Regional Disparities In Access Research Articles

Overlooked by the obstetric gaze – how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study

BackgroundDuring the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.MethodsIn this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 – February 2022. The data was analysed using inductive qualitative content analysis.ResultsOur results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women’s difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a ‘key person’ in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.ConclusionsOur study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

Availability and Access to Orphan Drugs for Rare Cancers in Bulgaria: Analysis of Delays and Public Expenditures.

Rare cancers are defined by an annual incidence of fewer than 6 per 100,000. Bearing similarities to rare diseases, they are associated with substantial health inequalities due to diagnostic complexity and delayed access to innovative therapies. This situation is further aggravated in Southeastern European countries like Bulgaria, where limited public resources and expertise underscore the need for additional policy and translational research on rare cancers. This study aimed to explore the availability and access to orphan drugs for rare cancers in Bulgaria for the period of 2020-2023. We cross-compared data from both the European Union and national public sources to evaluate the number of available and accessible orphan drugs for rare cancers, the delay from market authorization to reimbursement, the dynamics of public expenditures, and regional disparities in access across the country. We juxtaposed the main characteristics of oncological and non-oncological orphan drugs as well. Only 15 out of 50 oncological orphan drugs that were authorized by the European Medicine Agency were accessible for rare cancer patients in Bulgaria. The median delay between market authorization and inclusion in the Bulgarian Positive Drug List was 760 days. The total expenditures for all orphan drugs for rare cancers amounted to EUR 74,353,493 from 2020 to 2023. The budgetary impact of this group rose from 0.24% to 3.77% of total public medicinal product expenditures for the study period. Rare cancer patients represent a vulnerable population that often faces limited to no access to treatment. We call for targeted European and national policies to address this major inequality.

Abstract 26: Regional Inequities in Access to Stroke Facilities in India - Estimating Travel Distance and Times for Thrombolysis and Thrombectomy

Introduction: Stroke is a global health concern, with its impact more pronounced in low- and middle-income countries like India. The access to acute stroke treatments, especially intravenour thrombolysis and mechanical thrombectomy, is limited. This research dives into the regional variations in the distribution and accessibility of stroke centers in India. Methods: Data on stroke centers, including those capable of intravenous thrombolysis (IVT) and endovascular treatment (EVT), was gathered from pertinent medication and device providers and geocoded. We estimated driving distances and travel durations between population centers and their proximate IVT and EVT stroke facilities using Google Distance Matrix API, which provided gross estimations. We then compared the estimates across different zones to look at regional disparities in access to stroke facilities. Results: Of the 566 IVT-capable centers spread across 26 states/UTs, 361 (63%) were equipped for EVT. The average stroke centres per million (SCPM) population was 0.41 and 0.26 for IVT-C and EVT-C, respectively. Majority of stroke centres were located in the south zone (>35%), followed by the western and central zones, while the north, east and northeast zones collectively accounted for just 15% of stroke facilities. Median travel distances to IVT and EVT centers were 114 km and 140 km, respectively. Median travel durations to access IVT and EVT facilities stood at 3.04 and 3.46 hours, respectively. The median duration in the south zone for IVT-C and EVT-C centers was 2 and 2.5 Conclusions: The findings of this gross estimations a comprehensive view of stroke care infrastructure in India, highlighting significant regional disparities. The substantial travel times and distinct inconsistencies in stroke care facility availability underscore the need for strategic policy interventions and focused interventions, particularly in underserved regions.

Patent Foramen Ovale Management for Secondary Stroke Prevention: State-of-the-Art Appraisal of Current Evidence.

Patent foramen ovale (PFO) is frequently identified in young patients with ischemic stroke. Randomized controlled trials provide robust evidence supporting PFO closure in selected patients with cryptogenic ischemic stroke; however, several questions remain unanswered. This report summarizes current knowledge on the epidemiology of PFO-associated stroke, the role of PFO as a cause of stroke, and anatomic high-risk features. We also comment on breakthrough developments in patient selection algorithms for PFO closure in relation to the PFO-associated stroke causal likelihood risk stratification system. We further highlight areas for future research in PFO-associated stroke including the efficacy and safety of PFO closure in the elderly population, incidence, and long-term consequences of atrial fibrillation post-PFO closure, generalizability of the results of clinical trials in the real world, and the need for assessing the effect of neurocardiology teams on adherence to international recommendations. Other important knowledge gaps such as sex, race/ethnicity, and regional disparities in access to diagnostic technologies, PFO closure devices, and clinical outcomes in the real world are also discussed as priority research topics.

Regional Variation in Health Care Utilization Among Adults With Inadequate Cardiovascular Health in the USA.

Background Prior evidence of region-level differences in health outcomes and specialized healthcare services in the US poses questions of whether there are differences in utilization of healthcare that may account for regional differences in healthcare outcomes. This study aimed to examine regional differences in healthcare utilization for individuals with poor cardiovascular health (CVH) compared to those with ideal/intermediate CVH. Methods In this cross-sectional analytical study, two 3-year periods (2008-2010 and 2018-2020) were pooled and analyzed using multivariate Poisson's regression of region on counts of healthcare utilization, while controlling for relevant covariates. The interaction of the non-southern regions with recent years was to reveal how the regional dispersion in healthcare usage was changing over time for the non-southern regions compared to the south. Results The results showed significant regional variation in healthcare usage for individuals with poor CVH, with lower health utilization rates observed primarily in southern states, consistent with higher rates of coronary heart disease in those regions. The impact of a unit improvement on CVH score was to reduce the level of healthcare utilization by 15.7% ([95% CI, 15 - 17%; p < 0.001]) for individuals with poor CVH and 19.1% ([95% CI, 19 - 20%; p < 0.001]) for the intermediate and ideal subgroups, with the Northeast exhibiting the highest level of healthcare usage. Conclusion Our results suggest that there is a need for public health interventions to reduce regional disparities in access to healthcare for the people at greatest risk of cardiovascular events by considering individual factors as well as the broader regional and policy contexts where these people live.

Cost-utility of real-time continuous glucose monitoring versus self-monitoring of blood glucose and intermittently scanned continuous glucose monitoring in people with type 1 diabetes receiving multiple daily insulin injections in Denmark.

To determine the cost-effectiveness of the Dexcom G6 real-time continuous glucose monitoring (rt-CGM) system compared with both the self-monitoring of blood glucose (SMBG) and the Abbott FreeStyle Libre 1 and 2 intermittently scanned CGM (is-CGM) devices in people with type 1 diabetes receiving multiple daily insulin injections in Denmark. The analysis was performed using the IQVIA Core Diabetes Model, which associates rt-CGM use with glycated haemoglobin reductions of 0.6% and 0.36% based on data from the DIAMOND and ALERTT1 trials, respectively, compared with SMBG and is-CGM use. The analysis was performed from the payer perspective over a 50-year time horizon; future costs and clinical outcomes were discounted at 4% per annum. The use of rt-CGM was associated with an incremental gain of 1.37 quality-adjusted life years (QALYs) versus SMBG. Total mean lifetime costs were Danish Krone (DKK) 894 535 for rt-CGM and DKK 823 474 for SMBG, resulting in an incremental cost-utility ratio of DKK 51 918 per QALY gained versus SMBG. Compared with is-CGM, the use of rt-CGM led to a gain of 0.87 QALYs and higher mean lifetime costs resulting in an incremental cost-utility ratio of DKK 40 879 to DKK 34 367 per QALY gained. In Denmark, the rt-CGM was projected to be highly cost-effective versus both SMBG and is-CGM, based on a willingness-to-pay threshold of 1× per capita gross domestic product per QALY gained. These findings may help inform future policies to address regional disparities in access to rt-CGM.

National Access to EyeSi Simulation: A Comparative Study Among U.S. Ophthalmology Residency Programs.

Purpose The aim of this study was to evaluate regional disparities in access to EyeSi surgical simulation training among U.S. ophthalmology residency programs. Methods Access to EyeSi simulation was determined from sales data (2021) provided by VRMagic. Key demographic metrics of the primary counties of U.S. residency training programs were retrieved from the U.S. Census Bureau Database (2019) and PolicyMap (2021). Demographic metrics, Veterans Affairs (VA) hospital affiliation, and Doximity residency program ranking (2021) were compared using the Mann-Whitney U test and Fisher's exact test. Results A total of 124 residency training programs across 95 U.S. counties were included. Regional density (number of EyeSi simulators/million people) was calculated; the west had a significantly lower density when compared with the northeast (NE), south, and midwest (0.4 vs 1.0, 1.3, 1.1, respectively). In the NE, there was a significantly lower population of Blacks ( p = 0.01), Hispanics ( p = 0.028), and Native Americans ( p = 0.008) residing in counties with access to EyeSi, compared with counties without EyeSi access. Programs with EyeSi access ( N = 95) had a median Doximity ranking of 52.5, whereas programs without EyeSi access ( N = 35) had a lower median ranking of 94 ( p < 0.001). Conclusion Our analysis demonstrates significant disparities in access to EyeSi simulation training in the United States that could disproportionately impact minority communities. Access to an EyeSi simulator was associated with higher residency ranking independent of VA affiliation.

HIV in the Russian Federation: mortality, prevalence, risk factors, and current understanding of sexual transmission.

Although HIV infection in the Russian Federation was historically concentrated among marginalized populations (people who inject drugs, sex workers, MSM, and the prison population), recent evidence suggests that it has become a more generalized epidemic. The objective of our research was to explore how these trends in HIV prevalence and HIV-related mortality compare across Russia. We calculated HIV-associated mortality for both male and female individuals in each region (oblast) of the Russian Federation using data from the Russian Fertility and Mortality Database (RusFMD). Using current data on HIV prevalence, we computed the correlation between HIV prevalence and HIV-associated mortality. We also used oblast-level data to examine the associations between HIV prevalence and the risk factors most commonly associated with HIV infection. Over the past 20 years, the Russian Federation has experienced a rapid increase in HIV-associated mortality in both male and female individuals. Our findings revealed significant heterogeneity, with higher rates of HIV-associated mortality reported in oblasts in the Siberian and Ural Federal Districts. There is a strong correlation (0.8) between HIV-associated mortality and virus prevalence. These findings confirm that there are regional disparities in access and adherence to antiretroviral therapy (ART), as indicated by the low correlation (-0.4) between virus prevalence and access to ART coverage. The results from our modeling analysis revealed that, in addition to the factors most commonly associated with this disease (e.g. intravenous drug use), knowledge about sexual transmission of HIV in the general population has a broad impact on its prevalence at the oblast level. Interventions that reduce HIV prevalence, for example, opioid substitution therapy and needle-sharing programs for people who inject drugs, as well as the increased availability of educational and preventive programs may halt the spread of HIV across the Russian Federation. Similarly, increased access to treatment could help in reducing HIV-related mortality.

433P Variations in radiation oncology treatment access in Asia and its implications on cancer care

An estimated 70-80% of malignancies need multimodal treatment, which includes surgery, radiation, and chemotherapy. Radiation oncology is particularly vulnerable to regional disparities in access to care due to the unique nature of its treatments.It is vital to define geographic and demographic access to radiotherapy in order to improve patient access to clinical care.This first of its kind study aimed at quantifying the available radiation oncology resources across all Asian counties.

Fed up: a qualitative investigation on the influencing factors of food insecurity in the Azores

Abstract Background In 2019, over 1 billion people experienced food insecurity. In the Azores, a 9-island archipelago in the Atlantic Ocean, 13.4% of its population perceived food insecurity, the highest regional rate in Portugal (10.1%). These geographical limitations paired with high unemployment and low education rates, may challenge their access to nutritious food. It is still unclear how these (and other) contextual factors may affect access and availability to food in this remote area, and how they interact with individual determinants. Methods Data collection was conducted in early 2022 with 13, in-depth, 1:1 semi-structured interviews regarding topics of food consumption and supply in the Azores. Non-probability sampling was used, with use of purposive and snowball sampling. We included key-stakeholders currently living in the islands or working in a role related to the islands (i.e., in healthcare, supply chain, agriculture, etc.). We performed a thematic analysis with an inductive-deductive iterative analysis. Results Participants identified several challenges related to access and availability of food. Vegetables, fruit and fish can be scarce and are subject to seasonal variation. There are clear regional disparities in access to food, with more isolated islands having less variety, quality and quantity of healthy foods available. Its topography and weather limit agricultural practices and transportation, but education, culture, and policies subsidizing the production of meat and dairy were also identified as important barriers to local production of fruits and vegetables. Conclusions Food insecurity is a public health concern in this outermost EU region. If topography and geography limit the production and access of nutritious foods, economic and agricultural policies are a leading theme of concern to highlight. The solution for food insecurity thus demands an interdisciplinary dialogue to better adjust future policies in the Azores and in similar regions. Key messages

Social inequalities and gender differences in healthcare management of acute ischaemic stroke in France.

There are regional disparities in access to stroke units in France. Several studies have shown that living in disadvantaged areas is associated with a higher frequency of stroke, worse severity at presentation, increased level of dependency and higher mortality rates. However, few studies have explored the association between an individual's socioeconomic characteristics and stroke care. Our study aimed to determine if living standards are associated with stroke unit access for patients admitted to hospital for acute ischaemic stroke. Using the EDP-Santé French administrative database, all patients admitted to hospital for acute ischaemic stroke between 2014 and 2017 were selected. Acute ischaemic stroke corresponded to hospital stay with International Classification of Diseases 10th Revision codes I63 or I64 as the main diagnosis. Multivariate logistic regression was used to identify if standard of living was associated with likelihood of admission to a stroke unit. In all, 14,123 acute care episodes were identified, corresponding to 335,273 episodes in the general population when appropriately weighted. Of these, 52.9% were admitted to a stroke unit. Being in the first (i.e., poorest) living standard quartile was associated with lower likelihood of admission to a stroke unit compared with the fourth (i.e., wealthiest) quartile, and was associated with a higher likelihood of paralysis and language disorder, and death at 1year. A low living standard was associated with lower likelihood of admission to a stroke unit as well as a greater chance of paralysis and aphasia at the end of hospitalization and a higher possibility of death at 1year after stroke. Greater access to stroke units for disadvantaged people should be promoted.

Disparities in SNAP online grocery delivery and implementation: Lessons learned from California during the 2020-21 COVID pandemic.

During the COVID-19 pandemic in 2020, the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) was rapidly expanded across the US. This program, enabling direct-to-home grocery delivery, could be a transformative step towards improving fresh-food access. However, lack of information on which areas are serviced by SNAP OPP hinders the identification of potential demographic and regional disparities in access. Lessons from the initial implementation period are critical for understanding continuing inequities and informing the implementation of future programs. In California, SNAP OPP expanded food access for 85.9% of the state's SNAP households in 2020–21. Coverage was significantly greater in urban areas, covering 87.2% of CalFresh households in urban limited food access areas as compared with 29.9% of CalFresh households in rural limited food access areas. County-level COVID-19 rates did not have a meaningful association with SNAP OPP coverage.

Emergency Care Sensitive Conditions in Brazil: A Geographic Information System Approach to Timely Hospital Access

BackgroundThe benefits of treatment for many conditions are time dependent. The burden of these emergency care sensitive conditions (ECSCs) is especially high in low- and middle-income countries. Our objective was to analyze geospatial trends in ECSCs and characterize regional disparities in access to emergency care in Brazil. MethodsFrom publicly available datasets, we extracted data on patients assigned an ECSC-related ICD-10 code and on the country’s emergency facilities from 2015-2019. Using ArcGIS, OpenStreetMap, and WorldPop, we created catchment areas corresponding to 180 minutes of driving distance from each hospital. We then used ArcGIS to characterize space-time trends in ECSC admissions and to complete an Origin-Destination analysis to determine the path from household to closest hospital. FindingsThere were 1362 municipalities flagged as “hot spots,” areas with a high volume of ECSCs. Of those, 69.7% were more than 180 minutes (171 km) from the closest emergency facility. These municipalities were primarily located in the states of Minas Gerais, Bahia, Espiríto Santo, Tocantins, and Amapá. In the North region, only 69.1% of the population resided within 180 minutes of an emergency hospital. InterpretationsSignificant geographical barriers to accessing emergency care exist in certain areas of Brazil, especially in peri-urban areas and the North region. One limitation of this approach is that geolocation was not possible in some areas and thus we are likely underestimating the burden of inadequate access. Subsequent work should evaluate ECSC mortality data. FundingThis study was funded by the Duke Global Health Institute Artificial Intelligence Pilot Project.

Emergency Care Sensitive Conditions in Brazil: A Geographic Information System Approach to Timely Hospital Access

Background: The benefits of treatment for many conditions are time dependent. The burden of these emergency care sensitive conditions (ECSCs) is especially high in low- and middle-income countries. Our objective was to analyze geospatial trends in ECSCs and characterize regional disparities in access to emergency care in Brazil. Methods From publicly available datasets, we extracted data on all patients assigned an ECSC-related ICD-10 code and on the country’s emergency facilities from 2015-2019. Using ArcGIS, OpenStreetMap, and WorldPop, we created catchment areas corresponding to 180 minutes of driving distance from each hospital and estimated their contained population. We then used ArcGIS to characterize space-time trends in ECSC admissions and to complete an Origin-Destination analysis to determine the path from household to closest hospital. Findings: In the North, only 69.1% of the population resided within 180 minutes (171km) of an emergency hospital. In the Northeast and Southeast, there were clusters of increasing trends in ECSCs while the South and Midwest saw the opposite trend. The highest density of emergency centers was in Sao Paulo. Interpretations: Significant geographical barriers to accessing emergency care exist in certain regions of Brazil, especially in the North. One limitation of this approach is that, given the lack of roads and zip codes in this region, geolocation was not possible in many areas and thus we are likely underestimating the burden. Subsequent work should evaluate ECSC mortality data. Funding: This study was funded by the Duke Global Health Institute Artificial Intelligence Pilot Project. Declaration of Interest: None to declare.

Factors Affecting the Regional Inequalities in Pediatricians Workload and the Regional Disparities in Access to Pediatric Healthcare Service in Poland

Objective: The decreasing number of physicians is a serious problem in Poland. The purpose of this study was to identify the principal factors that determine the differences in the workload distribution of pediatricians and access to the public pediatric healthcare service in Poland. Methods: Using a range of attributive variables such as population size, socio-economic status, and pediatric service supply, the numerical changes that occurred in the workload of pediatricians (2010 to 2017) in 16 provinces (voivodeships) throughout Poland were analysed. Principal component analysis on the standardized attributive variables of voivodeships was performed and multiple regressions were undertaken. The index of accessibility to pediatricians was determined and its spatial diversity examined. Results: A moderate variation of the pediatrician workload in the period of 2010 to 2017 was found and the clubs convergence of the investigated phenomenon was observed. We identified two principal components: one that reflected the level of socio-economic status and second reflected degree of urbanization. The first component scores was negatively correlated with the number of treated patients per pediatrician. The study confirmed positive correlation between index of accessibility to pediatricians and disposable income per capita (0.672, p=0.004) and negative one with the number of treated patients per pediatrician (-0.663, p=0.005). Conclusion: The regional diversity of pediatrician's workload is governed by the rules of club convergence. An insufficient number of physicians and their high workload may have a significant impact on the quality of treatment provided.

Regional disparities in access to assisted reproductive technology: assessment of patient satisfaction when employing modern technology to close the gap

PurposeGeographic disparities for assisted reproductive technology (ART) continue to exist. Travel cost and time off work may create additional barriers for patients living remotely. Implementing telehealth can alleviate these barriers by reducing office visits. The aim of this study was to evaluate patient satisfaction with telehealth during ART.MethodsThis was a cross-sectional survey and retrospective cohort study. Patients living remotely who underwent ART utilizing telehealth between 2015 and 2018 at a single institution were selected for the telehealth group. The non-telehealth control group included randomly selected patients who underwent IVF at the same institution between 2015 and 2018. Demographic variables and treatment outcomes were obtained for both groups. A patient satisfaction questionnaire was distributed to telehealth patients. Statistical analysis using χ2 test was performed to compare ART outcomes between both groups.ResultsNinety-seven control and 97 telehealth patients were included. For telehealth patients, the mean number of office visits and distance traveled was 2.9 (± 0.8 SD) and 143.1 miles (± 49.2 SD) respectively. 58.8% of patients completed the survey. 44/57 participants had an oocyte retrieval and 42/44 underwent embryo transfer. For those who completed the survey, the clinical pregnancy rate was 31/44 and the live birth rate was 25/44. There was no difference in treatment outcomes between telehealth compared to controls. 73% of patients were highly satisfied with telehealth.ConclusionsTelehealth can improve access to ART in underserved areas and results in high patient satisfaction. Reproductive health providers could consider telehealth as a safe and efficacious tool to ameliorate geographic disparities.

A tale of two reforms: Telecommunications reforms in Mexico

The telecommunications industry in most parts of the world experienced a round of market-led reforms in the early 1990s. After a period of sustained development in the sector numerous countries are moving toward government-led network deployments. Even though it may appear as if the pendulum swung back to the previous 1990s period of government-led development, this paper argues persistent regional disparities in access and adoption of new technologies generated a need for public action in the second reform. By analyzing the Mexican case and comparing the policy choices in each one of the reforms, this paper sheds light on how particular policy decisions in the first reform generated inefficient market solutions and were key in creating a perception of the need for stronger public action. In both reforms, the policymaking process was carried out by a small elite that negotiated its contents behind closed doors. Paradoxically, within the transition to democracy, in the second reform, the leaders of the major political parties established a closed-door agreement. Even though the 2013 telecommunications reform improved the status quo, it did not decrease market concentration and, once again, we face low levels of investment and high levels of digital exclusion. By reconstructing the policy decision process in each reform, this paper argues that the closed-door policy choices taken, which were the result of the interaction of political actors with their own agenda and interests, hampered the most efficient solutions.

Access to radiotherapy and its association with cancer outcomes in a high-income country: Addressing the inequity in Canada

Background and purposeCanada is a high-income country with universal healthcare. In international comparisons, its overall level of access to radiotherapy appears sufficient. However, challenges exist due to Canada’s large geographic area and small population density. The association between access and cancer outcomes nationally has not yet been described. Materials and methodsWe quantified geographic accessibility for 2012 using the linear distance from each Canadian health region centroid to the nearest radiotherapy center. We used geospatial analytic techniques to detect clusters of age-standardized all-cancer mortality-to-incidence ratios (MIRs) across health regions, from 2010–2012. Global ordinary least squares (OLS) and geographically-weighted regression (GWR) were conducted to examine relationships between distance and MIR, adjusting for sociodemographic factors. ResultsMedian distance from health region centroid to nearest radiotherapy center was 101.73 km (range 1.14–2095.12). One cluster of worse outcomes (MIR range 0.45–0.88) involved most of northern Canada, with a second cluster of better outcomes (MIR range 0.40–0.41) in southern British Columbia. In both regression models, regions with longer distance to radiotherapy center (ß = 0.0001), increased smoking (ß = 0.002), and poorer food security (ß = –0.003) were significantly associated with worse outcomes (OLS R2 = 0.70, GWR R2 = 0.74). Distance remained independently associated with MIR for lung and colorectal cancer subgroups, but not breast and prostate. ConclusionsA clear north–south discordance in cancer outcomes exists in Canada, with poorer outcomes in the north, while radiotherapy centers are concentrated along the south. Increased distance to radiotherapy, along with other sociodemographic and health-system factors, are associated with poorer cancer outcomes. Our study could be replicated, particularly in other high-income countries, to help identify national patterns and regional disparities in access and outcomes.

Equity analysis of resource distribution for the Popular Pharmacy Program.

ABSTRACTOBJECTIVE To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region.METHODS Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program.RESULTS The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%.CONCLUSIONS Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.

Regional disparities in access to higher education in Greece

This study examines the geographical dimension of access to higher education in Greece by mapping spatial disparities in the distribution of vathmos prosvasis, the decisive score for being accepted...