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Assessing where vulnerable groups fare worst: a global multilevel analysis on the impact of welfare regimes on disability across different socioeconomic groups
  1. Margot I Witvliet1,
  2. Anton E Kunst1,
  3. Karien Stronks1,
  4. Onyebuchi A Arah1,2
  1. 1Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, USA
  1. Correspondence to Drs. Margot I Witvliet, Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands; m.witvliet{at}


Background Investigations on health differences within welfare states between low- and high-socioeconomic groups are mainly conducted in Europe. With the aim of gaining global insight on the extent welfare regimes influence personal disability for the most vulnerable, we explore how these health differences vary between low- and high-socioeconomic groups.

Methods The World Health Survey data were analysed on 199 595 adults from 46 countries using the welfare regime classification developed by Wood and Gough. Multilevel logistic regression was used to estimate welfare regime differences in self-reported disability according to individual educational attainment and employment status.

Results As compared with the low educated in the European-conservative regime, the odds of having a higher prevalence of disability was found among low-educated people residing in the informal-security regime of South Asia, with OR being 3.16 (95% CI 2.23 to 4.47). While state-organised regimes seemed to offer more protection against disability to the low educated, the productivist regime of East Asia trailed closely behind, with OR being 1.10 (95% CI 0.76 to 1.60) for the low educated. Similar findings were also observed in the unemployed.

Conclusions State-organised regimes of Europe and the productivist regime of East Asia seem to contain protecting features against disability for all citizens and especially for the most vulnerable. Apart from the productivist regime of East Asia, the low educated and the unemployed seem to carry the greatest health burden within more insecure regimes, highlighting a deficiency in social provisions within these regimes aimed at protecting the most vulnerable.

  • Global health
  • multilevel
  • welfare state
  • disability
  • World Health Survey
  • mental health
  • deprivation
  • psychosocial factors
  • housing
  • social inequalities

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  • This article uses data from the WHO World Health Surveys.

  • Funding Netherlands Organization for Scientific Research (NWO) Postbus 93138–2509 AC Den Haag The Netherlands. VENI career grant number 916.96.059 from the Netherlands Organization for Scientific Research (NWO) awarded to OAA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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