Socioeconomic Inequalities in Intimate Partner Violence: Evidence from Vietnam

Although socioeconomic inequality has been identified as a significant factor for violence against women, the connection between these two variables has not been widely recognized and addressed in many countries. This study aims to quantify the degree of socioeconomic inequalities in intimate partner violence (IPV) in Vietnam and investigate the contribution of each determinant factor that contributes to the observed inequality. We utilized the Vietnamese National Survey on Domestic Violence against Women (N = 4,019) for the analysis. Household wealth was used as a proxy for socioeconomic status. We used a concentration index to quantify the degree of socioeconomic inequality in emotional, physical, or sexual violence and a combination of these three types of violence. We further decomposed the concentration index to identify the contribution of each determinant to the observed inequality in IPV. We found that the prevalence of IPV was significantly concentrated among the worse-off across all types of IPV and that disparities in husband's occupation (48%), women's education (39%), husband's education (38%), and class (34%) were the primary factors contributing to increased inequalities in IPV. Our results indicated that higher education and engagement in skilled jobs were highly concentrated among the better-off, creating unequal distribution of these variables across wealth. Policy could mitigate the inequality in IPV by expanding women's access to education and economic opportunities. However, interventions should target both men and women and within couples because husband's characteristics also play an important role in explaining socioeconomic inequalities in IPV.

Determinants of Hispanic and non-Hispanic Workers' Intent to Work Past Age 65: An Analysis From the Life Course Perspective

Background: The average retirement age in the United States (U.S.) has increased over the past few decades. However, the rate of increase for Hispanics is lower than that for non-Hispanics. For Hispanics, the decision to retire later may be more influenced by their migration history and context rather than health or finances. Objective: This study aims to explore the differences in the determinants of intentions to delay retirement (i.e., work beyond the age of 65) between Hispanics and non-Hispanic Whites in the U.S. Methods: A pooled sample was generated from all waves of the Health and Retirement Study (1992-2014), including a unique record for each non-institutionalized individual aged 55-61 who was employed. All eligible Hispanics (n = 3,663) were included, while a random sample of non-Hispanic Whites (n = 3,663) was selected. Logistic mixed models were conducted for each group, and a Two-fold Oaxaca-Blinder decomposition analysis was used to explore differences between the groups. Results: The results indicate that non-Hispanic Whites are more likely to plan to postpone retirement. Furthermore, significant differences were found between Hispanics and non-Hispanic Whites regarding their intentions to delay retirement, specifically related to socioeconomic indicators such as individual earnings, amount of debt, level of education, and parents' level of education. The differences between the groups were primarily influenced by the amount of debt, having a defined benefit plan, and parents' level of education, reflecting the cumulative disadvantage experienced by Hispanics over their life course. Conclusion: Most existing research on the topic has focused on middle-class Whites, while few studies have examined race or ethnicity as the primary focus or explored the extent to which commonly identified predictors of delayed retirement apply to different ethno-racial groups. This is significant because Hispanics and other disadvantaged groups tend to experience financial insecurity during retirement, which directly impacts their health and well-being.

Global, regional and national burden of ischemic stroke attributed to high low-density lipoprotein cholesterol, 1990-2019：A decomposition analysis and age-period-cohort analysis

High levels of low-density lipoprotein cholesterol (LDL-C) have been associated with an augmented mortality of ischemic stroke. The yearly deaths and mortality data of IS-hLDL-C were derived from the global burden of disease 2019 dataset. The joinpoint, age-period-cohort and decomposition analysis were utilized to evaluate the long-term patterns in the disease burden of IS-hLDL-C, and the effects of population growth and aging. Globally, in 2019, 0.61 million ischemic stroke-related deaths were attributable to high LDL-C, with the highest death burden in the high-middle socio-demographic index (SDI) region. From 1990 to 2019, the age-standardized death rate (ASDR) for IS-hLDL-C exhibited a downward trend, with an average annual percentage change of -1.69 [95% confidence interval: -1.90, -1.48)]. The fastest decreasing trends in ASDR were experienced in the high SDI region. In 119 (58.33%) countries, aging increased the disease burden of hLDL-IS, and population growth increased the disease burden of IS-hLDL-C in 163 (79.90%) countries. The trend in disease burden of IS-hLDL-C exhibited variation across countries and regions, particularly in territories with high to middle high SDI. Aging in upper to middle-income countries and population growth in low to middle-income countries further offset endeavors to reduce the burden of ischemic stroke deaths.

Epidemiology of gout - Global burden of disease research from 1990 to 2019 and future trend predictions

Background

Understanding the global burden of gout in the past and future can provide important references for optimizing prevention and control strategies in healthcare systems.

Objectives

This study aimed to report variations in the global disease burden and risk factors of gout in 204 countries and territories from 1990 to 2019.

Design

We conducted a retrospective analysis of gout based on the latest Global Burden of Disease (GBD) 2019 database.

Methods

We collected data on the prevalence, incidence, and disability-adjusted life years (DALYs) of gout from 1990 to 2019. The data were then stratified by age, sex, and economic development level. Decomposition analysis, frontier analysis, and prediction models were used to analyze the changes and influencing factors influencing each indicator.

Results

Globally, there were 53,871,846.4 [95% uncertainty interval (UI): 43,383,204.6-66,342,327.3] prevalent cases, 92,228,86.8 (95% UI: 7419,132.1-11,521,165) incident cases, and 1673,973.4 (95% UI: 1,068,061.1-2,393,469.2) cases of DALYs of gout in 2019, more than double those in 1990. Moreover, the pace of increase in the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), and age-standardized DALY rate (ASDR) accelerated during 1990-2019, with estimated annual percentage changes (EAPC) of 0.94 [95% confidence interval (CI): 0.85-1.03], 0.77 (95% CI: 0.69-0.84), and 0.93 (95% CI: 0.84-1.02), respectively, especially among men. The disease burden of gout has increased in all the other 20 GBD regions in the past 30 years, except Western Sub-Saharan Africa. The highest risk of high body mass index (BMI) and kidney dysfunction was in high-income countries such as North America and East Asia. The global prevalence rate, incidence rate, and DALYs rate of gout in 2030 will reach 599.86, 102.96 per 100,000 population, and 20.26 per 100,000 population, respectively, roughly the same as in 2019.

Conclusion

With the development of society, the disease burden of gout will become increasingly severe. It is very important to study the accurate epidemiological data on gout for clinical diagnosis and treatment and health policy.

Causal decomposition maps: An exploratory tool for designing area-level interventions aimed at reducing health disparities

Methods for decomposition analyses have been developed to partition between-group differences into explained and unexplained portions. In this paper, we introduce the concept of causal decomposition maps, which allow researchers to test the effect of area-level interventions on disease maps before implementation. These maps quantify the impact of interventions that aim to reduce differences in health outcomes between groups and illustrate how the disease map might change under different interventions. We adapt a new causal decomposition analysis method for the disease mapping context. Through the specification of a Bayesian hierarchical outcome model, we obtain counterfactual small area estimates of age-adjusted rates and reliable estimates of decomposition quantities. We present two formulations of the outcome model, with the second allowing for spatial interference of the intervention. Our method is utilized to determine whether the addition of gyms in different sets of rural ZIP codes could reduce any of the rural-urban difference in age-adjusted colorectal cancer incidence rates in Iowa ZIP codes.

The occurence of cancer in ageing populations at global and regional levels, 1990 to 2019

BACKGROUND

population ageing contributes to increased cancer cases and deaths and has profound implications for global healthcare systems. We estimated the trends of cancer cases and deaths in ageing populations at global and regional levels.

METHODS

using data from the Global Burden of Disease Study 2019, we analysed the change in cancer cases and deaths associated with population ageing, population growth and epidemiological factors from 1990 to 2019 using decomposition analysis. Additionally, we estimated the proportions of people aged 65 years and over accounting for total cases and deaths, and investigated relationships between the proportions and the Sociodemographic Index (SDI) using the Pearson correlation coefficient.

RESULTS

from 1990 to 2019, there was an increase of 128.9% for total cases and 74.8% for total deaths in all cancers combined; the percentages of older people increased from 48.6% to 56.4% for cases and from 52.0% to 61.9% for deaths. Population ageing contributed to the largest increase in global cancer occurrence, with 56.5% for cases and 63.3% for deaths. However, the changes attributed to epidemiological factors was 5.2% for cancer cases and -33.4% for cancer deaths. The proportions of total cases and deaths of older adults were positively correlated with socioeconomic development of the country.

CONCLUSION

our findings revealed that the main contributor to increased cancer cases and deaths has changed from comprehensive epidemiological factors to demographic shifts. To respond to the rapidly growing occurrence of cancer in ageing populations, the global health priority should focus on meeting the rising demand for cancer diagnosis, treatment and care services for older people.

Driving factors and decoupling analysis of natural gas consumption in major Organization for Economic Cooperation and Development countries

Natural gas is regarded as the main transition energy under the carbon-neutral strategy and its main consumers are Organization for Economic Cooperation and Development countries, accounting for 44.5% of world consumption in 2021. In order to investigate the effects of technology, industry, and regions on natural gas consumption, 12 major Organization for Economic Cooperation and Development countries from three different country groups were selected in this paper to explore the consumption change. Firstly, the Logarithmetic Mean Divisia Index model is adopted to find out the driving factors. Then, the Tapio model is used to consider the decoupling state between natural gas consumption and economic growth. The results can be concluded as follows: (a) From 2000 to 2020, the technological progress effect has the biggest values of -148.86, followed by the industrial structure effect and the regional scale effect, with values of - 37.04 and 29.42, respectively. (b) From the perspective of industry view, these three effects have the largest impact on the secondary industry, followed by the tertiary industry and primary industry; (c) the regional scale effect has a positive effect on most countries, and the industrial structure effect and the regional scale effect have a negative effect on most countries; (d) the decoupling state vary differently in countries with different groups. Therefore, we concluded two policy recommendations for nature gas reduction: (a) Technological innovation is the most effective way for reducing natural gas consumption; (b) Industrial structure optimization can help save natural gas consumption.

Preventable burden of head and neck cancer attributable to tobacco and alcohol between 1990 and 2039 in China

Tobacco use and heavy alcohol consumption are risk factors for head and neck cancer (HNC), including oral, pharynx, and larynx cancer. No study has investigated the preventable burden of HNC attributable to tobacco and alcohol in China. We extracted data from 1990 to 2019 from the Global Burden of Disease. The preventable burden attributable to tobacco and alcohol was estimated by subtracting the overlapping fraction derived from a literature search. Descriptive analyses were performed initially, followed by joinpoint regression and age-period-cohort (APC) analysis. The future burden was forecasted using a Bayesian APC model. The crude burden increased significantly, while the age-standardized rates showed a downward trend from 1990 to 2019 in China. Both all-age and age-standardized population attributable fractions rose significantly, potentially due to the poor prognosis of tobacco- and alcohol-associated HNC. The absolute burden would continue to climb in the next 20 years from 2019, largely due to population aging. For site-specific burden, compared with total, pharynx, and larynx cancer burden, the substantial upward trend of oral cancer burden indicated a strong interaction with risk factors such as genetic susceptibility, betel nut chewing, oral microbiota, and human papillomavirus. The burden of oral cancer attributable to tobacco and alcohol is a major concern and is anticipated to become more severe than cancer in other anatomic sites. Altogether, our study provides useful information to rethink the current restrictions on tobacco and alcohol, lean healthcare resources, and develop effective HNC prevention and control strategies.

Investigating Health Inequality Using Trend, Decomposition and Spatial Analyses: A Study of Maternal Health Service Use in Nepal

Objectives: (a) To quantify the level and changes in socioeconomic inequality in the utilization of antenatal care (ANC), institutional delivery (ID) and postnatal care (PNC) in Nepal over a 20-year period; (b) identify key drivers of inequality using decomposition analysis; and (c) identify geographical clusters with low service utilization to inform policy. Methods: Data from the most recent five waves of the Demographic Health Survey were used. All outcomes were defined as binary variables: ANC (=1 if ≥4 visits), ID (=1 if place of delivery was a public or private healthcare facility), and PNC (=1 if ≥1 visits). Indices of inequality were computed at national and provincial-level. Inequality was decomposed into explanatory components using Fairile decomposition. Spatial maps identified clusters of low service utilization. Results: During 1996-2016, socioeconomic inequality in ANC and ID reduced by 10 and 23 percentage points, respectively. For PND, the gap remained unchanged at 40 percentage points. Parity, maternal education, and travel time to health facility were the key drivers of inequality. Clusters of low utilization were displayed on spatial maps, alongside deprivation and travel time to health facility. Conclusion: Inequalities in the utilization of ANC, ID and PNC are significant and persistent. Interventions targeting maternal education and distance to health facilities can significantly reduce the gap.

Socioeconomic Inequality in Knowledge About HIV and Its Contributing Factors Among Women of Reproductive Age in Sub-Saharan Africa: A Multicountry and Decomposition Analysis

Aim

To examine the socioeconomic inequality in knowledge about HIV and its contributing factors among women of reproductive age in sub-Saharan Africa.

Methods

We have used the most recent demographic and health survey data of the 15 sub-Saharan African countries. 204,495 women of reproductive age made up the entire weighted sample. Erreygers normalized concentration index (ECI) was utilized to evaluate socioeconomic inequality in knowledge about HIV. The variables that contributed to the observed socioeconomic inequality were determined using decomposition analysis.

Results

We found the pro-rich inequality in knowledge about HIV (the weighted ECI was 0.16 with a Standard error = 0.007 and P value< 0.001). The decomposition analysis indicated that educational status (46.10%), wealth status (30.85%), listening to the radio (21.73%), and reading newspapers (7.05%) were among the contributors to the pro-rich socioeconomic inequalities in knowledge about HIV.

Conclusion

Having knowledge about HIV is concentrated among rich reproductive-age women. Educational status, wealth status, and media exposure were the major contributors and should be a priority for interventions to reduce the inequality in knowledge about HIV.

Decomposing Disability Inequality in Unmet Healthcare Needs and Preventable Hospitalizations: An Analysis of the Korea Health Panel

Objectives: This study examines the inequality between people with and without disabilities regarding unmet healthcare needs and preventable hospitalization. Methods: We used the Korea Health Panel of 2016-2018; the final analytical observations were 43,512, including 6.95% of persons with disabilities. We examined the differences in contributors to the two dependent variables and decomposed the observed differences into explained and unexplained components using the Oaxaca-Blinder approach. Results: Unmet healthcare needs and preventable hospitalizations were 5.6% p (15.36% vs. 9.76%) and 0.68% p (1.82% vs. 0.61%), respectively, higher in people with disabilities than in those without, of which 48% and 35% were due to characteristics that the individual variables cannot explain. Decomposition of the distributional effect showed that sex, age, and chronic disease significantly increased disparities for unmet healthcare needs and preventable hospitalization. Socioeconomic factors such as income level and Medical aid significantly increased the disabled-non-disabled disparities for unmet healthcare needs. Conclusion: Socioeconomic conditions increased the disparities, but around 35%-48% of the disparities in unmet healthcare needs and preventable hospitalization were due to unexplained factors, such as environmental barriers.

Wealth- and education-related inequalities in minimum dietary diversity among Indonesian infants and young children: a decomposition analysis

Background

Over the last two decades, Indonesia has experienced remarkable economic growth. However, the percentage of infants and young children meeting the minimum dietary diversity (MDD) criteria has stagnated. Despite the growing body of evidence of the association between MDD and socioeconomic factors, there is little information about socioeconomic inequalities in MDD in Indonesia.

Objectives

The current study seeks to quantify the wealth- and education-related inequalities in MDD among infants and young children in Indonesia and determine the contribution of different factors to these disparities.

Methods

We included a total of 5038 children aged 6–23 months of the 2017 Indonesia Demographic and Health Survey. We measured wealth- and education-related inequalities using the concentration curve and Wagstaff normalised concentration index. Using a concentration index decomposition analysis, we then examined factors contributing to wealth- and education-related inequalities in MDD.

Results

The concentration indices by household wealth and maternal education were 0.220 (p < 0.001) and 0.192 (p < 0.001), respectively, indicating more concentration of inequalities among the advantaged population. The decomposition analysis revealed that household wealth (29.8%), antenatal care (ANC) visits (16.6%), paternal occupation (15.1%), and maternal education (11.8%) explained the pro-rich inequalities in MDD in Indonesia. Maternal education (26.1%), household wealth (19.1%), ANC visits (14.9%), and paternal occupation (10.9%) made the most considerable contribution to education-related inequalities in MDD.

Conclusions

There is substantial wealth- and education-related inequalities in MDD. Our findings suggest an urgent need to address the underlying causes of not reaching dietary diversity by promoting infant and young child feeding equity in Indonesia.

Wealth inequalities in reproductive and child health preventive care in Mozambique: a decomposition analysis

Background

Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference.

Objective

To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis.

Methods

Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15–49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality.

Results

The Cindex was −0.081 for non-ITN, −0.189 for lack of vaccination coverage and −0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap.

Conclusion

There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.

Diabetes, Hypertension, and Comorbidity among Bangladeshi Adults: Associated Factors and Socio-Economic Inequalities

Diabetes, hypertension, and comorbidity are still crucial public health challenges that Bangladeshis face. Nonetheless, very few studies have been conducted to examine the associated factors, especially the socioeconomic inequalities in diabetes, hypertension, and comorbidity in Bangladesh. This study explored the prevalence of, factors connected with, and socioeconomic inequalities in diabetes, hypertension, and comorbidity among Bangladeshi adults. We used the Bangladesh Demographic and Health Survey (BDHS) data set of 2017−2018. A total of 12,136 (weighted) Bangladeshi adults with a mean age of 39.5 years (±16.2) participated in this study. Multilevel (mixed-effect) logistic regression analysis was employed to ascertain the determinants of diabetes, hypertension, and comorbidity, where clusters were considered as a level-2 factor. The concentration curve (CC) and concentration index (CIX) were utilized to investigate the inequalities in diabetes, hypertension, and comorbidity. The weighted prevalence of diabetes, hypertension, and comorbidity was 10.04%, 25.70%, and 4.47%, respectively. Age, body mass index, physical activity, household wealth status, and diverse administrative divisions were significantly associated with diabetes, hypertension, and comorbidity among the participants. Moreover, participants’ smoking statuses were associated with hypertension. Women were more prone to hypertension and comorbidity than men. Diabetes (CIX: 0.251, p < 0.001), hypertension (CIX: 0.071, p < 0.001), and comorbidity (CIX: 0.340, p < 0.001) were higher among high household wealth groups. A pro-wealth disparity in diabetes, hypertension, and comorbidity was found. These inequalities in diabetes, hypertension, and comorbidity emphasize the necessity of designing intervention schemes geared towards addressing the rising burden of these diseases.

Trend of adherence to iron supplementation during pregnancy among Ethiopian women based on Ethiopian demographic and health surveys: A Multivariable decomposition analysis

Background

Iron deficiency is one of the significant factors of anemia during pregnancy. Iron supplementation is the main method of prevention and control of iron deficiency anemia, and its effectiveness depends on adherence to the iron supplementation.

Methods

This study was based on a secondary analysis of 2005, 2011, and 2016 EDHS data. After the data was weighted using sampling weight, 696, 1,282, and 3,096 in 2005, 2011, and 2016 EDHS data, respectively, were used for the final analysis. The data were edited, cleaned, coded, managed, and analyzed using StataCorp version 16 software. A logit-based multivariable decomposition analysis was used to identify variables significantly associated with the change in the adherence level during pregnancy.

Results

Adherence levels increased from 1.1% (95% CI; 0.4, 2.7) in 2005 EDHS to 12.4% (95% CI; 10.9, 14.1) in 2016 EDHS. About 30.9% of the overall change in the adherence level to iron supplement use during pregnancy was due to the difference in women's sociodemographic-related variables. After adjusting for these compositional changes, ~69.1% of the change in the adherence level was because of the difference in the coefficients (behavior-related variables). Among the behavioral characteristics, women's age-group, rich wealth index, and secondary and above-secondary educational status of their husbands had a statistically significant effect on the positive change in the adherence level of pregnant mothers.

Conclusion

The adherence level to iron supplement use during pregnancy has increased significantly over the last decade in Ethiopia. Both the compositional and behavioral characteristics of women play a major role in the increasing trend of adherence levels.

Infant Death Clustering in the Quarter of a Century in India: A Decomposition Analysis

The study aims to examine the clustering of infant deaths in India and the relative contribution of infant death clustering after accounting for the socio-economic and biodemographic factors that explain the decline in infant deaths. The study utilized 10 years of birth history data from three rounds of the National Family Health Survey (NFHS). The random effects dynamic probit model was used to decompose the decline in infant deaths into the contributions by the socio-economic and demographic factors, including the lagged independent variable, the previous infant death measuring the clustering of infant deaths in families. The study found that there has been a decline in the clustering of infant deaths among families during the past two and half decades. The simulation result shows that if the clustering of infant deaths in families in India was completely removed, there would be a decline of nearly 30 percent in the infant mortality rate (IMR). A decomposition analysis based on the dynamic probit model shows that for NFHS-1 and NFHS-3, in the total change of the probability of infant deaths, the rate of change for a given population composition contributed around 45 percent, and about 44 percent was explained by a compositional shift. Between NFHS-3 and NFHS-4, the rate of change for a given population composition contributed 86%, and the population composition for a given rate contributed 10% to the total change in the probability of infant deaths. Within this rate, the contribution of a previous infant was 0.8% and the mother's age was 10%; nearly 31% was contributed by the region of residence, 69% by the mother's education, and around 20% was contributed by the wealth index and around 8.7% by the sex of the child. The mother's unobserved factors contributed more than 50 percent to the variability of infant deaths in all the survey rounds and was also statistically significant (p < 0.01). Bivariate analysis suggests that women with two or more infant losses were much less likely to have full immunization (10%) than women with no infant loss (62%), although institutional delivery was high among both groups of women.

The influence factors of interprovincial power transmission on China's CO2 emissions

Electric power system is a major source of CO2 emission in China. Understanding the evolution of power-related CO2 emission is an important step to both emission reduction and a sustainable energy transition. Here, we assess the CO2 emission of power production in China, finding that it increased by 47% from 2008 to 2017 despite a significant decrease in CO2 emission intensity of power production. The CO2 emission intensity of power production differs greatly across provinces, with the highest provincial CO2 emission intensity 11 times the lowest. To understand the evolution of power-related CO2 emission, this study quantified the embodied CO2 emissions of power transmission, and then use decomposition analysis to explore the influencing factors of it. We found that China's embodied CO2 emissions from power transmission increased from 315 to 523 Mt between 2008 and 2017, and the increase in electricity consumption and the dependence on power transmission networks are the important reasons for the increase in embodied CO2 emissions. Nationally, power transmission reduced CO2 emission by 78 Mt. because, compared to the east, the west generally has a larger CO2 emission factor. These dynamics will become important for policymakers and energy planners to achieve carbon neutrality.

Exploring mental health disability gaps in the labour market: the UK experience during COVID-19

People with long-term mental health problems that affect their daily activities are a growing proportion of the UK working population and they have a particularly low employment rate. We analyse gaps in labour market outcomes between mental health disabled and non-disabled people during the COVID-19 pandemic in the UK. We also decompose the outcome gaps in order to explore the relative importance of different factors in explaining these gaps. Our results suggest that the employment effects of the pandemic for mental health disabled people may have been temporary. However, they were more likely to be away from work and/or working reduced hours than people without a disability. Workers with mental health disability were over-represented in part-time work and in caring, leisure and other service occupations, which were disproportionately affected by COVID-19 and the economic response. This is important new evidence on the contribution of segmentation and segregation in explaining the labour market position of people with mental health disability. The longer term effects of the pandemic were still not apparent at the end of our analysis period (2021:Q3), but the concentration of disabled workers in cyclically sensitive sectors and part-time work means that they will always be particularly vulnerable to economic downturns.

Assessing the income-related inequality in obesity among the elderly in China: A decomposition analysis

Background

Obesity among the elderly imposes a significant health and economic burden. The purpose of this study was to measure the obesity prevalence and income-related inequality among older adults in China and to explore the determinants of the inequity.

Methods

Data were obtained from 4,541 older adults (60 years and older) participating in the China Family Panel Study, 2018. Obesity was defined as body mass index (BMI) ≥28 kg/m². Normalized concentration index and concentration curve were calculated to measure the income-related inequality. Decomposition analysis was used to measure the contribution of each factor to the overall unfairness.

Results

The prevalence of obesity among the respondents was 7.99%. The 95% confidence interval for the overall prevalence was 7.20-8.78%. The normalized concentration index of obesity in the elderly was 0.075 (95% confidence interval: 0.047-0.103), indicating that obesity was more concentrated among the rich (p < 0.05). Socioeconomic factors contributed the most to the overall inequality (68.73%). Health behavior factors explained 16.38% of the observed income-related inequality in obesity among the elderly in China.

Conclusions

In 2018, obesity was more concentrated among the elderly with higher incomes in China. The pro-poor income-related inequality was mainly due to the higher socioeconomic status of higher-income older adults. Health behaviors and psychosocial factors could also exacerbate the inequality. To prevent the heavy burden of obesity on the health and finances of older adults, more attention should be paid to those who are financially better off, especially those who smoke and are physically inactive, while extroverted older adults also need to be focused on. For developing countries, concern needs to be given to the obesity of the wealthy elderly as a result of economic development.

Evaluating Global Inequality Using Decomposition Approach

Given that there is no recent research on decomposition for global inequality, the aim of this study is to fill the gap in the literature by investigating global inequality with decomposition technique. The data of this study were compiled from the World Bank and decomposition by subgroups was conducted to evaluate the driving forces behind the evolution of inequality. Almost all the countries in the world were included in this study, and the study period spans from 2000 to 2017. The analysis was carried out in several stages to evaluate the issue of North-South divide, as well as the impacts of regional and income subgroups. There are several salient findings derived from this study. First, the results show that there was a gradual decline of international inequality within the study period. Second, there was still a large disparity between the developed and developing countries, and the inequality within the developing countries has aggravated further. Third, geographical location has exerted great impacts on global inequality and East Asia contributed about 40% to the overall decline in international inequality. Fourth, decline in inequality amongst the upper-middle-income countries also contributed substantially to the fall in international inequality. The results derived from this paper can provide pertinent information for the formulation of a comprehensive and coherent strategy in coordinating international efforts and managing inequality while promoting human development under the framework of the newly established Sustainable Development Goals.

Socioeconomic Inequity in the Screening and Treatment of Hypertension in Kenya: Evidence From a National Survey

Background

Non-communicable diseases (NCDs) account for 50% of hospitalisations and 55% of inpatient deaths in Kenya. Hypertension is one of the major NCDs in Kenya. Equitable access and utilisation of screening and treatment interventions are critical for reducing the burden of hypertension. This study assessed horizontal equity (equal treatment for equal need) in the screening and treatment for hypertension. It also decomposed socioeconomic inequalities in care use in Kenya.

Methods

Cross-sectional data from the 2015 NCDs risk factors STEPwise survey, covering 4,500 adults aged 18-69 years were analysed. Socioeconomic inequality was assessed using concentration curves and concentration indices (CI), and inequity by the horizontal inequity (HI) index. A positive (negative) CI or HI value suggests a pro-rich (pro-poor) inequality or inequity. Socioeconomic inequality in screening and treatment for hypertension was decomposed into contributions of need [age, sex, and body mass index (BMI)] and non-need (wealth status, education, exposure to media, employment, and area of residence) factors using a standard decomposition method.

Results

The need for hypertension screening was higher among poorer than wealthier socioeconomic groups (CI = -0.077; p < 0.05). However, wealthier groups needed hypertension treatment more than poorer groups (CI = 0.293; p <0.001). Inequity in the use of hypertension screening (HI = 0.185; p < 0.001) and treatment (HI = 0.095; p < 0.001) were significantly pro-rich. Need factors such as sex and BMI were the largest contributors to inequalities in the use of screening services. By contrast, non-need factors like the area of residence, wealth, and employment status mainly contributed to inequalities in the utilisation of treatment services.

Conclusion

Among other things, the use of hypertension screening and treatment services in Kenya should be according to need to realise the Sustainable Development Goals for NCDs. Specifically, efforts to attain equity in healthcare use for hypertension services should be multi-sectoral and focused on crucial inequity drivers such as regional disparities in care use, poverty and educational attainment. Also, concerted awareness campaigns are needed to increase the uptake of screening services for hypertension.

The Evolutionary Trend of Global Inequality: Analyzing the Impacts of Economic Structure

The aim of this study is to examine the evolution of inequality by focusing on the impacts of the economic structure. The technique of decomposition by income sources is employed to evaluate the contribution of the three major sectors, namely the agricultural, industrial, and service sectors to overall inequality. The data cover almost all the countries in the world from 2001 to 2017 for a total of 18 years. There are four stages of analysis in this study. The first stage of study is to provide an overall view of the evolutionary trend of global inequality, the second stage focuses on the North-South divide, the third stage determines the impacts of income groups, and the fourth stage investigates the impacts for each region. There are several salient findings: First, global inequality had declined in the study period. Second, the service sector is identified as the largest contributor to global inequality, followed by the industrial sector, while the contribution of the agricultural sector is negligible. For the North-South divide, disparity in the service sector was more marked in the North than in the South. The industrial sector played a major role in the South and contributed more than 40% to overall inequality. For the comparison amongst the income groups, our findings show that the higher the income, the higher the percentage contribution of the service sector (except for the low-income group). Finally, for the comparison across regions, although the contribution of the agricultural sector in most regions are below 1.5%; however, the contribution of the agricultural sector in both Sub-Saharan Africa and South Asia is more than 8%. It implies that a lot of people in these regions still rely on the agricultural sector for a living, and the development in the industrial and service sectors in these two regions lagged behind those of the other regions. Our analysis show that the evolution pattern is very different for each region, therefore, it is necessary to take the effects of income and geographical location into consideration in formulating development policies.

LMDI Decomposition Analysis of E-Waste Generation in the ASEAN

The economies of ASEAN member states are growing rapidly, and electrical and electronic waste (E-waste) generated from them are also showing a rapid increase. In this context, this study conducted an LMDI decomposition analysis on the amount of E-waste generated in ASEAN member countries from 2015 to 2019 and decomposed it into E-waste intensity, economic growth, and population effects. Then, based on analysis results, policy implications are suggested to improve their E-waste management. According to the analysis results, ASEAN countries can be classified into three groups. The first group includes Indonesia, the Philippines, Singapore, Thailand; economic growth was the main driving factor of E-waste increase in these countries. However, E-waste had also decreased due to the effect of E-waste intensity. The second group includes countries where economic growth was not the only driving factor for E-waste increase, but also where E-waste had increased due to the effect of E-waste intensity. These countries include Cambodia, Malaysia, and Viet Nam. Finally, the third group consists of countries where the effect of E-waste intensity is the main driving factor, including Brunei Darussalam, Lao PDR, and Myanmar. This research shows that ASEAN countries need policies that can effectively deal with the threat of E-waste as a result of high economic growth and policies that can improve intensity by reducing the generation of E-waste.

A decomposition analysis for socioeconomic inequalities in health status associated with the COVID-19 diagnosis and related symptoms during Brazil's first wave of infections☆

Recent studies have shown that COVID-19 affects different population groups asymmetrically. This work uses data from the National Survey of Households—PNAD COVID-19/IBGE—to quantify the socioeconomic inequality in health during the first wave of COVID-19 infections in Brazil. We use the concentration curve, the concentration index, and a decomposition analysis to verify the factors that most influence the inequalities in the specified health variables. We find a positive concentration index for the incidence rate, indicating a greater concentration of diagnoses (number of tests) among groups with higher income levels. When considering symptoms similar to a COVID-19 infection, inequality practically disappears. Among people with higher income, a pre-existing disease has a more significant contribution to the concentration of COVID-19 in the presence of correlated symptoms than in its diagnosis. Tests of dominance support the findings. Moreover, the decomposition results show that if the inequalities were explained only by race (non-white) and place of living (North and Northeast), there would be a concentration of COVID-19 among the poorest.

Environmental analysis of Turkey's aggregated and sector-level CO2 emissions

Turkey's ecological footprint has recently been increasing, while its biocapacity has been decreasing. Furthermore, the country's CO₂ emissions have been rising substantially in recent decades. Therefore, this study aims to identify the factors that are changing the CO2 emissions in Turkey, not only at the aggregated level but also for the sectors with the highest increases in CO₂ emissions, namely, electricity and heat production. Research into the aggregated CO₂ emissions and the sector-level analysis covered the period 1990-2017. The Shapley decomposition method was utilized, and the impacts of five factors, namely, scale effect, migration effect, population, energy intensity, and carbon intensity, were considered to examine the changes in total CO₂ emissions. Regarding the analysis of the electricity and heat production sectors, the roles of four factors, namely, income effect, electricity intensity, fuel structure, and pollution coefficient, were investigated by using the same decomposition approach. The results showed that the scale effect is the primary driver of acceleration of total CO₂ emissions in Turkey; population, migration, and carbon intensity effects follow the scale effect in this respect. Energy intensity significantly decreases Turkey's total emissions. For the electricity and heat production sectors, the Shapley decomposition results showed that the income effect, electricity intensity, and fuel structure increase the country's CO₂ emissions rapidly. The pollution coefficient was the only factor that decreased CO₂ in these sectors in the studied period. This study reveals that Turkey is still deficient in terms of green development processes, which are essential for a sustainable future.

Health in Conflict Zones: Analyzing Inequalities in Mental Health in Colombian Conflict-Affected Territories

Objectives: Colombia’s civil conflict and persistent socio-economic disparities have contributed to mental health inequalities in conflict-affected territories. We explore the magnitude of mental health inequalities, contributing socio-economic factors, and sociodemographic characteristics that explain these differences.

Methods: The study draws on data collected in 2018, using the household survey Conflicto, Paz y Salud (CONPAS) applied to 1,309 households in Meta, Colombia. Logistic regression and decomposition analysis were used to analyze the risk of mental health disorders, measured with the Self-Reporting Questionnaire -20 (SRQ-20).

Results: Individuals with lower socio-economic status are at a higher risk for mental health disorders. Forced displacement accounts for 31% of the measured mental health inequalities. Disparities in employment, education level, disability and conflict incidence between municipalities are other contributing factors. Women and people with disabilities are respectively 2.3 and 1.2 times more prone to present a mental health disorder.

Conclusion: It is necessary to tackle the identified risk factors and sociodemographic circumstances that contribute to mental health inequalities in conflict-affected territories, as these hinder adequate/equitable access to mental health services.

Unhealthy Immigrants: Sources for Health Gaps Between Immigrants and Natives in Israel

The study focuses on sources for health gaps between Jewish immigrants and native-born Israelis. Unlike traditional immigrant societies where immigration is viewed as economically motivated, immigrants returning to Israel are viewed as the "returning diaspora". Because immigrants in Israel are entitled to the same health benefits and medical services as native-born, we expect Israel to attract unhealthy immigrants in disproportionate numbers. The data for the analysis are obtained from the Israeli National Health Interview Survey (2013-2015). The data set provides detailed information on health status and illness, sociodemographic attributes and origin of immigrants. Three major origin groups of immigrants are distinguished: the former Soviet Union, Western Europeans or the Americans (mostly Ashkenazim), and Asians or North Africans (mostly Sephardim). Our findings lend support to the expectations that the health status of all immigrant groups is poorer than that of native-born Israelis. The nativity-illness gap is most pronounced in the case of male immigrants (from Europe or the Americas or South Africa or Australia) and for female immigrants (from countries in the Middle East or North Africa) and least pronounced in the case of immigrants arriving from the former Soviet Union for both gender groups. Decomposition of the gaps into components reveals that some portion of the illness gap can be attributed to nativity status, but the largest portion of the gap is attributed to demographic characteristics. Neither socioeconomic status nor health-related behavior accounts for a substantial portion of the nativity-illness gap for all subgroups of immigrants.

[Effect of Hydraulic Residence Time on Removal Efficiency of Pollutants in Subsurface Flow Constructed Wetlands and Analysis of Denitrification Mechanism]

This study used vertical and horizontal subsurface constructed wetlands with continuous inflow, to compare and analyze the effects of four hydraulic residence times on the removal efficiency of conventional pollutants. Using the optimal hydraulic retention time, the two types of wetlands were examined in terms of the stromal layer nitrification, denitrification, and ammonia oxidation abundance of functional genes, as well as the intensity of nitrification and denitrification. In addition, redundancy analysis and variance decomposition analysis were used to determine the main factors affecting nitrogen removal in the two kinds of wetlands, so that targeted improvement measures can be suggested. The best removal efficiency of conventional pollutants (COD, TP, TN, and NH₄⁺-N) was achieved with a hydraulic retention time of 24 h, resulting in a removal rate of more than 70%. With a 24 h retention time, the removal rate of NH₄⁺-N and TN and the intensity of nitrification and denitrification exhibited a gradually decreasing trend along the flow direction. Among the three functional genes, the abundance of denitrification functional genes (nirS) was much higher than that of nitrification functional genes (nxrA) and ammonia oxidation functional genes (AOB-amoA). In this study, the nitrogen removal ability of the two subsurface flow constructed wetlands was jointly affected by environmental factors and microbial factors, among which microbial factors contributed the most to nitrogen removal (55% and 48%). In addition, the removal rates of TN and NH₄⁺-N were proportional to DO, specific surface area of substrate, COD concentration, as well as nitrification and denitrification functional genes, but inversely proportional to pH. Therefore, in order to improve the nitrogen removal efficiency of both systems, the amount of dissolved oxygen and carbon sources in the substrate layer should be increased, while the pH value should be appropriately reduced. Moreover, the horizontal subsurface constructed wetland significantly improves the nitrogen removal efficiency of the system, as the substrate layer has a larger specific surface area. This study provides a theoretical basis for the design of constructed wetlands and the selection of an optimal hydraulic residence time. Quantitative analysis of nitrogen removal pathways is of great significance for understanding the nitrogen removal mechanism and improving the nitrogen removal rate in constructed wetlands.

Socioeconomic Inequalities and Obesity in South Africa-A Decomposition Analysis

Background: Prior evidence shows that inequalities are related to overweight and obesity in South Africa. Using data from a recent national study, we examine the socioeconomic inequalities associated with obesity in South Africa and the factors associated with it. Methods: We use quantitative data from the South African National Health and Nutrition Examination Survey (SANHANES-1) carried out in 2012. We estimate the concentration index (CI) to identify inequalities and decompose the CI to explore the determinants of these inequalities. Results: We confirm the existence of pro-rich inequalities associated with obesity in South Africa. The inequalities among males are larger (CI of 0.16) than among women (CI of 0.09), though more women are obese than men. Marriage increases the risk of obesity for women and men, while smoking decreases the risk of obesity among men significantly. Higher education is associated with lower inequalities among females. Conclusions: We recommend policies to focus on promoting a healthy lifestyle, including the individual’s perception of a healthy body size and image, especially among women.

Persistent Socioeconomic Inequalities in Measles Vaccine Uptake in Ethiopia in the Period 2005 to 2016

OBJECTIVE

This study aims to quantify socioeconomic inequalities-and the factors contributing to these inequalities-in measles vaccine uptake among children aged 12 to 23 months in Ethiopia between 2005 and 2016.

METHODS

Inequalities in measles vaccine uptake were investigated based on data from the Ethiopian Demographic and Health Surveys conducted in 2005, 2011, and 2016. Concentration curves and concentration indices were used to measure the degree of inequality, and decomposition analysis was used to identify factors contributing to these inequalities.

RESULTS

The overall level of national measles vaccine uptake in Ethiopia exhibited an increasing trend between 2005 and 2016. As indicated by the concentration index of measles vaccine uptake, however, which was estimated at 0.202 (P < .01) in 2005, 0.226 (P < .01) in 2011, and 0.223 (P < .01) in 2016, measles vaccine uptake became consistently more concentrated among children from more affluent households. The dominance test of the concentration curve further confirmed the persistence of inequalities in measles vaccine uptake over time. Various factors-including maternal educational level, antenatal care use, institutional delivery, and exposure to media-were identified as the most important contributors to the inequalities.

CONCLUSIONS

Although the national measles vaccine uptake showed improvement between 2005 and 2016, socioeconomic inequalities in the uptake persisted over time. Efforts to improve the national immunization coverage should be accompanied by appropriate measures to address the inequalities.

Impact of Land Urbanization on Carbon Emissions in Urban Agglomerations of the Middle Reaches of the Yangtze River

The urban agglomerations in the middle reaches of the Yangtze River (MYR-UA) are facing a severe challenge in reducing carbon emissions while maintaining stable economic growth and prioritizing ecological protection. The energy consumption related to land urbanization makes an important contribution to the increase in carbon emissions. In this study, an IPAT/Kaya identity model is used to understand how land urbanization affected carbon emissions in Wuhan, Changsha, and Nanchang, the three major cities in the middle reaches of the Yangtze River, from 2000 to 2017. Following the core idea of the Kaya identity model, sources of carbon emissions are decomposed into eight factors: urban expansion, economic level, industrialization, population structure, land use, population density, energy intensity, and carbon emission intensity. Furthermore, using the Logarithmic Mean Divisia Index (LMDI), we analyze how the different time periods and time series driving forces, especially land urbanization, affect regional carbon emissions. The results indicate that the total area of construction land and the total carbon emissions increased from 2000 to 2017, whereas the growth in carbon emissions decreased later in the period. Energy intensity is the biggest factor in restraining carbon emissions, followed by population density. Urban expansion is more significant than economic growth in promoting carbon emissions, especially in Nanchang. In contrast, the carbon emission intensity has little influence on carbon emissions. Changes in population structure, industrial level, and land use vary regionally and temporally over the different time period.

Inequality and Inequity in Outpatient Care Utilization in Ethiopia: A Decomposition Analysis of Ethiopian National Health Accounts

BACKGROUND

Inequity in healthcare use is avoidable inequality, and it exists when there are differences in the use of healthcare after standardization of different needs among the population. In Ethiopia, wide variation and lower achievement exists in outpatient visit per person per year against the target to reach by 2020. Therefore, this study is aimed at measuring inequalities and inequities in outpatient care utilization in Ethiopia.

METHODS

The study utilized data from 2015/16 Ethiopian National Health Account survey. The analysis included a weighted sample of 42,460 individuals. Concentration curve and indices were used to measure inequality in outpatient care utilization. Deviations in the degree to which outpatient care was distributed according to need were measured by the horizontal inequity index. All statistical analyses were done using STATA version 14. In all analyses statistical significance was declared at a p-value < 0.05 and a 95% confidence interval.

RESULTS

The outpatient care utilizations were found to be concentrated among the rich. The actual (C = 0.0335, 95% CI: 0.0298, 0.0431) and need predicted (C = 0.0157, 95% CI: 0.0117, 0.0413) utilizations were concentrated among the rich. The distributions of outpatient care in Ethiopians were pro-rich (rich-favoring). The decomposition analysis revealed that need factors were the main positive contributors to the inequality (23.6%) and non-need factors were among the negative contributors to the inequality (-48.4%).

CONCLUSION

This study evidenced the presence of rich-favoring inequality and inequity in outpatient care utilization in Ethiopia. Therefore, there is a need to consider implementation strategies that focus on fairness in healthcare utilization.

Understanding Technology, Fuel, Market and Policy Drivers for New York State's Power Sector Transformation

A thorough understanding of the drivers that affect the emission levels from electricity generation, support sound design and the implementation of further emission reduction goals are presented here. For instance, New York State has already committed a transition to 100% clean energy by 2040. This paper identifies the relationships among driving factors and the changes in emissions levels between 1990 and 2050 using the logarithmic mean divisia index analysis. The analysis relies on historical data and outputs from techno-economic-energy system modeling to elude future power sector pathways. Three scenarios, including a business-as-usual scenario and two policy scenarios, explore the changes in utility structure, efficiency, fuel type, generation, and emission factors, considering the non-fossil-based technology options and air regulations. We present retrospective and prospective analysis of carbon dioxide, sulfur dioxide, nitrogen oxide emissions for the New York State’s power sector. Based on our findings, although the intensity varies by period and emission type, in aggregate, fossil fuel mix change can be defined as the main contributor to reduce emissions. Electricity generation level variations and technical efficiency have relatively smaller impacts. We also observe that increased emissions due to nuclear phase-out will be avoided by the onshore and offshore wind with a lower fraction met by solar until 2050.

Socioeconomic inequality in dental caries experience expressed by the significant caries index: cross-sectional results from the RaNCD Cohort Study

INTRODUCTION

Socioeconomic inequality in dental caries among Iranian middle-aged adults remains largely unstudied. This study aimed to measure socioeconomic inequality in dental caries experience and to identify determinants of this inequality.

MATERIALS AND METHODS

Data were obtained from the Ravansar Non-Communicable Diseases (RaNCD) Cohort Study. This cross-sectional analysis included 10,002 adults aged 35-65 years. Caries experience was dichotomised based on the decayed, missing and filled teeth (DMFT) of one-third of the population with the highest caries scores (i.e. significant caries index). Socioeconomic status (SES) was calculated using the principal component analysis. The concentration index (CI) was used to quantify the extent of socioeconomic inequality in dental caries experience. Decomposition analysis was conducted to quantify the contribution of each determinant to the observed inequality.

RESULTS

The mean DMFT for all individuals was 16.1(SD 9.1). The CI of having significant dental caries was -0.236 (95% CI: -0.0259, -0.213), indicating that having significant dental caries was more concentrated among low-SES individuals. SES (65.6%), age group (24.7%) and female gender (3.7%) were found to have the largest percentage of contributions to the observed inequality in dental caries.

CONCLUSION

This study indicates pro-rich inequalities in dental caries experience among middle-aged adults in Iran. The findings highlight the importance of early prevention of dental caries experience before it happens. To mitigate inequalities in dental caries experience, policy interventions should focus on females, older age groups, and low-SES individuals.

Socioeconomic-related inequalities in self-rated health status in Kermanshah city, Islamic Republic of Iran: a decomposition analysis

Background

Socioeconomic-related inequalities in health are a major public health challenge in both developed and developing countries. Little evidence is available on socioeconomic-related inequalities in health in different regions of the Islamic Republic of Iran.

Aims

This study aimed to determine socioeconomic-related inequality in poor self-rated health in adults in Kermanshah city, western Islamic Republic of Iran.

Methods

This cross-sectional study with stratified sampling obtained data on socioeconomic status, demographic characteristics, behavioural risk factors and self-rated health of 2040 adults (≥ 18 years) in Kermanshah city. A self-administrated questionnaire was used to collect data from the participants. The concentration (C) index and C curve were used to determine the socioeconomic-related inequality in poor self-rated health. A decomposition analysis of the C index was done to identify the factors explaining socioeconomic-related inequality in poor self-rated health.

Results

The crude and age-adjusted prevalence of poor self-rated health was 13.8% and 18.1%, respectively. The estimated C for the whole sample was -0.295, indicating that poor SRH was concentrated in the poor. The decomposition results suggested that socioeconomic status (45.5%), having a chronic health condition (11.9%) and smoking (7.3%) were the main factors contributing to the concentration of poor self-rated health among those of lower socioeconomic status.

Conclusion

The concentration of poor self-rated health among the poor in Kermanshah city warrants policy attention. Policies aimed at reducing inequality in wealth distribution and risky health behaviour and preventing chronic health conditions among the poor may mitigate socioeconomic-related inequalities in poor self-rated health in Kermanshah.

A latent class approach to inequity in health using biomarker data

We adopt an empirical approach to analyse, measure and decompose inequality of opportunity (IOp) in health, based on a latent class model. This addresses some of the limitations that affect earlier work in this literature concerning the definition of types, such as partial observability, the ad hoc selection of circumstances, the curse of dimensionality and unobserved type-specific heterogeneity that may lead to biased estimates of IOp. We apply our latent class approach to measure IOp in allostatic load, a composite measure of biomarker data. Using data from Understanding Society: The UK Household Longitudinal Study (UKHLS), we find that a latent class model with three latent types best fits the data, with the corresponding types characterised in terms of differences in their observed circumstances. Decomposition analysis shows that about two thirds of the total inequalities in allostatic load can be attributed to the direct and indirect contribution of circumstances and that the direct contribution of effort is small. Further analysis conditional on age-sex groups reveals that the relative (percentage) contribution of circumstances to the total inequalities remains mostly unaffected and the direct contribution of effort remains small.

The impact of violence on Venezuelan life expectancy and lifespan inequality

BACKGROUND

Venezuela is one of the most violent countries in the world. According to the United Nations, homicide rates in the country increased from 32.9 to 61.9 per 100 000 people between 2000 and 2014. This upsurge coincided with a slowdown in life expectancy improvements. We estimate mortality trends and quantify the impact of violence-related deaths and other causes of death on life expectancy and lifespan inequality in Venezuela.

METHODS

Life tables were computed with corrected age-specific mortality rates from 1996 to 2013. From these, changes in life expectancy and lifespan inequality were decomposed by age and cause of death using a continuous-change model. Lifespan inequality, or variation in age at death, is measured by the standard deviation of the age-at-death distribution.

RESULTS

From 1996 to 2013 in Venezuela, female life expectancy rose 3.57 [95% confidence interval (CI): 3.08-4.09] years [from 75.79 (75.98-76.10) to 79.36 (78.97-79.68)], and lifespan inequality fell 1.03 (-2.96 to 1.26) years [from 18.44 (18.01-19.00) to 17.41 (17.30-18.27)]. Male life expectancy increased 1.64 (1.09-2.25) years [from 69.36 (68.89-59.70) to 71.00 (70.53-71.39)], but lifespan inequality increased 0.95 (-0.80 to 2.89) years [from 20.70 (20.24-21.08) to 21.65 (21.34-22.12)]. If violence-related death rates had not risen over this period, male life expectancy would have increased an additional 1.55 years, and lifespan inequality would have declined slightly (-0.31 years).

CONCLUSIONS

As increases in violence-related deaths among young men (ages 15-39) have slowed gains in male life expectancy and increased lifespan inequality, Venezuelan males face more uncertainty about their age at death. There is an urgent need for more accurate mortality estimates in Venezuela.

Inequalities in Rotavirus Vaccine Uptake in Ethiopia: A Decomposition Analysis

A previous study in Ethiopia reported significant variation in rotavirus vaccine uptake across socioeconomic strata. This study aims to quantify socioeconomic inequality of rotavirus vaccine uptake in Ethiopia and to identify the contributing factors for the inequality. The concentration curve (CC) and the Erreygers Normalized Concentration Index (ECI) were used to assess the socioeconomic related inequality in rotavirus vaccine uptake using data from the 2016 Ethiopian Demographic and Health Survey. Decomposition analysis was conducted to identify the drivers of inequalities. The CC for rotavirus vaccine uptake lay below the line of equality and the ECI was 0.270 (p < 0.001) indicating that uptake of rotavirus vaccine in Ethiopia was significantly concentrated among children from families with better socioeconomic status. The decomposition analysis showed that underlining inequalities in maternal health care services utilization, including antenatal care use (18.4%) and institutional delivery (8.1%), exposure to media (12.8%), and maternal educational level (9.7%) were responsible for the majority of observed inequalities in the uptake of rotavirus vaccine. The findings suggested that there is significant socioeconomic inequality in rotavirus vaccine uptake in Ethiopia. Multi-sectoral actions are required to reduce the inequalities, inclusive increasing maternal health care services, and educational attainments among economically disadvantaged mothers.

Explaining Income-Related Inequalities in Dietary Knowledge: Evidence from the China Health and Nutrition Survey

Lack of adequate dietary knowledge may result in poor health conditions. This study aims to measure income-related inequality in dietary knowledge, and to explain the sources of the inequality. Data were from the China Health and Nutrition Survey (CHNS) conducted in 2015. A summary of the dietary knowledge score and dietary guideline awareness was used to measure the dietary knowledge of respondents. The concentration index was employed as a measure of socioeconomic inequality and was decomposed into its determining factors. The study found that the proportion of respondents who correctly answered questions on dietary knowledge was significantly low for some questions. Compared to rural residents, urban residents had a higher proportion of correctly answered dietary knowledge questions. In addition, there are pro-rich inequalities in dietary knowledge. This observed inequality is determined not only by individual factors but also high-level area factors. Our study recommends that future dietary education programs could take different strategies for individuals with different educational levels and focus more on disadvantaged people. It would be beneficial to consider local dietary habits in developing education materials.

Integrating Fitness Components Reveals That Survival Costs Outweigh Other Benefits and Costs of Group Living in Two Closely Related Species

Group living can be beneficial when individuals reproduce or survive better in the presence of others, but, simultaneously, there might be costs due to competition for resources. Positive and negative effects on various fitness components might thus counteract each other, so integration is essential to determine their overall effect. Here, we investigated how an integrated fitness measure (reproductive values [RVs]) based on six fitness components varied with group size among group members in cooperatively breeding red-winged and superb fairy wrens (Malurus elegans and Malurus cyaneus, respectively). Despite life-history differences between the species, patterns of RVs were similar, suggesting that the same behavioral mechanisms are important. Group living reduced RVs for dominant males, but for other group members, this was true only in large groups. Decomposition analyses showed that our integrated fitness proxy was most strongly affected by group size effects on survival and was amplified through carryover effects between years. Our study shows that integrative consideration of fitness components and subsequent decomposition analysis provide much needed insights into the key behavioral mechanisms shaping the costs and benefits of group living. Such attribution is crucial if we are to synthesize the relative importance of the myriad group size costs and benefits currently reported in the literature.

Inequality in the health services utilization in rural and urban china: A horizontal inequality analysis

BACKGROUND

Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality.

METHODS

This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method.

RESULTS

Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area.

CONCLUSION

The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.

Relative contributions of the correlates of stunting in explaining the mean length-for-age z-score difference between 24-month-old stunted and non-stunted children living in a slum of Dhaka, Bangladesh: results from a decomposition analysis

OBJECTIVE

Using MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) Bangladesh birth cohort data, we sought to measure the relative contributions of the most predictive correlates of stunting to mean length-for-age z (LAZ) score difference between stunted and non-stunted children at 24 months of age.

SETTING

Dhaka, Bangladesh PARTICIPANTS: 211 slum-dwelling children enrolled within 17 days of their birth.

VARIABLES AND METHOD

The explanatory variables were identified from the following groups: maternal characteristics, birth characteristics, macronutrient intake, socioeconomic status, morbidity and serum micronutrient level. At step 1, predictive correlates of stunting were identified longitudinally (from 9 to 24 months of age) using generalized estimating equations (GEE) model. Then, the relative contributions of the most predictive correlates of stunting to mean LAZ score difference between stunted and non-stunted children at 24 months of age was measured using Blinder-Oaxaca decomposition analysis RESULTS: The GEE multivariable model identified maternal height, birth weight, people per room, gender, having separate room for kitchen and energy intake as the most predictive correlates of stunting. At 24 months, mean LAZ score difference between stunted and non-stunted children was 1.48. The variable by variable decomposition of the LAZ gap identified maternal height (coefficient: -3.04; 95% CI: 0.35 to -6.44), birth weight (coefficient: -0.21; 95% CI: 0.88 to -1.30), people per room (coefficient: 0.31; 95% CI: 0.92 to -0.30) and energy intake (coefficient: -0.12; 95% CI: 0.22 to -0.46) as the top most factors responsible for the mean LAZ score difference between stunted and non-stunted children at 24 months of age.

CONCLUSIONS

The relative contributions of maternal height and birth weight to LAZ gap signifies that improvement in nutritional status of a women during her adolescence and pregnancy would have an impact on birth weight of her offspring, and ultimately, on linear growth of the child.

The Driving Forces of Point Source Wastewater Emission: Case Study of COD and NH4-N Discharges in Mainland China

Excess consumption of water resources and environmental pollution have become major challenges restricting sustainable development in China. In order to prevent the pollution of water resources, policymakers should have reliable emission reduction strategies. This paper aims to contribute new knowledge by analyzing the spatial-temporal characteristics and driving forces of point source emission. The chemical oxygen demand (COD) and ammonia nitrogen (NH₄-N) emission variations in 31 provinces and municipalities of mainland China during the years 2004–2017 are analyzed. The results obtained using the logarithmic mean Divisia index (LMDI) method indicate that: (1) the COD and NH₄-N emission effects have similar temporal characteristics. Technology improvement and pollutant emission intensity are the main factors inhibiting the incremental COD and NH₄-N emission effects, while economic development is the main driving factor of COD and NH₄-N emission effects. Population increases play a relatively less important role in COD and NH₄-N emission effects. (2) The spatial features of COD and NH₄-N emission effects show differences among provinces and municipalities. The reduction of COD emission effects in each province and municipality is obviously better than that of NH₄-N emissions. (3) In the eastern, central, and the western regions of China, the total COD emission effect shows a downward trend, while apart from the central region, the NH₄-N emission effect appears to be rising in the east and west of China. Therefore, increasing investment into pollution treatment, promoting awareness of water conservation, strengthening technological and financial support from the more developed eastern to the less developed central and western regions, can help to reduce the COD and NH₄-N emissions in China.

Inequality of opportunity in health: A decomposition-based approach

This paper presents new decomposition-based approaches to measure inequality of opportunity in health that capture Roemer's distinction between circumstances and effort and are consistent with both compensation and reward principles. Our approach is fully nonparametric in the way that it handles differences in circumstances and provides decompositions of both a rank-dependent relative (the Gini coefficient) and a rank-independent absolute inequality index (the variance). The decompositions distinguish the contribution of effort from the direct and indirect (through effort) contribution of circumstances to the total inequality. Our approach is illustrated by an empirical application that uses objectively measured biomarkers as health outcomes and as proxies for relevant effort variables. Using data from the Health Survey for England from 2003 to 2012, we find that circumstances are the leading determinant of inequality in cholesterol, glycated haemoglobin, and in a combined ill-health index whereas effort plays a substantial role in explaining inequality in fibrinogen only.

Understanding the geographical burden of stunting in India: A regression-decomposition analysis of district-level data from 2015-16

India accounts for approximately one third of the world's total population of stunted preschoolers. Addressing global undernutrition, therefore, requires an understanding of the determinants of stunting across India's diverse states and districts. We created a district-level aggregate data set from the recently released 2015-2016 National and Family Health Survey, which covered 601,509 households in 640 districts. We used mapping and descriptive analyses to understand spatial differences in distribution of stunting. We then used population-weighted regressions to identify stunting determinants and regression-based decompositions to explain differences between high- and low-stunting districts across India. Stunting prevalence is high (38.4%) and varies considerably across districts (range: 12.4% to 65.1%), with 239 of the 640 districts have stunting levels above 40% and 202 have prevalence of 30-40%. High-stunting districts are heavily clustered in the north and centre of the country. Differences in stunting prevalence between low and high burden districts were explained by differences in women's low body mass index (19% of the difference), education (12%), children's adequate diet (9%), assets (7%), open defecation (7%), age at marriage (7%), antenatal care (6%), and household size (5%). The decomposition models explained 71% of the observed difference in stunting prevalence. Our findings emphasize the variability in stunting across India, reinforce the multifactorial determinants of stunting, and highlight that interdistrict differences in stunting are strongly explained by a multitude of economic, health, hygiene, and demographic factors. A nationwide focus for stunting prevention is required, while addressing critical determinants district-by-district to reduce inequalities and prevalence of childhood stunting.

Explaining mental health inequalities in Northern Sweden: a decomposition analysis

Background: There has been a substantial increase of income inequalities in Sweden over the last 20 years, which also could be reflected in health inequalities, including mental health inequalities. Despite the growing body of literature focusing on health inequalities in Sweden, income-related inequalities in mental health have received little attention. Particularly scarce are research from Northern Sweden and examinations of the social determinants of health inequalities.

Objectives: The present study seeks to provide evidence regarding inequalities in mental health in Northern Sweden. The specific aims were to (1) quantify the income-related inequality in mental health in Northern Sweden, and (2) determine the contribution of social determinants to the inequality.

Methods: The study population comprised 25,646 participants of the 2014 Health on Equal Terms survey in the four northernmost counties of Sweden, aged 16 to 84 years old. Income-related inequalities in mental health were quantified by the concentration index and further decomposed by applying Wagstaff-type decomposition analysis.

Results: The overall concentration index of mental health in Northern Sweden was

−0.15 (95% CI: −0.17 to −0.13), indicating income inequalities in mental health disfavoring the less affluent population. The decomposition analysis results revealed that socio-economic conditions, including employment status (31%), income (22.6%), and cash margin (14%), made the largest contribution to the pro-rich inequalities in mental health. The second-largest contribution came from demographic factors, mainly age (11.3%) and gender (6%). Psychosocial factors were of smaller importance, with perceived discrimination (8%) and emotional support (3.4%) making moderate contributions to the health inequalities. Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings. These findings suggest that addressing the root causes is essential for promoting mental health equity in this region.

The Use of Decomposition Methods in Real-World Treatment Benefits Evaluation for Patients with Type 2 Diabetes Initiating Different Injectable Therapies: Findings from the INITIATOR Study

BACKGROUND

Determining characteristics of patients likely to benefit from a particular treatment could help physicians set personalized targets.

OBJECTIVES

To use decomposition methodology on real-world data to identify the relative contributions of treatment effects and patients' baseline characteristics.

METHODS

Decomposition analyses were performed on data from the Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens (INITIATOR) study, a real-world study of patients with type 2 diabetes started on insulin glargine (GLA) or liraglutide (LIRA). These analyses investigated relative contributions of differences in baseline characteristics and treatment effects to observed differences in 1-year outcomes for reduction in glycated hemoglobin A_1c (HbA_1c) and treatment persistence.

RESULTS

The greater HbA_1c reduction seen with GLA compared with LIRA (-1.39% vs. -0.74%) was primarily due to differences in baseline characteristics (HbA_1c and endocrinologist as prescribing physician; P < 0.050). Patients with baseline HbA_1c of 9.0% or more or evidence of diagnosis codes related to mental illness achieved greater HbA_1c reductions with GLA, whereas patients with baseline polypharmacy (6-10 classes) or hypogylcemia achieved greater reductions with LIRA. Decomposition analyses also showed that the higher persistence seen with GLA (65% vs. 49%) was mainly caused by differences in treatment effects (P < 0.001). Patients 65 years and older, those with HbA_1c of 9.0% or more, those taking three oral antidiabetes drugs, and those with polypharmacy of more than 10 classes had higher persistence with GLA; patients 18 to 39 years and those with HbA_1c of 7.0% to less than 8.0% had higher persistence with LIRA.

CONCLUSIONS

Although decomposition does not demonstrate causal relationships, this method could be useful for examining the source of differences in outcomes between treatments in a real-world setting and could help physicians identify patients likely to respond to a particular treatment.

The Income-Health Relationship 'Beyond the Mean': New Evidence from Biomarkers

The relationship between income and health is one of the most explored topics in health economics but less is known about this relationship at different points of the health distribution. Analysis based solely on the mean may miss important information in other parts of the distribution. This is especially relevant when clinical concern is focused on the tail of the distribution and when evaluating the income gradient at different points of the distribution and decomposing income-related inequalities in health is of interest. We use the unconditional quantile regression approach to analyse the income gradient across the entire distribution of objectively measured blood-based biomarkers. We apply an Oaxaca-Blinder decomposition at various quantiles of the biomarker distributions to analyse gender differentials in biomarkers and to measure the contribution of income (and other covariates) to these differentials. Using data from the Health Survey for England, we find a non-linear relationship between income and health and a strong gradient with respect to income at the highest quantiles of the biomarker distributions. We find that there is heterogeneity in the association of health to income across genders, which accounts for a substantial percentage of the gender differentials in observed health. Copyright © 2016 John Wiley & Sons, Ltd.

Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden

BACKGROUND

Intersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage.

OBJECTIVE

This article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression.

DESIGN

Participants (N=25,585) came from the cross-sectional 'Health on Equal Terms' survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used.

RESULTS

Significant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison).

CONCLUSIONS

The study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups.

Socio-economic inequity in HIV testing in Malawi

Background

Human immunodeficiency virus (HIV) is a significant contributor to Malawi's burden of disease. Despite a number of studies describing socio-economic differences in HIV prevalence, there is a paucity of evidence on socio-economic inequity in HIV testing in Malawi.

Objective

To assess horizontal inequity (HI) in HIV testing in Malawi.

Design

Data from the Demographic and Health Surveys (DHSs) 2004 and 2010 in Malawi are used for the analysis. The sample size for DHS 2004 was 14,571 (women =11,362 and men=3,209), and for DHS 2010 it was 29,830 (women=22,716 and men=7,114). The concentration index is used to quantify the amount of socio-economic-related inequality in HIV testing. The inequality is a primary method in this study. Corrected need, a further adjustment of the standard decomposition index, was calculated. Standard HI was compared with corrected need-adjusted inequity. Variables used to measure health need include symptoms of sexually transmitted infections. Non-need variables include wealth, education, literacy and marital status.

Results

Between 2004 and 2010, the proportion of the population ever tested for HIV increased from 15 to 75% among women and from 16 to 54% among men. The need for HIV testing among men was concentrated among the relatively wealthy in 2004, but the need was more equitably distributed in 2010. Standard HI was 0.152 in 2004 and 0.008 in 2010 among women, and 0.186 in 2004 and 0.04 in 2010 among men. Rural–urban inequity also fell in this period, but HIV testing remained pro-rich among rural men (HI 0.041). The main social contributors to inequity in HIV testing were wealth in 2004 and education in 2010.

Conclusions

Inequity in HIV testing in Malawi decreased between 2004 and 2010. This may be due to the increased support to HIV testing by global donors over this period.