Arjumand Siddiqi1, Faraz Vahid Shahidi2, Vincent Hildebrand3, Anthony Hong4, Sanjay Basu5. 1. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; Hospital for Sick Children, Toronto, Canada; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC. Electronic address: aa.siddiqi@utoronto.ca. 2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 3. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Economics, Glendon College - York University, Toronto, Canada. 4. Department of Economics, McMaster University, Toronto, Canada. 5. Center for Primary Care and Outcomes Research and Center for Population Health Sciences, Stanford University, Stanford, CA; Center for Primary Care, Harvard Medical School, Boston, MA.
Abstract
PURPOSE: We present a conceptual introduction to "distributional inequalities"-differences in distributions of risk factors or other outcomes between social groups-as a consequential shift for research on health inequalities. We also review a companion analytical methodology, "distributional decomposition", which can assess the population characteristics that explain distributional inequalities. METHODS: Using the 1999-2012 U.S. National Health and Nutrition Examination Survey, we apply statistical decomposition to (a) document gender-specific, black-white inequalities in the distribution of body mass index (BMI) and, (b) assess the extent to which demographic (age), socioeconomic (family income, education), and behavioral predictors (caloric intake, physical activity, smoking, alcohol consumption) are associated with broader distributional inequalities in BMI. RESULTS: Black people demonstrate favorable or no different caloric intake, smoking, or alcohol consumption than whites, but worse levels of physical activity. Racial inequalities extend beyond the obesity threshold to the broader BMI distribution. Demographic, socioeconomic, and behavioral characteristics jointly explain more of the distributional inequality among men than women. CONCLUSIONS: Black-white distributional inequalities are present both among men and women, although the mechanisms may differ by gender. The notion of "distributional inequalities" offers an additional purchase for studying social inequalities in health.
PURPOSE: We present a conceptual introduction to "distributional inequalities"-differences in distributions of risk factors or other outcomes between social groups-as a consequential shift for research on health inequalities. We also review a companion analytical methodology, "distributional decomposition", which can assess the population characteristics that explain distributional inequalities. METHODS: Using the 1999-2012 U.S. National Health and Nutrition Examination Survey, we apply statistical decomposition to (a) document gender-specific, black-white inequalities in the distribution of body mass index (BMI) and, (b) assess the extent to which demographic (age), socioeconomic (family income, education), and behavioral predictors (caloric intake, physical activity, smoking, alcohol consumption) are associated with broader distributional inequalities in BMI. RESULTS: Black people demonstrate favorable or no different caloric intake, smoking, or alcohol consumption than whites, but worse levels of physical activity. Racial inequalities extend beyond the obesity threshold to the broader BMI distribution. Demographic, socioeconomic, and behavioral characteristics jointly explain more of the distributional inequality among men than women. CONCLUSIONS: Black-white distributional inequalities are present both among men and women, although the mechanisms may differ by gender. The notion of "distributional inequalities" offers an additional purchase for studying social inequalities in health.
Authors: Anne Fuller; Arjumand Siddiqi; Faraz V Shahidi; Laura N Anderson; Vincent Hildebrand; Charles D G Keown-Stoneman; Jonathon L Maguire; Catherine Birken Journal: BMJ Open Date: 2022-02-15 Impact factor: 2.692