Disparities In Health Care Utilization Research Articles

Racial/Ethnic Variation in Use of Ambulatory and Emergency Care for Atopic Dermatitis among US Children

Previous studies indicate racial/ethnic differences in health care utilization for pediatric atopic dermatitis (AD), but do not account for disease severity impact. We sought to examine the relationship between race/ethnicity and health care utilization, both overall and by specific visit type, while accounting for AD control. A longitudinal cohort study of children with AD in the United States was performed to evaluate the association between race/ethnicity and health care utilization for AD. AD control and health care utilization were assessed biannually. Our study included 7,522 children (34.2% white, 54.2% black, and 11.5% Hispanic) who were followed for a median of 4 years (interquartile range 0.9-8.4 years). After adjusting for sociodemographic and other factors, black and Hispanic children were up to nearly threefold more likely than white children to receive medical care for AD across almost all levels of AD control. Black and Hispanic children had higher odds of primary care and emergency visits compared to whites. Black children with poorly controlled AD were significantly less likely to see a dermatologist than white children with similarly poorly controlled AD (odds ratio= 0.74, 95% confidence interval= 0.64-0.85 for limited control; odds ratio= 0.59, 95% confidence interval= 0.47-0.76 for uncontrolled AD). Together, these findings suggest the presence of racial/ethnic disparities in health care utilization for AD.

Disparities in Healthcare Utilization Among Adults with Obesity in the United States, Findings from the NHIS: 2006–2015

Few studies of disparities consider logistical hurdles faced by adults with obesity in obtaining needed healthcare. This study compared adults with obesity to adults without obesity on self-reported practical aspects of receiving healthcare including ease of seeing a doctor and wait times for appointments. Serious psychological distress and chronic health conditions are prevalent in adults with obesity. Because serious psychological distress and number of chronic health conditions can act as confounders in any observed differences between the adults with and without obesity in their use of healthcare, we have examined these differences independent of serious psychological distress and chronic health conditions. Adults 18 to 64 years sampled from the 2006–2015 National Health Interview Survey (NHIS) (n = 74,598) were examined on five self-reported indicators: does not need a doctor, waited too long in the doctor’s office, and to get an appointment, year since having seen a doctor, and saw a doctor ten times or more in the last 12 months. Multivariable models adjusted for serious psychological distress, chronic health conditions, gender, age, race/ethnicity, income, health coverage, and survey year demonstrated that adults with obesity were more likely to wait too long to get an appointment, and in the waiting room. Adults with obesity report not needing doctors despite seeing doctors frequently. Greater attention is needed to understand barriers to health care utilization in adults with obesity.

Differences in Perioperative Outcomes and Complications Between African American and White Patients After Total Joint Arthroplasty

BackgroundRacial disparities in healthcare utilization and outcomes have been reported and have wide-reaching implications for individual patient and healthcare system; as providers we bear an ethical burden to address this disparity and provide culturally competent care. This study will examine the influence of race on length of stay, discharge disposition, and complications requiring reoperation following total joint arthroplasty (TJA). MethodsSingle institution retrospective analysis of a consecutive series of 7208 primary TJA procedures performed between July 2013 and June 2017 was conducted. Chi-squared and t-tests were used to quantify differences between the groups and multiple logistic regression was used to identify race as an independent risk factor. ResultsIn total, 6182 (84.3%) white and 1026 (14.0%) African American (AA) patients were included. AA patients were younger (63.62 vs 66.84 years, P < .001), more likely female (68.8% vs 57.0%, P < .001), had a longer length of stay (2.19 vs 2.00 days, P < .001), more likely to experience septic complications (1.3% vs 0.5%, P = .002) and manipulation under anesthesia (3.9% vs 1.8%, P < .001), and less likely to discharge home (67.1% vs 81.1%, P < .001). Multiple logistic regression showed that AA patients were more likely to discharge to a facility (adjusted odds ratio 2.63, 95% confidence interval 2.19-3.16, P < .001) and experience a manipulation under anesthesia (adjusted odds ratio 1.90, 95% confidence interval 1.26-2.85, P = .002). ConclusionAA patients undergoing TJA were younger with longer length of stay and a higher rate of nonhome discharge; AA race was identified as an independent risk factor. Further study is required to understand the differences identified in this study. Targeted interventions should be developed to attempt to eliminate the disparity.

Disparity in Health Care Utilization by Income Level and Insurance Status at Gamping Muhammadiyah Hospital, Yogyakarta, Indonesia

Background: Ideal equity in health is defined as each individual has the same opportunity to get the best health and not be harmed in the process of obtaining the health services. Communities with different socio-economic status should receive the same health services according to their needs, including equal access rights in the utilization of health services. Nowadays, the quality health services cannot be enjoyed equally by the Indonesian. The purpose of this study was to examine disparity in health care utilization by income level and insurance status at Gamping Muhammadiyah Hospital, Yogyakarta, Indonesia. Subjects and Method: This study was an observational analytic study with a cross-sectional design. The study was conducted at PKU Muhammadiyah Gamping Hospital, Sleman Yogyakarta. 200 subjects were selected using simple random sampling. The dependent variable was the frequency of use of health services. The independent variables were the health insurance (BPJS) status, patient income, patient education level, and residence. The data were collected by questionnaire and analyzed by a multiple linear regression. Results : Frequency of health care utilization decreased with health insurance membership status (b= -4.49; 95% CI= -1.53 to -0.60; p <0.001) and longer distance (b= -7.33; 95% CI= -0.07 to -0.04; p<0.001). Frequency of health care utilization increased with patient age (b= 10.20; 95% CI= 0.06 to 0.09; p<0.001), family income (b= 3.30; 95% CI= 0.00 to 0.01; p = 0.001), and residence (b= 3.11; 95% CI= 0.33 to 1.47; p= 0.002). Conclusion : Frequency of health care utilization decreases with health insurance membership status and longer distance. Frequency of health care utilization increases with patient age, family income, and residence. Keywords : disparity, health insurance Correspondence: R. Haryo Nugroho. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: haryo_sleman@yahoo.co.id. Journal of Health Policy and Management (2019), 4(3): 195-203 https://doi.org/10.26911/thejhpm.2019.04.03.07

Access to health care, medical progress and the emergence of the longevity gap: A general equilibrium analysis

We study skill- and income-related differences in the access to health care as drivers of longevity inequality from a theoretical life-cycle as well as from a macroeconomic perspective. To do so, we develop an overlapping generations model populated by heterogeneous agents subject to endogenous mortality. We model two groups of individuals for whom differences in skills translate into differences in income and in the ability to use medical technology effectively in curbing mortality. We derive the skill- and age-specific individual demand for health care based on the value of life, the level of medical technology and the market prices. Calibrating the model to the development of the US economy and the longevity gap between the skilled and unskilled, we study the impact of rising effectiveness of medical care in improving individual health and examine how disparities in health care utilisation and mortality emerge as a consequence. In so doing, we explore the role of skill-biased earnings growth, skill-bias in the ability to access state-of-the art health care and to use it effectively, and skill-related differences in health insurance coverage. We pay attention to the macroeconomic feedback, especially to medical price inflation. Our findings indicate that skill-bias related to the effectiveness of health care explains a large part of the increase in the longevity with earnings-related differences in the utilisation of health care taking second place. Both channels tend to be reinforced by medical progress.

The impact of ACA Medicaid expansion on socioeconomic inequality in health care services utilization.

ObjectiveWe examined whether the Affordable Care Act (ACA) Medicaid expansion reduced socioeconomic inequalities in health care utilization.MethodsWe used data from the Behavioral Risk Factor Surveillance System, covering the 50 U.S. states and the District of Columbia, between 2011 and 2016. We selected outcome indicators, viz. ability to afford needed health care, having a personal doctor, use of health services in the past year (routine check-up, flu shot and dental visits), and attending screenings for breast, cervical, and colon cancers. Socioeconomic status was measured by household income. We calculated two indices of inequality by household income for each outcome: Slope Index of Inequality (SII) and Relative Index of Inequality (RII). We estimated difference-in-differences models to examine the impact of ACA Medicaid expansion on socioeconomic inequality in use of health care services.ResultsThe ACA Medicaid expansion appeared to reduce the socioeconomic gap in individuals reporting financial ability in accessing health care (difference-in-differences estimators, -0.045 for SII and RII), having a personal doctor (-0.037 for SII and RII), and receiving routine check-ups (-0.027 for SII and -0.039 for RII). However, the expansion was not associated with reduction in the socioeconomic gap for preventive health care visits or dental care.ConclusionsThe ACA Medicaid expansion had mixed effects on socioeconomic disparities in health care utilization. Medicaid expansion may not be sufficient to address socioeconomic disparities in preventive services uptake.

Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012.

Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

SOCIO-DEMOGRAPHIC DIFFERENCES IN PATIENTS HOSPITALIZED FOR ANAPHYLAXIS IN THE UNITED STATES

Introduction Anaphylactic shock is a life-threatening emergency that can lead to significant morbidity and mortality. Data from European studies have shown significant disparities in healthcare utilization for anaphylaxis, however there are limited studies describing the association between socioeconomic status and patient characteristics for hospitalizations related to anaphylaxis in the United States. Methods We utilized the National Inpatient Sample database years 2005-2014 to identify hospitalizations for anaphylactic shock (ICD-9 codes 995.0, 995.6x). The analysis focused on socio-demographic characteristics, medical comorbidities, and in-hospital death. We also performed an unadjusted analysis of trends in hospital costs and mortality rate. Results Between 2005 and 2014, anaphylaxis hospitalizations increased from 6,351 to 8,075. Of these, most were experienced by women (56.7%), whites (55.1%), paid for by private insurance (46.5%), and were more frequent in patients residing in areas with the highest income quartile (26.9%). Comorbidities frequently present in patients hospitalized for anaphylaxis were hypertension (36.6%), chronic pulmonary disease (28.8%), and electrolyte disorders (20.0%). Costs per hospitalization increased from $4,521 to $6,672 (2006-2015). The percentage of in hospital deaths rose from 0.86 (2006) to 0.93 (2015) and mean length of stay rose from 2.5 days (2005) to 2.7 days (2015). Conclusions There has been a modest increase in hospitalizations and in-hospital deaths from anaphylaxis in the last decade. In this study, more hospitalizations were associated with top-quartile income zip codes and private insurance. Further study is needed to determine whether these trends reflect disparities in access to healthcare or other factors that could affect health outcomes.

The Relationship Between Residential Mobility and Behavioral Health Service Use in a National Sample of Adults With Mental Health and/or Substance Abuse Problems

Objective: Individuals with mental health and/or substance abuse problems experience disparities in health care utilization. While previous studies have focused on individual and social determinants of health care use in these populations, few have investigated the role of residential stability, especially in relation to different types of service use (i.e., inpatient vs. outpatient treatment). The present study examined the relationship between residential mobility, defined as the number of residential relocations in the past year, and past-year use of four types of behavioral services (i.e., inpatient and outpatient mental health services, inpatient and outpatient substance abuse services) among a national sample of adults with mental health and/or substance abuse problems. Methods: Data were drawn from the 2011–2014 National Survey of Drug Use and Health (unweighted N = 43,411). Based on prior literature and theory, we hypothesized that individuals who frequently relocate are more likely to use inpatient services and are less likely to use outpatient services. Logistic regression analyses were conducted and all models controlled for predisposing, need, and enabling factors. Results: Compared to individuals who did not move in the past year, those who moved three or more times were more likely to report using inpatient mental health and substance abuse services. The relationship between residential mobility and outpatient mental health and substance use service use is not significant. Conclusions: The findings highlight the importance of understanding housing stability as a predictor factor of service use and access. Future research is needed to shed light on the pathway through which residential mobility affects behavioral health service utilization.

Rural-urban disparities in family physician practice patterns: A nationwide survey in Taiwan.

In a world with increasing urbanization, rural-urban disparities in health care utilization have been a long-term concern. However, the details regarding the practice patterns of family physicians in Taiwan have not received sufficient attention thus far. The National Health Insurance Research Database of Taiwan offered 0.2% of the total ambulatory visit records for Taiwan in 2013. Records from community clinics of family medicine were collected, with the clinics categorized as rural, suburban, or urban area clinics according to their locations. Among 100334 visits to family medicine clinics, the median patient age was 50years for urban clinics, 51 for suburban clinics, and 58 for rural clinics. The distributions of patient ages differed in the three areas (P<0.001). Four types of chronic diseases (cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers) accounted for 10.8%, 11.3%, and 13.6%, of the visits to urban, suburban, and rural clinics, respectively. The most common procedure was wound treatment, and the pattern of the top 10 procedures was similar in the three areas. Although rural patients in Taiwan were older and had more chronic diseases than urban and suburban patients, the pattern of procedures undertaken by rural family physicians did not differ from those of urban and suburban family physicians.

Social Determinants of Neighborhood Psychiatric Admissions: the Role of Open Data

Open data programs offer health care planners the opportunity to investigate disparities in health care utilization in a simple and cost-effective manner. This study employs publicly available census and psychiatric inpatient admission data for a large North American city to explore the association between sociodemographic characteristics and admissions, with an emphasis on housing-related factors. A regression model demonstrates that adult neighborhood inpatient admissions are significantly associated with the proportions of residents in collective dwellings (including homeless shelters and group homes) and in deteriorated housing. Other significant predictors are the population proportions of those married or co-habiting and of visible minorities, as well as neighborhood crime rate. These findings suggest the role of housing as a social determinant of psychiatric inpatient treatment. The open data approach used can be applied to local efforts to address imbalance in inpatient treatment and to equitably allocate hospital beds.

Disparities in Health Care Utilization of Adults With Traumatic Brain Injuries Are Related to Insurance, Race, and Ethnicity: A Systematic Review.

To characterize racial/ethnic and insurance disparities in the utilization of healthcare services among US adults with traumatic brain injury (TBI). The PubMed database was used to search for articles that directly examined the association between race/ethnicity and insurance disparities and healthcare utilization among patients with TBI. Eleven articles that met the criteria and were published between June 2011 and June 2016 were finally included in the review. Lack of insurance was significantly associated with decreased use of inhospital and posthospital healthcare services among patients with TBI. However, mixed results were reported for the associations between insurance types and healthcare utilization. The majority of studies reported that racial/ethnic minorities were less likely to use inhospital and posthospital healthcare services, while some studies did not indicate any significant relation between race/ethnicity and healthcare utilization among patients with TBI. This review provides evidence of a relation between insurance status and healthcare utilization among US adults with TBI. Insurance status may also account for some portion of the relation between race/ethnicity and healthcare utilization.

Economic Dimensions of Personalized and Precision Medicine in Asia: Evidence from Breast Cancer Treatment in Taiwan

High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer. Analyzing a unique dataset linking medical claims, cancer registry data and proxies for income between 2004 and 2015, we find that lower-income patients are more likely to be diagnosed with later stages of breast cancer, and this pattern renders NHI coverage of anti-HER2 therapy pro-poor even before full coverage of the diagnostic tests. Moreover, the expansion of NHI coverage—including the FISH diagnostic test and trastuzumab for early-stage breast cancer—strengthened the pro-poor distribution of genetic testing and target treatment, albeit only marginally. The extent of pharmaceutical company coverage of testing and its impact on patient access are topics of our ongoing research, contrasting breast cancer with colorectal cancer.

Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011

BackgroundDespite economic growth and improved health outcomes over the past few decades, China still experiences striking urban-rural health inequalities. Urban and rural residents distinguished by the hukou system may experience profound disparities because of institutional effect. The aim of this study is to estimate trends in urban-rural disparities in self-care, outpatient care, and inpatient care utilization from a perspective of the hukou system.MethodsData were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in self-care, outpatient care, and inpatient care utilization. Multinomial logistic regression was employed to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011 once known determinants of utilization are taken into account according to Andersen/Aday’s Health Behaviour Model.ResultsThe urban-rural disparities were evident after controlling for confounding variables: urban adults were 3.24 (p < 0.05), 2.23 (p < 0.1), and 4.77 (p < 0.01) times more likely to choose self-care vs. no care, outpatient care vs. no care, and inpatient care vs. no care than their rural counterparts, respectively. The results showed upward trends in self-care, outpatient care, and inpatient care utilization from 2004 to 2011. The urban-rural gaps in health care utilization gradually narrowed during the period of 1993–2011. The hukou distinctions of self-care, outpatient care, and inpatient care in 2011 were only 33.3%, 35.5%, and 9.6% of that in 1993, respectively.ConclusionsAlthough rural residents were underutilizing health care when compared to their urban counterparts, the significant decrements in urban-rural disparities reflect the positive effect of the on-going health system reform in China. To maintain an equitable distribution of health care utilization, policy makers need to be aware of challenges due to aging problems and health expenditure increment.

Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys

Eczema is a common chronic inflammatory disease of the skin. Studies suggest differences in disease prevalence and severity by race/ethnicity. Our knowledge of health care utilization for eczema among different racial/ethnic groups remains limited. To evaluate health care utilization for childhood eczema among different racial/ethnic groups in the United States. We performed a cohort study of non-Hispanic white (reference), non-Hispanic black, and Hispanic white individuals under the age of 18years with caregiver-reported eczema (N=2043) pooled from the 2-year longitudinal cohorts of the 2001-2013 Medical Expenditure Panel Surveys. Health care utilization outcomes were evaluated over the 2-year follow-up period by race/ethnicity using multivariable regression. Among all children with eczema, non-Hispanic blacks were less likely than whites to report an ambulatory visit for eczema (adjusted odds ratio [ORadj] 0.69; 95% confidence interval [CI] 0.51-0.92). Among those with ≥1 ambulatory visit for eczema, non-Hispanic blacks reported more visits (adjusted incidence rate ratio [IRRadj] 1.68; 95% CI 1.10-2.55) and prescriptions (IRRadj 1.22; 95% CI 1.01-1.46) than whites and were more likely than whites to report a dermatology visit (ORadj 1.82; 95% CI 1.06-3.14) for eczema. We used caregiver- or self-reported data. Our findings suggest disparities in health care utilization for eczema among non-Hispanic black children despite utilization patterns suggestive of more severe disease.

Intimate partner violence-related hospitalizations in Appalachia and the non-Appalachian United States.

The highly rural region of Appalachia faces considerable socioeconomic disadvantage and health disparities that are recognized risk factors for intimate partner violence (IPV). The objective of this study was to estimate the rate of IPV-related hospitalizations in Appalachia and the non-Appalachian United States for 2007–2011 and compare hospitalizations in each region by clinical and sociodemographic factors. Data on IPV-related hospitalizations were extracted from the State Inpatient Databases, which are part of the Healthcare Cost and Utilization Project. Hospitalization day, year, in-hospital mortality, length of stay, average and total hospital charges, sex, age, payer, urban-rural location, income, diagnoses and procedures were compared between Appalachian and non-Appalachian counties. Poisson regression models were constructed to test differences in the rate of IPV-related hospitalizations between both regions. From 2007–2011, there were 7,385 hospitalizations related to IPV, with one-third (2,645) occurring in Appalachia. After adjusting for age and rurality, Appalachian counties had a 22% higher hospitalization rate than non-Appalachian counties (ARR = 1.22, 95% CI: 1.14–1.31). Appalachian residents may be at increased risk for IPV and associated conditions. Exploring disparities in healthcare utilization and costs associated with IPV in Appalachia is critical for the development of programs to effectively target the needs of this population.

Can Social Integration and Social Support Help to Explain Racial Disparities in Health Care Utilization Among Men with Diabetes?

Discovering the mechanisms through which racial and ethnic background influence health is critical to better understanding racial disparities in health among men with a diabetes diagnosis. The present study examines whether social support and social integration mediate or buffer the relationship between race and health care utilization among U.S. men. This study used a sub-sample from the 2001 National Health Interview Survey that included Latino, African American, non-Latino White men living with self-reported diabetes (n = 7,148). Findings revealed that African American men with high levels of social integration were less likely to forego care (OR = 0.234, [CI = 0.053,1.045]). Also, African American men who did not attend church had higher odds of foregoing care (OR = 0.222, [CI = 0.110,0.448]). The effect of social networks operate differently for African American men with diabetes compared to non-Latino white men. Identifying racial differences in the influence of social networks on health will assist in developing interventions that may help to decrease gender and race gaps in health for men with diabetes.

Disparities in Health Care Utilization and Functional Limitations Among Adults With Serious Psychological Distress, 2006-2014.

This study compared health care access, utilization, and functional indicators among adults with and without serious psychological distress (SPD) in the years surrounding implementation of the Patient Protection and Affordable Care Act (ACA). Adults ages 18 to 64 from the 2006-2014 National Health Interview Survey (N=207, 853) were examined on 11 access, utilization, and functional indicators: health insurance coverage (health coverage), insufficient money for medications, delay in health care (delay in care), insufficient money for health care, visiting a doctor ten or more times in the past 12 months, change in place of health care, change in place of health care due to insurance, limitations in ability to work, limitations in activities of daily living (ADLs), insufficient money for mental health care, and having seen a mental health care provider. Multivariate models that were adjusted for health coverage and sociodemographic characteristics indicated that compared with adults without SPD, adults with SPD had greater odds of lacking money for medications (AOR=10.0) and health care (AOR=3.1), experiencing delays in care (AOR=2.7), visiting a doctor ten or more times in the past 12 months (AOR=3.2), changing usual place of health care (AOR=1.5), changing usual place of health care because of insurance (AOR=1.5), and experiencing limitations in ADLs (AOR=3.6) and ability to work (AOR=1.8). The proportions of adults with SPD who lacked health coverage and money to buy prescriptions increased during the study period. Although this trend reversed in 2014, the proportion with SPD experiencing barriers remained above 2006 levels. Health care patterns among adults with SPD require greater attention.

206 Racial/ethnic differences in healthcare utilization and school attendance among children with atopic dermatitis in the Pediatric Eczema Elective Registry

Little is known about healthcare utilization for atopic dermatitis (AD) and the impact of AD on school attendance especially among racial/ethnic minorities. We aimed to examine healthcare utilization and school missed due to AD by race/ethnicity among a cohort of U.S. children with AD. We performed a cross-sectional study of baseline data for children (ages 2-17) with physician-confirmed AD enrolled in the Pediatric Eczema Elective Registry (PEER; N=7,901). All subjects had to have used pimecrolimus cream for at least 6 weeks at the time of enrollment. Study outcomes were: 1) healthcare utilization by visit type, and 2) any school missed in the 6 months prior to enrollment. We performed multivariable logistic regression to assess the association between the outcomes and race/ethnicity, adjusting for age, gender, annual household income, history of asthma and allergic rhinitis, and AD severity (AD severity variable for outcome 2 only). For outcome 1, an interaction term of AD severity by race/ethnicity was included. The reference group was non-Hispanic whites. Non-Hispanic blacks (odds ratio [OR]=2.3; 95% CI=1.6-3.2) and Hispanics (3.1; 2.0-4.7) were more likely than whites to have visited the emergency room for their AD. Blacks were also less likely to have seen a dermatologist (0.6; 0.5-0.7). Interaction between race/ethnicity and AD severity was statistically significant but had small effects on the main ORs. Blacks (1.3; 1.1-1.6), Hispanics (1.8; 1.5-2.3), and Asians (3.6; 2.6-5.0) were more likely to have missed school due to their AD. Our results suggest disparities in healthcare utilization and poorer school attendance among racial/ethnic minority children with AD, after adjustment for AD severity. Further studies are needed to better understand these disparities and improve healthcare for and school attendance among racial/ethnic minority children with AD.

Financial Burden Associated with Ill-Health: Evidence from the Elderly Population in Nigeria

This study investigated the financial burden associated with ill-health among the elderly in Nigeria. Data were drawn from the 2010 National Living standard survey covering the six geopolitical zones with rural-urban dimension. The World Health Organization capacity to pay single threshold approach was adopted. The results showed that there is a huge financial burden associated with out-of-pocket health expenditure among the elderly in Nigeria and this financial burden increases with increase in income. This was attributed to the wide disparities in healthcare utilization between the rich and the poor, in favour of the rich. Also, more than 50% of elderly people in Nigeria have unmet healthcare needs due to poverty hence, there is need to protect them from the financial burden associated with ill-health. The study also showed that the National Health Insurance Scheme is not popular and does not make any provision for the elderly hence, there is need to establish centres for elderly care throughout the country. This can have substantial positive effect on healthcare utilization among elderly people in the country.