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1.
Int J Equity Health ; 20(1): 21, 2021 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413442

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor. METHODS: Using the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this paper estimated income-related health inequalities in South Africa before and during the COVID-19 pandemic. Health was a dichotomized self-assessed health measure, with fair and poor health categorized as "poor" health, while excellent, very good and good health were categorized as "better" health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality. RESULTS: The results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods, with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly predicted income-related health inequalities in the COVID-19 era (contributing 130%, 46% and 9% respectively to the inequalities), while being in paid employment had a nontrivial but statistically insignificant contribution (13%) to health inequality. CONCLUSIONS: Given the significance and magnitude of race, hunger, income and employment in determining socioeconomic inequalities in poor health, addressing racial disparities and hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 pandemic.


Asunto(s)
Disparidades en el Estado de Salud , Renta/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Sudáfrica/epidemiología
2.
J Surg Res ; 257: 278-284, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32866668

RESUMEN

BACKGROUND: Emergency general surgery has higher adverse outcomes than elective surgery. Patients leaving the hospital against medical advice (AMA) have a greater risk for readmission and complications. We sought to identify clinical and demographic characteristics along with hospital factors associated with leaving AMA after EGS operations. METHODS: A retrospective review of the Nationwide Inpatient Sample was performed. All patients who underwent an EGS procedure accounting for >80% of the burden of EGS-related inpatient resources were identified. 4:1 propensity score analysis was conducted. Regression analyses determined predictive factors for leaving AMA. RESULTS: 546,856 patients were identified. 1085 (0.2%) patients who underwent EGS left AMA. They were more likely to be men (59% versus 42%), younger (median age 51 y, IQR [37.61] versus 54, IQR [38.69]), qualify for Medicaid (26% versus 13%) or be self-pay (17% versus 9%), and be within the lowest quartile median household income (40% versus 28%) (all P < 0.05). After applying 4:1 propensity score matching, individuals who were self-pay (OR 3.15, 95% CI 2.44-4.06) or insured through Medicare (OR 2.75, 95% CI 2.11-3.57) and Medicaid (OR 3.58, 95% CI 2.83-4.52) had increased odds of leaving AMA compared with privately insured patients. In addition, history of alcohol (OR 2.21, 95% CI 1.65-2.98), drug abuse (OR 4.54, 95% CI 3.23-6.38), and psychosis (OR 2.31, 95% CI 1.65-3.23) were associated with higher likelihood for leaving AMA. CONCLUSIONS: Patients undergoing EGS have a high risk of complications, and leaving AMA further increases this risk. Interventions to encourage safe discharge encompassing surgical, psychiatric, and socioeconomic factors are warranted to prevent a two-hit effect and compound postoperative risk.


Asunto(s)
Tratamiento de Urgencia/efectos adversos , Cooperación del Paciente/estadística & datos numéricos , Alta del Paciente/normas , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Operativos/efectos adversos , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Renta/estadística & datos numéricos , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Cooperación del Paciente/psicología , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Estados Unidos/epidemiología
4.
Soc Sci Med ; 269: 113557, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33308909

RESUMEN

The tremendous job loss and wage cuts during the COVID-19 pandemic raises concerns about the mental health of the population. The impacts of income shocks on mental health may differ across U.S. states during the pandemic, as states have different policy contexts that likely influence mental health. The present study uses survey data from the Census Bureau's Household Pulse Survey (April-July 2020) to examine whether mental health outcomes vary across U.S. states and to what extent specific state-level contexts moderate the associations between household income shocks and depression (n = 582,440) and anxiety (n = 582,796). We find that the prevalence of depression and anxiety differs across states by household income shock status. For individuals, living in a state with supportive social policies - primarily those related to Medicaid, unemployment insurance, and suspended utility shut offs during the pandemic - weakens the association between household income shocks and mental health. Findings suggest that the lack of a strong federal response to the pandemic alongside the devolution of federal power to states over the past 40 years contributes to inequalities in mental health across states. We provide insight about how specific existing and emergency-related policies can reduce adverse mental health consequences of household income shocks.


Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Composición Familiar , Renta/estadística & datos numéricos , Política Pública , Gobierno Estatal , Adolescente , Adulto , Anciano , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Salarios y Beneficios/economía , Encuestas y Cuestionarios , Desempleo/psicología , Estados Unidos/epidemiología , Adulto Joven
5.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S43-S56, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32956299

RESUMEN

OBJECTIVE: To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States. DESIGN: We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes. SETTING: US counties and zip codes in Illinois and New York City, as of May 5, 2020. MAIN OUTCOME MEASURES: Rates, rate differences, and rate ratios of COVID-19 mortality, confirmed cases, and positive tests by category of county and zip code-level area-based socioeconomic measures. RESULTS: As of May 5, 2020, the COVID-19 death rate per 100 000 person-years equaled the following: 143.2 (95% confidence interval [CI]: 140.9, 145.5) vs 83.3 (95% CI: 78.3, 88.4) in high versus low poverty counties (≥20% vs <5% of persons below poverty); 124.4 (95% CI: 122.7, 126.0) versus 48.2 (95% CI: 47.2, 49.2) in counties in the top versus bottom quintile for household crowding; and 127.7 (95% CI: 126.0, 129.4) versus 25.9 (95% CI: 25.1, 26.6) for counties in the top versus bottom quintile for the percentage of persons who are people of color. Socioeconomic gradients in Illinois confirmed cases and New York City positive tests by zip code-level area-based socioeconomic measures were also observed. CONCLUSIONS: Stark social inequities exist in the United States for COVID-19 outcomes. We recommend that public health departments use these straightforward cost-effective methods to report on social inequities in COVID-19 outcomes to provide an evidence base for policy and resource allocation.


Asunto(s)
/epidemiología , Costo de Enfermedad , Grupos Étnicos/estadística & datos numéricos , Renta/estadística & datos numéricos , Gobierno Local , Pandemias/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Estudios Transversales , Humanos , Illinois/epidemiología , Ciudad de Nueva York/epidemiología , Factores Raciales , Estados Unidos/epidemiología
6.
PLoS One ; 15(12): e0242803, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33326451

RESUMEN

Not everybody is benefiting equally from rising mean incomes. We discuss the mean-income population share (MPS), the population percentage of earners below mean income, whose evolution can capture how representative rising mean values are for middle income households. Tracking MPS and its associated income share MIS over time indicates to what extent economic growth is inclusive of both the middle and the bottom of the income distribution. We characterize MPS and MIS analytically under different growth scenarios and compare their parametric estimation using micro-level and grouped income data. Our empirical application with panel data of 16 high- and middle-income countries shows that in the last decades rising mean incomes have mostly not favored middle income households in relative perspective, while the overall welfare effects of the changes in MPS and the correlation structure with the Gini coefficient are mixed.


Asunto(s)
Renta/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Humanos , Pobreza/estadística & datos numéricos , Bienestar Social/estadística & datos numéricos , Factores de Tiempo
7.
BMJ Open ; 10(12): e043805, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33310814

RESUMEN

INTRODUCTION: The negative impacts of COVID-19 have rippled through every facet of society. Understanding the multidimensional impacts of this pandemic is crucial to identify the most critical needs and to inform targeted interventions. This population survey study aimed to investigate the acute phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress between 3 April and 15 May 2020. METHODS: 6040 participants are included in this report. A multivariate linear regression model was used to identify factors associated with stress changes (as measured by the Cohen's Perceived Stress Scale (PSS)) relative to pre-outbreak retrospective estimates. RESULTS: On average, PSS scores increased from low stress levels before the outbreak to moderate stress levels during the outbreak (p<0.001). The independent factors associated with stress worsening were: having a mental disorder, female sex, having underage children, heavier alcohol consumption, working with the general public, shorter sleep duration, younger age, less time elapsed since the start of the outbreak, lower stress before the outbreak, worse symptoms that could be linked to COVID-19, lower coping skills, worse obsessive-compulsive symptoms related to germs and contamination, personalities loading on extraversion, conscientiousness and neuroticism, left wing political views, worse family relationships and spending less time exercising and doing artistic activities. CONCLUSION: Cross-sectional analyses showed a significant increase from low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with increased stress may be informative for intervention development. TRIAL REGISTRATION NUMBER: NCT04369690; Results.


Asunto(s)
/psicología , Empleo/estadística & datos numéricos , Renta/estadística & datos numéricos , Aislamiento Social , Estrés Psicológico/epidemiología , Adaptación Psicológica , Adulto , Anciano , Canadá/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Pandemias/economía , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios
8.
PLoS One ; 15(12): e0243028, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33270701

RESUMEN

BACKGROUND: Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana. METHODS: The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed. RESULTS: Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods. CONCLUSION: While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation.


Asunto(s)
/epidemiología , Disparidades en el Estado de Salud , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Empleo/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Louisiana/epidemiología , Poblaciones Vulnerables/estadística & datos numéricos
9.
Plast Reconstr Surg ; 146(6): 721e-730e, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33234949

RESUMEN

BACKGROUND: Implementation of payment reform for breast reconstruction following mastectomy demands a comprehensive understanding of costs related to the complex process of reconstruction. Bundled payments for services to women with breast cancer may profoundly impact reimbursement and access to breast reconstruction. The authors' objectives were to determine the contribution of cancer therapies, comorbidities, revisions, and complications to costs following immediate reconstruction and the optimal duration of episodes to incentivize cost containment for bundled payment models. METHODS: The cohort was composed of women who underwent immediate breast reconstruction between 2009 and 2016 from the MarketScan Commercial Claims and Encounters database. Continuous enrollment for 3 months before and 24 months after reconstruction was required. Total costs were calculated within predefined episodes (30 days, 90 days, 1 year, and 2 years). Multivariable models assessed predictors of costs. RESULTS: Among 15,377 women in the analytic cohort, 11,592 (75 percent) underwent tissue expander, 1279 (8 percent) underwent direct-to-implant, and 2506 (16 percent) underwent autologous reconstruction. Adjuvant therapies increased costs at 1 year [tissue expander, $39,978 (p < 0.001); direct-to-implant, $34,365 (p < 0.001); and autologous, $29,226 (p < 0.001)]. At 1 year, most patients had undergone tissue expander exchange (76 percent) and revisions (81 percent), and a majority of complications had occurred (87 percent). Comorbidities, revisions, and complications increased costs for all episode scenarios. CONCLUSIONS: Episode-based bundling should consider separate bundles for medical and surgical care with adjustment for procedure type, cancer therapies, and comorbidities to limit the adverse impact on access to reconstruction. The authors' findings suggest that a 1-year time horizon may optimally capture reconstruction events and complications.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Reforma de la Atención de Salud , Accesibilidad a los Servicios de Salud/economía , Mamoplastia/economía , Mastectomía/efectos adversos , Reclamos Administrativos en el Cuidado de la Salud/economía , Reclamos Administrativos en el Cuidado de la Salud/estadística & datos numéricos , Adulto , Implantes de Mama/economía , Neoplasias de la Mama , Estudios de Cohortes , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Mamoplastia/instrumentación , Mamoplastia/métodos , Mamoplastia/estadística & datos numéricos , Persona de Mediana Edad , Colgajos Quirúrgicos/economía , Colgajos Quirúrgicos/trasplante , Dispositivos de Expansión Tisular/economía , Trasplante Autólogo/economía , Trasplante Autólogo/estadística & datos numéricos , Estados Unidos
10.
Am J Emerg Med ; 38(10): 2007-2010, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33142165

RESUMEN

BACKGROUND: Socioeconomic disparities are engrained in the US healthcare system and may extend to the prehospital cardiac arrest setting where mortality is high. METHODS: Using the National Emergency Medical Services Information System (NEMSIS) database, 150,003 cases were analyzed comparing socioeconomic status and cardiac arrest outcomes. Cardiac arrest outcomes were measured by the percent of cases that achieved return of spontaneous circulation (ROSC) and the percent of cases in which ROSC occurred in the Emergency Department (ED) as opposed to a prehospital setting which was a proxy for the length of time spent in cardiac arrest. Chi-square tests checked for statistical significance and effect size was measured using Pearson's r values and linear regression coefficients. RESULTS: Comparing neighborhood poverty level and the percent of cardiac arrest cases that achieved ROSC resulted in a Pearson's r value of 0.9424 (R2 = 0.8881, p < 0.005) and a linear regression coefficient of 2.088 (p < 0.05, R2 = 0.8881, 95% CI [1.059, 3.117]) meaning for every interval increase in poverty, the chance of an individual in cardiac arrest achieving ROSC decreases 2.09%. Comparing neighborhood poverty level and the percent of ROSC cases that occurred in the ED yielded a Pearson's r value of 0.9005 (R2 = 0.8109, p < 0.05) and a linear regression coefficient of 0.7701 (p < 0.05, R2 = 0.8109, 95% CI [0.254, 1.286]) meaning for every interval increase in poverty, the chance that ROSC is delayed increases 0.77%. CONCLUSIONS: Low income individuals in cardiac arrest have a statistically significant lower probability of achieving ROSC and a higher chance of delayed ROSC.


Asunto(s)
Servicios Médicos de Urgencia/métodos , Paro Cardíaco/mortalidad , Evaluación de Resultado en la Atención de Salud/tendencias , Pobreza/estadística & datos numéricos , Clase Social , Adulto , Anciano , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Paro Cardíaco/epidemiología , Humanos , Renta/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pobreza/tendencias , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos/epidemiología
11.
Nat Hum Behav ; 4(12): 1294-1302, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33144713

RESUMEN

Physical distancing has been the primary strategy to control COVID-19 in the United States. We used mobility data from a large, anonymized sample of smartphone users to assess the relationship between neighbourhood income and physical distancing during the pandemic. We found a strong gradient between neighbourhood income and physical distancing. Individuals in high-income neighbourhoods increased their days at home substantially more than individuals in low-income neighbourhoods did. Residents of low-income neighbourhoods were more likely to work outside the home, compared to residents in higher-income neighbourhoods, but were not more likely to visit locations such as supermarkets, parks and hospitals. Finally, we found that state orders were only associated with small increases in staying home in low-income neighbourhoods. Our findings indicate that people in lower-income neighbourhoods have faced barriers to physical distancing, particularly needing to work outside the home, and that state physical distancing policies have not mitigated these disparities.


Asunto(s)
/prevención & control , Empleo/estadística & datos numéricos , Renta/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , /estadística & datos numéricos , Adulto , Humanos , Política Pública , Estados Unidos
12.
PLoS One ; 15(11): e0241571, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33166316

RESUMEN

BACKGROUND: It has been suggested that an increasing proportion of young adults in Japan have lost interest in romantic relationships, a phenomenon termed "herbivorization". We assessed trends in heterosexual relationship status and self-reported interest in heterosexual romantic relationships in nationally representative data. METHODS: We used data from seven rounds of the National Fertility Survey (1987-2015) and included adults aged 18-39 years (18-34 years in the 1987 survey; sample size 11,683-17,675). Current heterosexual relationship status (married; unmarried but in a relationship; single) was estimated by sex, age group and survey year, with singles further categorized into those reporting interest vs. no interest in heterosexual romantic relationships. Information about same-sex relationships were not available. RESULTS: Between 1992 and 2015, the age-standardized proportion of 18-39-year-old Japanese adults who were single had increased steadily, from 27.4 to 40.7% among women and from 40.3 to 50.8% among men. This increase was largely driven by decreases in the proportion of married women aged 25-39 years and men aged 30-39 years, while those in a relationship had increased only slightly for women and remained stable for men. By 2015, the proportion of single women was 30.2% in those aged 30-34 years and 24.4% in those aged 35-39 years. The corresponding numbers for men were 39.3% and 32.4%. Around half of the singles (21.4% of all women and 25.1% of all men aged 18-39 years) reported that they had no interest in heterosexual romantic relationships. Single women and men who reported no interest in romantic relationships had lower income and educational levels and were less likely to have regular employment compared to those who reported such an interest. CONCLUSIONS: In this analysis of heterosexual relationships in nationally representative data from Japan, singlehood among young adults had steadily increased over the last three decades. In 2015 around one in four women and one in three men in their thirties were unmarried and not in a heterosexual relationship. Half of the singles reported no interest in romantic relationships and these women and men had lower income and educational levels and were less likely to have regular employment.


Asunto(s)
Heterosexualidad/psicología , Matrimonio/psicología , Adolescente , Adulto , Escolaridad , Femenino , Humanos , Renta/estadística & datos numéricos , Japón , Masculino , Estado Civil/estadística & datos numéricos , Matrimonio/tendencias , Autoinforme/estadística & datos numéricos , Adulto Joven
13.
PLoS One ; 15(11): e0241994, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33237937

RESUMEN

OBJECTIVE: The study attempts (a) to compute the degree of socio-economic inequity in health care utilization and (b) to decompose and analyze the drivers of socio-economic inequity in health care utilization among adults (20-59 years) in India during the periods 2014 and 2017-18. DATA SOURCE: The analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0), of National sample Survey (NSS), corresponding to the 71st and 75th rounds. METHODS: Odds ratios were computed through logistic regression analysis to examine the effect of the socio-economic status on the health seeking behaviour of the ailing adult population in India. Concentration Indices (CIs) were calculated to quantify the magnitude of socio-economic inequity in health care utilization. Further, the CIs were decomposed to find out the share of the major contributory factors in the overall inequity. RESULTS: The regression results revealed that socio-economic status continues to show a strong association with treatment seeking behavior among the adults in India. The positive estimates of CIs across both the rounds of NSS suggested that health care utilization among the adults continues to be concentrated within the higher socio-economic status, although the magnitude of inequity in health care utilization has shrunk from 0.0336 in 2014 to 0.0230 in 2017-18. However, the relative contribution of poor economic status to the overall explained inequities in health care utilisation observed a rise in its share from 31% in 2014 to 45% in 2017-18. CONCLUSION: To reduce inequities in health care utilization, policies should address issues related to both supply and demand sides. Revamping the public health infrastructure is the foremost necessary condition from the supply side to ensure equitable health care access to the poor. Therefore, it is warranted that India ramps up investments and raises the budgetary allocation in the health care infrastructure and human resources, much beyond the current spending of 1.28% of its GDP as public expenditure on health. Further, to reduce the existing socio-economic inequities from the demand side, there is an urgent need to strengthen the redistributive mechanisms by tightening the various social security networks through efficient targeting and broadening the outreach capacity to the vulnerable and marginalized sections of the population.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Femenino , Gastos en Salud/estadística & datos numéricos , Instituciones de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , India , Masculino , Persona de Mediana Edad , Clase Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
14.
JAMA Netw Open ; 3(10): e2019854, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33030552

RESUMEN

Importance: Medicare has historically imposed higher beneficiary coinsurance for behavioral health services than for medical and surgical care but gradually introduced parity between 2009 and 2014. Although Medicare insures many people with serious mental illness (SMI), there is limited information on the impact of coinsurance parity in this population. Objective: To examine the association between coinsurance parity and outpatient behavioral health care use among low-income beneficiaries with SMI. Design, Setting, and Participants: This cohort study used Medicare claims data for a 50% national sample of lower-income Medicare beneficiaries from January 1, 2007, to December 31, 2016. The study sample included patients with SMI (schizophrenia, bipolar disorder, or major depressive disorder). Data analysis was performed from August 1, 2018, to July 15, 2020. Exposures: Reduction in behavioral health care coinsurance from 50% to 20% between January 1, 2009, and January 1, 2014. Main Outcomes and Measures: Total annual spending for outpatient behavioral health care visits and the percentage of beneficiaries with an annual outpatient behavioral health care visit overall, with a prescriber, and with a psychiatrist. A difference-in-difference approach was used to compare outcomes before and after the reduction in coinsurance for beneficiaries with and without cost-sharing decreases. Linear regression models with beneficiary fixed effects that adjusted for time-changing beneficiary- and area-level covariates were used to examine changes in outcomes. Results: The study included 793 275 beneficiaries with SMI in 2008; 518 893 (65.4%) were younger than 65 years (mean [SD] age, 57.6 [16.1] years), 511 265 (64.4%) were female, and 552 056 (69.6%) were White. In 2008, the adjusted percentage of beneficiaries with an outpatient behavioral health care visit was 40.7% (95% CI, 40.4%-41.0%) among those eligible for the cost-sharing reduction and 44.9% (95% CI, 44.9%-45.0%) among those with free care. The mean adjusted out-of-pocket costs for outpatient behavioral health care visits decreased from $132 (95% CI, $129-$136) in 2008 to $64 (95% CI, $61-$66) in 2016 among those with reductions in cost-sharing. The adjusted percentage of beneficiaries with behavioral health care visits increased to 42.2% (95% CI, 41.9%-42.5%) in the group with a reduction in coinsurance and to 47.2% (95% CI, 47.0%-47.3%) in the group with free care. The cost-sharing reduction was not positively associated with visits (eg, relative change of -0.76 percentage points [95% CI, -1.12 to -0.40 percentage points] in the percentage of beneficiaries with outpatient behavioral health care visits in 2016 vs 2008). Conclusions and Relevance: This cohort study found that beneficiary costs for outpatient behavioral health care decreased between 2009 and 2014. There was no association between cost-sharing reductions and changes in behavioral health care visits. Low levels of use in this high-need population suggest the need for other policy efforts to address additional barriers to behavioral health care.


Asunto(s)
Trastorno Bipolar/economía , Deducibles y Coseguros/estadística & datos numéricos , Trastorno Depresivo Mayor/economía , Financiación Personal/estadística & datos numéricos , Medicare/economía , Esquizofrenia/economía , Adulto , Anciano , Trastorno Bipolar/terapia , Estudios de Cohortes , Seguro de Costos Compartidos/estadística & datos numéricos , Trastorno Depresivo Mayor/terapia , Femenino , Humanos , Renta/estadística & datos numéricos , Beneficios del Seguro/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Esquizofrenia/terapia , Estados Unidos
15.
Artículo en Inglés | MEDLINE | ID: mdl-33050108

RESUMEN

Prenatal stress affects body composition in childhood and later in life. However, few studies assess body composition in infancy. Furthermore, most are in high-income countries and do not consider interactive or curvilinear relationships. We assessed distress and diet during pregnancy via questionnaires among 310 women in Vanuatu, a lower-middle income country. We measured body mass index (BMI) among 54 infants at 4-12 months of age. We analyzed interactive relationships between prenatal distress and diet with BMI Z-scores, and curvilinear relationships between distress and BMI Z-scores. There were no direct linear or interactive relationships between prenatal distress or diet with BMI Z-scores. We observed curvilinear relationships between prenatal distress and BMI Z-scores (p = 0.008), explaining 13.3 percent of unique variance. Results highlight that relationships between prenatal stress and body composition are evident in infancy but might not be detected if only linear relationships are assessed. Analyses in more diverse samples might help to explain inconsistencies in past studies.


Asunto(s)
Dieta , Pobreza , Índice de Masa Corporal , Niño , Femenino , Humanos , Renta/estadística & datos numéricos , Lactante , Embarazo , Vanuatu
16.
Artículo en Inglés | MEDLINE | ID: mdl-33080810

RESUMEN

The aim of this study was to examine spillover and crossover effects between job satisfaction, satisfaction with family life (SWFaL), satisfaction with food-related life (SWFoL) and overall life satisfaction (LS) in dual-earner couples. The gender of the couple members was also accounted for in these interrelationships. A sample of 473 dual-earner couples with adolescent children in Temuco, Chile, responded to a questionnaire. Both members of the couple answered the Satisfaction with Life Scale, Overall Job Satisfaction Scale, the Satisfaction with Family Life Scale and the Satisfaction with Food-related Life Scale. Using the Actor-Partner Interdependence Model and structural equation modeling, it was found that men's LS was positively associated with their own job satisfaction, SWFaL and SWFoL (spillover), as well as with their partner's SWFaL (crossover). Results also showed that women's LS was positively associated with their own job satisfaction, SWFaL and SWFoL (spillover), as well as with their partner's SWFaL and job satisfaction. Different gender patterns were found for job satisfaction and SWFoL. These findings suggest that for dual-earner couples, life satisfaction may not only be influenced by their own individual satisfaction in a life domain but also by their partner's satisfaction in the same domain.


Asunto(s)
Composición Familiar , Renta/estadística & datos numéricos , Satisfacción Personal , Calidad de Vida/psicología , Adolescente , Adulto , Chile , Estudios Cruzados , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
17.
Artículo en Inglés | MEDLINE | ID: mdl-33053788

RESUMEN

Early information on public health behaviors adopted to prevent the spread of coronavirus (COVID-19) may be useful in controlling the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission. The objective of this study was to assess the role of income level (IL) and the perception of older adults, regarding COVID-19 susceptibility and severity, on adopting stay-at-home preventive behavior during the first week of the outbreak in Mexico. Participants in this cross-sectional study were urban community dwellers, aged ≥ 65 years from Mexico City. A total of 380 interviews were conducted over the phone. The mean respondent age was 72.9 years, and 76.1% were women. Over half (54.2%) of the participants perceived their susceptibility to COVID-19 as very low or low. Similarly, 33.4% perceived COVID-19 severity as being very low or low, and 57.6% had decided to stay at home: this behavior was associated with IL (ß = 1.05, p < 0.001), and its total effect was partially mediated (15.1%) by perceived severity. Educational attainment was also associated with staying at home (ß = 0.10, p = 0.018) and its total effect was partially mediated (15.0%) by perceived susceptibility. Interventions aimed at low income and less educated older adults should be developed to improve preventive behaviors in this vulnerable group during the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Renta/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Aislamiento Social/psicología , Anciano , Ciudades/epidemiología , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Neumonía Viral/epidemiología , Medición de Riesgo
19.
PLoS One ; 15(10): e0240546, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33048990

RESUMEN

To analyze the effects of taxing sugar-sweetened beverages (SSBs) in Ecuador, this study estimates a Quadratic Almost Ideal Demand System model using data from the 2011-2012 National Survey of Income and Expenditure for Urban and Rural Households. We derive own- and cross-price elasticities by income quintiles and consumption deciles for five beverages, including two types of sugary drink: (i) milk, (ii) soft drinks, (iii) water, (iv) other sugary drinks, and (v) coffee and tea. Overall, results show that a 20% increase in the price of SSBs will decrease the consumption of soft drinks and other sugary drinks by 27% and 22%, respectively. Heterogeneous consumer behavior is revealed across income and consumption groups, as well as policy-relevant complementarity and substitution patterns. Policy impacts are simulated by considering an 18 cents per liter tax, implemented in Ecuador, and an ad-valorem 20% tax on the price. Estimated tax revenues and weight loss are larger for the latter. From a health perspective, high-income and heavy consumer households would benefit the most from this policy. Our study supports an evidence-based debate on how to correctly design and monitor food policy.


Asunto(s)
Comportamiento del Consumidor/estadística & datos numéricos , Política Nutricional/economía , Sobrepeso/prevención & control , Bebidas Azucaradas/economía , Impuestos , Comportamiento del Consumidor/economía , Ecuador , Ingestión de Energía/fisiología , Composición Familiar , Humanos , Renta/estadística & datos numéricos , Modelos Económicos , Sobrepeso/etiología , Sobrepeso/fisiopatología , Bebidas Azucaradas/efectos adversos , Bebidas Azucaradas/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos
20.
PLoS One ; 15(10): e0240053, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33002068

RESUMEN

Environmental pollution and income inequality are important issues related to sustainable economic and social development. Air pollution affects residents' physical health, and income inequality affects social stability and economic development. No scholar has yet confirmed the causal impact of air pollution on income inequality; therefore, this study is an important extension of the environmental Kuznets curve theory. This article examines the impact using balanced panel data from 156 countries (2004-2017) and applies the spatial Durbin model to analyze the mechanism of air pollution's impact on income inequality from the perspective of public health. The results prove the following. First, increasing air pollution does increase income inequality. Second, the spatial spillover effect of air pollution constitutes a relatively important part of the total effect of air pollution on income inequality compared with the direct effect. Third, general government public-health expenditures are an important transmission channel by which air pollution affects income inequality. The conclusions of the research have some important policy implications for environmental governance and income distribution policies at the national as well as supranational level.


Asunto(s)
Contaminación del Aire/estadística & datos numéricos , Gobierno , Renta/estadística & datos numéricos , Modelos Estadísticos , Salud Pública/economía , Factores Socioeconómicos
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