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1.
Braz Oral Res ; 33: e102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939495

RESUMO

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.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Índice CPO , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Índice Periodontal , Estudos Prospectivos , Qualidade de Vida , Autoimagem , Classe Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
3.
Medicine (Baltimore) ; 99(2): e18625, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914043

RESUMO

BACKGROUND: Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality. METHODS: This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method. RESULTS: Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area. CONCLUSION: The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , China , Feminino , Gastos em Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
5.
Artigo em Alemão | MEDLINE | ID: mdl-31915863

RESUMO

Today, health inequalities are one of the most important issues in public health worldwide. The digitalisation of healthcare is frequently attributed with the potential to reduce health inequalities. At the same time, effective internet usage is a prerequisite of the successful utilisation of digital health interventions. This might be a new obstacle for those who lack the necessary material resources or individual skills.Evidence on how exactly digital health interventions affect health inequalities is scarce. The aim of this study was to present a narrative review of the available literature. The majority of studies showed an association between the usage of digital health interventions and sociodemographic factors. The utilisation was generally higher among younger people and those with higher education and higher income. Only few studies showed no association. Other studies reported higher utilisation among those with higher levels of health literacy while health literacy showed a social gradient to the disadvantage of those in lower socioeconomic position. With a low overall level of evidence, there is currently no indication that digital health interventions are reducing health inequalities.The studies analysed in this review indicate that existing inequalities persist in the digital realm. Further evidence is needed to create a better understanding of the importance of sociodemographic factors for digital health interventions.


Assuntos
Exclusão Digital , Disparidades em Assistência à Saúde , Assistência à Saúde , Alemanha , Humanos , Saúde Pública , Fatores Socioeconômicos
9.
J Surg Res ; 245: 629-635, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31522036

RESUMO

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


Assuntos
Tratamento de Emergência/efeitos adversos , Disparidades em Assistência à Saúde/economia , Renda/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adolescente , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Rurais/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
10.
JAMA ; 322(22): 2173-2174, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821434
12.
Ther Adv Cardiovasc Dis ; 13: 1753944719891691, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31797738

RESUMO

BACKGROUND: Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lead to receiving prompt lifesaving treatment. In this study, we identified the influence of living in a rural area, rurality, on disparities in MI symptom awareness across the US. METHODS: We examined 2007 and 2009 Behavioral Risk Factor Surveillances System survey data using logistic regressions to model the impact of rurality on MI symptom awareness while controlling for sociodemographic and MI clinical factors. From the results of these models, we created a type of marginal probability, known as average adjusted predictions (AAPs) and the difference in AAPs, called average marginal effects (AMEs), to determine patterns of awareness for each MI symptom between rural, suburban, and urban areas. RESULTS: We found that there were similar odds and probabilities of being aware of all five MI symptoms between rural, suburban, and urban areas, although rural residents consistently had a slightly higher odds and probability of being aware of all five MI symptoms compared with suburban and urban residents. Rural, suburban, and urban residents had the highest probability of being aware of chest pain/discomfort (95.5-96.1%) and the lowest probability of being aware of jaw/back/neck pain (68.6-72.0%). After adjustment, more than 25% of rural, suburban, and urban residents were found to be unaware that jaw/back/neck pain and feeling weak/light-headed/faint were symptoms of MI. AMEs were greatest for all areas for jaw/back/neck pain (-3.5% to -3.2%) and smallest for chest pain/discomfort (-0.6% to -0.2%). CONCLUSIONS: The study's results highlight the need to increase awareness of the MI symptoms of jaw/back/neck pain and feeling weak/light-headed/faint to shorten hospital delay and time to treatment, especially for rural areas where cardiovascular disease mortality is high.


Assuntos
Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Infarto do Miocárdio/epidemiologia , Saúde da População Rural , Adolescente , Adulto , Idoso , Angina Pectoris/epidemiologia , Dor nas Costas/epidemiologia , Tontura/epidemiologia , Dor Facial/epidemiologia , Feminino , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Cervicalgia/epidemiologia , Prognóstico , Fatores de Risco , Saúde Suburbana , Estados Unidos/epidemiologia , Saúde da População Urbana , Adulto Jovem
13.
Rev Saude Publica ; 53: 97, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800910

RESUMO

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


Assuntos
Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Equador/epidemiologia , Feminino , Geografia Médica , Humanos , Masculino , Mortalidade , Áreas de Pobreza , Saúde Pública , Fatores Socioeconômicos
14.
Anticancer Res ; 39(12): 6877-6880, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810956

RESUMO

BACKGROUND/AIM: This study aimed to analyze associated factors of 30-day hospital readmission after surgery for melanoma. PATIENTS AND METHODS: We conducted a retrospective analysis of postoperative 30-day unplanned readmission in patients with melanoma in the National Cancer Database (NCDB). RESULTS: Higher odds of unplanned readmission were found in non-white patients compared to white, uninsured patients compared to those with private insurance, tumors with invasive behavior compared to in situ, presence of ulceration, American Joint Committee on Cancer stages greater than II, and location in the extremities. Lower odds of unplanned readmission were found in women living in areas where the percentage of adults who did not graduate from high school was below 13.0% with an annual income of $38,000 or more, who were treated in Academic/Research Programs or Integrated Network Cancer Programs. CONCLUSION: Non-white patients and low-income zip-codes were associated with unplanned readmission.


Assuntos
Melanoma/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Lactente , Recém-Nascido , Masculino , Melanoma/etnologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos/etnologia , Adulto Jovem
15.
Anticancer Res ; 39(12): 6881-6885, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810957

RESUMO

BACKGROUND/AIM: This study aimed to analyze facility characteristics contributing to disparities in breast reconstruction access in the United States. PATIENTS AND METHODS: Data from January 1, 2004, to December 31, 2015 were extracted from the National Cancer Database on patient, facility and treatment, and tumor characteristics. A total of 858,594 patients met the inclusion criteria of the study, including 553,517 (64.5%) patients who underwent mastectomy only (without breast reconstruction) and 305,077 (35.5%) patients who received breast reconstruction (implants or autologous tissue). RESULTS: Multivariate analysis showed that the odds of reconstruction were higher in Integrated Network Cancer Programs and Academic/Research Programs compared to Community Cancer Programs. Patients treated in the South, Midwest, and West regions had lower odds of reconstruction. Interestingly, patients treated in more than one Commission on Cancer facility had a higher likelihood of reconstruction. CONCLUSION: Facility characteristics and location impact on access to breast reconstruction.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/estatística & dados numéricos , Mastectomia/métodos , Mastectomia/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde , Humanos , Pessoa de Meia-Idade , Razão de Chances , Estados Unidos
16.
Pan Afr Med J ; 34: 60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762925

RESUMO

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


Assuntos
Equipamentos e Provisões/provisão & distribução , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Radiografia/instrumentação , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Zimbábue
18.
Nervenarzt ; 90(11): 1187-1200, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31667532

RESUMO

Social inequality refers to the inequitable distribution of social prosperity including the resource of health. The relationship between social inequality and mental health can be established by means of indicators of social inequality throughout all age groups in Germany. There are social gradients of mental health on the population level, i.e. the linear relationship between social classes or status and state of health. Fundamental determinants of health disparity are cultural, social, political, and geographical conditions, which interact with the genetic make-up and epigenetic processes. These determinants also influence the management of developmental tasks during the life course and are of utmost importance for the development of mental disorders. The maladaptation to chronic stress is at the core of health disparity. Interventions at the individual behavioral level should comprise the development of stress management and coping strategies.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Transtornos Mentais , Serviços de Saúde Mental/estatística & dados numéricos , Saúde Mental , Alemanha , Humanos , Transtornos Mentais/etnologia , Classe Social , Fatores Socioeconômicos
19.
Health Serv Res ; 54 Suppl 2: 1409-1418, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667831

RESUMO

OBJECTIVE: To examine experiences of racial/ethnic discrimination among Latinos in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 803 Latinos and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of Latinos reporting discrimination in several domains, including health care. We used logistic regression to compare the Latino-white difference in odds of discrimination, and among Latinos only to examine variation by socioeconomic status and country of birth. PRINCIPAL FINDINGS: One in five Latinos (20 percent) reported experiencing discrimination in clinical encounters, while 17 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Latinos also reported experiencing discrimination with employment (33 percent applying for jobs; 32 percent obtaining equal pay/promotions), housing (31 percent), and police interactions (27 percent). In adjusted models, Latinos had significantly higher odds than whites for reporting discrimination in health care visits (OR: 3.18, 95% CI: 1.61, 6.26) and across several other domains. Latinos with college degrees had significantly higher odds of reporting discrimination in multiple domains than those without college degrees, with few differences between foreign-born and US-born Latinos. CONCLUSIONS: Latinos in the United States report experiencing widespread discrimination in health care and other areas of their lives, at significantly higher levels than whites. Being born in the United States and earning a college degree are not protective against discrimination, suggesting that further health and social policy efforts to eliminate discrimination are needed.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
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