Introduction Indigenous peoples tend to differ from their non-Indigenous counterparts in use of health care services. Lack of available services, socioeconomic disparities, communication barriers and lack of trust have been found to be barriers driving the observed differences. Aim The aim of this study is to investigate ethnic differences in the use of assigned general practitioner and emergency health care (2012–2019) while adjusting for age, length of education, and county of residence. Methods Data from the SAMINOR 2 Questionnaire Survey was linked to records from the Norwegian Control and Payment of Health Refunds Database. Sami ethnicity was the primary exposure variable. Differences in mean number of consultations were investigated using the two-sample t-test. Adjustments for age (18–69 years), county of residence (Nordland/Trøndelag, Troms, Finnmark) and years of education (≤12 years, >12 years) were done using the generalized linear models Poisson loglinear and Negative binomial with log link. Results The study population consisted of 10,694 individuals: 5986 women (28.9% Sami) and 4708 men (22.7% Sami). Sami individuals had a significantly higher mean use of emergency medical care annually, and over the entire study period (2012–2019): Women (Sami 0.51, non-Sami 0.31, p < 0.01), Men (Sami 0.40, non-Sami 0.25, p < 0.01). However, no significant differences were observed in use of general practitioners. Adjusting for covariates did not alter the results for either outcome. Conclusion The findings highlight ethnic disparities in primary healthcare utilization, showing higher use of emergency medical care in Sami compared to non-Sami. Further research should explore the underlying and probably multifaceted factors driving the observed differences.

This article presents a research project examining expectations directed toward data, and the practices of data production and use in healthcare and social welfare services. Theoretically, the study is grounded in science and technology studies and critical data studies. The datafication of health and social services is analysed primarily through the concepts of sociotechnical imaginaries, friction, data work, and gendered practices. The results show that 1) the strategies and action plans of health and social services are marked by unrealistic expectations regarding digitalisation and the capabilities of data driven systems; 2) in practice, even simple automation can create friction – that is, additional work – even when such systems function as intended; 3) data work in health and social services is gendered and therefore often remains invisible; and 4) the maintenance of data quality is hindered by organisational factors, unstable and incomplete information systems, lack of time and resources, and incorrect entries. The authors argue that, in order to understand datafication, it is essential to study how data driven technologies operate in practice and to develop concepts that enable the analysis of their functioning.

Background: Maternal healthcare in Afghanistan remains a challenge as it has the highest maternal mortality rate around the globe. Over the last decade, political instability has affected Afghanistan's health system and utilization of healthcare services. Objectives: The study examines the utilization of maternal healthcare services in Afghanistan during 2010-2011 to 2022-2023 to determine the changes of maternal health over the time. Methodology: To achieve the study objective, data has been utilized from two rounds of Multiple Indicator Cluster Surveys (MICS4-2010-11 and MICS6-2022-23). Results: The findings revealed that antenatal care coverage increased significantly from 58% in 2010-2011 to 74% in 2022-23 (p < 0.001). The results also show a substantial growth in deliveries occurring at public health facilities (from 31.6% to 56.9%) and a 4-percentage-point decline in caesarean section deliveries during the study period. Furthermore, the findings indicate that women's education levels played an important role in shaping these outcomes. Conclusion: Maternal healthcare utilization may have increased between the two survey periods, the political transition during the survey period was not directly measured, limiting the ability to draw causal inferences. The study findings highlight that improvements in women's education and economic status are strongly associated with higher use of maternal healthcare services. Persistently low levels of educational attainment and poor economic conditions among women remain significant barriers to accessing essential maternal health services. Ensuring equitable access to education and healthcare is therefore critical for improving maternal health outcomes and advancing Afghanistan's progress toward achieving Sustainable Development Goals 3 and 4.

To compare the pattern of psychotropic drug prescriptions in adolescents who started a drug therapy after the COVD-19 pandemic and in adolescents who began before the pandemic. A healthcare database from Italy's Lombardy region was analysed to compare the prescription profiles of psychotropic drugs (N05 and N06 groups of the Anatomical Therapeutic Chemical classification system) and access to healthcare services among two cohorts of adolescents aged 12-17 years. One cohort received their first psychotropic drug prescription in 2018 (pre-pandemic), and the other received theirs in 2021 (post-pandemic). The incidence, number of prescriptions and persistence of therapy within 12 months of the first prescription date and prevalence of polytherapy (prescription of more than one psychotropic class) were evaluated. Additionally, access to healthcare services was monitored before and after the index prescription. The incident users were 1734 in 2018 and 2943 in 2021; the incidence increased from 3.01 per 1000 to 4.97 per 1000 (incidence rate ratio [IRR] 1.64; 95% CI 1.55-1.74), with the largest rise in girls aged 12-14 (IRR 2.35; 95% CI 2.01-2.77). Among girls, the median number of prescriptions (+50%), prevalence of polytherapy (+57%) and persistence at 12 months (+31%) all increased post-pandemic, while no significant changes were observed among boys. Healthcare service use was higher prior to initiation in 2021 (65.7%) than in 2018 (58.4%). The increase in incidence and intensity of psychotropic drug prescriptions in adolescent girls confirms the existence of sex-related differences in mental health during the pandemic.

Access to affordable and quality healthcare remains a persistent challenge in low- and middle-income countries, where high out-of-pocket expenditures expose households to financial hardship and delayed care-seeking. In contexts such as Eastern Democratic Republic of Congo, community-based financial mechanisms like Village Savings and Loan Associations (VSLAs) are increasingly recognized as potential pathways to strengthen household resilience and improve access to healthcare. This study examines the extent to which women’s participation in VSLA savings functions as a financial buffer influencing health-seeking behavior. A baseline cross-sectional comparative design was employed between November 2024 and January 2025 across three health zones (Goma, Karisimbi, and Nyiragongo). A total of 420 VSLA members were sampled, equally divided into intervention and control groups. Data were collected through structured interviews and analyzed using descriptive statistics, chi-square tests, and odds ratios to assess associations between savings participation, income levels, duration of membership, and healthcare utilization indicators. The findings indicate no significant baseline differences between groups in illness occurrence or healthcare utilization, confirming comparability. However, important trends emerge. While VSLA participation does not significantly influence the occurrence of illness, it is positively associated with healthcare-seeking behavior, particularly among members with 4–6 years of participation (OR = 1.91, p &lt; 0.05). Higher savings levels are also associated with increased use of formal healthcare services. Despite these improvements, over 90% of respondents rely on out-of-pocket payments, with minimal uptake of health insurance. In conclusion, VSLA savings participation enhances households’ financial capacity to seek healthcare but remains insufficient to ensure financial protection. Integrating VSLAs with community-based health insurance and strengthening health system support mechanisms are essential to achieving more equitable and sustainable healthcare access.

To investigate the access to specialist palliative care (SPC) and its impact on healthcare utilization at the end of life in patients with multiple myeloma (MM). This retrospective cohort study examined all Finnish patients who died of MM in 2019. Data were collected from national health databases. Patients were categorized by whether they had contact with SPC or not. We identified 278 patients (median age at death 77.5 years, 44.2% male), of whom 23.4% had SPC contact a median of 38 days before death. During the last 6 months of life, 92.4% of all patients had contact with the emergency department, 83.5% were hospitalized in secondary care, and 65.5% were hospitalized in primary care hospitals. Patients with SPC contact had fewer emergency department visits (50.8% vs. 65.3%, p = 0.041) and hospitalizations in secondary care (41.5% vs. 62.0%, p = 0.004) in the last month of life and fewer hospital deaths (69.2% vs. 84.0%, p = 0.012). Despite high healthcare service utilization at the end of life, access to SPC was often limited and late. Contact with SPC reduced acute healthcare utilization at the end of life, indicating better end-of-life care.

Vasculitis often poses a significant burden on individuals, their families and the health care system. Understanding its epidemiology can aid in facilitating timely interventions. We present a province-wide population study comparing the 1) incidence of vasculitis amongst farmers, rural-non farmers and urban residents, 2) the use of health services and 3) all-cause mortality rates across the three cohorts. The groups were randomly selected on the basis of provincial health data.Criteria for ascertaining vasculitis cases included either one hospital admission, two physician visits within a 2-year interval, or two ambulatory care visits within 2years related to the vasculitis diagnosis. Descriptive statistics were used to compare the incidence rates. A total sample size of 302,089, with 5437 vasculitis cases. Farmers had the highest incidence of all types of vasculitis (109.8/100,000 person-years (PY)), followed by rural non-farmers (93.1/100,000 PY) and urbanites (71.7/100,000 PY). Age at diagnosis was higher among farmers (66.2years) compared to rural non-farmers (64.5years) and urbanites (63.9years). Polymyalgia rheumatica (PMR) accounted for 47% of cases, followed by Arteritis Unspecified (15%) and small-vessel vasculitis (14%). Within the farming population, a higher percentage of males had positive cases of vasculitis compared to other populations. Rural non-farmer population had the highest use of health care services and unadjusted non-injury mortality rate (31.8/100,000 PY), followed by rural farmers (25.4/100,000 PY) and urban residents (23.8/100,000 PY). Our province-wide study revealed that farmers face the highest incidence rates of vasculitis as well asthe second highest burden of disease in terms of healthcare service needs and mortality. Key PointsAQ • There is a notable variation in the incidence rates of vasculitis among farmers, rural and urban residents with the farming population showing the highest incidence rate across most subtypes of vasculitis. • Farmers had a greater percentage of males diagnosed with vasculitis and an older age at diagnosis. • Rural non-farming patients with vasculitis demonstrate the highest utilization of healthcare services and mortality.

Many governments around the world subsidise upgrades to poorly insulated homes, yet the extent to which these energy-efficiency improvements reduce health risks remains unclear. We aimed to provide the first large-scale evidence on whether such retrofits lower the use of respiratory health-care services, particularly for children and other vulnerable individuals. We leveraged a large-scale natural experiment in which public housing units across the Netherlands were retrofitted between 2012 and 2021. Upgrades included insulation and mechanical ventilation and were implemented in homes eligible on the basis of poor energy efficiency and construction before the early 1990s. Treatment assignment was based on technical factors and was therefore shown to be unrelated to health outcomes, and opting out was not possible. We followed up 2 million individuals over 10 years, totalling approximately 12 million person-years-a sample size that provided high statistical power (95% CIs narrow enough to detect relative risk changes in medication use as small as 1%). Individual-level medication data were obtained from health insurers. Medication use and other health-care outcomes among 180 000 tenants in retrofitted homes were compared with those in not-yet-retrofitted homes using a staggered difference-in-differences design with individual fixed effects. The primary outcomes were the use of prescription respiratory-system medications: asthma or chronic obstructive pulmonary disease drugs, cough remedies, and antihistamines. Antihistamine use declined by 1·87% (95% CI 0·19-3·55; p=0·029) after retrofits. Among children younger than 18 years, respiratory medication use fell by 3·76% (1·04-6·48; p=0·0067). Specifically, after 5 years, asthma medication use was reduced by 6·91% (-0·04 to 13·85; p=0·051). No statistically significant effects were found for non-respiratory medication outcomes and health-care costs. Energy-efficiency upgrades led to measurable reductions in respiratory medication use, especially for children. These benefits probably reflect reduced exposure to indoor dampness and bad air quality. Childhood asthma reduction is a crucial co-benefit of energy-efficiency home upgrades. NWO Dutch Research Council, RVO Netherlands Enterprise Agency, and Villum Fonden.

BackgroundDiabetes mellitus and obesity represent public health challenges, with implications for healthcare utilization. While obesity increases the risk of diabetes and related comorbidities, its impact on healthcare service use among diabetic patients in the Saudi context remains underexplored.ObjectivesOur study aimed to examine the associations between BMI categories and patterns of healthcare utilization among People with diabetes.MethodsA cross-sectional analysis was conducted in 2024 using medical records from DSFH, Jeddah, Saudi Arabia, including 125,660 People with diabetes. Descriptive statistics summarized demographic, anthropometric, and utilization characteristics. Associations between BMI categories and demographic/utilization variables were assessed using chi-square tests. Multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for healthcare utilization across BMI categories.ResultsThe mean age was 58.7 years (SD = 14.7), and the mean BMI was 31.5 kg/m2 (SD = 5.9). Overweight and obesity were prevalent in 58.8 and 30.0% of patients, respectively, With significant associations between BMI and demographic/utilization variables (p < 0.001). Regression models revealed that overweight [OR = 1.43, 95% CI (1.37, 1.50)] and obese patients [OR = 1.83, 95% CI (1.75, 1.91)] utilized more outpatient services. In contrast, underweight patients had significantly higher odds of inpatient admissions [OR = 2.14, 95% CI (1.84, 2.48)]. Insurance was associated with increased outpatient and emergency utilization.ConclusionBMI and demographic factors are significant predictors of healthcare utilization among People with diabetes.

ABSTRACT This retrospective cohort study aimed to characterize individuals who self-identify as LGBTI+ entering the long-term aged care sector in Australia and their aged and health care services utilization after an aged care eligibility assessment or entering care. About 471 individuals were identified in the three-year study period. The median age at assessment was 77 (IQR 71–84), 45% (n = 212) identified as female, and 21.9% (n = 103) had a diagnosis of dementia. Within 12 months of their aged care eligibility assessment, 29.1% (n = 137) of the participants had not accessed any aged care services. LGBTI+ adults that did access services were young with a median age of 80 (IQR 73–85) for permanent residential care and a median age of 76 (IQR 70–84) for home care packages. Following aged care eligibility assessment, 21.9% (n = 101) of the participants had accessed a chronic disease management plan, and 26.5% (n = 111) experienced unplanned hospitalization. Our findings provide insights into how LGBTI+ older adults use aged and health care services in Australia to inform policy to improve health equity, service design and positively influence outcomes for this population.

The enhancement of women’s well-being through pregnancy, childbirth and following delivery is known as maternal health. However, lack of access to clean drinking water in households leads to a lot of time spent for collection of water by women and girls, resulting in an inability to avail of maternal healthcare services. As evidence on this topic for India is scant, we analyse the relationship between water carriage and continued use of skilled maternal healthcare services, namely antenatal care (ANC), delivery and postnatal care (PNC). Using data on 31,054 women from the National Family Health Survey-4 (NFHS-4), 2015–2016, we find that women who have to fetch drinking water for their households are significantly less likely to avail all three services from skilled personnel as compared to their counterparts who have it available on premises or get it delivered to their homes. Hence, providing safe indoor water is critical for the reduction of maternal deaths in India.

Exploring online and in-person mental healthcare access and app use in a cohort of people living with disability: results from the 2019 and 2020 California Health Interview Survey

BackgroundSurvey research has the potential to elevate the experiences and opinions of marginalized populations. The rising number of bot attacks, a method of participant fraud that creates multiple records in survey data using automated software, threatens to drown out those voices and produce inaccurate findings. Rapid identification and mitigation of bot attacks are vital; however, there is limited guidance for researchers on scalable approaches to address this problem.ObjectiveThis study aimed to assess how well recommended methods detect fraud using an epidemiological diagnostic test framework to inform web-based survey researchers on how best to identify and shut down bot attacks.MethodsWe analyzed data from a cross-sectional web-based statewide survey on access to pediatric subspecialty care in California that used Qualtrics survey software. Caregivers of children with chronic conditions were recruited through family resource centers (FRCs), nonprofit agencies serving families with developmental delays and chronic medical conditions. The survey was sent out to 17 FRCs, whose staff distributed anonymous links to their clients through listservs and flyers. Respondents who completed the survey received a US $30 gift card. Prior to launch, we designed a protocol to identify and respond to bot attacks and reviewed responses for markers of fraudulent activity. If markers were identified or there was a spike in responses, a senior member of our research team reviewed patterns among all submitted surveys for each FRC to look for signs of bot attacks. We calculated epidemiologic measures of diagnostic test accuracy, such as sensitivity, specificity, positive predictive value, and negative predictive value, which describe a test’s ability to distinguish “disease” (in this case, fraudulent records) from normal cases, to better understand the utility of recommended strategies to identify bot attacks.ResultsWe received 646 valid survey records and 905 fraudulent records resulting from bot attacks. The primary indicator of a bot attack was a sudden spike in responses to the survey. Differences in demographics and outcomes, including wait times for pediatric subspecialty care and use of health care services, between the valid and fraudulent data indicated that failure to remove fraudulent records would have substantially altered the survey results. Most recommended methods in the literature for identifying fraudulent responses had low sensitivity to detect bot attacks, and only 2 were better than chance alone at correctly identifying bot attacks. Combinations of fraud markers and blocks of repeated responses were particularly useful to identify bot attacks.ConclusionsFraudulent data entry using bots is increasing in survey research. Sharing flexible protocols to identify and mitigate them in a way that is responsive to their ever-changing nature is vital to ensuring that researchers elevate the voices of real people within survey research to inform policy and programmatic discussions.

Adolescence is a developmental stage characterized by significant physiological, psychological, and social changes. These changes are known to have a direct impact on medication use and adherence to treatment. Adolescents tend to have low adherence rates to treatment for chronic illnesses. When irrationally managed, this situation can lead to problems such as inadequate disease control, increased risk of complications, and increased use of healthcare services. The aim of this review is to evaluate the factors affecting medication adherence in adolescents, especially those specific to adolescents, considering the current literature and to suggest solutions. This review examines the implications of physiological and neurodevelopmental differences accompanying pubertal development on pharmacokinetic and pharmacodynamic processes. It also discusses the role of psychosocial factors such as the pursuit of autonomy, peer influence, aesthetic concerns, and performance anxieties on adherence during adolescence. Furthermore, changes in drug formulations and routes of administration, increased independence in accessing medications, and the transfer of treatment responsibility from parents to adolescents are evaluated. The potential contributions of digital health applications and mobile technologies to supporting adherence in adolescents are also addressed. Finally, recommendations aimed at increasing adherence through rational drug use in adolescents are presented. In conclusion, drug adherence in adolescents, which significantly determines the outcome of pharmacotherapy, is a complex process shaped by the interaction of numerous biological and psychosocial factors that requires holistic, developmentally appropriate approaches.

Despite its limited therapeutic value, high costs and the fact that it can compromise a patient's quality of life, aggressive care continues to be provided at the end of life. It has been associated with a significant symptom burden for patients, a greater use of healthcare resources, delay in accessing palliative care programmes and personal/family and healthcare costs. To investigate sociodemographic, clinical and community healthcare service factors associated with aggressive end-of-life care across malignant and non-malignant conditions. A 1-year retrospective analysis was conducted in a tertiary care centre in Saudi Arabia. All deaths of adult patients that occurred between 1 January, 2023 and 1 January, 2024, were included. Data were retrieved from medical charts, including sociodemographics, medical history, invasive medical interventions and use of healthcare services in the last 3 months of life. The study included 590 adults (mean age 59.6 years; 52.2% male), with 62% diagnosed with malignancy. The majority (71%) had one or more chronic comorbidities. In their last 90 days, 48.6% were admitted to the intensive care unit. Advance directives were present for only half of the patients included in this study. Non-malignant patients received significantly more aggressive end-of-life care, including intubation and cardiopulmonary resuscitation. Palliative care referrals were low overall (48.1%), but higher in cases of malignancy (70.5%). Patients with involvement in a palliative care team showed a lower symptom burden and less aggressive treatment. These findings suggest unequal access to end-of-life advocates for earlier palliative care referral, which could reduce aggressive treatments, especially for younger patients with non-malignant diseases. Non-cancer referral rates were low, highlighting a need for further collaboration and integration with palliative care services.

Common mental disorders (CMDs) are a leading cause of sickness absence and early retirement due to health problems. Early identification and treatment of CMDs may have a positive impact on prognosis and associated economic costs, including healthcare expenditure, lost productivity, and the societal burden. The effectiveness of workplace psychotherapeutic interventions has been studied, but information on cost-effectiveness in this population is lacking. This study evaluates the cost-effectiveness of the FRIAA intervention for employees with CMDs compared to care as usual (CAU), with the aim of reducing sickness absence and preventing early retirement. We used data from a multicenter randomized controlled trial involving 549 employees with mental health problems in different companies located near five study centers in Germany, who provided data at nine- and 15-month follow-up. A total of 545 records were available for the economic evaluation (EE). 278 participants were assigned to the intervention group (FRIAA), and 267 participants were assigned to the CAU condition. On average, intervention participants received eight intervention sessions. The use of health and social care services was assessed using the Client Sociodemographic and Service Receipt Inventory (CSSRI) at nine- and 15-month follow-up. Data were transformed to a 12-month reference period. Quality of life was measured using the EQ-5D-5L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional quality adjusted life year (QALY). The annual cost difference between FRIAA and CAU was euro 3,484.29 (95 % confidence interval [CI] euro 1,033.91 to euro 5,934.67), which was significant (p = 0.005). We estimated the average QALY in the CAU group to be 0.768 (SD = 0.200) and in the FRIAA-group to be 0.789 (SD = 0.192). The difference in QALY between FRIAA and CAU was 0.021 (95 % CI -0.013 to 0.055), which was not significant (p = 0.203). The incremental cost-utility ratio (ICUR) showed that the intervention was associated with costs of euro 165,918.57 for one additional year of full health. As far as we know, this was the first EE of a psychotherapeutic consultation at work called FRIAA. Compared to CAU, FRIAA did not result in improved quality of life in terms of QALYs, nor favourable cost-utility for FRIAA compared with CAU. The FRIAA intervention cannot be considered cost-effective compared to CAU. This EE found that differences in costs were significant (with higher costs in the FRIAA group), while no statistically significant differences in QALYs were observed between the study groups. In addition, the cost-utility for FRIAA compared with CAU was not favourable. Participants with CMDs may need more time to integrate what they discuss in psychotherapy sessions into their daily lives before they can improve their personal quality of life and thus show long-term changes in sick days. Longer follow-up periods may be needed in future studies.

BackgroundMigrants in Europe often face barriers to healthcare, contributing to poorer health outcomes. While healthcare utilisation has been studied within Beveridge systems (eg, the UK) and Bismarck systems (eg, Germany), less is known about healthcare use by migrants within the Netherlands’ hybrid model. The Dutch model combines a Bismarckian base with Beveridge-like supplements. We investigated the use of general practitioner (GP) services, specialist care, allied health services and complementary medicine among major migrant groups in Amsterdam (South Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin) compared with the Dutch-origin population.MethodsWe used pre-pandemic Healthy Life in an Urban Setting data (2015; n=21 614) to avoid biases from intra-COVID-19 and post-COVID-19 healthcare disruptions/alterations. Structured questionnaires assessed healthcare use and reasons for seeking care. Poisson regression with a log link and robust (sandwich) standard errors examined associations between migration background and healthcare utilisation, adjusting for demographics, acculturation, health literacy, lifestyle and chronic conditions. Sensitivity analyses explored motivations for care use and overall health status.ResultsAll migrant groups reported higher or similar use of GP services compared with the Dutch-origin population. Most migrant groups (except Ghanaians) also reported higher or similar use of specialist and allied health services. Conversely, use of complementary medicine was higher among Dutch-origin participants than among migrants.ConclusionMany migrant groups in Amsterdam show higher use of mainstream healthcare services compared with previous reports from other European settings. Further studies should examine and dissect these patterns to inform improvements in other European settings.

Underserved older adults face increased risk for certain chronic conditions and multimorbidity, yet research on healthcare spending and utilization in these groups is limited. For example, there is a glaring absence of research on sexual and gender minority (SGM) Medicare beneficiaries. To address this gap, this study uses linked data from Aging with Pride: National Health, Aging and Sexuality/Gender Study (NHAS) and CMS Chronic Conditions Warehouse data (n = 902) to examine chronic conditions, healthcare spending and utilization among a diverse sample of SGM older adult Medicare beneficiaries. Chronic condition complexity was identified using the Medicare Chronic Conditions/Other Chronic Conditions files. Additional explanatory variables included adverse experiences, psychological and social resources, health-related indicators, socioeconomic factors, and background characteristics. The Cost and Use file was used to calculate four outcome variables: total Medicare spending, spending on physician services, high-cost beneficiary status, and healthcare utilization. A series of linear and logistic regressions were used to estimate the association between explanatory and outcome variables. SGM older adult participants with the greatest severity and complexity of chronic conditions had significantly higher total Medicare spending, spending on physician services, and were more likely to be a high-cost beneficiary and higher use of healthcare services compared to those who were comparatively healthy. We also find strong evidence linking higher Medicare spending to disability and dual eligibility, highlighting an urgent need for research given SGM older adults' increased risk for disabling chronic conditions, yet at times lower healthcare utilization. Higher day-to-day discrimination was associated with greater likelihood of chronic condition complexity and lower Medicare spending. Understanding the relationship between chronic health conditions and healthcare cost and utilization is a critical step in developing responsive health services and effective interventions to promote healthy aging in our increasingly diverse yet often underserved communities.

Purpose People with disabilities, on average, have higher healthcare needs than others in the population. However, evidence shows that they frequently face barriers to accessing healthcare services and incur greater costs when seeking care, although data is lacking for sub-Saharan Africa. This study aimed to assess inequalities in health status and healthcare utilization among people with disabilities in Ethiopia. Methods This study used data from the 2021/22 Ethiopian Socio-Economic Panel Survey (ESPS) and included 17 181 respondents. Logistic regression models were employed for the analysis of the independent association between disability status and both reported illness and healthcare utilization, adjusting sequentially, first for predisposing factors (primarily age and sex) and then for additional variables. Results People with disabilities were more likely to report illness compared to those without disabilities (AOR = 2.91, 95% CI: 1.56–5.43). This pattern was consistent among both men (AOR = 3.06, 95% CI: 1.21–7.71) and women (AOR = 2.67, 95% CI: 1.26–5.68). People with disabilities also reported more frequent use of healthcare services (AOR = 1.49, 95% CI: 1.01–2.21). This association remained apparent among men with disabilities compared to those without disabilities (AOR = 1.99, 95% CI: 1.16–3.43), but not among women (AOR = 1.22, 95% CI: 0.67–2.24). Additionally, people with disabilities incurred higher mean annual healthcare expenditures (US$ 133.73) compared to those without disabilities (US$ 37.89, p = 0.04). Conclusion People with disabilities in Ethiopia had greater healthcare needs than people without disabilities, which were not fully matched by increased levels of healthcare utilization, and they incurred higher healthcare costs, indicating systemic inequalities in health. A twin-track approach could help address these gaps and support the realization of the human rights of people with disabilities in Ethiopia.

Purpose Across many countries, immigrants underuse specialized care services. Norway has universal health coverage that is mostly free or with only small out of pocket payments. Currently 19.9% of the population are either immigrants or born in Norway to immigrated parents. Earlier Norwegian studies have found underuse of hospital services but using mostly crude measures of activity. The purpose of this paper is to shed new light on the use of health-care services by immigrants in Norway. Design/methodology/approach This paper analyzes health-care utilization of the entire Norwegian population (2016–2017) by exploiting complete national registry data. Statistical regression methods measure the utilization of somatic hospital services at the individual level, to see whether there are associations between immigration variables and the use of services. Findings Immigrants use only about half of the amount hospital care relative to the average population. After controlling for individual characteristics especially age and mortality, utilization for immigrants is still lower than non-immigrants. When the analysis compares patients with other patients (rather than with healthy inhabitants), the differences are even smaller. Originality/value The present study finds clear evidence of underuse among immigrants in Norway for all types of specialized somatic hospital care. A large part of the underuse can be explained by age, mortality and patient status. The remaining causes of underuse are complex and likely to be related to health literacy, cultural issues, language barriers, perceived cost, accessibility and trust.