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Waiting times act as a non-price rationing mechanism to bring together the demand for and the supply of public healthcare services and ensure equal access independently of ability to pay. This study tests for the presence of socioeconomic inequalities in waiting times for ten publicly-funded planned and cancer surgeries in Catalonia (Spain) in 2015-2019. Socioeconomic status (SES), measured by four categories (very low, low, middle, high), is based on co-payment levels for medicines which depend on patient's income. Using administrative data, we estimate the association between SES and waiting times controlling for patient characteristics and hospital fixed effects. Compared to patients with low SES, patients with middle SES wait 2-6 fewer days for hip replacement, cataract surgery, and hysterectomy, and less than a day for breast cancer surgery. These inequalities arise within hospitals and are not explained by patient nor hospital characteristics. For some surgeries, the results also show that patients with higher SES are more likely to voluntarily exit the waiting list and have a lower probability of having a surgery canceled for medical reasons and dying while waiting.
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Acessibilidade aos Serviços de Saúde , Neoplasias , Feminino , Humanos , Espanha , Listas de Espera , Classe Social , Renda , Fatores SocioeconômicosRESUMO
INTRODUCTION: Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia after the approval of the PrEP, a territory with extensive implementation. METHODS: Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price) compared with non-implementation. A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. RESULTS: Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. CONCLUSIONS: The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.
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Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Masculino , Humanos , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina , Profilaxia Pré-Exposição/métodos , Análise de Custo-Efetividade , Análise Custo-Benefício , Medicamentos Genéricos/uso terapêuticoRESUMO
This paper estimates effects of long-term care (LTC) benefits on utilization of primary and secondary healthcare in Catalonia (Spain). Identification comes from plausibly exogenous variation in the leniency of LTC needs assessment. We estimate that receiving LTC benefits worth 365 euros per month, on average, reduces the probability of avoidable hospital admissions by 66%, and has no significant effect on planned hospitalisations nor on hospitalisation for any reason. Receiving LTC benefits is estimated to reduce unscheduled primary care visits by 44% and has no significant effect on scheduled visits. These findings have important policy implications suggesting that allocating resources to LTC may not only increase the welfare of LTC beneficiaries but also reduce avoidable and unscheduled utilisation of healthcare.
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Atenção à Saúde , Assistência de Longa Duração , Hospitalização , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , EspanhaRESUMO
BACKGROUND: Intensive care unit (ICU)-acquired infections with antibiotic-resistant bacteria have been associated with substantial health and economic costs. Moreover, southern Europe has historically reported high levels of antimicrobial resistance. OBJECTIVES: We estimated the attributable economic burden of ICU-acquired infections due to resistant bacteria based upon hospital excess length of stay (LOS) in a selected sample of southern European countries. METHODS: We studied a cohort of adult patients admitted to the ICU who developed an ICU-acquired infection related to an invasive procedure in a sample of Spanish, Italian, and Portuguese hospitals between 2008 and 2016, using data from The European Surveillance System (TESSy) released by the European Centers for Disease Control (ECDC). We analyzed the association between infections with selected antibiotic-resistant bacteria of public health importance and excess LOS using regression, matching, and time-to-event methods. We controlled for several confounding factors as well as time-dependent biases. We also computed the associated economic burden of excess resource utilization for each selected country. RESULTS: In total, 13,441 patients with at least 1 ICU-acquired infection were included in the analysis: 4,106 patients (30.5%) were infected with antimicrobial-resistant bacteria, whereas 9,335 patients (69.5%) were infected with susceptible bacteria. The unadjusted association between resistance status and excess LOS was 7 days (95% CI, 6.13-7.87; P < .001). Fully adjusted models yielded significantly lower estimates: 2.76 days (95% CI, 1.98-3.54; P < .001) in the regression model, 2.60 days (95% CI, 1.66-3.55; P < .001) in the genetic matching model, and a hazard ratio of 1.15 (95% CI, 1.11-1.19; P < .001) in the adjusted Cox regression model. These estimates, alongside the prevalence of resistance, translated into direct hospitalization attributable costs per ICU-acquired infection of 5,224 (95% CI, 3,691-6,757) for Spain, 4,461 (95% CI, 1,948-6,974) for Portugal, and 4,320 (95% CI, 1,662-6,977) for Italy. CONCLUSIONS: ICU-acquired infections associated with antibiotic-resistant bacteria are substantially associated with a 15% increase in excess LOS and resource utilization in 3 southern European countries. However, failure to appropriately control for significant confounders inflates estimates by â¼2.5-fold.
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Infecção Hospitalar , Humanos , Adulto , Portugal/epidemiologia , Infecção Hospitalar/microbiologia , Espanha/epidemiologia , Unidades de Terapia Intensiva , Resistência Microbiana a Medicamentos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias , Itália/epidemiologiaRESUMO
Understanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 81 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. We find that over 20.5 million years of life have been lost to COVID-19 globally. As of January 6, 2021, YLL in heavily affected countries are 2-9 times the average seasonal influenza; three quarters of the YLL result from deaths in ages below 75 and almost a third from deaths below 55; and men have lost 45% more life years than women. The results confirm the large mortality impact of COVID-19 among the elderly. They also call for heightened awareness in devising policies that protect vulnerable demographics losing the largest number of life-years.
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COVID-19/epidemiologia , COVID-19/mortalidade , Causas de Morte , Controle de Doenças Transmissíveis/métodos , Feminino , Saúde Global , Humanos , Expectativa de Vida , Masculino , SARS-CoV-2/isolamento & purificaçãoRESUMO
In this paper we document the evolution of the supermarket sales in one of the European countries, Spain, that has been most hardly hit by the COVID-19 pandemic. Using a very detailed dataset at the weekly and municipality level on the sales of a supermarket chain, we are able to separately identify the effects on sales for 12 different food products and for three population age groups. Furthermore, we distinguish between the impact of the lockdown, which affected the entire territory by mid-March, from the effect of the number of new confirmed positive COVID-19 cases at the municipal level. Our results show strong stockpiling effects for most of the products in the first week of adoption of the lockdown measures. On the other hand, the number of new cases at the municipal level is associated with reductions in sales, pointing towards increased fears of being infected as the main driver of the slowdown in sales. Finally, when we do a separate analysis for different age groups, we find no effects for individuals aged 66 and over.
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Comércio , Infecções/epidemiologia , Pandemias , Isolamento Social , Supermercados , Idoso , COVID-19/epidemiologia , Comércio/estatística & dados numéricos , Controle de Doenças Transmissíveis , Bases de Dados Factuais , Humanos , SARS-CoV-2 , Espanha/epidemiologia , Adulto JovemRESUMO
We evaluate the association between the variations in income and wealth, (both aggregate and split between real estate and financial wealth), and self-perceived health in Spain using a longitudinal sample of individuals before and after the financial crisis. We estimated generalized linear mixed models, with a binomial response and a logistic link, for four waves of the Spanish Survey of Household Finances (two before and two after the crisis), adjusting for variables at the family and individual levels. We also controlled for familial and individual heterogeneity and for temporal trends. While an increase in wealth greatly increases the probability of younger individuals reporting better health, this is not the case for older individuals. Decreases in gross wealth are associated with decreases in the probability of declaring good/very good health only in families whose reference person is over 44 years old. We conclude that: (i) not just income but net wealth effects impact on the consequences of income fluctuations on consumption and health assessed, (ii) the composition of individuals' net wealth may also matter, since they are differently affected by the shocks in the economic crisis, (iii) age plays a significant role and, finally, (iv) individual reactions in terms of consumption and savings, given any level of income and wealth, according to the risk aversions for precautionary idiosyncratic motives, may also need to be considered in order to complete the picture.
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Recessão Econômica , Nível de Saúde , Renda , Adulto , Características da Família , Feminino , Humanos , Masculino , EspanhaRESUMO
BACKGROUND: Infections with multidrug resistant (MDR) bacteria in hospital settings have substantial implications in terms of clinical and economic outcomes. However, due to clinical and methodological heterogeneity, estimates about the attributable economic and clinical effects of healthcare-associated infections (HAI) due to MDR microorganisms (MDR HAI) remain unclear. The objective was to review and synthesize the evidence on the impact of MDR HAI in adults on hospital costs, length of stay, and mortality at discharge. METHODS AND FINDINGS: Literature searches were conducted in PubMed/MEDLINE, and Google Scholar databases to select studies that evaluated the impact of MDR HAI on economic and clinical outcomes. Eligible studies were conducted in adults, in order to ensure homogeneity of populations, used propensity score matched cohorts or included explicit confounding control, and had confirmed antibiotic susceptibility testing. Risk of bias was evaluated, and effects were measured with ratios of means (ROM) for cost and length of stay, and risk ratios (RR) for mortality. A systematic search was performed on 14th March 2019, re-run on the 10th of June 2019 and extended the 3rd of September 2019. Small effect sizes were assessed by examination of funnel plots. Sixteen articles (6,122 patients with MDR HAI and 8,326 patients with non-MDR HAI) were included in the systematic review of which 12 articles assessed cost, 19 articles length of stay, and 14 mortality. Compared to susceptible infections, MDR HAI were associated with increased cost (ROM 1.33, 95%CI [1.15; 1.54]), prolonged length of stay (ROM 1.27, 95%CI [1.18; 1.37]), and excess in-hospital mortality (RR 1.61, 95%CI [1.36; 1.90]) in the random effects models. Risk of publication bias was only found to be significant for mortality, and overall study quality good. CONCLUSIONS: MDR HAI appears to be strongly associated with increases in direct cost, prolonged length of stay and increased mortality. However, further comprehensive studies in this setting are warranted. TRIAL REGISTRATION: PROSPERO (CRD42019126288).
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Infecção Hospitalar/economia , Farmacorresistência Bacteriana Múltipla , Adulto , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Custos Hospitalares , Mortalidade Hospitalar , Humanos , Tempo de Internação , Resultado do TratamentoRESUMO
In this paper, we analyze a tax on sugar-sweetened beverages (SSB) that was introduced in Catalonia on May 1, 2017. The Bill established the requirement of a 100% pass-through of the tax to the final consumer and two levels of the tax: 0.08 euro/liter for products with 5-less than 8â¯g of sugar and 0.12 euro/liter for products with 8â¯g of sugar or more. Previous literature focusing on the impact of SSB taxes finds that pass-though is only complete in the long-term. Our paper provides new evidence that, when the tax increases prices substantially and immediately, the sales response is also significant. In particular, we estimate that the new SSB tax in Catalonia reduced SSB purchases by 7.7%. We document that part of this reduction is substituted by an increase in sales of zero/light drinks (substitution effect). Importantly, the reduction in purchases is stronger in areas with a higher incidence of obesity, in areas with higher household incomes and for products with higher sugar content.
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Bebidas Adoçadas com Açúcar/economia , Bebidas Adoçadas com Açúcar/legislação & jurisprudência , Impostos/economia , Comportamento do Consumidor , Humanos , Obesidade/prevenção & controle , EspanhaRESUMO
The hypotheses we intended to contrast were, first, that the most deprived neighborhoods in Barcelona, Spain, present high exposure to environmental hazards (differential exposure) and, secondly, that the health effects of this greater exposure were higher in the most deprived neighborhoods (differential susceptibility). The population studied corresponded to the individuals residing in the neighborhoods of Barcelona in the period 2007-2014. We specified the association between the relative risk of death and environmental hazards and socioeconomic indicators by means of spatio-temporal ecological regressions, formulated as a generalized linear mixed model with Poisson responses. There was a differential exposure (higher in more deprived neighborhoods) in almost all the air pollutants considered, when taken individually. The exposure was higher in the most affluent in the cases of environmental noise. Nevertheless, for both men and women, the risk of dying due to environmental hazards in a very affluent neighborhood is about 30% lower than in a very depressed neighborhood. The effect of environmental hazards was more harmful to the residents of Barcelona's most deprived neighborhoods. This increased susceptibility cannot be attributed to a single problem but rather to a set of environmental hazards that, overall, a neighborhood may present.
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Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Disparidades nos Níveis de Saúde , Mortalidade , Ruído/efeitos adversos , Características de Residência/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Risco , Fatores Socioeconômicos , Espanha/epidemiologiaRESUMO
Following publication of the original article [1], the autor reported 5 references should be indicated in Spanish. The correct references can be found below.
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BACKGROUND: A number of factors contribute to attention deficit hyperactivity disorder (ADHD) and although they are not fully known, the occurrence of ADHD seems to be a consequence of an interaction between multiple genetic and environmental factors. However, apart from pesticides, the evidence is inadequate and inconsistent as it differs not only in the population and time period analysed, but also in the type of study, the control of the confounding variables and the statistical methods used. In the latter case, the studies also differ in the adjustment of spatial and temporal variability. Our objective here, is to provide evidence on an association between environmental factors and ADHD. METHODS: In our study, we used a population-based retrospective cohort in which we matched cases and controls (children free of the disease) by sex and year of birth (nâ¯=â¯5193, 78.9% boys). The cases were children born between 1998 and 2012 and diagnosed with ADHD (nâ¯=â¯116). To evaluate whether there was a geographical pattern in the incidence of ADHD, we first represented the smoothed standardized incidence rates on a map of the region being studied. We then estimated the probability of being a case by using a generalized liner mixed model with a binomial link. As explanatory variables of interest, we included the following environmental variables: distance to agricultural areas, distance to roads (stratified into three categories according to traffic density and intensity), distance to petrol stations, distance to industrial estates, and land use. We control for both observed (individual and family specific variables and deprivation index) and unobserved confounders (in particular, individual and familial heterogeneity). In addition, we adjusted for spatial extra variability. RESULTS: We found a north-south pattern containing two clusters (one in the centre of the study region and another in the south) in relation to the risk of developing ADHD. The results from the multivariate model suggest that these clusters could be related to some of the environmental variables. Specifically, living within 100â¯m from an agricultural area or a residential street and/or living fewer than 300â¯m from a motorway, dual carriageway or one of the industrial estates analysed was associated (statistically significant) with an increased risk of ADHD. CONCLUSION: Our results indicate that some environmental factors could be associated with ADHD occurring, particularly those associated with exposure to pesticides, organochlorine compounds and air pollutants because of traffic.
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Poluentes Atmosféricos/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Exposição Ambiental/efeitos adversos , Hidrocarbonetos Clorados/efeitos adversos , Praguicidas/efeitos adversos , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
a magnitud de la población de 65 años y más en situación de dependencia de la Argentina sería de más de un millón de personas. Dada la gran heterogeneidad en el tipo y en la intensidad de las ayudas que requieren las personas en situación de dependencia, resulta esencial establecer criterios de clasificación para identificar grupos homogéneos en términos de severidad.Objetivo: el trabajo busca establecer una metodología y unos criterios objetivos que permitan identificar grupos homogéneos de personas en situación de dependencia sobre la base de información secundaria (y limitada).Métodos: el método utilizado se basa en el Baremo de Valoración de la Situación de Dependencia (BVD) vigente en España y en la aplicación de la metodología de Arboles de Clasificación, bajo la función rpart del programa R. Las principales fuentes de información son la Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia de España (EDAD, 2008) y la Encuesta Nacional sobre Calidad de Vida de los Adultos Mayores de la Argentina (ENCaViAM, 2012).Resultados: el modelo seleccionado arroja un elevado grado de ajuste sugiriendo que es posible estimar la distribución de la población mayor en situación de dependencia según grado de severidad de manera razonable a partir de un grupo reducido de variables.Conclusiones: si bien la prevalencia de la dependencia de las personas mayores sería mayor en la Argentina respecto a lo obervado en España, la importancia relativa de los grupos con mayor severidad sería menor en el primer país (en Argentina).
he magnitude of the population 65 years and over in dependency status (ie, people with long-term care need) in Argentina would be more than one million people. Given the great heterogeneity in the type and intensity of the aid required by individuals with long-term care need, it is essential to establish some criteria to classify those in homogeneous groups in terms of severity.Objective: This work aims to establish a methodology and objective criteria that allow the identification of homogeneous groups of people in dependency status on the basis of secondary (and limited) information.Methods: The method used is based on the Valuation Scale of Dependency Situation from Spain and on the application of the Classification Trees method under the rpart function of the R program. The main sources of information are the Survey on Disability, Personal Autonomy and Dependency Situations from Spain (EDAD, 2008) and the National Survey on Quality of Life of the Elderly from Argentina (ENCaViAM, 2012).Results: the model selected shows a high degree of adjustment suggesting that it is possible to estimate the distribution of the elderly population in dependency status according to their severity level in a reasonable way from a reduced group of variables.Conclusions: although the prevalence of dependency among the elderly would be higher in Argentina than in Spain, the relative importance of groups with greater severity would be lower in the first country (in Argentina).
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BACKGROUND: The objective of this paper is to analyse whether the recent recession has altered health care utilisation patterns of different income groups in Spain. METHODS: Based on information concerning individuals 'income and health care use, along with health need indicators and demographic characteristics (provided by the Spanish National Health Surveys from 2006/07 and 2011/12), econometric models are estimated in two parts (mixed logistic regressions and truncated negative binominal regressions) for each of the public health services studied (family doctor appointments, appointments with specialists, hospitalisations, emergencies and prescription drug use). RESULTS: The results show that the principle of universal access to public health provision does not in fact prevent a financial crisis from affecting certain income groups more than others in their utilisation of public health services. CONCLUSIONS: Specifically, in relative terms the recession has been more detrimental to low-income groups in the cases of specialist appointments and hospitalisations, whereas it has worked to their advantage in the cases of emergency services and family doctor appointments.
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Atenção à Saúde/estatística & dados numéricos , Recessão Econômica , Disparidades em Assistência à Saúde , Renda/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Adulto JovemRESUMO
BACKGROUND: There is considerable evidence demonstrating socioeconomic inequalities in mortality, some of which focuses on intraurban inequalities. However, all the studies assume that the spatial variation of inequalities is stable over the time. We challenge this assumption and propose two hypotheses: (i) have spatial variations in socioeconomic inequalities in mortality at an intraurban level changed over time? and (ii) as a result of the economic crisis, has the gap between such disparities widened? In this paper, our objective is to assess the effect of the economic recession on the spatio-temporal variation of socioeconomic inequalities in mortality in Barcelona (Catalonia, Spain). METHODS: We used a spatio-temporal ecological design to analyse mortality inequalities at small area level in Barcelona. Mortality data and socioeconomic indicators correspond to the years 2005 and 2008-2011. We specified spatio-temporal ecological mixed regressions for both men and women using two indicators, neighbourhood and year. We allowed the coefficients of the socioeconomic variables to differ according to the levels and explicitly took into account spatio-temporal adjustment. RESULTS: For men and women both absolute and, above all, relative risks for mortality have increased since 2009. In relative terms, this means that the risk of dying has increased much more in the most economically deprived neighbourhoods than in the more affluent ones. CONCLUSIONS: Although the geographical pattern in relative risks for mortality in neighbourhoods in Barcelona remained very stable between 2005 and 2011, socioeconomic inequalities in mortality at an intraurban level have surged since 2009.
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Disparidades nos Níveis de Saúde , Mortalidade/tendências , Classe Social , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Saúde da População Urbana/tendências , Adulto JovemRESUMO
BACKGROUND: In recent decades demographic changes (low fertility rates, increased life expectancy ) in most OECD countries, have brought profound changes in the population pyramid, with several effects in the welfare of society. One of them is the increase in the number of people with disabilities, since age is a determining factor in the emergence of this dependency. OBJECTIVE/HYPOTHESIS: This paper studies the probability to enter and transit in and from a disability state, as well as its associated mortality, by attending to the distinction between the initial disability level and the process that leads on from it, and by addressing whether and how education, age and income affect this transition. METHODS: Applying a Markov model and a survival analysis to new Spanish administrative data set (Muestra Continua de Vida Laboral (MCVL)) we estimate the probability that a person changes the state of disability and the duration of her progression in each case. RESULTS: We find that people with an initial state of disability have a higher propensity to change status and take less time to transit amongst different stages than those who have no disability. Men do so more frequently than women and income have negative effects on the transition. CONCLUSIONS: These results may help to incorporate into welfare programs some protection mechanisms for delaying transitions and target the most fragile population groups.