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Flodin P, Allebeck P, Gubi E, Burström B, Agardh EE. Income-based differences in healthcare utilization in relation to mortality in the Swedish population between 2004-2017: A nationwide register study. PLoS Med 2023; 20:e1004230. [PMID: 37971955 PMCID: PMC10653442 DOI: 10.1371/journal.pmed.1004230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Despite universal healthcare, socioeconomic differences in healthcare utilization (HCU) persist in modern welfare states. However, little is known of how HCU inequalities has developed over time. The aim of this study is to assess time trends of differences in utilization of primary and specialized care for the lowest (Q1) and highest (Q5) income quantiles and compare these to mortality. METHODS AND FINDINGS Using a repeated cross-sectional register-based study design, data on utilization of (i) primary; (ii) specialized outpatient; and (iii) inpatient care, as well as (iv) cause of death, were linked to family income and sociodemographic control variables (for instance, country of origin and marital status). The study sample comprised all individuals 16 years or older residing in Sweden any year during the study period and ranged from 7.1 million in year 2004 to 8.0 million year 2017. HCU and mortality for all disease as well as for the 5 disease groups causing most deaths were compared for the Q1 and Q5 using logistic regression, adjusting for sex, age, marital status, and birth country. The primary outcome measures were adjusted odds ratios (ORs), and regression coefficients of annual changes in these ORs log-transformed. Additionally, we conducted negative binominal regression to calculate adjusted rate ratios (RRs) comparing Q1 and Q5 with regard to number of disease specific healthcare encounters ≤5 years prior to death. In 2017, for all diseases combined, Q1 utilized marginally more primary and specialized outpatient care than Q5 (OR 1.07, 95% CI [1.07, 1.08]; p < 0.001, and OR 1.04, 95% CI [1.04, 1.05]; p < 0.001, respectively), and considerably more inpatient care (OR 1.44, 95% CI [1.43, 1.45]; p < 0.001). The largest relative inequality was observed for mortality (OR 1.78, 95% CI [1.74, 1.82]; p < 0.001). This pattern was broadly reproduced for each of the 5 disease groups. Time trends in HCU inequality varied by level of care. Each year, Q1 (versus Q5) used more inpatient care and suffered increasing mortality rates. However, utilization of primary and specialized outpatient care increased more among Q5 than in Q1. Finally, group differences in number of healthcare encounters ≤5 years prior to death demonstrated a similar pattern. For each disease group, primary and outpatient care encounters were fewer in Q1 than in Q5, while inpatient encounters were similar or higher in Q1. A main limitation of this study is the absence of data on self-reported need for care, which impedes quantifications of HCU inequalities each year. CONCLUSIONS Income-related differences in the utilization of primary and specialized outpatient care were considerably smaller than for mortality, and this discrepancy widened with time. Facilitating motivated use of primary and outpatient care among low-income groups could help mitigate the growing health inequalities.
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Affiliation(s)
- Pär Flodin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter Allebeck
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ester Gubi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Emilie E. Agardh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Lo Sardo DR, Thurner S, Sorger J, Heiler G, Gyimesi M, Kautzky A, Leutner M, Kautzky-Willer A, Klimek P. Systematic population-wide ecological analysis of regional variability in disease prevalence. Heliyon 2023; 9:e15377. [PMID: 37123976 PMCID: PMC10130859 DOI: 10.1016/j.heliyon.2023.e15377] [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: 06/17/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
The prevalence of diseases often varies substantially from region to region. Besides basic demographic properties, the factors that drive the variability of each prevalence are to a large extent unknown. Here we show how regional prevalence variations in 115 different diseases relate to demographic, socio-economic, environmental factors and migratory background, as well as access to different types of health services such as primary, specialized and hospital healthcare. We have collected regional data for these risk factors at different levels of resolution; from large regions of care (Versorgungsregion) down to a 250 by 250 m square grid. Using multivariate regression analysis, we quantify the explanatory power of each independent variable in relation to the regional variation of the disease prevalence. We find that for certain diseases, such as acute heart conditions, diseases of the inner ear, mental and behavioral disorders due to substance abuse, up to 80% of the variance can be explained with these risk factors. For other diagnostic blocks, such as blood related diseases, injuries and poisoning however, the explanatory power is close to zero. We find that the time needed to travel from the inhabited center to the relevant hospital ward often contributes significantly to the disease risk, in particular for diabetes mellitus. Our results show that variations in disease burden across different regions can for many diseases be related to variations in demographic and socio-economic factors. Furthermore, our results highlight the relative importance of access to health care facilities in the treatment of chronic diseases like diabetes.
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Affiliation(s)
- Donald Ruggiero Lo Sardo
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Austria
- Complexity Science Hub Vienna, Josefst ädter Strasse 39, A-1080, Vienna, Austria
- Physics Department, Sapienza University of Rome, Piazzale Aldo Moro 2, 00185, Rome, Italy
- Corresponding author. Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Austria.
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Austria
- Complexity Science Hub Vienna, Josefst ädter Strasse 39, A-1080, Vienna, Austria
- IIASA, Schlossplatz 1, A-2361, Laxenburg, Austria
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM, 85701, USA
| | - Johannes Sorger
- Complexity Science Hub Vienna, Josefst ädter Strasse 39, A-1080, Vienna, Austria
| | - Georgh Heiler
- Complexity Science Hub Vienna, Josefst ädter Strasse 39, A-1080, Vienna, Austria
| | - Michael Gyimesi
- Austrian National Public Health Institute (GÖG), Stubenring 6, A-1010, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertal 18–20, A-1090, Vienna, Austria
| | - Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertal 18–20, A-1090, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertal 18–20, A-1090, Vienna, Austria
- Gender Institute, A-3571, Gars am Kamp, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Austria
- Complexity Science Hub Vienna, Josefst ädter Strasse 39, A-1080, Vienna, Austria
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Listorti E, Torbica A, Cella SG, Fiorini G, Corrao G, Franchi M. Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16447. [PMID: 36554329 PMCID: PMC9778250 DOI: 10.3390/ijerph192416447] [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: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Based on the principle of health equity, the Italian National Health Service is known worldwide for being a universalistic system that guarantees healthcare services for all its population, among which there are undocumented migrants. A commitment for their health needs is further motivated by their lower utilisation rates of healthcare services, which becomes even more crucial when considering chronic conditions such as diabetes that require adherence and continuity of care. However, the need for more official data has resulted in little research documenting these healthcare usage patterns. For this reason, our objective has been to deepen, from the Italian NHS perspective, the quantity, costs, type, preventability and organisation of healthcare services directed to undocumented migrants. We used official healthcare data from the Lombardy Region, which enable the identification of people receiving the STP code (undocumented migrants) and of people with foreign citizenship (documented migrants). After quantifying the average annual amount and expenditure for healthcare services grouped by Italian citizens, documented migrants and undocumented migrants for all clinical conditions (quantity and costs), we performed three primary investigations where we enlightened differences between the three mentioned groups focusing on the diagnosis of diabetes: (i) mapping the types of healthcare services used and their characteristics (type); (ii) quantifying the impact of preventable hospital admissions (preventability); (iii) examining the healthcare patterns linking pharmaceutical prescriptions with hospital accesses (organisation). Our results reveal significant differences among the three groups, such as more urgent hospital admissions, more preventable complications, and a higher recurrence in terms of access and costs to hospital services rather than pharmaceutical prescriptions for undocumented migrants. These findings can represent the leverage to raise awareness toward the emerging challenges of the migrant health burden.
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Affiliation(s)
- Elisabetta Listorti
- Centre for Healthcare and Social Care Management (CERGAS), SDA Bocconi, 20136 Milan, Italy
| | - Aleksandra Torbica
- Centre for Healthcare and Social Care Management (CERGAS), SDA Bocconi, 20136 Milan, Italy
| | - Silvano G. Cella
- Laboratory of Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milan, via Vanvitelli 32, 20129 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gianfrancesco Fiorini
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
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Crescioli G, Boscia E, Bettiol A, Pagani S, Spada G, Vighi GV, Bonaiuti R, Venegoni M, Vighi GD, Vannacci A, Lombardi N. Risk of Hospitalization for Adverse Drug Events in Women and Men: A Post Hoc Analysis of an Active Pharmacovigilance Study in Italian Emergency Departments. Pharmaceuticals (Basel) 2021; 14:ph14070678. [PMID: 34358104 PMCID: PMC8308702 DOI: 10.3390/ph14070678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/30/2022] Open
Abstract
This post hoc analysis of an Italian active pharmacovigilance study describes pharmacological differences of ADEs leading to emergency department (ED) visits and hospitalization in women and men. During the study period (January 2007-December 2018), 61,855 reports of ADEs leading to ED visits were collected. Overall, 30.6% of ADEs resulted in hospitalization (30% in women and 31% in men). Multivariate logistic regression showed that, among women, drug classes significantly associated with an increased risk of hospitalization were heparins (ROR 1.41, CI 1.13-176), antidepressants (ROR 1.12, CI 1.03-1.23) and antidiabetics (ROR 1.13, CI 1.02-1.24). Among men, only vitamin K antagonists (ROR 1.28, CI 1.09-1.50), opioids (ROR 1.30, CI 1.06-1.60) and digitalis glycosides (ROR 1.32, CI 1.09-1.59) were associated with a higher risk of hospitalization. Overall, older age, multiple suspected drugs and the presence of comorbidities were significantly associated with a higher risk of hospitalization. A significantly reduced risk of hospitalization was observed in both women and men experiencing an adverse event following immunization (ROR 0.36, CI 0.27-0.48 and 0.83, 0.42-0.74, respectively) compared to drugs. Results obtained from this real-world analysis highlight important aspects of drug safety between sexes.
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Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (G.C.); (E.B.); (R.B.); (A.V.)
- Tuscan Regional Center of Pharmacovigilance, 50122 Florence, Italy
| | - Ennio Boscia
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (G.C.); (E.B.); (R.B.); (A.V.)
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Silvia Pagani
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, 20871 Vimercate, Italy; (S.P.); (G.S.); (G.V.V.); (G.D.V.)
| | - Giulia Spada
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, 20871 Vimercate, Italy; (S.P.); (G.S.); (G.V.V.); (G.D.V.)
| | - Giuditta Violetta Vighi
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, 20871 Vimercate, Italy; (S.P.); (G.S.); (G.V.V.); (G.D.V.)
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (G.C.); (E.B.); (R.B.); (A.V.)
- Joint Laboratory of Technological Solutions for Clinical Pharmacology, Pharmacovigilance and Bioinformatics, University of Florence, 50139 Florence, Italy
| | - Mauro Venegoni
- Pharmacology Unit, Department of Diagnostics and Public Health, University of Verona, 37100 Verona, Italy;
| | - Giuseppe Danilo Vighi
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, 20871 Vimercate, Italy; (S.P.); (G.S.); (G.V.V.); (G.D.V.)
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (G.C.); (E.B.); (R.B.); (A.V.)
- Tuscan Regional Center of Pharmacovigilance, 50122 Florence, Italy
- Joint Laboratory of Technological Solutions for Clinical Pharmacology, Pharmacovigilance and Bioinformatics, University of Florence, 50139 Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (G.C.); (E.B.); (R.B.); (A.V.)
- Tuscan Regional Center of Pharmacovigilance, 50122 Florence, Italy
- Correspondence: ; Tel.: +39-055-27-58-206
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Kim J, Yang KH, Choi AR, Kang MY, Kim HJ, Lee H, Lee JY. Healthcare quality assessments: no guarantees of same outcomes for different socio-economic stroke patients. Int J Qual Health Care 2021; 33:6271471. [PMID: 33961032 DOI: 10.1093/intqhc/mzab081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/07/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Healthcare quality assessment is being conducted in many countries. Although improving health equity is one of the major objectives of medical quality assessment, it is not clear whether different socio-economic statuses show the same health outcomes even in the same medical quality hospitals. No study has directly compared the health outcomes of different socio-economic statuses in the same hospitals nationwide. OBJECTIVE To determine whether the mortality rate of acute stroke patients differs according to socioeconomic status. METHODS This study was a retrospective, observational study of patients who were subject to acute stroke quality assessment in 2013. A total of 10 399 stroke cases were included in the study. When evaluating the mortality rate, the researchers analysed 10 228 cases, after excluding 171 cases that were measured twice for the same person. The levels of socio-economic status were divided according to the use of medical benefits, either National Health Insurance (NHI) for general population or Medical Aid (MA) for the vulnerable. The primary outcomes measured according to socio-economic status were in-hospital mortality rate and 1-year follow-up mortality rate of stroke patients. The secondary outcome was the composite performance score. RESULTS MA recipients had a higher in-hospital mortality rate (12.5 vs. 8.3%, P < 0.001) and 1-year follow-up mortality rate (14.9 vs. 10.8%, P < 0.001) than NHI subscribers. MA recipients had slightly lower scores than NHI subscribers (83.2 vs. 84.4, P = 0.02). In hospitals of the same grade, MA recipients had lower performance scores than NHI subscribers, although the difference was not statistically significant. CONCLUSIONS There is a difference in mortality and healthcare performance according to socio-economic status in stroke patients in Korea. Efforts to improve equity are needed, including the development and monitoring of equality indicators and developing policies for healthcare equity.
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Affiliation(s)
- Jayeun Kim
- Institute of Health and Environment, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul 08826, Korea
| | - Ki Hwa Yang
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea
| | - Ah Rum Choi
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea
| | - Mi Yeon Kang
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University 1, Daehak-ro, Jeongmi-myeon, Dangjin-si, Chungcheongnam-do 31801, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Jin Yong Lee
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea.,Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 07061, Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 07061, Korea
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Outcomes of Culturally Tailored Dietary Intervention in the North African and Bangladeshi Diabetic Patients in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238932. [PMID: 33271775 PMCID: PMC7730264 DOI: 10.3390/ijerph17238932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023]
Abstract
Immigrants show higher adjusted diabetes prevalence than Italians, especially among South-East Asians followed by North and Sub-Saharan Africans. Diabetes progression is influenced by food behaviors, and diet control is a critical aspect in disease management. Food habits have many cultural and symbolic implications. Guidelines recommend that every patient should receive appropriate self-management education according to cultural and socioeconomic characteristics. This study aims to test whether a customized diet and transcultural mediator’s support can improve immigrants’ food habits. A pre-post quali-quantitative study was conducted among 20–79-year-old Bangladeshi and North African diabetic immigrants. The INMP transcultural mediator, an expert in the social and health care field, actively participates in clinical activity by decoding linguistic and cultural needs expressed by the foreigner patient. Five culturally tailored dietary profiles were designed according to international diabetes guidelines and adjusted to traditional food habits. Data were collected with two different semi-structured questionnaires. Changes in food consumption were assessed through McNemar’s test, while paired Wilcoxon Signed-Rank test was used to analyze pre and post intervention. Fifty-five patients were enrolled. At follow-up, cereals, meat, and potatoes intake significantly improved, and the number of adequate dietary habits for each patient increased significantly. Transcultural mediator support was 90% positively evaluated. Adherence to dietary control is favorably influenced by a transcultural intervention, which is based on clinical and socio-cultural criteria, in compliance with patient’s lifestyles.
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