ArticleBMC public health2019
Monitoring health inequalities when the socio-economic composition changes: are the slope and relative indices of inequality appropriate? Results of a simulation study.
Article in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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27 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Socioeconomic and health system determinants of maternal health inequities across Chinese provinces (2009-2021): a multivariate meta-regression analysis of regional heterogeneity in underlying mechanisms.Frontiers in public health · 2026Pooled it
- Monitoring Digital Health Equity Across the Digital Front Door: U.S. Trends in Broadband Access, Portal Offers, and Patient IT Use in 2017-2020.Healthcare (Basel, Switzerland) · 2026Article
- Socioeconomic Inequalities in Oral Health Across Age Groups Among Single-Person Households in South Korea.International dental journal · 2026Article
- Transition of obesity in India, 2006-2021: a state-wise investigation from an equity perspective.BMJ global health · 2026Article
- Growing Inequities in Median Age of Death and Obesity Prevalence Between Australian Major Cities and Remote Areas: A National, Longitudinal, Spatial Analysis.Public health challenges · 2026Article
- Substance use among second-generation immigrants in France: heritage language as a protective factor.International journal of public health · 2026Article
- Reassessing socioeconomic inequalities in mortality via distributional similarities.Population health metrics · 2025Article
- "Socioeconomic inequalities in health behaviors in children and adolescents: evidence from an Australian cohort".BMC public health · 2025Article
- Trends in Social Inequality in Overweight and Obesity Among Danish Infants, 2002-2022.International journal of public health · 2025Article
- Inequality in iron and folic acid consumption and dietary diversity in pregnant women following exposure to maternal nutrition interventions in three low- and middle-income countries.Public health nutrition · 2024Article
- The future burden of type 2 diabetes in Belgium: a microsimulation model.Population health metrics · 2024Article
- The effect of educational attainment on birthrate in Japan: an analysis using the census and the vital statistics from 2000 to 2020.BMC pregnancy and childbirth · 2024Article
- Persistent Social Inequality in Adolescent Health Indicators 1991-2022: Trend Study From Denmark.International journal of public health · 2024Article
- Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis.JMIR public health and surveillance · 2023Article
- Social inequalities in all-cause mortality among adults with multimorbidity: a 10-year prospective study of 0.5 million Chinese adults.International health · 2023Article
- Investigating Health Inequality Using Trend, Decomposition and Spatial Analyses: A Study of Maternal Health Service Use in Nepal.International journal of public health · 2023Article
- Socioeconomic inequality in overweight/obesity among US children: NHANES 2001 to 2018.Frontiers in pediatrics · 2023Article
- Missed opportunities for vaccination in Peru 2010-2020: A study of socioeconomic inequalities.Lancet regional health. Americas · 2022Article
- QALY losses for chronic diseases and its social distribution in the general population: results from the Belgian Health Interview Survey.BMC public health · 2022Article
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Abstract
backgroundThe slope (SII) and relative (RII) indices of inequality are commonly recommended to monitor health inequality policies. As an upwards shift of the educational level distribution (ELD) can be part of those policies, we examine how such a shift affects the SII, the RII and the population attributable fraction (PAF).
methodsWe simulated 632 distributions of 4 educational levels (ELs) by varying the share (p1 to p4) of each EL, with constant mortality rates (MR) and calculated the corresponding RII, SII and PAF. Second, we decomposed the effect on the three indices of a change affecting both the ELD and the MRs, into the contributions of each component.
resultsRIIs and SIIs sharply increase with p4 at fixed p1 values and evolve as reversed U-curves for p1 changing in complement to p4. The RII reaches a maximum, at much higher p4 values than the SII. PAFs monotonically decrease when p4 increases.
conclusionIf improving the educational attainment is part of a policy, an upwards shift of EL should be assessed as a progress; however the RII, and to a lesser extent the SII, frequently translate an increased EL4 share as a worsening. We warn against the use of SII and RII for monitoring inequality-tackling policies at changing socio-economic structures. Rather, we recommend to complement the assessment of changes in absolute and relative pairwise differentials, with changes in PAF and in the socio-economic group shares.
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