The impact of health insurance affiliation and socioeconomic status on cervical cancer survival in Bucaramanga, Colombia

Cervical cancer is still an important cause of death in countries like Colombia. We aimed to determine whether socioeconomic status of residential address (SES) and type of health insurance affiliation (HIA) might be associated with cervical cancer survival among women in Bucaramanga, Colombia. All patients residing in the Bucaramanga Metropolitan Area diagnosed with invasive cervical cancer (ICD-0-3 codes C53.X) between 2008 and 2016 (n = 725) were identified through the population-based cancer registry, with 700 women having follow-up data for >5 years (date of study closure: Dec 31, 2021), yielding an overall 5-year survival estimate (95 % CI) of 56.4 % (52.7 - 60.0 %). KM estimates of 5-year overall survival were obtained to assess differences in cervical cancer survival by SES and HIA. Multivariable Cox-proportional hazards modeling was also conducted, including interaction effects between SES and HIA. Five-year overall survival was lower when comparing low vs. high SES (41.9 % vs 57.9 %, p < 0.0001) and subsidized vs. contributive HIA (45.1 % vs 63.0 %, p < 0.0001). Multivariable Cox modeling showed increased hazard ratios (HR) of death for low vs. high SES (HR = 1.78; 95 % CI = 1.18-2.70) and subsidized vs. contributive HIA (HR = 1.44; 95 % CI = 1.13-1.83). The greatest disparity in HR was among women of low SES affiliated to subsidized HIA (vs. contributive HIA and high SES) (HR=2.53; 95 % CI = 1.62-3.97). Despite Colombia's universal healthcare system, important disparities in cervical cancer survival by health insurance affiliation and socioeconomic status remain.

Electrophysiological and behavioral methods in early detection of hearing impairment

BACKGROUND

Recent advances in neonatal life-support systems have contributed to the survival of high-risk newborns. However, protection of the auditory system and the prevention of sequelae is still paramount in neonatal neurology. The aim of this study was to compare auditory-evoked responses with a toy test and acoustic reflex in the early detection of hearing loss in infants.

METHODS

Three groups were studied. The first was composed of infants showing less than a 30 dB biaural threshold in the neurophysiological test. The second group was made up of infants showing peripheral alterations on one side or both ears. The third group was comprised of infants who showed no responses at 95 dB HL in both ears after neurophysiological testing. The neurophysiological test, toy test, and acoustic reflex were performed on the same day, with masked results given to each investigator. Sensitivity and specificity for each toy test and acoustic reflex were calculated afterward.

RESULTS

Forty-five controls, 44 peripheral alterations, and 8 non-response infants were studied. Most patients studied were born prior to the 37(th) week of gestation with a birthweight of less than 2,250 g, received required administration of potential ototoxic drugs and mechanical ventilation, and showed hyperbilirubinemia and hypoxia. Sensitivity for each toy was as follows: drum 0.54; wooden rattle 1.0, and metallic ratle 0.88. Specificity was 0.95, 1.0, and 1.0, respectively. Acoustic reflex sensitivity was 0.38 and specificity was 0.97.

CONCLUSIONS

Results suggest that the wooden and the metallic rattles of the toy test can be useful tools in the study of hearing in the high-risk infant and deserve more attention in future studies.