accessibility. This study provides critical insights for policymakers, emphasizing the need for both public and private stakeholders to ensure equitable distribution and accessibility of secondary schools across Osogbo metropolis.

Impact of urban facilities spatial inequality on sustainable travel mode.

With the implementation of sustainable development objectives in developing countries, urban planning, land use regulation, and urban mobility policies are expected to help reduce inequalities in access to urban facilities. Urban transport policies are also expected to encourage travel by non-motorised modes and public transport. These are considered to be the sustainable modes of urban transport. In this paper, we investigate how inequality of urban facilities impacts trips made by sustainable modes in the city of Santiago de Chile. We use a Poisson regression model and its geographical extension, the geographically weighted Poisson regression model (GWPR). The results suggest that the inequality of urban facilities impacts trips made by sustainable modes. The variables with the highest relevance are the spatial distribution of mixed land use, the spatial distribution of urban services related to transport infrastructure, primary and secondary education, as well as the spatial distribution of demographic variables related to people's life cycle.

A population-level framework to estimate unequal exposure to indoor heat and air pollution

As people in the UK spend 95% of their time indoors, buildings are an important modifier of exposure to both non-optimal temperatures and air pollution. High ambient temperature and high PM2.5 (particulate matter) concentrations often occur together in urban areas. Residential building types prone to overheating (e.g. purpose-built flats) are often also more common in urban areas. Together, this may lead to spatial and demographic inequalities in indoor exposure to heat and PM2.5 from outdoor sources. By combining building simulations (EnergyPlus), a spatially distributed description of the residential building stock—from publicly available Energy Performance Certificate (EPC) data, ambient temperature, PM2.5 data and area-level (40–250 households) socio-demographic data—we estimated these inequalities in exposure for the population of England and Wales. Maximum indoor temperature was higher in areas with larger ethnic minority and infant populations, and lower in areas with a higher proportion of people aged ≥ 65 years. Indoor concentrations of outdoor-source PM2.5 were higher in areas with larger ethnic minority and low-income populations. With rising inequality in England and Wales, housing and environmental conditions play an important role in contributing to health inequalities from social disadvantage. Policy relevance Differences in environmental exposures may partly explain inequalities in health outcomes. These differences are mediated by dwelling type and quality. Identifying the driving factors for differences in environmental exposures may allow for the development of interventions to address health inequalities more effectively. This study finds differences in indoor exposure across socio-demographic groups due to both location and housing. This could be of interest to national, regional and local authorities responsible for targeting building retrofit interventions across the housing stock.

Association between school commuting and adolescent mental health: Insights from a longitudinal study amid the pandemic

This study investigates the relationship between transportation modes and adolescent mental health, employing a natural experiment design to longitudinally track Brazilian high-school students amid the COVID-19 pandemic disruptions. We surveyed 213 students in the city of Curitiba during and after the COVID-19 lockdown period using the Depression, Anxiety, and Stress Scale (DASS-21) combined with a socioeconomic questionnaire. To analyze changes in DASS between these two times we used the paired-sample T-test, exploring association with school commuting modes through binomial logistic regression models. The use of public transportation emerges as a significant factor associated with a threefold odds of increasing depression levels among students (OR = 3.08). This likelihood nearly quadrupled (OR = 3.81) when considering students living 5 km or more from school. These findings unveil public transportation and home-school distance as critical factors in the development of depression among adolescents. For example, individuals who commute via individual motorized transportation demonstrate a markedly lower likelihood of experiencing depression, pointing to broader societal and environmental factors such as family income and access to opportunities. Despite appearing contradictory to the commonly understood impacts of car use on mental health, this observation may unveil overlapping layers of spatial inequality and underscore the nuanced dynamics between transportation modes and adolescent mental well-being.

Spatial inequality in water access in the US: case studies and solutions

ABSTRACT In addition to the 2.2 million Americans without safe water and sanitation in their homes, millions more regularly face service shut-offs either due to breakages or because of non-payment of bills. Households in areas outside administrative and service boundaries struggle to maintain private systems. Historic disinvestment in majority of African American cities, and decades of underinvestment in water infrastructure, have led to near collapse of many systems. The 2021 Bipartisan Infrastructure and Investment Jobs Act, passed by the United States government, is a historic opportunity to reinvest in water, especially in underinvested communities. These communities need significant assistance to prioritize appropriate investments, apply for available funding, and identify implementation partners. If this does not happen, the inequalities in access will be worsened. Coalitions of technical assistance providers and community-based organizations can help by identifying and matching providers with appropriate funding streams in the short term, while building their capacity to apply for larger federal funds. However, capital investment is only the first step toward equity. It is crucial that water and sewer rates be adjusted to account for household income, and service providers who serve large under-resourced areas receive long-term assistance for operation and maintenance of valuable assets.

Regional inequalities in years of life lost within the European Economic Area: Using the Gini coefficient and slope index of inequality to assess spatial disparities

Abstract Background Health inequalities have been linked to reduced life expectations. This study aimed to investigate regional variations in all-cause years of life lost (YLLs) in European Economic Area (EEA) countries prior to the COVID-19 pandemic. Methods Demographic data were extracted from Eurostat for 1390 small regions 32 EEA countries. Age-standardised sex specific YLL rates per 100,000 population in 2019 were estimated for EEA regions (Eurostat NUTS level 3) using methodologies derived from the Global Burden of Disease study. Relative spatial disparities were evaluated using the Gini coefficient (GC) and absolute spatial disparities assessed using the slope index of inequality (SII). Results Between EEA countries, relative geographical inequality in age-standardized YLL rates was higher than within them, slightly more so for males (GC = 16.96% [95% CI = 16.26-17.65]) than females (14.22% [13.62-14.82]). Among females, the UK (11.21% [95% CI 10.11-12.30]), Greece, and Croatia had the highest relative spatial inequality, while Ireland (3.37% [2.26-4.48]), Slovakia, and the Netherlands had the lowest. For males, Belgium (10.76% [9.34-12.17]), the UK, and Croatia exhibited the highest relative spatial inequality, while Ireland (1.99% [1.18-2.81]), Lithuania, and Slovakia had the lowest. Germany had the largest absolute geographical inequality in YLLs among females (SII=16.86% [16.28 to 17.44]), followed by Estonia and the UK. Among males, Estonia had the largest absolute spatial inequality (36.60% [-10.88 to 84.07]), followed by Latvia and Hungary. Ireland had the lowest absolute spatial inequality for both females and males. Conclusions Relative and absolute disparities in premature mortality rates are evident across regions of the EEA, both within countries and across the entire region. These findings offer insights for national and local stakeholders, aiding them in customising public health interventions to target spatial health disparities.

Socio-economic factors affecting spatial inequalities in pregnancy-related ambulance attendances in Greater London

Exploring inequalities in ambulance and pre-hospital demand is important to improve service equity and reduce wider health inequalities. Maternity incidents amongst ambulance demand are a key area of focus because of the specialized care that is needed for patients, as well as the impact of wider determinants of health on pregnancy outcomes. Since there are spatial inequalities amongst pregnant patients who call for an ambulance, the aim of this study is to assess the underlying factors associated with pregnancy related ambulance complaints, to determine why maternity patients utilize the ambulance service. Local indicators of spatial autocorrelation were used to identify clusters of ambulance maternity demand within Greater London (UK). A negative binomial regression model was used to explore associations between socioeconomic, environmental, accessibility and demographic variables. Our results reveal that neighborhoods with low adult skills (i.e. qualifications/English language abilities) have a higher rate of demand. Moreover, our results imply that the demand for ambulance services may not be directly tied to health outcomes; rather, it might be more closely associated with patients' reasons for calling an ambulance, irrespective of the actual necessity. The benefits of identifying factors that drive demand in ambulance services are not just linked to improving equity, but also to reducing demand, ultimately relieving pressure on services if alternative options are identified or underlying causes addressed. Doing so can improve health inequalities by firstly, improving ambulance care equity by directly supporting a better allocation of resources within ambulance systems to target patterns in demand.

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

Abstract Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to protecting the health of the most vulnerable groups. Objectives To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. Methods Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. Results IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. Conclusions Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population’s health from the earliest days. Key messages • Mortality patterns refer to the internal variability of the crisis’ effect and to persistent spatial regional inequalities appealing to the need for attention in policymaking. • The relevance of considering the political economy of global health finance and macroeconomic volatility as a major influence on the association of mortality rates with socioeconomic indicators.

All-cause Years of life lost due to death at municipality level in Norway. Association to educational attainment and median income

Abstract Background Norway, with 5.5 million people spread across 356 municipalities, has pursued an active policy to reduce social and geographical health inequalities. Despite, studies find significant health disparities linked to socioeconomic factors at the individual-level, although evidence at larger geographical-levels has been mixed. We used a key burden of disease (BoD) metric, Years of Life Lost (YLL), to examine spatial health inequities among Norwegian municipalities and their association with socioeconomic factors. Methods We analysed data from all residents in Norwegian municipalities with over 1000 inhabitants as of January 1, 2019. Data was sourced from the National Population Register and Statistics Norway. All-cause YLL were calculated based on age-specific aspirational life expectancy obtained from GBD 2019. Deprivation was measured using educational attainment and median income, categorized into quartiles. Geographical maps illustrating municipality-level all-cause age-standardised YLL rates for males and females were generated. Negative binomial regression models assessed associations between socioeconomic factors and YLL rates, adjusting for age, sex, and an index of centralisation. Results High-deprivation municipalities exhibited a 9% higher YLL rate in terms of education (Incidence Rate Ratio [IRR] = 1.09, 95% Confidence Interval [CI] = 1.01-1.17) and a 10% higher YLL rate in terms of income (IRR = 1.10, 95% CI = 1.02-1.08) compared to the least deprived, translating to absolute differences of 1391 and 1466 YLL per 100,000 population, respectively. Additionally, we discuss the potential expansion of this study to incorporate cause-specific outcomes and other BoD metrics based on previous county-level analyses. Conclusions Our study demonstrates the feasibility of using BoD methods to assess geographical deprivation and premature mortality at the municipality level, providing valuable insights for public health policy targeted at small administrative areas.

Health economics and services research in symbiosis: STREAMLINEing mental health services in Austria

Abstract Objectives The cost of mental diseases exceeds 4% of GDP in Europe. In Austria, every 5th person lives with mental ill-health (MIH). Ongoing epidemiological, demographic and societal changes increase the need for easily accessible, better integrated and good value services. In STREAMLINE, we combine, harmonize and implement the latest methods in human service mapping and economic costing to optimize future service provision and financing for MIH in Austria. Methods We comprehensively assess the availability, activity and affordability of human services targeting MIH in Vienna within the health and social care, education, labour and justice sectors based on a conceptual mind map. We identify services through extensive literature, document and web searches plus expert consultations. Services are mapped and costed according to the European PECUNIA methods: classification of the main service types using the international DESDE taxonomy of human services; development of Reference Unit Costs using the PECUNIA RUC templates with primary data; validation of the results with secondary data; compilation of a comprehensive multi-sectoral service catalogue; and synthesis for spatial and policy analyses. Results We identified 756 sources, 75% individual organisations, 5% multi-organisations and 20% existing provider lists. 84% relate to health and social care, 10% labour, and 3% education and justice sectors each. 58% deliver care to adults, 37% to children & adolescents, and 5% support carers. Further service mapping and RUCs will be presented. Discussion STREAMLINE pioneers in coordinated public mental health services and economics research at scale. Assessed levels of fragmentation call for better integration, improved transition, reduced spatial inequity and increased support for carers. Results increase the feasibility of service evaluations from a societal perspective. Planned public service atlas facilitates information and access for service users and carers. Funding: WWTF Key messages • New methods for harmonized health services and economics research allow comprehensive information for optimized future mental health service planning and financing. • Assessed levels of fragmentation highlight the need for better integration, improved transition, reduced spatial inequity and increased support for carers.

Inequalities in Primary Care Provision in Gwangju Metropolitan City, South Korea

Abstract Background Primary care clinics play a crucial role in community health promotion by facilitating early disease detection and management. The number of these clinics in Gwangju Metropolitan City increased from 931 in 2000 to 2,400 in 2022, but this growth was not evenly distributed within the city. This study aims to examine the spatial inequalities in the distribution of clinics in Gwangju Metropolitan City. Methods This study utilized local administrative licensing data on medical institutions classified as clinics. To estimate healthcare resource imbalances, Lorenz curves and Gini indices for the number of clinics per 100,000 individuals and per square kilometer were calculated by district. Results The number of primary care clinics per 1,000 individuals or per square kilometer was highest in Dong-gu and Seo-gu, while Gwangsan-gu had relatively fewer facilities. In particular, Buk-gu, Seo-gu, and Nam-gu had more than 40% of areas with a high number of healthcare facilities relative to population or area, whereas less than 50% of Gwangsan-gu fell into the lower tier in these categories. The Gini index, used to measure the geographical inequality of healthcare facility distribution, showed a slight improvement from 2000 to 2023. However, Seo-gu and Buk-gu exhibited different trends compared to other districts. Conclusions Geographical disparities in the distribution of primary care clinics in Gwangju Metropolitan City have slightly improved since 2000, but show different patterns by district. Addressing healthcare imbalances is essential for enhancing health equity, requiring multifaceted efforts to mitigate disparities and improve medical service accessibility in underserved areas. Key messages • Significant disparities exist in the distribution of primary care clinics across Gwangju, with higher densities in Dong-gu and Seo-gu, and fewer facilities in Gwangsan-gu. • The Gini index for clinic distribution has improved since 2000, but disparities remain, particularly in Seo-gu and Buk-gu. Continued efforts are essential to reduce healthcare inequalities further.