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Levinsen AKG, Kjaer TK, Maltesen T, Jakobsen E, Gögenur I, Borre M, Christiansen P, Zachariae R, Laurberg S, Christensen P, Kroman N, Larsen SB, Degett TH, Hölmich LR, Brown PDN, Johansen C, Kjær SK, Thygesen LC, Dalton SO. Educational differences in healthcare use among survivors after breast, prostate, lung, and colon cancer - a SEQUEL cohort study. BMC Health Serv Res 2023; 23:674. [PMID: 37349718 DOI: 10.1186/s12913-023-09683-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many cancer survivors experience late effects after cancer. Comorbidity, health literacy, late effects, and help-seeking behavior may affect healthcare use and may differ among socioeconomic groups. We examined healthcare use among cancer survivors, compared with cancer-free individuals, and investigated educational differences in healthcare use among cancer survivors. METHODS A Danish cohort of 127,472 breast, prostate, lung, and colon cancer survivors from the national cancer databases, and 637,258 age- and sex-matched cancer-free individuals was established. Date of entry was 12 months after diagnosis/index date (for cancer-free individuals). Follow-up ended at death, emigration, new primary cancer, December 31st, 2018, or up to 10 years. Information about education and healthcare use, defined as the number of consultations with general practitioner (GP), private practicing specialists (PPS), hospital, and acute healthcare contacts 1-9 years after diagnosis/index date, was extracted from national registers. We used Poisson regression models to compare healthcare use between cancer survivors and cancer-free individuals, and to investigate the association between education and healthcare use among cancer survivors. RESULTS Cancer survivors had more GP, hospital, and acute healthcare contacts than cancer-free individuals, while the use of PPS were alike. One-to-four-year survivors with short compared to long education had more GP consultations (breast, rate ratios (RR) = 1.28, 95% CI = 1.25-1.30; prostate, RR = 1.14, 95% CI = 1.10-1.18; lung, RR = 1.18, 95% CI = 1.13-1.23; and colon cancer, RR = 1.17, 95% CI = 1.13-1.22) and acute contacts (breast, RR = 1.35, 95% CI = 1.26-1.45; prostate, RR = 1.26, 95% CI = 1.15-1.38; lung, RR = 1.24, 95% CI = 1.16-1.33; and colon cancer, RR = 1.35, 95% CI = 1.14-1.60), even after adjusting for comorbidity. One-to-four-year survivors with short compared to long education had less consultations with PPS, while no association was observed for hospital contacts. CONCLUSION Cancer survivors used more healthcare than cancer-free individuals. Cancer survivors with short education had more GP and acute healthcare contacts than survivors with long education. To optimize healthcare use after cancer, we need to better understand survivors' healthcare-seeking behaviors and their specific needs, especially among survivors with short education.
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Affiliation(s)
| | - Trille Kristina Kjaer
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
| | - Søren Laurberg
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Danish Cancer Society, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Urological Research Unit, Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thea Helene Degett
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | | | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer late effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Xu D, Arling G. Are Frail Older People from Racial/Ethnic Minorities at Double Jeopardy of Putting off Healthcare during the Pandemic? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1034. [PMID: 36673788 PMCID: PMC9859101 DOI: 10.3390/ijerph20021034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Given the differential impacts of COVID-19 on racial and ethnic groups, it is unclear how racial/ethnic status and frailty combine to influence pandemic-related healthcare disruptions. This study aimed to test the double jeopardy hypothesis: racial/ethnic minority older adults suffer a double disadvantage in access to health care during the pandemic due to the interactive effects of frailty and race. This study uses the linked National Health and Aging Trends Study (NHATS) and COVID-19 public use data files. A multivariate logistic regression model was performed. Overall, approximately two out of five (41%) older adults reported postponing care due to the pandemic. The likelihood of putting off care increased slightly by frailty status. We found no significant difference between Whites and non-Whites in putting off care. However, the simple comparison masked significant variation across frailty status. Robust non-White older people were less likely to put off care than robust Whites (robust non-Whites: 29% vs. robust Whites: 39%); in contrast, frail non-White older people were more likely to put off care (frail non-Whites: 55% vs. frail Whites: 42%). Being frail and non-White creates double jeopardy, which has a negative impact on access to healthcare. Timely access to care is essential for frail older people, particularly non-Whites, because of their complex health conditions accentuated by health and social disparities.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, IN 47907, USA
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Rydland HT, Fjær EL, Eikemo TA, Huijts T, Bambra C, Wendt C, Kulhánová I, Martikainen P, Dibben C, Kalėdienė R, Borrell C, Leinsalu M, Bopp M, Mackenbach JP. Educational inequalities in mortality amenable to healthcare. A comparison of European healthcare systems. PLoS One 2020; 15:e0234135. [PMID: 32614848 PMCID: PMC7332057 DOI: 10.1371/journal.pone.0234135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types. METHODS This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities. RESULTS All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences. CONCLUSIONS This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.
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Affiliation(s)
- Håvard T. Rydland
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Erlend L. Fjær
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Terje A. Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Tim Huijts
- Research Centre for Education and the Labour Market, Maastricht University, Maastricht, The Netherlands
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Claus Wendt
- Sociology of Health and Healthcare Systems, University of Siegen, Siegen, Germany
| | - Ivana Kulhánová
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Carme Borrell
- Agència de Salut de Pública de Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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Guarnizo-Herreño CC, Watt RG, Garzón-Orjuela N, Tsakos G. Explaining oral health inequalities in European welfare state regimes: The role of health behaviours. Community Dent Oral Epidemiol 2018; 47:40-48. [DOI: 10.1111/cdoe.12420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/10/2018] [Accepted: 08/12/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Carol C. Guarnizo-Herreño
- Department of Epidemiology and Public Health; University College London; London UK
- Departamento de Salud Colectiva; Facultad de Odontología; Universidad Nacional de Colombia; Bogotá Colombia
| | - Richard G. Watt
- Department of Epidemiology and Public Health; University College London; London UK
| | - Nathaly Garzón-Orjuela
- Hospital Universitario Nacional de Colombia; Grupo de Equidad en Salud; Facultad de Medicina; Universidad Nacional de Colombia; Bogotá Colombia
| | - Georgios Tsakos
- Department of Epidemiology and Public Health; University College London; London UK
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Wong KK, Cohen AL, Martinson NA, Norris SA, Tempia S, von Mollendorf C, Walaza S, Madhi SA, McMorrow ML, Cohen C. Responses to hypothetical health scenarios overestimate healthcare utilization for common infectious syndromes: a cross-sectional survey, South Africa, 2012. BMC Infect Dis 2018; 18:344. [PMID: 30045687 PMCID: PMC6060471 DOI: 10.1186/s12879-018-3252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Asking people how they would seek healthcare in a hypothetical situation can be an efficient way to estimate healthcare utilization, but it is unclear how intended healthcare use corresponds to actual healthcare use. Methods We performed a cross-sectional survey between August and September 2012 among households in Soweto and Klerksdorp, South Africa, to compare healthcare seeking behaviors intended for hypothetical common infectious syndromes (pneumonia, influenza-like illness [ILI], chronic respiratory illness, meningitis in persons of any age, and diarrhea in a child < 5 years old) with the self-reported healthcare use among patients with those syndromes. Results For most syndromes, the proportion of respondents who intended to seek healthcare at any facility or provider (99–100%) in a hypothetical scenario exceeded the proportion that did seek care (78–100%). More people intended to seek care for a child < 5 years old with diarrhea (186/188 [99%]) than actually did seek care (32/41 [78%], P < 0.01). Although most people faced with hypothetical scenarios intended to seek care with licensed medical providers such as hospitals and clinics (97–100%), patients who were ill reported lower use of licensed medical providers (55–95%). Conclusions People overestimated their intended healthcare utilization, especially with licensed medical providers, compared with reported healthcare utilization among patients with these illnesses. Studies that measure intended healthcare utilization should consider that actual use of healthcare facilities may be lower than intended use.
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Affiliation(s)
- Karen K Wong
- Centers for Disease Control, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA. .,United States Public Health Service, Rockville, USA.
| | - Adam L Cohen
- Centers for Disease Control, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA.,United States Public Health Service, Rockville, USA
| | - Neil A Martinson
- MRC Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University, Baltimore, MD, USA
| | | | - Stefano Tempia
- Centers for Disease Control, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA.,National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Claire von Mollendorf
- University of Witwatersrand, Johannesburg, South Africa.,National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Sibongile Walaza
- University of Witwatersrand, Johannesburg, South Africa.,National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Shabir A Madhi
- University of Witwatersrand, Johannesburg, South Africa.,National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Meredith L McMorrow
- Centers for Disease Control, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA.,United States Public Health Service, Rockville, USA
| | - Cheryl Cohen
- University of Witwatersrand, Johannesburg, South Africa.,National Institute for Communicable Diseases, Johannesburg, South Africa
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6
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Jansen T, Rademakers J, Waverijn G, Verheij R, Osborne R, Heijmans M. The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study. BMC Health Serv Res 2018; 18:394. [PMID: 29855365 PMCID: PMC5984471 DOI: 10.1186/s12913-018-3197-4] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/09/2018] [Indexed: 02/05/2023] Open
Abstract
Background Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been associated with healthcare utilisation and with education attainment, we sought to explore whether health literacy is related to the use of out-of-hours (OOH) Primary Care Services (PCSs). Additionally, we aimed to study whether and to what extent health literacy accounts for some of the association between education and OOH PSC use. Methods A survey including measures of education attainment, health literacy (assessed by means of the Dutch version of the nine-dimension Health Literacy Questionnaire) and use of PCS was conducted among a sample of adults diagnosed with (any) somatic chronic condition in the Netherlands (response 76.3%, n = 1811). We conducted linear and logistic regression analyses to examine associations between education level and PCS use in the past year. We performed mediation analyses to assess whether the association between education and PCS use was (partly) explained by different aspects of health literacy. We adjusted the models for patient characteristics such as age and morbidity. Results Higher education attainment was associated with higher scores on the health literacy aspects Appraisal of health information, and Navigating the healthcare system. Additionally, appraisal and navigating the healthcare system partially accounted for educational differences in PCS use. Finally, higher appraisal of health information scores were associated with higher PCS utilisation. Conclusion Several aspects of health literacy were demonstrated to relate to PCS use, and partly accounted for educational differences herein. Accordingly, developing health literacy within individuals or communities may help to reduce inappropriate PCS use among people with low education.
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Affiliation(s)
- Tessa Jansen
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands.
| | - Jany Rademakers
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands.,Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands
| | - Geeke Waverijn
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands
| | - Robert Verheij
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands
| | - Richard Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia.,Department of Public Health, The University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen, Denmark
| | - Monique Heijmans
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands
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Schulz M. The intertwined relationship between patient education, hospital waiting times and hospital utilization. Health Serv Manage Res 2017; 30:213-218. [PMID: 28816522 DOI: 10.1177/0951484817725682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hospital waiting times are established instruments to ration healthcare when resources are scarce. However, higher educated patients may be better able to influence access to, and exit from, hospital care when waiting times are long. Methods Based on a representative sample of 11 European countries from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected in 2004/2005, this paper investigates whether the relationship between individual educational background and hospital utilization depends on the prevalent hospital waiting times in a country. Logistic regression with interaction effects between individual education and average waiting times per country are conducted. Results Primary education is significantly associated with a lower probability of visiting a hospital overnight (OR = 0.88) compared to secondary and tertiary education. Patients in countries with long waiting times had shorter stays (OR = 0.92), and the significant interaction effect indicates that lower educated patients have longer hospital stays than higher educated patients in countries where waiting times tend to be long (OR = 1.06). Conclusions While the findings imply that educational differences exist with regard to hospital care, future research should investigate potential underlying mechanisms, i.e. patients' perceived access barriers and the perceived quality of hospital treatment.
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Affiliation(s)
- Maike Schulz
- SOCIUM Research Center on Inequality and Social Policy, Department for Health, Long-term Care and Pensions, University Bremen, Bremen, Germany
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8
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Põld M, Pärna K, Ringmets I. Trends in self-rated health and association with socioeconomic position in Estonia: data from cross-sectional studies in 1996-2014. Int J Equity Health 2016; 15:200. [PMID: 27931236 PMCID: PMC5146881 DOI: 10.1186/s12939-016-0491-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/01/2016] [Indexed: 01/09/2023] Open
Abstract
Background Self-rated health (SRH) and socioeconomic position (SEP) as important determinants of health differences are associated with health and economic changes in society. The objectives of this paper were (1) to describe trends in SRH and (2) to analyze associations between SRH and SEP among adults in Estonia in 1996–2014. Methods The study was based on a 25–64-year-old subsample (n = 18757) of postal cross-sectional surveys conducted every second year in Estonia during 1990–2014. SRH was measured using five-point scale and was dichotomized to good and less-than-good. Standardized prevalence of SRH was calculated for each study year. Poisson regression with likelihood ratio test was performed for testing trends of SRH over study years. Age, nationality, marital status, education, work status and income were used to determine SEP. Logistic regression analysis was used to assess association between SRH and SEP. Results The prevalence of dichotomized good self-rated health increased significantly over the whole study period with slight decrease in 2008–2010. Until 2002, good SRH was slightly more prevalent among men, but after that, among women. Good SRH was significantly associated with younger age, higher education and income and also with employment status among both, men and women. Good SRH was more prevalent among Estonian women and less prevalent among single men. Conclusions There was a definite increase of good SRH over two decades in Estonia following economic downturn between 2008 and 2010. Good SRH was associated with higher SEP over the study period. Further research is required to study the possible reasons behind increase of good SRH, and it’s association with SEP among adults in Estonia.
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Affiliation(s)
- Mariliis Põld
- Estonian Health Insurance Fund, Lastekodu 48, 10144, Tallinn, Estonia.
| | - Kersti Pärna
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Inge Ringmets
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
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Buffel V, Van de Velde S, Bracke P. Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic, family-related and mental health status factors in explaining gender differences. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1641-53. [PMID: 24802317 DOI: 10.1007/s00127-014-0879-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 04/14/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries. METHODS Data from the Eurobarometer 248 (2005-2006) for 29 European countries is used and country-specific logistic regression analyses are performed. RESULTS Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women's poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women's higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women's care use. CONCLUSIONS Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.
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Affiliation(s)
- V Buffel
- Research Group HeDeRA, Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium,
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Mebratie AD, Van de Poel E, Yilma Z, Abebaw D, Alemu G, Bedi AS. Healthcare-seeking behaviour in rural Ethiopia: evidence from clinical vignettes. BMJ Open 2014; 4:e004020. [PMID: 24525391 PMCID: PMC3927812 DOI: 10.1136/bmjopen-2013-004020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the determinants of healthcare-seeking behaviour using five context-relevant clinical vignettes. The analysis deals with three issues: whether and where to seek modern care and when to seek care. SETTING This study is set in 96 villages located in four main regions of Ethiopia. The participants of this study are 1632 rural households comprising 9455 individuals. PRIMARY AND SECONDARY OUTCOME MEASURES Probability of seeking modern care for symptoms related to acute respiratory infections/pneumonia, diarrhoea, malaria, tetanus and tuberculosis. Conditional on choosing modern healthcare, where to seek care (health post, health centre, clinic and hospital). Conditional on choosing modern healthcare, when to seek care (seek care immediately, the next day, after 2 days, between 3 days to 1 week, a week or more). RESULTS We find almost universal preference for modern care. Foregone care ranges from 0.6% for diarrhoea to 2.5% for tetanus. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centres, private/Non-Government Organization (NGO) clinics as opposed to health posts. Delays in care-seeking behaviour are apparent mainly for adult-related conditions and among poorer households. CONCLUSIONS The analysis suggests that the lack of healthcare utilisation is not driven by the inability to recognise health problems or due to a low perceived need for modern care.
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Affiliation(s)
- Anagaw D Mebratie
- Institute of Social Studies of Erasmus University Rotterdam, The Hague, The Netherlands
| | - Ellen Van de Poel
- Institute of Health Policy and Management of Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Zelalem Yilma
- Institute of Social Studies of Erasmus University Rotterdam, The Hague, The Netherlands
| | - Degnet Abebaw
- Poverty and Human Resource Research Department, Ethiopian Economic Association, Addis Ababa, Ethiopia
| | - Getnet Alemu
- Regional and Local Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Arjun S Bedi
- Institute of Social Studies of Erasmus University Rotterdam, The Hague, The Netherlands
- School of Foreign Service, Georgetown University, Doha, Qatar
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do Rosário Oliveira Martins M, Rodrigues IC, Rodrigues TF. Projecting Health Outcomes for Portuguese Ageing Population: Challenges and Opportunities. Health (London) 2014. [DOI: 10.4236/health.2014.614220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Vikum E, Johnsen R, Krokstad S. Social inequalities in patient experiences with general practice and in access to specialists: the population-based HUNT Study. BMC Health Serv Res 2013; 13:240. [PMID: 23816237 PMCID: PMC3718649 DOI: 10.1186/1472-6963-13-240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 06/21/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In countries with gatekeeping and equitable access to general practitioners (GPs), social inequalities in GP-patient interaction could be an important mechanism by which inequalities in access to medical specialists arise. The aim of this study was to investigate whether socioeconomic inequalities in experiences with general practice are associated with socioeconomic inequalities in access to specialist services. METHODS The study included 6,067 participants in the third survey of the Nord-Trøndelag Health Study (HUNT3, 2006-08) who were asked to evaluate their experiences with primary care and their regular general practitioner in Norway. Self-reported data on health status and number of visits to GP and specialist services in the last 12 months were included in the study. Socioeconomic status was measured by education and household income and rescaled to relative index of inequality (RII). Relative risks were calculated using Poisson regression. RESULTS We found that a majority of patients reported positive experiences with general practice. Low socioeconomic status (SES) and male gender were associated with negative experiences. Patient experiences both directly and indirectly related to referrals were associated with the probability and quantity of specialist utilization: perception of low subjective influence on decisions about choice of medical care was associated with lower probability and quantity of specialist utilization, whereas desire to change the regular GP or to use GPs other than the regular GP and critical evaluations of the GP were associated with higher specialist consultation frequency. However, the level of education-related inequity in access to specialists was not sensitive to adjustment by survey responses. CONCLUSION Patient experiences with general practice were associated with the patients' level of utilization of specialist services. There are socioeconomic inequalities in patient experiences with general practice, however the aspects measured in this study do not explain the observed socioeconomic inequity in access to specialists.
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Affiliation(s)
- Eirik Vikum
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Health Authority, Levanger, Norway
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Vikum E, Bjørngaard JH, Westin S, Krokstad S. Socio-economic inequalities in Norwegian health care utilization over 3 decades: the HUNT Study. Eur J Public Health 2013; 23:1003-10. [PMID: 23729479 DOI: 10.1093/eurpub/ckt053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate socio-economic inequalities in health care utilization from the 1980s and through the last 3 decades in a Norwegian county population. METHODS Altogether, 166 758 observations of 97 251 individuals during surveys in 1984-86 (83% eligible responses), 1995-97 (51% eligible responses) and 2006-08 (50% eligible responses) of the total population of adults (≥ 20 years) from Nord-Trøndelag county in Norway were included. Health care utilization was measured as at least one visit to general practitioner (GP), hospital outpatient services and inpatient care in the past year. Socio-economy was measured by both education and income and rescaled to measure relative indexes of inequality (RII). Relative and absolute inequalities were estimated from multilevel logistic regression. Estimates were adjusted for age, sex, municipality size and self-reported health. RESULTS GP utilization was higher among individuals with higher education in 1984-86. Among men the RII was 0.54 (CI: 0.48-0.62), and among women RII was 0.67 (CI: 0.58-0.77). In 2006-08, the corresponding RII was 1.31 (CI: 1.13-1.52) for men and 1.00 (CI: 0.85-1.18) for women, indicating higher or equal GP utilization among those with lower education, respectively. The corresponding RIIs for outpatient consultations were 0.58 (CI: 0.49-0.68) for men and 0.40 (CI: 0.34-0.46) for women in 1984-86, and 0.53 (CI: 0.46-0.62) for men and 0.47 (CI: 0.41-0.53) for women in 2006-08. CONCLUSION Through the last 3 decades, the previous socio-economic differences in GP utilization have diminished. Despite this, highly educated people were more prone to utilize hospital outpatient consultations throughout the period 1984-2008.
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Affiliation(s)
- Eirik Vikum
- 1 Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Apostolidis A, de Nunzio C, Tubaro A. What determines whether a patient with LUTS seeks treatment?: ICI-RS 2011. Neurourol Urodyn 2012; 31:365-9. [DOI: 10.1002/nau.22212] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 01/12/2012] [Indexed: 11/10/2022]
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Klüwer-Trotter B, Lian O. Holdninger til legesøkning - variasjoner etter sosial tilhørighet? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:36-40. [DOI: 10.4045/tidsskr.11.0380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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