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2.
Braz Oral Res ; 33: e102, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939495

RESUMEN

The objective of this study was to evaluate the association between social inequality indicators and oral health conditions in an adult population. This prospective cohort study assessed a probabilistic sampling of adults (aged 20-64 years) living in Piracicaba, São Paulo, Brazil. Oral examinations were performed in 2011 and 2015, conducted at home, and used the decay-missing-filled (DMFT) index of permanent teeth, the Community Periodontal Index (CPI), and the visible biofilm criterion. A questionnaire was administered to determine demographic and socioeconomic aspects and dental services used, and collect oral health-related quality of life (OHRQoL) data. Social inequality indicators were evaluated according to social class (high, middle or low) and type of dental service used (public, health insurance or private), and compared with oral health conditions (visible biofilm, DMFT and incidence of tooth loss, periodontal pockets and bleeding, and OHRQoL), evaluated between 2011 and 2015. Analysis using chi-squared or Fisher tests (p < 0.05) and Cochran's Q test was conducted separately for each category analyzed between 2011 and 2015 (p < 0.05). A total of 143 adults who participated in an earlier study were examined after four years of follow-up. Although the occurrence of oral disease did not decrease over the study period (4 years), there was a reduction in inequality among lower social classes in regard to presence of tooth decay and oral health impact on self-perceived quality of life between 2011 and 2015 (p < 0.05). These results suggest that the Brazilian National Oral Health Policy has achieved its principles, especially that of greater equity.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Adulto , Brasil/epidemiología , Índice CPO , Femenino , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Índice Periodontal , Estudios Prospectivos , Calidad de Vida , Autoimagen , Clase Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
3.
J Surg Res ; 245: 629-635, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31522036

RESUMEN

BACKGROUND: Emergency general surgery (EGS) accounts for more than 2 million U.S. hospital admissions annually. Low-income EGS patients have higher rates of postoperative adverse events (AEs) than high-income patients. This may be related to health care segregation (a disparity in access to high-quality centers). The emergent nature of EGS conditions and the limited number of EGS providers in rural areas may result in less health care segregation and thereby less variability in EGS outcomes in rural areas. The objective of this study was to assess the impact of income on AEs for both rural and urban EGS patients. MATERIALS AND METHODS: The National Inpatient Sample (2007-2014) was queried for patients receiving one of 10 common EGS procedures. Multivariate regression models stratified by income quartiles in urban and rural cohorts adjusting for sociodemographic, clinical, and other hospital-based factors were used to determine the rates of surgical AEs (mortality, complications, and failure to rescue [FTR]). RESULTS: 1,687,088 EGS patients were identified; 16.60% (n = 280,034) of them were rural. In the urban cohort, lower income quartiles were associated with higher odds of AEs (mortality OR, 1.21 [95% CI, 1.15-1.27], complications, 1.07 [1.06-1.09]; FTR, 1.17 [1.10-1.24] P < 0.001). In the rural context, income quartiles were not associated with the higher odds of AE (mortality OR, 1.14 [0.83-1.55], P = 0.42; complications, 1.06 [0.97-1,16], P = 1.17; FTR, 1.12 [0.79-1.59], P = 0.52). CONCLUSIONS: Lower income is associated with higher postoperative AEs in the urban setting but not in a rural environment. This socioeconomic disparity in EGS outcomes in urban settings may reflect health care segregation, a differential access to high-quality health care for low-income patients.


Asunto(s)
Tratamiento de Urgencia/efectos adversos , Disparidades en Atención de Salud/economía , Renta/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Operativos/efectos adversos , Adolescente , Adulto , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/estadística & datos numéricos , Fracaso de Rescate en Atención a la Salud/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitales Rurales/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Población Rural/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Estados Unidos/epidemiología , Población Urbana/estadística & datos numéricos , Adulto Joven
4.
J Surg Res ; 245: 198-204, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421362

RESUMEN

BACKGROUND: Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. METHODS: This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included. RESULTS: A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients. CONCLUSIONS: Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.


Asunto(s)
Ciclismo/lesiones , Disparidades en Atención de Salud/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Conjuntos de Datos como Asunto , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia , Adulto Joven
5.
J Surg Res ; 245: 265-272, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421372

RESUMEN

BACKGROUND: Although insurance and race-based survival disparities in colon cancer are well studied, little is known regarding how these survival disparities are impacted by type of treating facility. MATERIALS AND METHODS: This is a retrospective cohort study of 433,997 patients diagnosed with colon adenocarcinoma using the National Cancer Database (NCDB). Using Cox proportional hazard analyses, we assessed overall survival (OS) as a function of race, insurance status, and treating facility, after adjusting for demographic and clinical factors. We also assessed differences in OS according to race and insurance status stratified by treating facility type. RESULTS: OS was significantly diminished for blacks (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.07-1.10; P < 0.001) and increased for patients of other race (primarily Asians; HR, 0.76; 95% CI, 0.74-0.78) compared with whites. Patients with private insurance had improved OS compared with uninsured (HR, 1.28; 95% CI, 1.25-1.31; P < 0.001), Medicaid (HR, 1.35; 95% CI, 1.33-1.38; P < 0.001) and Medicare (HR, 1.13, 95% CI, 1.12-1.15; P < 0.001) patients. Compared with patients treated at comprehensive community programs, patients treated at academic centers (ACs) had improved OS (HR, 0.86; 95% CI, 0.85-0.88; P < 0.001). When stratified by type of treating facility, racial disparities were not mitigated for patients treated at ACs compared with other facilities (P = 0.266 for interaction). At ACs, patients with Medicaid had persistent OS disparities compared with patients with private insurance (HR, 1.12; 95% CI, 1.09-1.15; P < 0.001), although these disparities were significantly diminished compared with patients treated at other facilities (HR, 1.41; 95% CI, 1.38-1.45; P < 0.001). CONCLUSIONS: Other race, private insurance, and treatment at AC were independently associated with improved OS in patients with colon cancer. Medicaid-based, but not race-based, survival disparities are reduced at ACs compared with other facilities.


Asunto(s)
Centros Médicos Académicos/estadística & datos numéricos , Neoplasias del Colon/terapia , Disparidades en Atención de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Afroamericanos/estadística & datos numéricos , Anciano , Neoplasias del Colon/mortalidad , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Estados Unidos/epidemiología
6.
J Surg Res ; 245: 309-314, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421378

RESUMEN

BACKGROUND: Pediatric postoperative opioid prescribing has come under scrutiny as a result of the ongoing opioid epidemic. Previous research has demonstrated that African American adults are less likely to receive analgesics, particularly opioids, after surgery, even after controlling for pain severity. We sought to examine racial disparities in the filling of opioid prescriptions by pediatric surgical patients after cholecystectomy. METHODS: We studied patients aged 1 to 18 y who were enrolled in Ohio Medicaid and underwent cholecystectomy. Procedures performed in January 2013-July 2016 were included. The percentage of patients who filled a postoperative opioid prescription within 14 d of their procedure was compared between black and white patients using log binomial regression models fit using generalized estimating equations to account for patient clustering within hospitals. RESULTS: We identified 1277 patients who underwent a cholecystectomy. In unadjusted analyses, black children were significantly less likely than white children to fill an opioid prescription postoperatively (74.9% versus 85.7%, P < 0.001). After adjustment for patient-level clinical and demographic characteristics, we found that black children treated at non-children's hospitals in large-/medium-sized urban counties were significantly less likely to fill an opioid prescription after cholecystectomy when compared with white children treated at urban children's hospitals or to white children treated in non-children's hospitals in either large/medium urban counties or other counties. However, this association was partly explained by a longer average length of stay among black children. CONCLUSIONS: Black children who undergo cholecystectomy at urban non-children's hospitals are less likely to fill a postoperative opioid prescription than white children who undergo cholecystectomy at those same hospitals or other hospitals. Further research is needed to identify whether this disparity is due to a lower rate of opioid prescribing or a lower rate of prescription filling.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Colecistectomía/efectos adversos , Disparidades en Atención de Salud/estadística & datos numéricos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Afroamericanos/estadística & datos numéricos , Niño , Preescolar , Prescripciones de Medicamentos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Lactante , Masculino , Ohio , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Índice de Severidad de la Enfermedad , Estados Unidos
7.
Rev Saude Publica ; 53: 97, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800910

RESUMEN

OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013-2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.


Asunto(s)
Disparidades en el Estado de Salud , Indicadores de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Ecuador/epidemiología , Femenino , Geografía Médica , Humanos , Masculino , Mortalidad , Áreas de Pobreza , Salud Pública , Factores Socioeconómicos
8.
Pan Afr Med J ; 34: 60, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762925

RESUMEN

Introduction: Approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources. Methods: The equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data. Results: Public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure. Conclusion: There exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data.


Asunto(s)
Equipos y Suministros/provisión & distribución , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Radiografía/instrumentación , Humanos , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Cobertura Universal del Seguro de Salud , Zimbabwe
11.
BMC Health Serv Res ; 19(1): 780, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31675967

RESUMEN

BACKGROUND: Higher income population tend to prefer brand-name to generic drugs, which may cause disparity in access to brand-name drugs among income groups. A potential policy that can resolve such disparity is imposing a greater co-payment rate on high-income enrollees. However, the effects of such policy are unknown. We examined how patients' choice between brand-name and generic drugs are affected by the unique income-based co-payment rates in Japan; 10% for general enrollees and 30% for those with high income among the elderly aged 75 and over. METHODS: We drew on cross-sectional price variation among commonly prescribed 311 drugs using health insurance claims data from a large prefecture in Japan between October 2013 and September 2014 to identify between-income-group differences in responses to differentiated payments. RESULTS: Running 311 multivariate logistic regression models controlling individual demographics, the median estimate indicated that high-income group was 3% (odds ratio = 0.97) less likely to choose a generic drug than the general-income group and the interquartile estimates ranged 0.92-1.02. The multivariate feasible generalized least squares model indicated high-income group's higher likelihood to choose brand-name drugs than the general-income group without co-payment rate differentiation (p < 0.001). Such gap in the likelihood was attenuated by 0.4% (p = 0.027) with an US$1 increase in the difference in additional payment/month for brand-name drugs between income groups - no gap with US$10 additional payment/month. This attenuation was observed in drugs for chronic diseases only, not for acute diseases. CONCLUSIONS: Income-based co-payment rates appeared to reduce disparity in access to brand-name drugs across income groups, in addition to reducing total medical expenditure among high-income group who shifted from brand-name drugs to generic ones due to larger drug price differences.


Asunto(s)
Deducibles y Coseguros/economía , Medicamentos Genéricos/economía , Disparidades en Atención de Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Medicamentos bajo Prescripción/economía , Anciano , Anciano de 80 o más Años , Conducta de Elección , Estudios Transversales , Femenino , Humanos , Japón , Masculino , Medicamentos bajo Prescripción/clasificación
12.
Int J Equity Health ; 18(1): 156, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615530

RESUMEN

BACKGROUND: With the adoption of the Sustainable Development Goals (SDGs), there is a renewed commitment of tackling the varied challenges of undernutrition, particularly stunting (SDG 2.2). Health equity is also a priority in the SDG agenda and there is an urgent need for disaggregated analyses to identify disadvantaged subgroups. We compared time trends in socioeconomic inequalities obtained through stratification by wealth quintiles and deciles for stunting prevalence. METHODS: We used 37 representative Demographic and Health Surveys and Multiple Indicator Cluster surveys from nine Latin American and Caribbean (LAC) countries conducted between 1996 and 2016. Stunting in children under-5 years was assessed according to the 2006 WHO Child Growth Standards and stratified by wealth quintiles and deciles. Within-country socioeconomic inequalities were measured through concentration index (CIX) and slope index of inequality (SII). We used variance-weighted least squares regression to estimate annual changes. RESULTS: Eight out of nine countries showed a statistical evidence of reduction in stunting prevalence over time. Differences between extreme deciles were larger than between quintiles in most of countries and at every point in time. However, when using summary measures of inequality, there were no differences in the estimates of SII with the use of deciles and quintiles. In absolute terms, there was a reduction in socioeconomic inequalities in Peru, Honduras, Dominican Republic, Belize, Suriname and Colombia. In relative terms, there was an increase in socioeconomic inequalities in Peru, Bolivia, Haiti, Honduras and Guatemala. CONCLUSIONS: LAC countries have made substantial progress in terms of reducing stunting,. Nevertheless, renewed actions are needed to improve equity. Particularly in those countries were absolute and relative inequalities did not change over time such Bolivia and Guatemala. Finer breakdowns in wealth distribution are expected to elucidate more differences between subgroups; however, this approach is relevant to cast light on those subgroups that are still lagging behind within populations and inform equity-oriented health programs and practices.


Asunto(s)
Trastornos del Crecimiento/epidemiología , Equidad en Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Niño , Preescolar , Femenino , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , América Latina/epidemiología , Prevalencia , América del Sur
13.
BMC Health Serv Res ; 19(1): 746, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651300

RESUMEN

BACKGROUND: Globally, female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Studies show that there are various factors in some contexts that render FSWs marginalised, which limits their access to sexual reproductive health (SRH) services. Access to SRH services are particularly challenging in countries where sex work is criminalised such as is the case in South Africa. Evidently, there are alternative ways in which FSWs in this context receive non-stigmatising SRH care through non-governmental organisations. The aim of this study was to understand the functioning of these non-governmental health care services as well as to document the experiences of FSWs utilising these services. METHODS: Eleven focus group discussions were held with 91 FSWs. In addition, 21 in-depth individual interviews with researchers, stakeholders and FSWs were conducted. Interview guides were utilised for data collection. Informed consent was obtained from all participants. Data were analysed thematically. RESULTS: The FSWs expressed challenges related to SRH care access at public health facilities. The majority felt that they could not consult for SRH-related services because of stigma. The non-governmental health and advocacy organisations providing SRH services to FSWs through their mobile facilities utilising the peer approach, have done so in a way that promotes trust between FSWs and mobile health care providers. FSWs have access to tailored services, prevention materials as well as health information. This has resulted in the normalising of HIV testing as well as SRH seeking behaviours. CONCLUSION: This study has established that health and advocacy organisations have attempted to fill the gap in responding to SRH care needs of FSWs amidst intersecting vulnerabilities. FSWs' engagement with these organisations has encouraged their willingness to test for HIV. However, it is important to note that these organisations operate in urban areas, thus FSWs operating outside these areas are most likely exposed to compounding health risks and lack access to tailored services.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud Reproductiva/estadística & datos numéricos , Trabajadores Sexuales/estadística & datos numéricos , Adulto , Actitud Frente a la Salud , Utilización de Instalaciones y Servicios , Femenino , Grupos Focales , Infecciones por VIH/prevención & control , Personal de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Organizaciones/estadística & datos numéricos , Defensa del Paciente , Rol Profesional , Trabajadores Sexuales/psicología , Conducta Sexual/psicología , Estigma Social , Sudáfrica , Adulto Joven
14.
BMC Public Health ; 19(1): 1373, 2019 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-31653250

RESUMEN

BACKGROUND: Since economic inequality is often accompanied by health inequalities, health care inequalities are increasingly becoming a hot issue on a global scale. As a developing country, China is still facing the same problems as other countries in the world. Especially in underdeveloped regions, owing to the relatively backward economy, health care inequality may be more serious. The objective of this study was to explore health care inequality in a socioeconomically underdeveloped city, thus providing a certain theoretical basis for further development and reform of the medical insurance schemes. METHODS: We mainly extracted relevant insurance information of 628,952 insured enrollees, as well as consumption of outpatient visit and hospitalization. The propensity score matching had been used to estimate different urban medical insurance schemes effect on healthcare utilization, the choice of hospital types and healthcare cost. RESULTS: Insured enrollees spent most hospitalization expenses in tertiary-level hospitals, which had lowest hospitalization compensation ratios. Healthcare utilization and cost vary significantly by different insurance schemes. Urban employees had significantly higher outpatient visit rates in all hospital types than urban residents. Urban employees preferred to receive hospitalization treatment in tertiary-level hospitals, while those who receive hospitalization treatment in first-level hospitals are more likely to be enrolled in Urban Residents Basic Medical Insurance. Hospitalization expenses and hospitalization compensation ratios of urban employees were also significantly higher than urban residents in all hospital types. CONCLUSIONS: Health care inequality is mainly reflected in the imbalance between hospitalization expenses and hospitalization compensation ratios, as well as inequalities under different medical insurance schemes in healthcare utilization, the choice of hospital types and healthcare cost in socioeconomically underdeveloped regions of China. We should conduct a targeted medical insurance reform for the socioeconomically underdeveloped regions, rather than applying templates of ordinary regions. Further efforts are needed in the future to provide equal health care for every patient.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Áreas de Pobreza , Adolescente , Adulto , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Adulto Joven
15.
Health Serv Res ; 54 Suppl 2: 1454-1466, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31659745

RESUMEN

OBJECTIVE: To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data came from a national, probability-based telephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites and 201 racial/ethnic minorities), conducted January-April 2017. METHODS: We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents. PRINCIPAL FINDINGS: Experiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system CONCLUSIONS: Discrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination.


Asunto(s)
Disparidades en Atención de Salud , Acoso Sexual , Minorías Sexuales y de Género/estadística & datos numéricos , Adolescente , Adulto , Femenino , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Vivienda , Humanos , Masculino , Acoso Sexual/etnología , Acoso Sexual/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Encuestas y Cuestionarios , Teléfono , Estados Unidos , Adulto Joven
16.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190015.SUPL.2, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596386

RESUMEN

INTRODUCTION: Despite the improvement in oral health conditions observed in the Brazilian population, there are still high social inequalities that must be monitored. OBJECTIVE: To evaluate income inequality in oral hygiene practices, oral health status and the use of dental services in the adult and senior Brazilian population. METHODS: Data from the National Health Survey conducted in 2013 (Pesquisa Nacional de Saúde - PNS 2013) were used for the population aged 18 years old or older. RESULTS: Inequalities were found among the income strata in most of the oral health indicators evaluated. The greatest inequalities were observed in the use of dental floss, in hygiene practices (PR = 2.85 in adults and PR = 2.45 in seniors), and in total tooth loss (PR = 6.74 in adults and PR = 2.24 in seniors) and difficulty in chewing (PR = 4.49 in adults and PR = 2.67 in seniors) among oral condition indicators. The magnitude of inequalities was high in both groups in most oral condition indicators. Income was a factor that persisted in limiting access to dental services, and even the lower income segments had high percentages that paid for dental consultations. CONCLUSION: Based on data from the first PNS, the findings of this study enabled the identification of oral health and dental care aspects more compromised by income differentials, thus, contributing to the planning of dental care in Brazil and to stimulate the monitoring of these disparities with data from future surveys.


Asunto(s)
Servicios de Salud Dental/estadística & datos numéricos , Encuestas de Salud Bucal/métodos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Clase Social , Adolescente , Adulto , Brasil/epidemiología , Encuestas de Salud Bucal/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Higiene Bucal , Prevalencia , Análisis de Regresión , Factores Socioeconómicos , Adulto Joven
17.
BMC Health Serv Res ; 19(1): 687, 2019 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-31601199

RESUMEN

BACKGROUND: Social inequities are widening globally, contributing to growing health and health care inequities. Health inequities are unjust differences in health and well-being between and within groups of people caused by socially structured, and thus avoidable, marginalizing conditions such as poverty and systemic racism. In Canada, such conditions disproportionately affect Indigenous persons, racialized newcomers, those with mental health and substance use issues, and those experiencing interpersonal violence. Despite calls to enhance equity in health care to contribute to improving population health, few studies examine how to achieve equity at the point of care, and the impacts of doing so. Many people facing marginalizing conditions experience inadequate and inequitable treatment in emergency departments (EDs), which makes people less likely to access care, paradoxically resulting in reliance on EDs through delays to care and repeat visits, interfering with effective care delivery and increasing human and financial costs. EDs are key settings with potential for mitigating the impacts of structural conditions and barriers to care linked to health inequities. METHODS: EQUIP is an organizational intervention to promote equity. Building on promising research in primary health care, we are adapting EQUIP to emergency departments, and testing its impact at three geographically and demographically diverse EDs in one Canadian province. A mixed methods multisite design will examine changes in key outcomes including: a) a longitudinal analysis of change over time based on structured assessments of patients and staff, b) an interrupted time series design of administrative data (i.e., staff sick leave, patients who leave without care being completed), c) a process evaluation to assess how the intervention was implemented and the contextual features of the environment and process that are influential for successful implementation, and d) a cost-benefit analysis. DISCUSSION: This project will generate both process- and outcome-based evidence to improve the provision of equity-oriented health care in emergency departments, particularly targeting groups known to be at greatest risk for experiencing the negative impacts of health and health care inequities. The main deliverable is a health equity-enhancing framework, including implementable, measurable interventions, tested, refined and relevant to diverse EDs. TRIAL REGISTRATION: Clinical Trials.gov # NCT03369678 (registration date November 18, 2017).


Asunto(s)
Prestación de Atención de Salud/normas , Servicio de Urgencia en Hospital/normas , Equidad en Salud/organización & administración , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Colombia Británica , Protocolos Clínicos , Servicio de Urgencia en Hospital/organización & administración , Humanos , Indios Norteamericanos/estadística & datos numéricos , Análisis de Series de Tiempo Interrumpido , Servicios de Salud Mental/normas , Servicios de Salud Mental/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Racismo/estadística & datos numéricos , Trastornos Relacionados con Sustancias/rehabilitación , Violencia/estadística & datos numéricos
18.
Health Serv Res ; 54 Suppl 2: 1442-1453, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31663120

RESUMEN

OBJECTIVE: To examine reported experiences of gender discrimination and harassment among US women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 1596 women, conducted January-April 2017. METHODS: We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity. PRINCIPAL FINDINGS: Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas' odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks' odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non-LGBTQ women. CONCLUSIONS: Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.


Asunto(s)
Disparidades en Atención de Salud , Sexismo , Acoso Sexual , Minorías Sexuales y de Género/estadística & datos numéricos , Salud de la Mujer , Adolescente , Adulto , Anciano , Empleo , Femenino , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Aceptación de la Atención de Salud , Sexismo/etnología , Sexismo/estadística & datos numéricos , Acoso Sexual/etnología , Acoso Sexual/estadística & datos numéricos , Encuestas y Cuestionarios , Teléfono , Estados Unidos
19.
West J Emerg Med ; 20(5): 799-802, 2019 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-31539337

RESUMEN

INTRODUCTION: Mobile health (mHealth) has the potential to change how patients make healthcare decisions. We sought to determine the readiness to use mHealth technology in underserved communities. METHODS: We conducted a cross-sectional survey of patients presenting with low-acuity complaints to an urban emergency department (ED) with an underserved population. Patients over the age of two who presented with low-acuity complaints were included. We conducted structured interview with each patient or parent (for minors) about willingness to use mHealth tools for guidance. Analysis included descriptive statistics and univariate analysis based on age and gender. RESULTS: Of 560 patients included in the survey, 80% were adults, 64% female, and 90% Black. The mean age was 28 ± 9 years for adults and 9 ± 5 years for children. One-third of patients reported no primary care physician, and 55% reported no access to a nurse or clinician for medical advice. Adults were less likely to have access to phone consultation than parents of children (odds ratio [OR] 0.49, 95% confidence interval [CI], 0.32 - 0.74), as were males compared to females (OR 0.52, 95% CI, 0.37-0.74). Most patients (96%) reported cellular internet access. Two-thirds of patients reported using online references. When asked how they would behave if an mHealth tool advised them that their current health problem was low risk, 69% of patients responded that they would seek care in an outpatient clinic instead of the ED (30%), stay home and not seek urgent medical care (28%), or use telehealth (11%). CONCLUSION: In this urban community we found a large capacity and willingness to use mHealth technology in medical triage.


Asunto(s)
Atención Ambulatoria/métodos , Servicio de Urgencia en Hospital/organización & administración , Disparidades en Atención de Salud/estadística & datos numéricos , Derivación y Consulta , Telemedicina/estadística & datos numéricos , Salud Urbana , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Área sin Atención Médica , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-31533209

RESUMEN

Since the onset of reform and opening up in China, large cities in the nation have been experiencing problems related to limited medical resources. These resource limitations are due to rapid population growth and urban expansion. As the country's fastest growing city, Shenzhen has experienced a substantial misalignment between the supply and the demand of healthcare services. Numerous researchers have analyzed spatial inequity in healthcare services by focusing on the spatial accessibility of medical facilities, such as hospitals, clinics, and community health service centers (CHSCs). However, the issue of inequity in healthcare services for vulnerable groups has largely been ignored. We chose general hospitals (GHs) and CHSCs, which provide direct healthcare services to residents, as the study objects. By performing spatial accessibility analysis using the gravity model and the two-step floating catchment area method, we investigated healthcare services inequity for vulnerable groups based on four dimensions: residential type, age, education level, and occupation. We found that the services provided by GHs cannot meet the demand in Shenzhen. This inadequacy is characterized by spatial centralization and neglect of those who reside in urban villages, who have low education levels, and who are employed in the manufacturing industry. In contrast, CHSCs generally serve a relatively broad population. This phenomenon is related to differences in the land and capital needs between GHs and CHSCs. Our study reveals that an appropriate adjustment of GH location could significantly improve healthcare services inequity. Therefore, to alleviate this inequity, it is particularly necessary to increase the number of GHs in the peripheral circle and in areas with large vulnerable populations, accelerate the implementation of the hierarchical medical system, and promote the transfer of medical resources to grassroot institutes through CHSCs. This study helps improve our understanding of healthcare services inequity in rapid expanding cities, which is of substantial significance for improving the planning and construction of medical facilities, facilitating scientific decision-making, and promoting social equity.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Análisis Espacial , Migrantes/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China , Ciudades , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Modelos Teóricos , Adulto Joven
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