1
|
Wang C, Shi L. Epidemiological trend of lung cancer burden caused by residential radon exposure in China from 1990 to 2019. Eur J Cancer Prev 2024; 33:232-240. [PMID: 37997905 DOI: 10.1097/cej.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVE This study employed time series data to assess long-term changes in the burden of lung cancer (LC) caused by residential radon exposure, an important environmental risk factor, so as to develop evidence-based strategies for future public health management. METHODS Based on the open data from the Global Burden of Disease (GBD 2019) database, we conducted an analysis of the residential radon exposure-caused LC mortality, disability-adjusted life years (DALYs), and corresponding crude rates and age-standardized rates (ASRs) for various age groups. We employed the employed age-period-cohort (APC) model to investigate the age, period, and cohort effects of the data, allowing us to discern the trends in LC disease burden attributable to radon exposure in residential settings over time. RESULTS From 1990 to 2019, age-standardized mortality rates (ASMR) and age-standardized DALYs rates of LC caused by residential radon exposure in China demonstrated an overall increasing trend, with males higher than females. The CMR and crude DALYs rate for males were higher than those for females across all age groups. The APC analysis revealed that the local drift of LC death and DALYs rates in males and females showed a decreasing trend before 60 and an increasing trend after 60. CONCLUSION The persistent presence of residential radon exposure as a crucial risk factor for LC underscores the need for public health authorities and policymakers to take more proactive measures to reduce radon exposure. Particularly, attention should be paid on the elderly population and male patients.
Collapse
Affiliation(s)
- Chengzhi Wang
- Department of Oncology and Hematology, The People's Hospital of Tongliang District, Chongqing City, China
| | | |
Collapse
|
2
|
Kolié D, Guillard E, Sow A, Manet H, Camara BS, Bigirimana T, Harouna M, Delamou A. Exploring experiences of HIV care to optimize patient-centred care in Conakry, Guinea: a qualitative study. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1134404. [PMID: 38655091 PMCID: PMC11035823 DOI: 10.3389/frph.2024.1134404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Studies on the organisation of care and the power dynamic between providers and patients with HIV in sub-Saharan Africa are rare. This study aims to describe the patient-provider relationship and explore the challenges to optimal and patient-centred care for HIV patients. Methods This was a qualitative exploratory descriptive study using in-depth individual interviews and focus group discussions. In total, 17 individual interviews and 5 focus group discussions were conducted. This was conducted in four urban health facilities in Conakry, the capital of Guinea. Three group of participants were included in this study namely patients with HIV; health providers including facilities and services managers; and psychosocial counsellors. Psychosocial counsellors provide emotional and psychosocial support to HIV patients. Their role in the organization care in Guinea is new and they contribute to strengthening adherence of patients with HIV to ARV treatment. Results Patients with HIV, health providers, and psychosocial counsellors have a positive perception of the patient-provider relationship. This relationship was characterized essentially by maintaining confidentiality of HIV status disclosure, caring attitudes towards patients (being available, adjusting locations for accessing ART, based on patients' preferences), and participating in HIV patient's social life. However, scolding and miscommunication about the interpretation of viral load tests were reported. The shortage of human resources, low salaries of health staff, poor infrastructure, and the financial burden borne by patients with HIV impede the implementation of optimal patient-centred care. Conclusion Integrating psychosocial counsellors in HIV care organization, improving access to ARV, infrastructure, increasing human resources, and removing the financial burden for HIV patients are needed to optimal patient-centred care in Guinea.
Collapse
Affiliation(s)
- Delphin Kolié
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | | | - Hawa Manet
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Bienvenu Salim Camara
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | | | - Alexandre Delamou
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| |
Collapse
|
3
|
Verjans A, Hooley B, Tani K, Mhalu G, Tediosi F. Cross-sectional study of the burden and determinants of non-medical and opportunity costs of accessing chronic disease care in rural Tanzania. BMJ Open 2024; 14:e080466. [PMID: 38553069 PMCID: PMC10982752 DOI: 10.1136/bmjopen-2023-080466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Countries in sub-Saharan Africa are seeking to improve access to healthcare through health insurance. However, patients still bear non-medical costs and opportunity costs in terms of lost work days. The burden of these costs is particularly high for people with chronic diseases (CDs) who require regular healthcare. This study quantified the non-medical and opportunity costs faced by patients with CD in Tanzania and identified factors that drive these costs. METHODS From November 2020 to January 2021, we conducted a cross-sectional patient survey at 35 healthcare facilities in rural Tanzania. Using the human capital approach to value the non-medical cost of seeking healthcare, we employed multilevel linear regression to analyse the impact of CDs and health insurance on non-medical costs and negative binomial regression to investigate the factors associated with opportunity costs of illness among patients with CDs. RESULTS Among 1748 patients surveyed, 534 had at least one CD, 20% of which had comorbidities. Patients with CDs incurred significantly higher non-medical costs than other patients, with an average of US$2.79 (SD: 3.36) compared with US$2.03 (SD: 2.82). In addition, they incur a monthly illness-related opportunity cost of US$10.19 (US$0-59.34). Factors associated with higher non-medical costs included multimorbidities, hypertension, health insurance and seeking care at hospitals rather than other facilities. Patients seeking hypertension care at hospitals experienced 35% higher costs compared with those visiting other facilities. Additionally, patients with comorbidities, older age, less education and those requiring medication more frequently lost workdays. CONCLUSION Outpatient care in Tanzania imposes considerable non-medical costs, particularly for people with CDs, besides illness-related opportunity costs. Despite having health insurance, patients with CDs who seek outpatient care in hospitals face higher financial burdens than other patients. Policies to improve the availability and quality of CD care in dispensaries and health centres could reduce these costs.
Collapse
Affiliation(s)
- Anna Verjans
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Brady Hooley
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Kassimu Tani
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
4
|
Oh DJ, Han JW, Kim TH, Kwak KP, Kim BJ, Kim SG, Kim JL, Moon SW, Park JH, Ryu SH, Youn JC, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW. Association of Depression With the Progression of Multimorbidity in Older Adults: A Population-Based Cohort Study. Am J Geriatr Psychiatry 2024:S1064-7481(24)00263-X. [PMID: 38443296 DOI: 10.1016/j.jagp.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The relationship between depression and the risk of multimorbidity progression has rarely been studied in older adults. This study was aimed to determine whether depression is associated with progression in the severity and complexity of multimorbidity, considering the influence of depression's severity and subtype. METHODS As a part of the Korean Longitudinal Study on Cognitive Aging and Dementia, this population-based cohort study followed a random sample of community-dwelling Koreans aged 60 and older for 8 years at 2-year intervals starting in 2010. Participants included those who completed mood and multimorbidity assessments and did not exhibit complex multimorbidity at the study's outset. Depression was assessed using the Geriatric Depression Scale, while multimorbidity was evaluated using the Cumulative Illness Rating Scale. The study quantified multimorbidity complexity by counting affected body systems and measured multimorbidity severity by averaging scores across 14 body systems. FINDINGS The 2,486 participants (age = 69.1 ± 6.5 years, 57.6% women) were followed for 5.9 ± 2.4 years. Linear mixed models revealed that participants with depression had a faster increase in multimorbidity complexity score (β = .065, SE = 0.019, p = 0.001) than those without depression, but a comparable increase in multimorbidity severity score (β = .001, SE = .009, p = 0.870) to those without depression. Cox proportional hazard models revealed that depression was associated with the risk of developing highly complex multimorbidity affecting five or more body systems, particularly in severe or anhedonic depression. INTERPRETATION Depression was associated with the worsening of multimorbidity in Korean older adults, particularly when severe or anhedonic. Early screening and management of depression may help to reduce the burden of multimorbidity in older adults.
Collapse
Affiliation(s)
- Dae Jong Oh
- Workplace Mental Health Institute (DJO), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry (JWH, KWK), Seoul National University Bundang Hospital, Gyeonggido, Korea
| | - Tae Hui Kim
- Department of Psychiatry (THK), Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry (KPK), Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bong Jo Kim
- Department of Psychiatry (BJK), Gyeongsang National University School of Medicine, Jinju, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry (SGK), Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jeong Lan Kim
- Department of Psychiatry (JLK), School of Medicine, Chungnam National University, Daejeon, Korea
| | - Seok Woo Moon
- Department of Psychiatry (SWM), School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry (JHP), Jeju National University Hospital, Jeju, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry (S-HR), School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry (JCY), Kyunggi Provincial Hospital for the Elderly, Yongin, Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry (DWL), Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seok Bum Lee
- Department of Psychiatry (SBL, JJL), Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- Department of Psychiatry (SBL, JJL), Dankook University Hospital, Cheonan, Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry (JHJ), Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry (JWH, KWK), Seoul National University Bundang Hospital, Gyeonggido, Korea; Department of Brain and Cognitive Science (KWK), Seoul National University College of Natural Sciences, Seoul, Korea.
| |
Collapse
|
5
|
Zhao HN, Yin H, Liu JY, Song LL, Peng YL, Ma BY. Deep learning-assisted ultrasonic diagnosis of cervical lymph node metastasis of thyroid cancer: a retrospective study of 3059 patients. Front Oncol 2024; 14:1204987. [PMID: 38390270 PMCID: PMC10881794 DOI: 10.3389/fonc.2024.1204987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
Objective This study aimed to develop a deep learning system to identify and differentiate the metastatic cervical lymph nodes (CLNs) of thyroid cancer. Methods From January 2014 to December 2020, 3059 consecutive patients with suspected with metastatic CLNs of thyroid cancer were retrospectively enrolled in this study. All CLNs were confirmed by fine needle aspiration. The patients were randomly divided into the training (1228 benign and 1284 metastatic CLNs) and test (307 benign and 240 metastatic CLNs) groups. Grayscale ultrasonic images were used to develop and test the performance of the Y-Net deep learning model. We used the Y-Net network model to segment and differentiate the lymph nodes. The Dice coefficient was used to evaluate the segmentation efficiency. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the classification efficiency. Results In the test set, the median Dice coefficient was 0.832. The sensitivity, specificity, accuracy, PPV, and NPV were 57.25%, 87.08%, 72.03%, 81.87%, and 66.67%, respectively. We also used the Y-Net classified branch to evaluate the classification efficiency of the LNs ultrasonic images. The classification branch model had sensitivity, specificity, accuracy, PPV, and NPV of 84.78%, 80.23%, 82.45%, 79.35%, and 85.61%, respectively. For the original ultrasonic reports, the sensitivity, specificity, accuracy, PPV, and NPV were 95.14%, 34.3%, 64.66%, 59.02%, 87.71%, respectively. The Y-Net model yielded better accuracy than the original ultrasonic reports. Conclusion The Y-Net model can be useful in assisting sonographers to improve the accuracy of the classification of ultrasound images of metastatic CLNs.
Collapse
Affiliation(s)
- Hai Na Zhao
- Department of Ultrasonography, West China hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hao Yin
- Computer science of Sichuan University, Chengdu, Sichuan, China
| | - Jing Yan Liu
- Department of Ultrasonography, West China hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lin Lin Song
- Department of Ultrasonography, West China hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yu Lan Peng
- Department of Ultrasonography, West China hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bu Yun Ma
- Department of Ultrasonography, West China hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
6
|
Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S. Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nat Med 2024; 30:414-423. [PMID: 38278990 DOI: 10.1038/s41591-023-02769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
Collapse
Affiliation(s)
- Dorit Talia Stein
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa B Reitsma
- Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kokou Agoudavi
- Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Deborah Carvalho Malta
- Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Soares Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Kibachio Joseph Mwangi
- World Health Organization, Pretoria, South Africa
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Maja E Marcus
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
7
|
Brindley C, Wijemunige N, Dieteren C, Bom J, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:127. [PMID: 38263128 PMCID: PMC10807218 DOI: 10.1186/s12913-023-10464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery. METHODS A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT). RESULTS We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed. CONCLUSION Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers. TRIAL REGISTRATION PROSPERO registration number CRD42022340059 .
Collapse
Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Zeng Q, Zhou J, Meng Q, Qian W, Wang Z, Yang L, Wang Z, Yang T, Liu L, Qin Z, Zhao X, Kan H, Hong F. Environmental inequalities and multimorbidity: Insights from the Southwest China Multi-Ethnic Cohort Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 908:167744. [PMID: 37863237 DOI: 10.1016/j.scitotenv.2023.167744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Multimorbidity is an increasingly significant public health challenge worldwide. Although the association between environmental factors and the morbidity and mortality of individual chronic diseases is well-established, the relationship between environmental inequalities and multimorbidity, as well as the patterns of multimorbidity across different areas and ethnic groups, remains unclear. We first focus on analyzing the differences in environmental exposures and patterns of multimorbidity across diverse areas and ethnic groups. The results show that individuals of Han ethnicity residing in Chongqing and Sichuan are exposure to higher levels of air pollutants such as PM2.5, PM10, and NO2. Conversely, Tibetans in Tibet and Yi people in Yunnan face elevated concentrations of O3. Furthermore, the Dong, Miao, Buyi ethnicities in Guizhou and Bai in Yunnan have greater access to green spaces. The key multimorbidity patterns observed in Southwest China are related to metabolic abnormalities combined with digestive system diseases. However, significant differences in multimorbidity patterns exist among different regions and ethnic groups. Further utilizing the logistic regression model, the analysis demonstrates that increased exposure to environmental pollutants (PM2.5, PM10, NO2, O3) is significantly associated with higher odds ratios of multimorbidity. Conversely, a greater presence of green spaces (NDVI 250, NDVI 500, NDVI 1000) significantly reduces the risk of multimorbidity. This large-scale epidemiological study provides some evidence of a significant association between environmental inequalities and multimorbidity. By addressing these environmental inequalities and promoting healthy environments for all, we can work towards reducing the prevalence of multimorbidity and improving overall population health.
Collapse
Affiliation(s)
- Qibing Zeng
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Jingbo Zhou
- Lab of Computational Chemistry and Drug Design, State Key Laboratory of Chemical Oncogenomics, Peking University Shenzhen Graduate School, Shenzhen, 518055, China
| | - Qiong Meng
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Wen Qian
- Chengdu Center for Disease Control and Prevention, Chengdu, 610044, China
| | - Zihao Wang
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - La Yang
- High Altitude Health Science Research Center of Tibet University, Lhasa, 850013, China
| | - Ziyun Wang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Tingting Yang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Leilei Liu
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Zixiu Qin
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
| | - Haidong Kan
- School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| | - Feng Hong
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China.
| |
Collapse
|
9
|
Hu B, Shi Y, Zhang P, Fan Y, Feng J, Hou L. Global, regional, and national burdens of hypertensive heart disease from 1990 to 2019 :A multilevel analysis based on the global burden of Disease Study 2019. Heliyon 2023; 9:e22671. [PMID: 38213586 PMCID: PMC10782162 DOI: 10.1016/j.heliyon.2023.e22671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024] Open
Abstract
Aim This study aimed to describe the prevalence, deaths, and disability-adjusted life-years (DALYs) of hypertensive heart disease (HHD) at the global, regional, and national levels and analyze epidemiological trends. Method We extracted global estimates of prevalence, deaths, and DALYs related to HHD in 204 countries and regions from the 2019 Global Burden of Diseases Study. Average annual percent change (AAPC) was calculated to represent temporal trends. Joinpoint regression models were used to analyze time trends from 1990 to 2019. Finally, the decomposition analysis showed the driving factors of burden changes. Results From 1990 to 2019, the global prevalence of HHD cases increased by 138 %, reaching 18,598,025 cases (95 % uncertainty interval [UI]: 13,544,365-24,898,411). DALYs also rose by 154 %, reaching 21,508,002 (95 % UI, 16,400,051-23,899,879). The death rate increased to 14.95 (95 % UI, 11.11-16.52) per 100,000 people. Of the five sociodemographic index (SDI) regions, the prevalence rate related to HHD was the highest in the high-middle SDI region. In contrast, the death and DALY rate related to HHD were the highest in the middle SDI region. In other regions, the prevalence rate was the highest in East Asia (548.87 per 100,000 people; 95 % UI, 395.40-747.83), and the death rate was the highest in Central Europe (42.64 per 100,000 people; 95 % UI, 30.58-49.38). At the national level, the Cook Islands had the highest prevalence rate for HHD (703.08 per 100,000 people; 95 % UI, 532.87-920.72), Bulgaria had the highest death rate (75.08 per 100,000 people; 95 % UI, 46.38-92.81), and Afghanistan had the highest DALY rate (1374.12 per 100,000 people; 95 % UI, 467.17-2020.70). High body mass index, a diet high in sodium, alcohol use, lead exposure, high temperature, and low temperature were identified as risk factors for death and DALYs related to HHD in 2019. Aging and population growth were the major drivers of prevalence, death, and DALYs. Finally, over the past 30 years, the global age-standardized prevalence rate (ASPR) of HHD has significantly risen (AAPC = 0.21 %, 95 % confidence interval [CI]: 0.17-0.24; P < 0.001), while the age-standardized deaths rate (ASDR) has shown significant declining trends (AAPC = -0.86 %, 95 % CI: 1.00 to -0.71; P < 0.001), and age-standardized DALY rates (AAPC = -1.08 %, 95 % CI: 1.23 to -0.93; P < 0.001). Conclusion Despite a significant decline in the global ASDR and age-standardized DALY rate of HHD over the past 30 years, the ASPR continues to rise. The burden of HHD is more heavily skewed towards non-high-income economies. Active prevention, control of risk factors, and improvement of medical protection levels to address the disease burden caused by population growth and aging are needed.
Collapse
Affiliation(s)
- Ben Hu
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical Medical School of Anhui Medical University, Hefei, 230000, Anhui, China
| | - Yihang Shi
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Pengcheng Zhang
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230000, Anhui, China
| | - Jun Feng
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Linlin Hou
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical Medical School of Anhui Medical University, Hefei, 230000, Anhui, China
| |
Collapse
|
10
|
Boudreaux C, Salvi D, Adler AJ, Wroe EB, Coates MM, Olsen M, Jain Y, Mocumbi AO, Bukhman G. Realigning noncommunicable disease monitoring with health systems priorities in the Africa region. Health Promot Int 2023; 38:daad156. [PMID: 38014770 DOI: 10.1093/heapro/daad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
The African region of the World Health Organization (WHO) recently adopted a strategy aimed at more comprehensive care for noncommunicable diseases (NCDs) in the region. The WHO's World Health Assembly has also newly approved several ambitious disease-specific targets that raise the expectations of chronic care and plans to revise and update the NCD-Global Action Plan. These actions provide a critically needed opportunity for reflection and course correction in the global health response to NCDs. In this paper, we highlight the status of the indicators that are currently used to monitor progress towards global goals for chronic care. We argue that weak health systems and lack of access to basic NCD medicines and technologies have prevented many countries from achieving the level of progress required by the NCD epidemic, and current targets do little to address this reality. We identify gaps in existing metrics and explore opportunities to realign the targets with the pressing priorities facing today's health systems.
Collapse
Affiliation(s)
- Chantelle Boudreaux
- Brigham and Women's Hospital, Division of Global Health Equity, Department of Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Devashri Salvi
- Brigham and Women's Hospital, Division of Global Health Equity, Department of Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Alma J Adler
- Brigham and Women's Hospital, Division of Global Health Equity, Department of Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Emily B Wroe
- Brigham and Women's Hospital, Division of Global Health Equity, Department of Medicine, 75 Francis St, Boston, MA 02115, USA
- Harvard Medical School, Department of Global Health and Social Medicine, Harvard University, 641 Huntington Ave, Boston, MA 02115, USA
| | - Matthew M Coates
- Brigham and Women's Hospital, Division of Global Health Equity, Department of Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Maia Olsen
- Partners in Health, 800 BoylstonSt, Suite 300, Boston, MA 02199, USA
| | - Yogesh Jain
- Sangwari, Village Amagasi, Surguja, Chhattisgarh, 497001, India
| | - Ana O Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, 3453 Av. Julius Nyerere, Maputo, 1101, Mozambique
- Non-Communicable Disease Division, Instituto Nacional de Saúde, Vila de Marracuene, Block n. 3943, EN1, Maputo, Mozambique
| | - Gene Bukhman
- Brigham and Women's Hospital, Division of Global Health Equity, Department of Medicine, 75 Francis St, Boston, MA 02115, USA
- Harvard Medical School, Department of Global Health and Social Medicine, Harvard University, 641 Huntington Ave, Boston, MA 02115, USA
| |
Collapse
|
11
|
Hejazi N, Ghalandari H, Nouri M, Askarpour M. Onion supplementation and health metabolic parameters: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN 2023; 58:1-13. [PMID: 38056991 DOI: 10.1016/j.clnesp.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Functional foods, such as onions, have been the center of many recent investigations. In this systematic-review and meta-analysis, we aimed to gather up the existing information with regard to the impact of onion supplementation on anthropometric measurements/indices, lipid profile, indices of glycemic control and hepatic health, systolic and diastolic blood pressures (SBP and DBP), and adiponectin and leptin. METHODS All major online datasets (PubMed, Web of Science, Cochrane, and Scopus) were thoroughly searched from inception up to October 2022. Relevant randomized controlled trials (RCTs) were obtained using the eligibility criteria. Weighted mean differences (WMDs) were calculated and reported. Statistical significance was set as p-values <0.05. RESULTS Among all the retrieved data, 14 RCTs were eligible to be included. The results of the crude analysis showed that onion supplementation significantly improved body fat percentage (BFP), low-density lipoprotein-cholesterol (LDL-c), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), systolic blood pressure, adiponectin, and aspartate aminotransferase (AST). Subgroup analysis revealed that interventions lasting more than 12 weeks can significantly alter weight, waist circumference (WC), body mass index (BMI), BFP, LDL-c, TC, SBP, and DBP. Moreover, the intake of dosages of >300 mg/day of onion supplementation could significantly improve weight, WC, BMI, BFP, LDL-c, HDL-C, TC, AST, ALT, SBP and DBP. CONCLUSION It seems that the intake of onion supplementation can improve health metabolic parameters. We observed that with either longer follow-up periods or higher dosages of onion supplementation, improvements in cardio-metabolic parameters could be expected.
Collapse
Affiliation(s)
- Najmeh Hejazi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Ghalandari
- Students' Research Committee, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Nouri
- Students' Research Committee, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Moein Askarpour
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Students' Research Committee, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
12
|
Ahsan A, Amalia N, Rahmayanti KP, Adani N, Wiyono NH, Endawansa A, Utami MG, Yuniar AM. Health taxes in Indonesia: a review of policy debates on the tobacco, alcoholic beverages and sugar-sweetened beverage taxes in the media. BMJ Glob Health 2023; 8:e012042. [PMID: 37813444 PMCID: PMC10565181 DOI: 10.1136/bmjgh-2023-012042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/14/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION One of the WHO's 'best buys' in controlling non-communicable diseases and their risk factors is to impose health taxes. While the Indonesian political process inhibits the implementation of health tax policy, studies to discuss the issue remain limited. METHODS We employed media analysis to document health tax policy dynamics, for example, the changes in policy timeline and key actors' statements. We conducted an article search in the Open-Source Intelligence database using appropriate terminology on three commodities, for example, tobacco, alcoholic beverages and sugar-sweetened beverages (SSB). RESULTS Throughout the 15 years of implementation (2007-2022), tobacco has received the most policy attention compared with the other two commodities. This is mainly related to the increasing tariff and reforming the tax structure. As Indonesia is a Muslim-majority country, alcohol consumption is low, and a tax on alcoholic beverages was nearly unchanging and lacked media coverage. Ministry of Finance (MoF) officials are key opinion leaders often cited in the media for health taxes. MoF's support for health taxes is important to pass and implement health taxes. While SSB taxation is emerging, key opinion leaders' media statements imply policy contestation, leading to delayed implementation. The policy debates on tobacco taxation implied election years as a major challenge for health tax passages. During the political years, anti-health tax arguments emerged from politicians. While the political contestation on SSB concluded that accentuating the health tax arguments in favour of public health generates the strongest opposition against taxation from the industry. CONCLUSIONS Politics of tobacco tax implementation are complex-compared with the other two commodities. The political context drives the divided views among policy-makers. Policy recommendations include generating public allies with key religious opinion leaders, continuing capacity building for politicians and Ministry of Health, and generating evidence-based arguments in favour of public health for MoF.
Collapse
Affiliation(s)
- Abdillah Ahsan
- Department of Economics, Faculty of Economics and Business, University of Indonesia, Depok, West Java, Indonesia
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Nadira Amalia
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Krisna Puji Rahmayanti
- Department of Public Administration, Faculty of Administrative Science, University of Indonesia, Depok, Indonesia
| | - Nadhila Adani
- Center for Research in Islamic Economics and Business, Universitas Indonesia Faculty of Economics and Business, Depok, West Java, Indonesia
| | - Nur Hadi Wiyono
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Althof Endawansa
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Maulida Gadis Utami
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Adela Miranti Yuniar
- Center for Research in Islamic Economics and Business, Universitas Indonesia Faculty of Economics and Business, Depok, West Java, Indonesia
| |
Collapse
|
13
|
Bolongaita S, Lee Y, Johansson KA, Haaland ØA, Tolla MT, Lee J, Verguet S. Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study. BMC Med 2023; 21:356. [PMID: 37710266 PMCID: PMC10503078 DOI: 10.1186/s12916-023-02957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/21/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Financial risk protection (FRP) is a key component of universal health coverage (UHC): all individuals must be able to obtain the health services they need without experiencing financial hardship. In many low-income and lower-middle-income countries, however, the health system fails to provide sufficient protection against high out-of-pocket (OOP) spending on health services. In 2018, OOP health spending comprised approximately 40% of current health expenditures in low-income and lower-middle-income countries. METHODS We model the household risk of catastrophic health expenditures (CHE), conditional on having a given disease or condition-defined as OOP health spending that exceeds a threshold percentage (10, 25, or 40%) of annual income-for 29 health services across 13 disease categories (e.g., diarrheal diseases, cardiovascular diseases) in 34 low-income and lower-middle-income countries. Health services were included in the analysis if delivered at the primary care level and part of the Disease Control Priorities, 3rd edition "highest priority package." Data were compiled from several publicly available sources, including national health accounts, household surveys, and the published literature. A risk of CHE, conditional on having disease, was modeled as depending on usage, captured through utilization indicators; affordability, captured via the level of public financing and OOP health service unit costs; and income. RESULTS Across all countries, diseases, and health services, the risk of CHE (conditional on having a disease) would be concentrated among poorer quintiles (6.8% risk in quintile 1 vs. 1.3% in quintile 5 using a 10% CHE threshold). The risk of CHE would be higher for a few disease areas, including cardiovascular disease and mental/behavioral disorders (7.8% and 9.8% using a 10% CHE threshold), while lower risks of CHE were observed for lower cost services. CONCLUSIONS Insufficient FRP stands as a major barrier to achieving UHC, and risk of CHE is a major problem for health systems in low-income and lower-middle-income countries. Beyond its threat to the financial stability of households, CHE may also lead to worse health outcomes, especially among the poorest for whom both ill health and financial risk are most severe. Modeling the risk of CHE associated with specific disease areas and services can help policymakers set progressive health sector priorities. Decision-makers could explicitly include FRP as a criterion for consideration when assessing the health interventions for inclusion in national essential benefit packages.
Collapse
Affiliation(s)
- Sarah Bolongaita
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Department of Global Public Health and Primary Care, University of Bergen, Pb. 7804, NO-5020, Bergen, Norway
| | - Yeeun Lee
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Pb. 7804, NO-5020, Bergen, Norway
| | - Øystein A Haaland
- Department of Global Public Health and Primary Care, University of Bergen, Pb. 7804, NO-5020, Bergen, Norway
| | - Mieraf Taddesse Tolla
- Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Jongwook Lee
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Department of Agricultural Economics and Rural Development, Seoul National University, Seoul, South Korea
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| |
Collapse
|
14
|
Brindley C, Wijemunige N, Dieteren C, Bom J, Engel M, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: protocol for a systematic review. BMJ Open 2023; 13:e066213. [PMID: 37620272 PMCID: PMC10450129 DOI: 10.1136/bmjopen-2022-066213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) has increased substantially in low- and middle-income countries (LMICs), and adapting health service delivery models to address this remains a challenge. Many patients with NCD seek private care at different points in their encounters with the health system, but the determinants and outcomes of these choices are insufficiently understood. The proposed systematic review will help inform the governance of mixed health systems towards achieving the goal of universal health coverage. This protocol details our intended methodological and analytical approaches, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). METHODS AND ANALYSIS Following the PRISMA approach, this systematic review will develop a descriptive synthesis of the determinants and outcomes of private healthcare utilisation for NCDs in LMICs. The databases Embase, Medline, Web of Science Core Collection, EconLit, Global Index Medicus and Google Scholar will be searched for relevant studies published in English between period 1 January 2010 and 30 June 2022 with additional searching of reference lists. The study selection process will involve a title-abstract and full-text review, guided by clearly defined inclusion and exclusion criteria. A quality and risk of bias assessment will be done for each study using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION Ethical approval is not required because this review is based on data collected from publicly available materials. The results will be published in a peer-reviewed journal and presented at related scientific events. PROSPERO REGISTRATION NUMBER CRD42022340059.
Collapse
Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten Engel
- Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Deng P, Fu Y, Chen M, Wang D, Si L. Temporal trends in inequalities of the burden of cardiovascular disease across 186 countries and territories. Int J Equity Health 2023; 22:164. [PMID: 37620895 PMCID: PMC10463977 DOI: 10.1186/s12939-023-01988-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally. The extent to which CVD affects the population's health varies across countries. Moreover, quantitative estimates of the trend of inequalities in CVD burden remain unclear. The objective of our study was to assess the socioeconomic inequalities and temporal trends of CVD burden across 186 countries and territories from 2000 to 2019. METHODS We extracted data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019, and conducted a cross-national time-series analysis. Age-standardized disability-adjusted life-year (DALY) rates were used to measure the burden of CVDs, and gross national income (GNI) per capita was used to approximate the socioeconomic development. Concentration curves and concentration indexes (CIs) were generated to evaluate the cross-national socioeconomic inequality of CVD burden. A joinpoint regression analysis was used to quantify the changes in trends in socioeconomic inequality of CVD burden from 2000 to 2019. RESULTS The age-standardized DALY rates of CVDs decreased in 170 (91%) of 186 countries from 2000 to 2019. The concentration curves of the age-standardized DALY rates of CVDs were above the equality line from 2000 to 2019, indicating a disproportional distribution of CVD burden in low-income countries. The CIs declined from - 0.091 (95% CI: -0.128 to - 0.054) in 2000 to - 0.151 (95% CI: -0.190 to - 0.112) in 2019, indicating worsened pro-poor inequality distributions of CVD burden worldwide. A four-phase trend of changes in the CIs of age-standardized DALY rates for CVD was observed from 2000 to 2019, with an average annual percentage change (AAPC) of - 2.7% (95% CI: -3.0 to - 2.4). Decreasing trends in CIs were observed in all CVD subcategories but endocarditis, with AAPC ranging from - 6.6% (95% CI: -7.3 to - 5.9) for ischemic heart disease to - 0.2% (95% CI: -0.4 to - 0.1) for hypertensive heart disease. CONCLUSIONS Globally, the burden of CVD has decreased in more than 90% of countries over the past two decades, accompanied by an increasing trend of cross-country inequalities. Moreover, the overall burden of CVD continues to fall primarily on low-income countries.
Collapse
Affiliation(s)
- Penghong Deng
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- Nanjing Drum Tower Hospital, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Dong Wang
- School of Public Administration, Nanjing University of Finance and Economics, Qixia District, Nanjing, 210023, China.
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| |
Collapse
|
16
|
Odunyemi A, Rahman T, Alam K. Economic burden of non-communicable diseases on households in Nigeria: evidence from the Nigeria living standard survey 2018-19. BMC Public Health 2023; 23:1563. [PMID: 37592334 PMCID: PMC10433548 DOI: 10.1186/s12889-023-16498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The importance of non-communicable diseases (NCDs) in Nigeria is reflected in their growing burden that is fast overtaking that of infectious diseases. As most NCD care is paid for through out-of-pocket (OOP) expenses, and NCDs tend to cause substantial income losses through chronic disabilities, the rising NCD-related health burden may also be economically detrimental. Given the lack of updated national-level evidence on the economic burden of NCDs in Nigeria, this study aims to produce new evidence on the extent of financial hardship experienced by households with NCDs in Nigeria due to OOP expenditure and productivity loss. METHODS This study analysed cross-sectional data from the most recent round (2018-19) of the Nigeria Living Standard Survey (NLSS). Household-level health and consumption data were used to estimate catastrophic health expenditure (CHE) and impoverishing effects due to OOP health spending, using a more equitable method recently developed by the World Health Organization European region in 2018. The productivity loss by individuals with NCDs was also estimated from income and work-time loss data, applying the input-based human capital approach. RESULTS On average, a household with NCDs spent ₦ 122,313.60 or $ 398.52 per year on NCD care, representing 24% of household food expenditure. The study found that OOP on cancer treatment, mental problems, and renal diseases significantly contribute to the cost of NCD care. The OOP expenditure led to catastrophic and impoverishing outcomes for households. The estimations showed that about 30% of households with NCDs experienced CHE in 2018, using the WHO Europe method at the 40% threshold. The study also found that the cost of NCD medications was a significant driver of CHE among NCD-affected households. The results showed heterogeneity in CHE and impoverishment across states and geographical regions in Nigeria, with a higher concentration in rural and North East geopolitical locations. The study also found that 20% of NCD-affected households were impoverished or further impoverished by OOP payment, and another 10% were on the verge of impoverishment. The results showed a negligible rate of unmet needs among households with NCDs. CONCLUSIONS The study highlights the significant effect of NCDs on Nigerian households and the need for effective policy interventions to address this challenge, particularly among the poor and vulnerable.
Collapse
Affiliation(s)
- Adelakun Odunyemi
- Murdoch Business School, Murdoch University, 90 South Street, Perth, WA, 6150, Australia.
- Hospitals' Management Board, Akure, Ondo State, Nigeria.
| | - Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
- Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, 90 South Street, Perth, WA, 6150, Australia
| |
Collapse
|
17
|
Sánchez-Cárdenas MA, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, González-Salazar LV, Cañón Piñeros ÁM, Fuentes-Bermúdez GP, María Vargas-Escobar L. Building an action plan to tackle palliative care inequality through multi-stakeholder platforms. Palliat Care Soc Pract 2023; 17:26323524231189520. [PMID: 37584058 PMCID: PMC10424546 DOI: 10.1177/26323524231189520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
Background To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Objective Build up Colombia's palliative care plan through stakeholder consensus. Method Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). Results The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. Conclusions The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.
Collapse
|
18
|
Alamnia TT, Sargent GM, Kelly M. Patterns of Non-Communicable Disease, Multimorbidity, and Population Awareness in Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study. Int J Gen Med 2023; 16:3013-3031. [PMID: 37465551 PMCID: PMC10351527 DOI: 10.2147/ijgm.s421749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Objective Ethiopia, like other developing countries, is going through an epidemiological transition, and high rates of non-communicable diseases (NCDs) are having a significant impact on the health system; however, there is limited evidence about community level NCD prevalence, multimorbidity, and population awareness that could inform targeted interventions and policy responses. This study aimed to identify factors associated with NCD prevalence, multimorbidity, and population awareness of NCDs in Bahir Dar, Northwest Ethiopia. Methods A community-based cross-sectional survey was conducted with 417 randomly sampled adults. We performed descriptive and logistic regression analyses to evaluate associations between NCD prevalence (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, chronic kidney disease, and hypertension) multimorbidity (2 or more NCDs) and demographic, socioeconomic, individual risk factors, anthropometrics, knowledge, and attitude. Results This study reveals that 24% of participating adults have an NCD, and 8% have multimorbidity. One-third (34.5%) have some NCD knowledge, and 75% consider NCDs more dangerous than communicable diseases. We find low NCD prevalence in participants: younger than 40 years of age (AOR 0.17, 95% CI 0.07 to 0.39); with normal body mass index (AOR 0.27, 0.10 to 0.77) and; with a family history of NCD (AOR 7.7, 4.2 to 14.1). Multimorbidity is lower in young adults (AOR 0.08, 0.03 to 0.26). NCD knowledge is higher in men (AOR 1.76, 1.06 to 2.93) and employed adults (AOR 2.91, 1.52 to 5.57), and NCD attitude in normal-weight adults (AOR 3.23, 1.42 to 7.39). Conclusion This study reveals a high prevalence of NCD and overall low NCD awareness in the population. Age above 40 years, family history of NCD, and weight in the obese category are significant predictors of NCD prevalence. These findings can help health professionals, health offices, and concerned stakeholders to plan targeted health interventions to reduce NCDs in the population.
Collapse
Affiliation(s)
- Tilahun Tewabe Alamnia
- College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ginny M Sargent
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
19
|
Akbarpour Z, Zarei L, Varahrami V, Peiravian F, Yousefi N. Main drivers of diabetes pharmaceuticals expenditures: evidence from OECD countries and Iran. J Diabetes Metab Disord 2023; 22:431-442. [PMID: 37255794 PMCID: PMC10225425 DOI: 10.1007/s40200-022-01161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 06/01/2023]
Abstract
Purpose This study aimed to identify the impact of prominent drivers on drug expenditure for diabetes. Method Following the examination of previous studies, this study identified possible factors contributing to diabetes pharmaceutical expenditures. The explanatory variables for the study were the median population age, access to innovative drugs, GDP per capita, prevalence, price, and consumption of diabetes drugs. Then, to estimate the per capita expenditure among diabetic patients, this study developed the panel data model and two time-series regression models for OECD countries and Iran, respectively. Results In the panel data regression model, R2 was 0.43. The influence of the age, prevalence, consumption volume and GDP per capita coefficients were + 1.79, + 0.704, + 3.86057, + 0.00054, respectively. Also, the probability level of all variables was less than 0.05. In Iran's comparative time-series regression model, R2 was 0.9, and the only significant influence coefficient was the age (β=+0.91). In the another model for Iran, R2 was 0.99, the influence coefficient of age was + 0.249, the prevalence was + 0.131, innovation was + 0.029, and the price was + 0.00054; all the probability levels were less than 0.05. Conclusion Pharmaceutical per capita expenditure is affected by several factors. These factors are not the same in various counties. Passing a judgment on drug utilization only based on pharmaceutical per capita expenditure cannot be perfect. Also, judging whether the per capita drug expenditure in one country is desirable without attention to the affecting factors and only relying on the value of utilized medicines is defective.
Collapse
Affiliation(s)
- Zahra Akbarpour
- Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Zarei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vida Varahrami
- Department of Economics, Shahid Beheshti University, Tehran, Iran
| | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
20
|
Oyando R, Were V, Koros H, Mugo R, Kamano J, Etyang A, Murphy A, Hanson K, Perel P, Barasa E. Evaluating the effectiveness of the National Health Insurance Fund in providing financial protection to households with hypertension and diabetes patients in Kenya. Int J Equity Health 2023; 22:107. [PMID: 37264458 PMCID: PMC10234077 DOI: 10.1186/s12939-023-01923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) can impose a substantial financial burden to households in the absence of an effective financial risk protection mechanism. The national health insurance fund (NHIF) has included NCD services in its national scheme. We evaluated the effectiveness of NHIF in providing financial risk protection to households with persons living with hypertension and/or diabetes in Kenya. METHODS We carried out a prospective cohort study, following 888 households with at least one individual living with hypertension and/or diabetes for 12 months. The exposure arm comprised households that are enrolled in the NHIF national scheme, while the control arm comprised households that were not enrolled in the NHIF. Study participants were drawn from two counties in Kenya. We used the incidence of catastrophic health expenditure (CHE) as the outcome of interest. We used coarsened exact matching and a conditional logistic regression model to analyse the odds of CHE among households enrolled in the NHIF compared with unenrolled households. Socioeconomic inequality in CHE was examined using concentration curves and indices. RESULTS We found strong evidence that NHIF-enrolled households spent a lower share (12.4%) of their household budget on healthcare compared with unenrolled households (23.2%) (p = 0.004). While households that were enrolled in NHIF were less likely to incur CHE, we did not find strong evidence that they are better protected from CHE compared with households without NHIF (OR = 0.67; p = 0.47). The concentration index (CI) for CHE showed a pro-poor distribution (CI: -0.190, p < 0.001). Almost half (46.9%) of households reported active NHIF enrolment at baseline but this reduced to 10.9% after one year, indicating an NHIF attrition rate of 76.7%. The depth of NHIF cover (i.e., the share of out-of-pocket healthcare costs paid by NHIF) among households with active NHIF was 29.6%. CONCLUSION We did not find strong evidence that the NHIF national scheme is effective in providing financial risk protection to households with individuals living with hypertension and/diabetes in Kenya. This could partly be explained by the low depth of cover of the NHIF national scheme, and the high attrition rate. To enhance NHIF effectiveness, there is a need to revise the NHIF benefit package to include essential hypertension and/diabetes services, review existing provider payment mechanisms to explicitly reimburse these services, and extend the existing insurance subsidy programme to include individuals in the informal labour market.
Collapse
Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya.
| | - Vincent Were
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
| | - Hillary Koros
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
| | | | - Jemima Kamano
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Anthony Etyang
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Adrianna Murphy
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, Oxford University, Oxford, 01540, UK
| |
Collapse
|
21
|
Faghy MA, Ashton RE, Skipper L, Kane B. Long COVID - integrated approaches to chronic disease management? Am J Med 2023:S0002-9343(23)00332-7. [PMID: 37230401 DOI: 10.1016/j.amjmed.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Mark A Faghy
- Biomedical Research Theme, School of Human Sciences, University of Debry, Derby, United Kingdom.
| | - Ruth Em Ashton
- Biomedical Research Theme, School of Human Sciences, University of Debry, Derby, United Kingdom
| | - Lindsay Skipper
- Patient and Public Involvement and Engagement Representative
| | - Binita Kane
- Manchester University Foundation Trust and School of Biological Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
22
|
Guo X, Cai L, Cao Y, Liu Z, Zhang J, Liu D, Jiang Z, Chen Y, Fu M, Xia Z, Yi G. New pattern of individualized management of chronic diseases: focusing on inflammatory bowel diseases and looking to the future. Front Med (Lausanne) 2023; 10:1186143. [PMID: 37265491 PMCID: PMC10231387 DOI: 10.3389/fmed.2023.1186143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 06/03/2023] Open
Abstract
Non-infectious chronic diseases, especially inflammatory bowel diseases (IBDs), hypertension, and diabetes mellitus, are characterized by a prolonged and multisystemic course, and their incidence increases annually, usually causing serious economic burden and psychological stress for patients. Therefore, these diseases deserve scientific and consistent disease management. In addition, the lack of a comprehensive "early disease clues tracking-personalized treatment system-follow-up" model in hospitals also exacerbates this dilemma. Based on these facts, we propose an individualized prediction management system for IBDs based on chronic diseases, focusing on the established IBDs-related prediction models and summarizing their advantages and disadvantages. We call on researchers to pay attention to the integration of models with clinical practice and the continuous correction of models to achieve truly individualized medical treatment for chronic diseases, thus providing substantial value for the rapid diagnosis and adequate treatment of chronic diseases such as IBDs, which follow the "relapse-remission" disease model, and realizing long-term drug use and precise disease management for patients. The goal is to achieve a new level of chronic disease management by scientifically improving long-term medication, precise disease management, and individualized medical treatment, effectively prolonging the remission period and reducing morbidity and disability rates.
Collapse
Affiliation(s)
- Xi Guo
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Liyang Cai
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Yuchen Cao
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zining Liu
- The First Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Jiexin Zhang
- The Third Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Danni Liu
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhujun Jiang
- The Second Clinical Medical College, Tianjin Medical University, Tianjin, China
| | - Yanxia Chen
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Min Fu
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhaoxia Xia
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guoguo Yi
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| |
Collapse
|
23
|
Ulasi II, Awobusuyi O, Nayak S, Ramachandran R, Musso CG, Depine SA, Aroca-Martinez G, Solarin AU, Onuigbo M, Luyckx VA, Ijoma CK. Chronic Kidney Disease Burden in Low-Resource Settings: Regional Perspectives. Semin Nephrol 2023; 42:151336. [PMID: 37058859 DOI: 10.1016/j.semnephrol.2023.151336] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The burden of chronic kidney disease (CKD) has increased exponentially worldwide but more so in low- and middle-income countries. Specific risk factors in these regions expose their populations to an increased risk of CKD, such as genetic risk with APOL1 among populations of West African heritage or farmers with CKD of unknown etiology that spans various countries across several continents to immigrant/indigenous populations in both low- and high-income countries. Low- and middle-income economies also have the double burden of communicable and noncommunicable diseases, both contributing to the high prevalence of CKD. The economies are characterized by low health expenditure, sparse or nonexistent health insurance and welfare programs, and predominant out-of-pocket spending for medical care. This review highlights the challenges in populations with CKD from low-resource settings globally and explores how health systems can help ameliorate the CKD burden.
Collapse
Affiliation(s)
- Ifeoma I Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; Renal Unit, Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Olugbenga Awobusuyi
- Department of Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Saurabh Nayak
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhatinda, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Carlos G Musso
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia
| | - Santos A Depine
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Confederation of Dialysis Associations of the Argentine Republic (CADRA), Buenos Aires, Argentina
| | - Gustavo Aroca-Martinez
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia; Facultad de Ciencias de la Salud, Universidad del Norte, Barranquilla, Colombia
| | - Adaobi Uzoamaka Solarin
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Macaulay Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA; College of Business, University of Wisconsin MBA Consortium, Eau Claire, Wisconsin, USA; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valerie A Luyckx
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Chinwuba K Ijoma
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| |
Collapse
|
24
|
Mohanty SK, Mishra RS, Upadhyay AK, O'Donnell O, Maurer J. Sociodemographic and geographic inequalities in diagnosis and treatment of older adults' chronic conditions in India: a nationally representative population-based study. BMC Health Serv Res 2023; 23:332. [PMID: 37013518 PMCID: PMC10069025 DOI: 10.1186/s12913-023-09318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
CONTEXT Expeditious diagnosis and treatment of chronic conditions are critical to control the burden of non-communicable disease in low- and middle-income countries. We aimed to estimate sociodemographic and geographic inequalities in diagnosis and treatment of chronic conditions among adults aged 45 + in India. METHODS We used 2017-18 nationally representative data to estimate prevalence of chronic conditions (hypertension, diabetes, lung disease, heart disease, stroke, arthritis, cholesterol, and neurological) reported as diagnosed and percentages of diagnosed conditions that were untreated by sociodemographic characteristics and state. We used concentration indices to measure socioeconomic inequalities in diagnosis and lack of treatment. Fully adjusted inequalities were estimated with multivariable probit and fractional regression models. FINDINGS About 46.1% (95% CI: 44.9 to 47.3) of adults aged 45 + reported a diagnosis of at least one chronic condition and 27.5% (95% CI: 26.2 to 28.7) of the reported conditions were untreated. The percentage untreated was highest for neurological conditions (53.2%; 95% CI: 50.1 to 59.6) and lowest for diabetes (10.1%; 95% CI: 8.4 to 11.5). Age- and sex-adjusted prevalence of any diagnosed condition was highest in the richest quartile (55.3%; 95% CI: 53.3 to 57.3) and lowest in the poorest (37.7%: 95% CI: 36.1 to 39.3). Conditional on reported diagnosis, the percentage of conditions untreated was highest in the poorest quartile (34.4%: 95% CI: 32.3 to 36.5) and lowest in the richest (21.1%: 95% CI: 19.2 to 23.1). Concentration indices confirmed these patterns. Multivariable models showed that the percentage of untreated conditions was 6.0 points higher (95% CI: 3.3 to 8.6) in the poorest quartile than in the richest. Between state variations in the prevalence of diagnosed conditions and their treatment were large. CONCLUSIONS Ensuring more equitable treatment of chronic conditions in India requires improved access for poorer, less educated, and rural older people who often remain untreated even once diagnosed.
Collapse
Affiliation(s)
- Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India.
| | - Radhe Shyam Mishra
- International Institute for Population Science, R4D India Project, Mumbai, India
| | - Ashish Kumar Upadhyay
- International Institute for Population Science, Research Coordinator, R4D India Project, Mumbai, India
| | - Owen O'Donnell
- Professor of Applied Economics, Erasmus School of Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jürgen Maurer
- Department of Economics, Institute of Health Economics and management, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
25
|
Hendrix N, Bolongaita S, Villano D, Memirie ST, Tolla MT, Verguet S. Equitable Prioritization of Health Interventions by Incorporating Financial Risk Protection Weights Into Economic Evaluations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:411-417. [PMID: 36494302 DOI: 10.1016/j.jval.2022.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Financial risk protection (FRP), or the prevention of medical impoverishment, is a major objective of health systems, particularly in low- and middle-income countries where the extent of out-of-pocket (OOP) health expenditures can be substantial. We sought to develop a method that allows decision makers to explicitly integrate FRP outcomes into their priority-setting activities. METHODS We used literature review to identify 31 interventions in low- and middle-income countries, each of which provided measures of health outcomes, costs, OOP health expenditures averted, and FRP (proxied by OOP health expenditures averted as a percentage of income), all disaggregated by income quintile. We developed weights drawn from the Z-score of each quintile-intervention pair based on the distribution of FRP of all quintile-intervention pairs. We next ranked the interventions by unweighted and weighted health outcomes for each income quintile. We also evaluated how pro-poor they were by, first, ordering the interventions by cost-effectiveness for each quintile and, next, calculating the proportion of interventions each income quintile would be targeted for a given random budget. A ranking was said to be pro-poor if each quintile received the same or higher proportion of interventions than richer quintiles. RESULTS Using FRP weights produced a more pro-poor priority setting than unweighted outcomes. Most of the reordering produced by the inclusion of FRP weights occurred in interventions of moderate cost-effectiveness, suggesting that these weights would be most useful as a way of distinguishing moderately cost-effective interventions with relatively high potential FRP. CONCLUSIONS This preliminary method of integrating FRP into priority-setting would likely be most suitable to deciding between health interventions with intermediate cost-effectiveness.
Collapse
Affiliation(s)
- Nathaniel Hendrix
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Bolongaita
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dominick Villano
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Solomon Tessema Memirie
- Department of Paediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mieraf Taddesse Tolla
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
26
|
Zou S, Wang Z, Tang K. Social inequalities in all-cause mortality among adults with multimorbidity: a 10-year prospective study of 0.5 million Chinese adults. Int Health 2023; 15:123-133. [PMID: 35922875 PMCID: PMC9977254 DOI: 10.1093/inthealth/ihac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/12/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chinese individuals face an increase in multimorbidity, but little is known about the mortality gradients of multimorbid people in different socio-economic groups. This study measures relative and absolute socio-economic inequality in mortality among multimorbid Chinese. METHODS For this study, the prospective China Kadoorie Biobank (CKB) enrolled 512 712 participants ages 30-79 y from 10 areas of China between 25 June 2004 and 15 July 2008. All-cause mortality was accessed with a mean follow-up period of 10 y (to 31 December 2016). Associations between multimorbidity and mortality were assessed using Cox proportional hazards models, with the relative index of inequality (RII) and slope index of inequality (SII) in mortality calculated to measure disparities. RESULTS Mortality risk was highest for those who had not attended formal school and with four or more long-term conditions (LTCs) (hazard ratio 3.11 [95% confidence interval {CI} 2.75 to 3.51]). Relative educational inequality was lower in participants with four or more LTCs (RII 1.92 [95% CI 1.60 to 2.30]), especially in rural areas. Absolute disparities were greater in adults with more LTCs (SII 0.18 [95% CI 0.14 to 0.21] for rural participants with three LTCs). CONCLUSIONS Whereas the relative inequality in all-cause mortality was lower among multimorbid people, absolute inequality was greater among multimorbid men, especially in rural areas.
Collapse
Affiliation(s)
- Siyu Zou
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China
- School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Zhicheng Wang
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China
| |
Collapse
|
27
|
Bryce E, Fedatto M, Cunningham D. Providing paediatric surgery in low-resource countries. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001603. [PMID: 36764702 PMCID: PMC9923288 DOI: 10.1136/bmjpo-2022-001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
Successful health systems comprise good outcomes, accessibility and availability. Surgery is the service that cuts across many treatment scenarios, yet in low- and middle-income countries 90% of people cannot access it. Estimates using most recent population data suggest that 1.75 billion children lack access to surgical care. Additionally, 30% of the global burden of disease is treatable with surgery, yet in LMICs as much as 87% of the surgical need remains unmet. Paediatric surgical services are not at the level they need to be, highlighting an increasing surgical burden on children’s health globally with a human cost of morbidity and mortality. Achieving Universal Health Coverage and the Sustainable Development Goals will fail if surgical systems are not strengthened in low resource settings. In 2018, global health charity Kids Operating Room was founded with a goal of ensuring every child has access to the surgery they need. The charity has a four-pillar approach to its work: provision of infrastructure and equipment, paediatric surgical workforce training, database development and research capacity strengthening, and advocating on behalf of children denied access to safe surgery. To ensure that paediatric surgical interventions produce real impact on service delivery, contextual understanding and needs assessment are key. The building of paediatric surgical capacity should align to countries’ priorities and wishes. Investing in local health workforce is essential to delivering quality services, supporting resilient health systems and provides integrated, people-centred health services. A competent surgical information system gives the local surgical workforce the tools needed to action evidence-driven decisions. Strengthening surgical services in a manner aligned to the WHO’s fundamental health system building blocks, allows for sustainable and long-lasting change. Confronting bottlenecks that exist in surgical services and establishing multi-faceted development, will allow global, national and local surgical targets to be met.
Collapse
Affiliation(s)
- Emma Bryce
- Department of Research, Kids Operating Room, Edinburgh, UK .,Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Maíra Fedatto
- Department of Research, Kids Operating Room, Edinburgh, UK.,International Development, King's College London, London, UK.,International Relations, University of Sao Paulo (USP), Sao Paulo, Brazil
| | | |
Collapse
|
28
|
Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, Ostovar A. Economic barriers and gaps to reach the desirable consumption of salt, sugar, and fat in Iran: a qualitative study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:8. [PMID: 36717955 PMCID: PMC9885062 DOI: 10.1186/s41043-023-00348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes are the main reason for more than two-thirds of global deaths, in which the unhealthy diet is one of the primary risk factors. The golden solution to reducing obesity and CVD linked to an unhealthy diet is to reduce calories, salt, sugar, and fat intake. Besides, activities highlighting lifestyles that contain healthy diets usually focus on reducing salt, sugar, and saturated fat consumption. As a result, the researchers aimed to study the gaps and economic barriers to recommended consumption of salt, sugar, and fat in Iran, based on WHO recommendations. METHODS This is a qualitative study. We conducted semi-structured and in-depth interviews with 30 stakeholders, including academics, experts, and key informants in different sectors from December 2018 until August 2019 in Tehran, Iran. We used a purposeful and snowball sampling method to select participants. All interviews were transcribed verbatim and thematically analyzed using MAXQDA 11. RESULTS Economic problems and inflation in Iran caused people to eat more unhealthy foods, while a healthy diet consumption was reduced due to higher prices. Unfair political sanctions imposed on the country caused economic pressure and adversely affected family nutrition. Worse still, despite legal bans, advertising unhealthy foods via media, mainly to generate revenue, encouraged more consumption of unhealthy food. The lack of targeted subsidies and failure in tax legislation and implementation related to the unhealthy products deteriorated the conditions. CONCLUSION Some economic barriers have hampered plans to reduce salt, fat, and sugar consumption in Iran. Fundamental reforms in the tax and subsidy system are required to improve people's eating habits. In particular, citizens' income that has been continuously shrinking due to economic conditions, imposed sanctions, and the inevitably high inflation needs to be addressed urgently. Unless the government of Iran deals with the economic barriers to healthy nutrition, the pathway for implementing the national action plan for prevention and control of NCDs toward a 30% mortality reduction due to NCDs by 2030 looks unlikely to reach.
Collapse
Affiliation(s)
- Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Poursina Ave, Tehran, Iran.
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- Heath Equity Research Center (HERC) - TUMS, Tehran, Iran.
- National Center for Health Insurance Research, The Iranian Health Insurance Organization, Tehran, Iran.
| | - Hamed Pouraram
- Ommunity Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Poursina Ave, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| |
Collapse
|
29
|
Liang Z, Wu D, Guo C, Gu J. Temporal trend of population structure, burden of diseases, healthcare resources and expenditure in China, 2000-2019. BMJ Open 2023; 13:e062091. [PMID: 36657769 PMCID: PMC9853154 DOI: 10.1136/bmjopen-2022-062091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To explore the evolutionary trend of population structure, disease burden, healthcare resources and expenditure in China, and to identify key domains that are most in need of intervention. DESIGN A cross-sectional and longitudinal analysis. DATA SOURCE Population and healthcare data from China Statistical Yearbook, and disease burden attributable to causes and risk factors from the Global Burden of Diseases between 2000 and 2019. MEASURES AND METHODS We used the Joinpoint Regression Program to measure trends in population composition, population change, dependency ratio, healthcare institution, personnel, expenditure and disease burden from 2000 to 2019. RESULTS Regarding the population in China between 2000 and 2019, a decreasing trend was observed among youth aged 0-14 years (average annual percent change (AAPC): -1.17), a slow rising trend was observed among individuals aged 15-64 years (AAPC: 1.10) and a rapidly increasing trend was observed among individuals older than 65 years (AAPC: 3.67). Astonishing increasing trends in healthcare institutions (AAPC: 3.97), medical personnel (AAPC: 3.26) and healthcare expenditures (AAPC: 15.28) were also observed. Among individuals younger than 70 years, neoplasms (AAPC: 0.54) and cardiovascular diseases (AAPC: 0.67) remained among the top three causes, while tobacco (AAPC: 0.22) remained a top three risk factor. However, while musculoskeletal disorders (AAPC: 1.88) were not a top three cause in 2000, they are a top three cause in 2019. CONCLUSION Comprehensive age/cause/risk factor-specific strategies are key to reconcile the tension among the triad of population ageing, disease burden and healthcare expenditure. The disease burden from cardiometabolic diseases, neoplasms and musculoskeletal disorders was identified as key domains that require intervention to reduce an increasing disease burden among individuals currently older than 70 years, as well as those approaching this age group.
Collapse
Affiliation(s)
- Zhenguo Liang
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dongze Wu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Cui Guo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Hong Kong SAR, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| |
Collapse
|
30
|
Shrinivas A, Jalota S, Mahajan A, Miller G. The importance of wage loss in the financial burden of illness: Longitudinal evidence from India. Soc Sci Med 2023; 317:115583. [PMID: 36565513 DOI: 10.1016/j.socscimed.2022.115583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/20/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND A key aim of Universal Health Coverage (UHC) is to protect individuals and households against the financial risk of illness, and large-scale health insurance expansions are a central focus of the UHC agenda. Importantly, however, health insurance does not protect against a key dimension of financial risk associated with illness: forgone wage income. In this paper, we quantify the economic burden of illness in India attributable - separately - to wage loss and to medical care spending, as well as differences in them across the socio-economic distribution. METHODS We use data from two longitudinal Indian household surveys: (i) the Village Dynamics in South Asia (VDSA) survey (1300 households surveyed every month for 60 months between 2010 and 2015) and (ii) the Indian Human Development Survey (IHDS) (more than 40,000 households surveyed in 2005 and again in 2011). Our regression models include a series of fixed effects that account for time-invariant household- (or individual-) level and time-varying unobservables common across households. FINDINGS We find that, in the VDSA sample, wage loss accounts for more than 80% of the total economic burden of illness among the poorest households, but only about 20% of the economic burden of illness among the most affluent. Estimates from the IHDS sample confirm that this socio-economic gradient is present in the Indian population generally. CONCLUSIONS Wage loss accounts for a substantial share of the total economic burden of illness in India - and disproportionately so among the poorest households. Our findings imply that if UHC is to achieve its objective of protecting households against the financial risk of illness - particularly poor households, the inclusion of wage loss insurance or another illness-related income replacement benefit is needed.
Collapse
Affiliation(s)
| | - Suhani Jalota
- Stanford University, Stanford, USA; Myna Mahila Foundation, Mumbai, India
| | - Aprajit Mahajan
- University of California, Berkeley, USA; National Bureau of Economic Research, USA
| | - Grant Miller
- Stanford University, Stanford, USA; National Bureau of Economic Research, USA.
| |
Collapse
|
31
|
Feasibility of the International Wealth Index and the Gapminder tool as instruments to assess household income and estimate catastrophic expenditure: A prospective patient-level cohort study in India. PLoS One 2023; 18:e0276339. [PMID: 37163512 PMCID: PMC10171689 DOI: 10.1371/journal.pone.0276339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/04/2022] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Patient income assessment is required to assess healthcare catastrophic expenditure (Sustainable Development Goal) but self-reported income has several biases. This study aimed to assess the feasibility of the International Wealth Index (IWI) and the Gapminder tool as indirect instruments to assess household income. METHODS Prospective cohort study of colorectal cancer patients in five tertiary care hospitals in India (Dec 2020-August 2021). Patient self-reported household income was compared to income estimated from the IWI (twelve questions about household goods) and the Gapminder tool (five pictures of household assets). Agreement between instruments was explored with Bland-Altman methods. Cancer care expenditure from the same cohort was used to illustrate the impact of these tools in catastrophic expenditure rates. RESULTS From the 226 patients included, 99.5% completed the IWI and the Gapminder tool. Overall, self-reported incomes were lower than the estimated from the IWI and Gapminder tools (median incomes: 17350₹ for self-reported, 37491₹ for IWI and 51520₹ for Gapminder). The IWI showed better agreement with the self-reported income than the Gapminder tool. For both instruments, the agreement was better for low income earning households. Illustrative catastrophic expenditure rates range from 71% to 56% to 43% when using self-reported, IWI and Gapminder incomes respectively. DISCUSSION It is feasible to use the IWI and the Gapminder tools to estimate household income although they might overestimate income, with an impact on catastrophic expenditure rates. Further refinement of these tools could enable global monitoring and modelling of catastrophic expenditure from real-world data, at low burden for patients.
Collapse
|
32
|
Okunogbe A, Hähnle J, Rotimi BF, Akande TM, Janssens W. Short and longer-term impacts of health insurance on catastrophic health expenditures in Kwara State, Nigeria. BMC Health Serv Res 2022; 22:1557. [PMID: 36539886 PMCID: PMC9764477 DOI: 10.1186/s12913-022-08917-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Out- of-pocket health expenditures (OOPs) constitute a significant proportion of total health expenditures in many low- and middle-income countries (LMICs), leading to an increased likelihood of exposure to financial catastrophe in the event of illness. Health insurance has the potential to reduce catastrophic health expenditures (CHE), but rigorous evidence of its sustained impact is limited, especially in LMICs. This study examined the short- and longer-term effects of a health insurance program in Kwara State, Nigeria on CHE. METHODS The analysis is based on a panel dataset consisting of 3 waves of household surveys in program and comparison areas. The balanced data consists of 1,039 households and 3,450 individuals. We employed a difference-in-differences (DiD) regression approach to estimate intention-to-treat effects, and then computed average treatment effects on the treated by combining DiD with propensity score weighting and an instrumental variables analysis. CHE was measured as OOPs exceeding 10% of household consumption and 40% of capacity-to-pay (CTP). RESULTS Using 10% of consumption as a CHE measure, we found that living in the program area was associated with a 4.3 percentage point (pp) decrease in CHE occurrence (p < 0.05), while the effect on insured households was 5.7 pp (p < 0.05). The longer-term impact four years after program introduction was not significant. Heterogeneity analyses show a reduction in CHE of 7.2 pp (p < 0.01) in the short-term for the poorest tercile. No significant effects were found for the middle and richest terciles, nor in the longer-term. Households with a chronically ill member experienced a reduction in CHE of 9.4 pp (p < 0.01) in the short-term, but not in the longer-term. Most estimates based on the 40% of CTP measure were not statistically significant. CONCLUSION These findings highlight the critical role of health insurance in reducing the likelihood of catastrophic health expenditures, especially for vulnerable populations such as the poor and the chronically ill, and by extension in achieving universal health coverage. They also show that the beneficial impacts of health insurance may attenuate over time, as households potentially adjust their health-seeking behavior to the new scheme.
Collapse
Affiliation(s)
- Adeyemi Okunogbe
- grid.62562.350000000100301493Global Health Division, RTI International, Washington, DC. USA
| | - Joel Hähnle
- grid.450091.90000 0004 4655 0462Amsterdam Institute for Global Health and Development (AIGHD), De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Bosede F. Rotimi
- grid.412974.d0000 0001 0625 9425Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria
| | - Tanimola M. Akande
- grid.412974.d0000 0001 0625 9425Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria
| | - Wendy Janssens
- grid.450091.90000 0004 4655 0462Amsterdam Institute for Global Health and Development (AIGHD), De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 6:None. [PMID: 36408078 PMCID: PMC9664978 DOI: 10.1016/j.lansea.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although colorectal cancer is increasing in India, the cost of comprehensive treatment and its consequences for patients and households are unknown. This study aimed to describe catastrophic expenditure and treatment attrition in patients with a treatment plan for colorectal cancer. METHODS A prospective, multicentre, cohort study was conducted in five tertiary hospitals in India from December 2020 to March 2022. Consecutive patients with a new treatment plan for colorectal cancer were followed-up for six months. The total cost of treatment was reported, including out-of-pocket payments (OOPP, paid by patients at the time-of-service use) and covered by third parties (insurance, public funds). The primary outcome was catastrophic expenditure, defined as OOPPs greater than 25% of patient's annual household income and the secondary outcome was treatment attrition, defined as unplanned interruption of the treatment course not recommended by the clinical team. FINDINGS Of 226 patients included, 20 died within six months of being offered a treatment plan and four were lost to follow-up. The median total cost of colorectal cancer treatment was 407,508 Indian Rupees (INR/5340 USD), to which the biggest contributor was the patient's OOPP (median 330,277 INR/4328 USD). Surgery and anaesthesia costs (median 85,944 INR/1126 USD) were higher than radiotherapy (median 55,525 INR/728 USD) and chemotherapy (median 14,780 INR/194 USD). The overall catastrophic expenditure rate was 90.1% (182/202) and the treatment attrition rate was 9.4% (19/202). Patients with treatment attrition made lower OOPPs than those who completed treatment (median 205,926 vs 349,398 INR, p < 0.01) but had a similar risk of catastrophic expenditure (OR 0.23, 95%CI 0.03-2.28, p = 0.186). INTERPRETATION Most treatment costs for colorectal cancer were paid out-of-pocket by patients and catastrophic expenditure was common. Treatment attrition rates at tertiary centres were low, suggesting greater attrition at previous stages of care. Better financial protection may allow more patients to receive comprehensive cancer treatment while avoiding household financial catastrophe. FUNDING This research was funded by the National Institute for Health Research (NIHR) (NIHR 16.136.79) using UK aid from the UK Government to support global health research, by the India Institute of the University of Birmingham and by the Global Challenges program of the University of Birmingham. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
Collapse
|
34
|
Xiang D, Hu S, Mai T, Zhang X, Zhang L, Wang S, Jin K, Huang J. Worldwide cancer statistics of adults over 75 years old in 2019: a systematic analysis of the global burden of disease study 2019. BMC Public Health 2022; 22:1979. [PMID: 36307792 PMCID: PMC9617321 DOI: 10.1186/s12889-022-14412-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Cancer has become one of the major killers of humanity due to the number of people over the age of 75 increasing with population ageing. The aim of this study was to analyse the incidence and mortality rates in people over 75 of 29 cancer types in 204 countries and regions, as well as the trends from 1990 to 2019. Methods Twenty-nine cancer types were collected from the Global Burden of Disease (GBD) 2019 database(https://vizhub.healthdata.org/gbd-results/). We collected global cancer data for 2019 in terms of sex, age, sociodemographic index (SDI), region, etc. The estimated annual percentage change (EAPC) was calculated to assess the trend of the cancer incidence and mortality rate from 1990 to 2019. Results In 2019, the number of new cancer cases and deaths among people 75 and older was almost 3 and 4.5 times that of 1990, respectively. From 1990 to 2019, there was a slow rise in incidence and a slight decline in mortality. There were significant differences in the cancer burden based on sex, age, region, and SDI. The cancer burden in men was higher than in women. In addition, the cancer burden varied from region to region. The highest cancer burden occurred in high-income North America. In addition, the higher the SDI was, the greater the burden of cancer. The incidence of cancer in high SDI was approximately seven times that of low SDI, and the trend of increase in high SDI was obvious. However, the trend of mortality in high SDI was decreasing, while it was increasing in low SDI. Conclusions The present study focused on the cancer burden in adults over 75 years old. The findings in the study could serve as the basis for an analysis of the types of cancers that are most prevalent in different regions. This is beneficial for strategies of prevention and treatment according to the characteristics of different countries and regions to reduce the burden of cancer in older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14412-1.
Collapse
|
35
|
Rahman T, Gasbarro D, Alam K. Financial risk protection against noncommunicable diseases: trends and patterns in Bangladesh. BMC Public Health 2022; 22:1835. [PMID: 36175951 PMCID: PMC9524135 DOI: 10.1186/s12889-022-14243-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Demographic and epidemiological transitions are changing the disease burden from infectious to noncommunicable diseases (NCDs) in low- and middle-income countries, including Bangladesh. Given the rising NCD-related health burdens and growing share of household out-of-pocket (OOP) spending in total health expenditure in Bangladesh, we compared the country's trends and socioeconomic disparities in financial risk protection (FRP) among households with and without NCDs. METHODS We used data from three recent waves of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016) and employed the normative food, housing (rent), and utilities method to measure the levels and distributions of catastrophic health expenditure (CHE) and impoverishing effects of OOP health expenditure among households without NCDs (i.e. non-NCDs only) and with NCDs (i.e. NCDs only, and both NCDs and non-NCDs). Additionally, we examined the incidence of forgone care for financial reasons at the household and individual levels. RESULTS Between 2005 and 2016, OOP expenses increased by more than 50% across all households (NCD-only: USD 95.6 to 149.3; NCD-and-non-NCD: USD 89.5 to 167.7; non-NCD-only: USD 45.3 to 73.0), with NCD-affected families consistently spending over double that of non-affected households. Concurrently, CHE incidence grew among NCD-only families (13.5% to 14.4%) while declining (with fluctuations) among non-NCD-only (14.4% to 11.6%) and NCD-and-non-NCD households (12.9% to 12.2%). Additionally, OOP-induced impoverishment increased among NCD-only and non-NCD-only households from 1.4 to 2.0% and 1.1 to 1.5%, respectively, affecting the former more. Also, despite falling over time, NCD-affected individuals more frequently mentioned prohibiting treatment costs as the reason for forgoing care than the non-affected (37.9% vs. 13.0% in 2016). The lowest quintile households, particularly those with NCDs, consistently experienced many-fold higher CHE and impoverishment than the highest quintile. Notably, CHE and impoverishment effects were more pronounced among NCD-affected families if NCD-afflicted household members were female rather than male, older people, or children instead of working-age adults. CONCLUSIONS The lack of FRP is more pronounced among households with NCDs than those without NCDs. Concerted efforts are required to ensure FRP for all families, particularly those with NCDs.
Collapse
Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA 6150 Australia
- Institute of Health Economics, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA 6150 Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA 6150 Australia
| |
Collapse
|
36
|
Almalki ZS, Alahmari AK, Alshehri AM, Altowaijri A, Alluhidan M, Ahmed N, AlAbdulsalam AS, Alsaiari KH, Alrashidi MA, Alghusn AG, Alqahtani AS, Alzarea AI, Alanazi MA, Alqahtani AM. Investigating households' out-of-pocket healthcare expenditures based on number of chronic conditions in Riyadh, Saudi Arabia: a cross-sectional study using quantile regression approach. BMJ Open 2022; 12:e066145. [PMID: 36171033 PMCID: PMC9528624 DOI: 10.1136/bmjopen-2022-066145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study investigated the level and associated factors, focusing on the number of individuals with chronic conditions, of out-of-pocket healthcare expenditures (OOPHE). DESIGN A cross-sectional study was conducted from January 2021 to June 2021. SETTING Riyadh Province, Saudi Arabia. PARTICIPANTS A total of 1176 households that used any healthcare services at least once in the past 3 months. OUTCOME MEASURES The OOPHE incurred in the previous 3-month period when a household member is receiving health services. The effects of predisposing, enabling and need factors on the level of OOPHE. The association between the number of individuals with chronic conditions in a household and OOPHE along with the OOPHE distribution. RESULTS The average household OOPHE among all the surveyed households (n=1176) was SAR1775.30. For households affected by one chronic condition, OOPHE was SAR1806, and for households affected by more than one chronic condition, OOPHE was SAR2704. If the head of the household was older, better educated and employed, they were more vulnerable to a higher OOPHE (p<0.0001). At the household level, the increased number of family members with chronic conditions, the presence of a member less than 14 years old, higher socioeconomic status, coverage from health insurance plans, residence in an urban area and the presence of a member with a disability in the household were correlated with a considerably greater level of OOPHE (p<0.0001). The result of quantile regression analysis indicates that an increase in the number of members with chronic conditions in a household was significantly associated with greater overall OOPHE at higher health expenditure quantiles. CONCLUSIONS The burden of OOPHE on households with chronic conditions remains heavy, and some disparities still exist. The number of individuals with chronic conditions in a household plays a substantial and prominent role in increasing the risk of incurring OOPHE.
Collapse
Affiliation(s)
- Ziyad S Almalki
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Abdullah K Alahmari
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Ahmed M Alshehri
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Abdulaziz Altowaijri
- Clinical Leadership Department, Center of National Health Insurance, Riyadh, Saudi Arabia
| | - Mohammed Alluhidan
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Nehad Ahmed
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Abdulhakim S AlAbdulsalam
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Khalid H Alsaiari
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Meshari A Alrashidi
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Abdulrahman G Alghusn
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Ali S Alqahtani
- Clinical Pharmacy, Prince Sattam Bin Abdulaziz University College of Pharmacy, Al-Kharj, Saudi Arabia
| | - Abdulaziz I Alzarea
- Clinical Pharmacy, Al-Jouf University College of Pharmacy, Sakaka, Saudi Arabia
| | - Mona A Alanazi
- Medical Research Administration, Prince Mohammed Bin Abdul Aziz Hospital, Riyadh, Saudi Arabia
| | | |
Collapse
|
37
|
Larkin J, Walsh B, Moriarty F, Clyne B, Harrington P, Smith SM. What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study. BMJ Open 2022; 12:e060502. [PMID: 36581975 PMCID: PMC9438209 DOI: 10.1136/bmjopen-2021-060502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Individuals with multimorbidity use more health services and take more medicines. This can lead to high out-of-pocket (OOP) healthcare expenditure. This study, therefore, aimed to assess the association between multimorbidity (two or more chronic conditions) and OOP healthcare expenditure in a nationally representative sample of adults aged 50 years or over. DESIGN Cross-sectional analysis of data collected in 2016 from wave 4 of The Irish Longitudinal Study on Ageing.SettingIreland.ParticipantsCommunity-dwelling adults aged 50 years and over.MethodA generalised linear model with log-link and gamma distributed errors was fitted to assess the association between multimorbidity and OOP healthcare expenditure (including general practitioner, emergency department, outpatients, specialist consultations, hospital admissions, home care and prescription drugs). RESULTS Overall, 3453 (58.5%) participants had multimorbidity. Among those with any OOP healthcare expenditure, individuals with multimorbidity spent more on average per annum (€806.8 for two conditions, €885.8 for three or more conditions), than individuals with no conditions (€580.3). Pharmacy-dispensed medicine expenditure was the largest component of expenditure. People with multimorbidity on average spent more of their equivalised household income on healthcare (7.1% for two conditions, 9.7% for three or more conditions), than people with no conditions (5.0%). A strong positive association was found between number of conditions and OOP healthcare expenditure (p<0.001) and between having private health insurance and OOP healthcare expenditure (p<0.001). A strong negative association was found between eligibility for free primary/hospital care and heavily subsidised medicines and OOP healthcare expenditure (p<0.001). CONCLUSIONS This study suggests that having multimorbidity in Ireland increases OOP healthcare expenditure, which is problematic for those with more conditions who have lower incomes. This highlights the need for this financial burden to be considered when designing healthcare/funding systems to address multimorbidity, so that access to essential healthcare can be maximised for those with greatest need.
Collapse
Affiliation(s)
- James Larkin
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Brendan Walsh
- Social Research Division, The Economic and Social Research Institute, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Patricia Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
38
|
Replacement of refined sugar by natural sweeteners: focus on potential health benefits. Heliyon 2022; 8:e10711. [PMID: 36185143 PMCID: PMC9519493 DOI: 10.1016/j.heliyon.2022.e10711] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 09/15/2022] [Indexed: 11/24/2022] Open
Abstract
Refined sugar is a processed product containing 99% sucrose, which is obtained from sugarcane (70%) or sugar beet (30%). In modern societies, sugar continues to play a significant role in the diet, recognised not only for its flavour and special sweetening properties but also for its role in food preservation. On the other hand, a high consumption of refined sugar is associated with non-communicable diseases and many health issues such as a high risk of dental caries, overweight and neurodevelopmental disorders in children. Alternatives like unrefined sugars have generated a lot of interest as a healthy substitute due to their nutraceutical properties. This paper is aimed to review the beneficial effects of sugar derived from natural sources and highlight health problems that could be caused by refined processed sugar. Refined sugar is frequently used in variety of items including processed foods, soft drinks or ice creams although it is considered unhealthy due to its high salt and sugar content as well as added fats and artificial coloring. Natural sugars are preferred because they have a high nutritional value and a high concentration of healthy compounds, which offset the negative effects of refined sugar. Therefore, removing refined sugar or at least reducing its consumption should be promoted as a healthier option in food choices.
Collapse
|
39
|
The Association of Socioeconomic Status With Hypertension in 76 Low- and Middle-Income Countries. J Am Coll Cardiol 2022; 80:804-817. [PMID: 35981824 DOI: 10.1016/j.jacc.2022.05.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs) requires an understanding of the condition's current socioeconomic gradients and how these are likely to change in the future as countries develop economically. OBJECTIVES This cross-sectional study aimed to determine how hypertension prevalence in LMICs varies by individuals' education and household wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country's gross domestic product (GDP) per capita. METHODS We pooled nationally representative household survey data from 76 LMICs. We disaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses to adjust for age and sex. RESULTS We included 1,211,386 participants in the analysis. Pooling across all countries, hypertension prevalence tended to be similar between education groups and household wealth quintiles. The only world region with a clear positive association of hypertension with education or household wealth quintile was Southeast Asia. Countries with a lower GDP per capita had, on average, a more positive association of hypertension with education and household wealth quintile than countries with a higher GDP per capita, especially in rural areas and among men. CONCLUSIONS Differences in hypertension prevalence between socioeconomic groups were generally small, with even the least educated and least wealthy groups having a substantial hypertension prevalence. Our cross-sectional interaction analyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.
Collapse
|
40
|
Ross S, Chadha K, Mishra S, Lewington S, Shepperd S, Gathani T. The burden of risk factors for non-communicable disease in rural Bihar, India: a comparative study with national health surveys. BMC Public Health 2022; 22:1538. [PMID: 35962330 PMCID: PMC9375264 DOI: 10.1186/s12889-022-13818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of non-communicable diseases (NCDs) is increasing in rural India. The National Family Health Survey-5 (NFHS-5) provides estimates of the burden of NCDs and their risk factors in women aged 15-49 and men aged 15-54 years. The aim of this study is to estimate the prevalence of hypertension and body-mass index (BMI) in adults aged 35-70 years in rural India and to compare these estimates, where age ranges overlap, to routinely available data. METHODS The Non-Communicable Disease in Rural India (NCDRI) Study was a cross-sectional household survey of 1005 women and 1025 men aged 35-70 conducted in Bihar in July 2019. Information was collected on personal characteristics, self-reported medical history and physical measurements (blood pressure, height and weight). Prevalence estimates for hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or diagnosed and treated for hypertension), and for underweight (body-mass index < 18.5 kg/m2), normal weight (18.5-25.0 kg/m2) and overweight (≥ 25.0 kg/m2) were calculated. Where age ranges overlapped, estimates from the NCDRI Study were compared to the NFHS-5 Survey. RESULTS In the NCDRI Study, the estimated prevalence of hypertension was 27.3% (N = 274) in women and 27.6% (N = 283) in men aged 35-70, which was three-times higher in women and over two-times higher in men than in the NFHS-5 Survey. One-quarter (23.5%; N = 236) of women and one-fifth (20.2%; N = 207) of men in the NCDRI Study were overweight, which was approximately 1.5 times higher than in the NFHS-5 Survey. However, where age groups overlapped, similar age-standardized estimates were obtained for hypertension and weight in both the NCDRI Study and the NFHS-5 Survey. CONCLUSION The prevalence of NCDs in rural India is higher than previously reported due to the older demographic in our survey. Future routine national health surveys must widen the age range of participants to reflect the changing disease profile of rural India, and inform the planning of health services.
Collapse
Affiliation(s)
- Stephanie Ross
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | | | | | - Sarah Lewington
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Sasha Shepperd
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Toral Gathani
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK. .,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | | |
Collapse
|
41
|
Almalki ZS, Alahmari AK, Alqahtani N, Alzarea AI, Alshehri AM, Alruwaybiah AM, Alanazi BA, Alqahtani AM, Ahmed NJ. Households' Direct Economic Burden Associated with Chronic Non-Communicable Diseases in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9736. [PMID: 35955092 PMCID: PMC9368111 DOI: 10.3390/ijerph19159736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Households' economic burden associated with chronic non-communicable diseases (NCDs) is a deterrent to healthcare access, adversely impacting patients' health. Therefore, we investigated the extent of out-of-pocket (OOP) spending among individuals diagnosed with chronic NCDs among household members in Riyadh, Saudi Arabia. Face-to-face interviews were conducted among households in Riyadh Province from the beginning of January 2021 to the end of June 2021. The respondents were asked to record OOP spending throughout the past three months in their health. A generalized linear regression model was used to determine the effects of several factors on the level of OOP spending. A total of 39.6% of the households studied had at least one member with a chronic NCD. Diabetes patients spent an average of SAR 932 (USD 248), hypertension patients SAR 606 (USD 162), and hypothyroid patients SAR 402 (USD 107). It was shown that households with older and more educated members had greater OOP spending. Households with an employed head of household, more family members, higher SES status, health insurance coverage, and urban residency had significantly higher OOP expenditure. The burden of OOP spending for chronic NCD households remains high, with some disparities. The research offers important information for decision making to lower OOP cost among NCD households.
Collapse
Affiliation(s)
- Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh 16278, Saudi Arabia
| | - Abdullah K. Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh 16278, Saudi Arabia
| | - Nasser Alqahtani
- Drug & Pharmaceutical Affairs, Riyadh First Health Cluster (C1) at Ministry of Health, Riyadh 12233, Saudi Arabia
| | | | - Ahmed M. Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh 16278, Saudi Arabia
| | - Abdulrahman M. Alruwaybiah
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh 16278, Saudi Arabia
| | - Bader A. Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh 16278, Saudi Arabia
| | - Abdulhadi M. Alqahtani
- Research Center, King Fahad Medical City, Clinical Research Department, Riyadh 12231, Saudi Arabia
| | - Nehad J. Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh 16278, Saudi Arabia
| |
Collapse
|
42
|
Adeniji FIP, Lawanson AO, Osungbade KO. The microeconomic impact of out-of-pocket medical expenditure on the households of cardiovascular disease patients in general and specialized heart hospitals in Ibadan, Nigeria. PLoS One 2022; 17:e0271568. [PMID: 35849602 PMCID: PMC9292125 DOI: 10.1371/journal.pone.0271568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cardiovascular diseases (CVDs) present a huge threat to population health and in addition impose severe economic burden on individuals and their households. Despite this, there is no research evidence on the microeconomic impact of CVDs in Nigeria. Therefore, this study estimated the incidence and intensity of catastrophic health expenditures (CHE), poverty headcount due to out-of-pocket (OOP) medical spending and the associated factors among the households of a cohort of CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan, Nigeria.
Methods
This study adopts a descriptive cross-sectional study design. A standardized data collection questionnaire developed by the Initiative for Cardiovascular Health Research in Developing Countries was adapted to electronically collect data from all the 744 CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan between 4th November 2019 to the 31st January 2020. A sensitivity analysis, using rank-dependent thresholds of CHE which ranged from 5%-40% of household total expenditures was carried out. The international poverty line of $1.90/day recommended by the World Bank was utilized to ascertain poverty headcounts pre-and post OOP payments for healthcare services. Categorical variables like household socio-demographic and clinical characteristics, CHE and poverty headcounts, were presented using percentages and proportions. Unadjusted and adjusted logistic regression models were used to assess the factors associated with CHE and poverty. Data were analyzed using STATA version 15 and estimates were validated at 5% level of significance.
Results
Catastrophic OOP payment ranged between 3.9%-54.6% and catastrophic overshoot ranged from 1.8% to 12.6%. Health expenditures doubled poverty headcount among households, from 8.13% to 16.4%. Having tertiary education (AOR: 0.49, CI: 0.26–0.93, p = 0.03) and household size (AOR: 0.40, CI: 0.24–0.67, p = 0.001) were significantly associated with CHE. Being female (AOR: 0.41, CI: 0.18–0.92, p = 0.03), household economic status (AOR: 0.003, CI: 0.0003–0.25, p = <0.001) and having 3–4 household members (AOR: 0.30, CI: 0.15–0.61, p = 0.001) were significantly associated with household poverty status post payment for medical services.
Conclusion
OOP medical spending due to CVDs imposed enormous strain on household resources and increased the poverty rates among households. Policies and interventions that supports universal health coverage are highly recommended.
Collapse
Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Akanni Olayinka Lawanson
- Department of Economics, Faculty of Economics & Management Sciences, University of Ibadan, Ibadan, Nigeria
| | - Kayode Omoniyi Osungbade
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
43
|
Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 217] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
Collapse
Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
| |
Collapse
|
44
|
Haakenstad A, Coates M, Buhkman G, McConnell M, Verguet S. Comparative Health Systems Analysis of Differences in the Catastrophic Health Expenditure Associated with Non-Communicable Versus Communicable Diseases Among Adults in Six Countries. Health Policy Plan 2022; 37:1107-1115. [PMID: 35819006 PMCID: PMC9557357 DOI: 10.1093/heapol/czac053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/15/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
The growing burden of non-communicable diseases (NCDs) in low- and middle-income countries may have implications for health system performance in the area of financial risk protection, as measured by catastrophic health expenditure (CHE). We compare NCD CHE to the CHE cases caused by communicable diseases (CDs) across health systems to examine whether: (1) disease burden and CHE are linked, (2) NCD CHE disproportionately affects wealthier households and (3) whether the drivers of NCD CHE differ from the drivers of CD CHE. We used the Study on Global Aging and Adult Health survey, which captured nationally representative samples of 44 089 adults in China, Ghana, India, Mexico, Russia and South Africa. Using two-part regression and random forests, we estimated out-of-pocket spending and CHE by disease area. We compare the NCD share of CHE to the NCD share of disability-adjusted life years (DALYs) or years of life lost to disability and death. We tested for differences between NCDs and CDs in the out-of-pocket costs per visit and the number of visits occurring before spending crosses the CHE threshold. NCD CHE increased with the NCD share of DALYs except in South Africa, where NCDs caused more than 50% of CHE cases but only 30% of DALYs. A larger share of households incurred CHE due to NCDs in the lowest than the highest wealth quintile. NCD CHE cases were more likely to be caused by five or more health care visits relative to communicable disease CHE cases in Ghana (P = 0.003), India (P = 0.004) and China (P = 0.093). Health system attributes play a key mediating factor in how disease burden translates into CHE by disease. Health systems must target the specific characteristics of CHE by disease area to bolster financial risk protection as the epidemiological transition proceeds.
Collapse
Affiliation(s)
- Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, MA 98121, USA
| | - Matthew Coates
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Gene Buhkman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| |
Collapse
|
45
|
Rahman T, Gasbarro D, Alam K. Financial risk protection in health care in Bangladesh in the era of Universal Health Coverage. PLoS One 2022; 17:e0269113. [PMID: 35749437 PMCID: PMC9231789 DOI: 10.1371/journal.pone.0269113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ensuring financial risk protection in health care and achieving universal health coverage (UHC) by 2030 is one of the crucial Sustainable Development Goals (SDGs) targets for many low- and middle-income countries (LMICs), including Bangladesh. We examined the critical trajectory of financial risk protection against out-of-pocket (OOP) health expenditure in Bangladesh. METHODS Using Bangladesh Household Income and Expenditure Survey data from 2005, 2010, and 2016, we examined the levels and distributions of catastrophic health expenditure (CHE) and impoverishment incidences. We used the normative food, housing, and utilities method, refining it by categorizing households with zero OOP expenses by reasons. RESULTS OOP expenditure doubled between 2005 and 2016 (USD 115.6 in 2005, USD 162.1 in 2010, USD 242.9 in 2016), accompanied by rising CHE (11.5% in 2005, 11.9% in 2010, 16.6% in 2016) and impoverishment incidence (1.5% in 2005, 1.6% in 2010, 2.3% in 2016). While further impoverishment of the poor households due to OOP expenditure (3.6% in 2005, 4.1% in 2010, 3.9% in 2016) was a more severe problem than impoverishment of the non-poor, around 5.5% of non-poor households were always at risk of impoverishment. The poorest households were the least financially protected throughout the study period (lowest vs. highest quintile CHE: 29.5% vs. 7.6%, 33.2% vs. 7.2%, and 37.6% vs. 13.0% in 2005, 2010, and 2016, respectively). The disparity in CHE among households with and without chronic illness was also remarkable in 2016 (25.0% vs. 9.1%). CONCLUSION Financial risk protection in Bangladesh exhibits a deteriorated trajectory from 2005 to 2016, posing a significant challenge to achieving UHC and, thus, the SDGs by 2030. The poorest and chronically ill households disproportionately lacked financial protection. Reversing the worsening trends of CHE and impoverishment and addressing the inequities in their distributions calls for implementing UHC and thus providing financial protection against illness.
Collapse
Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
| |
Collapse
|
46
|
Tavares MLDO, Montenegro LC, Beinner MA, Garcia-Vivar C, Pimenta AM. Fatores socioculturais que contribuem para a qualidade de vida de cuidadores familiares de adultos dependentes de cuidados crônicos. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: explorar os fatores socioculturais que contribuem para a qualidade de vida de cuidadores familiares de adultos dependentes de cuidados crônicos no Brasil. Método: estudo qualitativo realizado de outubro de 2016 a março de 2017 em Belo Horizonte, Minas Gerais, Brasil. Vinte e cinco cuidadores familiares de adultos dependentes de cuidados crônicos foram entrevistados por dois pesquisadores por meio de visitas domiciliares. Foi utilizado um roteiro com sete questões abertas relacionadas ao processo de cuidar. As entrevistas foram gravadas em áudio, transcritas e, posteriormente, analisadas por meio da análise de conteúdo. O COREQ foi utilizado para adequação da qualidade estrutural do manuscrito. Resultados: os participantes do estudo relataram diferentes fatores socioculturais que contribuem para sua qualidade de vida. Esses fatores foram categorizados em três categorias principais: O impacto dos construtos socioculturais no processo de cuidar; O autocuidado e suas nuances: velhos desafios para os cuidadores; e Estado e cuidadores: desafios e possibilidades. Conclusões: a qualidade de vida do cuidador é influenciada por suas características e condições socioculturais, apresentando relação com seu modo de viver e de se expressar, sendo, portanto, passível de mudanças. O desenvolvimento de políticas sociais e de saúde para famílias cuidadoras é urgente para a prevenção da sobrecarga familiar e para a promoção de famílias sustentáveis que convivem com doenças crônicas não transmissíveis.
Collapse
|
47
|
The Burden of Health-Related Out-of-Pocket Cancer Costs in Canada: A Case-Control Study Using Linked Data. Curr Oncol 2022; 29:4541-4557. [PMID: 35877219 PMCID: PMC9322389 DOI: 10.3390/curroncol29070359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The burden of out-of-pocket costs among cancer patients/survivors in Canada is not well understood. The objective of this study was to examine the health-related out-of-pocket cost burden experienced by households with a cancer patient/survivor compared to those without, examine the components of health-related costs and determine who experiences a greater burden. Data and methods: This study used a data linkage between the Survey of Household Spending and the Canadian Cancer Registry to identify households with a cancer patient/survivor (cases) and those without (controls). The out-of-pocket burden (out-of-pocket costs measured relative to household income) and mean costs were described and regression analyses examined the characteristics associated with the household out-of-pocket burden and annual out-of-pocket costs. Results: The health-related out-of-pocket cost burden and annual costs measured in households with a cancer patient/survivor were 3.08% (95% CI: 2.55–3.62%) and CAD 1600 (95% CI: 1456–1759), respectively, compared to a burden of 2.84% (95% CI: 2.31–3.38) and annual costs of CAD 1511 (95% CI: 1377–1659) measured in control households, respectively. Households with a colorectal cancer patient/survivor had a significantly higher out-of-pocket burden compared to controls (mean difference: 1.0%, 95% CI: 0.18, 0.46). Among both cases and controls, the lowest income quintile households experienced the highest health-related out-of-pocket cost burden. Interpretation: Within a universal health care system, it is still relevant to monitor health-related out-of-pocket spending that is not covered by existing insurance mechanisms; however, this is not routinely assessed in Canada. We demonstrate the feasibility of measuring such costs in households with a cancer patient/survivor using routinely collected data. While the burden and annual health-related out-of-pocket costs of households with a cancer patient/survivor were not significantly higher than control households in this study, the routine measurement of out-of-pocket costs in Canada could be systemized, providing a novel, system-level, equity-informed performance indicator, which is relevant for monitoring inequities in the burden of out-of-pocket costs.
Collapse
|
48
|
The Impact of Multimorbidities on Catastrophic Health Expenditures among Patients Suffering from Hypertension in China: An Analysis of Nationwide Representative Data. SUSTAINABILITY 2022. [DOI: 10.3390/su14137555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: Patients with hypertension are sensitive to multimorbidities (i.e., the existence of ≥2 chronic diseases), and the related treatment can create enormous economic burdens. We sought to examine the distribution of multimorbidities, the prevalence and factors of catastrophic health expenditure (CHE), the impact of multimorbidities on CHE, and the variation in this relationship across age groups, work status, and combinations of socioeconomic status and health insurance types. Methods: Socioeconomic-related inequality associated with CHE was estimated by concentration curve and concentration index. We examined the determinants of CHE and the impact of age groups, work status, and combinations of socioeconomic groups and health insurance schemes against the relationship with multimorbidities and CHE using logistic regression. Results: 5693 (83.3%) participants had multimorbidities. In total, 49.8% of families had experienced CHE, and the concentration index was −0.026 (95% confidence interval [CI], −0.032 to −0.020). Multimorbidities were related to the increased odds of CHE (odds ratio [OR], 1.21; 95% CI, 1.18–1.25). The relationship between multimorbidities and CHE persisted across age groups, work status, and combinations of socioeconomic status and health insurance schemes. Conclusions: More than 80% of patients with hypertension had multimorbidities. The protection of health insurance schemes against financial risks is very limited.
Collapse
|
49
|
Role of ABCA1 in Cardiovascular Disease. J Pers Med 2022; 12:jpm12061010. [PMID: 35743794 PMCID: PMC9225161 DOI: 10.3390/jpm12061010] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Cholesterol homeostasis plays a significant role in cardiovascular disease. Previous studies have indicated that ATP-binding cassette transporter A1 (ABCA1) is one of the most important proteins that maintains cholesterol homeostasis. ABCA1 mediates nascent high-density lipoprotein biogenesis. Upon binding with apolipoprotein A-I, ABCA1 facilitates the efflux of excess intracellular cholesterol and phospholipids and controls the rate-limiting step of reverse cholesterol transport. In addition, ABCA1 interacts with the apolipoprotein receptor and suppresses inflammation through a series of signaling pathways. Thus, ABCA1 may prevent cardiovascular disease by inhibiting inflammation and maintaining lipid homeostasis. Several studies have indicated that post-transcriptional modifications play a critical role in the regulation of ABCA1 transportation and plasma membrane localization, which affects its biological function. Meanwhile, carriers of the loss-of-function ABCA1 gene are often accompanied by decreased expression of ABCA1 and an increased risk of cardiovascular diseases. We summarized the ABCA1 transcription regulation mechanism, mutations, post-translational modifications, and their roles in the development of dyslipidemia, atherosclerosis, ischemia/reperfusion, myocardial infarction, and coronary heart disease.
Collapse
|
50
|
Mello AVD, Sarti FM, Fisberg RM. Associations among diet costs, food prices and income: Elasticities of risk and protection food groups for cardiometabolic diseases in Sao Paulo, Brazil (2003-2015). Nutr Health 2022:2601060221104579. [PMID: 35673763 DOI: 10.1177/02601060221104579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Economic dimension comprises important determinants of food choices, particularly income and prices. Aim: Identification of the influence of food prices and diet costs on the consumption of food groups considered protection and risk factors for cardiometabolic diseases. Methods: Food groups classification follows the proposal of "What we eat in America?" from the National Health and Nutrition Examination Survey (NHANES), adapted to Latin America. Data on food consumption from the Health Survey of Sao Paulo (2003, 2008, and 2015), representative at population level, was used. Log-linear regressions were estimated for food groups, controlling for endogeneity through augmented regression-test Results: Results showed increase in prices per calorie of whole grains and red meat from 2003-2015 and a decrease in prices per calorie of fruits, vegetables, beans, legumes, oilseeds and fish/seafood. Food groups had price elasticities between -0.01 and -1.6, i.e., decrease in consumption associated with increase in prices. Results showed statistically significant effects of substitution and complementarity, particularly substitution between sweetened beverages and fruits (2003, β = 0.606; 2008: β = 0.683; 2015, β = 0.848), complementarity between nuts and seeds and whole grains (2003, β = -0.646; 2008, β = -0.647; 2015,β = -0.901), and vegetables and processed meat (2003, β = -1.379; 2015, β = -1.685). Conclusion: Findings of the study represent relevant evidence for design strategies towards the adoption of healthier diets, particularly through subsidies to protection food groups, promoting lower prices and higher diet quality. The evidence may be useful for policymakers and researchers in fields of nutrition and health in diverse countries worldwide, especially due to absence of robust evidence in literature.
Collapse
Affiliation(s)
- Aline Veroneze de Mello
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
| | - Flávia Mori Sarti
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
| | - Regina Mara Fisberg
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
| |
Collapse
|