The effects of social determinants on children's health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).
The effects of social determinants on children's health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).
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10.1371/journal.pgph.0001588
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发表时间：
2023
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经验证据表明，生活在贫民窟的儿童的健康状况比生活在非贫民窟和其他城市地区的儿童差。改善健康，特别是改善生活在贫民窟的五岁以下儿童的健康，需要更好地了解推动其健康结果的健康社会决定因素。因此，我们的目标是通过交叉视角调查SDoH如何共同影响生活在孟加拉国贫民窟的5岁以下儿童的健康结果。我们使用的数据来自2013年最新的全国城市健康调查（UHS），涵盖达卡、吉大港、库尔纳、拉杰沙希、巴里萨尔、锡尔赫特和朗布尔省的城市人口。我们采用个体异质性和判别精度的多水平分析（MAIHDA），利用方差划分系数（VPC）和受试者工作特征曲线下面积（AUC-ROC）估计交叉效应估计的判别精度（DA）。我们还评估了比例方差变化（PCV）来计算交叉效应。我们考虑了五岁以下儿童的三种健康结局：咳嗽、发烧和急性呼吸道感染（ARI）。我们发现交叉层咳嗽（VPC = 0.77%, AUC-ROC = 61.90%）、发烧（VPC = 0.87%, AUC-ROC = 61.89%）和ARI （VPC = 1.32%, AUC-ROC = 66.36%）的DA较低，这表明考虑SDoH并不能将有健康结果的u5与有和没有健康结果的u5区分出来。咳嗽（85.90%）、发热（78.42%）和ARI（69.77%）的PCV表现为中度交叉效应。我们还发现，贫民窟位置、母亲的就业、户主年龄和家庭垃圾处理系统等SDoH因素与5岁以下儿童的健康结果有关。本分析中使用的变量区分有健康结果和没有健康结果的能力较低。然而，适度交叉效应估计的存在表明，某些社会群体中的u5比其他群体的健康结果更差。因此，决策者在设计旨在改善孟加拉国贫民窟5岁以下儿童健康结果的干预政策时，需要考虑不同的社会群体。
Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefore, we aim to investigate how SDoH collectively affects health outcomes of U5y living in Bangladesh slums through an intersectionality lens. We used data from the most recent national Urban Health Survey (UHS) 2013 covering urban populations in Dhaka, Chittagong, Khulna, Rajshahi, Barisal, Sylhet, and Rangpur divisions. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the Discriminatory Accuracy (DA) of the intersectional effects estimates using Variance Partition Coefficient (VPC) and the Area Under the Receiver Operating Characteristic Curve (AUC-ROC). We also assessed the Proportional Change in Variance (PCV) to calculate intersectional effects. We considered three health outcomes: cough, fever, and acute respiratory infections (ARI) in U5y.We found a low DA for cough (VPC = 0.77%, AUC-ROC = 61.90%), fever (VPC = 0.87%, AUC-ROC = 61.89%) and ARI (VPC = 1.32%, AUC-ROC = 66.36%) of intersectional strata suggesting that SDoH considered do not collectively differentiate U5y with a health outcome from those with and without a health outcome. The PCV for cough (85.90%), fever (78.42%) and ARI (69.77%) indicates the existence of moderate intersectional effects. We also found that SDoH factors such as slum location, mother’s employment, age of household head, and household’s garbage disposal system are associated with U5y health outcomes. The variables used in this analysis have low ability to distinguish between those with and without health outcomes. However, the existence of moderate intersectional effect estimates indicates that U5y in some social groups have worse health outcomes compared to others. Therefore, policymakers need to consider different social groups when designing intervention policies aimed to improve U5y health outcomes in Bangladesh slums.