Social Inequalities In Use Research Articles

Access to health services for non-Covid-19 causes during the pandemic. A literature review

Abstract Background Negative effects of the Covid-19 pandemic on access to care for other diseases are currently at debate. Aim To review existing literature on care access for non-Covid-19 conditions since the pandemic onset. Methods Scoping review using various databases (Medline, VHL, Web of Science, 2020/21). Terms used: ‘access', ‘health services', ‘Covid-19'. Out of 4,060 identified articles, 37 were selected after reviewing and assessing titles, abstracts and full text. Aday and Andersen's framework guided the analysis. Results Of selected articles, 21 analyse impact on health services use; 8 on performance; 8 on access barriers. Most analyse specific services during early pandemic stages through register review, showing an initial decline in use with inconsistent results on recovery. Some indicate increased complexity of treated patients and treatment delays. Studies surveying professionals analyse the impact on services performance or clinical practice, reporting a decrease in consultations/interventions for diverse pathologies and response implementation (e.g. telemedicine), but not how they affected access. Few studies focus on social inequalities in use, showing a greater reduction in low-income or ethnic minority users. Studies on unmet needs, access or barriers based on user surveys or qualitative methods are scarce, focused on a pathology or clinical area. Particularly in Spain, studies analyse impact on use of emergency, primary care and cancer diagnosis, and on emergency and cardiology services functioning. Studies based on user surveys are lacking: only a qualitative study analysed access difficulties for chronic patients in confinement. Methodological weaknesses are identified. Conclusions Although currently emerging, studies analysing the pandemic impact on equal access to care for non-Covid-19 conditions are scarce, limited in focus and methodology, especially in Spain. Comprehensive medium/long-term impact assessments, including analysis of causes, are needed. Key messages Research is lacking on the impact of the COVID-19 pandemic on healthcare access, particularly for vulnerable groups. Further evidence is needed to improve health systems resilience in the future.

Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries

This study examined inequalities in dental check-ups and medical screenings using subjective and objective socioeconomic indicators. Data from 23,464 adults, aged 20 years old and over, who participated in a multi-national survey across Europe (Eurobarometer 72.3) were analysed. Participants’ socioeconomic position (SEP) was measured by education, difficulty in paying bills and subjective social status. Use of preventive services was measured by attendance for dental check-ups, cancer and cardiovascular screenings in the past 12 months. Socioeconomic inequalities were assessed in two-level logistic regression (adults nested within countries), adjusting for demographic factors and type of healthcare system. There were apparent social inequalities in using all three preventive services. However, only dental check-ups showed consistent and significant inequalities across all socioeconomic indicators with those in the bottom groups in education (odds ratio: 0.51; 95% confidence interval: 0.46–0.55), difficulty in paying bills (OR: 0.64; 95% CI: 0.59–0.72) and subjective social status (OR: 0.63; 95% CI: 0.57–0.69) having lower odds of reporting dental check-ups in the past 12 months than those in the top groups. Cancer screening was not associated with difficulty in paying bills whereas cardiovascular disease screening was not associated with education and subjective social status. Despite the availability of universal health coverage, there were clear social gradients in using preventive services particularly across education and subjective social status groups. The stronger and more consistent gradients observed in dental check-ups compared to cancer and cardiovascular screening could be attributed to difference in the level of coverage of dental and medical services in Europe.

Countries With Public Dental Care Coverage Have Lower Social Inequalities in the Use of Dental Services Than Countries Without Such Coverage

Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage? Palència L, Espelt A, Cornejo-Ovalle M, Borrell C.Community Dent Oral Epidemiol 2014;42:97-105. Stefan Listl, Priv-Doz, Dr rer pol, Dr med dent, MSc The authors analyzed samples of persons age 50years or older from 11 European countries to examine whether social inequalities in dental care use are lower in countries with than in countries without public dental care coverage. None Cross-sectional study Level 3: Other evidence Not applicable.

Social inequalities in use of potentially addictive drugs in Norway – use among disability pensioners

Objectives: The Norwegian Government urges that actions are needed to stimulate the working capacity in disability pensioners (DPs) with such a potential. Information on factors that may impair rehabilitation efforts, including use of potentially addictive drugs, may be useful in this context. Thus, the aim was to study the association between DP on initiation as well as long-term use of benzodiazepines (BZDs), and to describe aspects of problematic use of BZDs in terms of: long-term use pattern, including escalation of dose over time, and use of other potentially addictive drugs.Methods: We followed a cohort of 8,942 men and 10,578 women aged 40, 45, 60 years (non-users of BZDs at baseline), who participated in health surveys in 2000-01 in three Norwegian counties, with respect to use of BZDs, and other potentially addictive drugs, by linkage to the Norwegian Prescription Database (NorPD) for 2004-2007. Information on DP status was retrieved from Statistics Norway.Results: Incident BZD use was highest among female DPs; 18-20% compared to 5-8% of the non-DPs. Multivariable analyses revealed an independent effect of DP on incident (OR 1.6 (95% CI 1.4-2.0)) and long-term use (OR 2.47 (95% CI 1.90-3.20)) of BZDs. Among incident users, 51-60% of the DPs retrieved BZDs throughout the period 2004-07, as compared to 32-33% of the non-DPs. The annual median defined daily doses (DDDs) of BZDs among long-term users increased throughout the period 2004-07, most pronounced in the youngest DPs; from 50 (interquartile range (IQR) 14,140) DDD to 205 (IQR 25,352) DDD.Conclusions: The chance of being prescribed BZDs as well as becoming a long-term user was higher among DPs. High continuation rates, with a steadily increasing annual amount of use among the long term users may reflect an unfavourable use pattern of potentially addictive drugs among DPs, most worrisome among the youngest.

Social inequality in use of dental services: relief of pain and extractions

The aim of this study was to assess social inequality in use of dental services by examination of visiting for relief of pain and receipt of extractions. Data were collected in the period of 2004-06, from a stratified clustered sample of Australians aged 15+ years, using a computer-aided telephone interview. Analysis was restricted to n=10,099 dentate adults. Visiting for relief of pain varied by age, country of birth, education and income with lower odds (Odds ratio, 95%CI) among 55-74 (0.43, 0.35-0.54) and 75+ year-olds (0.22, 0.15-0.33) compared to the 15-34 year-olds, lower odds among Australian-born persons (0.82,0.69-0.98) compared to those born overseas, higher odds for those with no post-secondary education (1.31, 1.07-1.61) and with TAFE, trade or other qualifications (1.34, 1.09-1.66) compared to university qualified, and for those in the <$20,000 income group (1.61, 1.23-2.12), the $20,000-<$40,000 (1.53, 1.20-1.96) and the $40,000-<$60,000 group (1.33, 1.02-1.72) compared to <$80,000+. Receipt of extractions varied by age, sex, qualifications and income, with lower odds of extraction among persons of 75+ years (0.61,0.40-0.93) compared to the youngest age group, higher odds among males (1.34, 1.13-1.59) compared to females, those with no post-secondary education (1.59, 1.27-1.99) and with TAFE, trade or other qualifications (1.49, 1.21-1.84) compared to university qualified, and for the income groups <$20,000 (3.06, 2.27-4.12), $20,000-<40,000 (2.37, 1.80-3.12) and $40,000-<60,000 (1.94 1.47-2.55) compared to the $80,000+ income group. The results indicate social inequality in provision of dental services and suggest an urgent need for the dental profession and governments to address this inequality.

Social Inequalities in Use of Prenatal Care in Manitoba

ObjectiveAnalysis of regional variations in use of prenatal care to identify individual-level and neighbourhood-level determinants of inadequate prenatal care among women giving birth in the province of Manitoba. MethodsData were obtained from Manitoba Health administrative databases and the 1996 Canadian Census. An index of prenatal care use was calculated for each singleton live birth from 1991 to 2000 (N=149 291). Births were geocoded into 498 geographic districts, and a spatial analysis was conducted, consisting of data visualization, spatial clustering, and data modelling using Poisson regression. ResultsWe found wide variation in rates of inadequate prenatal care across geographic areas, ranging from 1.1% to 21.5%. Higher rates of inadequate care were found in the inner-city of Winnipeg and in northern Manitoba. After adjusting for individual characteristics, the highest rates of inadequate prenatal care were among women living in neighbourhoods with the lowest average family income, the highest proportion of the population who were unemployed, the highest rates of recent immigrants, the highest percentage of the population reporting Aboriginal status, the highest percentage of single parent families, the highest percentage of the population with fewer than nine years of education, and the highest rates of women who smoked during pregnancy. ConclusionsSocial inequalities exist in the use of prenatal care among Manitoba women, despite there being a universally funded health care system. Regional disparities in rates of inadequate prenatal care emphasize the need for further research to determine specific risk factors for inadequate prenatal care in socioeconomically disadvantaged neighbourhoods, followed by provision of effective targeted services.