Geographical Inequalities Research Articles

7.X.1. Providing BoD estimates on a regional level – necessity in assessing health inequalities

Abstract Burden of disease indicators, such as Disability-adjusted life years (DALY), Years lost due to disability (YLD) and Years lost due to death (YLL) have become standard indicators in public health reporting systems. Due to the combination of morbidity and mortality, the DALY provides valuable information on the burden due to specific diseases. These tools are employed by policymakers to devise intervention programs with the objective of enhancing the collective health of the population. Studies at the subnational level offer a greater added value to the public health information systems. Identifying variations in health outcomes and disease burden across different regions is a key factor when introducing targeted interventions and allocating resources. Health inequalities persist also in countries with good health systems and well-developed welfare state. There are notable contrasts in the political, economic and social environments across Europe. Moreover, the European countries are at different stages of the epidemiological transition, which encompasses a range of factors influencing health and modifiable risk behaviours. These differences are determined by socioeconomic inequalities at national and sub-national level, such as municipalities, counties and others. It is therefore imperative to provide BoD indicators at the most possible detailed regional-level and to link this information with further indicators such as deprivation indexes or Gini coefficients. Obtaining regional-level data for BoD analysis and health inequalities is not straightforward and can pose many challenges. Data availability is usually scarce and may involve significant resources in collecting it. Data quality and data completeness can also pose challenges in the reporting systems, which can result in under-reporting of certain diseases and overlooking health problems in the population. Also, countries with smaller populations are confronted with the challenge of a limited number of cases, which poses difficulties in obtaining regional estimates. The following workshop presents examples from European BoD studies, that have analysed health inequalities at regional level. The first presentation shows a country comparison study of the overall YLL and their association with socioeconomic and geographical inequalities. The second is from an Estonian study, representing a country with a small population that has developed its own methodology for assessing regional health issues. The third presentation from the German BoD study presents results on 96 spatial planning regions, which have been combined with the German index of socioeconomic deprivation. The final presentation brings example from Norway, where the association between YLL and education and income is examined at municipality level. Key messages • By comparing BoD estimates at the regional level, policymakers and public health officials can identify areas with higher disease burdens, indicating potential health inequalities. • Linking information on BoD indicators with data on regional and socioeconomic inequalities is essential when monitoring developments and tailoring strategies in public health outcomes.

Regional inequalities in years of life lost within the European Economic Area: Using the Gini coefficient and slope index of inequality to assess spatial disparities

Abstract Background Health inequalities have been linked to reduced life expectations. This study aimed to investigate regional variations in all-cause years of life lost (YLLs) in European Economic Area (EEA) countries prior to the COVID-19 pandemic. Methods Demographic data were extracted from Eurostat for 1390 small regions 32 EEA countries. Age-standardised sex specific YLL rates per 100,000 population in 2019 were estimated for EEA regions (Eurostat NUTS level 3) using methodologies derived from the Global Burden of Disease study. Relative spatial disparities were evaluated using the Gini coefficient (GC) and absolute spatial disparities assessed using the slope index of inequality (SII). Results Between EEA countries, relative geographical inequality in age-standardized YLL rates was higher than within them, slightly more so for males (GC = 16.96% [95% CI = 16.26-17.65]) than females (14.22% [13.62-14.82]). Among females, the UK (11.21% [95% CI 10.11-12.30]), Greece, and Croatia had the highest relative spatial inequality, while Ireland (3.37% [2.26-4.48]), Slovakia, and the Netherlands had the lowest. For males, Belgium (10.76% [9.34-12.17]), the UK, and Croatia exhibited the highest relative spatial inequality, while Ireland (1.99% [1.18-2.81]), Lithuania, and Slovakia had the lowest. Germany had the largest absolute geographical inequality in YLLs among females (SII=16.86% [16.28 to 17.44]), followed by Estonia and the UK. Among males, Estonia had the largest absolute spatial inequality (36.60% [-10.88 to 84.07]), followed by Latvia and Hungary. Ireland had the lowest absolute spatial inequality for both females and males. Conclusions Relative and absolute disparities in premature mortality rates are evident across regions of the EEA, both within countries and across the entire region. These findings offer insights for national and local stakeholders, aiding them in customising public health interventions to target spatial health disparities.

1.X.2. Reducing inequalities in access to care in Europe: achieving universal health coverage and more

Abstract Accessibility is multi-dimensional. Universal Health Coverage emphasises the role of population coverage, the scope of services covered, and the depth of financial protection. However, there are other major barriers for patients that can inhibit universal access to health services: geographical inequalities, organisational barriers, and care denial. Health systems can provide extensive cover in some dimensions such as financial coverage or the range of services covered, but gaps in other dimensions can still act as a major barrier to care. Some groups are excluded from population coverage, other patients must navigate waiting times, medical deserts or cultural barriers in order to access care. In this session we will use an innovative filter framework outline common obstacles that patients in the European Union must overcome before they can access the care they need. We will then highlight policy responses to meet the dual goals of reducing inequalities in access to care and ensuring Universal Health Coverage. This workshop will provide a platform for sharing knowledge on reducing inequalities in access to care in EU countries. The objectives of the workshop are to i) highlight cross-cutting themes and approaches, and ii) establish opportunities for cross-country research and learning. The workshop will consist of four short presentations, followed by a broad discussion with audience interventions to bring in the experience of other Member States. Each panel member will make a short presentation in Pecha Kucha format: firstly outlining the filter framework for understanding access to health services then moving to descriptions of a policy journey to strengthening UHC in Cyprus, Estonia and Spain respectively. Bold reforms in Cyprus have expanded coverage under a new universal system; changes in Estonia have improved access to medicines; and policy-makers in Spain have sought to expand coverage of dental care. The moderated discussion will emphasise the potential for cross-country learning - identifying those policy choices of relevance for the rest of Europe. Presentations about specific policy initiatives draw on the latest Health Systems Reviews for Cyprus, Estonia and Spain. Health System Reviews underpin the Health Systems in Transition (HiT) series, a core part of country monitoring undertaken by the European Observatory on Health Systems and Policies. These Reviews are routinely updated and provide a systematic description of the functioning of health systems in countries as well as reform and policy initiatives in progress or under development. As these are in-depth descriptions which detail the intricacies of health systems and an assessment of their performance, they provide the ideal basis for understanding the true multidimensionality of accessibility. Key messages • Even health systems in high-income countries need to address inequalities in access to care to ensure universal health coverage. • The workshop will identify themes and approaches to improving access to care from a cross-country perspective through a multidimensional understanding of accessibility. Speakers/Panelists Erica Richardson European Observatory on Health Systems and Policies, London, UK Cristina Hernandez Quevedo European Observatory on Health Systems and Policies, London, UK Yulia Litvinova European Observatory on Health Systems and Policies, Berlin Hub, Berlin, Germany Gemma Williams European Observatory on Health Systems and Policies, London, UK

All-cause Years of life lost due to death at municipality level in Norway. Association to educational attainment and median income

Abstract Background Norway, with 5.5 million people spread across 356 municipalities, has pursued an active policy to reduce social and geographical health inequalities. Despite, studies find significant health disparities linked to socioeconomic factors at the individual-level, although evidence at larger geographical-levels has been mixed. We used a key burden of disease (BoD) metric, Years of Life Lost (YLL), to examine spatial health inequities among Norwegian municipalities and their association with socioeconomic factors. Methods We analysed data from all residents in Norwegian municipalities with over 1000 inhabitants as of January 1, 2019. Data was sourced from the National Population Register and Statistics Norway. All-cause YLL were calculated based on age-specific aspirational life expectancy obtained from GBD 2019. Deprivation was measured using educational attainment and median income, categorized into quartiles. Geographical maps illustrating municipality-level all-cause age-standardised YLL rates for males and females were generated. Negative binomial regression models assessed associations between socioeconomic factors and YLL rates, adjusting for age, sex, and an index of centralisation. Results High-deprivation municipalities exhibited a 9% higher YLL rate in terms of education (Incidence Rate Ratio [IRR] = 1.09, 95% Confidence Interval [CI] = 1.01-1.17) and a 10% higher YLL rate in terms of income (IRR = 1.10, 95% CI = 1.02-1.08) compared to the least deprived, translating to absolute differences of 1391 and 1466 YLL per 100,000 population, respectively. Additionally, we discuss the potential expansion of this study to incorporate cause-specific outcomes and other BoD metrics based on previous county-level analyses. Conclusions Our study demonstrates the feasibility of using BoD methods to assess geographical deprivation and premature mortality at the municipality level, providing valuable insights for public health policy targeted at small administrative areas.

Inequalities in Primary Care Provision in Gwangju Metropolitan City, South Korea

Abstract Background Primary care clinics play a crucial role in community health promotion by facilitating early disease detection and management. The number of these clinics in Gwangju Metropolitan City increased from 931 in 2000 to 2,400 in 2022, but this growth was not evenly distributed within the city. This study aims to examine the spatial inequalities in the distribution of clinics in Gwangju Metropolitan City. Methods This study utilized local administrative licensing data on medical institutions classified as clinics. To estimate healthcare resource imbalances, Lorenz curves and Gini indices for the number of clinics per 100,000 individuals and per square kilometer were calculated by district. Results The number of primary care clinics per 1,000 individuals or per square kilometer was highest in Dong-gu and Seo-gu, while Gwangsan-gu had relatively fewer facilities. In particular, Buk-gu, Seo-gu, and Nam-gu had more than 40% of areas with a high number of healthcare facilities relative to population or area, whereas less than 50% of Gwangsan-gu fell into the lower tier in these categories. The Gini index, used to measure the geographical inequality of healthcare facility distribution, showed a slight improvement from 2000 to 2023. However, Seo-gu and Buk-gu exhibited different trends compared to other districts. Conclusions Geographical disparities in the distribution of primary care clinics in Gwangju Metropolitan City have slightly improved since 2000, but show different patterns by district. Addressing healthcare imbalances is essential for enhancing health equity, requiring multifaceted efforts to mitigate disparities and improve medical service accessibility in underserved areas. Key messages • Significant disparities exist in the distribution of primary care clinics across Gwangju, with higher densities in Dong-gu and Seo-gu, and fewer facilities in Gwangsan-gu. • The Gini index for clinic distribution has improved since 2000, but disparities remain, particularly in Seo-gu and Buk-gu. Continued efforts are essential to reduce healthcare inequalities further.

Geographic inequities in hemodialysis access: a call to reassess dialysis facility locations in Brazil.

Patients who travel more than 60 min to undergo hemodialysis may experience higher mortality and lower quality of life. The primary aim of this study was to calculate the travel distance between patient city areas and dialysis facility care locations in Brazil, to highlight barriers and need to optimize access to chronic dialysis. We conducted a retrospective cohort study using claims data from the Brazilian Public Health System's database, focusing on kidney replacement therapy (KRT) by hemodialysis. Our study population comprised all patients undergoing hemodialysis in Brazil between January 2023 and December 2023. For patients from different city areas, we calculated the Haversine distance between the patient city area and the dialysis facility. We evaluated 154,788 patients who received hemodialysis funded by the Brazilian Public Health System. Fifty-nine percent of the patients underwent dialysis in the same city area. Overall, patients traveled a median (IQR) distance of 35.9 [19.5 - 64.2] kilometers to the facilities, 48% traveled more than 40 km, with a maximum traveling distance of 353 km. Notably, the median distance traveled was shortest in the Southeast (27.6 km) and longest in the North (84.3 km). The number of patients that traveled more than 40 km was lower in the Southeast (32%) and higher in the North region (77%). The travel distance to the dialysis facility is an important inequity to KRT access in Brazil. In the South and Southeast, where there is a higher dialysis unit density, patients have greater regional availability of dialysis centers, and shorter traveling distances than in the North, Midwest, and Northeast regions.

Family caregivers’ administration of medications at the end-of-life in China: a qualitative study

BackgroundEffective medication management is crucial for ensuring timely pain and symptom control at the end of life. Dying in pain is a major concern for patients, yet some find less effective pain control at home. Family caregivers (FCGs) play a vital role in managing pain and symptom control for dying patients. However, the experience of administering medications at home for terminal-stage patients has not been widely recognized or understood. Our study aimed to explore the experiences of FCGs in administering medications to adult dying patients.MethodsWe conducted a directed content analysis of data from 73 semi-structured interviews with FCGs across 19 Chinese provinces from 2021 to 2023. FCGs were recruited through the Voluntary Cooperative Network Research. We asked, “Could you recall the end-of-life care process for the patients?” We aligned the themes with the five issues identified by Wilson et al. (2018): administration, organizational skills, empowerment, relationships, and support.ResultsFCGs in China exhibit concerns about over-engagement and empowerment in medication administration, concealing medication information from the patient, and medication accessibility. FCGs faced significant challenges in accurately identifying and addressing pain and symptoms, determining appropriate dosages, accessing effective medications, and managing the emotional stress associated with potential medication errors. Financial burden, medication regulatory restrictions, geographical inequality, and travel restrictions during COVID impeded patients and FCGs from accessing medication. A culturally specific finding is the use of alternative medicine at the end of life.ConclusionOur findings build upon Wilson et al.‘s framework and extend their insights on empowerment, highlighting the need for policies to support home-based palliative care professionals in training FCGs for effective medication administration.

Telemedicine as a tool for bridging geographical inequity: insights in geospatial interactions from a study on chronic heart failure patients

IntroductionChronic heart failure patients experience large disparities in quality of and access to treatment, with rural populations receiving lower levels of care. Telemonitoring of patients is increasingly being used as an important tool for improving patient management and care and might reduce geographical inequities in healthcare.MethodsWe investigate the presence and magnitude of a geospatial interaction effect on the health benefit of a supplementary telemedicine intervention, by analyzing the relationship between distance to regular place of treatment and the benefit of telemedicine in a secondary analysis of data from a previously conducted RCT. We use change in EQ5D health status, SF-36 Physical component score and SF-36 Mental component score as the outcomes. In the unadjusted analysis, intervention group and distance group and the interaction term are included as the independent variables, in the adjusted analysis, multiple socioeconomic and health related variables are included to account for potential confounders.ResultsWe find evidence of a significant interaction between the effects of telemedicine and long distance to treatment for change in EQ5D health status (unadjusted: p = 0.016, adjusted p = 0.009) and unadjusted but not adjusted mental component score (unadjusted: p = 0.013, adjusted p = 0.0728), for the change in physical component score the interaction term was not significant (unadjusted: p = 0.118, adjusted p = 0.092).ConclusionIn our study we find that supplementary telemedicine is likely to reduce the health access inequities associated with geographical distance for chronic heart failure patients. However, our sample size was modest and further research is needed to confirm these findings.

Geographic Inequalities in the Distribution of Dentists: A scoping review

Background: Equity in health refers to ensuring that individuals have timely and sufficient access to healthcare services when needed. Human resources are a vital component of healthcare organizations, and they play a crucial role in improving people's access to services. Dentists, in particular, are essential healthcare professionals as oral and dental health significantly impacts overall societal health. This study aims to investigate the key factors contributing to the inequality in the distribution of dentists. Methods: A scoping review was conducted, systematically searching three databases—Scopus, PubMed, and WOS—using relevant keywords until January, 2023. A total of 565 preliminary results were screened, and 447 titles and abstracts were reviewed. Ultimately, 23 full-text articles were included in the analysis. Qualitative content analysis and thematic network were used to synthesize the extracted data. Results: Thematic analysis of the evidence yielded four main themes that contribute to inequality in the distribution of dentists: the development of the inequality situation, methods for analyzing inequality, causes of inequality, and potential solutions to address inequality. Conclusion: Policymakers should gain an understanding of the determinants that contribute to inequality and how these factors manifest in their respective countries. Policymakers can work towards achieving a more equitable distribution of dentists by directing resources towards policies and measures that improve access to oral and dental services. This will ultimately enhance overall societal access to oral healthcare services.

Identifying Geographic Inequities in Family Planning Service Uptake in Pakistan: A Comparative Study of PDHS 2006 and 2017 Using Cluster Hotspot Analysis

Identifying Geographic Inequities in Family Planning Service Uptake in Pakistan: A Comparative Study of PDHS 2006 and 2017 Using Cluster Hotspot Analysis

Population perinatal substance use and an environmental scan of health services in British Columbia, Canada

BackgroundSubstance use during pregnancy is underreported globally and there is limited data on its prevalence and the availability of supportive services. This study determined population perinatal substance use in British Columbia (BC) by region and examined the availability of clinical and community-based programs. MethodsUsing linked provincial health administrative data, we conducted a population-based retrospective cohort study including all BC residents accessing care for substance use (alcohol, opioids, stimulants, sedatives, and cannabis) within 12 months of first perinatal care record to delivery during 2016–2021. We also conducted an environmental scan to identify all programs offering perinatal care and substance use treatment/support in BC as of December 2022 and described program components by region. ResultsThe population included 12,439 people with perinatal substance use with 13,814 linked livebirths during the study period. The incidence rate of perinatal substance use was nearly eight times higher in rural/remote Northern BC compared to the metropolitan Vancouver Coastal region (1044.2 vs. 131.3 per 100,000 population, respectively). We identified 29 related services (19 wrap-around programs, 8 supportive housing, and only 2 acute care programs). Residents outside of Metro Vancouver accounted for 60 % (N=1745) of people with perinatal substance use; however, these regions represented only 35 % of BC’s specialized acute care and supportive housing beds (N=140). ConclusionsExpanding supports for perinatal substance use - particularly acute care and supportive housing within more rural/remote regions in BC - will be critical to address geographic inequities in access to perinatal care and improve health outcomes for pregnant people who use substances and their infants.

Geographic inequality in funding by National Institutes of Health negatively impacts almost one-half of the states in the United States.

The National Institutes of Health (NIH) is the primary federal agency in the United States (US) that supports biomedical research, training, and clinical trials. NIH funding creates patents and jobs and thus helps the regional and national economy grow. Therefore, NIH funding would be expected to flow equitably to all 50 US states. However, there is a significant geographic disparity in the level of NIH funding received by various states. To that end, in 1993, authorized by Congress, NIH initiated a funding program called the Institutional Development Award (IDeA) to support states, called IDeA states, which received low levels of NIH funding. However, whether this approach has helped reduce the geographic disparity in NIH funding is unclear. In the current study, we analyzed data on various NIH funding mechanisms awarded to 23 IDeA states vs. 27 non-IDeA states, as identified by NIH. We compared these data to the population size, federal taxes paid, and the number of PhDs and Post-doctoral Fellows(PDFs) trained in IDeA vs. non-IDeA states. The non-IDeA states received 93.6% of the total NIH funding, whereas IDeA states received only 6.4%. On average, one Institutional Training Grant was received for every 24 PhDs trained in non-IDeA states, while IDeA states received one such grant for every 46 PhDs trained. The non-IDeA states comprised 84.3% of the US population, whereas IDeA states comprised 15.7%. Thus, on a per capita basis, non-IDeA states received $120 from NIH, whereas IDeA states received $45 per person. For every million dollars contributed by the non-IDeA states toward federal taxes, they received $7,903 in NIH funding, while the IDeA States received only $4,617. For FY 2022, the NIH funding created an economic activity of $90.6 Billion in non-IDeA states and only $6.3 billion in IDeA states. When total NIH funding to the states was analyzed for the years 1992, 2002, 2012, and 2022, IDeA states received 4.7% of the total NIH funding in 1992, which increased to 7.2% in 2002 but dropped to 6.8% in 2012 and 6.5% in 2022. This demonstrated that IDeA states' share of NIH funding remained relatively unchanged for the past 20 years. Eliminating the geographic disparity in NIH funding is crucial for achieving equitable health outcomes across the US, and for the IDeA states to successfully train future generations of physicians and scientists, as well as grow the regional economy. Although the NIH IDeA programs have helped enhance the research capacity in IDeA states, the funding currently constitutes less than 1% of the total NIH budget. Thus, it is critical to increase NIH funding to IDeA states to improve health outcomes for all Americans.

Abstract PR011: Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients

Abstract Introduction. The advent of tyrosine kinase inhibitors (TKIs) has transformed chronic myeloid leukemia (CML) into a chronic condition, allowing many patients (pts) to achieve survival rates comparable to the general population. Yet, most pts patients require lifelong therapy, regular follow-up, and management of TKI side effects, posing challenges within the healthcare system alongside structural and financial barriers. We have previously found that CML pts with an allostatic load (AL) burden indicating cumulative stress, experience worse treatment outcomes. In light of this, we investigated whether AL is a biological indicator of social determinants of health (SDH) and its correlation with CML treatment outcomes. Methods. We conducted a single-institution retrospective study, enrolling CML pts and assessing 23 biomarkers across four domains (cardiovascular, metabolic, immunologic, and neuroendocrine) required to calculate the AL score at the time of the first visit. Pts were sorted into low and high AL groups using the cohort's median score of 5 as the threshold. SDH was evaluated at both individual and population levels by integrating data from medical records with the SDH database from the Agency for Healthcare Research and Quality. Statistical analyses, including chi-square and Fisher’s exact tests, were conducted with significance set at p<0.05. Results. Between 2003 and 2023, data from 108 CML pts undergoing first-line treatment were retrieved. Pts with high AL were more likely to be older (mean age 53.8 vs. 47.2 years, p=0.03), and a greater proportion were identified as Black compared to those in the low AL cohort (25.5% vs. 12.3%, p=0.01). We identified an association between high AL and overall mortality (13.7% vs. 1.8%, p=0.02), with effects trending towards a higher risk of CML-specific death (6.4% vs. 0, p=0.05). Higher AL was correlated with adverse SDH, such as reliance on public health insurance (32% vs. 52.2%, p=0.04), living alone (67.7% vs. 86.8%, p=0.05), and lack of regular exercise (38.9% vs. 7.4%, p=0.01). Geographic inequality was identified, as patients with high AL were more likely to reside in Georgia (GA) compared to South Carolina and other states (66.7% vs. 27.5% vs. 5.9%, p=0.01). Indeed, pts in GA who traveled shorter distances to the treatment facility and resided in areas with higher particulate matter levels, as an indicator of air pollution, were less likely to achieve major molecular response (p=0.011 and p=0.008, respectively). SDH such as regular exercise, home environment, and health insurance were associated with overall and CML-specific survival. However, birth country, language, household income, and education, were not associated with either AL or treatment outcomes. Conclusion. Adverse SDH significantly amplifies the burden of AL, serving as a comprehensive indicator of chronic stress, health behaviors, and environmental conditions. Our findings highlight the intricate interplay between social, economic, and environmental factors in shaping treatment outcomes among CML patients. Citation Format: Marisol Miranda-Galvis, Muhannad Sharara, Kellen C. Tjioe, McKenzie Maloney Maloney, Vamsi Kota, Anand Jillella, Locke Bryan, Amany R. Keruakous, Jorge E. Cortes. Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR011.

Mining the Sun: Coal-to-solar transitions and energetic place-making in Appalachia

A striking effort is under way to use energy investment, a key feature of US federal climate policy, to build solar farms on former mining lands and in legacy mining communities in central Appalachia. Focusing on community solar initiatives, we consider the geosociality of energy transitions from the perspective of communities where many people have considerable knowledge of energy systems and how they work. We note that the politics of place-making in the context of environmental sacrifice and capital abandonment enables negotiations around energy that often seek to bridge deep social contradictions. We highlight how solar energy’s diffuse networks of power, both social and electrical, privilege forms of temporal labor that are alliance-building, compositionist, para-ethnographic and intimately concerned with the capacity to build relations. Vernacular energy expertise can play a major role in creating novel forms of political sociality. In West Virginia, this both builds on and significantly shifts the emphasis of long legacies of energetic place-making. We expect the ongoing development of community-led solar investment to contribute to substantially important diversifying effects in West Virginian communities, especially when these efforts can more explicitly address the state’s extreme geographical, race, and class-based inequalities.

Equity And Inclusion For Access To The Brazilian Unified Health System (SUS)

The concept of equity in the Unified Health System (SUS) is crucial for ensuring a fair distribution of resources and health opportunities, taking into account the specific needs of different population groups. This principle aims not only to ensure universal access to health services but also to adjust these services to address socioeconomic, geographic, and cultural inequalities. Equity in SUS involves providing additional support to the most vulnerable populations, such as individuals with low income, those living in remote areas, and groups facing cultural and language barriers. Significant challenges include regional disparities, with inadequate health infrastructure in rural and peripheral areas, and socioeconomic inequalities that hinder access to care due to indirect costs and lack of information. To address these challenges, SUS must adopt multifaceted strategies, including increased funding and resources for underserved areas, public policies to reduce socioeconomic inequalities, and investments in transportation and health education. Inclusion in SUS is equally fundamental, requiring the removal of physical and social barriers, the promotion of a culture of respect and cultural competence among health professionals, and the active participation of diverse groups in health policy formulation. Additional strategies involve interinstitutional collaboration, community engagement, and the collection and analysis of disaggregated data to inform targeted policies. These approaches aim to create a fairer and more inclusive health system capable of meeting the needs of the entire Brazilian population

Challenges And Strategies In Healthcare Confronting Population Aging In Brazil

The concept of equity in the Unified Health System (SUS) is essential for ensuring a fair distribution of resources and health opportunities, taking into account the specific needs of different population groups. Equity goes beyond universal access to healthcare services, encompassing the adaptation of these services to address socioeconomic, geographic, and cultural inequalities. In SUS, this means providing additional support to vulnerable populations, such as low-income individuals, residents of remote areas, and groups with cultural and linguistic barriers. Key challenges include regional disparities, such as inadequate healthcare infrastructure in rural and peripheral areas, and socioeconomic inequalities that hinder access due to indirect costs and lack of information. To overcome these challenges, SUS should adopt comprehensive strategies, such as increasing funding and resources for underserved areas, implementing public policies that address socioeconomic inequalities, and investing in transportation and health education. Inclusion is equally crucial, requiring the removal of physical and social barriers, the promotion of a culture of respect and cultural competence among healthcare professionals, and the active participation of diverse groups in policy formulation. Furthermore, promoting interinstitutional collaboration, community participation, and the collection and analysis of disaggregated data to guide targeted policies is important. These strategies aim to create a fairer and more inclusive health system, capable of adequately serving the entire Brazilian population

Global, Regional and National Burden of Paediatric Atopic Dermatitis: A Trend and Geographic Inequalities Analysis.

Atopic dermatitis (AD) is a common chronic skin disorder in children. We aimed to investigate trends and regional disparities of burden in paediatric AD at global, regional and national levels, and to explore potential associated factors. Based on data from Global Burden of Disease study 2019, we assessed trends in burden of AD aged <19 years from 1990 to 2019, including prevalent and incident cases, age-standardised prevalence and age-standardised incidence. For potential associated factors, correlations of above trends and indexes of socio-economic status (sociodemographic index, SDI) and health service coverage (universal health coverage index, UHCI) were evaluated. We conducted decomposition analysis to understand the net contribution of population-level factors and their contribution proportions on changes of prevalent and incident cases, including age structure, population change and epidemiological change. Global prevalent and incident cases of paediatric AD increased by about 5.7 and 0.7 million between 1990 and 2019, respectively. Global age-standardised prevalence and incidence decreased by -0.17% (-0.19% to -0.16%) and -0.12% (-0.13% to -0.11%) per year from 1990 to 2019, respectively. Regionally, the highest increase of prevalent and incident cases was in low SDI region (by 96.77% and 84.85%); the highest decrease of age-standardised prevalence and incidence was in high SDI regions (by -0.20% and -0.27% per year). The correlation analyses identified significant negative correlations between trends and SDI and UHCI. Population change was a major driver of case rise; epidemiological change and age structure showed negative impact of case rise. Regional disparities in contribution of three population-level factors were seen, including net contribution direction (positive or negative) and contribution proportion levels. Global paediatric AD case numbers increased, primarily due to population growth. Prevalence and incidence decreased slightly. Geographic inequalities were seen. Developing region-specific strategies targeting potential factors is essential to reduce paediatric AD burden.

Catchment area and cancer population health research through a novel population-based statewide database: ascoping review.

Population-based linked datasets are vital to generate catchment area and population health research. The novel Cancer Information and Population Health Resource (CIPHR) links statewide cancer registry data, public and private insurance claims, and provider- and area-level data, representing more than 80% of North Carolina's large, diverse population of individuals diagnosed with cancer. This scoping review of articles that used CIPHR data characterizes the breadth of research generated and identifies further opportunities for population-based health research. Articles published between January 2012 and August 2023 were categorized by cancer site and outcomes examined across the care continuum. Statistically significant associations between patient-, provider-, system-, and policy-level factors and outcomes were summarized. Among 51 articles, 42 reported results across 23 unique cancer sites and 13 aggregated across multiple sites. The most common outcomes examined were treatment initiation and/or adherence (n = 14), mortality or survival (n = 9), and health-care resource utilization (n = 9). Few articles focused on cancer recurrence (n = 1) or distance to care (n = 1) as outcomes. Many articles discussed racial, ethnic, geographic, and socioeconomic inequities in care. These findings demonstrate the value of robust, longitudinal, linked, population-based databases to facilitate catchment area and population health research aimed at elucidating cancer risk factors, outcomes, care delivery trends, and inequities that warrant intervention and policy attention. Lessons learned from years of analytics using CIPHR highlight opportunities to explore less frequently studied cancers and outcomes, motivate equity-focused interventions, and inform development of similar resources.

Structural Racism and HIV Pre-exposure Prophylaxis Use in the Nationwide US: A County-Level Analysis.

Structural racism contributes to geographical inequalities in pre-exposure prophylaxis (PrEP) coverage in the United States (US). This study aims to investigate county-level variability in PrEP utilization across diverse dimensions of structural racism. The 2013-2021 nationwide county-level PrEP rate and PrEP-to-need ratio (PNR) data were retrieved from AIDSVu. PrEP rate was defined as the number of PrEP users per 100,000 population, and PNR was defined as the ratio of PrEP users to new HIV diagnoses per calendar year. Linear mixed effect regression was employed to identify associations of county-level structural racism (e.g., structural racism in housing and socioeconomic status) with PrEP rate and PNR on a nationwide scale of the US. From 2013 to 2021, the mean PrEP rate and PNR increased from 3.62 to 71.10 and from 0.39 to 10.20, respectively. Counties with more structural racism in housing were more likely to have low PrEP rates (adjusted β = - 5.80, 95% CI [- 8.84, - 2.75]). Higher PNR was found in counties with lower structural racism in socioeconomic status (adjusted β = - 2.64, 95% CI [- 3.68, - 1.61]). Regionally, compared to the Midwest region, counties in the West region were more likely to have higher PrEP rate (adjusted β = 30.99, 95% CI [22.19, 39.80]), and counties in the South had lower PNR (adjusted β = - 1.87, 95% CI [- 2.57, - 1.17]). County-level structural racism plays a crucial role in understanding the challenges of scaling up PrEP coverage. The findings underscore the importance of tailored strategies across different regions and provide valuable insights for future interventions to optimize PrEP implementation.

Life expectancy and geographic variation in mortality: an observational comparison study of six high-income Anglophone countries

ObjectiveTo compare life expectancy levels and within-country geographic variation in life expectancy across six high-income Anglophone countries between 1990 and 2018.DesignDemographic analysis using aggregated mortality data.SettingSix high-income Anglophone countries (USA,...