Spatial analysis of socioeconomic data and its relationship with illicit crops in Nariño-Colombia.

The Sustainable Development Goals (SDGs) aim to eradicate poverty and promote sustainable development; however, socioeconomic disparities persist globally, particularly in Colombia. With a Gini index of 0.556 in 2022, Colombia ranks among the most unequal countries in Latin America, with its southwest region of Nariño facing severe socioeconomic challenges. Concurrently, Nariño registers the highest levels of coca cultivation in Colombia, accounting for 65% of national cocaine production, reflecting the region's precarious conditions. This study investigates the extent to which the spatial distribution of socioeconomic factors explains coca cultivation patterns in Nariño. Grounded in conflict economics, social capital, and social marginalization theories, the research constructs composite indices representing education, health, public services, economic conditions, and vulnerability. Using spatial analysis, it identifies areas with heightened poverty and vulnerability and examines their relationship with illicit crops. The findings highlight spatial non-stationarity in the factors influencing coca cultivation, offering region-specific insights and policy recommendations to combat illicit crops and foster sustainable development. These results provide a foundation for targeted interventions and contribute to broader strategies addressing inequality and illegal economies in Colombia.

Association Between the Nutritional Quality of Food Purchases and Household Food at Home Expenditures in Mexico.

BACKGROUND: Poor-quality diets are a major risk factor for noncommunicable diseases. Few studies in Mexico have tested whether higher expenditures are needed to purchase high-quality food. OBJECTIVE: The objective of the study was to assess how dietary quality of food purchases was associated with household food at home expenditures. DESIGN: This study was a secondary analysis of cross-sectional data from the National Household Income and Expenditure Survey (EncuestaNacional de Ingresos y Gastos de los Hogares [ENIGH] 2018). PARTICIPANTS/SETTING: The study included 74 469 households with information on food and beverage purchases in Mexico in 2018. MAIN OUTCOME MEASURES: Quarterly household food at home expenditures by adult equivalent (AE) for all food groups that were scored with the Global Dietary Quality Score (GDQS) for food purchases expressed in dollars/quarterly/AE. STATISTICAL ANALYSES PERFORMED: Adjusted generalized linear models were used to evaluate the association between GDQS for food purchases (expressed in tertiles: low, mid, and high) and quarterly food expenditures. The analyses were performed at the national level by place of residence and income quintile. RESULTS: At the national level, the difference in food expenditures between the high- and the low-GDQS groups was +$13.85/AE. By place of residence, the difference between the high- and the low-GDQS groups was +$17.31/AE in urban and +$5.12/AE in rural areas. For income quintile 1 (lowest), there was a statistical difference of -$4.79/AE and +$43.25 for quintile 5 (highest). CONCLUSIONS: Quality of food purchases can be associated with higher or lower expenditures depending on the specific food purchased. High GDQS is associated with lower expenditures among the lowest-income households as they purchase less expensive options compared with high-income households.

Effect of age-related premium readjustment on health insurance cancellation in Brazil: Regression discontinuity approach.

Age is one of the most relevant observable risk attributes in determining the value of health insurance premiums. Empirical evidence indicates that the cost of health insurance is the leading cause of contract switching, which can compromise access to healthcare services and potentially result in treatment discontinuities. Using data from a Health Maintenance Organization in the Southern region of Brazil, we examined the effect of health plan price readjustment resulting from changes in the beneficiary's age group on disenrollment or switches to a more limited coverage plan. The estimates were obtained using the method of regression discontinuity. The main findings indicate that for age group transitions at 59 years old, the price readjustment effect led to an increase in contract cancellations and switching to cheaper plans. These findings highlight that an important consequence of the difference in premium sensitivity among age groups is that the exit of individuals from the health insurance sector is selective in age. The results of this paper can support policymaking to improve access to health insurance.

Bereaved Parents' Perspectives on Financial Toxicity at End of Life for Children with Cancer: A Qualitative Study.

OBJECTIVE: To explore financial toxicity (FT) experienced by the parents of children with cancer at end-of-life (EOL), including exploring differences by race and ethnicity. STUDY DESIGN: We performed secondary analysis of semistructured interviews of bereaved parents' perspectives on quality EOL care. Fifty-five interviews were conducted in California and Alabama representing 48 children (0-21 years at time of death) who died of cancer ≥6 months prior. Quotes related to FT were identified and iteratively grouped into themes without an a priori framework. RESULTS: Most participants were non-Hispanic White (30; 55%), and the most common diagnoses were noncentral nervous system solid tumors (16; 33%) and central nervous system tumors (16; 33%). Children died at a mean age of 11 and a median of 4 years prior to the interview. Almost all parents (52; 95%) discussed FT, including all Black and Hispanic parents. Parents identified transportation, housing, other basic needs, funeral costs, and medical costs as well as work disruptions as contributors to FT at EOL. Barriers to financial wellness included navigating insurance, insufficient financial support from the hospital, and long-term FT from treatment. Many parents discussed how the hospital and community served as facilitators of financial wellness. In some cases, finances prevented families from accessing nursing services and mental health support and affected EOL decisions. CONCLUSIONS: As FT affected almost all families' EOL experience, pediatric oncology programs should routinely screen for FT at EOL and ensure they have the resources to respond.

Acceptability and willingness to pay for a hypothetical HIV vaccine in Brazil and the implications: a cross-sectional study.

INTRODUCTION: The Human Immunodeficiency Virus (HIV) is one of the greatest public health challenges still facing communities worldwide, and until this moment, no vaccine is available for its prevention. In Brazil, the Rio de Janeiro State has stood out regarding the prevalence of this disease. As a result, an important state to consider the Willingness to Pay (WTP) for a hypothetical HIV vaccine to help with future pricing. METHODS: A cross-sectional study was conducted to assess the acceptability and WTP of individuals from Rio de Janeiro State for a hypothetical HIV vaccine with a 70% efficacy. RESULTS: 600 individuals were interviewed and the acceptability for this hypothetical vaccine was 77.2%. In addition, 452 participants were eligible for the WTP analysis and would accept a WTP US$79.37 (400 BRL) for this vaccine, a higher value than that found in another study (200 BRL) conducted in the Northern region of Brazil under the same methodological conditions. CONCLUSION: Economic studies such as WTP can contribute to discussions regarding the prices and specifications for future vaccines, particularly for a HIV vaccine in countries such as Brazil with over 5,000 municipalities spread across regions with diverse characteristics and challenges in terms of socioeconomic, epidemiological and cultural differences.

Direct healthcare costs for people with cerebral palsy in the Brazilian unified health system between 2015 and 2019.

BACKGROUND: Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. RESEARCH DESIGN AND METHODS: Health records of people with CP in the Hospital and Outpatient Information Systems of Brazil between 2015 and 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. RESULTS: A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD 'spastic quadriplegic CP' received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU, and the types of CP are related to increased cost. CONCLUSIONS: Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assist in better resource allocation for more effective healthcare provision.

Budget impact and cost per responder analysis of upadacitinib for the treatment of moderate to severe atopic dermatitis from the perspective of the social security and the private sector in Argentina.

OBJECTIVES: Our study assessed the budget impact and cost per responder of upadacitinib15mg and 30 mg for moderate to severe atopic dermatitis (MS-AD) treatment from social security and private health sector perspective in Argentina. METHODS: A budget impact model was adapted to depict clinical and economic aspects of treatment over a 5-years horizon time. Scenario analyses and deterministic sensitivity analyses were performed. A 16-weeks cost per responder model was adapted based on a network meta-analysis. Primary analyses assessed the cost per Eczema Area and Severity Index 50, 75 and 90 at week 16. RESULTS: The inclusion of upadacitinib 15 mg and 30 mg in the biological treatment mix for MS-AD was associated with an average budget saving per-member per-month ofU$S0.062 (social security) and U$S0.064 (private sector). Percentage of patients with access to treatment, acquisition cost of upadacitinib 30 mg and prevalence of MS-AD were the most influential parameters in the budget impact results. At week 16, upadacitinib 30 mg was associated with the lowest number needed to treat and the lowest cost per responder for all outcomes. CONCLUSION: The introduction of upadacitinib in MS-AD treatment was associated with modest savings for the social security and private payer budget in Argentina.

The Limits to Food and Beverage Industry Influence over Fiscal and Regulatory Policy in Latin America.

CONTEXT: Little is known about the political, institutional, and social contexts contributing to a decline in food and beverage industry power and influence over fiscal policy (soda taxes) and regulatory policy (sales/advertising restrictions and food labels). This article addresses this issue by exploring why Mexico and Chile eventually saw such a decline in the food and beverage industry's influence, whereas a similar decline did not occur in Brazil. The article argues that in Mexico and Chile, these outcomes are explained by presidential, congressional, and bureaucratic interests shifting to pursue policies that went against industry preferences. METHODS: This article took a qualitative methodological approach to comparative historical research. FINDINGS: Policy makers' interest in pursuing stronger food and beverage regulations were shaped by economic and public health concerns, new electoral contexts, epidemiological information, and normative beliefs. In Mexico, the infiltration of nutrition researchers within government facilitated this process. By contrast, Brazil's government was divided about pursuing regulatory policies, with presidents favoring partnerships with industry to implement a popular antihunger program; industry's power endured there with limited progress in policy reforms. CONCLUSION: Governments can eventually overcome industry power and policy influence, but it depends on a whole-government commitment to reform.

Open versus endoscopic surgery with helmet molding therapy in non-syndromic patients with craniosynostosis: an updated systematic review and meta-analysis of clinical outcomes and treatment-related costs.

OBJECTIVE: There is an ongoing debate regarding the optimal treatment for craniosynostosis as diverse factors influence the election between endoscopic and open surgery. Previous evidence favors endoscopic procedures. However, evidence remains unfulfilled by a limited number of patients and clustered in very few centers worldwide making it difficult to define it as a replicable technique in different populations. In recent years, evidence regarding endoscopic-assisted procedures has gone through a considerable spurt showing an increased interest among surgeons globally showing optimal outcomes in different populations and centers. In this systematic review and meta-analysis, we performed an updated analysis of previous reviews, including only non-syndromic patients. We also seek to provide a summary of the tendency of treatment observed in the literature. Similarly, this is the first study to include total costs within its analysis. MATERIAL AND METHODS: Three previous meta-analyses published in 2018 yielded 11 eligible papers. We performed a systematic review and meta-analysis of the literature in MEDLINE and EMBASE databases through PubMed, Scopus, and Ovid to fill the gap of information between 2018 and 2024. Twenty-three total articles were included in the final analysis. RESULTS: Variables analyzed were baseline characteristics, length of stay, blood loss, transfusion rates and volume, operative time, and costs. The analysis of data concluded a younger age at surgery in patients undergoing endoscopic surgery (p ≤0.00001). Blood loss, transfusion rates, and volumes depicted favored outcomes for endoscopy with less blood loss during surgery (p ≤0.00001), operative time (p ≤0.00001), and transfusion rates (p ≤0.00001) as well as lower transfused volumes (p ≤0.00001). CONCLUSION: Endoscopic surgery carries fewer complications than open surgery. Treatment-related costs are highly decreased in endoscopic procedures after including costs related to outpatient care. Open surgery can be considered in older children if no endoscope or experienced surgeons in endoscopic procedures are available.

Average direct cost of peripherally inserted central catheterization by nurses in hospitalized patients: a cost estimate.

OBJECTIVE: This study aimed to estimate the direct costs of peripherally inserted central catheterization by nurses for hospitalized patients. METHODS: A cost estimation study using a quantitative approach was conducted in a public teaching hospital in northern Paraná to calculate the direct costs of peripherally inserted central catheterization. The population included all medical records of patients between 15 and 99 years of age who were hospitalized and underwent peripherally inserted central catheterization by nurses between January 1, 2019, and December 31, 2021, totaling 664 insertions. The sample comprised 631 insertions. RESULTS: The catheter kits (epicutaneous catheter + introducer + angulators) corresponded to the items with the highest unit costs and the greatest impact on the composition of costs. The cost of peripherally inserted central catheterization was US$ 217.14 (SD=75.21), with the cost of materials and staff's labor being US$ 195.39 (SD=74.15) and US$ 20.00 (SD=2.22), respectively. CONCLUSION: Materials represented the highest cost, which was explained by the high unit cost of catheters and kits used in echocardiography, followed by the staff's labor costs. The estimated average direct cost allowed for financial visibility of the inputs used. The key challenge is promoting lasting changes in the behavior of managers who carry out administrative functions in healthcare institutions, where proper budget management directly affects the allocative efficiency of resources and the quality of care.

Cost of dengue in Colombia: A systematic review.

BACKGROUND: Dengue is hyperendemic in Colombia. It imposes a substantial economic burden on patients, caregivers, society, and the national health system. We intend to identify and synthesize the evidence regarding the economic burden of dengue in Colombia. METHODS: A systematic review (PROSPERO CRD42021257985) of economic studies was performed. A comprehensive search was completed in PubMed, EMBASE, the Cochrane Library, the LILACS, and SciELO databases. Study selection and data extraction was made by two researchers. RESULTS: 160 records were identified. Of these, 14 studies were selected for data extraction. Direct medical cost of dengue is mainly represented by hospitalization (USD 823 to 1,754). The annual aggregated cost is near to USD 159.6 million, with ambulatory care (USD 90.1 million) and fatal cases (USD 30.7 million) representing 75% of the total cost. The aggregate indirect cost (due to loss in income while sick or as a caretaker) was USD 92.8 million. Vaccination seems to reduce the economic cost of dengue. CONCLUSIONS: Dengue financial burden could be challenging for low-income communities as those affected in Colombia. An integrated approach including vector control and the introduction of a vaccine for dengue has the potential to reduce the economic burden of the disease.

Improving Affordability in Dermatology: Cost Savings in Mark Cuban Cost Plus Drug Company Versus GoodRx.

Unlabelled: This observational cost analysis was conducted to assess the efficacy of the Mark Cuban Cost Plus Drug Company (CostPlus) relative to GoodRx and found that CostPlus has significant potential to improve the financial burden of prescription medications within dermatology.

COSTS FOR THE SURGICAL TREATMENT OF OBESITY THROUGH LAPAROSCOPY IN A FEDERAL TERTIARY HOSPITAL BY THE BRAZILIAN UNIFIED HEALTH SYSTEM.

BACKGROUND: Obesity is a multifactorial disease affecting a significant portion of the population. Bariatric surgery emerges as a prominent approach in this context, representing an effective treatment both in the short and long term. The costs associated with bariatric surgery vary depending on the characteristics of the patients, current hospital practices, and available funding sources. AIMS: To analyze the costs of minimally invasive bariatric surgery for the treatment of obesity in a tertiary federal public hospital. METHODS: An observational and descriptive study aimed at assessing the costs associated with laparoscopic vertical gastrectomy (GV) and Roux-en-Y gastric bypass (RYGB) in a federal public tertiary service from 2018 to 2021. Data were obtained through the management of medical-hospital expenses related to surgical and anesthetic supplies, as well as the amount reimbursed by the funding source to the hospital. RESULTS: Over the analyzed period, a total of 177 minimally invasive bariatric surgeries were performed. In terms of the charges, since 2018, the hospital has been receiving an amount of R$ 6,145.00 for the "bariatric surgery by videolaparoscopy" procedure, which includes RYGB, and R$ 4,095.00 for "vertical gastrectomy." Regarding the average hospital cost of surgical supplies, RYGB incurred a total of R$ 9,907.54, while GV incurred a total of R$ 9,315.84. The average total cost of RYGB was R$ 10,799.23, and, for GV, it was R$ 10,207.53. These figures indicate that the hospital incurred a loss of approximately R$ 4,654.23 for performing RYGB and R$ 6,112.53 for GV. CONCLUSION: Despite the increasing number of eligible patients for surgical treatment of obesity and the consequent quantitative growth of these procedures funded by the Brazilian Unified Health System (SUS), the costs exceed the reimbursement from the funding source in federal public hospitals. There is a need for a precise assessment of financing in the fight against obesity.

Correlation between increased flushing intervals and malfunction and infectious complications in fully implantable catheters during the COVID-19 pandemic.

OBJECTIVE: To evaluate the incidence of malfunction and colonization rates of fully implantable long-term catheters left unflushed during the COVID-19 pandemic; and to evaluate the average cost of transporting each patient to the hospital for flushing. METHODS: During the COVID-19 pandemic, patients reduced the number of hospital visits and stopped flushing their catheters periodically with saline solution. After the pandemic stabilized in 2022, patients who completed chemotherapy treatment had their long-term catheters removed. We evaluated the catheters' function and colonization rates. To evaluate the incidence of malfunctions and the colonization rate of these catheters, we tested the flow and reflux during removal surgery, before removal, and by culturing their tips. These catheters were divided into two groups: a standard group, in which the last flushing occurred before 90 days, and another group, in which the last flushing occurred after 90 days. We analyzed the correlation between the time at which these catheters were closed, the incidence of malfunction, and the colonization rate of these catheters. To avoid confusion due to the reduced sample size, a second analysis was performed between the group of catheters that did not work and those that worked, evaluating the time they were closed and the catheter tip culture. We also analyzed the financial costs for each patient from home to the hospital. RESULTS: Among the 66 patients included in the study, 28 spent >90 days without catheter flushing, and 38 spent <90 days. The incidence of infection occurred in two patients with >90 days of flushing and in three patients with <90 days of flushing. Catheter malfunction occurred in 4 patients in the group with >90 days without flushing and in 5 patients with <90 days of flushing. In the secondary analysis, the group with a functioning catheter (n=52) had a mean time of 152 days, whereas for the group with a non-functioning catheter (n=9), the mean time was 229 days (p=0.51). No differences were statistically significant. No correlation was found between the colonization rate of catheter in the group with a functioning or non-functioning catheter, as the group with a functioning catheter had three cases of positive catheter tip culture and the group with a non-functioning catheter had one case of positive catheter tip culture. The average cost for each patient to travel from home to the hospital was 39.01 reais (approximately 7.50 USD). CONCLUSION: Among the patients followed up at our hospital during the COVID-19 pandemic, no statistically significant difference was observed in the function and colonization rate of long-term catheters between those who underwent flushing at intervals of <90 days and those with intervals of >90 days.

Did industrial and export complexity drive regional economic growth in Brazil?

Research on productive structures has shown that economic complexity conditions economic growth. However, little is known about which type of complexity, e.g., export or industrial complexity, matters more for regional economic growth in a large emerging country like Brazil. Brazil exports natural resources and agricultural goods, but a large share of the employment derives from services, non-tradables, and within-country manufacturing trade. Here, we use a large dataset on Brazil's formal labor market, including approximately 100 million workers and 581 industries, to reveal the patterns of export complexity, industrial complexity, and economic growth of 558 micro-regions between 2003 and 2019. Our results show that export complexity is more evenly spread than industrial complexity. Only a few-mainly developed urban places-have comparative advantages in sophisticated services. Regressions show that a region's industrial complexity is a significant predictor for 3-year growth prospects, but export complexity is not. Moreover, economic complexity in neighboring regions is significantly associated with economic growth. The results show export complexity does not appropriately depict Brazil's knowledge base and growth opportunities. Instead, promoting the sophistication of the heterogeneous regional industrial structures and development spillovers is a key to growth. This study demonstrates that industrial complexity, which accounts for all employment sectors, provides a more accurate basis for designing effective and inclusive industrial policies in emerging economies like Brazil, compared to export-based complexity.

General concepts on health economic evaluations. / Conceptos generales sobre las evaluaciones económicas en salud.

Health economics is an area of study that has critical tools for evidence-based healthcare decision making, among which are economic evaluations. These tools allow us to weigh the costs incurred for a given intervention in relation to its health outcomes. The main utility of these studies lies in accomplishing decision-making in healthcare and the formulation of public policies. This article is the first of two reviews on whose main purpose is to address fundamental theoretical concepts of health economic evaluations to facilitate their understanding and critical analysis. The text is part of a methodological series on clinical epidemiology, biostatistics and research methodology conducted by the Evidence-based Medicine team at the School of Medicine of the University of Valparaíso, Chile.

La economía de la salud es un área de estudio que cuenta con herramientas críticas para la toma de decisiones basadas en evidencia en salud, entre las que se encuentran las evaluaciones económicas. Estas permiten ponderar los costos en que se incurre para una determinada intervención respecto a sus consecuencias o desenlaces sanitarios. La principal utilidad de estos estudios radica en lograr decisiones informadas, y formular políticas públicas. El presente artículo corresponde a la primera de dos revisiones tituladas "Aproximación a las evaluaciones económicas en salud", cuyo propósito principal es abordar conceptos teóricos fundamentales de las evaluaciones económicas en salud para facilitar la comprensión y el análisis crítico de las mismas. A su vez, esta publicación se ha desarrollado en el contexto de una serie metodológica de epidemiología clínica, bioestadística y metodología de la investigación realizada por la cátedra de Metodología de la Investigación y de Medicina Basada en la Evidencia de la Escuela de Medicina de la Universidad de Valparaíso, Chile.

The effect of economic crisis and austerity measures on deaths of despair in Brazil: An interrupted time series analysis.

Some recent analyses have described that, in the context of the instability of social protection institutions and economic crisis, there is an increase in mortality rates selectively from drug overdoses, suicides and alcohol-related liver diseases. This group of causes was named "Deaths of Despair. In the last decade, Brazil experienced economic stagnation and fiscal austerity, influencing the profile of illnesses and deaths. Therefore, our study aimed to evaluate the effect of the economic crisis and fiscal austerity measures on deaths of despair in Brazil and to describe the trend of deaths of despair in Brazil between 2003 and 2018, according to the phases of the economic cycle. We analyzed the time series of rates by covariates and fitted an interrupted time series model to assess the effect of the crisis on the trend through the Prais-Winsten method. The temporal analysis showed a significant difference in the mean values ​ before and after economic stagnation (Mean 8.68 ± 0.71) and after (Mean 11.62 ± 0.62). We found a positive association between the economic crisis and deaths of despair, with a significant change in level (p-value = 0.003) and a non-significant trend effect (p-value = 0.300). There are differences in sex, age, and especially race: men, middle-aged and black/brown people are more at risk. The present study presents the effect of the economic crisis and mortality in the population, with demographic differences.

Impact of health conditions on non-medical costs: a time series analysis of disability insurance and hospital medical costs in Brazil (2010-2019).

BACKGROUND: Disability insurance represents a significant economic burden within Brazil's social security system, yet long-term cost trends across disease groups remain understudied, hindering informed prevention and management strategies. Hospital costs, which account for approximately 40% of direct healthcare expenses, were selected as a comparative reference to contextualize the economic burden of disability insurance. OBJECTIVE: This study analyzes long-term cost trends of newly granted disability insurance by disease groups in Brazil, comparing them to public health system hospitalization expenses. METHOD: This ecological time series study applied the inflection point regression model and Annual Average Percentage Change (AAPC) analysis, utilizing open-access federal government datasets. Annual rates and costs of disability insurance and hospitalizations were examined, categorized by International Classification of Diseases, 10th Revision (ICD-10) groups, and standardized per insured individuals and the general population. RESULTS: Between 2010 and 2019, the rate of temporary disability insurance granted (406 per 10,000 insureds) was 94% higher than permanent disability insurance (24 per 10,000), with women showing slightly higher rates but men incurring higher costs. The overall annual average rate of granted disability insurance (430 per 10,000 insureds) and its costs (BRL 5,084 per 100 insureds) were lower than those of hospitalizations (525 per 10,000 and BRL 5,870 per 100 Brazilians, respectively). Disabilities due to injuries, musculoskeletal disorders, and mental health problems had the highest rates (126, 89, and 40 per 10,000 insureds, respectively) and costs (BRL 1,455, 1,076, and 533 per 100 insureds, respectively). Neoplasms showed the only increasing trend in granted rates (AAPC 2.5%). The cost growth of granted disability insurance (AAPC 6.2%) was twice that of hospitalization costs (AAPC 2.9%), with disability insurance costs surpassing hospitalization expenses by 2018. Although most disease groups exhibited stable or declining trends in granted rates, costs increased across nearly all conditions. CONCLUSION: The rising costs of disability insurance in Brazil highlight the growing economic burden of non-medical expenses and the need for evidence-based policies focused on prevention, management, and the sustainability of the social security system.

Social and economic impacts of non-communicable diseases by gender and its correlates: a literature review.

BACKGROUND: Tackling social impacts derived from gender disparities is a pathway to universal health coverage (UHC). Gender intersects with other factors behind social and health inequalities, exacerbates them and influences health systems' performance. However, there is scarcity of gender-based studies that assess the social and economic impacts of non-communicable diseases (NCDs). This study aims to identify economic and social impacts of NCDs by gender and its correlates. METHODS: Following the guidelines proposed in the Cochrane Manual for Systematic Reviews of Interventions and the PRISMA Statement, we conducted a narrative and structured literature review to identify the economic (direct medical and non-medical, and indirect costs) and social (right to health, employment, poverty, social exclusion, and others) impacts of NCDs by gender, and its structural, sociodemographic, health conditions, political and health systems correlates, for the period 2002-2022, in English and Spanish. Reviewed studies were described according to country and research context, temporal evolution, gender, impacts of NCDs and correlates. FINDINGS: Five thousand five hundred fifty-one publications by title and abstract were reviewed, and 185 articles were selected. There is limited evidence with gender perspective addressing the social and economic impacts of NCDs (around 10% of publications) that helps to better understand the difference in the burden of these conditions between men and women. We identified that the social burden primarily affects women in their quality of life, where gender inequities are observed in aspects such as: health care, employment status and living conditions. In addition, a greater responsibility falls on them as caregivers. On the other hand, the economic burden affects more to men, both in terms of direct medical costs and indirect costs. Among the factors that most influenced the identified impacts, we found gender, age, and socioeconomic level. We also identified that access to health insurance that offers financial protection against these conditions is essential to reduce these impacts. CONCLUSIONS: NCDs pose a significant social and economic burden due to their impact on the health of the population, healthcare systems, and the economies of households and nations, which will likely increase over time. This impact is closely related to gender, although it has been scarcely documented. Public policies aimed at enhancing access and achieving UHC are essential to guarantee effective financial protection in health, especially for the most vulnerable sectors of the population.

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme.

BACKGROUND: Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders. METHODS AND FINDINGS: This cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10). CONCLUSIONS: BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.