Equitable Access To Health Care Research Articles

Healthcare workforce equity for health equity: An overview of its importance for the level of primary health care.

Healthcare workforce crises often stem from healthcare workers' inequities. This study provides an overview of the main PHC workforce policy questions related to health equity, offering examples of evidence necessary to support the implementation of policies and strategies that increase equity in the health workforce and access to the PHC workforce and services. The equity-related policies in PHC and workforce were linked with the indicators listed in the Global Health Workforce Network Data and Evidence Hub and guidelines for health workforce management. The policy-relevant questions in PHC cover many workforce issues such as the optimal size, equitable distribution, relevant competencies to ensure equitable healthcare access, and equitable approaches for retention, training, recruitment, benefits and incentive schemes and governance. This will require intersectionality evidence of the optimised staffing to PHC workload, that PHC practitioners' training demonstrates evidence-based knowledge aligned with locally relevant expertise. Critical for equitable PHC access and health equity is the establishment of efficient measurement of PHC workforce equity and its implications for population health. Using indicators that measure health and workforce equity in research, policy, and practices may improve recruitment and retention, and respond more effectively to the PHC workforce crises.

Beyond Boundaries: A Comprehensive Review of Anthropometric Indices in Urban and Rural India.

This comprehensive review examines anthropometric indices in the context of urban and rural India, shedding light on the dynamic interplay between lifestyle, socio-economic factors, and environmental influences on health outcomes. Analyzing indicators such as Body Mass Index (BMI), waist-to-hip ratio (WHR), and mid-upper arm circumference (MUAC), the study reveals distinct disparities between urban and rural populations. While rural areas face the challenges of undernutrition and stunting, urban environments grapple with the escalating prevalence of obesity and non-communicable diseases. The implications for public health underscore the need for tailored interventions, encompassing nutritional education, equitable healthcare access, and lifestyle interventions. The call-to-action advocates for collaborative efforts among policymakers, healthcare professionals, researchers, and communities to implement evidence-based strategies, advocate for policy reforms, and continually monitor anthropometric trends. This review serves as a roadmap for fostering healthier communities in India by addressing anthropometric disparities and steering toward a more equitable and sustainable future.

Challenges and Advancements in the Health-Related Quality of Life of Older People

Background. With the global trend of increasing life expectancy, the health-related quality of life of older people haspersonalised become an area of significant interest. It is crucial to comprehend the advancements and identify the ongoing challenges in this domain for better health management and policy formation. Objectives. This scoping review aimed to comprehensively investigate the existing challenges and recent advancements associated with the quality of health among older people. Methods. We utilized Arksey and O’Malley’s scoping review framework for this study. A systematic literature search was performed across multiple databases, namely, PubMed, Scopus, and Google Scholar, targeting publications from 2018 to 2023. Selected studies were then rigorously examined based on predefined inclusion and exclusion criteria, followed by an in-depth thematic analysis. Results. Of the initial 406 identified studies, 72 were included in the final review. The analysis underscored enduring challenges in physical and medical issues, psychological difficulties, socioeconomic obstacles, and policy-related challenges. Meanwhile, significant advancements were noted in several areas, including technology, medicine, social and societal facets, and policy. Conclusions. Despite noteworthy improvements in the health-related quality of life of older individuals, the continued presence of substantial challenges emphasizes the need for more targeted initiatives. These results suggest an immediate requirement for revising policies and implementing interventions that specifically address identified challenges, with a particular emphasis on ensuring equitable health care access, effectively managing chronic conditions, and enhancing the training of geriatric health care professionals. This comprehensive review serves as a roadmap for guiding future research and shaping policy directions in the health care of older people.

Ghana's Public Health Act, AI algorithms and Vaccine Distribution in Ghana

Objective: This paper examines the adequacy of Ghana’s Public Health Act 2012 for governing rising use of algorithmic systems like AI in automating vaccine distribution. Method: Employing the structured CREAC legal reasoning framework, it systematically analyses current statutory flexibility, rights safeguards and accountability provisions in the Act to balance technological innovation against risks of automated opacity, bias and exclusion errors. Results: While the legislation provides ample principles-based scope for administrative pilots and controlled deployment of AI coordination tools to improve immunization equity, reliance on 20th century assumptions of technological neutrality means significant gaps in addressing unique socio-ethical hazards of autonomous predictive analytics. Contributions: First structured application of legal study methodology to contemporize public health law assessments for coming healthcare automation advances, yielding actionable policy upgrades. Advances interdisciplinary discourse on ethical technological transformation of vital services. Significance: Anchored in legal realities and public access imperatives of a developing country, declines facile overhaul recommendations, favoring participative, evidence-led amendments upholding innovation incentives within updated rights regimes. Socially-grounded contribution bridging theory with practice in governance discourse. Sets agenda for anticipatory, democratic legal regimes upholding reliable and unbiased AI assistance in equitable healthcare access.

Exploring the landscape of health technology assessment in Iran: perspectives from stakeholders on needs, demand and supply

BackgroundThe evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran’s efforts to integrate HTA and aims to gain insights into stakeholder perspectives regarding capacity needs, demand and implementation.MethodsIn this study, we employed the HTA introduction status analysis questionnaire developed by the International Decision Support Initiative (iDSI), which has been utilized in various countries. The questionnaire consisted of 12 questions divided into three sections: HTA need, demand and supply. To identify key informants, we conducted a literature review and consulted with the Ministry of Health and Medical Education (MOHME), as well we experts in policy-making, health service provision and HTA. We selected stakeholders who held decision-making positions in the healthcare domain. A modified Persian version of the questionnaire was administered online from September 2022 to January 2023 and was pretested for clarity. The analysis of the collected data involved quantitative methods for descriptive analysis and qualitative methods for thematic analysis.ResultsIn this study, a total of 103 questionnaires were distributed, resulting in a favourable response rate of 61% from 63 participants, of whom 68% identified as male. The participants, when assessing the needs of HTA, rated allocative efficiency as the highest priority, with a mean rating of 8.53, thereby highlighting its crucial role in optimizing resource allocation. Furthermore, healthcare quality, with a mean rating of 8.17, and transparent decision-making, with a mean rating of 7.92, were highly valued for their impact on treatment outcomes and accountability. The importance of budget control (mean rating 7.58) and equity (mean rating 7.25) were also acknowledged, as they contribute to maintaining sustainability and promoting social justice. In terms of HTA demand, safety concerns were identified as the top priority, closely followed by effectiveness and cost-effectiveness, with an expanded perspective on the economy. However, limited access to local data was reported, which arose from various factors including data collection practices, system fragmentation and privacy concerns. The priorities of HTA users encompassed coverage, payment reform, benefits design, guidelines, service delivery and technology registration. Evidence generation involved the participation of medical universities, research centres and government bodies, albeit with ongoing challenges in research quality, data access and funding. The study highlights government support and medical education as notable strengths in this context.ConclusionsThis study provides a comprehensive evaluation of Iran’s HTA landscape, considering its capacity, demand and implementation aspects. It underlines the vital role of HTA in optimizing resources, improving healthcare quality and promoting equity. The study also sheds light on the strengths of evidence generation in the country, while simultaneously identifying challenges related to data access and system fragmentation. In terms of policy priorities, evidence-based decision-making emerges as crucial for enhancing healthcare access and integrating technology. The study stresses the need for evidence-based practices, a robust HTA infrastructure and collaboration among stakeholders to achieve better healthcare outcomes in Iran.

Characterizing predictors of COVID-19 vaccine refusal in an urban southern California jail population

BackgroundCorrectional populations have been disproportionately affected by COVID-19, and many large outbreaks have occurred in jails and prisons. Vaccination is a key strategy to reduce the SARS-CoV-2 transmission in carceral settings. Although implementation can be challenging due to vaccine hesitancy and medical mistrust, correctional settings provide largely equitable healthcare access and present a unique opportunity to identify potential predictors of vaccine hesitancy independent of access issues. MethodsWe retrospectively analyzed electronic health record data for individuals offered COVID-19 vaccination at the Los Angeles County Jail between January 19, 2021, and January 31, 2023, and used multivariable logistic regression to determine predictors of COVID-19 vaccine refusal. ResultsOf the 21,424 individuals offered COVID-19 vaccination, 2,060 (9.6 %) refused. Refusal was associated with male sex ([aOR] = 2.3, 95 % CI (1.9, 2.8)), age 18–34 ([aOR] = 1.2, 95 % CI (1.1, 1.4), referent group: age 45–54), Black race ([aOR] = 1.2, 95 % CI (1.1, 1.4)), reporting ever being houseless ([aOR] = 1.2, 95 % CI (1.1, 1.3)), and having a history of not receiving influenza vaccination while incarcerated ([aOR] = 2.4, 95 % CI (2.0, 2.8)). When analyzing male and female populations separately, male-specific trends reflected those seen in the overall population, whereas the only significant predictor of vaccine refusal in the female population was not receiving influenza vaccination while in custody ([aOR] = 6.5, 95 % CI (2.4, 17.6)). ConclusionIdentifying predictors of vaccine refusal in correctional populations is an essential first step in the development and implementation of targeted interventions to mitigate vaccine hesitancy.

Legal Challenges and Considerations in Implementing Telemedicine Services

Through this paper, I examine the legal and ethical issues surrounding telemedicine in India, with the goal of helping to develop a robust and compliant telemedicine framework. I analyzed the current legal framework in India, based on the Telemedicine Practice Guidelines, Medical Council Act, and Information Technology Act. The study found gaps regarding licensing, liability, credentialing, and data privacy without comprehensive data protection laws. Ethical issues were also explored, including informed consent, equitable healthcare access, patient privacy, and maintaining care quality in virtual consultations. The research identified a significant gap in existing literature on the legal and ethical complexities of telemedicine specifically in the Indian context. Recommendations were proposed to address these challenges, such as improving data protection laws, establishing a clear liability framework, harmonizing telemedicine regulations across jurisdictions, and promoting public-private partnerships. Leveraging advanced technologies like blockchain was highlighted to expand telemedicine services while ensuring patient data security. This study aims to guide policymakers, healthcare providers, and telemedicine platforms in developing an ethical, secure, and accessible telemedicine ecosystem in India, thereby improving healthcare quality while safeguarding patient privacy and data security.

Resilience Gap in Gastrointestinal Endoscopy Activity during the COVID-19 Pandemic in South Korea.

This study assessed the impact of distancing measures during the COVID-19 pandemic on cancer diagnostic activities, including gastrointestinal endoscopy (GIE). It analyzed GIE volumes from 2020 to 2022 in comparison to 2018-2019, considering variations in resilience linked to socioeconomic status (SES). The analysis utilized data from the Korean Health Insurance Review and Assessment Services database, covering the entire population and medical facilities. Diagnostic GIE rates (2018-2022) in Gwangju Metropolitan City and Jeonnam province were examined, comparing age-standardized rates (ASRs) by area, gender, and SES. The results indicated a decline in ASRs for colonoscopy and endoscopic gastroduodenoscopy (EGD) in 2020 compared to 2018-2019, followed by an increase in 2021-2022, except for EGD in the medical aid population. SES based and rural-urban disparities were evident in the recovery of GIE rates. The findings suggest that equity-focused strategies are needed to ensure equitable healthcare access among different socioeconomic groups after pandemic.

Community Adaptation to Heat stress − Social Network Analysis

Rising climate disasters underscore the overlooked impact of heat stress on health and productivity in densely populated Southeast Asia, particularly vulnerable coastal areas like India's. This study in the Indian Sundarbans employs surveys and social network analysis to explore heat stress effects, community adaptation, and support networks. Recognizing community significance, it views resilience as a blend of agency, wisdom, and networks. The research unveils rural adaptive behaviours, co-occurring stress responses, and network use for health solutions. These insights aim to enhance health advisories and crisis responses, fostering resilience in communities facing escalating climate challenges. The research covered 747 households from nine village segments, examining heat stress adaptation and social support networks. Social Network Analysis revealed internal and external sources of support for heat stress-induced health issues. The study employed matrices and network analysis tools to represent co-occurrence patterns of adaptation strategies and support networks. Findings highlighted collective adaptive behaviour and the role of social connections in combating climatic stress. The study outlines dual interventions to mitigate heat stress impacts: enhancing endogenous community adaptability and optimizing social-institutional networks for external support. Occupational profiling, socio-economic context, and health access can identify vulnerable groups. Perceived impacts can serve as early health crisis indicators, though not always linked to adaptive actions. Diverse adaptive activities co-occur, reflecting collective behaviour, but less central actions require attention. Medical care usage for heat stress remains minimal. Social networks lack local health providers needing community-level provisions. A comprehensive mitigation plan for identified vulnerable communities aims to bridge knowledge gaps, promote equitable healthcare access, and strengthen adaptive capacity through informed interventions.

Comprehensive Analysis of Cancer Incidence and Mortality Trends in Costa Rica: Implications for Public Health.

This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.

Understanding Renal Failure Mortality Trends and Determinants in the US (1999–2020): Impacts of the Affordable Care Act, Advancements, Disparities, and Challenges

Introduction: Renal failure, encompassing both acute and chronic forms, stands as a formidable public health challenge with far-reaching consequences for individual well-being and healthcare systems. This study delves into the mortality rates of renal failure in the United States over two transformative decades, from 1999 to 2020. Renal failure’s significance arises from its escalating prevalence, substantial healthcare costs, and the imperative to understand the multifaceted factors that influence its outcomes. Objectives: The primary objectives of this research are to analyze temporal trends in renal failure mortality rates, explore the impact of the Affordable Care Act (ACA) and advancements in renal care practices on mortality rates, and assess demographic disparities in mortality outcomes. Methods: Utilizing CDC WONDER’s multi-cause mortality data, we assessed mortality due to renal failure (ICD-10 Codes: N17–N19). Age-adjusted mortality rates (AAMRs) were collected and stratified by sex and race. The Joinpoint Regression Program analyzed trends, calculating annual percent change (APC) and significant average annual percent change (AAPC) from 1999 to 2020. Segmented line regression models were employed for parallel pairwise comparisons. Results: Renal failure mortality rates decreased for both sexes during the late 2000s. The ACA’s enactment in 2010 coincided with improved access to healthcare, possibly contributing to the decline. Demographic disparities highlighted variations in mortality rates across racial and gender groups. Advancements in renal care practices were evident, which were driven by innovations in treatment modalities and disease management. Significant temporal trends were observed by race, with varying periods of decrease or uptrend. Conclusions: The decline in renal failure mortality rates during the late 2000s was potentially influenced by the ACA and advances in renal care practices. Demographic disparities emphasize the need for equitable healthcare access and interventions. These findings underscore the significance of healthcare policies and medical advancements in reducing renal failure mortality rates and addressing disparities. Persistent efforts to mitigate challenges such as healthcare access, cost barriers, and disparities remain crucial to enhancing renal failure outcomes.

Heterogeneous effects of national health insurance scheme on healthcare utilisation: evidence from Ghana

PurposeThis paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth.Design/methodology/approachThe study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership.FindingsGenerally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries.Originality/valueTo the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330

Utilization of tuberculosis healthcare packages under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana-Arogya Karnataka: A comprehensive socio-demographic analysis

BackgroundTuberculosis (TB) is a major global health concern, causing millions of cases and deaths worldwide. India, particularly Karnataka, grapples with a significant TB burden, imposing a substantial economic strain on affected individuals and their families. Hospitalization for TB treatment is crucial but often results in financial distress, hindering inpatient care access due to exorbitant costs, leading to catastrophic medical expenses for many households. ObjectivesThis study evaluates the utilization of TB-specific healthcare packages within the AB-PMJAY-ArK in Karnataka State. The primary objective is to assess utilization patterns based on socio-demographic factors, geographical distribution, healthcare facility types, and the cost savings for TB patients and their families. MethodsUtilizing observational data from the AB-PMJAY-ArK preauthorization and claims database through Suvarna Arogya Suraksha Trust (SAST) portal, this study covers a 24-month period from July 2021 to June 2023. TB-specific treatment packages were identified, and descriptive statistics were employed for analysis. ResultsOf the 39,89,802 approved preauthorizations, 9173 patients with confirmed TB were analysed. Majority were male (68.3 %) and belonged to the below poverty line category (96.2 %). The public sector accounted for 97.9 % of TB treatment, with 96.4 % of approved preauthorization amounts. On average, the scheme averted catastrophic costs of approximately Rs. 10,000 per TB patient. Various healthcare facilities were utilized, with medical colleges being the most frequented. ConclusionAddressing the financial burden of TB hospitalization is crucial for ensuring equitable healthcare access. While AB-PMJAY-ArK has made significant strides in alleviating financial distress, policymakers and healthcare providers can amplify its impact through targeted interventions, healthcare system strengthening, and fostering public-private collaborations. Further research is needed to assess the long-term effects of these measures on patient outcomes and healthcare systems. This study provides valuable insights into strategies for mitigating financial distress resulting from TB hospitalization, with the potential to support the sustainable management of this global health challenge and enhance healthcare system resilience.

A Comprehensive Study on the Prevalence and Determinants of Vision Impairment in the Turkish Population

Objective: Vision impairment and eye diseases significantly affect quality of life and present a substantial public health challenge. According to the TUIK and the World Health Organization, a significant portion of the population suffers from preventable or unaddressed visual impairments. Understanding the prevalence, causes, and demographic distribution of these impairments can aid in formulating effective public health strategies. To analyze the prevalence, determinants, and demographic characteristics of individuals with vision impairment in Turkey, using data provided by TUIK. This proposal aims to utilize existing data to provide valuable insights into the public health issue of vision impairment in Turkey and to foster improved outcomes through targeted intervention strategies. Methods: Secure access to TUIK health survey data focusing on vision impairment in the population aged 0–65 years. We collected additional variables that may influence vision health, such as socioeconomic status, access to healthcare, educational level, and urban versus rural residence. We conducted a cross-sectional study using TUIK data from 2019 onwards, including demographic variables (age, sex, education, and income), and correlated them with the incidence and type of vision impairment. Results: Visual impairment affects approximately 1039000 individuals in Turkey, with a prevalence rate of 1.4%. There was a pronounced increase in visual impairment with age, peaking at 46.5% in those aged > 75 years. Females exhibited higher rates of impairment in most age groups. The most common causes of visual impairment include uncorrected refractive errors in children and young adults, glaucoma in adults aged 15-50, and age-related macular degeneration and diabetic retinopathy in those aged > 50 years. Conclusion: This study highlights a significant age and sex disparity in the prevalence of visual impairment in Turkey, necessitating age-specific and gender-responsive public health strategies. Prioritizing early screening, access to corrective measures, and managing age-related ocular diseases can address the increasing burden of visual impairment. Interventions should be tailored to mitigate risks and provide equitable healthcare access to improve visual health outcomes in the Turkish population.

Impact of healthcare inequities on survival in Mexican patients with metastatic renal cell carcinoma.

The survival of patients with metastatic renal cell carcinoma (mRCC) has improved dramatically due to novel systemic treatments. However, mRCC mortality continues to rise in Latin America. A retrospective, multicenter study of patients diagnosed with mRCC between 2010-2018 in Mexico City was conducted. The aim of the study was to evaluate the impact of healthcare insurance on access to treatment and survival in patients with mRCC. Among 924 patients, 55.4%, 42.6%, and 1.9% had no insurance (NI), social security, (SS) and private insurance (PI), respectively. De novo metastatic disease was more common in NI patients (70.9%) compared to SS (47.2%) and PI (55.6%) patients (p<0.001). According to IMDC Prognostic Index, 20.2% were classified as favorable, 49% as intermediate, and 30.8% as poor-risk disease. Access to systemic treatment differed by healthcare insurance: 36.1%, 99.5%, and 100% for the NI, SS, and PI patients, respectively (p<0.001). NI patients received fewer lines of treatment, with 24.8% receiving only one line of treatment (p<0.001). Median overall survival (OS) was 13.9 months for NI, 98.9 months for SS, and 147.6 months for NI patients (p<0.001). In multivariate analysis, NI status, brain metastases, sarcomatoid features, bone metastases, no treatment were significantly associated with worse OS. OS in mRCC was affected by insurance availability in this resource-limited cohort of Mexican patients. These results underscore the need for effective strategies to achieve equitable healthcare access in an era of effective, yet costly systemic treatments.

Health technology assessments and their roles in public health policy

Purpose of review Health Technology Assessment (HTA) is a multidisciplinary practice that summarizes information about the medical, social, economic, and ethical issues related to the use of a health technology in a systematic, transparent, and balanced manner. Health technologies include drugs, medical devices, procedures, and systems used in healthcare. The aim of this review is to present a snapshot on its uses, methods and current challenges to inform future research. Recent findings HTA has been instrumental in identifying health priorities, monitor trends, resource allocation, policy development, program planning and evaluation, health disparities, emergency preparedness, advocacy and community engagement. It can also be used in research and health systems comparisons. Several countries have set up specific agencies for HTA to inform their decision making and adjusting the current tools to address their needs by developing specific methods suitable for their context. Summary The advantages and disadvantages of health assessment technology are interconnected, and many of the disadvantages can be mitigated with proper planning, training, and effective technology implementation. The use of health assessment technology should be guided by a commitment to patient safety, data security, and equitable healthcare access.

Abstract 15714: Racial Disparities in Major Adverse Cardiac and Cerebrovascular Events Among Young Women (Aged 18-44) Admitted in Rural Settings: “A Comprehensive National Inpatient Analysis 2019”

Background: Limited research has focused on the rising incidence of major adverse cardiac and cerebrovascular events (MACCE) among young women (aged 18-44) with at least one traditional cardiovascular disease risk factor (CVD), especially in rural hospital settings. We aimed to address this research gap by providing insights into the burden of CVD in this population. Methods: Using data from the National Inpatient Sample (2019), we identified young women (aged 18-44) with at least one cardiovascular risk factor admitted to rural hospitals. Baseline demographics, comorbidities, and outcomes were assessed, including MACCE and all-cause mortality. Multivariable logistic regression was performed, adjusting for age, race, income, and comorbidities. Results: Among 179,410 young women, MACCE occurred in 2,455 individuals (1.4%), with varying rates among racial groups: whites (1.2%), blacks (2.4%), Hispanics (1.3%), Asian or Pacific Islanders (API) (2%), Native Americans (NA) (1.6%), and others (1%). All-cause mortality was observed in 385 women (0.2%), with rates of 0.2% for whites and 0.4% for blacks. Blacks had twice the event rates of MACCE, and all-cause mortality compared to whites. Comorbidities and substance abuse were associated with MACCE (P&lt;0.001). In higher-income households, multivariable analysis adjusted for confounders revealed significantly higher odds of MACCE in blacks (OR 1.23, 95% CI 0.11-14.08), API (OR 4.48, 95% CI 1.06-18.93), and NA (OR 10.22, 95% CI 1.03-101.50) compared to whites. In contrast, mortality rates were lower for Hispanics than whites (OR 0.24, 95% CI 0.02-3.80) (all p &lt; 0.001) (Table 1). Conclusion: In higher-income households, greater odds of MACCE were noted among blacks, API, and NA compared to whites. Future research should focus on understanding factors contributing to these disparities and developing interventions to prioritize equitable healthcare access for rural women across diverse ethnic and income classes.

Health Care Expenditures for Black and White US Adults Living Under Similar Conditions

Evidence suggests that racial disparities in health outcomes disappear or diminish when Black and White adults in the US live under comparable living conditions; however, whether racial disparities in health care expenditures concomitantly disappear or diminish is unknown. To examine whether disparities in health care expenditures are minimized when Black and White US adults live in similar areas of racial composition and economic condition. This cross-sectional study used a nationally representative sample of 7062 non-Hispanic Black or White adults who live in 2238 of 2275 US census tracts with a 5% or greater Black population and who participated in the Medical Expenditure Panel Study (MEPS) in 2016. Differences in total health care expenditures and 6 specific categories of health care expenditures were assessed. Two-part regression models compared expenditures between Black and White adults living in the same Index of Concentration at the Extremes (ICE) quintile, a measure of racialized economic segregation. Estimated dollar amount differences in expenditures were calculated. All analyses were weighted to account for the complex sampling design of the MEPS. Data analysis was performed from December 1, 2019, to August 7, 2023. Self-reported non-Hispanic Black or non-Hispanic White race. Presence and amount of patient out-of-pocket and insurance payments for annual total health care expenditures; office-based, outpatient, emergency department, inpatient hospital, or dental visits; and prescription medicines. ICE quintile 5 (Q5) reflected tracts that were mostly high income with mostly White individuals, whereas Q1 reflected tracts that were mostly low income with mostly Black individuals. A total of 7062 MEPS respondents (mean [SD] age, 49 [18] years; 33.1% Black and 66.9% White; 56.1% female and 43.9% male) who lived in census tracts with a 5% or greater Black population in 2016 were studied. In Q5, Black adults had 56% reduced odds of having any health care expenditures (odds ratio, 0.44; 95% CI, 0.27-0.71) compared with White adults, at an estimated $2145 less per year, despite similar health status. Among those in Q5 with any expenditures, Black adults spent 30% less on care (cost ratio, 0.70; 95% CI, 0.56-0.86). In Q3 (most racially and economically integrated), differences in total annual health care spending were minimal ($79 annually; 95% CI, -$1187 to $1345). In this cross-sectional study of Black and White adults in the US, health care expenditure disparities diminished or disappeared under conditions of both racial and economic equity and equitable health care access; in areas that were mostly high income and had mostly White residents, Black adults spent substantially less. Results underscore the continuing need to recognize place as a contributor to race-based differences in health care spending.

Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study.

We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV cohort. We included all confirmed mpox cases (May-December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells/μL; 83% had HIV-RNA < 50 copies/mL; and 1.8% CD4+T-cell < 200 cells/μL. PWH had no increased risk for complications, except those with CD4+T-cell < 200 cells/μL. PWH with CD4+T-cell < 200 cells/μL were more likely to be from Latin America, had more generalized exanthema, and required hospitalization more frequently (p = 0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p < 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness.

Impact of Poverty Reduction Programs on Healthcare Access in Remote Ar-eas: Fostering Community Development for Sustainable Health

This research investigates the impact of poverty reduction programs on healthcare access in remote areas, aiming to discern their effectiveness in addressing healthcare disparities. Employing a mixed-method approach, the study combines quantitative surveys, qualitative interviews, and focus group discussions to gather comprehensive data. The research reveals promising outcomes, demonstrating a significant increase in healthcare utilization among communities benefiting from poverty reduction initiatives. Improvements in healthcare infrastructure, positive health outcomes, and economic empowerment are evident, indicating the success of these programs in enhancing healthcare access. However, limitations including geographical constraints, potential biases, and sample representativeness are acknowledged. While acknowledging these constraints, the findings emphasize the significance of continued support for poverty reduction programs, policy development, and community involvement to sustain and expand the positive impact on healthcare access in remote areas. This research offers vital insights, contributing to academic knowledge, policy development, and practice, supporting the global agenda of sustainable development goals and advocating for more inclusive and equitable healthcare access in marginalized regions