Income inequality, emotional anxiety, and self-rated health in times of the coronavirus pandemic: Evidence from a cross-national survey

Determinants of self-rated health in socioeconomically disadvantaged women: a cross-sectional study in Iran

BACKGROUND

To reduce potential health disparities, it is critical to recognize health determinants among socioeconomically disadvantaged women. Therefore, we aimed to investigate the determinants of self-rated health in socioeconomically disadvantaged women supported by a Relief Foundation (RF).

METHOD

This cross-sectional study was conducted on women in Iran who were supported by a RF as an aided institute. We collected demographic and socioeconomic data, as well as information on physical, mental, and social health and self-rated health status. Data analysis was performed by random forest, classification and regression tree (CART) techniques, and gamma regression.

RESULTS

The mean age of the 556 included disadvantaged women was 42.8 ± 12.4 years, and the mean self-rated health status was 66.5. Physical health was the most important factor affecting self-rated health. In disadvantaged women with physical problem, nonacademic and academic educated had significantly greater health perceptions than illiterate individuals (1.267, 95% CI: 1.106, 1.451) and (1.666, 95% CI: 1.251, 2.217) respectively. Also, anxiety and stress were both significant predictors of self-rated health status in disadvantaged women with physical health problem (0.765, 95% CI: 0.653, 0.896), and (0.872, 95% CI: 0.762, 0.999) respectively.

CONCLUSION

The study of disadvantaged women revealed a significant influence of physical health on their overall sense of well-being. The findings suggest that education and anxiety have impacts on self-rated health of both diseased and healthy women. To improve the well-being of disadvantaged women, providing accessible physical and mental health support, along with expanding educational opportunities, would be beneficial.

Market integration and resident health in China

This paper uses data from the China Health and Nutrition Survey (CHNS) to study the impact of market integration on residents' health. The empirical results based on the probit model show that market integration has a significant dampening effect on resident incidence. For every one-unit increase in the degree of market integration, the probability of residents becoming sick decreases by approximately 1.45%. Moreover, after a series of robustness tests, the conclusion is still valid. This study further analyses the potential mechanism and finds that the promotion of market integration can improve the medical conditions available to residents, optimize the nutritional indices of residents, and reduce labor load of residents, thus improving their health. The results of the heterogeneity test show that there are certain differences in the impact of market integration on the health level of residents of different genders, ages and income classes. At the same time, this study also verifies that there is a synergistic effect between internet penetration and market integration.

An assessment of economy- and transport-oriented health performance

BACKGROUND

Good health can prolong one's lifespan and is a fundamental human right. Thus, human health is being influenced by prejudiced from sociological, environmental, economic, and geographic aspects. The economy and transportation system pose a serious challenge to the assessment of the health performance of economies.

OBJECTIVE

This study aims to assess the health performance of Organization for Economic Cooperation and Development (OECD) economies by using economic and transport-related indicators and examining the role of health expenditure and governance in improving efficiency.

METHODS

This study measures the economy- and transport-oriented health efficiency of 35 OECD economies for the period of 2000-2022. In the first stage, this study employs a slacks-based measure and the data envelopment analysis-window analysis approach to conduct individual (economy and transportation) and joint assessments to measure health efficiency. In the second stage, this study uses the tobit regression method to investigate the effects of influencing factors, namely, government general health and pharmaceutical expenditures, the medical infrastructure, and governance, on health efficiency.

RESULTS

Empirical results reveal that a 1-unit change in the health expenditure during the research period improves economy-oriented health efficiency by 71% and transport-oriented health efficiency by 58%. The econometric analysis demonstrates that all the coefficients of economy- and transport-oriented health efficiency are significant and positive. Notably, a 1-unit change in the medical infrastructure increases economy- and transport-oriented health efficiency by 50.8%, and a 1% increase in pharmaceutical expenditure increases the health, economy, and transport efficiency scores by 16.3%, 33%, and 58.6%, respectively.

CONCLUSIONS

The findings suggest that some of the economies were efficient with regard to their health-oriented outputs, that is, quality of life and mortality and morbidity rates, and most of the economies demonstrated excellent economic performance. The findings of the transport-oriented health efficiency assessment reveal that the economies were unable to perform well in the last year of the research period owing to the nationwide lockdowns. Nonetheless, they demonstrated efficiency in the first half of the research period. The joint assessment of economy- and transport-oriented health efficiency indicates that economic and transport input resources can adversely affect the GDP and life expectancy simultaneously, and the medical infrastructure, pharmaceutical expenditure, and number of medical graduates serve as constructive stimuli for health efficiency improvement.

Worsened self-rated health in the course of the COVID-19 pandemic among older adults in Europe

BACKGROUND

Governments across Europe deployed non-pharmaceutical interventions to mitigate the spread of coronavirus disease 2019 (COVID-19), which not only showed clear benefits but also had negative consequences on peoples' health. Health inequalities increased, disproportionally affecting people with higher age or lower education. This study analyzed associations between social factors and worsened self-rated health of elderly people in the course of the COVID-19 pandemic, taking different stringencies of government mandates as well as infection rates into account.

METHODS

Data stem from the European SHARE survey. The main outcome was a binary indicator of worsened self-rated health. Analyses included data from two waves (2020 and 2021) during the pandemic (N = 48 356 participants, N = 96 712 observations). Predictors were age, sex, education and living together with a partner, and two macro indicators that reflected the stringency of government response mandates and COVID-19 infection rates. Data were analyzed using logistic mixed-effects regression models.

RESULTS

Older age [odds ratio (OR) 1.73, confidence interval (CI) 1.65-1.81] and female sex (OR 1.26, CI 1.20-1.32) were positively associated and higher education (OR 0.74, CI 0.70-0.79) was negatively associated with worsened self-rated health. Not living together with a partner showed higher odds of worsened self-rated health (OR 1.30, CI 1.24-1.36). Inequalities increased from 2020 to 2021. Associations between worsened self-rated health and government response mandates or infection rates were inconsistent.

CONCLUSION

Self-rated health worsened in the course of the pandemic and health disparities increased. Possible future pandemics require targeted interventions to minimize adverse health outcomes, in particular among old, potentially isolated, and deprived people.

Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

BACKGROUND

Self-rated health (SRH) is widely recognized as a clinically significant predictor of subsequent mortality risk. Although COVID-19 may impair SRH, this relationship has not been extensively examined. The present study aimed to examine the correlation between habitual sleep duration, changes in sleep duration after infection, and SRH in subjects who have experienced SARS-CoV-2 infection.

METHODS

Participants from 16 countries participated in the International COVID Sleep Study-II (ICOSS-II) online survey in 2021. A total of 10,794 of these participants were included in the analysis, including 1,509 COVID-19 individuals (who reported that they had tested positive for COVID-19). SRH was evaluated using a 0-100 linear visual analog scale. Habitual sleep durations of < 6 h and > 9 h were defined as short and long habitual sleep duration, respectively. Changes in habitual sleep duration after infection of ≤ -2 h and ≥ 1 h were defined as decreased or increased, respectively.

RESULTS

Participants with COVID-19 had lower SRH scores than non-infected participants, and those with more severe COVID-19 had a tendency towards even lower SRH scores. In a multivariate regression analysis of participants who had experienced COVID-19, both decreased and increased habitual sleep duration after infection were significantly associated with lower SRH after controlling for sleep quality (β = -0.056 and -0.058, respectively, both p < 0.05); however, associations between current short or long habitual sleep duration and SRH were negligible. Multinomial logistic regression analysis showed that decreased habitual sleep duration was significantly related to increased fatigue (odds ratio [OR] = 1.824, p < 0.01), shortness of breath (OR = 1.725, p < 0.05), diarrhea/nausea/vomiting (OR = 2.636, p < 0.01), and hallucinations (OR = 5.091, p < 0.05), while increased habitual sleep duration was significantly related to increased fatigue (OR = 1.900, p < 0.01).

CONCLUSIONS

Changes in habitual sleep duration following SARS-CoV-2 infection were associated with lower SRH. Decreased or increased habitual sleep duration might have a bidirectional relation with post-COVID-19 symptoms. Further research is needed to better understand the mechanisms underlying these relationships for in order to improve SRH in individuals with COVID-19.

Predictors of depression: lifestyle choices during the pandemic

Our study intends to specify the impact of the singular pandemic stressors on the population and also quantify the contribution of different predictors of depression; some of them are stronger than others, and this research shows how the whole effect is divided into single items. This research included a structured online survey using data from 11,340 respondents from six European countries during the first months of the pandemic. The statistical analysis focused on how behavioural patterns appear in different groups of the population and how they mark the psychological wellbeing of these groups with regard to various factors. We targeted social media's role and analyzed the impact of its consumption on symptoms of depression in different groups divided by age and other characteristics. The analysis creates a mosaic of lifestyle choices and other characteristics that manifest different effects on depression inside selected groups whereas several groups generated by the cluster analysis are less vulnerable to their effect than others. Regarding our findings, the perceived reality through information sources and the manner of their processing seems to be more significant than the tangible reality (poor self-reported health correlated with depression more strongly than intrinsic health limitations).

Experiences of environmental services workers in a tertiary hospital in Asia during the COVID-19 pandemic: a qualitative study

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic has had a significant impact on all walks of life, in particular, environmental services workers in healthcare settings had higher workload, increased stress and greater susceptibility to COVID-19 infections during the pandemic. Despite extensive literature describing the impact of the pandemic on healthcare workers such as doctors and nurses, studies on the lived experiences of environmental services workers in healthcare settings are sparse and none has been conducted in the Asian context. This qualitative study thus aimed to examine the experiences of those who worked for a year of the COVID-19 pandemic.

METHODS

A purposive sample of environmental services workers was recruited from a major tertiary hospital in Singapore. Semi-structured interviews were conducted in-person, lasting around 30min, and included open-ended questions pertaining to five main domains: work experiences during COVID-19, training and education needs, resource and supplies availability, communication with management and other healthcare staff, and perceived stressors and support. These domains were identified based on team discussions and literature review. The interviews were recorded and transcribed for thematic analysis, as guided by Braun and Clarke.

RESULTS

A total of 12 environmental services workers were interviewed. After the first seven interviews, no new themes emerged but an additional five interviews were done to ensure data saturation. The analysis yielded three main themes and nine subthemes, including (1) practical and health concerns, (2) coping and resilience, and (3) occupational adaptations during the pandemic. Many expressed confidence in the preventive efficacy of proper PPE, infection control practice and COVID-19 vaccination in protecting them against COVID-19 and severe illness. Having prior experience with infectious disease outbreaks and previous training in infection control and prevention appeared to be useful as well for these workers. Despite the various challenges presented by the pandemic, they could still find meaning in their everyday work by positively impacting the wellbeing of patients and other healthcare workers in the hospital.

CONCLUSION

Besides uncovering the concerns shared by these workers, we identified helpful coping strategies, resilience factors and certain occupational adaptations, which have implications for future pandemic planning and readiness.

Educational inequalities in self-rated health and emotional exhaustion among workers during the COVID-19 pandemic: a longitudinal study

OBJECTIVE

This study aimed to investigate trends in educational inequalities in poor health and emotional exhaustion during the pandemic among workers, and differences in trends between men and women.

METHODS

Five waves (2019-2021) from the longitudinal study 'the Netherlands Working Conditions Survey COVID-19 study' were used (response rates: 32-38%). Generalized logistic mixed models were used to estimate the changes in absolute and relative educational inequalities in poor health and emotional exhaustion for all workers (n = 12,479) and for men and women, separately.

RESULTS

Low and intermediate educated workers reported more often poor health (OR 2.54; 95% CI 1.71-3.77 and OR 2.09; 95% CI 1.68-2.61, respectively) than high educated workers. Intermediate educated women (OR 0.49; 95% CI 0.37-0.64) reported less emotional exhaustion than high educated women, but no differences were observed among men. The prevalence of poor health first decreased across all educational levels until March 2021, and bounced back in November 2021. A similar pattern was found for emotional exhaustion, but for low and intermediate educated workers only. Relative educational inequalities in poor health reduced among men during the pandemic, and absolute differences decreased among men and women by 2.4-2.6%. Relative educational inequalities in emotional exhaustion widened among men only. Absolute differences in emotional exhaustion first increased among both men and women, but narrowed between the last two waves.

DISCUSSION

Socioeconomic inequalities for poor self-rated health remained but narrowed in relative and absolute terms during the pandemic. With regard to emotional exhaustion, socioeconomic inequalities returned to pre-COVID-19 levels at the end of 2021.

Effects of social assistance on self-rated health

Based on the China Health and Retirement Longitudinal Study (CHARLS) data in 2018, medical assistance and life assistance have significant negative influences on self-rated health, found via an empirical analysis based on the Oprobit model. Such negative influences are robust based on the substitution of explained variables and propensity score matching. It can be found from a heterogeneity analysis that the negative influences of medical assistance on self-rated health are more significant in urban residents and residents in Central China and East China. Meanwhile, negative influences of life assistance on self-rated health are more significant in urban residents, and residents in Central China, East China, and Northeast China. This study provides empirical evidence to improve the health of residents by using medical assistance and life assistance accurately and offers important policy enlightenments to formulate appropriate social assistance policies.

Gap and Inequality in the Economic Income of Independent Workers in the Region of Puno-Peru and the Effect of the Pandemic, 2019-2020

Objective

This article seeks to determine the social determinants of inequality in economic income in independent workers in the Puno region in the periods 2019 and 2020.

Methods

For which the quantitative approach was used, with descriptive and correlational design, considering the multiple regression model.

Results

It was determined that there is a very significant income gap by educational level due to the productive differential that coronavirus disease 2019 (COVID-19) affected all the households; there is inequality in the economic income of independent workers, since in 2019, there was a greater inequality of economic income among independent workers (Gini = 0.6142) in relation to the national level (Gini = 0.415) and in 2020, the inequality of economic income increased due to COVID-19 problem, where the Gini coefficient amounted to 0.7136 in relation to the national level (Gini = 0.431).

Conclusion

The determining factors of the economic income of the independent worker in the region of Puno in the periods 2019 and 2020 are the age that explains in 5.19 and 1.72%, the level of education that explains in 20.74 and 34.86% and the sex that explains in 37 and 14.19%, respectively.

The positive and negative effects of the COVID-19 pandemic on subjective well-being and changes in social inequality: Evidence from prefectures in Japan

This study aims to specify the effects of the COVID-19 pandemic on individual subjective well-being in Japan and to clarify the mechanism generating social inequality of subjective well-being during the crisis. Data were analyzed using fixed effects ordinary least squares (OLS) regression models from the Online Panel Survey of Social Stratification and Psychology in 2020 (SSPW2020-Panel), which was conducted in four waves in June 2020, September 2020, December 2020, and March 2021. The results reveal that COVID-19 spread in a prefecture had differential effects on subjective well-being in prefectures with high infection rates: positive effects for socially advantaged individuals and negative effects for socially disadvantaged individuals. In conclusion, social inequality in Japan, in terms of subjective well-being, has been widened by the COVID-19 pandemic during 2020.