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Savić N, Radević S, Jovanović V, Ranković N, Lukić I, Bogdanović Vasić S, Arandjelović B, Bajić B, Mirković A, Arnaut A, Bajić B, Vukosavljević S, Kocić S. Socioeconomic inequality as a predictor of unmet health needs in the older adult population of Serbia. Front Public Health 2024; 12:1373877. [PMID: 39091536 PMCID: PMC11293304 DOI: 10.3389/fpubh.2024.1373877] [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: 01/20/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives The aim of this paper is to assess the relationship between demographic and socioeconomic predictors and the unmet health needs of the older adult population in Serbia. Materials and methods The study is part of the Population Health Survey of Serbia, which was conducted in the period from October to December 2019 by the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut" and the Ministry of Health of the Republic of Serbia. The research was conducted on a representative sample of Serbian residents in the form of a cross-sectional study. For the purposes of this research study, data on senior citizens, aged 65 and older, were used. Results Multivariate regression analysis of demographic characteristics that showed statistical significance in the univariate model as a whole explains between 4.2% (Cox & Snell R Square) and 5.9% (Nagelkerke R Square) of the variance of unmet health needs and correctly classifies 66.3% cases. Statistically significant demographic predictors were the region where the respondents live, level of education, and material condition. The results of the research show that the most dominant predictors of the unmet health needs of the older adult population are related to socioeconomic inequalities, financial reasons, and predictors related to the inaccessibility of health care. Conclusion The results suggest that individual socioeconomic predictors have a great influence on the emergence of unmet health needs of the older adult population in Serbia. Every third older adult resident did not receive the necessary health care, most often due to financial constraints.
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Affiliation(s)
- Nikola Savić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Svetlana Radević
- Faculty of Medical Sciences, Department of Social Medicine, University of Kragujevac, Serbia, Kragujevac, Serbia
| | - Verica Jovanović
- Institute for Public Health of Serbia “Dr. Milan Jovanović Batut”, Belgrade, Serbia
| | - Nevena Ranković
- Tilburg School of Humanities and Digital Sciences, Department of Cognitive Science, Tilburg University, Tilburg, Netherlands
| | - Igor Lukić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | | | - Biljana Bajić
- Department of Health Promotion, Institute of Public Health of Montenegro, Podgorica, Montenegro
| | - Andrea Mirković
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Arnaut
- Faculty of Medical Sciences, Department of Dentistry, University of Kragujevac, Kragujevac, Serbia
| | - Borko Bajić
- Department for Health Ecology, Institute of Public Health of Montenegro, Podgorica, Montenegro
| | | | - Sanja Kocić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Faculty of Medical Sciences, Department of Social Medicine, University of Kragujevac, Serbia, Kragujevac, Serbia
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Huh Y, Huh JY, Jeon Y, Lee JH. Impact of unmet health-related need on suicidal behavior in Korean adults: a retrospective nationwide cohort study. Sci Rep 2024; 14:13369. [PMID: 38862658 PMCID: PMC11166641 DOI: 10.1038/s41598-024-63200-x] [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: 02/18/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
We aimed to evaluate the association of unmet health-related need with suicidal behaviors among Korean adults. We included 26,219 adults (13,937 men and 17,788 women) aged ≥ 19 years from the Korea National Health and Nutrition Examination Survey (2015-2020). Suicidal behavior included suicidal plan and attempt. We analyzed the odds ratios and 95% confidence intervals of suicidal behaviors according to unmet health-related need via multivariable logistic regression analysis and performed stratified analyses according to sex, age, income, education, and type of insurance. Of the participants, 9.6% had unmet health-related need. Suicidal plans and attempts had 1.3% and 0.5% of the participants, respectively. The prevalence of suicidal plans and attempts was 0.9% and 0.4% among participants without unmet health-related need and 3.1% and 1.0% among those with such need, respectively. The odd ratios of suicidal plans and attempts increased significantly among participants with unmet health-related need compared to those without. In subgroup analysis, most subgroups showed similar results, except for suicidal plan and attempt in the 45-64 age group, high education, and medical care and suicidal attempt in 19-44 age group, low-income, and unmarried. Unmet health-related need was independently associated with suicidal plan and attempt. A policy alternative is needed for these associations.
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Affiliation(s)
- Youn Huh
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ju Young Huh
- Institute of Knowledge and Culture, Duksung Women's University, Seoul, Republic of Korea
| | - Yerim Jeon
- Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Hyung Lee
- Department of Family Medicine, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Seoul, Gyeonggi-do, 10380, Republic of Korea.
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Bergeot J, Jusot F. How did unmet care needs during the pandemic affect health outcomes of older European individuals? ECONOMICS AND HUMAN BIOLOGY 2024; 52:101317. [PMID: 38029460 DOI: 10.1016/j.ehb.2023.101317] [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: 07/11/2023] [Revised: 10/06/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
The first wave of the COVID-19 pandemic left many people with unmet health care needs, which could have detrimental effects on their health. This paper examines the effects of these unmet needs during the first wave of the pandemic on health outcomes one year later. We combine two waves of the SHARE survey collected during the COVID-19 pandemic (in June/July 2020 and 2021), as well as four waves collected before the pandemic. Our health outcomes are four dummy variables: fatigue, falling, fear of falling and dizziness/faints/blackouts issues. Finally, we use OLS regression with individual and time fixed effects for our difference-in-difference analysis, as well as a doubly robust estimator to condition the parallel trend assumption on pre-pandemic covariates. We find substantial effects of having had unmet healthcare needs during 2020 on the probability of having trouble with fatigue and fear of falling one year later. We particularly find strong effects for general practitioner (GP) and specialist care, and in lower extent of physiotherapist, psychotherapist, and rehabilitation care.
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Affiliation(s)
- Julien Bergeot
- Department of Economics, Ca'Foscari University of Venice, San Giobbe, Cannaregio 873, Venice 30121, Italy.
| | - Florence Jusot
- LEDA, CNRS, Université Paris-Dauphine, Université PSL, Paris 75016, France
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Ge Z, Li C, Li Y, Wang N, Hong Z. Lifestyle and ADL Are Prioritized Factors Influencing All-Cause Mortality Risk Among Oldest Old: A Population-Based Cohort Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241235755. [PMID: 38411099 PMCID: PMC10901056 DOI: 10.1177/00469580241235755] [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: 12/07/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
To identify key factors affecting all-cause mortality in the elderly aged 80 years and above. Data from Chinese Longitudinal Healthy Longevity Survey (2011-2018) were utilized (N = 3993). A healthy lifestyle score was obtained by assigning 8 factors: smoking, drinking, exercise, sleep duration, social activity, waist circumference, BMI, and healthful plant-based diet index. Cox regression and decision tree model were used to identify factors influencing the mortality risk. Lifestyle and activities of daily living (ADL) were 2 of the most important modifiable factors influencing the mortality risk of the oldest seniors. A higher healthy lifestyle score was associated with lower mortality risk. The HR (95% CI) of death risk in Q2, Q3, and Q4 groups were 0.91 (0.81-1.01), 0.78 (0.71-0.86), and 0.64 (0.58-0.71), respectively, when compared with the Q1 group of healthy lifestyle score. Elderly with ADL disability had a higher mortality rate than those without ADL disability. When the elderly already have ADL disability, the healthier the lifestyle, the lower the mortality rate. Among individuals aged 80 to 89 years with ADL disability, the mortality rate was higher in the healthy lifestyle score Q1-Q2 groups (92.1%) than that in the Q3-Q4 groups (71.6%). Similar results were observed among subjects aged 90 to 99 years with ADL disability (Q1-Q2: 97.9%, Q3-Q4: 92.1%). For centenarians without ADL disability, maintaining a healthy lifestyle significantly reduced mortality (Q1-Q3: 90.5%, Q4: 75.5%). Caregivers should prioritize the consideration of lifestyle and ADL in their healthcare practices of the oldest old.
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Affiliation(s)
- Zhiwen Ge
- Capital Medical University, Beijing, China
| | - Cheng Li
- Capital Medical University, Beijing, China
| | - Yaru Li
- Capital Medical University, Beijing, China
| | - Nan Wang
- Capital Medical University, Beijing, China
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Lee H, Lee W. Association between unmet healthcare needs and suicidal behaviors among the Korean population. Gen Hosp Psychiatry 2023; 84:158-164. [PMID: 37499273 DOI: 10.1016/j.genhosppsych.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Suicide is an important public health concern. In South Korea, suicide rates have steadily risen over the past two decades. Unfortunately, there is a dearth of literature on the effects of unmet healthcare needs on suicide. Therefore, this study aimed to analyze the relationship between unmet healthcare needs and suicidal behaviors (suicidal ideation, plans, and attempts). METHOD This study analyzed data from 27,498 participants assessed by the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2020. Logistic regression was used to evaluate the relationship between unmet healthcare needs and suicidal behaviors, while controlling for age, sex, education, household income, occupation, smoking, obesity, and alcohol consumption. RESULTS Adjusted odds ratios (95% confidence interval) were significantly higher in participants who experienced unmet healthcare needs [suicidal ideation: 2.31 (1.84-2.90); suicidal planning: 2.23 (1.75-2.85); and suicidal attempts: 1.92 (1.27-2.87)]. After stratifying for sex and depression, this trend was maintained in male participants and those without a depression diagnosis. CONCLUSIONS This study analyzed the relationship between unmet healthcare needs and suicidal behavior. Further studies using data sources that include more detailed information on suicide and somatic symptoms are required.
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Affiliation(s)
- Hangyeol Lee
- College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Wanhyung Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
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Kim S, Hwang J. What are the factors affecting older adults' experience of unmet healthcare needs amid the COVID-19 pandemic in Korea? BMC Geriatr 2023; 23:517. [PMID: 37626287 PMCID: PMC10463954 DOI: 10.1186/s12877-023-04208-2] [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: 05/01/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Unmet healthcare need is a critical indicator, showing a plausible picture of how the healthcare system works in the unprecedented pandemic situation. It is important to understand what factors affect healthcare services of older adults in the midst of the outbreak, as this could help identify service- and performance-related challenges and barriers to the healthcare system. This study aimed to identify factors associated with unmet healthcare needs among the older Korean population amid the COVID-19 pandemic. METHODS Cross-sectional data were used from the Experience Survey on Healthcare Use of Older Adults during the COVID-19 (COVID-19 Survey) in Korea (n = 1,917). Our main outcome, unmet healthcare need, was measured based on self-reported experience of overall, regular, and irregular outpatient care services-related unmet healthcare needs. Independent variables were selected based on previous studies on determinants of unmet healthcare need during the COVID-19 pandemic and Andersen's expanded behavioural model, which theorizes that healthcare-seeking behaviours are driven by psychosocial, enabling, and need factors. RESULTS Using multiple logistic regression models, we identified a good understanding of the nation's health system was associated with lower likelihood of all types of unmet healthcare needs among older Korean adults (OR: 0.39, 95%CI: 0.25-0.61; OR: 0.36, 95%CI: 0.20-0.63; OR: 0.41, 95%CI: 0.23-0.75). Decreased social activities (i.e., shopping and visiting family members) and worsened psychological health issues (i.e., increased anxiety & nervousness and greater difficulty sleeping) were also factors affecting overall and irregular outpatient services-related unmet needs. CONCLUSIONS To ensure timely access to necessary healthcare services for older adults in the era of the COVID-19 outbreak, improving older adult's understanding on how the healthcare system works is necessary. Moreover, changes in psychological condition and daily activities due to COVID-19 should be considered as possible barriers to healthcare services among older adults during the global pandemic.
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Affiliation(s)
- Sujin Kim
- Korea Institute for Health and Social Affairs, Sejong-si, Korea
| | - Jongnam Hwang
- Division of Social Welfare & Health Administration, Wonkwang University, Iksandae-ro 460, Jeonbuk, 54538, Korea.
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Quintal C, Moura Ramos L, Antunes M, Lourenço Ó. Unmet healthcare needs among the population aged 50+ and their association with health outcomes during the COVID-19 pandemic. Eur J Ageing 2023; 20:12. [PMID: 37119316 PMCID: PMC10148617 DOI: 10.1007/s10433-023-00758-x] [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] [Accepted: 04/17/2023] [Indexed: 05/01/2023] Open
Abstract
The COVID-19 pandemic led to unprecedented levels of subjective unmet healthcare needs (SUN). This study investigates the association between SUN in 2020 and three health outcomes in 2021-mortality, cancer, and self-assessed health (SAH), among adults aged 50 years and older, using data from the regular administration of the Survey of Health, Ageing and Retirement in Europe and from the two special waves administered in 2020 and 2021 regarding COVID-19. Three types of SUN were surveyed: care foregone due to fear of contracting COVID-19, pre-scheduled care postponed, and inability to get medical appointments or treatments demanded. We resort on the relative risk and the logistic specification to investigate the association between SUN and health outcomes. To avoid simultaneity, 1-year lagged SUN variables are used. We found a negative association between SUN and mortality. This result differs from the (scarce) previous evidence, suggesting that health systems prioritised life-threatening conditions, in the pandemic context. In line with previous studies, we obtained a positive association between SUN and worse health, in the case of cancer, though it is statistically significant only for the global measure of SUN (any reason). The higher chances of reporting cancer among those exposed to SUN might mean delayed cancer diagnosis, confirming that healthcare foregone was truly needed for a timely diagnosis. The association between SUN and poor or fair SAH is positive but not statistically significant, for the period analysed.
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Affiliation(s)
- Carlota Quintal
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
| | - Luis Moura Ramos
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
| | - Micaela Antunes
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
| | - Óscar Lourenço
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
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Chamberlain S, Savage RD, Bronskill SE, Griffith LE, Rochon P, Batara J, Gruneir A. Retrospective cross-sectional study examining the association between loneliness and unmet healthcare needs among middle-aged and older adults using the Canadian Longitudinal Study of Aging (CLSA). BMJ Open 2023; 13:e068769. [PMID: 36918248 PMCID: PMC10016309 DOI: 10.1136/bmjopen-2022-068769] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES Our primary objective was to estimate the association between loneliness and unmet healthcare needs and if the association changes when adjusted for demographic and health factors. Our secondary objective was to examine the associations by gender (men, women, gender diverse). DESIGN, SETTING, PARTICIPANTS Retrospective cross-sectional data from 44 423 community-dwelling Canadian Longitudinal Study on Aging participants aged 45 years and older were used. PRIMARY OUTCOME MEASURE Unmet healthcare needs are measured by asking respondents to indicate (yes, no) if there was a time when they needed healthcare in the last 12 months but did not receive it. RESULTS In our sample of 44 423 respondents, 8.5% (n=3755) reported having an unmet healthcare need in the previous 12 months. Lonely respondents had a higher percentage of unmet healthcare needs (14.4%, n=1474) compared with those who were not lonely (6.7%, n=2281). Gender diverse had the highest percentage reporting being lonely and having an unmet healthcare need (27.3%, n=3), followed by women (15.4%, n=887) and men (13.1%, n=583). In our logistic regression, lonely respondents had higher odds of having an unmet healthcare need in the previous 12 months than did not lonely (adjusted odd ratios (aOR) 1.80, 95% CI 1.64 to 1.97), adjusted for other covariates. In the gender-stratified analysis, loneliness was associated with a slightly greater likelihood of unmet healthcare needs in men (aOR 1.90, 95% CI 1.64 to 2.19) than in women (aOR 1.73, 95% CI 1.53 to 1.95). In the gender diverse, loneliness was also associated with increased likelihood of having an unmet healthcare need (aOR 1.38, 95% CI 0.23 to 8.29). CONCLUSIONS Loneliness was related to unmet healthcare needs in the previous 12 months, which may suggest that those without robust social connections experience challenges accessing health services. Gender-related differences in loneliness and unmet needs must be further examined in larger samples.
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Affiliation(s)
| | - Rachel D Savage
- Women's College Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paula Rochon
- Women's College Research Institute, Toronto, Ontario, Canada
- Division of Geriatric Medicine, University of Toronto Department of Medicine, Toronto, Ontario, Canada
| | - Jesse Batara
- Department of Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Andrea Gruneir
- Women's College Research Institute, Toronto, Ontario, Canada
- Department of Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
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Li J, Wu D, Li H, Chen J. Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis. Front Public Health 2023; 11:1064846. [PMID: 36815170 PMCID: PMC9939901 DOI: 10.3389/fpubh.2023.1064846] [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: 10/08/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Abstract
Objectives Older populations have a relatively high prevalence of unmet healthcare needs, which can result in poor health status. Moreover, in the coming century, frailty is expected to become one of the most serious global public health challenges. However, there is a lack of clear evidence proving an association between unmet healthcare needs and frailty. This study aimed to assess whether unmet healthcare needs predict the onset of frailty in China. Methods The association between frailty and unmet healthcare needs was explored by analyzing data from the China Health and Retirement Longitudinal Study (CHARLS) using random-effects logistic regression and Cox regression with time-varying exposure. Results At baseline, 7,719 respondents were included in the analysis. Random-effects logistic regression shows that unmet outpatient healthcare needs were associated with increased risk of both contemporaneous (adjusted OR [aOR], 1.17; 95% CI, 1.02-1.35) and lagged (aOR, 1.24; 95% CI, 1.05-1.45) frailty, as were unmet inpatient needs (contemporaneous: aOR, 1.28; 95% CI, 1.00-1.64; lagged: aOR, 1.55; 95% CI, 1.17-2.06). For respondents not classified as frail at baseline (n = 5,392), Cox regression with time-varying exposure shows significant associations of both unmet outpatient needs (adjusted HR, 1.23; 95% CI, 1.05-1.44) and unmet inpatient needs (adjusted HR, 1.48; 95% CI, 1.11-1.99) with increased risk of developing frailty. Conclusions Reducing unmet healthcare needs would be a valuable intervention to decrease frailty risk and promote healthy aging in middle-aged and older populations. It is urgent and essential that the equity and accessibility of the medical insurance and health delivery systems be strengthened.
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Affiliation(s)
- Jun Li
- Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China,*Correspondence: Haomiao Li ✉
| | - Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
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Rahman MM, Rosenberg M, Flores G, Parsell N, Akter S, Alam MA, Rahman MM, Edejer T. A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people. HEALTH ECONOMICS REVIEW 2022; 12:60. [PMID: 36482044 PMCID: PMC9733388 DOI: 10.1186/s13561-022-00398-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted. METHODS An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual. RESULTS After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3-13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9-13.1] vs female [14.4, 95% CI, 11.8-17.3]), educational level (primary or less [13.3, 95% CI, 9.6-17.6] vs higher [7.5, 95% CI, 5.9-9.3]), self-reported health (poor [23.2, 95% CI, 18.8-27.8] vs good [4.4, 95% CI, 3.4-5.5]), insurance status (insured [9.0, 95% CI, 7.5-10.6] vs uninsured [27.7, 95% CI, 24.0-31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1-44.9] vs richest [7.1, 95% CI, 3.8-11.3]). One in four (25.1, 95% CI, 17.1-34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts. CONCLUSION With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs.
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Affiliation(s)
- Md Mizanur Rahman
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan.
| | - Megumi Rosenberg
- Centre for Health Development, World Health Organization, Kobe, Japan
| | - Gabriela Flores
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Nadia Parsell
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Shamima Akter
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Tessa Edejer
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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Smolić Š, Čipin I, Međimurec P. Access to healthcare for people aged 50+ in Europe during the COVID-19 outbreak. Eur J Ageing 2022; 19:793-809. [PMID: 36692730 PMCID: PMC8195455 DOI: 10.1007/s10433-021-00631-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 01/26/2023] Open
Abstract
This paper combines SHARE Corona Survey and SHARE Wave 7 data for 25 European countries and Israel (N = 40,919) with institutional and epidemic-related country characteristics to investigate healthcare access for Europeans aged 50+ during the outbreak of COVID-19. We use a micro-macro approach to examine whether and to what extent barriers to accessing healthcare measured by reported unmet healthcare needs vary within and between countries. We consider various aspects of barriers and distinguish among: (1) respondents who forewent medical treatment because they were afraid of becoming infected with the Coronavirus; (2) respondents who had pre-scheduled medical appointments postponed by health providers due to the outbreak; and (3) respondents who tried to arrange a medical appointment but were denied one. Limited access to healthcare during the initial outbreak was more common for the occupationally active, women, the more educated and those living in urban areas. A bad economic situation, poor overall health and higher healthcare utilisation were robust predictors of unmet healthcare. People aged 50+ in countries of 'Old' Europe, countries with higher universal health coverage and stricter containment and closure policies were more likely to have medical services postponed. Policymakers should address the healthcare needs of older people with chronic health conditions and a poor socio-economic status who were made more vulnerable by this pandemic. In the aftermath of the health crisis, public health systems might experience a great revival in healthcare demand, a challenge that should be mitigated by careful planning and provision of healthcare services.
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Affiliation(s)
- Šime Smolić
- Faculty of Economics & Business, Department of Macroeconomics and Economic Development, University of Zagreb, Zagreb, Croatia
| | - Ivan Čipin
- Faculty of Economics & Business, Department of Demography, University of Zagreb, Zagreb, Croatia
| | - Petra Međimurec
- Faculty of Economics & Business, Department of Demography, University of Zagreb, Zagreb, Croatia
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Eimontas J, Gegieckaitė G, Zamalijeva O, Pakalniškienė V. Unmet Healthcare Needs Predict Depression Symptoms among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158892. [PMID: 35897261 PMCID: PMC9330083 DOI: 10.3390/ijerph19158892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
Risk factors for depression in older adults include significant interpersonal losses, increasing social isolation, and deteriorating physical abilities and health that require healthcare. The effects of unmet healthcare needs on depression in older adults are understudied. This study aimed to analyze the association between unmet healthcare needs and symptoms of depression, sleep, and antidepressant medication while controlling for other significant factors among older adults. For this study, we used a multinational database from The Survey of Health, Ageing and Retirement in Europe (SHARE), containing data of individuals aged 50 and older. The final sample used in this research consisted of 39,484 individuals from 50 to 100 years (mean − 71.15, SD ± 9.19), 42.0 percent of whom were male. Three path models exploring relationships between symptoms of depression at an older age and unmet healthcare needs were produced and had a good model fit. We found that unmet healthcare needs were directly related to depression, activity limitations were related to depression directly and through unmet healthcare needs, whereas financial situation mostly indirectly through unmet healthcare needs. We discuss how depression itself could increase unmet healthcare needs.
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González-Touya M, Stoyanova A, Urbanos-Garrido RM. COVID-19 and Unmet Healthcare Needs of Older People: Did Inequity Arise in Europe? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179177. [PMID: 34501767 PMCID: PMC8431067 DOI: 10.3390/ijerph18179177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 01/20/2023]
Abstract
Background: The disruption in healthcare provision due to the COVID-19 pandemic forced many non-urgent medical treatments and appointments to be postponed or denied, which is expected to have huge impact on non-acute health conditions, especially in vulnerable populations such as older people. Attention should be paid to equity issues related to unmet needs during the pandemic. Methods: We calculated concentration indices to identify income-related inequalities and horizontal inequity in unmet needs due to postponed and denied healthcare in people over 50 during COVID-19, using data from the Survey on Health, Ageing and Retirement in Europe (SHARE). Results: Very few countries show significant income-related inequalities in postponed, rescheduled or denied treatments and medical appointments, usually favouring the rich. Only Estonia, Italy and Romania show a significant horizontal inequity (HI) in postponed healthcare, which apparently favours the poor. Significant pro-rich inequity in denied healthcare is found in Italy, Poland and Greece. Conclusions: Although important income-related horizontal inequity in unmet needs of European older adults during the early waves of the COVID-19 pandemic is not evident for most countries, some of them have to carefully monitor barriers to healthcare access. Delays in diagnosis and treatments may ultimately translate into adverse health outcomes, reduced quality of life and, even, widen socio-economic health inequalities among older people.
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Affiliation(s)
- Marta González-Touya
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Alexandrina Stoyanova
- Department of Economics, Faculty of Economics and Business, University of Barcelona, 08034 Barcelona, Spain
- Correspondence:
| | - Rosa M. Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, Faculty of Economics and Business, University Complutense of Madrid, 28223 Madrid, Spain;
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Kim JY, Kim DI, Park HY, Pak Y, Tran PNH, Thai TT, Thuy MTT, Dung DV. Unmet Healthcare Needs and Associated Factors in Rural and Suburban Vietnam: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176320. [PMID: 32878012 PMCID: PMC7503302 DOI: 10.3390/ijerph17176320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the current utilization of healthcare services, exploring unmet healthcare needs and the associated factors among people living in rural Vietnam. This cross-sectional study was conducted with 233 participants in a rural area. The methods included face-to-face interviews using a structured questionnaire, and anthropometric and blood pressure measurements. We considered participants to have unmet health needs if they had any kind of health problem during the past 12 months for which they were unable to see a healthcare provider. Multivariate logistic regression analysis was performed to determine the factors associated with unmet healthcare needs. Of the participants, 18% (n = 43) had unmet healthcare needs, for reasons like transportation (30%), a lack of available doctors or medicine (47%), and communication issues with healthcare providers (16%). The multivariate logistic regression showed that living in a rural area, having stage 2 hypertension, and having insurance were associated with unmet healthcare needs. To better meet the healthcare needs in rural or suburban areas of Vietnam, allocation of adequate healthcare resources should be distributed in rural areas and insurance coverage for personalized healthcare needs might be required. Efforts should focus on availability of medicine, improvement of transportation systems, and communication skills of healthcare providers to improve access to healthcare services.
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Affiliation(s)
- Ju Young Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.Y.K.); (D.I.K.); (H.Y.P.)
| | - Dae In Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.Y.K.); (D.I.K.); (H.Y.P.)
| | - Hwa Yeon Park
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.Y.K.); (D.I.K.); (H.Y.P.)
| | - Yuliya Pak
- Office of External Affairs, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Phap Ngoc Hoang Tran
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
| | - Truc Thanh Thai
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
| | - Mai Thi Thanh Thuy
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
| | - Do Van Dung
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
- Correspondence: ; Tel.: +84-91-838-2253
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Fridh M, Rosvall M, Lindström M. Poor psychological health and 5-year suicide mortality: A population-based prospective cohort study. Soc Sci Med 2020; 258:113056. [PMID: 32516638 DOI: 10.1016/j.socscimed.2020.113056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective was to investigate associations between the General Health Questionnaire with twelve sub-items (GHQ-12) and prospective five-year suicide mortality. The two commonly used GHQ-12 cut-offs (2/3 and 3/4) were analyzed. METHOD The 2008 public health survey, which was conducted in the autumn of 2008 in Scania, southern Sweden, is based on a postal questionnaire answered by 28,198 participants, aged 18 to 80. GHQ-12 was assessed from the baseline questionnaire, and five-year prospective register data on causes of death were connected to the baseline survey. In total, 21 persons died from intentional self-inflicted injuries, and twenty of them had complete answers regarding GHQ-12. Hazard rate ratios (HRR) were analyzed in survival (Cox-) regression analyses, adjusted for age, sex, marital status and socioeconomic status (SES). RESULTS The prevalence of poor psychological health according to GHQ-12 with the 2/3 cut-off was 14% among men and 18% among women, and with the 3/4 cut-off it was 11% among men and 15% among women. The 2/3 cut-off yielded a HRR of 3.02 (1.14-7.98, 95% CI) which decreased to 2.44 (0.92-6.49) when adjusted for marital status and SES, and a 3/4 cut-off HRR of 3.97 (1.51-10.47) which decreased to 3.23 (1.22-1.22-8.56) when adjusted for marital status and SES. CONCLUSION The results indicate high effect measures (HRRs) between GHQ12 with both cut offs and five-year suicide mortality.
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Affiliation(s)
- Maria Fridh
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02, Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02, Malmö, Sweden; Department of Community Medicine and Public Health, Institute of Medicine, University of Gothenburg, Sweden
| | - Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02, Malmö, Sweden.
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