Social inequality in food consumption between 2008 and 2019 in Brazil

Objective: To analyse the trend of social inequality in food consumption among Brazilians from 2008 to 2019. Design: Time series analyses using cross-sectional annual data from the Telephone Surveillance System (VIGITEL 2008–2019). Food consumption was evaluated through: (1) consumption of five or more portions of fruits and vegetables in ≥5 d/week; (2) consumption of beans in ≥5 d/week and (3) consumption of soft drinks or artificial juices in ≥5 d/week. Absolute inequality was assessed by the slope index of inequality (SII) and relative inequality by the concentration index (CIX). SII and CIX positive values indicate higher prevalence among more educated citizens and negative among less educated ones. Time trend was assessed by linear regression using weighted least squares. Setting: 26 Brazilian state capitals and the Federal District. Participants: 621 689 individuals ≥18 years. Results: Fruits and vegetable consumption was more prevalent among the more educated citizens, while beans were mostly consumed by the less educated, and soft drinks or artificial juices was more prevalent among individuals with intermediate education. The highest absolute inequality was found for beans (SII2019 -25·9). In 12 years, the absolute inequality increased for fruit and vegetable consumption (from SII2008 12·8 to SII2019 16·2), remained for beans (SII2008 -23·1 to SII2019 -25·9) and reduced for soft drinks or artificial juices (SII2008 8·7 to SII2019 0·4). Relative inequality was low and constant. Conclusion: Despite the advances reducing inequalities in soft drinks or artificial juice consumption, the increase in the social gap for adequate consumption of fruits and vegetables is troublesome.

Suicide mortality and its income-based inequalities in Korea, 2005-2017

Backgrounds The suicide mortality rate in Korea has been the highest in the Organization for Economic Co-operation and Development countries between 2003 and 2016. The trends of suicide mortality and its inequalities according to socioeconomic positions provide important information in establishing suicide prevention policies. This study investigated trends in suicide mortality and its income-based inequalities in Korea between 2005 and 2017. Methods Data from 2005-2017 National Health Insurance Database individually linked with cause-of-death data of Statistics Korea were employed. A total of 164,412 suicidal deaths from 574,610,162 subjects aged 10 or over were analyzed. Age-standardized suicide mortality rates were calculated by the calendar year, sex, and income quintiles. The slope index of inequality was calculated as an absolute measure for inequality and relative index of inequality was used as a relative inequality measure. Results The suicide mortality in Korea increased from 29.3 per 100,000 in 2005 to 33.3 in 2011, then decreased to 23.1 in 2017. Suicide mortality rates in men were more than twice as high as the rates in women and the gender gap remained throughout the period. The lower income-level, the higher the suicide mortality rate, especially in men. The absolute inequality in suicide measured by the slope index of inequality has changed as the suicide mortality rate fluctuated, but the relative inequality in suicide has increased since 2012. Conclusions The suicide mortality in Korea has increased due to the global financial crisis and copycat suicide following celebrity suicides in 2008, but it has decreased since the paraquat ban in 2011-12. Despite the recent decline in suicide mortality, the gap between income quintiles did not change meaningfully during the study period. In particular, the magnitude of relative inequality has increased. Progressive national policies should be implemented to reduce suicide mortality and its income gaps. Key messages Despite the recent decline in suicide mortality in Korea, the income-based inequalities in suicide did not change meaningfully. The magnitude of relative inequalities has increased recently.

Educational inequalities in all-cause and cause-specific mortality among people with gout: a register-based matched cohort study in southern Sweden

Background Gout is the most common inflammatory arthritis with a rising prevalence around the globe. While educational inequalities in incidence and prevalence of gout have been reported, no previous study investigated educational inequality in mortality among people with gout. The aim of this study was to assess absolute and relative educational inequalities in all-cause and cause-specific mortality among people with gout in comparison with an age- and sex-matched cohort free of gout in southern Sweden. Methods We identified all residents aged ≥30 years of Skåne region with doctor-diagnosed gout (ICD-10 code M10, n = 24,877) during 1998–2013 and up to 4 randomly selected age- and sex-matched comparators free of gout (reference cohort, n = 99,504). These were followed until death, emigration, or end of 2014. We used additive hazards models and Cox regression adjusted for age, sex, marital status, and country of birth to estimate slope and relative indices of inequality (SII/RII). Three cause-of-death attribution approaches were considered for RII estimation: “underlying cause”, “any mention”, and “weighted multiple-cause”. Results Gout patients with the lowest education had 1547 (95% CI: 1001, 2092) more deaths per 100,000 person-years compared with those with the highest education. These absolute inequalities were larger than in the reference population (1255, 95% CI: 1038, 1472). While the contribution of cardiovascular (cancer) mortality to these absolute inequalities was greater (smaller) in men with gout than those without, the opposite was seen among women. Relative inequality in all-cause mortality was smaller in gout (RII 1.29 [1.18, 1.41]) than in the reference population (1.46 [1.38, 1.53]). The weighted multiple-cause approach generally led to larger RIIs than the underlying cause approach. Conclusions Our register-based matched cohort study showed that low level of education was associated with increased mortality among gout patients. Although the magnitude of relative inequality was smaller in people with gout compared with those without, the absolute inequalities were greater reflecting a major mortality burden among those with lower education.

Quantifying changes in global health inequality: the Gini and Slope Inequality Indices applied to the Global Burden of Disease data, 1990–2017

BackgroundThe major shifts in the global burden of disease over the past decades are well documented, but how these shifts have affected global inequalities in health remains an underexplored topic. We applied comprehensive inequality measures to data from the Global Burden of Disease (GBD) study.MethodsBetween-country relative inequality was measured by the population-weighted Gini Index, between-country absolute inequality was calculated using the population-weighted Slope Inequality Index (SII). Both were applied to country-level GBD data on age-standardised disability-adjusted life years.FindingsAbsolute global health inequality measured by the SII fell notably between 1990 (0.68) and 2017 (0.42), mainly driven by a decrease of disease burden due to communicable, maternal, neonatal and nutritional diseases (CMNN). By contrast, relative inequality remained essentially unchanged from 0.21 to 0.19 (1990–2017), with a peak of 0.23 (2000–2008). The main driver for the increase of relative inequality 1990–2008 was the HIV epidemic in Sub-Saharan Africa. Relative inequality increased 1990–2017 within each of the three main cause groups: CMNNs; non-communicable diseases (NCDs); and injuries.ConclusionsDespite considerable reductions in disease burden in 1990–2017 and absolute health inequality between countries, absolute and relative international health inequality remain high. The limited reduction of relative inequality has been largely due to shifts in disease burden from CMNNs and injuries to NCDs. If progress in the reduction of health inequalities is to be sustained beyond the global epidemiological transition, the fight against CMNNs and injuries must be joined by increased efforts for NCDs.

Economic Inequality, Regional Development, and Internal Migration in Indonesia

This study aims to probe the determinants of inter-provincial migration flows in Indonesia and how economic and development changes affect migration patterns. We employ three census periods, 1990, 2000, and 2010. Our study finds that an increase in relative inequality between origin and destination provinces decreases inter-provincial migration and relatively high distance elasticity in Indonesia leads to high migration cost. People are more inclined to migrate due to push factors as opposed to pull factors from the destination region, thus indicating a strong relationship between the level of regional development and the willingness of people to migrate.

Decomposing the Quantile Ratio Index with Applications to Australian Income and Wealth Data

The quantile ratio index is a simple and effective measure of relative inequality for income data that is resistant to outliers. A useful property of this index is investigated here: given a partition of the income distribution into a union of sets of symmetric quantiles, one can find the inequality for each set and readily combine them in a weighted average to obtain the index for the entire population. When applied to data for various years, one can track how these contributions to inequality vary over time, as illustrated here for Australian Bureau of Statistics income and wealth data.

Understanding the Crime Gap: Violence and Inequality in an American City

The United States has experienced an unprecedented decline in violent crime over the last two decades. Throughout this decline, however, violent crime continued to concentrate in socially and economically disadvantaged urban neighborhoods. Using detailed homicide records from 1990 to 2010, this study examines the spatial patterning of violent crime in Chicago to determine whether or not all neighborhoods experienced decreases in violence. We find that while in absolute terms nearly all neighborhoods in the city benefited from reductions in homicide, relative inequality in crime between the city's safest and most dangerous neighborhoods actually increased by 10 percent. This increase was driven by a greater rate of decline in the city's safest neighborhoods. This crime gap can be partly attributed to the decreasing association between concentrated disadvantage and homicide in the safest neighborhoods. We also find that the decline did not significantly alter the spatial distribution of crime, as homicides remained concentrated in the initially most dangerous neighborhoods and their adjacent areas.

Inequality and Property Crime: Does Absolute Inequality Matter?

Economic crime models and the social strain theory argue that income inequality can foster property crime, yet empirical studies do not provide strong support for this relationship across countries. An important limitation of these studies is that they only consider relative inequality measures and omit absolute ones. Absolute inequality can have a crime-inducing effect for two main reasons: First, the potential monetary returns from crime can be expected to depend on the interaction between relative income inequality and mean income. Second, higher levels of absolute inequality imply that the economic elite can capture institutions in ways that can make them dysfunctional for society as a whole. This article finds that, in contrast to relative inequality, absolute inequality is a robust and statistically significant determinant of violent property crime rates for a sample of up to 59 developed and developing countries.