Unmet needs and the effect of healthcare system generosity on prevention activity - A multilevel analysis.

INTRODUCTION: Maintaining a healthy lifestyle and obtaining preventive care (hereafter, prevention-activity) usually have an inverse association with poverty status and unmet needs. We seek to estimate the extent to which the effect of individual unmet needs status on prevention-activity is moderated by the generosity of the healthcare system. MATERIALS AND METHODS: Two datasets were combined: Pre-Covid Wave-8 (2019-2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE, Release 8.0.0), with 46,500 individuals aged 50+ from 27 countries (26 European countries and Israel) and 12 healthcare generosity variables obtained from the OECD Health Statistics Library. An econometric two-level model was used in three sequentially models. Outcome variables included five prevention-activities align over a continuum (sports, smoking, flu vaccinations, mammography, and colon cancer screening) and unmet needs status, defined as the lack of resources necessary to meet basic human and medical needs. RESULTS: We found that unmet needs at the individual level had a significant negative fixed effect in all of the prevention-activity models including a healthy lifestyle, primary prevention and secondary prevention. Sources of intra-country variation were social/public insurance, health expenditure and number of nurses, which have had a significant and positive effect on an individual's prevention-activities (except years of smoking). Nonetheless, the gaps in generous countries between people reporting on unmet need and others were larger or similar to those in less generous countries, suggesting that disparities increase with the generosity of the health system. CONCLUSIONS: The study provides insight into the effect of health system generosity on socioeconomic inequalities in healthy lifestyle and prevention care. Our findings suggest that the state has an important and decisive role to play in ensuring that prevention services are accessible to the entire population, particularly those reporting unmet needs.

Usefulness of helical computed tomography in detection of mitral annular calcification as a marker of coronary artery disease.

BACKGROUND: Mitral annulus calcification (MAC) may be a form of atherosclerosis. The goal of the present work was to investigate whether helical CT can determine the presence of MAC and to clarify its possible association with coronary artery disease (CAD) in elderly patients. DESIGN AND METHODS: Three hundred and twenty-nine consecutive elderly patients (165 men and 164 women, age range 60-79 years) underwent double helical CT of the heart to determine MAC and coronary calcifications (CC) according to a previously described protocol. RESULTS: MAC was documented in 60 patients (25 men, 35 women; mean age 69 +/- 4.5 years, range 60-78 years). The non-MAC group (control) included 269 patients (140 men, 129 women; mean age 67 +/- 4.6 years, range 60-79 years). Age was the only risk factor which had significant association with MAC (p = 0.01). A significant difference was found between MAC and control group for mean total CC score and advanced CC (total CC > 300) (323 +/- 565 vs. 184 +/- 429, p = 0.033 and 30% vs. 16%, p = 0.017, respectively). A significant difference was also found between groups for the prevalent proven CAD (30% vs. 16%, p = 0.008). Stepwise logistic regression analysis identified age [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.7-6.4, p < 0.001)], gender (male) (OR 3.1, 95% CI 1.6-6.0, p = 0.001), and MAC (OR 2.4, 95% CI 1.2-5.0, p = 0.016) as the independent variables significantly associated with CAD. The independent variables significantly associated with advanced CC (TCS > 300) were MAC (OR 2.6, 95% CI 1.3-5.2, p = 0.005), gender (male) (OR 2.3, 95% CI 1.2-4.2, p = 0.012) and age (OR 1.9, 95% CI 1.0-3.7, p = 0.052). CONCLUSIONS: Our study demonstrated the usefulness of helical computed tomography in the detection of mitral annular calcification as an additional marker of prevalent CAD. However, the diagnostic significance of the MAC detection is relatively minor and should not be considered as a direct proof for coronary atherosclerosis.

Aortic valve calcium on spiral computed tomography (dual slice mode) is associated with advanced coronary calcium in hypertensive patients.

BACKGROUND: Aortic valve calcium (AVC) is common in the elderly and is associated with an increase risk of death from cardiovascular causes and of myocardial infarction. The goal of the present study was to determine whether an association exists between the presence of AVC and coronary calcium (CC) in high-risk hypertensive patients as detected by spiral computed tomography (dual slice mode) (DHCT). DESIGN AND METHODS: Three hundred and seventy-six hypertensive patients participating in the International Nifedipine Gastrointestinal Therapeutic System (GITS) Study of Intervention as a Goal in Hypertension Treatment (INSIGHT) in our region were included (197 men and 179 women, age range 55-79 years). All underwent DHCT of the heart for CC scoring using previously published methods. A positive test for the presence of CC was defined as the presence of at least one lesion with an area of 0.5 mm and DHCT density above 90 Hounsfield units (total CC score >0). CC was considered advanced when total calcium score was >300. AVC was defined by DHCT as any detected calcified deposit in the region of the aortic valve. Patients without AVC served as the control group. RESULTS: AVC was documented in 70 patients (36 men, 34 women; mean age 66 +/- 5 years, range 57-79 years). The age- and sex-matched non-AVC group (control group) included 306 patients (161 men, 145 women; mean age 67 +/- 5 years, range 55-75 years). There were no intergroup differences in risk factors for atherosclerosis. Significant differences were found between AVC and the control groups for mean CC score (388 +/- 754 compared with 147 +/- 307, P< 0.001) and between the presence of advanced CC and the control group (27 compared with 15%, P= 0.02). Significant differences were also found for the presence of three-vessel calcification (36 compared with 21%, P= 0.01) and the number of vessels involved (1.8 +/- 1.1 compared with 1.4 +/- 1.1, P= 0.01). Stepwise logistic regression found age [odds ratio (OR) 1.08, 95% confidence intervals (CI) 1.03-1.15), gender (OR 0.45, 95% CI 0.25-0.82) and AVC (OR 2.07, 95% CI 1.06-4.02)] to be the only variables that predict advanced CC. CONCLUSIONS: Our study demonstrated a significant association between the presence of AVC and advanced CC on spiral computed tomography. These results strengthen earlier findings of a high association between AVC and increased risk of death from cardiovascular causes.