Modeling the intersectionality of processes in the social production of health inequalities

Evans, Clare R.

doi:10.1016/j.socscimed.2019.01.017

Cited by 64 publications

(54 citation statements)

References 21 publications

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“…While previously having been used for investigation of geographical [35, 45] and institutional effects [46, 47] on individual outcomes, MAIDHA has recently incorporated an intersectional approach. Based on studies by Jones et al [48] and Evans et al [41, 49] as well as by our research group [34, 37, 50], intersectional MAIHDA models the individual health outcome (i.e., opioid prescription receipt in the present case) through a multilevel logistic regression analysis of individuals (level 1) nested within intersectional strata (level 2). The intersectional strata consist of a matrix of all possible combinations, or intersections, of the socioeconomic and demographic variables under study.…”

Section: Introductionmentioning

confidence: 99%

Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

et al. 2019

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Background In light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt. Methods and findings Using data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional strata from combinations of gender, age, income, cohabitation status, and presence or absence of psychological distress. We modelled the absolute risk (AR) of opioid prescription receipt in a series of multilevel logistic regression models distinguishing between additive and interaction effects. By means of the Variance Partitioning Coefficient (VPC) and the area under the receiver operating characteristic curve (AUC), we quantified the discriminatory accuracy (DA) of the intersectional strata for discerning those who received opioid prescriptions from those who did not. The AR of opioid prescription receipt ranged from 2.77% (95% CI 2.69–2.86) among low-income men aged 18–34, living alone, without psychological distress, to 28.25% (95% CI 27.95–28.56) among medium-income women aged 65 and older, living alone, with psychological distress. In a model that conflated both additive and interaction effects, the intersectional strata had a fair DA for discerning opioid users from non-users (VPC = 13.2%, AUC = 0.68). However, in the model that decomposed total effects into additive and interaction effects, the VPC was very low (0.42%) indicating the existence of small interaction effects for a number of the intersectional strata. Conclusions The intersectional MAIHDA approach aligns with the aims of precision public health, through improving the evidence base for health policy by increasing understanding of both health inequalities and individual heterogeneity. This approach is particularly relevant for socioeconomically conditioned outcomes such as opioid prescription receipt. We have identified intersections of social position within the Swedish population at greater risk for opioid prescription receipt.

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Section: Introductionmentioning

confidence: 99%

Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

et al. 2019

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“…We argue that our approach maintains such a critical edge for two reasons. First, as argued by Evans (2019), the main issue with descriptive intersectional studies is not their descriptive nature per se, but that they tend to be atheoretical in framing and interpretation, and therefore fail to draw attention to (and critique) the social processes that generate observed intersectional patterns. By drawing on critical theories of population health (Conrad and Kern, 1981;Doyal, 1979;Krieger, 2011) and interpreting observed inequalities accordingly, we aim to highlight the underlying social processes driving the POM epidemic.…”

Section: Intersectionality In Population Healthmentioning

confidence: 99%

Intersectional inequalities and the U.S. opioid crisis: challenging dominant narratives and revealing heterogeneities

Persmark

Wemrell

Evans

et al. 2019

Critical Public Health

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“…ocioeconomic inequalities play an important role in health. (1) Despite health progress and development into modernity worldwide, inequalities in health continue to exist among populations within the same society and there are inequalities between nations in both developing and developed countries. (2) Health inequalities refer to differences including the access to treatment, prevention, or rehabilitation; inequalities in mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study for Socioeconomic Inequalities in Health among Jordanian Adolescents

Alshammari

Pikó

2019

Journal of High Institute of Public Health

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Background: Socioeconomic inequalities play an important role in health. Although studies report less inequalities in adolescent health compared to other age groups, there may be differences in their health behavior and mental health. Objective(s): This cross-sectional pilot study aimed to analyze these associations. Methods: Using a sample of students (n = 112, aged 13-18 years) data were collected from public and private schools in Irbid governorate, Jordan, November, 2018. Measurements included socioeconomic status indicators (education and income of the parents, assessed by the adolescent), the Global School-based Student Health Survey, health behaviors (tobacco use, personal hygiene, dietary behavior), Satisfaction with Life Scale, Center for Epidemiological Studies Depression Scale for Children. Results: The results indicated that there was a significant association between the family affluence and both paternal (p= 0.003) and maternal educational levels (p= 0.008). There was a relationship between paternal education and not having enough food at home (p= 0.006), adolescents' eating fruit per week (p= 0.037), and washing their hands before eating (p= 0.004). Maternal education level was related to the students' eating vegetables (p= 0.011) and fruits (p = 0.030) per week. The association of family affluence with eating fast food was significant (p= 0.05). The relationship of depression and family affluence was linear. Conclusion: Our findings suggest that adolescents' health behavior may dominantly be related to paternal education, while their mental health may be related to family affluence. The data of this study will help in establishing effective and efficient counseling and support intervention programs.

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Modeling the intersectionality of processes in the social production of health inequalities

Cited by 64 publications

References 21 publications

Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

Intersectional inequalities and the U.S. opioid crisis: challenging dominant narratives and revealing heterogeneities

A Pilot Study for Socioeconomic Inequalities in Health among Jordanian Adolescents

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