Highest Socioeconomic Quintile Research Articles

Prodromal symptoms of rheumatoid arthritis in a primary care database: variation by ethnicity and socioeconomic status.

To assess whether prodromal symptoms of rheumatoid arthritis (RA), as recorded in the Clinical Practice Research Datalink Aurum (CPRD) database of English primary care records, differ by ethnicity and socioeconomic status. A cross-sectional study to determine the coding of common symptoms (≥0.1% in the sample) in the 24 months preceding RA diagnosis in CPRD Aurum, recorded between January 1st 2004 to May 1st 2022. Eligible cases were adults with a code for RA diagnosis. For each symptom, a logistic regression was performed with the symptom as dependent variable, and ethnicity and socioeconomic status as independent variables. Results were adjusted for sex, age, BMI, and smoking status. White ethnicity and the highest socioeconomic quintile were comparators. In total, 70115 cases were eligible for inclusion, of which 66.4% female. Twenty-one symptoms were coded in > 0.1% of cases so were included in the analysis. Patients of South Asian ethnicity had higher frequency of codes for several symptoms, with the largest difference by odds ratio being muscle cramps (OR 1.71, 1.44-2.57) and shoulder pain (1.44, 1.25-1.66). Patients of Black ethnicity had higher prevalence of several codes including unintended weight loss (2.02, 1.25-3.28) and ankle pain (1.51, 1.02-2.23). Low socioeconomic status was associated with morning stiffness (1.74, 1.08-2.80) and falls (1.37, 2.03-1.82). There are significant differences in coded symptoms between demographic groups, which must be considered in clinical practice in diverse populations and to avoid algorithmic bias in prediction tools derived from routinely collected healthcare data.

Stereotactic Body Radiation Therapy for Spine Metastases-Findings from an Australian Population-Based Study.

Background: To evaluate the use of stereotactic body radiation therapy (SBRT) for spine metastases and the associated factors in Australia. Methods: The Victorian Radiotherapy Minimum Dataset, which captures all episodes of radiotherapy delivered in the state of Victoria, was accessed to evaluate the patterns and trends of SBRT for spine metastases. The primary outcome was SBRT use and associated factors. Results: There were 6244 patients who received 8861 courses of radiotherapy for spine metastases between 2012 and 2017. Of these, 277 (3%) courses were SBRT, which increased from 0.4% in 2012 to 5% in 2017 (P-trend < 0.001). There was a higher proportion of SBRT use in patients with prostate cancer (6%) and melanoma (4%) compared to other cancers (2-3%) (p < 0.001). Patients from the highest socioeconomic quintiles (5%) were more likely to be treated with SBRT compared to patients from the lowest socioeconomic quintiles (3%) (p < 0.001). There was a higher proportion of SBRT use in private radiotherapy centres (6%) compared to public radiotherapy centres (1%) (p < 0.001). No spine SBRT was delivered in regional centres. In multivariate analyses, the year of treatment, age, primary cancers and radiotherapy centres were independently associated with SBRT use. Conclusion: This is the first Australian population-based study quantifying the increasing use of spine SBRT; however, the overall use of spine SBRT remains low. We anticipate an ongoing increase in spine SBRT, as spine SBRT gradually becomes the standard-of-care treatment for painful spine metastases.

RET testing and treatment patterns among patients with aNSCLC in US clinical practice.

9091 Background: Biomarker testing, including for rearrangement during transfection (RET), is recommended and important in selecting efficacious targeted therapy for patients with advanced non-small cell lung cancer (aNSCLC). This retrospective cohort study characterized RET testing and treatment patterns among aNSCLC patients in clinical practice. Methods: We used the nationwide Flatiron Health electronic health record-derived de-identified database to select patients diagnosed with aNSCLC (stage ≥IIIB) from 2017-2022. We measured rates of RET testing (test result ≤90 days after advanced diagnosis). We used logistic regression to identify baseline characteristics predictive of timely testing. Finally, we described treatment patterns for patients with RET+ aNSCLC before and after the US approval of RET inhibitors. Results: Among 26,329 aNSCLC patients, rates of RET testing ≤90 days after advanced diagnosis increased from 25% (2017 Q1) to 73% (2022 Q1). Patients were less likely to receive RET testing within 90 days if they were Black (multivariate odds ratio [OR] 0.8) or Hispanic (OR 0.8) compared to White, or had Medicare (OR 0.9; all p&lt;0.001) compared to commercial insurance. Patients were more likely to receive RET testing within 90 days if they were in the highest socioeconomic quintile (OR 1.4), had de novo disease (OR 2.1), or no history of smoking (OR 1.3; all p&lt;0.001). Between 2017 and 2022, there were increases in the use of next-generation sequencing (66% to 89%) and blood samples for biomarker testing (25% to 49%) and a decrease in mean days from diagnosis to test result (33 to 28) for the first RET test among those who had testing within 90 days. Among all patients with aNSCLC tested within 90 days (n=12,275), 73 were RET+ and received 1L treatment ≤90 days after advanced diagnosis. The most common 1L treatments before (n=35) and after (n=38) RET inhibitor approval were chemotherapy (40%) and RET inhibitor (42%), respectively (Table). Conclusions: RET testing has increased over time, but certain patient subgroups are less likely to receive timely RET testing and therefore may not be optimally treated. Among patients with RET+ aNSCLC identified after RET inhibitor approval, only 42% were treated with a RET inhibitor in the 1L setting. These results suggest both disparities in access to RET testing and unmet medical need among patients with RET+ aNSCLC. [Table: see text]

Reproductive genetic carrier screening for cystic fibrosis, fragile X syndrome and spinal muscular atrophy: patterns of community and healthcare provider participation in a Victorian screening program.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and The Royal Australian College of General Practice recommend that information on carrier screening for at least the most common inherited genetic conditions in our population, that is, thalassaemia, cystic fibrosis (CF), spinal muscular atrophy (SMA), and fragile X syndrome (FXS), should be offered to all women planning pregnancy or in early pregnancy regardless of family history or ethnicity. The aim of this study was to investigate patterns of participation by healthcare providers (HCP) and the community in screening. Participation in a Victorian program screening for CF, SMA and FXS between September 2013 and October 2018 was analysed. Requesting HCP and patient data were extracted from screening request forms. Data were analysed with respect to profession of requesting HCP, and characteristics of women screened (age, pregnancy status, socioeconomic status, geographic location, and family history of CF, SMA or FXS). In total, 21 172 women and 1288 HCPs participated in the program over this period. There was a steep socioeconomic gradient in screening uptake, with nearly half the women screened (10 349) being in the highest socioeconomic quintile. The screening rate was much higher in metropolitan areas than in regional areas. Obstetricians made most of the requests for screening, whereas 20% of requests were by GPs. Most participating GPs only made a single screening request (78%) and very few GPs made >100 screening requests compared with obstetricians (0.2% vs 17%). GPs were more likely to screen women before pregnancy compared with obstetricians (47% vs 11%). Approximately 1.5% of Victorian women of child-bearing age and 3% of pregnant Victorian women were screened by this program over the period of this study. This study highlights the translation gap between recommendations and practice, with marked inequity of access to reproductive genetic carrier screening in relation to socioeconomic status and geography. Increased participation by GPs could improve community access to reproductive genetic carrier screening, particularly access to preconception screening. Addressing the causes of inequity of access will allow more women and couples the opportunity to make informed choices about participation in screening.

Radiotherapy Utilization in a Population-Based Cohort of Cancer Patients Diagnosed in Victoria, Australia from 2013 to 2017

To evaluate the variation and trend in radiation therapy (RT) utilization in the state of Victoria, Australia from 2013 to 2017. This is a population-based linkage study between the Victorian Cancer Registry (VCR), which captured all incident cancer cases in the state of Victoria, and the Victorian Radiotherapy Minimum Data Set (VRMDS), which captured all episodes of RT delivered in all public and private RT facilities in Victoria. The primary outcome was RT utilization within 12 months of cancer diagnosis (RT12). Differences in RT12 by age, sex, socio-economic status, integrated cancer service region (geographic cancer health service administrative divisions), and remoteness of area of residence for each cancer were evaluated using Pearson’s chi-squared test. There were a total of 150,034 individuals with new cancer diagnoses in Victoria between 2013 and 2017. The overall RT12 for the cohort was 25% (19% were radical RT and 6% palliative RT). The top 5 cancer types with highest RT12 utilization were: breast cancer (63%), central nervous system cancer (57%), head and neck cancer (53%), esophageal cancer (51%), and cervical cancer (44%). There were large differences in RT utilization across different age groups for most cancer types, and in general older patients (aged 80 and above) were significantly less likely to receive RT (P<0.001). The association of sociodemographic factors and RT12 varied across cancers. For breast cancer, women from lowest socioeconomic quintile were less likely to have RT compared to those from top quintile (59% vs. 66%, P<0.001), and women living in major cities were more likely to have RT compared to those living in outer regional areas (64% vs. 58%, P = 0.001). For esophageal cancer, there was no substantial difference in RT12 between patients from lowest vs. highest socioeconomic quintile (55% vs. 53%, P = 0.18), or between patients living in major cities vs. outer regional areas (50% vs. 50%, P = 0.5). This is the largest Australian contemporary population-based study on RT utilization among cancer patients. Overall, RT12 is less than would be expected from widely-employed ‘optimal use models’, with only 1-in-4 patients receiving RT within 12 months of cancer diagnosis. There is large variation in RT utilization by patient and socio-demographic factors, depending on cancer type.

Association between household socioeconomic level and consumption of fast food and soft drinks: a cross-sectional assessment of the Young Lives cohort in Peru

Introduction: The consumption of fast food and soft drinks is a risk factor for developing overweight and obesity. This study aimed at assessing if there is association between household socioeconomic level and the consumption of fast food and soft drinks among children. Material and Methods: A cross-sectional assessment of the data from the third round (2009-2010) of the youngest cohort of the Young Lives study in Peru was conducted. Sampling was conducted in three stages: in the first one, the country was divided into equal geographical regions, excluding the 5% of the richest district; in the second stage, 20 sentinel sites were chosen and an area within each sentinel site was selected. Finally, in the third stage, eligible children were selected. Outcomes were the self-reported consumption of fast food and soft drinks (never, sometimes, and always), whereas the exposure was household socioeconomic status (in quintiles). Crude and adjusted models were created between variables of interest using Poisson regression models, with robust variance, to report prevalence ratios (PR) and 95% confidence intervals (95% CI).Results: Data of 1901 children, of which 942 (49.6%) were girls, with a mean age of 7.5 (SD: 0.5) was analyzed. A total of 24.1% (95%CI: 22.2% – 26.1%) reported always consuming fast food, whilst this number was 22.4% (20.5% – 24.3%) for soft drinks. Compared to the lowest socioeconomic quintile, those who were in higher socioeconomic status had more probability of consuming fast food and soft drinks (Chi-squared for trends &lt; 0.001). The highest socioeconomic quintile had a greater probability to always consume fast food (PR = 1.42; 95%CI: 1.08 – 1.88) and soft drinks (PR = 1.71; 95%CI: 1.24 – 2.37). Conclusions: This study shows that there is a significant association between the household socioeconomic level and the consumption of soft drinks and fast food.

Potentially Preventable Mortality in Young Australian Women, 2001 to 2016

We examined mortality rates in Australian women aged twenty to fifty years during 2001–2016, demonstrating continued disparity by socioeconomic status. Mortality has declined but the reduction occurred in the first decade with no evidence of improved rates since 2010. There have been steady improvements in death rates from causes not considered preventable, while potentially preventable deaths increased in all but the highest socioeconomic quintiles. These rises are particularly alarming in what have been termed “deaths of despair.” As well as the obvious compassionate responses to death in prime aged women, there are important economic considerations that should prompt further research and a policy response.

Abstract 036: Contemporary Estimates of Obesity Incidence of Among Children in the United States

Introduction: Childhood obesity is a growing epidemic in the United States with approximately 1 in 5 children being obese. Although prevalence estimates for childhood obesity are regularly updated, little is known about the current incidence of childhood obesity among a nationally representative population, since initial estimates were provided by the Early Childhood Longitudinal Study Kindergarten (ECLS-K) Class of 1998. Methods: We estimated the annual incidence of obesity and the cumulative incidence of obesity over 5 years using the contemporary ECLS-K Class of 2011 (analytic sample = 7019). Height and weight were measured at eight time points between kindergarten (2010) and fourth grade (2015). We defined normal weight (&lt;85 th percentile), overweight (85 th -95 th percentile), and obesity (&gt;95 th percentile) using Centers for Disease Control and Prevention sex-and age-specific growth curves. Results: At kindergarten entry (mean age 5.6 years), 15.5% of children were overweight and 14.7% of children were obese; in fourth grade (mean age 10.1 years) overweight prevalence had increased to 17.3% and obesity prevalence had increased to 20.1%. Kindergarteners who were overweight were 6 times as likely as normal-weight kindergarteners to become obese by fourth grade (5-year cumulative incidence, 30.5% vs. 5.2%). In early elementary school, annualized obesity incidence proportions were higher over summer breaks (5.6% and 5.4% during summer breaks from Kindergarten to first grade and first grade to second grade, respectively) than during the school year (3.8% and 3.8% during Kindergarten and first grade school years, respectively). Incident obesity was higher among boys compared girls, non-Hispanic black and Hispanic children compared to non-Hispanic white children, and among those from the poorest socioeconomic quintiles compared to the highest socioeconomic quintile. Conclusions: Incident obesity between the ages of 5 and 10 years was more likely to have occurred during summer breaks and primarily among children who had entered kindergarten overweight. Childhood obesity prevention efforts should focus on the prevention of overweight prior to kindergarten and investigate causes of summer weight gain during elementary school.

Events Within the First Year of Life, but Not the Neonatal Period, Affect Risk for Later Development of Inflammatory Bowel Diseases

Background & AimsWe performed a population-based study to determine whether there was an increased risk of inflammatory bowel diseases (IBD) in persons with critical events at birth and within 1 year of age.MethodsWe collected data from the University of Manitoba IBD Epidemiology Database, which contains records on all Manitobans diagnosed with IBD from 1984 through 2010 and matched controls. From 1970 individuals’ records can be linked with those of their mothers, so we were able to identify siblings. All health care visits or hospitalizations during the neonatal and postnatal periods were available from 1970 through 2010. We collected data on infections, gastrointestinal illnesses, failure to thrive, and hospital readmission in the first year of life and sociodemographic factors at birth. From 1979, data were available on gestational age, Apgar score, neonatal admission to the intensive care unit, and birth weight. We compared incident rate of infections, gastrointestinal illnesses, and failure to thrive between IBD cases and matched controls as well as between IBD cases and siblings.ResultsData on 825 IBD cases and 5999 matched controls were available from 1979. Maternal diagnosis of IBD was the greatest risk factor for IBD in offspring (odds ratio [OR], 4.53; 95% confidence interval [CI], 3.08–6.67). When we assessed neonatal events, only being in the highest vs lowest socioeconomic quintile increased risk for later development of IBD (OR, 1.35; 95% CI, 1.01–1.79). For events within the first year of life, being in the highest socioeconomic quintile at birth and infections (OR, 1.39; 95% CI, 1.09–1.79) increased risk for developing IBD at any age. Infection in the first year of life was associated with diagnosis of IBD before age 10 years (OR, 3.06; 95% CI, 1.07–8.78) and before age 20 years (OR, 1.63; 95% CI, 1.18–2.24). Risk for IBD was not affected by gastrointestinal infections, gastrointestinal disease, or abdominal pain in the first year of life.ConclusionsIn a population-based study, we found infection within the first year of life to be associated with a diagnosis of IBD. This might be due to use of antibiotics or a physiologic defect at a critical age for gut microbiome development.

Abstract 148: Association of Socioeconomic Context With Blood Pressure Response and Cardiovascular Outcomes in ALLHAT

Introduction: Observational studies demonstrate that in low socioeconomic (SE) communities, where residents face social challenges and fewer opportunities for healthy lifestyle behaviors or quality care, blood pressure (BP) is higher and there are worse cardiovascular (CV) outcomes. Yet whether the effectiveness of antihypertensive therapy on BP control and CV outcomes varies by SE context in a randomized clinical trial (RCT) - where patients are treated under a standard protocol - is unknown. Methods: We used data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), which randomized 42,418 people with hypertension (HTN) to chlorthalidone, lisinopril, amlodipine or doxazosin. After excluding non-continental US sites and the doxazosin arm (terminated early), our study included 27,862 participants. We defined SE context by mapping study site ZIP codes to counties and stratifying these into income quintiles based on the national distribution of cost-of-living adjusted county median household income (2000 US Census). We compared characteristics and outcomes between participants in the lowest and highest SE quintiles using multivariable regression models. We replicated the analysis with black participants (n = 10532). Results: Participants enrolled in low SE sites (n = 2169, 7.8%) were more likely to be female, black, Hispanic, less educated, live in the South, and have fewer CV risk factors than participants in high SE sites (n = 10458, 37.6%). Participants in low SE sites were less likely to achieve BP control (&lt;140/90 mmHg) at 6 years (OR 0.48, 95% CI [0.37, 0.63]). They had higher all-cause mortality (HR 1.25, 95% CI [1.10, 1.41]) and heart failure hospitalization/mortality (HR 1.26, 95% CI [1.03, 1.55]), though lower angina hospitalization (HR 0.70, 95% CI [0.59, 0.83]) and coronary revascularization (HR 0.71, 95% CI [0.57, 0.89]) and no differences in stroke or MI. Results were similar among black participants. Conclusion: Despite having access to extra resources afforded by an RCT, ALLHAT participants in low SE sites had poorer BP control, higher mortality and greater heart failure morbidity. Our findings suggest a need to address the SE context beyond the medical environment to attain equity in HTN outcomes.

Predictors of recovery in cyclists hospitalised for orthopaedic trauma following an on-road crash

BackgroundAs cycling-related injury rates are on the rise, there is a need to understand the long term outcomes of these patients in order to quantify the burden of injury and to inform injury prevention strategies. This study aimed to investigate predictors of return to work and functional recovery in a cohort of cyclists hospitalised for orthopaedic trauma from crashes occurring on-road. MethodsA retrospective analysis of data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) was conducted for patients who were hospitalised for orthopaedic trauma following a cycling crash that occurred on-road between July 2007 and June 2015. ResultsThere were 1787 injured cyclists admitted at the participating hospitals. Most cyclists were male (79%), resided in major cities (89%) and were in the highest socioeconomic quintile (52%). The majority of crashes were either non-collisions (41%) or collisions with a motor vehicle (35%). A smaller proportion of cyclists who collided with motor vehicles had returned to work and had returned to pre-injury functional levels at 12 months post-injury, when compared to collisions with other impact counterparts and non-collisions. Mixed effects logistic regression models revealed that compensable patients demonstrated lower odds of complete functional recovery and return to work when compared with non-compensable patients. ConclusionCyclists who collided with motor vehicles had worse outcomes compared to crashes with other impact counterparts and non-collision events. These findings provide support for reducing the potential for interaction between cyclists and motor vehicles.

Regional Variation in Rates of IVF Treatment across Australia: A Population-based Study.

Background: There is variation in uptake of in vitro fertilisation (IVF) between countries, and Australia has high incidence rates of IVF due to universal public funding. However, it remains unclear whether there is regional variation and, if present, what might cause this.Objectives: We sought to determine whether regional variations in treatment rates existed and what might influence these.Methods: The number of cycles of fresh IVF and intrauterine insemination (IUI) for women were obtained for the period 2011 until 2014 in two age groups (25 to 34 years and 35 to 44 years) to calculate incidence rates. Proxy indicators that might influence treatment affordability were: unemployment rates; average weekly total earnings; coverage of private health insurance; and, percentage of women in the highest socioeconomic quintile. Measures of accessibility considered were percentage of the population remote from urban areas and average state population density. Linear regressions were performed using log-transformed ratio of IVF and IUI incidence rates.Results: Variations were found in IVF uptake between states with greater differences in older women. There was no significant association between IVF procedures and population density or geographic isolation. Economic factors were not associated with IVF uptake.Conclusion: These findings suggest that factors such as physician preference, clinical practice guidelines, and cryopreservation protocols of ART units might explain the national variation in uptake of IVF.

Western Australia population trends in the incidence of acute myocardial infarction between 1993 and 2012

BackgroundAcute myocardial infarction (AMI) incidence has been declining throughout the developed world. Australia has been an outlier to this trend, with AMI incidence reportedly increasing. This study provides a detailed investigation on the incidence of acute myocardial infarction (AMI) in Western Australia overall, and by age, sex, level of geographic remoteness and socioeconomic status. MethodsIndividual level data was sourced from routinely collected hospital admissions and the Western Australian mortality register, providing coverage of the entire population. Hospital admissions were grouping into continuous inpatient stays to avoid double counting individual AMIs. The mortality register provided coverage of out of hospital AMI deaths. ResultsAMI incidence decreased in Western Australia from 1993 to 2012 by 1.2% per year (95% confidence interval (CI): −1.7 to −0.8). This decrease was concentrated in the 50–80 age group, with rates for those under 50 and over 80 remaining stable. AMI rates increased in both regional (Annual percentage change (APC), 95% (CI): 4.7, 3.7 to 5.7) and remote areas (APC, 95% CI: 4.6, 3.5 to 5.6). There was a large effect of socioeconomic status, with those from the lowest quintile having a 68% higher AMI incidence than those from the highest socioeconomic quintile. ConclusionsThese results are generally in line with other developed nations. Previous findings of increased incidence Australia-wide appear likely the result of double-counting AMIs within hospitals, and excluding out of hospital deaths. Further focus is required on particular subpopulations showing increased incidence of AMI, such as those in regional and remote areas. Focus on primary care prevention of cardiovascular risk factors will likely be the most effective method to ensure reductions in AMI incidence in these populations.

Determinants of readiness to adopt mHealth in a rural community of Bangladesh

IntroductionEvidence in favor of mHealth for healthcare delivery in settings where trained health workforce is limited or unavailable is accumulating. With rapid growth in access to mobile phones and an acute shortage of health workforce in Bangladesh, mHealth initiatives are increasing with more than 20 current initiatives in place. “Readiness” is a crucial prerequisite to the successful implementation of telehealth programs. However, systematic assessment of the community readiness for mHealth-based services in the country is lacking. We report on a recent study describing the influence of community readiness for mHealth of a rural Bangladesh community. MethodsA conceptual framework for mHealth readiness was developed, which included three categories: technological, motivational and resource readiness. This guided the questionnaire development for the survey conducted in the Chakaria sub-district of Bangladesh from November 2012 to April 2013. Multivariate logistic regression was used to examine ownership of mobile phones, use of the technology, and knowledge regarding awareness of mHealth services as predictors of the community readiness to adopt mHealth. ResultsA total of 4915 randomly selected household members aged 18 years and over completed the survey. The data explained the sub-categories of the readiness dimensions. In terms of access, 45% of respondents owned a mobile phone with ownership higher among males, younger participants and those in the highest socioeconomic quintiles. Results related to technological readiness showed that among mobile phone owners, 50% were aware of SMS but only sending and receiving SMS. Only 37% generally read the received SMS. Only 5% of respondents used the internet capabilities on their phone and 25% used voice messages. The majority (73%) of the participants were interested in joining mHealth programs in the future. Multivariate analysis showed that ownership of a mobile phone (aOR 1.3, 95% CI 1.1–1.5), younger age (aOR 2.6, 95% CI 2.1–3.3), males (aOR 1.8, 95% CI 1.6–2.1), educated respondents (11 years or more education) (aOR 11.1, 95% CI 6.2–19.2) and those belonging to the highest socio-economic group (aOR 3.7, 95% CI 2.9–4.7) were significantly independently associated with knowledge regarding awareness of current mHealth services. ConclusionsWe developed a conceptual framework to assess community readiness for mHealth. We described three high level dimensions of readiness and have partially tested the conceptual framework in a rural sub-district in Bangladesh. We found that the community has some technological readiness but inequity was observed for human resource readiness and technological capabilities. The study population is motivated to use mHealth. Our conceptual framework is a promising tool to assist policy-makers in planning and implementing mHealth programs.

Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007–2008

BackgroundSince 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the...

Access to medicines and out of pocket payments for primary care: Evidence from family medicine users in rural Tajikistan

BackgroundIn Tajikistan it is estimated that out of pocket payments constitute two-thirds of all health spending with high proportions of these contributions through informal payments. As a consequence, access to basic care is a major concern particularly among the most needy and vulnerable groups.This article evaluates accessibility of prescription medicines and patient expenditures for primary care services in two rural districts of Tajikistan.Methods901 patients aged 18 years or above who had accessed primary care facilities were interviewed, using a questionnaire based on questions regarding patient's experience of visiting the health facility. To group respondents by socio-economic status, an asset index was created using principal component analysis of the information included in the questionnaires.Results76.7% of patients were prescribed a medicine during the visits and more than 83% of them managed to obtain it. Patients spent on average US$ 9.3 on medicines, with wide variation among socio-economic groups. Around 45% of patients paid the Family Doctor. Additionally, over 41% of patients in the highest socioeconomic quintile were referred to a specialist, while only 29% of the poorest 40%.ConclusionThis survey showed that there are financial barriers potentially inactivating utilization of basic services. These barriers can only be reduced by mobilizing more public resources to fund the health sector, providing incentives for family doctors to stop requiring payments from patients, and increasing the availability of prescription drugs in PHC facilities.

Statin prescribing in Australia: socioeconomic and sex differences

To assess if there are any differences in statin prescribing across Australia by socioeconomic status or sex and to relate prescribing rates to coronary heart disease (CHD) mortality rates. Cross-sectional study using data on statin prescribing by age, sex and patient postcode for the period May to December 2002. The Australian population, stratified by sex and quintile of Index of Relative Socio-Economic Disadvantage (IRSD). Age-standardised rates of statin scripts per 1000 population per month for each sex and IRSD quintile. 9.1 million prescriptions for statins were supplied between May and December 2002, for a total cost of 570 million dollars. The age-standardised rates for statin prescribing in women varied from 56.9 (95% CI, 56.6-57.2) scripts per 1000 population per month in the most disadvantaged socioeconomic quintile through 53.4 (95% CI, 53.0-53.7), 50.3 (95% CI, 50.0-50.6), 48.4 (95% CI, 48.1-48.7) to 46.3 (95% CI, 46.0-46.6) in the least disadvantaged quintile. For men the figures were 52.6 (95% CI, 52.3-52.9), 50.9 (95% CI, 50.6-51.2), 48.8 (95% CI, 48.6-49.1), 47.7 (95% CI, 47.4-47.9), and 51.9 (95% CI, 51.6-52.2). There was a significant linear association between statin prescribing and CHD mortality by quintile of socioeconomic disadvantage in women (weighted least squares slope, 0.380; 95% CI, 0.366 to 0.395; P < 0.0001), but not in men (slope, -0.002; 95% CI, -0.010 to 0.006; P = 0.65). Our results suggest that in men there is either overprescribing of statins in the highest socioeconomic quintile or underprescribing in the lowest. Furthermore, contrary to expectation, women - relative to men - are prescribed statins at higher rates at lower levels of risk (using CHD deaths as a proxy measure of risk).

Geographical pattern of female deaths from myocardial infarction in an urban population: fatal outcome out-of-hospital related to socio-economic deprivation.

This study of myocardial infarction (MI) amongst urban women has sought to assess whether there are differences in fatal outcome, in-hospital respectively out-of-hospital, between residential areas defined in terms of socio-economic circumstances. Register-based surveillance study 1986-95. Seventeen residential areas in the city of Malmö, Sweden. Women 20-74 years of age. Differences in fatal outcome, in-hospital respectively out-of-hospital, between residential areas were expressed in terms of age-adjusted odds ratios (ORs), calculated by means of logistic regression. Socio-economic circumstances in the areas were expressed in terms of a composite score. Between residential areas there were marked and statistically significant differences in incidence (range 124-328/10(5), P < 0.001, d.f.=16) and mortality (range 38-132/10(5), P < 0.005, d.f.=16). Area rates of mortality covaried with incidence (r=0.85, P < 0.001) and with odds ratios of fatal outcome out-of-hospital (r=0.52, P=0.031) but not in-hospital. The odds ratios of fatal outcome out-of-hospital decreased in a statistically significant stepwise fashion from areas in the lowest socio-economic quintile (reference) to areas in the highest socio-economic quintile (OR: 0.67, 95% CI: 0.48-0.94). There was no corresponding association with the odds ratios of fatal outcome in-hospital. The high rate of mortality from MI amongst women in areas with deprived socio-economic circumstances was related to deaths occurring out-of-hospital. In order to assess the preventive potential there is a need for further studies that may clarify to what extent the association with socio-economic circumstances can be explained by other factors and conditions known to influence the probability of survival.