Littérature scientifique sur le sujet « Wagstaff decomposition »

Introduction Vitamin A (VA) cannot be made in the human body and thus foods rich in VA are the only sources of vitamin A for the body. However, ensuring availability in adequate amount of foods rich in VA remains a challenge, mainly in low-income counties including Ethiopia. In addition, children from the poorest and less educated families of same country have disproportionately limited consumptions of foods rich in VA. Therefore, the present study aimed assessing the wealth related inequality in vitamin A consumption (VAC) and decompose it to the various contributing factors. Methods This study was conducted using the 2019 Ethiopian demographic and health survey data on a weighted sample of 1,497 children of age 6–23 months in Ethiopia. The wealth related inequality in VAC was quantified using concentration index and plotted using concentration curve. The Wagstaff decomposition analysis was performed to assess the relative contributions of each explanatory variable to the inequalities in the overall concentration index of VAC. Result The overall Wagstaff normalized concentration index (C) analyses of the wealth-related inequality in consumption of foods rich in VA among children aged 6–23 months was [C = 0.25; 95% C: 0.15, 0.35]. Further decomposition of the C by the explanatory variables reported the following contributions; primary level of women’s education (7.2%), secondary and above (17.8%), having ANC visit during pregnancy (62.1%), delivery at a health institution (26.53%), living in the metropolis (13.7%), central region (34.2%), child age 18–23 months (4.7%) contributed to the observed wealth related inequality in the consumption of foods rich in vitamin A in Ethiopia. Conclusion We found pro-rich wealth-related inequality in VAC among children of age 6–23 months in Ethiopia. Additionally, maternal education, region, ANC visit, and place of delivery were the significant contributors of wealth-related inequality of VAC. Nutritional related interventions should prioritise children from poorer households and less educated mothers. Moreover, enhancing access to ANC and health facilities delivery services through education, advocacy, and campaign programs is highly recommended in the study setting.

Aims: Increasing income inequalities in leisure time physical inactivity have been reported in the relatively socially equal setting of northern Sweden. The present report seeks to contribute to the literature by exploring the contribution of different factors to the income inequalities in leisure time physical inactivity in northern Sweden. Methods: This study was based on the 2014 Health on Equal Terms survey, distributed in the four northernmost counties of Sweden. The analytical sample consisted of 21,000 respondents aged 16–84. Six thematic groups of explanatory variables were used: demographic variables, socioeconomic factors, material resources, family-, psychosocial conditions and functional limitations. Income inequalities in leisure time physical inactivity were decomposed by Wagstaff-type decomposition analysis. Results: Income inequalities in leisure time physical inactivity were found to be explained to a considerable degree by health-related limitations and unfavourable socioeconomic conditions. Material and psychosocial conditions seemed to be of moderate importance, whereas family and demographic characteristics were of minor importance. Conclusions: This study suggests that in order to achieve an economically equal leisure time physical inactivity, policy may need to target the two main barriers of functional limitations and socioeconomic disadvantages.

Access to care and child health remain public health concerns in developing countries; in particular in Senegal despite the free child care initiative. Therefore, this article examines the effect of free care on child undernutrition and social inequalities in health care utilization. The data used are from the Continuous Demographic and Health Surveys (DHS-C). The trivariate model and the inequality index decomposition method proposed by Wagstaff et al [2003] are used respectively to analyze the effect of the free health care policy on undernutrition and social inequalities in health care utilization. The results underline that the free health care policy improves the nutritional status of children. In addition, it increases social inequalities in the use of health care in favor of the rich and contributes to horizontal inequalities to the tune of 7.56 %. It is therefore necessary to review and monitor this policy within the health structures in order to correct its regressive nature. Moreover, a combination of policies of access to care and fight against undernutrition is essential for a better result in terms of child health.

Purpose The purpose of this paper is to assess the trends of socioeconomic-related inequalities in maternal healthcare utilization in Ghana between 2003 and 2014 and examine the causes of inequalities in maternal healthcare utilization in Ghana. Design/methodology/approach Data are drawn from three rounds of the Ghana Demographic and Health Survey collected in 2003, 2008 and 2014, respectively. The authors employ two alternative measures of socioeconomic inequalities in health – the Wagstaff and Erreygers indices – to examine the trends of socioeconomic inequalities in maternal healthcare utilization. The authors proceed to decompose the causes of inequalities in maternal healthcare by applying a recently developed generalized decomposition technique based on recentered influence function regressions. Findings The study finds substantial pro-rich inequalities in maternal healthcare utilization in Ghana. The degree of inequalities has been decreasing since 2003. The elimination of user fees for maternal healthcare has contributed to achieving equity and inclusion in utilization. The decomposition analysis reveals significant contributions of individual, household and locational characteristics to inequalities in maternal healthcare. The authors find that educational attainment, urban residence and challenges with physical access to healthcare facilities increase the socioeconomic gap in maternal healthcare utilization. Originality/value There is a need to target vulnerable women who are unlikely to utilize maternal healthcare services. In addition to the elimination of user fees, there is a need to reduce inequalities in the distribution and quality of maternal health services to achieve universal coverage in Ghana.

Background Catastrophic health expenditure (CHE) is frequently used as an indicator of financial protection. CHE exists when health expenditure exceeds a certain threshold of household consumption. Although CHE is reported to have declined in Kenya, it is still unacceptably high and disproportionately affects the poor. This study examines the socioeconomic factors that contribute to inequalities in CHE as well as the change in these inequalities over time in Kenya. Methods We used data from the Kenya household health expenditure and utilisation (KHHEUS) surveys in 2007 and 2013. The concertation index was used to measure the socioeconomic inequalities in CHE. Using the Wagstaff (2003) approach, we decomposed the concentration index of CHE to assess the relative contribution of its determinants. We applied Oaxaca-type decomposition to assess the change in CHE inequalities over time and the factors that explain it. Results The findings show that while there was a decline in the incidence of CHE, inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off. Higher wealth quintiles and employed household heads positively contributed to the inequalities in CHE, suggesting that they disadvantaged the poor. The rise in CHE inequalities overtime was explained mainly by the changes in the elasticities of the household wealth status. Conclusion Inequalities in CHE are persistent in Kenya and are largely driven by the socioeconomic status of the households. This implies that the existing financial risk protection mechanisms have not been sufficient in cushioning the most vulnerable from the financial burden of healthcare payments. Understanding the factors that sustain inequalities in CHE is, therefore, paramount in shaping pro-poor interventions that not only protect the poor from financial hardship but also reduce overall socioeconomic inequalities. This underscores the fundamental need for a multi-sectoral approach to broadly address existing socioeconomic inequalities.

ObjectivesOlder adults with adverse socioeconomic conditions suffer disproportionately from a poor quality of life. Stratified by sex, income-related inequalities have been decomposed for functional deficiencies and chronic diseases among older adults, and the degree to which social and demographic factors contribute to these inequalities was identified in this study.DesignCross-sectional study.ParticipantsData used for this study were retrieved from the WHO Study on Global AGEing and Adult Health Wave 1. A total of 3753 individuals (men: 1979, and women: 1774) aged ≥60 years were found eligible for the analysis.MeasuresInstrumental Activity of Daily Living (IADL) deficiency and presence of chronic diseases.MethodThe decomposition method proposed by Adam Wagstaff and his colleagues was used. The method allows estimating how determinants of health contribute proportionally to inequality in a health variable.ResultsCompared with men, women were disproportionately affected by both functional deficiencies and chronic diseases. The relative contribution of sociodemographic factors to IADL deficiency was highest among those with poor economic status (38.5%), followed by those who were illiterate (22.5%), which collated to 61% of the total explained inequalities. Similarly, for chronic diseases, about 93% of the relative contribution was shared by those with poor economic status (42.3%), rural residence (30.5%) and illiteracy (20.3%). Significant difference in predictors was evident between men and women in IADL deficiency and chronic illness.ConclusionPro-poor intervention strategies could be designed to address functional deficiencies and chronic diseases, with special attention to women.

Background Antenatal care (ANC) services are essential to reduce maternal and newborn morbidity and mortality rates. However, the trends and socioeconomic inequality of utilizing recommended ANC services has not been well studied in Ethiopia. Therefore, this study aims to investigate the trends and socioeconomic disparities in receiving recommended ANC services among Ethiopian women. Methods This study used recent Ethiopian Demographic Health Surveys (EDHS) conducted in 2011, 2016, and 2019. Binary logistic regression model was employed to assess the association between receiving the recommended ANC services and explanatory variables and socioeconomic disparities were estimated through concentration index (CIX) analysis. Moreover, Wagstaff approach was used to decompose the relative CIX to the contribution of explanatory variables for the observed disparities. Results This study found that 37.37% (95%CI: 36.46–38.28%) of mothers utilized the recommended ANC services in Ethiopia. The trend in the coverage of recommended ANC services increased from ~ 30% in 2011 to 44.70% in 2019. Mother’s age and education, household wealth status, distance of the nearest health facility, and experiencing domestic abuse (i.e., wife beating) were significantly associated with utilization of recommended ANC services. The relative estimated CIX for wealth index, mothers education, Ethiopian administrative regions, and residence were 0.15 (P < 0.001), 0.14 (P < 0.001), 0.07(P < 0.001), and −0.11(P < 0.001), respectively. Wealth status of the households contributed for almost two-thirds (66.58%) of the observed disparity in recommended ANC service utilization across wealth categories. Conclusion The study revealed that Ethiopian women’s utilization of recommended ANC services was unequal by their socioeconomic classes, with better off women more likely to utilize the recommended ANC services than worse off women. Hence, the responsible body should improve the access and quality of antenatal care services for underprivileged women in Ethiopia.

Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index (WI) and Erreygers index (EI). Following this, it compares health inequalities among the elderly in different age groups, and finally, uses the Shapley and recentered influence function-index-ordinary least squares (RIF-I-OLS) model to decompose the effect of four factors on health inequality among the elderly in rural China. The QWB score distribution shows that the health of the elderly in rural China improved with social economic development and medical reform from 2002 to 2014. However, at the same time, we were surprised to find that the health level of the 65–74 years old group has been declining steadily since 2008. This phenomenon implies that the incidence of chronic diseases is moving towards the younger elderly. The WI and EI show that there is indeed pro-rich health inequality among the rural elderly, the health inequality of the younger age groups is more serious than that of the older age groups, and the former incidence of health inequality is higher. Health inequality in the age group of 65–74 years old is higher than that in other groups, and the trend of change fluctuated downward from 2002 to 2014. Health inequality in the age group of 75–84 years old is lower than that in the group of 65–74 years old, but higher than that in the other age groups. The results of Shapley decomposition show that demographic characteristics, socioeconomic status (SES), health care access, and quality of later life contributed 0.0054, 0.0130, 0.0442, and 0.0218 to the health inequality index of the elderly, which accounted for 6.40%, 15.39%, 52.41%, and 25.80% of health inequality index. From the results of RIF-I-OLS decomposition, this paper has analyzed detailed factors’ marginal effects on health inequality from four dimensions, which indicates that the health inequality among the elderly in rural China was mainly caused by the disparity of income, medical expenses, and living arrangement.

SummaryThe gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010–11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of −0.1147, −0.1146, −0.2859 and −0.0638 for <3 antenatal care visits; CI of −0.1338, −0.0925, −0.1960 and −0.2531 for non-institutional delivery; and CI of −0.1153, −0.0370, −0.1817 and −0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

IntroductionHealth equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China.MethodsData were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method.ResultsThe CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (−3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (−5.24%) was the top negative contributor, followed by commercial (−1.43%) and basic medical insurance (−0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134).ConclusionPro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.

Cette étude vise à expliquer les inégalités liées au revenu dans la distribution de la santé auto-déclarée (SRH) en utilisant des données longitudinales EUSLIC sur la période 2004-2029. Le cadre conceptuel des déterminants sociaux de la santé développé par l'Organisation mondiale de la santé (OMS), qui structure hiérarchiquement les contextes politiques et économiques, la démographie, la position socio-économique et enfin les conditions de logement, est utilisé. Du point de vue de la théorie de l'égalité des chances, le premier ensemble de déterminants est appelé circonstances (à la base des inégalités injustes en matière de santé) et les conditions de logement, les efforts (à la base des inégalités équitables en matière de santé).Différentes variables de santé (liées à la santé sexuelle et reproductive) et différentes méthodologies ont été mises en œuvre dans les trois chapitres de cette étude. Les deux premiers chapitres sont consacrés à l'évaluation de la contribution des déterminants de la santé, sur la base d'un modèle de santé et d'une méthode de décomposition. Dans le premier chapitre, la variable de santé considérée est continue, le modèle de santé est le modèle de régression par intervalles et la méthode de décomposition est celle de Wagstaff. Dans le deuxième chapitre, la variable santé est autodéclarée, le modèle utilisé est le modèle logit ordonné, et la nouvelle méthode de décomposition provient de la valeur de Shapley et de la valeur d'Owen. Le chapitre 3 vise à comprendre les variations des inégalités de santé en fonction des inégalités dans les déterminants sociaux de la santé. La méthode de régression et de décomposition RIF a été explorée.Les trois chapitres ont montré la persistance des inégalités de santé en Europe sur la période 2004-2019. Ils montrent que les différences individuelles et régionales de revenus ont un impact significatif sur les inégalités de santé. Elles sont également les principaux moteurs de ces inégalités au cours de la période étudiée. Les résultats ont également mis en évidence la vulnérabilité de certains groupes de population (personnes n'ayant pas fait d'études secondaires, personnes âgées, retraités).En outre, les résultats ont montré le rôle important de l'accessibilité financière et de la privation matérielle non sévère dans l'explication de ces inégalités matérielles. Toutefois, lorsque l'influence des circonstances est supprimée, les contributions de l'accessibilité financière et de la privation matérielle non sévère aux conditions de logement passent de positives à négatives. En termes de politique économique, la recherche d'une redistribution équitable des revenus doit être considérée comme un pilier important de la réduction des inégalités de santé en Europe
This study aims to explain income-related inequalities in the distribution of self-reported health (SRH) using longitudinal EUSLIC data over the period 2004-2029. The conceptual framework of social determinants of health developed by the World Health Organization (WHO), which hierarchically structures political and economic contexts, demographics, socio-economic position and finally housing conditions, is used. From the perspective of Equality Opportunity Theory, the first set of determinants are called circumstances (at the basis of unjust inequalities in health) and housing conditions, the efforts (at the basis of fair inequalities in health).Different health variables (related to the SRH) and different methodologies have been implemented in the three chapters of this study. The first two chapters are devoted to assessing the contribution of health determinants, based on a health model and a decomposition method. In the first chapter, the health variable considered is continuous, the health model is the interval regression model, and the decomposition method is that of Wagstaff. In the second chapter, the health variable is self-reported, the model used is the ordered logit model, and the new decomposition method comes from the Shapley value and the Owen value. Chapter 3 aims to understand variations in health inequalities based on inequalities in health's social determinants. The RIF method of regression and decomposition has been explored.The three chapters have shown the persistence of health inequalities in Eu- rope over the period 2004-2019. They show that individual and regional in- come differences have a significant impact on health inequalities. They are also the main drivers over the study period. The results also highlighted the vulnerability of certain population groups (people with less than secondaryeducation, the elderly, retirees). In addition, the results showed the important role of affordability and non-severe material deprivation in explaining these material inequalities. However, when the influence of circumstances is removed, the contributions of affordability and non-severe material deprivation to housing conditions change from positive to negative. In terms of economic policy, the search for a fair redistribution of income must be seen as an important pillar for reducing health inequalities in Europe