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1.
Medicine (Baltimore) ; 99(18): e19871, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358355

RESUMEN

The presence of comorbid conditions along with heterogeneity in terms of healthcare practices and service delivery could have a significant impact on the patient's outcomes. With a strong interest in social epidemiology to examine the impact of health services and variations on health outcomes, the current study was conducted to analyse the incidence of hemodialysis-associated infection (HAI) as well as its associated factors, and to quantify the extent to which the contextual effects of the care facility and regional variations influence the risk of HAI.A total of 6111 patients with end-stage renal disease who received hemodialysis treatment between 1 October 2015 and 31 March 2016 were identified from the insurance claim database as a population-based, close-cohort retrospective study. Patients were followed for one year from April 1, 2016 to March 31, 2017. A total of 200 HAI cases were observed during the follow-up and 12 patients died within 90 days of the onset of HAI. Increased risks for HAI were associated with moderate (HR 1.73, 95% confidence interval [CI] 1.00-2.98) and severe (HR 1.87, 95% CI 1.11-3.14) comorbid conditions as well as malignancy (HR 1.36, 95% CI 1.00-1.85). Increased risk was also seen among patients who received hemodialysis treatment from clinics (HR 2.49, 95% CI 1.1-5.33). However, these statistics were no longer significant when variations at the level of care facilities were statistically controlled. In univariate analyses, no statistically significant association was observed between 90-day mortality and baseline patients, and the characteristics of the care facility.The results of the multivariate, multilevel analyses indicated that HAI variations were only significant at the care facility level (σ 2.07, 95% CI 1.3-3.2) and were largely explained by the heterogeneity between care facilities. The results of this study highlight the need to look beyond the influence of patient-level characteristics when developing policies that aim at improving the quality of hemodialysis healthcare and service delivery in Japan.


Asunto(s)
Infecciones/epidemiología , Fallo Renal Crónico/terapia , Diálisis Renal/efectos adversos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Infecciones/etiología , Seguro de Salud/estadística & datos numéricos , Japón/epidemiología , Fallo Renal Crónico/microbiología , Masculino , Persona de Mediana Edad , Análisis Multinivel , Estudios Retrospectivos
2.
J Glob Health ; 10(1): 010805, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257169

RESUMEN

Methods: We used the baseline survey and first follow-up surveys of the China Health and Retirement Longitudinal Study of middle-aged and older populations conducted between 2011 and 2013. Correlates of effective coverage and treatment coverage for hypertension were analysed using multivariate logistic regression models, after controlling for demographic characteristics. Results: In 2011, 38.40% of 13 702 individuals surveyed were identified with hypertension. Overall, the effective treatment coverage among the middle-aged and older population in China from 2011 to 2013 was only 22.40% compared to the treatment coverage of 55.86%. Variations in effective coverage among patients enrolled in the three public health insurance schemes ranged from 22.60% to 29.31%. Conclusions: The level of effective coverage for hypertension treatment in China was still very low, and that health insurance schemes play a significant role in improving treatment coverage and effective coverage for hypertension treatment. In the implementation of China's health system reform, health equity and health care equality should be emphasised and enhanced by offering more equitable benefits packages across social health insurance schemes.


Asunto(s)
Antihipertensivos/uso terapéutico , Gastos en Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/economía , China/epidemiología , Femenino , Reforma de la Atención de Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud , Envejecimiento Saludable , Humanos , Hipertensión/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Jubilación , Cobertura Universal del Seguro de Salud/economía
3.
J Glob Health ; 10(1): 010807, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257170

RESUMEN

Background: The concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants' utilization of the essential public health services and its underlying factors on account of change of residence, and social support. Methods: Data came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants. Results: Approximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants' utilization of essential public health services. Conclusions: The utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud , Seguro de Salud/estadística & datos numéricos , Migrantes , Adulto , Anciano , Grupo de Ascendencia Continental Asiática , China/epidemiología , Empleo , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Características de la Residencia , Población Rural , Apoyo Social , Población Urbana
4.
PLoS Negl Trop Dis ; 14(3): e0008193, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32208419

RESUMEN

BACKGROUND: A recent study in French Guiana suggested that populations living in precarious neighborhoods were more at risk for Chikungunya CHIKV than those living in more privileged areas. The objective of the present study was to test the hypothesis that Zika virus (ZIKV) infection was more frequent in precarious pregnant women than in non-precarious pregnant women, as reflected by their health insurance status. METHODS: A multicentric cross-sectional study was conducted in Cayenne hospital including ZIKV pregnant women with serological or molecular proof of ZIKV during their pregnancy between January and December 2016. Health insurance information was recorded at delivery, which allowed separating women in: undocumented foreigners, precarious but with residence permit, and non-precarious. RESULTS: A total of 6654 women were included. Among them 1509 (22,7%) had confirmed ZIKV infection. Most women were precarious (2275/3439) but the proportion of precarious women was significantly greater in ZIKV-confirmed 728/906 (80.4%) than the ZIKV-negatives 1747/2533 (69.0%), p<0.0001. There were 1142 women classified as non-precarious, 1671 were precarious legal residents, and 1435 were precarious and undocumented. Precariousness and undocumented status were associated with a higher prevalence of ZIKV during pregnancy (adjusted prevalence ratio = 1.59 (95%CI = 1.29-1.97), p<0.0001), (adjusted prevalence ratio = 1.5 (95%CI = 1.2-1.8), p<0.0001), respectively. CONCLUSIONS: These results illustrate that in French Guiana ZIKV transmission disproportionately affected the socially vulnerable pregnant women, presumably because of poorer housing conditions, and lack of vector control measures in poor neighborhoods.


Asunto(s)
Complicaciones Infecciosas del Embarazo/epidemiología , Factores Socioeconómicos , Infección por el Virus Zika/epidemiología , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Guyana Francesa/epidemiología , Humanos , Seguro de Salud/estadística & datos numéricos , Persona de Mediana Edad , Embarazo , Prevalencia , Medición de Riesgo , Adulto Joven
5.
Med Care ; 58(5): 474-482, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32028523

RESUMEN

BACKGROUND: The health of Latino migrants is most often studied with samples of immigrants settled in the United States or returned migrants in Mexico. We examine health outcomes and health care access of Mexican migrants traversing the Mexican border region to gain a better understanding of migrant health needs as they transition between migration phases. METHODS: We used data from a 2013 probability survey of migrants from Northbound and Southbound migration flows in Tijuana, Mexico (N=2412). Respondents included Northbound migrants with and without US migration experience, Southbound migrants returning home from the United States or the Mexican border region, and migrants returning to Mexico via deportation. Descriptive statistics and regression models were estimated to characterize and compare their health status, behavioral health, and health care access across migration phases. RESULTS: Northbound migrants with US migration experience, Southbound migrants from the United States, and deported migrants had worse levels of health insurance, health care utilization, and diabetes than Northbound migrants without US migration experience. Southbound migrants returning from the border reported worse self-rated health and deportees had higher odds of reported substance use compared with Northbound migrants without US migration experience. CONCLUSIONS: Mexican migrants' health profile and health care access vary significantly across migration flows and generally are worse for migrants with US migration experience. The results add to our understanding of Mexican migrant health along the migration continuum and can inform services in sending, receiving, and intermediate communities.


Asunto(s)
Accesibilidad a los Servicios de Salud , Estado de Salud , Migrantes/estadística & datos numéricos , Adulto , Diabetes Mellitus/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , México/epidemiología , Sobrepeso/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos/epidemiología
6.
BMC Health Serv Res ; 20(1): 100, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32041586

RESUMEN

BACKGROUND: Length of hospital stay (LOS) for hip fracture treatments is associated with mortality. In addition to patient demographic and clinical factors, hospital and payer type may also influence LOS, and thus mortality, among hip fracture patients; accordingly, outcome disparities between groups may arise from where patients are treated and from their health insurance type. The purpose of this study was to examine if where hip fracture patients are treated and how they pay for their care is associated with outcome disparities between patient groups. Specifically, we examined whether LOS differed between patients treated at safety-net and non-safety-net hospitals and whether LOS was associated with patients' insurance type within each hospital category. METHODS: A sample of 48,948 hip fracture patients was extracted from New York State's Statewide Planning and Research Cooperative System (SPARCS), 2014-2016. Using means comparison and X2 tests, differences between safety-net and non-safety-net hospitals on LOS and patient characteristics were examined. Relationships between LOS and hospital category (safety-net or non-safety-net) and LOS and insurance type were further evaluated through negative binomial regression models. RESULTS: LOS was statistically (p ≤ 0.001) longer in safety-net hospitals (7.37 days) relative to non-safety-net hospitals (6.34 days). Treatment in a safety-net hospital was associated with a LOS that was 11.7% (p = 0.003) longer than in a non-safety-net hospital. Having Medicaid was associated with a longer LOS relative to having commercial health insurance. CONCLUSION: Where hip fracture patients are treated is associated with LOS and may influence outcome disparities between groups. Future research should examine whether outcome differences between safety-net and non-safety-net hospitals are associated with resource availability and hospital payer mix.


Asunto(s)
Disparidades en Atención de Salud , Fracturas de Cadera/terapia , Tiempo de Internación/estadística & datos numéricos , Proveedores de Redes de Seguridad/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Seguro de Salud/estadística & datos numéricos , Masculino , Medicaid/estadística & datos numéricos , Persona de Mediana Edad , New York , Estados Unidos , Adulto Joven
7.
Am J Surg ; 219(4): 557-562, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32007235

RESUMEN

BACKGROUND: The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist? METHODS: The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough. Multivariable analyses were performed. RESULTS: White patients who reside in the Bronx are significantly more likely than racial minorities to travel into Manhattan for elective surgical care, and these differences persist across different insurance types, including Medicare. CONCLUSIONS: Marked race-based differences in choice of location for elective surgical care exist in New York city. If left unchecked, these differences can contribute to furthering racial segregation within our healthcare system.


Asunto(s)
Conducta de Elección , Grupos de Población Continentales/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Ubicación de la Práctica Profesional/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Medicaid/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Participación del Paciente , Factores Raciales , Estados Unidos
8.
PLoS One ; 15(2): e0224006, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053621

RESUMEN

INTRODUCTION: The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in ≥4 ANC visits during pregnancy in Indonesia. METHODS: Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. RESULTS: With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making ≥4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making ≥4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making ≥4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. CONCLUSION: There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of ≥4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.


Asunto(s)
Política de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Femenino , Geografía , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Indonesia/epidemiología , Seguro de Salud/estadística & datos numéricos , Mortalidad Materna , Persona de Mediana Edad , Paridad , Embarazo , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Adulto Joven
9.
Am J Public Health ; 110(4): 537-539, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32078351

RESUMEN

Objectives. To estimate the effects of same-sex marriage recognition on health insurance coverage.Methods. We used 2008-2017 data from the American Community Survey that represent 18 416 674 adult respondents in the United States. We estimated changes to health insurance outcomes using state-year variation in marriage equality recognition in a difference-in-differences framework.Results. Marriage equality led to a 0.61 percentage point (P = .03) increase in employer-sponsored health insurance coverage, with similar results for men and women.Conclusions. US adults gained employer-sponsored coverage as a result of marriage equality recognition over the study period, likely because of an increase in dependent coverage for newly recognized same-sex married partners.


Asunto(s)
Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Matrimonio/legislación & jurisprudencia , Adulto , Femenino , Humanos , Masculino , Estados Unidos
10.
Rev Saude Publica ; 54: 20, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32074219

RESUMEN

OBJECTIVE: To compare the access to and effective use of health services available among international migrants and Chileans. METHODS: Secondary analysis of the National Socioeconomic Characterization Survey (CASEN - Caracterización Socioeconómica Nacional ), version 2017. Indicators of access to the health system (having health insurance) and effective use of health services (perceived need, appointment or coverage, barriers and need satisfaction) were described in immigrants and local population, self-reported. Gaps by immigrant status were estimated using logistic regressions, with complex samples. RESULTS: Immigrants were 7.5 times more likely to have no health insurance than local residents. Immigrants presented less perceived need than local residents, together with a greater lack of appointments (OR: 1.7 95%CI: 1.2-2.5), coverage (OR: 2.7 95%CI: 2.0-3.7) and unsatisfied need. The difference between immigrants and locals was not statistically significant in barriers to health care access (α = 0.005). CONCLUSIONS: Disadvantages persist regarding the access to and use of health services by immigrants as opposed to Chileans compared with information from previous years. It is necessary to reduce the gaps between immigrants and people born in Chile, especially in terms of health system access. This is the first barrier to effective use of services. The generation of concrete strategies and health policies that consider an approach of social participation of the immigrant community is suggested to bring the health system closer to this population.


Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Política Pública , Chile , Estudios Transversales , Femenino , Disparidades en el Estado de Salud , Encuestas Epidemiológicas , Humanos , Masculino , Características de la Residencia , Población Rural/estadística & datos numéricos , Autoinforme , Factores Socioeconómicos , Migrantes/estadística & datos numéricos , Población Urbana/estadística & datos numéricos
11.
Nat Hum Behav ; 4(3): 255-264, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31959926

RESUMEN

Health and social scientists have documented the hospital revolving-door problem, the concentration of crime, and long-term welfare dependence. Have these distinct fields identified the same citizens? Using administrative databases linked to 1.7 million New Zealanders, we quantified and monetized inequality in distributions of health and social problems and tested whether they aggregate within individuals. Marked inequality was observed: Gini coefficients equalled 0.96 for criminal convictions, 0.91 for public-hospital nights, 0.86 for welfare benefits, 0.74 for prescription-drug fills and 0.54 for injury-insurance claims. Marked aggregation was uncovered: a small population segment accounted for a disproportionate share of use-events and costs across multiple sectors. These findings were replicated in 2.3 million Danes. We then integrated the New Zealand databases with the four-decade-long Dunedin Study. The high-need/high-cost population segment experienced early-life factors that reduce workforce readiness, including low education and poor mental health. In midlife they reported low life satisfaction. Investing in young people's education and training potential could reduce health and social inequalities and enhance population wellbeing.


Asunto(s)
Crimen/estadística & datos numéricos , Prescripciones de Medicamentos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Bienestar Social/estadística & datos numéricos , Factores Socioeconómicos , Heridas y Traumatismos/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Análisis por Conglomerados , Crimen/economía , Bases de Datos Factuales , Dinamarca/epidemiología , Prescripciones de Medicamentos/economía , Escolaridad , Femenino , Hospitalización/economía , Hospitales Públicos/economía , Humanos , Lactante , Seguro de Salud/economía , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Satisfacción Personal , Bienestar Social/economía , Heridas y Traumatismos/economía , Adulto Joven
12.
Infect Dis Poverty ; 9(1): 11, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-31996258

RESUMEN

Marking the end of the five-year programme initiated by the Chinese Government to lift more than 70 million people out of poverty, the year 2020 is a milestone. Poverty alleviation has moved strongly forward in China and the major health indicators are now better than the average of all middle- and high-income countries. However, the dual burden of infectious and chronic diseases remains a challenge with respect to achieving the health target in the United Nations 2030 Agenda for sustainable development goals (SDGs). In 2015, about 44% of the poor population in China were impoverished by illness but already in 2018, multi-sectoral actions delivered by the Health-related Poverty Alleviation programme had reduced the number almost by half. In the past three years 15 million poor people (98% of the poor population) with infectious and chronic diseases had been treated and taken care of thanks to financial support through multiple health insurance schemes and other governmental subsidies. This article discusses the lessons learnt with regard to health-related poverty alleviation in China with special reference to those still remaining impoverished by illness. Consolidation of the achievements reached and provision of basic needs to those still disadvantaged and in poor health will require a major improvement of accessibility to, and affordability of, health services. The next step towards enhanced productivity and better living conditions will involve upgrading of the capacity of health professionals in the poor regions, promotion of coherent efforts in health-related poverty alleviation and rural revitalization measures. As an additional measure, data monitoring and research on health poverty alleviation should be strengthened as they are essential to generate the evidence and knowledge needed to support the move in the direction envisioned by the SDGs, and the new Healthy China 2030 programme.


Asunto(s)
Costo de Enfermedad , Seguro de Salud/estadística & datos numéricos , Pobreza/estadística & datos numéricos , China , Apoyo Financiero , Humanos , Factores Socioeconómicos
13.
Am J Public Health ; 110(3): 370-377, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31944849

RESUMEN

Objectives. To examine gaps in identification of preexposure prophylaxis (PrEP) candidates, uptake, and use of PrEP by populations most likely to seroconvert.Methods. At a federally qualified health center in Chicago, Illinois, we used electronic medical records, prescription data, and our best approximation of Centers for Disease Control and Prevention PrEP guidelines to determine how many patients were indicated for PrEP relative to HIV diagnoses (indication:HIV), how many were on PrEP relative to indications (PrEP:indication), and how many were on PrEP relative to HIV diagnoses (PrEP:HIV). We compared these ratios across age, gender and orientation, race/ethnicity, and insurance.Results. Overall, there were 32 indications per incident diagnosis and 16 patients on PrEP per incident diagnosis. In adjusted models, Whites had higher indication:HIV and PrEP:HIV ratios compared with Blacks, men who have sex with men had higher indication:HIV and PrEP:HIV ratios compared with transwomen but lower PrEP:indication ratios, and uninsured patients had higher indication:HIV but lower PrEP:indication and PrEP:HIV ratios compared with those with insurance.Conclusions. PrEP use, relative to HIV diagnoses, differs by important patient characteristics. While improved guidelines will address some of the disparity, better approaches for determining PrEP candidates and more normalized patient-provider communication are needed to ensure better PrEP access to all individuals at high risk for HIV.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición/estadística & datos numéricos , Adulto , Anciano , Fármacos Anti-VIH/uso terapéutico , Chicago , Registros Electrónicos de Salud , Grupos Étnicos , Femenino , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Minorías Sexuales y de Género/estadística & datos numéricos
14.
MMWR Morb Mortal Wkly Rep ; 69(3): 72-76, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31971934

RESUMEN

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra la Influenza/administración & dosificación , Seguro de Salud/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Adulto , Femenino , Florida , Humanos , Medicaid/estadística & datos numéricos , Embarazo , Sector Privado/estadística & datos numéricos , Estados Unidos , Adulto Joven
15.
Med Care ; 58(2): 183-191, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31934958

RESUMEN

BACKGROUND: This study examines the expansion of health insurance coverage in Massachusetts under state health reform as a natural experiment to investigate whether expanded insurance coverage reduced the likelihood of advanced stage colorectal cancer (CRC) and breast cancer (BCA) diagnosis. METHODS: Our study populations include CRC or BCA patients aged 50-64 years observed in the Massachusetts Cancer Registry and Surveillance Epidemiology and End Results (SEER) registries for 2001-2013. We use difference-in-differences regression models to estimate changes in the likelihood of advanced stage diagnosis after Massachusetts health reform, relative to comparison states without expanded coverage (Connecticut, New Jersey, Georgia, Kentucky, and Michigan). RESULTS: We find some suggestive evidence of a decline in the proportion of advanced stage CRC cases. Approximately half of the CRC patients in Massachusetts and control states were diagnosed at advanced stages pre reform; there was a 2 percentage-point increase in this proportion across control states and slight decline in Massachusetts post reform. Adjusted difference-in-difference estimates suggest a 3.4 percentage-point (P=0.005) or 7% decline, relative to Massachusetts baseline, in the likelihood of advanced stage diagnosis after the reform in Massachusetts, though this result is sensitive to years included in the analysis. We did not find a significant effect of reform on BCA stage at diagnosis. CONCLUSIONS: The decline in the likelihood of advanced stage CRC diagnosis after Massachusetts health reform may suggest improvements in access to health care and CRC screening. Similar declines were not observed for BCA, perhaps due to established BCA-specific safety-net programs.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Reforma de la Atención de Salud/estadística & datos numéricos , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Estadificación de Neoplasias , Programa de VERF
16.
PLoS One ; 15(1): e0227541, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31945102

RESUMEN

BACKGROUND: Due to substantial improvements in prevention and therapy, stroke incidence and mortality rates have decreased during the last decades, but evidence is still lacking on whether all socioeconomic groups benefited equally and how the length of life affected by stroke developed over time. Our study investigates time trends in stroke-free life years and life years affected by stroke. Special emphasis is given to the question whether trends differ between income groups, leading to decreasing or increasing social inequalities. METHODS: The analyses are based on claims data of a German statutory health insurance company of the two time periods 2006-2008 and 2014-2016. Income inequalities and time trends in incidence and mortality risks were estimated using multistate survival models. Trends in stroke-free life years and life years affected by stroke are analysed separately for income groups by applying multistate life table analyses. RESULTS: Stroke incidence and mortality risks decreased in men and women in all income groups. While stroke-free lifetime could be gained in men having higher incomes, improvements in mortality counterbalanced decreasing incidences, leading to increases in life years affected by stroke among men of the lower and higher income group. Among women, no significant changes in life years could be observed. CONCLUSIONS: Changes in stroke-affected life years occur among men in all income groups, but are more pronounced in the higher income group. However, irrespective of the income group the proportion of stroke-affected life years remains quite stable over time, pointing towards constant inequalities. Further research is needed on whether impairments due to stroke reduced over time and whether all socioeconomic groups are affected equally.


Asunto(s)
Renta/tendencias , Seguro de Salud/estadística & datos numéricos , Factores Socioeconómicos , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/epidemiología , Adulto , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Riesgo
17.
BMC Public Health ; 20(1): 87, 2020 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-31959153

RESUMEN

BACKGROUND: Reducing maternal morbidity and mortality remains a top global health agenda especially in high HIV/AIDS endemic locations where there is increased likelihood of mother to child transmission (MTCT) of HIV. Social health insurance (SHI) has emerged as a viable option to improve population access to health services, while improving outcomes for disenfranchised populations, particularly HIV+ women. However, the effect of SHI on healthcare access for HIV+ persons in limited resource settings is yet to undergo rigorous empirical evaluation. This study analyzes the effect of health insurance on obstetric healthcare access including institutional delivery and skilled birth attendants for HIV+ pregnant women in Kenya. METHODS: We analyzed cross-sectional data from HIV+ pregnant women (ages 15-49 years) who had a delivery (full term, preterm, miscarriage) between 2008 and 2013 with their insurance enrollment status available in the electronic medical records database of a HIV healthcare system in Kenya. We estimated linear and logistic regression models and implemented matching and inverse probability weighting (IPW) to improve balance on observable individual characteristics. Additionally, we estimated heterogeneous effects stratified by HIV disease severity (CD4 < 350 as "Severe HIV disease", and CD4 > 350 otherwise). FINDINGS: Health Insurance enrollment is associated with improved obstetric health services utilization among HIV+ pregnant women in Kenya. Specifically, HIV+ pregnant women covered by NHIF have greater access to institutional delivery (12.5-percentage points difference) and skilled birth attendants (19-percentage points difference) compared to uninsured. Notably, the effect of NHIF on obstetric health service use is much greater for those who are sicker (CD4 < 350) - 20 percentage points difference. CONCLUSION: This study confirms conceptual and practical considerations around health insurance and healthcare access for HIV+ persons. Further, it helps to inform relevant policy development for health insurance and HIV financing and delivery in Kenya and in similar countries in sub-Saharan Africa in the universal health coverage (UHC) era.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Infecciones por VIH/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Seguridad Social , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Kenia/epidemiología , Persona de Mediana Edad , Embarazo , Adulto Joven
18.
World Neurosurg ; 136: e440-e446, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31931234

RESUMEN

OBJECTIVE: To explore patient demographics as to predicting vestibular schwannoma (VS) size and treatment plan within a single institution. METHODS: Using a large tertiary referral skull base center database, all patients with sporadic VS who presented to the center between 2009 and 2018 were reviewed. RESULTS: A total of 816 patients with VS over 18 years of age were included. The median age was 56.8 years (range: 18.6-90.9 years). The median tumor diameter at diagnosis was 11.9 mm (range: 0.6-51.1 mm). With multivariate analysis, older age was associated with decreased tumor size (0.23 mm, 95% confidence interval [CI]: 0.17-0.29), whereas married patients had larger tumors (2.5 mm, 95% CI: 0.92-4.09). When comparing observation, radiation, or surgery, older patients are more likely to pursue observation as compared with surgery and radiation (odds ratio [OR]: 1.08, 95% CI: 1.06-1.10 and OR: 1.20, 95% CI: 1.08-1.33), respectively. Married patients were less likely to pursue observation as compared with surgery (OR: 0.49, 95% CI: 0.29-0.82). Each additional mile a patient lives farther from the center increases his or her odds of pursuing treatment (OR: 1.002, 95% CI: 1.001-1.003). CONCLUSIONS: Older age is associated with smaller tumors, whereas married patients have larger tumors at diagnosis as compared with nonmarried patients. Furthermore, married patients are more likely to pursue treatment, specifically surgery, as compared with nonmarried patients, whereas patients who live farther from the center are more likely to pursue treatment.


Asunto(s)
Neuroma Acústico/patología , Carga Tumoral , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Estado Civil , Persona de Mediana Edad , Neuroma Acústico/terapia , Planificación de Atención al Paciente , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Adulto Joven
19.
PLoS One ; 15(1): e0222387, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978141

RESUMEN

In order to gain insights into how the effects of the uneven adoption of Medicaid expansion varies across the rural/urban spectrum and between racial/ethnic groups in the United States, this research used the fertility question in the 2011-2015 American Community Survey to link infants' records to their mothers' household health insurance status. This preliminary exploration of the Medicaid expansion used logistic regression to examine the probability that an infant will be born without health insurance coverage. Overall, the states that adopted Medicaid expansion improved the health insurance coverage for households with infants. However, rural households with infants report lower percentages of coverage than urban households with infants. Furthermore, the rural/urban gap in health insurance coverage is wider in states that adopted the Medicaid expansion. Additionally, Hispanic infants remain significantly less likely to have health insurance coverage compared to Non-Hispanic White infants. Understanding infant health insurance coverage across ethnic/racial groups and the rural/urban spectrum will become increasingly important as the U.S. population transitions to a minority-majority and also becomes more urban. Although not a perfect solution, our findings showed that the Medicaid expansion of health insurance coverage had a mainly overall positive effect on the percentage of U.S. households with infants who have health insurance coverage.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Adulto , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea , Femenino , Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Hispanoamericanos , Humanos , Lactante , Cobertura del Seguro , Masculino , Pacientes no Asegurados , Patient Protection and Affordable Care Act/estadística & datos numéricos , Población Rural , Estados Unidos/epidemiología
20.
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
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