International Journal for Equity in Health最新文献

{"title":"Public assistance program and food diversity among older people: a cross-sectional study using the Japan Gerontological Evaluation Study data : Public assistance program and food diversity.","authors":"Kotone Tanaka, Daisuke Nishioka, Atsushi Nakagomi, Keiko Ueno, Kazushige Ide, Shiho Kino, Nobuko Murayama, Katsunori Kondo","doi":"10.1186/s12939-025-02494-3","DOIUrl":"10.1186/s12939-025-02494-3","url":null,"abstract":"<p><strong>Background: </strong>Food diversity plays an important role in people's healthy and affluent lives. However, poverty and eating alone can create multi-dimensional barriers to food diversity. Although public assistance programs guarantee a minimum income to people in need, financial support alone may not be sufficient to support the health of people in poverty. This study aimed to identify the differences in food diversity intake between older recipients of public assistance and non-recipients.</p><p><strong>Methods: </strong>This cross-sectional study utilized data from the Japanese Gerontological Evaluation Study (2022), involving 14,467 participants aged 65 years and older. The Dietary Variety Score (DVS), ranging from 0 to 10 (higher scores indicate higher dietary variety), assessed dietary diversity based on the regular consumption of ten food groups. Receiving public assistance was categorized as \"yes\" or \"no.\" Eating together was defined as eating with others every day. To assess the relationship between receiving public assistance and the DVS, we calculated the unstandardized coefficient (β) and p values using a general linear model. Additionally, the interaction between public assistance and eating together was examined. As covariates, we adjusted for sociodemographic factors such as age, disease, marital status, and living alone.</p><p><strong>Results: </strong>Men recipients of public assistance had a lower DVS, even after adjusting for sociodemographic factors (adjusted β: -0.72, p = 0.04). For women, no association was seen between receiving public assistance and a lower DVS (adjusted β: -0.19, p = 0.66). An interaction between public assistance and eating together was observed among men (p = 0.07).</p><p><strong>Conclusions: </strong>Even after adjusting for sociodemographic factors, men recipients of public assistance have less food diversity than non-recipient men. Men recipients were more likely to increase their food diversity by eating together. To ensure recipients' rights to food security, the public assistance program should provide additional support to integrate recipients into communities that enable them to eat together in addition to providing financial support.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"134"},"PeriodicalIF":4.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985738","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":"Community participation through women's health collectives promoted by India's National Urban Health Mission: a realist evaluation in Chhattisgarh state.","authors":"Shriyuta Abhishek, Samir Garg, Mukesh Dewangan, Ashu Sahu, Lalita Xalxo, Prabodh Nanda, Pradeep Tandan, M Jawed Quereishi, Anand Kumar Sahu","doi":"10.1186/s12939-025-02498-z","DOIUrl":"https://doi.org/10.1186/s12939-025-02498-z","url":null,"abstract":"<p><strong>Background: </strong>The urban poor especially women slum dwellers face health inequity including disproportionate challenges in participating meaningfully in government programmes on health and its social determinants. To allow equitable participation of the urban poor in health, India's National Urban Health Mission has promoted women's health collectives known as the Mahila Arogya Samitis (MAS) in urban slums since 2013. No evaluations of this important government initiative are available.</p><p><strong>Methods: </strong>A realist evaluation was conducted. A sequential exploratory mixed-method approach involving the following steps was applied - 1) Developing the Initial Programme Theory on action and outcomes of MAS; 2) Testing the programme theory through quantitative and qualitative methods; and 3) Refining and consolidating the theory.</p><p><strong>Results: </strong>Over three years preceding the survey, 59.1% of MAS in Chhattisgarh had taken action on healthcare related problems, 74.1% on food-security and nutrition, 60.8% on gender-based violence, 56.4% on drinking water, 70.8% on sanitation and 64.1% on social environment related issues. Around 95.3% MAS had taken action on at least one of the above six domains. The community participation through MAS was not limited to increased uptake of healthcare services but to a wider people-centred agenda on social determinants of health. The MAS were able to devise multiple strategies for identifying and solving the problems. Participatory selection of women as MAS members, autonomy in decision making, appropriate training design, regular meetings and facilitation provided to MAS by the community health workers emerged as the main enablers to their human-rights orientation and action. Their work is facilitated by the supervisory cadre under the Mitanin program under the leadership of State Health Resource Centre. The social recognition gained by women members of MAS acted as the key source of motivation to sustain their action. However, there are limitations to the actions taken by MAS. The action taken by MAS remained limited to their immediate surroundings, and they were unable to improve public accountability at the higher echelons, or bringing policy-level changes.</p><p><strong>Conclusion: </strong>The MAS experience in Chhattisgarh offers an example of effective community participation of urban poor in health through a process that empowers the underprivileged women. Equitable community processes require appropriate design and need to be nurtured through capacity building and facilitation guided by a similar ethos. The government can further enhance community participation and advance equity in health by allowing collectives such as the MAS a greater say in health planning and monitoring.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"132"},"PeriodicalIF":4.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007210","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":"Precision public health after Covid-19: a scoping review.","authors":"Martha Kenney, Laura Mamo","doi":"10.1186/s12939-025-02489-0","DOIUrl":"10.1186/s12939-025-02489-0","url":null,"abstract":"<p><p>\"Precision public health\" (PPH) emerged in 2015 as a charismatic vision to revolutionize traditional public health with data-driven solutions to the world's most challenging public health problems. A central goal of PPH is to use population-level data to improve health equity by targeting geographically localized at-risk populations. For this article, we conducted a scoping review to investigate whether and how PPH approaches were used for Covid-19 pandemic response and how they incorporated health equity goals in their approaches. We found that during the Covid-19 pandemic, discussions of PPH in the academic literature mostly focused on potential future implementation of PPH rather than on-the-ground Covid-19 pandemic response. In the few articles that described a research project and/or public health intervention at the intersection of PPH and Covid-19, researchers articulated PPH together with three sets of Covid-19 era public health practices: 1) vulnerability indexes; 2) near real-time surveillance; 3) pathogen sequencing. In each of these articulations, the most common method for achieving health equity was using epidemiological surveillance data to create risk stratification to direct resources to the most vulnerable. As these new articulations are tentative and have not yet become common in public health literature and policy, the article ends with a critical call to interrogate which versions of health equity are enacted and foreclosed in data-driven approaches to public health and how PPH can best serve vulnerable populations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"129"},"PeriodicalIF":4.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025776","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":"Independent and joint associations of sex and birth order with non‑national immunization program vaccine coverage among Chinese children: a cross-sectional analysis.","authors":"Hongyu Cai, Yaguan Zhou, Anna Heng Du, Yu Wang, Qian Long, Holly Seale, Shenglan Tang, Xiaolin Xu","doi":"10.1186/s12939-025-02502-6","DOIUrl":"https://doi.org/10.1186/s12939-025-02502-6","url":null,"abstract":"<p><strong>Background: </strong>In response to declining fertility rates, China implemented universal two- and three-child policies, leading to an increase of multi-child families. However, little is known whether and how these policy changes influenced the uptake of non-National Immunization Program (non-NIP) vaccines. We evaluated associations of sex and birth order with non-NIP vaccine coverage in 1-6-year-old children in China.</p><p><strong>Methods: </strong>Our study was a cross-sectional survey of caregivers of 1-6-year-old children in Zhejiang and Henan Provinces in 2022. We obtained information on sex, birth order, vaccination history, and family socio-demographics and determined uptake of five commonly-used non-NIP vaccines for infants [Haemophilus influenza b (Hib), varicella, rotavirus, enterovirus 71 (EV71), and 13-valent pneumococcal (PCV13) vaccines]. Children were considered vaccinated if they received the first dose of at least three of these vaccines. Log-binomial regression models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for independent and joint associations of sex and birth order with non-NIP vaccine coverage, and multiplicative and additive interactions of sex and birth order.</p><p><strong>Results: </strong>A total of 1611 children with accompanying parents/guardians were included in the survey; 48.0% (n = 773) were girls; the median age was 3.3 years (interquartile range 2.0-4.8); and 824 (51.1%) were first-born children, 578 (35.9%) were second-born children, and 209 (13.0%) were third-or-later born children. Coverage of non-NIP vaccines varied by sex and birth order, ranging from 58.2% for first-born boys to 28.4% for third-or-later born girls. Coverage among girls was less than among boys (PR: 0.91, 95% CI: 0.82-1.00), but the sex differences were not significant after adjusting for sociodemographic factors (PR: 0.94, 95% CI: 0.86-1.03). Compared with first-born children, coverage PRs were 0.85 (0.76-0.93) for second-born children and 0.82 (0.65-1.00) for third-or-later born children (p for trend < 0.001). Sex and birth order had joint effects on coverage, with the lowest coverage PRs in the third-or-later born girls (0.71, 95% CI: 0.49-0.97), compared to first-born boys. Multiplicative interactions of sex and birth order were significant (PR: 0.86, 95% CI: 0.75-0.98 in second-born girls).</p><p><strong>Conclusions: </strong>Birth order of children was independently associated with non-NIP vaccines coverage, whereas sex showed no significant. However, sex and birth order were jointly associated with receipt of non-NIP vaccines, with later born children and girls having significantly lower coverage than first-born boys. In the context of the three-child policy in China, interventions to promote non-NIP vaccine equity should consider children's sex and birth order.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"131"},"PeriodicalIF":4.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970671","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":"Refining the definitions of cultural safety, cultural competency and Indigenous health: lessons from Aotearoa New Zealand.","authors":"Elana Curtis, Belinda Loring, Rhys Jones, David Tipene-Leach, Curtis Walker, Sarah-Jane Paine, Papaarangi Reid","doi":"10.1186/s12939-025-02478-3","DOIUrl":"https://doi.org/10.1186/s12939-025-02478-3","url":null,"abstract":"<p><p>Eliminating Indigenous and ethnic health inequities requires culturally-competent and culturally-safe health workforces and systems. Health professional training institutions and regulatory bodies are increasingly including cultural competency and cultural safety in health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. In 2019, we published a review of international understandings of these terms, and proposed an Indigenous-led definition for cultural safety that we believed to be more fit for purpose in achieving health equity. We also clarified essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The aim of this paper is to share our expert reflections upon the experience over the six years since 2019, of implementing this definition in an Aotearoa New Zealand (NZ) context. Recent work undertaken with health regulatory bodies in NZ to refine the understandings of cultural competency, cultural safety and Indigenous health has extended our positioning on these important concepts. A practical example of how these related but distinct concepts apply to Indigenous health is presented.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"130"},"PeriodicalIF":4.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022176","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":"Examining pathways between structural stigma and tobacco use: a comparison among young adults living in the United States by sexual orientation and gender identity.","authors":"Wilson Figueroa, Srinivasan Sridhar, Emma Jankowski, Alysha Ennis, Anne Trinh, Eric Seiber, Joanne G Patterson","doi":"10.1186/s12939-025-02487-2","DOIUrl":"https://doi.org/10.1186/s12939-025-02487-2","url":null,"abstract":"<p><strong>Background: </strong>Sexual and gender minority young adult (SGM YA) populations use tobacco at higher rates than their non-SGM YA peers. Prior studies have identified significant correlations between interpersonal stigma and tobacco use, yet structural stigma may also influence tobacco use among SGM YA. This study aimed to assess the indirect effects of structural stigma on current tobacco use among SGM YA and non-SGM YA via depletion of economic resources, interpersonal discrimination, and perceived psychological stress.</p><p><strong>Methods: </strong>Structural Equation Modeling was used to conduct a secondary data analysis from a cross-sectional parent study. Eligible participants were 18-35 years old and currently residing in the U.S. (N = 2,649). Current use of combustible cigarettes and nicotine vapes was our dependent variable. Our independent variable of interest, structural stigma, was a latent variable comprised of three state-level indicator items: Attitudes toward SGM people, SGM protective policies (absence of), and SGM discriminatory policies (introduced or passed in 2022). We assessed three mediators of interest: Depletion of economic resources was a latent variable, which included two indicator items: food insecurity and financial strain. Interpersonal discrimination and perceptions of psychological stress were also assessed. Covariates included race/ethnicity, age, and educational attainment.</p><p><strong>Results: </strong>Structural stigma was indirectly associated with current tobacco use via depletion of economic resources for SGM YA, but not non-SGM YA. Structural stigma was not indirectly associated with current tobacco use via interpersonal discrimination or psychological stress for either group.</p><p><strong>Conclusions: </strong>Future tobacco intervention research should consider the role of structural stigma when working with SGM YA; specifically, how interventions promoting economic stability may influence tobacco use and cessation in this population.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"128"},"PeriodicalIF":4.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970670","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":"On equal footing? The impact of patient companions on Lifeworld integration and patient-centeredness in linguistically diverse emergency consultations.","authors":"Antoon Cox, Marianne Couillard Larocque, Nicolas Dauby, Yvan Leanza","doi":"10.1186/s12939-025-02425-2","DOIUrl":"https://doi.org/10.1186/s12939-025-02425-2","url":null,"abstract":"<p><strong>Introduction: </strong>Patient companions (PCs) can have an ambiguous impact on the quality of communication during multilingual medical consultations and therefore on health outcomes. Studies of multilingual medical consultations have focused mainly on PCs' role as interpreters, with less regard to other roles they may take up. This paper uses mixed methods to investigate PC role dynamics in multilingual PC-mediated consultations and how they affect the management of a patient's Lifeworld, a crucial element for history taking and rapport building.</p><p><strong>Methods: </strong>Nine recordings of multilingual PC-mediated consultations from a Brussels emergency department, complemented with ethnographic notes and clinician interviews, were subjected to linguistic-ethnographic analysis and a codification of communication patterns and PC roles to explore the link between PC roles and Lifeworld management. PC roles were grouped into four stances (Linguistic agent, Lifeworld agent, System agent, and Principal). The communication patterns were grouped into three categories (\"strictly medicine\", \"Lifeworld heard/included\", and \"Lifeworld interrupted\").</p><p><strong>Results: </strong>In ED consultations, patients' Lifeworld frequently remains inadequately addressed, primarily due to physician interruptions. Significant associations are observed between roles taken up by PCs and the way patients' Lifeworld is managed. Successful integration of Lifeworld aspects is best supported by PCs taking up the role of System agent, possibly because it allows them to link the Lifeworld directly to medical issues. Linguistic-ethnographic analysis reveals how language barriers, PC role changes and Lifeworld management strategies are taking shape organically (often implicitly) determined by a wide range of situational factors, such as the complexity of the topic, the available (non)verbal linguistic repertoire, the level of meta-communication, explicit role negotiation and timing.</p><p><strong>Conclusion: </strong>Since poor Lifeworld management negatively impacts care, clinicians should be trained to detect and manage role dynamics and relevant situational factors in PC-mediated multilingual consultations to protect patients' right to high-quality communication and healthcare.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"126"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018880","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":"Universal health coverage in fragile and conflict-affected States: insights from Somalia.","authors":"Zlatko Nikoloski, Mubarik M Mohamoud, Elias Mossialos","doi":"10.1186/s12939-025-02486-3","DOIUrl":"https://doi.org/10.1186/s12939-025-02486-3","url":null,"abstract":"<p><strong>Introduction: </strong>Achieving Sustainable Development Goal (SDG) 3, which focuses on health, and more specifically SDG 3.8-universal health coverage (UHC)-by 2030 remains a critical objective for all nations. This paper presents an updated evaluation of Somalia's progress toward UHC. Additionally, by identifying key barriers to achieving UHC in Somalia, this study offers insights that may be valuable for other conflict-affected and post-conflict countries striving to improve healthcare access and financial protection.</p><p><strong>Methodology: </strong>To assess Somalia's progress at various levels, we developed a UHC index incorporating access to essential healthcare services and financial risk protection. Furthermore, we employed standard analytical methods, including equity analysis and logit modelling, to examine the key factors influencing both healthcare access and the financial burden associated with seeking medical care.</p><p><strong>Results: </strong>With an overall UHC index score of 33.5, Somalia ranks lowest among the countries previously analysed. While there is some regional variation in UHC scores, these differences are not as pronounced as the disparities in poverty rates, resulting in a weak correlation between regional socio-economic development (measured by poverty levels) and overall UHC performance. Equity analysis highlights that socio-economic status, educational attainment, and, to a lesser extent, healthcare infrastructure significantly contribute to disparities in access to essential health services, favouring wealthier populations. Additionally, financial risk protection analysis indicates that the most economically disadvantaged groups are at a higher risk of experiencing catastrophic healthcare expenditures.</p><p><strong>Implications: </strong>Given Somalia's ongoing security challenges, achieving SDG 3.8 by 2030 remains a formidable task. However, targeted interventions that address key determinants-such as household income, education levels, and healthcare infrastructure-could help improve access to essential health services and reduce financial barriers to care.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"125"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026531","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 equity and COVID-19 vaccine policies for pregnant people: a global analysis.","authors":"Eleonor Zavala, Elizabeth Doggett, Andrew Nicklin, Ruth A Karron, Ruth R Faden","doi":"10.1186/s12939-025-02497-0","DOIUrl":"https://doi.org/10.1186/s12939-025-02497-0","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing vaccine availability and evidence and expert recommendations to support administration, some countries maintained restrictive policies regarding COVID-19 vaccination in pregnancy throughout the pandemic. This global analysis explores the role of gender equity, country income level, and vaccine availability in predicting national policies on COVID-19 vaccine administration in pregnancy.</p><p><strong>Methods: </strong>Policies were collected from May 2021 to January 2023 from 224 countries/territories using publicly available information posted on national public health authority web pages. Policies were categorized into 6 types, representing different levels of permissiveness, from recommended for some or all to not recommended, and changes in national policies were captured over time. Outcomes were defined as: 1) prevalence of restrictive policies at a specific time point; 2) country-level change from restrictive policy/no position at an earlier time point to a permissive policy at a later timepoint. Simple and multivariable logistic regressions were performed to explore the association between the outcomes and potential policy predictors, including income level, mRNA vaccine availability, and the Global Gender Gap Index (GGGI).</p><p><strong>Results: </strong>Complete cross-sectional data were available for 114 countries as of June 2021, 137 countries as of October 2021, and 142 countries as of March 2022. The number of maternal immunization policies increased and became steadily more permissive between 2021 and 2022. Availability of mRNA vaccines and higher income level were associated with reduced odds of a restrictive policy at the 2021 timepoints, and higher GGGI scores were associated with reduced odds of restrictive policies at all timepoints. After adjusting for income level and mRNA vaccine availability, higher GGGI scores reduced the relative odds of a restrictive COVID-19 vaccine policy by 10% (aOR: 0.90, 95CI: 0.81, 0.99) in October 2021 and 14% (aOR: 0.86, 95%CI: 0.76, 0.97) in March 2021. Higher GGGI scores were also associated with increased odds of a policy switch from restrictive/no position in June 2021 to permissive in October 2021 (aOR: 1.12, 95%CI: 1.00, 1.24).</p><p><strong>Conclusions: </strong>Gender inequity was associated with greater odds of a restrictive policy for use of COVID-19 vaccines in pregnancy, suggesting that gender biases may influence fair policymaking for pregnant people in pandemic preparedness and response.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"127"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006980","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":"Forgone and delayed care in Germany- inequalities and perceived health risk of unmet need.","authors":"Jens Klein, Daniel Lüdecke, Olaf von dem Knesebeck","doi":"10.1186/s12939-025-02483-6","DOIUrl":"https://doi.org/10.1186/s12939-025-02483-6","url":null,"abstract":"<p><strong>Background: </strong>Subjective unmet need is an established indicator of unequal access to medical care and is often measured by delaying and forgoing medically necessary treatment. Research on delayed and forgone care among the general population in Germany including different reasons, social deprivation measures, and the perceived health risk of unmet need is sparse. This study aims to examine reasons, inequalities, and health-related consequences of unmet need in terms of delayed and forgone care.</p><p><strong>Methods: </strong>A cross-sectional online survey was carried out based on a randomly drawn sample of the German adult population in December 2022 (N = 2,201). Respondents were asked whether medical treatments were delayed or forgone in the past 12 months due to different reasons (waiting time, travel distance, financial costs). If unmet need was indicated, the respondents were subsequently asked about their perception of related health risks. Associations with individual social (sex, age, migration history, education, income) and regional factors (social deprivation) as well as insurance status were examined using multilevel logistic regressions analyses.</p><p><strong>Results: </strong>Among N = 1,955 respondents who indicated need for medical care, 30% reported at least one reason for forgone care (waiting time 23%, financial costs 11%, travel distance 9%). In terms of delayed care, highest rate was found for waiting time (34%). Multilevel analyses revealed significant associations of unmet need with female sex, younger age, lower education, lower income, and statutory health insurance. Associations varied depending on the reason for unmet need. Differences in regional social deprivation were particularly found for forgone care due to distance. Between half and nearly two-thirds of the participants reported worsening of symptoms in case of unmet need. Associations with social characteristics were inconsistent.</p><p><strong>Discussion: </strong>Unmet need is a prevailing issue in Germany and associated with perceived worsening of health, various indicators of social inequality, and health insurance. Reducing waiting times (e.g. through the further development of appointment service centres) and private co-payments as well as ensuring health care provision in deprived areas can contribute to a decrease of barrier-related unmet need and health risks. However, more in-depth studies are required to account for the complex nature of health care access.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"122"},"PeriodicalIF":4.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021937","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}