Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.977
Filtrar
1.
Health Aff (Millwood) ; 39(10): 1677-1683, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33017241

RESUMEN

Four recent reports from the National Academies of Sciences, Engineering, and Medicine framed around the issues of poverty; mental, emotional, and behavioral health; adolescence; and young family health and education build on extensive recent evidence of what can be done to improve the health and well-being of children, youth, and families. We describe the process of generating the reports, briefly summarize each report's content, and identify crosscutting themes and recommendations. We also note how the coronavirus disease 2019 (COVID-19) pandemic highlights major disparities and systemic problems addressed in the reports and heightens the relevance of their policy recommendations. The reports issue a unified, urgent call for measures with the potential to change the trajectory and outcomes for children and youth. Among these are basic income supports, other family supports, universal health care structured to meet family needs, and a broad national policy that prioritizes children and youth.


Asunto(s)
Salud del Adolescente , Salud del Niño , Infecciones por Coronavirus/prevención & control , Guías como Asunto , Disparidades en Atención de Salud/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adolescente , Niño , Infecciones por Coronavirus/epidemiología , Femenino , Política de Salud , Disparidades en el Estado de Salud , Humanos , Masculino , Evaluación de Necesidades , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Formulación de Políticas , Medición de Riesgo , Sociedades Médicas , Factores Socioeconómicos , Estados Unidos
2.
J Drugs Dermatol ; 19(10): 960-967, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33026775

RESUMEN

BACKGROUND: Growing evidence suggests a possible sex disparity in COVID-19 disease related outcomes. OBJECTIVE: To explore the sex disparity in COVID-19 cases and outcomes using New York City (NYC) population level data. SETTING: NYC surveillance data from February 29 to June 12, 2020. PARTICIPANTS: Individuals tested for COVID-19 in metropolitan NYC.Outcome Measurements and Statistical Analysis: Outcomes of interest included rates of COVID-19 case positivity, hospitalization and death. Relative risks and case fatality rates were computed for all outcomes based on sex and were stratified by age groups. RESULTS AND LIMITATIONS: 911,310 individuals were included, of whom 434,273 (47.65%) were male and 477,037 (52.35%) were female. Men represented the majority of positive cases (n=106,275, 51.36%), a majority of hospitalizations (n=29,847, 56.44%), and a majority of deaths (n=13,054, 59.23%). Following population level adjustments for age and sex, testing rates of men and women were equivalent. The majority of positive cases and hospitalizations occurred in men for all age groups except age >75 years, and death was more likely in men of all age groups. Men were at a statistically significant greater relative risk of case positivity, hospitalization, and death across all age groups except those <18 years of age. The most significant difference for case positivity was observed in the 65–74 age group (RR 1.22, 95%CI 1.19–1.24), for hospitalization in the 45–65 age group (RR 1.85, 95% 1.80–1.90), and for death in the 18–44 age group (RR 3.30, 95% CI 2.82–3.87). Case fatality rates were greater for men in all age-matched comparisons to women. Limitations include the use of an evolving surveillance data set and absence of further demographic characteristics such as ethnographic data. CONCLUSION: Men have higher rates of COVID-19 positivity, hospitalization, and death despite greater testing of women; this trend remains after stratification by age. J Drugs Dermatol. 2020;19(10):960-967. doi:10.36849/JDD.2020.5590.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Adulto , Anciano , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Evaluación de Resultado en la Atención de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales
4.
Mayo Clin Proc ; 95(10): 2110-2124, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33012342

RESUMEN

OBJECTIVE: To address the issue of limited national data on the prevalence and distribution of underlying conditions among COVID-19 deaths between sexes and across age groups. PATIENTS AND METHODS: All adult (≥18 years) deaths recorded in England and Wales (March 1, 2020, to May 12, 2020) were analyzed retrospectively. We compared the prevalence of underlying health conditions between COVID and non-COVID-related deaths during the COVID-19 pandemic and the age-standardized mortality rate (ASMR) of COVID-19 compared with other primary causes of death, stratified by sex and age group. RESULTS: Of 144,279 adult deaths recorded during the study period, 36,438 (25.3%) were confirmed COVID deaths. Women represented 43.2% (n=15,731) of COVID deaths compared with 51.9% (n=55,980) in non-COVID deaths. Overall, COVID deaths were younger than non-COVID deaths (82 vs 83 years). ASMR of COVID-19 was higher than all other common primary causes of death, across age groups and sexes, except for cancers in women between the ages of 30 and 79 years. A linear relationship was observed between ASMR and age among COVID-19 deaths, with persistently higher rates in men than women across all age groups. The most prevalent reported conditions were hypertension, dementia, chronic lung disease, and diabetes, and these were higher among COVID deaths. Pre-existing ischemic heart disease was similar in COVID (11.4%) and non-COVID (12%) deaths. CONCLUSION: In a nationwide analysis, COVID-19 infection was associated with higher age-standardized mortality than other primary causes of death, except cancer in women of select age groups. COVID-19 mortality was persistently higher in men and increased with advanced age.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Disparidades en Atención de Salud/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Neumonía Viral/mortalidad , Adulto , Distribución por Edad , Factores de Edad , Anciano , Causas de Muerte , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Distribución por Sexo , Factores Socioeconómicos , Gales/epidemiología
5.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33000953

RESUMEN

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Asunto(s)
Toma de Decisiones Conjunta , Detección Precoz del Cáncer/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Neoplasias Pulmonares/diagnóstico , Fumar/etnología , Determinación de la Elegibilidad , Grupos Étnicos/estadística & datos numéricos , Costos de la Atención en Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Ciencia de la Implementación , Cobertura del Seguro , Comercialización de los Servicios de Salud/métodos , Medicaid , Pacientes no Asegurados/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Derivación y Consulta/estadística & datos numéricos , Factores Sexuales , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar/estadística & datos numéricos , Clase Social , Estados Unidos
6.
Ann Glob Health ; 86(1): 135, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-33117656

RESUMEN

The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Refugiados/estadística & datos numéricos , Telemedicina/organización & administración , Adulto , Niño , Preescolar , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/prevención & control , Infecciones por Coronavirus/prevención & control , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Masculino , Pandemias/prevención & control , Neumonía Viral/prevención & control , Turquia , Poblaciones Vulnerables/estadística & datos numéricos
7.
PLoS One ; 15(10): e0240346, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052960

RESUMEN

BACKGROUND: Given the severity and scope of the current COVID-19 pandemic, it is critical to determine predictive features of COVID-19 mortality and medical resource usage to effectively inform health, risk-based physical distancing, and work accommodation policies. Non-clinical sociodemographic features are important explanatory variables of COVID-19 outcomes, revealing existing disparities in large health care systems. METHODS AND FINDINGS: We use nation-wide multicenter data of COVID-19 patients in Brazil to predict mortality and ventilator usage. The dataset contains hospitalized patients who tested positive for COVID-19 and had either recovered or were deceased between March 1 and June 30, 2020. A total of 113,214 patients with 50,387 deceased, were included. Both interpretable (sparse versions of Logistic Regression and Support Vector Machines) and state-of-the-art non-interpretable (Gradient Boosted Decision Trees and Random Forest) classification methods are employed. Death from COVID-19 was strongly associated with demographics, socioeconomic factors, and comorbidities. Variables highly predictive of mortality included geographic location of the hospital (OR = 2.2 for Northeast region, OR = 2.1 for North region); renal (OR = 2.0) and liver (OR = 1.7) chronic disease; immunosuppression (OR = 1.7); obesity (OR = 1.7); neurological (OR = 1.6), cardiovascular (OR = 1.5), and hematologic (OR = 1.2) disease; diabetes (OR = 1.4); chronic pneumopathy (OR = 1.4); immunosuppression (OR = 1.3); respiratory symptoms, ranging from respiratory discomfort (OR = 1.4) and dyspnea (OR = 1.3) to oxygen saturation less than 95% (OR = 1.7); hospitalization in a public hospital (OR = 1.2); and self-reported patient illiteracy (OR = 1.1). Validation accuracies (AUC) for predicting mortality and ventilation need reach 79% and 70%, respectively, when using only pre-admission variables. Models that use post-admission disease progression information reach accuracies (AUC) of 86% and 87% for predicting mortality and ventilation use, respectively. CONCLUSIONS: The results highlight the predictive power of socioeconomic information in assessing COVID-19 mortality and medical resource allocation, and shed light on existing disparities in the Brazilian health care system during the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Modelos Estadísticos , Neumonía Viral/epidemiología , Factores Socioeconómicos , Brasil , Comorbilidad , Infecciones por Coronavirus/mortalidad , Demografía/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Pandemias , Neumonía Viral/mortalidad
9.
N Z Med J ; 133(1520): 15-26, 2020 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-32994590

RESUMEN

AIMS: To explore variations in the use of and timeliness of chemotherapy in patients diagnosed with colorectal cancer in New Zealand. METHODS: This study included patients diagnosed with colorectal cancer in New Zealand between 1 January 2006 and 31 December 2016. The first chemotherapy regime was identified from Pharmaceutical Collection dataset. Logistic regression model was used to estimate the adjusted odds ratio of having chemotherapy by subgroup after adjustment for other factors. RESULTS: 27.8% (6,737/24,217) of colon cancer patients and 43.8% (3,582/8,170) of rectal cancer patients received publicly funded chemotherapy. The uptake and timeliness of chemotherapy has been improving over time. Pacific people were the least likely to receive chemotherapy, followed by Maori and Asian. Younger patients, New Zealand European, patients with metastatic disease and patients in the Southern Cancer Network were more likely to have chemotherapy in less than 10 weeks post-diagnosis. Over half of the advanced colorectal cancer patients who did not receive chemotherapy were aged 80+ years or had a short life expectancy. CONCLUSIONS: Although the uptake and timeliness of chemotherapy for colorectal cancer has been improving, Maori, Pacific, Asian and older patients were less likely to receive chemotherapy and less likely to receive chemotherapy in a timely manner. There is a variation in use of chemotherapy by Region with patients in the Southern Cancer region appearing to be the most likely to receive chemotherapy and to receive it within a timely period.


Asunto(s)
Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Quimioterapia/métodos , Disparidades en Atención de Salud/etnología , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Quimioterapia/economía , Grupos Étnicos , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Esperanza de Vida/etnología , Esperanza de Vida/tendencias , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Nueva Zelanda/etnología , Factores de Tiempo
10.
MMWR Morb Mortal Wkly Rep ; 69(38): 1369-1373, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32970656

RESUMEN

Coronavirus disease 2019 (COVID-19) has had a substantial impact on racial and ethnic minority populations and essential workers in the United States, but the role of geographic social and economic inequities (i.e., deprivation) in these disparities has not been examined (1,2). As of July 9, 2020, Utah had reported 27,356 confirmed COVID-19 cases. To better understand how area-level deprivation might reinforce ethnic, racial, and workplace-based COVID-19 inequities (3), the Utah Department of Health (UDOH) analyzed confirmed cases of infection with SARS-CoV-2 (the virus that causes COVID-19), COVID-19 hospitalizations, and SARS-CoV-2 testing rates in relation to deprivation as measured by Utah's Health Improvement Index (HII) (4). Age-weighted odds ratios (weighted ORs) were calculated by weighting rates for four age groups (≤24, 25-44, 45-64, and ≥65 years) to a 2000 U.S. Census age-standardized population. Odds of infection increased with level of deprivation and were two times greater in high-deprivation areas (weighted OR = 2.08; 95% confidence interval [CI] = 1.99-2.17) and three times greater (weighted OR = 3.11; 95% CI = 2.98-3.24) in very high-deprivation areas, compared with those in very low-deprivation areas. Odds of hospitalization and testing also increased with deprivation, but to a lesser extent. Local jurisdictions should use measures of deprivation and other social determinants of health to enhance transmission reduction strategies (e.g., increasing availability and accessibility of SARS-CoV-2 testing and distributing prevention guidance) to areas with greatest need. These strategies might include increasing availability and accessibility of SARS-CoV-2 testing, contact tracing, isolation options, preventive care, disease management, and prevention guidance to facilities (e.g., clinics, community centers, and businesses) in areas with high levels of deprivation.


Asunto(s)
Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Áreas de Pobreza , Adulto , Anciano , Infecciones por Coronavirus/diagnóstico , Humanos , Incidencia , Persona de Mediana Edad , Factores de Riesgo , Utah/epidemiología , Adulto Joven
11.
BMC Public Health ; 20(1): 1466, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993570

RESUMEN

BACKGROUND: Lung cancer is the most diagnosed cancer worldwide. In low- and middle-income countries (LMICs), lung cancer is often diagnosed at a late stage due to poor knowledge and awareness of its signs and symptoms. Increasing lung cancer awareness is likely to reduce the diagnosis and treatment delays. The implementation of early palliative care has also been reported to improve a patient's quality of life, and even survival. The aim of this scoping review was to map evidence on lung cancer awareness and palliative care interventions implemented in sub-Saharan Africa (SSA) and other LMICs. METHODS: This scoping review was guided by Arksey and O'Malley's framework. Databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, World Health Organization (WHO) library and grey literature were used to perform systematic searches of relevant articles. The methodological quality assessment of included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVivo version 10 software was used to perform the thematic content analysis of the included studies. RESULTS: A total number of screened articles was 2886, with 236 meeting the eligibility criteria and 167 further excluded following abstract screening. Sixty-nine (69) articles qualified for full-article screening and 9 were selected for detailed data extraction and methodological quality assessment. Of the included nine studies, eight described at least one lung cancer warning signs and symptoms, while one described the effectiveness of palliative care for lung cancer. Eight articles recognized the level of lung cancer knowledge, risk factors awareness of warning signs and symptoms in LMICs, mostly Africa and Asia. CONCLUSIONS: Most of the participants were aware of tobacco use as the major risk factor for lung cancer but lacked knowledge on the other pre-disposing risk factors. Evidence on palliative care is scarce, therefore, awareness interventions packaged with evidence on the value of timely access to palliative care services in improving the quality of life of the lung cancer patients and their families, are required.


Asunto(s)
Países en Desarrollo , Disparidades en Atención de Salud/estadística & datos numéricos , Neoplasias Pulmonares/terapia , Cuidados Paliativos/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Adulto , África del Sur del Sahara , Asia , Femenino , Humanos , Neoplasias Pulmonares/economía , Calidad de Vida , Factores de Riesgo
12.
N Z Med J ; 133(1522): 84-95, 2020 09 25.
Artículo en Inglés | MEDLINE | ID: mdl-32994619

RESUMEN

AIMS: Global trends show an increase in medication dispensing for attention-deficit/hyperactivity disorder (ADHD) in young people over time. The current study aimed to examine whether similar trends were observed in New Zealand youth over the period of 2007/08 to 2016/17. METHODS: We estimated the prevalence in ADHD medication dispensing using national pharmaceutical data for each fiscal year from 2007/08 to 2016/17 in approximately 2.4 million New Zealand youth aged 1-24 years. We also examined whether trends varied by sociodemographic factors. RESULTS: The total dispensing prevalence almost doubled from 516 per 100,000 to 996 per 100,000 over the study period. Males had a consistently higher dispensing prevalence relative to females. Young people aged 7-17 years had the highest dispensing prevalence. The most deprived quintile had a slightly lower dispensing prevalence relative to other quintiles. Ethnic differences in dispensing prevalence were apparent, with deprivation differences also existing within most ethnic groups. CONCLUSIONS: Overall, our study showed an increase in ADHD medication use by young people in New Zealand, similar to international findings. Further research is needed into why disparities in dispensing prevalence occur across ethnic and socioeconomic groups.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Prescripciones de Medicamentos/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Estudios Transversales , Grupos Étnicos/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Lactante , Masculino , Nueva Zelanda/epidemiología , Prevalencia , Adulto Joven
13.
N Z Med J ; 133(1521): 55-68, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994637

RESUMEN

BACKGROUND: Racism is an underlying cause of ethnic health inequities both in Aotearoa New Zealand and internationally. It is timely to synthesise racism and health research within New Zealand particularly given the current policy environment and shift towards addressing the health effects of racism. AIM: To review quantitative research examining self-reported experiences of racial discrimination and associations with measures of health (health conditions, health risk, health status and healthcare) in New Zealand. METHODS: MEDLINE, PsycINFO, Web of Science and CINAHL databases were searched for studies reporting on associations between experiences of racism and health. RESULTS: The systematic review identified 24 quantitative studies reporting associations between self-reported racial discrimination across a wide range of health measures including mental health, physical health, self-rated health, wellbeing, individual level health risks, and healthcare indicators. CONCLUSIONS: Quantitative racism and health research in New Zealand consistently finds that self-reported racial discrimination is associated with a range of poorer health outcomes and reduced access to and quality of healthcare. This review confirms that experience of racial discrimination is an important determinant of health in New Zealand, as it is internationally. There is a pressing need for effectively designed interventions to address the impacts of racism on health.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Racismo/estadística & datos numéricos , Grupo de Ascendencia Continental Europea , Estado de Salud , Disparidades en el Estado de Salud , Humanos , Nueva Zelanda , Grupo de Ascendencia Oceánica , Autoinforme
14.
N Z Med J ; 133(1521): 69-76, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994638

RESUMEN

Maori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Maori. For prostate cancer, Maori men are less likely than non-Maori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Maori men resulting in an excess mortality rate in Maori men compared with non-Maori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Maori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Maori men; and general barriers to healthcare that exist for Maori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Maori men.


Asunto(s)
Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Disparidades en Atención de Salud , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Neoplasias de la Próstata , Adulto , Anciano , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/terapia , Factores de Riesgo , Factores Socioeconómicos
17.
PLoS One ; 15(9): e0239482, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32970711

RESUMEN

BACKGROUND: I investigate the association of perceived discrimination based both on race and other attributes such as age, gender, and insurance status on self-reported health access and health outcomes in a diverse and densely populated metropolitan area. METHODS: Restricted data from the 2016 round of the New York City Community Health Survey was used to create prevalence estimates for both racial and non-racial discrimination. Logistic regression models were used to estimate the association of these discrimination measures with health access and health outcome variables. RESULTS: Among residents who perceived discrimination receiving health care during the previous year, 15% reported the reason behind such discrimination to race, while the rest chose other reasons. Among the non-race based categories, 34% reported the reason behind such discrimination to be insurance status, followed by other reasons (26.83%) and income (11.76%). Non-racial discrimination was significantly associated with the adjusted odds of not receiving care when needed (AOR = 6.96; CI: [5.00 9.70]), and seeking informal care (AOR = 2.24; CI: [1.13 4.48] respectively, after adjusting for insurance status, age, gender, marital status, race/ethnicity, nativity, and poverty. It was also associated with higher adjusted odds of reporting poor health (AOR = 2.49; CI: [1.65 3.75]) and being diagnosed with hypertension (AOR = 1.75; CI: [1.21 2.52]), and diabetes (AOR = 1.84; CI: [1.22 2.77]) respectively. CONCLUSIONS: Perceived discrimination in health care exists in multiple forms. Non-racial discrimination was strongly associated with worse health access and outcomes, and such experiences may contribute to health disparities between different socioeconomic groups.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Prejuicio/estadística & datos numéricos , Prestación de Atención de Salud/tendencias , Grupos Étnicos/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Cobertura del Seguro/estadística & datos numéricos , Masculino , Ciudad de Nueva York/epidemiología , Racismo/estadística & datos numéricos , Autoinforme , Factores Socioeconómicos
18.
Artículo en Inglés | MEDLINE | ID: mdl-32872662

RESUMEN

Health disparities in diabetes management and control are well-documented. The objective of this study is to describe one diabetes education program delivered in the United States in terms of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Planning and Evaluation Framework. Questionnaires, clinical data, and administrative records were analyzed from 8664 adults with diabetes living in South Texas, an area characterized by high health disparities. The Diabetes Education Program delivered was a professionally led 12-month program involving 8 h of in-person workshop education followed by quarterly follow-up sessions. Changes in average blood glucose levels over the past 3 months (e.g., A1c levels) were the primary clinical outcome. Descriptive and multiple generalized linear mixed models were performed. This community-based initiative reached a large and diverse population, and statistically significant reductions in A1c levels (p < 0.01) were observed among participants with Type 2 diabetes at 3 months. These reductions in A1c levels were sustained at 6-, 9-, and 12-month follow-up assessments (p < 0.01). However, considerable attrition over time at follow-up sessions indicate the need for more robust strategies to keep participants engaged. For this diabetes education program, the RE-AIM model was a useful framework to present study processes and outcomes.


Asunto(s)
Diabetes Mellitus Tipo 2 , Educación en Salud , Disparidades en el Estado de Salud , Relaciones Comunidad-Institución , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Femenino , Educación en Salud/estadística & datos numéricos , Promoción de la Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Encuestas y Cuestionarios , Texas/epidemiología
19.
JAMA Netw Open ; 3(9): e2015470, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32876682

RESUMEN

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures: Hospital referral to home health care. Main Outcomes and Measures: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud/etnología , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Derivación y Consulta , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Planes de Aranceles por Servicios , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Medicaid/estadística & datos numéricos , Medicare , Medicare Part C , Alta del Paciente , Pobreza/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Desempleo/estadística & datos numéricos , Estados Unidos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA