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Aarø LE, Ohm E, Skogen JC, Nilsen T, Knapstad M, Vedaa Ø, Nes RB, Clarsen B, Klepp KI. A cross-sectional study of the relationship between injuries and quality of life, psychological distress, sleeping problems, and global subjective health in adults from three Norwegian counties. Health Qual Life Outcomes 2023; 21:120. [PMID: 37919801 PMCID: PMC10623734 DOI: 10.1186/s12955-023-02191-1] [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: 03/24/2023] [Accepted: 09/13/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Studies examining associations between injuries and outcomes like quality of life and psychological distress are important to understand a broader range of possible consequences of injuries for population health. AIMS The aim of this study was to examine associations between self-reported injury and quality of life, psychological distress, sleeping problems, and global subjective health. METHODS The sample was drawn from the Norwegian National Population Register. Data were collected among the general adult populations in three Norwegian counties in 2019-2020 (response rate 45.3%, n = 74,030). Exposure variables were being injured during the last 12 months, cause of injury (if more than one, the most serious one), and functional impairment due to injuries. Outcome variables included measures of total quality of life, global quality of life, positive affect, negative affect, positive social relations, social capital (trust, belongingness, feeling safe), psychological distress, sleep problems, loneliness, and global subjective health. Data were analysed with General Linear Modelling in SPSS Complex. RESULTS Reporting to have been injured once during the last 12 months was associated with slightly elevated levels of psychological distress, sleeping problems, and loneliness, and lower mean scores on quality-of-life indicators and global subjective health. Reporting being injured twice or more showed more pronounced contrasts to the reference group on the same outcomes, with Cohen's d-values (absolute numbers) ranging from 0.17 to 0.54. For having been victim to violence, d-values ranged from 0.30 to 1.01. Moderate functional impairment due to injuries was associated with less favourable scores on all outcomes (d ranging from 0.15 to 0.71). For strong functional impairment d-values ranged from 0.35 to 1.17. CONCLUSIONS Elevated levels of distress and reduced levels of quality of life are particularly associated with multiple injuries, being victim to violence, and functional impairment due to injuries. Prospective, longitudinal studies with high quality instruments and large samples, allowing adjustment for baseline values of outcome variables, and utilization of state-of-the-art statistical techniques, would bring this research closer to examining causality.
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Affiliation(s)
- Leif Edvard Aarø
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaesgt. 7, NO-5015, Bergen, Norway.
| | - Eyvind Ohm
- Department of Health and Inequality, Norwegian Institute of Public Health, Marcus Thranes Gate 6, NO-0473, Oslo, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaesgt. 7, NO-5015, Bergen, Norway
- Centre for Alcohol & Drug Research, Stavanger University Hospital, Lagårdsveien 78, NO-4068, Stavanger, Norway
| | - Thomas Nilsen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Sandakerveien 24C, NO-0473, Oslo, Norway
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaesgt. 7, NO-5015, Bergen, Norway
| | - Øystein Vedaa
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaesgt. 7, NO-5015, Bergen, Norway
| | - Ragnhild Bang Nes
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Sandakerveien 24C, NO-0473, Oslo, Norway
| | - Benjamin Clarsen
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaesgt. 7, NO-5015, Bergen, Norway
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Marcus Thranes Gate 6, NO-0473, Oslo, Norway
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Prinja S, Dixit J, Gupta N, Dhankhar A, Kataki AC, Roy PS, Mehra N, Kumar L, Singh A, Malhotra P, Goyal A, Rajsekar K, Krishnamurthy MN, Gupta S. Financial toxicity of cancer treatment in India: towards closing the cancer care gap. Front Public Health 2023; 11:1065737. [PMID: 37404274 PMCID: PMC10316647 DOI: 10.3389/fpubh.2023.1065737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/18/2023] [Indexed: 07/06/2023] Open
Abstract
Background The rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities. Methods A total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression. Results Mean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment. Conclusion There is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Anushikha Dhankhar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
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David S, Roy N, Lundborg CS, Wärnberg MG, Solomon H. 'Coming home does not mean that the injury has gone'-exploring the lived experience of socioeconomic and quality of life outcomes in post-discharge trauma patients in urban India. Glob Public Health 2022; 17:3022-3042. [PMID: 35129081 DOI: 10.1080/17441692.2022.2036217] [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: 12/15/2022]
Abstract
Trauma results in long-term socioeconomic outcomes that affect quality of life (QOL) after discharge. However, there is limited research on the lived experience of these outcomes and QOL from low - and middle-income countries. The aim of this study was to explore the different socioeconomic and QOL outcomes that trauma patients have experienced during their recovery. We conducted semi-structured qualitative interviews of 21 adult trauma patients between three to eight months after discharge from two tertiary-care public hospitals in Mumbai, India. We performed thematic analysis to identify emerging themes within the range of different experiences of the participants across gender, age, and mechanism of injury. Three themes emerged in the analysis. Recovery is incomplete-even up to eight months post discharge, participants had needs unmet by the healthcare system. Recovery is expensive-participants struggled with a range of direct and indirect costs and had to adopt coping strategies. Recovery is intersocial-post-discharge socioeconomic and QOL outcomes of the participants were shaped by the nature of social support available and their sociodemographic characteristics. Provisioning affordable and accessible rehabilitation services, and linkages with support groups may improve these outcomes. Future research should look at the effect of age and gender on these outcomes.
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Affiliation(s)
- Siddarth David
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Doctors For You, Mumbai, India
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | | | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, Durham, NC, USA
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Prinja S, Dixit J, Gupta N, Mehra N, Singh A, Krishnamurthy MN, Gupta D, Rajsekar K, Kalaiyarasi JP, Roy PS, Malik PS, Mathew A, Pandey A, Malhotra P, Gupta S, Kumar L, Kataki A, Singh G. Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol. BMJ Open 2021; 11:e048513. [PMID: 34326050 PMCID: PMC8323373 DOI: 10.1136/bmjopen-2020-048513] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The rising economic burden of cancer on healthcare system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritising available resources to maximise value of investments in health. Economic evaluations are an integral component of this important evidence. Lack of existing evidence on healthcare costs and health-related quality of life (HRQOL) makes conducting economic evaluations a very challenging task. Therefore, it is imperative to develop a national database for health expenditure and HRQOL for cancer. METHODS AND ANALYSIS The present study proposes to develop a National Cancer Database for Cost and Quality of Life (CaDCQoL) in India. The healthcare costs will be estimated using a patient perspective. A cross-sectional study will be conducted to assess the direct out-of-pocket expenditure (OOPE), indirect cost and HRQOL among cancer patients who will be recruited at seven leading cancer centres from six states in India. Mean OOPE and HRQOL scores will be estimated by cancer site, stage of disease and type of treatment. Economic impact of cancer care on household financial risk protection will be assessed by estimating prevalence of catastrophic health expenditures and impoverishment. The national database would serve as a unique open access data repository to derive estimates of cancer-related OOPE and HRQOL. These estimates would be useful in conducting future cost-effectiveness analyses of management strategies for value-based cancer care. ETHICS AND DISSEMINATION Approval was granted by Institutional Ethics Committee vide letter no. PGI/IEC-03/2020-1565 of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study results will be published in peer-reviewed journals and presented to the policymakers at national level.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute-WIA, Chennai, Tamil Nadu, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, India Ministry of Health and Family Welfare, New Delhi, Delhi, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr B Borooah Cancer Society Trust, Guwahati, Assam, India
| | | | - Anisha Mathew
- Department of Medical Oncology, AIIMS, New Delhi, Delhi, India
| | - Awadhesh Pandey
- Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Sudeep Gupta
- Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Lalit Kumar
- Department of Medical Oncology, AIIMS, New Delhi, Delhi, India
| | - Amal Kataki
- Department of Gynaecologic Oncology, Dr B Borooah Cancer Society Trust, Guwahati, Assam, India
| | - Gurpreet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Quantification of injury burden using multiple data sources: a longitudinal study. Sci Rep 2021; 11:3078. [PMID: 33542517 PMCID: PMC7862366 DOI: 10.1038/s41598-021-82799-9] [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: 05/24/2020] [Accepted: 01/26/2021] [Indexed: 11/08/2022] Open
Abstract
Quantification of injury burden is vital for injury prevention, as it provides a guide for setting policies and priorities. This study generated a set of Hong Kong specific disability weights (DWs) derived from patient experiences and hospital records. Patients were recruited from the Accident and Emergency Department (AED) of three major trauma centers in Hong Kong between September 2014 and December 2015 and subsequently interviewed with a focus on health-related quality of life at most three times over a 12-month period. These patient-reported data were then used for estimation of DWs. The burden of injury was determined using the mortality and inpatient data from 2001 to 2012 and then compared with those reported in the UK Burden of Injury (UKBOI) and global burden of diseases (GBD) studies. There were 22,856 mortality cases and 817,953 morbidity cases caused by injuries, in total contributing to 1,027,641 disability-adjusted life years (DALYs) in the 12-year study timeframe. Estimates for DALYs per 100,000 in Hong Kong amounted to 1192, compared with 2924 in UKBOI and 3459 in GBD. Our findings support the use of multiple data sources including patient-reported data and hospital records for estimation of injury burden.
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Mortality and Disease Burden of Injuries from 2008 to 2017 in Anhui Province, China. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7303897. [PMID: 32382567 PMCID: PMC7193292 DOI: 10.1155/2020/7303897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/15/2020] [Indexed: 11/18/2022]
Abstract
Objective To investigate the temporal trends in mortality and disease burden of injuries in Anhui province from 2008 to 2017, so as to provide reference for injury control and prevention. Methods Data of mortality were collected from 9 national surveillance points in Anhui province during 2008-2017 in the Information System for Death Cause Register and Management. The surveillance data were analyzed by using crude mortality, standardized mortality rate (SMR), potential year of life lost (PYLL), PYLL rate (PYLLR), and average of year life lost (AYLL). Results There were a total of 44855 people died from injury, accounted for 9.44% of the all-cause mortality, ranked as the fifth leading cause of deaths in the whole population, and denoted the first leading cause of deaths in the 0-44 year's group. The leading causes of injury deaths were road traffic accidents, suicide, accidental falls, drowning, and poisoning. Road traffic accidents was the primary cause of injury deaths among the male population, while suicide was the dominate cause of injury deaths among the female population. Drowning, traffic accidents, and suicide accounted for the most injury deaths among the population aged 0-14 years, 15-64 years, and above 60 years, respectively. The road traffic accidents accounted for the largest proportion of injury PYLL and PYLLR, and drowning caused the highest AYLL among injury deaths. Conclusion In Anhui province, road traffic accidents, suicide, accidental falls, drowning, and poisoning were the top five causes of injury deaths that harm the health of local residents; corresponding injury prevention strategies should be formulated.
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