Disparities In Health Services Research Articles

Internações hospitalares por desnutrição infantil no Brasil: um panorama epidemiológico dos últimos 10 anos

Objective: To describe the number of hospital admissions due to child malnutrition in Brazil. Methods: This is an epidemiological, descriptive, observational study with a quantitative approach, focusing on hospitalizations of children aged 1 to 9 years due to malnutrition across Brazilian regions. Data were collected from the Notifiable Diseases Information System (SINAN) between January 2012 and December 2022. Results: A total of 20,855 cases of child malnutrition were reported in Brazil. The years with the highest incidence within the analyzed period were 2012, with 13.0% of cases, followed by 2014, with 12.4%. The Northeast region showed the highest number of hospitalizations, accounting for 34.2% of the total cases. Reports of malnutrition were more common among males (50.9%), children aged 1 to 4 years (70.9%), and those self-identified as brown (40.8%). Regarding the number of deaths, 286 cases were reported, with the highest incidence in 2012 (12.9%). Conclusion: Although there has been a significant decrease in hospitalizations due to malnutrition over the study period, child malnutrition remains a public health issue, driven by fac- tors related to socioeconomic inequalities and disparities in health services across the country.

The Affordable Care Act and Racial Disparities in Healthcare Utilization: New Evidence From Employer Mandate

The 2010 United States Affordable Care Act (ACA) mandates small and mid-size firms to provide health insurance for full-time workers. This study investigates whether a key provision of the ACA employer mandate has reduced racial disparities in health services use among uterine cancer (UC) survivors. Employing a nationally representative Medical Expenditure Panel Survey (MEPS) data from 2008 to 2017 and the Difference-in-Differences empirical model, we find that the ACA employer mandate increases the utilization of pap smear tests among all groups of UC survivors. Additionally, our results suggest a rise in physician's office visits among non-Hispanic Black and Hispanic UC survivors driven by the announcement of the employer mandate in the post-ACA period. Our results further suggest a reduction in out-of-pocket prescription drug expenditure among UC survivors of racial and ethnic minorities. Study findings have implications for improving ethnic minority female population health outcomes.

Unveiling spatial disparities in basic medical and health services: insights from China’s provincial analysis

Based on the panel data of 31 provinces (municipalities and autonomous regions) in China from 2012 to 2019, this paper constructs the evaluation index system of basic medical and health services in China from seven dimensions: medical and health facilities, health expenditure, medical services, traditional Chinese medicine hospital services, maternal and child health care, people’s health and medical security, disease control and public health. The entropy method was used to measure the level of basic medical and health services in China, and its spatial differences and convergence characteristics were further investigated. In this study, we employ the entropy weight method, σ convergence, and β convergence as our primary methodologies. The entropy weight method is used to evaluate the variability of each indicator, determine the weights of indicators, and quantify the information content of the data. σ convergence illustrates the process by which the variance of a sample decreases over time. β convergence refers to the gradual approach of variables within an economic system towards their long-term equilibrium level over time. The results show that: (1) The scores of basic medical and health services in China’s four major regions (including Northeast, East, Central and West) remain in a relatively stable state, with small fluctuations and great room for improvement; (2) There are significant regional differences in the level of basic medical and health services in China, and the intra-regional differences are much greater than the inter-regional differences; (3) There is no significant σ convergence observed in China and its four major regions; however, there is a notable presence of β convergence.

Patterns, barriers, and utilization of oral healthcare provided at primary health centers (PHCs) and its association with oral health status among rural population in Rohtak district, Haryana: A household cross-sectional study.

Access to oral healthcare is limited in rural areas, resulting in disparities in oral health services. Primary health centers (PHCs) are essential for providing integrated oral healthcare to rural populations. This study examines the patterns, barriers, and utilization of oral healthcare at PHCs in Rohtak district, Haryana. In this 6-month household cross-sectional study, data were collected from a sample of 600 participants residing in rural areas under the jurisdiction of three randomly selected PHCs in Rohtak district. The study employed multistage cluster systematic random sampling procedures. Data collection included structured questionnaires and clinical oral examinations following the type-III ADA classification. Participants' oral health status was evaluated using the WHO oral health assessment form for adults (2013). Descriptive and analytical statistics were used for data analysis. Dental caries and periodontal diseases were more common in older age groups. Barriers to oral healthcare among the elderly include fear of dental procedures and low dental literacy. Proximity to PHCs influenced dental service utilization, with higher rates among participants living near a PHC, that is, within 5 km of a PHC. Age, gender, proximity to PHCs, household size, and socioeconomic status play crucial roles in the utilization of oral health services among the rural population. Addressing these factors is essential for improving oral healthcare and overcoming barriers. It is crucial to enhance the accessibility, affordability, and availability of oral health services at PHCs to promote better oral health and overall well-being in rural areas.

Evolution of The Right to Health in India Vis-A-Vis Bioinformatics and Medical Infrastructure in Bengaluru District

Objective: This research aims to identify the study of Right to Health and Development in India especially through the existing framework of Law specifically related to bioinformatics and medical infrastructure laws in India. Methodology: Exploratory and Analytical research is employed in this work using Primary and secondary data from Legislations, Journals, Books, Articles, and reports and also a data set from empirically sourced data. Result: The survey indicated that the Urban Primary Healthcare Centres (UPHC’s) find it difficult to address the Gender Disparities in Health Access, Age-Related Health Service Utilization, Effectiveness of Bioinformatics in Health Management, Impact of Medical Infrastructure on Health Outcomes, Regional Disparities in Health Access, Community Engagement and Health Services, Bioinformatics Adoption and Staff Capacity. Conclusion: Right to health, bioinformatics and medical infrastructure in themselves are a very broad subject matter. The concept of Right to Health aimed at Development in the advent of advances in the technology, the study of medicine and the modes of experimentation, has changed drastically and the approach in respect to the findings involved in these studies have radically changed. Therefore, invariably this has to be dealt with constitutionally as Right to Health is an implied right that has taken birth from the fundamental right of Life and Liberty as envisioned under the Article 21 of the Indian Constitution and the same has to be looked into from a detailed perspective in relation to the medical infrastructure and preservation of the biological samples and subsequent updating in terms of databases. Ultimately the services offered in the UPHC’s by the state should be on par with, if not ahead, of the Private Health Care Centres in order for the concept of Right to Health to be fully realised and the UPHC’s should ensure work, clinical consideration, training, retirement aide, medical care, education and social security of the Doctors and staff at in the UPHC’s.

Revealing spatiotemporal inequalities, hotspots, and determinants in healthcare resource distribution: insights from hospital beds panel data in 2308 Chinese counties

BackgroundEnsuring universal health coverage and equitable access to health services requires a comprehensive understanding of spatiotemporal heterogeneity in healthcare resources, especially in small areas. The absence of a structured spatiotemporal evaluation framework in existing studies inspired us to propose a conceptual framework encompassing three perspectives: spatiotemporal inequalities, hotspots, and determinants.MethodsTo demonstrate our three-perspective conceptual framework, we employed three state-of-the-art methods and analyzed 10 years’ worth of Chinese county-level hospital bed data. First, we depicted spatial inequalities of hospital beds within provinces and their temporal inequalities through the spatial Gini coefficient. Next, we identified different types of spatiotemporal hotspots and coldspots at the county level using the emerging hot spot analysis (Getis-Ord Gi* statistics). Finally, we explored the spatiotemporally heterogeneous impacts of socioeconomic and environmental factors on hospital beds using the Bayesian spatiotemporally varying coefficients (STVC) model and quantified factors’ spatiotemporal explainable percentages with the spatiotemporal variance partitioning index (STVPI).ResultsSpatial inequalities map revealed significant disparities in hospital beds, with gradual improvements observed in 21 provinces over time. Seven types of hot and cold spots among 24.78% counties highlighted the persistent presence of the regional Matthew effect in both high- and low-level hospital bed counties. Socioeconomic factors contributed 36.85% (95% credible intervals [CIs]: 31.84–42.50%) of county-level hospital beds, while environmental factors accounted for 59.12% (53.80–63.83%). Factors’ space-scale variation explained 75.71% (68.94–81.55%), whereas time-scale variation contributed 20.25% (14.14–27.36%). Additionally, six factors (GDP, first industrial output, local general budget revenue, road, river, and slope) were identified as the spatiotemporal determinants, collectively explaining over 84% of the variations.ConclusionsThree-perspective framework enables global policymakers and stakeholders to identify health services disparities at the micro-level, pinpoint regions needing targeted interventions, and create differentiated strategies aligned with their unique spatiotemporal determinants, significantly aiding in achieving sustainable healthcare development.

Developing user personas to capture intersecting dimensions of disadvantage in older patients who are marginalised: a qualitative study.

Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome digital disparities can be challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard. To develop and test a set of personas to reflect the lived experiences and challenges that older people who are disadvantaged face when navigating remote and digital primary care services. Qualitative study of digital disparities in NHS community health services offering video appointments. Following familiarisation visits and interviews with service providers, 17 older people with multiple markers of disadvantage (limited English, health conditions, and poverty) were recruited and interviewed using narrative prompts. Data were analysed using an intersectionality lens, underpinned by sociological theory. Combining data across all participant interviews, we produced personas and refined these following focus groups involving health professionals, patients, and advocates (n = 12). Digital services create significant challenges for older patients with limited economic, social, and linguistic resources and low digital, health, or system literacy. Four contrasting personas were produced, capturing the variety and complexity of how dimensions of disadvantage intersected and influenced identity and actions. The personas illustrate important themes including experience of racism and discrimination, disorientation, discontinuity, limited presence, weak relationships, loss of agency, and mistrust of services and providers. Personas can illuminate the multiple and intersecting dimensions of disadvantage in patient populations who are marginalised and may prove useful when designing or redesigning digital primary care services. Adopting an intersectional lens may help practices address digital disparities.

Socioeconomic, Health Services, and Multimorbidity Disparities in Chinese Older Adults

IntroductionAs one of the world's most populous countries, China persistently confronts a significant multimorbidity burden. This study aimed to elucidate the multimorbidity burden experienced by Chinese older adults, explore its interplay with socioeconomic disparity, and investigate potential correlations between these provincial disparities and health services availability. MethodsThe fourth wave of China's national Urban and Rural Elderly Population study, conducted in 2015, was used to construct a multimorbidity index (MHI) and elucidate the geographical differences in the multimorbidity burden. Incorporating macro-level indicators about socioeconomic and health services availability, quantile regression and spearman correlation analyses were employed to investigate the relationship between multimorbidity and socioeconomic disparities, and examine the potential linkages between these provincial disparities and health services availability. Analyses were performed in 2023. ResultsFinal analysis included a total of 213,857 older adults. At the provincial level, significant geographic disparities in multimorbidity burden were identified. After adjusting for individual social determinants of health, an independent association was found between the human development index (HDI) and a higher MHI [coefficient = -0.22; 95% CI: (-0.24, -0.19)]. Furthermore, a significant positive correlation emerged between HDI and both population and geographic densities of health services availability. Notably, geographic density displayed greater inequality (Gini coefficients of 0.45 to 0.48) compared to population density (Gini coefficients of 0.03 to 0.10). ConclusionsThis study demonstrates that multimorbidity burden in China is linked to provincial socioeconomic disparities, and inequality in health services availability may account for this, which would advocate for a need to reduce disparities in health services availability.

Addressing Disparities in Maternal and Child Health Services: A Focus on Uttar Pradesh, India

Background: India faces a critical challenge in maternal and child health, having reported the highest maternal and child deaths globally in 2010 and 2009, respectively. Despite a 70% decline in maternal mortality from 1990 to 2015, India still accounts for 15% of global maternal deaths. This study focuses on Uttar Pradesh, India's most populous state, where under-five child mortality rates are alarming, particularly in rural areas. Despite governmental efforts, accessibility, availability, and affordability of maternal and child health services remain problematic. Data and Methods: This study utilizes publicly available multi-level data from the HMIS portal of the Ministry of Health and Family Welfare, focusing on Uttar Pradesh. The HMIS is a crucial tool for monitoring and implementing national health programs. Examining data from 2018 to 2020, the study assesses the spatial distribution of Maternal and Child Health (MCH) coverage at the district level using descriptive statistics. The findings contribute to understanding MCH service utilization in Uttar Pradesh. Result and Discussion: This research investigates maternal health service utilization across districts in Uttar Pradesh, India, analyzing key indicators from 2018 to 2020. The study reveals significant variations in early registration, antenatal care, vaccination, and delivery preferences. Positive changes, notably in Basti and Kanpur Dehat, contrast with negative trends in Meerut and Varanasi. The findings underscore the need for targeted interventions to address disparities and enhance maternal health outcomes in Uttar Pradesh. Conclusion: Maternal health service utilization is vital for community well-being. Despite increased awareness, persistent gaps exist due to barriers like inadequate infrastructure and cultural norms. Addressing these demands a multi-faceted approach, including policy reforms, education, and innovative technologies. Optimizing maternal health requires holistic efforts to bridge socio-economic gaps and build resilient communities.

Disparities in occupational health services: an international comparative study

BackgroundOccupational Health Services (OHS) are comprehensive, multidisciplinary services supplied by various trained workers, including occupational physicians (OP), whose specialty is focused on workers’ health.AimsOur study questions are whether the OP/worker ratio may reflect the scope and availability of OHS.MethodsThis comparative study, conducted on globally different OHS, was based on literature analysis of peer-reviewed articles published in journals covering topics of occupational medicine and public health that addressed parameters on the type and scope of OHS provision.ResultsWe described the number of OP/worker ratio, and the correlation to economic parameters (Gross domestic product—GDP, health expenditure, Gini Index—GI) by country. We found that among countries with a GDP per capita higher than US$30,000, only three (US, South Korea and Israel) had a very low OP/worker ratio (about 1:50,000 compared to 1:5,000 in other countries). Looking at all the countries together, there was a statistically significant negative correlation between health expenditure percentage of GDP per capita and OP/worker ratio (rs = -0.54, p = 0.01) and a significant positive correlation between GI and OP/worker ratio (rs = 0.47, p = 0.04).ConclusionsThe lesser the percentage of health expenditure of GDP and the subsequent greater general inequality as reflected by the GI, the lower the OP/worker ratio. The data collected in our comparative study show that the OP/worker ratio is a parameter both easy to define and obtain which best represents the status and disparity of OHS in each country.

552-P: Disparities in Preventive Reproductive Health Services in Women with Type 1 and Type 2 Diabetes

About 50% of (~13 million) reproductive aged women with Type I or II diabetes receive any preconception care. Even fewer receive contraceptive counseling, or other vital reproductive health services. This scoping review aimed to explore if reproductive aged women with diabetes receive adequate preventative reproductive health services compared to women without diabetes. A systematic search strategy of the published literature was built and applied in multiple databases (PubMed, Web of Science, Cochrane). Interventional and observational studies describing access to reproductive health services among reproductive-aged women with compared to those without diabetes were included. The Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search strategy identified 6785 unique records. A two reviewer method was used to screen abstracts, with 41 studies identified to be relevant. These studies were separated into the domains of contraception counseling (N=20), cervical cancer screening (N=12), counseling/screening for sexually transmitted infections (N=3), and preconception counseling (N=12). We did not include studies focusing on prenatal care, pregnancy, menstrual irregularities, sexual dysfunction, or breast cancer screening. While a vast amount of literature exists related to diabetes and pregnancy, this scoping review draws attention to the lack of research focused on the reproductive health of women with diabetes prior to pregnancy. The majority of available literature focuses on contraception and preconception management, consistently demonstrating that women with diabetes lack adequate preventative reproductive healthcare compared to their nondiabetic counterparts. Far less evidence exists for sexually transmitted infection risk assessment and screening. It is imperative that future research focus on ways to mitigate disparities in access to reproductive health services for women with diabetes. Disclosure M.Treasure: None. P.S.Nourbakhsh: None. A.Osuna-garcia: None. S.C.Esteves: None. L.N.Kransdorf: None. L.E.Wisk: None.

Mental Health Service Utilization and Disparities in the U.S: Observation of the First Year into the COVID Pandemic.

This study examined mental health service utilization and disparities during the first year of COVID. We analyzed data from all adult respondents with any mental illness in the past year (n = 6967) in the 2020 National Survey on Drug Use and Health to evaluate if mental health service utilization differed by geographic areas, race/ethnicity, and age groups. Only 46% of individuals with any mental illness had received mental health treatment. Compared to non-Hispanic Whites, Asian and Hispanics were less likely to receive outpatient services and prescription medicine. Rural residents received less outpatient treatment compared to large metropolitan residents. No difference was found in telemedicine utilization across area types and race/ethnicity groups. Older individuals were less likely to utilize telemedicine services. Our findings highlighted continued mental health treatment disparities among race/ethnic minorities and other sub-populations during COVID. Targeted strategies are warranted to allow older populations to benefit from telemedicine.

The effect of health insurance and socioeconomic status on women’s choice in birth attendant and place of delivery across regions in Indonesia: a multinomial logit analysis

BackgroundEvidence suggests that women gave birth in diverse types of health facilities and were assisted by various types of health providers. This study examines how these choices are influenced by...

User Expectations on Telemedicine Financing in the National Health Insurance Era

Telemedicine users have increased during the Covid-19 pandemic. Telemedicine can provide alternative solutions to improving quality, and access, and reducing disparities in health services, especially in urban and remote areas. However, in the era of national health insurance, not all telemedicine is covered by Healthcare and Social Security Agency (BPJS Kesehatan). This study aims to determine user expectations of telemedicine financing in the national health insurance era. This research is quantitative research with a descriptive approach which was conducted in February-April 2022. The respondents were 102 people who had used telemedicine services in Indonesia that were selected through the quota sampling method. The results showed that 95.1% of respondents agreed that telemedicine services were covered by the National Health Insurance (NHI), either fully or by sharing costs. As many as 31.95% of respondents expect 25% of cost-sharing with NHI, 35.05% of respondents expect 50% of cost-sharing with NHI, 12.37% of respondents expect 80% of cost-sharing with NHI, and 20.63 % hope 100% will be covered by NHI. Further and specific regulation related to telemedicine is needed. The type of telemedicine service covered communication with the telemedicine service provider, and the amount of the service fee covered needs to be communicated between the relevant parties

Health Services Utilization Barriers for Rural Elderly Women in Bangladesh: Narratives of Clinicians, Pharmacists and Public Health Assistants.

Bangladesh has the third largest population of poor older adults in the world and 73% of them live in rural areas. Disparity in the country's health services is evident that creates a substantial pressure, especially on rural elderly women who live in a compromised socio-cultural atmosphere. This is true that we know about rural elderly women's self-reported health and service use barriers, but no studies captured the views of health staff. This study presents a qualitative exploration of the views held by rural health staff whose role is to provide care to local elderly women. We conducted 11 interviews with clinicians, pharmacists and public health assistants in Sylhet district, Bangladesh. A critical thematic discourse analysis, using the critical social constructs of Habermas and Honneth, of the data informed the women's inadequate healthcare access and associated barriers that were complex and overlapping but had explicit institutional, subjective and material consequences. Five major themes emerged including: unequal distribution of health services; marginalization in patient-staff relationships; living with poverty; social relegation; and mistrust of clinical treatment. Rural areas were viewed with inequitably distributed health services and traditionally a large proportion of elderly women living in poverty who lacked social support and demonstrated a mistrust towards healthcare system. No recognition of the women and power differences were underpinned by economic factors and cultural societal values. The findings suggest a need for health policy solutions and education of healthcare staff and elderly women regarding accessing healthcare.

Central and Eastern European migrants’ experiences of mental health services in the UK: A qualitative study post-Brexit

ObjectiveCentral and Eastern European (CEE) migrants are a large minority group in the UK who are vulnerable to experiencing mental health problems. However, due to their shared ‘whiteness’ with the majority population, health service disparities may be overlooked. This is the first study exploring CEE-born people’s experiences of mental health services post-Brexit. MethodThirteen CEE migrants who had received mental health services in the UK were interviewed and data was thematically analysed. ResultsBarriers and facilitators to engagement reflected: 1) attitudes towards help-seeking; 2) cultural in/visibility; and 3) professional-service user communication. Some barriers were unique to the CEE community and not shared by other minority groups, such as the ‘invisibility’ of ethnic identity and this framed the way participants navigated interactions with services. ConclusionsCultural differences and mental health stigma were reported to influence understanding of mental health, attitudes to help-seeking, and experiences of services. Flexible ethnic identity and majority group “passing” could conceal inequalities in healthcare. Practice implicationsThe need for culturally informed approaches, professional upskilling, strengthened inter-agency working, and collaboration with CEE communities. The need to build on pre-existing strengths, for self-directed and self-care activities, for appropriate pacing and confidentiality discussions, and the use of web-based resources.

Multi-level determinants of endometrial cancer diagnosis as experienced by Black women.

107 Background: Black women experience inequity in access to timely endometrial cancer (EC) diagnosis compared to non-Hispanic white women. Delays in obtaining a timely diagnosis and referral for treatment can amplify poorer outcomes in Black women. Communication between Black patients and providers are likely influenced by determinants at multiple levels (e.g., individual, community, systems). Examining determinants at multiple levels can provide insight on how they influence guideline-concordant EC diagnosis in Black women through patient-provider communication. This study reports on Black women’s EC diagnosis experience, from the time of symptom onset to obtaining a diagnosis. Methods: We conducted a qualitative study using semi-structured interviews guided by the socio-cultural framework for the study of health service disparities (SCF-HSD). We used deductive thematic analysis using codes from the SCF-HSD framework, and inductive thematic analysis for new themes arising in the data. Participants were recruited using a study posting on an online patient research platform associated with an academic hospital in North Carolina. Eligible patients had to identify as Black, English-speaking, aged 40 years or older, and have a diagnosis of EC within the last 3 years. Results: Thirteen Black women with EC participated in online & phone interviews ranging from 22-50 minutes. Participants were primarily between 40-49 years of age (mean age = 45), stage II (100%), and either had private (47%), Medicare (23%) or Medicaid (30%) health insurance. Participants identified determinants at 3 levels: individual (symptom misinformation; delay in seeking support for symptoms - competing needs with work and family; fear and anxiety while waiting for tests and results), community (convenience of primary care clinics; existing relationships with providers; delay in referral by primary care providers; lack of information on testing rationale and expectations), and environment (distance to cancer centers; difficulty in obtaining appointments). Many participants reported that the onus was on them to find a cancer center and oncologist to conduct further diagnostic testing after seeing a primary care provider for their symptoms. When asked whether participants felt they were treated differently (positively/negatively) because of their race, many participants mentioned being Black negatively affected their ability to obtain timely appointments for diagnostic testing (e.g. biopsy, vaginal ultrasound). A few participants specifically mentioned reaching out to Black providers for management of their cancer. Conclusions: Black women with EC report several determinants to timely diagnosis at multiple levels. These findings will be mapped onto implementation strategies in a system-strengthening intervention to improve guideline-concordant diagnosis.

Predictors of alcohol screening quality in a US general population sample and subgroups of heavy drinkers

Alcohol screening is one of the most cost-effective clinical preventive services and important for intervening in the development of alcohol problems. We examine predictors of the quality of alcohol screening, approximated by alcohol quantity screening, which is a prerequisite for appropriate counseling, and compare conventional regression approach with Classification and Regression Trees (CART). Data come from the 2020 National Alcohol Survey, a population survey of US adults aged 18 years and over. Analyses focus on those reporting any alcohol screening at all (N = 989). The primary outcome was whether a healthcare profession had ever asked how much they drink, which is necessary to identify heavy drinking. We examined 12 potential predictors of alcohol quantity: gender, age, race and ethnicity, education, marital status, having a usual source of primary care, insurance, and health conditions. Analyses were replicated in heavy episodic drinking (HED) and high intensity drinking (HID) subgroups, both warranting alcohol counseling. Logistic regression results show that having diabetes and not having a college degree predict missed alcohol quantity screening in the sample overall, and younger age predicts missed alcohol quantity screening in the HED/HID subgroups. CART identified Black and Hispanic respondents who had not attended college at high risk of missed screening for heavy drinking in the overall sample, and those with public insurance at high risk of missed screening for heavy drinking in the HED/HID subgroups. The quality of alcohol screening needs improvement in general, and to avoid unintended disparities in alcohol-related health services.

Injury characteristics and circumstances of firearm trauma: Assessing suicide survivors and decedents.

Despite representing fewer than 5% of suicide attempts, firearms account for over half of deaths. Yet there is little clinical information regarding firearm attempts, particularly survivors. We assessed clinical factors differentiating firearm suicide survivors from decedents, firearm attempters from other methods, and firearm attempters from similarly injured trauma patients. We used clinical data from the National Trauma Data Bank (2017) to assess firearm suicide attempts using cross-sectional and case-control designs. We used logistic and multinomial regression to compare groups and assess firearm type and discharge destination. Older age, being uninsured, and injury location were associated with increased mortality among firearm attempters. Older age, White race, male sex, and being uninsured were associated with firearm attempts. Major psychiatric disorders were associated with firearm attempts and using a rifle or shotgun. Major psychiatric disorders, female sex, and smoking were associated with psychiatric discharge. Black and other race were associated with law enforcement discharge, and Black race was associated with lower odds of psychiatric discharge. Uninsured patients had lower odds of discharge to long-term care, psychiatric, or rehabilitation facilities. This study identifies factors associated with firearm suicide and includes indicators of disparities in health services for patients at high risk of suicide death.

Multi-jurisdictional Prostate Cancer Registry Linkage.

ObjectiveThe Prostate Cancer Outcomes Registry for Australian and New Zealand (PCOR-ANZ) aims to monitor population-wide prostate cancer characteristics, treatments, and outcomes. However, long-term follow-up of secondary treatments, disease progression, and side effects is limited. This novel project provides increased utility, enhancing this clinical registry by integrating national and jurisdictional data.
 ApproachThe Tasmanian and South Australian jurisdictional registries (PCOR-Tas and PCOR-SA) are being treated as pilots for this nationally relevant data linkage project. Each contains descriptive data on clinical characteristics, primary treatments, survival, and patient-reported outcomes for prostate cancer in their jurisdictions. Data linkages include state-based hospital patient records and central cancer registries, with additional linkages to national data on prescribed medicines, procedures, and deaths; refer Figure 1.
 Authorisation by contributing custodians and ethics committees, and funding from the Movember charity, has enabled the more detailed evaluation of patient follow-up after the initial treatment to examine historical trends, health service utilisation, disparities and gaps, and long-term patient outcomes.
 ResultsSouth Australian study cohort consists of all men in the SACR (South Australia's central cancer registry) who were diagnosed with prostate cancer [ICD10=C61] as well as any additional men recorded in the PCOR-SA diagnosed from January 2002 to June 2021 (n=25,000). Men who do not have SA addresses recorded in either source are excluded from the South Australian pilot. The Tasmanian cohort is younger (established 2015) and smaller (n=2080), but for comparison is linked with the equivalent local and national datasets
 The South Australian data linkage is being undertaken by SA NT DataLink, with the Tasmanian linkage undertaken by the Tasmania Data linkage Unit. For both jurisdictions, the national datasets are being linked by the Australian Institute for Health and Welfare (AIHW).
 ConclusionSince the Australian health system involves components managed at both the State and Federal levels, multijurisdictional data linkage adds additional complexity to linkage projects. Undertaking this project was not without its challenges, but it demonstrates what can be achieved and the value of enhancing high-quality clinical registry data to address important outcomes in prostate cancer.