Socioeconomic inequalities in the use of medical consultation services in Peru, 2019.

BACKGROUND: Socioeconomic inequalities in the population influence access to health services and constitute a challenge for health systems, especially in low- and middle-income countries. In Peru, an increase in the use of medical services has been estimated; however, the study of inequalities in the use of medical services is limited. Therefore, the objective of this research was to analyze and decompose socioeconomic inequalities in the use of medical consultation services in Peru. METHODS: A cross-sectional analytical study was conducted using data from the National Household Survey 2019. The outcome variable was the use of a consultation attended by a physician in the last 4 weeks in persons who presented symptom or discomfort, illness, relapse of chronic disease and/or accident. Concentration curves and Erreygers concentration indices were used to determine socioeconomic inequalities, and a generalized linear regression model was used for the decomposition analysis of inequalities. RESULTS: A total of 52,715 persons were included in the study. The frequency of medical consultation was 25.4% (95% confidence interval: 24.8 - 26.1%). In the inequality analysis, it was found that the use of medical consultations was concentrated among the wealthiest individuals. The main contributing factors were having another type of health insurance (social health insurance [EsSalud], private health insurance, health provider, the Armed Forces, and the Police), residing in an urban area, belonging to the richest wealth quintile, having a chronic disease, and residing in the highlands of Peru. CONCLUSIONS: Based on our findings, government institutions seeking to achieve equitable access to health services should consider the main factors contributing to this inequality in the formulation of strategies to lessen the negative impact of inadequate disease control in the population.

Measuring Socioeconomic Inequalities in HIV Testing During Antenatal Care: A Peruvian National Survey.

Although several Latin American countries have 70% antenatal care coverage, the proportion of human immunodeficiency virus (HIV) testing of Peruvian pregnant women and the socioeconomic inequalities of this preventive measure are unknown. This study aimed to determine socioeconomic inequalities and quantify the contribution of contextual and compositional factors on HIV testing during prenatal care in Peru. A cross-sectional study of the 2021 Demographic and Family Health Survey data was conducted. The outcome variable was HIV testing of pregnant women during prenatal care. An analysis of inequalities was performed including the determination of concentration curves and a decomposition analysis of concentration indices. Of a total of 17521 women aged 15 to 49 years, 91.4% had been tested for HIV during prenatal care. The concentration curves showed that prenatal HIV testing was concentrated among richer women, while the decomposition analysis determined that the main contributors to inequality were having a higher education, residing in an urban area, and in the highlands, belonging to the wealthy quintile, and being exposed to television and newspapers. Strategies focused on improving access, promotion and restructuring of prevention of mother-to-child transmission measures should be prioritized.

Frequency, inequalities and spatial distribution of oral health services utilization in Peruvian children under twelve years of age: a population-based comparative analysis of the years 2017 and 2021.

BACKGROUND: Oral diseases pose a significant public health challenge among Peruvian children. However, oral health services utilization among them is marked by inequalities, which may have been exacerbated by the COVID-19 pandemic. The objective was to compare the frequency, inequalities, determinants of inequality, and spatial distribution in oral health services utilization in Peruvian children under 12 years of age in 2017 and 2021. METHODS: Comparative secondary data analysis from the Demographic and Family Health Survey (ENDES) for the years 2017 (38,787 minors) and 2021 (36,729 minors). Age-adjusted prevalence ratios (PR) with 95% confidence intervals (CI) were calculated to assess the change in oral health services utilization in the last 12 months between the years 2017 and 2021, stratifying by demographic and socioeconomic covariates. Inequality was assessed by decomposing the Erreygers Concentration Index (ECI) and calculating the percentage contribution to inequality of the independent variables. Spatial analysis was performed using spatial autocorrelation methods, Hot Spot Analysis, Cluster and Outlier analysis, Inverse Distance Weighting, ordinary Kriging, and Kulldorff analysis. RESULTS: The probability of Peruvian children under 12 years of age using oral health services in the last 12 months was reduced by 45% in 2021 compared to 2017. The ECI identified a significant reduction in oral health services utilization inequalities at the national level (Diff: -0.0963; p < 0.001). The main contributor to inequality was higher tutor education level (55.2% in 2017 and 82.7% in 2021). In the comparison of spatial distribution, there was a greater dispersion of the conglomerates in which the use of oral health services is concentrated in 2021. CONCLUSIONS: The frequency of oral health services utilization in the Peruvian children under 12 years of age was halved between 2017 and 2021. This problem is transversal to the entire population at the demographic and socioeconomic level. The key factor contributing to inequalities in the utilization of oral health services was the higher educational attainment of caregivers or guardians. Despite the improvement observed in inequalities and spatial distribution of the concentration of oral health services utilization, it is necessary to keep monitoring these patterns to guide decision-making.

Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis.

BACKGROUND: The COVID-19 pandemic disrupted health systems in 2020, but it is unclear how financial hardship due to out-of-pocket (OOP) health-care costs was affected. We analysed catastrophic health expenditure (CHE) in 2020 in five countries with available household expenditure data: Belarus, Mexico, Peru, Russia, and Viet Nam. In Mexico and Peru, we also conducted an analysis of drivers of change in CHE in 2020 using publicly available data. METHODS: In this time-series analysis, we defined CHE as when OOP health-care spending exceeds 10% of consumption expenditure. Data for 2004-20 were obtained from individual and household level survey microdata (available for Mexico and Peru only), and tabulated data from the National Statistical Committee of Belarus and the World Bank Health Equity and Financial Protection Indicator database (for Viet Nam and Russia). We compared 2020 CHE with the CHE predicted from historical trends using an ensemble model. This method was also used to assess drivers of CHE: insurance coverage, OOP expenditure, and consumption expenditure. Interrupted time-series analysis was used to investigate the role of stay-at-home orders in March, 2020 in changes in health-care use and sector (ie, private vs public). FINDINGS: In Mexico, CHE increased to 5·6% (95% uncertainty interval [UI] 5·1-6·2) in 2020, higher than predicted (3·2%, 2·5-4·0). In Belarus, CHE was 13·5% (11·8-15·2) in 2020, also higher than predicted (9·7%, 7·7-11·3). CHE was not different than predicted by past trends in Russia, Peru, and Viet Nam. Between March and April, 2020, health-care visits dropped by 4·6 (2·6-6·5) percentage points in Mexico and by 48·3 (40·6-56·0) percentage points in Peru, and the private share of health-care visits increased by 7·3 (4·3-10·3) percentage points in Mexico and by 20·7 (17·3-24·0) percentage points in Peru. INTERPRETATION: In three of the five countries studied, health systems either did not protect people from the financial risks of health care or did not maintain health-care access in 2020, an indication of health systems failing to maintain basic functions. If the 2020 response to the COVID-19 pandemic accelerated shifts to private health-care use, policies to cover costs in that sector or motivate patients to return to the public sector are needed to maintain financial risk protection. FUNDING: The Bill & Melinda Gates Foundation.

Migration Status and Utilization of Healthcare Services Among Venezuelan Immigrants in Peru.

BACKGROUND: In general, migrants in illegal situations encounter a greater barrier to accessing medical care because of their migration status due to not having the required documentation to be able to obtain insurance in the receiving country. OBJECTIVE: To evaluate the association between migration status and the use of health services in the Venezuelan population residing in Peru. METHODS: Data from the second Survey Directed to the Venezuelan Population Residing in Peru (ENPOVE) of 2022 were analyzed. The dependent variable was use of health services in the last month. The exposure variable was migration status (legal/illegal). Generalized linear models of the Poisson family with link log function were used to obtain crude and adjusted prevalence ratios (aPR), for potential confounding variables. Additionally, we evaluated the association of interest, stratified by gender. FINDINGS: Data from 1569 migrants were analyzed. Participants with illegal migration status represented 32.4% (men: 24.3%; women: 36.7%); likewise, 58.1% did not use health services. Illegal migration status was associated with lower health care use (aPR: 0.75; 95%CI: 0.61-0.92). Likewise, after stratifying by sex, the association was maintained only in male migrants (aPR: 0.53; 95%CI: 0.39-0.82) but not in women (aPR: 0.84; 95%CI: 0.67-1.05). CONCLUSION: 58.1% of Venezuelan migrants in Peru did not seek medical attention despite having health problems. Having an illegal immigration status leads to a lower probability of using these services, especially in men.

Socioeconomic Inequalities and Factors Associated with the Use of Modern Contraceptive Methods in Women of Childbearing Age in Ecuador, 2018.

The objective of this study was to determine the socioeconomic inequalities and factors associated with the use of modern contraceptive methods (MCM) in the population of sexually active women of childbearing age in Ecuador. This was an analytical observational study, based on a secondary data analysis of the 2018 National Health and Nutrition Survey (ENSANUT). Information on 19,106 sexually active, married, or cohabiting women between the ages of 15 and 49 were included. Concentration curves (CC) and Erreygers concentration indices (ECI) were calculated, taking into account the use of MCM as the dependent variable and the wealth index as the independent variable. Crude and adjusted prevalence ratios with 95% confidence intervals were calculated using generalized linear models of the Poisson family. We found that 92.8% of the women surveyed used some type of MCM in the last month. A higher educational level presented a significant pro-rich concentration in the use of MCM (EIC: 0.05; p = 0.004). On the other hand, women belonging to the age group of 20 to 29 years (ECI: -0.027; p = 0.027), women with no job (ECI: -0.025; p = 0.004), and non-indigenous women (EIC: -0.031; p < 0.001), presented a pro-poor concentration. Factors significantly associated with MCM use were age, marital status, occupation, parity, ethnicity, area of residence, and living on the coast. In Ecuador, there are socioeconomic inequalities at different levels of population subgroups in women of childbearing age. Measures to promote the use of MCM are required, focusing on groups that present inequality, taking into account the factors associated with their use.

Geographic and Socioeconomic Determinants of Full Coverage COVID-19 Vaccination in Peru: Findings from a National Population-Based Study.

Despite the fact that vaccination coverage against COVID-19 has made great progress in Peru, there is still a quarter of the population that has not been fully vaccinated. This study aims to determine the factors associated with complete vaccination in Peruvian adults. An analysis of the National Household Survey 2022 in Peru was performed. Prevalence ratios with their 95% confidence intervals (95% CI) were estimated to assess the factors associated with vaccination with three or more doses of the COVID-19 vaccine. A total of 58,471 participants were included in the study and 75.8% of the surveyed population were found to have received full vaccination. Significant differences in complete coverage were observed according to sex, age, educational level, ethnicity, poverty status, and geographic location. In the adjusted analysis, individuals aged 60 years or older, those with higher educational attainment, the non-poor, and those living in urban areas were more likely to be fully vaccinated. Native individuals and people who live in households without media are less likely to be fully covered. These results highlight the importance of considering demographic and socioeconomic factors when analyzing COVID-19 vaccination coverage. Additional strategies are needed to address vaccination gaps and ensure better vaccination coverage.

Determinants, inequalities, and spatial patterns of diarrhea in the Peruvian under-five population: findings from nationally representative survey data.

Objective: To determine the associated factors, decompose the socioeconomic inequalities, and analyze the spatial distribution of childhood diarrhea in Peru. Methods: A cross-sectional analytical study was conducted using data from the National Demographic and Family Health Survey 2021. The dependent variable was the presence of diarrhea in the last two weeks. Three types of analysis were performed: (i) to evaluate the associated factors, generalized linear models of the Poisson family with logarithmic link were applied and prevalence ratios with their 95% confidence intervals were reported; (ii) for the analysis of inequalities, a decomposition of the Erreygers concentration index was performed using a generalized linear model; and (ii) a spatial autocorrelation analysis, hot spot analysis and cluster and outlier analysis were performed. Results: A total of 18,871 children under 5 years of age were included. The prevalence of diarrhea in this population was 10.0%. Determinants such as being aged 0-23 months, being male, belonging to the poorest, poorer and rich wealth index, and residing in the Highlands and Jungle increased the probability of presenting diarrhea. In the decomposition analysis, diarrhea had a pro-poor orientation, with the greatest contributors were age 0-23 months, belonging to the poorest and poorer wealth indexes, and residing in the Highlands and Jungle. Spatial analysis showed that the highest concentrations and occurrence of this event were observed in departments of the Highlands and Jungle. Conclusion: Government institutions seeking to reduce the numbers and burden of childhood diarrhea should focus their strategies on promoting hygiene measures and improving access to water and sanitation services, especially in poor populations living in the Peruvian Highlands and Jungle.

Socioeconomic and Demographic Factors Associated with the Influence of the Food Traffic Light Labeling on the Decision of the Adult Population of Ecuador to Purchase Processed Foods, 2018.

To determine the socioeconomic and demographic factors associated with the influence of the nutritional traffic light (NTL) on the decision to purchase processed foods using information from the National Health and Nutrition Survey (ENSANUT) 2018 of Ecuador, a cross-sectional and analytical study based on a secondary analysis of the information from the ENSANUT 2018 was performed. We collected data from 25,932 participants 18 years of age or older who knew or had seen the NTL, and for whom complete information on the variables of interest for the study was available. The "Influence of the NTL on the purchase decision of processed foods" was the outcome variable of the study. Generalized linear models of the Poisson family, with log link, were used to assess the association between socioeconomic factors and outcome, using crude (PR) and adjusted (aPR) prevalence ratios, with 95% confidence intervals (CI) and a p-value < 0.05. Participants who understood the NTL (aPR: 2.49; 95% CI: 2.19-2.83), with a higher educational level (aPR: 1.33; 95% CI: 1.09-1.61), women (aPR 1.06; 95% CI: 1.01-1.10), and who had a partner (aPR 1.09; 95% CI: 1.04-1.14) were more likely to be influenced by the NTL when deciding to purchase processed foods, compared to people who did not understand the NTL, who had no educational level or who only attended a literacy center, were men, and those without a partner. The inhabitants of the coastal region (aPR: 0.92; 95% CI: 0.88-0.97), the Amazon (aPR 0.93; 95% CI: 0.88-0.98), and the insular region (aPR 0.76; 95% CI: 0.68-0.84) had few probabilities of being influenced by the NTL in the decision to purchase processed foods, in comparison with the residents of the highlands. Similarly, compared to non-poor people, poor people had a lower probability of being influenced by the NTL (aPR 0.89; 95% CI: 0.82-0.97). Factors associated with the influence of NTL on the decision to purchase processed foods were identified. It is recommended to reformulate and focus awareness strategies for using the NTL to purchase processed foods by taking into account the associated factors.

Chronic disease relapses: A cross-sectional study of the associated factors and socioeconomic inequalities during the COVID-19 pandemic in Peru.

OBJECTIVES: To investigate the prevalence, associated factors and socioeconomic inequalities in chronic disease relapses (CDR) during 2020 in Peru. METHODS: A secondary analysis was made of the National Household Survey on Living Conditions and Poverty (ENAHO) 2020. Participants older than 18 years who suffered from a chronic disease and with information about the occurrence of a CDR in the last 4 weeks prior to the survey were included. Adjusted prevalence ratios (aPRs) were estimated to determine the associated factors. Socioeconomic inequality in CDR was estimated using concentration curves (CC) and the Erreygers concentration index (ECI). RESULTS: Data from 38,662 participants were analyzed; the prevalence of CDR in the last 4 weeks prior to the survey was 16.5% (95% CI: 15.8-17.2). Being female (aPR 1.29; 95% CI: 1.21-1.37), with regards to being male; being 30-39 (aPR 1.22; 95% CI: 1.05-1.42), 40-49 (aPR 1.29; 95% CI: 1.12-1.48), 50-59 (aPR 1.60; 95% CI: 1.41-1.82), and 60 years or older (aPR 1.80; 95% CI: 1.58-2.04), compared to 18-29; reaching up to primary (aPR 1.18; 95% CI: 1.07-1.31), or secondary education (aPR 1.13; 95% CI: 1.02-1.24), in contrast to tertiary education; presenting some physical, psychological or cognitive limitation (aPR 1.33; 95% CI: 1.21-1.46), with respect to experiencing no limitations; and being affiliated to a health insurance (aPR 1.18; CI 95%: 1.09-1.29), opposed to not having health insurance; were associated with a higher probability of CDR. Residing in the natural region of the coastal area (aPR 0.83; 95% CI: 0.74-0.92) was associated with a lower probability of relapse compared to residing in the jungle area. In people with limitations and residents of the jungle areas, the prevalence of CDR was concentrated in those with higher per capita spending. CONCLUSIONS: Approximately 1 in 6 Peruvians with chronic diseases had a relapse within the last 4 weeks prior to the survey of 2020 and certain geographic and sociodemographic factors were found to be associated with CDR. It was also found that a higher concentration of CDR was observed in the population with the highest per capita spending with some limitations, as well as in residents of the jungle, implying the need for appropriate policy interventions that address CDR with a special focus on these populations.

Socio-economic inequalities in the consumption of fruits and vegetables in Peru between 2014 and 2019.

OBJECTIVE: To estimate the prevalence and socio-economic inequalities in adequate consumption of fruits and vegetables in Peru between 2014 and 2019. DESIGN: Analytical cross-sectional study. The outcome variable was adequate consumption of fruits and vegetables, defined as the consumption of five or more servings of fruits and vegetables per d (yes/no). We used concentration curves and Erreygers concentration index to describe socio-economic inequalities and a microeconometric approach to determine the contribution of each variable to inequality. SETTING: Peru. PARTICIPANTS: Data from Peruvians aged 18 years or older collected by the Demographic and Family Health Survey. RESULTS: The prevalence of adequate fruit and vegetable consumption did not change between 2014 (10·7 %; 95 % CI (10·0, 11·4)) and 2019 (11 %; 95 % CI (10·4, 11·7)). We found socio-economic inequalities in the adequate consumption of fruits and vegetables, with wealthier individuals having a higher prevalence of adequate consumption compared to poorer individuals in 2014 (19·2 % v. 3·5 %) and 2019 (18·6 % v. 4·7 %). The decomposition analysis found that education, urban areas and being wealthy were the main factors associated with socio-economic inequality in adequate fruit and vegetable consumption, being structural problems of society. CONCLUSION: Despite the current regulations on healthy eating in Peru, adequate consumption of fruits and vegetables remains low, and there are socio-economic inequalities between the poorest and wealthiest individuals. Our findings suggest that more efforts are needed to increase the intake and assess the disparities in adequate fruit and vegetable consumption.

Socioeconomic Inequalities in the Prevalence of Diabetes in Argentina: A Repeated Cross-Sectional Study in Urban Women and Men.

This study measured the socioeconomic inequalities in the prevalence of diabetes between 2005 and 2018 in an urban Argentinian population. Data were obtained from the repeated cross-sectional surveys "National Survey of Risk Factors" (ENFR is its acronym in Spanish). From 2005 to 2018, four rounds of ENFR were administered to men and women over 18 years of age. Concentration curves (CC) and the Erreygers concentration index (ECI) were used to describe the socioeconomic inequalities in diabetes' prevalence. A decomposition analysis was performed to determine the contribution of each variable to inequality in diabetes' prevalence. Data from 41,219 (2005), 34,583 (2009), 32,232 (2013), and 29,094 (2018) individuals were analyzed. Women reported a greater prevalence of diabetes compared with men for all the years included. According to the CC and ECI, we found no evidence of inequality in men throughout all study years. For women, throughout all years, the CCs were above the line of equity, and the ECIs during all the years were negative and different from zero (p < 0.01). For women, we found no evidence of a reduction in inequalities between 2005 and 2018 (p = 0.475). The socioeconomic inequality for women was largely driven by public insurance, primary and secondary education, and employment. Diabetes' prevalence was not associated with socioeconomic status in men, while the prevalence of diabetes in women was more concentrated among poorer women. During the 13 years, there was no evidence of a reduction of inequality in women, noting that interventions must prioritize and should focus on the main contribution of inequalities, such as education and employment.

Satisfaction and perceptions about aspects of the city that affect health, by socioeconomic status, 2010-2019, in Lima. / Satisfacción y percepciones sobre aspectos de la ciudad que afectan la salud, por nivel socioeconómico, 2010-2019, en Lima Metropolitana.

We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens.

Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos¼ entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

Satisfacción y percepciones sobre aspectos de la ciudad que afectan la salud, por nivel socioeconómico, 2010-2019, en Lima Metropolitana / Satisfaction and perceptions about aspects of the city that affect health, by socioeconomic status, 2010-2019, in Lima

RESUMEN Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos¼ entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

ABSTRACT We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens.

Geographic and socioeconomic inequalities in cesarean birth rates in Peru: A comparison between 2009 and 2018.

BACKGROUND: There is a global concern about the high rates of cesarean birth (CB). This study aimed to investigate the geographic and socioeconomic inequalities in CB rates in the Peruvian population. METHODS: We conducted a population-based study using the Peruvian Demographic and Family Health Surveys (ENDES, the Spanish acronym for Encuesta Demográfica y de Salud Familiar) between 2009 and 2018. ENDES reported data from births registered in the five years preceding survey execution. For the years 2009 (n = 10 289) and 2018 (n = 23 077), we calculated the weighted rates of CB among variables such as natural geographic domain (Coast, Andean, or Amazon), area of residence (rural or urban), wealth index quintile (quintile 1 is poorest, and quintile 5 is richest), and educational level. To assess inequalities, we calculated the concentration index (CIs), the slope index of inequality (SII), and the relative index of inequality (RII). RESULTS: The CB rates by year were 21.4% (95% confidence interval [CI]: 20.0-22.9) in 2009 and 34.5% (95% CI: 33.4-35.5) in 2018. Women living in urban and coastal regions and with a higher education level had the highest CB rates. All the CIs were positive, reflecting a prowealthy inequality in CB rates, and both SII and RII were positive, indicating a gap between the use of cesarean in women in the higher wealth quintile compared with those in the lower quintile. CONCLUSIONS: Cesarean birth rates have increased by 60% during the last decade in Peru. The richest wealth quintiles had the highest CB rates during the study years, which were well above global recommendations.

Determinants of Eye Care Service Utilization among Peruvian Adults: Evidence from a Nationwide Household Survey.

PURPOSE: This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. METHODS: A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. RESULTS: Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33-2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28-1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67-2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74-3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. CONCLUSION: The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.

Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population.

BACKGROUND: Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. METHODS: This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions (ENAHO) from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were (i) the proportion of individuals who incurred OOP expenditures and (ii) the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic. RESULTS: ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (P=.916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (P=.073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups. CONCLUSION: The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures.

Socioeconomic determinants and inequalities in exclusive breastfeeding among children in Peru.

Introduction: Although Latin America and the Caribbean have one of the highest prevalences of exclusive breastfeeding (EBF), the countries in this region have socioeconomic determinants that influence the frequency of this practice and do not allow achieving the 70% target recommended by the World Health Organization. Therefore, the objective of the study was to examine the socioeconomic determinants and perform a decomposition analysis of socioeconomic inequalities in EBF in Peruvian children 6 to 59 months of age. Methods: A cross-sectional study was carried out using the 2021 Demographic and Family Health Survey. The dependent variable for the study was EBF up to 6 months of age and the wealth index variable was used to perform the inequality analysis. Poisson log generalized linear regression models were fitted to evaluate the association between EBF and the independent variables, and concentration curves and Erreygers concentration index decomposition were used to analyze inequalities in EBF. Results: A total of 9926 surveyed participants were included. The prevalence of EBF was 70.5% (95% confidence interval: 69.2-71.8). Women who were married, self-identified as native, received EBF training, resided in the highlands and jungle, and their child was the second or older showed a higher likelihood of EBF. In the inequality analysis, EBF was concentrated among the poorest mothers and the major contributors were residing in the highlands and jungle and belonging to the middle and wealthy quintiles. Discussion: Our findings suggest that the main strategies to encourage the practice of EBF should be focused on all mothers regardless of their socioeconomic status in order to reduce the EBF gap between richer and poorer women.

Intercambio desde los cigarrillos convencionales a los sistemas electrónicos de administración de nicotina: revisión sistemática rápida con metaanálisis y aspectos económicos / Switching from cigarettes to electronic nicotine delivery system: rapid systematic review and meta-analysis and economic aspects

RESUMEN Objetivos. Evaluar cómo y en qué medida se produce un intercambio desde los cigarrillos convencionales (CC) a los sistemas electrónicos de administración de nicotina (SEAN). Materiales y métodos. Se realizó una revisión sistemática hasta agosto de 2019. El desenlace primario fue la proporción de un intercambio completo o parcial de CC a los SEAN y sus aspectos económicos. Los desenlaces secundarios como medidas de resultado fueron la probabilidad de intercambio y la tendencia en el intercambio por países. Resultados. Se encontraron 3628 referencias y se incluyeron 49 estudios con datos epidemiológicos y económicos. Los estudios económicos sobre la elasticidad cruzada de precios mostraron que los CC son parcialmente intercambiables por SEAN. La mayoría de los estudios reportaron que la prevalencia del consumo de cigarrillos electrónicos se incrementó con el tiempo. Tres estudios reportaron una reducción significativa de los CC consumidos por día entre fumadores duales (convencionales más SEAN) en comparación con los consumidores de CC. El odds ratio ajustado y combinado de dejar los CC entre consumidores de SEAN en comparación con quienes nunca consumieron o lo hicieron en el pasado fue de 1,19 (IC95%: 1,09-1,30; heterogeneidad 0%). Los estudios longitudinales mostraron una creciente prevalencia del uso de cigarrillos electrónicos, principalmente en adolescentes. Se encontró una relación negativa entre el consumo y aumento de precio de CC y electrónicos. Conclusión. La probabilidad de dejar de fumar CC entre consumidores habituales de SEAN se incrementó respecto a los consumidores que nunca o que solían consumir SEAN. Estudios económicos reportaron que los cigarrillos electrónicos son parcialmente intercambiables por los CC.

ABSTRACT Objectives. To assess how and in what extent the electronic nicotine delivery systems (ENDS) use substituted the consumption of traditional combustible cigarettes (c-cigarettes, c-cig). Materials and Methods. We performed a systematic review of the literature up to August 2019 in scientific databases. Primary outcomes were proportion of complete or partial substitution of conventional to electronic cigarettes and related economic aspects. Secondary outcomes were odds ratio of substitution and country-wise time trends. Results. We retrieved 3,628 references and included 49 studies, providing economic and epidemiological data. Economic studies of cross-price elasticity showed that combustible cigarettes are partially substitutable for electronic cigarettes. Most studies reported that electronic cigarettes consumption prevalence increased over time. Three studies reported a significant reduction of combustible cigarettes consumed per day among dual users (combustible- plus electronic- cigarettes users) versus combustible-cigarettes users. The pooled adjusted odds ratio of quitting combustible cigarettes among electronic cigarettes users versus never or past electronic cigarettes (e-cigarettes, e-cig) users was 1.19 (95% confidence interval 1.09 to 1.30; heterogeneity score 0%). Longitudinal studies showed globally a growing prevalence of electronic cigarettes use, mainly in adolescents. A negative relationship between consumption and price increase of electronic and combustible cigarettes was found. Conclusion. The chance of quitting smoking combustible cigarettes among current electronic nicotine delivery systems users was increased with respect to never- or past- electronic nicotine delivery systems users. Economic studies reported that electronic cigarette is partially substitutable for combustible cigarettes.

Prevalence of home birth among 880,345 women in 67 low- and middle-income countries: A meta-analysis of Demographic and Health Surveys.

OBJECTIVE: The objective of this study was to determine the prevalence of home birth in low-middle income countries (LMIC) according to geographic area and sociodemographic characteristics between 2000 and 2019. METHODS: A meta-analysis was carried out using the most recent demographic and health surveys as a data source (total countries: 67). A random-effects meta-analysis was obtained to calculate pooled prevalence estimates of home birth for all the countries included and by geographic region of the world. Likewise, a subgroup analysis was performed to estimate the prevalence of home birth according to the sociodemographic factors considered for this study. RESULTS: The global prevalence of home birth was 28% (95% CI: 0.24-0.33), with the lowest prevalence in the region of Europe & Central Asia (5%, 95% CI: 0.03-0.07) and the highest in East Asia & Pacific region (38%, 95% CI: 0.26-0.51). Twelve countries had proportions of home births greater than 50% (seven belonged to the Sub-Saharan Africa region). The countries with the highest proportion of home births were Chad (78%), Ethiopia (73%), and Niger and Yemen (70% each). Concerning the wealth index, in general, the richest quintile (quintile 5) presented the lowest proportion of home births. In contrast, the poorest (quintile 1) generally had the highest prevalence of home births. Regarding educational level, women without education presented the highest proportions of home births in general. In relation to the area of residence, in almost all the countries studied, women in rural areas generally had a higher proportion of home births than those in urban areas. CONCLUSIONS: Home births occurred in approximately 3 out of 10 women in LMIC. There are also differences in the proportion of home births according to socioeconomic factors such as educational level, wealth index, and rurality.