Health service utilization among adults aged 50+ across eleven European countries (the SHARE study 2004/5)

Socio-economic inequalities in the use of flu vaccination in Europe: a multilevel approach

BACKGROUND

The European-wide statistics show that the use of flu vaccination remains low and the differences between countries are significant, as are those between different population groups within each country. Considerable research has focused on explaining vaccination uptake in relation to socio-economic and demographic characteristics, health promotion and health behavior factors. Nevertheless, few studies have aimed to analyze between-country differences in the use of flu vaccination for the EU population. To address this gap, this study examines the socio-economic inequalities in the use of influenza vaccination for the population aged 15 years and over in all 27 EU Member States and two other non-EU countries (Iceland and Norway).

METHODS

Using data from the third wave of European Health Interview Survey (EHIS) 2019, we employed a multilevel logistic model with a random intercept for country, which allows controlling simultaneously the variations in individuals' characteristics and macro-contextual factors which could influence the use of flu vaccination. In addition, the analysis considers the population stratified into four age groups, namely adolescents, young adults, adults and elderly, to better capture heterogeneities in flu vaccination uptake.

RESULTS

The main findings confirm the existence of socio-economic inequalities between individuals in different age groups, but also of significant variation between European countries, particularly for older people, in the use of influenza vaccination. In this respect, income and education are strong proxy of socio-economic status associated with flu vaccination uptake. Moreover, these disparities within each population group are also explained by area of residence and occupational status. Particularly for the elderly, the differences between individuals in vaccine utilization are also explained by country-level factors, such as the type of healthcare system adopted in each country, public funding, personal health expenditure burden, or the availability of generalist practitioners.

CONCLUSIONS

Overall, our findings reveal that vaccination against seasonal influenza remains a critical public health intervention and bring attention to the relevance of conceiving and implementing context-specific strategies to ensure equitable access to vaccines for all EU citizens.

Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20

This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

BACKGROUND

This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events.

RESULTS

In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care.

CONCLUSIONS

The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners' penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.