An Intersectional Analysis Providing More Precise Information on Inequities in Self-Rated General Health

Abstract

BackgroundIntersectionality theory combined with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) can facilitate our understanding of health disparities. This enables a more precise application of proportionate universalism for resource allocation in public health. Analyzing self-rated general health in Sweden, we show how an intersectional perspective allows for a detailed mapping of health inequalities while avoiding simplification and stigmatization based on indiscriminate interpretations of differences between group averages. MethodsWe analyzed responses (n=133,244) to 14 consecutive National Public Health Surveys conducted in Sweden in 2004–2016 and 2018. Applying AIHDA, we investigated the risk of bad self-rated general health across 12 intersectional strata defined by gender, income and migration status, adjusted by age and survey year. We calculated prevalence ratios (with 99% confidence intervals) to evaluate between-strata differences, using native men with high income as the comparison reference. We calculated the area under the receiver operating characteristic curve (AUC) to evaluate the discriminatory accuracy of the intersectional strata. ResultsThe analysis of intersectional strata showed a clear social gradient where the risk of bad self-rated health among immigrated women with low income was six times higher (PR 6.01 [99% CI 5.32–6.79]) than that of native men with high income. A large degree of heterogeneity was present, however, as the discriminatory accuracy of the intersectional strata for identifying individuals according to their self-assessed general health status was relatively low (AUC=0.674).ConclusionsAn intersectional AIHDA approach provides more precise information on the distribution of bad self-assessed general health in the population and could thus guide public health interventions according to the principle of proportionate universalism.

Decomposing intersectional inequalities in subjective physical and mental health by sex, gendered practices and immigration status in a representative panel study from Germany

“…Gender is often operationalised through the proxy of sex assigned at birth in intersectional studies [21,[39][40][41].…”