ABSTRACT
Globalization, income growth and changing cultural trends are believed to prompt consumers in low-income countries to adopt the more affluent diet of high-income countries. This study investigates the convergence of food expenditure patterns worldwide, focusing on total food expenditure, raw food categories and ultra-processed foods and beverages across more than 90 countries over the past decades. Contrary to prior belief, we find that food expenditure patterns of lower-income countries do not universally align with those of higher-income nations. This trend is evident across most raw food categories and ultra-processed foods and beverages, as the income level of a country continues to play a crucial role in determining its food expenditure patterns. Importantly, expenditure patterns offer estimates rather than a precise idea of dietary intake, reflecting consumer choices shaped by economic constraints rather than exact dietary consumption.
Subject(s)
Developed Countries , Developing Countries , Food , Income , Humans , Developed Countries/economics , Developed Countries/statistics & numerical data , Developing Countries/economics , Developing Countries/statistics & numerical data , Food/economics , Income/statistics & numerical data , Diet/economics , Fast Foods/economics , Fast Foods/statistics & numerical data , Beverages/economics , Beverages/statistics & numerical data , Poverty/statistics & numerical data , Poverty/economicsABSTRACT
This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017-2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI -0.10; outpatient CI -0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India.
Subject(s)
Health Expenditures , Patient Acceptance of Health Care , Socioeconomic Factors , Humans , India , Health Expenditures/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Female , Male , Healthcare Disparities/economics , Healthcare Disparities/statistics & numerical data , Adult , Insurance, Health/economics , Insurance, Health/statistics & numerical data , Middle Aged , Poverty/statistics & numerical data , Poverty/economics , Cost of Illness , Surveys and QuestionnairesABSTRACT
BACKGROUND: Whether variation in Medicaid reimbursement fees influenced the impacts of the Medicaid expansions is not well understood. OBJECTIVE: We examine whether changes in health care access associated with Medicaid expansion are different in states with comparatively high Medicaid reimbursement rates compared against expanding in states with lower Medicaid reimbursement rates. DESIGN: Using a difference-in-difference-in-difference (DDD or triple-difference) regression approach, we compare relative differences in Medicaid expansion effects between lower and higher reimbursement states. PARTICIPANTS: 512,744 low-income adults aged 20-64 in the 2011-2019 Behavioral Risk Factor Surveillance System. MAIN MEASURES: Health insurance coverage status, unmet medical needs due to cost, regular source for health care, and a regular/scheduled checkup within the past year. KEY RESULTS: Medicaid expansion has significant and positive impacts on health coverage and access in both high- and low-fee states. In states with fee levels above the median Medicare-to-Medicaid ratios, expanding Medicaid eligibility reduced uninsurance rate by 15.2 percentage point (ppt, p < 0.01), shrank the cost-associated unmet medical need by 10.3 ppt (p < 0.01), improved access to usual source of care by 1.9 ppt (p < 0.1), and increased regular checkup by 14.4 ppt (p < 0.01), while such effects in low-fee states were 11.7 ppt (p < 0.01), 8.3 ppt (p < 0.01), 3.1 ppt (p < 0.1), and 12.3 ppt (p < 0.01), respectively. Our results suggest that Medicaid expansion effect on unmet medical need due to cost in higher-reimbursing states was 2.98 ppt (p < 0.05) larger than in lower-reimbursing states. Evidence suggests modest increases in health care access were more strongly associated with expansions in higher-fee states. CONCLUSIONS: Medicaid's fee structure should be considered as a factor influencing large-scale coverage expansions.
Subject(s)
Health Services Accessibility , Medicaid , Poverty , Humans , Medicaid/economics , Medicaid/statistics & numerical data , United States , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Adult , Middle Aged , Poverty/economics , Female , Male , Young Adult , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Patient Protection and Affordable Care Act/economics , Insurance, Health, Reimbursement/economics , Behavioral Risk Factor Surveillance SystemABSTRACT
Importance: American Indian and Alaska Native persons face significant health disparities; however, data regarding the burden of cardiovascular disease in the current era is limited. Objective: To determine the incidence and prevalence of cardiovascular disease, the burden of comorbid conditions, including cardiovascular disease risk factors, and associated mortality among American Indian and Alaska Native patients with Medicare insurance. Design, Setting, and Participants: This was a population-based cohort study conducted from January 2015 to December 2019 using Medicare administrative data. Participants included American Indian and Alaska Native Medicare beneficiaries 65 years and older enrolled in both Medicare part A and B fee-for-service Medicare. Statistical analyses were performed from November 2022 to April 2023. Main Outcomes and Measures: The annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]). Results: Among 220â¯598 American Indian and Alaska Native Medicare beneficiaries, the median (IQR) age was 72.5 (68.5-79.0) years, 127â¯402 were female (57.8%), 78â¯438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. In the cohort, 44.8% of patients (98â¯833) were diagnosed with diabetes, 61.3% (135â¯124) were diagnosed with hyperlipidemia, and 72.2% (159â¯365) were diagnosed with hypertension during the study period. The prevalence of CAD was 38.6% (61â¯125 patients) in 2015 and 36.7% (68â¯130 patients) in 2019 (P < .001). The incidence of acute myocardial infarction increased from 6.9 per 1000 person-years in 2015 to 7.7 per 1000 patient-years in 2019 (percentage change, 4.79%; P < .001). The prevalence of HF was 22.9% (36â¯288 patients) in 2015 and 21.4% (39â¯857 patients) in 2019 (P < .001). The incidence of HF increased from 26.1 per 1000 person-years in 2015 to 27.0 per 1000 person-years in 2019 (percentage change, 4.08%; P < .001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14â¯899 patients] vs 2019: 9.3% [25â¯175 patients]). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1000 person-years in 2015 and 12.1 per 1000 person-years in 2019; percentage change, 5.08; P = .004). Fifty percent of patients (110â¯244) had at least 1 severe cardiovascular condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8% (43â¯589 patients). Conclusions and Relevance: In this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of cardiovascular disease and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the cardiovascular health of this population.
Subject(s)
American Indian or Alaska Native , Cardiovascular Diseases , Medicare , Poverty , Social Determinants of Health , Aged , Female , Humans , Male , American Indian or Alaska Native/statistics & numerical data , Atrial Flutter , Cardiovascular Diseases/economics , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/ethnology , Cardiovascular Diseases/mortality , Cohort Studies , Coronary Artery Disease , Heart Failure , Ischemic Attack, Transient , Medicare/economics , Medicare/statistics & numerical data , Stroke , United States/epidemiology , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Cost of Illness , Incidence , Prevalence , Comorbidity , Risk Factors , Cardiometabolic Risk Factors , Social Determinants of Health/economics , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data , Poverty/economics , Poverty/ethnology , Poverty/statistics & numerical dataSubject(s)
Agriculture , Food Supply , Socioeconomic Factors , Sustainable Development , Unemployment , Agriculture/economics , Agriculture/trends , Food Supply/economics , Food Supply/methods , Poverty/economics , Poverty/prevention & control , Sustainable Development/economics , Sustainable Development/trends , Unemployment/trendsABSTRACT
The modern world is facing chaos of different connected issues. Achieving sustainability in the tourism industry for poverty reduction is one of them, having limited guidance for stakeholders. Thus, following SDG-3 guidelines for good well-being via tourism development could contribute to SDG-1 for no poverty. This roadmap needs scientific validation. Therefore, this research aims to determine how much of an overall impact tourism has on alleviating poverty and what factors account for the wide range of estimates of that impact. Using data from 2002 to 2020 and the ARDL model with eight variables, including (a) currency supply, (b) GDP per capita, and (c) tourism earnings higher GDP area, the current emphasis is on reducing the likelihood of any negative impacts this business may have on tourism. Lower Gross Domestic Product (GDP) regions, higher profits per capita from tourism, and reduced poverty all have a role. With a 1% significance threshold, the observed data becomes more convincing. Last, the results show that the Laotian government intends for tourism to contribute to long-term environmentally responsible financial development. In addition, the study's empirical results corroborated the conclusion that policymakers should encourage the successful expansion of the tourist industry.
Subject(s)
Income , Poverty , Sustainable Development , Tourism , Humans , Poverty/economics , Sustainable Development/economics , LaosABSTRACT
Importance: Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact. Objective: To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors. Design, Setting, and Participants: Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores. Exposure: Moving to a low-poverty neighborhood. Main Outcomes: Caregiver-reported asthma exacerbations and symptoms. Results: Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations. Conclusions and Relevance: Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.
Subject(s)
Asthma , Housing , Residence Characteristics , Social Determinants of Health , Symptom Flare Up , Systemic Racism , Child , Female , Humans , Male , Asthma/diagnosis , Asthma/economics , Asthma/epidemiology , Asthma/psychology , Cohort Studies , Housing/economics , Poverty/economics , Poverty/ethnology , Poverty/psychology , Child, Preschool , Adolescent , Vulnerable Populations/psychology , Urban Population , Systemic Racism/economics , Systemic Racism/ethnology , Systemic Racism/psychology , Social Determinants of Health/economics , Social Determinants of Health/ethnologyABSTRACT
Poverty is an important social determinant of health that is associated with increased risk of death1-5. Cash transfer programmes provide non-contributory monetary transfers to individuals or households, with or without behavioural conditions such as children's school attendance6,7. Over recent decades, cash transfer programmes have emerged as central components of poverty reduction strategies of many governments in low- and middle-income countries6,7. The effects of these programmes on adult and child mortality rates remains an important gap in the literature, however, with existing evidence limited to a few specific conditional cash transfer programmes, primarily in Latin America8-14. Here we evaluated the effects of large-scale, government-led cash transfer programmes on all-cause adult and child mortality using individual-level longitudinal mortality datasets from many low- and middle-income countries. We found that cash transfer programmes were associated with significant reductions in mortality among children under five years of age and women. Secondary heterogeneity analyses suggested similar effects for conditional and unconditional programmes, and larger effects for programmes that covered a larger share of the population and provided larger transfer amounts, and in countries with lower health expenditures, lower baseline life expectancy, and higher perceived regulatory quality. Our findings support the use of anti-poverty programmes such as cash transfers, which many countries have introduced or expanded during the COVID-19 pandemic, to improve population health.
Subject(s)
Child Mortality , Developing Countries , Mortality , Poverty , Adult , Child, Preschool , Female , Humans , Child Mortality/trends , COVID-19/economics , COVID-19/epidemiology , Developing Countries/economics , Poverty/economics , Poverty/prevention & control , Poverty/statistics & numerical data , Life Expectancy , Health Expenditures/statistics & numerical data , Public Health/methods , Public Health/statistics & numerical data , Public Health/trends , Mortality/trendsABSTRACT
Crop yields in sub-Saharan Africa need to increase to keep pace with food demands from the burgeoning population. Smallholder farmers play an important role in national food self-sufficiency, yet many live in poverty. Investing in inputs to increase yields is therefore often not viable for them. To investigate how to unlock this paradox, whole-farm experiments can reveal which incentives could increase farm production while also increasing household income. In this study we investigated the impact of providing farmers with a US$ 100 input voucher each season, for five seasons in a row, on maize yields and overall farm-level production in two contrasting locations in terms of population density, Vihiga and Busia, in western Kenya. We compared the value of farmers' produce with the poverty line and the living income threshold. Crop yields were mainly limited by cash constraints and not by technological constraints as maize yield immediately increased from 16% to 40-50% of the water-limited yield with the provision of the voucher. In Vihiga, at best, one-third of the participating households reached the poverty line. In Busia half of the households reached the poverty line and one-third obtained a living income. This difference between locations was caused by larger farm areas in Busia. Although one third of the households increased the area farmed, mostly by renting land, this was not enough for them to obtain a living income. Our results provide empirical evidence of how a current smallholder farming system could improve its productivity and value of produce upon the introduction of an input voucher. We conclude that increasing yields of the currently most common crops cannot provide a living income for all households and additional institutional changes, such as alternative employment, are required to provide smallholder farmers a way out of poverty.
Subject(s)
Crop Production , Crops, Agricultural , Farms , Financing, Organized , Income , Poverty , Agriculture/economics , Agriculture/methods , Crops, Agricultural/economics , Crops, Agricultural/supply & distribution , Farms/economics , Kenya , Crop Production/economics , Crop Production/methods , Motivation , Poverty/economics , Financing, Organized/economics , Financial SupportABSTRACT
The global 2030 goal set by the World Organization for Animal Health (WOAH), the World Health Organization (WHO), and the Food and Agriculture Organization (FAO), to eliminate dog-mediated human rabies deaths, has undeniably been a catalyst for many countries to re-assess existing dog rabies control programmes. Additionally, the 2030 agenda for Sustainable Development includes a blueprint for global targets which will benefit both people and secure the health of the planet. Rabies is acknowledged as a disease of poverty, but the connections between economic development and rabies control and elimination are poorly quantified yet, critical evidence for planning and prioritisation. We have developed multiple generalised linear models, to model the relationship between health care access, poverty, and death rate as a result of rabies, with separate indicators that can be used at country-level; total Gross Domestic Product (GDP), and current health expenditure as a percentage of the total gross domestic product (% GDP) as an indicator of economic growth; and a metric of poverty assessing the extent and intensity of deprivation experienced at the individual level (Multidimensional Poverty Index, MPI). Notably there was no detectable relationship between GDP or current health expenditure (% GDP) and death rate from rabies. However, MPI showed statistically significant relationships with per capita rabies deaths and the probability of receiving lifesaving post exposure prophylaxis. We highlight that those most at risk of not being treated, and dying due to rabies, live in communities experiencing health care inequalities, readily measured through poverty indicators. These data demonstrate that economic growth alone, may not be enough to meet the 2030 goal. Indeed, other strategies such as targeting vulnerable populations and responsible pet ownership are also needed in addition to economic investment.
Subject(s)
Dog Diseases , Global Health , Health Services Accessibility , Rabies , Animals , Dogs , Humans , Dog Diseases/economics , Dog Diseases/epidemiology , Dog Diseases/prevention & control , Global Health/economics , Global Health/statistics & numerical data , Poverty/economics , Poverty/statistics & numerical data , Rabies/economics , Rabies/epidemiology , Rabies/prevention & control , Rabies/veterinary , Rabies virus , Mortality , Health Services Accessibility/statistics & numerical data , Economic Development/statistics & numerical data , Gross Domestic Product/statistics & numerical data , Health Expenditures/statistics & numerical data , Post-Exposure Prophylaxis/economics , Post-Exposure Prophylaxis/statistics & numerical data , World Health OrganizationABSTRACT
INTRODUCTION: Initiatives to support adherence to HIV treatment in South Africa are often centred on service delivery thereby avoiding key challenges to adherence: stigma and poverty. In contrast, this study aims to demonstrate the strength of an inclusive research and programme approach to improving the lives of people living with HIV and simultaneously ARV adherence. METHODS: Participatory Action Research combined with a visual participatory method (Photovoice) was used by postpartum women to share their experience of taking ARVs. The research was analysed from an interpretative and critical paradigm where both the women and a non-governmental organisation collaborated in the data collection, analysis and interpretation of the findings. Together, they then disseminated the findings and used a community-led approach to create a programme addressing these barriers effectively. FINDINGS: Two main barriers to ARV adherence emerged: the anticipated stigma associated with issues of disclosure and poverty epitomized by alcohol abuse, gender-based violence and hunger. The women and the NGO staff successfully presented their findings at conferences and collaborated to develop a programme of support for all women living with HIV in the area. The programme addresses each of the issues raised by the co-researchers and is run via a community-led process where the participants lead on design, implementation, and monitoring and ultimately will revise the programme as needed. DISCUSSION: The inclusive approach of this study enabled these postpartum women to portray the intersectional nature of both HIV stigma and poverty that affects their lives. By working with the local NGO to develop a programme based on these insights, they were able to tailor specific interventions to the issues women living with HIV face in their area. In doing so, they aim to improve the lives of people living with HIV by demonstrating a more sustainable way to impact ARV adherence. CONCLUSION: Currently, health service insistence on measuring ARV adherence does not address the core barriers to taking ARVs and misses the opportunity to focus on the long term health and well-being of people living with HIV. In contrast, locally targeted participatory research and programme development based on inclusivity, collaboration and ownership do address the fundamental challenges of people living with HIV. In doing so, it can have a greater impact on their long term well-being.
Subject(s)
Anti-HIV Agents , HIV Infections , Medication Adherence , Poverty , Psychosocial Support Systems , Social Stigma , Female , Humans , HIV Infections/drug therapy , HIV Infections/economics , HIV Infections/psychology , Postpartum Period , Poverty/economics , Poverty/psychology , Treatment Adherence and Compliance/psychology , South Africa , Community Health Services/economics , Community Health Services/methods , Health Services Accessibility/economics , Medication Adherence/psychology , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/therapeutic use , Social Determinants of Health/economics , Patient Participation/economics , Patient Participation/methods , Patient Participation/psychology , Intersectional Framework , Community-Based Participatory ResearchABSTRACT
Single motherhood and poverty have a significant, negative impact on mothers and their children. When their mothers experience maternal distress, adolescent children have to take up more instrumental and emotional filial responsibilities to comfort their mother and adapt to related changes. Based on 325 mother-child dyads of Chinese single-mother families experiencing economic disadvantage, this study examined the relationship between maternal distress and adolescent mental health problems (indexed by anxiety and depression) and the moderating roles of instrumental and emotional filial responsibilities. Results indicated that maternal distress was positively associated with anxiety and depression in adolescent children. In addition, instrumental filial responsibility intensified the associations of maternal distress with adolescent anxiety and depression. Moreover, the moderating role of emotional filial responsibility in the predictive relationship between maternal distress and adolescent anxiety was different in boys and girls. Adolescent girls with more emotional filial responsibility reported higher adolescent anxiety than did those who shouldered less emotional filial responsibility when their mother exhibited more distress, whereas the relationship between maternal distress and adolescent anxiety was stable in boys, regardless of emotional filial responsibility. In short, the present study showed that parentification was likely to occur in poor Chinese single-mother families, and adolescent children who took up a more caregiving role in the family exhibited poorer mental health. Family counselling and tangible support for single-mother families experiencing economic disadvantage are urged.
Subject(s)
East Asian People , Mental Health , Mother-Child Relations , Mothers , Poverty , Single-Parent Family , Adolescent , Female , Humans , Male , East Asian People/psychology , Emotions , Mental Health/economics , Mother-Child Relations/psychology , Mothers/psychology , Single-Parent Family/psychology , Poverty/economics , Poverty/psychology , Child Poverty/economics , Child Poverty/psychology , China , Anxiety/economics , Anxiety/psychology , Depression/economics , Depression/psychology , Adolescent Health/economics , Caregiver Burden/economics , Caregiver Burden/psychologyABSTRACT
Importance: Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. Objective: To determine whether treatment patterns and outcomes for patients presenting with acute myocardial infarction differ for low- vs high-income individuals across 6 countries. Design, Setting, and Participants: Serial cross-sectional cohort study of all adults aged 66 years or older hospitalized with acute myocardial infarction from 2013 through 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. Exposures: Being in the top and bottom quintile of income within and across countries. Main Outcomes and Measures: Thirty-day and 1-year mortality; secondary outcomes included rates of cardiac catheterization and revascularization, length of stay, and readmission rates. Results: We studied 289â¯376 patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and 843â¯046 hospitalized with non-STEMI (NSTEMI). Adjusted 30-day mortality generally was 1 to 3 percentage points lower for high-income patients. For instance, 30-day mortality among patients admitted with STEMI in the Netherlands was 10.2% for those with high income vs 13.1% for those with low income (difference, -2.8 percentage points [95% CI, -4.1 to -1.5]). One-year mortality differences for STEMI were even larger than 30-day mortality, with the highest difference in Israel (16.2% vs 25.3%; difference, -9.1 percentage points [95% CI, -16.7 to -1.6]). In all countries, rates of cardiac catheterization and percutaneous coronary intervention were higher among high- vs low-income populations, with absolute differences ranging from 1 to 6 percentage points (eg, 73.6% vs 67.4%; difference, 6.1 percentage points [95% CI, 1.2 to 11.0] for percutaneous intervention in England for STEMI). Rates of coronary artery bypass graft surgery for patients with STEMI in low- vs high-income strata were similar but for NSTEMI were generally 1 to 2 percentage points higher among high-income patients (eg, 12.5% vs 11.0% in the US; difference, 1.5 percentage points [95% CI, 1.3 to 1.8 ]). Thirty-day readmission rates generally also were 1 to 3 percentage points lower and hospital length of stay generally was 0.2 to 0.5 days shorter for high-income patients. Conclusions and Relevance: High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries. Our results suggest that income-based disparities were present even in countries with universal health insurance and robust social safety net systems.
Subject(s)
Myocardial Infarction , Humans , Coronary Artery Bypass/economics , Coronary Artery Bypass/statistics & numerical data , Cross-Sectional Studies , Myocardial Infarction/economics , Myocardial Infarction/epidemiology , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Non-ST Elevated Myocardial Infarction/economics , Non-ST Elevated Myocardial Infarction/epidemiology , Non-ST Elevated Myocardial Infarction/mortality , Non-ST Elevated Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/economics , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Treatment Outcome , Socioeconomic Factors , Poverty/economics , Poverty/statistics & numerical data , Aged , Hospitalization/economics , Hospitalization/statistics & numerical data , Patient Readmission/economics , Patient Readmission/statistics & numerical data , Myocardial Revascularization/economics , Myocardial Revascularization/statistics & numerical data , Cardiac Catheterization/economics , Cardiac Catheterization/statistics & numerical data , Length of Stay/economics , Length of Stay/statistics & numerical data , InternationalityABSTRACT
BACKGROUND: Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs. METHODS: We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107). RESULTS: In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed. CONCLUSION: The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.
Subject(s)
Child Health , Delivery of Health Care , Developing Countries , Ill-Housed Persons , Maternal Health , Poverty , Child , Female , Humans , Pregnancy , Child Health/economics , Child Health/statistics & numerical data , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Developing Countries/economics , Developing Countries/statistics & numerical data , Lactation , Systematic Reviews as Topic , Maternal Health/economics , Maternal Health/statistics & numerical data , Ill-Housed Persons/statistics & numerical data , Homeless Youth/statistics & numerical data , Urban Population/statistics & numerical data , Child Poverty/economics , Child Poverty/statistics & numerical data , Poverty/economics , Poverty/statistics & numerical data , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical dataABSTRACT
Behavioral difficulties among African American youth are disproportionately detrimental to their future well-being compared to when demonstrated by White American youth. The majority of gene-environment studies of behavior have been conducted with European ancestry samples, limiting our knowledge of these processes among African Americans. This study examined the influence of positive and negative neighborhood conditions, in the context of genetic risk, on behavioral difficulties among low-income African American adolescents. Data were from the Genes, Environment, and Neighborhood Initiative study of African American youth in high-poverty neighborhoods, n = 524, M age = 15.89, SD = 1.42. DNA samples were collected using the Oragene Discovery 500 series, and polygenic risk scores for behavioral difficulties computed. Neighborhood informal social control, social cohesion, physical disorder, and social disorder were assessed. Adolescent alcohol use, hyperactivity/inattention and conduct problems were examined as outcomes. After controlling for polygenic risk, lower levels of neighborhood social disorder and higher levels of social cohesion were associated with fewer youth-reported hyperactivity/inattention and conduct problems. Less social disorder also was associated with fewer parent-reported behavioral difficulties. Neighborhood characteristics did not moderate associations between genetic risk and the outcomes. Higher levels of positive and lower levels of negative neighborhood characteristics can be associated with lower levels of behavioral difficulties among African American youth living in poverty, even after taking into account genetic risk.
Subject(s)
Black or African American , Neighborhood Characteristics , Poverty , Social Determinants of Health , Adolescent , Humans , Black or African American/genetics , Poverty/economics , Poverty/ethnology , Poverty/psychology , Residence Characteristics , Risk Factors , Gene-Environment Interaction , Social Determinants of Health/economics , Genetic Predisposition to Disease/ethnology , Genetic Predisposition to Disease/geneticsABSTRACT
When COVID-19 arrived in Buffalo, New York in March 2020, there was already significant food insecurity in the region. However, barriers to food access were greatly exacerbated by the pandemic. This study assesses the pandemic's impact on food access in Buffalo through 75 surveys and 30 qualitative interviews conducted with users of food pantries. Results show that, while the pandemic did contribute to food insecurity, many food pantry users were already experiencing chronic food access issues. Specifically, issues related to transportation, stigma, and chronic poverty must be addressed for food insecure households to better endure emergency events like pandemics.