Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey

Ding, Lanlin; Chen, Zhuo; Liu, Shiyong; Zhang, Qi; Shi, Zumin; Wang, Lu; Xue, Hong; Liu, Gordon G.; Wang, Youfa

doi:10.1186/s12939-021-01448-9

Cited by 17 publications

(16 citation statements)

References 46 publications

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“…The lack of financial security could trigger economic anxiety, which was rated as high as health anxiety in a cross-national study (Bareket-Bojmel et al, 2020). While income disparities in COVID-19 infections, food and housing insecurity, and health care access have been documented (Hall et al, 2021; Jay et al, 2020; Nie et al, 2021; Tan et al, 2021), the present study uniquely showed that the latent class with serious financial stressors had worse alcohol-related, mental health, and quality of life outcomes. These findings highlight the need to provide tangible assistance, social support, and coping skills to these individuals to prevent problematic alcohol use, mental health problems, and reduced quality of life across multiple domains.…”

Section: Discussioncontrasting

confidence: 51%

A person-centered approach to capture health disparities and multidimensional impact of COVID-related stressors.

Luk¹,

Stangl²,

Schwandt³

et al. 2023

American Psychologist

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The COVID-19 pandemic has influenced people's lives in diverse ways. The authors utilized latent class analysis (LCA), a person-centered approach, to examine distinct patterns of COVID-related stressors and their associations with alcohol-related, mental health, and quality of life outcomes. Participants were 463 adults who completed the baseline assessment of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study from June 2020 to January 2022. Using cross-sectional data, three analytic methods (continuous sum score, categorical grouping, and LCA) were applied to model 17 COVIDrelated stressors. Regression analyses indicated higher COVID-related stress and endorsement of four or more COVID-related stressors were generally associated with worse health-related outcomes. LCA revealed four classes: Class 1: Minimal COVID-Related Impact (51.6%); Class 2: Work Interruptions (24.8%); Class 3: Family/Friends Affected by COVID (14.5%); and Class 4: Serious Financial Stress (9.1%). Racial/ethnic minorities were more likely to be in Class 3, whereas individuals with more years of education and higher income were less likely to be in Class 4. Individuals with a history of alcohol use disorder were more likely to be in Classes Public Significance StatementThis study examined different types of stressors that people encountered during the COVID-19 pandemic such as work interruptions, financial stress, and knowing someone infected with COVID-19. Individuals who experienced multiple financial stressors made up a small minority but had higher mental health and alcohol-related problems, as well as lower quality of life. This group of individuals may benefit from holistic interventions and community outreach.

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Section: Discussioncontrasting

confidence: 51%

A person-centered approach to capture health disparities and multidimensional impact of COVID-related stressors.

Luk¹,

Stangl²,

Schwandt³

et al. 2023

American Psychologist

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“…Measures of inequality were firstly developed by economists to assess inequality in income distribution [ 22 ]. Other metrics have been developed as practical tools in measuring inequality, including the Coefficient of Variation [ 23 , 24 ], the Concentration Index (CI) [ 11 ], Decile Ratios [ 25 ], the Generalized Entropy (GE) Index [ 26 ], and the Atkinson Index [ 27 ], among others. Of these, the Gini Coefficient is the most widely used index to quantify inequality in the public health sphere.…”

Section: Introductionmentioning

confidence: 99%

“…With the emergence of Covid-19 in late 2019, and harsh government measures to contain the virus (e.g., lockdown, restriction of movement, closures of public and private facilities), PA inequality has widened [7][8][9]. The inequality is more profound, as the socio-economic turmoil from Covid-19 pandemic has disrupted the lives and livelihoods of individuals, families, and society worldwide [9][10][11]. Previous findings indicate that the socially and economically under-privileged population has lost most of their access to PA facilities, experienced a significant decline in their PA, and have increased sedentary behavior during strict Covid-19 containment measures [7,8,12].…”

Section: Introductionmentioning

confidence: 99%

Refining index to measure physical activity inequality: which group of the population is the most vulnerable?

Widyastari

Khanawapee

Charoenrom

et al. 2022

Int J Equity Health

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Background The existing body of research mostly discusses inequality in physical activity (PA) based on the difference in the level of moderate-to-vigorous physical activity (MVPA). Evidence is lacking on the quantified inequality measures (e.g., how big the inequality is, and the distribution) in order to identify the most vulnerable groups of a population. This study measured PA inequality among Thai adults by using three parameters to construct an inequality index: (1) Proportion of the population with sufficient MVPA; (2) Cumulative minutes of MVPA; and (3) The Gini coefficient. Methods This study employed three rounds of data from Thailand’s Surveillance on Physical Activity (SPA) 2019–2021. In each round, over 6,000 individuals age 18–64 years were selected as nationally-representative samples, and were included in the analysis. PA inequality was constructed by using three parameters, with a combination of the three as the final measure, to identify the sub-groups of the Thai adults who are most vulnerable: groups with the least MVPA, highest insufficiency, and highest inequality index (Gini). Results Covid-19 containment measures have widened the gap in PA inequality, as shown by a declining proportion of the population meeting the recommended guidelines, from 74.3% in 2019 to 56.7% in 2020 and 65.5% in 2021. PA inequality existed in all sub-populations. However, by combining three parameters, the most vulnerable groups during the Covid-19 epidemic were identified as follows: (1) Those with no income; (2) The unemployed; (3) Those who have no access to PA facilities; (4) Older adults aged 60 + years; and (5) Those earning < 3,500 baht per month. Further, residents of Bangkok, young adults aged 18–24, individuals who attained primary level education or less, those who had no exposure to a PA awareness campaign and those who have a debilitating chronic disease also had elevated risk of PA insufficiency. Conclusion A concerning level of PA inequality existed in all sub-populations. The use of combined indicators in measuring PA inequality should aid in determining the most vulnerable groups of the population with a refined procedure. This method can be applied in many settings since the baseline data used to measure inequality (i.e., percent sufficient and cumulative minutes of MVPA) are widely available.

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“…In contrast, only one study found decreased income-related inequality in self-rated health during the period of 2010 to 2014 ( 24 ). Pro-poor inequality was also remained during the period of the COVID-19 pandemic ( 25 ). The current literature consistently suggested that equality-oriented programs should be implemented to support vulnerable groups.…”

Section: Introductionmentioning

confidence: 99%

Income-related health inequality among rural residents in western China

Tang

2022

Front. Public Health

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ObjectiveHealth equality has drawn much public attention in both developed and developing countries. China, the largest developing country, has implemented a new round of health system reform to improve health equality since 2009. This study aims to examine the magnitude and sources of income-related health inequality in western rural regions of China.MethodsData were obtained from the Survey of Rural Economic and Social Development in Western China conducted in 2014, in which 14,555 individuals from 5,299 households in 12 provinces were included. Health outcome variables of interest were self-rated health status, prevalence of chronic disease and four-week illness. Concentration index was calculated to assess magnitude of income-related health inequality, and nonlinear decomposition analysis was performed to identify the sources of health inequality.ResultsThe Concentration indexes for poor self-rated health status, prevalence of chronic disease and four-week illness were −0.0898 (P<0.001),−0.0860 (P<0.001) and −0.1284 (P<0.001), respectively. Income and education were two main sources of health inequality, accounting for about 25−50% and 15% contribution to the inequality. Ethnicity made <10% contribution to income-related health inequality, and enrollment in New Rural Cooperative Medical Scheme contributed to <1%.ConclusionThis study found slight income-related health inequality among rural residents in western China, implying that although China has made substantial progress in economic development and poverty alleviation, health inequality in western rural region should still be concerned by the government. To achieve health equality further, the Chinese government should not only strengthen its reimbursement mechanism of the current health insurance scheme to improve affordability of primary healthcare for residents in western rural regions, but also implement health poverty alleviation policies targeting socioeconomically vulnerable population and ethnic minorities in future.

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Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey

Cited by 17 publications

References 46 publications

A person-centered approach to capture health disparities and multidimensional impact of COVID-related stressors.

A person-centered approach to capture health disparities and multidimensional impact of COVID-related stressors.

Refining index to measure physical activity inequality: which group of the population is the most vulnerable?

Income-related health inequality among rural residents in western China

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