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UNASSIGNED: Despite significant progress made toward tuberculosis (TB) elimination, racial and ethnic disparities persist in TB incidence and case-fatality rates in the US.
UNASSIGNED: To estimate the health outcomes and economic cost of TB disparities among US-born persons from 2023 to 2035.
UNASSIGNED: Generalized additive regression models projecting trends in TB incidence and case-fatality rates from 2023 to 2035 were fit based on national TB surveillance data for 2010 to 2019 in the 50 US states and the District of Columbia among US-born persons. This baseline scenario was compared with alternative scenarios in which racial and ethnic disparities in age- and sex-adjusted incidence and case-fatality rates were eliminated by setting rates for each race and ethnicity to goal values. Additional scenarios were created examining the potential outcomes of delayed reduction of racial and ethnic disparities. The potential benefits of eliminating disparities from differences between baseline and alternative scenario outcomes were quantified. Data were analyzed from January 2010 to December 2019.
UNASSIGNED: Non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Black, Hispanic, non-Hispanic Native Hawaiian or Other Pacific Islander, or non-Hispanic White race and ethnicity.
UNASSIGNED: TB cases and deaths averted, quality-adjusted life years gained, and associated costs from a societal perspective.
UNASSIGNED: The study included 31 811 persons with reported TB from 2010 to 2019 (mean [SD] age, 47 [24] years; 20 504 [64%] male; 1179 [4%] American Indian or Alaska Native persons; 1332 [4%] Asian persons; 12 152 [38%] Black persons; 6595 [21%] Hispanic persons; 299 [1%] Native Hawaiian or Other Pacific Islander persons; and 10 254 [32%] White persons). There were 3722 persons with a reported TB death. Persistent racial and ethnic disparities were associated with an estimated 11 901 of 26 203 TB cases among US-born persons (45%; 95% uncertainty interval [UI], 44%-47%), 1421 of 3264 TB deaths among US-born persons (44%; 95% UI, 39%-48%), and an economic cost of $914 (95% UI, $675-$1147) million from 2023 to 2035. Delayed goal attainment reduced the estimated avertable TB outcomes by 505 (95% UI, 495-518) TB cases, 55 (95% UI, 51-59) TB deaths, and $32 (95% UI, $24-$40) million in societal costs annually.
UNASSIGNED: In this modeling study of racial and ethnic disparities of TB, these disparities were associated with substantial future health and economic outcomes of TB among US-born persons without interventions beyond current efforts. Actions to eliminate disparities may reduce the excess TB burden among these persons and may contribute to accelerating TB elimination within the US.

UNASSIGNED: Sleep is an essential factor for health and wellbeing in people across the age spectrum; yet many adolescents do not meet the recommended 8-10 h of nightly sleep. Unfortunately, habitually insufficient sleep, along with the metabolic changes of puberty, puts adolescents at increased risk for a host of adverse health outcomes such as obesity and type 2 diabetes (T2D). Furthermore, individuals from historically minoritized racial and ethnic groups (e.g. Hispanic/Latinx, African American/Black) are more likely to experience shorter sleep duration compared to adolescents of White/European origin, placing them at even greater risk for disparities in T2D risk.
UNASSIGNED: We conducted a literature review on the role of race and ethnicity in adolescent sleep health and its relation to cardiometabolic outcomes, specifically T2D. We use the minority stress model and the stress and coping theory as guiding theoretical frameworks to examine individual and societal level factors that may contribute to sleep health disparities and their downstream effects on T2D risk.
UNASSIGNED: This review highlights that the unique race-related stressors adolescents from minoritized groups face may play a role in the sleep and T2D connection on a biological, psychological, and social level. However, although there has been advancement in the current research on adolescent racial and ethnic sleep health disparities in relation to T2D, mechanisms underlying these disparities in sleep health need further investigation. Addressing these gaps is crucial for identifying and mitigating sleep health disparities and T2D among racial and ethnic minority youth.
UNASSIGNED: We conclude with a discussion of the implications and future research directions of racial and ethnic disparities in sleep health and T2D prevention research. A comprehensive understanding of adolescent sleep health disparities has potential to better inform preventative and educational programs, interventions, and policies that promote sleep health equity and improve cardiometabolic outcomes like T2D.

BACKGROUND: Health inequalities in the UK are investigated and addressed by analysing data across socioeconomic factors, geography and specific characteristics, including those protected under law. It is acknowledged that the quality of data underpinning these analyses can be improved. The objective of this work was to gain insights from professionals working across the health and care sector in England into the type(s) of resource(s) that can be instrumental in implementing mechanisms to improve data quality into practice.
METHODS: Qualitative study based on semistructured interviews involving health and care professionals.
METHODS: England.
METHODS: A total of 16 professionals, mainly from the East of England.
RESULTS: Awareness of mechanisms that could be put in place to improve quality of data related to health inequalities was high among interviewees. However, logistical (eg, workforce time, capacity and funding) as well as data usage (eg, differences in data granularity, information governance structures) barriers impacted on implementation of many mechanisms. Participants also acknowledged that concepts and priorities around health inequalities can vary across the system. While there are resources already available that can aid in improving data quality, finding them and ensuring they are suited to needs was time-consuming. Our analysis indicates that resources to support the creation of a shared understanding of what health inequalities are and share knowledge of specific initiatives to improve data quality between systems, organisations and individuals are useful.
CONCLUSIONS: Different resources are needed to support actions to improve quality of data used to investigate heath inequalities. These include those aimed at raising awareness about mechanisms to improve data quality as well as those addressing system-level issues that impact on implementation. The findings of this work provide insights into actionable steps local health and care services can take to improve the quality of data used to address health inequalities.

UNASSIGNED: Understanding how disability progresses with ageing is important for shaping policies aimed at improving older adults\' quality of life, especially when considering the global trends in ageing, life expectancy (LE), and gender disparity. We aimed to assess the health transition probabilities of daily living activities and their implications on LE and gender gaps in global middle-aged and elderly populations.
UNASSIGNED: In this multi-cohort study with a sample of 74 101 individuals aged ≥50 years, we analysed data from six international cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Study (HRS) in the USA, the Mexican Longitudinal Study of Ageing (MHAS), the Korean Longitudinal Study of Ageing (KLoSA), and the Survey of Health, Ageing and Retirement in Europe (SHARE). We estimated probabilities between robust health; disabilities related to instrumental activities of daily living (IADL) and basic activities of daily living (BADL); and mortality through multi-state Markov models. We included gender as a covariate in the models to calculate hazard ratios (HRs), while we calculated LE within the distinct health states of robust health, IADL disabilities, BADL disabilities, and mortality using the stochastic population analysis for complex events (SPACE) microsimulation.
UNASSIGNED: Women had higher progressions to disability (IADL: HR = 1.392; BADL: HR = 1.356) compared to men, who conversely showed lesser progression from IADL to BADL disability (HR = 0.856) and lower mortality rates (span of HRs = 0.232-0.692). LE at age 50 favoured women (32.16-38.22 years) over men (28.99-33.58 years), yet they spent more time in states of disability. We otherwise observed significant regional and gender disparities in healthy LE.
UNASSIGNED: We identified ageing patterns in which longer lives are often coupled with extended periods of disability. Pronounced gender and regional differences indicate a need for targeted health interventions to address inequities and improve seniors\' quality of life. Our findings highlight the necessity for policy interventions focussed on health equity to more completely respond to the demographic shift towards older populations.

UNASSIGNED: In low- and middle-income countries (LMICs) and territories, maternal infections impose a non-negligible disease burden. We aimed to analyse the secular trends, age distribution, and associated factors of maternal sepsis and other maternal infections (MSMI) across 131 LMICs from 1990 to 2019.
UNASSIGNED: We collected yearly data of incidences, deaths, and disability adjusted life years (DALYs) on MSMI in 131 LMICs from 1990 to 2019 from the Global Burden of Disease 2019 (GBD 2019). The sociodemographic index (SDI) and universal health coverage effective coverage index (UHCI) were also acquired. Relative percent change and estimated annual percentage change (EAPC) were used to assess the secular trends. Correlation analyses were also employed to explore the associations between the burden of MSMI with SDI and UHCI.
UNASSIGNED: Between 1990 and 2019, the age-standardised incident rates (ASIRs), age-standardised maternal mortality ratios (ASMMRs) and age-standardised DALYs rates of low-income countries (LICs) were much higher than that of lower-middle-income countries (LMCs) and upper-middle income countries (UMCs), although they all continued to decline. At least six of 131 LMICs had ASMMR greater than 70.00 per 100 000 live births in 2019. The incidences of MSMI increased first till 20-24 years and then decreased with age both in 1990 and 2019, while the ASMMRs were higher in the youngest and the oldest age group. With the growth of SDI and UHCI in 2109, the decreasing trend of ASIR, ASMMR, and age-standardised DALYs rates slowed down.
UNASSIGNED: Although the progress has been made in reducing the burden of MSMI in 131 LMICs, the disease burden in LICs far exceeded that of LMCs and UMCs. Socio-economic status and universal health coverage were both associated with the MSMI burden, and further research is needed to explore the underlying factors contributing to these disparities and to identify effective strategies for reducing the burden of MSMI.

BACKGROUND: Risky behaviours, including tobacco use, are highly prevalent among adolescents worldwide. Although these behaviours are largely influenced by various sociodemographic factors, including sex, there is a paucity of regionally representative literature on the sex-related inequalities in cigarette smoking among adolescents in Africa. This study examined the sex-based disparities in current cigarette smoking among adolescents aged 13-15 years in Africa.
METHODS: The present study employed a secondary analysis of nationally representative data on 45 African countries obtained from the Global Youth Tobacco Survey, accessible through the World Health Organization (WHO) Global Health Observatory. We used the online version of the WHO Health Equity Assessment Toolkit (HEAT) to generate the results.
RESULTS: The prevalence of current cigarette smoking among the adolescents surveyed ranged from 1.6% in Eritrea to 10.4% in Mali among the low-income countries, from 1.3% in Tanzania to 13.1% in Mauritania among the lower-middle-income countries, from 5.2% in Gabon to 15.3% in Mauritius among the upper-middle-income countries, and 14.7% in Seychelles, the only high-income country in the study. The absolute summary measure (D) showed diverse sex-related disparities in the burden of current cigarette smoking among adolescents across the sub-regions. In all countries surveyed, the prevalence of cigarette smoking was higher among male adolescents compared to females, except in Liberia and Mozambique, where female adolescents bore a more significant burden than their male counterparts. Furthermore, male adolescents were more burdened with high cigarette smoking prevalence than females in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia, where such disparities were most pronounced. Meanwhile, we found less disparity in the burden of cigarette smoking between male and female adolescents in most of the lower and upper-middle-income countries surveyed.
CONCLUSIONS: This study sheds light on the sex-based inequalities in the prevalence of current cigarette smoking among adolescents in Africa. In contrast to female adolescents, male adolescents bear a greater burden of current cigarette smoking. The burden of cigarette smoking is most pronounced in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia. Conversely, in most of the lower and upper-middle-income countries surveyed, the burdens of current cigarette smoking among male and female adolescents were found to be less disparate. Consequently, cigarette smoking prevention programmes and strategies must be implemented in all African nations. There is also the need to intensify interventions aimed at altering the smoking behaviour of male adolescents. Policymakers can develop and implement evidence-based interventions to address the burden of cigarette smoking among the adolescents. Finally, existing policies and programmes addressing adolescents\' cigarette smoking should be re-assessed and strengthened to achieve their objectives.

UNASSIGNED: The Roma minority, Europe\'s largest ethnic minority, experiences significant disparities in living conditions and health outcomes compared to the non-Roma populations across the continent. Despite extensive documentation of the socio-economic challenges faced by the Roma, there is a notable lack of comparative research.
UNASSIGNED: This study aims to fill this gap by examining the differences in socio-economic characteristics, living conditions, and self-reported health status between Roma (R) and non-Roma (nR) women in in Hungary (HU), Romania (RO), and Slovakia (SK), providing a cross-country comparative analysis. Utilizing simple and multiple binary logistic models, our research analysed data collected from September 2020 to March 2022, involving 322 Roma and 294 non-Roma women in Hungary, 258 Roma and 183 non-Roma women in Romania, and 146 Roma and 163 non-Roma women in Slovakia.
UNASSIGNED: Findings indicate significant associations between increased age (R:OR = 1.04[1.02,1.06], p < 0.001), (nR:OR = 1.04[1.02,1.05], p < 0.001) lower financial situation (R:OR = 2.05[1.01,4.18], p = 0.048) (nR:OR = 1.67[1.01,2.77], p = 0.047), and basic education level (R:OR = 3.60[1.29,10.08], p = 0.015) (nR:OR = 3.64[1.77,7.51], p < 0.001) with the likelihood of poor health status across both groups in Hungary. In Romania, increased age (OR = 1.04[1.02,1.06], p < 0.001) and basic education level (OR = 5.24[2.29,11.99], p < 0.001) were particularly predictive of poor health among non-Roma, while in Slovakia, age (OR = 1.05[1.02,1.07], p < 0.001) was a significant factor for Roma, and intermediate education level (OR = 2.68[1.16,6.20], p = 0.021) was for non-Roma. The study also found that a higher number of children (HU:OR = 1.35[1.12,1.63], p = 0.002), (RO:OR = 1.57[1.25,1.96], p < 0.001) and problems with housing comfort (RO:OR = 4.83[2.19,10.62], p = 0.015) and wall conditions (RO:OR = 2.81[1.22,6.46], p < 0.001) significantly impacted the health status of non-Roma women in Hungary and Romania. Conversely, an increase in household size was associated with a better health status among Roma women in Hungary (OR = 0.88[0.79,0.99]) and Slovakia (OR = 0.78[0.61,0.99]).
UNASSIGNED: By offering a novel comparative analysis, this study highlights the critical need for focused attention on the health disparities faced by Roma women, particularly those in a multiply disadvantaged situation due to their ethnic and socio-economic status.

UNASSIGNED: This study systematically reviews evidence of socioeconomic health disparities in Costa Rica, a middle-income country, to elucidate the relationship between socioeconomic status and health outcomes.
UNASSIGNED: Published studies were identified through a systematic review of PubMed (English) and Scielo (Spanish) databases from December 2023 to January 2024, following PRISMA guidelines. Search terms included socioeconomic status, social determinants, social gradient in health, and health inequalities.
UNASSIGNED: Of 236 identified references, 55 met the inclusion criteria. Findings were categorized into health inequalities in mortality (among the general population, infants, and older adults), life expectancy, cause-specific mortality, and health determinants or risk factors mediating the association between the social environment and health. The studies indicate higher mortality among the most disadvantaged groups, including deaths from respiratory diseases, violence, and infections. Higher socioeconomic status was associated with lower mortality rates in the 1990s, indicating a positive social gradient in health (RII = 1.3, CI [1.1-1.5]). Disparities were less pronounced among older adults. Urban areas exhibited concentrated wealth and increased risky behaviors, while rural areas, despite greater socioeconomic deprivation, showed a lower prevalence of risky behaviors. Regarding smoking, people living in rural areas smoked significantly less than those in urban areas (7% vs. 10%). Despite the relatively equitable distribution of public primary healthcare, disparities persisted in the timely diagnosis and treatment of chronic diseases. Cancer survival rates post-diagnosis were positively correlated with the wealth of districts (1.23 [1.12-1.35] for all cancers combined).
UNASSIGNED: The study highlights the existence of social health inequalities in Costa Rica. However, despite being one of the most unequal OECD countries, Costa Rica shows relatively modest social gradients in health compared to other middle and high-income nations. This phenomenon can be attributed to distinctive social patterns in health behaviors and the equalizing influence of the universal healthcare system.

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