Submit to Healthcare Review for Healthcare Propose a Special Issue

Journal Browser

► Journal Browser

Inequality in Health Systems and Health Outcomes

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Related Special Issue
Published Papers

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 7873

Share This Special Issue

Special Issue Editor

Dr. Hossein Zare

E-Mail Website
Guest Editor

Johns Hopkins Bloomberg School of Public Health, University of Maryland Global Campus, Largo, MD 20774, USA
Interests: income inequality; disparities; justice inequality; place-based inequality; geographical inequality
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, researchers have become increasingly interested in how the distribution of income across society affects health outcomes. One theoretical perspective postulated that as income disparities increase, low-income individuals experience financial insecurity and shame.

Studies highlighted the association between income inequality and race/ethnicity, communities of color continue to have lower incomes and worse health outcomes. The neighborhood is as important as income inequality and race/ethnicity. Residents in poor communities experience higher negative effects of health-related outcomes—including self-related health, health behaviors, such as physical activity, alcohol-related issues, worse medical conditions, and higher mortality rates. A lack of investment in low-income areas (i.e., housing, education, and public transportation) exacerbate other inequities that lead to worse health outcomes. Studies showed that the risk of being depressed is higher in populations with higher income inequality.

The combination of the racial composition of race, place/neighborhoods, and income inequality creates an area with the unhealthiest population. People in these areas experience social conditions, such as high poverty, low educational attainment, or lack of racial/ethnic diversity in combination. Our primary search indicated gaps in the literature regarding determining the interaction of race, place, and income inequality and their influence on health outcomes. In the first Special Issue, we have focused on inequality in the health system for this specific issue we would like to focus on health outcomes. Some of the main areas to be covered in this Special Issue include:

Poverty, income inequality, and health outcome (life expectancy, low birth weight, depression, obesity, hypertension, etc.);
Housing inequalities and health outcomes;
Education inequalities and health outcomes;
Lobbying, rent-seeking, and health inequality;
Structural racism and income inequality and its impact on health outcomes.

Dr. Hossein Zare
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

income inequality
health inequality
structural racism and racial disparities
education inequalities

Related Special Issue

Inequality in Health Systems in Healthcare (12 articles)

Published Papers (5 papers)

Download All Papers

Research

12 pages, 992 KiB

Open AccessArticle

Impact of COVID-19 on Perinatal Outcomes and Birth Locations in a Large US Metropolitan Area

by Esther G. Lee, Alejandra Perez, Arth Patel, Aloka L. Patel, Thaddeus Waters, Marielle Fricchione and Tricia J. Johnson

Healthcare 2024, 12(3), 340; https://doi.org/10.3390/healthcare12030340 - 30 Jan 2024

Viewed by 631

Abstract

This was a population-based study to determine the impact of COVID-19 on birth outcomes in the Chicago metropolitan area, comparing pre-pandemic (April–September 2019) versus pandemic (April–September 2020) births. Multivariable regression models that adjusted for demographic and neighborhood characteristics were used to estimate the marginal effects of COVID-19 on intrauterine fetal demise (IUFD)/stillbirth, preterm birth, birth hospital designation, and maternal and infant hospital length of stay (LOS). There were no differences in IUFD/stillbirths or preterm births between eras. Commercially insured preterm and term infants were 4.8 percentage points (2.3, 7.4) and 3.4 percentage points (2.5, 4.2) more likely to be born in an academic medical center during the pandemic, while Medicaid-insured preterm and term infants were 3.6 percentage points less likely (−6.5, −0.7) and 1.8 percentage points less likely (−2.8, −0.9) to be born in an academic medical center compared to the pre-pandemic era. Infant LOS decreased from 2.4 to 2.2 days (−0.35, −0.20), maternal LOS for indicated PTBs decreased from 5.6 to 5.0 days (−0.94, −0.19), and term births decreased from 2.5 to 2.3 days (−0.21, −0.17). The pandemic had a significant effect on the location of births that may have exacerbated health inequities that continue into childhood. Full article

(This article belongs to the Special Issue Inequality in Health Systems and Health Outcomes)

► Show Figures

Figure 1

13 pages, 1507 KiB

Open AccessArticle

Dynamic Changes in Drinking Behaviour among Subpopulations of Youth during the COVID-19 Pandemic: A Prospective Cohort Study

by Mahmood R. Gohari, Thepikaa Varatharajan, James MacKillop and Scott T. Leatherdale

Healthcare 2023, 11(13), 1945; https://doi.org/10.3390/healthcare11131945 - 5 Jul 2023

Viewed by 870

Abstract

Objective: Youth drinking is highly heterogenous, and subpopulations representing different alcohol use patterns may have responded differently to the COVID-19 pandemic. This study examined changing patterns of alcohol use in subpopulations of the youth population over the first two years of the pandemic. Method: We used linked survey data from 5367 Canadian secondary school students who participated in three consecutive waves of the COMPASS study between 2018/19 and 2020/21. Latent transition analysis (LTA) was used to identify patterns of alcohol use based on the frequency of drinking and frequency of binge drinking and to estimate the probability of transitioning between identified patterns. Results: LTA identified five patterns of alcohol use each representing a unique subpopulation: abstainer, occasional drinker-no binging, occasional binge drinker, monthly binge drinker, weekly binge drinker. Probability of being engaged in binge drinking for a subpopulation of occasional drinkers pre-pandemic was 61%, which reduced to 43% during the early-pandemic period. A lower proportion of occasional binge drinkers reported moving to monthly or weekly binge drinking. Female occasional drinkers were more likely to move to binge drinking patterns during the pandemic than males. Conclusions: Less frequent drinking and younger students were more likely to reduce their drinking and binge drinking than more established drinkers during the COVID-19 pandemic. Understanding of heterogenous patterns of alcohol drinking and different responses to public health crises may inform future preventive programs tailored to target subpopulations more effectively. Full article

(This article belongs to the Special Issue Inequality in Health Systems and Health Outcomes)

► Show Figures

Figure 1

10 pages, 251 KiB

Open AccessArticle

Self-Rated Health of US Older Adults in the General Social Survey (GSS) 1972–2021: Complexity of the Associations of Education and Immigration

by Hafifa Siddiq, Mona Darvishi and Babak Najand

Healthcare 2023, 11(4), 463; https://doi.org/10.3390/healthcare11040463 - 5 Feb 2023

Cited by 2 | Viewed by 1158

Abstract

Background: Multiple studies have shown a link between high education and better self-rated health (SRH). However, recent studies have suggested that immigrants may experience a weaker association between education and SRH than native-born individuals. Aim: Using a national sample of US older adults, this investigation studied whether there is an inverse association between education and SRH and whether immigration status moderates this association. Methods: This study is based on marginalized diminished returns (MDRs) that argues socioeconomic status (SES) resources, such as education, may generate less favorable health outcomes for marginalized groups. Data were from the General Social Survey (GSS) 1972–2021, a cross-sectional survey in the US. A total of 7999 participants who were 65+ years old were included. The independent variable was education, measured as years of schooling and treated as a continuous variable. The dependent variable was poor/fair (poor) SRH. Immigration status was the moderator. Age, sex, and race were control variables. Logistic regressions were used for data analysis. Results: We found that higher levels of education were protective against poor SRH. However, this effect was weaker for immigrants than for US-born individuals. Conclusions: This study found that native-born US older individuals are more likely to experience the protective effect of their education against poor SRH compared to their immigrants. Eliminating health inequality between immigrant and US-born individuals needs policies that go beyond socioeconomic status (SES) equality and address barriers that hinder highly-educated immigrants. Full article

(This article belongs to the Special Issue Inequality in Health Systems and Health Outcomes)

14 pages, 941 KiB

Open AccessArticle

Racial/Ethnic Differences in Arrest Probability Trajectories after Traumatic Brain Injury: A Model Systems Study

by Mickeal Pugh, Jr., Paul B. Perrin, Juan Carlos Arango-Lasprilla, Daniel W. Klyce, Shawn C. T. Jones and Natalie D. Dautovich

Healthcare 2022, 10(10), 2078; https://doi.org/10.3390/healthcare10102078 - 19 Oct 2022

Cited by 1 | Viewed by 1474

Abstract

Background: Previous literature has documented racial/ethnic differences in traumatic brain injury (TBI) risk, cause, treatment, and rehabilitation. The purpose of the current study was to investigate potential racial/ethnic differences in arrest probability trajectories over the first 10 years after TBI and whether injury and sociodemographic characteristics accounted for these differences. Methods: The current study included 13,195 participants with moderate-to-severe TBI in the TBI Model Systems National Database who had arrest data from at least one follow-up time point (Years 1, 2, 5, and/or 10). A series of hierarchical linear models assessed racial/ethnic differences in trajectories of arrest probability over these 10 years post-injury and then included socio-demographic and injury-related covariates. Results: White individuals with TBI had lower arrest probability trajectories than Black and Native American individuals, and Asian individuals with TBI had lower arrest probability trajectories than White, Black, Latinx, and Native American persons. In many cases, racial/ethnic disparities persisted even when injury and sociodemographic characteristics were covaried. Conclusion: These results suggest that rehabilitation clinicians should assess for post-injury arrest risk factors such as age, sex, education, pre-injury unemployment, arrest history, and substance abuse, particularly in Black, Latinx, and Native American groups, and integrate programming to lessen post-injury arrest probability and improve overall rehabilitation outcomes. Full article

(This article belongs to the Special Issue Inequality in Health Systems and Health Outcomes)

► Show Figures

Figure 1

15 pages, 1055 KiB

Open AccessArticle

How Income Inequality and Race Concentrate Depression in Low-Income Women in the US; 2005–2016

by Hossein Zare, Adriele Fugal, Mojgan Azadi and Darrell J. Gaskin

Healthcare 2022, 10(8), 1424; https://doi.org/10.3390/healthcare10081424 - 29 Jul 2022

Cited by 3 | Viewed by 2861

Abstract

Aim: To estimate the association between income and depressive symptoms in adult women, ages 20 years and older. Methods: Data for this study came from the 2005–2016 National Health and Nutrition Examination Survey (NHANES). We measured the presence of depressive symptoms by using a 9-item PHQ (Public Health Questionnaire, PHQ-9) and the Poverty to Income Ratio (PIR) as a proxy for income. We employed Negative Binomial Regression (NBRG) and logistic regression models in a sample of 11,420 women. We adjusted models by age, racial/ethnic groups, marital status, education, health insurance, comorbidity, and utilization of mental health professionals. We calculated the Gini Coefficient (GC) as a measure of income inequality, using PIR. Results: Between 2005 and 2016, 20.1% of low-PIR women suffered from depression (PHQ ≥10) compared with 12.0% of women in medium-PIR and 5.0% in high-PIR. The highest probabilities of being depressed were in Black Non-Hispanics (BNH) and Hispanics (12.0%), and then in White NH (WNH; 9.1%). The results of NBRG have shown that women in medium-PIR (0.90 [CI: 0.84–0.97]) and high-PIR 0.76 (CI: 0.70–0.82) had a lower incidence-rate ratio than women in low-PIR. The logistic regression results showed that income is protective in High-PIR groups (OR = 0.56, CI [0.43–0.73]). Conclusion: Policies to treat depression should prioritize the needs of low-income women of all racial groups and women. Full article

(This article belongs to the Special Issue Inequality in Health Systems and Health Outcomes)

► Show Figures