Relationship between classic indicators of health behaviour and contraceptive choices in women in Flanders.

BACKGROUND: In this study we shed light on ongoing trends in contraceptive use in Flanders (Belgium). Building on the fundamental cause theory and social diffusion of innovation theory, we examine socio-economic gradients in contraceptive use and the relationship to health behaviours. METHODS: Using the unique and recently collected (2020) ISALA data, we used multinomial logistic regression to model the uptake of contraceptives and its association to educational level and health behaviour (N:4316 women). RESULTS: Higher educated women, and women with a healthy lifestyle especially, tend to use non-hormonal contraceptives or perceived lower-dosage hormonal contraceptives that are still trustworthy from a medical point of view. Moreover, we identified a potentially vulnerable group in terms of health as our results indicate that women who do not engage in preventive health behaviours are more likely to use no, or no modern, contraceptive method. DISCUSSION: The fact that higher educated women and women with a healthy lifestyle are less likely to use hormonal contraceptive methods is in line with patient empowerment, as women no longer necessarily follow recommendations by healthcare professionals, and there is a growing demand for naturalness in Western societies. CONCLUSION: The results of this study can therefore be used to inform policy makers and reproductive healthcare professionals, since up-to-date understanding of women's contraceptive choices is clearly needed in order to develop effective strategies to prevent sexually transmitted infections and unplanned pregnancies, and in which women can take control over their sexuality and fertility in a comfortable and pleasurable way.

Deprivation as a fundamental cause of morbidity and reduced life expectancy: an observational study using German statutory health insurance data.

Across all developed countries, there is a steep life expectancy gradient with respect to deprivation. This paper provides a theoretical underpinning for this gradient in line with the Grossman model, indicating that deprivation affects morbidity and, consequently, life expectancy in three ways: directly from deprivation to morbidity, and indirectly through lower income and a trade-off between investments in health and social status. Using rich German claims data covering 6.3 million insured people over four years, this paper illustrates that deprivation increases morbidity and reduces life expectancy. It was estimated that highly deprived individuals had approximately two more chronic diseases and a life expectancy reduced by 15 years compared to the least deprived individuals. This mechanism of deprivation is identified as fundamental, as deprived people remain trapped in their social status, and this status results in health investment decisions that affect long-term morbidity. However, in the German setting, the income and investment paths of the effects of deprivation were of minor relevance due to the broad national coverage of its SHI system. The most important aspects of deprivation were direct effects on morbidity, which accumulate over the lifespan. In this respect, personal aspects, such as social status, were found to be three times more important than spatial aspects, such as area deprivation.

A Matter of Time: Racialized Time and the Production of Health Disparities.

An expansive and methodologically varied literature designed to investigate racial disparities in health now exists. Empirical evidence points to an overlapping, complex web of social conditions that accelerate the pace of aging and erodes long-term health outcomes among people of color, especially Black Americans. However, a social exposure-or lack thereof-that is rarely mentioned is time use. The current paper was specifically designed to address this shortcoming. First, we draw on extant research to illustrate how and why time is a critical source of racial disparities in health. Second, we employ fundamental causes theory to explain the specific mechanisms through which the differential distribution of time across race is likely to give rise to unequal health outcomes. Finally, we introduce a novel conceptual framework that identifies and distinguishes between four distinct forms of time use likely to play an outsized role in contributing to racial disparities in health.

Mechanism substitution in preventive innovations: Dissecting the reproduction of health inequalities in the United States.

In the last three decades, numerous studies in different countries have corroborated the main postulates of the Fundamental Cause Theory (FCT), providing evidence showing how health inequalities are reproduced as society increases its capacity to control disease and/or avoid its consequences through preventive innovations. However, documenting the reproductive logic proposed by the theory requires the development of a dynamic analytical approach to consider socioeconomic disparities in the incorporation of multiple preventive innovations over time, which could act as mediating mechanisms of the durable relationship between socioeconomic status and health/mortality. This study draws on data from different waves of the National Health Interview Survey and the National Health and Nutrition Examination Survey to analyze the diffusion processes of various innovations in the U.S. The results of the study show that educational inequalities emerge, are amplified, and are reduced by the continuous diffusion of preventive innovations, supporting the meta-hypothesis of substitution of mediating mechanisms according to the interconnections of FCT and Diffusion of Innovation Theory.

"Whoever takes the dog gets the house": How older adults negotiate, budget, and deploy resources for multispecies family health and well-being.

In this study, we interrogate the ways that older adult pet owners exercise their agency within the limits of their social statuses to allocate their resources for the management of the health needs of their multispecies families. Guided by fundamental cause theory, we consider how the participants' memberships in socially constructed categories can impact their experiences with household health management. We conducted focus groups with 30 community-dwelling older adults who owned pets. Using a thematic analytic approach, we found that the participants' bonds with their pets led them to negotiate priorities and make concessions for the benefit of the household.

Did Resilience and Socioeconomic Status Predict Older Adults' Finding a Silver Lining in COVID?

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic stretched our limits-physically, mentally, and economically. However, some older adults report that it led to positive changes. This study aims to understand whether prepandemic resilience, education, or income predicted older adults' subsequent likelihood of reporting positive changes in their lives during the pandemic. Research Design and Methods: We use data from the National Social Life, Heath, and Aging Project, an ongoing panel study with a COVID-19 ancillary supplement (N = 2,650). Results: The study results aligned with the fundamental cause theory. In demographically adjusted models including resilience, education, and income, as well as the effect of the pandemic on employment and a COVID-disruption score, the odds of reporting any positive change were 2.6 times higher for those with an associate degree (p < .01) and 4.7 times higher for those with a bachelor's or higher (p < .001), compared to those without a high school degree. In contrast, neither resilience nor income was significantly associated with endorsing a positive change. We also categorize specific changes thematically coded from open-ended responses and examine their demographic distributions. Categories include spirituality, home organization, hygiene practices, and increased quality time with others. Discussion and Implications: These findings show that older adults with more education could navigate COVID-19 challenges in a way that improved their perspectives on at least one aspect of their lives.

Socioeconomic status and disparities in COVID-19 vaccine uptake in Eastern Oslo, Norway.

Objective: The objective of this study was to assess whether socioeconomic status still remain a barrier to COVID-19 vaccination in eastern Oslo, Norway. Study design: A cross-section study. Methods: We conducted a web-based survey among the residents of six eastern parishes in Oslo, Norway. Text (SMS) messages were sent to 59978 potential participants. 5447 surveys were completed for a response rate of 9.1%. After removing participants who had not been offered the COVID-19 vaccine, we ended up with a valid sample of 4000. Results: We find a significant association between education and the likelihood of taking the COVID-19 vaccine in bivariate logistic regression. Further, we find a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group. However, when we add control variables to the regression, the significant results concerning both income and education are eliminated. In further analysis, we found that age worked as a moderator between socioeconomic status and vaccine uptake: In the youngest age group (18-29), we found a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group, and in the higher education group compared to the primary education group. Conclusion: Socioeconomic status remains a barrier to COVID-19 vaccination in the eastern parishes of Oslo, Norway. Indicating that Norwegians of lower socioeconomic status still disproportionately face barriers such as transportation, language, flexible work hours, and paid sick time. However, our analysis shows that this association is only found in the age group 18-29.

Educational Disparities in Hypertension Prevalence and Blood Pressure Percentiles in the Health and Retirement Study.

OBJECTIVES: Hypertension and uncontrolled high blood pressure (BP) are more prevalent among less-educated older adults than those with more schooling. However, these dichotomous indicators may fail to fully characterize educational disparities in BP, a continuous measure that predicts morbidity and mortality across much of its range. This study therefore focuses on the distribution of BP, assessing educational disparities across BP percentiles in addition to disparities in hypertension and uncontrolled BP. METHODS: Data are from the 2014-2016 Health and Retirement Study, a nationally representative survey of older U.S. adults (n = 14,498, ages 51-89). To examine associations between education, hypertension, and uncontrolled BP, I estimate linear probability models. To assess relationships between education and BP, I fit linear and unconditional quantile regression models. RESULTS: Less-educated older adults are not only more likely to have hypertension and uncontrolled BP than those with more schooling, they also have higher systolic BP across nearly the entire BP distribution. Educational disparities in systolic BP increase in magnitude across BP percentiles and are largest at the highest levels of BP. This pattern is observed for those with and without diagnosed hypertension, is robust to early-life confounders, and is only partially explained by socioeconomic and health-related circumstances in adulthood. DISCUSSION: Among older U.S. adults, the distribution of BP is compressed at lower, healthier levels for those with more education, and skewed toward the highest, most harmful levels among those with less education. Educational inequities in hypertension awareness and treatment efficacy may underlie these patterns. Implications for fundamental cause theory are discussed.

Health disparity in the spread of COVID-19: Evidence from social distancing, risk of interactions, and access to testing.

OBJECTIVE: - To identify and assess whether three major risk factors that due to differential access to flexible resources might help explain disparities in the spread of COVID-19 across communities with different socioeconomic status, including socioeconomic inequalities in social distancing, the potential risk of interpersonal interactions, and access to testing. METHODS: Analysis uses ZIP code level weekly COVID-19 new cases, weekly population movement flows, weekly close-contact index, and weekly COVID-19 testing sites in Southern California from March 2020 to April 2021, merged with the U.S. census data to measure ZIP code level socioeconomic status and cofounders. This study first develops the measures for social distancing, the potential risk of interactions, and access to testing. Then we employ a spatial lag regression model to quantify the contributions of those factors to weekly COVID-19 case growth. RESULTS: Results identify that, during the first COVID-19 wave, new case growth of the low-income group is two times higher than that of the high-income group. The COVID-19 case disparity widens to four times in the second COVID-19 wave. We also observed significant disparities in social distancing, the potential risk of interactions, and access to testing among communities with different socioeconomic status. In addition, all of them contribute to the disparities of COVID-19 incidences. Among them, the potential risk of interactions is the most important contributor, whereas testing accessibility contributes least. We also found that close-contact is a more effective measure of social distancing than population movements in examining the spread of COVID-19. CONCLUSION: - This study answers critically unaddressed questions about health disparities in the spread of COVID-19 by assessing factors that might explain why the spread is different in different groups.

Impacts of the New York State COVID-19 disaster emergency orders on prescription dispensing for opioids and medication for opioid use disorder.

AIMS: The aim of this study is to examine whether the March 2020 New York State (NYS) SARS-CoV-2 emergency orders were associated with an initial surge in opioid dispensing and a longer-term reduction in access to medications for opioid use disorder (MOUD). DESIGN: Time-series analyses of the dispensing of non-MOUD opioid and MOUD prescriptions using IQVIA's longitudinal prescription claims database (n = 16 087 429) in NYS by week, from 1 January 2018 to 31 July 2020. IQVIA is a multi-national company that provides biopharmaceutical development and commercial outsourcing services. SETTING AND PARTICIPANTS: NYS Zone Improvement Plan (ZIP) codes (n = 1218) in which prescriptions were dispensed. MEASUREMENT: For each ZIP code, for each week, the following dispensing measures were calculated: total weekly morphine milligram equivalents/day (MME/day), total weekly MME/day dispensed via prescriptions for ≤ 7 days and the count of MOUD prescriptions dispensed. Differences in dispensing metrics, comparing each week in 2020 with corresponding weeks in 2019, were calculated for each ZIP code. RESULTS: During the study period, weekly MME/day per ZIP code of dispensed non-MOUD opioids steadily declined. Compared with the difference in dispensing between 2019 and 2020 during the first week in 2020, there was a significantly larger drop in dispensed weekly total MME/day beginning 21 March 2020, and lasting until the week of 17 April (P < 0.05 for each week). Mean weekly total MME/day dispensed from 21 March to 17 April 2020 was 17.07% lower [95% confidence interval (CI) = 13.97%, 20.17%] than in the 4 weeks before 21 March almost entirely due to a drop in MME/day dispensed for prescriptions of ≤ 7 days. There was not a discernable drop in MOUD dispensing associated with the period of the emergency orders. CONCLUSIONS: New York State emergency orders in March 2020 to reduce SARS-CoV-2 transmission and preserve hospital capacity appeared to be associated with a decline in dispensing of opioids not used as MOUD. Access to MOUD appeared to be unaffected by the orders, probably because of policy initiatives by the Substance Abuse and Mental Health Services Administration.

Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage.

BACKGROUND: Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. OBJECTIVE: This study aimed to review the literature on how multiple disadvantage-specifically, older age, lower socioeconomic status, and limited English proficiency-has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. METHODS: Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. RESULTS: Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. CONCLUSIONS: A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities.

Time availability as a mediator between socioeconomic status and health.

This study shows that time availability is a significant mediator between SES and health. I draw on representative survey data from the Canadian Multinational Time Use Survey and supplement this data source with a second data set containing localized sociodemographic and time availability measures. In addition to testing existing time scarcity measures, I also propose a broader set of new, more inclusive measures. Analyses involve two stages. First, binary logistic regressions evaluate statistically significant relationships. The second stage uses mediation analyses to assess whether time availability is statistically significant in mediating the relationship between SES and self-reported health. I compute direct, indirect, and total effects, independently for each of the objective and subjective time availability measures, for both the nationally representative sample and for the localized sample. My results show that both time scarcity and time excess are important when examining the mechanisms linking SES and health. For example, 12 percent of the effect of household-level SES on health is via discretionary time availability. Further, over 10 percent of the effect of neighborhood-level SES on health is via subjective time scarcity. Objective time poverty mediates about 9 percent. 7.3 percent of the effect of SES on health is via objective time excess. Considering the differing temporal needs of marginalized populations, this work has important health policy implications for sociotemporal disparities in health.

Health and health behaviors in China: Anomalies in the SES-health gradient?

Objectives: Fundamental Cause Theory (FCT) predicts that higher socioeconomic status (SES) leads to better health outcomes, through mechanisms including health-promoting behaviors. Most studies supporting FCT use data from Western countries. However, limited empirical studies from China, as well as theoretical considerations suggested by China's unique history and culture, raise questions about the generalizability of FCT to the Chinese context. This study explores whether the associations between SES, health behaviors, and health status in Western countries are also observed in China, and to what extent behavioral risk factors explain socioeconomic disparities in Chinese health. Data and method: Using data on adults age 45+ from the nationally-representative 2015 China Health and Retirement Longitudinal Study (CHARLS; n = 14,420), we conduct regressions of multiple health outcomes (self-rated health, disease count, and several common chronic conditions) on demographic characteristics, SES (measured via education and wealth), and behavioral risk factors (smoking, high-frequency drinking, and overweight). To assess whether behavioral risk factors mediate the SES-health association, we use the Karlson, Holm and Breen (KHB) mediation analysis method. Results: Supporting FCT, both education and wealth predict higher self-rated health and lower risk of arthritis. However, inconsistent with FCT, neither education nor wealth predict disease count, diabetes, or hypertension; education shows some positive association with cardiovascular disease; and higher SES is strongly associated with higher risk of dyslipidemia. Prevalence of smoking and high-frequency drinking are flat by wealth and inversely U-shaped by education, while overweight is somewhat concentrated in the highest SES groups. Results of mediation analyses show both suppression and mediation effects. Conclusion: High prevalence of behavioral risk factors across SES groups appears to damage health in much of the Chinese population, and thus attenuates social gradients in health. A broader range of cultural, historical, and political factors should be incorporated into FCT's theoretical framework, particularly in non-Western contexts.

Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers.

Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted. CONTEXT: Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators. METHODS: Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality. FINDINGS: An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities. CONCLUSIONS: Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.

Material Insecurity, Racial Capitalism, and Public Health.

In the influential 1995 article "Social Conditions as Fundamental Causes of Disease," Bruce Link and Jo Phelan described social and political factors as "fundamental causes" of death and disease. Whitney Pirtle has recently declared racial capitalism another such fundamental cause. Using the case of the water crisis in Flint, Michigan, she has argued that racial capitalism's role in that situation meets each of the criteria Link and Phelan's article outlines: racial capitalism influenced multiple disease outcomes, affected disease outcomes through multiple risk factors, involved access to flexible resources that can be used to minimize both risks and the consequences of disease, and was reproduced over time through the continual replacement of intervening mechanisms. We argue for Pirtle's conclusion using the extensive literature on racial capitalism and case studies concerning housing in the United States and Brazil and what Naomi Klein has termed "corona capitalism" in India. If races correspond to hierarchies of material security, as suggested by Ruth Wilson Gilmore, then these hierarchies and their causal effects are fundamental determinants of public health.

The intersection of race and opioid use disorder treatment: A quantitative analysis.

INTRODUCTION: Racial health inequities exist in the United States. Racial minorities and whites have different health care experiences and health outcomes. Past studies examined this relationship for health care treatment, but additional research on whether and how race affects treatment for opioid use disorder (OUD) is needed. Based on systematic racism theory, this study examines the relationship between race and OUD treatment in three ways, representing three different phases in the treatment process: referral source for treatment, whether the treatment plan includes medications for OUD (MOUD), and reason for discharge. METHODS: This study examines the relationship between race and treatment for OUD. The study uses data from the 2013 and 2017 Treatment Episode Data Set Discharges (TEDS-D) dataset to run logistical and multinomial regression models. RESULTS: This study found that a relationship between race and treatment for OUD exists in all three areas that we examined. Specifically, this study found that being a minority was associated with a decreased likelihood of being referred to treatment by a medical professional, a decreased likelihood of having MOUD as part of the treatment plan (although the opposite was true in 2013), and a decreased likelihood of leaving treatment because the treatment episode was complete. CONCLUSION: Policymakers should use these findings to develop policy interventions for OUD that recognize the systematic racism that exists rather than our current colorblind policies.

An examination of socioeconomic and racial/ethnic disparities in the awareness, knowledge and utilization of three colorectal cancer screening modalities.

While colorectal cancer (CRC) mortality rates have been decreasing, disparities by socioeconomic status (SES) and race/ethnicity persist. CRC screening rates remain suboptimal among low SES and racial/ethnic minority populations, despite the availability of multiple screening modalities. Understanding awareness, knowledge, and utilization of common screening modalities within different racial/ethnic and SES groups is critical to inform efforts to improve population screening uptake and reduce disparities in CRC-related health outcomes. Through the theoretical lenses of diffusion of innovation and fundamental cause theory, we examined the associations of race/ethnicity and SES with awareness, knowledge, and utilization of three guideline recommended CRC screening strategies among individuals at average risk for CRC. Data were obtained from a survey of a nationally representative panel of US adults conducted in November 2019. The survey was completed by 31.3% of invited panelists (1595 of 5097). Analyses were focused on individuals at average risk for CRC, aged 45-75 for awareness and knowledge outcomes (n = 1062) and aged 50-75 for utilization outcomes (n = 858). Analyses revealed racial/ethnic and SES disparities among the three CRC screening modalities, with more racial/ethnic and SES differences observed in the awareness, knowledge, and utilization of screening colonoscopy and mt-sDNA than FIT/gFOBT. Patterns of disparities are consistent with previous research showing that inequities in social and economic resources are associated with an imbalanced adoption of medical innovations. Our findings demonstrate a need to increase awareness, knowledge, and access of various CRC screening modalities in specific populations defined by race/ethnicity or SES indicators. Efforts to increase CRC screening should be tailored to the needs and social-cultural context of populations. Interventions addressing inequalities in social and economic resources are also needed to achieve more equitable adoption of CRC screening modalities and reduce disparities in CRC-related health outcomes.

A cross-sectional study on the determinants of health-related quality of life in the Philippines using the EQ-5D-5L.

PURPOSE: The purpose of this study was to identify the determinants of Filipinos' health-related quality of life (HRQoL). METHODS: Data were collected from 1000 Filipinos across the nation who reported that they did not have known active disease or disability. HRQoL was measured through EuroQoL's (EQ) 5-level tool (EQ-5D-5L) and the EQ Visual Analog Scale (EQ-VAS). Both were implemented via the EQ Valuation Technology software. HRQoL was regressed on socioeconomic characteristics (age, sex, marital status, educational attainment, employment, poverty status, and availability of savings), social support factors (religion, religious attendance, and caregiving status), community- or societal-level factors (type and major island group of residence), and disease status. RESULTS: Majority of respondents reported that they did not have any problems across all EQ-5D-5L dimensions, namely mobility, self-care, usual activity, pain or discomfort, and anxiety or depression. Pain or discomfort had the highest rate of respondents reporting slight to extreme problems followed by anxiety or depression. Having savings was positively associated with HRQoL, while religious attendance, caregiver status, living in an urban area, living in Visayas or Mindanao, and having a diagnosed disease were negatively associated with HRQoL. CONCLUSION: This current study confirms that HRQoL varied across socioeconomic statuses and communities in the Philippines.

Medical innovations can reduce social inequalities in health: an analysis of blood pressure and medication in the HUNT study.

This paper examines whether the use of blood pressure medication has an influence on social inequalities in blood pressure levels. In Norway, cardiovascular disease has for decades been associated with high mortality and social inequalities. High blood pressure is an important risk factor in this aspect, and prescription drugs have been established as a standard treatment of hypertension. We have seen population blood pressure levels fall, blood pressure inequality levels remaining stabile, and medication use increase. The paper uses panel data from the Nord-Trøndelag Health Study linked with registry data on education and income. Results from fixed effects regression analyses indicate that blood pressure medication overall has a levelling effect. The traditional social gradient is mainly found among non-users of medication. With blood pressure medication being plausibly at a late stage of its diffusion, these findings give some support to the hierarchical diffusion model, while they also imply the need for equal access to sufficient blood pressure treatment.

Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.

Fundamental cause theory (FCT) is among the most widely recognised and accepted social science frameworks used to examine the processes driving health inequalities. Despite the wide influence of the theory, it remains largely underutilised in practical and applied research on health disparities. This paper proposes that Pierre Bourdieu's theories of capital and symbolic power can be integrated with FCT to address limitations in the latter theory, making it more useful in health disparities research. Using a case study of U.S. health insurance claim denials for genetic testing among women with a breast cancer diagnosis, this work illustrates how the theoretical constructs of FCT and Bourdieu's work articulate, and consequently deepens our appreciation for the durable relationship between socioeconomic status and health. Study results reveal the multiple and complex mechanisms that play a role in access to healthcare services, which has significant implications for how we think about the role of health policy in addressing health disparities.