Trends In Social Inequalities Research Articles

A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001–20

This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position—education, occupation, and household wealth—and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001–20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.

Trends in social inequalities in early childhood caries using population-based clinical data.

To assess the longitudinal trends in social inequalities in early childhood caries (ECC) using collected population-based data. Clinical data on children were routinely collected from 2008 to 2019 in Victoria, Australia. ECC prevalence and severity (dmft) were quantified according to Indigenous status, culturally and linguistically diverse (CALD) status, concession cardholder status, geographic remoteness and area deprivation. The inverse probability weighting was used to quantify social inequalities in ECC. The weighted prevalence differences, and the ratio between the weighted prevalence of ECC and mean dmft and their 95% confidence interval, were then plotted. Absolute inequalities in ECC prevalence increased for children by 7% for CALD status and cardholder status between 2008 and 2019. Likewise, absolute inequalities in ECC severity in this time period increased by 0.6 for CALD status and by 0.4 for cardholder status. Relative inequalities in ECC increased by CALD (ratio: 1.3 to 2.0), cardholder status (1.3 to 2.0) and area deprivation (1.1 to 1.3). Relative inequalities in severity increased by CALD (1.5 to 2.8), cardholder (1.4 to 2.5) or area deprivation (1.3 to 1.5). Although children with Indigenous status experienced inequalities in ECC prevalence and severity, these did not increase on the absolute (ECC: 0.1-0.1 Severity: 1.0-0.1) or relative scale (ECC ratio: 1.3-1.3 Severity ratio: 1.6-1.1). Trends in inequalities in ECC were different according to sociodemographic measures. Oral health policies and interventions must be evaluated on the basis of reducing the prevalence of oral diseases and oral health inequalities between population sub-groups.

Trends in absolute and relative educational inequalities in health during times of labour market restructuring in coastal areas: The HUNT Study, Norway

BackgroundRestructuring labour markets offers natural population-level experiments of great social epidemiological interest. Many coastal areas have endured substantial restructuring of their local labour markets following declines in small-scale fishing and transitions to new employment opportunities. It is unknown how educational inequalities in health have developed in formerly fishery-dependent communities during such restructuring. In this study, we compare trends in social inequalities in health in Norwegian coastal areas with adjacent geographical areas between 1984 and 2019. MethodsWe used cross-sectional population-based data from the Trøndelag Health Study (HUNT), collected four times: HUNT1 (1984–86), HUNT2 (1995–97), HUNT3 (2006–08) and HUNT4 (2017–19). Adults above 30 years of age were included. Using Poisson regression, we calculated absolute and relative educational inequalities in self-rated health, using slope (SII) and relative (RII) indices of inequality. ResultsTrends in absolute and relative inequalities in rural coastal health were generally more favourable than in adjacent geographical areas. We found a statistically significant trend of declining relative educational inequalities in self-rated health in the rural coastal population from HUNT1 to HUNT4. Absolute inequalities overall increased from HUNT1 to HUNT4, although a declining trend followed HUNT2. Nonetheless, the rural coastal population exhibited the highest prevalence of poor self-rated health across the four decades. ConclusionsAlthough absolute educational inequalities in self-rated health widened in all geographical areas, the smallest increase was in rural coastal areas. Relative educational inequalities narrowed in this rural coastal population. Considering the concurrent processes of large-scale investments in the Norwegian public sector and welfare schemes, increased fishing fleet safety, and employment opportunities in aquaculture, our findings do not suggest that potential positive effects on public health of this restructuring have benefitted inhabitants with higher educational attainment more than inhabitants with lower educational attainment in this rural coastal population.

Social inequalities and trends in pre-pregnancy body mass index in Swedish women

Obesity rates in adolescence and young adulthood have increased in Sweden, reflecting global trends. To which extent this occurs across different socioeconomic strata has not been clarified. The aim of the present study was to investigate trends in social inequalities in body mass index (BMI) in young/mid-adulthood Swedish women. We obtained weight and height for all women aged 20–45 years, at their first registered pregnancy (< 12 weeks of gestation) in the Swedish Medical Birth Register 1982–2013 (1,022,330, mean age = 28.8 years), documenting education and county of residence. Trends in mean BMI and in the prevalence of BMI categories between 1982 and 2013 were estimated across education levels and geographical location. Overall, mean BMI increased from 22.7 kg/m2 (SD 3.2) to 24.3 kg/m2 (SD 4.4) between 1982 and 2013. Simultaneously, the prevalence of overweight and obesity (BMI ≥ 25 kg/m2) increased from 18.1 to 33.4% while that of moderate obesity (BMI ≥ 30 to < 35 kg/m2) and severe obesity (BMI ≥ 35 kg/m2) increased markedly from 3.4 and 0.4% to 7.4 and 3.1%, respectively. The prevalence of moderate and severe obesity more than doubled during the study period across all educational levels. In conclusion, BMI and moderate and severe obesity increased markedly among young/mid-adulthood Swedish women regardless of education with a widening gap between those with lower and higher education. These growing social inequalities in BMI are likely to cause a rising divide in serious health problems following early and long-lasting obesity.

Socioeconomic inequalities in lung cancer \u2013 a time trend analysis with German health insurance data

BackgroundLung Cancer (LC) is one of the most prevalent cancer diseases. Due to the lack of databases which allow the combination of information on individual socioeconomic status (SES) and cancer incidence, research on social inequalities in LC among the German population is rare. The aim of the study is to analyse time trends in social inequalities in LC in Germany.MethodsThe analyses are based on data of a large statutory health insurance provider. The data contain information on diagnoses, occupation and education (working age), and income (full age range) of the insurance population. Trends were analysed for two subpopulations (retirement age and working age) and stratified by sex. The analyses are based on incidence rates and proportional hazard models spanning the periods 2006–2009, 2010–2013 and 2014–2017.ResultsIncidence rates declined in men but increased in women. For men, inequalities were strongest in terms of income and the decline in incidence was most pronounced in middle- and higher-income men. Among women at retirement age, a reversed income gradient was found which disappeared in the second period. The educational gradient among the working-age population decreased over time due to the trend towards increasing incidence among individuals with higher education. Declining gradients were also found for occupational position.ConclusionThe findings reveal considerable inequalities in LC and that trends vary with respect to SES, sex and age. Widening income inequalities were found in the retired population, while educational and occupational inequalities tend to narrow among the working-age population.

Trends in social inequalities in breastfeeding and infant formulas in Latin American countries between the 1990 and 2010 decades.

To analyse trends of social inequality in breastfeeding and infant formula (IF) use in Latin America between 1990 and 2010 decades. Time-series cross-sectional study with data from Demographic and Health Surveys. We described the prevalence of exclusive breastfeeding (EBF), breastfeeding between 6 and 12 months (BF6-12) and IF for infants under 6 months (IF < 6) and between 6 and 12 months (IF6-12). Social inequalities were assessed using the slope index of inequality (SII) and concentration index (CIX). Trends in the prevalence of breastfeeding, IF and index of social inequality were analysed by a linear regression model with weighted least squares variance. Bolivia, Colombia, Dominican Republic, Guatemala, Haiti and Peru. 51·358 alive infants younger than 12 months. Five countries showed an increasing trend for EBF and BF6-12, four increased for IF < 6 and six for IF6-12. Simultaneous decrease in IF < 6 (Colombia: -0·3/year; Haiti: -0·02/year) and increase in EBF (Colombia: +2·0/year; Haiti: +1·9/year) were observed only in two countries. EBF prevalence was high in the lowest income quintiles in five countries, and IF prevalence was high in the highest income quintiles in all countries and over the decades. For BF6-12, a decrease in inequality (prevalence increased in the highest quintile) was observed in Guatemala (SII1995 = -0·42; SII2015 = -0·28) and the Dominican Republic (SII1996 = -0·54; SII2013 = -0·26). Guatemala was the only country showing a decrease in inequality for BF (SII = -0·005; CIX = -0·0035) and an increase for IF (SII = 0·022; CIX = 0·01). The inequality in BF and IF remained over time. However, inequality in IF < 6 has decreased because low-income infants have increased use and high-income infants have decreased.

Widening income inequalities in life expectancy? Analysing time trends based on German health insurance data

BackgroundWhile social disparities in mortality have been shown in the majority of high-income countries, research on inequalities in the German population is still limited. This applies especially to studies investigating...

Future trends in social inequalities in obesity in England, Wales and Scotland.

Previous studies have shown persistent or increasing socioeconomic inequalities in obesity in many European countries. The aim of this study was to project trends in social inequalities in obesity to 2035 in male and female adults (aged 16+) in the UK to ascertain if the gap is widening or narrowing. BMI data for the UK were extracted from the Health Survey for England (2004-14), Scottish Health Survey (2008-14) and the Welsh Health Survey (2004-14), respectively. A non-linear multivariate regression model was fitted to cross-sectional risk factor data to create longitudinal projections to 2035 stratified by sex, and occupational status or education level. Individuals in routine and manual jobs are projected to have the highest prevalence of obesity by 2035 and to experience the highest increases in obesity prevalence to 2035. Social inequalities based on occupation are projected to widen (except in English females). Social inequalities based on education are projected to decrease (except in Welsh females). A population strategy of prevention focused on the structural determinants of obesity is needed to change the trajectory of obesity prevalence trends and to tackle health inequalities.

Educational expansion without equalization: a reappraisal of the ‘Effectively Maintained Inequality’ hypothesis in children’s choice of the upper secondary track

ABSTRACTPrevious studies of trends in social inequalities in upper secondary track choices in Italy found evidence that, in the period of highest educational expansion, horizontal inequalities increased, consistently with the Effectively Maintained Inequality thesis (EMI). Our paper, focusing on the youngest birth cohorts (1958–1989), documents that enrolments at upper secondary schools have become almost universal and have been followed by a huge expansion of the academic track. Although the latter has also involved children from the lowest social strata, our evidence suggests that their relative disadvantage to attend the academic track, compared to the most privileged social groups, has diminished only slightly. When distinguishing between different curricula within the academic track, we found evidence supporting the EMI hypothesis also among recent cohorts: the expansion of the academic track has gone hand-in-hand with increasing social inequalities in the chances to attend more prestigious curricula. Finally, social class inequalities in the chances of enrolling at the academic track are stronger at high levels of parental education, while they are largely muted among low-educated parents. We suggest the latter as a possible mechanism to explain why educational expansion may not produce a decline in the association between social origins and educational attainment.

Trends in social inequalities in smoking and secondhand smoke exposure among adolescents in Germany

Trends in social inequalities in smoking and secondhand smoke exposure among adolescents in Germany

Social Inequalities on Selected Determinants of Active Aging and Health Status Indicators in a Large Brazilian City (2003-2010).

To assess trends in social inequalities among 2,624 elderly living in Belo Horizonte, Brazil, in three domains of the World Health Organization's Active Aging model (physical environment, social determinants, use of health services) and health status indicators. Data came from two representative household surveys conducted in 2003 and 2010. Social inequality was measured by the slope and the relative index of inequality. Educational level was used to define socioeconomic status. Significant improvements were observed in the prevalence rates of 7 out of 12 indicators. However, the social inequalities persisted through 10 out of 12 selected active aging and health status indicators, except for fear of falling on the sidewalks/crossing the streets and fear of being robbed. Social inequalities persistence might be assigned to the continuity of unequal distribution of resources among groups with different educational levels.

Trends in social inequalities in adolescent health complaints from 1994 to 2010 in Europe, North America and Israel: The HBSC study.

Studies have shown constant or increasing health inequalities in adulthood in the last decades, but less is known about trends in health inequalities among adolescents. The aim is to analyse changes in socioeconomic differences in subjective health complaints from 1994 to 2010 among 11- to 15-year-olds in Europe, North America and Israel. Data were obtained from the international 'Health Behaviour in School-aged Children' (HBSC) survey. Analyses were based on the HBSC surveys conducted in 1994 (19 countries), 1998 (25 countries), 2002 (32 countries), 2006 (37 countries) and 2010 (36 countries) covering a time period of up to 16 years. Log binomial regression models were used to assess inequalities in multiple health complaints. Socioeconomic position was measured using perceived family wealth. Inequalities in multiple health complaints emerged in almost all countries, in particular since 2002 (RR 1.1-1.7). Trend analyses showed stable (29 countries), increased (5 countries), decreased (one country) and no social inequalities (2 countries) in adolescent health complaints. In almost all countries, social inequalities in health complaints remained constant over a period of up to 16 years. Our findings suggest a need to intensify efforts in social and health policy to tackle existing inequalities.

Growing social inequality in the prevalence of type 2 diabetes in Canada, 2004-2012.

The prevalence of diabetes in Canada has nearly doubled since 2000. Trends in social inequalities in diabetes across Canada and its different regions have not been assessed. We estimated relative and absolute social inequalities in type 2 diabetes prevalence in Canada between 2004 and 2012. We used the relative (RII) and slope (SII) indices of inequality to measure relative and absolute education-based inequalities respectively in type 2 diabetes prevalence in a sample of 413,453 men and women surveyed as part of the Canadian Community Health Survey between 2004 and 2012. Across regions and time periods, inequalities were more pronounced for women than for men, both on the absolute and relative scales. The difference in the prevalence of type 2 diabetes between individuals with the highest level of educational attainment compared to the lowest, as reflected by the SII, expanded from approximately 2.5% to 4.5% for women and 1.4% to 2.3% for men between 2004 and 2012. Monitoring and tracking social inequalities in the burden of diabetes over time can help to assess whether Canadian diabetes strategies are effective at reaching marginalized populations and mitigating inequalities. Our results signal the need for interventions to address growing social inequalities in Canada with regard to type 2 diabetes, particularly among women.

Social inequalities in the utilization of maternal care in Bangladesh: Have they widened or narrowed in recent years?

BackgroundNotwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. In this study, we aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care (ANC), facility based delivery (FBD), and skilled birth attendance (SBA) in Bangladesh between 1995 and 2010.MethodsData were extracted from the five latest rounds of Bangladesh Demographic Health Surveys (BDHS). The Theil index (T) and between-group variance (BGV) were used to calculate relative and absolute disparities in the utilization of three measures (ANC, FBD, and SBA) of maternal care across six administrative regions. The relative and slope indices of inequality (RII and SII, respectively) were also used to calculate wealth- and education-based inequality in the utilization of maternal care.ResultsThe results of the T-index suggest that relative inequality in SBA has declined by 0.2% per year. Nevertheless, the estimated BGV demonstrated that absolute inequalities in all three measures of maternal care have increased across administrative divisions. For all three measures of maternal care, the RII and SII indicated consistent socioeconomic inequalities favouring wealthier and more educated women. The adjusted RII suggested that wealth- and education-related inequalities for ANC declined by 9% and 6%, respectively, per year during the study period. The adjusted SII, however, showed that wealth- and education-related inequalities for FBD increased by 0.6% per year.ConclusionsAlthough socially disadvantaged mothers increased their utilization of care relative to mothers of higher socioeconomic status, the absolute gap in utilization of care between socioeconomic groups has increased over time. Our findings indicate that wealthier and more educated women, as well as those living in urban areas, are the major users of ANC, FBD and SBA in Bangladesh. Thus, priority focus should be given to implementing and evaluating interventions that benefit women who are poorer, less educated and live in rural areas.

Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis.

This study assessed trends in social inequalities in tooth loss in the United Kingdom between 1988 and 2009. Data from 20,126 adults who participated in the latest three national Adult Dental Health Surveys in England, Wales and Northern Ireland were used. Social class was determined using the 6-point Registrar General’s Social Class. Three indicators of tooth loss were analysed; the proportion of edentate people among all adults and the number of teeth and the proportion with functional dentition (defined as having 20+ teeth) among dentate adults. Trends were modelled within an age, period and cohort framework using partial least squares regression (PLSR). Confidence intervals for PLSR estimates were obtained using non-parametric bootstrapping. The Slope and Relative Index of Inequality (SII and RII) were used to quantify social inequalities in tooth loss. Between 1988 and 2009, absolute inequalities in total tooth loss narrowed (SII changed from −28.4% to −15.3%) while relative inequalities widened (RII from 6.21 to 20.9) in the whole population. On the other hand, absolute and relative social inequality in tooth loss remained fairly stable over time among dentate adults. There was an absolute difference of 2.5–2.9 in number of teeth and 22–26% in the proportion with functional dentition between the lowest and highest social classes. In relative terms, the highest social class had 10–11% more teeth and 25–28% higher probability of having functional dentition than the lowest social class. The findings show pervasive inequalities in tooth loss by social class among British adults despite marked improvements in tooth retention in recent years and generations. In the whole adult population, absolute inequalities in tooth loss have narrowed while relative inequalities have increased steadily. Among dentate adults, absolute and relative inequalities in number of teeth and proportion of people with functional dentition have remained significant but unchanged over time.

Health disparities calculator: a methodologically rigorous tool for analyzing inequalities in population health.

Historically, researchers and policy planners have selected a single indicator to measure trends in social inequalities. A more rigorous approach is to review the literature and data, select appropriate inequality measures to address the research question, compute results from various indices, and graphically compare resulting trends. The Health Disparities Calculator (HD*Calc, version 1.2.4; National Cancer Institute, Bethesda, MD) computes results from different indices and graphically displays them, making an arduous task easier, more transparent, and more accessible.

Sozioökonomische Ungleichheiten in der subjektiven Gesundheit bei 11- bis 15-Jährigen in Deutschland. Eine Trendanalyse von 2002-2010

Health is strongly linked to social position. Several studies showed consistent or increasing health inequalities in the last decades. So far, few studies focused on trends in social inequalities in health among children and adolescents. The objective of this study was to determine changes in socioeconomic differences in subjective health between 2002 and 2010 of 11- to 15-year-old students in Germany.Data were obtained from the German part of the cross-sectional WHO "Health Behaviour in School-aged Children" survey in 2002 (n=5.221), 2006 (n=6.896) and 2010 (n=4.723). Log binomial regression models were used to assess the extent of inequalities in self-rated health across the survey years. Socioeconomic position was measured using the family affluence scale (FAS) and perceived family wealth.A relatively small improvement in good/excellent self-rated health was observed in both boys and girls from 2002 (85.2%) to 2010 (87%). Despite this improvement, inequalities in self-rated health could be identified for all survey years, regardless of which socioeconomic indicator was used (RR 1.4 up to 1.8). The level of these differences remained virtually unchanged in girls and boys in that time period.The same relationship of family affluence, family wealth and self-rated health has persisted for almost a decade in Germany. Recent strategies could not tackle existing inequalities in self-rated health which indicates an increasing need to develop and implement innovative measures and to intensify efforts of social and health policy.

Using multiple measures of inequalities to study the time trends in social inequalities in smoking

The time trends in social inequalities in smoking have been examined in a number of international publications; however, these studies have rarely used multiple measures of health inequalities simultaneously. Also the analytical approach used often did not account, as recommended, for the changes in the relative distribution of social groups and the changes in the absolute level of the health outcome within social groups. Data from four successive waves of the Belgian Health Interview Survey (1997, 2001, 2004, 2008) were used to study the time trends in educational inequalities in daily smoking for those aged between 15 and 74 years. We estimated two measures of relative inequalities: the OR and the relative index of inequality; and two measures of absolute inequalities: the population attributable fraction and the slope index of inequality. Three of these measures (relative index of inequality, population attributable fraction, slope index of inequality) account for the change in the relative size of the social groups over time. The four measures of inequality were consistent in showing significant inequalities among educational groups. The time trends, however, were less consistent. Measures of trends in relative inequalities witnessed a small linear increase. However, no substantial over time change was observed with the measures of absolute inequalities. The time trends in social inequalities in smoking varied according to the measure of inequality used. This study confirms the importance of using multiple measures of inequalities to understand and monitor social inequalities in smoking.

Trends in social inequalities for premature coronary heart disease mortality in Great Britain, 1994–2008: a time trend ecological study

ObjectiveTo compare trends in metrics of socioeconomic inequalities in premature coronary heart disease (CHD) mortality in Great Britain.DesignTime trend ecological study with area-level deprivation as exposure.SettingGreat Britain, 1994–2008.ParticipantsMen and women...

P1-411 Using multiple measures of social inequalities to study time trends in smoking inequalities

IntroductionTrends in social inequalities in smoking have been examined in a number of international publications; however these studies have rarely used multiple measures of health inequalities and did not compare...