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Borboudaki L, Linardakis M, Tsiligianni I, Philalithis A. Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20. Healthcare (Basel) 2024; 12:928. [PMID: 38727485 PMCID: PMC11083176 DOI: 10.3390/healthcare12090928] [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: 03/15/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.
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Affiliation(s)
- Lena Borboudaki
- Department of Social Medicine, School of Medicine, University of Crete, 71500 Heraklion, Greece; (M.L.); (I.T.); (A.P.)
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Andrade CAS, Mahrouseh N, Gabrani J, Charalampous P, Cuschieri S, Grad DA, Unim B, Mechili EA, Chen-Xu J, Devleesschauwer B, Isola G, von der Lippe E, Baravelli CM, Fischer F, Weye N, Balaj M, Haneef R, Economou M, Haagsma JA, Varga O. Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study. Int J Equity Health 2023; 22:140. [PMID: 37507733 PMCID: PMC10375608 DOI: 10.1186/s12939-023-01958-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest. METHODS DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries. RESULTS Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low. CONCLUSIONS The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.
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Affiliation(s)
- Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Diana Alecsandra Grad
- Department of Public Health, Babes-Bolyai University, Cluj-Napoca-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | - Enkeleint A Mechili
- Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
| | - José Chen-Xu
- Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Gaetano Isola
- Department of General Surgery and Surgical Medical Specialties, University of Catania, Catania, Italy
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nanna Weye
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mirza Balaj
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary.
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Halpern-Manners A, McLeod JD, Anderson EM, Ekl EA. COVID-19 and changes in college student educational expectations and health by disability status. SSM Popul Health 2022; 19:101195. [PMID: 35992965 PMCID: PMC9375263 DOI: 10.1016/j.ssmph.2022.101195] [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: 04/19/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022] Open
Abstract
This study examines the implications of the coronavirus pandemic for college students' health and education, with special attention to variation by disability status. Disaster research supports the hypothesis that students with disabilities will experience higher-than-usual levels of pandemic-related stress, which could lead to re-evaluations of their educational expectations and declines in health. We evaluate this hypothesis by modeling changes in students’ (1) mental and physical health and (2) educational expectations during the first year (spring of 2020 to spring of 2021) of the pandemic, using survey data collected from a population-based sample of college students in the state of Indiana. Although we observe across-the-board declines in both domains, students with disabilities were especially vulnerable. Mediation analyses suggest that differential exposure to financial and illness-related stressors is partially to blame, explaining a significant portion of the group differences between students with and without disabilities. We interpret these results as evidence of the unique vulnerabilities associated with disability status and its wide-ranging importance as a dimension of social stratification. College students with disabilities were more likely to experience declines in mental and physical health during the first year of the pandemic than students without disabilities. Students with disabilities were also more likely to report declines in their educational expectations. Similar patterns were evident for students with an autism spectrum disorder (ASD). Differential exposure to financial and illness related stressors explains a significant portion of the group differences between students with and without disabilities.
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Benach J, Padilla-Pozo Á, Martínez-Herrera E, Molina-Betancur JC, Gutiérrez M, Pericàs JM, Gutiérrez-Zamora Navarro M, Zografos C. What do we know about the impact of economic recessions on mortality inequalities? A critical review. Soc Sci Med 2022; 296:114733. [DOI: 10.1016/j.socscimed.2022.114733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/07/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
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Darvishi B, Behzadifar M, Ghanbari MK, Ehsanzadeh SJ, Bakhtiari A, Behzadifar M, Azari S, Bragazzi NL. Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:465-476. [PMID: 34602884 PMCID: PMC8461582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. Method: Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I2 statistics. Results: Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). Conclusion: The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.
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Affiliation(s)
- Banafshe Darvishi
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Mahboubeh Khaton Ghanbari
- Health Management and Economics Research Center, Health
Management Research Institute, Iran University of Medical Sciences, Tehran,
Iran
| | - Seyed Jafar Ehsanzadeh
- School of Health Management and Information Sciences,
Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Bakhtiari
- Department of Health Economics and Management, School
of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Samad Azari
- Hospital Management Research Center, Iran University of
Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), School of
Public Health, University of Genoa, Genoa, Italy
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Bartoll-Roca X, Gotsens M, Palència L. Decomposition and changes in socio-economic inequalities in mental health in Barcelona between 2006 and 2016. JOURNAL OF PUBLIC MENTAL HEALTH 2021. [DOI: 10.1108/jpmh-01-2021-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims, firstly, to analyse the contribution of socio-economic determinants to mental health (MH) inequalities before the economic crisis, in 2006, and again in a year during recovery, 2016, and secondly, to analyse the changes in these contributions between the two points in time in Barcelona city.
Design/methodology/approach
The concentration index (CI) was calculated for MH inequalities for the population aged 16 or older using the Barcelona Health Surveys for 2006 and 2016. MH was measured with the 12-item General Health Questionnaire. The CI was broken down for each year and gender based on a set of socio-economic determinants plus social support and the presence of chronic diseases. The contribution of each factor to variation in MH inequality between the two points in time was analysed with Oaxaca decomposition.
Findings
Income inequalities in MH increased for men and women (a CI from −0.06 in 2006 to around −0.16 in 2016). Employment status and social class are the main contributors to MH inequalities (more than 50%), except for women in 2006 that is chronic disease. The main contribution to increases in MH inequality between 2006 and 2016 was due to unemployment (26.5% men, 23.8% women), being a student (22.8% men, 20.7% women), homemaker in women (30.7%) and men in the manual class (31.6%).
Originality/value
MH inequalities have been amplified between the two years among the economically vulnerable population or for those who are out of the labour market with unexpected changes for women.
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Economic Crisis: A Factor for the Delayed Diagnosis of Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083998. [PMID: 33920282 PMCID: PMC8069543 DOI: 10.3390/ijerph18083998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
Considering the constant increase in breast cancer patients, identifying factors that influence the moment of diagnosis is essential for optimizing therapeutic management and associated cost. The purpose of the study is to evaluate the impact of the economic crisis on the moment of a breast cancer diagnosis. This retrospective observational study analyzed a cohort of 4929 patients diagnosed with breast cancer over the course of 19 years in the Western region of Romania. The time interval was divided based on the onset of the economic crisis into 3 periods: pre-crisis (2001–2006), crisis (2007–2012), and post-crisis (2013–2019). The disease stage at the moment of diagnosis was considered either early (stages 0, I, II) or advanced (stages III, IV). Although recording a similar mean number of patients diagnosed per year during the pre- and crisis periods, a significantly higher percentage of patients were diagnosed with late-stage breast cancer during the economic crisis period compared to the previous interval (46.9% vs. 56.3%, p < 0.01). This difference was further accentuated when accounting for environmental setting, with 65.2% of patients from a rural setting being diagnosed with advanced disease during the crisis interval. An overall improvement of 12% in early-stage breast cancer diagnosis was recorded in the post-crisis period (55.7%, p < 0.001). The findings of this study support periods of economic instability as potential factors for a delay in breast cancer diagnosis and highlight the need for the development of specific strategies aimed at reducing cancer healthcare and associated financial burden in times of economic crisis.
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Hrzic R, Vogt T, Janssen F, Brand H. Mortality convergence in the enlarged European Union: a systematic literature review. Eur J Public Health 2020; 30:1108-1115. [PMID: 32206793 PMCID: PMC7733049 DOI: 10.1093/eurpub/ckaa038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The high mortality rates in the European Union (EU) Member States that acceded in 2004 sparked political interest in mortality convergence. Whether mortality is converging in the EU remains unclear. We reviewed the literature on mortality convergence in the post-2004 EU territory as a whole. We also explored whether the study designs influenced the results and whether any determinants of mortality convergence had been empirically examined. Methods A systematic literature review was performed. Our search included scientific databases and the websites of international governmental institutions and European demographic research institutes. Results We uncovered 94 unique records and included seven studies that reported on 36 analyses. There was marked methodological heterogeneity, including in the convergence measures (beta and sigma convergence). All of the beta convergence analyses found narrowing mortality differentials, whereas most of the sigma convergence analyses found widening mortality differentials. The results are robust to the units of analysis and mortality and dispersion measures. Our results also suggest that there is a lack of evidence on the determinants of mortality convergence in the EU. Conclusions There is general agreement that the EU regions and the Member States with high initial mortality rates improved the fastest, but this trend did not lead to overall mortality convergence in the EU. The harmonization of mortality convergence measures and research into determinants of mortality convergence are needed to support future EU cohesion policy. Policy-makers should consider supporting areas that have moderate but stagnant mortality rates, in addition to those with high mortality rates.
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Affiliation(s)
- Rok Hrzic
- Department of International Health, Maastricht University, Care and Public Health Research Institute, CAPHRI, Maastricht, The Netherlands
| | - Tobias Vogt
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Fanny Janssen
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.,Netherlands Interdisciplinary Demographic Institute - KNAW / University of Groningen, The Hague, The Netherlands
| | - Helmut Brand
- Department of International Health, Maastricht University, Care and Public Health Research Institute, CAPHRI, Maastricht, The Netherlands.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Gotsens M, Ferrando J, Marí-Dell’Olmo M, Palència L, Bartoll X, Gandarillas A, Sanchez-Villegas P, Esnaola S, Daponte A, Borrell C. Effect of the Financial Crisis on Socioeconomic Inequalities in Mortality in Small Areas in Seven Spanish Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030958. [PMID: 32033162 PMCID: PMC7037194 DOI: 10.3390/ijerph17030958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 01/08/2023]
Abstract
Background: The aim of this study was to analyze the trend in socioeconomic inequalities in mortality in small areas due to several specific causes before (2001–2004, 2005–2008) and during (2009–2012) the economic crisis in seven Spanish cities. Methods: This ecological study of trends, with census tracts as the areas of analysis, was based on three periods. Several causes of death were studied. A socioeconomic deprivation index was calculated for each census tract. For each small area, we estimated standardized mortality ratios, and controlled for their variability using Bayesian models (sSMR). We also estimated the relative risk of mortality according to deprivation in the different cities, periods, and sexes. Results: In general, a similar geographical pattern was found for the socioeconomic deprivation index and sSMR. For men, there was an association in all cities between the deprivation index and all-cause mortality that remained stable over the three periods. For women, there was an association in Barcelona, Granada, and Sevilla between the deprivation index and all-cause mortality in the third period. Patterns by causes of death were more heterogeneous. Conclusions: After the start of the financial crisis, socioeconomic inequalities in total mortality in small areas of Spanish cities remained stable in most cities, although several causes of death showed a different pattern.
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Affiliation(s)
- Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
| | - Josep Ferrando
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Marc Marí-Dell’Olmo
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
| | - Ana Gandarillas
- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, 28035 Madrid, Spain
| | - Pablo Sanchez-Villegas
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía, Escuela Andaluza de Salud Pública, 18080 Granada, Spain
| | - Santi Esnaola
- Department of Health of the Basque Country, 01006 Vitoria-Gasteiz, Spain
| | - Antonio Daponte
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía, Escuela Andaluza de Salud Pública, 18080 Granada, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Correspondence:
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Staff J, Maggs JL, Ploubidis GB, Bonell C. Risk factors associated with early smoking onset in two large birth cohorts. Addict Behav 2018; 87:283-289. [PMID: 29935736 DOI: 10.1016/j.addbeh.2018.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
We use prospective data from the ongoing British Cohort Study (BCS) and Millennium Cohort Study (MCS) to: 1) document changes in the prevalence of childhood smoking onset; 2) assess whether broad historic shifts in key risk factors, such as maternal education, parental smoking, and peer childhood smoking, explain observed cohort changes in childhood smoking; and 3) evaluate whether inequalities in onset have narrowed or widened during this period. The children in these two studies were born 31 years apart (i.e., BCS in 1970; MCS in 2001), and were followed from infancy through early adolescence (n = 23,506 children). Our outcome variable is child self-reports of smoking (ages 10, 11). Early life risk factors were assessed via parent reports in infancy and age 5. Findings reveal that the odds of childhood smoking were over 12 times greater among children born in 1970 versus 2001. The decline in childhood smoking by cohort was partly explained by increases in maternal education, decreases in mothers' and fathers' smoking, and declines in the number of children whose friends smoked. Results also show that childhood smoking is now more linked to early life disadvantages, as MCS children were especially likely to smoke if their mother had low education or used cigarettes, or if the child had a friend who smoked. Although the prevalence of child and adult smoking has dropped dramatically in the past three decades, policy efforts should focus on the increased social inequality resulting from the concentration of early life cigarette use among disadvantaged children.
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Koritala BSC, Çakmaklı S. The human circadian clock from health to economics. Psych J 2018; 7:176-196. [DOI: 10.1002/pchj.252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Bala S. C. Koritala
- Department of Biology; Rutgers, The State University of New Jersey; Camden New Jersey USA
- Center for Computational and Integrative Biology; Rutgers, The State University of New Jersey; Camden New Jersey USA
| | - Selim Çakmaklı
- Department of Economics; Rutgers, The State University of New Jersey; Camden New Jersey USA
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12
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The main causes of death contributing to absolute and relative socio-economic inequality in Italy. Public Health 2018; 164:39-48. [DOI: 10.1016/j.puhe.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 11/19/2022]
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Affiliation(s)
| | - Moisés Goldbaum
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
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Heggebø K, Tøge AG, Dahl E, Berg JE. Socioeconomic inequalities in health during the Great Recession: A scoping review of the research literature. Scand J Public Health 2018; 47:635-654. [DOI: 10.1177/1403494818801637] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: The so-called ‘Great Recession’ in Europe triggered widespread concerns about population health, as reflected by an upsurge in empirical research on the health impacts of the economic crisis. A growing body of empirical studies has also been devoted to socioeconomic inequalities in health during the Great Recession. The aim of the current study is to summarise this health inequality literature by means of a scoping review. Methods: We have performed a scoping review of the research literature (English language) published in the years 2012–2017. Only empirical papers with (a) health status measured on the individual level, (b) information on socioeconomic position (i.e. employment status, educational level, income/wealth, and/or occupational class), and (c) data from European countries in both pre- and post-crisis years were considered relevant. In total, 49 empirical studies fulfilled these inclusion criteria. Results: The empirical findings in the 49 included studies predominantly show that socioeconomic inequalities in health either increased or remained stable from pre- to post-crisis years. Two-thirds (65%) of the studies found evidence of either increasing or partially increasing health inequalities. Thus, people in lower socioeconomic strata fared worse overall in terms of health during the Great Recession, compared to people with higher socioeconomic status. Conclusions: The Great Recession in Europe tends to be followed by increasing socioeconomic inequalities in health. Policymakers should take note of this finding. Widening socioeconomic inequalities in health is a major cause of concern, in particular if health deterioration among ‘vulnerable groups’ is caused by accelerating cumulative disadvantages.
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Affiliation(s)
| | - Anne Grete Tøge
- Work Research Institute (AFI), Oslo Metropolitan University, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - John Erik Berg
- Department of Occupational Therapy, Oslo Metropolitan University, Norway
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Cabrera de León A, Rodríguez IM, Gannar F, Pedrero García AJ, González DA, Rodríguez Pérez MDC, Brito Díaz B, Alemán Sánchez JJ, Aguirre-Jaime A. Austerity Policies and Mortality in Spain After the Financial Crisis of 2008. Am J Public Health 2018; 108:1091-1098. [PMID: 29995474 DOI: 10.2105/ajph.2018.304346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008. METHODS We examined mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis. RESULTS During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain. CONCLUSIONS The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.
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Affiliation(s)
- Antonio Cabrera de León
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Itahisa Marcelino Rodríguez
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Fadoua Gannar
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Arturo J Pedrero García
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Delia Almeida González
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - M Del Cristo Rodríguez Pérez
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Buenaventura Brito Díaz
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - José Juan Alemán Sánchez
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Armando Aguirre-Jaime
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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Doetsch J, Pilot E, Santana P, Krafft T. Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: a qualitative case study in Lisbon, Portugal. Int J Equity Health 2017; 16:184. [PMID: 29070050 PMCID: PMC5657062 DOI: 10.1186/s12939-017-0679-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recent economic and financial crisis in Portugal urged the Portuguese Government in April 2011 to request financial assistance from the troika austerity bail out program to get aid for its government debt. The troika agreement included health reforms and austerity measures of the National Health Service (NHS) in Portugal to save non-essential health care costs. This research aimed to identify potential barriers among the elderly population (aged 65 and above) to healthcare access influenced by the economic crisis and the troika agreement focussing on the Memorandum of Understanding on Specific Economic Policy Conditionality (MoU) in Lisbon metropolitan area, Portugal. METHODS The qualitative study is including 13 semi-structured interviews of healthcare experts, municipality authority, health care providers, negotiator of the troika agreement, hospital managers, health economists and elderly. A content analysis was performed to evaluate the interviews applying Nvivo2011 software. The barriers identified were clustered towards the five areas of the 'Conceptual framework on health care access' by Levesque et al. (Int J Equity Health 12:18, 2013). RESULTS Healthcare access for the elderly was found inadequate in four areas of the framework: availability; appropriateness; approachability; and affordability. The fifth area on acceptability was not identified since the study neither followed a gender nor ethnic specific purpose. The main identified barriers were: current financial situation and pension cuts; insufficient provision and increased user fees in primary care; inadequate design and availability of hospital care service; lack of long-term care facilities; increased out-of-pocket-payment on pharmaceuticals; limitations in exemption allowances; cuts in non-emergent health transportation; increased waiting time for elective surgery; and poor unadapted housing conditions for elderly. CONCLUSIONS The health reforms and health budget cuts in the MoU implemented as part of the troika agreement have been associated with increasing health inequalities in access to healthcare services for the elderly population. The majority of responses disclosed an increasing deficiency across the entire National Health Service (NHS) to collaborate, integrate and communicate between the different healthcare sectors for providing adequate care to the elderly. An urgent necessity of restructuring the health care system to adapt towards the elderly population was implied.
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Affiliation(s)
- Julia Doetsch
- Faculty of Health, Medicine and Life Sciences (FHML), School of Public Health and Primary Care (CAPHRI), Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
- Centre of Studies on Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
| | - Eva Pilot
- Faculty of Health, Medicine and Life Sciences (FHML), School of Public Health and Primary Care (CAPHRI), Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
| | - Paula Santana
- Centre of Studies on Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
| | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences (FHML), School of Public Health and Primary Care (CAPHRI), Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
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Nelson K, Tøge AG. Health trends in the wake of the financial crisis—increasing inequalities? Scand J Public Health 2017; 45:22-29. [DOI: 10.1177/1403494817707088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The financial crisis that hit Europe in 2007–2008 and the corresponding austerity policies have generated concern about increasing health inequalities, although impacts have been less salient than initially expected. One explanation could be that health inequalities emerged first a few years into the crisis. This study investigates health trends in the wake of the financial crisis and analyses health inequalities across a number of relevant population subgroups, including those defined by employment status, age, family type, gender, and educational attainment. Methods: This study uses individual-level panel data (EU-SILC, 2010–2013) to investigate trends in self-rated health. By applying individual fixed effects regression models, the study estimates the average yearly change in self-rated health for persons aged 15–64 years in 28 European countries. Health inequalities are investigated using stratified analyses. Results: Unemployed respondents, particularly those who were unemployed in all years of observation, had a steeper decline in self-rated health than the employed. Respondents of prime working age (25–54 years) had a steeper decline than their younger (15–24) and older (55–64) counterparts, while single parents had a more favorable trend in self-rated health than dual parents. We did not observe any increasing health inequalities based on gender or educational attainment. Conclusions: Health inequalities increased in the wake of the financial crisis, especially those associated with employment status, age, and family type. We did not observe increasing health inequalities in terms of levels of educational attainment and gender.
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Affiliation(s)
- Kenneth Nelson
- The Swedish Institute for Social Research, Stockholm University, Stockholm
| | - Anne Grete Tøge
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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18
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The right to health in Brazil: A Constitutional guarantee threatened by fiscal austerity. J Public Health Policy 2017; 38:493-502. [DOI: 10.1057/s41271-017-0083-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Iglesias-García C, Sáiz PA, Burón P, Sánchez-Lasheras F, Jiménez-Treviño L, Fernández-Artamendi S, Al-Halabí S, Corcoran P, García-Portilla MP, Bobes J. Suicide, unemployment, and economic recession in Spain. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:70-77. [PMID: 28238615 DOI: 10.1016/j.rpsm.2016.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/25/2016] [Accepted: 04/28/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of the present work is to determine the association between unemployment and suicide, and to investigate whether this association is affected by changes in the economic cycle or other variables such as age and sex. METHODS A time-trend analysis was conducted to study changes in the number of suicides between 1999 and 2013 in Spain. Pearson's correlation coefficients and regression models were used to find the association between unemployment and suicide. RESULTS A significant positive association was found between unemployment and suicide in the pre-crisis period in men. In that period (1999-2007), each 1% annual increase in unemployment was associated with a 6.90% increase in the annual variation of suicide in the total population, and with a 9.04% increase in the annual variation of suicide in working age men. CONCLUSIONS The correlation between unemployment and suicide is significant in periods of economic stability, but has weakened during the recent financial crisis. Unemployment and suicide have a complex relationship modulated by age, sex and economic cycle.
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Affiliation(s)
- Celso Iglesias-García
- Departmento de Psiquiatría, Universidad de Oviedo, Oviedo, España; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España; Servicio de Salud del Principado de Asturias, SESPA, Asturias, España.
| | - Pilar A Sáiz
- Departmento de Psiquiatría, Universidad de Oviedo, Oviedo, España; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España; Servicio de Salud del Principado de Asturias, SESPA, Asturias, España
| | - Patricia Burón
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España
| | | | - Luis Jiménez-Treviño
- Departmento de Psiquiatría, Universidad de Oviedo, Oviedo, España; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España; Servicio de Salud del Principado de Asturias, SESPA, Asturias, España
| | - Sergio Fernández-Artamendi
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España; Servicio de Salud del Principado de Asturias, SESPA, Asturias, España
| | - Susana Al-Halabí
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España
| | | | - M Paz García-Portilla
- Departmento de Psiquiatría, Universidad de Oviedo, Oviedo, España; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España; Servicio de Salud del Principado de Asturias, SESPA, Asturias, España
| | - Julio Bobes
- Departmento de Psiquiatría, Universidad de Oviedo, Oviedo, España; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, España; Instituto Universitario de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, España; Servicio de Salud del Principado de Asturias, SESPA, Asturias, España
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Maynou L, Saez M. Erratum to: Economic crisis and health inequalities: evidence from the European Union. Int J Equity Health 2016; 15:178. [PMID: 27814730 PMCID: PMC5095972 DOI: 10.1186/s12939-016-0466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Laia Maynou
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, C/Ramon Trias Fargas, 25-27, Mercè Rodoreda Building, 08005, Barcelona, Spain. .,Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Campus de Montilivi, 17071, Girona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Marc Saez
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, C/Ramon Trias Fargas, 25-27, Mercè Rodoreda Building, 08005, Barcelona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Campus de Montilivi, 17071, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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