Search

Context: How do health coverage denials keep care out of reach for American patients by imposing unevenly distributed administrative burdens? This article argues that the process of appealing insurers' denials imposes administrative burdens on patients inequitably, deepening the divide between those with meaningful access to health coverage and those for whom benefits are out of reach. Methods: The author conducted a nationwide survey of 1,340 US adults on their experiences with coverage denials; this was supplemented with 110 semistructured interviews with patients, physicians, and former health insurance executives. Findings: Those who were less affluent were significantly less likely than their wealthier counterparts to appeal denials of coverage. Patients who underestimated the rate at which patients prevail in insurance appeals were less likely to appeal their own denials. Black Medicaid patients and those who were in worse health were significantly less likely to prevail in the appeals they pursued. Many unappealed denials were attributable to the significant administrative burdens associated with appeal, including learning and psychological costs. Conclusions: Administrative burdens associated with appealing denials of coverage can deepen health inequities along class and race lines, suggesting a need for policy interventions to make it easier to navigate the health insurance bureaucracy. [ABSTRACT FROM AUTHOR]

Although social disparities in morbidity and mortality are well-documented, little is known how socioeconomic status (SES) shapes diabetes-concordant comorbidity (DCC). This study examines socioeconomic inequalities in DCC among adults with diabetes in the United States. The study incorporated a cross-sectional nationally representative household health survey. This study used data from the National Health Interview Survey, 1997–2018. The analysis included 56,192 adults aged 30 or above with diabetes. Multinomial logistic regression was used to obtain relative risk ratios in gender-stratified models after adjusting for sociodemographic covariates. The multivariable-adjusted analyses suggest that across all SES indicators and in both men and women, individuals with lower SES had greater odds of DCC than individuals with higher SES. The associations of SES indicators with DCC were larger in magnitude among women than in men. For example, compared to individuals with a college or higher degree, men with less than a high school degree were 2.06 times (95% confidence interval = 1.76–2.41) and women with less than a high school degree were 3.19 times (95% confidence interval = 2.67–3.82) more likely to have 3 or more DCCs. Similar associations were observed for other indicators of SES. Study findings suggest strong social status and gender-based patterns in DCC. Identifying population groups with poor social status may be useful for informing interventions aiming to improve healthcare services of diabetes-related complications. [ABSTRACT FROM AUTHOR]

Although many studies have found a high correlation between socio-economic inequalities and risk of COVID-19 deaths, there is a reason to believe that much of this association is the product of differing levels of education. We use a multi-level negative binomial regression model for analyzing COVID-19 mortality. We present multivariate models of fortnightly (n = 60) COVID-19 deaths in 3108 US counties for the period January 20, 2020, to May 10, 2022. We model the direct (unmediated) effect of education, controlling for economy, race, geography, lack of vaccination, political orientation (vote Republican), poor health, and lack of preventative health behavior. After controlling for correlated risk factors and indirect mechanisms that mediate education's impact on COVID-19 mortality, we find a strong direct (unmediated) correlation between low education and COVID-19 mortality (incidence rate ratio = 1.17; 95% confidence interval: 1.15, 1.20). We theorize that this correlation reflects education's relationship with (1) collective cultures, such as norms of mask wearing, and (2) individual literacy, such as ability to engage with scientific communication. Low education is strongly correlated with COVID-19 deaths, with an effect size of a university degree comparable to that of being aged >65 years. If this correlation is indeed causal, then it would imply that low education accounts for between 1 in 10 and 1 in 7 deaths in low-education counties. Education should be conceptualized as a potential high-risk factor for COVID-19 death and be taken into account when attempting to combat COVID-19 in disadvantaged communities. The effect of education cannot be reduced to its impact on vaccination or correlation with poor health or economic status, but it seems likely that low-education communities have collective cultures that expose individuals to greater risks and lack of individual literacy that limits engagement with public health messaging. [ABSTRACT FROM AUTHOR]

The American Public Health Association (APHA) and prominent U.S. health organizations have acknowledged racism as a central cause of health inequality. In the midst of the COVID-19 pandemic, the U.S. confronts an additional public health crisis: mass impairment from Long COVID. Occupational segregation and institutionalized racism have made working-class Black, Indigenous, and people of color (BIPOC) more likely to experience Long COVID. Medical gatekeepers also prevent equal access to health: BIPOC face more obstacles in their search for disability accommodations and social support. To provide health equity to the Long COVID community, Disability Studies must confront racialized understandings of chronic pain and the consequences of these meanings by centering the lived experiences of BIPOC living with chronic pain. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the association of neighborhood environment and mortality among community-dwelling older populations. Geographic Information Systems-based measures of neighborhood physical environment may provide new insights on the health effects of the social and built environment.Method: We studied 4 379 community-dwelling older adults in the United States aged 65 years and older from the Cardiovascular Health Study. Principal component analysis was used to identify neighborhood components from 48 variables assessing facilities and establishments, demographic composition, socioeconomic status, and economic prosperity. We used a Cox model to evaluate the association of neighborhood components with 5-year mortality. Age, sex, race, education, income, marital status, body mass index, smoking status, disability, coronary heart disease, and diabetes were included as covariates. We also examined the interactions between neighborhood components and sex and race (Black vs White or other).Results: We identified 5 neighborhood components, representing facilities and resources, immigrant communities, community-level economic deprivation, resident-level socioeconomic status, and residents' age. Communities' economic deprivation and residents' socioeconomic status were significantly associated with 5-year mortality. We did not find interactions between sex or race and any of the 5 neighborhood components. The results were similar in a sensitivity analysis where we used 10-year mortality as the outcome.Conclusions: We found that communities' economic status but not facilities in communities was associated with mortality among older adults. These findings revealed the importance and benefits living in a socioeconomically advantaged neighborhood could have on health among older residents with different demographic backgrounds. [ABSTRACT FROM AUTHOR]

With the growing call for private sector actors to address global challenges, it is necessary to first assess whether regions with the greatest needs are accessing corporate philanthropy. In this paper, we ask whether corporate philanthropy is reaching those with the greatest health-care needs. Drawing on economic geography and corporate homophily, we argue that corporate philanthropy tends to exacerbate health inequality as grants are destined for counties with fewer health problems. We test and find support for this hypothesis using data on health grants made by US corporate foundations and county-level health data. Our results that corporate health grants are less likely to go to counties which have a lower proportion of medical service providers and insured citizens suggest that corporate foundations are unwittingly complicit in worsening the resource gap between small, poor, rural counties and large, wealthy, urban counties. From an ethical perspective, we provide some guidance as to how this may be corrected. [ABSTRACT FROM AUTHOR]

Introduction: Socio-economic background is often an important determinant for health with low income households having higher exposure to risk factors and diminished access to healthcare and prevention, in a way that is specific to each country., Methods: Here, we perform a comparative analysis of the relations between health and income inequality in two developed countries, USA and Italy, using longitudinal and cross-sectional data from surveys., Results and Discussion: We show that the income class determines the incidence of chronic pathologies, associated risk-factors and psychiatric conditions, but find striking differences in health inequality between the two countries. We then focus our attention on a fraction of very disadvantaged households in the USA whose income in persistently at the bottom of the distribution over a span of 20 years and which is shown to display particularly dire health conditions. Low income people in the USA also display comorbidity patterns that are not found in higher income people, while in Italy income appears to be less relevant for comorbidity. Taken together our findings illustrate how differences in lifestyle and the healthcare systems affect health inequality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 La Porta and Zapperi.)

Background: Socioeconomic disparities play an important role in disease epidemiology and outcomes in pregnancy., Objective: The objective was to evaluate whether pregnant women with COVID-19 living in a food desert, are at increased risk of more severe disease reflected by symptoms at presentation and need for hospitalization., Methods: In this retrospective observational study, the electronic medical records of all pregnant patients with documented SARS-CoV-2 infection were reviewed. Food deserts were defined by the USDA and the patient's residence was mapped on the Food Access Research Atlas to determine whether each patient lived within a food desert. Comparisons between those with documented symptomatic COVID-19 required hospitalization to those with documented COVID-19 without need for hospitalization were made using univariate analysis and multivariable logistic regression analysis., Results: The cohort consisted of 129 pregnant patients with COVID-19, with 59.7% (n = 77) asymptomatic and 33.3% (n = 43) requiring admission due to disease severity. The majority were Hispanic (70.5%), and obese (median BMI 31.91 kg/m 2 ), with 33.3% living in a food desert. Patients with disease severity necessitating admission were significantly more likely to reside in a food desert (46.5% vs. 27.9%, P 0.037, OR 2.246, 95% CI 1.048-4.814). No other significant differences were identified on univariate. Multivariable binary logistic regression modeling confirmed food desert residence to be the only independent predictor of more severe COVID-19., Conclusion for Practice: There is a strong association between living in a food desert and the development of symptomatic COVID-19 requiring hospitalization in pregnancy., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Early life disadvantage has enduring effects on health into adulthood. In this analysis, we are interested in the social reproduction of health inequality across generations within families. We use data from the National Longitudinal Study of Adolescent to Adult Health, a representative sample of U.S. adolescents in grades 7–12 and their parents (N = 11,171) interviewed during the 1994–1995 school year and followed into young adulthood. We investigate whether the intersection of family structure and parents' health predicts poor health in early adulthood and several potential explanations for health continuity across generations. We also examine whether social mobility across generations changes the association between parent and child health. Results indicate an intergenerational persistence in health, net of childhood socioeconomic context, childhood health, educational attainment, and social mobility. Findings suggest that adult health reflects the transmission of resources and practices across generations within one's family, reproducing health inequalities. [ABSTRACT FROM AUTHOR]

Previous research has suggested that incarceration has negative implications for individuals' well-being, health, and mortality. Most of these studies, however, have not followed former prisoners over an extended period and into older adult ages, when the risk of health deterioration and mortality is the greatest. Contributing to this literature, this study is the first to employ the Panel Study of Income Dynamics (PSID) to estimate the long-run association between individual incarceration and mortality over nearly 40 years. We also supplement those analyses with data from the National Longitudinal Survey of Youth 1979 (NLSY79). We then use these estimates to investigate the implications of the U.S. incarceration regime and the post-1980 incarceration boom for the U.S. health and mortality disadvantage relative to industrialized peer countries (the United Kingdom). [ABSTRACT FROM AUTHOR]

We develop a method for comparing levels and trends in inequality in mortality in the United States and France between 1990 and 2010 in a similar framework. The comparison shows that while income inequality has increased in both the United States and France, inequality in mortality in France remained remarkably low and stable. In the United States, inequality in mortality increased for older groups (especially women) while it decreased for children and young adults. These patterns highlight the fact that despite the strong cross-sectional relationship between income and health, there is no necessary connection between changes in income inequality and changes in health inequality. [ABSTRACT FROM AUTHOR]

While the proliferation of inclusionary and exclusionary state policies has led to an increasingly heterogeneous patchwork of state climates, state policy and the climates they create have become increasingly important for health outcomes. We leverage the heterogeneity across state policy climates to test the relationship between state-level policies and health inequality across the US. We include 24 state policies related to public health and safety, immigration enforcement, integration, and healthcare to capture the state climate. Using the Survey of Income and Program Participation (SIPP), a nationally representative study of households in the U.S., we estimate multilevel regression models to assess the relationship between state policy climate and healthcare utilization. We further examine differential effects of the policy climate across various vulnerable groups, by examining differences by citizenship status and race. We find that more exclusionary policies may be detrimental to healthcare utilization for all residents regardless of race and legal status- but ultimately racial minorities and noncitizens see the greatest benefits from inclusive policy climates., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

We study inequality in the distribution of self-assessed health (SAH) in the United States and China, two large countries that have expanded their insurance provisions in recent decades, but that lack universal coverage and differ in other social determinants of health. Using comparable health survey data from China and the United States, we compare health inequality trends throughout the period covering the public health insurance coverage expansions in the two countries. We find that whether SAH inequality is greater in the US or in China depends on the concept of status and the inequality-sensitivity parameter used; however, the regional pattern of SAH inequality is clearly associated with health-insurance coverage expansions in the US but not significant in China., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

In several countries, personal income tax permits tax credits for out-of-pocket healthcare expenditure. Tax credits benefit taxpayers at all income levels by reducing their net tax liability and modify the price of out-of-pocket expenditure. To the extent that consumer demand is price elastic, they may influence the amount of eligible healthcare expenditure for which taxpayers may claim a credit. These effects influence, in turn, income distributions and taxpayers' health status and therefore income-related inequality in health. Redistributive consequences of tax credits have been widely investigated. However, little is known about the ability of tax credits to alleviate health inequality. In this paper, we study the potential effects that tax credits for health expenses may have on income-related inequality in health status with reference to the Italian institutional setting. The analysis is performed using a tax-benefit microsimulation model that reproduces the personal income tax and incorporates taxpayers' behavioral responses to changes in tax credit rate. Our results suggest that the current healthcare tax credit design tends to favor the richest part of the population. [ABSTRACT FROM AUTHOR]

In our nation of rapidly growing diversity and increasing cross-cultural interactions, cultural competence has been recognized as critical for reducing health disparities and improving access to high-quality health care. However, more than a decade of experience in establishing, developing, and implementing cultural immersion programs for nursing students in the United States and in developing countries has convinced this scholar that although cultural competence is of critical importance, many other factors need to be examined and kept in mind as we continue to take on the monumental challenge of eliminating health disparities. This article presents the background and context of current efforts to eliminate health disparities and points out some other key considerations that will be vital in achieving the desired outcome. [ABSTRACT FROM AUTHOR]

In this article we explore systematically the different conceptions of health equity in key national health policy documents in the United States, the United Kingdom, and France. We find substantial differences across the three countries in the characterization of group differences (by SES, race/ethnicity, or territory), and the theorized causes of health inequalities (socioeconomic structures versus health care system features). In all three countries, reports throughout the period alluded at least minimally to inequalities in social determinants as the underlying cause of health inequalities. However, even in the reports with the strongest attachment to this causal model, the authors stop well short of advocating the redistribution of power and resources that would likely be necessary to redress these inequalities. [ABSTRACT FROM AUTHOR]

Background: Telehealth has become widely used as a novel way to provide outpatient care during the COVID-19 pandemic, but data about telehealth use in primary care remain limited. Studies in other specialties raise concerns that telehealth may be widening existing health care disparities, requiring further scrutiny of trends in telehealth use., Objective: Our study aims to further characterize sociodemographic differences in primary care via telehealth compared to in-person office visits before and during the COVID-19 pandemic and determine if these disparities changed throughout 2020., Methods: We conducted a retrospective cohort study in a large US academic center with 46 primary care practices from April-December 2019 to April-December 2020. Data were subdivided into calendar quarters and compared to determine evolving disparities throughout the year. We queried and compared billed outpatient encounters in General Internal Medicine and Family Medicine via binary logic mixed effects regression model and estimated odds ratios (ORs) with 95% CIs. We used sex, race, and ethnicity of the patient attending each encounter as fixed effects. We analyzed socioeconomic status of patients in the institution's primary county based on the patient's residence zip code., Results: A total of 81,822 encounters in the pre-COVID-19 time frame and 47,994 encounters in the intra-COVID-19 time frame were analyzed; in the intra-COVID-19 time frame, a total of 5322 (11.1%) of encounters were telehealth encounters. Patients living in zip code areas with high utilization rate of supplemental nutrition assistance were less likely to use primary care in the intra-COVID-19 time frame (OR 0.94, 95% CI 0.90-0.98; P=.006). Encounters with the following patients were less likely to be via telehealth compared to in-person office visits: patients who self-identified as Asian (OR 0.74, 95% CI 0.63-0.86) and Nepali (OR 0.37, 95% CI 0.19-0.72), patients insured by Medicare (OR 0.77, 95% CI 0.68-0.88), and patients living in zip code areas with high utilization rate of supplemental nutrition assistance (OR 0.84, 95% CI 0.71-0.99). Many of these disparities persisted throughout the year. Although there was no statistically significant difference in telehealth use for patients insured by Medicaid throughout the whole year, subanalysis of quarter 4 found encounters with patients insured by Medicaid were less likely to be via telehealth (OR 0.73, 95% CI 0.55-0.97; P=.03)., Conclusions: Telehealth was not used equally by all patients within primary care throughout the first year of the COVID-19 pandemic, specifically by patients who self-identified as Asian and Nepali, insured by Medicare, and living in zip code areas with low socioeconomic status. As the COVID-19 pandemic and telehealth infrastructure change, it is critical we continue to reassess the use of telehealth. Institutions should continue to monitor disparities in telehealth access and advocate for policy changes that may improve equity., (©Rachel D'Amico, Patrick M Schnell, Randi Foraker, J Nwando Olayiwola, Daniel E Jonas, Seuli Bose Brill. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.05.2023.)

We develop a flexible test for changes in the SES-mortality gradient that accounts for changes in the distribution of education, the most commonly used marker of SES. We implement the test for the period between 1984 and 2006 in the United States using microdata from the Census and other surveys linked to death records. Using our flexible test, we find that the evidence for a change in the SES-mortality gradient is not as strong as previous research has suggested. Our results indicate that the gradient increased for females during this time period, but we cannot rule out that the gradient among males has not changed. Informally, the results suggest that the changes for females are mainly driven by the bottom of the education distribution. [ABSTRACT FROM AUTHOR]

Background: Periodic surveys of sexual and gender minority (SGM) populations are essential for monitoring and investigating health inequities. Recent legislative efforts to ban so-called conversion therapy make it necessary to adapt youth surveys to reach a wider range of SGM populations, including those <18 years of age and those who may not adopt an explicit two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) identity., Objective: We aimed to share our experiences in recruiting SGM youth through multiple in-person and online channels and to share lessons learned for future researchers., Methods: The Understanding Affirming Communities, Relationships, and Networks (UnACoRN) web-based survey collected anonymous data in English and French from 9679 mostly SGM respondents in the United States and Canada. Respondents were recruited from March 2022 to August 2022 using word-of-mouth referrals, leaflet distribution, bus advertisements, and paid and unpaid campaigns on social media and a pornography website. We analyzed the metadata provided by these and other online resources we used for recruitment (eg, Bitly and Qualtrics) and describe the campaign's effectiveness by recruitment venue based on calculating the cost per completed survey and other secondary metrics., Results: Most participants were recruited through Meta (13,741/16,533, 83.1%), mainly through Instagram; 88.96% (visitors: 14,888/18,179) of our sample reached the survey through paid advertisements. Overall, the cost per survey was lower for Meta than Pornhub or the bus advertisements. Similarly, the proportion of visitors who started the survey was higher for Meta (8492/18,179, 46.7%) than Pornhub (58/18,179, 1.02%). Our subsample of 7037 residents of Canada had a similar geographic distribution to the general population, with an average absolute difference in proportion by province or territory of 1.4% compared to the Canadian census. Our US subsample included 2521 participants from all US states and the District of Columbia. A total of CAD $8571.58 (the currency exchange rate was US $1=CAD $1.25) was spent across 4 paid recruitment channels (Facebook, Instagram, PornHub, and bus advertisements). The most cost-effective tool of recruitment was Instagram, with an average cost per completed survey of CAD $1.48., Conclusions: UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed., (©Jorge Andrés Delgado-Ron, Thiyaana Jeyabalan, Sarah Watt, Stéphanie Black, Martha Gumprich, Travis Salway. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 12.01.2023.)

The present study provides a comparative analysis of the association between wealth and health in six healthcare systems (Sweden, the United Kingdom, Germany, the Czech Republic, Israel, the United States). National samples of individuals fifty years and over reveal considerable cross-country variations in health outcomes. In all six countries wealth and health are positively associated. The findings also show that state-based healthcare systems produce better population health outcomes than private-based healthcare systems. The results indicate that in five out of the six countries studied, the wealth–health gradients were remarkably similar, despite significant variations in healthcare system type. Only in the United States was the association between wealth and health substantially different from, and much greater than that in the other five countries. The findings suggest that private-based healthcare system in the U.S. is likely to promote stronger positive associations between wealth and health. [ABSTRACT FROM AUTHOR]

Background: Infant mortality rates in the US exceed those in all other developed countries and in many less developed countries, suggesting political factors may contribute.Methods: Annual time series on overall, White and Black infant mortality rates in the US were analysed over the 1965-2010 time period to ascertain whether infant mortality rates varied across presidential administrations. Data were de-trended using cubic splines and analysed using both graphical and time series regression methods.Results: Across all nine presidential administrations, infant mortality rates were below trend when the President was a Democrat and above trend when the President was a Republican. This was true for overall, neonatal and postneonatal mortality. Regression estimates show that, relative to trend, Republican administrations were characterized by infant mortality rates that were, on average, 3% higher than Democratic administrations. In proportional terms, effect size is similar for US Whites and Blacks. US Black rates are more than twice as high as White, implying substantially larger absolute effects for Blacks.Conclusions: We found a robust, quantitatively important association between net of trend US infant mortality rates and the party affiliation of the president. There may be overlooked ways by which macro-dynamics of policy impact microdynamics of physiology, suggesting the political system is a component of the underlying mechanism generating health inequality in the USA. [ABSTRACT FROM AUTHOR]

This study investigates the link between incarceration and health behavior among a sample of young adults from the National Longitudinal Study of Adolescent Health (N = 1,670). The association is analyzed using propensity score methods and a strategic comparison group: respondents who have been convicted of crimes, but not incarcerated. Findings suggest that former inmates consume more fast food and have a higher likelihood of smoking than do similarly situated peers. These associations operate partly through increased financial strife and decreased social standing. Given the role of health behavior in predicting future health outcomes, poor health behavior may be a salient force driving health and mortality risk among the formerly incarcerated population. [ABSTRACT FROM AUTHOR]

Highlights: [•] Analysis of health and segregation for Hispanics, by nativity and ethnic subgroup. [•] Negative effect on self-rated health of residential segregation for Hispanics. [•] Nativity does not appear to have a significant interaction effect. [•] Mexicans experience negative effects; Cubans experience positive effects. [•] Consistent with assimilation theory, compositional factors influence health more. [Copyright &y& Elsevier]

Social inequalities in the United States resulted in negative health outcomes for the African Americans. Their stressful living conditions of poverty, discrimination, racism, abuse and rejection from American society contribute to their negative health outcomes. The lifestyles of African Americans have been influenced by poverty and prior injustices, which have molded their worldview of health and illness. Dr. Martin Luther King, national civil rights leader, brought about social change with much prayer; however, he went a step further with collective gatherings to include the power of non-violence massive public demonstrations. This paper is an analytical review of the literature addressing social inequalities impacting on health inequalities of African Americans resulting in health disparities. Policy changes are proposed by implementing transformation development and community empowerment models as frameworks for community / public health nurses in guiding African American communities with addressing health disparities. These models empower members of the community to participate in a collaborative effort in making political and social changes to improve their overall health outcomes. [ABSTRACT FROM AUTHOR]

Background: Vaccination reduces the overall burden of COVID-19, while its allocation procedure may introduce additional health inequality, since populations characterized with certain social vulnerabilities have received less vaccination and been affected more by COVID-19. We used structural equation modeling to quantitatively evaluate the extent to which vaccination disparity would amplify health inequality, where it functioned as a mediator in the effect pathways from social vulnerabilities to COVID-19 mortality., Methods: We used USA nationwide county (n = 3112, 99% of the total) level data during 2021 in an ecological study design. Theme-specific rankings of social vulnerability index published by CDC (latest data of 2018, including socioeconomic status, household composition & disability, minority status & language, and housing type & transportation) were the exposure variables. Vaccination coverage rate (VCR) during 2021 published by CDC was the mediator variable, while COVID-19 case fatality rate (CFR) during 2021 published by John Hopkinson University, the outcome variable., Results: Greater vulnerabilities in socioeconomic status, household composition & disability, and minority status & language were inversely associated with VCR, together explaining 11.3% of the variance of VCR. Greater vulnerabilities in socioeconomic status and household composition & disability were positively associated with CFR, while VCR was inversely associated with CFR, together explaining 10.4% of the variance of CFR. Our mediation analysis, based on the mid-year data (30 th June 2021), found that 37.6% (mediation/total effect, 0.0014/0.0037), 10% (0.0003/0.0030) and 100% (0.0005/0.0005) of the effects in the pathways involving socioeconomic status, household composition & disability and minority status & language, respectively, were mediated by VCR. As a whole, the mediation effect significantly counted for 30.6% of COVID-19 CFR disparity. Such a mediation effect was seen throughout 2021, with proportions ranging from 12 to 32%., Conclusions: Allocation of COVID-19 vaccination in the USA during 2021 led to additional inequality with respect to COVID-19 mortality. Viable public health interventions should be taken to guarantee an equitable deployment of healthcare recourses across different population groups., (© 2022. The Author(s).)

Children from low income families are vulnerable to physical problems including obesity, asthma, hypertension and psychological problems including depression, anxiety. This study was done to identify trends in welfare policy for children from low-income families and future direction for solving health disparity problems. Dream Start is a government-sponsored project that offers services for vulnerable children, ages 0 (include pregnant woman) to 12 years and their families. The Korean Government has made an effort to alleviate health disparity through the 'Health Plan' by establishing health objectives. However, in spite of these efforts by the Korean government, health disparity has worsened in Korea. In order to strengthen family function as well as promote growth and development for vulnerable children, experts in child care need to be significantly involved in identifying neglected children in the community. [ABSTRACT FROM AUTHOR]

Health inequalities, which have been well documented for decades, have more recently become policy targets in developed countries. This review describes time trends in health inequalities (by sex, race//ethnicity, and socioeconomic status), commitments to reduce health inequalities, and progress made to eliminate health inequalities in the United States, United Kingdom, and other OECD countries. Time-trend data in the United States indicate a narrowing of the gap between the best- and worst-off groups in some health indicators, such as life expectancy, but a widening of the gap in others, such as diabetes prevalence. Similarly, time-trend data in the United Kingdom indicate a narrowing of the gap between the best- and worst-off groups in some indicators, such as hypertension prevalence, whereas the gap between social classes has increased for life expectancy. More research and better methods are needed to measure precisely the relationships between stated policy goals and observed trends in health inequalities. [ABSTRACT FROM AUTHOR]

HOPE VI has funded the demolition of public housing developments across the United States and created in their place mixed-income communities that are often inaccessible to the majority of former tenants. This recent uprooting of low-income, urban, and predominantly African American communities raises concern about the health impacts of the HOPE VI program for a population that already shoulders an enormous burden of excess morbidity and mortality. In this paper, we rely on existing literature about HOPE VI relocation to evaluate the program from the perspective of weathering-a biosocial process hypothesized by Geronimus to underlie early health deterioration and excess mortality observed among African Americans. Relying on the weathering framework, we consider the effects of HOPE VI relocation on the material context of urban poverty, autonomous institutions that are health protective, and on the broader discourse surrounding urban poverty. We conclude that relocated HOPE VI residents have experienced few improvements to the living conditions and economic realities that are likely sources of stress and illness among this population. Additionally, we find that relocated residents must contend with these material realities, without the health-protective, community-based social resources that they often rely on in public housing. Finally, we conclude that by disregarding the significance of health-protective autonomous institutions and by obscuring the structural context that gave rise to racially segregated public housing projects, the discourse surrounding HOPE VI is likely to reinforce health-demoting stereotypes of low-income urban African American communities. Given the potential for urban and housing policies to negatively affect the health of an already vulnerable population, we argue that a health-equity perspective is a critical component of future policy conversations. [ABSTRACT FROM AUTHOR]

Abstract: This paper uses sequential stochastic dominance procedures to compare the joint distribution of health and income across space and time. It is the first application of which we are aware of methods to compare multidimensional distributions of income and health using procedures that are robust to aggregation techniques. The paper’s approach is more general than comparisons of health gradients and does not require the estimation of health equivalent incomes. We illustrate the approach by contrasting Canada and the US using comparable data. Canada dominates the US over the bottom part of the bi-dimensional distribution of health and income, though not generally over the uni-dimensional distributions of health or income. The paper also finds that welfare for both Canadians and Americans has not unambiguously improved during the last decade over the joint distribution of income and health, in spite of the fact that the uni-dimensional distributions of income have clearly improved during that period. [Copyright &y& Elsevier]

Deaton and Lubotsky (2003) found that the robust positive relationship across American cities between mortality and income inequality became small, insignificant, and/or non-robust once they controlled for the fraction of each city's population that is black. Ash and Robinson (Ash, M., & Robinson D. Inequality, race, and mortality in US cities: a political and econometric review. Social Science and Medicine, 2009) consider alternative weighting schemes and show that in one of our specifications, in one data period, and with one of their alternative weighting schemes, income inequality is estimated to be a risk factor. All of our other specifications, as well as their own preferred specification, replicate our original result, which is supported by the weight of the evidence. Conditional on fraction black, there is no evidence for an effect of income inequality on mortality. [Copyright &y& Elsevier]

Our replication of Deaton and Lubotsky's [(2003). Mortality, inequality and race in American cities and states. Social Science & Medicine, 56.] study “Mortality, Inequality and Race in American Cities and States" identifies a coding error in the econometric analysis in the original paper. Correcting the error changes the basic results of the paper with respect to inequality and mortality in a relevant and substantive way. We also propose an alternative interpretation of the other main result of the paper regarding racial composition and mortality. [Copyright &y& Elsevier]

This article examines the relative impact of socioeconomic status as a 'fundamental cause' of health disparities in Canada and the US. Fundamental cause theory suggests that persons of higher socioeconomic status have available a broad range of resources to benefit their health and therefore hold an advantage in warding off whatever particular threats to health exist at a given time. This leads to two predictions: (1) SES is more strongly associated with diseases that are more highly preventable than with less preventable diseases; and (2) SES has a stronger relationship to health in the US, where higher economic inequality and a lack of universal health insurance leads to a greater vying for resources. Findings indicate lower levels of SES increase the odds of experiencing a highly preventable disease relative to a less preventable disease in the US, but not in Canada, suggesting that social policies and level of economic inequality may buffer the relationship between socioeconomic resources and the incidence of preventable disease. [ABSTRACT FROM AUTHOR]

Since the early 80s, incentives have been introduced to stimulate R&D for rare diseases. We develop a theoretical model to study the impact of push and pull incentives on the intensive and extensive margin of optimal R&D investments. The model describes the mechanisms by which the type of incentives provided may favor R&D for orphan diseases with comparatively high prevalence. In our empirical analysis, we merge data on orphan drug designations by the Food and Drug Administration with Orphanet data on disease characteristics. In line with the theoretical results, we find evidence supporting the idea that the incentives adopted may have contributed substantially to widening the gap between more and less rare diseases classified as orphan. Our theoretical and empirical findings together suggest that, if providing some therapeutic option to patients with very rare diseases is a priority, a revision of the current system of incentives should be considered. [ABSTRACT FROM AUTHOR]

In this article, we report statistical properties of two classes of generalized Gini coefficients (G1 and G2). The theoretical results were assessed via Monte Carlo simulations. Further, we used G1 and G2 on life expectancy to measure health inequalities among the provinces of China and the states of the United States. For China, the results indicated that there was statistically significant health inequality by both G1 and G2. However, for the US, the results showed that there was significant health inequality by G1 but no statistical significance was found in health inequality by G2. Overall, from our study, China has higher health inequality than the United States. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to examine state-level variations in income-related inequality in health and overall health achievement in the US. Data that were representative of the US and each state in 2001 were extracted from the Current Population Survey 2001. Income-related inequality in health and health achievement were measured by Health Concentration and Health Achievement Indices, respectively. Significant variations were found across states in income-related inequality in health and health achievement. In particular, states in the south and east regions, on average, experienced a higher degree of health inequality and lower health achievement. About 80% of the state-level variation in health achievement could be explained by demographics, economic structure and performance, and state and local government spending and burden. In contrast, medical care resource indicators were not found to contribute to health achievement in states. States with better health achievement were more urbanized, had lower proportions of minority groups, females and the elderly, fewer individuals below the poverty line, larger primary industry, and lower unemployment rates. Also, per capita state and local government spending, particularly the proportion spent on public health, was positively associated with better health achievement. Because of the direct implications of health level and distribution in resource allocation and social norms, states with a lower level of health achievement need to prioritize efforts in increasing and reallocating resources to diminish health inequality and to improve population health. [Copyright &y& Elsevier]

The current national COVID-19 mortality rate for Black Americans is 2.1 times higher than that of Whites. In this commentary, we provide historical context on how structural racism undergirds multi-sector policies which contribute to racial health inequities such as those highlighted by the COVID-19 pandemic. We offer a concrete, actionable path forward to address structural racism and advance health equity for Black Americans through anti-racism, implicit bias, and cultural competency training; capacity building; community-based participatory research (CBPR) initiatives; validated metrics for longitudinal monitoring of efforts to address health disparities and the evaluation of those interventions; and advocacy for and empowerment of vulnerable communities. This necessitates a multi-pronged, coordinated approach led by clinicians; public health professionals; researchers; social scientists; policy-makers at all governmental levels; and local community leaders and stakeholders across the education, legal, social service, and economic sectors to proactively and systematically advance health equity for Black Americans across the USA., (© 2020. W. Montague Cobb-NMA Health Institute.)

We rank counties in the United States with respect to population health. We utilize the five observable county health variables used to construct the University of Wisconsin Population Health Institute's County Health Rankings (CHRs). Our method relies on a Bayesian factor analysis model that estimates data-driven weights for our rankings, incorporates county population sizes into the level of rank uncertainty, and allows for spillovers of health stock across county lines. We find that demographic and economic variation explains a large portion of the variation in health rankings. We address the importance of uncertainty caused by imputation of missing data and show that there is a substantial quantity of uncertainty in rankings throughout the rank distribution. Analyzing the health of counties both within and across state lines shows notable degrees of disparity in county health. While we find some disagreement between the ranks of our model and the CHRs, we show that there is additional information gained by utilizing the rankings produced by both methods., (© 2021 John Wiley & Sons Ltd.)

Early studies reported higher risk of COVID-19 outcomes for racial/ethnic minorities in the early phase of the pandemic in the United States. While the initial surge of COVID-19 was concentrated in some areas, COVID-19 became pervasive across the entire continent with high impacts in the northern region and central region in the end of 2020. With this geographical transition, we aim to investigate patterns of these racial/ethnic disparities over time. We assessed associations of percentage of race/ethnic minorities and racial segregation indexes with COVID-19 case and mortality rates in 3108 counties of the continental United States during the pandemic's early phase, second, and third phase (January 21-June 15, June 16-August 31, and September 1-December 18, 2020, respectively). We adjusted for population density, age, and sex. We tested whether time-varying associations were consistent across climate regions and explained by socioeconomic variables. In the early phase, counties with higher percentage of Black/African Americans and higher Black-White segregation had higher COVID-19 case and mortality rates. These associations decreased over time and reversed in the third phase. Associations between Hispanic and COVID-19 outcomes were positive in all periods, but more so early in the pandemic. Higher COVID-19 case rates for counties with higher non-Hispanic White population emerged in the third phase. These trends were similar across climate regions, and socioeconomic variables did not explain these trends. In summary, county-level racial/ethnic disparities of COVID-19 are not stationary but change over the course of the pandemic, suggesting complex social, cultural, and political influences., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children., (Copyright © 2021 The Authors.)

Immigration is central to our understanding of U.S. racial and ethnic health disparities, yet relatively little is known about the health of white immigrants – a group whose ethnic origins have become increasingly diverse. To the extent that whites are included in social stratification research, they are typically used as the reference category for gauging health inequities, with little attention to diversity among them. This study addresses this question using nationally representative data from the American Community Survey (2008–2017). We disaggregate non-Hispanic whites by nativity, region of birth, and period of arrival in the U.S. and examine differences in physical disability among adults aged 40 and older (n = 12, 075, 638). The analysis finds that foreign-born whites have a slightly lower prevalence of disability than U.S.-born whites, and this varies by arrival cohort. Immigrants who arrived in the 1981–1990 and 1991–2000 cohorts have a smaller advantage over U.S.-born whites than immigrants in the earlier and later cohorts. Compositional changes in the region of birth of white immigrants, especially the influx of eastern Europeans and Middle Easterners during the 1980s and 1990s, explained this variation. These findings challenge the oft-assumed notion that whites are a monolithic group and highlight growing intra-ethnic heterogeneity that is obscured by the aggregate category. Our findings also suggest that the standard practice of using whites as the reference for benchmarking health inequities may mask health inequities not only among them, but also between whites and other racial and ethnic populations. • Whites are the standard reference group for gauging U.S. health disparities. • We examine diversity among them by nativity, birth region, and arrival cohort. • Foreign-born whites are healthier than the U.S.-born but it varies by arrival cohort. • This health advantage is smaller for immigrants who arrived in the 1980s or 1990s. • The influx of eastern Europeans and Middle Easterners explained this variation. [ABSTRACT FROM AUTHOR]

Despite unprecedented global wealth creation, health inequity-the unjust health inequality between classes and groups among and within countries-persists, reviving the relevance of social justice as a lens to understand and as an instrument to intervene in these issues. However, the theoretical aspects and polysemous character of social justice as applied in the field of public health are often assumed rather than explicitly explained. An intersectional justice approach to understanding health inequality, inequity, and injustice might be useful. It argues that preexisting class-, race/ethnicity-, and gender-based health injustice and the socially differentiated impacts of the COVID-19 pandemic are shaped, interconnectedly, by economic maldistribution, cultural misrecognition, and political misrepresentation. Pursuing health justice requires analyses, strategies, and interventions that integrate the economic, cultural, and political spheres of redistribution, recognition, and representation, respectively. Such an intersectional approach to health justice is even more relevant and compelling in light of the COVID-19 pandemic. This article is broadly about class, race/ethnicity, and gender political economy of public health-but with a narrower focus on maldistribution, misrecognition, and misrepresentation, shaping social and health injustices.

Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contribute to suicide differ across racial/ethnic groups. This study investigated suicide circumstances among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asian/Pacific Islanders, non-Hispanic Native American/Alaskan Natives, and Hispanics by sex and age. Using de-identified National Violent Death Reporting System (NVDRS) Restricted Access Database files from 2006-2015, we examined proximal circumstances of suicide among decedents aged 10 years and older. Hierarchical logistic regression analysis revealed racial/ethnic differentials in non-alcohol substance abuse problem, intimate partner problem, and physical health problem across sex and age, controlling for potential confounders. Study findings highlight priority areas for suicide interventions.

Background: Socio-economic and sexual orientation inequalities in cigarette smoking are well-documented; however, there is a lack of research examining the social processes driving these complex inequalities. Using an intersectional framework, the current study examines key processes contributing to inequalities in smoking between four intersectional groups by education and sexual orientation. Methods: The sample (28,362 adults) was obtained from Wave 2 (2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study. Four intersectional positions were created by education (high- and low-education) and sexual orientation (heterosexual or lesbian, gay, bisexual, or queer/questioning (LGBQ). The joint inequality, the referent socio-economic inequality, and the referent sexual orientation inequality in smoking were decomposed by demographic, material, tobacco marketing-related, and psychosocial factors using non-linear Oaxaca decomposition. Results: Material conditions made the largest contribution to the joint inequality (9.8 percentage points (p.p.), 140.9%), referent socio-economic inequality (10.01 p.p., 128.4%), and referent sexual orientation inequality (4.91 p.p., 59.8%), driven by annual household income. Psychosocial factors made the second largest contributions to the joint inequality (2.12 p.p., 30.3%), referent socio-economic inequality (2.23 p.p., 28.9%), and referent sexual orientation inequality (1.68 p.p., 20.5%). Referent sexual orientation inequality was also explained by marital status (20.3%) and targeted tobacco marketing (11.3%). Conclusion: The study highlights the pervasive role of material conditions in inequalities in cigarette smoking across multiple dimensions of advantage and disadvantage. This points to the importance of addressing material disadvantage to reduce combined socioeconomic and sexual orientation inequalities in cigarette smoking. [ABSTRACT FROM AUTHOR]

Education affords a range of direct and indirect benefits that promote longer and healthier lives and stratify health lifestyles. We use tobacco clean air policies to examine whether policies that apply universally-interventions that bypass individuals' unequal access and ability to employ flexible resources to avoid health hazards-have an effect on educational inequalities in health behaviors. We test theoretically informed but competing hypotheses that these policies either amplify or attenuate the association between education and smoking behavior. Our results provide evidence that interventions that move upstream to apply universally regardless of individual educational attainment-here, tobacco clean air policies-are particularly effective among young adults with the lowest levels of parental or individual educational attainment. These findings provide important evidence that upstream approaches may disrupt persistent educational inequalities in health behaviors. In doing so, they provide opportunities to intervene on behaviors in early adulthood that contribute to disparities in morbidity and mortality later in the life course. These findings also help assuage concerns that tobacco clean air policies increase educational inequalities in smoking by stigmatizing those with the fewest resources.

Research in the health sciences reports persistent racial differences in health care access, utilization, and outcomes. This study investigates three potential sources of these disparities - differential quality of care, physician discrimination, and patient response to therapy. It uses a unique panel dataset of physician-patient encounters, the resulting medication therapies and the patients' adherence to those medical recommendations. Equalizing access to quality health care will not erase the racial differences in mortality among chronically ill patients. Targeted programs aimed at improving adherence with medication therapy among disadvantaged groups must be an integral part of any policy aimed at achieving equality in health outcomes., (Copyright © 2013 Elsevier B.V. All rights reserved.)