1
|
Wang X, Wang Y. Association between digital engagement and urban-rural disparities in Chinese women's depressive symptoms: A national-level cross-sectional study. Digit Health 2024; 10:20552076241239246. [PMID: 38577314 PMCID: PMC10993679 DOI: 10.1177/20552076241239246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/27/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives This study aims to investigate the impact of digital engagement on urban-rural disparities in depressive symptoms among Chinese women. Methods Using a dataset from the China Family Panel Studies (CFPS) wave 2020, this study analyzes the impact of digital engagement on the urban-rural disparity in women's depressive symptoms using multiple linear regression and recentered influence function (RIF) models. Furthermore, the extent to which digital engagement affects the urban-rural disparity in women's depressive symptoms was calculated using the RIF decomposition method. Results Analysis showed that rural women had significantly higher levels of depressive symptoms compared to urban women; digital engagement significantly reduced women's depressive symptoms levels and mitigated the urban-rural disparity for women with moderate to high levels of depressive symptoms, and the mitigating effect was stronger for the highly depressed sample, but still widened the urban-rural disparity in women's depressive symptoms overall. In addition, the results of the RIF decomposition showed that digital engagement explained 28.28% of the urban-rural disparity in women's depressive symptoms. Conclusion There is a significant disparity in depressive symptoms levels between urban and rural women in China. Digital engagement reduces women's depressive symptoms, but it also widens the depressive symptoms disparity between urban and rural women overall. Digital engagement is potentially positive for reducing women's depressive symptoms.
Collapse
Affiliation(s)
- Xiaochen Wang
- Faculty of Education, Southwest University, Chongqing, China
| | - Yangyang Wang
- School of Communication, Soochow University, Suzhou, China
| |
Collapse
|
2
|
Mpody C, Kemper AR, Aldrink JH, Michalsky MP, Tobias JD, Nafiu OO. Trends and Economic Implications of Disparities in Postoperative Pneumonia. Pediatrics 2023; 151:e2022058774. [PMID: 37057490 DOI: 10.1542/peds.2022-058774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Postoperative pneumonia is the third most common surgical complication and can seriously impair surgical rehabilitation and lead to related morbidity and mortality. We evaluated the temporal trends in racial and ethnic disparities in postoperative pneumonia and quantified the economic burden resulting from these inequalities in the United States. METHODS This population-based study includes 195 028 children (weighted to 964 679) admitted for elective surgery across 5340 US hospitals reporting to the Nationwide Inpatient Sample between 2010 and 2018. We estimated the risk-adjusted incidence of postoperative pneumonia, comparing racial and ethnic groups. We also quantified the inflation-adjusted hospital costs attributable to racial and ethnic disparities in postoperative pneumonia. RESULTS The risk-adjusted rates of pneumonia declined across all racial and ethnic categories, with Black children having the lowest annual rate of decline (Black: 0.03 percentage points, Hispanic: 0.05 percentage points, white: 0.05 percentage points). The risk-adjusted rates of pneumonia trended consistently higher for Black and Hispanic children, relative to white children, throughout the study period (Black versus white: relative risk, 1.31 (95% confidence interval, 1.14-1.51), P < .01; Hispanic versus white: relative risk, 1.16 (95% confidence interval, 1.02-1.32), P = .02). These disparities did not narrow significantly over time. During the study period, the excess hospitalization cost attributable to racial and ethnic disparities in postoperative pneumonia was $24 533 458 for Black children and $26 200 783 for Hispanic children (total, $50 734 241). CONCLUSIONS Against the backdrop of decreasing postoperative pneumonia, Black and Hispanic children continue to experience higher rates compared with white children. These persistent disparities in postoperative pneumonia were associated with considerable excess cost of surgical care.
Collapse
Affiliation(s)
- Christian Mpody
- Departments of Anesthesiology and Pain Medicine
- Ohio State University College of Medicine, Columbus, Ohio
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
- Ohio State University College of Medicine, Columbus, Ohio
| | - Jennifer H Aldrink
- General Pediatric Surgery
- Ohio State University College of Medicine, Columbus, Ohio
| | - Marc P Michalsky
- General Pediatric Surgery
- Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph D Tobias
- Departments of Anesthesiology and Pain Medicine
- Ohio State University College of Medicine, Columbus, Ohio
| | - Olubukola O Nafiu
- Departments of Anesthesiology and Pain Medicine
- Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
3
|
Missiuna S, Plante C, Pahwa P, Muhajarine N, Neudorf C. Trends in mental health inequalities in urban Canada. Canadian Journal of Public Health 2021; 112:629-637. [PMID: 33877585 DOI: 10.17269/s41997-021-00498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Canadians do not all enjoy equal levels of health. The presence of income-related health inequalities has been well established in Canada, but there is a lack of consistent reporting of mental health inequalities in Canada's largest cities. This study reports the prevalence and inequalities in mental health outcomes at the city, provincial, and national levels over time. METHODS Self-reported poor mental health, life stress, and physician-diagnosed self-reported mood and anxiety disorder from the Canadian Community Health Survey were pooled over five-year intervals and combined with neighbourhood income information from the Canadian Census. First, prevalence rates were calculated for each interval at the neighbourhood level for urban communities. Second, the distributions of these neighbourhood rates were summarized at the city level and for Canada as a whole using overall prevalence rates and concentration indices of inequality. Finally, trends in these city- and country-level outcomes were also explored. RESULTS At the national level, starting from 2001 to 2005, the prevalence of poor mental health (27.9%), mood disorder (7.3%), and anxiety disorder (6.8%) had significantly increased by 2011-2015. Inequalities were present in 2001-2005 and worsened over time. The prevalence rate at the national level of life stress was 66.6% in 2001-2005 and decreased over time. CONCLUSION The large and increasing values of inequalities and the difference in prevalence rates and inequalities in cities highlight the necessity for mental disorder-specific data and for city-level analysis of inequalities. The next steps in reducing inequalities involve deconstructing the health inequalities, and continued monitoring.
Collapse
Affiliation(s)
- Sharalynn Missiuna
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada.
| | - Charles Plante
- Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, Diefenbaker Building 141-101 Diefenbaker Place, Saskatoon, Saskatchewan, S7N 5B8, Canada
| | - Punam Pahwa
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
| |
Collapse
|
4
|
Amri MM, Jessiman-Perreault G, Siddiqi A, O’Campo P, Enright T, Di Ruggiero E. Scoping review of the World Health Organization's underlying equity discourses: apparent ambiguities, inadequacy, and contradictions. Int J Equity Health 2021; 20:70. [PMID: 33658033 PMCID: PMC7931570 DOI: 10.1186/s12939-021-01400-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications. ELIGIBILITY CRITERIA Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded. SOURCES OF EVIDENCE We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search. RESULTS Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. CONCLUSIONS Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.
Collapse
Affiliation(s)
- Michelle M. Amri
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, Boston, MA 02115-6021 USA
- School of Public Health and Social Policy, Human and Social Development Building, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2 Canada
| | | | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5B 1T8 Canada
| | - Theresa Enright
- Department of Political Science, University of Toronto, 100 St George Street, Toronto, Ontario M5S 3G3 Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
| |
Collapse
|
5
|
Strous RD, Karni T. Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic? JOURNAL OF MEDICAL ETHICS 2020; 46:732-735. [PMID: 32958693 PMCID: PMC7507248 DOI: 10.1136/medethics-2020-106348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
A recent update to the Geneva Declaration's 'Physician Pledge' involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi ('ultra-orthodox') religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public's best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach.
Collapse
Affiliation(s)
- Rael D Strous
- Department of Psychiatry, Mayanei HaYeshua Medical Center, Bnei Brak, Tel Aviv, Israel
- Department of Psychiatry, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tami Karni
- Department of Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel
| |
Collapse
|
6
|
Muszyńska M, Janssen F. The concept of the Equivalent Length of Life for quantifying differences in age-at-death distributions across countries. GENUS 2016. [DOI: 10.1186/s41118-016-0011-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
7
|
Inclusive Growth and Inequalities in the Context of Structural Transformation: Evidence from Ethiopia. Development 2014. [DOI: 10.1057/dev.2015.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Tranvåg EJ, Ali M, Norheim OF. Health inequalities in Ethiopia: modeling inequalities in length of life within and between population groups. Int J Equity Health 2013; 12:52. [PMID: 23845045 PMCID: PMC3716728 DOI: 10.1186/1475-9276-12-52] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Most studies on health inequalities use average measures, but describing the distribution of health can also provide valuable knowledge. In this paper, we estimate and compare within-group and between-group inequalities in length of life for population groups in Ethiopia in 2000 and 2011. METHODS We used data from the 2011 and 2000 Ethiopia Demographic and Health Survey and the Global Burden of Disease study 2010, and the MODMATCH modified logit life table system developed by the World Health Organization to model mortality rates, life expectancy, and length of life for Ethiopian population groups stratified by wealth quintiles, gender and residence. We then estimated and compared within-group and between-group inequality in length of life using the Gini index and absolute length of life inequality. RESULTS Length of life inequality has decreased and life expectancy has increased for all population groups between 2000 and 2011. Length of life inequality within wealth quintiles is about three times larger than the between-group inequality of 9 years. Total length of life inequality in Ethiopia was 27.6 years in 2011. CONCLUSION Longevity has increased and the distribution of health in Ethiopia is more equal in 2011 than 2000, with length of life inequality reduced for all population groups. Still there is considerable potential for further improvement. In the Ethiopian context with a poor and highly rural population, inequality in length of life within wealth quintiles is considerably larger than between them. This suggests that other factors than wealth substantially contribute to total health inequality in Ethiopia and that identification and quantification of these factors will be important for identifying proper measures to further reduce length of life inequality.
Collapse
Affiliation(s)
- Eirik Joakim Tranvåg
- Department of Global Public Health and Primary Care, University of Bergen, N-5020, Bergen, Norway
| | - Merima Ali
- Chr. Michelsen Institute, N-5892, Bergen, Norway
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, N-5020, Bergen, Norway
| |
Collapse
|
9
|
Mæstad O, Norheim OF. A universal preference for equality in health? Reasons to reconsider properties of applied social welfare functions. Soc Sci Med 2012; 75:1836-43. [PMID: 22939571 DOI: 10.1016/j.socscimed.2012.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 07/06/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
Abstract
The literature on how to combine efficiency and equity considerations in the social valuation of health allocations has borrowed extensively from applied welfare economics, including the literature on inequality measurement. By so doing, it has adopted normative assumptions that have been applied for evaluating the allocation of welfare (or income) rather than the allocation of health, including the assumption of a monotonically declining social marginal value of welfare/income/health. At the same time, empirical studies that have elicited social preferences for allocation of health have reported results that are seemingly incompatible with this assumption. There are two ways of addressing this inconsistency; we may censor the stated preferences by arguing that they cannot be supported by normative arguments, or we may reject or modify the analytical framework in order to accommodate the stated preferences. We argue that the stated preferences can be supported by normative reasoning and therefore conclude that one should be cautious in applying the standard welfare economic framework to the allocation of health.
Collapse
|
10
|
Abstract
Inequality in the distribution of adult length of life - defined as age at death in the population aged 15 and over - is studied for virtually all countries of the world using a new database with over 9000 life tables covering a period of up to two centuries. The data reveal huge variation among countries and time periods in the degree to which the available years of life are distributed equally among the population. Most length of life inequality (about 90%) is within-country inequality. Our findings make clear that measures of length of life inequality should be adjusted for life expectancy to get a more relevant indicator of length of life differentials across populations. At similar levels of life expectancy, substantial differences in inequality are observed, even among highly developed countries. Expressed as premature mortality, inequality may be 35-70% higher in the most unequal countries compared to the most equal ones. Countries that reached a certain level of life expectancy earlier in time than other countries, and countries that improved their life expectancy more quickly than others, experienced higher levels of inequality.
Collapse
Affiliation(s)
- Jeroen Smits
- Department of Economics, Radboud University Nijmegen, PO Box 9108, 6500 HK Nijmegen, The Netherlands.
| | | |
Collapse
|
11
|
Morley CP. Primary care, patient autonomy, and healthcare justice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2008; 8:22-23. [PMID: 19003701 DOI: 10.1080/15265160802478438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Christopher P Morley
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
| |
Collapse
|
12
|
Abstract
OBJECTIVES The aim of this study was to introduce the concept of health inequalities, and to discuss the underlying assumptions and ethical backgrounds associated with the issue, as well as the theoretical and practical implications of health inequalities. METHODS Based on a review of the literature, we summarize the concepts of health inequalities and inequities and discuss the underlying assumptions and ethical backgrounds associated with these issues from the view of social justice theory. We then discuss the theoretical and practical implications of health inequalities. RESULTS Health inequality involves ethical considerations, such as judgments on fairness, and it could provide a sensitive barometer to reflect the fairness of social arrangements. Discussion on health inequalities could deepen our understanding of the social etiology of health and provide a basis for the development of comprehensive and integrative social policies. CONCLUSIONS Health equity is not a social goal in and of itself, but should be considered as a part of a broader effort to seek social justice.
Collapse
Affiliation(s)
- Young-Jeon Shin
- Department of Preventive Medicine, Hanyang University College of Medicine.
| | | |
Collapse
|