International Journal for Equity in Health最新文献

Background: Evidence on how poverty and social determinants influence adverse maternal and perinatal outcomes in the UK is limited. While ethnicity and area-level deprivation are well described, fewer studies examine the cumulative impact of poverty-related factors such as low income, employment insecurity, housing, and access to social support.

Methods: We analysed 67,308 pregnancies from the eLIXIR cohort using linked NHS records. Social determinants were defined using the WHO framework as structural (ethnicity, migration status, area deprivation) and intermediary (housing, employment, financial hardship, social support, barriers to care). The primary outcome was a composite adverse perinatal outcome. Binary logistic regression models with random intercepts accounted for repeated pregnancies, and adjusted risk ratios (aRRs) were estimated controlling for key sociodemographic and clinical factors.

Results: Structural poverty-related social determinants of health were associated with increased risk of adverse perinatal outcomes, including Black (aRR 1.50, 95% CI 1.42-1.59), Asian (aRR 1.49, 95% CI 1.39-1.59), and other minoritised ethnic backgrounds (aRR 1.50, 95% CI 1.42-1.59), residence in the most deprived areas (aRR 1.10, 95% CI 1.01-1.20), non-UK birth (aRR 1.20, 95% CI 1.15-1.25), and recent migration (aRR 1.32, 95% CI 1.14-1.53). Intermediary poverty-related social determinants of health were independently associated with increased risk beyond ethnicity and deprivation, including lack of social support (aRR 1.21, 95% CI 1.02-1.42), unemployment (aRR 1.16, 95% CI 1.10-1.23), financial hardship (aRR 1.17, 95% CI 1.01-1.35), living in social housing (aRR 1.16, 95% CI 1.09-1.24), transfer of care between hospitals (aRR 1.27, 95% CI 1.18-1.37), missed appointments (aRR 1.19, 95% CI 1.04-1.37), and unscheduled maternity care use (aRR 1.21, 95% CI 1.14-1.29). Women exposed to multiple overlapping poverty-related social determinants of health had a substantially higher likelihood of adverse perinatal outcomes (aRR 1.23, 95% CI 1.12-1.35).

Conclusions: Structural and intermediary social determinants related to poverty have a substantial and cumulative impact on maternal and perinatal outcomes, independent of individual clinical risk. Addressing these inequities requires integrated, cross-sector strategies that extend beyond healthcare to the wider social conditions influencing maternal and child health.

Clinical trial number: Not applicable.

Introduction: The population of migrant, refuge, and asylum-seeking children and adolescents across the globe has increased in recent decades. These minors often undergo adverse experiences that negatively impact their mental health and psychosocial well-being (MHPWB). In light of the transient nature and multiple stressors inherent in the transit stage, this scoping review was conducted to characterize the evidence on interventions aimed at promoting the MHPWB of minors during their migration journey.

Methods: Following the PRISMA-ScR guidelines, we systematically searched the MEDLINE, Embase, Global Health, APA PsycInfo, and Web of Science databases, as well as the Google Scholar search engine, for studies published between January 2010 and September 2025 that included the evaluation of some aspect of interventions aimed at promoting MHPWB in minors during transit, regardless of the language and location where the study was conducted. Systematic reviews of the literature were excluded. The data most relevant to answering the research questions were presented in tables and accompanied by a narrative synthesis.

Results: Of the 1,835 unique documents identified, 28 met the inclusion criteria. Most of the interventions had been implemented in refugee camps and were aimed at school-age children and adolescents who had been forcibly displaced, mainly from the Middle East. Most of the interventions combined different approaches, such as psychoeducation and cognitive-behavioral therapy, and had a family or group approach. All interventions reported some degree of positive change on children's MHPWB. However, few studies considered at-risk subgroups, and no interventions targeted two of the main forcibly displaced populations at the time of the study, Venezuelans and South Sudanese.

Conclusions: Our study effectively describes existing interventions aimed at promoting MHPWB for minors in transit and their effectiveness and/or implementation process, as well as identifies gaps in the current evidence and lessons learned that can help improve future interventions.

Background: Despite numerous efforts to implement inclusive policies in Kerala, transgender and gender-diverse (TGD) individuals continue to face institutional discrimination, resulting in significant challenges in accessing health care. Existing literature highlights the need for actions to expand the availability and utilisation of health care services for these individuals to prevent institutional erasure. This study aimed to identify the barriers health care faced by transgender people in Kerala.

Methods: A mixed-methods approach was employed, combining a cross-sectional survey among 120 TGD individuals for quantitative data and in-depth interviews among 13 TGD individuals for qualitative insights.

Results: This study examined barriers to healthcare access among transgender people in Kerala, using Levesque et al.'s framework. Participants (mean age 33 years) included transwomen, transmen, and gender-fluid individuals. Key barriers included the limited functionality of the specialised TGD clinics, a perceived lack of awareness and responsiveness among health care workers, and experiences of discrimination. Financial constraints further restricted access to hormone therapy and gender-affirming surgeries. Structural barriers, such as the absence of gender-neutral facilities and inadequate admission protocols compounded these challenges. Participants emphasised the need for health care worker training and the expansion of public provision for gender-affirming care to address these barriers.

Conclusion: The identified barriers are deeply rooted in the social position of the TGD community, necessitating an approach that acknowledges the social determinants of their health to achieve meaningful improvements in health care access.

Background: The United States (U.S.) healthcare system consistently underperforms in equity and value compared to peer countries. Socially disadvantaged groups, such as racial and ethnic minorities, refugees, and low-income populations, experience worse access to healthcare and poorer health outcomes. This issue highlights the need for targeted interventions to reduce disparities and improve healthcare quality in both public health and clinical practice. This scoping review aims to map existing literature on interventions that promote healthcare equity and value in the US, focusing on access to healthcare and health outcomes for disadvantaged populations.

Methods: A scoping review of systematic reviews was conducted to map literature on high-value, equitable healthcare in the U.S. Using the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on systematic reviews of interventions, strategies, and policies promoting healthcare equity and value published between 2018 and 2023 that addressed U.S.-based healthcare. A two-step article selection process and qualitative synthesis of findings were employed.

Results: The review synthesized 54 studies, comprising mostly systematic reviews, scoping reviews, and meta-analyses. These studies focused on disadvantaged populations, including racial and ethnic minorities, refugees, and low-income groups. Interventions were categorized into four themes: community engagement and outreach (e.g., use of community health workers), culturally-tailored interventions (e.g., language-concordant care), technology adoption (e.g., digital health tools), and policy reforms (e.g., Medicaid expansion). Findings highlighted the critical role of community health workers and culturally responsive programs in improving access to care and health outcomes for disadvantaged populations. However, most interventions, including these approaches, aim to improve health outcomes measured across whole populations, rather than healthcare gaps between groups within populations.

Conclusions: This review underscores the importance of culturally tailored interventions, community engagement and outreach, and policy reforms in addressing equity and value in healthcare. There is a significant gap in research directly tackling healthcare inequities. Future research should focus on system accountability, addressing structural inequities, and developing new care models to enhance equity and value.