Healthcare-seeking behaviour and utilization of treatment in a community-based screening study for obstructive sleep apnoea in Busselton, Western Australia

Development and Validation of the Resident Healthcare-Seeking Culture Scale (RHCS) Among Chinese Demographics in the Community Setting

OBJECTIVE

This study aimed to develop a measurement scale with good reliability and validity to assess the reasonableness of resident healthcare-seeking culture.

METHODS

This investigation utilized a cross-sectional research design, employing a multi-stage random sampling technique to select adult inhabitants aged eighteen and above who possess fundamental literacy abilities. An online survey was conducted from March to April 2021 across 27 provinces in China, encompassing 911 questionnaires for scale development. This study primarily applied discriminant coefficients and exploratory factor analysis to refine the scale items. Scale reliability was assessed using Cronbach's alpha, and split-half reliability. Scale validity was determined through content validity and structural validity. Data analysis was performed using SPSS 21.0, and structural equation modeling was executed with AMOS 23.0 software. Statistical significance was defined at P<0.05.

RESULTS

The Resident Healthcare-seeking Culture Scale (RHCS) ultimately comprised 5 dimensions and 20 items. The cumulative explained variance of the five common factors within this scale amounts to 55.24%, satisfactorily adhering to the established criterion of social science research that the extracted factors should explain between 50% and 60% of the total variance. The Cronbach's alpha coefficient for the total scale was 0.83. Split-half reliability was 0.87. The Pearson correlation coefficients associating the scores from the five dimensions with the overall scale score were 0.78, 0.65, 0.65, 0.64, and 0.42, respectively, all statistically significant with P-values less than 0.001. The results of confirmatory factor analysis suggested that RMR=0.045, GFI=0.952, AGFI=0.936, PGFI=0.712, NFI=0.917, IFI=0.944, TLI=0.931, CFI = 0.943, and RMSEA = 0.046.

CONCLUSION

The measurement scale for healthcare-seeking culture among Chinese residents exhibits superior reliability and validity, serving as an effective instrument for hospital administrators to evaluate the reasonableness of demand-side healthcare culture.

The preventable productivity burden of sleep apnea in Australia: a lifetime modelling study

Obstructive sleep apnea (OSA) is a common disorder. OSA is associated with cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and depression, among other comorbidities. We aim to determine the productivity burden of OSA in Australia using productivity-adjusted life-years (PALYs). Using life table modelling, we built a multistate Markov model to estimate the impact of moderate to severe OSA on the whole working-age Australian population in 2021 (aged 20-65 years) with OSA until retirement (aged 66 years). The model also captured the impact of OSA on CVD, T2DM, depression, and vehicle-related accidents. Data for OSA and comorbidities and Australian specific labour data, were extracted from published sources. A second cohort was then modelled to test the effect of a hypothetical intervention, assuming a 10% reduction in OSA prevalence and a 10% reduction in comorbidities in patients with OSA. The primary outcome of interest were PALYs accrued. All outcomes were discounted 5% annually. Over a lifetime, the Australian population with OSA accrued 193,713,441 years of life lived and 182,737,644 PALYs. A reduction of 10% in OSA prevalence and comorbidities would result in 45,401 extra years of life lived and 150,950 extra PALYs. This resulted in more than AU$25 billion of gained gross domestic product over the lifetime of the working population. Our study highlights the substantial burden of OSA on the Australian population and the need to tailor interventions at the population level to reduce the health and economic impacts.

The Social And Economic Cost Of Sleep Disorders

STUDY OBJECTIVES

To estimate economic cost of common sleep disorders in Australia for 2019-2020.

METHODS

Costs were estimated for obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) using prevalence, financial, and nonfinancial data from national databases. These included: (1) financial costs associated with health care, informal care, productivity losses, non-medical accident costs, deadweight loss from taxation/welfare inefficiencies; and (2) nonfinancial costs associated with loss of well-being. They were expressed in US dollars ($).

RESULTS

Estimated overall cost of sleep disorders in Australia in 2019-2020 (population: 25.5 million) was $35.4 billion (OSA $13.1 billion; insomnia $13.3 billion, RLS $9.0 billion). Of this, the financial cost component was $10.0 billion, comprised of: health system costs $0.7 billion; productivity losses $7.7 billion; informal care $0.2 billion; other, mainly non-medical accident costs, $0.4 billion; and deadweight losses $1.0 billion. For moderate to severe OSA syndrome, insomnia unrelated to other conditions and RLS, financial costs represented $16,717, $21,982, and $16,624 per adult with the condition for the year, respectively. The nonfinancial cost was $25.4 billion.

CONCLUSIONS

The economic costs associated with sleep disorders are substantial. The financial component of $10.0 billion is equivalent to 0.73% of Australian gross domestic product. The nonfinancial cost of $25.4 billion represents 3.2% of total Australian burden of disease for the year. Health system costs of these disorders are low relative to those associated with their consequences, suggesting greater expenditure on detection, treatment and prevention is warranted.