Inequalities In Health Care Research Articles

Ethics in Patients' Health Literacy: a scoping review and a critical discussion.

A growing body of literature has acknowledged that a high number of populations with low Health Literacy (HL) is related to poor health outcomes, inequities in healthcare and high economic costs. Those findings have formulated the research questions of this review: (i) what ethical issues arise within the context of patients' HL and (ii) What is the relationship between HL and quality of life? This review followed the guidelines of Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) and it was conducted in five databases: PubMed, CINAHL, MEDLINE, Scopus and Science Direct between June 2022 and December 2023. Out of the 3164 titles retrieved, 285 abstracts were eligible to proceed. Following a thorough examination of the full text of 61 papers, 45 sources were identified that met the inclusion criteria. The data analysis process was guided by the research questions, employing a thematic approach. Four themes were identified: the use of language and patient understanding, human rights, the principlism approach (justice, beneficence, non-maleficence and autonomy) and quality of life. The first theme mainly focused on the relation of HL with the notion of consent forms and national action plans. Human rights in relation to HL were discussed as a minor issue. The bioethical framework by Beauchamp and Childress (Principles of Biomedical Ethics, 6th edn. Oxford University Press, New York, NY, 2009), was addressed by several studies, with a particular focus on justice and the loss of autonomy. Quality of life indicated a positive correlation with HL by most of the authors, while few studies revealed a moderate correlation.

Inequality in financial risk protection in health among displaced populations: The case of Venezuelan women in Brazil

ObjectiveWorsening economic and social conditions in Venezuela have forced many to migrate. Women and girls are particularly at risk of health vulnerability in this context. This study examines healthcare expenditure and financial risk protection inequalities among Venezuelan migrant women in Brazil. MethodsWe conducted a survey of 2012 Venezuelan women aged 15–49 who migrated to Brazil between 2018 and 2021. We estimated and decomposed concentration indices to analyse inequalities in out-of-pocket healthcare expenditures (OOPHE) and catastrophic health expenditures (CHE) across the entire socioeconomic distribution. We applied Blinder-Oaxaca decompositions to explain differences in healthcare spending between migrant and Brazilian women. ResultsVenezuelan migrant women displayed noticeable disparities in OOPHE and incidence of CHE. Approximately half of our sample of migrants reported no income, no expenditures, and hence no CHE. OOPHE and CHE incidence were concentrated among less poor migrant women, whilst for Brazilian women, CHE was concentrated among the poorer. Location, time since arrival to Brazil, higher education, and income were key contributors to socioeconomic inequality in OOPHE and CHE for migrants. The main explanatory factor for differences in OOPHE between migrants and non-migrants was differences in income profiles. ConclusionsAddressing financial risk protection in health is crucial for displaced populations, especially women and girls. While the public health system in Brazil offers universal healthcare coverage in principle, our results suggest that there is still a significant risk of lack of access to healthcare for Venezuelan migrant women, which may be driven by insufficient financial means.

Evaluating the gap in rapid diagnostic testing: insights from subnational Kenyan routine health data

BackgroundUnderstanding diagnostic capacities is essential to addressing healthcare provision and inequity, particularly in low-income and middle-income countries. This study used routine data to assess trends in rapid diagnostic test (RDT)...

Understanding racial disparities in health care expenditures for cervical cancer.

Cervical cancer demonstrates a notable efficacy in treatment, evidenced by a 92% 5-year survival rate among cases diagnosed at a localized stage. In 2020, the estimated annual national expenditure for cervical cancer care amounted to $2.3 billion in the United States. Limited real-world data are available for racial disparities in health care expenditures for cervical cancer. To evaluate racial disparities associated with annual health care expenditures among patients diagnosed with cervical cancer in the United States. A retrospective observational cohort study of annual health care expenditures in patients with cervical cancer diagnosed during 2014-2019 was performed using the Medical Expenditure Panel Survey data. In addition to the descriptive weighted analysis, an unadjusted analysis of the annual health care expenditure was conducted. An adjusted linear regression model with log transformation of the outcome variable was used to evaluate the total annual health care expenditure as well as expenditures by category across the racial groups. Overall, 826 patients with cervical cancer were identified from the Medical Expenditure Panel Survey during 2014-2019. The majority were classified as White patients (81.2%) and in the age group of 45-64 years (44.65%). On average, the total annual health care expenditure was $11,537 (95% CI = $9,887-$13,186) among the White cohort, $10,659 (95% CI = $6,704-$14,614) among the African American cohort, and $8,726 (95% CI = $6,113-$11,340) among the Hispanic cohort. After adjusting for covariates, the average total annual health care expenditure for the Hispanic cohort was 35% of the total health care expenditure of the White cohort (P < 0.001) and 46% of the African American cohort's health care expenditure (P = 0.02). Specifically, adjusted costs of office-based and outpatient visits for the Hispanic cohort were 47% (P = 0.009) and 57% (P = 0.005) lower than for the White cohort, respectively. The total annual home health care expenditure for the African American cohort was 49% lower than White patients (P = 0.03), and the Hispanic cohort's total expenditure, excluding prescription medicines, was 57% lower than African American patients (P = 0.02). This study provides valuable information regarding the health care disparities that need to be addressed among certain minority races. Reducing the disparities in health care spending across racial groups should be included as a crucial element in tackling well-established health care inequities.

Global Health Care Inequalities of Head and Neck Cancer Imaging and Treatment Protocols Emphasizing PET/CT Availability

Global Health Care Inequalities of Head and Neck Cancer Imaging and Treatment Protocols Emphasizing PET/CT Availability

Eliminating Health Care Access and Quality Inequities in Sickle Cell Disease: Policy Lessons from the End Sepsis Initiative

Abstract: Sickle cell disease is a prime example of the devastating impact of healthcare inequities. The End Sepsis Initiative developed after a tragic death due to sepsis, provides a powerful model for the sickle cell community. This model recognizes the importance of evidence-based protocols and policy recommendations/mandates to drive transformative systems change. We propose that the sickle cell community mirror this approach. We propose that hospital systems, healthcare organizations, and insurers implement evidence-based protocols, including personalized pain plans, stigma reduction through staff training, vaccinations, preventative screening, disease-modifying therapies, pediatric to adult transition, and connecting unaffiliated SCD patients to a medical home. We recommend state-level interventions, such as using SCD navigator in electronic health records for quality reporting, supporting community health workers' use, and ensuring rural hospitals have access to SCD specialists.

Stroke in sickle cell patients, epidemiology, pathophysiology, systemic and surgical treatment options and prevention strategies

AbstractBackgroundA hereditary haemoglobinopathy known as sickle cell disease (SCD) affects over 100 000 people in the United States severely. Cerebrovascular disease is a prominent consequence of SCD. By the age of 30, 53% of patients have silent cerebral infarcts (SCIs) (a stroke that occurs without any obvious symptoms because it damages a small part of the brain that isn't responsible for any essential functions), and by the age of 40, 3.8% have overt strokes.Main bodyThe multidimensional burden of cerebrovascular illness in SCD is reviewed in detail in this article, which includes both clinical strokes and the frequently asymptomatic SCIs. The intricate pathophysiology of SCD and stroke is explored. With SCD, there are currently very few methods for preventing primary and secondary stroke; the most common ones are hydroxyurea and blood transfusion. Nevertheless, not enough research has been done on the possible contributions of anticoagulation and aspirin to strokes linked to SCD. Promising evidence is also highlighted in the study, suggesting that new drugs intended to treat SCD may be able to alleviate leg ulcers and renal impairment in addition to reducing unusually high transcranial Doppler flow velocity – a crucial component of cerebrovascular events. Given that these novel medications specifically target haemolysis and vaso‐occlusion, the two main causes of strokes in this population, more research is desperately needed to determine whether they are effective in avoiding strokes in people with SCD. The literature review also emphasizes how common healthcare inequities are and how they hinder advancements in SCD research and management in the United States.ConclusionTo successfully address these inequities, the evaluation recommends more funding for both SCD management and research, as well as for patient and clinician education. This multimodal viewpoint highlights the intricate terrain of cerebrovascular problems associated with SCD and the urgent need for all‐encompassing and fair strategies to improve patient outcomes and advance research.

The Impact of Gendered Ageism and Related Intersectional Inequalities on the Health and Well-being of Older Women

Gendered ageism contributes to invisibility and homogenization of older women, harming their health, quality of life and limiting their social participation. Health issues related to aging have received increasing attention in the scientific literature. However, studies on aging that include a gender dimension or ethnic aspects remain scarce. This article presents the results of a systematic review on older women’s health and wellbeing, gender inequalities, age discrimination experienced by older women and their intersections with other forms of discrimination. Between January and February 2023, we conducted a literature review using PRISMA in the Web of Science Core Collection, MEDLINE and SciELO Citation Index. We selected 43 empirical studies from different countries focusing on women over 65 years. The findings show the incidence of discrimination and inequality in health care experienced by older women, ageist attitudes among health care providers and other professionals, experiences of abuse and gender-based violence among older women. Additionally, the study examines the impact of ageism and other forms of discrimination on the health of LGBTQ+ older people, ethnic minorities, older women with disabilities, and other non-traditional groups.

Cutaneous Melanoma Mortality-to-Incidence Ratio and Its Association With Socioeconomic and Healthcare Factors in Canada: A National Ecological Study.

The mortality-to-incidence ratio (MIR) can be used to approximate healthcare inequities and is helpful to understand/compare cancer survival between geographic regions/jurisdictions. We investigated cutaneous melanoma (CM) outcomes through MIR analysis in Canadian jurisdictions and census divisions (CDs) between 1992 and 2016. Data were obtained from the national databases from 1992 to 2016 for all Canadian jurisdictions, except Quebec. Age-standardized overall and median MIRs were calculated per province per year, while crude MIRs were calculated for CDs. Generalized linear regression models were conducted to study the effect of province and year on MIR, while a mixed effect regression model was used to determine how healthcare and socioeconomic factors affect MIR, while accounting for possible clustering effects (eg, year and province). We identified 106,015 CM cases and 20,570 CM deaths between 1992 and 2016. National MIR from 1992 to 2016 demonstrated a significant linear decrease (P value < .0001). The national median MIR was 15.4 (ie, 0.154 × 100), whereby Manitoba (19.9), Ontario (19.5), Saskatchewan (18.5), British Columbia (16.1), and Newfoundland and Labrador (15.9) demonstrated higher MIRs than the Canadian average. CDs with the highest MIRs were commonly identified in the southern regions of provinces. No healthcare or socioeconomic factors were found to be significantly associated with higher MIR at the provincial level. MIRs have decreased at the national and provincial levels in recent decades, which is reassuring. Higher MIRs were noted in select rural CDs and in the Canadian territories, reinforcing the importance of proper dermatological care in all parts of the country.

Equitable Care for Children With a Tracheostomy: Addressing Challenges and Seeking Systemic Solutions.

Children with medical complexity (CMC) often face significant barriers to accessing care, obtaining appropriate insurance coverage for medical devices, technology, supplies, home nursingand social services. These challenges, when viewed through the lens of social determinants of health, highlight concerns about healthcare inequity. These inequities can impact CMC by limiting access to follow-up appointments, leading to disproportionate use of emergency department services, restricting support services, reducing the quality of medical productsand increasing the likelihood of adverse events. Addressing these concerns requires comprehensive policy changes at both state and federal levels. Achieving successful collaborations between states and federal agencies is particularly challenging and may take months or even years to accomplish. Through an exploratory qualitative approach, this study facilitates a nuanced inquiry into the experiences and systemic challenges encountered by medical professionals and primary caregivers managing CMC who require a paediatric tracheostomy. Qualitative interviews were conducted with 17 health professionals and primary caregivers residing in the United States. A thematic analysis was used to analyse the transcribed interview data. Using exploratory thematic analysis, we identified challenges and opportunities for improvement regarding (a) access to health insurance, (b) procurement of essential medical supplies, (c) logistical constraintsand (d) identifying interim solutions. Building on our findings, we discuss how socioecological factors impact health and quality of life of CMC and families. Additionally, we address the growing gap in quality of care through a comprehensive approach that considers patient needs, regulatory frameworksand affordability. Medical practitioners and healthcare professionals were actively involved in the development, productionand implementation of the research project. These individuals were given the opportunity to review their statements and review the manuscript before publishing. While caregivers did not engage in member checking, each provided their consent before data collection.

Advancements and limitations in integrating robotics into medicine: A comprehensive review

The integration of robotics into medicine represents a groundbreaking advancement with transformative potential across various medical domains. This comprehensive review delves into both the remarkable advancements and the significant limitations associated with this integration. Advancements in robotic medicine include precision surgery, which facilitatesintricate procedures with enhanced accuracy and minimal invasiveness. Robotic systems enable teleoperation, allowing surgeons to perform procedures remotely, and expanding access to specialized care. Enhanced imaging and navigation capabilities further augment surgical precision and efficiency. Additionally, robotics play a vital role in rehabilitation therapy, aiding in personalized patient recovery. However, these advancements have substantial limitations. The cost of acquiring and maintaining robotic systems poses a significant barrier to widespread adoption, particularly in resource-constrained healthcare settings. Moreover, mastering robotic surgical techniques demands extensive training, contributing to a steep learning curve for healthcare professionals. Technical challenges such as system reliability and interoperability also present hurdles to seamless integration. Ethical considerations surrounding patient autonomy, accountability, and data privacy must be carefully addressed. Legal frameworks and regulatory standards are essential to ensure patient safety and mitigate liability risks associated with robotic-assisted interventions. Furthermore, disparities in access to robotic technology may exacerbate existing healthcare inequalities. Addressing these limitations requires concerted efforts from healthcare stakeholders, policymakers, and technology developers. Collaborative initiatives are needed to overcome financial, educational, technical, ethical, and regulatory barriers to integrating robotics into mainstream medical practice. By navigating these challenges, the full potential of robotics in medicine can be realized, ushering in an era of enhanced precision, efficiency, and accessibility in healthcare delivery.

The five hundred rupee note.

This reflective piece deals with the challenges of healthcare delivery in a resource-constrained setting. The narrative is set in an emergency room and the story follows a doctor's desperate efforts to save a young girl suffering from disseminated tuberculosis, whose condition is exacerbated by economic hardships and delayed diagnosis. This story is a compelling commentary on the inequities in healthcare, and the urgent need for systemic change to ensure that all individuals, regardless of their economic status, have access to quality healthcare and health as a fundamental right of the people is established.

Understanding the unprecedented 2023 dengue outbreak in Bangladesh: a data-driven analysis

ObjectivesThis study aims to elucidate the epidemiological characteristics, spatial distribution, and potential contributing factors associated with the 2022-2023 dengue outbreak in Bangladesh. MethodsWe retrospectively analyzed dengue fever cases reported by national health surveillance systems, focusing on incidence, geographical spread, and fatalities. Statistical methods were used to explore correlations between population density, healthcare capacity, and disease prevalence. ResultsOur study revealed that in 2023, dengue cases and deaths surged five-fold (from 62,382 to 320,835) and nearly six-fold (from 281 to 1699) compared with 2022. Major cities such as Dhaka and Chittagong emerged as epicenters with significantly higher caseloads and mortality rates. The analysis identified a strong positive correlation between population density and disease prevalence, suggesting urbanization as a contributing factor. In addition, a shift in the peak dengue season from August to September was observed. Furthermore, disparities in health care infrastructure were identified, with densely populated areas experiencing critical shortages of hospital beds, potentially impacting fatality rates. ConclusionsThis unprecedented dengue outbreak in Bangladesh highlights the need for a multifaceted approach. Prioritizing vector control, targeted public awareness in identified hotspots, addressing healthcare resource inequities, and further research on environmental and demographic determinants of transmission are crucial for mitigating future outbreaks in Bangladesh.

Socio-economic inequality in the distribution of health care in the UK

Abstract This commentary begins with a discussion of how health care is modelled in a human capital approach and what that implies for inequality in the distribution of health care. This is followed by an outline of some of the key issues in the measurement of inequalities in health care. It ends with a brief review of what the empirical literature shows on inequality in health-care utilization in the UK by socio-economic status.1

Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis.

The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers. To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement. A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline. A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play. Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.

Consultations With Muslims From Minoritised Ethnic Communities Living in Deprived Areas: Identifying Inequities in Mental Health Care and Support.

Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. Twenty-seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti-racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence-based mental health care provisions to tackle mental health inequities. This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region.

Pricing of medication abortion in the United States, 2021-2023.

Financial costs remain one of the greatest barriers to abortion, leading to delays in care and preventing some from getting a desired abortion. Medication abortion is available through in-person facilities and telehealth services. However, whether telehealth offers a more affordable option has not been well-documented. We used Advancing New Standards in Reproductive Health (ANSIRH)'s Abortion Facility Database, which includes data on all publicly advertising abortion facilities and is updated annually. We describe facility out-of-pocket prices for medication abortion in 2021, 2022, and 2023, comparing in-person and telehealth provided by brick-and-mortar and virtual clinics, and by whether states allowed Medicaid coverage for abortion. The national median price for medication abortion remained consistent at $568 in 2021 and $563 in 2023. However, medications provided by virtual clinics were notably lower in price than in-person care and this difference widened over time. The median cost of a medication abortion offered in-person increased from $580 in 2021 to $600 by 2023, while the median price of a medication abortion offered by virtual clinics decreased from $239 in 2021 to $150 in 2023. Among virtual clinics, few (7%) accepted Medicaid. Median prices in states that accept Medicaid were generally higher than in states that did not. Medication abortion is offered at substantially lower prices by virtual clinics. However, not being able to use Medicaid or other insurance may make telehealth cost-prohibitive for some people, even if prices are lower. Additionally, many states do not allow telehealth for abortion, deepening inequities in healthcare.

United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico.

Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico's deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico's limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. (Am J Public Health. 2024;114(S6):S478-S484. https://doi.org/10.2105/AJPH.2024.307585) [Formula: see text].

Healthcare Through the Lens of Music

In this episode of SoundPractice, host Mike Sacopulos interviews Stephen Klasko and Ken Terry about the future of healthcare. They talk about their book, Feelin’ Alright: How the Message in Music Can Make Healthcare Healthier, which explores the power of music to bring people together and send messages about healthcare. They discuss the negative effects of the current healthcare system, including fragmentation and inequity, and propose solutions such as moving healthcare to outpatient sites and using technology such as large language models and wearables to improve patient care. They also discuss the importance of addressing social determinants of health and reducing healthcare inequalities. Klasko and Terry offer a novel proposal for reforming healthcare financing and delivery without adopting Medicare for all, and they emphasize the importance of doctors having a stake in the healthcare system and address the mistrust that currently exists.

Health inequities in health and social care in geriatric psychiatry: from healthy aging to subjective cognitive decline and dementia

Health inequities in health and social care in geriatric psychiatry: from healthy aging to subjective cognitive decline and dementia