International Journal for Equity in Health最新文献

{"title":"Understanding the profile of community health workers in breast cancer screening education: women's preferences and insights from a qualitative focus group study.","authors":"Ilka Jacobs, Dorien Vanden Bossche, Sara Willems, Katrien Vanthomme","doi":"10.1186/s12939-025-02508-0","DOIUrl":"10.1186/s12939-025-02508-0","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"193"},"PeriodicalIF":4.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of fragmented care on cancer outcomes among korean women with breast and cervical cancer: a focus on regional and economic disparities.","authors":"Sun Jung Kim, Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Seojin Park, Kyu-Tae Han","doi":"10.1186/s12939-025-02542-y","DOIUrl":"10.1186/s12939-025-02542-y","url":null,"abstract":"<p><strong>Background: </strong>The patterns of breast and cervical cancers have improved owing to national cancer control over the past decades, but the disparity in medical resources and increasing number of patients with cancer in the capital area have worsened. Previous studies have revealed the association of fragmented care (FC) with health disparities; however, studies have been lacking in women's cancers and outcomes. The study aims to examine the impact of FC in women with breast and cervical cancers and compare them according to health disparity factors.</p><p><strong>Methods: </strong>Data used from the National Health Insurance (NHI) claim data from 2011 to 2021. Female patients with cancer aged ≥ 30 years were selected as the participants. The final population-based sample included 84,931 patients with breast cancer and 14,520 patients with cervical cancer. Regression and survival analyses were conducted to investigate the associations between length of stay (LOS), medical expenditure, 5-year mortality, and FC. Subgroup analyses were performed based on residential areas, type of hospital with major cancer treatment, and economic level to compare differences in the association with FC.</p><p><strong>Results: </strong>Of the 84,931 patients with breast cancer and 14,520 with cervical cancer, 13,946 (16.4%) and 1,674 (11.5%) experienced FC, respectively. The LOS (Breast: RR 1.18, 95% CI 1.14-1.23; Cervical: RR 1.47, 95% CI 1.33-1.61) and medical expenditure (Breast: RR 1.08, 95% CI 1.07-1.10; Cervical: RR 1.49, 95% CI 1.39-1.59) were higher for patients with FC compared to those without. Higher risk of mortality was observed among patients with cervical cancer with FC (HR 1.48, 95% CI 1.33-1.65), but no significant association was observed in breast cancer (HR 0.95, 95% CI 0.87-1.03). These associations were greater in patients who lived in metropolitan areas, had a low economic status, or visited low-level hospitals.</p><p><strong>Conclusion: </strong>FC can negatively affect the efficiency of healthcare delivery, resulting in excessive medical expenditures and deterioration of health outcomes. These associations may be greater under conditions of disparities in cancer care such as accessibility.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"192"},"PeriodicalIF":4.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare professionals' advocacy strategies for trans-inclusive primary care: a qualitative analysis.","authors":"Inna Blus-Kadosh, Gilly Hartal","doi":"10.1186/s12939-025-02547-7","DOIUrl":"10.1186/s12939-025-02547-7","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"188"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between oral health-related quality of life and structural determinants of health among elderly populations. a systematic review and meta-analysis.","authors":"Roberta Borg-Bartolo, Andrea Roccuzzo, Karla Gambetta-Tessini, Martin Schimmel, Pedro Molinero-Mourelle, Gabriela Sabatini, Martina Ferrillo, Marcella Esteves-Oliveira, Rodrigo A Giacaman, Christian Tennert, Guglielmo Campus","doi":"10.1186/s12939-025-02557-5","DOIUrl":"10.1186/s12939-025-02557-5","url":null,"abstract":"<p><strong>Background: </strong>Oral diseases disproportionately affect poorer and disadvantaged groups of society. Despite this, there is scarce evidence regarding the monitoring of the structural determinants of health and their impact on oral health status. Thus, this systematic review addresses the question: Is oral health-related quality of life (OHRQoL) of elderly persons (aged ≥ 60 years) associated with structural determinants of health?</p><p><strong>Methods: </strong>The present systematic review of observational studies applied the following inclusion and exclusion criteria; inclusion criteria: participants living in the community aged ≥ 60 years, reporting OHRQoL using Oral Health Impact Profile (OHIP), Geriatric Oral Health Assessment Index (GOHAI) or Oral Impact Daily Profile (OIDP).</p><p><strong>Exclusion criteria: </strong>studies reporting outcomes of participants aged < 60 years and residing in long-term care facilities. Three electronic databases (i.e., Embase, MEDLINE via Pubmed and Scopus) were screened (last searched on 23rd August 2024). Quality assessment of the included studies was performed using the tailored quality assessment tool developed by the National Heart, Lung and Blood Institute for observational cohort and cross-sectional studies. Meta-analysis; the overall sum score of OHIP, GOHAI and OIDP were transformed on a scale of 0-100. Sub-group analyses were performed for OHRQoL sum scores stratified by the following variables: Country-level income, Gini index, unemployment rate, Human Development Index (HDI), out-of-pocket health expenditure, health expenditure per capita, prevalence of dental caries, edentulism and periodontal disease.</p><p><strong>Results: </strong>The search identified 910 records. After deduplication, title, abstract and full-text review, 45 papers were included for data extraction. The highest OHRQoL sum scores were recorded in studies from countries with high-middle to high income (77.9, 95% CI 70.2-85.6), low Gini index (91.3, 95% CI 90.0-92.6), high to very high HDI (78.4, 95% CI 71.1-85.8) and lowest out-of-pocket expenditure (83.9, 95% CI 75.2-92.6). Countries with low dental caries prevalence reported higher OHRQoL compared to countries with high dental caries prevalence (81.5, 95% CI 76.5-86.6). Limitations include the fair quality of > 50% of the studies included and the high inter- study heterogeneity.</p><p><strong>Conclusions: </strong>Structural determinants of health contribute to a good quality of life related to oral health. Upstream interventions are essential for improving oral health conditions and quality of life among older adults.</p><p><strong>Registration: </strong>The review protocol was registered (CRD42024573590) with the International Prospective Register of Systematic Reviews (PROSPERO) system.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"189"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-biased diagnosis and treatment of depression: considering our blind eye on men's depression.","authors":"Andreas Walther","doi":"10.1186/s12939-025-02569-1","DOIUrl":"10.1186/s12939-025-02569-1","url":null,"abstract":"<p><p>The commentary explores the critical issue of gender bias in the diagnosis and treatment of depression, responding to the study by Bacigalupe et al. [3] that highlights disparities in mental health care for older adults. While acknowledging the study's strengths, it argues for deeper exploration into systemic biases and gendered symptomatology. Women's frequent healthcare interactions increase their likelihood of diagnosis and treatment, while men's reluctance to seek help often results in delayed or missed diagnoses, further complicated by male-typical externalizing symptoms like aggression, risk-taking, and substance abuse. Traditional diagnostic tools and criteria, rooted in prototypical internalizing symptoms, fail to adequately capture these male-typical presentations.The commentary also underscores the role of traditional masculinity ideologies (TMI) in shaping men's mental health behaviors. These socially constructed norms promote emotional suppression and self-reliance, exacerbating gender role conflict, dysfunction and discrepancy stress, thereby reducing help-seeking behaviors. High conformity to TMI correlates with poor therapeutic outcomes, higher dropout rates, and diminished treatment efficacy. The commentary critiques the dual bias evident in overmedicalizing women's mental health while neglecting masculine expressions of distress, advocating for gender-sensitive diagnostic reforms.In conclusion, the commentary calls for equitable mental health care frameworks that recognize diverse depressive manifestations across genders. Addressing these biases through gender-sensitive practices and diagnostic adjustments can bridge disparities, reduce over- or under-treatment, and foster inclusivity in mental health care systems, ensuring better outcomes for all individuals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"190"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health equity and system resilience during crises - ensuring healthcare for refugees based on lessons from Iran's response to the 2021 Afghan migration.","authors":"Zahra Karimian, Asgar Aghaei Hashjin, Saverio Bellizzi, Volker Winkler","doi":"10.1186/s12939-025-02564-6","DOIUrl":"10.1186/s12939-025-02564-6","url":null,"abstract":"<p><strong>Background: </strong>Sudden influxes of displaced populations can strain health systems, especially in low- and middle-income countries. Iran hosts one of the world's largest migrant and refugee populations -predominantly from Afghanistan - and provides inclusive access to public health and education services. In August 2021, the crisis in Afghanistan triggered a sharp increase in Afghan arrivals to Iran, raising healthcare demand amid the COVID-19 pandemic. This study examines how one of the largest public health networks in Tehran responded to this surge and the resulting impact on equitable service coverage and system resilience.</p><p><strong>Methods: </strong>We retrospectively analyzed monthly healthcare utilization data over a 13-month period (February 2021-February 2022) from the largest public health network in western Tehran, which serves approximately 5.5 million residents, including nearly 1 million migrants and refugees. Patients were categorized into six demographic subgroups: children, women of childbearing age, adolescents, young adults, middle-aged adults, and the elderly. Changes in the number and proportion of patients receiving the full Essential Health Service Package (EHSP) were assessed using six-month pre-/post-event comparisons, with statistical significance determined via chi-square tests (p < 0.05).</p><p><strong>Results: </strong>The total number of patients served increased eight-fold, from 88,091 in February 2021 to 717,382 in February 2022. In the six-month period following the crisis, the number of Afghan patients receiving full EHSP coverage rose by 84,522; however, the proportion of full-service coverage declined by 3.2%. Children were the most affected subgroup: despite 2,739 additional patients receiving full services, their coverage rate fell by 10.6%. In contrast, young Afghan adults experienced an increase in both number and proportion of patients receiving full services (+ 25,421, + 1.2%). All subgroup changes were statistically significant (p < 0.001).</p><p><strong>Conclusions: </strong>Although the public health network rapidly expanded service delivery, maintaining proportional coverage for full services proved challenging, particularly for vulnerable groups. Even established health systems with decades of experience in serving displaced populations may face transient coverage shortfalls amid demand surges compounded by pandemic-related strain. Strengthening public health emergency management through targeted resource allocation, surge capacity, and real-time monitoring of coverage indicators is essential to sustaining health equity and system resilience during future crises.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"191"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12218945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-pocket cost and financial catastrophe of patients with cancer: the alarming cost-of-illness in Bangladesh.","authors":"Abdur Razzaque Sarker, Rasedul Islam, An Tran-Duy","doi":"10.1186/s12939-025-02421-6","DOIUrl":"10.1186/s12939-025-02421-6","url":null,"abstract":"<p><strong>Background: </strong>Out-of-pocket (OOP) cost of cancer treatment has increased substantially globally. In low- and middle-income countries, many patients face financial distress due to cancer. For patients with cancers in Bangladesh, this study aimed to (1) estimate the annual OOP cost of cancers from households' perspective, (2) assess the coping strategies and financial distress, and (3) examine factors associated with OOP cost.</p><p><strong>Methods: </strong>We used data from a cross-sectional hospital-based survey conducted in three randomly selected hospitals in Bangladesh. A bottom-up micro-costing approach was used to estimate the OOP cost components. We used the logistic regression model and the generalized linear model to examine the determinants of distress financing and OOP cost, respectively.</p><p><strong>Results: </strong>The average annual OOP cost per cancer patient was US$ 6,504 (range, US$ 959 - 29,681), which was greater than 2 times the average annual household income. About 90% of households faced distress financing due to cancer. Having at least one comorbid condition, cancer stage 2 or higher, households having no elderly people, or having treatment abroad was significantly associated with a higher OOP cost compared to those without the condition.</p><p><strong>Conclusion: </strong>OOP cost of cancer treatment and the proportions of patients with distress financing and financial catastrophe are alarmingly high in Bangladesh. Earlier cancer diagnosis and implementation of Government financial health protection schemes are crucial and urgent to alleviate the enormous economic burden and ensure equitable access to care for the patients.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"186"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stigmatization and discrimination of female tuberculosis patients in Kyrgyzstan - a phenomenological study.","authors":"Rhea Brüggemann, Fabian Schlumberger, Firuza Chinshailo, Matthew Willis, Abdullaat Kadyrov, Gulmira Kalmambetova, Mo Chen, Sophie Cw Unterkircher, Nestan Moidunova, Altynai Sydykova, Anil Fastenau","doi":"10.1186/s12939-025-02566-4","DOIUrl":"10.1186/s12939-025-02566-4","url":null,"abstract":"<p><strong>Introduction: </strong>The Republic of Kyrgyzstan is among the 30 countries with the highest burden of multidrug-resistant Tuberculosis worldwide. One of the reasons is widespread stigmatization and discrimination. As previous research has shown, particularly women experience stigma while its impact on their life and (mental) health is even greater than for men. This is the first phenomenological study to explore women's lived experiences of TB-related stigmatization in Kyrgyzstan. This study aims to raise awareness about the gender-specific impact of stigmatization and discrimination.</p><p><strong>Methodology: </strong>Descriptive phenomenology was used. 15 semi-structured in-depth interviews with female TB-patients were conducted between 28th May and 14th June 2024. Themes were stigma experiences, their consequences and coping strategies. Participants were recruited from two TB Hospitals and two Family Medical Centers (primary health care units) in Bishkek through purposive sampling. The data analysis followed a thematic approach based on a combination of deductive and inductive coding.</p><p><strong>Results: </strong>14 of 15 participants experienced stigmatization and discrimination in one way or another. Anticipated stigma was very prominent, manifesting in non-disclosure of the diagnosis apart from close family. Enacted stigma mostly occurred within society or non-TB-specialized healthcare facilities. Self-stigmatization often followed anticipated and enacted stigma. Stigma experiences impacted daily and social life, marital prospects and access to educational and work opportunities but mainly led to mental health issues, which 12 of 15 participants reported.</p><p><strong>Discussion: </strong>and Conclusion. In contrast to previous research, this study did not find diagnostic delay nor non-adherence to treatment because of stigmatization and discrimination. However, experiences within the healthcare facilities impacted the perceived quality of care. Stigmatization within the family, mostly by in-laws, was anchored in the patriarchal and conservative attitudes of Kyrgyz society. Overall, key findings of this study were widespread lack of knowledge about the disease and its transmission as a reason for and mental health issues because of stigmatization and discrimination. The findings imply the need for intervention strategies and policies focusing on education about TB, integration of psychosocial support into treatment and improvements in quality of care. Altogether, this could contribute to the reduction of TB-related stigmatization and discrimination which would reduce the individual burden of TB.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"185"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to pediatric extracorporeal membrane oxygenation: a geospatial analysis of the racial/ethnic composition of areas with and without access.","authors":"Zoel A Quiñónez, Kathleen Ryan, Tristan D Margetson, Elisabeth Grosvenor, Charlotte D Smith, Laura M Diaz, Angel Benitez-Melo, Seth Hollander, Danton Char","doi":"10.1186/s12939-025-02571-7","DOIUrl":"10.1186/s12939-025-02571-7","url":null,"abstract":"<p><strong>Background: </strong>We propose that all communities should have access to lifesaving technologies like pediatric extracorporeal membrane oxygenation (ECMO), and that distance is one actionable component to accessibility. We chose to examine whether geographic access by distance to pediatric ECMO differs by race/ethnicity for populations historically excluded from health services and technologies.</p><p><strong>Methods: </strong>Population data was obtained from the US Census Bureau's American Community Survey. Pediatric ECMO program data was obtained from the Extracorporeal Life Support Organization Registry. We compared the proportion of individuals that are American Indian/Alaska Native, Black/African American, Hispanic/Latina(o), or White that live within and outside of a 200-mile distance from pediatric ECMO programs.</p><p><strong>Results: </strong>43% of the total US land area falls outside of the US catchment area for pediatric ECMO; and 4.91% of the US population (or 16,433,563 persons) does not have access to a Pediatric ECMO center. One of every four individuals that identify as American Indian/Native American, one of every 100 who identify as Black/African American, one of every 12 that identify as Hispanic/Latina(o), and one of every 21 that identify as White live outside of the pediatric ECMO catchment area for the United States.</p><p><strong>Conclusions: </strong>American Indian/Native Americans and Hispanic/Latina(o)s lack access to pediatric ECMO by proximity. While Black/African Americans live close to ECMO programs, previous studies show that this population has less access to primary and specialized care. Distance is one actionable measurement that should be used to extend access to medical technologies for populations that have historically been excluded.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"187"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple deprivations as drivers of suboptimal basic child vaccination in Latin America and the Caribbean: cross-sectional analysis of household survey data for 18,136 children across 211 regions in 15 countries.","authors":"Fato Fene, Mira Johri, Manassé Eliantus Michel, Hortensia Reyes-Morales, Blanca Estela Pelcastre-Villafuerte","doi":"10.1186/s12939-025-02561-9","DOIUrl":"10.1186/s12939-025-02561-9","url":null,"abstract":"<p><strong>Background: </strong>Latin America and the Caribbean (LAC) maintained high childhood vaccination coverage for 17 years but faced setbacks, increasing vulnerability to vaccine-preventable diseases. Despite signs of recovery, geographic inequalities and social deprivations persist. This study provides an up-to-date cross-sectional analysis of prevalence, subnational variation, and key determinants of suboptimal basic child vaccination (BCV).</p><p><strong>Methods: </strong>We produced weighted estimates of suboptimal BCV prevalence at the national and subnational levels via harmonized data from household surveys spanning a 12-year period (2011-2022) in the LAC region. Six BCV-related outcomes were analysed: completely unvaccinated, no BCG, no DTP, no OPV, no MCV and not fully vaccinated. We employed a four-level mixed-effects logistic regression to analyse determinants of suboptimal BCV and to partition the total outcome variation over country, region, primary sample units (PSUs) and child‒mother‒household levels. Choropleth maps were used to illustrate the weighted mean prevalence of subnational regions for each outcome. Additionally, sensitivity analyses were performed to validate the findings and assess robustness.</p><p><strong>Findings: </strong>A total of 18,136 children aged 12-23 months across 211 subnational regions in 15 LAC countries were analysed. The prevalence of suboptimal BCV ranged from 0.99% completely unvaccinated to 66% not fully vaccinated. Significant subnational disparities were observed: while all subnational regions in Cuba and Costa Rica had consistently low rates of completely unvaccinated children (< 3%), subnational regions or states such as Upper Takutu-Upper Essequibo and Mahaica-Berbice (Guyana) reported much higher rates, reaching 30.23% (95% CI: 9.52-50.94) and 26.56% (95% CI: 11.39-41.73), respectively. Maternal deprivation increased the risk of suboptimal BCV. The prevalence of completely unvaccinated children was significantly greater among those whose mothers did not have institutional delivery (3.35%; 95% CI: 3.07-3.63) than among those whose mothers had institutional delivery (0.74%; 95% CI: 0.70-0.79). The likelihood of suboptimal BCV outcomes increased as health services and socioeconomic deprivation intensified and intersected.</p><p><strong>Conclusions: </strong>In LACs, geographic inequalities and multiple deprivations increase the risk of suboptimal BCV. These countries should prioritize efforts to vaccinate children whose mothers lack access to one or more key health services, especially those from poor families.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"184"},"PeriodicalIF":4.5,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}