RESUMO
The aim of the present study was to identify specific actions and financial precautions undertaken by individuals in preparation for their long-term care needs, as well as to determine the correlates of these actions. A population-based survey of the German population aged 65 years and above (n = 1006) was used. Individuals were asked whether they have undertaken financial preparations for their long-term care needs (no; yes). With respect to specific actions, individuals were asked whether they (no; yes): (i) Had obtained information (e.g., from doctor, internet, care support center, care facility), (ii) had modified their home (e.g., installed a stair lift), and (iii) had moved (e.g., old-age housing, care in relatives' homes). In total, 30.4% had undertaken financial preparations for their long-term care needs. With respect to the specific actions undertaken, 6.5% had obtained information, 4.8% modified their home, and 7.3% had moved. The outcome measure, 'had modified home', was positively associated with lower age, West Germany, and lower self-rated health. The outcome measure, 'had moved', was positively associated with being female, and higher education. The outcome measure, 'financial preparations for long-term care needs', was positively associated with lower age, West Germany, higher education, being born in Germany, and private health insurance. It is alarming that only around one in three individuals aged 65 and older had undertaken financial preparations for long-term care needs, and that far fewer individuals had undertaken other actions to prepare for their long-term care needs. The provision of timely information regarding the risk of long-term care, as well as its associated costs, may assist in sustaining the satisfaction of long-term care recipients. It may also help to reduce the risk of long-term care for individuals in old age.
Assuntos
Planejamento Antecipado de Cuidados/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Assistência de Longa Duração/psicologia , Assistência de Longa Duração/estatística & dados numéricos , Vigilância da População , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
AIM OF THE STUDY: The aim of this paper was to conduct a systematic review of cost-of-illness studies for overweight and adiposity in Germany. METHODS: We conducted a PubMed search to identify relevant studies. To increase comparability, all cost data were inflated to 2014 prices. For bottom-up studies, we additionally calculated relative cost-differences between normal weight and overweight, as well as adiposity. These relative differences were pooled using meta-analytical techniques and extrapolated to the German population. RESULTS: We identified 15 bottom-up studies, 6 top-down studies and 2 Markov simulations. On average, top-down studies reported direct costs of 7.9 billion Euros and indirect costs of 3.6 billion Euros. Due to between-study heterogeneity, we were not able to pool absolute costs reported in bottom-up studies. The pooled relative cost-differences for studies conducted with adult persons were +22% for the difference between normal weight and overweight and +53% for the difference between normal weight and adiposity. The corresponding effect sizes were 0.07 (- 0.05; 0.19) and 0.15 (0.02; 0.28), respectively. In studies conducted with children and adolescents, relative cost-differences were considerably smaller with corresponding effect sizes being close to zero. Extrapolation of relative pooled cost-differences from bottom-up studies to the German total population yielded direct and indirect excess costs of 22.2 billion Euros for overweight and 23.0 billion Euros for adiposity. CONCLUSION: We found substantial heterogeneity of cost findings between studies for top-down and bottom-up studies as well, which points to substantial uncertainty and strongly hampers clear statements about the costs of overweight and adiposity. Our findings imply that costs are underestimated by top-down studies, whereas overestimated by our extrapolation. The true costs presumably lie between the findings of both approaches.
Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Obesidade , Sobrepeso , Adolescente , Adulto , Criança , Alemanha , Humanos , Obesidade/economia , Sobrepeso/economiaRESUMO
BACKGROUND: Long-term care is one of the most pressing health policy issues in Germany. It is expected that the need for long-term care will increase markedly in the next decades due to demographic shifts. The purpose of this study was to investigate the factors associated with preferences for long-term care settings in old age individuals in Germany. METHODS: Based on expert interviews and a systematic review, a questionnaire was developed to quantify long-term care preferences. Data were drawn from a population-based survey of the German population aged 65 and over in 2015 (n = 1006). RESULTS: In multiple logistic regressions, preferences for home care were positively associated with providing care for family/friends [OR: 1.6 (1.0-2.5)], lower self-rated health [OR: 1.3 (1.0-1.6)], and no current need of care [OR: 5.5 (1.2-25.7)]. Preferences for care in relatives' homes were positively associated with being male [OR: 2.0 (1.4-2.7)], living with partner or spouse [OR: 1.8 (1.3-2.4)], having children [OR: 1.6 (1.0-2.5)], private health insurance [OR: 1.6 (1.1-2.3)], providing care for family/friends [OR: 1.5 (1.1-2.0)], and higher self-rated health [OR: 1.2 (1.0-1.4)]. Preferences for care in assisted living were positively associated with need of care [OR: 1.9 (1.0-3.5)] and higher education [for example, University, OR: 3.5 (1.9-6.5)]. Preferences for care in nursing home/old age home were positively associated with being born in Germany [OR: 1.8 (1.0-3.1)] and lower self-rated health [OR: 1.2 (1.0-1.4)]. Preferences for care in a foreign country were positively associated with lower age [OR: 1.1 (1.0-1.2)] and being born abroad [OR: 5.5 (2.7-11.2)]. CONCLUSIONS: Numerous variables used are sporadically significant, underlining the complex nature of long-term care preferences. A better understanding of factors associated with preferences for care settings might contribute to improving long-term care health services.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Assistência de Longa Duração/psicologia , Preferência do Paciente , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Prática Clínica Baseada em Evidências/organização & administração , Feminino , Alemanha , Serviços de Assistência Domiciliar , Humanos , Expectativa de Vida/tendências , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Casas de Saúde , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The aim of the study was to evaluate objective and subjective image qualities of virtual monoenergetic imaging (VMI) in dual-source dual-energy computed tomography (DECT) and optimal kiloelectron-volt (keV) levels for lung cancer. METHODS: Fifty-nine lung cancer patients underwent chest DECT. Images were reconstructed as VMI series at energy levels of 40, 60, 80, and 100 keV and standard linear blending (M_0.3) for comparison. Objective and subjective image qualities were assessed. RESULTS: Lesion contrast peaked in 40-keV VMI reconstructions (2.5 ± 2.9) and 60 keV (1.9 ± 3.0), which was superior to M_0.3 (0.5 ± 2.7) for both comparisons (P < 0.001). Compared with M_0.3, subjective ratings were highest for 60-keV VMI series regarding general image quality (4.48 vs 4.52; P = 0.74) and increased for lesion demarcation (4.07 vs 4.84; P < 0.001), superior to all other VMI series (P < 0.001). Image sharpness was similar between both series. Image noise was rated superior in the 80-keV and M_0.3 series, followed by 60 keV. CONCLUSIONS: Virtual monoenergetic imaging reconstructions at 60-keV provided the best combination of subjective and objective image qualities in DECT of lung cancer.
Assuntos
Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Imageamento Tridimensional , Iopamidol/análogos & derivados , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Razão Sinal-RuídoRESUMO
BACKGROUND: excess weight is a risk factor for numerous co-morbidities that predominantly occur in later life. This study's purpose was to analyse the association between excess weight and health service use/costs in the older population in Germany. METHODS: this cross-sectional analysis used data of n = 3,108 individuals aged 58-82 from a population-based prospective cohort study. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated based on clinical examinations. Health service use was measured by a questionnaire for a 3-month period. Corresponding costs were calculated applying a societal perspective. RESULTS: 21.8% of the sample were normal weight, 43.0% overweight, 25.5% obese class 1 and 9.6% obese class ≥2 according to BMI. In 42.6%, WHtR was ≥0.6. For normal weight, overweight, obese class 1 and obese class ≥2 individuals, mean costs (3-month period) of outpatient care were 384, 435, 475 and 525 (P < 0.001), mean costs of inpatient care were 284, 408, 333 and 652 (P = 0.070) and mean total costs 716, 891, 852 and 1,244 (P = 0.013). For individuals with WHtR <0.6 versus ≥0.6, outpatient costs were 401 versus 499 (P < 0.001), inpatient costs 315 versus 480 (P = 0.016) and total costs 755 versus 1,041 (P < 0.001). Multiple regression analyses controlling for sociodemographic variables showed a significant effect of obesity on costs of outpatient care (class 1: +72; class ≥2: +153) and total costs (class ≥2: +361) while the effect of overweight was not significant. WHtR ≥0.6 significantly increased outpatient costs by +79 and total costs by +189. CONCLUSIONS: excess weight is associated with increased service use and cost in elderly individuals, in particular in obese class ≥2 individuals.
Assuntos
Custos de Cuidados de Saúde , Serviços de Saúde/estatística & dados numéricos , Sobrepeso/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Feminino , Seguimentos , Alemanha/epidemiologia , Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Sobrepeso/economia , Sobrepeso/prevenção & controle , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVES: To define optimal keV settings for advanced monoenergetic (Mono+) dual-energy computed tomography (DECT) in patients with head and neck squamous cell carcinoma (SCC). METHODS: DECT data of 44 patients (34 men, mean age 55.5 ± 16.0 years) with histopathologically confirmed SCC were reconstructed as 40, 55, 70 keV Mono + and M_0.3 (30 % 80 kV) linearly blended series. Attenuation of tumour, sternocleidomastoid muscle, internal jugular vein, submandibular gland, and noise were measured. Three radiologists with >3 years of experience subjectively assessed image quality, lesion delineation, image sharpness, and noise. RESULTS: The highest lesion attenuation was shown for 40 keV series (248.1 ± 94.1 HU), followed by 55 keV (150.2 ± 55.5 HU; P = 0.001). Contrast-to-noise ratio (CNR) at 40 keV (19.09 ± 13.84) was significantly superior to all other reconstructions (55 keV, 10.25 ± 9.11; 70 keV, 7.68 ± 6.31; M_0.3, 5.49 ± 3.28; all P < 0.005). Subjective image quality was highest for 55 keV images (4.53; κ = 0.38, P = 0.003), followed by 40 keV (4.14; κ = 0.43, P < 0.001) and 70 keV reconstructions (4.06; κ = 0.32, P = 0.005), all superior (P < 0.004) to linear blending M_0.3 (3.81; κ = 0.280, P = 0.056). CONCLUSIONS: Mono + DECT at low keV levels significantly improves CNR and subjective image quality in patients with head and neck SCC, as tumour CNR peaks at 40 keV, and 55 keV images are preferred by observers. KEY POINTS: ⢠Mono + DECT combines increased contrast with reduced image noise, unlike linearly blended images. ⢠Mono + DECT imaging allows for superior CNR and subjective image quality. ⢠Head and neck tumour contrast-to-noise ratio peaks at 40 keV. ⢠55 keV images are preferred over all other series by observers.
Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Estudos RetrospectivosRESUMO
In 2011, Konnopka et al. (Eur J Health Econ 12:345-352, 2011) published a top-down cost of illness study on the health burden, and direct and indirect costs of morbidity and mortality attributable to excess weight (BMI ≥25 kg/m(2)) in Germany in 2002. The objective of the current study was to update the 2002 estimates to the year 2008. To simplify comparisons, we closely followed the methods and assumptions of the original study, using 2008 data for most input parameters (e.g. prevalence, mortality, resource use, costs). Excess weight related deaths increased by 31% (from 36,653 to 47,964) and associated years of potential life lost (from 428,093 to 588,237) and quality adjusted life years lost (from 367,722 to 505,748) by about 37%, respectively. Excess weight caused 16,797 million in total costs in 2008 (+70%), of which 8,647 million were direct costs (corresponding to 3.27% of total German health care expenditures in 2008). About 73% (12,235 million) of total excess weight related costs were attributable to obesity (BMI ≥30 kg/m(2)). The main drivers of direct costs were endocrinological (44%) and cardiovascular (38%) diseases. Indirect costs amounted to 8,150 million in 2008 (+62%), of which about two-thirds were indirect costs from unpaid work. The great majority of indirect costs were due to premature mortality (5,669 million). The variation of input parameters (univariate sensitivity analyses) resulted in attributable costs between 8,978 million (-47% compared to base case) and 25,060 million (+49%). The marked increase in excess weight related costs can largely be explained by increases in the prevalence of overweight and obesity, and to a lesser extent from increases in resource consumption, as well as increases in (unit) costs and wages (comprising 5.5% inflation).
Assuntos
Efeitos Psicossociais da Doença , Sobrepeso/economia , Sobrepeso/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Obesidade/economia , Obesidade/epidemiologia , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Licença Médica/economiaRESUMO
BACKGROUND: To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population. METHODS: Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. RESULTS: Mean total costs per respondent were 889 for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. CONCLUSIONS: Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
Assuntos
Atenção à Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Atenção à Saúde/economia , Feminino , Alemanha/epidemiologia , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos PsicológicosRESUMO
PURPOSE: To evaluate the feasibility of phantomless in vivo dual-energy computed tomography (CT)-based three-dimensional (3D) bone mineral density (BMD) assessment in comparison with dual x-ray absorptiometry (DXA). MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. Data from clinically indicated dual-energy CT and DXA examinations within 2 months, comprising the lumbar spine of 40 patients, were included. By using automated dedicated postprocessing dual-energy CT software, the trabecular bone of lumbar vertebrae L1-L4 were analyzed and segmented. A mixed-effects model was used to assess the correlations between BMD values derived from dual-energy CT and DXA. RESULTS: One hundred sixty lumbar vertebrae were analyzed in 40 patients (mean age, 57.1 years; range, 24-85 years), 21 male (mean age, 54.3 years; range, 24-85 years) and 19 female (mean age, 58.5 years; range, 31-80 years). Mean BMD of L1-L4 determined with DXA was 0.995 g/cm(2), and 18 patients (45%) showed an osteoporotic BMD (T score less than -2.5) of at least two vertebrae. Mean dual-energy CT-based BMD of L1-L4 was 0.254 g/cm(3). Bland-Altman analysis with mixed effects demonstrated a lack of correlation between dual-energy CT-based and DXA-based BMD values, with a mean difference of 0.7441 and 95% limits of agreement of 0.7441 ± 0.4080. CONCLUSION: Dedicated postprocessing of dual-energy CT data allows for phantomless in vivo BMD assessment of the trabecular bone of lumbar vertebrae and enables freely rotatable color-coded 3D visualization of intravertebral BMD distribution.
Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico por imagem , Imageamento Tridimensional , Vértebras Lombares/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Absorciometria de Fóton , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas Metabólicas/patologia , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Osteoporose/patologia , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos RetrospectivosRESUMO
OBJECTIVE: To analyze the impact of body mass index on sick leave days and related costs in Germany. METHODS: Cross-sectional analysis of German Socio-Economic Panel data (n = 7990). The relationship between body mass index class and sick leave days was analyzed via analyses of variance (ANOVA) (bivariate) and zero-inflated negative binomial regression models (multivariate). RESULTS: Body mass index was positively associated with annual sick leave days in the bivariate analysis (P < 0.001). In the fully adjusted zero-inflated negative binomial, overweight women had 3.64, obese women 5.19, and obese men 3.48 excess sick leave days in 2009 (vs normal weight), while excess sick leave days of overweight men were not statistically significant. The extrapolated excess costs in the German working population amount to &OV0556;2.18 billion (base case). CONCLUSIONS: The absenteeism-related lost productivity costs associated with excess weight are formidable and emphasize the persistent need for health promotion efforts in Germany.
Assuntos
Índice de Massa Corporal , Efeitos Psicossociais da Doença , Obesidade/economia , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Eficiência , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/economia , Adulto JovemRESUMO
Obesity has substantially increased in recent decades and is now one of the major global health problems. The large obesity-related health burden negatively impacts many relevant health outcomes (e.g. quality of life, disability, mortality) and leads to increased healthcare utilization. This excess service use is the main driver behind high healthcare costs of obese individuals. Findings indicate that costs rise curvilinearly with increasing body mass index, especially among the obese. As more individuals of a country's population become obese, a larger share of total annual national healthcare expenditure is spent on obesity and obesity-related health problems. In addition to escalating healthcare costs, obesity goes along with indirect costs through decreases in workforce productivity. The empirical evidence has shown beyond doubt that obesity negatively impacts individuals, healthcare systems, employers, and the economy as a whole. This article provides a brief overview of selected economic consequences associated with excess-weight.
Assuntos
Custos de Cuidados de Saúde , Sobrepeso/economia , Absenteísmo , Adolescente , Adulto , Criança , Efeitos Psicossociais da Doença , Humanos , Mortalidade Prematura , Obesidade/complicações , Obesidade/economia , Obesidade/mortalidade , Sobrepeso/complicações , Sobrepeso/mortalidadeRESUMO
OBJECTIVE: To conduct a systematic literature review of cost-of-illness studies and economic evaluations for diabetic patients with comorbid depression. METHODS: Systematic literature search in PubMed and NHS EED in March 2011, complemented by a bibliographic search within all eligible articles. RESULTS: The search produced a total of 388 studies of which 16 were analysed in full text. Altogether, eleven studies were included into the review, all of which were conducted in the USA. The results from cost-of-illness studies (nâ=â8) indicate excess costs in between 35â% and 300â% for diabetics with comorbid depression, in comparison to those without depression. Three economic evaluations indicate that appropriate interventions can lead to improved health (i.âe. more depression free days) at no extra cost. The results from two cost-effectiveness analyses indicate dominance (more depression free days and cost-savings compared to "usual care") for the evaluated interventions. CONCLUSIONS: Depressive symptoms are associated with increased health care costs in diabetic patients. Part of these excess costs can be attributed to the treatment of diabetes. Appropriate interventions aimed at depression treatment can increase time free of depression at no greater cost than usual care.
Assuntos
Transtorno Depressivo/economia , Transtorno Depressivo/epidemiologia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Programas Nacionais de Saúde/economia , Terapia Combinada/economia , Comorbidade , Análise Custo-Benefício , Transtorno Depressivo/terapia , Diabetes Mellitus/terapia , Alemanha , Custos de Cuidados de Saúde/estatística & dados numéricos , HumanosRESUMO
This systematic literature review identified and summarized 35 studies that investigated the relationship between multiple chronic conditions (MCCs) and health care utilization outcomes (i.e. physician use, hospital use, medication use) and health care cost outcomes (medication costs, out-of-pocket costs, total health care costs) for elderly general populations. Although synthesis of studies was complicated because of ambiguous definitions and measurements of MCCs, and because of the multitude of outcomes investigated, almost all studies observed a positive association of MCCs and use/costs, many of which found that use/costs significantly increased with each additional condition. Several studies indicate a curvilinear, near exponential relationship between MCCs and costs. The rising prevalence, substantial costs, and the fear that current care arrangements may be inappropriate for many patients with MCCs, bring about a multitude of implications for research and policy, of which the most important are presented and discussed.
Assuntos
Doença Crônica/economia , Atenção à Saúde/economia , Atenção à Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Humanos , Estados UnidosRESUMO
OBJECTIVE: To investigate the role of perfusion defect (PD) size on dual energy CT pulmonary blood volume assessment as predictor of right heart strain and patient outcome and its correlation with d-dimer levels in acute pulmonary embolism (PE). METHODS: 53 patients with acute PE who underwent DECT pulmonary angiography were retrospectively analyzed. Pulmonary PD size caused by PE was measured on DE iodine maps and quantified absolutely (VolPD) and relatively to the total lung volume (RelPD). Signs of right heart strain (RHS) on CT were determined. Information on d-dimer levels and readmission for recurrent onset of PE and death was collected. RESULTS: D-dimer level was mildly (r = 0.43-0.47) correlated with PD size. Patients with RHS had significantly higher VolPD (215 vs. 73 ml) and RelPD (9.9 vs. 2.9%) than patients without RHS (p < 0.003). There were 2 deaths and 1 readmission due of PE in 18 patients with >5% RelPD, while no such events were found for patients with <5% RelPD. CONCLUSION: Pulmonary blood volume on DECT in acute PE correlates with RHS and appears to be a predictor of patient outcome in this pilot study.
Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pulmão/irrigação sanguínea , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/mortalidade , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Função do Átrio Esquerdo/fisiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos de Coortes , Intervalos de Confiança , Feminino , Testes de Função Cardíaca , Humanos , Estimativa de Kaplan-Meier , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Circulação Pulmonar/fisiologia , Embolia Pulmonar/sangue , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Função Ventricular Direita/fisiologiaRESUMO
BACKGROUND: Due to demographic change, the advanced elderly represent the fastest growing population group in Europe. Health problems tend to be frequent and increasing with age within this cohort. AIMS OF THE STUDY: To describe and compare health status of the elderly population in six European countries and to analyze the impact of socio-demographic variables on health. METHODS: In the European Study of the Epidemiology of Mental Disorders (ESEMeD), representative non-institutionalized population samples completed the EQ-5D and Short Form-12 (SF-12) questionnaires as part of personal computer-based home interviews in 2001-2003. This study is based on a subsample of 1659 respondents aged ≥ 75 years from Belgium (n = 194), France (n = 168), Germany (n = 244), Italy (n = 317), the Netherlands (n = 164) and Spain (n = 572). Descriptive statistics, bivariate- (chi-square tests) and multivariate methods (linear regressions) were used to examine differences in population health. RESULTS: 68.8% of respondents reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (55.2%), followed by mobility (50.0%), usual activities (36.6%), self-care (18.1%) and anxiety/depression (11.6%). The proportion of respondents reporting any problems increased significantly with age in bivariate analyses (age 75-79: 65.4%; age 80-84: 69.2%; age ≥ 85: 81.1%) and differed between countries, ranging from 58.7% in the Netherlands to 72.3% in Italy. The mean EQ VAS score was 61.9, decreasing with age (age 75-79: 64.1; age 80-84: 59.8; age ≥ 85: 56.7) and ranging from 60.0 in Italy to 72.9 in the Netherlands. SF-12 derived Physical Component Summary (PCS) and Mental Component Summary (MCS) scores varied little by age and country. Age and low educational level were associated with lower EQ VAS and PCS scores. After controlling for socio-demographic variables and reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and Belgium, and lower in Germany than the grand mean. CONCLUSIONS: More than two thirds of the advanced elderly report impairment of health status. Impairment increases rapidly with age but differs considerably between countries. In all countries, health status is significantly associated with socio-demographic variables.
Assuntos
Envelhecimento , Nível de Saúde , Qualidade de Vida , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Análise de Variância , Europa (Continente) , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Análise Multivariada , Psicometria , Vigilância de Evento Sentinela , Fatores SocioeconômicosRESUMO
BACKGROUND: In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+. METHODS: Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. RESULTS: Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. CONCLUSIONS: While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous.