Time Trends In Socioeconomic Inequalities Research Articles

Trends in socioeconomic inequalities in stunting prevalence in Latin America and the Caribbean countries: differences between quintiles and deciles

BackgroundWith the adoption of the Sustainable Development Goals (SDGs), there is a renewed commitment of tackling the varied challenges of undernutrition, particularly stunting (SDG 2.2). Health equity is also a priority in the SDG agenda and there is an urgent need for disaggregated analyses to identify disadvantaged subgroups. We compared time trends in socioeconomic inequalities obtained through stratification by wealth quintiles and deciles for stunting prevalence.MethodsWe used 37 representative Demographic and Health Surveys and Multiple Indicator Cluster surveys from nine Latin American and Caribbean (LAC) countries conducted between 1996 and 2016. Stunting in children under-5 years was assessed according to the 2006 WHO Child Growth Standards and stratified by wealth quintiles and deciles. Within-country socioeconomic inequalities were measured through concentration index (CIX) and slope index of inequality (SII). We used variance-weighted least squares regression to estimate annual changes.ResultsEight out of nine countries showed a statistical evidence of reduction in stunting prevalence over time. Differences between extreme deciles were larger than between quintiles in most of countries and at every point in time. However, when using summary measures of inequality, there were no differences in the estimates of SII with the use of deciles and quintiles. In absolute terms, there was a reduction in socioeconomic inequalities in Peru, Honduras, Dominican Republic, Belize, Suriname and Colombia. In relative terms, there was an increase in socioeconomic inequalities in Peru, Bolivia, Haiti, Honduras and Guatemala.ConclusionsLAC countries have made substantial progress in terms of reducing stunting,. Nevertheless, renewed actions are needed to improve equity. Particularly in those countries were absolute and relative inequalities did not change over time such Bolivia and Guatemala. Finer breakdowns in wealth distribution are expected to elucidate more differences between subgroups; however, this approach is relevant to cast light on those subgroups that are still lagging behind within populations and inform equity-oriented health programs and practices.

Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990–2011

Objective: Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. Methods: Data were drawn from three national examination surveys conducted in 1990–1992, 1997–1999 and 2008–2011 (n = 18,541; age range: 25–69 years). Obesity was defined by a body mass index ≥30 kg/m² using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. Results: In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01–1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05–0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19–1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI –0.27 to 0.92, p = 0.283). Conclusions: These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.

Trends in socioeconomic inequalities in five major risk factors for cardiovascular disease in the Korean population: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2001–2014

ObjectivesTo examine trends in socioeconomic inequalities in major cardiovascular disease (CVD) risk factors among the Korean population.DesignCross-sectional study.SettingA nationally representative population survey database.ParticipantsA total of 42 725 Koreans, aged 25–64...

Cardiovascular risk factors—using repeated cross-sectional surveys to assess time trends in socioeconomic inequalities in neighbouring countries

ObjectivesThis study compares trends in socioeconomic inequalities related to key cardiovascular risk factors in neighbouring countries Northern Ireland (NI) and the Republic of Ireland (RoI).DesignRepeated cross-sectional studies.SettingPopulation based.Participants3500–4000 in national...

Time-trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents

Time-trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents

Time trends in socio-economic inequalities in stunting prevalence: analyses of repeated national surveys - CORRIGENDUM.

Time trends in socio-economic inequalities in stunting prevalence: analyses of repeated national surveys - CORRIGENDUM.

Time trends in socio-economic inequalities in the lack of access to dental services among children in Spain 1987-2011.

IntroductionAdult oral health is predicted by oral health in childhood. Prevention improves oral health in childhood and, consequently in adulthood, so substantial cost savings can be derived from prevention. The burden of oral disease is particularly high for disadvantaged and poor population groups in both developing and developed countries. Therefore, an appropriate and egalitarian access to dental care becomes a desirable objective if children’s dental health is to be promoted irrespective of socioeconomic status. The aim of this research is to analyse inequalities in the lack of access to dental care services for children in the Spanish National Health System by socio-economic group over the period 1987–2011.MethodsPooled data from eight editions of the Spanish National Health Survey for the years 1987–2011, as well as contextual data on state dental programmes are used. Logistic regressions are used to examine the related factors to the probability of not having ever visited the dentist among children between 6 and 14 years old. Our lack of access variable pays particular attention to the socioeconomic level of children’s household.ResultsThe mean probability of having never been to the dentist falls considerably from 49.5% in 1987 to 8.4% in 2011. Analysis by socioeconomic level indicates that, in 1987, the probability of not having ever gone to the dentist is more than two times higher for children in the unskilled manual social class than for those in the upper non-manual social class (odds ratio 2.35). And this difference is not reduced significantly throughout the period analysed, rather it increases as in 1993 (odds of 2.39) and 2006 (odds of 3.03) to end in 2011 slightly below than in 1987 (odds ratio 1.80).ConclusionThere has been a reduction in children’s lack of access to dentists in Spain over the period 1987–2011. However, this reduction has not corrected the socioeconomic inequalities in children’s access to dentists in Spain.

Time trends in socio-economic inequalities in stunting prevalence: analyses of repeated national surveys.

Much is known about national trends in child undernutrition, but there is little information on how socio-economic inequalities are evolving over time. We aimed to assess socio-economic inequalities in stunting prevalence over time. We selected nationally representative surveys carried out since the mid-1990s for which information was available on asset indices and on child anthropometry. We identified twenty-five countries that had at least two surveys over an interval of 10 years or more, totalling eighty-seven surveys. Stunting prevalence was calculated according to wealth quintiles. Absolute and relative inequalities were calculated and time trends were obtained by regression. Setting Nationally representative household surveys from twenty-five low- and middle-income countries. Children <5 years of age. National prevalence declined significantly in twenty-two of the twenty-five countries. In eighteen out of twenty-five countries, relative reductions were higher among the rich than among the poor. Overall, there was no indication that inequalities improved. Striking examples are Nepal, with a 17·0 percentage points decline in stunting per decade, but where inequalities increased sharply; and Brazil, where stunting fell by 6·7 percentage points and inequalities were all but eliminated. Global progress in reducing stunting has not been accompanied by improved equity, but countries varied markedly in how successful they were in reducing prevalence among the poorest children. It is important to document how some countries were able to reduce inequalities, so that these lessons can be used to foster global progress, particularly in light of the increased importance of within-country inequalities in the post-2015 agenda.

Time trends in socioeconomic inequalities in cancer mortality: results from a 35 year prospective study in British men.

BackgroundSocioeconomic inequalities in cancer mortality in Britain have been shown to be present in the 1990s and early 2000s. Little is known about on-going patterns in such inequalities in cancer mortality. We examined time trends in socioeconomic inequalities in cancer mortality in Britain between 1978 and 2013.MethodsA socially representative cohort of 7489 British men with data on longest-held occupational social class, followed up for 35 years, in whom 1484 cancer deaths occurred.ResultsThe hazard ratio for cancer mortality for manual vs. non-manual social classes remained unchanged; among men aged 50–59 years it was 1.62 (95%CI 1.17–2.24) between 1980–1990 and 1.65 (95%CI 1.14–2.40) between 1990–2000. The absolute difference (non-manual minus manual) in probability of surviving death from cancer to 70 years remained at 3% over the follow-up. The consistency of risks over time was similar for both smoking-related and non-smoking related cancer mortality.ConclusionSocioeconomic inequalities in cancer mortality in Britain remain unchanged over the last 35 years and need to be urgently addressed.

Measuring social inequalities in cause-specific mortality in France: Comparison between linked and unlinked approaches

BackgroundMonitoring the time trends in socioeconomic inequalities in mortality by cause is a key public health issue. The aim of this study was to compare methods to measure social inequalities in cause-specific mortality in the French population aged 25–55years. More specifically, it compares bias and precision related to the use of occupational class declared at the last census (linked data) to the one declared at the time of death on the death certificate (unlinked data). MethodsWe used a representative sample of 1% of the French population. Causes of death were obtained by direct linkage with the French national death registry. Occupational class was classified into eight categories. Taking professionals and managers as the reference, relative risks of mortality by cause and their 95% confidence intervals were estimated using Poisson models for the 1983–1989, 1991–1997, and 2000–2006 periods. The relative risks were calculated with both linked data and exhaustive unlinked data. ResultsOver the 2000–2006 period, occupational classes declared at census and on the death certificate were consistent for half of the deaths. Relative risks for manual workers were found to be similar between the two approaches over the 1983–1989 and 1991–1997 periods, and higher for the unlinked approach over the 2000–2006 period. Over the latter period, the order and magnitude of relative risks varied similarly by occupational class and cause of death for both approaches. Confidence intervals obtained from linked data were wide. ConclusionOccupational class derived from the death certificate must be used with caution as a measure for epidemiological purposes and the available linked data do not allow accurate estimates of social inequalities in cause-specific mortality. Other solutions should be considered in order to improve the follow-up of social inequalities in mortality. This would require the collection of educational level on the death certificate or the linkage of the cause of death database with other exhaustive and informative databases.

Time trends in socio-economic inequalities for women and men with disabilities in Australia: evidence of persisting inequalities

IntroductionThe socio-economic circumstances and health of people with disabilities has been relatively ignored in public health research, policy and practice in Australia and internationally. This is despite emerging evidence that the socio-economic circumstances that people with disabilities live in contributes to their poorer health. Compared to other developed countries, Australians with disabilities are more likely to live in disadvantaged circumstances, despite being an economically prosperous country; it is therefore likely that the socio-economic disadvantage experienced by Australians with disabilities makes a significant contribution to their health. Despite the importance of this issue Australia does not routinely monitor the socio-economic inequalities for people with disabilities. This paper addresses this gap by describing time trends in socio-economic conditions for Australians with and without disabilities according to the severity of the disability and sex.MethodsCross-sectional analyses of the Australian Bureau of Statistics Survey of Disability, Ageing and Carers were carried out at three time points (1998, 2003 and 2009) to estimate the proportions of women and men (aged between 25 and 64 years) who were living on low incomes, had not completed year 12, were not in paid work, living in private rental and experiencing multiple disadvantage (three or more of the indicators).ResultsPeople with disabilities are less likely to have completed year 12, be in paid work and are more likely to be living on low incomes and experiencing multiple disadvantage. These conditions worsened with increasing severity of disability and increased or persisted over time, with most of the increase between 1998 and 2003. While women with milder disabilities tended to fare worse than men, the proportions were similar for those with moderate and severe/profound disabilities.ConclusionPeople with disabilities experience high levels of socio-economic disadvantage which has increased or persisted over time and these are likely to translate into poorer health outcomes. A large proportion experience multiple forms of disadvantage, reinforcing the need to tackle disadvantage in a coordinated way across sectors.People with disabilities should be a priority population group for public health. Monitoring socio-economic conditions of people with disabilities is critical for informing policy and assessing the impact of disability reforms.

Socioeconomic inequalities in the rate of stillbirths by cause: a population-based study

ObjectiveTo assess time trends in socioeconomic inequalities in overall and cause-specific stillbirth rates in England.DesignPopulation-based retrospective study.SettingEngland.ParticipantsStillbirths occurring among singleton infants born between 1 January 2000 and 31 December 2007.Main...

153 Socioeconomic Inequalities in Neonatal Mortality: The Impact of Preterm Birth on the Widening Deprivation Gap

Background and aims: Socio-economic inequalities in neonatal mortality exist within many developed countries despite improvements in mortality rates. In the UK, the deprivation gap is widening in spite of attempts to address it. We aimed to investigate time trends in socioeconomic inequalities in cause-specific neonatal mortality in England 1997-2007.Methods: Information about all live births and neonatal deaths (18524 deaths) of singleton infants were obtained. Deprivation was measured using the UK Government Index of Multiple Deprivation. Socioeconomic inequalities in cause-specific neonatal mortality rates over time were estimated using Poisson regression models.Results: The all-cause mortality rate ratio between the most deprived decile and the least deprived decile increased from 2.08 in 1997-1999 to 2.68 in 2003-2005 before a slight fall to 2.35 in 2006-2007. Mortality due to immaturity (< 24 weeks gestation) did not decrease over time and had the widest deprivation gap. Mortality rates for all other causes fell over time. The deprivation gap widened between 1997-1999 and 2003-2005 before a slight fall in 2006-2007 for congenital anomalies; immaturity; and accidents and other specific causes. In contrast mortality rates fell slightly more among the more deprived quintile for intra-partum events and sudden infant deaths leading to a narrowing of the deprivation gap but they comprised only 16.8% of deaths.Conclusions: 80% of the deprivation gap in all-cause mortality was explained by immaturity and congenital anomalies. Understanding the link between deprivation and preterm birth should be a major research priority so interventions to reduce preterm birth can be identified.

Nature of socioeconomic inequalities in neonatal mortality: population based study

Objective To investigate time trends in socioeconomic inequalities in cause specific neonatal mortality in order to assess changing patterns in mortality due to different causes, particularly prematurity, and identify key...