RESUMO
OBJECTIVE: Diabetic foot ulcers (DFU) are a major sequela of uncontrolled diabetes with a high risk of adverse outcomes. Poor DFU outcomes disproportionately impact patients living in rural and economically distressed communities with lack of access to consistent, quality care. This study aimed to analyze the risk of geographic and economic disparities, including rural status and county economic distress, on the disease burden of DFU at presentation utilizing the SVS WIfI classification system. METHODS: We conducted a retrospective review of 454 patients diagnosed with a DFU from 2011 to 2020 at a single institution's inpatient and outpatient wound care service. Patients >18 years old, with type II diabetes mellitus, and diabetic foot ulcer were included. RESULTS: ANCOVA analyses showed rural patients had significantly higher WIfI composite scores (F(1,451) = 9.61, p = .002), grades of wound (F(1,439) = 11.03, p = .001), and ischemia (F(1,380) = 12.574, p = .001) compared to the urban patients. Patients that resided in at-risk economic counties had significantly higher overall WIfI composite scores (F(2,448) = 3.31, p = .037) than patients who lived in transitional economic counties, and higher foot infection grading (F(2,440) = 3.02, p = .05) compared to patients who lived in distressed economic counties. DFU patients who resided in distressed economic counties presented with higher individual grades of ischemia (F(2, 377) = 3.14, p = .04) than patients in transitional economic counties. Chi-Square analyses demonstrated patients who resided in urban counties were significantly more likely to present with grade 1 wounds (χ2(3) = 9.86, p = .02) and grade 0 ischemia (χ2(3) = 16.18, p = .001) compared to patients in rural areas. Economically distressed patients presented with significantly less grade 0 ischemia compared to patients in transitional economic counties (χ2(6) = 17.48, p = .008). CONCLUSIONS: Our findings are the first to demonstrate the impact of geographic and economic disparities on the disease burden of DFU at presentation utilizing the SVS WIfI classification system. This may indicate need for improved multidisciplinary primary care prevention strategies with vascular specialists in these communities to mitigate worsening DFU and promote early intervention.
Assuntos
Pé Diabético , População Rural , Humanos , Pé Diabético/economia , Pé Diabético/epidemiologia , Pé Diabético/classificação , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , População Rural/estatística & dados numéricos , Isquemia/economia , Isquemia/epidemiologia , Isquemia/complicações , Isquemia/classificação , Medição de Risco , Estresse Financeiro/epidemiologia , Estresse Financeiro/economia , Extremidade Inferior , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Índice de Gravidade de Doença , Efeitos Psicossociais da DoençaRESUMO
Importance: Medicare beneficiaries with functional disabilities often require more medical care, leading to substantial financial hardship. However, the precise magnitude and sources of this hardship remain unknown. Objectives: To quantify the financial burden from health care expenses by functional disability levels among Medicare beneficiaries. Design, Setting, and Participants: This cross-sectional study used data, including demographic and socioeconomic characteristics, health status, and health care use, from a nationally representative sample of Medicare beneficiaries from the 2013 to 2021 Medical Expenditure Panel Survey. Functional disability was measured using 6 questions and categorized into 3 levels: none (no difficulties), moderate (1-2 difficulties), and severe (≥3 difficulties). Data were analyzed from December 2023 to March 2024. Main Outcomes and Measures: Financial hardship from health care expenses was assessed using objective measures (annual out-of-pocket spending, high financial burden [out-of-pocket spending exceeding 20% of income], and catastrophic financial burden [out-of-pocket spending exceeding 40% of income]) and subjective measures (difficulty paying medical bills and paying medical bills over time). We applied weights to produce results representative of national estimates. Results: The sample included 31â¯952 Medicare beneficiaries (mean [SD] age, 71.1 [9.7] years; 54.6% female). In weighted analyses, severe functional disability was associated with a significantly higher financial burden from health care expenses, with out-of-pocket spending reaching $2137 (95% CI, $1943-$2330) annually. This exceeded out-of-pocket spending for those without functional disability by nearly $700 per year ($1468 [95% CI, $1311-$1625]) and for those with moderate functional disability by almost $500 per year ($1673 [95% CI, $1620-$1725]). The primary factors that played a role in this difference were home health care ($399 [95% CI, $145-$651]) and equipment and supplies ($304 [95% CI, $278-$330]). Beneficiaries with severe functional disability experienced significantly higher rates of both high and catastrophic financial burden than those without disability and those with moderate disability (13.2% [12.2%-14.1%] vs 9.1% [95% CI, 8.6%-9.5%] and 9.4% [95% CI, 9.1%-9.7%] for high financial burden, respectively, and 8.9% [95% CI, 7.8%-10.1%] vs 6.4% [95% CI, 6.1%-6.8%] and 6.0% [95% CI, 5.6%-6.4%] for catastrophic financial burden, respectively). Similar associations were observed in subjective financial hardship. For example, 11.8% (95% CI, 10.3%-13.3%) of those with severe functional disability experienced problems paying medical bills, compared with 7.7% (95% CI, 7.6%-7.9%) and 9.3% (95% CI, 9.0%-9.6%) of those without functional disability and those with moderate functional disability, respectively. Notably, there were no significant differences in financial hardship among those with Medicaid based on functional disability levels. Conclusions and Relevance: In this cross-sectional study of Medicare beneficiaries, those with severe functional disability levels experienced a disproportionate burden from health care costs. However, Medicaid played a pivotal role in reducing the financial strain. Policymakers should explore interventions that effectively relieve the financial burden of health care in this vulnerable population.
Assuntos
Pessoas com Deficiência , Estresse Financeiro , Gastos em Saúde , Medicare , Humanos , Estados Unidos , Medicare/economia , Medicare/estatística & dados numéricos , Feminino , Masculino , Estudos Transversais , Idoso , Pessoas com Deficiência/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Estresse Financeiro/economia , Idoso de 80 Anos ou mais , Efeitos Psicossociais da DoençaAssuntos
Estresse Financeiro , Custos de Cuidados de Saúde , Gastos em Saúde , Idoso , Humanos , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Estresse Financeiro/economia , Estresse Financeiro/epidemiologia , Estresse Psicológico/economia , Estresse Psicológico/epidemiologiaRESUMO
BACKGROUND: The economic burden of psychotic disorders is not well documented in LMICs like India, due to several bottlenecks present in Indian healthcare system like lack of adequate resources, low budget for mental health services and inequity in accessibility of treatment. Hence, a large proportion of health expenditure is paid out of pocket by the households. OBJECTIVE: To evaluate the direct and indirect costs incurred by patients with First Episode Psychosis and their families in a North Indian setting. METHOD: Direct and Indirect costs were estimated for 87 patients diagnosed at AIIMS, New Delhi with first-episode psychosis (nonaffective) in the first- and sixth month following diagnosis, and the six months before diagnosis, using a bespoke questionnaire. Indirect costs were valued using the Human Capital Approach. RESULTS: Mean total costs in month one were INR 7991 ($107.5). Indirect costs were 78.3% of this total. Productivity losses was a major component of the indirect cost. Transportation was a key component of direct costs. Costs fell substantially at six months (INR 2732, Indirect Costs 61%). Respondents incurred substantial costs pre-diagnosis, related to formal and informal care seeking and loss of income. CONCLUSION: Families suffered substantial productivity loss. Care models and financial protection that address this could substantially reduce the financial burden of mental illness. Measures to address disruption to work and education during FEP are likely to have significant long-term benefits. Families also suffered prolonged income loss pre-diagnosis, highlighting the benefits of early and effective diagnosis.
Assuntos
Efeitos Psicossociais da Doença , Estresse Financeiro , Transtornos Psicóticos , Humanos , Índia , Transtornos Psicóticos/economia , Transtornos Psicóticos/terapia , Adulto , Masculino , Feminino , Adulto Jovem , Estresse Financeiro/epidemiologia , Estresse Financeiro/economia , Gastos em Saúde/estatística & dados numéricos , Família , Adolescente , Pessoa de Meia-IdadeRESUMO
AIM: Financial toxicity describes the financial burden and distress that patients experience due to medical treatment. Financial toxicity has yet to be characterized among patients with inflammatory bowel disease (IBD) undergoing surgical management of their disease. This study investigated the risk of financial toxicity associated with undergoing surgery for IBD. METHODS: This study used a retrospective analysis using the National Inpatient Sample from 2015 to 2019. Adult patients who underwent IBD-related surgery were identified using the International Classification of Diseases (10th Revision) diagnostic and procedure codes and stratified into privately insured and uninsured groups. The primary outcome was risk of financial toxicity, defined as hospital admission charges that constituted 40% or more of patient's post-subsistence income. Secondary outcomes included total hospital admission cost and predictors of financial toxicity. RESULTS: The analytical cohort consisted of 6412 privately insured and 3694 uninsured patients. Overall median hospital charges were $21 628 (interquartile range $14 758-$35 386). Risk of financial toxicity was 86.5% among uninsured patients and 0% among insured patients. Predictors of financial toxicity included emergency admission, being in the lowest residential income quartile and having ulcerative colitis (compared to Crohn's disease). Additional predictors were being of Black race or male sex. CONCLUSION: Financial toxicity is a serious consequence of IBD-related surgery among uninsured patients. Given the pervasive nature of this consequence, future steps to support uninsured patients receiving surgery, in particular emergency surgery, related to their IBD are needed to protect this group from financial risk.
Assuntos
Preços Hospitalares , Doenças Inflamatórias Intestinais , Pessoas sem Cobertura de Seguro de Saúde , Humanos , Masculino , Feminino , Estudos Retrospectivos , Estados Unidos , Pessoa de Meia-Idade , Adulto , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Preços Hospitalares/estatística & dados numéricos , Doenças Inflamatórias Intestinais/cirurgia , Doenças Inflamatórias Intestinais/economia , Colite Ulcerativa/cirurgia , Colite Ulcerativa/economia , Efeitos Psicossociais da Doença , Doença de Crohn/cirurgia , Doença de Crohn/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Seguro Saúde/economia , Estresse Financeiro/economia , Idoso , Custos Hospitalares/estatística & dados numéricosRESUMO
The financial impact of liver transplantation has been underexplored. We aimed to identify associations between high financial burden (≥10% annual income spent on out-of-pocket medical costs) and work productivity, financial distress (coping behaviors in response to the financial burden), and financial toxicity (health-related quality of life, HRQOL) among adult recipients of liver transplant. Between June 2021 and May 2022, we surveyed 207 adult recipients of liver transplant across 5 US transplant centers. Financial burden and distress were measured by 25 items adapted from national surveys of cancer survivors. Participants also completed the Work Productivity and Activity Impairment and EQ-5D-5L HRQOL questionnaires. In total, 23% of recipients reported high financial burden which was significantly associated with higher daily activity impairment (32.9% vs. 23.3%, p =0.048). In adjusted analyses, the high financial burden was significantly and independently associated with delayed or foregone medical care (adjusted odds ratio, 3.95; 95% CI, 1.85-8.42) and being unable to afford basic necessities (adjusted odds ratio, 5.12; 95% CI: 1.61-16.37). Recipients experiencing high financial burden had significantly lower self-reported HRQOL as measured by the EQ-5D-5L compared to recipients with low financial burden (67.8 vs. 76.1, p =0.008) and an age-matched and sex-matched US general population (67.8 vs. 79.1, p <0.001). In this multicenter cohort study, nearly 1 in 4 adult recipients of liver transplant experienced a high financial burden, which was significantly associated with delayed or foregone medical care and lower self-reported HRQOL. These findings underscore the need to evaluate and address the financial burden in this population before and after transplantation.
Assuntos
Efeitos Psicossociais da Doença , Gastos em Saúde , Transplante de Fígado , Qualidade de Vida , Humanos , Transplante de Fígado/economia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Gastos em Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia , Inquéritos e Questionários/estatística & dados numéricos , Estresse Financeiro/economia , Estresse Financeiro/epidemiologia , Idoso , Adaptação Psicológica , Doença Hepática Terminal/cirurgia , Doença Hepática Terminal/economia , Doença Hepática Terminal/diagnóstico , EficiênciaRESUMO
OBJECTIVES: The present study examined how different family level (family financial stress, family violence) and individual (food insecurity, gender, race) determinants of health were associated with mental health among Puerto Rican adolescents living in the U.S. during the COVID-19 pandemic. METHOD: A sample consisting of 119 Puerto Rican adolescents, aged 13 to 17, was collected via Qualtrics Panels between November 2020 and January 2021. We examined the association between family financial stress experienced during the pandemic and psychological distress. We also evaluated whether the association between family financial stress and psychological distress was moderated by family violence, food insecurity, and the participant's gender and race. RESULTS: Findings showed that food insecurity positively predicted psychological distress. Results also showed that participants' race moderated the association between family financial stress and psychological distress. Specifically, we found that while there was a significant positive association between family financial stress and psychological distress among Puerto Rican adolescents who identified as a racial minority, this association was nonsignificant among White Puerto Rican adolescents. CONCLUSION: Our research highlights the significant role of COVID-19 related family financial stress and food insecurity on Puerto Rican adolescents' poor mental health during the COVID-19 pandemic.
Assuntos
COVID-19 , Estresse Financeiro , Hispânico ou Latino , Saúde Mental , Pandemias , Estresse Psicológico , Adolescente , Humanos , Ansiedade , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/psicologia , Hispânico ou Latino/etnologia , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricos , Estados Unidos/epidemiologia , Porto Rico/etnologia , Estresse Financeiro/economia , Estresse Financeiro/epidemiologia , Estresse Financeiro/etnologia , Estresse Financeiro/psicologia , Insegurança Alimentar/economia , Estresse Psicológico/economia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etnologia , Estresse Psicológico/psicologiaRESUMO
BACKGROUND: The COVID-19 pandemic has had major ramifications for health and the economy at both the individual and collective levels. This study examined exogenous negative changes in household income and their implications on psychological well-being (PWB) among the Chinese population during the COVID-19 pandemic. METHODS: Data were drawn from the early China COVID-19 Survey, a cross-sectional anonymous online survey administered to the general population in China. Self-reported PWB was measured using a 5-point Likert scale with five questions related to the participants' recent psychological state. Hierarchical multiple linear regression was employed to examine whether income loss during the COVID-19 pandemic was associated with poor psychological health. RESULTS: This study included 8,428 adults, of which 90% had suffered from a moderate or severe loss of household income due to the early COVID-19 pandemic. Those who had experienced moderate or severe loss of income scored significantly lower on psychological well-being than those who did not experience income loss (19.96 or 18.07 vs. 21.46; P < 0.001); after controlling for confounders, income loss was negatively associated with PWB scores (moderate income loss: B = - 0.603, P < 0.001; severe income loss: B = - 1.261, P < 0.001). An interaction effect existed between the degree of income loss and pre-pandemic income groups. Specifically, participants in the middle-income group who had suffered severe income loss scored the lowest on PWB (B = - 1.529, P < 0.001). There was also a main effect on income loss, such that participants with varying degrees of income loss differed across five dimensions, including anhedonia, sleep problems, irritability or anger, difficulty with concentration, and repeated disturbing dreams related to COVID-19. CONCLUSIONS: Income loss during the pandemic has had detrimental consequences on psychological well-being, and the magnitude of the impact of income loss on psychological well-being varied according to previous income levels. Future policy efforts should be directed toward improving the psychological well-being of the economically vulnerable and helping them recover from lost income in the shortest time possible.
Assuntos
COVID-19 , População do Leste Asiático , Estresse Financeiro , Determinantes Sociais da Saúde , Adulto , Humanos , COVID-19/economia , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/psicologia , Estudos Transversais , População do Leste Asiático/psicologia , População do Leste Asiático/estatística & dados numéricos , Pandemias , Bem-Estar Psicológico , Renda , Estresse Financeiro/economia , Estresse Financeiro/epidemiologia , Estresse Financeiro/etnologia , Estresse Financeiro/psicologia , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Saúde Mental/economia , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricosRESUMO
Nowadays, the international situation is severe and complex, and the structural issues within the Chinese economy are prominent. Consequently, the financial risks faced by Chinese listed companies continue to escalate. Hence, it is of great practical significance to furnish effective early warnings for financial crises in listed companies. In this paper, we first employ web crawler technology and natural language processing technology to assess four text-linguistic features in the Management Discussion and Analysis (MD&A) section of the annual financial reports of listed companies in China from 2011 to 2020. These features are text tone, forward-looking, readability and similarity. Subsequently, we combine these features with traditional financial indicators and explore thirteen mainstream machine learning models to comparatively analyze their effectiveness in predicting financial crises in listed companies. The empirical findings of this research reveal that MD&A text readability and similarity indicators contribute valuable incremental information to prediction models, whereas text tone and forward-looking indicators exhibit the opposite effect. The latter two indicators can be manipulated more effortlessly by management, as this study's empirical findings indicate no evidence of their contributions in incremental informational value. In fact, the forward-looking indicator even introduces additional noise to the prediction. Finally, by comparing the early warning effects of thirteen machine learning models, it is found that RF, Bagging, CatBoost, GBDT, XGBoost and LightGBM models maintain stable and accurate sample recognition ability. In general, this paper constructs a more effective financial crisis early warning model by exploring the MD&A text-linguistic feature indicators, thereby offering a fresh research perspective for further investigations in this field.
Assuntos
Comércio , Estresse Financeiro , Linguística , China , Estresse Financeiro/economia , Aprendizado de Máquina , Setor Privado/economia , Comércio/economia , Processamento de Linguagem NaturalRESUMO
BACKGROUND: The association of historical redlining policies, a marker of structural racism, with contemporary heart failure (HF) risk among White and Black individuals is not well established. METHODS: We aimed to evaluate the association of redlining with the risk of HF among White and Black Medicare beneficiaries. Zip code-level redlining was determined by the proportion of historically redlined areas using the Mapping Inequality Project within each zip code. The association between higher zip code redlining proportion (quartile 4 versus quartiles 1-3) and HF risk were assessed separately among White and Black Medicare beneficiaries using generalized linear mixed models adjusted for potential confounders, including measures of the zip code-level Social Deprivation Index. RESULTS: A total of 2 388 955 Medicare beneficiaries (Black n=801 452; White n=1 587 503; mean age, 71 years; men, 44.6%) were included. Among Black beneficiaries, living in zip codes with higher redlining proportion (quartile 4 versus quartiles 1-3) was associated with increased risk of HF after adjusting for age, sex, and comorbidities (risk ratio, 1.08 [95% CI, 1.04-1.12]; P<0.001). This association remained significant after further adjustment for area-level Social Deprivation Index (risk ratio, 1.04 [95% CI, 1.002-1.08]; P=0.04). A significant interaction was observed between redlining proportion and Social Deprivation Index (Pinteraction<0.01) such that higher redlining proportion was significantly associated with HF risk only among socioeconomically distressed regions (above the median Social Deprivation Index). Among White beneficiaries, redlining was associated with a lower risk of HF after adjustment for age, sex, and comorbidities (risk ratio, 0.94 [95% CI, 0.89-0.99]; P=0.02). CONCLUSIONS: Historical redlining is associated with an increased risk of HF among Black patients. Contemporary zip code-level social determinants of health modify the relationship between redlining and HF risk, with the strongest relationship between redlining and HF observed in the most socioeconomically disadvantaged communities.
Assuntos
Insuficiência Cardíaca , Medicare , Características da Vizinhança , Determinantes Sociais da Saúde , Idoso , Humanos , Masculino , População Negra , Comorbidade , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etnologia , Insuficiência Cardíaca/psicologia , Medicare/economia , Medicare/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População Branca , Estresse Financeiro/economia , Estresse Financeiro/epidemiologia , Estresse Financeiro/etnologia , Características da Vizinhança/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricosRESUMO
BACKGROUND: Prior research findings are mixed regarding whether prosocial behavior is positively or negatively related to socioeconomic status and its correlates, such as economic pressure. This may be due to the lack of considerations for the type of prosocial behavior. AIMS: In this study, we aimed to examine how six types of prosocial behavior (i.e., public, anonymous, compliant, emotional, dire, and altruistic) are related to economic pressure among early adolescents. We hypothesized that family economic pressure would be associated with each type of prosocial behavior in differing ways. MATERIALS & METHODS: Participants were 11-14 years old (N = 143, Mage = 12.2 years, SDage = 0.87, 63 boys, 1 trans-identified boy, 55 girls), early adolescents and their parents. Among them, 54.6% were non-Hispanic/Latinx (NH/L) White, 23.8% were NH/L Black, 11.2% were NH/L Asian, 2.1% were NH/L Multiracial, and 8.4% were Hispanic/Latinx. Parents reported family economic pressure and adolescents' six types of prosocial behavior. RESULTS: Path analysis revealed that economic pressure was negatively associated with emotional and dire prosocial behavior over and above age, gender, and race/ethnicity. Family economic pressure was unrelated to public, anonymous, compliant, and altruistic prosocial behavior. DISCUSSION: These findings show some support for the Family Stress Model, such that economic stress might hinder youth's prosocial development. At the same time, youth may have similar levels of certain types of prosocial behavior regardless of their family's economic pressure. CONCLUSION: This research provided insight into the complex relation between economic pressure and youth's prosocial behavior which varies depending on the type of behavior.
Assuntos
Comportamento do Adolescente , Altruísmo , Adolescente , Criança , Feminino , Humanos , Masculino , Comportamento do Adolescente/etnologia , Comportamento do Adolescente/psicologia , Asiático , Negro ou Afro-Americano , Estresse Financeiro/economia , Estresse Financeiro/psicologia , Hispânico ou Latino , Pais , Comportamento Social , Classe Social , Fatores Socioeconômicos , Brancos , Pessoas TransgêneroRESUMO
OBJECTIVES: The purpose of this study was to explore social determinants of health (SDoH), and disease severity as predictors of sleep quality in persons with both Obstructive Sleep Apnea (OSA) and type 2 diabetes (T2D). METHODS: Disease severity was measured by Apnea-Hypopnea Index [(AHI) ≥ 5] and HbA1c for glycemic control. SDoH included subjective and objective financial hardship, race, sex, marital status, education, and age. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). RESULTS: The sample (N = 209) was middle-aged (57.6 ± 10.0); 66% White and 34% African American; and 54% men and 46% women. Participants carried a high burden of disease (mean AHI = 20.7 ± 18.1, mean HbA1c = 7.9% ± 1.7%). Disease severity was not significantly associated with sleep quality (all p >.05). Worse sleep quality was associated with both worse subjective (b = -1.54, p = .015) and objective (b = 2.58, p <.001) financial hardship. Characteristics significantly associated with both subjective and objective financial hardship included being African American, female, ≤ 2 years post high school, and of younger ages (all p < .01).Discussion: Financial hardship is a more important predictor of sleep quality than disease severity, age, sex, race, marital status, and educational attainment, in patients with OSA and T2D.
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Diabetes Mellitus Tipo 2 , Estresse Financeiro , Apneia Obstrutiva do Sono , Qualidade do Sono , Determinantes Sociais da Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Estresse Financeiro/economia , Hemoglobinas Glicadas , Polissonografia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/economia , Índice de Gravidade de Doença , Determinantes Sociais da Saúde/economiaRESUMO
BACKGROUND: China has stepped into an era of aging society, where the impending considerable economic burden attributed to high prevalence of dementia in the elderly appears to be one of the most important health and social issues to deal with for the country. However, population-based quantification and projections for the economic burden of dementia in China are lacking for further health action and policy making. OBJECTIVE: To estimate and predict the costs of managing dementia in the elderly population aged 60 and above from 2010 to 2050 in China. METHODS: Data were collected from a six-province study (n = 7072) and other multiple sources for calculation of the economic burden of dementia. With the convincing data from published studies, we quantified and projected the costs attributed to dementia in China from 2010 to 2050. RESULTS: The national cost of dementia in 2010 was estimated to be US$22.8 billion by the opportunity cost method and US$26.4 billion by the proxy method. In 2050, the costs would increase to US$372.3 billion by the opportunity cost method and US$430.6 billion by the proxy method, consuming 0.53% and 0.61% of China's total GDP, respectively. A series of sensitivity analyses showed that the changes in the proportions of informal caregiving led to the most robust changes in the total burden of care for dementia in China. CONCLUSION: Dementia represents an enormous burden on China's population health and economy. Due to the changes in policies and population structure, policymakers should give priority to dementia care.
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Envelhecimento , Efeitos Psicossociais da Doença , Demência/economia , Estresse Financeiro/economia , Custos de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Demência/epidemiologia , Demência/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: It is increasingly appreciated that some patients with cancer will experience financial burden due to their disease but little is known specifically about patients with haematological malignancies. Therefore, this study aimed to measure financial toxicity experienced by patients with haematological malignancies in the context of a publicly funded health care system. METHOD: All current patients diagnosed with leukaemia, lymphoma or multiple myeloma, from two major metropolitan health services in Melbourne, Australia were invited to complete a survey capturing; patient demographics, employment status, income sources, financial coping and insurances, OOP expenses and self-reported financial toxicity using a validated measure. RESULTS: Of the 240 people approached, 113 (47 %) participated and most had leukaemia (62 %). Forty-seven (42 %) participants experienced some degree of financial toxicity using the Comprehensive Score for financial toxicity (COST) instrument. On multivariate linear regression, older age (>65 years, p = 0.007), higher monthly income (>$8000, p = 0.008), not having and being forced into unemployment or early retirement (p < 0.001) remained significantly associated with less financial toxicity. CONCLUSION: Financial toxicity is present in Australian haematology patients and those at higher risk may be patients of working age, those without private health insurance and patients that have been forced to retire early or have become unemployed due to their diagnosis.
Assuntos
Efeitos Psicossociais da Doença , Atenção à Saúde/economia , Estresse Financeiro/economia , Neoplasias Hematológicas/economia , Saúde Pública/economia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Austrália , Estudos Transversais , Atenção à Saúde/métodos , Atenção à Saúde/estatística & dados numéricos , Feminino , Estresse Financeiro/psicologia , Gastos em Saúde/estatística & dados numéricos , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/terapia , Humanos , Leucemia/diagnóstico , Leucemia/economia , Leucemia/terapia , Linfoma/diagnóstico , Linfoma/economia , Linfoma/terapia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/economia , Mieloma Múltiplo/terapia , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
There has been resistance to COVID-19 public health restrictions partly due to changes and reductions in work, resulting in financial stress. Psychological reactance theory posits that such restrictions to personal freedoms result in anger, defiance, and motivation to restore freedom. In an online study (N = 301), we manipulated the target of COVID-19 restrictions as impacting self or community. We hypothesized that (a) greater pandemic-related financial stress would predict greater reactance, (b) the self-focused restriction condition would elicit greater reactance than the community-focused restriction condition, (c) reactance would be greatest for financially-stressed individuals in the self-focused condition, and (d) greater reactance would predict lower adherence to social distancing guidelines. Independent of political orientation and sense of community, greater financial stress predicted greater reactance only in the self-focused condition; the community-focused condition attenuated this association. Additionally, greater reactance was associated with lower social distancing behavior. These findings suggest that economic hardship exacerbates negative responses to continued personal freedom loss. Community-focused COVID-19 health messaging may be better received during continued pandemic conditions.
Assuntos
COVID-19/economia , COVID-19/psicologia , Saúde Pública/tendências , Adulto , Idoso , Ira , Feminino , Estresse Financeiro/economia , Liberdade , Política de Saúde/economia , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Motivação , Pandemias/economia , Distanciamento Físico , Teoria Psicológica , Saúde Pública/métodos , SARS-CoV-2/patogenicidade , Inquéritos e QuestionáriosRESUMO
Background: Our study estimated insurance payments and patient out-of-pocket (OOP) expenses associated with discarded weight-based intravenous antineoplastic drugs for privately insured US adult patients with cancer. Methods: We identified patients who received weight-based antineoplastic drugs from a 2017 MarketScan health risk assessment (IBM Corp, Armonk, NY) linked to claims data. Using weight information in the health risk assessment, we derived the recommended dose and calculated the percentage of drugs discarded. We applied ß-regression to determine factors associated with the discarded percentages. To compare patients with and without high-deductible plans, we employed a generalized linear model and a 2-part model to examine insurance payment and OOP expense, respectively. All statistical tests were 2-sided. Results: Of 27 350 claims for 58 weight-based antineoplastic drugs from 1970 patients, the median discarded percentage was 9.8% (mean [SD] = 12.8% [10.5%]). Aside from drug and tumor type, statistically significantly higher discarded percentages were found for patients in the lowest weight group (5.5% [95% confidence interval = 4.7% to 6.4%]; P < .001; weight <150 lb [68.0 kg] vs ≥200 lb [90.7 kg]). Private payers spent $5090 per patient in 2017 on discarded weight-based antineoplastic drugs, and patients' mean OOP expense on discarded drugs was $63. In total, 39.7% of patients had high-deductible plans. The adjusted mean OOP expense for discarded drugs was statistically significantly higher for those in high-deductible plans ($95 vs $47; P < .001). Conclusions: Private insurers incurred substantial financial burden from discarded weight-based antineoplastic drugs. Although the OOP expenses of discarded drugs were modest for most privately insured patients with cancer, approximately 5% spent more than $400 on the discarded drugs. Policies designed to reduce drug waste from single-dose, weight-based antineoplastic drugs should evaluate their financial consequences for payers and patients.
Assuntos
Antineoplásicos/economia , Peso Corporal , Custos de Medicamentos , Cálculos da Dosagem de Medicamento , Gastos em Saúde , Reembolso de Seguro de Saúde/economia , Administração Intravenosa , Antineoplásicos/administração & dosagem , Dedutíveis e Cosseguros/economia , Dedutíveis e Cosseguros/estatística & dados numéricos , Embalagem de Medicamentos/métodos , Feminino , Estresse Financeiro/economia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Setor Privado/economiaRESUMO
BACKGROUND: Understanding the economic burden imposed by head and neck cancer diagnoses essential to contextualize healthcare decision-making for these patients. METHODS: A retrospective, cross-sectional analysis of the US National Health Interview Survey was performed between 2013 and 2018. Demographic and socioeconomic characteristics of adult head and neck cancer patients were analyzed in relation to survey responses related to financial stress factors. RESULTS: Among 710 head and neck cancer patients, 21.39% (95% Cl, 17.69%-25.09%) reported difficulty paying medical bills within the previous 12 months. Multivariable logistic regression revealed insurance status [aOR 2.17 (95% CI, 1.15-4.07), p < 0.001] and poverty status [aOR 2.55 (95% CI, 1.48-4.37), p = 0.017] to be significantly associated with difficulty paying medical bills. CONCLUSION: A large proportion of HNC patients may experience financial stress related not only to out-of-pocket health care costs, but also exogenous financial challenges. These findings suggest that a significant proportion of HNC patients may experience financial stress related not only to out-of-pocket health care costs, but also exogenous financial challenges. Such barriers may impede patients' ability to access and adhere to treatment or force detrimental tradeoffs between health care and other essential needs.