1
|
Van Wilder L, Devleesschauwer B, Clays E, Van der Heyden J, Charafeddine R, Scohy A, De Smedt D. QALY losses for chronic diseases and its social distribution in the general population: results from the Belgian Health Interview Survey. BMC Public Health 2022; 22:1304. [PMID: 35799140 PMCID: PMC9264606 DOI: 10.1186/s12889-022-13675-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The burden of chronic diseases is rapidly rising, both in terms of morbidity and mortality. This burden is disproportionally carried by socially disadvantaged population subgroups. Quality-adjusted life years (QALYs) measure the impact of disease on mortality and morbidity into a single index. This study aims to estimate the burden of chronic diseases in terms of QALY losses and to model its social distribution for the general population. Methods The Belgian Health Interview Survey 2013 and 2018 provided data on self-reported chronic conditions for a nationally representative sample. The annual QALY loss per 100,000 individuals was calculated for each condition, incorporating disease prevalence and health-related quality of life (HRQoL) data (EQ-5D-5L). Socioeconomic inequalities, based on respondents’ socioeconomic status (SES), were assessed by estimating population attributable fractions (PAF). Results For both years, the largest QALY losses were observed in dorsopathies, arthropathies, hypertension/high cholesterol, and genitourinary problems. QALY losses were larger in women and in older individuals. Individuals with high SES had consistently lower QALY loss when facing a chronic disease compared to those with low SES. In both years, a higher PAF was found in individuals with hip fracture and stroke. In 2013, the health inequality gap amounts to 33,731 QALYs and further expanded to 42,273 QALYs in 2018. Conclusion Given that chronic diseases will rise in the next decades, addressing its burden is necessary, particularly among the most vulnerable (i.e. older persons, women, low SES). Interventions in these target groups should get priority in order to reduce the burden of chronic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13675-y.
Collapse
Affiliation(s)
- Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, University Hospital, Ghent, Belgium.
| | - Brecht Devleesschauwer
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, University Hospital, Ghent, Belgium
| | | | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Aline Scohy
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, University Hospital, Ghent, Belgium
| |
Collapse
|
2
|
The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020–2021. Arch Public Health 2022; 80:109. [PMID: 35366953 PMCID: PMC8976211 DOI: 10.1186/s13690-022-00856-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/18/2022] [Indexed: 02/08/2023] Open
Abstract
Background In Belgium, current research on socio-economic inequalities in the coronavirus disease 2019 (COVID-19) crisis has mainly focused on excess mortality and data from the first epidemiological wave. The current study adds onto this by examining the association between COVID-19 incidence and area deprivation during the first five wave and interwave periods, thus adding a temporal gradient to the analyses. Methods We use all confirmed COVID-19 cases between March 2020 and June 2021 in Belgium, aggregated at the municipality-level. These data were collected by the national laboratory-based COVID-19 surveillance system. A level of area deprivation was assigned to each Belgian municipality using data of three socio-economic variables: the share of unemployed persons in the active population, the share of households without a car and the share of low-educated persons. The spatio-temporal association between COVID-19 incidence and area deprivation was assessed by performing multivariate negative-binomial regression analyses and computing population attributable fractions. Results A significant association between COVID-19 incidence and area deprivation was found over the entire study period, with the incidence in the most deprived areas predicted to be 24% higher than in the least deprived areas. This effect was dependent on the period during the COVID-19 crisis. The largest socio-economic inequalities in COVID-19 infections could be observed during wave 2 and wave 3, with a clear disadvantage for deprived areas. Conclusion Our results provide new insights into spatio-temporal patterns of socio-economic inequalities in COVID-19 incidence in Belgium. They reveal the existence of inequalities and a shift of these patterns over time. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00856-9.
Collapse
|
3
|
van Overbeeke E, Hauber B, Michelsen S, Peerlinck K, Lambert C, Hermans C, Lê PQ, Goldman M, Simoens S, Huys I. Patient preferences for gene therapy in haemophilia: Results from the PAVING threshold technique survey. Haemophilia 2021; 27:957-966. [PMID: 34472162 PMCID: PMC9293173 DOI: 10.1111/hae.14401] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/07/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of the Patient preferences to Assess Value IN Gene therapies (PAVING) study was to investigate trade-offs that adult Belgian people with haemophilia (PWH) A and B are willing to make when choosing between prophylactic factor replacement therapy (PFRT) and gene therapy. METHODS The threshold technique was used to quantify the minimum acceptable benefit (MAB) of a switch from PFRT to gene therapy in terms of 'Annual bleeding rate' (ABR), 'Chance to stop prophylaxis' (STOP), and 'Quality of life' (QOL). The design was supported by stakeholder involvement and included an educational tool on gene therapy. Threshold intervals were analysed using interval regression models in Stata 16. RESULTS A total of 117 PWH completed the survey. Mean thresholds were identified for all benefits, but substantial preference heterogeneity was observed; especially for the STOP thresholds, where the distribution of preferences was bimodal. Time spent on the educational tool and residence were found to impact MAB thresholds. The most accepted (88% of PWH) gene therapy profile investigated in this study comprised of zero bleeds per year (vs. six for PFRT), 90% chance to stop prophylaxis, no impact on QoL, and 10 years of follow-up on side effects (vs. 30 for PFRT). CONCLUSIONS Results from this study proved the value of educating patients on novel treatments. Moreover, preference heterogeneity for novel treatments was confirmed in this study. In gene therapy decision-making, preference heterogeneity and the impact of patient education on acceptance should be considered.
Collapse
Affiliation(s)
- Eline van Overbeeke
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| | - Brett Hauber
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, USA.,Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Sissel Michelsen
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| | | | | | - Cedric Hermans
- Haemophilia Clinic, St-Luc University Hospital, Brussels, Belgium
| | - Phu Quoc Lê
- Hémato-Oncologie, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Michel Goldman
- Institute for Interdisciplinary Innovation in healthcare, Université libre de Bruxelles, Brussels, Belgium
| | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Abstract
Purpose Health-related quality of life outcomes are increasingly used to monitor population health and health inequalities and to assess the (cost-) effectiveness of health interventions. The EQ-5D-5L has been included in the Belgian Health Interview Survey, providing a new source of population-based self-perceived health status information. This study aims to estimate Belgian population norms for the EQ-5D-5L by sex, age, and region and to analyze its association with educational attainment. Methods The BHIS 2018 provided EQ-5D-5L data for a nationally representative sample of the Belgian population. The dimension scores and index values were analyzed using logistic and linear regressions, respectively, accounting for the survey design. Results More than half of respondents reported problems of pain/discomfort, while over a quarter reported problems of anxiety/depression. The average index value was 0.84. Women reported more problems on all dimensions, but particularly on anxiety/depression and pain/discomfort, resulting in significantly lower index values. Problems with mobility, self-care, and usual activities showed a sharp increase after the age of 80 years. Consequently, index values decreased significantly by age. Lower education was associated with a higher prevalence of problems for all dimensions except anxiety/depression and with a significantly lower index value. Conclusion This paper presents the first nationally representative Belgian population norms using the EQ-5D-5L. Inclusion of the EQ-5D in future surveys will allow monitoring over time of self-reported health, disease burden, and health inequalities. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02971-6.
Collapse
|
5
|
Weng SS, Chan TC, Hsu PY, Niu SF. Neighbourhood Social Determinants of Health and Geographical Inequalities in Premature Mortality in Taiwan: A Spatiotemporal Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137091. [PMID: 34281027 PMCID: PMC8297024 DOI: 10.3390/ijerph18137091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 12/18/2022]
Abstract
Geographical inequalities in premature mortality and the role of neighbourhood social determinants of health (SDOH) have been less explored. This study aims to assess the geographical inequalities in premature mortality in Taiwan and how neighbourhood SDOH contribute to them and to examine the place-specific associations between neighbourhood SDOH and premature mortality. We used township-level nationwide data for the years 2015 to 2019, including age-standardized premature mortality rates and three upstream SDOH (ethnicity, education, and income). Space-time scan statistics were used to assess the geographical inequality in premature mortality. A geographical and temporal weighted regression was applied to assess spatial heterogeneity and how neighbourhood SDOH contribute to geographic variation in premature mortality. We found geographical inequality in premature mortality to be clearly clustered around mountainous rural and indigenous areas. The association between neighbourhood SDOH and premature mortality was shown to be area-specific. Ethnicity and education could explain nearly 84% variation in premature mortality. After adjusting for neighbourhood SDOH, only a handful of hotspots for premature mortality remained, mainly consisting of rural and indigenous areas in the central-south region of Taiwan. These findings provide empirical evidence for developing locally tailored public health programs for geographical priority areas.
Collapse
Affiliation(s)
- Shiue-Shan Weng
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (S.-S.W.); (T.-C.C.)
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Ta-Chien Chan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (S.-S.W.); (T.-C.C.)
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Pei-Ying Hsu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
| | - Shu-Fen Niu
- Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
- Department of Nursing, Fu Jen Catholic University, Taipei 242, Taiwan
- Correspondence:
| |
Collapse
|
6
|
Rosskamp M, Verbeeck J, Gadeyne S, Verdoodt F, De Schutter H. Socio-Economic Position, Cancer Incidence and Stage at Diagnosis: A Nationwide Cohort Study in Belgium. Cancers (Basel) 2021; 13:cancers13050933. [PMID: 33668089 PMCID: PMC7956180 DOI: 10.3390/cancers13050933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Socio-economic position is associated with cancer incidence, but the direction and magnitude of this relationship differs across cancer types, geographical regions, and socio-economic parameters. In this nationwide cohort study, we evaluated the association between different individual-level socio-economic and -demographic factors, cancer incidence, and stage at diagnosis in Belgium. Methods: The 2001 census was linked to the nationwide Belgian Cancer Registry for cancer diagnoses between 2004 and 2013. Socio-economic parameters included education level, household composition, and housing conditions. Incidence rate ratios were assessed through Poisson regression models. Stage-specific analyses were conducted through logistic regression models. Results: Deprived groups showed higher risks for lung cancer and head and neck cancers, whereas an inverse relation was observed for malignant melanoma and female breast cancer. Typically, associations were more pronounced in men than in women. A lower socio-economic position was associated with reduced chances of being diagnosed with known or early stage at diagnosis; the strongest disparities were found for male lung cancer and female breast cancer. Conclusions: This study identified population groups at increased risk of cancer and unknown or advanced stage at diagnosis in Belgium. Further investigation is needed to build a comprehensive picture of socio-economic inequality in cancer incidence.
Collapse
Affiliation(s)
- Michael Rosskamp
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
- Correspondence: ; Tel.: +32-2-250-1010
| | - Julie Verbeeck
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
| | - Sylvie Gadeyne
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, B-1050 Brussels, Belgium;
| | - Freija Verdoodt
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
| | - Harlinde De Schutter
- Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium; (J.V.); (F.V.); (H.D.S.)
| |
Collapse
|
7
|
Rosskamp M, Verbeeck J, Sass V, Gadeyne S, Verdoodt F, De Schutter H. Social Inequalities in Cancer Survival in Belgium: A Population-Based Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 30:45-52. [PMID: 33082205 DOI: 10.1158/1055-9965.epi-20-0721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/28/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is an important factor in cancer survival; however, results are heterogeneous and linked to characteristics of the study population and health care system. This population-based cohort study evaluates the association between individual-level socioeconomic and demographic factors and cancer survival for the first time in Belgium. METHODS From the Belgian Cancer Registry, we identified 109,591 patients diagnosed between 2006 and 2013 with one of eight common cancer types. Information on treatment, socioeconomic parameters, and vital status were retrieved from multiple data sources and linked using a unique personal identification number. The outcome was 5-year observed survival. Associations between survival and socioeconomic and demographic factors were assessed using multivariable Cox proportional-hazard regression models. RESULTS Lower income, unemployment, and living alone were all associated with worse cancer survival. These associations were most pronounced for certain lifestyle-related cancer types (e.g., head and neck cancers) and those with good to moderate prognosis (e.g., colorectal and female breast cancer). CONCLUSIONS These results indicate that, despite a comprehensive and nationwide health insurance program in which equity in rights and access to health care are pursued, SES is associated with disparities in cancer survival in Belgium. IMPACT This population-based study with individual-level socioeconomic information of more than 100,000 patients with cancer identifies patient groups that may be at highest risk for socioeconomic disparities in cancer survival. Reasons behind the observed disparities are multiple and complex and should be further examined. Health policy interventions should consider the observed deprivation gap to plan targeted actions.
Collapse
Affiliation(s)
| | | | - Victoria Sass
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Sociology, University of Washington, Seattle, Washington
| | - Sylvie Gadeyne
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | |
Collapse
|
8
|
Lewer D, Jayatunga W, Aldridge RW, Edge C, Marmot M, Story A, Hayward A. Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study. Lancet Public Health 2020; 5:e33-e41. [PMID: 31813773 PMCID: PMC7098478 DOI: 10.1016/s2468-2667(19)30219-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Low socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England. METHODS We used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality. FINDINGS 35·6% (95% CI 35·3-35·9) of premature deaths were attributable to socioeconomic inequality, equating to 877 082 deaths, or one every 10 min. The biggest contributors were ischaemic heart disease (152 171 excess deaths), respiratory cancers (111 083) and chronic obstructive pulmonary disease (83 593). The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. Inequality was greater among men and peaked in early childhood and at age 40-49 years. The proportion of deaths attributable to inequality increased during the study period, particularly for women, because mortality rates among the most deprived women (excluding cardiovascular diseases) plateaued, and for some diseases increased. A mean of 14·4 months of life before age 75 years are lost due to socioeconomic inequality. INTERPRETATION One in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge. Interventions that address upstream determinants of health should be prioritised. FUNDING National Institute of Health Research; Wellcome Trust.
Collapse
Affiliation(s)
- Dan Lewer
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute for Health Informatics, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK.
| | - Wikum Jayatunga
- Institute for Health Informatics, University College London, London, UK
| | - Robert W Aldridge
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute for Health Informatics, University College London, London, UK
| | - Chantal Edge
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
| | - Michael Marmot
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alistair Story
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK; Find and Treat, University College London Hospitals, London, UK
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
| |
Collapse
|