International Journal for Equity in Health最新文献

Access to quality essential healthcare services is a fundamental right for all residents. However, the unequal allocation of healthcare resources affects patients' accessibility to care, thereby influencing their healthcare choices. Utilizing health insurance administrative data and employing a difference-in-differences (DID) model, this study examines the impact of China's healthcare resource allocation reform on patients' healthcare choices. The findings reveal that increased investment in rural healthcare resources significantly reduces the proportion of residents seeking medical services outside their counties, alleviates patients' medical burden, and enhances healthcare quality. Notably, these improvements primarily benefit patients with common diseases, while the impact on those with rare diseases remains less pronounced. These results underscore the importance of strengthening the comprehensive capabilities of county-level hospitals and prioritizing high-quality resource allocation in rural areas as key directions for future reforms in healthcare system.

Introduction: Digestive diseases (DD) pose a significant global health burden, with the Middle East and North Africa (MENA) region providing a unique landscape to study the impact of socioeconomic disparities on DD incidence and outcomes. This study examines the burden of DD in the MENA region, focusing on socioeconomic influences.

Methods: We utilized data from the Global Burden of Disease (GBD) dataset from 1990 to 2021, analyzing trends in incidence, mortality, and disability-adjusted life years (DALYs) for DD. Percentage changes and estimated annual percentage changes (EAPCs) were calculated for age-standardized rates, and correlations were assessed between disease metrics and socio-demographic indices, including the Socio-demographic Index (SDI), Human Development Index (HDI), and Gender Inequality Index (GII).

Results: Between 1990 and 2021, the total incidence of DD rose by 129.8%, from 19.7 million to 45.4 million cases. Age-standardized mortality and DALY rates decreased by 48.3% and 44.7%, respectively. Strong correlations were observed between age-standardized incidence rates (ASIR) and SDI (r = 0.90), HDI (r = 0.88), and GII (r = - 0.86). EAPCs for incidence, deaths, and DALYs were 0.79, -2.29, and - 1.88, respectively.

Conclusion: Despite a reduction in mortality and DALY rates, the persistently high incidence rates of DD in the MENA region underscores ongoing public health challenges. Socioeconomic factors strongly influence disease burden, highlighting the need for targeted interventions to address disparities and improve digestive disease outcomes across the region.

Background: Achieving equity in access to care is a priority at both national and provincial levels in Canada to address health disparities. However, equitable access remains a challenge due to significantly higher rheumatoid arthritis (RA) prevalence in vast rural areas, whereas the RA care providers are primarily concentrated in the two largest cities. Rural-urban disparities in access may be partially attributed to geographic barriers. It is important to measure travel burden of people with RA for developing targeted interventions and policies to mitigate identified geographic barriers and informing equitable access to health care.

Methods: A cross-sectional study was conducted between April 1, 2019 and March 31, 2020 for people with RA in Alberta, Canada. RA cohort was identified using a validated RA case definition based on administrative health data. Travel time between patients' postal codes and providers' clinic postal codes was calculated using network analysis. Median travel time was reported at geographic area level. Wilcoxon Rank Sum Test was applied to test the statistical significance between rural-urban categories. The distance decay effect of travel time on health care utilizaton was modelled using a reverse cumulative probability approach.

Results: RA patients took a median of 13 min (IQR: 5-28) to visit general practitioners (GPs) and 34 min (IQR: 21-51) to visit rheumatologists. There were significant rural-urban disparities in access to GP and rheumatology care. The results showed a 4-fold difference in GP travel time (remote areas:5 min, IQR 5-79; moderate metro:20 min, IQR 7-34) and 8.7-fold difference to rheumatologist visit (remote: 226 min, IQR 165-331; metro: 26 min, IQR 17-36) across the rural-urban continuum. Remote patients experienced the longest travel time to rheumatology care but the shortest median travel time to GP care. In remote areas, travel time showed the weakest impact on health care utilization compared to other rural-urban continuum.

Conclusions: Measuring the travel burden for people with RA to access care reveals patterns about the differences in how far patients travelled to seek RA care based on their residential geographic location. These findings will provide evidence to inform health care planning and address observed disparities towards the goal of achieving equitable care.

Introduction: Young migrants are increasingly recognised as being particularly vulnerable to sexual violence. This vulnerability is largely structural, due to the different laws and policies impacting their access to rights and services. Post-structural approaches to policy argue that policies are not responses to existing problems, but rather that social issues are constructed through policy. They define both whether something is a problem and how that problem is to be addressed. The aim of this study was to understand how sexual violence is conceived of in the Swedish policy environment and how this interacts with the migration regime to affect young migrants' vulnerability to sexual violence.

Methods: A systematic search was conducted to identify Swedish national-level policies: (1) addressing sexual violence; and (2) relating to the migration regime. 14 documents were included in the analysis: 6 addressed sexual violence, and 8 were related to migration. An intersectionality-based policy analysis was conducted by applying three questions to the relevant policies: (1) How is sexual violence conceived of in the policies? (2) How are young migrants represented in the policies? (3) How does the conception of sexual violence interact with the migration regime to impact young migrants' vulnerability?

Findings: Power is central to how sexual violence is conceived of in Swedish policies, as is access to human right and services. Young persons and migrants are both identified as vulnerable groups in these policies but as separate categories. Structural sources of vulnerability are recognised but not addressed in policies addressing sexual violence. The migration regime works largely to restrict migrants' access to rights and services, thereby contributing to young migrants' vulnerability to sexual violence.

Conclusion: Although migrants and youth are included separately in policies addressing sexual violence, the migration regime largely works to exclude different groups of young migrants from access to rights and services and thereby increases their vulnerability to sexual violence.

Background: Frequent hospital readmissions place a significant burden on patients, families, and society. Many high-income countries have implemented financial incentives to reduce readmissions. In China, readmission metrics have also been introduced as part of the performance evaluation for secondary hospitals. However, the understanding of hospital readmissions, particularly in rural and remote areas of China, remains limited. This study aims to analyze geographic disparities in hospital readmissions among high-need patients.

Methods: This retrospective cohort study used anonymized hospital discharge data from January 1, 2017, to December 31, 2021, from three public secondary county hospitals. We included rural patients aged 15 and older with hypertension or type 2 diabetes. The outcomes were 30-day, 90-day, and annual readmissions. The explanatory variable was the travel distance to county hospitals, calculated based on the longitude and latitude of registered addresses. Covariates included patient demographics (gender, age, marital status, and ethnicity); health status (Charlson comorbidity score, types of chronic diseases, surgery, and length of stay); and other factors (health insurance and admitted departments). We first reported unweighted readmissions stratified by travel distances (< 40 km versus ≥ 40 km). Multiple logistic regression models were then used to examine the relationship between travel distances and readmissions.

Results: The 30-day, 90-day and annual readmission rates for hypertension or type 2 diabetes were 8.5%, 19.1%, and 39.7%, respectively. Patients living far away were more vulnerable - older (aged 65 and older 59.1% versus 58.5%, P < 0.001), predominantly minorities (Minority 55.6% versus 29.4%, P < 0.001), and having more hypertension and diabetes-related complications, as well as undergoing more surgeries (surgery 29.4% versus 23.3%, P < 0.001) compared to those living nearby. After adjusting covariates and weights, patients living 40 km away had 11% decrease in the odds of being readmitted within 30 days (OR = 0.89, 95%CI = 0.83-0.96), 10% decrease in the odds of 90-day readmissions (OR = 0.90, 95%CI = 0.85-0.94), and 13% decrease in the odds of annual readmissions (OR = 0.87, 95%CI = 0.84-0.91) compared to those living within 40 km.

Conclusion: We found significant geographic disparities in hospital readmissions among high-need patients. Patients living farther from hospitals had significantly lower odds of readmissions. Readmission rates reflect patients' healthcare utilization patterns in rural and remote areas. Policymakers should address the geographic access barriers and be cautious when using readmission rates as a measure of hospital performance.

Aims: This paper aims to shed light on routine communication practices between all types of hospital workers- medical, administrative and psycho-social -, and patients using a language other than French.

Methods: A cross-sectional survey was conducted at a University Hospital, located in a Parisian suburb, where the proportion of immigrants is high. The survey targeted any type of hospital employee, provided that the employee was in contact with patients. The survey items included: routine communication practices with patients using a language other than French; perceived quality of communication; issues experienced when communicating with non-French speaking patients; main languages raising communications difficulties; ways to improve communication with patients using a language other that French. Descriptive and bivariate analysis were conducted with R software. Survey findings were cross-analyzed with 2-year records of professional interpreter services at the University hospital.

Results: A total of 362 participants responded in June 2022 to the online survey, of which 353 had no missing value. All types of hospital staff were represented, the majority being paramedics and medical doctors. "The use of a professional interpreter" was ranked as third most used practice, behind "getting by" and "use of an accompanying adult". South Asian languages were those fueling the most important communication issues. Medical doctors and psychologists had significantly more access to professional interpreters, whereas paramedics and administrative staff made more use of application software. Several negative consequences on everyday care, significantly impacting its perceived quality, were raised.

Conclusions: Our findings showed the importance of alleviating communication difficulties with patients using a language other than French, in order to achieve health equity, and means to achieve this are discussed.

Background: From a biocultural perspective, health is a multifaceted concept shaped not only by biomedical factors but also by social, cultural, political, and economic forces. In Indigenous contexts, health is particularly vulnerable, as it is profoundly influenced by external socioeconomic and cultural changes, often introduced or imposed by the broader society. The Xavante Indigenous community, located in the Central-Western region of Brazil, is one of the most extensively studied Indigenous groups in the country in terms of health. Despite a rich body of literature addressing various aspects of their health, there has been a notable absence of comprehensive studies that trace the historical evolution of their health status through bibliographic analysis. This article seeks to fill this gap by providing an in-depth examination of the historical transformation of the Xavante health, positioning this issue within the broader discourse of Indigenous health as a public health concern, while applying a decolonial perspective.

Methods: A systematic bibliographic analysis was conducted to trace the historical trajectory of health among the Xavante people from Mato Grosso, Brazil.

Results: A total of 109 academic publications meeting the inclusion criteria were identified. The analysis revealed sustained scholarly interest in the health of the Xavante community, particularly since their first sustained contact with the urbanized society. A comparative examination of the earliest and most recent, comprehensive studies on this topic highlighted a marked decline in the health status of the Xavante people over time.

Conclusions: Despite periodic shifts in the administrative frameworks governing Indigenous healthcare in Brazil, including reductions in mortality rates and increased utilization of hospital services, the overall health status of the Xavante has significantly deteriorated. This article critically analyzes this trend through a decolonial lens, highlighting the limitations and shortcomings of existing health policies and interventions. It argues that the prevailing colonial approach to healthcare, compounded by the denial of culturally appropriate services, represents a clear violation of human rights. Furthermore, the article underscores the substantial impact of social determinants-such as historical trauma, cultural disruption, and systemic inequality-on the health outcomes of this community.

Background: Health behavior theories are scientific frameworks used to inform health behavior interventions to address health-related issues, given their use in understanding and modifying behavior change.

Purpose: We aimed to assess how theory-informed health behavior interventions utilize health equity frameworks and methods.

Methods: Using the PRISMA guidelines, we conducted a scoping review of ten often taught health behavior theories found in health behavior textbooks. We identified 656 intervention papers, and after the title and abstract screening and full-text review, we extracted data from 26 studies. We conducted a thematic analysis to examine 1) the prevalence and quality of behavior interventions informed by health equity frameworks and 2) the application of health equity frameworks in the design and implementation of health behavior interventions.

Results: Theory-informed health behavior interventions incorporating equity frameworks predominately focused on two strategies. First, by incorporating multilevel frameworks via the socioecological model to influence behavior at multiple levels of risk. The second was utilizing community-based participatory methods to integrate the community's cultural, social, and lived experiences into the interventions. Creating practices and policies rooted in lived experiences, such as recording meetings, having childcare, and processes for inclusion of feedback served to embed equity into the intervention design and implementation. Studies that were more dedicated to community involvement showed greater community acceptance and improved intervention outcomes.

Conclusions: Our scoping review identified that incorporating equity into health behavior interventions is essential yet not widely practiced and poorly understood regarding how to "bake in equity." Enhanced training on incorporating equity into theory-informed behavioral interventions could improve health behavior and health education training, research, and practice.

Background: Since October 2023, the humanitarian crisis in Gaza has dramatically escalated and food insecurity (FI) has rapidly deteriorated. In the face of such situation, it has been recommended that accurate information on FI should be integrated in emergency reporting systems in order to better target and assess the impact of humanitarian aid. To achieve this, field practitioners, researchers and decision-makers should be equipped with user-friendly and psychometrically sound measures tailored to real-life war situations and the Palestinian context. Therefore, the present study aimed to test the psychometric properties of the Food Insecurity Experiences Scale (FIES) in a sample of Arabic-speaking community adults currently living in the Gaza Strip during the war.

Methods: This study used a cross-sectional design, snowball sampling as a recruiting strategy, and a self-administered online questionnaire to collect data from participants. It was performed during the period from September 1st to 30th, 2024. A total of 534 valid responses were received and were included in the final analysis.

Results: Approximately one out of two people in Gaza were experiencing any FI. Fit indices in confirmatory factor analysis indicated that a one-factor solution fit the data with acceptable factor loadings. Furthermore, our findings indicated that the Arabic version of the FIES presented an excellent level of reliability, with both Cronbach's alpha and McDonald omega coefficients of 0.94. Cross-sex measurement invariance in the FIES was established at scalar and metric levels. Finaly, concurrent validity was evidenced by FIES's positive correlations with water insecurity experiences, post-traumatic stress, depression and anxiety symptoms.

Conclusion: Altogether, our findings showed that the FIES fulfils requirements of validity and reliability. It may thus be considered as appropriate tool for assessing FI in Gazan war-affected populations currently suffering from acute FI emergency and requiring urgent action to meet their food needs. The FIES is simple, short, economic and time-effective. As a FI indicator, the Arabic FIES is useful in providing information that enables actions by policy makers and guides humanitarian-aid actors' efforts aimed at decreasing, mitigating, or preventing severe FI, and saving lives or livelihoods.

Clinical trial number: Not applicable.

Background: Variations in hospital costs often indicate deficiency in efficient and standardised care. Case-based provider payment systems are utilised globally to address these issues. In China, an innovative case-based payment scheme called the Diagnosis-Intervention Packet (DIP) under the global budget framework has been progressively implemented. However, evidence regarding its effectiveness and potential mechanisms underlying its impact is limited. This study aimed to investigate the impact of DIP reform on hospital cost variations among patients with cerebral infarction (CI) and to explore potential pathways through quality-cost trade-offs.

Methods: This cross-sectional study analysed de-identified discharge records of patients from City G, China, between January 2018 and December 2022. The study included 293,255 cases discharged with CI from 185 hospitals. Interrupted time series models were used to assess the overall and heterogeneous impacts on hospital cost variations, measured by the coefficient of variation (CV) and interquartile range (IQR) of the hospital-level average cost per case. The contribution of each itemised cost was quantified using grey relational analysis. Quality measures were compared across hospital groups organised based on the hospitals' relative cost rankings.

Results: Following the DIP reform, a significant immediate decline of 0.137 (p = 0.031) was observed in the CV. The quarterly trends in CV decreased by 0.001 (p = 0.954) and IQR by 103.40 RMB ($14.48; p = 0.389). Subgroup analyses found significant reductions in secondary hospitals, surgical groups, and medication costs, with medication costs aligning the most with the total change. Given hospital convergence toward the average cost level, no association between costs and quality was observed. Hospitals transitioning from the high-cost category experienced a reduction in in-hospital mortality (-0.5%). Similarly, those moving from the average- to low-cost category demonstrated decreased mortality (-0.7%) and complications (-0.5%).

Conclusions: Our findings revealed a concentrated distribution of post-reform hospital costs without compromising quality. These findings suggest the effectiveness of case-based payment systems in reducing hospital cost variations and improving healthcare efficiency, potentially because providers adopt more standardised behaviours in response to incentive changes. This study offers insights to other countries on payment systems as leverage to achieve efficient, equitable, and high-value care.