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Epidemiologia
Special Issues
Socio-Economic Inequalities in Health
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Socio-Economic Inequalities in Health

A special issue of Epidemiologia (ISSN 2673-3986).

Deadline for manuscript submissions: 31 December 2024 | Viewed by 10480

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,

Despite a negative correlation between economic inequalities and health, evidence shows that the world underestimates the true level of inequality or may not be completely aware of its impact on health. It is thus essential to bring it to the attention of policymakers. The concavity effect of inequality plays a crucial role in equity. In this approach, transferring an additional dollar from rich to poor improves the health status of poor communities more than that of wealthy communities.

For this Special Collection, we would like to focus on place-based inequalities considering social determinants of health. Some of the areas of interest include but are not limited to:

  • Place-based disparities and social determinants of health;
  • Geographical disparities and utilization of inpatient/outpatient services;
  • Structural racism and economic inequality;
  • The impact of health insurance coverage on reducing economic inequality;
  • Wage disparities and economic inequality and its impact on health outcome;
  • The labor market and socioeconomic disparities;
  • Socioeconomic inequality and the justice system;
  • Socioeconomic inequality and men’s/women’s health.

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. Epidemiologia is an international peer-reviewed open access quarterly 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 1200 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

  • economic inequality
  • geographical inequality
  • place-based disparities
  • justice inequality
  • income inequality
  • racial disparities
  • inequality and social control

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Published Papers (4 papers)

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Research

13 pages, 270 KiB  
Article
How Physician—Insurance Contracting Contributes to the Medical Exodus and Access to Ophthalmic Care in Puerto Rico
by Luma Al-Attar, Rafael A. Ocasio Diaz, Andrea N. Ponce and Hossein Zare
Epidemiologia 2024, 5(4), 715-727; https://doi.org/10.3390/epidemiologia5040050 - 23 Nov 2024
Viewed by 511
Abstract
Background: Puerto Rico (PR) has experienced significant demographic changes, characterized primarily by an aging population and an unprecedented exodus of medical doctors. Ophthalmologists are of particular concern as they commonly serve older populations, and the island has high rates of some age-related eye [...] Read more.
Background: Puerto Rico (PR) has experienced significant demographic changes, characterized primarily by an aging population and an unprecedented exodus of medical doctors. Ophthalmologists are of particular concern as they commonly serve older populations, and the island has high rates of some age-related eye diseases in the United States (US). Our research aims to investigate the factors driving ophthalmologists in PR to emigrate to the mainland US. Methods: This is a cross-sectional study among ophthalmologists in PR, using survey data collected from May to June 2023. This study recruited a convenient sample of all ophthalmologists practicing in PR via outreach in person and online communities. The survey covered various types of challenges faced by ophthalmologists, their demographics, and practice details. STATA/BE 18 statistical software was used for data analysis. Statistical tests, such as chi-square and proportion tests, were performed, stratifying results by age, gender, subspecialty, geographic health districts, experience, and practice type. Results: Among 130 of the estimated 218 ophthalmologists in PR, insurance/billing issues were identified as the primary challenge to practicing in PR and the primary reason to leave PR. The challenges that were identified included required authorizations for patient care, unjustified claim rejections, and threats of contract cancellation. We found that new ophthalmologists (≤15 years of practice) faced more specific challenges than experienced ophthalmologists (>15 years of practice), such as difficulty in obtaining insurance contracts. Conclusions: Insurance/billing issues are a pervasive concern for ophthalmologists in PR. New ophthalmologists are disproportionately affected by these challenges, potentially leading some to find employment outside of PR. There is a need for targeted policies—regulation of insurance contracting and increased reimbursement from private insurance plans—to reduce insurance contracting barriers for keeping a sustainable physician workforce in PR. Full article
(This article belongs to the Special Issue Socio-Economic Inequalities in Health)
16 pages, 331 KiB  
Article
Socio-Economic and Health Literacy Inequalities as Determinants of Women’s Knowledge about Their Reproductive System: A Cross-Sectional Study
by Viktória Prémusz, Kálmán András Kovács, Eszter Skriba, Zoltán Tándor, Gábor Szmatona and Olívia Dózsa-Juhász
Epidemiologia 2024, 5(4), 627-642; https://doi.org/10.3390/epidemiologia5040044 - 26 Sep 2024
Viewed by 1257
Abstract
Background/Objectives: To support women’s informed decisions and reproductive self-care, confident reproductive health-related knowledge is needed, supported by adequate health literacy (HL). No corresponding survey has been carried out in Hungary on inequalities to provide information addressing education. Materials and Methods: In the current [...] Read more.
Background/Objectives: To support women’s informed decisions and reproductive self-care, confident reproductive health-related knowledge is needed, supported by adequate health literacy (HL). No corresponding survey has been carried out in Hungary on inequalities to provide information addressing education. Materials and Methods: In the current cross-sectional online survey, 301 women of reproductive age (27.16 ± 0.36 years) were asked with the Hungarian versions of validated and standardised questionnaires about reproductive knowledge on hormones, ovulation, menstrual cycle, pregnancy signs and birth control (Knowledge of Female Body Scale—KFB), and HL (Brief Health Literacy Screening Tool—BRIEF). Spearman correlation and multivariable linear regression analyses were utilised, with a significance level set at p < 0.05. IBM SPSS version 28.0 (IBM SPSS, Armonk, NY, USA: IBM Corp.) and G*Power (version 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) software. The STROBE checklist was followed. The Clinical Trial Registry Nr. is NCT06146673. Results: The KFB composite score was high (20.01 ± 2.33); 86.374% had “high knowledge”. Still, lacking information was identified for the mechanisms of certain contraceptive methods and early physical signs of pregnancy. A significant difference was also found in the KFB scores in the case of higher age (p = 0.019), higher education level (p = 0.018) and previous live birth (p = 0.028). A positive correlation was found between KFB and HL (p < 0.001), education (p = 0.005), and age (p = 0.021). A multiple regression analysis (R2 = 0.087, p < 0.001) indicated that both HL (p < 0.001) and age (p = 0.003) are potential positive predictors of adequate reproductive knowledge, whereas induced abortion (p = 0.013) might serve as an inverse predictor. Conclusions: Inequalities in women’s knowledge about their reproductive system and HL were found, and it was significantly the lowest in their highest conception probability age. Therefore, in addition to targeted education, HL also needs improvement. Full article
(This article belongs to the Special Issue Socio-Economic Inequalities in Health)
15 pages, 309 KiB  
Article
The Association between Fear of Crime, Educational Attainment, and Health
by Gloria Macassa, Cormac McGrath, Katarina Wijk, Mamunur Rashid, Anne-Sofie Hiswåls and Joaquim Soares
Epidemiologia 2023, 4(2), 148-162; https://doi.org/10.3390/epidemiologia4020016 - 30 Apr 2023
Cited by 4 | Viewed by 2642
Abstract
Fear of crime is an important public health problem that impacts people’s quality of life, health, and wellbeing, and causes mental health ailments (e.g., anxiety). This study aimed to determine whether there was an association between fear of crime, educational attainment, and self-rated [...] Read more.
Fear of crime is an important public health problem that impacts people’s quality of life, health, and wellbeing, and causes mental health ailments (e.g., anxiety). This study aimed to determine whether there was an association between fear of crime, educational attainment, and self-rated health and anxiety among women residing in a county in east-central Sweden. A sample (n = 3002) of women aged 18–84 years surveyed in the Health on Equal Terms survey carried out in 2018 was included in the study. Bivariate and multivariate regression analysis was performed on the relationship between the composite variables fear of crime, educational attainment, and self-rated health and anxiety. Women with primary education or similar who reported fear of crime had increased odds of poor health (odds ratio (OR) 3.17; 95% confidence interval (CI) 2.40–4.18) compared with women with primary education/similar and no fear of crime (OR 2.90; CI 1.90–3.20). A statistically significant relationship persisted in the multivariate analysis after controlling for other covariates, although the odds were reduced (OR 1.70; CI 1.14–2.53 and 1.73; CI 1.21–2.48, respectively). Similarly, in the bivariate analysis, women who reported fear of crime and who only had primary education had statistically significant odds of anxiety (OR 2.12; CI 1.64–2.74); the significance was removed, and the odds were reduced (OR 1.30; CI 0.93–1.82) after adjusting for demographic, socioeconomic, and health-related covariates. Women with only primary education or similar who reported fear of crime had higher odds of poor health and anxiety compared with those with university education or similar, with and without fear of crime. Future studies (including longitudinal ones) are warranted—on the one hand, to understand possible mechanisms of the relationship between educational attainment and fear of crime and its consequences to health, and on the other, to explore low-educated women’s own perceptions regarding factors underlining their fear of crime (qualitative studies). Full article
(This article belongs to the Special Issue Socio-Economic Inequalities in Health)
13 pages, 789 KiB  
Article
Barriers to the Utilization of Primary Health Centers (PHCs) in Iraq
by Taysir Al Janabi
Epidemiologia 2023, 4(2), 121-133; https://doi.org/10.3390/epidemiologia4020013 - 13 Apr 2023
Cited by 6 | Viewed by 4819
Abstract
Primary care has been viewed as a means to ensure equitable access to care, enhance efficiency within healthcare systems, and improve health service quality. In recent decades, Iraq has transformed its compromised health system, shifting the healthcare model from hospital-based to primary care [...] Read more.
Primary care has been viewed as a means to ensure equitable access to care, enhance efficiency within healthcare systems, and improve health service quality. In recent decades, Iraq has transformed its compromised health system, shifting the healthcare model from hospital-based to primary care through primary health centers (PHCs) and referral mechanisms. Based on an extensive literature review, this qualitative paper explores the healthcare utilization of PHCs in different regions of Iraq. It also identifies some barriers to PHC use and recommends evidence-based approaches for improving PHCs’ performance. Some reported challenges to better utilizing PHCs were the poor quality of services, patient dissatisfaction, long walking distance to a health center, and limited availability and affordability of the medications. If Iraq is to use primary care as a tool in achieving sustainable development goals (SDGs), collaborative efforts addressing the facility-related factors should be a priority. Full article
(This article belongs to the Special Issue Socio-Economic Inequalities in Health)
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