Multi-Morbid Health Profiles and Specialty Healthcare Service Use: A Moderating Role of Poverty

Ethnic Inequalities in Healthcare Use and Care Quality among People with Multiple Long-Term Health Conditions Living in the United Kingdom: A Systematic Review and Narrative Synthesis

Indicative evidence suggests that the prevalence of multiple long-term conditions (i.e., conditions that cannot be cured but can be managed with medication and other treatments) may be higher in people from minoritised ethnic groups when compared to people from the White majority population. Some studies also suggest that there are ethnic inequalities in healthcare use and care quality among people with multiple long-term conditions (MLTCs). The aims of this review are to (1) identify and describe the literature that reports on ethnicity and healthcare use and care quality among people with MLTCs in the UK and (2) examine how healthcare use and/or care quality for people with MLTCs compares across ethnic groups. We registered the protocol on PROSPERO (CRD42020220702). We searched the following databases up to December 2020: ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science core collection. Reference lists of key articles were also hand-searched for relevant studies. The outcomes of interest were patterns of healthcare use and care quality among people with MLTCs for at least one minoritised ethnic group, compared to the White majority population in the UK. Two reviewers, L.B. and B.H., screened and extracted data from a random sample of studies (10%). B.H. independently screened and extracted data from the remaining studies. Of the 718 studies identified, 14 were eligible for inclusion. There was evidence indicating ethnic inequalities in disease management and emergency admissions among people with MLTCs in the five studies that counted more than two long-term conditions. Compared to their White counterparts, Black and Asian children and young people had higher rates of emergency admissions. Black and South Asian people were found to have suboptimal disease management compared to other ethnic groups. The findings suggest that for some minoritised ethnic group people with MLTCs there may be inadequate initiatives for managing health conditions and/or a need for enhanced strategies to reduce ethnic inequalities in healthcare. However, the few studies identified focused on a variety of conditions across different domains of healthcare use, and many of these studies used broad ethnic group categories. As such, further research focusing on MLTCs and using expanded ethnic categories in data collection is needed.

Types of multidimensional vulnerability and well-being among the retired in the U.S

BACKGROUND

An extensive study investigated the risk factors for low well-being in post-retirement. Most previous studies have taken a unidimensional perspective, focusing on single factors such as financial status, physical health, and mental health.

OBJECTIVE

Drawing on the vulnerability framework, we first identify and describe the empirical subgroups of vulnerability among retirees in the United States across four major domains of later life: material, physical, social, and mental vulnerability. Then, we investigate the association between vulnerability profiles and well-being.

METHOD

The sample included 3,158 retirees aged 65+ who participated in the Health and Retirement Study (HRS). Latent class analysis was utilized to identify the heterogeneous subgroups of vulnerability, and then a series of OLS regression analyses was conducted to examine the relationship between patterns of vulnerability and well-being.

RESULTS

Five vulnerability patterns were identified: material vulnerable (12%), health & social vulnerable (14%), material, health & social vulnerable (6%), least vulnerable (34%), and social vulnerable (35%). The health & social vulnerable group had the strongest negative influence on well-being among all subgroups. As the largest subgroup, the social vulnerable group's negative influence on well-being stood out, with a stronger effect than that of material privation experienced by those in the material vulnerable group.

CONCLUSION

By empirically identifying subgroups of differential vulnerability patterns among retirees, this study showed that post-retirement vulnerability reflects complex interactions among multiple disadvantages. Findings of this study enhance understanding of the disparities in well-being within the retired population, pointing to the possibility of targeted policy and program development.

Supply and Demand-Related Decisive Factors in the Utilization of Non-Medical Community Healthcare Services among Elderly Chinese

There is little research on the utilization of non-medical community healthcare services among the elderly, compared with that of medical community healthcare services. From the perspective of both supply and demand, based on the survey data from Shaanxi province, this study examined supply-related factors (including service supply, service quality, service charge and service accessibility) and demand-related factors (including service need, individual financial status, family care support and knowledge of service) affecting the utilization of non-medical community healthcare services among the elderly in China by using Poisson regression. The findings show that service supply, service quality, service need and knowledge of service are positively associated with the utilization of non-medical community healthcare services among elderly Chinese, but the other factors identified in previous studies are not significant predictors for the utilization of the services among the elderly in the context of China. To our knowledge, this is the first study to examine both supply-related factors and demand-related factors affecting the utilization of non-medical community healthcare services among elderly Chinese.