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A publicly well-accepted measure versus an academically desirable measure of health inequality: cross-sectional comparison of the difference between income quintiles with the slope index of inequality.

ABSTRACT: OBJECTIVES:The difference between income quintiles in health is relatively well accepted by the general public as a measure of health inequality. However, the slope index of inequality (SII) in health reflects the patterns of all social groups, including the middle 60%, and it could therefore be considered more academically desirable. If these two measures are closely correlated, the widespread use of the difference between income quintiles in health would be better supported. This study was conducted to compare differences between income quintiles in life expectancy (LE) and healthy life expectancy (HLE) with the SII. DESIGN:Cross-sectional comparison using correlational analysis of district level income differences in LE and HLE with associated SII. SETTING:All 252 subnational districts of Korea. PARTICIPANTS:A total of 342 439 895 subjects (171 287 729 men, 171 152 166 women) and 1 753 476 deaths (970?928 men, 782?548 women) between 2008 and 2014 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES:Difference in LE and HLE by income quintile and associated SII. RESULTS:The Pearson correlation coefficients between differences between income quintiles and the SII were generally high: 0.97 (95% CI 0.96 to 0.98) for LE in men and women combined and 0.96 (95% CI 0.94 to 0.97) for HLE in men and women combined. In most districts, the SII was greater than the difference between income quintiles. CONCLUSION:Differences between income quintiles were closely correlated with the SII. The widespread use of differences between income quintiles in health as a measure of health inequality may be preferable for communicating results of health inequality measurements to the public.

SUBMITTER: Khang YH

PROVIDER: S-EPMC6597623 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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A publicly well-accepted measure versus an academically desirable measure of health inequality: cross-sectional comparison of the difference between income quintiles with the slope index of inequality.

Khang Young-Ho YH Lim Dohee D Bahk Jinwook J Kim Ikhan I Kang Hee-Yeon HY Chang Youngs Y Jung-Choi Kyunghee K

BMJ open 20190627 6

<h4>Objectives</h4>The difference between income quintiles in health is relatively well accepted by the general public as a measure of health inequality. However, the slope index of inequality (SII) in health reflects the patterns of all social groups, including the middle 60%, and it could therefore be considered more academically desirable. If these two measures are closely correlated, the widespread use of the difference between income quintiles in health would be better supported. This study ...[more]

PMID: 31248930

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Project description:The novel coronavirus is part of a series of infectious disease outbreaks that include: Ebola, Avian influenza, Middle East respiratory syndrome coronavirus, and Influenza A. This paper addresses the question of how do these epidemics and pandemics affect income inequality in countries around the world during the first two decades of this century. To achieve its objective, the paper develops a model that indicates a positive association between these health crises and income inequality. To empirically test our theoretical predictions, the paper explores the effect on the Gini coefficient of a dummy variable that indicates the occurrence of an epidemic or a pandemic in a country in a given year and the number of deaths per 100,000. To properly address potential endogeneity, we implement a Three-Stage-Least Squares technique. The estimation shows that the number of deaths per 100,000 population variable has a statistically significant positive effect on the Gini coefficient, especially when we incorporate COVID-19 data. This suggests that not only the occurrence, but also the health consequences of COVID-19 have a significant and economically important effect on income inequality.BackgroundThe purpose of the study is to examine the effect of epidemics and pandemics on income inequality. This has important implications as the outcome of this study can guide policymakers into implementing policies that can mitigate the economic consequences of these health crises.MethodsThe study is a cross country analysis using fixed effects estimation. To address potential endogeneity and determine causality, the paper uses the Three-Stage-Least-Squares estimation.ResultsThe paper finds that the number of epidemic deaths per 100,000 population variable has a statistically significant positive effect on the Gini coefficient, especially when we incorporate COVID-19 data.ConclusionsThe paper finds that it is not only the occurrence of an epidemic, captured by the epidemics dummy variable, but also the health consequences, captured by the number of deaths per 100,000 population, that have a significant effect on income inequality. This is especially the case when we incorporate COVID-19 in our analysis.Trial registrationNot Applicable.

Project description:BackgroundSocioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. We examined whether there is contextual variation in socioeconomic inequalities in tooth loss across Brazilian municipalities.MethodsData from the 2010 National Oral Health Survey of 9633 adults living in 157 Brazilian municipalities were used. The individual socioeconomic indicators were education and household income. At the municipal level, we used the Municipal Human Development Index (HDI) as our contextual indicator of socioeconomic status (low:< 0.699 versus high: > 0.70). The Relative (RII) and Slope (SII) Indexes of Inequality, Relative (RCI), and Absolute (ACI) Concentration Indexes were calculated to compare the magnitude of education and income-based inequalities among municipalities with low versus high HDI. Multilevel Poisson regression models with random intercepts and slopes were developed.ResultsAt the individual level, adults with lower education & income reported more tooth loss. The mean number of missing teeth was 9.52 (95% CI: 7.93-11.13) and 6.95 (95% CI: 6.43-7.49) in municipalities with low and high HDI, respectively. Municipalities with high HDI showed higher relative and absolute education-based inequality. For income-based inequalities, higher SII and RCI was observed in municipalities with lower HDI. A significant cross-level interaction indicated that high-education adults reported fewer missing teeth when they lived in municipalities with high HDI compared to adults with the same education level living in low HDI municipalities. For individuals with the lowest education level, there was no difference in the number of teeth between those from municipalities with high and low HDI.ConclusionsThere was a social gradient in tooth loss by education and income. Living in disadvantaged municipalities cannot overcome the risk associated with low schooling. The protective effect of higher education can be reduced when people live in disadvantaged areas.

Project description:BACKGROUND:It is not known whether equity-oriented primary care investment that seeks to scale up the delivery of effective care in disadvantaged communities can reduce health inequality within high-income settings that have pre-existing universal primary care systems. We provide some non-randomised controlled evidence by comparing health inequality trends between two similar jurisdictions-one of which implemented equity-oriented primary care investment in the mid-to-late 2000s as part of a cross-government strategy for reducing health inequality (England), and one which invested in primary care without any explicit equity objective (Ontario, Canada). METHODS:We analysed whole-population data on 32,482 neighbourhoods (with mean population size of approximately 1,500 people) in England, and 18,961 neighbourhoods (with mean population size of approximately 700 people) in Ontario. We examined trends in mortality amenable to healthcare by decile groups of neighbourhood deprivation within each jurisdiction. We used linear models to estimate absolute and relative gaps in amenable mortality between most and least deprived groups, considering the gradient between these extremes, and evaluated difference-in-difference comparisons between the two jurisdictions. RESULTS:Inequality trends were comparable in both jurisdictions from 2004-6 but diverged from 2007-11. Compared with Ontario, the absolute gap in amenable mortality in England fell between 2004-6 and 2007-11 by 19.8 per 100,000 population (95% CI: 4.8 to 34.9); and the relative gap in amenable mortality fell by 10 percentage points (95% CI: 1 to 19). The biggest divergence occurred in the most deprived decile group of neighbourhoods. DISCUSSION:In comparison to Ontario, England succeeded in reducing absolute socioeconomic gaps in mortality amenable to healthcare from 2007 to 2011, and preventing them from growing in relative terms. Equity-oriented primary care reform in England in the mid-to-late 2000s may have helped to reduce socioeconomic inequality in health, though other explanations for this divergence are possible and further research is needed on the specific causal mechanisms.

Dataset Information

A publicly well-accepted measure versus an academically desirable measure of health inequality: cross-sectional comparison of the difference between income quintiles with the slope index of inequality.

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A publicly well-accepted measure versus an academically desirable measure of health inequality: cross-sectional comparison of the difference between income quintiles with the slope index of inequality.

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