Trends In Inequality Research Articles

Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis.

BackgroundMaternal mortalities remain high in the Lao People’s Democratic Republic (Lao PDR). Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011–12 and 2011–12 to 2017.MethodsWe used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011–12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women’s age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots.ResultsThe coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011–12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values.ConclusionThere was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011–12 while between 2011–12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011–12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits.

Regional catastrophic health expenditure and health inequality in China

BackgroundCatastrophic health expenditures (CHE) can trigger illness-caused poverty and compound poverty-caused illness. Our study is the first regional comparative study to analyze CHE trends and health inequality in eastern, central and western China, exploring the differences and disparities across regions to make targeted health policy recommendations.MethodsUsing data from China's Household Panel Study (CFPS), we selected Shanghai, Henan and Gansu as representative eastern-central-western regional provinces to construct a unique 5-year CHE unbalanced panel dataset. CHE incidence was measured by calculating headcount; CHE intensity was measured by overshoot and CHE inequality was estimated by concentration curves (CC) and the concentration index (CI). A random effect model was employed to analyze the impact of household head socio-economic characteristics, the household socio-economic characteristics and household health utilization on CHE incidence across the three regions.ResultsThe study found that the incidence and intensity of CHE decreased, but the degree of CHE inequality increased, across all three regions. For all regions, the trend of inequality first decreased and then increased. We also revealed significant differences across the eastern, central and western regions of China in CHE incidence, intensity, inequality and regional differences in the CHE influencing factors. Affected by factors such as the gap between the rich and the poor and the uneven distribution of medical resources, families in the eastern region who were unmarried, use supplementary medical insurance, and had members receiving outpatient treatment were more likely to experience CHE. Families with chronic diseases in the central and western regions were more likely to suffer CHE, and rural families in the western region were more likely to experience CHE.ConclusionsThe trends and causes of CHE varied across the different regions, which requires a further tilt of medical resources to the central and western regions; improved prevention and financial support for chronic diseases households; and reform of the insurance reimbursement policy of outpatient medical insurance. On a regional basis, health policy should not only address CHE incidence and intensity, but also its inequality.

Toward a dialogical sociology: Presidential address – XX ISA World Congress of Sociology 2023

In the first quarter of the twenty-first century, the entangled pathologies of late modernity are increasingly revealing themselves in a simultaneous: (1) emergence of authoritarianism in the South and Right populism in the North that is gaining momentum year after year; (2) rising trends of inequality, precarity, and exclusion; and (3) hierarchical social polarizations are emerging in more and more societies. How do, and how should, the social sciences, and particularly sociology, react to these pathologies of late modernity? I would argue that the bulk of the responses of the social sciences and/or sociology to these pathologies are defined as being classically liberal but politically illiberal – I call this peculiar combination ‘Symbolic Liberalism’. To address the inherent problems with Symbolic Liberalism and as an alternative to it, I propose Dialogical Sociology as a form of balance between collective and individual political liberal project.

Trends in socioeconomic inequalities in incidence of severe mental illness - A population-based linkage study using primary and secondary care routinely collected data between 2000 and 2017.

In 2008, the UK entered a period of economic recession followed by sustained austerity measures. We investigate changes in inequalities by area deprivation and urbanicity in incidence of severe mental illness (SMI, including schizophrenia-related disorders and bipolar disorder) between 2000 and 2017. We analysed 4.4 million individuals from primary and secondary care routinely collected datasets (2000-2017) in Wales and estimated the incidence of SMI by deprivation and urbanicity measured by the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator respectively. Using linear modelling and joinpoint regression approaches, we examined time trends of the incidence and incidence rate ratios (IRR) of SMI by the WIMD and urban/rural indicator adjusted for available confounders. We observed a turning point of time trends of incidence of SMI at 2008/2009 where slope changes of time trends were significantly increasing. IRRs by deprivation/urbanicity remained stable or significantly decreased over the study period except for those with bipolar disorder sourced from secondary care settings, with increasing trend of IRRs (increase in IRR by deprivation after 2010: 1.6% per year, 95% CI: 1.0%-2.2%; increase in IRR by urbanicity 1.0% per year, 95% CI: 0.6%-1.3%). There was an association between recession/austerity and an increase in the incidence of SMI over time. There were variations in the effects of deprivation/urbanicity on incidence of SMI associated with short- and long-term socioeconomic change. These findings may support targeted interventions and social protection systems to reduce incidence of SMI.

Trends in social inequality and how mental wellbeing vary and covary among Norwegian adolescents and their families: the Young-HUNT Study.

The study had two aims: first, to investigate trends in socioeconomic inequalities in psychological distress and loneliness among Norwegian adolescents, and second, to study variation and covariation of psychological distress and loneliness within adolescents and between siblings within families. Multivariate mixed models were used to investigate trends in socioeconomic inequality in psychological distress and loneliness using three separate cohorts of Norwegian adolescents from the Young-HUNT study conducted in 1995-1997 (Young-HUNT1, n = 8980), 2006-2008 (Young-HUNT3, n = 8199) and 2017-2019 (Young-HUNT4, n = 8066). Register data on parental education level was used as a marker of socioeconomic position (SEP), and a unique family number was used to identify adolescents belonging to the same family. A three-level multivariate mixed model was created, consisting of the outcomes at level 1, adolescents at level 2 and families at level 3. No statistically significant difference in scores on loneliness and psychological distress was observed between low and high parental education level in Young-HUNT1, whereas in Young-HUNT4, low parental education level was associated with a higher score on both psychological distress (β = 0.09; 95% confidence interval (CI), 0.03-0.14) and loneliness (β = 0.12; 95% CI 0.07-0.17). Analyses of covariation between psychological distress and loneliness showed that they were correlated within adolescents and strongly correlated within families across all timepoints. Increasing socioeconomic inequalities in psychological distress and loneliness among Norwegian adolescents is worrisome. Further, the family seems to be an important arena for potential prevention of psychological distress and loneliness among adolescents, regardless of parental education level.

비동거 가구원 보정이 소득불평등지표 변화에 미치는 영향에 관한 연구

Since 2017, income inequality in South Korea has been measured using the Survey of Household Finances and Living Conditions. This survey combines income information gathered through surveys with highly reliable administrative data which include tax data from the National Tax Service and health insurance payment data from the National Health Insurance Service. Based on the Survey of Household Finances and Living Conditions, income inequality in South Korea has steadily decreased from 2017 to 2019. However, there are some who contend that income distribution has actually become more unequal during this same period. In light of these differing viewpoints, the purpose of this study is to examine whether the measure of income inequality derived from the Survey of Household Finances and Living Conditions accurately portrays the current income inequality situation in South Korea. The technical reports indicate that the survey considers a family of origin to include one-person households who move out for work or study. The issue here is that a relatively high percentage of these one-person households, especially young single adults, tend to have lower incomes and poorer living conditions. Therefore, this study aims to examine how the separation of these young one-person household members who live independently for work or study from their original households impacts the trends in income inequality from 2017 to 2019 as reported in the Survey of Household Finances and Living Conditions. The results reveal that when adjustments are made for one-person households, there are discernible differences in income inequality indices such as the Income quintile share ratio, Gini coefficient, and Palma ratio between the adjusted data and the original data. Further analysis of income inequality trends by age groups suggests that, after adjusting for non-cohabiting household members, the worsening income inequality among young adults in their twenties contributes to the differences observed in income inequality trends from 2017 to 2019 between the original data and the adjusted data.

Corrigendum: analysis of inequality trends in self-rated oral health and oral health-related quality of life of adults according to household income level using data from the Korea National Health and Nutrition Examination Survey

Corrigendum: analysis of inequality trends in self-rated oral health and oral health-related quality of life of adults according to household income level using data from the Korea National Health and Nutrition Examination Survey

Bayesian spatiotemporal modelling for disease mapping: an application to preeclampsia and gestational diabetes in Florida, United States.

Morbidities generally show patterns of concentration that vary by space and time. Disease mapping models are useful in estimating the spatiotemporal patterns of disease risks and are therefore pivotal for effective disease surveillance, resource allocation, and the development of prevention strategies. This study considers six spatiotemporal Bayesian hierarchical models based on two spatial conditional autoregressive priors. It could serve as a guideline on the development and application of Bayesian hierarchical models to assess the emerging risk trends, risk clustering, and spatial inequality trends, with estimation of covariables' effects on the interested disease risk. The method is applied to the Florida Birth Record data between 2006 and 2015 to study two cardiovascular risk factors: preeclampsia and gestational diabetes. High-risk clusters were detected in North Central Florida for preeclampsia and in Central Florida for gestational diabetes. While the adjusted disease trend was stable, spatial inequality peaked in 2011-2012 for both diseases. Exposure to PM2.5 at first or/and second trimester increased the risk of preeclampsia and gestational diabetes, but the magnitude is less severe compared to previous studies. In conclusion, this study underscores the significance of selecting appropriate disease mapping models in estimating the intricate spatiotemporal patterns of disease risk and suggests the importance of localized interventions to reduce health disparities. The result also identified an opportunity to study potential risk factors of preeclampsia, as the spike of risk in North Central Florida cannot be explained by current covariables.

Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021.

This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels. We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model. The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening. Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.

Inequality Below the Poverty Line since 1967: The Role of the U.S. Welfare State

Since the War on Poverty in the 1960s, the U.S. social safety net has shifted away from direct cash assistance for the lowest-income households and toward tax-based transfers targeted at working families with children. Previous research has assessed this shift by evaluating its effect on the national poverty rate. Doing so, however, overlooks how it may also have led to increased inequality among low-income households. We apply a decomposition framework to measure how changes in taxes/transfers and composition have affected trends in inequality below the poverty line from 1967 to 2019. Income inequality among the poorest households has been volatile since the 1960s, and changes to the American welfare state played a decisive role in expanding or reducing inequality below the poverty line. Unlike in previous decades, after the mid-1990s, the policies that most reduced poverty were also those that most increased inequality among the poor. These findings challenge standard theories regarding the effectiveness of income transfers in reducing poverty by revealing that recent state-led antipoverty efforts have placed the near poor and the deeply poor on divergent paths.

Technical change, task reallocation, and wage inequality

Abstract This paper empirically investigates wage inequality within the group of skilled workers in the recent four decades in the USA using CPS data and finds evidence that the trend of wage growth of the top and bottom 10th percentile of skilled workers significantly diverged starting from 2000. Using a task-based framework of occupation, I find that the changing trend of wage inequality was entirely driven by one category of occupation, namely the nonroutine analytic occupation. Then, I consider in a model task reallocation between two broad task categories, namely the routine and abstract task, induced by an ongoing investment-specific technical change. In my model, the labor in the routine task is replaced by cheaper machines due to investment-specific technical change, then workers that are less productive in the abstract task enter abstract occupations. As a result, the wage inequality in the abstract task widens because of the reallocation of less productive workers from the routine task to the abstract task, that is, the “composition effect.” In addition, since economic agents tend to postpone the investment in machines after the ongoing investment-specific technical change takes place for a while, the expansion path of wage inequality is not linear but features an acceleration of wage dispersion in the middle of the technical change. The quantitative results suggest that the model is able to provide a well-matched timing and magnitude of the nonlinear expansion path in wage inequality that is observed in the data.

Trends in ethnic inequality in child welfare interventions in Wales, 2010 – 2021

ObjectivesChildren’s chances of receiving welfare interventions are found to vary by ethnicity in England, but the ethnic pattern in child welfare interventions in Wales over time is unknown. We aim to estimate the scale and trend of ethnic inequalities in intervention rates in Wales over a 12-year period, using population-based linked administrative records.
 MethodsWe analyse cross-sectional administrative children’s social care data: the Children in Need (CIN) dataset from 2010 to 2016 and the Children Receiving Care and Support (CRCS) dataset from 2017 to 2021. These data are linked to both the ethnic population data to obtain the ethnic variation in child welfare intervention rates and, using the WIMD, to identify the relative deprivation level in the neighbourhoods from which children entered care. For observations in CIN/CRCS whose ethnicity are missing, we link Census 2011 to obtain the children’s ethnicity to achieve a fuller coverage. For the first time, our analysis also links children’s social care data with the religion variable in the Census data, allowing us to estimate the extent of religious inequalities in child welfare intervention.
 ResultsBased on research findings in England on ethnic variation in child welfare intervention, we hypothesise higher intervention rates among Black children and a lower intervention rates among Asian children in Wales, compared to White children, controlling for deprivation status. By extension, we also hypothesise lower intervention rates among Muslim children compared to Christian children.
 ConclusionsNo research to date has quantitatively documented the pattern and trend of ethnic inequalities in child welfare intervention in Wales using linked administrative data on CIN/CRCS. Our study is also the first to examine religious inequality in UK child welfare by linking social care data to the Census. Our findings will have significant implications on policy and practice in social work and particularly in children’s social services. We conclude by discussing what future research questions may emerge from the new insight we shed.

Development of geographic inequality in dental caries and its association with socioeconomic factors over an 18-year period in Denmark

BackgroundFew studies have examined the development of geographic and socioeconomic inequalities in caries over time or have simultaneously assessed individual-level socioeconomic position (SEP) and neighborhood-level factors as a multi-layered phenomenon influencing caries inequalities. This study examined (i) the trends in geographic inequalities in caries among adolescents in Denmark and (ii) how the association between SEP and caries has progressed over time, when accounting for individual and neighborhood-level confounding factors.MethodsThis nationwide repeated cross-sectional study included 15-year-olds in Denmark from 1995, 2003, and 2013 (n = 149,808). The outcome was caries experience (measured by the decayed, missing, and filled tooth surfaces [DMFS] index). The exposure of interest was SEP, indicated by the previous year’s parental education, occupational social class, and (equivalized) disposable household income. Covariates included individual-level factors (immigration status, country of origin, number of children and persons in the family, and household type) and neighborhood (residence municipality)-level factors (Gini index; proportion of unemployed, low-educated, and unmarried/non-cohabiting individuals; proportion of single-parent households and households with overcrowding). Data sources included the Danish national dental and administrative social registers and Statistics Denmark’s statistics database (StatBank). Data were analyzed using spatial and spatiotemporal modelling utilizing zero-inflated negative binomial regressions and integrated nested Laplace approximations for Bayesian parametric inference. Observed caries experience geo-maps of the Danish municipalities for 1995, 2003, and 2013 were created.ResultsBetween 1995 and 2013, caries prevalence in the 15-year-olds declined sharply (1995, 71%; 2013, 45%). Caries experience declined in nearly all socioeconomic subgroups and municipalities. However, geographic inequalities persisted with higher caries levels largely concentrated in the relatively deprived areas of Denmark. Increasing relative socioeconomic inequalities in caries over time were observed with significant graded associations between SEP and caries despite adjustment for the various individual and neighborhood-level covariates and the effect of assessment year (e.g., 15-year-olds with parents having basic education had 1.91-fold [95% CI: 1.86–1.95] higher caries experience than those having parents with high education).ConclusionsReducing these enduring inequalities will likely require additional resources and targeted supportive and preventive measures for adolescents from lower SEP backgrounds and those residing in municipalities with higher caries prevalence.

Changing trends in child welfare inequalities in Northern Ireland

ObjectivesThis study uses longitudinal administrative data to investigate the relationship between area level deprivation and the 1) referral, 2) investigation, 3) registration and 4) looked-after stages of children’s contact with child and family social work in Northern Ireland (NI) from 2010-2017 (stages 1-3) and 2010-2020 (stage 4).
 MethodsChildren’s social care data (SOSCARE database) for the years 2010 to 2020 were obtained from the Honest Broker Service in NI. The data were linked with the 2017 NI Multiple Deprivation Measure through the family of origin postcode. Cross-tabulations of year and deprivation decile were used to produce frequencies of children who experienced the four levels of intervention within each of the study years. These were then used to calculate various measures of absolute and relative inequality including the Slope Index of Inequality (SII), the Relative Ratio of Inequality (RRI) and the Relative Index of Inequality (RII).
 ResultsThere was a clear and increasing social gradient in child welfare interventions over time. Children referred to children’s social care during 2010-2017 were 4-5 times more likely to come from the most deprived areas compared to the least deprived. Despite fairly stable levels of referral inequality, the ratio of children subject to child protection investigations rose from 3 in 2010 to 6 in 2017, the ratio of children subject to child protection plans rose from 4.5 in 2010 to 8 in 2017 and the ratio of children looked after rose from 4 in 2010 to 9 in 2020. This widening inequality was largely driven by the increasing involvement of younger children from the most deprived areas in child protection and looked-after processes.
 ConclusionIn an environment of economic austerity and reduced spending, we are intervening in the lives of children and families living in the most deprived areas of NI at disproportionate rates. The current independent review of children’s social care offers an opportunity to reconfigure current provision with a clear inequalities focus.

Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999-2020.

Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. Pain-related visits to the ED by Black or White patients. Prescriptions for opioid and non-opioid analgesics. A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.

Inequitable Financial Protection in Health for Indigenous Populations: the Mexican Case.

There is an important gap in the literature concerning the level, inequality, and evolution of financial protection for indigenous (IH) and non-indigenous (NIH) households in low- and middle-income countries. This paper offers an assessment of the level, socioeconomic inequality and middle-term trends of catastrophic (CHE), impoverishing (IHE), and excessive (EHE) health expenditures in Mexican IHs and NIHs during the period 2008-2020. We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors. We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016-2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016-2020 (6.7% in IHs and 5.6% in NIHs). In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health.

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 Income and Expenditure Inequality in the 1980s and 1990s: A Re-Examination and Further Results

Trends in Income and Expenditure Inequality in the 1980s and 1990s: A Re-Examination and Further Results

Temporal trends in inequalities of the burden of cardiovascular disease across 186 countries and territories

BackgroundCardiovascular disease (CVD) is a leading cause of morbidity and mortality globally. The extent to which CVD affects the population’s health varies across countries. Moreover, quantitative estimates of the trend of inequalities in CVD burden remain unclear. The objective of our study was to assess the socioeconomic inequalities and temporal trends of CVD burden across 186 countries and territories from 2000 to 2019.MethodsWe extracted data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019, and conducted a cross-national time-series analysis. Age-standardized disability-adjusted life-year (DALY) rates were used to measure the burden of CVDs, and gross national income (GNI) per capita was used to approximate the socioeconomic development. Concentration curves and concentration indexes (CIs) were generated to evaluate the cross-national socioeconomic inequality of CVD burden. A joinpoint regression analysis was used to quantify the changes in trends in socioeconomic inequality of CVD burden from 2000 to 2019.ResultsThe age-standardized DALY rates of CVDs decreased in 170 (91%) of 186 countries from 2000 to 2019. The concentration curves of the age-standardized DALY rates of CVDs were above the equality line from 2000 to 2019, indicating a disproportional distribution of CVD burden in low-income countries. The CIs declined from − 0.091 (95% CI: −0.128 to − 0.054) in 2000 to − 0.151 (95% CI: −0.190 to − 0.112) in 2019, indicating worsened pro-poor inequality distributions of CVD burden worldwide. A four-phase trend of changes in the CIs of age-standardized DALY rates for CVD was observed from 2000 to 2019, with an average annual percentage change (AAPC) of − 2.7% (95% CI: −3.0 to − 2.4). Decreasing trends in CIs were observed in all CVD subcategories but endocarditis, with AAPC ranging from − 6.6% (95% CI: −7.3 to − 5.9) for ischemic heart disease to − 0.2% (95% CI: −0.4 to − 0.1) for hypertensive heart disease.ConclusionsGlobally, the burden of CVD has decreased in more than 90% of countries over the past two decades, accompanied by an increasing trend of cross-country inequalities. Moreover, the overall burden of CVD continues to fall primarily on low-income countries.

Trends in mental health inequalities for people with disability, Australia 2003 to 2020.

Cross-sectional studies have demonstrated that people with disability have substantial inequalities in mental health compared to people without disability. However, it is not known if these inequalities have changed over time. This study compared the mental health of people with and without disability annually from 2003 to 2020 to investigate time trends in disability-related mental health inequalities. We use annual data (2003-2020) of the Household, Income and Labour Dynamics in Australia Survey. Mental health was measured using the five-item Mental Health Inventory. For each wave, we calculated population-weighted age-standardised estimates of mean Mental Health Inventory scores for people with and without disability and calculated the mean difference in Mental Health Inventory score to determine inequalities. Analyses were stratified by age, sex and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). From 2003 to 2020, people with disability had worse mental health than people without disability, with average Mental Health Inventory scores 9.8 to 12.1 points lower than for people without disability. For both people with and without disability, Mental Health Inventory scores decreased, indicating worsening mental health, reaching the lowest point for both groups in 2020. For some subpopulations, including young females and people with intellectual disability, brain injury or stroke, mental health inequalities worsened. This paper confirms that people with disability experience worse mental health than people without disability. We add to previous findings by demonstrating that disability-related inequalities in mental health have been sustained for a long period and are worsening in some subpopulations.