Examining Health Inequalities in Latvia : A Decade of Association between Socioeconomic Position and Perceived Health Status

Publisher Copyright: © 2017 Anželika Berķe-Berga et al.The relationship between socioeconomic position (SEP) and population health is contextual. This study identifies the determinants of SEP producing health inequalities in the Latvian population. We also estimate the proportional contribution of different socioeconomic strata- (SES-) related determinants in Latvian health inequalities and measure the changes in the relative contributions of such determinants over the period 2005-2015. Using the household survey data (2005-2015), we construct a principal component analysis based SES index. A regression-based concentration index (CI) is our measure of health inequality to examine the distribution of perceived health status. Finally, we identify and estimate the contribution of predictors of health inequalities by decomposing CI with Oaxaca-Blinder decomposition. SES-related health inequalities have declined from 2005 (CI: 0.201) to 2015 (CI: 0.137) in Latvia - better-off Latvians enjoyed better perceived health during that period. The proportional contributions of education and working status have increased in 2015 compared to 2005. Although we have generated the first evidence to suggest policy relevant measures in addressing Latvian health inequalities, our decomposition method explains the extent of variation in perceived health instead of covariance between health and SEP.publishersversionPeer reviewe

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The distributive fairness of out-of-pocket healthcare expenditure in the Russian Federation

International audienceThis article examines the effects of socioeconomic position and urban–rural settlement on the distribution of out-of-pocket expenditure (OPE) for health in the Russian Federation. Data comes from 2005 to 2016 waves of the Russian Longitudinal Monitoring Survey. Concentration index reflects changes in the distribution of OPE between the worse-off and the better-off Russians over a 12-year period. Finally, unconditional quantile regression—a recentred influence function approach estimates differential impacts of covariates along the distribution of OPE. OPE is concentrated amongst the better-off Russians in 2016. Urban settlements contribute to top end OPE distribution for the richest and town settlements, at the median for the richest and the poorest. Our model for the analysis is unique in the context of study population, as it marginalises the effect over the distributions of other covariates used in the model

Inequalities in perceived health in the Russian Federation, 1994–2012

Abstract Background Individual characteristics and socioeconomic strata (SES) are important determinants of health differences. We examine health inequalities in Russia and estimate the association of demography (gender and age) and SES (working status, income, geography of residence, living standard, wealth possession, and durable asset-holding) with perceived health over the period 1994–2012. Methods This study uses nationally representative datasets from the Russian Longitudinal Monitoring Survey (RLMS: 1994–2012). We apply a random effect GLS model to examine the association of individual characteristics and individual heterogeneity in explaining self-perceived health status. In addition, we estimate a regression-based concentration index, which we decompose into the determinants of health inequalities. Results The self-perceived health differences between the better-off and the worse-off is reduced over the 18 year period (1994 – 2012). The individual variances in self-perceived health status are higher compared to the variances between the individuals over the period. The measure of health inequality index (concentration index) indicates a change for better health for the better-off Russians. Being employed matters in perceiving a better health status for the Russians in 2012. Conclusions Self-perceived health differences in the Russian Federation has changed over time. Such differences in changes are attributable to both changes in the distribution of the determinants of health as well as changes in the association between the determinants of health with the self-perceived health status. Though this study identifies the determinants of health inequalities for the Russians, the future research is to examine the in-country distribution of these determinants that produce health differences within the Russian Federation

Do differences in brute luck influence preferences for redistribution in favour of the environment and health?

International audienceRedistributive justice is based on the premise that it is unfair for people to be better or worse off relative to others simply because of their fortune or misfortune. It assumes equal opportunities arising from four factors: social circumstances, effort, option luck and brute luck. This paper seeks to investigate how differences in perceived brute luck influence individual preferences for redistribution in favour of two public policies: “health intervention” and “environmental actions”. These policies are viewed somewhat differently: the environment is considered a pure “public good” and health, more as a “private good” with a strong public good element. Consequently, potential self-serving biases inherent in the preferences for redistributive policies are expected to differ, more likely favouring health than the environment. The perceived degree of brute luck may capture such a difference—those perceiving themselves as luckiest should be less amenable to redistribution in favour of health than the unluckiest. Data from the three waves (2000, 2006 and 2008) of a French population survey are used to examine this self-serving bias. A Generalised Ordered Logit (GOL) model is found to be statistically more relevant compared to other logistic regression models (multinomial and ordered). We find that a perceived low degree of brute luck is significantly associated with a decreased preference of redistributive environmental policies but the reverse is true for redistributive health policies, i.e., association with an increased preference. Assuming that all inequalities due to differing luck are unjust, this empirical validation gives redistributive justice grounds for equalisation policies regarding health

Health inequality in the Russian Federation: An examination of the changes in concentration and achievement indices from 1994 to 2013

Background: To assess and quantify the magnitude of health inequalities ascribed to socioeconomic strata from 1994 to 2013 in the Russian Federation. Methods: A balanced sample of 1,496 adult individuals extracted from the 1994 wave of the Russian Longitudinal Monitoring Survey (RLMS) is followed for stated self-perceived health status until 2013. The socioeconomic strata (SES) index is constructed with a set of variables (adult equivalent household income, ownership of assets and living conditions) by applying principal component analysis (PCA). We use a regression-based concentration index to measure differences in self-perceived health status. Finally, we examine the degree of aversion to inequalities in self-perceived health status between the worse-off and the better-off with the achievement index. Results: By 2013, the mean standardized self-perceived health status has improved by 4.6 % compared to 1994. The absolute size of Concentration Index (CI) for non - standardized self-perceived health status is reduced by 44.27 % from 1994 to 2013. No systematic trend emerges in the evolution of CI for self-perceived health status of the Russians over the 19 year period. However, avoidable inequalities in self-perceived health status of the Russian population is reduced by almost 60 % over the two decades (1994–2013). Conclusion: SES, as defined with objective indicators, shows little consistency in association with self-perceived health status in the Russian Federation. This study highlights the need for future research that considers the context of stated self-perceived health status in the realm of subjective socioeconomic status (SSS)

A comparison of regret-based and utility-based discrete choice modelling – an empirical illustration with hospital bed choice

There is some concern that the unobserved preference heterogeneity in random utility maximization theory-based discrete choice experiment modelling is an important source of error variability. The randomness in utility is often interpreted as interpersonal preference heterogeneity but it can also be intrapersonal random variation in preferences. We compare utility maximization and regret minimization-based choice models’ sensitivity to individual heterogeneity, examine differences between two consecrated models and validate with empirical illustrations. We use frequency of category (public, semi-private, and private) of bed chosen from Swiss cross-sectional datasets (2007–2012) to compare two approaches – utility maximization and regret minimization by applying multinomial logit (MNL) models in regard to the variances in utility (regret) function, goodness-of-fit and predicted marginal effects (pseudo-elasticity) of additional payment. We find parameters with the same sign and estimates with almost same order of magnitude in both the approaches. The statistical significance of attribute effects is consistent in all variants of utility -based MNL models while effects of different attributes are significant only in heteroskedastic extreme value (HEV) variant of regret-based MNL models. This empirical illustration suggests that HEV variant of regret-based models perform better in capturing attribute effects in choice behaviour

Does Self-Assessed Health Reflect the True Health State?

International audienceSelf-assessed health (SAH) is a widely used tool to estimate population health. However, the debate continues as to what exactly this ubiquitous measure of social science research means for policy conclusions. This study is aimed at understanding the tenability of the construct of SAH by simultaneously modelling SAH and clinical morbidity. Using data from 17 waves (2001–2017) of the Russian Longitudinal Monitoring Survey, which captures repeated response for SAH and frequently updates information on clinical morbidity, we operationalise a recursive semi-ordered probit model. Our approach allows for the estimation of the distributional effect of clinical morbidity on perceived health. This study establishes the superiority of inferences from the recursive model. We illustrated the model use for examining the endogeneity problem of perceived health for SAH, contributing to population health research and public policy development, in particular, towards the organisation of health systems