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1.
Am J Surg ; 2020 Apr 20.
Article in English | MEDLINE | ID: mdl-32354603

ABSTRACT

BACKGROUND: Hospital charges due to major injury can result in high out-of-pocket expenses for patients. We analyzed the effect of the Affordable Care Act (ACA) on catastrophic health expenditures (CHE) among trauma patients. METHODS: We identified trauma patients aged 19-64 admitted to a safety-net Level 1 trauma center in California from 2007 to 2017. Out-of-pocket expenditures and income were calculated using hospital charges, insurance status, and ZIP code. CHE was defined using the World Health Organization definition of out-of-pocket spending exceeding 40% of inflation-adjusted income minus food and housing expenditures. Multivariable logistic regression was performed to assess odds of CHE post-ACA (2014-2017) vs. pre-ACA (2007-2013). RESULTS: Of 7519 trauma patients, 20.6% experienced CHE, including 89.0% of uninsured patients. There was a 74% decrease in odds of CHE post-ACA (aOR: 0.26, 95% CI: 0.22-0.30), with greater decreases among Black (aOR: 0.09, 95% CI: 0.04-0.18) and Hispanic (aOR: 0.23, 95% CI: 0.19-0.29) patients. CONCLUSIONS: ACA implementation was associated with markedly decreased odds of catastrophic expenditures and decreased racial disparities in financial protection among trauma patients in our study.

2.
J Cancer Res Clin Oncol ; 146(5): 1169-1196, 2020 May.
Article in English | MEDLINE | ID: mdl-32246217

ABSTRACT

BACKGROUND: In the literature, men are often described as unwilling to use healthcare services, whereas women as frequent users. We conducted a systematic literature review to examine the gender differences in healthcare utilisation of lung cancer patients. Our aim was to synthesise evidence to assess whether men and women utilise cancer diagnosis and treatments differently. METHODS: The databases of PubMed, Scopus, Web of Science, EBSCO Host, Ovid nursing, and Cochrane was systematically searched. We used pre-defined eligibility criteria to identify peer-reviewed published literature that reported healthcare use of lung cancer patients. Two reviewers independently screened the title, abstract, full texts and retrieved relevant data. RESULTS: A total of 42 studies met the eligibility criteria from 1356 potential studies. In these studies, the most commonly measured healthcare utilisation is surgery (n = 19), followed by chemotherapy (n = 13). All the studies were from developed countries and had a higher percentage of male participants. Substantial evidence of heterogeneity in the use of treatments by gender were found. In relation to diagnosis interval and stage of cancer diagnosis, it was found that women had longer diagnostic intervals. Nonetheless, women tend to get diagnosed at an earlier stage. Furthermore, women had a higher probability of using inpatient cancer-care services and surgical treatments. Conversely, men had greater risks of readmission after surgery and longer length of stay. Lastly, there were no significant gender differences in the likelihood of receiving chemotherapy and radiation therapy. CONCLUSION: This study synthesised evidence of disparities in the use of lung cancer treatments based on gender in developed countries, with no evidence available from least-developed and developing countries. Further studies are required to understand this gender-specific inequality and to design interventions to improve the survival rate of lung cancer patients.


Subject(s)
Lung Neoplasms/psychology , Lung Neoplasms/therapy , Patient Acceptance of Health Care/psychology , Female , Humans , Lung Neoplasms/diagnosis , Male , Patient Acceptance of Health Care/statistics & numerical data , Sex Factors
3.
Article in English | MEDLINE | ID: mdl-32244280

ABSTRACT

The various benefits of urban green space are gaining increasing attention nowadays. Hence, the distribution of green space has become a scrutinized concern for spatial equity among local governments and the planning scholars. This study is the first quantitative evaluation of urban park accessibility using house-level data in urban China, from the perspective of social equity. We chose Nanjing as the empirical case and examined 2709 real estate units and 79 parks within the city. Accessibility is measured by the 10-min walking distance from homes to the adjacent urban parks. Using the Street Network Analysis model in ArcGIS and the statistical methods in SPSS, the result shows that 60.5% of the real estates in Nanjing are located within a 10-min walk to access urban parks. However, this accessibility is positively correlated with housing prices, and negatively correlated with the age of the buildings, holding all other factors constant. While affluent homeowners capture a high-quality green amenity, newly-built low-income communities, where most residents are classified as a vulnerable population, have the lowest percentage of accessible green space. This study reveals the existing spatial disparities of urban park accessibility among different socio-economic groups in Nanjing, China. Additionally, we found that urban redevelopment projects with greening and the large-scale affordable housing construction are pricing out the urban poor and rural immigrants from the inner city to the urban peripheral areas. This will reduce the accessibility to urban parks and other public service facilities among the lower income families, and exacerbate the inequality among the rich and the poor in terms of their quality of life. Main findings of this study can inform policy decisions regarding equitable park provision in the construction of the green city and the sustainable development in urban China and other developing countries.

5.
Rev Environ Health ; 2020 Apr 22.
Article in English | MEDLINE | ID: mdl-32324166

ABSTRACT

Studies that assess the connection between the prevalence of chronic diseases and continuous exposure to air pollution are scarce in developing countries, mainly due to data limitations. Largely overcoming data limitations, this study aimed to investigate the association between the likelihood of reporting a set of chronic diseases (diabetes, cancer, stroke and myocardial infarction, asthma, and hypertension) and continuous exposure to carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and coarse particulate matter (PM10). Using the estimated associations, the disease burden and economic costs of continuous exposure to air pollutants were also approximated. A 2011 Health Equity Assessment and Response Tool survey from Tehran, Iran, was used in the main analyses. A sample of 67,049 individuals who had not changed their place of residence for at least 2 years before the survey and reported all relevant socioeconomic information was selected. The individuals were assigned with the average monthly air pollutant levels of the nearest of 16 air quality monitors during the 2 years leading to the survey. Both single- and multi-pollutant analyses were conducted. The country's annual household surveys from 2002 to 2011 were used to calculate the associated economic losses. The single-pollutant analysis showed that a one-unit increase in monthly CO (ppm), NO2 (ppb), O3 (ppb), and PM10 (µg/m3) during the 2 years was associated with 751 [confidence interval (CI): 512-990], 18 (CI: 12-24), 46 (CI: -27-120), and 24 (CI: 13-35) more reported chronic diseases in 100,000, respectively. The disease-specific analyses showed that a unit change in average monthly CO was associated with 329, 321, 232, and 129 more reported cases of diabetes, hypertension, stroke and myocardial infarction, and asthma in 100,000, respectively. The measured associations were greater in samples with older individuals. Also, a unit change in average monthly O3 was associated with 21 (in 100,000) more reported cases of asthma. The multi-pollutant analyses confirmed the results from single-pollutant analyses. The supplementary analyses showed that a one-unit decrease in monthly CO level could have been associated with about 208 (CI: 147-275) years of life gained or 15.195 (CI: 10.296-20.094) thousand US dollars (USD) in life-time labor market income gained per 100,000 30-plus-year-old Tehranis.

7.
Environ Res ; 186: 109519, 2020 Apr 15.
Article in English | MEDLINE | ID: mdl-32335428

ABSTRACT

Urban transportation is an important determinant of health and environmental outcomes, and therefore essential to achieving the United Nation's Sustainable Development Goals. To better understand the health impacts of transportation initiatives, we conducted a systematic review of longitudinal health evaluations involving: a) bus rapid transit (BRT); b) bicycle lanes; c) Open Streets programs; and d) aerial trams/cable cars. We also synthesized systems-based simulation studies of the health-related consequences of walking, bicycling, aerial tram, bus and BRT use. Two reviewers screened 3302 unique titles and abstracts identified through a systematic search of MEDLINE (Ovid), Scopus, TRID and LILACS databases. We included 39 studies: 29 longitudinal evaluations and 10 simulation studies. Five studies focused on low- and middle-income contexts. Of the 29 evaluation studies, 19 focused on single component bicycle lane interventions; the rest evaluated multi-component interventions involving: bicycle lanes (n = 5), aerial trams (n = 1), and combined bicycle lane/BRT systems (n = 4). Bicycle lanes and BRT systems appeared effective at increasing bicycle and BRT mode share, active transport duration, and number of trips using these modes. Of the 10 simulation studies, there were 9 agent-based models and one system dynamics model. Five studies focused on bus/BRT expansions and incentives, three on interventions for active travel, and the rest investigated combinations of public transport and active travel policies. Synergistic effects were observed when multiple policies were implemented, with several studies showing that sizable interventions are required to significantly shift travel mode choices. Our review indicates that bicycle lanes and BRT systems represent promising initiatives for promoting population health. There is also evidence to suggest that synergistic effects might be achieved through the combined implementation of multiple transportation policies. However, more rigorous evaluation and simulation studies focusing on low- and middle-income countries, aerial trams and Open Streets programs, and a more diverse set of health and health equity outcomes is required.

8.
Pediatr Endocrinol Rev ; 17(Suppl 1): 210-219, 2020 Mar.
Article in English | MEDLINE | ID: mdl-32208565

ABSTRACT

Globally it is estimated that over 1 million children and adolescents have Type 1 diabetes with large variations in incidence between different contexts. Health systems need to provide a variety of elements to ensure appropriate diabetes care, such as service delivery; healthcare workforce; information; medical products and technologies; financing and leadership and governance. Describing these elements between Geneva, Switzerland, a high-income country with high spending on healthcare and a large density of doctors, and low- and middle-income countries this article aims to highlight the global inequality of diabetes care. Type 1 diabetes can serve as a litmus as we move towards the centenary of the discovery of insulin and beyond as there is a need for a global movement to ensure that innovation in the management of diabetes benefits the whole diabetes community and not just a select few.


Subject(s)
Diabetes Mellitus, Type 1 , Delivery of Health Care , Developing Countries , Global Health , Humans , Socioeconomic Factors , Switzerland
9.
Global Health ; 16(1): 15, 2020 02 20.
Article in English | MEDLINE | ID: mdl-32079530

ABSTRACT

In 2015, the United Nations' (UN) Member States adopted a bold and holistic agenda of the Sustainable Development Goals (SDGs), integrating a vision of peace and prosperity for people and planet. Extensive work within, between, across sectors is required for this bold and holistic agenda to be implemented. It is in this context that this special article collection showcases multisectoral approaches to achieving SDG 3-Good Health and Well-Being-which, though focused explicitly on health, is connected to almost all other goals. A confluence of social and health inequities, within a context of widespread environmental degradation demands systems thinking and intersectoral action. Articles in this issue focus on the SDGs as a stimulus for renewed multisectoral action: processes, policies, and programs primarily outside the health sector, that have health implications through social, commercial, economic, environmental, and political determinants of health. Case studies offer critical lessons on effectively engaging other sectors to enhance their health outputs, identifying co-benefits and 'win-wins' that enhance human health.

10.
PLoS One ; 15(2): e0227952, 2020.
Article in English | MEDLINE | ID: mdl-32032381

ABSTRACT

Social responsibility fulfillment helps modern enterprises achieve sustainable development. Based on empirical data on China's A-share listed companies in 2013-2016, this paper examines the impact of corporate social responsibility performance on a company's financing costs from the perspective of targeted poverty alleviation. Specifically, we find that enterprises' engagement in poverty alleviation social responsibility helps to reduce the cost of equity capital. The result is robust to using alternative indicators of the cost of equity capital, propensity score matching method, change model and sample removed financial sector. Furthermore, we find that the negative relationship between enterprises' engagement in poverty relief and the cost of equity capital is mainly concentrated in private enterprises and in the central and eastern regions of China. Moreover, the negative relationship mainly exists after China's listed companies were forced to disclose information on poverty alleviation. This paper also finds that institutional investors' shareholding plays a partial mediating role in this reduction effect and that enterprises' poverty alleviation efforts help companies improve their financial performance and firm value. This study enriches the relevant literature on corporate social responsibility and the cost of equity capital and has reference value for corporate sustainable development. It also provides a theoretical basis for corporate poverty alleviation work in developing countries and the economic results of CSR.


Subject(s)
Financial Statements , Organizations , Poverty , Social Responsibility , China , Models, Theoretical , Regression Analysis
11.
Laryngoscope ; 2020 Feb 14.
Article in English | MEDLINE | ID: mdl-32057101

ABSTRACT

OBJECTIVE: The current landscape of patient safety/quality improvement (PS/QI) research dedicated to Otolaryngology-Head and Neck Surgery (OHNS) has not been established. This systematic review aims to define the breadth and depth of PS/QI research dedicated to OHNS and to identify knowledge gaps as well as potential areas of future study. METHODS: The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process. A computerized Ovid/Medline database search was conducted (January 1, 1965-September 30, 2019). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar. Articles were classified by year, subspecialty, PS/QI category, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass. RESULTS: Computerized searches yielded 11,570 eligible articles, 738 (6.4%) of which met otolaryngology PS/QI inclusion criteria; 178 (24.1%) were not specific to any one subspecialty. The most prevalent subspecialty foci were head and neck (29.9%), pediatric otolaryngology (16.9%), and otology/neurotology (11.0%). Studies examining complications or risk factors (32.0%) and outcomes/quality measures (16.3%) were the most common foci. Classification by the IOM included effective care (31.4%), safety (29.9%), and safety/effective care (25.3%). Most research fell into the WHO categories of understanding causes (28.5%) or measuring harm (28.3%). CONCLUSION: Most OHNS PS/QI projects (32.0%) focus on reporting complications or risk factors, followed by outcomes/quality measures (16.3%). Knowledges gaps for future research include healthcare disparities, multidisciplinary care, and the WHO category of studies translating evidence into safer care. LEVEL OF EVIDENCE: NA Laryngoscope, 2020.

12.
J Environ Manage ; 262: 110250, 2020 May 15.
Article in English | MEDLINE | ID: mdl-32090880

ABSTRACT

Given the aim of maintaining global warming below 2 °C, carbon emission reduction has become a global top priority. Since the Belt and Road Initiative has increasing influence on manufacturing-oriented developing countries, more attention should be paid to carbon emission reduction in these regions. This study conducts a comprehensive analysis by analyzing the carbon inequality and regional development and compares the carbon emissions driven by final demand among countries in and outside the Belt and Road area from 1990 to 2015. It is found that the majority of the Belt and Road regions achieved a rapid GDP growth rate with increasing carbon emissions, in which the investment-driven type demonstrated a significant growth. In contrast, the developed countries outside the Belt and Road area maintained their economic growth while decreasing the carbon emissions owed to the declining of investment-driven emissions; however the consumption-driven emissions stably remained a relatively high level. Our results showed that the inequality of carbon emission within Belt and Road regions is lower than the global average, while the inequality of the investment-driven emissions showed an obviously increasing trend. By discussing the carbon inequality and regional development, rational and feasible strategies for countries and regions within and outside the Belt and Road area are essential, and different types of strategies such as low-carbon technologies transfers and overseas financial cooperation are suggested for regional carbon emission reduction and sustainable regional development under the Belt and Road Initiative.


Subject(s)
Carbon , Economic Development , Carbon Dioxide , China , Global Warming , Socioeconomic Factors
13.
Article in English | MEDLINE | ID: mdl-32079197

ABSTRACT

In the US, rural communities face challenges to meet the community health needs of older adults and children. Meanwhile, rural areas lag in age-friendly built environment and services. AARP, a US based organization promoting livability for all ages, has developed a Livability Index based on the World Health Organization's (WHO) domains of age-friendly communities: health, housing, neighborhood, transportation, environment, engagement, and opportunity. This study links the 2018 AARP Livability Index categories with demographic structure and socio-economic factors from the American Community Survey at the county level in the US to examine if the physical, built and social environment differentiate communities with better community health across the rural-urban divide. Results show that the neighborhood built environment has the largest impact on community health for all county types. Although rural areas lag in community health, those which give more attention to engagement and opportunity rank higher. Rural communities with more African Americans, children, and poor Whites, rank lower on community health. While neighborhood characteristics have the strongest link to community health, a broader approach with attention to age, race, poverty and engagement and opportunity is needed for rural areas.

15.
Health Policy Plan ; 35(5): 503-521, 2020 Jun 01.
Article in English | MEDLINE | ID: mdl-32091080

ABSTRACT

We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization 'Best Buys' guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a 'policy cube' incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.

16.
Am J Public Health ; 110(3): 303-308, 2020 03.
Article in English | MEDLINE | ID: mdl-31944844

ABSTRACT

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services.Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries.Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level.


Subject(s)
Health Equity , Health Services Administration , Prisons/organization & administration , Health Services/economics , Health Services/standards , Humans , Prisoners , Prisons/standards
17.
Syst Rev ; 9(1): 18, 2020 01 23.
Article in English | MEDLINE | ID: mdl-31973757

ABSTRACT

BACKGROUND: The importance of access to healthcare for all is internationally recognised as a global goal, high on the global agenda. Yet inequalities in health exist within and between countries which are exacerbated by inequalities in access to healthcare. In order to address these inequalities, we need to better understand what drives them. While there exists a wealth of research on access to healthcare in different countries and contexts, and for different patient groups, to date no attempt has been made to bring this evidence together through a global lens. This study aims to address that gap by bringing together evidence of what factors affect patients' access to healthcare and exploring how those factors vary in different countries and contexts around the world. METHODS: An overview of reviews will be conducted using a comprehensive search strategy to search four databases: Medline, Embase, Global Health and Cochrane Systematic Reviews. Additional searches will be conducted on the Gates Foundation, the World Health Organisation (WHO) and World Bank websites. Titles and abstracts will be screened against the eligibility criteria and full-text articles will be obtained for all records that meet the inclusion criteria or where there is uncertainty around eligibility. A data extraction table will be developed during the review process and will be piloted and refined before full data extraction commences. Methodological quality/risk of bias will be assessed for each included study using the AMSTAR 2 tool. The quality assessment will be used to inform the narrative synthesis, but a low-quality score will not necessarily lead to study exclusion. DISCUSSION: Factors affecting patients' ability to access healthcare will be identified and analysed according to different country and context characteristics to shed light on the importance of different factors in different settings. Results will be interpreted accounting for the usual challenges associated with conducting such reviews. The results may guide future research in this area and contribute to priority setting for development initiatives aimed at ensuring equitable access to healthcare for all. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019144775.

18.
Expert Rev Anti Infect Ther ; 18(2): 165-170, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31914829

ABSTRACT

Background: Antimicrobials resistance (AMR) is an increasingly serious global health problem, both in terms of clinical implications and economic expenditure. In Italy, there are differences in prescribing rates between regions. We aimed to compare these differences in two Italian provinces: one of Emilia Romagna (north region) and one of Puglia (south region).Methods: The number of antibiotics prescribed packages and the relative expenditure data (year 2015) were obtained. We applied the prescription quality indicators proposed by the European Surveillance of Antimicrobial Consumption for an in-depth analysis.Results: Both consumption and expenditure were higher in the south province. In the Apulian province also the use of parenteral antibiotics was more frequent. The most prescribed antibiotics in both the provinces were: penicillins (combined or not), macrolides, and fluoroquinolones.Conclusion: We observed variability between the north and south province in terms of antibiotics prescription. Overall, our study indicates that antibacterials could be overprescribed. The choice of the right antibiotic continues to be a demanding task for practitioners and much still needs to be done in the fight against AMR, starting from a more appropriate use and interventions aimed at raising awareness of antibiotic resistance.

19.
Int Health ; 2020 Jan 17.
Article in English | MEDLINE | ID: mdl-31951257

ABSTRACT

BACKGROUND: It is known that health impacts economic performance. This article aims to assess the current state of health inequality in the tropics, defined as the countries located between the Tropic of Cancer and the Tropic of Capricorn, and estimate the impact of this inequality on gross domestic product (GDP). METHODS: We constructed a series of concentration indices showing between-country inequalities in disability-adjusted life years (DALYs), taken from the Global Burden of Disease Study. We then utilized a non-linear least squares model to estimate the influence of health on GDP and counterfactual analysis to assess the GDP for each country had there been no between-country inequality. RESULTS: The poorest 25% of the tropical population had 68% of the all-cause DALYs burden in 2015; 82% of the communicable, maternal, neonatal and nutritional DALYs burden; 55% of the non-communicable disease DALYs burden and 61% of the injury DALYs burden. An increase in the all-cause DALYs rate of 1/1000 resulted in a 0.05% decrease in GDP. If there were no inequality between countries in all-cause DALY rates, most high-income countries would see a modest increase in GDP, with low- and middle-income countries estimated to see larger increases. CONCLUSIONS: There are large and growing inequalities in health in the tropics and this has significant economic cost for lower-income countries.

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