Time Trends In Inequalities Research Articles

Trends in educational inequalities in smoking-attributable mortality and their impact on changes in general mortality inequalities: evidence from England and Wales, Finland, and Italy (Turin)

BackgroundSocioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in...

Life stage-specific trends in educational inequalities in health-related quality of life and self-rated health between 2002 and 2016 in Germany: findings from the German Socio-Economic Panel Study (GSOEP)

ObjectivesWhile evidence suggests persisting health inequalities, research on whether these trends may vary according to different stages of life has rarely been considered. Against this backdrop, we analysed life stage-specific...

Temporal trends in socioeconomic inequalities in HIV testing: an analysis of cross-sectional surveys from 16 sub-Saharan African countries

Overall increases in the uptake of HIV testing in the past two decades might hide discrepancies across socioeconomic groups. We used data from population-based surveys done in sub-Saharan Africa to quantify socioeconomic inequalities in uptake of HIV testing, and to establish trends in testing uptake in the past two decades. We analysed data from 16 countries in sub-Saharan Africa where at least one Demographic and Health Survey was done before and after 2008. We assessed the country-specific and sex-specific proportions of participants who had undergone HIV testing in the previous 12 months across wealth and education groups, and quantified socioeconomic inequalities with both the relative and slope indices of inequalities. We assessed time trends in inequalities, and calculated mean results across countries with random-effects meta-analyses. We analysed data for 537 784 participants aged 15-59 years (most aged 15-49 years) from 32 surveys done between 2003 and 2016 (16 before 2008, and 16 after 2008) in Cameroon, Côte d'Ivoire, DR Congo, Ethiopia, Guinea, Kenya, Lesotho, Liberia, Malawi, Mali, Niger, Rwanda, Sierra Leone, Tanzania, Zambia, and Zimbabwe. A higher proportion of female participants than male participants reported uptake of HIV testing in the previous 12 months in five of 16 countries in the pre-2008 surveys, and in 14 of 16 countries in the post-2008 surveys. After 2008, in the overall sample, the wealthiest female participants were 2·77 (95% CI 1·42-5·40) times more likely to report HIV testing in the previous 12 months than were the poorest female participants, whereas the richest male participants were 3·55 (1·85-6·81) times more likely to report HIV testing than in the poorest male participants. The mean absolute difference in uptake of HIV testing between the richest and poorest participants was 11·1 (95% CI 4·6-17·5) percentage points in female participants and 15·1 (9·6-20·6) in male participants. Over time (ie, when pre-2008 and post-2008 data were compared), socioeconomic inequalities in the uptake of HIV testing in the previous 12 months decreased in male and female participants, whereas absolute inequalities remained similar in female participants and increased in male participants. Although relative socioeconomic inequalities in uptake of HIV testing in sub-Saharan Africa has decreased, absolute inequalities have persisted or increased. Greater priority should be given to socioeconomic equity in assessments of HIV-testing programmes. INSERM-ANRS (France Recherche Nord and Sud Sida-HIV Hépatites).

Trends in inequality in life expectancy at birth between 2004 and 2017 and projections for 2030 in Korea: multiyear cross-sectional differences by income from national health insurance data

ObjectivesThe current status, time trends and future projections of a national health equity target are crucial elements of national health equity surveillance. This study examined time trends in inequality by...

Local governments, in-kind transfers, and economic inequality

We examine how in-kind transfers provided by local governments affect economic inequality. The allocation of in-kind transfers to households and the adjustment for differences in needs are derived from a model of local government spending behavior. The model distinguishes between fixed and variable costs in production as well as mandatory programmatic spending components versus discretionary spending on different service sectors and target groups. To estimate the model, we combine Norwegian data from municipal accounts and administrative registers for the period 1982–2013. We find that economic inequality is considerably lower when taking in-kind transfers into account. While the poor benefit from receiving a relatively large share of public services, the equalizing effect of in-kind transfers tends to be smaller than the equalizing contribution from public cash transfers. When examining the time trends in inequality, we find that local governments attenuated the growth in cash income inequality by re-allocating in-kind transfers to low-income families. This reduction in inequality is mostly due to changes in spending priorities across service sectors and target groups, while the contribution from re-allocation of resources across municipalities is much smaller.

Measuring coverage in MNCH: determining and interpreting inequalities in coverage of maternal, newborn, and child health interventions.

To monitor progress towards the Millennium Development Goals, it is essential to monitor the coverage of health interventions in subgroups of the population, because national averages can hide important inequalities. In this review, we provide a practical guide to measuring and interpreting inequalities based on surveys carried out in low- and middle-income countries, with a focus on the health of mothers and children. Relevant stratification variables include urban/rural residence, geographic region, and educational level, but breakdowns by wealth status are increasingly popular. For the latter, a classification based on an asset index is the most appropriate for national surveys. The measurement of intervention coverage can be made by single indicators, but the use of combined measures has important advantages, and we advocate two summary measures (the composite coverage index and the co-coverage indicator) for the study of time trends and for cross-country comparisons. We highlight the need for inequality measures that take the whole socioeconomic distribution into account, such as the relative concentration index and the slope index of inequality, although simpler measures such as the ratio and difference between the richest and poorest groups may also be presented for non-technical audiences. Finally, we present a framework for the analysis of time trends in inequalities, arguing that it is essential to study both absolute and relative indicators, and we provide guidance to the joint interpretation of these results.

Educational inequality in stillbirth: temporal trends in Québec from 1981 to 2009.

Educational inequality in stillbirth has been documented in high-income countries and the province of Québec, Canada, but temporal trends are poorly understood. Our objective was to determine time trends in inequality related to maternal education for all-cause and cause-specific stillbirth over the past three decades in Québec. We included 2,397,971 live births and 9,983 stillbirths from 1981 through 2009 using Québec vital statistics. For each decade, we computed measures of inequality capturing relative (relative index of inequality, RII) and absolute (slope index of inequality, SII) differences between the least- and most-educated mothers for all-cause and cause-specific stillbirth, adjusting for maternal characteristics. Stillbirth rates decreased over time for all education levels. Absolute educational inequality (SII 2.5 per 1000 births, 95% CI 2.1-2.8; all periods combined) was stable over time, whereas relative inequality increased (RII(1981-1989) 1.8 vs. RII(2000-2009) 2.3). Absolute inequality decreased for stillbirths caused by placental abruption (SII(1981-1989) 0.6 vs. SII(2000-2009) 0.3), but increased for unspecified causes (SII(1981-1989) 0.2 vs. SII(2000-2009) 0.7). Absolute educational inequality in stillbirth persisted and relative inequality increased over the past three decades, despite an overall decrease in stillbirth rates. The decrease in absolute inequality for placental abruption was countered by an increase for unspecified causes. A better understanding of the underlying components of unspecified causes is needed to further address educational inequality in stillbirth.

Time trends in inequalities in health.

SummaryThe conventional belief since the publication of the Black Report is that social inequalities in health have been increasing since 1931–32 although it has been argued that the measure of inequality used is inappropriate. All analyses have been based on mortality rates which, in large part, reflect inequalities in health over the previous 50 years and not current trends. This paper argues that time trends should be assessed with a current health status measure and suggests using height at age 20 as a good measure of the achieved health status of a group. Analysis of a government survey shows that inequalities have stayed the same since 1940, both for men classified by their own occupation and for women classified by their father's occupation.