Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.113
Filtrar
1.
JAMA ; 325(5): 445-453, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33528535

RESUMO

Importance: After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear. Objective: To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults. Design, Setting, and Participants: Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010). Exposures: Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]). Main Outcomes and Measures: Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity. Results: Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, -0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, -0.4% [95% CI, -0.8% to -0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, -0.5% [95% CI, -0.9% to -0.1%]). After accounting for baseline prosperity and demographic and health care-related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year. Conclusions and Relevance: In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study.


Assuntos
Doenças Cardiovasculares/mortalidade , Emprego/tendências , Renda/tendências , Adulto , Emprego/economia , Emprego/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia
2.
Lancet Diabetes Endocrinol ; 9(4): 203-211, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33636102

RESUMO

BACKGROUND: Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. METHODS: In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. FINDINGS: Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. INTERPRETATION: The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.


Assuntos
Agregação de Dados , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economia , Saúde Global/tendências , Renda/tendências , Internacionalidade , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Incidência
3.
Sci Adv ; 7(6)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33547077

RESUMO

Despite numerous journalistic accounts, systematic quantitative evidence on economic conditions during the ongoing COVID-19 pandemic remains scarce for most low- and middle-income countries, partly due to limitations of official economic statistics in environments with large informal sectors and subsistence agriculture. We assemble evidence from over 30,000 respondents in 16 original household surveys from nine countries in Africa (Burkina Faso, Ghana, Kenya, Rwanda, Sierra Leone), Asia (Bangladesh, Nepal, Philippines), and Latin America (Colombia). We document declines in employment and income in all settings beginning March 2020. The share of households experiencing an income drop ranges from 8 to 87% (median, 68%). Household coping strategies and government assistance were insufficient to sustain precrisis living standards, resulting in widespread food insecurity and dire economic conditions even 3 months into the crisis. We discuss promising policy responses and speculate about the risk of persistent adverse effects, especially among children and other vulnerable groups.


Assuntos
/economia , Países em Desenvolvimento/economia , Emprego/tendências , Renda/tendências , Pandemias/economia , Adulto , África/epidemiologia , Agricultura/economia , Ásia/epidemiologia , Criança , Colômbia/epidemiologia , Violência Doméstica , Recessão Econômica , Características da Família , Feminino , Programas Governamentais/economia , Humanos , Masculino , Estações do Ano , Inquéritos e Questionários
5.
Public Health ; 185: 189-195, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32645506

RESUMO

OBJECTIVES: Lung cancer is the most commonly diagnosed cancer in Canada. This study aims to assess trends in income and education inequalities in the incidence of lung cancer in Canada. STUDY DESIGN: The study design is a time-trend analysis of nationally collected data. METHODS: Using a linked data set of the Canadian Cancer Registry (CCR) data file, the Canadian Census of Population and National Household Survey, we calculated the incidence of lung cancer in Canada over the period between 1992 and 2010. The age-adjusted concentration index (C), which captures socio-economic inequality across a continuous spectrum of socio-economic status, was used to measure income and education inequalities in the incidence of lung cancer in men and women. RESULTS: The crude incidence rate for men decreased significantly over time in Canada from 85 to 78 per 100,000 population from 1992 to 2010, respectively. For women, the crude incidence rate increased significantly over time in Canada from 45 to 67 per 100,000 population from 1992 to 2010, respectively. The age-adjusted C indicated a higher concentration of lung cancer incidence among low income and less educated Canadians over the study period. Although income inequality in lung cancer incidence decreased significantly over time for men, education inequality increased significantly for both men and women. CONCLUSIONS: Increased occurrence of lung cancer among the poor and less educated populations in Canada remains a challenge in Canada. Income and education gradients in the lung cancer incidence are likely explained by variations in known risk factors especially smoking across socio-economic groups. Continuous efforts are required to reduce the causes of lung cancer among low socio-economic status Canadians.


Assuntos
Escolaridade , Renda/tendências , Neoplasias Pulmonares/epidemiologia , Canadá/epidemiologia , Feminino , Humanos , Incidência , Renda/estatística & dados numéricos , Masculino , Pobreza , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Classe Social , Fatores Socioeconômicos
8.
JAMA Netw Open ; 3(6): e2012403, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32556260

RESUMO

Importance: Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. Objective: To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults. Design, Setting, and Participants: A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020. Main Outcomes and Measures: The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response. Results: The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19-related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning ≥$100 000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (-9.4 percentage points; 95% CI, -13.1 to -5.7 percentage points; P < .001), Hispanic respondents (-4.8 percentage points; 95% CI, -8.9 to -0.77 percentage points; P = .02), and people younger than 30 years (-10.3 percentage points; 95% CI, -14.1 to -6.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors. Conclusions and Relevance: In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Comportamentos de Risco à Saúde/fisiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Cultura , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Renda/tendências , Conhecimento , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Prevalência , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia
9.
PLoS One ; 15(6): e0233549, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484807

RESUMO

The literature on growth convergence has focused to a great extent on the role of initial incomes as a primary determinant of long-term growth outcomes. Expanded versions of growth models have used other explanators to unpack the growth process. In this paper we add to the literature in two significant ways: (a) we use socioeconomic variables that are sometimes overlooked in explaining growth (such as, political stability and political alliance, social heterogeneity, and demographic distribution), and (b) we demonstrate that earlier analyses may be overlooking the problem of normality and endogeneity in regression models (and we provide alternate methods like instrumental variable and distribution dynamics to control for these). In this paper we analyze the per capita income growth at the subnational level in India for the period 1981-82 to 2010-11 using an expanded growth framework. We find that initial incomes, the ratio of working age group to total population, political stability and alliance, and the extent of development expenditure play a positive and significant role in predicting growth. We also find that, contrary to popular belief, the presence of marginalized groups-namely Scheduled Castes and Scheduled Tribes-have not been a hindrance to growth of per capita incomes in states. Our findings on the influence of social institutions may have significant implications for a public policy of affirmative action in India. The results on the impact of development expenditure on growth is also important for states seeking to increase their growth rates through policy intervention.


Assuntos
Economia/tendências , Renda/tendências , Fatores Socioeconômicos/história , Demografia , Economia/estatística & dados numéricos , Gastos em Saúde , História do Século XX , História do Século XXI , Humanos , Índia/epidemiologia , Dinâmica Populacional , Política Pública , Classe Social
10.
Proc Natl Acad Sci U S A ; 117(17): 9277-9283, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32284412

RESUMO

It is well documented that earnings inequalities have risen in many high-income countries. Less clear are the linkages between rising income inequality and workplace dynamics, how within- and between-workplace inequality varies across countries, and to what extent these inequalities are moderated by national labor market institutions. In order to describe changes in the initial between- and within-firm market income distribution we analyze administrative records for 2,000,000,000+ job years nested within 50,000,000+ workplace years for 14 high-income countries in North America, Scandinavia, Continental and Eastern Europe, the Middle East, and East Asia. We find that countries vary a great deal in their levels and trends in earnings inequality but that the between-workplace share of wage inequality is growing in almost all countries examined and is in no country declining. We also find that earnings inequalities and the share of between-workplace inequalities are lower and grew less strongly in countries with stronger institutional employment protections and rose faster when these labor market protections weakened. Our findings suggest that firm-level restructuring and increasing wage inequalities between workplaces are more central contributors to rising income inequality than previously recognized.


Assuntos
Países Desenvolvidos/economia , Fatores Socioeconômicos , Emprego/economia , Emprego/tendências , Europa (Continente) , Extremo Oriente , Humanos , Renda/tendências , Oriente Médio , América do Norte , Ocupações/economia , Salários e Benefícios/tendências , Países Escandinavos e Nórdicos , Local de Trabalho/psicologia
11.
JAMA Netw Open ; 3(4): e201917, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32236531

RESUMO

Importance: Measuring health care utilization and costs before death has the potential to initiate health care improvement. Objective: To examine population-level trends in health care utilization and expenditures in the 2 years before death in Canada's single-payer health system. Design, Setting, and Participants: This population-based cohort included 966 436 deaths among adult residents of Ontario, Canada, from January 2005 to December 2015, linked to health administrative and census data. Data for deaths from 2005 to 2013 were analyzed from November 1, 2016, through January 31, 2017. Analyses were updated from May 1, 2019, to June 15, 2019, to include deaths from 2014 and 2015. Exposures: Sociodemographic exposures included age, sex, and neighborhood income quintiles, which were obtained by linking decedents' postal codes to census data. Aggregated Diagnosis Groups were used as a general health service morbidity-resource measure. Main Outcomes and Measures: Health care services accessed for the last 2 years of life, including acute hospitalization episodes of care, intensive care unit visits, and emergency department visits. Total health care costs were calculated using a person-centered costing approach. The association of area-level income with high resource use 1 year before death was analyzed with Poisson regression analysis, controlling for age, sex, and Aggregated Diagnosis Groups. Results: Among 966 436 decedents (483 038 [50.0%] men; mean [SD] age, 76.4 [14.96] years; 231 634 [24.0%] living in the lowest neighborhood income quintile), health care expenditures increased in the last 2 years of life during the study period (CAD$5.12 billion [US $3.83 billion] in 2005 vs CAD$7.84 billion [US $5.86 billion] in 2015). In the year before death, 758 770 decedents (78.5%) had at least 1 hospitalization episode of care, 266 987 (27.6%) had at least 1 intensive care unit admission, and 856 026 (88.6%) had at least 1 emergency department visit. Overall, deaths in hospital decreased from 37 984 (45.6%) in 2005 to 39 474 (41.5%) in 2015. Utilization in the last 2 years, 1 year, 180 days, and 30 days of life varied by resource utilization gradients. For example, the proportion of individuals visiting the emergency department was slightly higher among the top 5% of health care users compared with other utilization groups in the last 2 years of life (top 5%, 45 535 [94.2%]; top 6%-50%, 401 022 [92.2%]; bottom 50%, 409 469 [84.7%]) and 1 year of life (top 5%, 43 007 [89.0%]; top 6%-50%, 381 732 [87.8%]; bottom 50%, 380 859 [78.8%]); however, in the last 30 days of life, more than half of individuals in the top 6% to top 50% (223 262 [51.3%]) and bottom 50% (288 480 [59.7%]) visited an emergency department, compared with approximately one-third of individuals in the top 5% (16 916 [35.0%]). No meaningful associations were observed in high resource use between individuals in the highest income quintile compared with the lowest income quintile (rate ratio, 1.02; 95% CI, 0.99-1.05) after adjusting for relevant covariates. Conclusions and Relevance: In this study, health care use and spending in the last 2 years of life in Ontario were high. These findings highlight a trend in hospital-centered care before death in a single-payer health system.


Assuntos
Assistência à Saúde/economia , Gastos em Saúde/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Terminal/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/tendências , Hospitalização/estatística & dados numéricos , Humanos , Renda/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Características de Residência/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
13.
Infant Behav Dev ; 58: 101415, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32004759

RESUMO

Consistency in parenting infants has positive developmental outcomes. Yet, the role of socioeconomic status (SES) in consistency of maternal behaviors is not well understood. We investigated individual-order continuity of maternal smile and laughter and positive vocalization from 6 to 12 months of age in 82 mother-infant dyads. Overall, individual differences in maternal smile and laughter, and positive vocalization were consistent across time. A multidimensional measure of SES moderated the association of maternal smile and laughter from 6 to 12 months, such that infants from lower SES families were vulnerable to unpredictable parenting - experiencing a lack of consistency in maternal smiles and laughter.


Assuntos
Afeto/fisiologia , Riso/fisiologia , Comportamento Materno/fisiologia , Comportamento Materno/psicologia , Relações Mãe-Filho/psicologia , Classe Social , Adulto , Feminino , Humanos , Renda/tendências , Lactente , Riso/psicologia , Masculino , Mães/psicologia , Poder Familiar/psicologia , Poder Familiar/tendências , Sorriso/fisiologia , Sorriso/psicologia
14.
J Vasc Surg ; 72(2): 611-621.e5, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31902593

RESUMO

BACKGROUND: Despite guidelines cautioning against the use of endovascular peripheral vascular interventions (PVI) for claudication, more than 1.3 million PVI procedures are performed annually in the United States. We aimed to describe national rates of PVI for claudication, and identify patient and county-level risk factors associated with a high rate of PVI. METHODS: We used the Medicare claims database to identify all Medicare beneficiaries with a new diagnosis of claudication between January 2015 and June 2017. A hierarchical logistic regression model accounting for patient age, sex, comorbidities; county region and setting; and a patient race-county median income interaction was used to assess the associations of race and income with a high PVI rate. RESULTS: We identified 1,201,234 patients with a new diagnosis of claudication for analysis. Of these, 15,227 (1.27%) underwent a PVI. Based on hierarchical logistic regression accounting for patient and county-level factors, black patients residing in low-income counties had a significantly higher odds of undergoing PVI than their white counterparts (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.20-1.40), whereas the odds of PVI for black versus white patients was similar in high-income counties (OR, 1.06; 95% CI, 0.99-1.14). PVI rates were higher for low versus high-income counties in both the black (OR, 1.46; 95% CI, 1.31-1.64) and white (OR, 1.19; 95% CI, 1.12-1.27) groups. There were no significant associations of Hispanic, Asian, North American native, or other races with PVI in either low- or high-income counties after risk adjustment (all P ≥ .09). CONCLUSIONS: In the Medicare population, the mean rate of PVI of 12.7 per 1000 claudication patients varies significantly based on race and income. Our data suggest there are racial and socioeconomic differences in the treatment of claudication across the United States.


Assuntos
Procedimentos Endovasculares/tendências , Disparidades em Assistência à Saúde/tendências , Renda/tendências , Claudicação Intermitente/terapia , Sobremedicalização/tendências , Doença Arterial Periférica/terapia , Determinantes Sociais da Saúde/tendências , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Procedimentos Endovasculares/economia , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/economia , Claudicação Intermitente/etnologia , Masculino , Sobremedicalização/economia , Medicare , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/economia , Doença Arterial Periférica/etnologia , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia , Resultado do Tratamento , Estados Unidos/epidemiologia
15.
PLoS One ; 15(1): e0227541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945102

RESUMO

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.


Assuntos
Renda/tendências , Seguro Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/epidemiologia , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Risco
16.
Seizure ; 74: 71-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31835058

RESUMO

PURPOSE: Epilepsy has well-documented associations with low income and low education levels, but the impact of a patient's socioeconomic standing (SES) on the effects of epilepsy have been less studied. METHOD: We performed a register-based cross-sectional study and asked if SES was associated with more severe epilepsy or limited access to care in Sweden, where health care is universal, and if socioeconomic outcomes (employment and income) differed for persons with epilepsy (PWE) with different levels of educational attainment. The study cohort consisted of all adult patients with an epilepsy diagnosis in the Swedish patient register in 2000-2015 (n = 126,406) and controls (n = 379,131) matched for age, gender, and place of birth. RESULTS: Somatic and psychiatric comorbidities were more common in PWE, while education and income levels were lower. Among PWE, hospitalizations were more common in persons with lower income or education. Having at least one prescription written by a neurologist in the study period was more common in the high-income and high-education groups. Finally, although low educational attainment was associated with low levels of income and inversely associated with employment in both persons with epilepsy and controls, regression analyses demonstrated that these associations were much more noticeable in cases than controls. CONCLUSIONS: We conclude that both the severity and consequences of epilepsy are greater in persons of low SES, even in a country with universal health care. This indicates that universal access may not be sufficient to mitigate socioeconomic inequity in epilepsy.


Assuntos
Epilepsia/economia , Epilepsia/epidemiologia , Acesso aos Serviços de Saúde/economia , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Emprego/economia , Emprego/tendências , Epilepsia/terapia , Feminino , Acesso aos Serviços de Saúde/tendências , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Suécia/epidemiologia
17.
Int J Soc Psychiatry ; 66(1): 34-40, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31564187

RESUMO

BACKGROUND: Suicide events observed in various groups, community or countries, especially in the periods of economic recession. It is thought that suicide cases increase when people's income decreases dramatically and they lose their jobs. AIM/OBJECTIVE: In this study, it was aimed to investigate whether the 2008 economic crisis had any effect on suicides in the United States. METHODS: Autoregressive distributed lag method was used. For the purpose of the study, the number of suicide-related deaths was taken as the dependent variable, while unemployment rates and 2008 economic crisis were taken as independent variables. FINDINGS: The short-term and long-term relationships obtained within the scope of the study indicated that the 2008 economic crisis had a statistically significant effect on suicide cases in the United States. RESULTS AND CONCLUSION: It can be said that the results of this study are consistent with the information which emphasizes that economic crises increase suicide cases in the literature.


Assuntos
Recessão Econômica , Renda/tendências , Suicídio/tendências , Desemprego/estatística & dados numéricos , Distribuição Binomial , Humanos , Suicídio/estatística & dados numéricos , Desemprego/psicologia , Estados Unidos
18.
Acad Med ; 95(4): 623-628, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31626001

RESUMO

PURPOSE: To describe a long-term overview of accredited continuing medical education (CME) at M.D.-granting medical schools in the United States. METHOD: Self-reported data about type, duration, and numbers of learner participants of accredited CME activities and income for CME units from each medical school were compiled annually by the Accreditation Council for Continuing Medical Education (ACCME) between 1998 and 2017. Comparisons were made with data from all other ACCME-accredited organizations. RESULTS: Between 1998 and 2017, medical schools represented 18%-19% of all ACCME-accredited organizations. CME activities, hours of instruction, learner participants, and income increased gradually until reaching the highest levels between 2008 and 2011 before remaining constant. In 2017, each school generated a median of 132 activities (interquartile range [IQR]: 66-266), of which 44% were courses and 31% were regularly scheduled series (RSS), and a median of 29,824 learner interactions (IQR: 8,464-46,255). Total income rose gradually until 2010 before declining. In 2017, each school reported a median annual income of $1.0 million (IQR: $0.2 million - $2.9 million) from CME activities, comprising 44% from registration fees, 39% from commercial support, and 14% from advertising and exhibits. Compared with other accredited organization types, medical schools generally developed more RSS activities and proportionally fewer interprofessional and online activities. CONCLUSIONS: While medical schools represent less than 20% of all ACCME-accredited organizations, their role is pivotal and their influence far-reaching. For medical schools to fulfill their responsibility as education leaders, they need to prioritize support for CME offices and faculty development and implement new approaches to teaching and learning.


Assuntos
Educação Médica Continuada/tendências , Hospitais , Renda/tendências , Organizações sem Fins Lucrativos , Faculdades de Medicina , Sociedades Médicas , Acreditação , Assistência à Saúde , Educação Médica Continuada/economia , Humanos , Estados Unidos
19.
Nat Rev Endocrinol ; 16(1): 17-29, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31616074

RESUMO

The incidence of thyroid cancer is on the rise, and this disease is projected to become the fourth leading type of cancer across the globe. From 1990 to 2013, the global age-standardized incidence rate of thyroid cancer increased by 20%. This global rise in incidence has been attributed to several factors, including increased detection of early tumours, the elevated prevalence of modifiable individual risk factors (for example, obesity) and increased exposure to environmental risk factors (for example, iodine levels). In this Review, we explore proven and novel hypotheses for how modifiable risk factors and environmental exposures might be driving the worldwide increase in the incidence of thyroid cancer. Although overscreening and the increased diagnosis of possibly clinically insignificant disease might have a role in certain parts of the world, other areas could be experiencing a true increase in incidence due to elevated exposure risks. In the current era of personalized medicine, national and international registry data should be applied to identify populations who are at increased risk for the development of thyroid cancer.


Assuntos
Exposição Ambiental/efeitos adversos , Saúde Global/economia , Renda , Neoplasias da Glândula Tireoide/economia , Neoplasias da Glândula Tireoide/epidemiologia , Distribuição por Idade , Comportamento Alimentar/fisiologia , Saúde Global/tendências , Humanos , Incidência , Renda/tendências , Sistema de Registros , Fatores de Risco , Distribuição por Sexo , Neoplasias da Glândula Tireoide/diagnóstico
20.
Ciênc. Saúde Colet ; 24(12): 4415-4426, dez. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1055757

RESUMO

Resumo O estudo tem como objetivo analisar as tendências e os padrões regionais das receitas e despesas em saúde dos estados brasileiros no período de 2006 a 2016. Trata-se de estudo exploratório e descritivo com base em dados secundários de abrangência nacional e indicadores selecionados. Verificou-se crescimento da receita corrente líquida per capita para o conjunto dos estados e regiões, com quedas em anos específicos associadas às crises de 2008-2009 e de 2015-2016. A despesa em saúde per capita apresentou tendência de crescimento, mesmo em momentos de crise econômica e queda da arrecadação. Observou-se diversidade de fontes e heterogeneidade de receitas e despesas em saúde, e impactos diferenciados da crise sobre os orçamentos estaduais das regiões. Os resultados sugerem o efeito protetor relacionado à vinculação constitucional da saúde, aos compromissos e prioridades de gastos, e aos mecanismos de compensação de fontes de receitas do federalismo fiscal nas despesas em saúde dos estados. Contudo, permanecem desafios para a implantação de um sistema de transferências que diminua as desigualdades e estabeleça maior cooperação entre os entes, em um contexto de austeridade e fortes restrições ao financiamento público da saúde no Brasil.


Abstract This study aims to analyze regional trends and patterns of health revenues and expenditure in the Brazilian states from 2006 to 2016. This is an exploratory and descriptive study based on secondary national data and selected indicators. Higher per capita net current revenues for all states and regions, with decreasing levels in specific years associated with the crises of 2008-2009 and 2015-2016 were observed. Per capita health expenditure showed an increasing trend, even in times of economic crisis and declining collection. Diversity of sources and heterogeneity of health revenues and expenditures, as well as different impacts of the crisis on the regional budgets, were observed. The results suggest the protective effect of constitutional health linkage, spending commitments and priorities, and compensation mechanisms of fiscal federalism revenue sources in state health expenditures. However, challenges remain for the implementation of a transfer system that reduces inequalities and establishes greater cooperation among entities, in a context of austerity and strong public health financing constraints in Brazil.


Assuntos
Humanos , Planos Governamentais de Saúde/economia , Planos Governamentais de Saúde/tendências , Gastos em Saúde/tendências , Financiamento da Assistência à Saúde , Financiamento Governamental/tendências , Renda/tendências , Fatores de Tempo , Brasil , Governo Federal , Financiamento Governamental/economia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...