Cultural and leisure expenditure in Chile: A quantile regression analysis of socioeconomic and regional disparities using household budget survey microdata

Introduction: Breast cancer (BC) is the most frequently diagnosed and lethal neoplasm among women globally and in Brazil, constituting a significant public health burden. Mammography is the primary strategy for early detection of BC, but its effectiveness in reducing mortality is most evident in populations where adherence to the exam reaches at least 70% of the target population. In Brazil, unfortunately, there is a significant regional disparity in access to health services, raising concerns about the true effectiveness BC screening. In light of this, we aim to access the regional disparities in the consolidation of breast cancer screening, comparing the number of mammograms performed in Brazil by the five regions (North, Northeast, Southwest, South, and Midwest) between the years 2020 and 2024. Methodology: The DATASUS platform was used to collect data from the Cancer Information System (SISCAN), with analysis of the screening mammography variant according to the patient's state of residence and the year of the procedure. Additionally, data from the Brazilian Institute of Geography and Statistics (IBGE) was used to consult the target female population for screening between two thresholds: of 40 and 74 years old and 50 and 69 years old, according to the 2022 Demographic Census. Results: A total of 8,954,424 mammograms were performed in Brazil between 2020 and June 2024, with the Southeast region accounting for approximately 36.8% of this total. The Northeast region ranked second, with 30.8% of the exams, followed by the South (20.6%), Midwest (6.9%), and North (4.7%) regions. The proportion of mammograms per female population aged 40-74 years varied across regions, with the highest percentage found in the South (29.16%), followed by the Northeast (26.44%), Midwest (20.09%), Southeast (17.92%), and North (15.70%). Furthermore, when analyzing the proportion of mammograms in women aged 50-69 years, the South region achieved the highest mammography coverage rate (51.42%), followed by the Northeast (49.73%), Midwest (38.13%), Southeast (32.27%), and North (31.17%). Conclusion: The study revealed significant regional disparities in access to mammography screening across Brazil. The South and Northeast regions demonstrated the highest accessibility rates for the target population, while the North region faced alarmingly low rates. Regardless of the age range considered as the target population, the national percentages fell short of the recommended levels for adequate screening. This scenario can be attributed, primarily, to the lack of effective public policies that ensure equitable access to healthcare, a fundamental principle of Brazil's Unified Health System (SUS). This lack of equity hinders the consolidation of effective breast cancer screening nationwide. Citation Format: Letícia Pinheiro Amorim, Mariana Macambira Noronha, Valbert Oliveira Costa Filho, Pedro Robson Costa Passo, Duílio Reis da Rocha Filho, Leonardo Saraiva Pontes, Eric Lima Freitas Mota, Gabriel Sampaio Feitosa, Ígor Giordan Duarte Jorge, Izaberen Sampaio Estevam, Paulo Eduardo de Oliveira, Kevin Lucas Silva Ribeiro, Carlos Alberto Barbosa Neto, Josmara Ximenes Andrade Furtado, Markus Andret Cavalcante Gifoni, Márcio Marcondes Vieira, Elvis Lopes Barbosa, Luiz Gonzaga Porto Pinheiro, Paulo Henrique Diógenes Vasques, Eduardo Araújo Costa Lima, Gabriel Fontenelle Costa, Júlia Matos Dubanhevitz, Saulo Rabelo Costa, João Luiz Lima Pinheiro, Eduarda Severo Alvarenga, Fabrícia Cardoso Marques, Cecília Dias Caminha Gentile, Juliana Pinho da Costa Leitão, Danielle Calheiros Campelo Maia, Francisco Pimentel Cavalcante. Regional Disparities in Mammography Access in Brazil: The Impact on the Consolidation of Effective Breast Cancer Screening [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-06-08.

Even in health systems with universal health coverage (UHC), disparities in access to time-sensitive stroke interventions may persist, leading to inequities in patient survival. I aimed to quantify regional disparities in access to endovascular thrombectomy (EVT) and 1-year mortality among patients with acute ischemic stroke (AIS) in South Korea and to assess associations with individual and regional healthcare factors. This retrospective cohort study analyzed the 2021 National Health Insurance Service claims data of 29,755 adults hospitalized with AIS across 250 administrative districts in South Korea. Districts were classified as having no EVT center, a low-volume EVT center (<24 annual cases), or a high-volume EVT center (≥24 annual cases per year). Multilevel logistic regression models were used to assess the association between individual- and regional-level factors with EVT receipt and 1-year mortality. Regional inequalities were further evaluated using Gini coefficients across the adjustment levels. Of the 29,755 patients, 22.5% resided in districts without EVT centers, 20.5% in low-volume districts, and 57.0% in high-volume districts. After adjusting for age, sex, comorbidities, and stroke severity, patients residing in high-volume districts were more likely to receive EVT (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.10–1.46) and had lower odds of 1-year mortality (aOR, 0.80; 95% CI, 0.73–0.89) than those residing in districts without EVT centers. Regional inequality in EVT access increased after adjustment for individual factors (Gini coefficient, 0.0948 to 0.1353), and mortality inequality also increased (0.0449 to 0.1184), indicating that crude comparisons underestimated the disparities. In a nationwide UHC system, regional disparities in EVT access and 1-year mortality were modest but persistent and associated with the availability of high-volume EVT centers. Expanding EVT capacity and strengthening prehospital–hospital networks in underserved regions may be associated with reduced inequities in stroke care and improve survival outcomes in patients with stroke.

Coordinated care has been introduced in Poland since 2022 as a nationwide reform to improve healthcare continuity and reduce patient out-of-pocket expenditures. However, the regional implementation of coordinated care remains uneven, with limited evidence on equity and household-level impacts. This study aimed to assess territorial disparities in access to coordinated healthcare in Poland by integrating infrastructural, financial, and perceptual dimensions. We combined administrative data on healthcare providers with anonymized household-level data from the 2023 Household Budget Survey (28,089 households). A synthetic Accessibility and Satisfaction Index (ASI) was developed, incorporating three weighted components: number of coordinated care facilities per 10,000 inhabitants (0.4), Subjective Index of Health Needs Satisfaction (0.3), and Household Economic Burden Index (0.3). Concentration indices (Gini, Theil, Shannon entropy) and correlation analyses (Pearson, Spearman) were applied to assess interregional inequalities and relationships between accessibility, household income, and healthcare expenditures. Although coordinated care facilities were relatively evenly distributed nationwide (Gini = 0.134; Theil = 0.0288; Shannon entropy = 2.744), the ASI revealed significant disparities in effective access. Lubelskie (0.851), Dolnośląskie (0.781), and Świętokrzyskie (0.765) achieved the highest ASI scores, while Wielkopolskie (0.563) and Opolskie (0.543) ranked lowest. Infrastructural availability strongly correlated with ASI values (r = 0.78), whereas subjective satisfaction showed weak associations (r = 0.07). Household income was negatively correlated with the health expenditure burden (r = − 0.46), confirming the regressive character of private health costs. Expenditures on pharmaceuticals were negatively associated with facility availability (r = − 0.28), suggesting self-medication in regions with limited access. The findings confirm that infrastructure is the main determinant of coordinated healthcare accessibility in Poland, while subjective satisfaction plays a minor role. The proposed ASI offers a valid and stable synthetic tool for evaluating spatial disparities in access to coordinated healthcare. Policymakers should prioritize harmonizing regional infrastructure, monitoring waiting times, and integrating financial and perceptual dimensions into health system evaluation.

Lymphedema has a significant impact on patient quality of life. However, it remains unclear whether the provision of lymphedema treatment in Japan is uniform across regions. This study aimed to clarify the current situation regarding lymphedema treatment with emphasis on complex decongestive therapies (CDT) availability and implementation in Japan. A nationwide web-based survey was conducted. Respondents included healthcare professionals from designated cancer care hospitals and other medical institutions treating lymphedema in Japan. The distribution of variables, including the implementation of lymphedema treatment, was compared between designated cancer care hospitals and other facilities using the chi-square test. Japan was divided into nine regions to compare and analyze access to medical institutions providing CDT for lymphedema on both inpatient and outpatient bases. Of the 372 facility responses analyzed, ˃95% reported treating secondary lymphedema of the extremities, whereas ˂30% treated head and neck lymphedema. The number of CDT inpatients per 100 000 people in the region with the lowest patient volume was approximately 2% of that in the region with the highest volume. Similarly, the number of CDT outpatients per 100 000 people in the lowest-volume region was one-third of that in the highest-volume region. There was no significant correlation between facilities with high outpatient numbers and those with low outpatient numbers (ρ =0.57, P-value=0.11). Eliminating regional disparities in access to lymphedema treatment facilities, particularly for inpatient CDT, would improve quality of life and enable patients to manage the condition regardless of where they live.

This study examines how federal distribution policies affected regional disparities in access to COVID-19 therapeutics over time in Texas. To evaluate therapeutic accessibility, drug-to-case ratios were calculated by comparing the amount of therapeutic supply to confirmed case counts across counties during each policy period. A Bayesian spatiotemporal Integrated Nested Laplace Approximation (INLA) model was used to analyse how healthcare infrastructure, demographic characteristics, and regional vulnerabilities affected access. During the period when distribution was managed by state authorities, supply was quickly mobilized but often lagged demand, particularly in rural areas and communities with high rates of diabetes and older populations. In the next phase, test-to-treat program expanded overall supply, but access remained limited in areas with high racial and ethnic vulnerability due to the absence of demographic targeting. In the final phase, when therapeutics were allocated based on population thresholds and replenished regularly, spatial distribution became more stable and racial disparities narrowed. However, certain high-risk populations continued to face lower access. Findings show that each policy phase not only reflected but also reshaped regional disparities in therapeutic access. While early centralized efforts enabled swift response, they failed to address local needs. Later phases offered improved consistency but were still limited in addressing demographic and health-related vulnerabilities. This study underscores the importance of developing unified yet flexible distribution strategies that can respond to population-specific risks and infrastructure gaps, ensuring equitable access to treatment in future public health emergencies.

Cancer care guidelines have been developed in many subspecialities, usually in advanced health systems. However, there are notable global disparities in healthcare access, which can impact sarcoma care. Unfortunately, there is a lack of global data on this subject. Our aim was to describe access to sarcoma care based on a comprehensive global survey among orthopaedic oncologists, and assess for global as well as regional differences. A 25-question survey was emailed to the attendees of the 2024 Birmingham Orthopaedic Oncology Meeting and included questions about the respondents' training and practice, access to sarcoma centres, and specific items for sarcoma diagnosis and treatment. For data analysis and comparison, countries were grouped geographically and per the World Bank's income classification. A total of 192 specialists from 47 countries completed the survey (67%). Overall, 40% declared that most patients in their country were treated in a specialized sarcoma centre. Declared access to specific diagnostic technology ranged from 69% (translocation studies) to 86% (various immunohistochemistry). Only 31% stated having access to proton therapy and 82% to all possible reconstruction methods. Compromise of ideal surgical management because of prior treatments and financial constraints was declared to have happened regularly in 40% and 17% of practices, respectively. Regions with better-developed healthcare systems had improved access to all aspects surveyed. Similar results were observed when comparing high-income countries against low- to middle-income countries. Our study highlights substantial global and regional disparities in access to sarcoma services, which could potentially impact clinical outcomes. Further studies are needed to clarify this reality.

Improved prognosis of pulmonary arterial hypertension (PAH) has been reported from specialized facilities, though nationwide patient access to both specialized centers and initial treatment regimen in Japan remains unclear. The study group comprised patients with PAH defined as having disease-specific ICD-10 code, administration of medications and diagnostic testing between 2012 and 2023 in the National Database of Health Insurance Claims. Among 13,228 patients across the country, 30.7% accessed Japan Pulmonary Hypertension Registry facilities and 23.7% were initiated with disease-specific combination therapy, though numbers varied across regions. Regional disparities in access to disease-specific specialized treatment for PAH need to be addressed.

This study evaluates regional disparities in access to treatment and preventive screenings for high-mortality non-communicable diseases (NCDs) -specifically cancer and diabetes- in Chile, using data from the 2022-2023 National Health, Sexuality, and Gender Survey (ENSSEX). Four key indicators were analyzed: mammography (MAM), Pap smear (PAP), prostate-specific antigen test (PSA), and diabetes treatment (DIA). Disparities were assessed using both general and relative disparity indices (ID) to quantify regional inequalities. The general disparity index (IDg) revealed substantial differences in access to preventive screenings, with regional gaps reaching up to 20% for PSA tests, mammograms, and Pap smears. In contrast, disparities in diabetes treatment access were notably smaller (<5%). Better performance was observed in the northern and southern macrozones, while regions such as Tarapacá, Maule, and Metropolitana showed significant lags. The findings underscore persistent regional disparities in preventive healthcare services in Chile. Targeted decentralization policies and subnational prioritization are crucial to reducing these gaps. Addressing these disparities is essential for achieving Sustainable Development Goal 3.4 and lowering premature mortality from NCDs.

This paper investigates regional disparities in access to healthcare, measured by self-reported unmet medical needs. It looks at disparities across 86 regions in 5 European countries: Czech Republic, France, Italy, Spain and the United Kingdom. The results show that in addition to individual factors, such as age, gender, health status, or education, the characteristics of the region where people live, such as the average skill endowment or employment rate, have a significant impact on the probability of unmet medical needs. Individual and regional determinants play different roles across regions in these five countries. Moreover, in three of these countries (Czech Republic, Italy and Spain), age and chronic illness have different impacts on unmet medical needs depending on the region of residence, when all the other conditions are kept the same. The result calls for further investigation on regionalspecific factors that could be modified with targeted policies in order to reduce the probability of foregone health care.

Introduction: Access to high-complexity oncological surgeries is an essential component of cancer treatment, yet its availability shows major territorial disparities in Brazil. Objective: To analyze regional disparities in access to high-complexity oncological surgeries within the Brazilian Unified Health System (SUS) using a national database. Methods: This descriptive, quantitative, and retrospective study examined high-complexity oncological surgical procedures performed in Brazil between 2010 and 2021, using DATASUS data. Procedure rates per 100,000 inhabitants, distribution of specialized centers, funding indicators by macroregions, and temporal trends, including the impact of the COVID-19 pandemic, were assessed. Results: Significant regional inequalities were identified, with services concentrated in the South and Southeast regions. The North and Northeast presented the lowest procedure rates per inhabitant (approximately 65% lower than those observed in the Southeast) and the longest travel times to access treatment. Statistical analyses (ANOVA, p&lt;0.001) confirmed the significance of these disparities. Funding for oncological surgery accounted for approximately 10% of total oncology resources during the study period, with heterogeneous regional distribution. A 28.7% reduction in procedures was observed during the initial pandemic period (2020), followed by partial recovery in 2021. Conclusion: Regional disparities in access to highcomplexity oncological surgeries remain a significant challenge for the SUS, highlighting the need for public policies that promote the decentralization of specialized services, training of oncological surgeons, and more equitable funding models.

According to the United Nations, the world has met the Millennium Development Goal target of halving the proportion of people without access to safe drinking water. However, global figures mask massive disparities between regions and countries, and within countries. For instance, only 64% of the people in sub-Saharan Africa have access to improved water sources. Over 40% of all people globally who lack access to drinking water live in sub-Saharan Africa. Rwanda is used as a case in point in this study. Despite the abundance of water resources in the country, access to improved water sources is limited. Using the Rwandan Demographic and Health Surveys (2000–2010), we examined regional disparities in access to improved water sources. Results from logistic regression models show that overall, access to improved water has declined between 2000 and 2010; except in the western region, where access to water marginally improved. Educated individuals, wealthier and urban dwellers were more likely to have access to improved water sources over time compared to their uneducated, poor and rural counterparts. The persistence of regional disparities in access to improved water over time suggests the need for policy to address insufficient investments in water infrastructure in Rwanda.

BackgroundThe aim of this study is to review data on infants who received hearing aid support through the Infantile Hearing Aid Support Program after the settlement of universal newborn hearing screening (NHS) in the country over the past five years in Korea. This study seeks to identify the characteristics of infants with bilateral moderate hearing loss and to explore effective strategies for auditory rehabilitation by analyzing the timing of hearing aid interventions and regional disparities.MethodsWe analyzed the National Health Insurance Service (NHIS) records and the Infantile Hearing Aid Support Program database between January 2019 and December 2023. Our analysis included the NHS performance rate, NHS results, diagnostic hearing test outcomes, types of hearing loss, and the relationship between NHS results and hearing loss risk factors. Additionally, we examined the submission dates for the program, hearing aid purchase dates, types of hearing aids, and whether the residential area, prescription area, and hearing aid purchase areas matched.ResultsIn this period, a total of 1,318,551 neonates were born and 540 bilateral moderate hearing loss infants registered for the Infantile Hearing Aid Support Program. The NHS performance rate increased to 95.4% by 2023, while the proportion of infants receiving diagnostic hearing tests within three months was 46.2%. The rate of infants receiving hearing aids within six months for auditory rehabilitation was 22.4%. Although no correlation was found between risk factors for hearing loss and NHS results, it was observed that infants admitted to the neonatal intensive care unit or with other syndromes had a higher likelihood of being diagnosed with moderate hearing loss, even if they passed the NHS. Finally, there were regional disparities in access to hearing aid prescriptions and rehabilitation.ConclusionOur findings suggest that auditory rehabilitation achieves greater focus following the implementation of NHS. This study also provides valuable insights into the hearing status and rehabilitation outcomes of infants with moderate hearing loss. Furthermore, we anticipate that these results will contribute to informing policies aimed at reducing regional disparities in access to auditory rehabilitation services.

Ferritin is the best biomarker for assessing iron deficiency, but ferritin concentrations increase with inflammation. Several adjustment methods have been proposed to account for inflammation's effect on iron biomarker interpretation. The most recent and highly recommended method uses linear regression models, but more research is needed on other models that may better define iron status in children, particularly when distributions are heterogenous and in contexts where the effect of inflammation on ferritin is not linear. Assess the utility and relevance of quadratic regression models and quantile quadratic regression models in adjusting ferritin concentration in the presence of inflammation. We used data from children aged under five years, taken from Cuba's national anemia and iron deficiency survey, which was carried out from 2015-2018 by the National Hygiene, Epidemiology and Microbiology Institute. We included data from 1375 children aged 6 to 59 months and collected ferritin concentrations and two biomarkers for inflammation: C-reactive protein and α-1 acid glycoprotein. Quadratic regression and quantile regression models were used to adjust for changes in ferritin concentration in the presence of inflammation. Unadjusted iron deficiency prevalence was 23% (316/1375). Inflammation-adjusted ferritin values increased iron-deficiency prevalence by 2.6-4.5 percentage points when quadratic regression correction model was used, and by 2.8-6.2 when quantile regression was used. The increase when using the quantile regression correction model was more pronounced and statistically significant when both inflammation biomarkers were considered, but adjusted prevalence was similar between the two correction methods when only one biomarker was analyzed. The use of quadratic regression and quantile quadratic regression models is a complementary strategy in adjusting ferritin for inflammation, and is preferable to standard regression analysis when the linear model's basic assumptions are not met, or when it can be assumed that ferritin-inflammation relationships within a subpopulation may deviate from average trends.

The article examines the prospects and challenges of digitalizing civil society in Ukraine, with a particular focus on the regional level. It identifies key aspects of implementing digital technologies in civic activities and analyzes their impact on interactions between government authorities, civil organizations, and citizens. Emphasis is placed on regional disparities in access to digital infrastructure and resources, which significantly affect the pace and quality of digital transformations. The analysis highlights the importance of addressing these challenges to ensure equitable and inclusive digital development across the country.International experience from Estonia, Latvia, Sweden, and Denmark is studied to provide valuable insights into effective e-governance practices. Examples include Estonia’s comprehensive e-governance system, Latvia’s initiatives to bridge the digital divide, and the use of open data platforms in Sweden and Denmark to enhance transparency and citizen engagement. These examples demonstrate the potential of digital technologies to strengthen civil society and foster democratic participation.The article also explores practical measures such as the development of digital infrastructure, targeted educational programs to enhance digital literacy, and the implementation of user-friendly online platforms to encourage citizen involvement in decision-making processes. Recommendations are provided for overcoming regional digital disparities, promoting technological accessibility, and creating a cohesive strategy for digital transformation. The findings conclude that integrating successful international practices, combined with tailored solutions that consider Ukraine’s unique regional characteristics, can significantly contribute to the effective digital transformation of civil society. By addressing the challenges of the digital divide, enhancing the capacity for civic engagement, and fostering collaboration between stakeholders, Ukraine can create a robust and inclusive framework for the sustainable development of its civil society in the digital era.

ObjectiveTo assess the proportion of, and reasons for, households not utilising the policy of free healthcare for children under 6 years of age (FCCU6) for hospitalisation with diarrhoea, and assess the risk of catastrophic expenditure for households that forgo FCCU6 and pay out of pocket.MethodsInvoices detailing insurance information and charges incurred from 472 hospitalised diarrhoeal cases in one paediatric hospital in Ho Chi Minh City were retrieved. Hospital charges and the utilisation of elective services were analysed for patients utilising and not utilising FCCU6. Associations between socio-economic factors with non-utilisation of FCCU6 were evaluated.ResultsOverall, 29% of patients were FCCU6 non-users. The FCCU6 non-users paid a median hospital charge of $29.13 (interquartile range, IQR: $18.57–46.24), consuming no more than 1.4% of a medium-income household's annual income. Seventy per cent of low-income FCCU6 non-users utilised less-expensive elective services, whereas only 43% of medium income patients and 21% of high-income patients did (P = 0.036). Patients from larger households and those with a parent working in government were more likely to use FCCU6.ConclusionsThe rate of FCCU6 non-usage in this study population was 29%. A significant proportion of those that did not use FCCU6 was from lower income households and may perceive a justifiable cost–benefit ratio when forgoing FCCU6. Although a single diarrhoeal hospitalisation is unlikely to induce a catastrophic expenditure, FCCU6 non-usage may disproportionately increase the risk of catastrophic expenditure for lower income households over multiple illnesses.