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Xue S, Zeng W, Yang X, Li J, Zhu L, Zou G. Factors associated with the enrollment of commercial medical insurance in China: Results from China General Social Survey. PLoS One 2024; 19:e0303997. [PMID: 38781252 PMCID: PMC11115273 DOI: 10.1371/journal.pone.0303997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The Chinese government has been promoting commercial medical insurance (CMI) in recent decades as it plays an increasingly important role in addressing disease burden, health inequities, and other healthcare challenges. However, compared with developed countries, the CMI is still less fledged with low coverage. OBJECTIVE This study aims to explore the factors associated with enrollment in CMI, with regards to explicit characteristics (including sociodemographic characteristics and family economic status), latent characteristics (including social security status), and the global incentive compatibility index (including health status), to inform the design of CMI to improve its coverage in China. METHODS Based on the principal-agent model, we summarized and classified the factors associated with the enrollment in CMI, and then analyzed the data generated from the Chinese General Social Survey in 2015,2018 and 2021 respectively. A comparison of factors regarding sociodemographic characteristics, family economic status, social security status, and health status was conducted between individuals enrolled and unenrolled in CMI using Mann-Whitney U test and Chi-square test. Binary logistic regression analysis was used to explore factors influencing the enrollment status of CMI. RESULTS Of all individuals, the proportion of enrolled individuals shows an increasing trend year by year, with 8.7%,11.8% and 14.1% enrolled in CMI in 2015,2018 and 2021, respectively. The binary regression analysis further suggested that the factors associated with the enrollment in CMI were consistent in 2015,2018 and 2021.We found that individuals divorced, obese, who had a higher level of education, had non-agricultural household registration, perceived themselves as the upper social status, conducted daily exercise, had more family houses, had a car, had investment activities, or did not have basic health insurance were more likely to be enrolled in CMI. CONCLUSIONS We identified multidimensional factors associated with the enrollment of CMI, which help inform the government and insurance industry to improve the coverage of CMI.
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Affiliation(s)
- Songyue Xue
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wu Zeng
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaocong Yang
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Jianguo Li
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Zhu
- School of Postgraduate Studies, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
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Datta Gupta A, Wilson D, Tucker G, Albanese D, Berrigan S, Nath S. Effects of an outpatient exercise programme for Australians with cancer-related fatigue: an unmet need. Intern Med J 2023; 53:1400-1408. [PMID: 36043994 DOI: 10.1111/imj.15909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a common debilitating condition. International evidence supports an exercise prescription for CRF. The majority of Australians with cancer do not meet recommended exercise targets. AIMS To analyse the effects of a guideline-based supervised exercise programme on CRF among a representative private hospital cancer patient sample (n = 268). METHODS We collected data from 268 patients recruited from haematology and oncology over a 5-year period. Participants underwent a 3-month CRF exercise programme based on internationally recognised exercise guidelines. The programme, conducted by a multidisciplinary team, operated twice weekly sessions of 2 h duration comprising aerobic, resistance and balance exercises; hydrotherapy and condition counselling; fatigue management; and dietetic, speech pathology and swallowing education (head and neck cancers). The effect of the programme was measured in relation to the following outcomes: Functional Assessment of Chronic Illness Therapy, Fatigue (self-reported fatigue); Functional Assessment of Cancer Therapy, general quality of life (health-related quality of life in cancer); six-minute walk test; and Lawton's Instrumental Activities of Daily Living Scale. RESULTS Multivariate outcomes showed statistically significant improvements in all four major outcome measures, plus a programme effect of greater than 0.7 for each outcome variable. The programme treatment outcomes were consistent over the 5 years of the programme. CONCLUSIONS The outcomes of this programme contribute to exercise guidelines in Australia. Currently only position statements exist on the subject, but there are no programme guidelines. An exercise prescription is critical to cancer outcomes. This programme is likely to benefit cancer survivors experiencing CRF across private and public hospitals in Australia.
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Affiliation(s)
- Anupam Datta Gupta
- Department of Rehabilitation Medicine, The Queen Elizabeth Hospital (University of Adelaide), Adelaide, South Australia, Australia
| | - David Wilson
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Aging, Basil Hetzel Institute, Adelaide, South Australia, Australia
| | - Graeme Tucker
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Aging, Basil Hetzel Institute, Adelaide, South Australia, Australia
| | | | - Sonia Berrigan
- Memorial Hospital, North Adelaide, South Australia, Australia
| | - Shriram Nath
- Adelaide Haematology, Adelaide, South Australia, Australia
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Yu XQ, Goldsbury D, Feletto E, Koh CE, Canfell K, O'Connell DL. Socioeconomic disparities in colorectal cancer survival: contributions of prognostic factors in a large Australian cohort. J Cancer Res Clin Oncol 2021; 148:2971-2984. [PMID: 34822016 PMCID: PMC8614213 DOI: 10.1007/s00432-021-03856-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022]
Abstract
Purpose We quantified the contributions of prognostic factors to socioeconomic disparities in colorectal cancer survival in a large Australian cohort. Methods The sample comprised 45 and Up Study participants (recruited 2006–2009) who were subsequently diagnosed with colorectal cancer. Both individual (education attained) and neighbourhood socioeconomic measures were used. Questionnaire responses were linked with cancer registrations (to December 2013), records for hospital inpatient stays, emergency department presentations, death information (to December 2015), and Medicare and Pharmaceutical Benefits claims for subsidised procedures and medicines. Proportions of socioeconomic survival differences explained by prognostic factors were quantified using multiple Cox proportional hazards regression. Results 1720 eligible participants were diagnosed with colorectal cancer after recruitment: 1174 colon and 546 rectal cancers. Significant colon cancer survival differences were only observed for neighbourhood socioeconomic measure (p = 0.033): HR = 1.55; 95% CI 1.09–2.19 for lowest versus highest quartile, and disease-related factors explained 95% of this difference. For rectal cancer, patient- and disease-related factors were the main drivers of neighbourhood survival differences (28–36%), while these factors and treatment-related factors explained 24–41% of individual socioeconomic differences. However, differences remained significant for rectal cancer after adjusting for all these factors. Conclusion In this large contemporary Australian cohort, we identified several drivers of socioeconomic disparities in colorectal cancer survival. Understanding of the role these contributors play remains incomplete, but these findings suggest that improving access to optimal care may significantly reduce these survival disparities.
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Affiliation(s)
- Xue Qin Yu
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia.
| | - David Goldsbury
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
| | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Ismail L, Materwala H, Al Kaabi J. Association of risk factors with type 2 diabetes: A systematic review. Comput Struct Biotechnol J 2021; 19:1759-1785. [PMID: 33897980 PMCID: PMC8050730 DOI: 10.1016/j.csbj.2021.03.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetes is the leading cause of severe health complications and one of the top 10 causes of death worldwide. To date, diabetes has no cure, and therefore, it is necessary to take precautionary measures to avoid its occurrence. The main aim of this systematic review is to identify the majority of the risk factors for the incidence/prevalence of type 2 diabetes mellitus on one hand, and to give a critical analysis of the cohort/cross-sectional studies which examine the impact of the association of risk factors on diabetes. Consequently, we provide insights on risk factors whose interactions are major players in developing diabetes. We conclude with recommendations to allied health professionals, individuals and government institutions to support better diagnosis and prognosis of the disease.
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Affiliation(s)
- Leila Ismail
- Intelligent Distributed Computing and Systems Research Laboratory, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates
| | - Huned Materwala
- Intelligent Distributed Computing and Systems Research Laboratory, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates
| | - Juma Al Kaabi
- College of Medicine and Health Sciences, Department of Internal Medicine, United Arab Emirates University, Al Ain, Abu Dhabi 15551, United Arab Emirates
- Mediclinic, Al Ain, Abu Dhabi, United Arab Emirates
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Khoo J, Hasan H. Analysing health data sources to inform chronic disease management decisions of health insurers: A mixed methods study. Inform Health Soc Care 2018; 44:221-236. [PMID: 30102093 DOI: 10.1080/17538157.2018.1496088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background and Objective: Both health care providers and payers recognize the need to improve chronic disease care. Chronic disease management relies on high-quality health information for people with, and at risk of developing, chronic diseases. This article focuses on the health insurance sector and investigates ways that payment claims data and other data sources can provide useful information to support chronic disease management interventions. Methods and Results: In this mixed methods study, we first examine methods of selecting target populations from insurance claims data for common chronic conditions-diabetes, cardiovascular disease, and mental health disorders. The analysis of claims data reveals data quality issues and indicates that other data sources should be considered to provide additional information. We undertake a qualitative review of factors influencing the development of information systems for chronic disease management that use multiple data sources. Conclusions: Claims data should be supplemented with other data to inform chronic disease management. The article proposes a conceptual framework with four domains that need to be considered when developing chronic disease information systems using multiple data sources-information requirements, data sources, data collection, and information systems integration. There are policy and organizational factors that influence framework implementation.
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Affiliation(s)
- Joanna Khoo
- a Australian Health Services Research Institute, School of Management Operations and Marketing, University of Wollongong , Wollongong , Australia.,b Capital Markets CRC Limited, Sydney, Australia
| | - Helen Hasan
- a Australian Health Services Research Institute, School of Management Operations and Marketing, University of Wollongong , Wollongong , Australia.,b Capital Markets CRC Limited, Sydney, Australia
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Mehra T, Moos RM, Seifert B, Bopp M, Senn O, Simmen HP, Neuhaus V, Ciritsis B. Impact of structural and economic factors on hospitalization costs, inpatient mortality, and treatment type of traumatic hip fractures in Switzerland. Arch Osteoporos 2017; 12:7. [PMID: 28013447 DOI: 10.1007/s11657-016-0302-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED The assessment of structural and potentially economic factors determining cost, treatment type, and inpatient mortality of traumatic hip fractures are important health policy issues. We showed that insurance status and treatment in university hospitals were significantly associated with treatment type (i.e., primary hip replacement), cost, and lower inpatient mortality respectively. INTRODUCTION The purpose of this study was to determine the influence of the structural level of hospital care and patient insurance type on treatment, hospitalization cost, and inpatient mortality in cases with traumatic hip fractures in Switzerland. METHODS The Swiss national medical statistic 2011-2012 was screened for adults with hip fracture as primary diagnosis. Gender, age, insurance type, year of discharge, hospital infrastructure level, length-of-stay, case weight, reason for discharge, and all coded diagnoses and procedures were extracted. Descriptive statistics and multivariate logistic regression with treatment by primary hip replacement as well as inpatient mortality as dependent variables were performed. RESULTS We obtained 24,678 inpatient case records from the medical statistic. Hospitalization costs were calculated from a second dataset, the Swiss national cost statistic (7528 cases with hip fractures, discharged in 2012). Average inpatient costs per case were the highest for discharges from university hospitals (US$21,471, SD US$17,015) and the lowest in basic coverage hospitals (US$18,291, SD US$12,635). Controlling for other variables, higher costs for hip fracture treatment at university hospitals were significant in multivariate regression (p < 0.001). University hospitals had a lower inpatient mortality rate than full and basic care providers (2.8% vs. both 4.0%); results confirmed in our multivariate logistic regression analysis (odds ratio (OR) 1.434, 95% CI 1.127-1.824 and OR 1.459, 95% confidence interval (CI) 1.139-1.870 for full and basic coverage hospitals vs. university hospitals respectively). The proportion of privately insured varied between 16.0% in university hospitals and 38.9% in specialized hospitals. Private insurance had an OR of 1.419 (95% CI 1.306-1.542) in predicting treatment of a hip fracture with primary hip replacement. CONCLUSION The seeming importance of insurance type on hip fracture treatment and the large inequity in the distribution of privately insured between provider types would be worth a closer look by the regulatory authorities. Better outcomes, i.e., lower mortality rates for hip fracture treatment in hospitals with a higher structural care level advocate centralization of care.
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Affiliation(s)
- Tarun Mehra
- Medical Directorate, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.
| | - Rudolf M Moos
- Medical Directorate, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Bopp
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Senn
- Institute for General Practice, University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland
| | - Bernhard Ciritsis
- Division of Trauma Surgery, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland
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Grigorakis N, Floros C, Tsangari H, Tsoukatos E. Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2017; 17:10.1007/s10754-016-9203-7. [PMID: 28050680 DOI: 10.1007/s10754-016-9203-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/03/2016] [Indexed: 02/28/2024]
Abstract
The high level of out of pocket (OOP) payments constitutes a major concern for Greece and several other European and OECD countries as a result of the significant down turning of their public health finances due to the 2008 financial crisis. The basic objective of this study is to provide empirical evidence on the effect of combining social health insurance (SHI) and private health insurance (PHI) on OOP payments. Further, this study examines the catastrophic impact of OOP payments on insured's welfare using the incidence and intensity methodological approach of measuring catastrophic health care expenditures. Conducting a cross-sectional survey in Greece in 2013, we find that the combination of SHI-PHI has a strong negative influence on insured OOP payments for inpatient health care in private hospitals. Furthermore, our results indicate that SHI coverage is not sufficient by itself to manage with this issue. Moreover, we find that poor people present a greater tendency to incur catastrophic OOP expenditures for hospital health care in private providers. Drawing evidence from Greece, a country with huge fiscal problems that has suffered the consequences of the economic crisis more than any other, could be a starting point for policymakers to consider the perspective of SHI-PHI co-operation against OOP payments more seriously.
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Affiliation(s)
| | - Christos Floros
- School of Management and Economics, T.E.I of Crete, Heraklion, Greece.
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Lo TKT, Parkinson L, Cunich M, Byles J. Factors associated with the health care cost in older Australian women with arthritis: an application of the Andersen's Behavioural Model of Health Services Use. Public Health 2016; 134:64-71. [PMID: 26791096 DOI: 10.1016/j.puhe.2015.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/27/2015] [Accepted: 11/27/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Factors associated with the utilisation of health care have not been rigorously examined in people with arthritis. The objective of this study was to examine the determinants of health care utilisation and costs in older women with arthritis using the Andersen's behavioural model as a framework. STUDY DESIGN Longitudinal cohort study. METHODS Participants of Surveys 3 to 5 of the Australian Longitudinal Study on Women's Health who reported arthritis were included in the study. Information about health care utilisation and unit prices were based on linked Medicare Australia data, which included prescription medicines and health services. Total health care costs of participants with arthritis were measured for the years 2002 to 2003, 2005 to 2006, and 2008 to 2009, which corresponded to the survey years. Potential explanatory variables of the health care cost and other characteristics of the participants were collected from the health surveys. Explanatory variables were grouped into predisposing characteristics, enabling factors and need variables conforming to the Andersen's Behavioural Model of Health Services Use. Longitudinal data analysis was conducted using generalized estimating equations. RESULTS A total of 5834 observations were included for the three periods. Regression analysis results show that higher health care cost in older Australian women with arthritis was significantly associated with residing in an urban area, having supplementary health insurance coverage, more comorbid conditions, using complementary and alternative medicine, and worse physical functioning. It was also found that predisposing characteristics (such as the area of residence) and enabling factors (such as health insurance coverage) accounted for more variance in the health care cost than need variables (such as comorbid conditions). CONCLUSION These results may indicate an inefficient and unfair allocation of subsidised health care among older Australian women with arthritis, where individuals with less enabling resources and more socio-economic disadvantages have a lower level of health care utilisation. Future research may focus on evaluating the effectiveness of policies designed to reduce excessive out-of-pocket costs and to improve equity in health care access in the older population.
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Affiliation(s)
- T K T Lo
- Research Centre for Gender, Health and Ageing, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - L Parkinson
- Central Queensland University, School of Human Health and Social Sciences, Rockhampton, QLD 4701, Australia
| | - M Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - J Byles
- Research Centre for Gender, Health and Ageing, The University of Newcastle, Callaghan, NSW 2308, Australia
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Teusner DN, Brennan DS, Spencer AJ. Associations between level of private dental insurance cover and favourable dental visiting by household income. Aust Dent J 2015; 60:479-89. [DOI: 10.1111/adj.12268] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- DN Teusner
- Australian Research Centre for Population Oral Health; School of Dentistry; The University of Adelaide; South Australia
| | - DS Brennan
- Australian Research Centre for Population Oral Health; School of Dentistry; The University of Adelaide; South Australia
| | - AJ Spencer
- Australian Research Centre for Population Oral Health; School of Dentistry; The University of Adelaide; South Australia
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Tang W, Grace B, McDonald SP, Hawley CM, Badve SV, Boudville NC, Brown FG, Clayton PA, Johnson DW. Socio-Economic Status and Peritonitis in Australian Non-Indigenous Peritoneal Dialysis Patients. Perit Dial Int 2014; 35:450-9. [PMID: 24497587 DOI: 10.3747/pdi.2013.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 07/09/2013] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The aim of the present study was to investigate the relationship between socio-economic status (SES) and peritoneal dialysis (PD)-related peritonitis. ♦ METHODS Associations between area SES and peritonitis risk and outcomes were examined in all non-indigenous patients who received PD in Australia between 1 October 2003 and 31 December 2010 (peritonitis outcomes). SES was assessed by deciles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Disadvantage (IRSD), Index of Relative Socio-economic Advantage and Disadvantage (IRSAD), Index of Economic Resources (IER) and Index of Education and Occupation (IEO). ♦ RESULTS 7,417 patients were included in the present study. Mixed-effects Poisson regression demonstrated that incident rate ratios for peritonitis were generally lower in the higher SEIFA-based deciles compared with the reference (decile 1), although the reductions were only statistically significant in some deciles (IRSAD deciles 2 and 4 - 9; IRSD deciles 4 - 6; IER deciles 4 and 6; IEO deciles 3 and 6). Mixed-effects logistic regression showed that lower probabilities of hospitalization were predicted by relatively higher SES, and lower probabilities of peritonitis-associated death were predicted by less SES disadvantage status and greater access to economic resources. No association was observed between SES and the risks of peritonitis cure, catheter removal and permanent hemodialysis (HD) transfer. ♦ CONCLUSIONS In Australia, where there is universal free healthcare, higher SES was associated with lower risks of peritonitis-associated hospitalization and death, and a lower risk of peritonitis in some categories.
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Affiliation(s)
- Wen Tang
- Division of Nephrology, Peking University Third Hospital, Beijing, China ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | | | - Stephen P McDonald
- ANZDATA Registry, Adelaide, Australia Department of Nephrology and Transplantation Services, University of Adelaide at Central Northern Adelaide Renal and Transplantation Services, Adelaide, Australia
| | - Carmel M Hawley
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Sunil V Badve
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Neil C Boudville
- ANZDATA Registry, Adelaide, Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia
| | - Fiona G Brown
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Philip A Clayton
- ANZDATA Registry, Adelaide, Australia Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia School of Public Health, University of Sydney, Sydney, Australia
| | - David W Johnson
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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Holliday EG, Magee CA, Kritharides L, Banks E, Attia J. Short sleep duration is associated with risk of future diabetes but not cardiovascular disease: a prospective study and meta-analysis. PLoS One 2013; 8:e82305. [PMID: 24282622 PMCID: PMC3840027 DOI: 10.1371/journal.pone.0082305] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/22/2013] [Indexed: 11/24/2022] Open
Abstract
Epidemiologic studies have observed association between short sleep duration and both cardiovascular disease (CVD) and type 2 diabetes, although these results may reflect confounding by pre-existing illness. This study aimed to determine whether short sleep duration predicts future CVD or type 2 diabetes after accounting for baseline health. Baseline data for 241,949 adults were collected through the 45 and Up Study, an Australian prospective cohort study, with health outcomes identified via electronic database linkage. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals. Compared to 7h sleep, <6h sleep was associated with incident CVD in participants reporting ill-health at baseline (HR=1·38 [95% CI: 1·12-1·70]), but not after excluding those with baseline illness and adjusting for baseline health status (1·03 [0·88-1·21]). In contrast, the risk of incident type 2 diabetes was significantly increased in those with <6h versus 7h sleep, even after excluding those with baseline illness and adjusting for baseline health (HR=1·29 [1·08-1·53], P=0.004). This suggests the association is valid and does not simply reflect confounding or reverse causation. Meta-analysis of ten prospective studies including 447,124 participants also confirmed an association between short sleep and incident diabetes (1·33 [1·20-1·48]). Obtaining less than 6 hours of sleep each night (compared to 7 hours) may increase type 2 diabetes risk by approximately 30%.
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Affiliation(s)
- Elizabeth G. Holliday
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- * E-mail:
| | - Christopher A. Magee
- Centre for Health Initiatives, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- The Sax Institute, Sydney, New South Wales, Australia
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
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Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People's attitudes, beliefs, and experiences regarding polypharmacy and willingness to Deprescribe. J Am Geriatr Soc 2013; 61:1508-14. [PMID: 24028356 DOI: 10.1111/jgs.12418] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To capture people's attitudes, beliefs, and experiences regarding the number of medications they are taking and their feelings about stopping medications. DESIGN Administration of a validated questionnaire. SETTING Multidisciplinary ambulatory consulting service at the Royal Adelaide Hospital. PARTICIPANTS Participants were individuals aged 18 and older (median 71.5) taking at least one regular prescription medication; 100 participants completed all items of the questionnaire, 65 of whom were aged 65 and older. MEASUREMENTS Participants were administered the 15-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire. RESULTS Participants were taking an average of 10 different prescription and nonprescription (including complementary), regular and as-needed medications. More than 60% felt that they were taking a "large number" of medications, and 92% stated that they would be willing to stop one or more of their current medications if possible. Number of regular medications, age, and number of medical conditions were not found to be correlated with willingness to stop a medication. The findings were similar in older and younger participants. CONCLUSION This study has shown that a cohort of mostly older adults were largely accepting of a trial of cessation of medication(s) that their prescriber deemed to be no longer required. Because few factors were associated with willingness to cease medications, all patients should be individually evaluated for deprescribing.
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Affiliation(s)
- Emily Reeve
- Sansom Institute, University of South Australia, Adelaide, SA, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
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Odeyemi IAO, Nixon J. The role and uptake of private health insurance in different health care systems: are there lessons for developing countries? CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:109-18. [PMID: 23494071 PMCID: PMC3593711 DOI: 10.2147/ceor.s40386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI). This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity. METHODS A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia) that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity. RESULTS In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system. CONCLUSION PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care.
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Affiliation(s)
- Isaac AO Odeyemi
- Senior Director and Head of Health Economics and Outcomes Research, Astellas Pharma UK Ltd, Chertsey, UK
| | - John Nixon
- Teaching Associate in Health Economics, Department of Economics and Related Studies, University of York, York, UK
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Rogers KD, Blyth FM, March LM, Jorm L. A nested case-control analysis of self-reported physical functioning after total knee replacement surgery in the 45 and Up Study Cohort. BMJ Open 2013; 3:bmjopen-2012-002291. [PMID: 23836760 PMCID: PMC3710975 DOI: 10.1136/bmjopen-2012-002291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The rate of total knee arthroplasty surgery (TKA) is rising in Australia despite varying impacts of TKA on physical function (PF) in population-based studies. There are potentially modifiable risk factors that could enhance PF after TKA, so we evaluated (1) the levels of PF in persons with TKA and the rest of the population, (2) potentially modifiable characteristics of those reporting poor PF after TKA. DESIGN Nested case-control study. SETTING Population-based cohort study in New South Wales, Australia. PARTICIPANTS Members of a large (n=267 151) cohort study recruited by a self-completed, mailed questionnaire from 2006 to 2008. After exclusions (for hip arthroplasty, partial TKA, missing important variables and mismatching TKA status between self-reported and hospital record data), this study included 205 148 participants. PRIMARY AND SECONDARY OUTCOMES Primary outcome, Medical Outcomes Study Physical Function scale (MOS-PF). Secondary outcome, dispensings of analgesics or anti-inflammatory drugs. RESULTS We found 2916 TKA participants and 202 232 participants with no TKA (confirmed across datasets). Persons with TKA had a lower MOS-PF (59.9, 95% CI 58.5 to 60.6) than those without TKA (83.8, 95% CI 83.7 to 83.9). In the matched analysis, the TKA group had a lower MOS-PF (59.9, 95% CI 59.9 to 62.4) than those without TKA (68.4, 95% CI 67.8 to 69.0). In persons with TKA, lower levels of MOS-PF were associated with low self-rated health, high psychological distress, comorbidity, greater age, recent treatment for osteoarthritis and use of paracetamol. Women had an MOS-PF that was 11.6 points (95% CI 9.5 to 13.8) lower than men. CONCLUSIONS Several modifiable risk factors have been identified to influence PF in persons receiving TKA, with notable differences between sexes. The importance of these risk factors should be examined in incident TKA to test if early identification and intervention for individuals can improve outcomes.
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Affiliation(s)
- Kris D Rogers
- Department of Intramural Research, The Sax Institute, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Department of Intramural Research, The Sax Institute, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Concord, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lyn M March
- Department of Rheumatology, The University of Sydney Institute of Bones and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Louisa Jorm
- Department of Intramural Research, The Sax Institute, Sydney, New South Wales, Australia
- School of Medicine, University of Western Sydney, Penrith, New South Wales, Australia
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Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int 2012; 83:138-45. [PMID: 22895516 DOI: 10.1038/ki.2012.304] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Socioeconomic disadvantage has been linked to reduced access to kidney transplantation. To understand and address potential barriers to transplantation, we used the Australia and New Zealand Dialysis and Transplant Registry and examined primary kidney-only transplantation among adult non-Indigenous patients who commenced chronic renal replacement therapy in Australia during 2000-2010. Socioeconomic status was derived from residential postcodes using standard indices. Among the 21,190 patients who commenced renal replacement therapy, 4105 received a kidney transplant (2058 from living donors (660 preemptive) or 2047 from deceased donors) by the end of 2010. Compared with the most socioeconomic disadvantaged quartile, patients from the most advantaged quartile were more likely to receive a preemptive transplant (relative rate 1.93), and more likely to receive a living-donor kidney (adjusted subhazard ratio 1.34) after commencing dialysis. Socioeconomic status was not associated with deceased-donor transplantation. Thus, the association between socioeconomic status and living- but not deceased-donor transplantation suggests that potential donors (rather than recipients) from disadvantaged areas may face barriers to donation. Although the deceased-donor organ allocation process appears essentially equitable, it differs between Australian states.
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Leach LS, Butterworth P, Whiteford H. Private health insurance, mental health and service use in Australia. Aust N Z J Psychiatry 2012; 46:468-75. [PMID: 22535295 DOI: 10.1177/0004867411434713] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report on the private health insurance (PHI) status of individuals with and without a mental health problem, and examine whether PHI status is associated with access to psychological services. METHODS This is a descriptive study of nationally representative population-based data collected in 2009 (HILDA) with participants aged 15-93 (n = 13,301). Key measures included: PHI status (categorised as 'hospital cover only', 'extras cover only', or 'both hospital and extras cover'); mental health status (categorised as 'have a mental health problem' or 'do not have a mental health problem' using the mental health index (MHI) of the medical outcomes study short form); mental health service use (access to a mental health professional (psychologist/psychiatrist) in the past 12 months categorised as 'yes' or 'no'). RESULTS Individuals with a mental health problem were less likely to have PHI than those without a mental health problem. However, PHI was not associated with access to a mental health professional in the past 12 months. CONCLUSIONS The findings suggest that while the discrepancy in PHI status is a marker of inequity between those with and without a mental health problem, it is not a key factor in facilitating access to mental health services.
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Affiliation(s)
- Liana S Leach
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
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Banks E, Jorm L, Lujic S, Rogers K. Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort. AUSTRALIA AND NEW ZEALAND HEALTH POLICY 2009; 6:17. [PMID: 19638201 PMCID: PMC2724511 DOI: 10.1186/1743-8462-6-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 07/28/2009] [Indexed: 11/22/2022]
Abstract
Correction to Banks E, Jorm L, Lujic S, Rogers K. Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort. ANZ Health Policy 2009; 6: 16.
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Affiliation(s)
- Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia.,The Sax Institute, P.O. Box 123, Broadway NSW 2007, Australia
| | - Louisa Jorm
- School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith South DC NSW 1797, Australia.,School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith South DC NSW 1797, Australia
| | - Sanja Lujic
- School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith South DC NSW 1797, Australia
| | - Kris Rogers
- The Sax Institute, P.O. Box 123, Broadway NSW 2007, Australia
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