ArticleAmerican journal of public health2018
The Inverse Equity Hypothesis: Analyses of Institutional Deliveries in 286 National Surveys.
Article in American journal of public health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 91 papers, 1 of them a synthesis that pooled it.
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Who cites it
91 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Evaluations of effective coverage of maternal and child health services: A systematic review.Health policy and planning · 2022Pooled it
- Achieving equitable uptake of handwashing and sanitation by addressing both supply and demand-based constraints: findings from a randomized controlled trial in rural Bangladesh.International journal for equity in health · 2021Trial
- Dietary diversity and the triple burden of malnutrition among children aged 6-23 months in 62 low- and middle-income countries: an analysis of Demographic and Health Surveys.Journal of global health · 2026Article
- Economic development and under-five mortality: a global longitudinal analysis of lagged effects and between-country inequalities.BMC public health · 2026Article
- Trends and cross-county disparities in childhood pneumococcal vaccination in Zhejiang Province, China, 2011-2022.BMC health services research · 2026Article
- The Role of Public Health Services in Reducing Maternal and Newborn Health Inequalities in Urban India: A Survey Analysis of 200,000 Births Over Two Decades.Journal of urban health : bulletin of the New York Academy of Medicine · 2026Article
- Who gets to deliver in a health facility? An investigation of wealth-based inequities in institutional delivery in Ghana.BMJ open · 2026Article
- Exacerbation of antenatal care inequities as coverage recommendations rise in Brazil: evidence for the inverse equity hypothesis from national health information system data (SINASC) in 2023.International journal for equity in health · 2026Article
- Trends in Socioeconomic Inequalities of Dental Caries Experience among 12-Year-Olds in Chile: An Ecological Cohort Study.Caries research · 2026Article
- A school-based material needs intervention for chronic absenteeism: a state-wide staggered interrupted time series analysis.Journal of epidemiology and community health · 2026Article
- Education-Based Inequality in Edentulism and Functional Dentition Among Older Brazilian Adults: A Study Covering a Period of 20 Years.International journal of dentistry · 2026Article
- [Distribution of Dental Specialty Centers across health regions in Brazil, 2023].Cadernos de saude publica · 2026Article
- Global health trajectories: analysis of health production functions and inequality decomposition.Frontiers in public health · 2026Article
- Neonatal mortality inequalities in Peru, 2007-2021: an ecological joinpoint trends analysis.International journal for equity in health · 2025Article
- Wealth-based inequalities in the uptake of three or more doses of intermittent preventive treatment in pregnancy in West Africa, 2015-2021.Malaria journal · 2025Article
- Intersectional impact of cash transfers on AIDS among 12.3 million Brazilian women.Nature human behaviour · 2025Article
- Maternal disorders among women aged 15 to 49 years: global trends and inequalities from the GBD study 2021.BMC public health · 2025Article
- Trends in health facility deliveries by time, region, and sociodemographic characteristics in low- and middle- income countries.BMC pregnancy and childbirth · 2025Article
- Optimizing Care for Cardiovascular-Kidney-Metabolic Syndrome: Leveraging Implementation Science in the Path Toward Pharmacoequity.Current cardiology reports · 2025Review
- EQUALSS GUIDE Multiple: A novel framework for equity-focused evidence synthesis.Public health in practice (Oxford, England) · 2025Article
31 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesTo test the inverse equity hypothesis, which postulates that new health interventions are initially adopted by the wealthy and thus increase inequalities-as population coverage increases, only the poorest will lag behind all other groups.
methodsWe analyzed the proportion of births occurring in a health facility by wealth quintile in 286 surveys from 89 low- and middle-income countries (1993-2015) and developed an inequality pattern index. Positive values indicate that inequality is driven by early adoption by the wealthy (top inequality), whereas negative values signal bottom inequality.
resultsAbsolute inequalities were widest when national coverage was around 50%. At low national coverage levels, top inequality was evident with coverage in the wealthiest quintile taking off rapidly; at 60% or higher national coverage, bottom inequality became the predominant pattern, with the poorest quintile lagging behind.
conclusionsPolicies need to be tailored to inequality patterns. When top inequalities are present, barriers that limit uptake by most of the population must be identified and addressed. When bottom inequalities exist, interventions must be targeted at specific subgroups that are left behind.
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