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Table 2 Potential pathways to inequity identified among eligible studies

From: A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults

Category of Equity Issue Example
Access to care Underdiagnosis of asthma in the Alaska Native population related to a lack of health care providers [35].
  Job requirements that may limit the ability to access health care services during normal business hours [36].
Access to transportation The role of access to public or private transportation in influencing ambulance service and emergency room use for asthma [30, 36].
Discrimination Potential variability in likelihood of asthma diagnosis due to different standards applied to different ethnic groups [15].
Environmental & occupational exposures Association between lower educational level, poverty, visible minority status, ethnicity, and/or immigrant status and higher risk of developing asthma due to increased exposure to irritants and occupational risk factors [23, 27, 32].
  Proximity of low-income urban neighborhoods to sources of pollutants (e.g. highways and truck routes) [39, 42]. Potential migration of high-risk populations to areas with lower pollutants [40], and potential reduced exposure to air pollutants in rural areas [41].
Housing & neighborhood environment Poor housing conditions in low-income neighborhoods that may increase exposure to cockroach and rodent allergens, dampness, and mold [24, 39].
  Increased stress related to community violence, and insufficient public services resulting in a poor physical environment in low-income neighborhoods [39, 42].
Insurance status Association between lack of insurance or Medicaid and discharge against medical advice and worse asthma control [26, 31].
  Emergency rooms as last resort for patients without health insurance in U.S. [28].
Race/ethnicity Race/ethnicity as a marker for social disadvantage (e.g. low income, lack of insurance coverage) rather a risk factor itself [15, 28, 29].
  Association between black race/ethnicity and increased emergency room visits [28].
  Potential link between stress associated with multiple race identification and higher rates of asthma among adults who are both American Indian/Alaska Native and white [37].
Socioeconomic status Relationship between race/ethnicity and discharge against medical advice neutralized when socioeconomic factors taken into account [31].
  Association between low socioeconomic status or lack of employment and increased asthma symptoms, poor compliance, and worse asthma-related quality of life [29, 33, 34, 38].
  Asthma as both a consequence and contributor to poverty by restricting ability to work and incurring medical expenses [23, 38].