1097Inequalities in full vaccination coverage by maternal education and wealth quintiles in South Asian countries

Background Estimated one in four children is not fully immunized in South Asia. This study aimed to compare full vaccination coverage in the region and its inequalities by maternal education and household wealth quintile. Methods We used data from the most recent Demographic and Health Survey (DHS) from Nepal, India, Pakistan, Bangladesh, Afghanistan, and the Maldives. Children aged 12-23 months were included. We defined full vaccination as receiving at least six antigen: Bacille Calmette Guerin, Diptheria, Pertussis, Tetanus, Polio, and Measles. We measured absolute inequalities using the slope index of inequality (SII), and relative inequalities using the relative index of inequality (RII) both for maternal education and household wealth quintiles. Results The full vaccination coverage ranged from 46% in Afghanistan to 84% in Bangladesh. Pakistan had the largest inequalities in coverage by maternal education (SII: -50.0, RII: 0.4) and household wealth quintile (SII: -47.1, RII: 0.5). The SII by wealth quintiles was smaller (-8.4) in Nepal compared to Bangladesh, India, Pakistan, and Afghanistan, but it was larger (-30.5) by maternal education compared to Bangladesh and India, although smaller than Pakistan and Afghanistan. The RII followed a similar trend. Conclusions All South Asian countries studied had full vaccination coverage under 85%. Both absolute and relative inequalities were larger by maternal education compared to wealth quintile in four of the six countries. Key messages Larger inequalities by maternal education compared to wealth-based inequalities in most South Asian countries indicate the critical role of maternal education to improve child health outcomes.

Trends in socioeconomic inequality of periodontal health status among Dutch adults: a repeated cross-sectional analysis over two decades

Background Studies exclusively focusing on trends in socioeconomic inequality of oral health status in industrialized countries are relatively sparse. This study aimed to assess possible differences in oral hygiene and periodontal status among people of different socioeconomic status (SES) in the Netherlands over two decades. Methods A repeated cross-sectional analysis of 3083 participants aged 25–54 years was conducted on the Dutch National Oral Health Surveys of 1995, 2002, 2007, and 2013. Plaque-free was defined according to the Simplified Oral Hygiene Index (OHI-S = 0). Periodontal status was classified in two different ways, either periodontal health/disease (probing pocket depth index [PDI] = 0/ ≥ 1) or with/without deep pockets (PDI = 2). We used the regression-based absolute and relative effect index to measure the absolute and relative socioeconomic inequalities. Multivariable logistic regressions were used to explore temporal trends in oral hygiene and periodontal status by low- and high-SES groups. Results Age-standardized percentages of individuals with plaque-free increased in the whole population from 1995 to 2013 (12.7% [95% CI 10.5–14.9] to 28.1% [24.8–31.5]). Plaque-free showed significant socioeconomic differences in absolute and relative inequalities in 2007 and 2013. Between 1995 and 2013, age-standardized percentage of periodontal health increased (from 51.4% [48.1–54.7] to 60.6% [57.0–64.1]). The significant absolute inequalities for periodontal health were seen in 2002 and 2013. The relative scale presented a similar pattern. Regarding deep pockets, there was little difference in the age-standardized overall prevalence in 1995 versus 2013 (from 6.5% [4.9–8.2] to 5.4% [3.7–7.0]). The significant absolute and relative inequalities in deep pockets prevalence were found in 1995. Yet, all interaction terms between survey year and SES did not reach significance (plaque-free: P = .198; periodontal health: P = .490; deep pockets: P = .678). Conclusions Socioeconomic inequalities in oral hygiene and periodontal status were present in the Netherlands in the last two decades.

Lung cancer incidence differences in migrant men in Belgium, 2004–2013: histology-specific analyses

Background Immigrants make up an important share of European populations which has led to a growing interest in research on migrants’ health. Many studies have assessed migrants’ cancer mortality patterns, yet few have studied incidence differences. This paper will probe into histology-specific lung cancer incidence by migrant origin aiming to enhance the knowledge on lung cancer aetiology and different risk patterns among population groups. Methods We used data on all lung cancer diagnoses during 2004–2013 delivered by the Belgian Cancer Registry individually linked with the 2001 Belgian Census and the Crossroads Bank for Social Security. Absolute and relative inequalities in overall and histology-specific lung cancer incidence have been calculated for first-generation Italian, Turkish and Moroccan migrant men aged 50–74 years compared to native Belgian men. Results Moroccan men seemed to be the most advantaged group. Both in absolute and relative terms they consistently had lower overall and histology-specific lung cancer incidence rates compared with native Belgian men, albeit less clear for adenocarcinoma. Turkish men only showed lower overall lung cancer incidence when adjusting for education. On the contrary, Italian men had higher incidence for overall lung cancer and squamous cell carcinoma, which was explained by adjusting for education. Conclusions Smoking habits are likely to explain the results for Moroccan men who had lower incidence for smoking-related histologies. The full aetiology for adenocarcinoma is still unknown, yet the higher incidence among Italian men could point to differences in occupational exposures, e.g. to carcinogenic radon while working in the mines.

Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean

Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.

Future smoking prevalence by socioeconomic status in England: a computational modelling study

BackgroundThe difference in smoking across socioeconomic groups is a major cause of health inequality. This study projected future smoking prevalence by socioeconomic status, and revealed what is needed to achieve the tobacco-free ambition (TFA) by 2030 in England.MethodsUsing data from multiple sources, the adult (≥18 years) population in England was separated into subgroups by smoking and highest educational qualification (HEQ). A discrete time state-transition model was used to project future smoking prevalence by HEQ deterministically and stochastically.ResultsIn a status quo scenario, smoking prevalence in England is projected to be 10.8% (95% uncertainty interval: 9.1% to 12.9%) by 2022, 7.8% (5.5% to 11.0%) by 2030 and 6.0% (3.7% to 9.6%) by 2040. The absolute difference in smoking rate between low and high HEQ is reduced from 12.2% in 2016 to 7.9% by 2030, but the relative inequality (low/high HEQ ratio) is increased from 2.48 in 2016 to 3.06 by 2030. When applying 2016 initiation/relapse rates, achievement of the TFA target requires no changes to future cessation rates among adults with high qualifications, but increased rates of 37% and 149%, respectively, in adults with intermediate and low qualifications.ConclusionsIf the current trends continue, smoking prevalence in England is projected to decline in the future, but with substantial differences across socioeconomic groups. Absolute inequalities in smoking are likely to decline and relative inequalities in smoking are likely to increase in future. The achievement of England’s TFA will require the reduction of both absolute and relative inequalities in smoking by socioeconomic status.

Measuring Income-Related Inequalities in Health in Multi-Country Analysis

Health inequalities remain a cause of concern for policymakers across the world. However, the measurement and monitoring of health inequalities over time and across countries remain a research challenge. The concentration index is one of the most popular measurement tools, however, it presents several drawbacks, especially for bounded variables, which are discussed in this study. Results from the European Community Household Panel dataset and the Statistics of Income and Living Conditions for Europe suggest that there is evidence of persistent socioeconomic inequalities in health in Europe. Further, results show the need of reporting both absolute and relative inequalities for appropriately monitoring and comparing trends in health inequalities across countries.

Trends in socioeconomic inequalities in self-rated health in Germany: a time-trend analysis of repeated cross-sectional health surveys between 2003 and 2012

ObjectivesThis study assessed the extent of educational and income inequalities in self-rated health (SRH) in the German adult population between 2003 and 2012 and how these inequalities changed over time.DesignRepeated cross-sectional health interview surveys conducted in 2003, 2009, 2010 and 2012.Setting and participantsThe study population was the German adult population aged 25–69, living in private households in Germany. In total 54 197 randomly selected participants (2003: 6890; 2009: 16 418; 2010: 17 145; 2012: 13 744) were included.Main outcome measuresSRH was assessed with one single question. Five answer categories were dichotomised into good (‘very good’ and ‘good’) versus poor (‘moderate’, ‘poor’, ‘very poor’) SRH. To estimate the extent of the correlation between absolute and relative inequalities in SRH on the one hand, and income and education on the other; slope indices of inequality (SII) and relative indices of inequality (RII) were estimated using linear probability and log-binomial regression models.ResultsThere were considerable and persisting educational and income inequalities in SRH in every survey year. Absolute educational inequalities were largely stable (2003: SII=0.25, 95% CI 0.21 to 0.30; 2012: 0.29, 95% CI 0.25 to 0.33; p trend=0.359). Similarly, absolute income inequalities were stable (2003: SII=0.22, 95% CI 0.17 to 0.27; 2012: SII=0.26, 95% CI 0.22 to 0.30; p trend=0.168). RII by education (2003: 2.53, 95% CI 2.11 to 3.03; 2012: 2.72, 95% CI 2.36 to 3.13; p trend=0.531) and income (2003: 2.09. 95% CI 1.75 to 2.49; 2012: 2.53, 95% CI 2.19 to 2.92; p trend=0.051) were equally stable over the same period.ConclusionsWe found considerable and persisting absolute and relative socioeconomic inequalities in SRH in the German adult population between 2003 and 2012, with those in lower socioeconomic position reporting poorer SRH. These findings should be a concern for both public health professionals and political decision makers.

Life course socioeconomic inequalities and oral health status in later life

OBJECTIVE: To investigate the association between life course socioeconomic conditions and two oral health outcomes (edentulism and use of dental prostheses among individuals with severe tooth loss) among older Brazilian adults. METHODS: This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) which includes information on persons aged 50 years or older residing in 70 municipalities across the five great Brazilian regions. Regression models using life history information were used to investigate the relation between childhood (parental education) and adulthood (own education and wealth) socioeconomic circumstances and edentulism and use of dental prostheses. Slope index of inequality and relative index of inequality for edentulism and use of dental prostheses assessed socioeconomic inequalities in both outcomes. RESULTS: Approximately 28.8% of the individuals were edentulous and among those with severe tooth loss 80% used dental prostheses. Significant absolute and relative inequalities were found for edentulism and use of dental prostheses. The magnitude of edentulism was higher among individuals with lower levels of socioeconomic position during childhood, irrespective of their current socioeconomic position. Absolute and relative inequalities related to the use of dental prostheses were not related to childhood socioeconomic position. CONCLUSIONS: These findings substantiate the association between life course socioeconomic circumstances and oral health in older adulthood, although use of dental prostheses was not related to childhood socioeconomic position. The study also highlights the long-lasting relation between childhood socioeconomic inequalities and oral health through the life course.

Socioeconomic inequalities in suicide in Europe: the widening gap

BackgroundSuicide has been decreasing over the past decade. However, we do not know whether socioeconomic inequality in suicide has been decreasing as well.AimsWe assessed recent trends in socioeconomic inequalities in suicide in 15 European populations.MethodThe DEMETRIQ study collected and harmonised register-based data on suicide mortality follow-up of population censuses, from 1991 and 2001, in European populations aged 35–79. Absolute and relative inequalities of suicide according to education were computed on more than 300 million person-years.ResultsIn the 1990s, people in the lowest educational group had 1.82 times more suicides than those in the highest group. In the 2000s, this ratio increased to 2.12. Among men, absolute and relative inequalities were substantial in both periods and generally did not decrease over time, whereas among women inequalities were absent in the first period and emerged in the second.ConclusionsThe World Health Organization (WHO) plan for ‘Fair opportunity of mental wellbeing’ is not likely to be met.Declaration of interestNone.

Changes in mortality inequalities across occupations in Japan: a national register based study of absolute and relative measures, 1980-2010

ObjectiveChanges in mortality inequalities across socioeconomic groups have been a substantial public health concern worldwide. We investigated changes in absolute/relative mortality inequalities across occupations, and the contribution of different diseases to inequalities in tandem with the restructuring of the Japanese economy.MethodsUsing complete Japanese national death registries from 5 year intervals (1980–2010), all cause and cause specific age standardised mortality rates (ASMR per 100 000 people standardised using the Japanese standard population in 1985, aged 30–59 years) across 12 occupations were computed. Absolute and relative inequalities were measured in ASMR differences (RDs) and ASMR ratios (RRs) among occupations in comparison with manufacturing workers (reference). We also estimated the changing contribution of different diseases by calculating the differences in ASMR change between 1995 and 2010 for occupations and reference.ResultsAll cause ASMRs tended to decrease in both sexes over the three decades except for male managers (increased by 71% points, 1995–2010). RDs across occupations were reduced for both sexes (civil servants 233.5 to −1.9 for men; sales workers 63.3 to 4.5 for women) but RRs increased for some occupations (professional workers 1.38 to 1.70; service workers 2.35 to 3.73) for men and decreased for women from 1980 to 2010. Male relative inequalities widened among farmer, fishery and service workers, because the percentage declines were smaller in these occupations. Cerebrovascular disease and cancer were the main causes of the decrease in mortality inequalities among sexes but the incidence of suicide increased among men, thereby increasing sex related inequalities.ConclusionsAbsolute inequality trends in mortality across occupations decreased in both sexes, while relative inequality trends were heterogeneous in Japan. The main drivers of narrowing and widening mortality inequalities were cerebrovascular disease and suicide, respectively. Future public health efforts will benefit from eliminating residual inequalities in mortality by considering the contribution of the causes of death and socioeconomic status stratification.