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Merid, Mehari Woldemariam, Fantu Mamo Aragaw, Tilahun Nega Godana, Anteneh Ayelign Kibret, Adugnaw Zeleke Alem, Melaku Hunie Asratie, Dagmawi Chilot, and Daniel Gashaneh Belay. "Wealth-related inequality in vitamin A rich food consumption among children of age 6–23 months in Ethiopia; Wagstaff decomposition of the 2019 mini-DHS data." PLOS ONE 19, no. 10 (October 8, 2024): e0302368. http://dx.doi.org/10.1371/journal.pone.0302368.
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Introduction Vitamin A (VA) cannot be made in the human body and thus foods rich in VA are the only sources of vitamin A for the body. However, ensuring availability in adequate amount of foods rich in VA remains a challenge, mainly in low-income counties including Ethiopia. In addition, children from the poorest and less educated families of same country have disproportionately limited consumptions of foods rich in VA. Therefore, the present study aimed assessing the wealth related inequality in vitamin A consumption (VAC) and decompose it to the various contributing factors. Methods This study was conducted using the 2019 Ethiopian demographic and health survey data on a weighted sample of 1,497 children of age 6–23 months in Ethiopia. The wealth related inequality in VAC was quantified using concentration index and plotted using concentration curve. The Wagstaff decomposition analysis was performed to assess the relative contributions of each explanatory variable to the inequalities in the overall concentration index of VAC. Result The overall Wagstaff normalized concentration index (C) analyses of the wealth-related inequality in consumption of foods rich in VA among children aged 6–23 months was [C = 0.25; 95% C: 0.15, 0.35]. Further decomposition of the C by the explanatory variables reported the following contributions; primary level of women’s education (7.2%), secondary and above (17.8%), having ANC visit during pregnancy (62.1%), delivery at a health institution (26.53%), living in the metropolis (13.7%), central region (34.2%), child age 18–23 months (4.7%) contributed to the observed wealth related inequality in the consumption of foods rich in vitamin A in Ethiopia. Conclusion We found pro-rich wealth-related inequality in VAC among children of age 6–23 months in Ethiopia. Additionally, maternal education, region, ANC visit, and place of delivery were the significant contributors of wealth-related inequality of VAC. Nutritional related interventions should prioritise children from poorer households and less educated mothers. Moreover, enhancing access to ANC and health facilities delivery services through education, advocacy, and campaign programs is highly recommended in the study setting.
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Szilcz, Máté, Paola A. Mosquera, Miguel San Sebastián, and Per E. Gustafsson. "Income inequalities in leisure time physical inactivity in northern Sweden: A decomposition analysis." Scandinavian Journal of Public Health 48, no. 4 (January 11, 2019): 442–51. http://dx.doi.org/10.1177/1403494818812647.
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Aims: Increasing income inequalities in leisure time physical inactivity have been reported in the relatively socially equal setting of northern Sweden. The present report seeks to contribute to the literature by exploring the contribution of different factors to the income inequalities in leisure time physical inactivity in northern Sweden. Methods: This study was based on the 2014 Health on Equal Terms survey, distributed in the four northernmost counties of Sweden. The analytical sample consisted of 21,000 respondents aged 16–84. Six thematic groups of explanatory variables were used: demographic variables, socioeconomic factors, material resources, family-, psychosocial conditions and functional limitations. Income inequalities in leisure time physical inactivity were decomposed by Wagstaff-type decomposition analysis. Results: Income inequalities in leisure time physical inactivity were found to be explained to a considerable degree by health-related limitations and unfavourable socioeconomic conditions. Material and psychosocial conditions seemed to be of moderate importance, whereas family and demographic characteristics were of minor importance. Conclusions: This study suggests that in order to achieve an economically equal leisure time physical inactivity, policy may need to target the two main barriers of functional limitations and socioeconomic disadvantages.
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Pouye, Rokhy. "Effect of the policy of free health care for children under five on child undernutrition and social inequalities in health care use in Senegal." New Medical Innovations and Research 5, no. 5 (June 14, 2024): 01–09. https://doi.org/10.31579/2767-7370/102.
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Access to care and child health remain public health concerns in developing countries; in particular in Senegal despite the free child care initiative. Therefore, this article examines the effect of free care on child undernutrition and social inequalities in health care utilization. The data used are from the Continuous Demographic and Health Surveys (DHS-C). The trivariate model and the inequality index decomposition method proposed by Wagstaff et al [2003] are used respectively to analyze the effect of the free health care policy on undernutrition and social inequalities in health care utilization. The results underline that the free health care policy improves the nutritional status of children. In addition, it increases social inequalities in the use of health care in favor of the rich and contributes to horizontal inequalities to the tune of 7.56 %. It is therefore necessary to review and monitor this policy within the health structures in order to correct its regressive nature. Moreover, a combination of policies of access to care and fight against undernutrition is essential for a better result in terms of child health.
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Fenny, Ama Pokuaa, Derek Asuman, Aba Obrumah Crentsil, and Doreen Nyarko Anyamesem Odame. "Trends and causes of socioeconomic inequalities in maternal healthcare in Ghana, 2003–2014." International Journal of Social Economics 46, no. 2 (February 11, 2019): 288–308. http://dx.doi.org/10.1108/ijse-03-2018-0148.
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Purpose The purpose of this paper is to assess the trends of socioeconomic-related inequalities in maternal healthcare utilization in Ghana between 2003 and 2014 and examine the causes of inequalities in maternal healthcare utilization in Ghana. Design/methodology/approach Data are drawn from three rounds of the Ghana Demographic and Health Survey collected in 2003, 2008 and 2014, respectively. The authors employ two alternative measures of socioeconomic inequalities in health – the Wagstaff and Erreygers indices – to examine the trends of socioeconomic inequalities in maternal healthcare utilization. The authors proceed to decompose the causes of inequalities in maternal healthcare by applying a recently developed generalized decomposition technique based on recentered influence function regressions. Findings The study finds substantial pro-rich inequalities in maternal healthcare utilization in Ghana. The degree of inequalities has been decreasing since 2003. The elimination of user fees for maternal healthcare has contributed to achieving equity and inclusion in utilization. The decomposition analysis reveals significant contributions of individual, household and locational characteristics to inequalities in maternal healthcare. The authors find that educational attainment, urban residence and challenges with physical access to healthcare facilities increase the socioeconomic gap in maternal healthcare utilization. Originality/value There is a need to target vulnerable women who are unlikely to utilize maternal healthcare services. In addition to the elimination of user fees, there is a need to reduce inequalities in the distribution and quality of maternal health services to achieve universal coverage in Ghana.
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Njagi, Purity, Jelena Arsenijevic, and Wim Groot. "Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya." PLOS ONE 15, no. 12 (December 29, 2020): e0244428. http://dx.doi.org/10.1371/journal.pone.0244428.
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Background Catastrophic health expenditure (CHE) is frequently used as an indicator of financial protection. CHE exists when health expenditure exceeds a certain threshold of household consumption. Although CHE is reported to have declined in Kenya, it is still unacceptably high and disproportionately affects the poor. This study examines the socioeconomic factors that contribute to inequalities in CHE as well as the change in these inequalities over time in Kenya. Methods We used data from the Kenya household health expenditure and utilisation (KHHEUS) surveys in 2007 and 2013. The concertation index was used to measure the socioeconomic inequalities in CHE. Using the Wagstaff (2003) approach, we decomposed the concentration index of CHE to assess the relative contribution of its determinants. We applied Oaxaca-type decomposition to assess the change in CHE inequalities over time and the factors that explain it. Results The findings show that while there was a decline in the incidence of CHE, inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off. Higher wealth quintiles and employed household heads positively contributed to the inequalities in CHE, suggesting that they disadvantaged the poor. The rise in CHE inequalities overtime was explained mainly by the changes in the elasticities of the household wealth status. Conclusion Inequalities in CHE are persistent in Kenya and are largely driven by the socioeconomic status of the households. This implies that the existing financial risk protection mechanisms have not been sufficient in cushioning the most vulnerable from the financial burden of healthcare payments. Understanding the factors that sustain inequalities in CHE is, therefore, paramount in shaping pro-poor interventions that not only protect the poor from financial hardship but also reduce overall socioeconomic inequalities. This underscores the fundamental need for a multi-sectoral approach to broadly address existing socioeconomic inequalities.
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Singh, Lucky, Richa Goel, Rajesh Kumar Rai, and Prashant Kumar Singh. "Socioeconomic inequality in functional deficiencies and chronic diseases among older Indian adults: a sex-stratified cross-sectional decomposition analysis." BMJ Open 9, no. 2 (February 2019): e022787. http://dx.doi.org/10.1136/bmjopen-2018-022787.
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ObjectivesOlder adults with adverse socioeconomic conditions suffer disproportionately from a poor quality of life. Stratified by sex, income-related inequalities have been decomposed for functional deficiencies and chronic diseases among older adults, and the degree to which social and demographic factors contribute to these inequalities was identified in this study.DesignCross-sectional study.ParticipantsData used for this study were retrieved from the WHO Study on Global AGEing and Adult Health Wave 1. A total of 3753 individuals (men: 1979, and women: 1774) aged ≥60 years were found eligible for the analysis.MeasuresInstrumental Activity of Daily Living (IADL) deficiency and presence of chronic diseases.MethodThe decomposition method proposed by Adam Wagstaff and his colleagues was used. The method allows estimating how determinants of health contribute proportionally to inequality in a health variable.ResultsCompared with men, women were disproportionately affected by both functional deficiencies and chronic diseases. The relative contribution of sociodemographic factors to IADL deficiency was highest among those with poor economic status (38.5%), followed by those who were illiterate (22.5%), which collated to 61% of the total explained inequalities. Similarly, for chronic diseases, about 93% of the relative contribution was shared by those with poor economic status (42.3%), rural residence (30.5%) and illiteracy (20.3%). Significant difference in predictors was evident between men and women in IADL deficiency and chronic illness.ConclusionPro-poor intervention strategies could be designed to address functional deficiencies and chronic diseases, with special attention to women.
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Tsega, Yawkal, Abel Endawkie, Gebeyehu Tsega, Asnakew Molla Mekonen, Yeshimebet Ali Dawed, and Chad Stecher. "Trends and socioeconomic inequalities of recommended antenatal care services utilization in Ethiopia: A decomposition analysis using Ethiopian nationwide Demographic Health Surveys 2011–2019." PLOS ONE 20, no. 2 (February 4, 2025): e0318337. https://doi.org/10.1371/journal.pone.0318337.
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Background Antenatal care (ANC) services are essential to reduce maternal and newborn morbidity and mortality rates. However, the trends and socioeconomic inequality of utilizing recommended ANC services has not been well studied in Ethiopia. Therefore, this study aims to investigate the trends and socioeconomic disparities in receiving recommended ANC services among Ethiopian women. Methods This study used recent Ethiopian Demographic Health Surveys (EDHS) conducted in 2011, 2016, and 2019. Binary logistic regression model was employed to assess the association between receiving the recommended ANC services and explanatory variables and socioeconomic disparities were estimated through concentration index (CIX) analysis. Moreover, Wagstaff approach was used to decompose the relative CIX to the contribution of explanatory variables for the observed disparities. Results This study found that 37.37% (95%CI: 36.46–38.28%) of mothers utilized the recommended ANC services in Ethiopia. The trend in the coverage of recommended ANC services increased from ~ 30% in 2011 to 44.70% in 2019. Mother’s age and education, household wealth status, distance of the nearest health facility, and experiencing domestic abuse (i.e., wife beating) were significantly associated with utilization of recommended ANC services. The relative estimated CIX for wealth index, mothers education, Ethiopian administrative regions, and residence were 0.15 (P < 0.001), 0.14 (P < 0.001), 0.07(P < 0.001), and −0.11(P < 0.001), respectively. Wealth status of the households contributed for almost two-thirds (66.58%) of the observed disparity in recommended ANC service utilization across wealth categories. Conclusion The study revealed that Ethiopian women’s utilization of recommended ANC services was unequal by their socioeconomic classes, with better off women more likely to utilize the recommended ANC services than worse off women. Hence, the responsible body should improve the access and quality of antenatal care services for underprivileged women in Ethiopia.
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Pan, Fan, Yang, and Deng. "Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey." International Journal of Environmental Research and Public Health 16, no. 20 (October 20, 2019): 4018. http://dx.doi.org/10.3390/ijerph16204018.
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Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index (WI) and Erreygers index (EI). Following this, it compares health inequalities among the elderly in different age groups, and finally, uses the Shapley and recentered influence function-index-ordinary least squares (RIF-I-OLS) model to decompose the effect of four factors on health inequality among the elderly in rural China. The QWB score distribution shows that the health of the elderly in rural China improved with social economic development and medical reform from 2002 to 2014. However, at the same time, we were surprised to find that the health level of the 65–74 years old group has been declining steadily since 2008. This phenomenon implies that the incidence of chronic diseases is moving towards the younger elderly. The WI and EI show that there is indeed pro-rich health inequality among the rural elderly, the health inequality of the younger age groups is more serious than that of the older age groups, and the former incidence of health inequality is higher. Health inequality in the age group of 65–74 years old is higher than that in other groups, and the trend of change fluctuated downward from 2002 to 2014. Health inequality in the age group of 75–84 years old is lower than that in the group of 65–74 years old, but higher than that in the other age groups. The results of Shapley decomposition show that demographic characteristics, socioeconomic status (SES), health care access, and quality of later life contributed 0.0054, 0.0130, 0.0442, and 0.0218 to the health inequality index of the elderly, which accounted for 6.40%, 15.39%, 52.41%, and 25.80% of health inequality index. From the results of RIF-I-OLS decomposition, this paper has analyzed detailed factors’ marginal effects on health inequality from four dimensions, which indicates that the health inequality among the elderly in rural China was mainly caused by the disparity of income, medical expenses, and living arrangement.
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Goli, Srinivas, Dipty Nawal, Anu Rammohan, T. V. Sekher, and Deepshikha Singh. "DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA." Journal of Biosocial Science 50, no. 6 (October 30, 2017): 749–69. http://dx.doi.org/10.1017/s0021932017000530.
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SummaryThe gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010–11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of −0.1147, −0.1146, −0.2859 and −0.0638 for <3 antenatal care visits; CI of −0.1338, −0.0925, −0.1960 and −0.2531 for non-institutional delivery; and CI of −0.1153, −0.0370, −0.1817 and −0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.
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Yao, Qiang, Xiaodan Zhang, Yibo Wu, and Chaojie Liu. "Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study." BMJ Global Health 8, no. 11 (November 2023): e013350. http://dx.doi.org/10.1136/bmjgh-2023-013350.
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IntroductionHealth equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China.MethodsData were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method.ResultsThe CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (−3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (−5.24%) was the top negative contributor, followed by commercial (−1.43%) and basic medical insurance (−0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134).ConclusionPro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.
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Rezaei, Satar, Mohammad Hajizadeh, Sina Ahmadi, Sadaf Sedghi, Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad, and Enayatollah Homaie Rad. "Socioeconomic inequality in catastrophic healthcare expenditures in Western Iran." International Journal of Social Economics 46, no. 9 (August 12, 2019): 1049–60. http://dx.doi.org/10.1108/ijse-01-2019-0034.
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Purpose Financial protection of households against catastrophic healthcare expenditure (CHE) is defined as one of the main goals in health systems. The purpose of this paper is to measure and decompose socioeconomic inequality in CHE among households in Kermanshah province, Western of Iran. Design/methodology/approach This cross-sectional study was carried out among 1,188 households in 2017. Data were extracted from the Household Income and Expenditure Survey which is conducted by the Statistical Center of Iran. The CHE is defined as household healthcare expenditure greater than or equal to the 40 percent of household’s “capacity to pay.” The concentration curve and the Wagstaff (W) and Erreygers (E) indexes were used to illustrate and measure the extent of socioeconomic inequality in CHE. In addition, the authors decomposed the W and E indexes to identify the main determinants of socioeconomic inequality in CHE. Findings The results indicated that the prevalence of CHE among households was 4.12 percent (95% confidence interval (CI): 3.13 to 5.42 percent). The estimated value of the W and E indexes were −0.2849 (95% CI: −0.4493 to −0.1205) and −0.0451 (95% CI: −0.0712 to −0.0190), respectively; suggesting the concentration of CHE prevalence among the poor households. Decomposition analyses indicated socioeconomic status as the most important factor contributing to the concentration of CHE among the poor. In contrast, health insurance coverage was found to increase the concentration of CHE among the rich in Iran. Originality/value The current study demonstrated a higher concentration of CHE among the poor households in Kermanshah province. These results call for the government’s efforts to reduce healthcare expenditure among socioeconomically disadvantaged populations. Further studies are required to understand the mechanisms through which health insurance coverage increased the probability of CHE among rich in Kermanshah province.
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Khanam, Moriam, and Abdur Razzaque Sarker. "Dietary Diversity among Children Aged 6-23 Months in Bangladesh: Determinants and Inequalities." Bangladesh Development Studies XLIV, no. 3 & 4 (April 23, 2023): 81–102. http://dx.doi.org/10.57138/hkfc5019.
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Inadequate dietary intake is one of the causes of childhood undernutrition and associated morbidity and mortality in many low and middle-income countries, including Bangladesh. The study aims to identify the prevalence, associated factors, and socio-economic inequalities in minimum dietary diversity, minimum meal frequency, and minimum acceptable diet among 6-23 month-children in Bangladesh. This study uses data from the latest round of the Bangladesh Demographic and Health Survey (BDHS) 2017-18. Descriptive analyses have been conducted to report frequencies and percentages of the socio-demographic and economic characteristics of 6-23 months aged children. Bivariate and multiple logistic models are used to identify the predictors of each dietary indicator. In addition, we estimate concentration indices and use Wagstaff-based decomposition analysis to identify socio-economic inequalities in dietary diversity and their contributing factors. The study finds the prevalence of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet as 38%, 81%, and 36%, respectively. Education of mothers is a significant predictor of all three dietary indicators. In addition, household wealth status and administrative division are significant predictors of minimum dietary diversity and minimum acceptable diet. Children of working mothers are found to have higher odds of having minimum meal frequency and minimum acceptable diet compared to their counterparts. We find concentration indices for minimum dietary diversity as 0.21 (p<0.001), for minimum meal frequency as 0.08 (p<0.05), and for minimum acceptable diet as 0.19 (p<0.001). Wealth status of household, mother’s and father’s education levels, and exposure to mass media are the major contributing factors to these inequalities. Therefore, policymakers and other stakeholders need to give prior attention to enhancing household wealth status, empowering women, and awareness-raising initiatives to improve the feeding practices of children in Bangladesh.
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Chowdhury, Muhammad Abdul Baker, Mirajul Islam, Jakia Rahman, Mohammed Taj Uddin, Md Rabiul Haque, and Md Jamal Uddin. "Changes in prevalence and risk factors of hypertension among adults in Bangladesh: An analysis of two waves of nationally representative surveys." PLOS ONE 16, no. 12 (December 2, 2021): e0259507. http://dx.doi.org/10.1371/journal.pone.0259507.
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Introduction Bangladesh is one of the countries where the prevalence of non-communicable diseases (NCDs) such as hypertension is rising due to rising living standards, sedentary lifestyles, and epidemiological transition. Among the NCDs, hypertension is a major risk factor for CVD, accounting for half of all coronary heart disease worldwide. However, detailed research in this area has been limited in Bangladesh. The objective of the study was to estimate changes in the prevalence and risk factors of hypertension among Bangladeshi adult population. The study also sought to identify socioeconomic status-related inequality of hypertension prevalence in Bangladesh. Methods Cross-sectional analysis was conducted using nationally representative two waves of the Bangladesh Demographic and Health Survey (BDHS) in 2011 and 2017–18. Survey participants were adults 18 years or older- which included detailed biomarker and anthropometric measurements of 23539 participants. The change in prevalence of hypertension was estimated, and adjusted odds ratios were obtained using multivariable survey logistic regression models. Further, Wagstaff decomposition method was also used to analyze the relative contributions of factors to hypertension. Results From 2011 to 2018, the hypertension prevalence among adults aged ≥35 years increased from 25.84% to 39.40% (p<0.001), with the largest relative increase (97%) among obese individuals. The prevalence among women remained higher than men whereas the relative increase among men and women were 75% and 39%, respectively. Regression analysis identified age and BMI as the independent risk factors of hypertension. Other risk factors of hypertension were sex, marital status, education, geographic region, wealth index, and diabetes status in both survey years. Female adults had significantly higher hypertension risk in both survey years in the overall analysis in, however, in the subgroup analysis, the gender difference in hypertension risk was not significant in rural 2011 and urban 2018 samples. Decomposition analysis revealed that the contributions of socio-economic status related inequality of hypertension in 2011 were46.58% and 20.85% for wealth index and BMI, respectively. However, the contributions of wealth index and BMI have shifted to 12.60% and 55.29%, respectively in 2018. Conclusion The prevalence of hypertension among Bangladeshi adults has increased significantly, and there is no subgroup where it is decreasing. Population-level approaches directed at high-risk groups (overweight, obese) should be implemented thoroughly. We underscore prevention strategies by following strong collaboration with stakeholders in the health system of the country to adopt healthy lifestyle choices.
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Khoramrooz, Maryam, Fariba Zare, Farideh Sadeghian, Ali Dadgari, Reza Chaman, and Seyed Mohammad Mirrezaie. "Socioeconomic inequalities in employees’ health-enhancing physical activity: Evidence from the SHAHWAR cohort study in Iran." PLOS ONE 18, no. 5 (May 15, 2023): e0285620. http://dx.doi.org/10.1371/journal.pone.0285620.
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Background Increasing level of physical activity (PA) among working population is of particular importance, because of the high return of investment on employees’ PA. This study was aimed to investigate socioeconomic inequalities in Health-Enhancing Physical Activity (HEPA) among employees of a Medical Sciences University in Iran. Methods Data were extracted from the SHAHWAR Cohort study in Iran. Concentration index (C) and Wagstaff decomposition techniques were applied to determine socioeconomic inequality in the study outcomes and its contributors, respectively. Results Nearly half of the university employees (44.6%) had poor HEPA, and employees with high socioeconomic status (SES) suffered more from it (C = 0.109; 95% CI: 0.075, 0.143). Also, we found while poor work-related PA (C = 0.175; 95% CI: 0.142, 0.209) and poor transport-related PA (C = 0.081, 95% CI: 0.047, 0.115) were more concentrated among high-SES employees, low-SES employees more affected by the poor PA at leisure time (C = -0.180; 95% CI: -0.213, -0.146). Shift working, and having higher SES and subjective social status were the main factors that positively contributed to the measured inequality in employees’ poor HEPA by 33%, 31.7%, and 29%, respectively, whereas, having a married life had a negative contribution of -39.1%. The measured inequality in poor leisure-time PA was mainly attributable to SES, having a married life, urban residency, and female gender by 58.1%, 32.5%, 28.5%, and -32.6%, respectively. SES, urban residency, shift working, and female gender, with the contributions of 42%, 33.5%, 21.6%, and -17.3%, respectively, were the main contributors of poor work-related PA inequality. Urban residency, having a married life, SES, and subjective social status mainly contributed to the inequality of poor transport-related PA by 82.9%, -58.7%, 36.3%, and 33.5%, respectively, followed by using a personal car (12.3%) and female gender (11.3%). Conclusions To reduce the measured inequalities in employees’ PA, workplace health promotion programs should aim to educate and support male, urban resident, high-SES, high-social-class, and non-shift work employees to increase their PA at workplace, and female, married, rural resident, and low-SES employees to increase their leisure-time PA. Active transportation can be promoted among female, married, urban resident, high-SES, and high-social-class employees and those use a personal car.
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Belay, Daniel G., Molla M. Wassie, Melaku Birhanu Alemu, Mehari Woldemariam Merid, Richard Norman, and Gizachew A. Tessema. "Socio-economic and spatial inequalities in animal sources of iron-rich foods consumption among children 6–23 months old in Ethiopia: A decomposition analysis." PLOS Global Public Health 4, no. 5 (May 16, 2024): e0003217. http://dx.doi.org/10.1371/journal.pgph.0003217.
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Iron deficiency anaemia is the most common type of anaemia in young children which can lead to long-term health consequences such as reduced immunity, impaired cognitive development, and school performance. As children experience rapid growth, they require a greater supply of iron from iron-rich foods to support their development. In addition to the low consumption of iron-rich foods in low- and lower-middle-income countries, there are also regional and socio-economic disparities. This study aimed to assess contributing factors of wealth-related inequality and geographic variations in animal sources of iron-rich food consumption among children aged 6–23 months in Ethiopia. We used data from the Ethiopian Mini Demographic and Health Surveys (EMDHS) 2019, a national survey conducted using stratified sampling techniques. A total of 1,461 children of age 6–23 months were included in the study. Iron-rich animal sources of food consumption were regarded when parents/caregivers reported that a child took at least one of the four food items identified as iron-rich food: 1) eggs, 2) meat (beef, lamb, goat, or chicken), 3) fresh or dried fish or shellfish, and 4) organs meat such as heart or liver. Concentration indices and curves were used to assess wealth-related inequalities. A Wagstaff decomposition analysis was applied to identify the contributing factors for wealth-related inequality of iron-rich animal source foods consumption. We estimated the elasticity of wealth-related inequality for a percentage change in socioeconomic variables. A spatial analysis was then used to map the significant cluster areas of iron-rich animal source food consumption among children in Ethiopia. The proportion of children who were given iron-rich animal-source foods in Ethiopia is 24.2% (95% CI: 22.1%, 26.5%), with figures ranging from 0.3% in Dire Dawa to 37.8% in the Oromia region. Children in poor households disproportionately consume less iron-rich animal-source foods than those in wealthy households, leading to a pro-rich wealth concentration index (C) = 0.25 (95% CI: 0.12, 0.37). The decomposition model explained approximately 70% of the estimated socio-economic inequality. About 21% of the wealth-related inequalities in iron-rich animal source food consumption in children can be explained by having primary or above education status of women. Mother’s antenatal care (ANC) visits (14.6%), living in the large central and metropolitan regions (12%), household wealth index (10%), and being in the older age group (12–23 months) (2.4%) also contribute to the wealth-related inequalities. Regions such as Afar, Eastern parts of Amhara, and Somali were geographic clusters with low iron-rich animal source food consumption. There is a low level of iron-rich animal source food consumption among children, and it is disproportionately concentrated in the rich households (pro-rich distribution) in Ethiopia. Maternal educational status, having ANC visits, children being in the older age group (12–23 months), and living in large central and metropolitan regions were significant contributors to these wealth-related inequalities in iron-rich animal source foods consumption. Certain parts of Ethiopia such as, Afar, Eastern parts of Amhara, and Somali should be considered priority areas for nutritional interventions to increase children’s iron-rich animal source foods consumption.
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Kumar, Pradeep, Shobhit Srivastava, Shekhar Chauhan, Ratna Patel, Strong P. Marbaniang, and Preeti Dhillon. "Associated factors and socio-economic inequality in the prevalence of thinness and stunting among adolescent boys and girls in Uttar Pradesh and Bihar, India." PLOS ONE 16, no. 2 (February 24, 2021): e0247526. http://dx.doi.org/10.1371/journal.pone.0247526.
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Background Despite economic growth observed in developing countries, under-nutrition still continues to be a major health problem. Undernutrition in adolescence can disrupt normal growth and puberty development and may have long-term impact. Therefore, it is important to study the undernutrition among adolescents. This study aimed to assess the prevalence and the associated factors of stunting, thinness and the coexistence of both (stunting and thinness) among the adolescent belonging to Uttar Pradesh and Bihar, India. Methods The study utilized data from Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey, which was conducted in two Indian states Uttar Pradesh and Bihar, in 2016 by Population Council under the guidance of Ministry of Health and Family Welfare, Government of India. Utilizing information on 20,594 adolescents aged 10–19 years (adolescent boys-5,969 and adolescent girls-14,625), the study examined three outcome variables, i.e., thinness, stunting, and co-existence of both. The study used descriptive and bivariate analysis. Furthermore, the study examined income-related inequality in stunting and thinness through concentration index. At last, the study used Wagstaff decomposition analysis to decompose the concentration index. Results The prevalence of thinness was higher among adolescent boys as compared to girls (25.8 per cent vs. 13.1 per cent). However, stunting was more prevalent among girls (25.6 per cent) than in boys (39.3 per cent). The odds of stunting were higher among late adolescents [Boys- OR:1.79; CI: 1.39, 2.30] and [Girls- OR: 2.25; CI: 1.90,2.67], uneducated adolescents [Boys- OR:2.90; CI: 1.67, 5.05] and [Girls- OR: 1.82; CI: 1.44,2.30], and poorest adolescents [Boys- OR:2.54; CI: 1.80, 3.58] and [Girls- OR: 1.79; CI: 1.38,2.32]. Similarly age, educational status, working status and wealth index were significantly associated with thinness among adolescent boys and girls. Media exposure [Boys- OR: 11.8% and Girls- 58.1%] and Wealth index [Boys: 80.1% and Girls: 66.2%] contributed significantly to the inequality in the prevalence of thinness among adolescents. Similarly, wealth index [Boys: 85.2% and Girls: 84.1%] was the only significant contributor to the inequality in the prevalence of stunting among adolescents. Conclusion The study provides an understanding that stunting and thinness is a significant public health concern among adolescents, and there is a need to tackle the issue comprehensively. By tackling the issue comprehensively, we mean that the state government of Uttar Pradesh and Bihar shall screen, assess, and monitor the nutritional status of adolescent boys and girls. The interventions shall focus towards both boys as well as girl adolescents, and particular emphasis should be given to adolescents who belonged to poor households. Also, efforts should be taken by stakeholders to increase family wealth status.
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Ankara, Hasan Giray. "SOCIOECONOMIC VARIATIONS IN INDUCED ABORTION IN TURKEY." Journal of Biosocial Science 49, no. 1 (April 22, 2016): 99–122. http://dx.doi.org/10.1017/s0021932016000158.
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SummaryThis study aimed to identify the levels of, and socioeconomic variations in, income-related inequality in induced abortion among Turkish women. The study included 15,480 ever-married women of reproductive age (15–49) from the 2003 and 2008 waves of the Turkish Demographic and Health Survey. The measured inequalities in abortion levels and their changes over time were decomposed into the percentage contributions of selected socioeconomic factors using ordinary least square analysis and concentration indices were calculated. The inequalities and their first difference (difference in inequalities between 2003 and 2008) were decomposed using the approaches of Wagstaffet al.(2003). Higher socioeconomic characteristics (such as higher levels of wealth and education and better neighbourhood) were found to be associated with higher rates of abortion. Inequality analyses indicated that although deprived women become more familiar with abortion over time, abortion was still more concentrated among affluent women in the 2008 survey. The decomposition analyses suggested that wealth, age, education and level of regional development were the most important contributors to income-related inequality in abortion. Therefore policies that (i) increase the level of wealth and education of deprived women, (ii) develop deprived regions of Turkey, (iii) improve knowledge about family planning and, especially (iv) enhance the accessibility of family planning services for deprived and/or rural women, may be beneficial for reducing socioeconomic variations in abortion in the country.
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Muhammad, T., Anjali Elsa Skariah, Manish Kumar, and Shobhit Srivastava. "Socioeconomic and health-related inequalities in major depressive symptoms among older adults: a Wagstaff’s decomposition analysis of data from the LASI baseline survey, 2017–2018." BMJ Open 12, no. 6 (June 2022): e054730. http://dx.doi.org/10.1136/bmjopen-2021-054730.
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ObjectivesTo find out the association between socioeconomic and health status and depression among older adults and explore the contributing factors in the socioeconomic and health-related inequalities in late-life depression.DesignA cross-sectional study was conducted using large representative survey data.Setting and participantsData for this study were derived from the baseline wave of the Longitudinal Ageing Study in India conducted during 2017–2018. The effective sample size was 30 888 older adults aged 60 years and above.Primary and secondary outcome measuresThe outcome variable in this study was depression among older adults. Descriptive statistics along with bivariate analysis was conducted to report the preliminary results. Multivariable binary logistic regression analysis and Wagstaff’s decomposition were used to fulfil the objectives of the study.ResultsThere was a significant difference for the prevalence of depression (4.3%; p<0.05) among older adults from poor (11.2%) and non-poor categories (6.8%). The value of the Concentration Index was −0.179 which also confirms that the major depression was more concentrated among poor older adults. About 38.4% of the socioeconomic and health-related inequality was explained by the wealth quintile for major depression among older adults. Moreover, about 26.6% of the inequality in major depression was explained by psychological distress. Self-rated health (SRH), difficulty in activities of daily living (ADL) and instrumental ADL (IADL) contributed 8.7%, 3.3% and 4.8% to the inequality, respectively. Additionally, region explained about 23.1% of inequality followed by life satisfaction (11.2) and working status (9.8%) for major depression among older adults.ConclusionsFindings revealed large socioeconomic and health-related inequalities in depression in older adults which were especially pronounced by poor household economy, widowhood, poor SRH, ADL and IADL difficulty, and psychological distress. In designing prevention programmes, detection and management of older adults with depression should be a high priority, especially for those who are more vulnerable.
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Kumar, Pradeep, Shobhit Srivastava, Pratishtha Chaudhary, and T. Muhammad. "Factors contributing to socio-economic inequality in utilization of caesarean section delivery among women in Indonesia: Evidence from Demographic and Health Survey." PLOS ONE 18, no. 9 (September 13, 2023): e0291485. http://dx.doi.org/10.1371/journal.pone.0291485.
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Background Most of the existing literature in developing countries focused on either the rising trend of CS or its determinants. There is a paucity of population-based studies on existing socioeconomic inequalities in availing CS services by women in Indonesia. This study aimed to assess the factors associated with caesarian section (CS) delivery and explore the various factors contributing to inequalities in CS delivery rates in Indonesia. Methods The study utilized nationally representative cross-sectional data from the Indonesia Demographic and Health Survey (IDHS), 2017. We conducted multivariable logistic regression to find the factors associated with CS delivery. Concentration index and Wagstaff’s decomposition analysis were used to examine the socioeconomic inequalities in CS delivery among women and associated factors. Results About 17% of women in Indonesia delivered babies through CS. A concentration index of 0.31 in CS delivery rate showed a higher CS delivery rate among women belonging to rich households. About 44.7% of socioeconomic status inequality in CS delivery was explained by educational status among women who went for CS delivery. Women’s place of residence explained 30.1% of socioeconomic inequality, and women’s age at first birth explained about 11.9% and reporting ANC visits explained 8.4% of the observed inequality. Highest socioeconomic inequality was witnessed in central Sulawesi (0.529), followed by Maluku (0.488) and West Kalimantan (0.457), whereas the lowest was recorded in Yogyakarta (0.021) followed by north Sulawesi (0.047) and east Kalimantan (0.171). Education (44.7%) followed by rural-urban place of residence (30.1%) and age of first birth (11.9%) contributed most to explain the gap in CS delivery among rich and poor women. Conclusion The study highlighted the higher CS delivery rates among women from higher socioeconomic groups and thus, it is important to frame policies after identifying the population subgroups with potential underuse or overuse of CS method of delivery.
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Kundu, Jhumki, and Ruchira Chakraborty. "Socio-economic inequalities in burden of communicable and non-communicable diseases among older adults in India: Evidence from Longitudinal Ageing Study in India, 2017–18." PLOS ONE 18, no. 3 (March 30, 2023): e0283385. http://dx.doi.org/10.1371/journal.pone.0283385.
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Developing countries like India grapple with significant challenges due to the double burden of communicable and non-communicable disease in older adults. Examining the distribution of the burden of different communicable and non-communicable diseases among older adults can present proper evidence to policymakers to deal with health inequality. The present study aimed to determine socioeconomic inequality in the burden of communicable and noncommunicable diseases among older adults in India. This study used Longitudinal Ageing study in India (LASI), Wave 1, conducted during 2017–2018. Descriptive statistics along with bivariate analysis was used in the present study to reveal the initial results. Binary logistic regression analysis was used to estimate the association between the outcome variables (communicable and non-communicable disease) and the chosen set of separate explanatory variables. For measurement of socioeconomic inequality, concentration curve and concentration index along with state wise poor-rich ratio was calculated. Additionally, Wagstaff’s decomposition of the concentration index approach was used to reveal the contribution of each explanatory variable to the measured health inequality (Communicable and non- communicable disease). The study finds the prevalence of communicable and non-communicable disease among older adults were 24.9% and 45.5% respectively. The prevalence of communicable disease was concentrated among the poor whereas the prevalence of NCDs was concentrated among the rich older adults, but the degree of inequality is greater in case of NCD. The CI for NCD is 0.094 whereas the CI for communicable disease is -0.043. Economic status, rural residence are common factors contributing inequality in both diseases; whereas BMI and living environment (house type, drinking water source and toilet facilities) have unique contribution in explaining inequality in NCD and communicable diseases respectively. This study significantly contributes in identifying the dichotomous concentration of disease prevalence and contributing socio- economic factors in the inequalities.
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Dessie, Anteneh Mengist, Melkamu Aderajew Zemene, Asaye Alamneh Gebeyehu, Denekew Tenaw Anley, Rahel Mulatie Anteneh, Natnael Moges, Ermias Sisay Chanie, et al. "Measurement and decomposition of education-related inequality in exclusive breastfeeding practice among Ethiopian mothers: applying Wagstaff decomposition analysis." Frontiers in Public Health 12 (December 9, 2024). https://doi.org/10.3389/fpubh.2024.1407210.
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BackgroundHuman breast milk, a naturally balanced source of infant nutrition, promotes optimal growth and health when exclusively fed for 6 months. Exclusive breastfeeding reduces common childhood infections, provides protection against some chronic illnesses, and contributes to achieving several Sustainable Development Goals. Despite its benefits, only 58% of Ethiopian women practice it, and the associated education-related inequality is not well documented. Thus, this study aims to quantify and decompose the education-related inequality in exclusive breastfeeding practice among Ethiopian mothers.MethodsA total of 1,504 weighted samples were studied using a Performance Monitoring for Action Ethiopia longitudinal panel survey dataset (2021–2023). Wagstaff normalized concentration index and its concentration curve were used to assess education-related inequality in exclusive breastfeeding practice. Wagstaff decomposition analysis was performed to decompose the concentration index and identify factors contributing to the observed education-related inequality. Significance was declared at p-value <0.05.ResultsThe overall prevalence of exclusive breastfeeding among Ethiopian women was 57.29% (95% CI: 54.79, 59.80%), with a greater concentration found among women with lower levels of education. This indicates an inequality that favors less educated women (pro-less educated inequality), as demonstrated by the Wagstaff normalized concentration index of −0.058 (95% CI: −0.113, −0.002). Factors that made a significant contribution to the observed education-related inequality in exclusive breastfeeding practice were residence (18.80%), region (29.31%), place of birth (−7.38%), and the wantedness status of the indexed pregnancy (82.58%). The indexed pregnancy’s wantedness was made a more elastic (elasticity = 0.282) contribution.ConclusionThe study identified a small yet significant education-related inequality in exclusive breastfeeding, favoring less educated women. Hence, emphasis should be placed not only on educating women but also on healthy habits that they can leave behind when they learn. Residence, region, place of birth, and indexed pregnancy’s wantedness significantly contributed to the observed education-related inequality. The elasticity value for each factor suggests that policy changes addressing these factors could readily reduce the observed inequality.
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Saidi, Olfa, Nada Zoghlami, Kathleen E. Bennett, Paola Andrea Mosquera, Dhafer Malouche, Simon Capewell, Habiba Ben Romdhane, and Martin O’Flaherty. "Explaining income-related inequalities in cardiovascular risk factors in Tunisian adults during the last decade: comparison of sensitivity analysis of logistic regression and Wagstaff decomposition analysis." International Journal for Equity in Health 18, no. 1 (November 15, 2019). http://dx.doi.org/10.1186/s12939-019-1047-6.
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Abstract Background It is important to quantify inequality, explain the contribution of underlying social determinants and to provide evidence to guide health policy. The aim of the study is to explain the income-related inequalities in cardiovascular risk factors in the last decade among Tunisian adults aged between 35 and 70 years old. Methods We performed the analysis by applying two approaches and compared the results provided by the two methods. The methods were global sensitivity analysis (GSA) using logistic regression models and the Wagstaff decomposition analysis. Results Results provided by the two methods found a higher risk of cardiovascular diseases and diabetes in those with high socio-economic status in 2005. Similar results were observed in 2016. In 2016, the GSA showed that education level occupied the first place on the explanatory list of factors explaining 36.1% of the adult social inequality in high cardiovascular risk, followed by the area of residence (26.2%) and income (15.1%). Based on the Wagstaff decomposition analysis, the area of residence occupied the first place and explained 40.3% followed by income and education level explaining 19.2 and 14.0% respectively. Thus, both methods found similar factors explaining inequalities (income, educational level and regional conditions) but with different rankings of importance. Conclusions The present study showed substantial income-related inequalities in cardiovascular risk factors and diabetes in Tunisia and provided explanations for this. Results based on two different methods similarly showed that structural disparities on income, educational level and regional conditions should be addressed in order to reduce inequalities.
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Nzepang, Fabrice, Siméon Serge Atangana, and Saturnin Bertrand Nguenda Anya. "Do ICTs reduce inequalities in access to professional training in Cameroon?" International Journal of Information and Learning Technology, July 27, 2023. http://dx.doi.org/10.1108/ijilt-08-2022-0167.
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PurposeThis work aims to assess the effects of information and communication technology (ICT) on inequalities in access to professional training (PT) in Cameroon.Design/methodology/approachThis study used data from the fourth Cameroonian Household Survey (ECAM 4), the concentration index (CI) calculations and the Wagstaff et al. (2003) decomposition.FindingsThe preliminary results show that the CI calculations by groups of individuals reveal the existence of significant inequalities in favour of the poor. This is the case for all groups of individuals who use ICT tools, namely radio, internet, telephone and television. The results of the Wagstaff et al. (2003) decomposition reveal that an equitable distribution of income between those who use and those who do not use the telephone, radio and internet reduces inequalities in access to FP in favour of the poor.Originality/valueDespite the wealth of literature devoted to the study of inequalities in access to education, the consideration of PT is still very marginal. In Cameroon, the literature devoted to the study of inequalities in access to PT is still almost non-existent, probably because of a low level of interest in the scientific community. However, as just seen, PT is a tool for combating unemployment, particularly in economies where the informal sector is important, insofar as the proportion of unemployed and inactive people is very low amongst the ones that have taken a PT course. Moreover, studies on the effects of ICT on inequalities in access to PT are still rare in the literature.
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Bashir, Saima, Shabana Kishwar, Muhammad Nasir, and Shehzad Ali. "Socioeconomic Inequalities in Out-of-Pocket and Catastrophic Health Expenditures in Pakistan." International Journal of Public Health 69 (November 12, 2024). http://dx.doi.org/10.3389/ijph.2024.1607313.
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ObjectivesIn Pakistan, healthcare utilization is linked to out-of-pocket payments (OOP) which disproportionately affect low-income households. We investigated socioeconomic inequality in OOP and catastrophic health expenditures (CHEs), and the contribution of sociodemographic factors to these inequalities.MethodsSocioeconomic inequalities were quantified using the concentration index (CI), and the slope (SII) and relative (RII) indices of inequality using data from three rounds of Household Integrated Economic Survey (2007-08, 2011-12, and 2018-19). Decomposition analyses were conducted using the Wagstaff and Erreygers approach.ResultsOOP payments increased from PKR 127 (2007-08) to PKR 250 (2018-19). CHEs in the most deprived quintile (Q1) changed from 8.3% (2007-08) to 13.7% (2018-19), and for the least deprived quintile (Q5) from 5.1% (2007-08) to 8.4% (2018-19). The OOP CI increased from 0.028 to 0.051, while the SII and RII increased from 0.89 to 1.32 and 1.18 to 1.36, respectively. Decomposition analysis showed that household size, composition, employment, and the province of residence explained much of the socioeconomic inequality in CHEs.ConclusionPoor households experience high CHE, disproportionately impacting larger families with children and elderly members. Policymakers should implement targeted financial protection strategies to safeguard vulnerable households from the impoverishing effects of healthcare expenses.
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Jalili, Faramarz, Nichole Austin, M. Ruth Lavergne, and Mohammad Hajizadeh. "Socioeconomic Inequalities in Participation in Colorectal Cancer Screening in Ontario, Canada: A decomposition analysis." Cancer Epidemiology, Biomarkers & Prevention, November 19, 2024. http://dx.doi.org/10.1158/1055-9965.epi-24-1239.
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Abstract Background: The relationship between socioeconomic status and colorectal cancer (CRC) screening in Canada remains poorly understood. This study aims to measure and explain the extent of socioeconomic inequalities in CRC screening participation in Ontario, Canada. Methods: This study assesses socioeconomic inequalities in CRC screening uptake in Ontario among adults aged 50 to 74 years (n=12,039) utilizing cross-sectional data from the 2017-2018 Canadian Community Health Survey (CCHS). The Wagstaff Index (WI) and the Erreygers Index (EI) were used to quantify and decompose income-related inequality in CRC screening participation. Results: The results revealed an overall CRC screening rate of 71.7%, with higher rates among females (78.4%) compared to males (69.4%). The positive values of the WI (0.193; 95% confidence interval [CI]: 0.170 to 0.215) and the EI (0.156; 95% CI: 0.138 to 0.174) indicated a pro-rich inequality in CRC screening participation in Ontario (i.e., screening is more concentrated among wealthier individuals). The decomposition analysis identified income (71.61%), education (8.61%), and language barriers with healthcare providers (5.76%) as the primary factors contributing to the observed income-related inequality in CRC screening participation. Conclusion: Income is the primary driver of socioeconomic inequality, requiring targeted strategies to boost screening rates among low-income residents. Addressing education and language barriers through awareness initiatives and language support can reduce socioeconomic inequalities in cancer screening uptake in Ontario. Impact: Our study reveals significant socioeconomic inequality in colorectal cancer screening in Ontario, driven by income, education, and language barriers, underscoring the need for targeted interventions to promote equitable access.
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Zubair, Muhammad, Lubna Naz, and Shyamkumar Sriram. "Decomposing socioeconomic inequality in household out of pocket health expenditures in Pakistan (2010-11–2018-19)." BMC Health Services Research 24, no. 1 (July 24, 2024). http://dx.doi.org/10.1186/s12913-024-11203-9.
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Abstract Background The increased socioeconomic inequality in catastrophic health expenditure (CHE) disproportionately affects disadvantaged populations, subjecting them to financial hardships, limiting their access to healthcare, and exacerbating their vulnerability to morbidity. Objectives This study examines changes in socioeconomic inequality related to CHE and analyzes the contributing factors responsible for these changes in Pakistan between 2010-11 and 2018-19. Methods This paper extracted the data on out-of-pocket health expenditures from the National Health Accounts for 2009-10 and 2017-18. Sociodemographic information was gathered from the Household Integrated Economic Surveys of 2010-11 and 2018-19. CHE was calculated using budget share and the ability-to-pay approaches. To assess socioeconomic inequality in CHE in 2010-11 and 2018-19, both generalized and standard concentration indices were used, and Wagstaff inequality decomposition analysis was employed to explore the causes of socioeconomic inequality in each year. Further, an Oaxaca-type decomposition was applied to assess changes in socioeconomic inequality in CHE over time. Results The concentration index reveals that socioeconomic inequality in CHE decreased in 2018-19 compared to 2010-11 in Pakistan. Despite the reduction in inequality, CHE was concentrated among the poor in Pakistan in 2010-11 and 2018-19. The inequality decomposition analysis revealed that wealth status was the main cause of inequality in CHE over time. The upper wealth quantiles indicated a positive contribution, whereas lower quantiles showed a negative contribution to inequality in CHE. Furthermore, urban residence contributed to pro-rich inequality, whereas employed household heads, private healthcare provider, and inpatient healthcare utilization contributed to pro-poor inequality. A noticeable decline in socioeconomic inequality in CHE was observed between 2010 and 2018. However, inequality remained predominantly concentrated among the lower socio-economic strata. Conclusion These results underscore the need to improve the outreach of subsidized healthcare and expand social safety nets.
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Soleimanvandiazar, Neda, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, SalahEddin Karim, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, and Ameneh Setareh Forouzan. "Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 61 (January 2024). http://dx.doi.org/10.1177/00469580241229622.
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Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: −83.79) and having basic insurance coverage (RS: −3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
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Gatimu, Samwel Maina, and Thomas Wiswa John. "Socioeconomic inequalities in hypertension in Kenya: a decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors." International Journal for Equity in Health 19, no. 1 (December 2020). http://dx.doi.org/10.1186/s12939-020-01321-1.
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Abstract Background One in four Kenyans aged 18–69 years have raised blood pressure. Despite this high prevalence of hypertension and known association between socioeconomic status and hypertension, there is limited understanding of factors explaining inequalities in raised blood pressure in Kenya. Hence, we quantified the socioeconomic inequality in hypertension in Kenya and decomposed the determinants contributing to such inequality. Methods We used data from the 2015 Kenya STEPwise survey for non-communicable diseases risk factors. We included 4422 respondents aged 18–69 years. We estimated the socioeconomic inequality using the concentration index (C) and decomposed the C using Wagstaff decomposition analysis. Results The overall concentration index of hypertension in Kenya was − 0.08 (95% CI: − 0.14, − 0.02; p = 0.005), showing socioeconomic inequalities in hypertension disfavouring the poor population. About half (47.1%) of the pro-rich inequalities in hypertension was explained by body mass index while 26.7% by socioeconomic factors (wealth index (10.4%), education (9.3%) and paid employment (7.0%)) and 17.6% by sociodemographic factors (female gender (10.5%), age (4.3%) and marital status (0.6%)). Regional differences explained 7.1% of the estimated inequality with the Central region alone explaining 6.0% of the observed inequality. Our model explained 99.7% of the estimated socioeconomic inequality in hypertension in Kenya with a small non-explained part of the inequality (− 0.0002). Conclusion The present study shows substantial socioeconomic inequalities in hypertension in Kenya, mainly explained by metabolic risk factors (body mass index), individual health behaviours, and socioeconomic factors. Kenya needs gender- and equity-focused interventions to curb the rising burden of hypertension and inequalities in hypertension.
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Singh, S. K., Shobhit Srivastava, and Shekhar Chauhan. "Inequality in child undernutrition among urban population in India: a decomposition analysis." BMC Public Health 20, no. 1 (December 2020). http://dx.doi.org/10.1186/s12889-020-09864-2.
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Abstract Background With increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life. This study analyses child undernutrition among urban poor and non-poor and decomposes the contribution of various factors influencing socio-economic inequality. This paper uses data from two recent rounds of National Family Health Survey (NFHS-3&4) conducted during 2005–06 and 2015–16. Methods The concentration index (CI) and the concentration curve (CC) measure socio-economic inequality in child growth in terms of stunting, wasting, and underweight. Wagstaff decomposition further analyses key contributors in CI by segregating significant covariates into five groups-mother’s factor, health-seeking factors, environmental factors, child factors, and socio-economic factors. Results The prevalence of child undernutrition was more pronounced among children from poor socio-economic strata. The concentration index decreased for stunting (− 0.186 to − 0.156), underweight (− 0.213 to − 0.162) and wasting (− 0.116 to − 0.045) from 2005 to 06 to 2015–16 respectively. The steepness in growth was more among urban poor than among urban non-poor in every age interval. Maternal education contributed about 19%, 29%, and 33% to the inequality in stunting, underweight and wasting, respectively during 2005–06. During 2005–06 as well as 2015–16, maternal factors (specifically mother’s education) were the highest contributory factors in explaining rich-poor inequality in stunting as well as underweight. More than 85% of the economic inequality in stunting, underweight, and wasting among urban children were explained by maternal factors, environmental factors, and health-seeking factors. Conclusion All the nutrition-specific and nutrition-sensitive interventions in urban areas should be prioritized, focusing on urban poor, who are often clustered in low-income slums. Rich-poor inequality in child growth calls out for integration and convergence of nutrition interventions with policy interventions aimed at poverty reduction. There is also a need to expand the scope of the Integrated Child Development Services (ICDS) program to provide mass education regarding nutrition and health by making provisions of home visits of workers primarily focusing on pregnant and lactating mothers.
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Yahyavi Dizaj, Jafar, Maryam Khoramrooz, Vajihe Ramezani-Doroh, Satar Rezaei, Reza Hashempour, Kamran Irandoust, Shahin Soltani, and Ali Kazemi-Karyani. "Socioeconomic inequality in informal payments for health services among Iranian households: a national pooled study." BMC Public Health 23, no. 1 (February 23, 2023). http://dx.doi.org/10.1186/s12889-023-15071-6.
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Abstract Background There is limited evidence on the prevalence and socioeconomic inequality in informal payments (IP) of households in the Iranian health system. This study was conducted to investigate the prevalence of IP and related socioeconomic inequalities among Iranian households in all provinces. Method Data on Household Income and Expenditure Surveys (HIES) for 91,360 households were used to examine the prevalence and inequality in informal health sector payments in the years 2016 to 2018. The Normalized Concentration Index (NC) was used to examine inequality in these payments and the decomposition analysis by the Wagstaff approach was used to determine the share of variables affecting the measured inequality. Results Of the total households, 7,339 (7.9%) reported IP for using health services. Urban households had higher IP (10%) compared to rural ones (5.42%). Also, the proportion of households with IP in 2016 (11.69%) was higher than in 2017 (9.9%), and 2018 (4.60%). NC for the study population was 0.129, which shows that the prevalence of IP is significantly higher in well-off households. Also, NC was 0.213 (p < 0.0001) and -0.019 for urban and rural areas, respectively (p > 0.05). Decomposition analysis indicated that income, sex of head of household, and the province of residence have the highest positive contribution to measured inequality (with contributions of 156.2, 45.8, and 25.6%, respectively). Conclusion There are a significant prevalence and inequality in IP in Iran's health system and important variables have shaped it. On the whole, inequality was pro-rich. This may lead to increasing inequality in access to quality services in the country. Our findings showed that previous health policies such as regulatory tools, and the health transformation plan (HTP) have not been able to control IP in the health sector in the desired way. It seems that consumer-side policies focusing on affluent households, and high-risk provinces can play an important role in controlling this phenomenon.
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CHEN, YU, MINCHUL KIM, ELIZABETH A. LUNDEEN, DEBORAH B. ROLKA, JOSHUA R. EHRLICH, PAULA ANNE NEWMAN-CASEY, ANGELA ELAM, DAVID B. REIN, CHRISTOPHER S. HOLLIDAY, and JINAN B. SAADDINE. "42-PUB: Income-Related Inequalities in Self-Reported Vision Problems among U.S. Adults, 1999–2018." Diabetes 73, Supplement_1 (June 14, 2024). http://dx.doi.org/10.2337/db24-42-pub.
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Introduction & Objective: Research has shown that the prevalence of vision problems is higher among U.S. adults with low income. Recent changes in income-related inequalities (IRI) in the prevalence of vision problems are unknown. We aim to examine trends in IRI in vision problems and to identify the relative contribution of determining factors. Methods: We estimated annual IRI in vision problems in 1999−2018 among US adults aged ≥18 years using data from the National Health Interview Survey. Vision problems are defined as an affirmative response to the question: “Do you have trouble seeing, even when wearing glasses or contact lenses?”. We used the concentration index (CI) to measure IRI and quantified the extent to which the prevalence of vision problems concentrates in lower income versus higher income groups. We used the Wagstaff decomposition method to decompose CI into contributors. We examined trends from 1999−2018 in vision problems inequality and contributors to those trends over time. Results: Between 1999−2018, the CIs were below 0, signifying that vision problems were more concentrated among individuals with lower incomes. The degree of IRI in vision problems increased from 1999−2018 (annual percent change=0.6, p=0.03). IRI in vision problems was greater among adults aged 45-64 years than other age groups. Decomposition analysis revealed that poverty-to-income ratio and public health insurance coverage were the largest contributors to IRI in vision problems, with smaller contributions made by smoking, physical inactivity, and female sex. Among all variables, non-White race/ethnicity, lower physical activity, and poverty-to-income ratio were the main factors explaining trends in vision problems inequality over time. Conclusion: Self-reported vision problems were more prevalent in low-income populations, and IRI widened over time. The sustained growth in income inequality may lead to a larger population burden of vision problems. Disclosure Y. Chen: None. M. Kim: None. E.A. Lundeen: None. D.B. Rolka: None. J.R. Ehrlich: None. P. Newman-Casey: None. A. Elam: None. D.B. Rein: None. C.S. Holliday: None. J.B. Saaddine: None.
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Khoramrooz, Maryam, Seyed Mohammad Mirrezaie, Mohammad Hassan Emamian, Hajar Golbabaei Pasandi, Ali Dadgari, Hassan Hashemi, and Akbar Fotouhi. "Economic inequalities in decayed, missing, and filled first permanent molars among 8–12 years old Iranian schoolchildren." BMC Oral Health 23, no. 1 (October 7, 2023). http://dx.doi.org/10.1186/s12903-023-03471-4.
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Abstract Background First permanent molars (FPM) play an important role in the masticatory function and oral health. This study aimed to assess the economic inequalities of FPM health indices among schoolchildren in the northeast of Iran. Methods A total of 4051 children aged 8–12 years old were included in the analyses of this cross-sectional study in 2015. Economic status was measured using the principal component analysis on home assets. Concentration index (C) was used to measure economic inequality in FPM health indices, and its contributing factors determined by Wagstaff decomposition technique. Results The prevalence of having decayed, missing, and filled FPMs among children was 40.9% (95% CI: 38.8–43.0), 1.2% (95% CI: 0.8–1.6%), and 7.8% (95% CI: 6.7–8.9%), respectively. Missing FPM was generally more concentrated among low-economic children (C=-0.158), whereas, filled FPM was more concentrated on high-economic children (C = 0.223). Economic status, mother education, having a housekeeper mother, and overweight/obesity, contributed to the measured inequality in missing FPM by 98.7%, 97.5%, 64.4%, and 11.2%, respectively. Furthermore, 88.9%, 24.1%, 14.5%, and 13.2% of filled FPM inequality was attributable to children’s economic status, father education, residence in rural areas, and age, respectively. Conclusion There is a significant economic inequality in both missing and filled FPM. This inequality can be attributed to the economic status of individuals. To reduce FPM extraction, it is important to target low-income and rural children and provide them with FPM restoration services. Additionally, it is necessary to provide training to less-educated parents and housekeeper mothers to address the observed inequalities.
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Cai, Jiaoli, Yue Li, and Peter C. Coyte. "The impacts on population health by China's regional health data centers and the potential mechanism of influence." DIGITAL HEALTH 11 (January 2025). https://doi.org/10.1177/20552076251314102.
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Background China recently established a series of pilot regional health data centers with a mandate to acquire, consolidate, analyze, and translate data into evidence for health policy decision-making. This experiment with “big data” has the potential to influence population health and is the focus of this study. Methods This study used national longitudinal survey data from the China Family Panel Studies over the period 2014–2020 to empirically assess the impact of China's establishment of pilot regional health data centers on population health and health inequality. A difference-in-differences model was employed to investigate the policy effect on population health, with additional exploration of possible mechanisms of influence. The corrected concentration index was used to measure health inequality, while Wagstaff decomposition method was applied to examine the marginal influence of the policy effect on health inequality. Results Overall health status of local residents has improved after the establishment of the pilot regional health data centers. Using mechanism analysis, the findings demonstrated that improvements to population health were driven by promoting healthy lifestyles and innovations in medical practices. Furthermore, due to differences in individual e-health literacy, the pilot centers produced “pro-rich” health inequality where high-income groups benefited more from the establishment of the pilot centers in terms of health than low-income groups. Conclusions This study has highlighted the potential to improve population health, in general, with the advent of big data centers, but for these benefits be unevenly distributed among the resident population.
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You, Jialu, Jinhua Zhang, and Ze Li. "Consumption-Related Health Education Inequality in COVID-19: A Cross-Sectional Study in China." Frontiers in Public Health 10 (April 25, 2022). http://dx.doi.org/10.3389/fpubh.2022.810488.
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BackgroundThe COVID-19 pandemic influences various aspects of society, especially for people with low socioeconomic status. Health education has been proven to be a critical strategy in preventing a pandemic. However, socioeconomic characteristics may limit health education among low socioeconomic status groups. This study explores consumption-related health education inequality and the factors that contribute to this, which are variable across China during COVID-19.MethodsThe 2020 China COVID-19 Survey is a cross-sectional study in China, based on an anonymous online survey from 7,715 samples in 85 cities. It employed machine-learning methods to assess household consumption and other contributing variates associated with health education during the pandemic. Concentration Index (CI) and Horizontal Index (HI) were used to measure consumption-related inequalities in health education, respectively. Moreover, Wagstaff decomposition analysis was employed to identify other contributing variables to health education inequality.ResultsThe result indicates that participants with more education, better income, and positive consumption preferences undertake higher health education during COVID-19. The CI and HI of consumption-health education inequality are 0.0321 (P < 0.001) and 0.0416 (p < 0.001), respectively, which indicates that health education is concentrated in wealthy groups. We adapted Lasso regression to solve issues and omit variables. In terms of other socioeconomic characteristics, Annual Income was also a major contributor to health education inequalities, accounting for 27.1% (P < 0.001). The empirical results also suggests that education, health status, identification residence, and medical health insurance contribute to health education inequality.ConclusionsThe difference in Household consumption, annual income, rural and urban disparity, and private healthcare insurance are critical drivers of health education inequality. The government should pay more attention to promoting health education, and healthcare subside policy among vulnerable people. Significantly to improve awareness of undertaking health education with lower education, rural residential, to enhance confidence in economic recovery and life after COVID-19.
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Mishra, Prem Shankar, Debashree Sinha, Pradeep Kumar, Shobhit Srivastava, and Rahul Bawankule. "Newborn low birth weight: do socio-economic inequality still persist in India?" BMC Pediatrics 21, no. 1 (November 19, 2021). http://dx.doi.org/10.1186/s12887-021-02988-3.
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Abstract Background The incidence of preterm birth and subsequent low birth weight (LBW) are vital global public health issues. It contributes to high infant and child mortality in the early stages of life and later on in adult life; it increases the risk for non-communicable diseases. The study aims to understand the socio-economic status-related inequality for LBW among children in India. It hypothesises that there is no association between the socio-economic status of the household and the newborn’s LBW in India. Methods The study utilised data from the fourth round of the National Family Health Survey, a national representative cross-sectional survey conducted in 2015-16 (N = 127,141). The concentration index (CCI) and the concentration curve (CC) measured socio-economic inequality in low birth status among newborns. Wagstaff decomposition further analysed key contributors in CCI by segregating significant covariates. Results About 18.2% of children had low birth weight status. The value of concentration was − 0.05 representing that low birth weight status is concentrated among children from lower socio-economic status. Further, the wealth quintile explained 76.6% of the SES related inequality followed by regions of India (− 44%) and the educational status of mothers (43.4%) for LBW among children in India. Additionally, the body mass index of the women (28.4%), ante-natal care (20.8%) and residential status (− 15.7%) explained SES related inequality for LBW among children in India. Conclusion Adequate attention should be given to the mother’s nutritional status. Awareness of education and usage of health services during pregnancy should be promoted. Further, there is a need to improve the coverage and awareness of the ante-natal care (ANC) program. In such cases, the role of the health workers is of utmost importance. Programs on maternal health services can be merged with maternal nutrition to bring about an overall decline in the LBW of children in India.
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Sk, Md Illias Kanchan, Balhasan Ali, Mohai Menul Biswas, and Mrinal Kanti Saha. "Disparities in three critical maternal health indicators amongst Muslims: Vis-a-vis the results reflected on National Health Mission." BMC Public Health 22, no. 1 (February 9, 2022). http://dx.doi.org/10.1186/s12889-022-12662-7.
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Abstract Background The post national health mission era has been recognized for India’s accelerating improvement in maternal health care utilization. Concurrent investigations with the purview of examining inequalities in maternal care utilisation have rigorously examined across various socio-economic groups, focusing on Muslim women. The present study examined socio-economic differentials in maternal health care utilisation among Muslims and the delineated factors which are contributing for these inequalities. Methods Study used the data from National Family Health Survey (NFHS) conducted in 2005-06 and 2015-16. the present study applied concentration index and Wagstaff-type decomposition analysis to measure and decompose the inequality in maternal health services. Results This study found that utilisation of full antenatal care (full ANC), skilled attendants at birth (SBAs) and postnatal care was increased during 2005-06 to 2015-16. However, the least improvement was observed in full antenatal care whereas substantial improvement was achieved in utilising skilled attendants at birth. Further, the poor and non-poor gap in maternal health care utilisation mostly prevailed among the educated, urban resident, other backward castes among Muslims. The inequality has been declined largely in SBA utilisation compared to full ANC and PNC, especially in the southern India. Higher education, mass media exposure, higher birth order and urban residence contribute and explain most of these inequalities in maternal care among Muslim women Conclusions Despite the fact that free and cash benefitted health programmes, wealth, mass media exposure and education etc welfare programs benefitted a large number of citizens, it also produced most of the inequalities among Muslims in India. The results focus on the significance of wealth, education, and mass media exposure in bridging the socioeconomic gap in maternal health care utilization among Muslims.
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Singh, Saurabh, Neha Shri, and Akancha Singh. "Inequalities in the prevalence of double burden of malnutrition among mother–child dyads in India." Scientific Reports 13, no. 1 (October 7, 2023). http://dx.doi.org/10.1038/s41598-023-43993-z.
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AbstractIn the midst of rapid urbanization and economic shifts, the global landscape witnesses a surge in overweight and obese individuals, even as child malnutrition persists as a formidable public health challenge in low- and middle-income countries (LMICs). This study seeks to unravel the prevalence of the double burden of malnutrition (DBM) within the context of India and delve into the associated disparities rooted in wealth. This study leverages data from the fifth wave of the National Family and Health Survey (NFHS-5), a nationally representative survey conducted in the year 2019–21 in India. This study focuses on mother–child dyads with children under the age of 3 years. Descriptive, bivariate and logistic regression analysis is used to decipher the intricate web of DBM’s prevalence and risk factors, as underscored by socio-demographic attributes. Wagstaff decomposition analysis is applied to quantify the contribution of each inequality in the social determinants on the observed income-related inequality in the DBM. Result from bivariate and logistic regression indicated a heightened risk of DBM within households marked by C-section births, affluence, ongoing breastfeeding practices, advanced maternal age, and larger household sizes. Additionally, households harbouring women with abdominal obesity emerge as hotspots for elevated DBM risk. Notably, the interplay of abdominal obesity and geographical disparities looms large as drivers of substantial inequality in DBM prevalence, whereas other factors exert a comparably milder influence. As India grapples with the burgeoning burden of DBM, a conspicuous imbalance in its prevalence pervades, albeit inadequately addressed. This juncture warrants the formulation of dual-purpose strategies, and a slew of innovative actions to deftly navigate the complex challenges poised by the dual burden of malnutrition. Amidst these exigencies, the imperative to forge a holistic approach that encompasses both sides of the malnutrition spectrum remains a beacon guiding the quest for equitable health and nutrition outcomes.
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Arabi, Samira, Nader Jahanmehr, and Maryam Khoramrooz. "National and regional economic inequalities in first- and second-hand tobacco consumption among women of reproductive ages in Iran." BMC Public Health 23, no. 1 (December 18, 2023). http://dx.doi.org/10.1186/s12889-023-17287-y.
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Abstract Introduction The epidemic of tobacco consumption is one of the major public health threats the world has been facing so far. This study was performed to investigate the economic inequalities in tobacco consumption among women of reproductive ages at national and regional levels in Iran. Methods We used data from 10,339 women of reproductive ages (18–49 years) who participated in Iran’s 7th Non-Communicable Disease Risk Factor Surveillance (STEPS). Wagstaff normalized concentration index and decomposition method were applied to measure economic inequalities in first- and second-hand tobacco consumption and determine their corresponding contributory factors, respectively. Results The prevalence of women’s first-hand tobacco consumption, and their exposure to second-hand smoke in the home, and workplace were 3.6%, 28.3%, and 8.4%, respectively. First- and second-hand tobacco consumption was significantly more concentrated among low-economic women. Exposure to home second-hand smoke, education, and economic status had the largest contributions to the measured inequality in first-hand tobacco consumption (48.9%, 38.9%, and 30.8%, respectively). The measured inequality in women’s secondhand smoke exposure at home was explained by their level of education (43.8%), economic status (30.3%), and residency in rural areas (18%), and at work by residency in rural areas (42.2%), economic status (38.8%), and level of education (32%). Our results also revealed diversity in the geographical distribution of inequalities in rural and urban areas and five regions of the country. Conclusion The present study highlighted the need for more enforcement of tobacco control rules and increasing tobacco taxes as general measures. Furthermore, there is a need for gender-sensitive initiatives at national and regional levels to educate, support, and empower low-economic women and households for tobacco cessation, and complying with restrictive smoking rules.
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Fritzell, S., H. Källberg, H. Busch, and P. Gustafsson. "Income-related inequalities in mental health in Sweden and the role of social determinants." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz185.633.
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Abstract Background Mental health is an increasing concern in all European countries as the burden of mental disorders continue to grow and cause substantial suffering and costs to societies. Furthermore, research shows there are social inequalities in the distribution of mental illness. This study aims to increase knowledge on income-related inequalities in mental health in Sweden and the role of social determinants. Methods Drawing on a national survey (Health on Equal Terms) representative of the population aged 16-84, years 2010-2015 (n = 57107) we quantify the income-related inequality in mental health and estimate the contribution of social determinants of the inequality. Poor mental health is defined as a value of at least 3, based on the general health questionnaire (GHQ)-12. Income is measured as yearly disposable income. Income related inequalities in mental health are quantified by the concentration index and decomposed using the Wagstaff-type decomposition analysis. Results Preliminary results show that the income inequalities in mental health, as measured by the overall concentration index in mental health was - 0,16 (95% CI -0.17 to -0.15), indicating income inequalities to the disadvantage of those less affluent. The determinants that contributed most to the inequalities were employment, financial strain and experiencing harassment. Together they explained 43 % of the income inequalities in mental health. Generally, socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance. Conclusions The income related inequalities in mental health are substantial in Sweden. Recently, a national target of reducing the preventable inequalities in health within a generation was adopted. To improve surveillance of inequalities and inform policy we need to closely follow the development of inequalities in mental health and to disentangle the contribution of specific social determinants. Key messages Income-related inequalities in mental health in Sweden are considerable. Socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.
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Srivastava, Shobhit, and Shubham Kumar. "Does socio-economic inequality exist in micro-nutrients supplementation among children aged 6–59 months in India? Evidence from National Family Health Survey 2005–06 and 2015–16." BMC Public Health 21, no. 1 (March 19, 2021). http://dx.doi.org/10.1186/s12889-021-10601-6.
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Abstract Background Globally, about 25% of children suffer from subclinical vitamin A deficiency (VAD), and approximately 300 million children globally had anemia as per 2011 estimates. Micronutrient deficiencies are generally referred to as “hidden hunger” because these deficiencies developed gradually. The present study determines the socio-economic inequalities in vitamin A supplementation (VAS) and Iron supplementation (IS) among children aged 6–59 months in India and to estimate the change in the percent contribution of different socio-economic correlates for such inequality from 2005 to 06 to 2015–16. Methods Data from National Family Health Survey (NFHS) 2005–06 and 2015–16 was used for the analysis. Bivariate analysis and logistic regression analysis was used to carve out the results. Moreover, Wagstaff decomposition analysis was used to find the factors which contributed to explain socio-economic status-related inequality among children in India. Results It was revealed that the percentage of children who do not receive vitamin A supplementation was reduced from 85.5% to 42.1%, whereas in the case of IS, the percentage reduced from 95.3% to 73.9% from 2005-06 to 2015–16 respectively. The child’s age, mother’s educational status, birth order, breastfeeding status, place of residence and empowered action group (EAG) status of states were the factors that were significantly associated with vitamin A supplementation and iron supplementation among children in India. Moreover, it was found the children who do not receive vitamin A supplementation and iron supplementation got more concentrated among lower socio-economic strata. A major contribution for explaining the gap for socio-economic status (SES) related inequality was explained by mother’s educational status, household wealth status, and empowered action group status of states for both vitamin A supplementation and iron supplementation among children aged 6–59 months in India. Conclusion Schemes like the Integrated Child Development Scheme (ICDS) would play a significant role in reducing the socio-economic status-related gap for micro-nutrient supplementation among children in India. Proper implementation of ICDS will be enough for reducing the gap between rich and poor children regarding micro-nutrient supplementation.
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Muhammad, T., Shobhit Srivastava, and T. V. Sekher. "Assessing socioeconomic inequalities in cognitive impairment among older adults: a study based on a cross-sectional survey in India." BMC Geriatrics 22, no. 1 (May 4, 2022). http://dx.doi.org/10.1186/s12877-022-03076-6.
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Abstract Background The rapidly aging population is a major concern for countries, especially where cognitive health in older age is poor. The study examined the socioeconomic and health-related factors associated with cognitive impairment among older adults and the contribution of those factors to the concentration of low cognitive functioning among older adults from economically poor households. Methods Data this study were derived from the “Building Knowledge Base on Population Ageing in India” (BKPAI) survey, which was carried out in seven major states of India. The effective sample size for the analysis was 9176 older adults aged 60 years and above. Results from descriptive and bivariate analysis were reported in the initial stage. Multivariable logistic regression analysis was conducted to explore the associations. Additionally, the concentration index and concentration curve were used to measure socioeconomic inequality in cognitive impairment among older adults. Wagstaff decomposition was employed to explore the key contributors in the concentration index. Results Nearly 60% of older adults suffered from cognitive impairment in the study. The likelihood of cognitive impairment were higher among older adults with a low level of self-perceived income sufficiency [coefficient: 0.29; confidence interval (CI): 0.07- 0.52] compared to older adults with higher levels of perceived income status. Older adults with more than 10 years of schooling were less likely to be cognitively impaired [coefficient: -1.27; CI: − 1.50- -1.04] in comparison to those with no education. Cognitive impairment was concentrated among older adults from households with the lowest wealth quintile (concentration index (CCI): − 0.10: p < 0.05). Educational status explained 44.6% of socioeconomic inequality, followed by 31.8% by wealth status and 11.5% by psychological health. Apart from these factors, difficulty in instrumental activities of daily living (3.7%), caste (3.7%), and perceived income sufficiency to fulfil basic needs (3.0%) explained socioeconomic inequality in cognitive impairment among older adults. Conclusions Findings suggest that older adults with lower perceived income, lower levels of education, poor physical and mental health, and poor physical and social resources were more likely to be cognitively impaired. Education, wealth and psychological health are major contributors in socioeconomic inequality in late-life cognitive impairment, which may be target areas in future policy formulation to reduce the inequality in cognitive impairment in older Indian adults.
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Musheiguza, Edwin, Michael J. Mahande, Elias Malamala, Sia E. Msuya, Festo Charles, Rune Philemon, and Melina Mgongo. "Inequalities in stunting among under-five children in Tanzania: decomposing the concentration indexes using demographic health surveys from 2004/5 to 2015/6." International Journal for Equity in Health 20, no. 1 (January 23, 2021). http://dx.doi.org/10.1186/s12939-021-01389-3.
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Abstract Background Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3–59 months from 2004 to 2016. Methods Data were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning. Results Inequalities in stunting were significantly concentrated among the poor; evidenced by CIX = − 0.019 (p < 0.001) in 2004, − 0.018 (p < 0.001) in 2010 and − 0.0096 (p < 0.001) in 2015. There was insignificant decline in inequalities in stunting; the difference in CIX from 2004 to 2010 was 0.0015 (p = 0.7658), from 2010 to 2015/6 was − 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time. Conclusion Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.
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Nie, Peng, Lanlin Ding, Zhuo Chen, Shiyong Liu, Qi Zhang, Zumin Shi, Lu Wang, Hong Xue, Gordon G. Liu, and Youfa Wang. "Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey." International Journal for Equity in Health 20, no. 1 (April 26, 2021). http://dx.doi.org/10.1186/s12939-021-01448-9.
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AbstractBackgroundPartial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic.MethodsThe 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities.ResultsMost participants reported their health status as “very good” (39.0%) or “excellent” (42.3%). CCI of SRH and mental health were − 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%),p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health).ConclusionsPer capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.
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Kumar, Pradeep, Sherry Mangla, and Sampurna Kundu. "Inequalities in overweight and obesity among reproductive age group women in India: evidence from National Family Health Survey (2015–16)." BMC Women's Health 22, no. 1 (June 2, 2022). http://dx.doi.org/10.1186/s12905-022-01786-y.
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Abstract Background In developing nations like India, fertility and mortality have decreased, and diseases related to lifestyle have become more common. Females in India are more prone to being overweight and obese than their male counterparts, more specifically in affluent families than the poor ones. Understanding the overweight and obesity trend may help develop feasible public health interventions to reduce the burden of obesity and associated adverse health outcomes. Methods The study utilizes the fourth round of the National Family Health Survey (NFHS-4), 2015–16. Descriptive statistics, bivariate and multivariate analysis was used to check the significant relationship between overweight and obesity, and other background characteristics. Income-related inequality in overweight and obesity among women was quantified by the concentration index and the concentration curve. Further, Wagstaff decomposition analysis was done to decompose the concentration index, into the contributions of each factor to the income-related inequalities. Results Overweight & obesity among women had a significant positive association with their age and educational level. The odds of overweight and obesity were 57% more likely among women who ever had any caesarean births than those who did not [AOR: 1.57; CI: 1.53–1.62]. The likelihood of overweight and obesity was 4.31 times more likely among women who belonged to richest [AOR: 5.84; CI: 5.61–6.08] wealth quintile, than those who belonged to poor wealth quintile. Women who ever terminated the pregnancy had 20% higher risk of overweight and obesity than those who did not [AOR: 1.20; CI: 1.17–1.22]. The concentration of overweight and obesity among women was mostly in rich households of all the Indian states and union territories. Among the geographical regions of India, the highest inequality was witnessed in Eastern India (0.41), followed by Central India (0.36). Conclusion The study results also reveal a huge proportion of women belonging to the BMI categories of non-normal, which is a concern and can increase the risks of developing non-communicable diseases. Hence, the study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status which can reduce the risks of health consequences due to overweight and obesity. Development nutrition-specific as well as sensitive interventions can be done for mobilization of local resources that addresses the multiple issues under which a woman is overweight or obese.
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Okutse, Amos O., and Henry Athiany. "Socioeconomic disparities in child malnutrition: trends, determinants, and policy implications from the Kenya demographic and health survey (2014 - 2022)." BMC Public Health 25, no. 1 (January 24, 2025). https://doi.org/10.1186/s12889-024-21037-z.
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Abstract Background Child malnutrition remains a critical public health problem, with socioeconomic factors playing a significant role. Socioeconomic factors include household income, parental education, and access to healthcare, which influence a child’s nutritional status. Despite overall progress in reducing under-five child malnutrition in Kenya, disparities persist. This paper analyzes changes, and determinants of child malnutrition, contributions of these determinants to health inequality, and their potential use in the screening for chronic malnutrition in children under five years. Methods We use data from the Kenyan Demographic and Health Survey (KDHS 2014 and 2022) and analyze malnutrition using three indicators: Stunting, underweight, and wasting. The determinants of malnutrition are analyzed using multivariate logistic regression. Trends in socioeconomic inequality are analyzed using concentration indices and visualized using concentration curves. Wagstaff decomposition is used to explore the contributions of determinants to inequality in child malnutrition. We investigate diagnostic utility using sensitivity, specificity, predictive values, and area under the ROC curve. Results Socioeconomic inequality in under-five child malnutrition increased between 2014 and 2022, with children from the poorest socioeconomic quintiles being disproportionately affected. A child’s age (in months) (Adjusted Odds Ratio [AOR] = 1.01; 95% Confidence Interval [CI]: 1.01 – 1.02), being born to a household in the poorest socioeconomic quintile (AOR = 2.67; 95%CI: 1.92 - 3.72), and sex (male) (AOR = 1.50; 95%CI: 1.35 – 1.67) were associated with an increased risk of stunting. The mother’s age, sex of the child (male), and household socioeconomic status (poorest) was associated with an increased risk of being underweight and wasted, whereas residence was associated with an increased risk of wasting alone after adjusting for potential confounders. A household’s socioeconomic status was the largest contributing factor to health inequality. Sensitivity, specificity, and AUC values were 67.4% (95% CI: 66.4% – 68.4%), 50.6% (95%CI: 50.0% - 51.1%), and 0.59 (95%CI: 0.58 – 0.60), respectively, when using socioeconomic status as a screening tool for stunting. Conclusion Socioeconomic disparities are a major barrier to reducing child malnutrition in Kenya, with children from lower socioeconomic quintiles at a greater risk of stunting, underweight, or wasting. This study identifies a child’s sex, age, and household socioeconomic status as key predictors of malnutrition, highlighting the need to include these factors in public health interventions. Addressing these disparities with targeted strategies considering immediate health risks and underlying socioeconomic challenges is essential for equitably improving child health outcomes.
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Kumar, Pradeep, and Himani Sharma. "Prevalence and determinants of socioeconomic inequality in caesarean section deliveries in Bangladesh: an analysis of cross-sectional data from Bangladesh Demographic Health Survey, 2017-18." BMC Pregnancy and Childbirth 23, no. 1 (July 4, 2023). http://dx.doi.org/10.1186/s12884-023-05782-4.
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Abstract Background Caesarean section deliveries, which involve incisions in the abdomen and uterus of the mother, have been a widespread event among women with obstructed labour. The current study not only estimated the socioeconomic and demographic factors of caesarean deliveries in Bangladesh but also decomposed the existing socioeconomic inequality in caesarean deliveries. Data and methods 2017-18 Bangladesh Demographic and Health Survey (BDHS) data was used for this study. The adequate sample size for the analysis was 5,338 women aged 15–49 years who had given birth at a health facility for three years preceding the survey. Explanatory variables included women’s age, women’s educational level, women’s working status, mass media exposure, body mass index (BMI), birth order, Ante Natal Care (ANC) visits, place of delivery, partner’s education and occupation, religion, wealth index, place of residence, and divisions. Descriptive statistics along with bivariate and multivariate logistic regression analysis was performed to identify the factors associated with the outcome variable. Concentration index and concentration curve were made to measure the socioeconomic inequality in caesarean births in Bangladesh. Further, Wagstaff decomposition analysis was used to decompose the inequalities in the study. Results About one-third of the deliveries in Bangladesh were caesarean. Education of the women and the family’s wealth had a positive relationship with caesarean delivery. The likelihood of caesarean delivery was 33% less among working women than those who were not working [AOR: 0.77; CI: 0.62–0.97]. Women who had mass media exposure [AOR: 1.27; CI: 0.97–1.65], overweight/obese [AOR: 1.43; CI: 1.11–1.84], first birth order, received four or more Antenatal check-ups (ANC) [AOR: 2.39; CI: 1.12–5.1], and delivered in a private health facility [AOR: 6.69; CI: 5.38–8.31] had significantly higher likelihood of caesarean delivery compared to their counterparts. About 65% of inequality was explained by place of delivery followed by wealth status of the household (about 13%). ANC visits explained about 5% of the inequality. Furthermore, the BMI status of the women had a significant contribution to caesarean births-related inequality (4%). Conclusion Socioeconomic inequality prevails in the caesarean deliveries in Bangladesh. The place of delivery, household wealth status, ANC visits, body mass index, women’s education and mass media have been the highest contributors to the inequality. The study, through its findings, suggests that the health authorities should intervene, formulate specialized programs and spread awareness about the ill effects of caesarean deliveries amongst the most vulnerable groups of women in Bangladesh.
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Srivastava, Shobhit, Parimala Mohanty, T. Muhammad, and Manish Kumar. "Socio-economic inequalities in non-use of modern contraceptives among young and non-young married women in India." BMC Public Health 23, no. 1 (May 1, 2023). http://dx.doi.org/10.1186/s12889-023-15669-w.
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Abstract Background It is documented that married women do not utilize contraceptive methods, because of the fear of adverse effects, no or seldom sexual interaction; perception that they should not use contraception during breastfeeding, postpartum amenorrhea, or dissatisfaction with a specific method of contraception. The current study aimed to examine the socio-economic inequalities associated with the non-use of modern contraceptive methods among young (15-24 years) and non-young (25-49 years) married women and the contributing factors in those inequalities. Methods The present study utilized the cross-sectional data from the fourth round of the National Family Health Survey (NFHS-4) with a sample of 499,627 women who were currently married. The modern methods of family planning include sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, the standard days method, condoms, diaphragm, foam/jelly, the lactational amenorrhea method, and emergency contraception. Multivariable logistic regression analysis was used to estimate the odds of non-use of modern contraceptive methods according to different age groups after controlling for various confounding factors. Additionally, concentration curve and Wagstaff decomposition method were used in the study. Results The prevalence of non-use of modern contraceptive use was higher among women from young category (79.0%) than non-young category (45.8%). The difference in prevalence was significant (33.2%; p < 0.001). Women from non-young age group had 39% significantly lower odds of non-use of modern contraceptive use than women from young age group (15–24 years) [AOR: 0.23; CI: 0.23, 0.23]. The value of concentration quintile was -0.022 for young and -0.058 for non-young age groups which also confirms that the non-use of modern contraceptives was more concentrated among women from poor socio-economic group and the inequality is higher among non-young women compared to young women. About 87.8 and 55.5% of the socio-economic inequality was explained by wealth quintile for modern contraceptive use in young and non-young women. A higher percent contribution of educational status (56.8%) in socio-economic inequality in non-use of modern contraceptive use was observed in non-young women compared to only -6.4% in young women. Further, the exposure to mass media was a major contributor to socio-economic inequality in young (35.8%) and non-young (43.2%) women. Conclusion Adverse socioeconomic and cultural factors like low levels of education, no exposure to mass media, lack of or limited knowledge about family planning, poor household wealth status, religion, and ethnicity remain impediments to the use of modern contraceptives. Thus, the current findings provide evidence to promote and enhance the use of modern contraceptives by reducing socioeconomic inequality.
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Dorjdagva, J., E. Batbaatar, B. Dorjsuren, and J. Kauhanen. "Socioeconomic Inequalities in Mental Health in Mongolia." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.1062.
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Abstract Background Promotion of mental health and well-being is recently recognized as a health priority at the global level. In Mongolia, mental health issues have been on the rise. However, less is known on socioeconomic inequality in mental health in the country. The aim of this study is to examine socioeconomic inequality in mental health in the adult population in Mongolia. Methods This study analyzed the data of 30,567 adults from the Household Socio-Economic Survey, collected in 2012 by the National Statistical Office of Mongolia. Self-reported mental health was used as a health outcome variable. Socioeconomic status was measured by household income. We employed the Wagstaff's concentration index to assess the degree of socioeconomic inequality in mental health. Results The results show that the prevalence of self-reported mental health was 1.17% among the respondents. The adults living in urban areas suffer significantly more with mental illness compared to the adults living in rural settlements. The Wagstaff's concentration index for mental health was significantly negative (-0.243), indicating that mental health problems were concentrated among the lower-income groups. The decomposition results show that education, economic activity status and marital status were the main contributors to socioeconomic inequalities in mental health after removing age-sex related contributions. Conclusions Socioeconomic inequality in mental health exists in the adult population in Mongolia, which was mainly explained by the education level, employment and marital status. Prospective policies are needed to reduce socioeconomic inequality in mental health in the country. Key messages Socioeconomic inequality in mental health exists in Mongolia. It calls for further policy actions.
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Rahaman, Margubur, Avijit Roy, Pradip Chouhan, Nanigopal Kapasia, and T. Muhammad. "Factors associated with public and private healthcare utilization for outpatient care among older adults in India: A Wagstaff's decomposition of Anderson's behavioural model." International Journal of Health Planning and Management, January 25, 2024. http://dx.doi.org/10.1002/hpm.3771.
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AbstractIn India, an expanding ageing population will become a public health alarm, putting additional pressure on the healthcare system. Therefore, the current study aimed to examine the factors associated with outpatient healthcare choices among older Indian adults. We used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017–2018). A total of 34,588 individuals (age 45 years and over) who accessed outpatient healthcare services in the last 12 months during the survey were included in this research. A bivariate chi‐square test was used to present the percentage distribution of types of outpatient healthcare utilisation by background characteristics. Multinomial logistic regression and Wagstaff's decomposition analyses were employed to explore the interplay of outpatient healthcare utilisation and allied predisposing, enabling, and need factors and examine these factors' contributions to the wealth‐based inequalities in public, private, and other healthcare utilisation. Outpatient healthcare utilisation varied significantly according to socioeconomic and demographic factors. The findings suggest that consumption quintiles, place of residence, education, and health insurance were significant determinants of private and public healthcare utilisation and contributed to wealth‐based inequalities in healthcare choices. The current study emphasises the need to strengthen and promote public healthcare services.
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Rafique, Zahrah. "Socioeconomic determinants of antenatal healthcare inequalities in urban Pakistan." International Journal of Social Economics, December 12, 2022. http://dx.doi.org/10.1108/ijse-06-2022-0390.
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PurposeOne of the targets of sustainable development goal (SDG) 2030 is to reduce maternal mortality ratio to 70 per 100,000 live births and ensure pregnant women attend at least four antenatal visits. In urban Pakistan, it is expected that more women utilize antenatal care (ANC) because urban areas have more resources, higher education and wealthier people. Despite these facilities, the lack of utilization of antenatal care among pregnant women is abysmal—the latest estimate by Pakistan Demographic and Health Survey (PDHS) places the figure at 63%. Therefore, the paper attempts to identify the factors that affect the utilization of ANC in urban areas by using the PDHS 2017–2018.Design/methodology/approachThe study used cross-tabs to determine the socioeconomic characteristics of women, and used the marginal effects from the probit model to evaluate the significance and relationship between socioeconomic determinants and antenatal visits. Finally, the study used Adam Wagstaff's decomposition analysis to identify the magnitude and main determinants of inequality.FindingsThe marginal effects show that socioeconomic variables such as education, province of residence, birth of a first child, age, education and consulting a doctor predicted the probability of 4+ antenatal visits. The decomposition analysis shows that women who consulted a doctor, belonged to non-poor class, were more educated and older contributed significantly to the inequality of antenatal care utilization in urban areas.Practical implicationsThe study calls for increasing the number of doctors, promoting education, increasing awareness related to pregnancy complications and reducing wealth inequality. Moreover, the study also calls for increasing global intervention by implementing programs similar to ending preventable maternal mortality (EPPM) to increase antenatal coverage.Originality/valueThe distinctiveness of the study can be found in the fact that no study has been conducted that analyses the inequality related to the usage of ANC in urban areas of Pakistan.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-06-2022-0390