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Background: Although the prevalence of poor oral health among older populations in Australia and the United States is higher, the contribution of ethnicity status is unknown. We aimed to estimate the contribution of social inequalities in oral health among older populations in Australia and the United States. Methods: Cross-sectional study design using data from Australia's National Survey of Adult Oral Health (NSAOH 2004–06 and 2017–18) and the United States' National Health and Nutrition Examination Survey (NHANES 2003–04 and 2011–16). Participants included in the analysis were aged 65 + years. Oaxaca-Blinder type decomposition analysis was used to assess the contribution of demographic (age, sex), socioeconomic position (educational attainment, household income) and dental behaviors (last dental visit) to changes in prevalence of edentulism and non-functional dentition, and mean number of missing teeth by ethnicity status over time in Australia and the United States. Results: The number of participants aged 65 + years who provided clinical and sociodemographic/dental behaviour data was 1043 and 1269 in NSAOH 2004–06 and 2017–18, and 1372 and 1328 in NHANES 2003–04 and 2011–16 respectively. The prevalence of edentulism was from 13 percent (NHANES 2011–16) to 28 percent (NSAOH 2004–06), while the prevalence of non-functional dentition was from 41 percent (NSAOH 2017–18 and NHANES 2011–16) to 61 percent (NHANES 2003–04). The mean number of missing teeth was from 11 (NSAOH 2017–18) to 18 (NHANES 2003–04). The prevalence of edentulism and non-functional dentition, and the mean number of missing teeth were higher among older Australians identifying as White and the opposite results were observed among older Americans identifying as Non-White. For older adults in Australia, risk factors with the greatest impact on oral health outcomes by ethnicity status were educational attainment and household income. For older adults in the United States, the most dominant risk factor for non-optimal oral health outcomes by ethnicity status was last dental visit. Conclusions: There are important policy translation implications from our findings, as they indicate that social and structural systems in Australia and the United States operate differently in the context of oral health over time among culturally diverse older citizens. This information will help inform initiatives that both target effective oral health promotion for older, culturally-diverse populations and provide evidence for the distribution of resources in the public dental health setting for this age group and cultural demographic. [ABSTRACT FROM AUTHOR]

Despite the huge difference in their climatic regimes, the OECD countries are among the world's largest energy consumers and emitters of greenhouse gases, particularly carbon dioxide. Nonetheless, no studies have been conducted to decompose and decouple the long-term influential primary factors of carbon emissions for these countries. In this research, the Log Mean Divisia Method I is used to inspect the contribution of several influencing factors to fill this knowledge gap. Moreover, Tapio (Transp Policy 12(2):137–151, 2005) decomposition analysis (DA) is performed to investigate the driving forces of CO2 emissions over the 1990–2019 years. The study provides an in-depth analysis of how to reduce CO2 emissions and the factors that contribute to their variation, which is crucial for both global and regional climate change policies. DA shows that, up to 2004, the activity effect and the population effect drove the emissions to increase; while, in more recent years, the activity effect was able to curb the emissions. Decoupling analysis show the prevalence of the expansive negative decoupling regime for the 1990–2004 and 2015–2019 periods, while several countries were in the strong decoupling phase over the central period (2005–2009). According to the results, further efforts to increase energy efficiency, political support for digitalization and decentralized energy systems, and setting up a unique emission trading system are recommended for air pollution reduction. [ABSTRACT FROM AUTHOR]

Introduction: Fertility refers to the biological capacity to reproduce and have children. It is a key aspect of reproductive health influenced by various factors. Therefore, this study aims to explore the determinants of fertility rates based on urban and rural settings in Ethiopia. Method: A stratified two-stage cluster sampling approach was used, employing data from the 2019 Ethiopian Mini Demographic and Health Survey (https://dhsprogram.com). The study comprised 8,885 women aged 15 to 49 years. The study employed Stata 17, and the data was described using descriptive statistics. Associations were examined using decomposition analysis and negative binomial regression. The Incidence Rate Ratio and p-value were used to determine the statistical significance of the variables examined. Results: The negative binomial regression found that factors such as maternal age (IRR, 1.08, P-value,0.00), living in rural (IRR,1.09, P-value,0.00), being Muslim (IRR,1.13, P-value,0.00), being from other religious groups (IRR,1.16, P-value,0.00), having six up to nine household members (IRR,1.24, P-value,0.00), having greater than nine household member(IRR,1.14, P-value,0.04), having one child under five year (IRR,1.35, P-value,0.00), having two children under five year (IRR,1.77, P-value,0.00), and having more than two under five years (IRR,1.99, P-value,0.00), being currently pregnant (IRR,1.08, P-value,0.00), use of contraceptive(IRR,1.13, P-value,0.00) are positively associated with bearing more children. On the other hand, completing primary education (IRR,0.84, P-value,0.00), secondary education (IRR,0.61, P-value,0.00), being from the richest household (IRR = 0.94, P-value,0.00), and being single/divorced and widowed (IRR,0.49, P-value,0.00) are negatively associated with having more children because their IRR is less than one. The decomposition analysis also demonstrated that marital status has a stronger negative correlation with fertility in rural compared to urban settings. Additionally, the number of children under five exerts a greater influence on fertility in urban areas. Conclusion: the study found significant rural-urban differences in the factors shaping fertility in Ethiopia. While demographics like maternal age, education, and wealth influenced fertility in both settings, the relationships varied in nature and magnitude. To address this, Policymakers should develop targeted fertility programs that address the unique needs and challenges faced by rural and urban populations. [ABSTRACT FROM AUTHOR]

Union dissolution has severe consequences for women's economic well-being. Theoretical work links these consequences to ethnic inequality. Ethnic groups vary in terms of separation rates, female employment, repartnering trajectories, kin support, and reliance on welfare benefits. The current study examines whether ethnicity moderates the dissolution penalty. To do so, the authors draw on register data, covering women from five major ethnic groups in the Netherlands: Dutch, Antillean, Surinamese, Moroccan, and Turkish. The authors describe women's income trajectories from 1 year before to 5 years after union dissolution. Using decomposition techniques, changes in household income are decomposed into changes in six underlying income sources (i.e., earnings, benefits, alimony, partner income, and coresident family income). The results show that ethnicity moderates the dissolution penalty and, especially, the contribution of the various income sources when recovering from dissolution. [ABSTRACT FROM AUTHOR]

This article examines the evolution of the gender wealth gap in Germany during the first decade of the XXI century. This period is characterized by an increase in labour supply of women and change in occupational structure due to numerous reforms undertaken by the government. We use the Firpo, Fortin, Lemieux detailed decomposition technique throughout the wealth distribution to identify the main factors explaining the gap over time. Findings indicate that an increase in the labour market participation of women and the resulting changes in the occupational structure are accompanied by positive changes in women's wealth accumulation, which reduce the gender wealth gap. The role of permanent income decreases due to a reduction both in the gender difference in average permanent income and in gender differences in its returns. There remain substantial differences in the way women and men accumulate wealth. Policy interventions to further reduce the gap are discussed. [ABSTRACT FROM AUTHOR]

Many modern industrial processes involve multiple quality measures, and using individual control charts for each measure can be misleading if these measures are highly related. This paper proposes a new method for statistically controlling electronic products with multiple, interconnected quality characteristics. The method utilizes a combined model: a multivariate autoregressive (MAR) model with neural networks, to handle the presence of both correlation and autocorrelation in the data. The study compares the effectiveness of MCUSUM, MEWMA, and T² Hotelling charts in detecting small shifts in the overall process quality. To pinpoint the specific variables causing out-of-control signals in the T² Hotelling chart, we introduce a novel decomposition technique. This technique allows us to identify which measures are contributing most to these signals. Additionally, the MCUSUM and MEWMA charts demonstrate excellent performance in detecting small quality changes, leading to faster corrective actions. Overall, these findings suggest that our proposed method can significantly improve the reliability and responsiveness of quality control in electronics manufacturing. [ABSTRACT FROM AUTHOR]

Characterizing and quantifying livestock carbon emissions helps mitigate temperature rise and potential climate risks. Here, the spatial and temporal characteristics of China's carbon emissions of meat, egg, and milk are analyzed from the perspective of production and consumption. A driving factor decomposition model of carbon emissions of meat, egg, and milk production and consumption is established using the logarithmic mean Divisia index (LMDI). Using a static scenario analysis and dynamic Monte Carlo simulations (MCS), the evolution trajectory of carbon peak in meat, egg, and milk production and consumption in China during 2021–2030 is analyzed. China's carbon emissions from meat, egg, and milk production and consumption have risen in 2020, reaching 794.1 and 465.88 Mt, respectively. Moreover, western China has the highest carbon emissions in production (33.84%), which are concentrated in Sichuan, Inner Mongolia, and Xinjiang. For consumption, the carbon emissions are mainly concentrated in the eastern region (42.96%), and Guangdong is the primary source of carbon emissions in eastern China. The key drivers of carbon emissions for this production and consumption are the farmland output value and residential income effects, respectively. Conversely, reverse urbanization, agricultural industry structure, and food money purchasing power effects play significant suppressive roles. Under the business-as-usual scenario (BAU), China's carbon emissions from meat, egg, and milk production and consumption in 2030 will increase by 40.1% and 4.86% from 2020, respectively. The middle low-carbon scenario (Mid-LC) mitigates carbon emission growth by 24.51% and − 5.7%, respectively, for the production and consumption of meat, egg, and milk in 2030 compared to 2020. In the highly low-carbon scenario (Hig-LC), production and consumption will achieve a carbon peak by 2030. Ultimately, this study highlights the importance of reducing carbon emissions from livestock on production and consumption, and provides help for China's agricultural green development from the geospatial characteristics, drivers, and future trends of carbon emissions at both the production and consumption sides. [ABSTRACT FROM AUTHOR]

Agricultural transformation in Punjab, spurred by the Green Revolution of the mid-1960s, has led to significant shifts in land use patterns, crop diversification, and cropping dynamics. This transformation has profound implications for sustainability and economic resilience. This study delves into the complex relationship among agricultural growth, instability, and environmental sustainability in Punjab. It examines the growth and instability in the state's key crops' area, production, and yield/productivity over 56 years, from 1966–1967 to 2021–2022. Using secondary data, this study employs an assortment of methodologies, including compound annual growth rate, simple linear regression, diversity indices such as the Herfindahl index and Simpson diversity index, instability analysis, and decomposition analysis. The results indicate an increase in cropping intensity, indicating agricultural intensification, with a shift towards wheat and rice monoculture from once diverse cropping patterns. The instability analysis reveals that wheat and rice emerge as the most stable crops in their area, production, and yield, while others exhibit instability, raising concerns about diminishing crop diversity and its implications for Punjab's natural resources. The study emphasizes the urgent necessity for sustainable agricultural practices and policies to counteract monoculture's adverse effects and ensure long-term agricultural resilience. [ABSTRACT FROM AUTHOR]

Abstract Background Although the prevalence of poor oral health among older populations in Australia and the United States is higher, the contribution of ethnicity status is unknown. We aimed to estimate the contribution of social inequalities in oral health among older populations in Australia and the United States. Methods Cross-sectional study design using data from Australia’s National Survey of Adult Oral Health (NSAOH 2004–06 and 2017–18) and the United States’ National Health and Nutrition Examination Survey (NHANES 2003–04 and 2011–16). Participants included in the analysis were aged 65 + years. Oaxaca-Blinder type decomposition analysis was used to assess the contribution of demographic (age, sex), socioeconomic position (educational attainment, household income) and dental behaviors (last dental visit) to changes in prevalence of edentulism and non-functional dentition, and mean number of missing teeth by ethnicity status over time in Australia and the United States. Results The number of participants aged 65 + years who provided clinical and sociodemographic/dental behaviour data was 1043 and 1269 in NSAOH 2004–06 and 2017–18, and 1372 and 1328 in NHANES 2003–04 and 2011–16 respectively. The prevalence of edentulism was from 13 percent (NHANES 2011–16) to 28 percent (NSAOH 2004–06), while the prevalence of non-functional dentition was from 41 percent (NSAOH 2017–18 and NHANES 2011–16) to 61 percent (NHANES 2003–04). The mean number of missing teeth was from 11 (NSAOH 2017–18) to 18 (NHANES 2003–04). The prevalence of edentulism and non-functional dentition, and the mean number of missing teeth were higher among older Australians identifying as White and the opposite results were observed among older Americans identifying as Non-White. For older adults in Australia, risk factors with the greatest impact on oral health outcomes by ethnicity status were educational attainment and household income. For older adults in the United States, the most dominant risk factor for non-optimal oral health outcomes by ethnicity status was last dental visit. Conclusions There are important policy translation implications from our findings, as they indicate that social and structural systems in Australia and the United States operate differently in the context of oral health over time among culturally diverse older citizens. This information will help inform initiatives that both target effective oral health promotion for older, culturally-diverse populations and provide evidence for the distribution of resources in the public dental health setting for this age group and cultural demographic.

Abstract Introduction Fertility refers to the biological capacity to reproduce and have children. It is a key aspect of reproductive health influenced by various factors. Therefore, this study aims to explore the determinants of fertility rates based on urban and rural settings in Ethiopia. Method A stratified two-stage cluster sampling approach was used, employing data from the 2019 Ethiopian Mini Demographic and Health Survey ( https://dhsprogram.com ). The study comprised 8,885 women aged 15 to 49 years. The study employed Stata 17, and the data was described using descriptive statistics. Associations were examined using decomposition analysis and negative binomial regression. The Incidence Rate Ratio and p-value were used to determine the statistical significance of the variables examined. Results The negative binomial regression found that factors such as maternal age (IRR, 1.08, P-value,0.00), living in rural (IRR,1.09, P-value,0.00), being Muslim (IRR,1.13, P-value,0.00), being from other religious groups (IRR,1.16, P-value,0.00), having six up to nine household members (IRR,1.24, P-value,0.00), having greater than nine household member(IRR,1.14, P-value,0.04), having one child under five year (IRR,1.35, P-value,0.00), having two children under five year (IRR,1.77, P-value,0.00), and having more than two under five years (IRR,1.99, P-value,0.00), being currently pregnant (IRR,1.08, P-value,0.00), use of contraceptive(IRR,1.13, P-value,0.00) are positively associated with bearing more children. On the other hand, completing primary education (IRR,0.84, P-value,0.00), secondary education (IRR,0.61, P-value,0.00), being from the richest household (IRR = 0.94, P-value,0.00), and being single/divorced and widowed (IRR,0.49, P-value,0.00) are negatively associated with having more children because their IRR is less than one. The decomposition analysis also demonstrated that marital status has a stronger negative correlation with fertility in rural compared to urban settings. Additionally, the number of children under five exerts a greater influence on fertility in urban areas. Conclusion the study found significant rural-urban differences in the factors shaping fertility in Ethiopia. While demographics like maternal age, education, and wealth influenced fertility in both settings, the relationships varied in nature and magnitude. To address this, Policymakers should develop targeted fertility programs that address the unique needs and challenges faced by rural and urban populations.

Using the World Bank's Changing Wealth of Nations database, this paper provides novel evidence on the cross-country inequality of wealth from 1995 to 2018. Overall, judging by both the top/middle/bottom shares and coefficients of variation, the analysis found that inequality in wealth per capita decreased prior to the 2008 global financial crisis and has remained stable since then. Adopting a before-after approach, this study further showed that different components of national wealth, including human capital, produced capital, natural capital, and net foreign assets, have heterogeneous impacts on between-country wealth inequality. In addition, we introduced a rank-based correlation analysis to explore wealth mobility across nations, revealing extremely low and decreasing mobility over time. Unlike most existing studies that exclude some major components of wealth, this study relied on a more comprehensive accounting of wealth and thus offers new insights into the dynamics of global per capita wealth inequality, the impact of the 2008 financial crisis, and the component-level contributions to wealth disparities. These findings have significant implications for understanding global challenges, including the North-South divide, climate change, and the distributive consequences of globalization.

This study investigates the main factors influencing carbon emissions from Four Wheel Passenger Vehicles (FWPVs) in Sri Lanka, an emerging economy where the transport sector contributes 12 % of total emissions. Pioneering a new methodology, we integrate System Dynamics (SD) modeling and decomposition analysis to comprehensively map the factors affecting fuel efficiency for the first time in Sri Lanka. Employing the additive Logarithmic Mean Divisia Index (LMDI I), we analyze a comprehensive time series dataset covering all petrol, diesel, and electric-powered FWPVs registered between 2015 and 2019. Our study delves into significant drivers of CO2 emissions, including population dynamics, vehicle ownership trends, annual travel distances, fuel types, engine capacities, and technological advancements. Additionally, we quantify the impact of fiscal policies on FWPV emissions, revealing a surge in emissions in 2018 and 2019 driven by consumer preferences for high-capacity vehicles. Our findings offer critical insights for crafting effective policies to promote energy-efficient vehicles and mitigate carbon emissions in the transport sector, emphasizing the importance of targeted fiscal measures. By imposing taxes on high-capacity vehicles and incentivizing the adoption of low-emission options through tax variations and renewable energy incentives, policymakers can influence consumer behavior and drive significant emission reductions. Our study underscores the need for ongoing monitoring and evaluation of fiscal policies to refine existing measures and accelerate the transition towards a sustainable, low-carbon transportation sector in Sri Lanka.

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

Purpose: The purpose of this study was to examine racial/ethnic differences in AFS use and their contributing factors using a decomposition analysis. Design/methodology/approach: The 2018 National Financial Capability Study dataset was used to analyze the four major types of AFS—title loans, payday loans, pawnshops, and rent-to-own (RTO) stores—as proxies for AFS use. The study conducted both logistic regression analysis and decomposition analysis to examine the contributing factors. Findings: The results of the logistic regression analysis demonstrated significant disparities in the use of alternative financial services (AFS) among racial and ethnic groups. Specifically, it was found that Blacks were more likely to utilize title and payday loans, pawnshops, and rent-to-own (RTO) stores compared to Whites. In contrast, Hispanics and Asians/individuals of other ethnicities were less likely to use title loans, but Hispanics were more likely to opt for payday loans over Whites. Furthermore, objective financial literacy exhibited a negative association with the likelihood of using these four types of AFS, whereas subjective financial literacy consistently showed a positive association. When examining the decomposition analyses, it became evident that both objective and subjective financial literacy played significant roles in explaining the racial and ethnic disparities in AFS usage. However, the patterns varied in three specific pairwise comparisons. Originality/value: This study revealed the relative contributions of each factor to the racial/ethnic disparities through decomposition analysis. Our Fairlie decomposition approach addressed non-linearities within the decomposition framework, particularly in estimating the probabilities of AFS utilization, given its binary outcomes. This extension builds upon the Oaxaca decomposition. The study offers valuable insights into the variations in AFS use among different racial and ethnic groups. [ABSTRACT FROM AUTHOR]

Limited understanding exists regarding the social determinants of psychological well-being inequalities, particularly in developing countries with less developed healthcare and public policy systems for older individuals. This study employed two common decomposition analyses in health inequality research to explore factors influencing socioeconomic-related disparities in psychological well-being within and between Vietnam and Myanmar. Utilizing surveys from the 2012 Myanmar Aging Survey (N = 4,056) and the 2011 Vietnam Aging Survey (N = 2,688), we observed that inequality disproportionately affected the worse-off in both countries, with Vietnam experiencing a greater degree of inequality than Myanmar. The concentration index decomposition highlighted subjective income and offspring's financial assistance as significant contributors to the observed inequality across both countries. The Oaxaca-Blinder decomposition showed that the disparity between Vietnam and Myanmar in inequality primarily stemmed from uneven wealth distribution across factors. This implies that wealth redistribution policies could mitigate disparities within and between the two countries. [ABSTRACT FROM AUTHOR]

Abstract Background Early neonatal deaths, occurring within the first six days of life, remain a critical public health challenge. Understanding the trends and factors associated with this issue is crucial for designing effective interventions and achieving global health goals. This study aims to examine the trends in early neonatal mortality in Ethiopia and identify the key factors associated with changes in early neonatal mortality over time. Methods This study utilized five consecutive Ethiopian Demographic and Health Survey datasets from 2000 to 2019. To investigate the trends and identify factors influencing changes in early neonatal mortality over time, conducted a trend analysis and a logit-based multivariate decomposition analysis. Data management and analyses were performed using STATA version 17/MP software. All analyses were weighted to account for sampling probabilities and non-response. Statistical significance was determined at a two-sided p-value threshold of less than 0.05. Result The analysis included a total of 12,260 weighted women from the 2000 survey and 5,527 weighted women from the 2019 survey. Over the study period, there was an overall downward trend in early neonatal mortality, decreasing from 34 deaths per 1000 live births in 2000 to 27 deaths per 1000 live births in 2019. The annual rate of reduction was estimated to be 1.03%. Approximately 45% of the observed decline in early neonatal mortality rate can be attributed to changes in population characteristics or endowments (E) during the study period. Factors such as the mother’s age, maternal education, marital status, preceding birth interval, types of pregnancy, and the sex of the child significantly contributed to the compositional change in the early neonatal mortality rate. Conclusion Over the past two decades, Ethiopia has seen a modest decline in early neonatal mortality, but this progress falls short of the Sustainable Development Goal (SDGs) targets. To achieve the SDGs, the Ministry of Health and its partners should intensify efforts to reduce early neonatal mortality. Strategies like preventing early/late pregnancies, promoting appropriate marriage timing, and prioritizing education could help further reduce early neonatal deaths. Further research is also needed to explore the factors driving this issue.

Abstract Background Perinatal mortality is a global health problem, especially in Ethiopia, which has the highest perinatal mortality rate. Studies about perinatal mortality were conducted in Ethiopia, but which factors specifically contribute to the change in perinatal mortality across time is unknown. Objectives To assess the trend and multivariate decomposition of perinatal mortality in Ethiopia using EDHS 2005–2016. Methods A community-based, cross-sectional study design was used. EDHS 2005–2016 data was used, and weighting has been applied to adjust the difference in the probability of selection. Logit-based multivariate decomposition analysis was used using STATA version 14.1. The best model was selected using the lowest AIC value, and variables were selected with a p-value less than 0.05 at 95% CI. Result The trend of perinatal mortality in Ethiopia decreased from 37 per 1000 births in 2005 to 33 per 1000 births in 2016. About 83.3% of the decrease in perinatal mortality in the survey was attributed to the difference in the endowment (composition) of the women. Among the differences in the endowment, the difference in the composition of ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and birth attendant significantly decreased perinatal mortality in the last 10 years. Among the differences in coefficients, skilled birth attendants significantly decreased perinatal mortality. Conclusion and recommendation The perinatal mortality rate in Ethiopia has declined over time. Variables like ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and skilled birth attendants reduce perinatal mortality. To reduce perinatal mortality more, scaling up maternal and newborn health services has a critical role.

Abstract Background Over the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality. Methods Data for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination. Results The coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake. Conclusions There was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.

Abstract Background Financial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town. Methods This study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p

Abstract Background Digital health, aiming to boost healthcare accessibility, is an emerging concept in the domain of healthcare administration and delivery in developing countries. In India, according to the National Family Health Survey (NFHS-5), more than half (55%) of the men have reported ever using the internet, while only one-third (33%) of the women have done so. This gendered digital divide is further complicated and worsened by the fact that individuals in the lowest wealth quintile exhibit significantly lower internet usage rates, with only 9% of women and 26% of men. Such intersectionality of the gendered digital divide might prove a barrier to realizing the full potential of digital health in India. Eliminating digital inequalities in all forms and ensuring universal digitalization is essential for desired digital health outcomes. Methods This study aims to explore India’s readiness for digital health in terms of access to basic digital infrastructure, i.e., the internet. We analyze access to the Internet among Indian women of reproductive age using pan-India survey data from the fifth round of the National Family Health Survey (2019–21). We investigate predictors of Internet use in a regression model and apply the Erreygers Concentration Index (ECI) to examine inequalities in Internet access. Using decomposition analyses, we analyze factors contributing to digital inequality in terms of internet use. Results Our inequality analysis based on the ECI [ECI- 0.4444 (p

Abstract China, the world’s largest carbon emitter, has one of the most stringent provincial emissions reduction programs, incorporated into its Five-Year National Plan to reduce carbon emissions. However, the widening energy intensity gap between provinces poses a great challenge for carbon reduction. In this study, we analyze the convergence of Energy intensity (EIC), i.e., the time-dependent decrease of differences among regional energy intensity over time focusing on a data set of 30 Chinese provinces from 2000 to 2015. Our goal is to identify the provinces that are responsible for the observed divergence in energy intensity and identify the factors causing that divergence in each individual case. The Theil index is used to capture inter-provincial energy inequality. We use the LMDI decomposition analysis to identify the drivers of energy inequality (energy consumption structure, energy efficiency, and industrial structure). The results suggest that reducing energy intensity in Inner Mongolia, Xinjiang, and Hebei is the key to solving China's increasing energy intensity “gap” dilemma. The factors causing the energy intensity divergence in Inner Mongolia and Xinjiang are related to lagging economic growth and low energy efficiency, which impedes carbon emission reductions significantly. The factors causing the divergence of energy intensity in Hebei are rooted in its heavy industrial structure. Our findings are directly applicable to crafting regional energy policy with more targeted and practical emission reduction programs.

Background: Early neonatal deaths, occurring within the first six days of life, remain a critical public health challenge. Understanding the trends and factors associated with this issue is crucial for designing effective interventions and achieving global health goals. This study aims to examine the trends in early neonatal mortality in Ethiopia and identify the key factors associated with changes in early neonatal mortality over time. Methods: This study utilized five consecutive Ethiopian Demographic and Health Survey datasets from 2000 to 2019. To investigate the trends and identify factors influencing changes in early neonatal mortality over time, conducted a trend analysis and a logit-based multivariate decomposition analysis. Data management and analyses were performed using STATA version 17/MP software. All analyses were weighted to account for sampling probabilities and non-response. Statistical significance was determined at a two-sided p-value threshold of less than 0.05. Result: The analysis included a total of 12,260 weighted women from the 2000 survey and 5,527 weighted women from the 2019 survey. Over the study period, there was an overall downward trend in early neonatal mortality, decreasing from 34 deaths per 1000 live births in 2000 to 27 deaths per 1000 live births in 2019. The annual rate of reduction was estimated to be 1.03%. Approximately 45% of the observed decline in early neonatal mortality rate can be attributed to changes in population characteristics or endowments (E) during the study period. Factors such as the mother's age, maternal education, marital status, preceding birth interval, types of pregnancy, and the sex of the child significantly contributed to the compositional change in the early neonatal mortality rate. Conclusion: Over the past two decades, Ethiopia has seen a modest decline in early neonatal mortality, but this progress falls short of the Sustainable Development Goal (SDGs) targets. To achieve the SDGs, the Ministry of Health and its partners should intensify efforts to reduce early neonatal mortality. Strategies like preventing early/late pregnancies, promoting appropriate marriage timing, and prioritizing education could help further reduce early neonatal deaths. Further research is also needed to explore the factors driving this issue. [ABSTRACT FROM AUTHOR]

Background: Perinatal mortality is a global health problem, especially in Ethiopia, which has the highest perinatal mortality rate. Studies about perinatal mortality were conducted in Ethiopia, but which factors specifically contribute to the change in perinatal mortality across time is unknown. Objectives: To assess the trend and multivariate decomposition of perinatal mortality in Ethiopia using EDHS 2005–2016. Methods: A community-based, cross-sectional study design was used. EDHS 2005–2016 data was used, and weighting has been applied to adjust the difference in the probability of selection. Logit-based multivariate decomposition analysis was used using STATA version 14.1. The best model was selected using the lowest AIC value, and variables were selected with a p-value less than 0.05 at 95% CI. Result: The trend of perinatal mortality in Ethiopia decreased from 37 per 1000 births in 2005 to 33 per 1000 births in 2016. About 83.3% of the decrease in perinatal mortality in the survey was attributed to the difference in the endowment (composition) of the women. Among the differences in the endowment, the difference in the composition of ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and birth attendant significantly decreased perinatal mortality in the last 10 years. Among the differences in coefficients, skilled birth attendants significantly decreased perinatal mortality. Conclusion and recommendation: The perinatal mortality rate in Ethiopia has declined over time. Variables like ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and skilled birth attendants reduce perinatal mortality. To reduce perinatal mortality more, scaling up maternal and newborn health services has a critical role. [ABSTRACT FROM AUTHOR]

Land use can affect energy consumption by changing the economic and social structure of cities. Thus, the optimization of land use patterns is key to promoting energy sustainability. In this study, we explored the spatiotemporal evolution of China's urban energy consumption and its driving factors from the role of land use, with the application of high-precision nighttime light images and land use data acquired from remote sensing satellites. A deep clustering network in deep learning was used for clustering analysis of urban energy consumption. The results indicated that the economic and structural effects of land use were the primary driving factors of the increasing urban energy consumption, whereas the decrease in the energy intensity (caused by technological progress) restrained the growth rate of energy consumption. With the exception of economically developed cities, generally, the contribution of the population size to the temporal increase in energy consumption was relatively small. The spatial difference in urban energy consumption was mainly due to the between-group differences among the diversified cluster groups, which were strongly influenced by land urbanization and population size. These conclusions can help the Chinese government formulate differentiated urban energy policies. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality. Methods: Data for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination. Results: The coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake. Conclusions: There was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities. [ABSTRACT FROM AUTHOR]

Background: Financial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town. Methods: This study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p < 0.05. Results: The incidence of CHE was 17.94% and 5.58% among non-insured and insured households, respectively. About 53% and 153.20% of the insured-non-insured disparities in the magnitude of CHE were due to the difference in characteristics (endowments) and the effect of characteristics (coefficients), respectively. Age of the household head between 46 and 60 years and above 60 years, divorced and widowed marital status of household head, and chronic health conditions were the explanatory variables widening the gap in the incidence of CHE. However, do not seeking traditional medicine, family size above 4, and age of household head between 31 and 45 years were the variables contribute in reducing the gap (i.e. due to endowments) in the incidence of CHE between insured and non-insured households. Moreover, the variables that contributed to the gap in the incidence of CHE due to covariate effects were age (31–45) and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Conclusion: This study revealed there is a significant disparity in the incidence of CHE between insured and non-insured households. Age, marital status and occupation of the household head, family size of household, presence of a chronically ill household member and seeking traditional medicine were significantly contributing factors for the disparity of CHE between insured and non-insured households due to endowments. The variables that contributed to the disparity in the incidence of CHE due to covariate effects were age and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Therefore, the policy makers need to emphasize in increasing the insurance coverage among households, and providing affordable health services in Ethiopia in general and Debre Tabor town in particular. [ABSTRACT FROM AUTHOR]

Background: Digital health, aiming to boost healthcare accessibility, is an emerging concept in the domain of healthcare administration and delivery in developing countries. In India, according to the National Family Health Survey (NFHS-5), more than half (55%) of the men have reported ever using the internet, while only one-third (33%) of the women have done so. This gendered digital divide is further complicated and worsened by the fact that individuals in the lowest wealth quintile exhibit significantly lower internet usage rates, with only 9% of women and 26% of men. Such intersectionality of the gendered digital divide might prove a barrier to realizing the full potential of digital health in India. Eliminating digital inequalities in all forms and ensuring universal digitalization is essential for desired digital health outcomes. Methods: This study aims to explore India's readiness for digital health in terms of access to basic digital infrastructure, i.e., the internet. We analyze access to the Internet among Indian women of reproductive age using pan-India survey data from the fifth round of the National Family Health Survey (2019–21). We investigate predictors of Internet use in a regression model and apply the Erreygers Concentration Index (ECI) to examine inequalities in Internet access. Using decomposition analyses, we analyze factors contributing to digital inequality in terms of internet use. Results: Our inequality analysis based on the ECI [ECI- 0.4444 (p < 0.001)] suggests that a significant inequality exists in internet access. Furthermore, the decomposition analyses in the study find women's educational level to be the most prominent (28.19%) contributing factor to internet inequality, followed by wealth (25.67%), place of residence (23.16%), and caste (1.10%). Recommendation: We suggest a comprehensive readiness and need assessment, revamping of digital infrastructure, and moving with caution in implementing digital health innovation in the country as it may further exacerbate the existing healthcare access inequities. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the factors influencing urban–rural differences in depressive symptoms among old people in China and to measure the contribution of relevant influencing factors. Design: A cross-sectional research. The 2018 data from The Chinese Longitudinal Health Longevity Survey (CLHLS). Setting: Twenty-three provinces in China. Participants: From the 8th CLHLS, 11,245 elderly participants were selected who met the requirements of the study. Measurements: We established binary logistic regression models to explore the main influencing factors of their depressive symptoms and used Fairlie models to analyze the influencing factors of the differences in depressive symptoms between the urban and rural elderly and their contribution. Results: The percentage of depressive symptoms among Chinese older adults was 11.72%, and the results showed that rural older adults (12.41%) had higher rates of depressive symptoms than urban (10.13%). The Fairlie decomposition analysis revealed that 73.96% of the difference in depressive symptoms could be explained, which was primarily associated with differences in annual income (31.51%), education level (28.05%), sleep time (− 25.67%), self-reported health (24.18%), instrumental activities of daily living dysfunction (20.73%), exercise (17.72%), living status (− 8.31%), age (− 3.84%), activities of daily living dysfunction (− 3.29%), and social activity (2.44%). Conclusions: The prevalence of depressive symptoms was higher in rural than in urban older adults, which was primarily associated with differences in socioeconomic status, personal lifestyle, and health status factors between the urban and rural residents. If these factors were addressed, we could make targeted and precise intervention strategies to improve the mental health of high-risk elderly. [ABSTRACT FROM AUTHOR]

This article provides a novel approach to the traditional constant market share (CMS) analysis recognizing the importance of global production networks and fragmentation that necessitate using trade in value added (TiVA) rather than gross trade. We discuss how the components of a CMS analysis need to be (re)interpreted and apply our Constant Value Added Share (CVAS) analysis to the Philippines in the years 1995–2020 using the latest TiVA 2023 dataset (released in November 2023) and compare CMS to CVAS in order to facilitate understanding the contribution of the novel approach. The CVAS analysis finds that while Philippine and world Value Added grew at par, the country lost competitiveness. Traditional CMS suggests a smaller loss of competitiveness. Our approach also identifies specific sectoral weaknesses (i.e., computer and electronics exports) and emerging strengths (technology-related business services) that are unclear in CMS analysis. We argue that Constant Value Added Share analysis is useful for assessing the global value chain performance of other developing countries as well. [ABSTRACT FROM AUTHOR]

China, the world's largest carbon emitter, has one of the most stringent provincial emissions reduction programs, incorporated into its Five-Year National Plan to reduce carbon emissions. However, the widening energy intensity gap between provinces poses a great challenge for carbon reduction. In this study, we analyze the convergence of Energy intensity (EIC), i.e., the time-dependent decrease of differences among regional energy intensity over time focusing on a data set of 30 Chinese provinces from 2000 to 2015. Our goal is to identify the provinces that are responsible for the observed divergence in energy intensity and identify the factors causing that divergence in each individual case. The Theil index is used to capture inter-provincial energy inequality. We use the LMDI decomposition analysis to identify the drivers of energy inequality (energy consumption structure, energy efficiency, and industrial structure). The results suggest that reducing energy intensity in Inner Mongolia, Xinjiang, and Hebei is the key to solving China's increasing energy intensity "gap" dilemma. The factors causing the energy intensity divergence in Inner Mongolia and Xinjiang are related to lagging economic growth and low energy efficiency, which impedes carbon emission reductions significantly. The factors causing the divergence of energy intensity in Hebei are rooted in its heavy industrial structure. Our findings are directly applicable to crafting regional energy policy with more targeted and practical emission reduction programs. [ABSTRACT FROM AUTHOR]

Many authors state that climate change is driven by increasing CO2 emissions worldwide. An understanding of the major driving forces affecting emissions over time in both developed and developing countries is important. Thus, in this study, structural break analysis is used to identify when the trends of environmental indicators—CO2 emissions and environmental efficiency (EE)—across countries worldwide change. Our findings revealed notable structural breaks occurring in countries in 1994, coinciding with ballooning fossil energy prices. Regarding CO2, 55 of 143 countries experienced a structural break. Furthermore, another wave of structural breaks emerged in 2014, corresponding to the implementation of CO2 emission reduction plans by certain nations. For CO2, 64 of 143 countries experienced a structural break. Upon detecting breakpoints and their trends, we utilized LMDI factor decomposition analysis to discern their driving factors, thereby elucidating the underlying dynamics. In Latin America and the Caribbean, most breakpoints were undesirable shifts, but recently, desirable shifts have increased in North America, Oceania, and Europe, which include many countries with high economic levels, improving energy-related factors. Sub-Saharan Africa can also be said to have undergone an undesirable shift regarding energy-related factors. This study clarifies the precise influences on the trend of CO2 emissions at the global level by identifying the point in time when there is a significant statistical, rather than a subjective, breakpoint. [ABSTRACT FROM AUTHOR]

Objective: This study examines the educational diffusion of divorce in Europe and the role of women's decisionmaking therein. Background: As the contextual barriers to divorce have lowered, the divorce rates of less-educated women have increased in many societies. Changes in divorce barriers are likely more pertinent to married women than to married men. However, no previous study has tested whether less-educated women increasingly take the initiative to divorce or whether less-educated women are increasingly left by their husbands. Method: The authors used retrospective panel data from the Generations and Gender Survey, covering 39,650 marital unions across 49 country-cohort contexts in Europe. Multilevel models showed how divorce barriers were associated with the educational gradient in divorce. Competing-risks models decomposed the associations into a wife-initiated share and a husband- or jointly-initiated share. Results: Lower divorce barriers are associated with the educational diffusion of divorce. This diffusion is largely driven by women's own divorce initiation. Conclusion: More permissive family norms and greater economic autonomy enable less-educated women to leave a dissatisfying marriage. [ABSTRACT FROM AUTHOR]

The article presents a detailed decomposition analysis of energy consumption and greenhouse gas emissions in European Union (EU) member states, using Index Decomposition Analysis (IDA) with the Logarithmic Mean Divisia Index (LMDI) method. Topics include the differences in emissions and energy use between wealthier and less affluent EU countries, the impact of economic activity on these factors, and the need for tailored approaches and policies to achieve climate neutrality within the region.

Due to its potential contribution to educational achievement, immigration has garnered increased attention in literature. However, the existing research has predominantly examined the relationship between immigration and academic achievement through remittance or has failed to sufficiently control for the numerous factors that explain and mitigate the impacts of a student's immigration status. This paper aims to explore one socio-demographic dimension of immigration, i.e., how immigration status helps explain the school performance gap. We compared native and immigrant students in Cameroon, ages 6–20 years old on outcomes of reading, writing, and level of educational attainment, controlling for relevant socio demographic factors. The results show that native students are more likely to be able to read and write a simple sentence in the official language than immigrant students. The level of education attended by the student increases the differences in academic achievements between native and immigrant students. Marital status, on the other hand, reduces the gaps in school performance. To narrow the school performance gap among students, the Cameroonian government should focus on students by highlighting linguistic skills, supplying specific teachers for immigrant students, and offering psychosocial staff to assist them. [ABSTRACT FROM AUTHOR]

Maternal and neonatal mortality and morbidity, particularly in developing countries, are high even in the twenty-first century, which is a cause for concern. Therefore, this paper examines the Continuum of Mother and Neonatal Health Care (MNH), i.e., at least four ante-natal care visits (ANC 4 +), skilled birth attendance at delivery (SBA), post-natal care (PNC), and its determinants in 10 developing countries in Asia. It uses Demographic and Household Survey data (2014–2021) and finds that only 46% of women received all the MNH services, and 8% did not receive any services. In Afghanistan, only 2.8% of women availed complete care of MNH services, followed by Timor-Leste (26.1%), Bangladesh (31.5%), Pakistan (35.1%), and Nepal (38.8%). Empirical analysis shows that women with higher education, those living in urban areas, from wealthy families, and female-headed households have higher odds of availing all MNH. Media exposure, ease of access to MNH services, and the women who have attended the first ANC at less than four months of pregnancy have higher odds of availing all three MNH services. Therefore, the MNH policy should target women in rural areas who have a lower level of education and come from low-income families to improve the mother and neonatal health situation in South and Southeast Asia. [ABSTRACT FROM AUTHOR]

HIV/AIDS remains a public health crisis, HIV/AIDS remains a public health crisis, especially among male adolescents in Indonesia. This urgency stems from the rapid increase in cases among adolescents, who often lack adequate access to education and prevention resources. If left unaddressed, the epidemic could continue to spread among younger populations, leading to long-term social and economic consequences. Despite the crucial role of HIV knowledge in prevention, disparities exist between rural and urban areas. This study examines these disparities, identifying factors influencing HIV knowledge. This cross-sectional study employed a total of 10,943 male adolescents enrolled in a survey called Indonesia Demographic Health Survey (IDHS) 2017. To address those disparities, a stratification chi-square based on place of residence was employed. We also employed a multivariate decomposition analysis to examine which variables account for most gaps. Results found that only 15% of adolescents were knowledgeable (9.5% in urban and 5.5% in rural areas). Bivariate Analysis showed that education level and HIV test awareness were associated in both areas ( p-value < 0.05), while wealth quintile and internet use were associated in urban areas only ( p-values < 0.05). The HIV knowledge gap would decrease by 8% if internet use was equalized, by 11% if HIV testing awareness was equalized, by 17% if educational attainment was equalized, and by 24% if wealth quintiles were equalized. This calls for a multi-sectoral intervention targeting such factors for better HIV outcomes in Indonesia.

Abstract The kidney cancer (KC) burden measures have changed dramatically in recent years due to changes in exposure to the determinants over time. We aimed to decompose the difference in the KC burden measures between 1990 and 2019. This ecological study included data on the KC burden measures as well as socio-demographic index (SDI), behavioral, dietary, and metabolic risk factors from the global burden of disease study. Non-linear multivariate decomposition analysis was applied to decompose the difference in the burden of KC. Globally, ASIR, ASMR, and ASDR of KC increased from 2.88 to 4.37, from 1.70 to 2.16, and from 46.13 to 54.96 per 100,000 people between 1990 and 2019, respectively. The global burden of KC was more concentrated in developed countries. From 1990 to 2019, the burden of KC has increased the most in Eastern European countries. More than 70% of the difference in the KC burden measures between 1990 and 2019 was due to changes in exposure to the risk factors over time. The SDI, high body mass index (BMI), and alcohol use had the greatest contribution to the difference in the KC burden measures. Changes in characteristics over time, including SDI, high BMI, and alcohol consumption, appear to be important in the evolving landscape of KC worldwide. This finding may help policymakers design policies and implement prevention programs to control and manage KC.

Abstract Background and objective On the trajectory towards universal health coverage in Bhutan, health equity requires policy attention as significant disparities exist between urban and rural health outcomes. This paper examines health services utilization patterns, inequalities and their socio-economic determinants in rural and urban areas and decomposes the factors behind these differences. Methods We used the Bhutan Living Standard Survey 2017 to profile health services utilization patterns and equalities. We employed two different decomposition analyses: decomposition of mean differences in utilization using the Oaxaca–Blinder decomposition framework and differences in the income-related distribution in utilization using recentered influence function regressions between rural and urban areas. Results Significant differences exist in the type of outpatient services used by the rural and urban population groups, with those living in rural areas having 3.4 times higher odds of using primary health centers compared to outpatient hospital care. We find that the use of primary health care is pro-poor and that outpatient hospital resources is concentrated among the more affluent section of the population, with this observed inequality consistent across settings but more severe in rural areas. The rural–urban gap in utilization is primarily driven by income and residence in the eastern region, while income-related inequality in utilization is influenced, aside from income, by residence in the central region, household size, and marriage and employment status of the household head. We do not find evidence of significant mean differences in overall utilization or inequality in utilization of inpatient health care services. Conclusions While the differences in average contacts with health services are insignificant, there are prominent differences in the level of services availed and the associated inequality among rural and urban settings in Bhutan. Besides, while there are obvious overlaps, factors influencing income-related inequality are not necessarily the same as those driving the utilization gaps. Cognizance of these differences may lead to better informed, targeted, and potentially more effective future research and policies for universal health coverage.

The use of energy-efficient technologies tends to reduce the overall energy use of a country and foster the energy transition pathways. However, a change in energy can occur either due to a change in activity effect, intensity effect, or structural effect. The objective of the study is firstly to examine and measure the magnitude of change in energy use and identify the factor responsible for the change in energy use in the selected sectors. Secondly, the paper aims to analyze the impact of the Norwegian economy on the three effects of energy use. The study contributes significantly to identifying the sector that experiences a reduction in energy use due to energy efficiency and examining the impact of the economy on energy use. The overall energy use between 1990 and 2017 is decomposed into three different effects for selected energy-intensive sectors by deploying the ‘Logarithmic Mean Divisia Index’ (LMDI) method. Further, the impact of the Norwegian economy is examined on the three effects of energy use. It is observed that in each Phase, the key driver for change in energy use in all three Phases is the transport sector. Post-recession, the energy use in the transport sector was due to structural effects. Consumer behavior and limitations of sources of finance are the challenges for the deployment of electric vehicles even after technological breakthroughs in energy efficiency. Finally, the policies to enhance energy efficiency in energy-intensive sectors, such as the transport, and services sector must be undertaken to efficiently visualize energy efficiency-driven energy transition.

Introduction: Diabetes poses a global public health challenge and our understanding of its temporal evolution in China relative to the rest of the world is limited. Our study aims to comprehensively examine the temporal trend of diabetes DALYs in China from a global perspective. Methods: We analyzed data on diabetes incidence, prevalence, and mortality for individuals aged =20 years in China and globally from the Global Burden of Disease (GBD) 2019 study. We assessed trends in age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of diabetes in China and globally by estimating annual percentage changes (EAPCs). We employed decomposition analysis to reveal factors driving the trend of diabetes DALYs in China. Results: During 1990-2019, the number of diabetes patients increased by 160% from 35.14 million to 91.70 million in China. The ASIR of diabetes increased from 249 per 100,000 to 329 per 100,000 in China, which was lower than the global rate (419 per 100,000 in 2019). The EAPC of diabetes incidence was also lower in China compared to the global rate (1.02% vs. 1.57%). Consistently, the age-standardized prevalence rate of diabetes increased from 4788 per 100,000 to 8170 per 100,000 during 1990-2019 in China, which remained lower than the corresponding global rate (8827 per 100,000 in 2019). Further, the ASMR of diabetes increased from 9 per 100,000 to 15 per 100,000 during 1990-2019 in China, which was lower than the corresponding global rate (30 per 100,000 in 2019). However, EAPC of diabetes mortality in China was much higher than the global level (1.75% vs. 1.07%). Globally, the rising diabetes DALYs was predominantly attributed to population growth (55.2%) and epidemiologic changes (24.6%). In comparison, population growth (48.9%) also played an important role in the increasing diabetes DALYs in China, but aging (43.7%) was second major contributor. Conclusion: Our findings show that diabetes DALYs in China followed a global increasing trend during 1990-2019. Notably, aging has a very substantial contribution to the increase in diabetes DALYs in China in addition to population growth. [ABSTRACT FROM AUTHOR]

Background and objective: On the trajectory towards universal health coverage in Bhutan, health equity requires policy attention as significant disparities exist between urban and rural health outcomes. This paper examines health services utilization patterns, inequalities and their socio-economic determinants in rural and urban areas and decomposes the factors behind these differences. Methods: We used the Bhutan Living Standard Survey 2017 to profile health services utilization patterns and equalities. We employed two different decomposition analyses: decomposition of mean differences in utilization using the Oaxaca–Blinder decomposition framework and differences in the income-related distribution in utilization using recentered influence function regressions between rural and urban areas. Results: Significant differences exist in the type of outpatient services used by the rural and urban population groups, with those living in rural areas having 3.4 times higher odds of using primary health centers compared to outpatient hospital care. We find that the use of primary health care is pro-poor and that outpatient hospital resources is concentrated among the more affluent section of the population, with this observed inequality consistent across settings but more severe in rural areas. The rural–urban gap in utilization is primarily driven by income and residence in the eastern region, while income-related inequality in utilization is influenced, aside from income, by residence in the central region, household size, and marriage and employment status of the household head. We do not find evidence of significant mean differences in overall utilization or inequality in utilization of inpatient health care services. Conclusions: While the differences in average contacts with health services are insignificant, there are prominent differences in the level of services availed and the associated inequality among rural and urban settings in Bhutan. Besides, while there are obvious overlaps, factors influencing income-related inequality are not necessarily the same as those driving the utilization gaps. Cognizance of these differences may lead to better informed, targeted, and potentially more effective future research and policies for universal health coverage. [ABSTRACT FROM AUTHOR]

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

Focusing on why and how public attitudes towards immigration in Canada have grown more positive between 1998 and 2021, this paper examines whether the changes in attitudes stem from changes in population characteristics or changes in the effect of these characteristics. Our analysis sheds light on the implications of the 2008–2010 financial crisis on the support for immigration. Our logit regression analysis shows that positive attitudes towards immigration are positively related to higher levels of education attainment regardless of the survey years but negatively associated with the support for conservative political parties, especially during and after the financial crisis. By employing decomposition analysis, we investigate the shift in public opinions across individual characteristics before, during, and after the 2008 financial crisis. We find that, for all periods, most of the attitude shift results from the change in the effect of population characteristics rather than the change in the characteristics themselves. [ABSTRACT FROM AUTHOR]

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