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Tan JHI, Goh AXC, Yi H. Health inequity and social determinants of healthcare utilization in the disadvantaged community of Hong Kong. Health Promot Int 2023; 38:daab195. [PMID: 34897425 DOI: 10.1093/heapro/daab195] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Access to appropriate healthcare among disadvantaged populations in countries with universal healthcare requires a critical understanding of the relationships between poverty, social exclusion and health in the local context. The qualitative study explored the experiences of healthcare utilization in an inner-city impoverished community living in slum conditions in Hong Kong. Interviews with 40 slum residents in one of the poorest neighbourhoods in the city explored the following domains: experience and perceptions of the community, housing conditions, informal social capital and support system, interactions with community workers, and experiences in utilizing social and healthcare services. Framework analysis was conducted to identify local themes under the model of healthcare utilization: approachability, acceptability, availability and accommodation, affordability and appropriateness. Despite the subsidized public healthcare system, multiple barriers were identified. Low literacy of healthcare systems was prevalent. Specifically, structural barriers relating mainly to the availability, accommodation and affordability of health services were salient to impede access to healthcare. The barriers related to healthcare providers primarily stemmed from the interactions of healthcare providers, perceived stigma and the lack of patient-centred care. In addition, poverty-related sociocultural norms and personal beliefs of healthcare were found to be significant barriers to healthcare access. Despite the well-established subsidized public healthcare system, healthcare inequity was evident. Lack of quality healthcare access needs to be addressed by providing social and educational resources that facilitate collective efficacy for healthcare, community engagement from public sectors and person-centred care with healthcare providers.
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Affiliation(s)
- Joelle Hwee Inn Tan
- Yong Loo Lin School of Medicine, 10 Medical Drive, National University of Singapore, 117597, Singapore
| | - Amelia Xin Chun Goh
- Yong Loo Lin School of Medicine, 10 Medical Drive, National University of Singapore, 117597, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, 12 Science Drive, National University of Singapore, 117549, Singapore, and National University Health System, Singapore
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Melariri H, Els T, Oyedele O, Suttle TK, Bermosky KT, De Freitas A, Murtaza A, Moosajee M, Melariri PE. Prevalence of locoregional recurrence and survival post-treatment of head and neck cancers in Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101964. [PMID: 37125401 PMCID: PMC10139903 DOI: 10.1016/j.eclinm.2023.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Background Recurrent cancers of the head and neck are associated with poor survival outcome. Yet, their burden in Africa is not reliably known. We therefore aimed to estimate the prevalence of recurrence and the 5-year overall survival among patients treated for head and neck cancers (HNC) in Africa. Method In this systematic review and meta-analysis, we searched four electronic databases (Pubmed, CINAHL, MEDLINE, and Web of Science) and the grey literature for studies reporting the prevalence of HNC recurrence and 5-year overall survival post treatment, published between January 1, 2002, and December 31, 2022. We contacted corresponding authors of relevant studies. Searches were extended to reference lists of review articles and other relevant sources for potentially eligible studies. Each record was assessed for inclusion or exclusion by two independent reviewers. Records with individual-level data on recurrence and survival conducted in Africa were included while exclusion was based on the study design and availability of relevant data. Data were independently extracted by three reviewers from eligible studies, and summary estimates were sought. Our primary outcomes were recurrence and 5-year overall survival of patients who have been treated for HNC, and our secondary outcomes included risk factors, tumor site, squamous cell histology, clinical stage of tumor, and treatment options received. Only records selected for primary outcomes were assessed for secondary outcome data extraction. Random-effects meta-analysis was conducted for each outcome. Meta-regression models were used in addressing sample heterogeneity among the studies. Protocol for this study was registered with PROSPERO, CRD42022372307. Findings This systematic review and meta-analysis returned 3998 records, yielding 28 included studies after exclusion. Eighteen studies reported on the prevalence of HNC recurrence while 24 articles reported on the 5-year overall survival. Of the pooled total study population, 7199 (70.5%) of 10,218 patients were males while 2603 (25.5%) were females. We found that the prevalence of HNC recurrence was 15.4% (I2 = 96.2%; 95% CI: 9.5-22.3; n = 3214; k = 18), and the 5-year overall survival was 54.4% (I2 = 99.5%; 95% CI: 40.1-68.4; n = 9798; k = 24). We also found that the prevalence of smoking and alcohol consumption as risk factors for HNC were 42.6% (I2 = 98.8%; 95% CI: 25.2-61.0; n = 4374; k = 15) and 35.8% (I2 = 98.9%; 95% CI: 21.7-51.4; n = 4110; k = 11) respectively. The pooled current prevalence for advanced HNC (clinical stages III-IV) was 80.0% (I2 = 99.2%; 95% CI: 68.6-89.5; n = 7624; k = 18) compared to 12.2% (I2 = 96.4%; 95% CI: 6.2-19.8; n = 7624; k = 18) in early disease (clinical stages I-II). Interpretation The results showed significantly high prevalence of cancer recurrence, poor 5-year overall survival and very high prevalence of advanced cancers at time of diagnosis. This study provides robust evidence for strategies towards prompt diagnosis and appropriate management of HNC to improve patients' outcome in the African continent. Funding This study was not supported by any funding.
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Affiliation(s)
- Herbert Melariri
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
- Corresponding author. Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Buckingham Road, Mount Croix, Gqeberha, South Africa.
| | - Timothy Els
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Opeoluwa Oyedele
- Department of Computing, Mathematical, and Statistical Sciences, School of Science, University of Namibia, Windhoek, Namibia
- Department of Environmental Health, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Tessa K. Suttle
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Kim Theresa Bermosky
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Adelaide De Freitas
- Department of Radiation Oncology, Livingstone Tertiary Hospital, Gqeberha, South Africa
| | - Amir Murtaza
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Mohamed Moosajee
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Paula E. Melariri
- Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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Monitoring socioeconomic inequalities in health in Hong Kong: insights and lessons from the UK and Australia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 31:100636. [PMID: 36879790 PMCID: PMC9985041 DOI: 10.1016/j.lanwpc.2022.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
In many developed countries such as the UK and Australia, addressing socioeconomic inequalities in health is a priority in their policy agenda, with well-established practices and authorities to collect and link selected health and social indicators for long-term monitoring. Nonetheless, the monitoring of socioeconomic inequalities in health in Hong Kong remains in a piecemeal manner. Also, the common international practice to monitor inequalities at area level appears to be unsuitable in Hong Kong due to its small, compact, and highly interconnected built environment that limits the variation of neighbourhood deprivation level. To enhance inequality monitoring in Hong Kong, we aim to draw reference and lesson from the UK and Australia to explore the feasible steps forward regarding collection of health indicators and contextually appropriate equity stratifiers with strong implication on policy actions, and discuss potential strategies to promote the public awareness and motivations for a more comprehensive inequality monitoring system.
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BURAN G, BAŞOĞLU M, CİNDAŞ P. Yabancı Uyruklu Öğrencilerin Kültürel Özellikleri, Kadın Sağlığı ve Sağlık Hizmeti Alımı İlişkisi. DOKUZ EYLÜL ÜNIVERSITESI HEMŞIRELIK FAKÜLTESI ELEKTRONIK DERGISI 2022. [DOI: 10.46483/deuhfed.1050403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Giriş: Yabancı uyruklu öğrencilerin farklı dil ve kültürel özelliklere sahip olması, sağlık hizmeti alımı ve kadın sağlığı açısından önemlidir.
Amaç: Çalışmada yabancı uyruklu kadın öğrencilerin kültürel özelliklerinin kadın sağlığı ve sağlık bakım hizmeti alma durumları arasındaki ilişkinin belirlenmesi amaçlanmıştır.
Yöntem: Kesitsel ve tanımlatıcı nitelikte olan araştırmanın örneklemini 2019-2020 güz yarıyılında ULUTÖMER’de öğrenim gören, 27 ülkeden oluşan, 62 kadın öğrenci oluşturdu. Verileri toplama aracı olarak “Hemşirelik Bakımında Kültürel Özellikleri Tanılama Rehberi” kullanılmıştır.
Bulgular: Yaş ortalaması 20.66±2.52 olan kadın öğrencilerin %93.5’i bekârdır. Bu öğrencilerin menstruasyon ağrısı için geleneksel ya da tıbbi tedavi uygulamalarının ülkeler arasında anlamlı düzeyde farklı olduğu belirlenmiştir (p < .005). Çalışmada öğrencilerin sağlık bakım sistemi ilişkin bilgi engelli ve kadın sağlığına ilişkin kültürel uygulamaları arasında pozitif yönde anlamlı bir ilişki bulunmuştur (r = .253, p = .047). Öğrencilerin sağlık hizmeti alımında iletişim engeli ile inancı gereği sağlık bakım hizmeti alamaya engel olan durumlar arasında orta düzeyde negatif yönlü (r = -.317, p = .012), sağlık bakım hizmetine ulaşım engeli arasında da pozitif yönlü güçlü ilişki olduğu tespit edilmiştir (r = .480, p = .000).
Sonuç: Yabancı uyruklu kadın öğrencilerin kadın sağlığına ilişkin kültürel uygulamaları ile sağlık bakım hizmetinde yaşadıkları engeller arasında pozitif yönde ilişki belirlenmiştir. Öğrencilerin sağlık hizmeti alımında iletişim engeli arttıkça, sağlık bakım hizmeti alama engelini de artırdığını göstermiştir.
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Affiliation(s)
| | | | - Pakize CİNDAŞ
- BURSA ULUDAĞ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ
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5
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Jia H, Sai X, Su Y, Huang Y. Measurement and Decomposition of the Health Poverty of Rural Residents in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12876. [PMID: 36232182 PMCID: PMC9566343 DOI: 10.3390/ijerph191912876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
Narrowing the health gap and promoting health equality is the key to effectively blocking the intergenerational transmission of rural poverty. Previous studies have mainly focused on the relationship between health and poverty, but assessments of health poverty are lacking, especially with regard to the health poverty of rural residents. Based on China's large sample household survey data, this study uses the Alkire-Foster (AF) method to measure and decompose the health poverty of rural residents. The results show that the health poverty of Chinese rural residents greatly improved from 2016 to 2018. However, significant regional differences exist with regard to the level of health poverty. The marginal contribution of economic poverty alleviation is diminishing; the equalization of health services and security has shifted to a policy focus. Community environmental management has also become an important aspect of health poverty governance, and individual health literacy and behavior have played an important role in endogenous poverty alleviation. Ultimately, this paper offers some insightful policy implications. This study extends the multidimensional poverty measurement system and reveals the relationship between health poverty and regional economic and social development. The findings also enhance the understanding of the health poverty of rural residents in developing countries.
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Affiliation(s)
- Haiyan Jia
- School of Public Administration and Policy, Shandong University of Finance and Economics, Jinan 250014, China
| | - Xiaoyu Sai
- School of Public Administration and Policy, Shandong University of Finance and Economics, Jinan 250014, China
| | - Yangyue Su
- School of Management Engineering, Shandong Jianzhu University, Jinan 250014, China
| | - Ying Huang
- School of Public Administration and Policy, Shandong University of Finance and Economics, Jinan 250014, China
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Chan SM, Chung GKK, Kwan MHW, Woo J. Mitigating inequalities in community care needs of older adults with dementia: a qualitative case study of an integrated model of community care operated under the proportionate universalism principle. BMC PRIMARY CARE 2022; 23:244. [PMID: 36131245 PMCID: PMC9494773 DOI: 10.1186/s12875-022-01855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/29/2022] [Indexed: 05/31/2023]
Abstract
Abstract
Background
Population ageing and community care on older adults, as well as the marked social inequalities in health, have received growing concern by the government and the community. This study evaluated the medico-social integrated day care model of the Cadenza Hub for older adults with dementia. We also examined whether services subsidized by the publicly funded graded financial support of the Community Care Service Voucher for the Elderly (CCSV) could mitigate social inequalities in community care needs, from the perspective of the caregivers.
Methods
In this qualitative case study, we adopted purposeful sampling strategy to recruit 14 caregivers of active day care service users with dementia, with different socioeconomic background and duration of service use, for face-to-face semi-structured in-depth interviews between June and August 2021. The transcribed data were closely read to capture key themes using thematic analyses.
Results
Caregivers faced tremendous caregiving burden in the absence of community care support and struggled in choosing care services. Most informants benefited from the day care service, whereas the financial support of CCSV was crucial to ensure equitable access to community care. Non-governmental organizations and social workers were the key to bridging the information gap.
Conclusion
The integrated day care of the Cadenza Hub appeared to have addressed the unmet needs of older adults with dementia and their caregivers, including the socioeconomically disadvantaged with the CCSV support. The community care service delivery model might be applicable to address other health inequalities problems.
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7
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Chung RYN, Chung GKK, Chan SM, Chan YH, Wong H, Yeoh EK, Allen J, Woo J, Marmot M. Socioeconomic inequality in mental well-being associated with COVID-19 containment measures in a low-incidence Asian globalized city. Sci Rep 2021; 11:23161. [PMID: 34848754 PMCID: PMC8633192 DOI: 10.1038/s41598-021-02342-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/03/2021] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in places with relatively well-controlled outbreaks such as Hong Kong. This study aimed to explore whether the socioeconomically disadvantaged fare worse via various types of worry in terms of their mental health and well-being. Between September and October 2020, 1067 adults in Hong Kong were recruited via a cross-sectional population-wide telephone survey. The inter-relationship between deprivation, types of worry, mental health disorders, and subjective well-being was assessed using structural equation modelling. Results showed significant total effects of deprivation on worries about being infected (p = 0.002), economic activities and livelihood (p < 0.001), and personal savings (p < 0.001), as well as mental health disorders (p < 0.001) and subjective well-being (p < 0.001). Specifically, worry about economic activities and livelihood partly mediated the total effect of deprivation on mental health disorders (p = 0.004), whereas worry about personal savings and worry about economic activities and livelihood partially mediated the total effect of deprivation on subjective well-being (p = 0.007 and 0.002, respectively). Socioeconomic inequality, particularly in mental health and well-being, could be exacerbated via people's economic concerns during the pandemic, which was largely induced by the COVID-19 containment measures rather than the pandemic per se given the relatively low COVID-19 incidence in Hong Kong.
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Affiliation(s)
- Roger Yat-Nork Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China. .,The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. .,CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China. .,4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China.
| | - Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siu-Ming Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,CityU Department of Social and Behavioural Sciences, The City University of Hong Kong, Hong Kong SAR, China
| | - Yat-Hang Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eng Kiong Yeoh
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Allen
- Department of Epidemiology and Public Health, UCL Institute of Health Equity, UCL Research, London, UK
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Epidemiology and Public Health, UCL Institute of Health Equity, UCL Research, London, UK
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Chung GKK, Chan SM, Chan YH, Woo J, Wong H, Wong SY, Yeoh EK, Marmot M, Chung RY. Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City, Hong Kong. Emerg Infect Dis 2021; 27:2874-2877. [PMID: 34469286 PMCID: PMC8544972 DOI: 10.3201/eid2711.204840] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although coronavirus disease (COVID-19) outbreaks have been relatively well controlled in Hong Kong, containment remains challenging among socioeconomically disadvantaged persons. They are at higher risk for widespread COVID-19 transmission through sizable clustering, probably because of exposure to social settings in which existing mitigation policies had differential socioeconomic effects.
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Chung GKK, Chan SM, Chan YH, Yip TCF, Ma HM, Wong GLH, Chung RYN, Wong H, Wong SYS, Yeoh EK, Marmot M, Woo J. Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8168. [PMID: 34360461 PMCID: PMC8346110 DOI: 10.3390/ijerph18158168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of COVID-19 severity and its effect modification with multimorbidity in Hong Kong. 3074 local COVID-19 cases diagnosed from 5 July to 31 October 2020 were analyzed and followed up until 30 November 2020. Data on residential addresses, socio-demographic background, COVID-19 clinical conditions, and pre-existing chronic diseases of confirmed cases were retrieved from the Centre for Health Protection and the Hospital Authority. Results showed that, despite an independent adverse impact of multimorbidity on COVID-19 severity (aOR = 2.35 [95% CI = 1.72-3.19]), it varied across the socioeconomic ladder, with no significant risk among those living in the wealthiest areas (aOR = 0.80 [0.32-2.02]). Also, no significant association of the area-level income-poverty rate with severe COVID-19 was observed. In conclusion, the socioeconomic patterning of severe COVID-19 was mild in Hong Kong. Nonetheless, socioeconomic position interacted with multimorbidity to determine COVID-19 severity with a mitigated risk among the socioeconomically advantaged. Plausible explanations include the underlying socioeconomic inequalities in chronic disease management and the equity impact of the public-private dual-track healthcare system.
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Affiliation(s)
- Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
| | - Siu-Ming Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| | - Yat-Hang Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China; (T.C.-F.Y.); (H.-M.M.); (G.L.-H.W.)
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hon-Ming Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China; (T.C.-F.Y.); (H.-M.M.); (G.L.-H.W.)
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China; (T.C.-F.Y.); (H.-M.M.); (G.L.-H.W.)
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Roger Yat-Nork Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Samuel Yeung-Shan Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eng Kiong Yeoh
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
- UCL Institute of Health Equity, UCL Research Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China; (S.-M.C.); (Y.-H.C.); (R.Y.-N.C.); (H.W.); (S.Y.-S.W.); (E.K.Y.); (M.M.); (J.W.)
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China; (T.C.-F.Y.); (H.-M.M.); (G.L.-H.W.)
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Chung RYN, Chung GKK, Marmot M, Allen J, Chan D, Goldblatt P, Wong H, Lai E, Woo J, Yeoh EK, Wong SYS. COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong. J Epidemiol Community Health 2021; 75:616-623. [PMID: 33402396 DOI: 10.1136/jech-2020-215392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND We examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence. METHODS 752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factors, worry of COVID-19, general health, economic activity, and personal protective equipment (PPE) and related hygiene practice by deprivation status. The associations between deprivation and negative COVID-19 related issues were analysed using binary logistic regressions, while the associations of these issues with health were analysed using linear regressions. Path analysis was conducted to determine the direct effect of deprivation, and the indirect effects via COVID-19 related issues, on health. Interactions between deprivation and the mediators were also tested. RESULTS Deprived individuals were more likely to have job loss/instability, less reserves, less utilisation and more concerns of PPE. After adjustments for potential confounders, being deprived was associated with having greater risk of low reserve of face masks, being worried about the disease and job loss/instability. Being deprived had worse physical (β=-0.154, p<0.001) and mental health (β=-0.211, p<0.001) and had an indirect effect on mental health via worry and job loss/instability (total indirect effect: β=-0.027, p=0.017; proportion being mediated=11.46%). In addition, significant interaction between deprivation and change of economic activity status was observed on mental health-related quality of life. CONCLUSION Even if the COVID-19 incidence was relatively low, part of the observed health inequality can be explained by people's concerns over livelihood and economic activity, which were affected by the containment measures. We should look beyond the incidence to address COVID-19 related health inequalities.
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Affiliation(s)
- Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jessica Allen
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Dicken Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter Goldblatt
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Lai
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eng-Kiong Yeoh
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel Y S Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Huang R, Ghose B, Tang S. Effect of financial stress on self-rereported health and quality of life among older adults in five developing countries: a cross sectional analysis of WHO-SAGE survey. BMC Geriatr 2020; 20:288. [PMID: 32787806 PMCID: PMC7425413 DOI: 10.1186/s12877-020-01687-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
In developing countries, older adults (65 years of age and above) share an increased vulnerability to catastrophic health expenditures and financial stress which can have significant bearing on their health and well-being. Currently, research evidence on how financial stress correlates with health and well-being among older adults in the developing countries is limited. Therefore, in this study, we aimed to assess the relationship between financial stress and subjective 1) health, 2) depression, 3) quality of life, and 4) life satisfaction among older adults in five developing countries. METHODS Data used in this study were cross-sectional which were collected from the first wave of Study on Global AGEing and Health (SAGE) survey of World Health Organization. Sample population were 12,299 community dwelling men and women in China (n = 4548), Ghana (n = 1968), India (n = 2441), South Africa (n = 1924), and Russia (n = 1418). Using generalized linear models with logit links, we assessed the correlation between self-reported financial stress and income inequality with the four outcome measures by adjusting for various sociodemographic factors. RESULTS Overall, the prevalence of good self-reported health, quality of life and positive life-satisfaction was 47.11, 79.25 and 44.40% respectively, while 20.13% of the participants reported having depression during past 12 months. Only about a fifth (18.67%) of the participants reported having enough money to meet daily their necessities completely, while more than quarter (28.45%) were in the lowest income quintile. With a few exceptions, the odds of reporting good self-reported health, quality of life, and life satisfaction were generally lower among those with varying degrees of financial stress, and larger among those in the higher income quintiles. Conversely, the likelihood of self-reported depression was significantly higher among those with any level of financial stress, and lower among those in the higher income quintiles. CONCLUSION This study concludes that both subjectively and objectively measured financial stress are inversely associated with good self-reported health, quality of life, life satisfaction, and positively associated with self-reported depression among older adults.
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Affiliation(s)
- Rui Huang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Bishwajit Ghose
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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