Could working less promote environmental concern? A cross-national intercohort analysis.

Working time and the environment are two important issues of our time and have attracted wide attention from both academia and the public. An emerging body of literature connects these two fields and discusses the environmental impacts of long working hours, yet little is known about how working time is related to the underlying pro-environmental attitude change. Drawing upon literature in worktime studies and environmental sociology, this study examines the extent to which working hours are associated with environmental concern, and how this relationship is contingent on the level of national economic development and cohort replacement. Cross-national intercohort analyses of four waves of ISSP data show that consistent with the political economic theories and degrowth perspective, working hours are negatively related to environmental concern. Furthermore, this association is more salient in high-income countries and intensifies among younger cohorts. This study highlights the importance of examining environmental concern in a dynamic social structure as well as the possibility of constructing a socio-ecological sustainable society.

The burden of knee osteoarthritis worldwide, regionally, and nationally from 1990 to 2019, along with an analysis of cross-national inequalities.

OBJECTIVE: To describe the disease burden of knee osteoarthritis (KOA) globally, regionally, and in 204 countries by age, sex, and sociodemographic index (SDI) from 1990 to 2019, and to explore cross-national inequalities across SDI. METHODS: The Global Burden of Disease (GBD) 2019 database collected data on KOA worldwide from 1990 to 2019, including prevalence, incidence, years lived with disability (YLDs). The average annual percentage change (AAPC) was used to measure temporal trends. In addition, the inequality slope index and the health concentration index were calculated to quantify the unequal distribution of the burden of KOA across 204 countries worldwide. RESULTS: In 2019, the global age-standardized prevalence rate increased by 7.5% compared with 1990, and the age-standardized incidence rate increased by about 6.2%; The age-standardized YLDs rate increased by about 7.8%. In addition to the Republic of Korea and the United States of America, the disease burden of KOA has increased year by year in other countries around the world. The incidence of KOA was highest at ages 50-59, while the prevalence and rates of YLDs were highest at ages 75-84. The burden of KOA was higher in women than in men. Cross-country inequality suggests that the inequality in the burden of KOA between high SDI and low SDI countries becomes greater, and that countries with high SDI bear a disproportionately high burden. CONCLUSION: The global KOA burden has risen steadily between 1990 and 2019, and cross-national inequality gaps remain large. Targeted measures must therefore be taken to address this inequality and the increasing global KOA disease burden.

Converging economies of care? Immigrant women workers across 17 countries and four care regimes.

This study analyses 17 care economies using 2016 Luxembourg Income Study data to contribute to extant debate regarding the ongoing utility of care regimes as a classificatory schema for cross-national comparison. Examining similarities and differences in the provision of low-status work in health, education, social work, and domestic services - the 'care economy' - the data reveal devaluation of the labour done by immigrant women care workers, net of national and regime-level variation. In addition, numerous similarities across liberal, corporatist, social democratic, and central and eastern European care regimes emerge, in terms of the overrepresentation of immigrant women in low status care work, and the disproportionate financial penalties these workers incur. Together, findings suggest that notwithstanding national and policy-specific differences, there has been considerable convergence across economies of care towards a 'migrant in the market' model of employment. Such large-scale evidence of this trend calls into question the ongoing efficacy of care regimes for national comparisons of migrant care work under conditions of neoliberal globalization.

A Cross-National Comparison of Biosimilars Pricing in Argentina, Australia, Brazil, and Italy.

BACKGROUND: Biosimilar medicines are defined as biological products highly similar to an already licensed biological product (RP). The market entry of biosimilars is expected to reduce the costs of biological treatments. OBJECTIVE: This study aims to evaluate the range of differences between the prices of biosimilars and the corresponding RP for biologicals approved in four countries. METHOD: This is a cross-national comparison of pricing of biosimilars in Argentina, Australia, Brazil, and Italy. The study examined online price databases provided by the national authorities of the investigated countries. Biosimilar price difference was calculated by subtracting the unit price of the biosimilar by the unit price of the RP, and then dividing it by the unit price of the RP. The results were presented as percentage. RESULTS: Brazil had the highest median price reduction (- 36.3%) in biosimilars price, followed by Italy (- 20.0%) and Argentina (- 18.6%). All the biosimilars in Italy were priced below the RP presenting a minimum reduction of 6.3%, while in Australia, most of the prices of biosimilars were equal to the RP. In Argentina, one infliximab-biosimilar displayed price above the RP (40.7%) while the lower priced brand had a reduction of 14.4%. Brazil had four biosimilars with prices above the respective RP, including isophane insulin (1), insulin glargine (1) and somatropin (2). CONCLUSION: The study revealed a marked dispersion in the price's differences between biosimilars and RP across the studied countries. Governments should evaluate whether their policies have been successful in improving affordability of biological therapies.

How Education Shapes Indigenous Health Inequalities in the USA and Mexico.

Indigenous peoples around the world face significant health disparities relative to the dominant groups in their countries, yet the magnitude and patterns of health disparities vary across countries. We use data from the National Health Interview Survey and Mexican Family Life Survey to examine the health of Indigenous peoples in Mexico and American Indians and Alaska Natives in the USA and to evaluate how they fare relative to the majority populations in their countries (non-Indigenous Mexicans and non-Hispanic Whites, respectively). We assess disparities in self-rated health and activity limitations, with a focus on how Indigenous health disparities intersect with educational gradients in health. Regression analyses reveal three primary findings. First, Indigenous health disparities are larger in the USA than in Mexico. Second, differences in educational attainment account for most of the differences between Indigenous and non-Indigenous populations in Mexico, but less than half in the USA. Third, in both countries, health is moderated by educational attainment such that between-group disparities are largest at the highest levels of education. However, for Indigenous Mexicans there is a "cross-over" in which Indigenous Mexicans report better health at the lowest level of education. Overall, this study finds a weak relationship between education and Indigenous health, and raises the question about the validity of using traditional measures of SES in Indigenous contexts.

Did Descriptive and Prescriptive Norms About Gender Equality at Home Change During the COVID-19 Pandemic? A Cross-National Investigation.

Using data from 15 countries, this article investigates whether descriptive and prescriptive gender norms concerning housework and child care (domestic work) changed after the onset of the COVID-19 pandemic. Results of a total of 8,343 participants (M = 19.95, SD = 1.68) from two comparable student samples suggest that descriptive norms about unpaid domestic work have been affected by the pandemic, with individuals seeing mothers' relative to fathers' share of housework and child care as even larger. Moderation analyses revealed that the effect of the pandemic on descriptive norms about child care decreased with countries' increasing levels of gender equality; countries with stronger gender inequality showed a larger difference between pre- and post-pandemic. This study documents a shift in descriptive norms and discusses implications for gender equality-emphasizing the importance of addressing the additional challenges that mothers face during health-related crises.

Cross-national comparisons of later-life cognitive function using data from the Harmonized Cognitive Assessment Protocol (HCAP): Considerations and recommended best practices.

The Harmonized Cognitive Assessment Protocol (HCAP) is a major innovation that provides, for the first time, harmonized data for cross-national comparisons of later-life cognitive functions that are sensitive to linguistic, cultural, and educational differences across countries. However, cognitive function does not lend itself to direct comparison across diverse populations without careful consideration of the best practices for such comparisons. This perspective discusses theoretical and methodological considerations and offers a set of recommended best practices for conducting cross-national comparisons of risk factor associations using HCAP data. Because existing and planned HCAP studies provide cognition data representing an estimated 75% of the global population ≥65 years of age, these recommended best practices will support high-quality comparative analyses of cognitive aging around the world. The principles described in this perspective are applicable to any researcher aiming to integrate or compare harmonized data on cognitive outcomes and their risk and protective factors across diverse populations.

Inequalities in Mortality in the Asia-Pacific: A Cross-National Comparison of Socioeconomic Gradients.

OBJECTIVES: Social inequalities in mortality are poorly studied in much of the Asia-Pacific. Using data from harmonized nationally representative longitudinal health and aging surveys our study systematically assesses mortality disparities across 3 standardized measures of socioeconomic status in 7 Asia-Pacific countries. METHODS: We used data from multiple waves of 7 representative sample surveys: the Health, Income and Labour Dynamics in Australia survey, China Health and Retirement Longitudinal Study, the Indonesian Family Life Survey, the New Zealand Health, Work and Retirement survey, the Korean Longitudinal Study on Ageing and the Health, Aging and Retirement in Thailand survey, and the Japanese Study of Aging and Retirement. We use Cox proportional hazards modeling to examine how the hazard of mortality differs across domains of social stratification including educational attainment, wealth, and occupational status across countries. RESULTS: We found consistent and pervasive gradients in mortality risk in the high-income countries by all available measures of social stratification. In contrast, patterns of inequality in adult mortality in middle-income and recently transitioned high-income countries investigated varied depending on the measure of social stratification, with strong gradients by wealth but mixed gradients by education. DISCUSSION: Analyzing social gradients in mortality in the Asia-Pacific shows that inequalities, especially wealth-based inequalities, in later-life health are present across the region, and that the magnitude of social gradients in mortality is overall larger in high-income countries as compared to middle-income countries.

Educational Attainment and Later-Life Cognitive Function in High- and Middle-Income Countries: Evidence From the Harmonized Cognitive Assessment Protocol.

OBJECTIVES: Identifying social policies that can promote cognitive health is crucial for reducing the global burden of dementia. We evaluated the importance of educational attainment for later-life cognitive function in various social and geographic settings. METHODS: Using harmonized data for individuals aged ≥65 years from the United States Health and Retirement Study (HRS) and its international partner studies in England, Mexico, China, and India, and each study's respective Harmonized Cognitive Assessment Protocol (HCAP), we conducted a cross-national comparative study to examine the role of educational attainment in later-life cognitive function across countries (n = 14,980, 2016-2019). We used multivariable-adjusted regression to estimate associations between educational attainment and harmonized global cognitive function scores. RESULTS: In Mexico, China, and India, the general cognitive function scores on average are approximately one standard deviation of the HRS-HCAP cognitive function score distribution lower compared to the United States and England, paralleling patterns of educational attainment across countries. In all countries, higher educational attainment was associated with progressively higher later-life cognitive function scores. Population-level differences in educational attainment explained about 50%-90% of the observed differences in cognitive function scores across countries. DISCUSSION: The relationship between education and later-life cognitive function across social and geographic contexts underscores the crucial role of education to promote cognitive health and reduce dementia risk. Continual improvement of educational attainment in low- and middle-income settings may yield a significant pay-off in later-life cognitive health.

Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India.

INTRODUCTION: We compared gender disparities in later-life memory, overall and by education, in India and the United States (US). METHODS: Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N = 4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N = 3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education. RESULTS: In the United States, older women had better memory than older men (0.28 SD-unit difference; 95% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95% CI: -0.20, -0.10), which attenuated with increasing education and literacy. CONCLUSION: We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy.

Parental education level and adolescent depression: A multi-country meta-analysis.

Adolescent depression, as a common problem, has always been the focus of attention and research. However, no consistent conclusion has been drawn on its relationship with parental education level. Therefore, this study used meta-analysis and dose-response analysis techniques to explore the overall relationship between the two, and further explore the moderating factors affecting the relationship between the two through subgroup analysis and meta-regression analysis. After a literature search and screening, a total of 22 literatures were included, including 634,821 adolescents aged 9-25, distributed in 10 countries. The results showed that: (1) Overall parental education level was negatively correlated with adolescent depressive symptoms (RR = 0.88. p < 0.001), and there was a dose-response relationship between the two. (2) Geographical location (p = 0.002 < 0.05) and national economic development (p = 0.03 < 0.05) significantly moderated and affected the association between parental education level and adolescent depression, thus presenting a global inconsistency. The results of this study provide a more accurate conclusion on the relationship between parental education and adolescent depression to some extent, highlight the importance and necessity of considering family, economic and cultural factors when studying and solving adolescent depression problems, and guide us to pay more attention to the cross-regional and cross-cultural differences in adolescent depression problems.

Association of Friendly School and Family Contexts and Reducing Health Risk Behaviors Among Adolescents: A Cross-National Study in Europe, North America, and China.

BACKGROUND: Social factors play an important role in adolescents' behaviors. This study aims to understand percentages of health risk behaviors across country in Europe, North America, and China; explore the associations between friendly school and family contexts and involvement for several health risk behaviors among adolescents. METHODS: Data derived from health behavior in school-aged children cross-sectional surveys and China Education Panel Survey in 2014-2015. Hierarchical generalized linear modeling was used to analyze data. RESULTS: The highest percentages of health risk behaviors including unhealthy diet, smoking or alcohol, screen-based sedentary behaviors, and violent behaviors across country ranged from 28.62% to 65.24%. National classmate friendliness was negatively associated with 5 out of 9 health risk behaviors prevalence rates in 41 countries (p < 0.05). Adolescents' perceived peer friendly and helpful were common protective factor for engaging in several health risk behaviors (p < 0.01). Individual family contexts were associated with 3 types of health risk behaviors involvement (p < 0.001). SCHOOL HEALTH POLICY IMPLICATIONS: Health risk behaviors among adolescents reducing was associated with the implementation of friendly school and family contexts, emphasizing the significance of the goals of embedding friendly adolescents, along with the home-school collaboration. CONCLUSIONS: Public health strategies should promote national climate of friendship and individual perceived friendly school contexts to reduce health risk behaviors.

Explaining Variations in Long-term Care Use and Expenditures Under the Public Long-term Care Insurance Systems: A Case Study Comparison of Korea and Japan.

BACKGROUND: Establishing universal coverage of formal long-term care (LTC) services is an urgent policy need for aging populations that requires efficient management of quality and financing. Although current variation in LTC service use between and within countries suggests the potential for improvement by efficient management, this topic remains underexamined. We aimed to identify the sources of variance in LTC use and expenditures through a unique cross-country comparison of Japan and South Korea, which have formal public LTC insurance (LTCI) schemes that are analogous but have unique operational and demographic structures. METHODS: Taking administrative regions as the unit of analysis, we assembled data on the LTC utilization rate of people aged ≥65 years, and expenditures per recipient from 2013 to 2015 as the outcome variables. Explanatory variables included demand-related factors, such as regional demographic and economic conditions, and supply characteristics derived from existing public databases. We conducted weighted least squares regression with fixed effects for the pooled data and used Blinder-Oaxaca decomposition to identify sources of outcome variance between the two countries. RESULTS: The average LTC utilization rate was 6.8% in Korea and 18.2% in Japan. Expenditures per recipient were approximately 1.4 times higher in Japan than in Korea. The difference in the utilization rate was mostly explained by between-country differences in supply- and demand-related factors, whereas the difference in expenditures per recipient was largely attributed to unobserved country-specific factors. CONCLUSION: The current findings suggest that LTC utilization is determined largely by the demographic and functional characteristics of older people, whereas expenditures are more likely affected by institutional factors such as the insurance governance scheme and the policy choice of the target population segment and coverage. The results suggest that strategic choice of LTC institutional schemes is required to ensure financial sustainability to meet changing demands caused by population aging.

Migration-related inequalities in loneliness across age groups: a cross-national comparative study in Europe.

This study aims to contribute to the growing interest in the consequences of migration for loneliness by investigating the role of generational status across various age groups in countries with differing integration policies and attitudes towards immigrants. Using data from rounds 5, 6 and 7 of the European Social Survey, I conducted logistic multilevel models on a sample of 121,835 respondents aged 18 years and older, residing in 26 countries. Loneliness was assessed based on a single-item item question from the Center for Epidemiologic Studies of Depression scale. The findings suggest that individuals with a migration background are more likely to experience loneliness than those without. Within this group, I found that first-generation immigrants who arrived after the age of 18 are more vulnerable to loneliness than those who arrived earlier, although the latter still reported more loneliness than second-generation immigrants. Furthermore, migration-related inequalities in loneliness were greater among the youngest age group (18-34 years) and in countries with a more positive public stance towards immigrants. In sum, this study highlights the persistent challenges that migration poses for loneliness across generations and age groups, and emphasizes the need to extend research in this area beyond older adults. Moreover, it suggests that promoting a welcoming culture towards immigrants may have unintended consequences for loneliness gaps, but further research is needed to explain this observation.

Participatory Inequality Across Countries: Contacting Public Officials Online and Offline.

The Internet offers low-cost ways to participate in political life, which reduces the motivation required to participate and thus potentially reduces inequalities in participation. I examine online and offline contacting of elected officials using original survey data from Canada, France, the United Kingdom, and the United States collected in 2019 and 2021. Education is a consistent positive predictor of contacting in all countries as well as both modes of contact (online and offline). Income differences are small. Younger people are more likely to contact officials, online and offline, compared to older people. Females are less likely to contact officials, online and offline, compared to males. While political interest, efficacy, online information consumption, and online group ties are believed to lead to more equity in online communication, I do not see strong differences in these variables for online and offline contacting. I conclude by discussing the implications of exclusively online contacting of officials when this form of contact is devalued by elected officials, as well as the implications of participatory inequalities with respect to influencing public policy and access to government services.

Beverage-specific consumption trends: A cross-country, cross-sectional comparison.

INTRODUCTION: The price of alcoholic beverages can vary for a range of reasons, including tax. Risky drinkers purchase more low-cost alcoholic drinks than moderate drinkers, contributing to beverage-specific risks for that category. The study aimed to examine the proportion of total alcohol consumption comprised by each beverage type and their correlates. Australian and New Zealand populations were compared, where drinking cultures are similar, but taxation of alcohol differs. METHOD: Data was taken from the International Alcohol Control study in Australia (N=1580) and New Zealand (N =1979), a cross national survey that asks questions on beverage specific alcohol consumption at a range of different locations. Tax rates were obtained from previous analyses run on the dataset. RESULTS: Ready to Drink (pre-mixed) beverages are more popular in New Zealand and the proportion of these drinks consumed out of total alcohol consumption by risky drinkers was correspondingly higher there. Conversely, the proportion of wine consumed by risky drinkers was higher in Australia. The consumption of spirits and beer by risky drinkers was similar in both countries. DISCUSSION: Differences found for the proportion of beverages consumed by risky drinkers between the countries are fairly well aligned with differences in the taxation of each drink type. Future adaptations in taxation systems should consider the impact of taxes on preferential beverage choice and associated harms.

Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations.

INTRODUCTION: The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings. METHODS: We used data from the Harmonized Cognitive Assessment Protocol Surveys (HCAP) in five countries (total N = 11,250) to quantify associations between items on functional limitations and cognitive impairment. RESULTS: Many items performed better in the United States and England compared to South Africa, India, and Mexico. Items on the Community Screening Instrument for Dementia (CSID) had the least variability across countries (SD = 0.73 vs. 0.92 [Blessed] and 0.98 [Jorm IQCODE]), but also the weakest associations with cognitive impairment (median odds ratio [OR] = 2.23 vs. 3.01 [Blessed] and 2.75 [Jorm IQCODE]). DISCUSSION: Differences in cultural norms for reporting functional limitations likely influences performance of items on functional limitations and may affect the interpretation of results from substantive studies. HIGHLIGHTS: There was substantial cross-country variation in item performance. Items from the Community Screening Instrument for Dementia (CSID) had less cross-country variability but lower performance. There was more variability in performance of instrumental activities of daily living (IADL) compared to activities of daily living (ADL) items. Variability in cultural expectations of older adults should be taken into account. Results highlight the need for novel approaches to assessing functional limitations.

A cross-country utilization patterns comparison of high expenditure therapeutic groups between Portugal and six European countries: the two sides of the Portuguese coin.

BACKGROUND: Understanding variability in prescribing patterns through comparative drug utilization studies can contribute to improve an efficient, effective and safe use of medicines. OBJECTIVES: To perform a cross-country comparison of consumption patterns of ambulatory high expenditure therapeutic groups between Portugal and six European countries and simulate potential cost-saving scenarios through the adoption of the different prescribing patterns of studied countries. METHODS: Cross-country comparison of 2019 drug consumption patterns between Portugal, Denmark, England, Finland, the Netherlands, Norway, and Spain. Analysis comprised antihypertensive drugs, glucose lowering drugs (GLD), insulins, lipid lowering drugs (LLD) and oral anticoagulants. Cost-saving analysis were performed using the Portugal average annual cost/daily defined dose and the potential reduction in expenditure simulating other European countries consumption pattern scenarios. RESULTS: Portugal had the lowest consumption uptake of metformin and the highest consumption of GLD (30.1%) and LLD (8.5% vs <3%) fixed-dose combinations. Annual cost-savings scenarios showed that Portugal would have saved between 53 M€ and 305 M€ if it had the same prescribing patterns than Norway or the Netherlands, respectively. CONCLUSIONS: Different utilization patterns across countries were found. Although Portugal has the lowest gross domestic product per capita among the countries studied, it had the highest uptake of newly and costly drugs.

Gender Disparities in Healthy Aging: A Cross-National Comparative Study in the United States and South Korea from 2006 to 2016.

Using the 2006-2016 wave of Health and Retirement Study and Korean Longitudinal Study of Aging, this study explores the gender disparities in the health of older adults in the United States and South Korea. A logit model is adopted to explore the differences in the likelihood of aging healthily by gender in two countries. Results indicate that older females in the United States have a significantly higher probability of healthy aging than their male counterparts. However, the opposite finding is demonstrated among the older population in South Korea. These results are verified using various robustness check methods. The heterogeneities in the gender disparities in healthy aging across age groups and income levels are further explored. The gender effect in each healthy aging domain is investigated to understand the underlying causes of gender disparities. These findings can provide cross-national insights for policymakers to establish targeted aging policies with a gender perspective.

Socioeconomic differences in informal caregiving in Europe.

Disclosing socioeconomic differences in informal care provision is increasingly important in aging societies as it helps to identify the segments of the population that may need targeted support and the types of national investments to support family caregivers. This study examines the association between individual-level socioeconomic status and informal care provision within the household. We also examine the role of contextual factors, income inequality, and the generosity of social spending, to identify how macro-level socioeconomic resource structures shape individuals' provision of care to household members. We use pooled data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1, 2, 4, 5, 6) and the English Longitudinal Study of Ageing (ELSA, waves 2, 3, 4, 6, 7). Poisson regression multilevel models estimate the associations between household socioeconomic status (education, income, and wealth), and country socioeconomic resources (income inequality and social spending as a percentage of GDP), and the likelihood of older adults' informal care provision within the household. Results indicate that lower individual socioeconomic resources-education, income, and wealth-were associated with a higher incidence of older adults' informal care provision within the household. At the macro-level, income inequality was positively associated while social spending was negatively associated with older adults' care provision within the household. Our findings suggest that socioeconomically disadvantaged groups are more likely to provide informal care, which may reinforce socioeconomic inequalities. At the national level, more equitable resource distribution and social spending may reduce intensive family caregiving.