Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden.
The study used data from the Health on Equal Terms survey (age group 16-24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables.
Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services.
These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.
To characterize the patient population served by Atlantic Canada's Multi-Organ Transplant Program liver transplant service over the first five years of activity in its current iteration.
Data from a prospective institutional database, supplemented by retrospective medical record review, were used to identify and characterize the cohort of patients assessed for consideration of first liver transplant between December 1, 2004 and December 1, 2009.
In the five-year period after reactivation, the program assessed 337 patients for first liver transplant. The median age at referral for this group of 199 men (59.0%) and 138 women (41.0%) was 56.1 years (range 16.3 to 72.3 years). The leading three liver diseases indicating liver replacement were alcohol-related end-stage liver disease (20.5%), hepatocellular cancer (16.6%) and hepatitis C-related end-stage liver disease (14.0%). When evaluated according to provincial population-standardized incidence, significant differences in the incidence of liver transplant assessment among the four Atlantic Canadian provinces were found (per 100,000 inhabitants: Nova Scotia 19.8, New Brunswick 13.0, Newfoundland and Labrador 9.1 and Prince Edward Island 11.0; Fisher's exact P
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Cites: Transplantation. 2003 Nov 15;76(9):1385-814627921
Cites: Transplantation. 2003 Nov 15;76(9):1389-9414627922
Cites: Transplantation. 2003 Nov 15;76(9):1395-814627923
Cites: Transplantation. 2003 Nov 15;76(9):1398-40314627924
Earlier studies have reported socioeconomic differences in coronary heart disease incidence and mortality and in coronary treatment, but less is known about outcomes of care. We examined trends in income group differences in outcomes of coronary revascularizations among Finnish residents in 1998-2010.
First revascularizations for 45-84-year-old Finns were extracted from the Hospital Discharge Register in 1998-2009 and followed until 31 December 2010. Income was individually linked to them and adjusted for family size. We examined the risk of major adverse cardiac events (MACEs), coronary mortality and re-revascularization. We calculated age-standardized rates with direct method and Cox regression models.
Altogether 69 076 men and 27 498 women underwent revascularization during the study period. Among men [women] in the 1998 cohort, 41% [35%] suffered MACE during 29 days after the operation and 30% [28%] in the 2009 cohort. Myocardial infarction mortality within 1 year was 2% among both genders in both cohorts. Among men [women] 9% [14%] underwent revascularization within 1 year after the operation in 1998 and 12% [12%] in 2009. Controlling for age, co-morbidities, year, previous infarction and disease severity, an inverse income gradient was found in MACE incidence within 29 days and in coronary mortality. The excess MACE risk was 1.39 and excess mortality risk over 1.70 among both genders in the lowest income quintile. All income group differences remained stable from 1998 to 2010.
In health care, more attention should be paid to prevention of adverse outcomes among persons with low socioeconomic position undergoing revascularization.
In Canada, stratification by geographic area or socio-economic status remains relatively rare in national and provincial reporting and surveillance for injury prevention and trauma care. As injuries are known to affect some populations more than others, a more nuanced understanding of injury risk may in turn inform more effective prevention policy. In this study we assessed rates of hospitalization and death from motor vehicle collisions (MVC) in British Columbia (BC) by socio-economic status (SES) and by rural and urban status between 2001 and 2007. Excess risk in injury morbidity and mortality between different SES groups were assessed using a population attributable fraction (PAF). Over a six-year period rural populations in BC experienced a three-fold increase in relative risk of death and an average of 50% increase in relative risk of hospitalization due to injury. When assessed against SES, relative risk of MVC mortality increased from 2.36 (2.05-2.72) to 4.07 (3.35-4.95) in reference to the least deprived areas, with an estimated 40% of all MVC-related mortality attributable to the relative differences across SES classes. Results from this study challenge current provincial and national reporting practises and emphasize the utility of employing the PAF for assessing variations in injury morbidity and mortality.
Primus Group, Clinical Research Center (CHUS), Department of Family Medicine, Faculty of Medicine, Université de Sherbrooke, 300, 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4. ngaminingui@gmail.com
Canadian provincial health systems are obligated to ensure access to health services for all citizens, based primarily on the principles of "universality" and "accessibility" which is enshrined in the Canada Health Act. Nevertheless, less than 40% of Canadian with mental health problems uses mental health services. Efforts to understand underutilization of mental health services have focused on individual and neighborhood characteristics. The aim of this study was to examine whether we could identify areas with mental health facilities shortage in the southwest of Montreal which may possibly explain disparities in access to mental health facilities. We applied the two-step floating catchment area method for our analyses. The results of our analysis show that mental health services are not equally distributed in the southwest of Montreal and in consequence, accessibility scores vary greatly from one DA to another.
Health Policy, Management, and Evaluation, University of Toronto, Institute for Clinical Evaluative Sciences, 4th Floor, 155 College St., Toronto, ON, Canada. anna.durbin@gmail.com
We examined income source and match between recommended and received care among users of community mental health services. We conducted a secondary analysis of needs-based planning data on adults in Ontario community mental health programs from 2000 to 2002. The outcome was whether clients were severely underserved (yes/no) based on the match between level of care recommended and received. A logistic regression model investigated if income source predicted this outcome. 13% of clients were severely underserved. Over 40% were on public assistance and they had a higher risk of being severely undeserved than the others. Men were at greater risk. One aim of mental health reform is to increase access to care for vulnerable individuals. The finding that among users of community mental health services, individuals with public assistance income support are most vulnerable to being severely underserved should be considered by service planners and providers.
Racial and ethnic disparities in breast cancer incidence, stage at diagnosis, survival and mortality are well documented; but few studies have reported on disparities in breast cancer treatment. This paper compares the treatment received by breast cancer patients in British Columbia (BC) for three ethnic groups and three time periods. Values for breast cancer treatments received in the BC general population are provided for reference.
Information on patients, tumour characteristics and treatment was obtained from BC Cancer Registry (BCCR) and BC Cancer Agency (BCCA) records. Treatment among ethnic groups was analyzed by stage at diagnosis and time period at diagnosis. Differences among the three ethnic groups were tested using chi-square tests, Fisher exact tests and a multivariate logistic model.
There was no significant difference in overall surgery use for stage I and II disease between the ethnic groups, however there were significant differences when surgery with and without radiation were considered separately. These differences did not change significantly with time. Treatment with chemotherapy and hormone therapy did not differ among the minority groups.
The description of treatment differences is the first step to guiding interventions that reduce ethnic disparities. Specific studies need to examine reasons for the observed differences and the influence of culture and beliefs.
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Cancer is the leading cause of death among Alaska Native people. The objective of this study was to examine cancer incidence data for 2007-2011, age-specific rates for a 15-year period, incidence trends for 1970-2011, and mortality trends for 1990-2011.
US data were from the Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat database and from the SEER Alaska Native Tumor Registry. Age-adjusted cancer incidence rates among Alaska Native people and US whites were compared using rate ratios. Trend analyses were performed using the Joinpoint Regression Program. Mortality data were from National Center for Health Statistics.
During 2007-2011 the cancer incidence rate among Alaska Native women was 16% higher than the rate among US white women and was similar among Alaska Native men and US white men. Incidence rates among Alaska Native people exceeded rates among US whites for nasopharyngeal, stomach, colorectal, lung, and kidney cancer. A downward trend in colorectal cancer incidence among Alaska Native people occurred from 1999 to 2011. Significant declines in rates were not observed for other frequently diagnosed cancers or for all sites combined. Cancer mortality rates among Alaska Native people during 2 periods, 1990-2000 and 2001-2011, did not decline. Cancer mortality rates among Alaska Native people exceeded rates among US whites for all cancers combined; for cancers of the lung, stomach, pancreas, kidney, and cervix; and for colorectal cancer.
Increases in colorectal screening among Alaska Native people may be responsible for current declines in colorectal cancer incidence; however; improvements in treatment of colon and rectal cancers may also be contributing factors.
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From 1970 to 2010, the Alaskan population increased from 302,583 to 698,473. During that time, the growth rate of Alaskan seniors (65+) was 4 times higher than their national counterparts. Ageing in Alaska requires confronting unique environmental, sociodemographic and infrastructural challenges, including an extreme climate, geographical isolation and less developed health care infrastructure compared to the continental US.
The objective of this analysis is to compare the health needs of Alaskan seniors to those in the continental US.
We abstracted 315,161 records of individuals age 65+ from the 2013 and 2014 Behavioral Risk Factor Surveillance System, of which 1,852 were residents of Alaska. To compare residents of Alaska to residents of the 48 contiguous states we used generalized linear models which allowed us to adjust for demographic differences and survey weighting procedures. We examined 3 primary outcomes - general health status, health care coverage status and length of time since last routine check-up.
Alaskan seniors were 59% less likely to have had a routine check-up in the past year and 12% less likely to report excellent health status than comparable seniors in the contiguous US.
Given the growth rate of Alaskan seniors and inherent health care challenges this vulnerable population faces, future research should examine the specific pathways through which these disparities occur and inform policies to ensure that all US seniors, regardless of geographical location, have access to high-quality health services.
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