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Mendoza-Pinto C, Etchegaray-Morales I, Munguía-Realpozo P, Solis-Poblano JC, Osorio-Peña ÁD, Zárate-Arellano D, Méndez-Martínez S, García-Carrasco M. Trends in the disease burden of musculoskeletal disorders in Mexico from 1990-2019. Clin Rheumatol 2024; 43:1-13. [PMID: 37775642 DOI: 10.1007/s10067-023-06775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE This study aimed to describe the disease burden and trends of musculoskeletal (MSK) disorders in Mexico from 1990 to 2019. METHOD A cross-sectional study using systematic analysis from the Global Burden of Disease Study 2019 (GBD study 2019) was performed to analyze data on MSK disorders and estimate crude and age-standardized rates per 100,000 population concerning disease prevalence, incidence, mortality, disability-adjusted life-years (DALY), and years lived with disability (YLD). The average annual percentage change (AAPC) was calculated using the joinpoint regression. RESULTS In 2019, there were 4.8 million (95% UI 4.3, 5.4) new cases and 3,312 (95% UI 2201, 4,790) deaths attributable to MSK disorders. In 2019, MSK disorders ranked first, increasing from 1990 (second rank) for the YLD in Mexico. Subnational variations were identified, with the state of Oaxaca having the highest age-standardized incidence rate (ASIR) per 100,000 population in 2019. Joinpoint analysis revealed a significant increase in prevalence in Mexico from 1990 to 2019 (AAPC: 0.14%; 95%CI 0.09-0.19), incidence (AAPC: 0.05%; 95%CI 0.03-0.07), DALY (AAPC: 0.13%; 95%CI 0.04-0.22), and YLD (AAPC: 0.13%; 95%CI 0.02-0.24). Among the risk factors, occupational ergonomic factors and high body mass index (BMI) had the largest influence on MSK disorders. CONCLUSIONS In Mexico, we observed an increase the national burden of MSK disorders from 1990 to 2019. Specific determinants, such as occupational ergonomic factors and high BMI, contribute to the MSK disorder burden. The burden of MSK disorders requires an improved and prompt assessment to plan valuable diagnostic and management approaches. Key Points • In Mexico, the burden of musculoskeletal (MSK) disorders increased from 1990 to 2019. • Specific risk factors, such as occupational ergonomic factors and high body mass index, contribute to the MSK disorder burden.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Unit, HE, UMAE- CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Unit, HE, UMAE- CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Puebla, México.
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México.
| | | | - Ángel David Osorio-Peña
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Diana Zárate-Arellano
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | | | - Mario García-Carrasco
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
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Sarker AR, Zabeen I, Khanam M, Akter R, Ali N. Healthcare-seeking experiences of older citizens in Bangladesh: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001185. [PMID: 36962985 PMCID: PMC10022267 DOI: 10.1371/journal.pgph.0001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/15/2023] [Indexed: 02/10/2023]
Abstract
Despite improvements in many health indicators in the last few decades, providing access to affordable and quality healthcare for older citizen remains a considerable challenge in Bangladesh. This study aimed to understand individuals 'experiences regarding their healthcare-seeking, treatment cost, accessibility and coping mechanisms for the promotion of appropriate strategies to enhance the quality of life of the older citizens of Bangladesh.A qualitative descriptive approach was used in this study. A total of 27 In-Depth Interviews (IDIs) were conducted in a district in Bangladesh with older people between January and February 2020, where gender distribution was equal. Face-to-face interviews were conducted by trained and experienced interviewers regarding healthcare-seeking and accessibility, affordability, and healthcare coping strategy. Thematic analysis was conducted to analyse the data. It was found that the health condition of the older population is not satisfactory. Most of them had been suffering from several diseases such as benign tumor, chronic kidney disease, body aches, gastric ulcers for a longer period of time. The majority of the participants were suffering from multiple non-communicable diseases while diabetes and hypertension were the foremost of all diseases. This study provides insight into the challenges of managing healthcare services for older citizens in Bangladesh. Healthcare facilities were available, but high out-of-pocket payments, lack of caregivers, and time distance created a barrier to the service provision. The findings indicated that geriatric care policymakers and service providers should prioritize the older-friendly health infrastructures with affordable cost of treatment for the betterment of the health status of older citizens in Bangladesh.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Irfat Zabeen
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Moriam Khanam
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
| | | | - Nausad Ali
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
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Anjorin SS, Ayorinde AA, Abba MS, Mensah D, Okolie EA, Uthman OA, Oyebode OO. Equity of national publicly funded health insurance schemes under the universal health coverage agenda: a systematic review of studies conducted in Africa. J Public Health (Oxf) 2022; 44:900-909. [PMID: 34390345 DOI: 10.1093/pubmed/fdab316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The implementation of publicly funded health insurance schemes (PFHIS) is the major strategy to drive progress and achievement of universal health coverage (UHC) by 2030. We appraised evidence on the equity of insurance schemes across Africa. METHODS We conducted a systematic review of published studies that assessed equity in health insurance schemes implemented under the UHC agenda in Africa. Seven databases, Web of Science, Medline, CINAHL, Scopus, Cochrane Library, EMBASE and World Bank eLibrary, were searched; we operationalized the PROGRESS-Plus (place of residence; race/ethnicity/culture/language; occupation; gender/sex religion; education; socioeconomic status; social capital) equity framework to assess equity areas. RESULTS Forty-five studies met the inclusion criteria and were included in the study, in which 90% assessed equity by socioeconomic status. Evidence showed that rural residents, those self-employed or working in the informal sector, men, those with lower educational attainment, and the poor were less likely to be covered by health insurance schemes. Broadly, the insurance schemes, especially, community-based health insurance (CBI) schemes improved utilization by disadvantaged groups, however, the same groups were less likely to benefit from health services. CONCLUSIONS Evidence on equity of PFHIS is mixed, however, CBI schemes seem to offer more equitable coverage and utilization of essential health services in Africa.
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Affiliation(s)
- Seun S Anjorin
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Abimbola A Ayorinde
- NIHR Applied Research Collaboration West Midlands, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Mustapha S Abba
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Daniel Mensah
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Elvis A Okolie
- Department of Public Health, School of Health and Life Sciences, Teesside University, Tee Valley, Middlesbrough, North Yorkshire, TS1 3BX, UK
| | - Olalekan A Uthman
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Oyinlola O Oyebode
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
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Endalamaw A, Gilks CF, Ambaw F, Assefa Y. Universality of universal health coverage: A scoping review. PLoS One 2022; 17:e0269507. [PMID: 35994455 PMCID: PMC9394787 DOI: 10.1371/journal.pone.0269507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The progress of Universal health coverage (UHC) is measured using tracer indicators of key interventions, which have been implemented in healthcare system. UHC is about population, comprehensive health services and financial coverage for equitable quality services and health outcome. There is dearth of evidence about the extent of the universality of UHC in terms of types of health services, its integrated definition (dimensions) and tracer indicators utilized in the measurement of UHC. Therefore, we mapped the existing literature to assess universality of UHC and summarize the challenges towards UHC. METHODS The checklist Preferred Reporting Items for Systematic reviews and Meta-analysis extension for Scoping Reviews was used. A systematic search was carried out in the Web of Science and PubMed databases. Hand searches were also conducted to find articles from Google Scholar, the World Bank Library, the World Health Organization Library, the United Nations Digital Library Collections, and Google. Article search date was between 20 October 2021 and 12 November 2021 and the most recent update was done on 03 March 2022. Articles on UHC coverage, financial risk protection, quality of care, and inequity were included. The Population, Concept, and Context framework was used to determine the eligibility of research questions. A stepwise approach was used to identify and select relevant studies, conduct data charting, collation and summarization, as well as report results. Simple descriptive statistics and narrative synthesis were used to present the findings. RESULTS Forty-seven papers were included in the final review. One-fourth of the articles (25.5%) were from the African region and 29.8% were from lower-middle-income countries. More than half of the articles (54.1%) followed a quantitative research approach. Of included articles, coverage was assessed by 53.2% of articles; financial risk protection by 27.7%, inequity by 25.5% and quality by 6.4% of the articles as the main research objectives or mentioned in result section. Most (42.5%) of articles investigated health promotion and 2.1% palliation and rehabilitation services. Policy and healthcare level and cross-cutting barriers of UHC were identified. Financing, leadership/governance, inequity, weak regulation and supervision mechanism, and poverty were most repeated policy level barriers. Poor quality health services and inadequate health workforce were the common barriers from health sector challenges. Lack of common understanding on UHC was frequently mentioned as a cross-cutting barrier. CONCLUSIONS The review showed that majority of the articles were from the African region. Methodologically, quantitative research design was more frequently used to investigate UHC. Palliation and rehabilitation health care services need attention in the monitoring and evaluation of UHC progress. It is also noteworthy to focus on quality and inequity of health services. The study implies that urgent action on the identified policy, health system and cross-cutting barriers is required to achieve UHC.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Charles F. Gilks
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Assefa
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst 2022; 20:83. [PMID: 35906591 PMCID: PMC9336110 DOI: 10.1186/s12961-022-00886-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00886-3.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Miao W, Zhang X, Shi B, Tian W, Wu B, Lai Y, Li Y, Huang Z, Xia Q, Yang H, Ding F, Shan L, Xin L, Miao J, Zhang C, Li Y, Li X, Wu Q. Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China. BMC Med Res Methodol 2022; 22:151. [PMID: 35614385 PMCID: PMC9134696 DOI: 10.1186/s12874-022-01630-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to. METHODS The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE. RESULTS The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents' Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30-3.24) and 2.16 times (95% CI 1.81-2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them. CONCLUSIONS Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.
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Affiliation(s)
- Wenqing Miao
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Xiyu Zhang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Wanxin Tian
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Bing Wu
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yongqiang Lai
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yuze Li
- Department of Medicine, Jiamusi University, Jiamusi, 154007, Heilongjiang, China
| | - Zhipeng Huang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qi Xia
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Huiqi Yang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Fan Ding
- School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Linghan Shan
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ling Xin
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Jingying Miao
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Chenxi Zhang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ye Li
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Xiaodong Li
- The First Department of General Surgery, Heilongjiang Provincial Hospital, No. 82 Zhongshan Road, Xiangfang District, Harbin, 150036, Heilongjiang, China.
| | - Qunhong Wu
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
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Gao Q, Prina AM, Ma Y, Aceituno D, Mayston R. Inequalities in Older age and Primary Health Care Utilization in Low- and Middle-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2022; 52:99-114. [PMID: 34672829 PMCID: PMC8645300 DOI: 10.1177/00207314211041234] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
The objective of this research was to systematically review and synthesize quantitative studies that assessed the association between socioeconomic inequalities and primary health care (PHC) utilization among older people living in low- and middle- income countries (LMICs). Six databases were searched, including Embase, Medline, Psych Info, Global Health, Latin American and Caribbean Health Sciences Literature (LILACS), and China National Knowledge Infrastructure, CNKI, to identify eligible studies. A narrative synthesis approach was used for evidence synthesis. A total of 20 eligible cross-sectional studies were included in this systematic review. The indicators of socioeconomic status (SES) identified included income level, education, employment/occupation, and health insurance. Most studies reported that higher income, higher educational levels and enrollment in health insurance plans were associated with increased PHC utilization. Several studies suggested that people who were unemployed and economically inactive in older age or who had worked in formal sectors were more likely to use PHC. Our findings suggest a pro-rich phenomenon of PHC utilization in older people living in LMICs, with results varying by indicators of SES and study settings.
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Affiliation(s)
- Qian Gao
- King’s College London, London, UK
| | | | - Yuteng Ma
- University College London, London, UK
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9
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Multimorbidity and obesity in older adults from six low- and middle-income countries. Prev Med 2021; 153:106816. [PMID: 34599928 DOI: 10.1016/j.ypmed.2021.106816] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022]
Abstract
Prevalence of multimorbidity (i.e., ≥2 chronic conditions), chronic diseases, and obesity is increasing in low- and middle-income countries (LMICs), posing a potential threat to the health of older adults living in these areas. This study hence investigates the unexplored association between obesity and multimorbidity among older adults from LMICs. Cross-sectional, community-based data from the WHO Study on global Ageing and adult health (SAGE) were analysed. The sample consisted of 20,198 individuals aged ≥60 years [Mean age (SD) = 69.3 (13.1) years; 54.1% female] from China, India, Ghana, Mexico, Russia, South Africa. Twelve chronic conditions were assessed. Multivariable logistic regression was conducted to assess the association between BMI ≥ 30 kg/m2, high waist circumference (WC, cut-points > 102 cm for males and > 88 cm for females) and multimorbidity. After adjusting for potential confounders, overall, BMI ≥ 30 kg/m2 was associated with 1.43 (95%CI = 1.21-1.69) times higher odds for multimorbidity, while this estimate for high WC was 1.50 (95%CI = 1.21-1.86). Significant associations emerged between obesity measures and five out of twelve chronic conditions. Results from this study underline the need to reduce obesity among older adults in areas where its prevalence is increasing, as it is associated with increased odds for multimorbidity. Future longitudinal research in this setting is required to assess the impact of obesity reduction on multimorbidity incidence.
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Eozenou PHV, Neelsen S, Smitz MF. Financial Protection in Health among the Elderly - A Global Stocktake. Health Syst Reform 2021; 7:e1911067. [PMID: 34402386 DOI: 10.1080/23288604.2021.1911067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Universal Health Coverage is one of the key targets of the Sustainable Development Goals and it implies that everyone can access the healthcare they need without suffering financial hardship. In this paper, we use a large set of household surveys to examine if older populations are facing different degrees of financial hardship compared to younger populations. We find that while differences in average age structures between countries are not systematically associated with higher financial risk related to out-of-pocket health expenditures, there are large differences in financial hardship between younger and older households within countries. Households with more elderly members are more likely to face catastrophic and impoverishing out-of-pocket health payments compared to younger households, and this age gradient is stronger for the poorest segments of the population. Making progress toward Universal Health Coverage will require extension and improved targeting of benefit packages and financial protection to meet the health needs of older adults, and especially the poorest and most vulnerable segments of elderly populations.
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Affiliation(s)
| | - Sven Neelsen
- Health, Nutrition, and Population Unit, The World Bank, Washington, DC, USA
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Yang W, Hu B. Catastrophic health expenditure and mental health in the older Chinese population: The moderating role of social health insurance. J Gerontol B Psychol Sci Soc Sci 2021; 77:160-169. [PMID: 34255044 PMCID: PMC8755894 DOI: 10.1093/geronb/gbab130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Catastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the relationships between CHE and people's mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether the association differs between those with and without social health insurance (SHI). METHODS The data came from three waves of the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, and 2015, N = 13,166). We focused on older people aged 60 and above. We built panel data regression and quantile regression models to analyse the data. RESULTS Incurring CHE is significantly associated with poor mental health. The association is weakened among older people receiving SHI, which indicates that SHI has a protective effect. Moreover, the association between CHE and mental health and the protective effect of SHI are stronger among those with mild or moderate mental health problems. DISCUSSION Our findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for older people with greater healthcare needs.
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Affiliation(s)
- Wei Yang
- Department of Global Health and Social Medicine, King's College London, Strand, London
| | - Bo Hu
- Care Policy and Evaluation Centre (CPEC), Department of Health Policy, The London School of Economics and Political Science
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Sarker AR, Sultana M, Alam K, Ali N, Sheikh N, Akram R, Morton A. Households' out-of-pocket expenditure for healthcare in Bangladesh: A health financing incidence analysis. Int J Health Plann Manage 2021; 36:2106-2117. [PMID: 34218437 DOI: 10.1002/hpm.3275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite improvements in many health indicators, providing access to affordable healthcare remains a considerable challenge in Bangladesh. Financing incidence analysis will enable an evaluation of how well the healthcare system performs to achieve equity in health financing. The objective of this study is to assess the burden of out-of-pocket (OOP) cost on different socio-economic groups by assessing the health financing incidence because OOP cost dominates household expenditure on health in Bangladesh. METHODS The study was conducted using latest Household Income and Expenditure Survey (HIES) 2016. We focused mainly on four specific indicators: level of monthly household OOP cost on in-patient care, urban-rural differences in OOP cost, socio-economic status differences in different payment mechanisms and the Kakwani index. Descriptive statistics were employed to analyse and summarise the selected variables based on the SES and location of residence (e.g., rural and urban). RESULTS The study showed the overall OOP healthcare expenditure was 7.7% of the household monthly income while the poorer income group suffered more and spent up to 35% of their household income on healthcare. The Kakwani index indicated that the poorest quintile spends a greater share of their income on healthcare services than the richest quintile. CONCLUSIONS This study observed that OOP cost in Bangladesh is regressive, that is, poorer members of society contribute a greater share of their income. Therefore, policymakers should initiate health reforms for developing and implementing risk-pooling financing mechanisms such as social health insurance to achieve the Universal Health Coverage in Bangladesh.
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Affiliation(s)
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Khorshed Alam
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Nausad Ali
- Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nurnabi Sheikh
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Raisul Akram
- Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
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Hweidi IM, Carpenter CL, Al-Obeisat SM, Alhawatmeh HN, Nazzal MS, Jarrah MI. Nutritional status and its determinants among community-dwelling older adults in Jordan. Nurs Forum 2021; 56:529-538. [PMID: 33834507 DOI: 10.1111/nuf.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/12/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The elderly population of Jordan is growing, due to the low mortality rate, high total fertility rate, and the high rate of forced migration from neighboring countries to Jordan in recent years. However, the prevalence of chronic illnesses associated with other comorbidities among the elderly population in Jordan is high. Maintaining a good nutritional status is essential for maintaining general health and well-being among older people. AIM The aim of this study is to identify the nutritional status of community-dwelling older adults in Jordan and determine its possible associated factors. METHODOLOGY A cross-sectional, descriptive design was utilized. Proportional multistage nonprobability sampling was employed to obtain a convenient sample of 225 Jordanian community-dwelling older adults. The participants were asked to complete a set of questionnaires related to nutritional status, which included a demographic information sheet, and the Mini Nutritional Assessment (MNA). RESULTS Among the sample, only 60 participants (26.7%) showed normal nutritional status. Most of the participants (n = 156; 68.3%) were found to be at risk of malnutrition, and nine participants (4%) were found to suffer from malnutrition. Advanced age (r = -0.631; p = 0.001), body mass index (BMI) (r = 0.546; p = 0.001), being single (mean (M) = 20.43, SD = 3.55), being male (M = 21.10, SD = 3.73), being unemployed (M = 21.71, SD = 3.51), being dependent in activities of daily living (ADLs) (M = 21.35; SD = 3.62), eating only two meals per day (M = 19.60; SD = 3.39), having suffered from illness or anxiety in the preceding 3 months (M = 21.11; SD = 2.39), having a mid-arm circumference of less than 31 cm (M = 19.51; SD = 3.47), low consumption of fruit and vegetables (M = 20.79; SD = 2.53), and polypharmacy (M = 20.62, SD = 4.09) were found to predict susceptibility to malnutrition among the participating older adults. Amongst the variables, age was identified as the most significant predictor of nutritional status and explained approximately 40% of the variance in nutritional status. CONCLUSION Malnutrition in older adults is a multifaceted phenomenon that needs to be integrated into the comprehensive assessment of older adults. It is essential that health-care professionals, particularly nurses, are fully aware of the associated risks of malnutrition among the elderly population. The high prevalence of the risk factors for malnutrition warrants conducting a controlled national-based assessment, using probability sampling, of the nutritional status among older adults in Jordan. Specifically, there is a real need to assess nutritional status among older adults who are at high risk of malnutrition, including senior, unmarried, male, unemployed, ADL dependent, and/or poly-medicated older adults.
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Affiliation(s)
- Issa M Hweidi
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Catherine L Carpenter
- Department of Nutritional Epidemiology & Clinical Nutrition, Center for Human Nutrition, School of Medicine and Nursing, University of California at Los Angles (UCLA), Los Angeles, California, USA
| | - Salwa M Al-Obeisat
- Maternal-Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Hossam N Alhawatmeh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Nazzal
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamad I Jarrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Ifeagwu SC, Yang JC, Parkes-Ratanshi R, Brayne C. Health financing for universal health coverage in Sub-Saharan Africa: a systematic review. Glob Health Res Policy 2021; 6:8. [PMID: 33641673 PMCID: PMC7916997 DOI: 10.1186/s41256-021-00190-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential learnings. METHODS A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. On 19 to 30 July 2019, MEDLINE, EMBASE, Web of Science, Global Health Database, the Cochrane Library, Scopus and JSTOR were searched for literature published from 2005. Studies describing health financing approaches for UHC in SSA were included. Evidence was synthesised in form of a table and thematic analysis. RESULTS Of all records, 39 papers were selected for inclusion. Among the included studies, most studies were conducted in Kenya (n = 7), followed by SSA as a whole (n = 6) and Nigeria (n = 5). More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for UHC. The results indicate that a majority of health care revenue in SSA is from direct out-of-pocket payments. Another common financing mechanism was donor funding, which was reported by most of the studies. The average quality score of all studies was 81.6%, indicating a high appraisal score. The interrater reliability Cohen's kappa score, κ=0.43 (p = 0.002), which showed a moderate level of agreement. CONCLUSIONS Appropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of UHC. It is evident from the review that innovative health financing strategies in SSA are needed. Some limitations of this review include potentially skewed interpretations due to publication bias and a higher frequency of publications included from two countries in SSA. Establishing evidence-based and multi-sectoral strategies tailored to country contexts remains imperative.
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Affiliation(s)
- Susan C. Ifeagwu
- Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Justin C. Yang
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Rosalind Parkes-Ratanshi
- Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK
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Zhou F, Xu C, Sun Y, Meng X. Influencing Factors of Outpatients' Satisfaction in China a Cross-Sectional Study of 16 Public Tertiary Hospitals. Patient Prefer Adherence 2021; 15:1243-1258. [PMID: 34135576 PMCID: PMC8200138 DOI: 10.2147/ppa.s311786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to analyze the status of patient satisfaction in outpatients of tertiary hospitals and the factors affecting patient satisfaction, in order to provide a scientific basis for improving patient satisfaction. METHODS A total of 6480 surveys of outpatients were conducted by a cross-sectional study in 16 tertiary hospitals in the Zhejiang province of China. The main contents of the survey were the basic characteristics of patients. Statistical description, single-factor analysis and binary logistic regression analysis were used to screen influencing factors. RESULTS Results of this study showed that the total satisfaction score of outpatients was 87.13±13.47, and higher scored factors in the survey factors were nursing level, the convenience of registration and convenience of appointment diagnosis and treatment. The factors with lower scores were treatment effect, environmental sanitation and comfort and other staffs' attitudes. Hospital managers should pay attention to the improvement of treatment level, environmental sanitation and comfort and other staffs' attitudes. CONCLUSION In the process of serving outpatients, doctors should pay more attention to patients who are male, 31-45 years old or over 60 years old, permanent residents, from public institutions, possessed postgraduate education, without medical insurance, and who visiting paediatrics and Chinese medicine hospitals.
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Affiliation(s)
- Fangwei Zhou
- Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Caiming Xu
- Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yanxiang Sun
- Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Xuehui Meng
- Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of China
- Correspondence: Xuehui Meng Humanities and Management School of Zhejiang Chinese Medical University, 548# Binwen Road, Binjiang District, Hangzhou, 310051, People’s Republic of ChinaTel/Fax +86 571-86633056 Email
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Fischer FB, Mengliboeva Z, Karimova G, Abdujabarov N, Prytherch H, Wyss K. Out of pocket expenditures of patients with a chronic condition consulting a primary care provider in Tajikistan: a cross-sectional household survey. BMC Health Serv Res 2020; 20:546. [PMID: 32546162 PMCID: PMC7298845 DOI: 10.1186/s12913-020-05392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within its reform efforts, the Government of Tajikistan is embracing the essential role of primary health care (PHC) in decreasing out of pocket (OOP) expenditures and increasing equity in access to health services. In the light of the increasing burden of disease relating to chronic conditions, we investigated OOP expenditures of patients with chronic conditions within a PHC setting; and if and how those expenditures are impacted by several interventions currently being implemented within Tajikistan. METHODS A cross-sectional survey among 1600 adult patients who had visited a PHC facility was conducted. The data obtained through interviews were descriptively analysed, and logistic regressions and gamma generalized linear models were performed. RESULTS The total OOP expenditures related to a patient's last visit to the PHC facility were 17.2 USD for those with chronic conditions and 13.9 USD for those visiting due to an acute condition. Adjustment for potential confounders reduced the discrepancy from 3.3 USD to 0.5 USD. This convergence of costs was only observed in districts covered by the Basic Benefit Package (BBP), a governmental pilot project, aiming to standardise exemptions for payment and formal co-payments for health care services. Hence, we found the BBP to have a protective impact for patients with chronic conditions. However, considering the demographics of these patients (older in age, with greater dependency on pensions and social aid, and lower socio-economic status) in combination with the 40% higher utilisation rate of PHC and the high rate of onward referrals to specialists; it is clear that patients with chronic conditions continue to face substantial long-term costs and disadvantages. CONCLUSIONS After accounting for confounders, patients with chronic and acute conditions faced similar costs related to a single visit to a PHC facility in districts covered by the BBP. However, greater efforts are required to ensure that citizens are well informed about their rights to health care, the BBP and the services that should be provided at no cost at the point of delivery. Moreover, the needs of patients with chronic conditions warrant a more integrative approach that takes long-term expenditures and services beyond the level of PHC into account.
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Affiliation(s)
- Fabienne B. Fischer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zulfira Mengliboeva
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Gulzira Karimova
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Nasrullo Abdujabarov
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Srivastava S, Gill A. Untreated morbidity and treatment-seeking behaviour among the elderly in India: Analysis based on National Sample Survey 2004 and 2014. SSM Popul Health 2020; 10:100557. [PMID: 32258352 PMCID: PMC7109628 DOI: 10.1016/j.ssmph.2020.100557] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
The changing demographic structure in India and worldwide accompanies with it a gamut of problems and opportunities. According to the Census of India, the proportion of elderly in the overall population rose from 5.6 per cent in 1961 to 8.6 per cent in 2011 and is expected to rise to 20 per cent in 2050. Considering the consequent growing challenges in healthcare the main aim of the study is to find essential determinants contributing to untreated morbidity among the elderly. Also, the paper examines treatment-seeking behaviour for infectious and chronic diseases among the elderly in India. Data from the 60th and 71st round of National Sample Survey Organization was used for the analysis. Relative differences were calculated along with logistic regression to study the objectives and the heckprobit model was used to carve out the treatment-seeking behaviour among the elderly in India. It was found that the overall decrease in relative decadal difference was 41% for untreated morbidity. In both the rounds, the elderly living below the poverty line had 42% and 50% more likelihood of untreated morbidities respectively in comparison to elderly not living below the poverty line. The study indicates that elderly who were living with a spouse in comparison to those living alone had less likelihood to have untreated morbidities. Also, elderly from rural areas and having lower levels of education had higher likelihood of untreated morbidity. Similar inequalities were observed in treatment-seeking behaviour as well, where it was found that elderly belonging to lower socio-economic status were less likely to seek treatment. Linking the results from the heckprobit model this study provides the evidence that social and economic factors play a significant role in affecting both untreated morbidity and treatment-seeking behaviour of elderly in India.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Anayat Gill
- Centre for Research in Rural and Industrial Development, Sector 19, Chandigarh, India
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Pak LM, Kwon NK, Baldini EH, Learn PA, Koehlmoos T, Haider AH, Raut CP. Racial Differences in Extremity Soft Tissue Sarcoma Treatment in a Universally Insured Population. J Surg Res 2020; 250:125-134. [PMID: 32044509 DOI: 10.1016/j.jss.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 11/05/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In prior reports from population-based databases, black patients with extremity soft tissue sarcoma (ESTS) have lower reported rates of limb-sparing surgery and adjuvant treatment. The objective of this study was to compare the multimodality treatment of ESTS between black and white patients within a universally insured and equal-access health care system. METHODS Claims data from TRICARE, the US Department of Defense insurance plan that provides health care coverage for 9 million active-duty personnel, retirees, and dependents, were queried for patients younger than 65 y with ESTS who underwent limb-sparing surgery or amputation between 2006 and 2014 and identified as black or white race. Multivariable logistic regression analysis was used to evaluate the impact of race on the utilization of surgery, chemotherapy, and radiation. RESULTS Of the 719 patients included for analysis, 605 patients (84%) were white and 114 (16%) were black. Compared with whites, blacks had the same likelihood of receiving limb-sparing surgery (odds ratio [OR], 0.861; 95% confidence interval [95% CI], 0.284-2.611; P = 0.79), neoadjuvant radiation (OR, 1.177; 95% CI, 0.204-1.319; P = 0.34), and neoadjuvant (OR, 0.852; 95% CI, 0.554-1.311; P = 0.47) and adjuvant (OR, 1.211; 95% CI, 0.911-1.611; P = 0.19) chemotherapy; blacks more likely to receive adjuvant radiation (OR, 1.917; 95% CI, 1.162-3.162; P = 0.011). CONCLUSIONS In a universally insured population, racial differences in the rates of limb-sparing surgery for ESTS are significantly mitigated compared with prior reports. Biologic or disease factors that could not be accounted for in this study may contribute to the increased use of adjuvant radiation among black patients.
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Affiliation(s)
- Linda M Pak
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Nicollette K Kwon
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Peter A Learn
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tracey Koehlmoos
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Adil H Haider
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Health-care coverage and access to health care in the context of type 2 diabetes and hypertension in rural Mexico: a systematic literature review. Public Health 2020; 181:8-15. [PMID: 31918156 DOI: 10.1016/j.puhe.2019.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 10/22/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aimed to identify the coverage rates and use of health care and to explore barriers and facilitators of access in rural Mexico. STUDY DESIGN Systematic review of the literature. METHODS We undertook a structured search in the electronic databases EMBASE, Medline, and Scopus. Inclusion criteria comprised articles published in Spanish and English during the period 1986-2018. The studies were screened and selected by two independent reviewers in accordance with predefined criteria. RESULTS The review included 14 studies. Over the last 30 years, the rates of health-care coverage have increased from 30% to >50% in rural Mexico. Although the rates of health-care coverage increased, aspects such as lack of resources, language, and health-care professionals remained important barriers to health care. Cash transfer programs were identified as a facilitator. CONCLUSIONS Despite increased health-care coverage of >50% in the last three decades, action is needed to fulfill the needs of rural Mexican populations. It is important to increase the number of trained health professionals who practice in rural areas. Moreover, health programs should be developed and adapted to meet the needs of rural and indigenous populations.
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van Hees SGM, O'Fallon T, Hofker M, Dekker M, Polack S, Banks LM, Spaan EJAM. Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review. Int J Equity Health 2019; 18:134. [PMID: 31462303 PMCID: PMC6714392 DOI: 10.1186/s12939-019-1040-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND One way to achieve universal health coverage (UHC) in low- and middle-income countries (LMIC) is the implementation of health insurance schemes. A robust and up to date overview of empirical evidence assessing and substantiating health equity impact of health insurance schemes among specific vulnerable populations in LMICs beyond the more common parameters, such as income level, is lacking. We fill this gap by conducting a systematic review of how social inclusion affects access to equitable health financing arrangements in LMIC. METHODS We searched 11 databases to identify peer-reviewed studies published in English between January 1995 and January 2018 that addressed the enrolment and impact of health insurance in LMIC for the following vulnerable groups: female-headed households, children with special needs, older adults, youth, ethnic minorities, migrants, and those with a disability or chronic illness. We assessed health insurance enrolment patterns of these population groups and its impact on health care utilization, financial protection, health outcomes and quality of care. RESULTS The comprehensive database search resulted in 44 studies, in which chronically ill were mostly reported (67%), followed by older adults (33%). Scarce and inconsistent evidence is available for individuals with disabilities, female-headed households, ethnic minorities and displaced populations, and no studies were yielded reporting on youth or children with special needs. Enrolment rates seemed higher among chronically ill and mixed or insufficient results are observed for the other groups. Most studies reporting on health care utilization found an increase in health care utilization for insured individuals with a disability or chronic illness and older adults. In general, health insurance schemes seemed to prevent catastrophic health expenditures to a certain extent. However, reimbursements rates were very low and vulnerable individuals had increased out of pocket payments. CONCLUSION Despite a sizeable literature published on health insurance, there is a dearth of good quality evidence, especially on equity and the inclusion of specific vulnerable groups in LMIC. Evidence should be strengthened within health care reform to achieve UHC, by redefining and assessing vulnerability as a multidimensional process and the investigation of mechanisms that are more context specific.
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Affiliation(s)
- Suzanne G M van Hees
- Radboud Institute for Health Sciences (RIHS), Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Work and Health, HAN University of Applied Sciences, Kapittelweg 33, P.O. Box 6960, 6503GL, Nijmegen, Netherlands.
| | - Timothy O'Fallon
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Marleen Dekker
- African Studies Center, Leiden University, Leiden, The Netherlands
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Ernst J A M Spaan
- Radboud Institute for Health Sciences (RIHS), Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
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Bitton A, Fifield J, Ratcliffe H, Karlage A, Wang H, Veillard JH, Schwarz D, Hirschhorn LR. Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017. BMJ Glob Health 2019; 4:e001551. [PMID: 31478028 PMCID: PMC6703296 DOI: 10.1136/bmjgh-2019-001551] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/25/2019] [Accepted: 06/15/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The 2018 Astana Declaration reaffirmed global commitment to primary healthcare (PHC) as a core strategy to achieve universal health coverage. To meet this potential, PHC in low-income and middle-income countries (LMIC) needs to be strengthened, but research is lacking and fragmented. We conducted a scoping review of the recent literature to assess the state of research on PHC in LMIC and understand where future research is most needed. METHODS Guided by the Primary Healthcare Performance Initiative (PHCPI) conceptual framework, we conducted searches of the peer-reviewed literature on PHC in LMIC published between 2010 (the publication year of the last major review of PHC in LMIC) and 2017. We also conducted country-specific searches to understand performance trajectories in 14 high-performing countries identified in the previous review. Evidence highlights and gaps for each topic area of the PHCPI framework were extracted and summarised. RESULTS We retrieved 5219 articles, 207 of which met final inclusion criteria. Many PHC system inputs such as payment and workforce are well-studied. A number of emerging service delivery innovations have early evidence of success but lack evidence for how to scale more broadly. Community-based PHC systems with supportive governmental policies and financing structures (public and private) consistently promote better outcomes and equity. Among the 14 highlighted countries, most maintained or improved progress in the scope of services, quality, access and financial coverage of PHC during the review time period. CONCLUSION Our findings revealed a heterogeneous focus of recent literature, with ample evidence for effective PHC policies, payment and other system inputs. More variability was seen in key areas of service delivery, underscoring a need for greater emphasis on implementation science and intervention testing. Future evaluations are needed on PHC system capacities and orientation toward social accountability, innovation, management and population health in order to achieve the promise of PHC.
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Affiliation(s)
- Asaf Bitton
- Ariadne Labs, Boston, Massachusetts, USA
- Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Hong Wang
- The Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Jeremy H Veillard
- World Bank Group, Washington, District of Columbia, USA
- Institute of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Dan Schwarz
- Ariadne Labs, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Ariadne Labs, Boston, Massachusetts, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Vancampfort D, Stubbs B, Firth J, Koyanagi A. Handgrip strength, chronic physical conditions and physical multimorbidity in middle-aged and older adults in six low- and middle income countries. Eur J Intern Med 2019; 61:96-102. [PMID: 30509483 DOI: 10.1016/j.ejim.2018.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Handgrip strength provides a clinically validated marker of overall health and mortality risk. There are however, no multi-national population-based studies investigating the associations between handgrip strength, chronic physical conditions, and physical multimorbidity (i.e., ≥2 chronic conditions). We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six in low- and middle-income countries (LMICs). METHODS Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Eleven chronic physical conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed. Weak handgrip strength was defined as <30 kg for men and <20 kg for women. Multivariable logistic regression analysis was conducted. RESULTS The final sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). After adjustment for potential confounders, when compared to those with no chronic physical conditions, having 1, 2, 3, and ≥4 physical chronic conditions was associated with 1.22 (95%CI = 1.08-1.37), 1.29 (95%CI = 1.11-1.50), 1.41 (95%CI = 1.18-1.68), and 1.78 (95%CI = 1.46-2.18) times higher odds for weak handgrip strength. Similar associations were observed in the analyses stratified by age and sex. There was a moderate level of between-country heterogeneity in the association between weak handgrip strength and physical multimorbidity (Higgin's I2 = 67.8%) with the pooled estimate being 1.26 (95%CI = 1.06-1.50). CONCLUSION Weaker handgrip strength is associated with a range of chronic physical conditions and multimorbidity. Future research should seek to establish the predictive value of this inexpensive measure for clinical use.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hills, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box, SE5 8AF, United Kingdom
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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Ashdown-Franks G, Stubbs B, Koyanagi A, Schuch F, Firth J, Veronese N, Vancampfort D. Handgrip strength and depression among 34,129 adults aged 50 years and older in six low- and middle-income countries. J Affect Disord 2019; 243:448-454. [PMID: 30273883 DOI: 10.1016/j.jad.2018.09.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/16/2018] [Accepted: 09/15/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Handgrip strength is a simple and inexpensive marker of health and mortality risk. It presents an ideal risk-stratifying method for use in low and middle-income countries (LMICs). There are, however, no population-based studies investigating the associations between handgrip strength and depression in LMICs. We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six LMICs. METHOD Cross-sectional data on individuals aged ≥ 50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Depression was based on the Composite International Diagnostic Interview. Weak handgrip strength was defined as < 30 kg for men and < 20 kg for women using the average value of two handgrip measurements of the dominant hand. Multivariable logistic regression analysis was conducted. RESULTS The sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). The prevalence of weak handgrip strength and depression were 47.4% and 6.2%, respectively. Individuals with weak handgrip strength had a higher prevalence of depression than those without this condition (8.8% vs. 3.8%; p < 0.001). Across all countries, after adjustment for potential confounders, weak handgrip strength was associated with a 1.45 (95%CI = 1.12-1.88) times higher odds for depression, although some between-country differences were noted. DISCUSSION Weaker handgrip strength is associated with higher odds for depression in LMICs. Future research should seek to establish the predictive value of this inexpensive measure for clinical use. Furthermore, interventional studies should examine if muscular strength can be a target of resistance-training interventions to address depressive symptoms in low-resourced settings.
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Affiliation(s)
- Garcia Ashdown-Franks
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London,De Crespigny Park, London Box SE5 8AF, United Kingdom; Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada.
| | - Brendon Stubbs
- Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Felipe Schuch
- La Salle University, Canoas, Brazil; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Nicola Veronese
- Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, Leuven 3001, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, Kortenberg 3070, Belgium
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Gender differences in the association between migration and cognitive function among older adults in China and India. Arch Gerontol Geriatr 2018; 81:31-38. [PMID: 30502567 DOI: 10.1016/j.archger.2018.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aims to examine gender differences in the association between migration and cognitive function among adults in China and India. METHODS Data from the World Health Organization Study on global AGEing and adult health (SAGE) study were used that included adults aged 50 + from China (N = 12,937) and India (N = 6244). Migration status included: urban residents, rural residents, urban-to-urban, rural-to-urban, rural-to-rural, and urban-to-rural migrants. Cognitive function was assessed by immediate and delayed recall tests, digit span tests, and verbal fluency test. Ordinary least square regression models were used to adjust for sociodemographic characteristics, psychosocial factors, health behaviors, and physical health status. RESULTS Controlling for multiple covariates, significant differences in cognitive function were found between men and women, and across migration groups. A consistent female disadvantage was found in China and India for cognitive function. Women who were rural residents or rural-to-rural migrants had the poorest cognitive function in both the Chinese and the Indian samples. Among males in China, rural residents had poorer cognitive function than urban residents, while urban-to-urban migrants had highest cognition scores; however, for male counterparts in India, rural-to-rural migrants had the poorest cognitive function. CONCLUSIONS The results suggest that the association between migration and cognitive function differs by gender and country. In our study populations, major sociodemographic characteristics play a key role in accounting for the differences in cognitive function.
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Murphy A, Kowal P, Albertini M, Rechel B, Chatterji S, Hanson K. Family transfers and long-term care: An analysis of the WHO Study on global AGEing and adult health (SAGE). JOURNAL OF THE ECONOMICS OF AGEING 2018; 12:195-201. [PMID: 30555777 PMCID: PMC6282503 DOI: 10.1016/j.jeoa.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Populations globally are ageing, resulting in increased need for long-term care. Where social welfare systems are insufficient, these costs may fall to other family members. We set out to estimate the association between long-term care needs and family transfers in selected low- and middle- income countries. METHODS We used data from the World Health Organization's Study on global AGEing and adult health (SAGE). Using regression, we analysed the relationship between long-term care needs in older households and i) odds of receiving net positive transfers from family outside the household and ii) the amount of transfer received, controlling for relevant socio-demographic characteristics. RESULTS The proportion of household members requiring long-term care was significantly associated with receiving net positive transfers in China (OR: 1.76; p = 0.023), Ghana (OR: 2.79; p = 0.073), Russia (OR: 3.50; p < 0.001). There was a statistically significant association with amount of transfer received only in Mexico (B: 541.62; p = 0.010). CONCLUSION In selected LMICs, receiving family transfers is common among older households, and associated with requiring long-term care. Further research is needed to better understand drivers of observed associations and identify ways in which financial protection of older adults' long-term care needs can be improved.
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Affiliation(s)
| | - Paul Kowal
- World Health Organization, United States
- University of Newcastle, Australia
| | | | - Bernd Rechel
- European Observatory on Health Systems and Policies, UK
| | | | - Kara Hanson
- London School of Hygiene and Tropical Medicine, UK
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Yerramilli P, Fernández Ó, Thomson S. Financial protection in Europe: a systematic review of the literature and mapping of data availability. Health Policy 2018; 122:493-508. [DOI: 10.1016/j.healthpol.2018.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 10/18/2022]
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Tarín-Arzaga L, Arredondo-Campos D, Martínez-Pacheco V, Martínez-González O, Ramírez-López A, Gómez-De León A, Gutiérrez-Aguirre CH, Cantú-Rodríguez O, Jaime-Pérez JC, Gómez-Almaguer D. Impact of the affordability of novel agents in patients with multiple myeloma: Real-world data of current clinical practice in Mexico. Cancer 2018; 124:1946-1953. [DOI: 10.1002/cncr.31305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Luz Tarín-Arzaga
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Daniela Arredondo-Campos
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Victor Martínez-Pacheco
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Odra Martínez-González
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Alba Ramírez-López
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Andrés Gómez-De León
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Cesar Homero Gutiérrez-Aguirre
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Olga Cantú-Rodríguez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - José Carlos Jaime-Pérez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - David Gómez-Almaguer
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
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Stubbs B, Vancampfort D, Veronese N, Schofield P, Lin PY, Tseng PT, Solmi M, Thompson T, Carvalho AF, Koyanagi A. Multimorbidity and perceived stress: a population-based cross-sectional study among older adults across six low- and middle-income countries. Maturitas 2017; 107:84-91. [PMID: 29169587 DOI: 10.1016/j.maturitas.2017.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/21/2017] [Accepted: 10/09/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stress in chronic conditions or multimorbidity (≥2 chronic conditions) has been reported to affect clinical outcomes but there are no studies on the association between stress and chronic conditions/multimorbidity among older adults in low- and middle-income countries (LMICs). Thus, we investigated this association among adults aged ≥50 years across six LMICs. METHODS A cross-sectional analysis using data from the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) was conducted. A perceived stress score [range 0 (lowest stress) -100 (highest stress)] was computed based on two questions from the Perceived Stress Scale. Thirteen chronic conditions were assessed. Multivariable linear regression analyses were conducted. RESULTS 34,129 adults with a mean age of 62.4 (SD=16.0)years (52.1% females) were included. Overall, 56.6% (95% CI=55.0%-58.2%) had multimorbidity. In the adjusted model including all countries, compared with those with no chronic conditions, higher numbers of chronic conditions were significantly associated with higher stress levels, dose dependently. In a countrywide meta-analysis, multimorbidity was associated with significantly higher stress levels in all countries (especially India and Ghana) although characterized by moderate heterogeneity (I2=54.6%). For single chronic conditions, notably high stress scores were observed for depression, stroke, and hearing problems. CONCLUSION Chronic conditions and multimorbidity are associated with higher levels of stress in older adults in LMICs. Given that perceived stress and chronic conditions are collectively associated with worse health outcomes, low-cost, population-level integrated interventions to address stress among those with chronic conditions are urgently needed.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom.
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Alshamsan R, Lee JT, Rana S, Areabi H, Millett C. Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health. J R Soc Med 2017; 110:365-375. [PMID: 28895493 DOI: 10.1177/0141076817724599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.
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Affiliation(s)
- Riyadh Alshamsan
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia.,2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - John Tayu Lee
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK.,3 Saw Swee Hock School of Public Health, University of Singapore, Singapore 117549
| | - Sangeeta Rana
- 4 Field Epidemiology Service South East and London, Public Health England, London SE1 6LH, UK.,5 Imperial College Healthcare NHS Trust, London SW7 2AZ, UK
| | - Hasan Areabi
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia
| | - Christopher Millett
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
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Pandey A, Ploubidis GB, Clarke L, Dandona L. Horizontal inequity in outpatient care use and untreated morbidity: evidence from nationwide surveys in India between 1995 and 2014. Health Policy Plan 2017; 32:969-979. [PMID: 28419286 PMCID: PMC5886081 DOI: 10.1093/heapol/czx016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995-96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995-96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (-0.320; -0.391, -0.249) than the younger (-0.176; -0.211, -0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995-96 for the older (-0.189; -0.234, -0.145 vs - 0.065; -0.129, -0.001) and the younger (-0.145; -0.175, -0.115 vs - 0.056; -0.086, -0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population.
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Affiliation(s)
- Anamika Pandey
- Public Health Foundation of India, New Delhi, India
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, Department of Social Science, UCL-Institute of Education, University College London, UK
| | - Lynda Clarke
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Li J, Feng XL. Health care-seeking behaviours and health expenditures in adults aged 45 years and older in China, 2011-2013. Trop Med Int Health 2017; 22:638-654. [PMID: 28278358 DOI: 10.1111/tmi.12865] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To provide an assessment of China's progress to universal health coverage (UHC) from the perspective of people-centred care. METHODS We obtained data on 28 103 participants from the China Health and Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic regressions and generalised linear models to analyse care-seeking behaviours and medical expenditures. RESULTS We found that 95.5% of the subjects were covered by social health insurance in 2013, and nearly 60% subjects in need of medical care were self-medicated. Health insurance was a strong predictor for the access to outpatient care. Use of pure and mixed self-medication increased by 15% and 32% respectively, while use of pure outpatient care fell by 10% between 2011 and 2013, after adjusting for predisposing, service needs and enabling factors. Such trends were particularly evident for the Urban Resident Basic Medical Insurance and the New Cooperative Medical Scheme, which covered more than 80%. The monthly out-of-pocket medical expenditures and the probability of encountering catastrophic health expenditures for outpatient care were four times larger than that for self-medication. Between 2011 and 2013, outpatient care medical costs rose by nearly 50%, whereas there was no such obvious trend for self-medication. People with insurance schemes offering lower cost sharing incurred consistently higher out-of-pocket outpatient payments. CONCLUSIONS The monitoring of global progress to UHC should incorporate self-medication. In China, it seems that the current reform and the huge government investment have not resulted in access to affordable quality care. To achieve UHC, not only universal insurance, but system-level efforts are needed.
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Affiliation(s)
- Jiasen Li
- School of Public Health, Peking University, Beijing, China
| | - Xing Lin Feng
- School of Public Health, Peking University, Beijing, China
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