ArticleInternational journal for equity in health2016
Monitoring subnational regional inequalities in health: measurement approaches and challenges.
Article in International journal for equity in health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 2 of them syntheses that pooled it.
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Who cites it
51 citing papers in PubMed, 2 syntheses or guidelines pooled it, 104 citations in OpenAlex.
- Understanding multifactorial drivers of child stunting reduction in Exemplar countries: a mixed-methods approach.The American journal of clinical nutrition · 2020Pooled it
- Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.The Lancet. Global health · 2019Pooled it
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- The Municipal Sustainable Development Health Index (MSDHI) to monitor the 2030 agenda in Brazil: a methodological proposal.International journal for equity in health · 2026Article
- Wealth-based inequalities in family planning and perinatal coverage among adolescent and young women: analyses of national surveys from Latin America and the Caribbean.Lancet regional health. Americas · 2026Article
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- The maternal and child mortality in the Middle East and North Africa between 2000 and 2020: the role of health financing.Global health research and policy · 2025Article
- Inequality in Utilization of Maternal Healthcare Services in Low‑ and Middle‑Income Countries: A Scoping Review of the Literature.Maternal and child health journal · 2025Article
- Global disparities in the burden of pancreatic cancer (1990-2021): insights from the 2021 Global Burden of Disease study.BMC cancer · 2025Article
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- Health inequalities in Brazilian adolescents: Measuring and mapping gaps in a cross-sectional school-based survey.Health science reports · 2023Article
- Equity trends for the UHC service coverage sub-index for reproductive, maternal, newborn and child health in Pakistan: evidence from demographic health surveys.International journal for equity in health · 2023Article
- Maternal Health Care Service Utilization in the Post-Conflict Democratic Republic of Congo: An Analysis of Health Inequalities over Time.Healthcare (Basel, Switzerland) · 2023Article
- Going deeper with health equity measurement: how much more can surveys reveal about inequalities in health intervention coverage and mortality in Zambia?International journal for equity in health · 2023Article
- Time trends in ethnic inequalities in child health and nutrition: analysis of 59 low and middle-income countries.International journal for equity in health · 2023Article
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- How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study.BMC health services research · 2023Article
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Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundMonitoring inequalities based on subnational regions is a useful practice to unmask geographical differences in health, and deploy targeted, equity-oriented interventions. Our objective is to describe, compare and contrast current methods of measuring subnational regional inequality. We apply a selection of summary measures to empirical data from four low- or middle-income countries to highlight the characteristics and overall performance of the different measures.
methodsWe use data from Demographic and Health Surveys conducted in Bangladesh, Egypt, Ghana and Zimbabwe to calculate subnational regional inequality estimates for reproductive, maternal, newborn, and child health services generated from 11 summary measures: pairwise measures included high to low absolute difference, high to low relative difference, and high to low ratio; complex measures included population attributable risk, weighted variance, absolute weighted mean difference from overall mean, index of dissimilarity, Theil index, population attributable risk percentage, coefficient of variation, and relative weighted mean difference from overall mean. Four of these summary measures (high to low absolute difference, high to low ratio, absolute weighted mean difference from overall mean, and relative weighted mean difference from overall mean) were selected to compare their performance in measuring trend over time in inequality for one health indicator.
resultsOverall, the 11 different measures were more remarkable for their similarities than for their differences. Pairwise measures tended to support the same conclusions as complex summary measures-that is, by identifying same best and worst coverage indicators in each country and indicating similar time trends. Complex measures may be useful to illustrate more nuanced results in countries with a great number of subnational regions.
conclusionsWhen pairwise and complex measures lead to the same conclusions about the state of subnational regional inequality, pairwise measures may be sufficient for reporting inequality. In cases where complex measures are required, mean difference from mean measures can be easily communicated to non-technical audiences.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.