Measuring inequity in using routinely collected data in an emergency setting: a systematic review

Background

The international literature has highlighted many potential challenges in terms of inequitable access to care. In the last few years, health equity is becoming an increasingly important issue for policymakers, particularly in developed countries. The aim of this systematic review was to find how equity is measured and to identify some of its determinants.

Methods

We conducted a systematic review on all major databases (Medline Ovid SP, PubMed, Embase and Web of Science), following the PRISMA guidelines. We included published observational studies that reported on health equity and using administrative data, with a focus on emergency and unplanned hospital care. Study selection and data extraction were conducted independently and compared by two reviewers.

Results

In total, 223 records were screened and 39 articles met the inclusion criteria. Studies come from the United States (US) (23), United Kingdom (6), Canada (4), Australia (2) and some European countries (4). To measure health inequity, most of the studies used at least one of these 4 indicators: hospitalisations for chronic ambulatory care sensitive conditions (or preventable hospitalisations), emergency hospitalisation rate, readmissions or mortality. The most relevant health equity determinants concerned race/ethnicity (19), poverty (17), health insurance coverage (17) and gender (16). Race/ethnicity and gender are important determinants of inequities. Concerning poverty, despite the use of heterogeneous indicators, most of studies showed a socio-economic gradient of access to care. Health insurance coverage was often used but with conflicting results.

Conclusions

The use of indicators linking primary, emergency and hospital care seems to be particularly relevant to measure health inequity. Race/ethinicity, gender and socio-economic status are clear determinants of inequitable access to care. More studies are needed to explain and analyse the determinants of health equity.

Key messages

Health equity remains a major issue even for high-income countries health care system. Quantitative data about health equity still are needed to support policymaker’s recommendation.

The relationship of health/food literacy and salt awareness to daily sodium and potassium intake among a workplace population in Switzerland

BACKGROUND AND AIMS

High sodium (Na) and low potassium (K) intake are associated with hypertension and CVD risk. This study explored the associations of health literacy (HL), food literacy (FL), and salt awareness with salt intake, K intake, and Na/K ratio in a workplace intervention trial in Switzerland.

METHODS AND RESULTS

The study acquired baseline data from 141 individuals, mean age 44.6 years. Na and K intake were estimated from a single 24-h urine collection. We applied validated instruments to assess HL and FL, and salt awareness. Multiple linear regression was used to investigate the association of explanatory variables with salt intake, K intake, and Na/K. Mean daily salt intake was 8.9 g, K 3.1 g, and Na/K 1.18. Salt intake was associated with sex (p < 0.001), and K intake with sex (p < 0.001), age (p = 0.02), and waist-to-height ratio (p = 0.03), as was Na/K. HL index and FL score were not significantly associated with salt or K intake but the awareness variable "salt content impacts food/menu choice" was associated with salt intake (p = 0.005).

CONCLUSION

To achieve the established targets for population Na and K intake, health-related knowledge, abilities, and skills related to Na/salt and K intake need to be promoted through combined educational and structural interventions. Clinical Trials Registry number: DRKS00006790 (23/09/2014).