International Journal for Equity in Health最新文献

{"title":"Long-term trends and factors associated with migrant participation in Korea's National Health Screening Program: a nationwide retrospective population-based study.","authors":"Woojin Jang, Hyeon-Kyoung Cheong, YongJoo Rhee, In-Hwan Oh","doi":"10.1186/s12939-026-02941-9","DOIUrl":"10.1186/s12939-026-02941-9","url":null,"abstract":"<p><strong>Background: </strong>Migrant health is an increasingly important future determinant of population health in Korea due to growing migrant numbers. Preventive care inequalities affecting migrants may receive limited attention, however because of relative health advantages at their time of arrival and because downstream adverse outcomes may not yet be apparent in this group. In this context, Korea's National Health Screening Program (NHSP), which is largely free at the point of use, provides a valuable window into early disparities in preventive care participation. We aimed to quantify 15-year disparities in Korea's National Health Screening Program (NHSP) participation between migrants and non-migrants, identify associated factors, and assess the persistence of these gaps, even among long-term enrollees after covariate adjustment.</p><p><strong>Methods: </strong>In this retrospective population-based cohort study using linked nationwide administrative data from the Korean National Health Insurance Service and National Health Screening Program records, 1,244,820 migrants and 2,050,771 non-migrants eligible in 2022 were analyzed. Annual participation trends from 2008 to 2022 were examined using crude and age-standardized rates. Multivariable logistic regression among individuals continuously enrolled for ≥ 10 years assessed the independent association of migrant status with ever having undergone screening by 2022.</p><p><strong>Results: </strong>Age-standardized participation rates were consistently lower among migrants throughout 2008-2022. In 2022, crude participation was 40.3% among migrants and 53.5% among the non-migrant comparison group, whereas age-standardized rates were 31.5% and 38.8%, respectively. Among long-term enrollees, migrants had significantly lower adjusted odds of ever having undergone screening by 2022 (adjusted OR 0.18, 95% CI 0.18-0.19).</p><p><strong>Conclusions: </strong>Screening participation disparities persisted throughout the study period and remained evident even among migrants continuously enrolled in National Health Insurance for more than a decade. After multivariable adjustment, this disparity was more pronounced than the crude comparisons suggested. In the context of Korea's ongoing demographic change, these findings underscore the importance of early identification and management of migrant screening inequalities. Migrant-tailored, multilingual, and navigation-supported strategies are needed to reduce the risk of preventive care gaps becoming more deeply rooted health inequalities.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420734","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":"Financial strain and sleep problems in the United Kingdom: longitudinal patterns by race-ethnicity.","authors":"Lei Chai, Cheng Chow, Kazumi Tsuchiya","doi":"10.1186/s12939-026-02931-x","DOIUrl":"10.1186/s12939-026-02931-x","url":null,"abstract":"<p><strong>Background: </strong>Financial strain is a well-established risk factor for poor sleep, yet few studies have examined whether this association varies by race-ethnicity, particularly using longitudinal data. This study investigates the relationship between financial strain and multiple dimensions of sleep, including sleep quality, sleep disturbance, daytime dysfunction, sleep latency, and sleep medication use, across White, Black, Mixed, Asian, and Other racial-ethnic groups.</p><p><strong>Methods: </strong>Data were drawn from Waves 4, 7, 10, and 13 of the UK Household Longitudinal Study (N = 36,544 individuals; 114,164 person-years). Fixed-effects regression models were applied to assess within-person changes over time.</p><p><strong>Results: </strong>Financial strain was associated with poorer outcomes across all sleep dimensions. These associations varied by race-ethnicity: they were stronger among Asian individuals than among their White counterparts. Further disaggregation revealed that this pattern was particularly pronounced among Pakistani individuals but not among other Asian subgroups.</p><p><strong>Conclusions: </strong>By revealing subgroup-specific disparities, particularly among Pakistani individuals, this study underscores the importance of tailoring public health strategies to address the combined effects of financial strain and racial-ethnic identity, thereby advancing equity in sleep health and overall well-being.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411662","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":"Restoring self-esteem and quality of life through multidisciplinary care: a cross-sectional evaluation of the Panzi One-Stop Centre model among rape survivors in Eastern Democratic Republic of Congo.","authors":"Samuel Kasereka Musisiva, Géant Chuma Basimine, Juvenal Bazilashe Mukungu Balegamire, Ida Andersen, Adelaide Blavier","doi":"10.1186/s12939-026-02936-6","DOIUrl":"10.1186/s12939-026-02936-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sexual violence in conflict settings is a major public health and social justice issue with long-lasting psychological consequences. In the Democratic Republic of Congo (DRC), the Panzi One-Stop Centre model provides integrated medical, psychosocial, legal, and socio-economic support to rape survivors. However, evidence on how different combinations of services are associated with psychosocial well-being and equity in health outcomes remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional study in July 2025 among 314 rape survivors who had received care between 2022 and 2024 in Eastern DRC. Self-esteem and life satisfaction were assessed using validated scales. Sociodemographic data and care pathways were collected through structured interviews. Standardised scores were analyzed using correlation and regression analyses, while analysis of variance (ANOVA) was used to compare mean standardised scores between pillars. General linear models (GLMs) were used to examine associations between sociodemographic factors, care configuration, self-esteem, and life satisfaction. Standardized regression coefficients (β) are reported throughout.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Average life satisfaction was low, whereas self-esteem was moderately low, with substantial variability across participants. Survivors who were classified in care configurations including a combination of three care pillars (medical, psychosocial and socio-economic support), trend to show the slightly higher observed psychosocial well-being scores, although confidence intervals (CI) overlapped across several subgroups. Medical-only care was associated with comparatively lower observed scores. Employment was positively associated with self-esteem, whereas perceived social support appeared to be more consistently associated with life satisfaction than with self-esteem. A positive association was observed between the number of care pillars utilised and both self-esteem and life satisfaction. Care configurations including the socio-economic pillar tended to display a more pronounced positive relationship between self-esteem and life satisfaction. However, subgroup comparisons should be interpreted cautiously because several groups had small sample sizes and overlapping confidence intervals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Integrated multidisciplinary care was positively associated with psychosocial well-being among survivors. Variations observed across different combinations of care pillars suggest that equitable access to holistic services may be related to differences in recovery indicators. These findings highlight the potential relevance of ensuring the continuity and availability of multidisciplinary services for survivors of sexual violence in conflict-affected settings. However, given the cross-sectional nature of the study, these findings should be interpreted as descriptive associations rather than evidence of causal effects","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411654","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":"Heat exhaustion, domestic heat exposure and socioeconomic disparities among older adults: a cross-sectional mediation analysis from Germany.","authors":"Catherina Heinken, Saskia Muellmann, Tilman Brand, Thomas Behrens, Swaantje Casjens, Jacob Spallek, Jonas Frost, Nadine Glaser, Nils Opel, Janka Massag, Rafael Mikolajczyk, Michael Gekle, Irene Moor, Oliver Tüscher, Michael Heuser, Benjamin Schüz, Hajo Zeeb","doi":"10.1186/s12939-026-02934-8","DOIUrl":"10.1186/s12939-026-02934-8","url":null,"abstract":"<p><strong>Background: </strong>Older adults are particularly vulnerable to the effects of heatwaves and extreme heat due to physiological changes often exacerbated by chronic diseases and decreased mobility. Although cool indoor temperatures can moderate the health consequences of extreme outdoor heat to some extent, it is important to recognize that access to cool indoor temperatures is distributed unequally across population groups. This study aimed to assess the mediating effect of (indoor) domestic heat exposure on the relationship between socioeconomic position and heat exhaustion in older adults.</p><p><strong>Methods: </strong>In August 2024, 10,000 participants from the DigiHero cohort were invited to take part in an online survey. Of the 5,026 respondents, persons aged 65 or older were included in the analysis (n = 1,457). Domestic heat exposure was assessed through self-reported indoor temperatures during the day and at night, as well as the availability of cooler rooms at night. Heat exhaustion was measured using self-reported symptoms. Income and education were used as indicators for socioeconomic position. We applied structural equation modelling to assess the total impact of socioeconomic position (education/income) on heat exhaustion and the portion of this effect mediated through domestic heat exposure. Additionally, the analyses were stratified by sex/gender and degree of urbanization.</p><p><strong>Results: </strong>In the study sample, 54% were female; mean age was 72.8 (SD = 5.1); 50% had a high education level; and 70% were not exposed to domestic heat. Lower income and education were linked to more frequent symptoms of heat exhaustion. Lower income, but not education, was associated with higher domestic heat exposure which mediated the income-heat exhaustion relationship (total effect β = -0.09 (-0.14, -0.03); indirect effect β = -0.01 (-0.02, -0.003)). Sex/gender-stratified analyses showed these associations only among women. Sensitivity analyses indicated a stronger mediation in urban settings.</p><p><strong>Conclusion: </strong>The analysis revealed that lower income result in more frequent symptoms of heat exhaustion in older women, partially due to differential domestic heat exposure. Potential sex/gender differences in the effects of heat exposure warrant further exploration.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404480","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":"Is traditional Chinese medicine service accessibility associated with health inequality? Evidence from the distribution of health capital among rural residents in China.","authors":"Na Xiong, Yingxin Lin, Haitao Cui","doi":"10.1186/s12939-026-02942-8","DOIUrl":"10.1186/s12939-026-02942-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Health inequality remains a persistent challenge in rural areas, where limited healthcare accessibility is often associated with lower levels of health capital. In China, traditional Chinese medicine (TCM) service accessibility constitutes an important component of the rural healthcare system. However, whether and to what extent TCM service accessibility is associated with health capital and health inequality remains insufficiently understood. This study investigates whether, and through which mechanisms, TCM service accessibility is associated with health capital among rural residents and whether it is associated with lower health inequality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study uses micro-level survey data from 12860 rural residents across six provinces in China, combined with county-level healthcare resource statistics. The empirical strategy includes multivariate regression, instrumental variable estimation, mediation analysis, heterogeneity analysis, and inequality decomposition. Health capital is measured using a composite index constructed from four standardized dimensions: self-rated health, activities of daily living, chronic disease status, and objective physiological indicators (including blood pressure and fasting blood glucose). These indicators are aggregated using principal component analysis (PCA), with the first principal component used as the health capital index. TCM service accessibility is operationalized along three dimensions: supply availability, geographical accessibility, and individual utilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results show that greater TCM service accessibility is significantly associated with higher levels of health capital among rural residents. Specifically, a 0.1-unit increase in TCM service accessibility corresponds to an increase of approximately 0.021 units in the health capital index. The estimated effects exhibit significant heterogeneity, with larger magnitudes among individuals with poorer baseline health and lower income levels, and in settings with higher levels of social support. From an equity perspective, TCM service accessibility shows an equalizing association with the distribution of health capital, with a contribution share of -0.10 and an estimated contribution corresponding to approximately 0.030 of the health capital Gini coefficient. This represents the largest equalizing association among all examined factors, including income, education, and Western medical resources. Quantile regression results further indicate that the estimated effect at the 10th percentile of the health capital distribution is four times larger than that at the 90th percentile, suggesting larger estimated associations for disadvantaged groups. Mediation analysis suggests that healthcare utilization and health behavior are key potential pathways linking TCM service accessibility to health capital, with the total mediating effect accounting for 47.6% of the overall","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404533","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":"Associations between government-supported institutional long-term care and health outcomes among socioeconomically disadvantaged older adults in China.","authors":"Qiufeng Gao, Yuxin Jiang, Xintong Wang, Bei Zhou, Yaojiang Shi","doi":"10.1186/s12939-026-02940-w","DOIUrl":"10.1186/s12939-026-02940-w","url":null,"abstract":"<p><strong>Introduction: </strong>Although Long-Term Care (LTC) benefits aging populations, evidence on government-supported LTC for socioeconomically disadvantaged older adults in low- and middle-income countries remains limited. This study examines how government-supported institutional LTC is associated with physical and mental health outcomes among welfare-dependent older adults in rural China.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted among 313 welfare recipients aged 60 and above in Shaanxi Province. Health outcomes were assessed using validated measures of physical health (self-rated health, pain, functional limitations) and mental health (depression, anxiety, loneliness). Regression models and propensity score matching were used to examine associations, and potential mechanisms were further explored.</p><p><strong>Results: </strong>Government-supported institutional LTC was significantly associated with better physical and mental health, particularly higher self-rated health (ATT = 0.177, p = 0.005; β = 0.079, p = 0.006) and lower anxiety (ATT=-0.288, p < 0.001; β=-0.146, p = 0.016). Longer stays were associated with more favorable health patterns. Mechanism analyses suggested that these associations may relate to age-friendly environments, improved healthcare access, enhanced social participation, and better nutritional conditions. Heterogeneity analyses indicated the associations were stronger among older, illiterate individuals and those with family guardians, particularly male guardians.</p><p><strong>Conclusions: </strong>This study provides robust empirical evidence of associations between government-supported institutional LTC and better health outcomes among socioeconomically disadvantaged older adults, highlighting its potential role in enhancing well-being in rural settings. These findings emphasize the importance of expanding equitable, integrated, and high-quality LTC services to support sustainable, person-centered aging care for vulnerable populations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396296","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":"Encapsulating the burden and social determinants of self-reported general health problems among a specific sub-group of transgender women in Dhaka, Bangladesh: a mixed-methods study.","authors":"Sharful Islam Khan, Samira Dishti Irfan, Md Masud Reza, Wasifa Tasnim Shamma, Sazzad Hossain Khan, Mohammad Sha Al Imran, Sahadat Hossain","doi":"10.1186/s12939-026-02932-w","DOIUrl":"10.1186/s12939-026-02932-w","url":null,"abstract":"<p><strong>Background: </strong>In Bangladesh and other resource-constrained settings, a sub-group of transgender women (predominantly known as hijra in South Asia) encounter systemic marginalization, which unfairly predisposes them to health disadvantages. Although studies are beginning to illuminate the emerging burden of various communicable and non-communicable diseases, the global scholarship has predominantly confined these marginalized people within HIV/STI research framework. Our study explored the burden of diverse self-reported health problems and their underlying contexts among hijra in Dhaka, Bangladesh.</p><p><strong>Methods: </strong>A mixed-methods cross-sectional study was conducted among 483 hijra. The quantitative component applied systematic sampling approaches from eight drop-in centers. Moreover, in-depth interviews and focus group discussions were convened with hijra and key-informant interviews with hijra leaders known as hijra guru, DIC staff, and public health experts. Qualitative findings were manually analyzed using the social determinants of health framework and equity lenses, within the domain of thematic analysis.</p><p><strong>Results: </strong>Hijra living in Dhaka, Bangladesh reported heightened levels of general health ailments, exacerbated by the stigma, socio-economic marginalization, and limited healthcare access. Findings reflected high health burdens (58.4% with at least one ailment in the past year); self-reported mental health concerns (61.3%), anal conditions (55.7%), cold/cough (51.1%), asthma (41.5%), hypertension (33.3%), and diabetes (24.8%). Qualitative findings linked these health ailments to various contexts underpinned by structural inequities and social determinants, e.g. mental health concerns were linked to educational and familial exclusion, infectious diseases were exacerbated by poor living conditions, and non-communicable diseases were perpetuated by food insecurities and hormone intake linked to occupational risks.</p><p><strong>Conclusion: </strong>Findings demonstrated the burden and variegated contexts of general health problems among hijra. However, these problems are often buried beneath the HIV paradigm. Their health problems were linked to structural inequities, marginalization, and healthcare constraints, and these inequities need to be addressed to ensure their health and wellbeing. Solely biomedical and public health frameworks may not suffice for hijra, rather we need to move towards a comprehensive equity-oriented approach.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387258","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":"Medical deserts and uneven access: a U.S.-anchored critical conceptual review.","authors":"Ki Jun Kang","doi":"10.1186/s12939-026-02937-5","DOIUrl":"10.1186/s12939-026-02937-5","url":null,"abstract":"<p><strong>Background: </strong>Medical desert terminology is used inconsistently across rural health, health services research, and health policy. In some studies, it describes structural scarcity of local services. In others, it is used for waiting time, affordability, quality, or sociocultural barriers. This inconsistency blurs three different tasks: defining an underserved place, measuring that place, and explaining why people in the same place experience access differently.</p><p><strong>Methods: </strong>This U.S.-anchored critical conceptual review draws together literature on desert terminology, access theory, rural service erosion, and medical mistrust.</p><p><strong>Results: </strong>Medical deserts are defined here as structurally underserved places where needed services are locally unavailable, hard to reach, unstable, or difficult to replace after service loss. Institutional credibility and medical mistrust are treated as related explanatory dimensions of realized access. The review presents a heuristic that links structural access and institutional credibility while keeping them analytically distinct, and it outlines a multilevel measurement agenda for structural access, credibility, mistrust, and realized access.</p><p><strong>Conclusions: </strong>This distinction may sharpen health equity research and policy by separating service infrastructure from the conditions that make care usable.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375772","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 the impact of inequity on the attainment of health results in the African Region: a methodological exploration.","authors":"Humphrey Karamagi, Sokona Sy, Joseph Mung'atu, Anabay Mamo, Bertha Kembabazi, Hillary Kipruto, Benson Droti","doi":"10.1186/s12939-026-02935-7","DOIUrl":"10.1186/s12939-026-02935-7","url":null,"abstract":"<p><strong>Background: </strong>The core of Universal Health Coverage (UHC) is ensuring everyone can access essential health services without financial hardship, shifting focus from specific interventions to individual outcomes. Yet, in the WHO African region, there remains a critical gap in understanding the interrelations of the dimensions of health inequities with each other, and with health outcomes. This paper explores the interrelations among inequity drivers to inform their prioritization in each country of the region.</p><p><strong>Methods: </strong>This study analysed the association of the commonly used eight drivers of health inequity (independent variable): residence, ethnicity, occupation, gender, religion, education, socioeconomic status, and social capital, with differences in health results across countries (dependent variable). UHC indices served as the indicators for the dependent variable. Data came from the Demographic and Health Surveys with normalized indices for ethnicity and religion from prior studies. Missing values were imputed. Principal Component Analysis generated weighted composite indices, and inequity gaps were normalized to a 0-1 scale. Partial Least Squares regression examined relationships while addressing multicollinearity. Model validation used Root Mean Square Error of Prediction and explained variance, verified against known country-level inequity patterns.</p><p><strong>Results: </strong>Health inequity in the WHO African Region shows marked disparities, with an average composite gap of 0.49 (± 0.038) on a 0-1 scale. Angola (0.79), Kenya (0.68), and Chad (0.67) record the highest inequities, while Algeria and Equatorial Guinea (0.31) show greater equity. Ethnicity is the strongest driver (0.65), creating 30% more disparity than wealth (0.55) or social capital (0.56). Four latent variables emerged as drivers of inequity and explained up to 77% of the variance in UHC service coverage across countries. These are personal characteristics, geographic residence, social networks, and socioeconomic position.</p><p><strong>Conclusion: </strong>The major emerging drivers of inequity are not the same drivers of inequality. It is more targeted to focus on deciphering the four emerging latent variables as drivers of inequities to align with the need for person-centred health services required in the PHC approach for attaining UHC results - a shift away from the common programmatic focus of the eight drivers of inequality.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375745","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":"Worrying about future finances and sleep problems: loneliness as a psychosocial pathway.","authors":"Lei Chai, Xuejie Ding","doi":"10.1186/s12939-026-02921-z","DOIUrl":"10.1186/s12939-026-02921-z","url":null,"abstract":"<p><strong>Background: </strong>This study provides the first longitudinal evidence on whether anticipatory financial strain, defined as worrying about one's future finances, is associated with loneliness and sleep problems, whether loneliness mediates the association between anticipatory financial strain and sleep problems, and whether these relationships vary by gender.</p><p><strong>Methods: </strong>Using Waves 10 and 13 of the United Kingdom Household Longitudinal Study, corresponding to fieldwork conducted in 2018-2020 and 2021-2023, respectively (20,355 individuals; 40,710 person-wave observations), fixed-effects regression models were estimated to assess within-person changes over time. Sleep problems were measured using five PSQI-derived indicators. Mediation was assessed using the Karlson-Holm-Breen method, and moderation was examined using interaction terms.</p><p><strong>Results: </strong>Anticipatory financial strain-expecting to be worse off rather than the same or better off-was associated with higher loneliness and worse outcomes on specific sleep dimensions, including poorer sleep quality and greater sleep disturbance. Loneliness partially mediated the association between anticipatory financial strain and these sleep outcomes. In contrast, anticipatory financial strain was not significantly associated with sleep latency, daytime dysfunction, or sleep medication use. Gender did not moderate the association between anticipatory financial strain and loneliness or most sleep dimensions, with the exception of sleep medication use.</p><p><strong>Conclusions: </strong>Interventions and policies aimed at reducing financial uncertainty, alongside strategies that strengthen social connections and reduce loneliness, may help mitigate sleep problems among individuals experiencing heightened economic worry.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360387","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}