Violent Crime Convicted Persons (VCCPs) are at increased risk of somatic health problems over the life course. However, the topic remains insufficiently studied, particularly regarding interactions with healthcare services in high-risk groups over extended periods. This prospective study aimed to explore adverse somatic outcomes in young adult VCCPs with a history of imprisonment and their interactions with healthcare services in Sweden. In the Development of Aggressive Antisocial Behavior Study (DAABS) cohort, male VCCPs aged 18-25 (n = 266) imprisoned for violent and/or 'contact sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries throughout 2017. Information regarding somatic inpatient healthcare utilization (HCU), somatic morbidity, and prescribed drug use was tracked and compared with a general population comparison group (n = 10,000). Baseline risk factors were used to explore prospective somatic inpatient HCU in VCCPs. The DAABS cohort exhibited higher rates of both somatic outpatient (IRR = 1.8 [1.6-2.5]) and inpatient (IRR = 3.3 [2.2-4.9]) healthcare utilization compared with the general population group. They also showed a higher cumulative incidence of injuries of all types (IRR = 3.1 [2.4-4.0]), as well as ambulatory care sensitive conditions (ACSCs) (IRR = 2.2 [1.5-3.2]). Increased rates of prescription drug use were observed for nervous and respiratory systems, whereas reduced rates were especially noted in drugs used for the alimentary tract and metabolism as well as blood and blood forming organs. The DAABS cohort exhibited a severely elevated risk of all-cause mortality (HR 16.1 [9.4-27.8]). Low educational attainment decreased the incidence rate, while foster home placement and the assignment to a persistent offending trajectory increased the incidence rate of somatic inpatient HCU within the cohort. The VCCP cohort exhibited atypical patterns of somatic healthcare utilization, characterized by elevated inpatient and outpatient use, high rates of ACSCs and injuries, and a strikingly increased risk of premature mortality compared with the general population. The atypical nature of this utilization, reflected in the elevated incidence of ACSCs, underscores the need to improve understanding of the group's HCU patterns and the potential barriers to primary care. Enhancing health literacy and reducing barriers to timely and appropriate care are essential steps toward mitigating adverse health outcomes and promoting healthcare equity in this vulnerable population.

Increasing proportions of adverse maternal health outcomes occur in the 12-month postpartum period and could be addressed in outpatient settings. Our objective was to develop and test an algorithm to support a population health tool to identify high-risk prenatal patients served by federally qualified health centers (FQHCs). We leveraged human-centered design to develop and test the population health tool and algorithm. We conducted focus groups and a literature search to identify risk criteria for the tool. To evaluate the tool, we conducted structured interviews and predictive modeling to compare the recall between the original tool and the refined algorithm. The population health tool was initially tested using electronic health record (EHR) data at six pilot FQHCs. To test the model's predictive capacity, we expanded to 18 FQHCs. Focus group participants included FQHC clinicians and staff. Data to evaluate the population health tool were queried from prenatal patients receiving care at participating FQHCs. The primary outcomes were adverse outcomes addressed in outpatient settings and health care utilization within 12 months postpartum. Two focus groups (N = 7) were conducted to inform the implementation. In follow-up interviews (n = 6), users highlighted the tool's utility for identifying high-risk patients. In the predictive models (N = 82,829), the adverse outcome recall increased by 16%, but the algorithm only correctly predicted 42% of adverse outcomes experienced. The postpartum visit recall increased by 45%, with the algorithm correctly predicting 96% of visits utilized. Results of this project highlight the importance of a deep understanding of EHR data capture and the involvement of clinicians when developing, testing, and evaluating interventions aimed at optimizing care for vulnerable patient populations. Future research should incorporate inpatient, outpatient, and social determinants data to develop a more comprehensive understanding of maternal health risk in the postpartum period.

Background/Objectives: Older adults with chronic kidney disease (CKD) are particularly vulnerable to polypharmacy-related adverse outcomes due to altered pharmacokinetics, multimorbidity, and increased susceptibility to medication-related harm. Polypharmacy in CKD is associated with falls, hospitalizations, and functional decline. Clinical pharmacist-led medication reviews may mitigate these risks; however, access barriers limit their implementation in routine care. To evaluate the clinical impact of a digitally mediated pharmacist consultation service on medication burden, fall risk, healthcare utilization, and resource use among older adults with CKD and polypharmacy. Methods: We conducted a retrospective cohort study using anonymized electronic medical records from a large integrated healthcare organization. Adults aged ≥ 65 years with CKD and polypharmacy (≥8 chronic medications) were included. Patients receiving a structured digital medication review by a clinical pharmacist, delivered via the primary care physician, were compared with a comparable control group of eligible patients who did not receive the intervention during the study period. Outcomes included changes in medication use, fall risk, renal function, and healthcare utilization. Results: Among 6124 eligible patients (1226 intervention; 4898 control), pharmacist consultation was associated with a modest but clinically meaningful reduction in medication burden and a higher likelihood of fall-risk reduction compared with controls. Decreases in outpatient healthcare utilization were also observed following the intervention. Renal function decline was similar between groups. Conclusions: A digitally mediated, physician-integrated pharmacist consultation may reduce polypharmacy-related risks and adverse outcomes in older adults with CKD. This model offers a scalable approach to improving medication safety in a high-risk CKD population while minimizing reliance on patient digital engagement.

This study examined whether frailty mediates the relationship between sexual and gender minority (SGM) status and three types of outpatient healthcare utilization among adults aged 50 and older in the All of Us Research Program (2017-2022). We estimated controlled direct effects of SGM status across generalist, specialist, and mental health visits. Healthcare utilization and SGM status were self-reported, and frailty was measured using a survey-based deficit accumulation index. Both SGM status and frailty were independently associated with increased rates of all outpatient visit types. Regarding mediation, our results suggest that if all participants were robust, SGM adults would still have higher healthcare utilization compared to cisgender heterosexual older adults. This indicates that factors beyond frailty influence patterns of healthcare use in this population and highlights the importance of identifying additional determinants to ensure that older SGM adults receive appropriate and responsive care.

BackgroundIndigenous populations, including the Orang Asli in Malaysia, experience persistent health disparities due to historical, socioeconomic, geographic, and cultural barriers. Despite government initiatives to improve access, significant gaps remain, and limited nationwide data hinder policy development. This study examines the prevalence and determinants of outpatient healthcare utilisation among the Orang Asli.MethodsThis study utilised data from the Orang Asli Health Survey, a nationwide cross-sectional survey of Orang Asli communities in Peninsular Malaysia, with 89.8% response rate. Andersen’s Behavioural Model was applied in the analysis to assess the predisposing, enabling, and health need factors influencing outpatient healthcare use among the adult (aged 18 and over) population. Weighted descriptive statistics and logistic regression were used to examine outpatient healthcare utilisation and its determinants. Analyses were performed in STATA 18.ResultsThe overall prevalence of outpatient service utilisation in the past 12 months was 17.9%. Higher utilisation was observed among females, urban residents, and the Senoi and Negrito tribes. Determinants of outpatient use included female (adjusted odds ratio [aOR]: 1.64, 95% CI: 1.31–2.06), urban locality (aOR: 2.39, 95% CI: 1.15–4.96), Senoi (aOR 2.66; 95% CI: 1.52–4.64) and Negrito (aOR: 3.91, 95% CI: 2.01–7.60) tribes, unemployment (aOR: 1.27, 95% CI: 1.11–1.46), recent acute health problems (aOR: 2.17, 95% CI: 1.68–2.81), fair to very poor self-rated health (aOR: 2.30, 95% CI: 1.39–3.79), and presence of one (aOR: 2.90, 95% CI: 2.00–4.21) or two or more non-communicable diseases (NCD) (aOR: 4.63, 95% CI: 2.89–7.41). Interaction effects indicated lower outpatient use among Senoi and Negrito adults with poor self-rated health compared to other groups.ConclusionOutpatient healthcare utilisation among Orang Asli adults was driven by gender, tribe, health needs, and NCDs. Improved access requires needs-based sensitive interventions and existing services optimisation. Follow-up studies are warranted to explore the underlying cultural behavioural aspects.

In many health care systems, health data often include either diagnostic or cost data but not both. This poses a challenge for epidemiological or cost-of-illness studies. In this paper, we aim to identify diseases based on the utilization of outpatient services employing statistical learning models. We combine insurance claims data of the hospitalized population of a large Swiss health insurer from 2017 with diagnostic information in the national hospital inpatient registry from 2016 and 2017 at the patient level. We use random forests and boosting algorithms to predict the presence of 32 diseases based on outpatient health care utilization alone. The features include drug spending by four-digit ATC codes, spending by service provider, and spending by subchapter of national fee-for-service catalogues. We use the models to predict the prevalence of a disease in the non-hospitalized population for which no disease labels are available. Disease prediction worked best for diseases with specific treatment options (e.g., diabetes). Random forests achieved the best performance in 56% of all classification problems. For 25 diseases, drug utilization by ATC chapter was the most important feature in the prediction. Prevalence rates predicted for the full population were close to those reported previously for few diseases only, and showed large deviations for other diseases. Information on health care utilization from claims data may be used to predict the presence of diseases, but predictive performance varies across diseases, warranting further research on population-wide disease prevalence rates with incomplete information on diagnostic data.

Health care utilization rates in elderly kidney transplant were no different between the high kidney donor profile index and low kidney donor profile index group. Number of readmissions and surgical interventions in elderly kidney transplant was no different between the high kidney donor profile index and low kidney donor profile index group. Death censored graft loss was higher in the high kidney donor profile index group, whereas the patient survival was no different between the high kidney donor profile index and low kidney donor profile index groups. High kidney donor profile index (KDPI) kidneys (KDPI >85%) are often associated with increased risks of post-kidney transplant (KT) complications and greater health care utilization (HCU), particularly in elderly recipients with multiple comorbidities. These concerns frequently lead to underutilization of high KDPI kidneys in older transplant candidates, thereby limiting their access to transplantation despite potential clinical benefits. The aim of this study was to compare post-KT HCU between elderly recipients of high versus low KDPI deceased donor kidneys. The primary outcome included differences in hospital readmissions, surgical interventions, and outpatient service use at multiple post-transplant time points. Secondary outcome included graft function, graft survival, and patient survival. A retrospective analysis of elderly solitary KT recipients (age ≥65 years) between January 1, 2011, and December 31, 2020. Patients were stratified into high KDPI (>85%, n =160) and low KDPI (≤85%, n =453) groups. We assessed inpatient and outpatient HCU, including readmissions at 30, 90, and 365 days post-transplant, surgical interventions, and outpatient visits (emergency department, transplant clinic, endocrine clinic, and ambulatory infusion units). There were no statistically significant differences between high and low KDPI groups in rates of hospital readmissions, surgical interventions, or outpatient visits (all P > 0.05). Delayed graft function rates were also similar ( P = 0.61). The low KDPI group had significantly higher eGFR at 4 months, 1, 2, and 3 years post-transplant (all P < 0.001). However, days alive and out of the hospital within 90 and 365 days post-transplant were comparable between the groups (all P > 0.05). Overall patient survival was similar ( P = 0.08), although death-censored graft loss was significantly higher in the high KDPI group ( P = 0.001). Among elderly KT recipients, high KDPI kidney recipients had comparable post-transplant HCU and overall survival with those receiving low KDPI kidneys, despite lower long-term graft function. These findings suggest that high KDPI kidneys remain a viable option for older patients, offering timely access to transplantation.

Healthcare utilization patterns in Indonesia: insights from the 2023 National Socio-economic Survey

This study aimed to examine adverse event occurrences in outpatient care settings and healthcare utilisation after discharge and to identify the characteristics of patients at high risk of safety issues during the care transition from the hospital to their homes. In addition, the performance of outpatient triggers for the detection of adverse events was explored. A retrospective cohort study using hospital medical record reviews over 6 months postdischarge. A tertiary teaching hospital in South Korea. A total of 746 adult patient medical records mainly including patients potentially at high risk of adverse events were analysed, comprising 5439 outpatient visits. Occurrence of adverse events. Approximately 14.2% of patients experienced at least one adverse event within 6 months postdischarge. Medication-related (84.2%) and surgical/procedural (13.2%) events were common. Most events were mild in severity and assessed as unpreventable. Patients who experienced adverse events had significantly more all-cause re-hospitalisations, emergency room visits and outpatient clinic visits. No difference was found in mortality. Controlling for other variables, multiple logistic regression analysis showed that patients who are overweight (OR=0.48, 95% CI 0.25 to 0.90), with circulatory system diseases (OR=0.38, 95% CI 0.15 to 0.96) and with a National Early Warning Score 2 (NEWS2) ≥2 at discharge (OR=0.26, 95% CI 0.12 to 0.54) were less likely to experience adverse events. Those with admissions via emergency rooms or day-surgery centres (OR=1.98, 95% CI 1.18 to 3.32), in medical departments (OR=1.93, 95% CI 1.15 to 3.23), with a diagnosis of cancer (OR=2.03, 95% CI 1.14 to 3.62) and longer hospital stays (OR=1.07, 95% CI 1.02 to 1.11) were more likely to experience adverse events postdischarge. Outpatient triggers with relatively high performance included 'constipation with narcotics/calcium channel blockers', 'abrupt medication discontinuation', 'rash' and 'white blood cell count <3000/mm³'. Approximately 14% of patients, mainly comprising high-risk patients, experienced adverse events postdischarge, with more emergency room visits and all-cause re-hospitalisations. Patients experiencing adverse events were characterised by body mass index, type of admission route, clinical department, medical diagnosis, length of hospital stay and NEWS2. Patient and caregiver participation in the monitoring and reporting of adverse events should be encouraged to improve postdischarge patient safety. The use of triggers to detect potential patient safety problems is recommended.

Children with multidrug-resistant (MDR)/rifampicin-resistant (RR) tuberculosis (TB) are an important but neglected group in cost-effectiveness research. Digital health information systems enable new approaches to health-service cost analysis. The Provincial Health Data Centre (PHDC) in the Western Cape, South Africa, collates disparate health system data including hospital inpatient and outpatient data, medications, laboratory tests, and primary health care utilisation. A health-service cost analysis used anonymised, integrated PHDC data for children treated for MDR/RR-TB between 2018 and 2021. Health-service utilisation was costed using local unit prices, and total per-patient costs were summarised by key patient and disease characteristics (age, sex, resistance profile, site of disease, and HIV status) and reported in 2021 USD. A log-linear regression model identified cost drivers, and alternative parametric distributions were fitted to total costs to assess distributional fit. There was significant total cost variation across the 271 children in the data sample (median US$7576; interquartile range 2725-22,986). Regression analysis indicates younger age, extrapulmonary disease site, living with HIV, and treatment duration had significant impact on costs; impact of resistance profile was significant but subject to modelling assumptions. The distribution of total per-patient costs fitted a gamma distribution (α = 0.93, β = 14,496). Treatment for MDR/RR-TB in children remains costly for health systems. Utilising routinely collected, real-world data from an established health information system enables accurate and representative insights to overall costs and major cost drivers. Costs were highly skewed, with a small proportion of patients incurring very high costs. This cost analysis can assist in decision making and programme development at local and international levels and as an input to secondary analysis.

In developing countries, chronic patients face dual challenges: high healthcare expenditures coupled with inadequate utilization of outpatient services. Leveraging an administrative claim dataset and applying a two-way fixed effects approach, this study makes one of the first attempts to examine the impacts of chronic disease coverage, which extends additional insurance benefits for outpatient care, on healthcare utilization and expenditures among enrollees diagnosed with hypertension or diabetes in China. The empirical results reveal a dual effect of chronic disease coverage: (1) enrollees with hypertension or diabetes experienced a substantial reduction in outpatient cost-sharing rates, leading to a significant increase in both outpatient service utilization and associated expenditures; (2) concurrently, we observed decreases in general outpatient visits without this special coverage, inpatient utilization, and corresponding expenditures. Notably, the magnitude of expenditure reduction in these non-targeted services was outweighed by the increased spending on covered outpatient services, resulting in a net increase in total healthcare expenditures. Heterogeneity analysis further demonstrates that the impacts were more pronounced among older adults, those with more comprehensive insurance benefits and residents in areas with better-endowed medical facilities. This study offers empirically validated insights for enhancing chronic disease management within medical security systems and establishing age-friendly medical insurance schemes in China as well as other developing countries.

BackgroundAs primary health care forms the basis of the health care system, it is regarded as an efficient way to address main causes of, and risk factors for, poor health. In the Swedish health care system, general practitioners play a role in facilitating access to specialized health care and in coordinating care from other parts of the health care system. In Sweden, recent marketization efforts in primary health care, particularly the Patient Choice Reform, have adversely impacted geographical equity in access health care. This study aimed to examine long-term trends in specialized outpatient health care utilization in the context of the Patient Choice Reform, and to do so in regard to demographical, socioeconomic and geographical determinants of health care utilization.MethodRegister data from Region Skåne, the third most populous region in Sweden, was retrieved and a cohort was constructed, describing individuals’ health care utilization between 2007 and 2017. Utilization was measured as the number of outpatient visits to physicians in specialized health care, and based on trajectory analyses trends in utilization were identified. Differences in demographic, geographic and socioeconomic determinants between subgroups with distinct utilization trends were analyzed using logistic regression models.ResultsA closed cohort of 659,298 individuals was constructed. Utilization increased in all sex and age groups except for younger women where utilization decreased. Increased utilization was, in younger individuals, associated with lower socioeconomic status and, in older individuals, with higher socioeconomic status. In all female groups, increased utilization was associated with residence in urban areas and decreased utilization to residence in non-urban areas.ConclusionThis study provides key insights into long-term trends in outpatient SHC utilization during a time period that overlaps with the Patient Choice Reform. The impact of socioeconomic and geographic determinants on utilization varies in magnitude and direction between different age groups of the population in a similar pattern as previously described for primary health care. However, unlike previously reported trends of primary health care utilization, specialized health care utilization in younger women is decreasing.

BackgroundData on economic costs of respiratory syncytial virus (RSV) infections among children in primary care are scarce, although most RSV-infections are managed in this setting.AimTo estimate outpatient costs for RSV-positive children aged < 5 years.MethodsIn the RSV ComNet prospective cohort, children < 5 years with acute respiratory infection were recruited for RSV testing through primary care physicians in Belgium, Italy, the Netherlands, Spain and the United Kingdom (UK) during RSV seasons 2020/21 (UK only), 2021/22 and 2022/23. Outpatient healthcare utilisation and parental work absence were assessed over 30 days through parental questionnaires. Average costs per RSV episode were calculated from outpatient healthcare sector and societal perspectives, stratified by country and age.ResultsWe included 3,414 children and 1,124 (33%) tested RSV-positive. Physicians completed reports for 878 episodes, with follow-up questionnaire data for 819 (93%). Outpatient costs ranged from EUR 97 (95% CI: 91-104) in the Netherlands to EUR 300 (95% CI: 287-312) in Spain and were higher for infants than children aged 1-5 years. Societal costs ranged from EUR 454 (95% CI: 418-494) in the UK to EUR 994 (95% CI: 938-1,053) in Belgium. For children aged 1-5 years, societal costs were primarily driven by parental work absence. In infants, the main societal cost driver varied by country, but overall outpatient healthcare costs represented a higher proportion of societal costs vs older children.ConclusionRSV infections in children attending primary care result in substantial economic costs per episode, although differences exist across countries. This study provides essential data to inform cost-effectiveness analyses on novel RSV immunisations.

Abstract The prevalence of physical, psychological, and cognitive multimorbidity is marked by socioeconomic status (SES) inequalities. However, the relationship between multimorbidity patterns—particularly those involving cognitive conditions—and healthcare utilization, as well as the role of health insurance, remains poorly understood. This is the first study to explore healthcare-seeking behaviour among individuals with multimorbidity and assess whether these vary by SES and health insurance coverage. This multicohort study analyzed data from six longitudinal studies across 31 countries, including participants aged 50 years and older. Multimorbidity was defined as the coexistence of two or more disorders across physical, psychological, or cognitive disorders. Outpatient and inpatient healthcare utilization were measured. Random-effects logistic regression models were employed to assess associations with healthcare utilization, and random-effects Poisson regression models analyzed visit frequencies. Country-specific analyses were aggregated via multinational meta-analyses using random-effects models to generate overall effect sizes. We included a total of 1450209 individuals. Compared with individuals without any conditions, those with the most complex multimorbidity pattern had higher outpatient care utilization (OR 3.13, 95% CI [2.21–4.05]) but not as high as those with physical-psychological multimorbidity (OR 7.83, 95% CI [6.59–9.07]). Additionally, the association varied across socioeconomic groups, with lower SES individuals experiencing more pronounced disparities in care use. In contrast, the association between multimorbidity and inpatient care utilization was less pronounced. Health insurance coverage weakened the association between multimorbidity and outpatient care use, especially for individuals with physical-psychological-cognitive multimorbidity. Those with insurance had a stronger likelihood of utilizing outpatient care (OR 6.14, 95% CI [5.26, 7.16]) compared with those without insurance (OR 2.98, 95% CI [2.65, 3.36]). Cognitive disorders further complicate multimorbidity, indicating unmet healthcare needs, especially among individuals with lower SES. Our study highlights a potential role of health insurance in mitigating disparities in healthcare utilization related to multimorbidity.

Universal population coverage for healthcare was achieved in several countries, including Thailand, while retaining fragmented health insurance schemes. Fragmentation in health financing has been debated since it can exacerbate inequalities, especially when health systems are under stress due to a public health emergency. This study examines whether the type of public health insurance affects outpatient healthcare utilization and out-of-pocket expenditure in Thailand before and during the coronavirus pandemic. Using the 2019 and 2021 waves of the nationally representative Health and Welfare Survey and a repeated cross-sectional design, logit and multinomial logit models are estimated to investigate the effect of health insurance type on outpatient healthcare utilization (n=10,220), while two-part and Tobit models are employed as alternative models for the analysis of out-of-pocket expenditure (n=12,014). For both healthcare utilization and out-of-pocket expenditure, the study also explores models with and without interactive terms between insurance coverage type and a dummy variable capturing the COVID-19 period. Type of health insurance is found to impact provider choice (i.e., designated versus non-designated providers) rather than outpatient care utilization per se. Insignificant interaction effects indicate further that the relationship between health insurance type and outpatient care utilization is not affected by the pandemic. The regression results also show that health insurance type is associated with out-of-pocket expenditure (separated into medical and transportation spending) but the magnitude of the effect is relatively small, pre- and peri-pandemic. High-need persons with, for example, chronic conditions, however, face a higher out-of-pocket burden in terms of medical and transportation spending. Overall, the results suggest that Thailand's universal health coverage system has continued to live up to its promise of access and financial protection in the face of COVID-19, despite existing fragmentation. Notwithstanding, this study highlights that universal health coverage is an ongoing effort that requires careful monitoring, inter alia to mitigate undesirable consequences of fragmentation and to ensure that high-need and other vulnerable persons are not left behind.

January 2025 brought devastating wildfires to Los Angeles (LA) County, California, causing poor air quality, destroying homes and businesses, and displacing thousands of people. We used electronic health record data from 3.7 million Kaiser Permanente Southern California members to promptly determine if the 2025 LA Fires increased outpatient acute healthcare utilization. We created exposure categories using the maximum wildfire burn zone reached by an LA or Ventura County wildfire as of January 16, 2025. Highly-exposed members resided in census tracts located <20km from burn zones and moderately-exposed members lived in tracts ≥20km but within LA County. We identified daily outpatient and virtual acute care visits in five categories: all-cause, cardiovascular, injury, neuropsychiatric, and respiratory. We conducted 2-stage interrupted time-series analyses using machine-learning algorithms to determine if and by how much the 2025 LA Fires increased acute healthcare utilization. Across the week following the January 7 LA Fires ignitions, virtual respiratory visits were 41% (95% empirical confidence interval [eCI]: 26%, 56%) higher and 34% (95% eCI: 17%, 52%) higher than expected in highly- and moderately-exposed groups, respectively, totaling 3,221 excess visits. Similarly, both exposure groups had approximately 35% more virtual cardiovascular visits than expected over the same period. Among highly-exposed members, outpatient and virtual injury visits and outpatient neuropsychiatric visits were ≥ 18% higher than expected on January 7. Substantial increases in acute healthcare utilization driven primarily by virtual care-seeking were observed following the LA Fires. As disruptive climate events increase, such data are essential to inform healthcare preparedness and response.

BackgroundIncreasing sociocultural diversity has implications for emergency department (ED) care. Individuals with a migration context face challenges that can manifest as barriers in healthcare access and use. Therefore, our aim was to examine differences in healthcare delivery for and utilization of ED patients in Germany regarding their migration context.MethodsWe utilized routine healthcare data from the INDEED project. Patient records from three EDs in Berlin, Germany, from 2016 were linked with associated outpatient treatment data spanning 2014 to 2017. Using an onomastic approach, patients were assigned to one of nine regions of origin (refers to “migration context”) based on their names in addition to citizenship. Demographic and clinical data were compared between patients with and without a presumed migration context. Regression analyses were conducted to determine the association of migration context on triage category, hospital admission, frequent ED use (more than two visits within one year), and the number of outpatient presentations, adjusting for sex, age in years and multimorbidity (more than three different diagnoses over three calendar quarters within four consecutive calendar quarters before the first ED visit).ResultsIn total, 123 572 (49 003 (40.2%), 74 569 (59.8%) without presumed migration context) cases were examined. ED patients with a presumed migration context were younger and more often male than those without. Adjusted regression analyses demonstrated that the overall migration context was associated with a slightly higher likelihood of more urgent triage categorization (adjusted odds ratio: 1.03; 95%-confidence interval: 1.01–1.04), while it was also associated with fewer hospital admissions after the ED stay (adjusted odds ratio 0.92; 95%-confidence interval 0.90–0.96), being a frequent ED user (1.22; 1.15–1.30), and fewer contacts with outpatient healthcare services (exponentiated estimates 0.86; 0.85–0.86).ConclusionOur routine data analysis highlighted differences in healthcare pathways between ED patients with and without a presumed migration context in Germany. The likely complex and multifactorial reasons behind these disparities warrant further investigation, preferably by prospective studies. Understanding these factors can enhance the promotion of healthcare provision that is more sensitive to a diverse society.

The increasing prevalence of chronic conditions is a significant challenge for healthcare systems worldwide, not only from a public health perspective but also for the aggregate cost that these represent. This paper estimates the additional use of healthcare services due to chronic health conditions and their associated costs in nine European countries. We analyzed inpatient and outpatient healthcare utilization using longitudinal data (Survey of Health, Ageing and Retirement in Europe [SHARE]). We implemented a difference-in-differences approach across multiple time periods. Monetary estimates were derived using WHO-CHOICE healthcare service costs. To compare countries, we calculated the healthcare cost burden of chronic conditions as a percentage of total health expenditure. People with chronic conditions require significantly more healthcare services than those without such conditions, averaging three additional outpatient visits and one extra overnight inpatient stay annually. These patterns vary across countries. In Germany, outpatient care usage is particularly high, with an average of four additional visits, while Switzerland leads in inpatient care with two extra overnight stays. The associated costs also differ widely, influenced by variations in healthcare demand, service pricing, and the prevalence of chronic conditions in each country. Chronic conditions significantly increase healthcare utilization, and demographic trends suggest this demand will continue to grow steadily. This rising pressure poses serious challenges for healthcare systems, necessitating a shift toward more efficient service delivery models.

BackgroundDocumenting Long COVID cases has been challenging partly due to the lack of population-level data and uncertain diagnostic criteria, hindering the ability to ascertain healthcare utilization patterns over time. The objective of this study is to examine the characteristics and healthcare utilization patterns of Long COVID patients in Colorado pre- and post-diagnosis compared to controls.MethodsRetrospective, longitudinal case-control study using a 100% sample of Colorado’s All-Payer Claims Database. The sample includes individuals 18 or older diagnosed with Long COVID between October 1, 2021, and August 1, 2022, with patients followed until August 2023. Long COVID was identified using the International Classification of Diseases, 10th Revision, U09.9 code in medical insurance claims. Analysis of healthcare utilization required one year of continuous enrollment before and after diagnosis. Controls were matched 2:1 on age group, sex, payer, and index month to account for contemporaneous trends in utilization.Results26,358 individuals were ever diagnosed with Long COVID, resulting in a claims-based prevalence of 674 per 100,000 during the study period (population 3,906,402 individuals). Of these, 12,698 individuals had continuous enrollment and a Long COVID diagnosis: mean (SD) age, 59.0 (17.1); 65.3% female; 60.1% white; 83.0% residing in urban areas. The Long COVID sample was matched with 25,376 controls. Before diagnosis, 17% of Long COVID patients were hospitalized at least once, and 40% visited an emergency department on at least one occasion. Within the year following diagnosis, utilization of acute healthcare services significantly decreased relative to controls: hospitalizations, -6.1percentage points (p.p.), emergency department visits, -7.7 p.p., whereas outpatient services and medications increased: office visits, 3.6 p.p.; specialist office visits, 4.7 p.p.; and 5.2 new medications, (controls: 2.8). Changes in diagnoses of some conditions (e.g., metastatic carcinomas and lung cancer) were similar between groups.Conclusions and relevanceLong COVID patients increased outpatient healthcare utilization following a diagnosis, switching from acute care settings. The change in service settings among this population suggests that diagnosis could lead to better patient management. Healthcare utilization among these patients is high, underscoring the need to understand the Long COVID burden on healthcare systems with population-level data.

The global community aims to eradicate hunger by 2030 through a renewed focus on agricultural development, specifically SDG 2, to ensure food insecurity and nutrition. Food insecurity, a significant socioeconomic issue, affects over 7.5 million households in Pakistan, impacting 25% of the population and negatively influencing the health status of 40 million individuals. Therefore, this research aims to explore the connection between inpatient and outpatient healthcare utilization and food insecurity by highlighting those with severe health risks and resource constraints. This study used secondary data from the Pakistan Social and Living Standards Measurement Survey (PSLM) 2018-19, collected by the Pakistan Bureau of Statistics. The study used data for 24809 households from different areas of Pakistan including both rural and urban areas of Pakistan. The food insecurity Experience Scale (FIES) is used to estimate food insecurity and Instrumental Variable Probit Regression (IVprobit) is utilized for analyzing the effect of food insecurity on healthcare utilization. IVprobit model is used to eliminate the bias arising from the endogeneity of the food insecurity variable. The study reveals that higher food insecurity scores decrease access to modern healthcare for outpatient and inpatient care, with factors like age, sex, residence, household size, social protection, and illness characteristics also influencing individual behavior. Thus, the study’s results indicate that modern healthcare utilization, particularly outpatient treatment for households, could improve the food insecurity status of households in Pakistan