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PubMed2002

Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians.

BACKGROUND: The aim of this study was to test the hypothesis that in Europeans and South Asians (Indians, Pakistanis, Bangladeshis) alike, worse socio-economic status is associated with a higher prevalence of coronary heart disease (CHD), glucose intolerance (impaired glucose tolerance and diabetes) and related risk factors (the predicted direction of association). METHODS: Cross-sectional data were analysed from a community-based prevalence study seeking associations between social class, education and Townsend deprivation score and ECG evidence of CHD, glucose tolerance test and 12 cardiovascular risk factors. The study population consisted of South Asians (n = 684) comprising Indians (n = 259), Pakistanis (n = 305) and Bangladeshis (n = 120), and Europeans (n = 825), aged 25-74 years in Newcastle. The analysis examined up to 84 associations for each ethnic group. Interactions between ethnicity and socio-economic variables were examined using regression analysis. The main outcome measure was the number of associations in the predicted direction. RESULTS: Europeans fared better in some indicators of socio-economic position, South Asians in others. Indians were socio-economically advantaged compared with Pakistanis and Bangladeshis. Most measures of socio-economic position were associated with health measures in the predicted direction in Europeans [71/84 (85 per cent) associations, 25 statistically significant] and less so in the South Asians combined [58/84 (69 per cent) associations, 12 statistically significant]. In South Asian men 25/42 (60 per cent) of associations were as predicted, seven significantly so, in women 33/42 (79 per cent) were, five being statistically significant. There were apparent differences between Indians 152/78 (67 per cent) of associations as predicted, seven statistically significant], Pakistanis [41/84 (49 per cent), four statistically significant] and Bangladeshis [39/79 (49 per cent), one statistically significant]. In Indians, Townsend deprivation score was mostly associated as predicted [23/27 (85 per cent), five associations statistically significant], more so than social class [14/27 (52 per cent), none statistically significant]. In South Asian men and women combined, associations with anthropometric [18/24 (75 per cent)], biochemical [15/18 (83 per cent)], and lifestyle 114/18 (78 per cent)] measures were often as predicted, but those with blood pressure (4/12, 33 per cent) and CHD and glucose intolerance (7/12, 58 per cent) were less often so. Interactions between socio-economic position and ethnicity were found. CONCLUSIONS: The European pattern of inequalities is being established in South Asian men and women, possibly at a different pace in different subgroups. Future studies of inequalities should be large, separate Indian, Pakistani and Bangladeshi populations, study men and women separately and track changes over time.

Adult↗
PubMed1993

Trends in health, nutrition, and socio-economic status in Nigeria, India, and Brazil (1960-1990).

The present study compared and analysed the nutritional and economic situations in Nigeria, India, and Brazil over the three-decades between 1960 and 1990. Intra-country comparisons were undertaken for each country. The various indicators studied included among others the gross national product, total external debt, population, literacy, immunization, daily calorie intake, mortality, and life expectancy. It was noted that the economic situation influences the social and general health indicators of a country. Positive economic growth can lead to improved social development as well as diet and general health conditions. The opposite is also true, when economic growth is poor. The relationship between economic growth, and social and general health indicators is, however, not always applicable. This happens when the government fails to distribute incomes fairly; improvements in the country's social development, with nutritional and health indicators, does not occur. These findings call for a larger comparative study of the economic, social and health indicators for all the countries in the world.

Brazil↗
PubMed1998

Economic impact of granulopoiesis stimulating agents on the management of febrile neutropenia.

The granulopoiesis-stimulating agents (GSAs) have been effectively utilized in a variety of fashions to treat or prevent febrile neutropenia or to assist patients receiving dose-intensive chemotherapy with or without stem cell support. The high cost of these agents, along with their wide-scale clinical application, has fostered a number of economic analyses. Cost minimization models based on randomized trials and driven by hospitalization costs have provided febrile neutropenia risk thresholds for the use of the GSAs which have been incorporated into clinical practice guidelines. A number of important studies concerning the clinical and economic impact of these agents have been reported over the past year. The clinical role and economic impact of the GSAs in the management of either established febrile neutropenia or afebrile neutropenia remains uncertain. While several studies have confirmed the clinical value of the prophylactic use of these agents in both solid tumors and hematological malignancies, few have addressed their effect on cost or quality of life. The GSAs have demonstrated clinical as well as potential economic benefit in patients receiving high-dose chemotherapy with either bone marrow or peripheral blood stem cell support. Recent studies suggest a clinical and economic advantage for growth factor mobilization and peripheral blood stem cell support compared with bone marrow transplantation in patients receiving high-dose chemotherapy. The rapid evolution of technological and supportive care methods in this area will necessitate further clinical and economic evaluation.

Colony-Stimulating Factors↗
PubMed1992

Economic analysis in randomized control trials.

In medical technology assessment, randomized control trials (RCTs) play an important role in determining the relative efficacy of compared treatments. As scarce resources necessitate choosing among options for care, comparing costs of alternative tests, treatments, or programs also becomes important. This study assessed the prevalence and completeness of economic analyses in RCTs published from January 1966 through June 1988. It was found that only 121 of over 50,000 published randomized trials (0.2%) included economic analyses. For a random sample of 51 of these 121 studies, results revealed a mean quality of research score of 0.32 (SD of measurement = 0.14) and a mean economic analysis completeness score of 0.52 (SD = 0.13) on scales of 0 to 1. It was also found that higher economic completeness scores were positively correlated with later dates of publication (r = 0.28, P = 0.046) and with the presence of a statement of study perspective (r = 0.38, P = 0.006). A near-zero correlation between the economic completeness and the quality of research scores was revealed. Also noted were several deficiencies among the economic analyses, including improper allocation of overhead costs, absence of sensitivity analyses, and the fact that only 28% of the 51 studies included some form of aggregation of treatment costs and consequences. Progress in health care depends on accurate assessments of both relative efficacy and costs. The quality of both needs improvement.

Cost-Benefit Analysis↗
PubMed2004

Are economic evaluations of vaccines useful to decision-makers? Case study of Haemophilus influenzae type b vaccines.

BACKGROUND: In concert with efforts to increase global provision, economic evaluations of newer and relatively costly vaccines have proliferated in the medical literature. The extent to which existing vaccine evaluations are useful to decision makers is not clear. We conducted a systematic review of published economic evaluations of conjugate Haemophilus influenzae type b (Hib) vaccine, anticipating that their usefulness to past and present decision makers would be limited by the quality of the analyses and by the extent to which the results were transferable to other settings. METHODS: We systematically identified economic evaluations of conjugate Hib vaccine. We appraised their quality according to a customized checklist and assessed the extent of and reasons for variability of the results. RESULTS: Quality assessment of the available economic evaluations disclosed a number of shortcomings, including the failure across all models to derive systematic estimates of vaccine efficacy as well as a lack of transparency in the costing of Hib disease treatment. Wide variations in results appeared to be caused primarily by epidemiologic and health system differences between settings and secondarily to methodologic differences between models. The generalizability of model results appeared low. CONCLUSIONS: There is scope for improving the overall quality of economic evaluations of Hib vaccination. Relevance to decision makers may also be increased by addressing local budget constraints and vaccine price. There is a need to better understand the decision process, particularly at the national level, to ensure the role of future economic evaluations as important decision tools in the implementation of new vaccines.

Australia↗
PubMed2005

Socio-economic and climate change impacts on agriculture: an integrated assessment, 1990-2080.

A comprehensive assessment of the impacts of climate change on agro-ecosystems over this century is developed, up to 2080 and at a global level, albeit with significant regional detail. To this end an integrated ecological-economic modelling framework is employed, encompassing climate scenarios, agro-ecological zoning information, socio-economic drivers, as well as world food trade dynamics. Specifically, global simulations are performed using the FAO/IIASA agro-ecological zone model, in conjunction with IIASAs global food system model, using climate variables from five different general circulation models, under four different socio-economic scenarios from the intergovernmental panel on climate change. First, impacts of different scenarios of climate change on bio-physical soil and crop growth determinants of yield are evaluated on a 5' X 5' latitude/longitude global grid; second, the extent of potential agricultural land and related potential crop production is computed. The detailed bio-physical results are then fed into an economic analysis, to assess how climate impacts may interact with alternative development pathways, and key trends expected over this century for food demand and production, and trade, as well as key composite indices such as risk of hunger and malnutrition, are computed. This modelling approach connects the relevant bio-physical and socio-economic variables within a unified and coherent framework to produce a global assessment of food production and security under climate change. The results from the study suggest that critical impact asymmetries due to both climate and socio-economic structures may deepen current production and consumption gaps between developed and developing world; it is suggested that adaptation of agricultural techniques will be central to limit potential damages under climate change.

Agriculture↗
PubMedDate not supplied

Economic well-being and children's social adjustment: the role of family process in an ethnically diverse low-income sample.

Using latent variable structural equation modeling, a family economic stress model that links economic well-being to child well-being in an ethnically diverse, low-income sample of 419 elementary school-age children was evaluated. The sample was 57% African American and 28% Hispanic, and most families were headed by single mothers. The results provided support for the position that family process is a critical mediator of the effects of economic hardship on children's social adjustment. Lower levels of economic well-being, and the corollary elevated perceptions of economic pressure indirectly affected parenting behavior through an adverse impact on parental psychological well-being. Distressed parents reported feeling less effective and capable in disciplinary interactions with their child and were observed to be less affectionate in parent-child interactions. In turn, less than optimal parenting predicted lower teacher ratings of children's positive social behavior and higher ratings of behavior problems. Multiple-group analyses revealed that the pathways by which economic hardship influences children's behavior appear to operate similarly for boys and girls, and for African American and Hispanic families.

Child↗
PubMed2004

How does childhood economic disadvantage lead to crime?

BACKGROUND: This study sought to examine the associations between indices of socio-economic deprivation in childhood and later involvement in crime. METHOD: Data were gathered as part of the Christchurch Health and Development Study. In this project a cohort of 1,265 children born in Christchurch in 1977 have been studied from birth to age 21 years. The measures collected included: self-reported property and violent crime (15-16, 17-18, and 20-21 years); officially recorded convictions for property/violent crime; measures of childhood socio-economic status; and a series of intervening factors, including parenting (use of physical punishment, maternal care, family change, parental attachment, parental offending), individual (conduct and attention problems), school (truancy, suspensions, examination performance, scholastic ability), and peer factors (affiliations with deviant and substance using peers). RESULTS: The results suggest that childhood socio-economic disadvantage was associated with clear increases in rates of both self-reported crime and officially recorded convictions. However, using block recursive negative binomial regression models a range of parental, individual, school, and peer factors were found to intervene between socio-economic disadvantage and crime. Following introduction of these measures into the models, the association between socio-economic disadvantage and crime became both statistically and practically non-significant. CONCLUSIONS: This study suggests that the higher rates of crime found amongst young people from socio-economically disadvantaged families reflect a life course process in which adverse family, individual, school, and peer factors combine to increase individual susceptibility to crime.

Adolescent↗
PubMed2005

Annotation: Economic evaluations of child and adolescent mental health interventions: a systematic review.

BACKGROUND: Recognition has grown over recent years of the need for economic information on the impacts of child and adolescent mental health problems and the cost-effectiveness of interventions. METHODS: A range of electronic databases were examined using a predefined search strategy to identify economic studies which focused on services, pharmacological interventions and other treatments for children and adolescents with a diagnosed mental health problem or identified as at risk of mental illness. Published studies were included in the review if they assessed both costs and outcomes, with cost-effectiveness being the primary interest. Studies meeting the criteria for inclusion were assessed for quality. RESULTS: There are still relatively few economic evaluations in this field. Behavioural disorders have been given relatively greater attention in economic evaluations of child and adolescent mental health. These studies tentatively suggest child behavioural gains and parent satisfaction from parent and child training programmes, although the cost-effectiveness of the location of delivery for behavioural therapies is less clear. In general, the quality of economic evaluations was limited by small sample sizes, constrained measurement of costs, narrow perspectives and over-simple statistical and econometric methods. CONCLUSION: Economic evaluations in the field of child and adolescent mental health interventions are few in number and generally poor in quality, although the number of studies being undertaken now appears to be rising.

Adolescent↗
PubMedDate not supplied

Analytic considerations in economic evaluations of multinational cardiovascular clinical trials.

OBJECTIVES: The growing number of economic evaluations that use data collected in multinational clinical trials raises numerous questions regarding their execution and interpretation. Although recommendations for conducting economic evaluations have been widely disseminated, relatively little guidance has been given for conducting economic evaluations alongside clinical trials, particularly multinational trials. METHODS: Building on a literature review that was conducted in preparation for an expert workshop, we evaluated a subset of methodological issues related to conducting economic evaluations alongside multinational clinical trials. RESULTS: We found wide variation in the types of costs included as part of the analyses and in the methods used to assign costs to hospitalization events. Furthermore, we found that the extrapolation of costs and survival outcomes beyond the trial period is an inconsistent practice and is often not dependent on whether a survival benefit was observed in the trial or on the epidemiology or practice patterns in the country to which the findings are directed. CONCLUSIONS: Although the limited sample size precluded a quantitative analysis of trial characteristics and their associations with the methodologies employed, our findings highlight the need for more guidance to analysts regarding the execution of economic evaluations using data from multinational clinical trials. As the research community grapples with the complexities of methodological and logistical issues involved in multinational economic evaluations, the development of a standardized format to report the basic methodological characteristics of such studies would help to improve transparency and comparability for other analysts and decision-makers.

Cardiovascular Diseases↗
PubMed2004

The relationship between socio-economic status and physical activity patterns in South African children.

AIM: To examine: (1) the associations between socio-economic status, physical activity, anthropometric and body composition variables in South African children; (2) the influence maternal characteristics have on children's physical activity levels; and (3) associations between television watching, activity level and body composition. METHODS: In 381 South African children, physical activity and socio-economic status were assessed via structured retrospective interview using validated questionnaires. An asset indicator score was calculated as a proxy measure of socio-economic status and used to divide children into quartiles. RESULTS: Children falling into the highest socio-economic status quartile had mothers with the highest educational levels, generally came from dual parent homes, were highly physically active, watched less television, weighed more and had greater lean tissue than children in lower quartiles. A greater percentage of children living in dual parent homes and with mothers of a higher educational status were highly active compared with children living in single parent homes and with mothers of a lower educational status. We found greater levels of lean mass with increased activity level after controlling for television watching time and fat mass. There were high levels of low activity and high television watching time among lower socio-economic status groups. There were significant racial differences in patterns of activity. White children were found to be more active than black children, more likely to participate in physical education classes at school and watched less television than black children. CONCLUSION: Physical activity levels and socio-economic variables are closely related in this population of South African children.

Child↗
PubMed1999

Economic impact of hospital closure on small rural counties, 1984 to 1988: demonstration of a comparative analysis approach.

Hospital closure in a rural community may affect the locale's economic prospects as well as the health of its residents. Studies of economic effects have primarily relied on modeling techniques rather than observation of actual change. This study demonstrates the use of a comparative analysis approach for estimating the economic effects of hospital closure on small rural counties. The experiences of 103 small rural counties at which a hospital closed between 1984 and 1988 was compared with a matched group of counties at which no closure took place. "Comparable" counties were selected based on seven scales measuring the similarity between a closure county and potential comparisons. Three scales examined population and economic characteristics in the year before closure; two scales measured change throughout a three-year period preceding closure; and two scales measured change throughout a five-year period preceding closure. Closure effects were measured through a multivariate analysis of the post-closure economic history of closure and comparison counties. The key assumption is that similar counties should have similar experiences over time. If an event occurs within some of these counties but not others, this event should have visible effects. Comparative analysis suggested that earned income in closure counties (excluding farming and mining income) was lower than in comparison counties subsequent to closure and that labor force growth was similarly affected. A comparative analysis approach produces results that parallel those obtained from economic modeling and should be considered for further research.

Health Facility Closure↗
PubMed2006

China at the crossroads: the economics of tobacco and health.

OBJECTIVE: To analyse economic aspects of tobacco control policy issues in China. METHODS: Published and collected survey data were used to analyse economic consequences of smoking. Economic analysis was used to address the role of tobacco farmers and the cigarette industry in the Chinese economy. RESULTS: In the agricultural sector, tobacco has the lowest economic rate of return of all cash crops. At the same time, the tobacco industry's tax contribution to the central government has been declining. CONCLUSION: Economic gains become less important as the negative health impact of smoking on the population garners more awareness. China stands at a crossroads to implement the economic promises of the World Health Organization's Framework Convention on Tobacco Control and promote the health of its population.

China↗
PubMed1994

Economic and cost-effectiveness investigations of radiologic practices.

Economic evaluations provide scientific data regarding the cost implications of radiologic practices and, most important, which strategies for patient care yield the best outcomes for the least cost. Although this article is meant to enrich understanding of cost-effectiveness studies, it cannot be regarded as a complete training program for undertaking such investigations. Just as training in clinical science is important for radiology research, training in the economics of health and medical care is important for performing economic investigations. Therefore, radiologists' work in this area is likely to be enhanced by involving an individual with appropriate economics training on the research team when conducting an economic investigation. Clinical radiologists and investigators in radiologic sciences should be capable of understanding and evaluating the design, performance, and interpretation of results of economic investigations, since radiology practice is likely to be influenced by the findings from such research. The principles described in this article are fundamental to generation of sound information that can guide radiologists' practice in an environment increasingly threatened by resource constraints (37).

Cost-Benefit Analysis↗
PubMed2000

Conceptual and practical difficulties with the economic evaluation of health services developments.

Five recent economic evaluations comparing hospital at home schemes with acute hospital care faced remarkably similar problems. This paper outlines these problems and considers what strategies can be derived from these experiences, which will be relevant to economic evaluations of other aspects of the organisation of care, particularly those crossing the interfaces between primary and secondary health care or the interface between health and social services. The difficulties experienced can be divided into conceptual and practical problems. Conceptual problems were primarily associated with issues of context and related to the choice of comparator, capacity constraints and size of schemes, and the choice between a short or a long run perspective. Practical problems were connected with the time at which schemes were evaluated, the type of clinical study alongside which studies were conducted and the types of data available for use in the analysis. Strategies which can be pursued in conducting economic evaluations of organisational change include giving greater attention to conceptual and hence contextual problems as well as reporting these contextual issues in detail, accepting the need for repeated economic evaluations as organisational changes become more widespread and considering carefully the clinical study design where economic evaluations of organisational change are conducted alongside. These strategies are of importance not just to those conducting economic evaluations but also to those funding appraisals of changes in the organisation of care. Use of different strategies such as those suggested here should be evaluated.

Delivery of Health Care↗
PubMed1996

Effects on birthweights of maternal education, socio-economic status, and work-related characteristics.

Birthweights of 3,451 infants of women registered for antenatal care in Uppsala County, Sweden, were analyzed using three different maternal socio-economic indicators; education, socio-economic status and work environment exposure characteristics. Other explanatory variables were maternal age, parity, height, smoking habits, and length of gestation. Mean birthweights increase with longer education and higher socio-economic status. No general pattern was seen for work environment characteristics. When smoking habits are controlled for, social differences in birthweight decrease to non-significant values. A regression model with a socio-economic indicator alone explains only a minor part, less than 1%, of the variation in birthweight. When smoking is included, adding a socio-economic indicator does not significantly improve the model. Practically all social differences in birthweight are related to the differences in maternal age, parity, height, and smoking habits. If a socio-economic indicator is to be included in the analysis of birthweights (for other reasons like international comparisons), we recommend education.

Adolescent↗
PubMed2005

Stunted child-overweight mother pairs: prevalence and association with economic development and urbanization.

This paper explores the prevalence of the coexistence of a stunted child and an overweight mother in the same household (SCOWT), a somewhat paradoxical phenomenon when found in the developing world. It tests whether this phenomenon is associated with a country's level of economic development and urbanization and, by implication, the nutrition transition. It then highlights policy directions for public nutrition. Data from 42 Demographic and Health Surveys in Africa, Asia, and Latin America were used. Stunting was defined as height-for-age < -2 SD of the reference population, and maternal overweight as a body-mass index > 25 kg/m2. World Bank and United Nations figures were used for gross domestic product (GDP) per capita (an indicator of economic development) and for level of urbanization. Descriptive statistics were derived, and regression analysis was used to model the association between economic development, urbanization, and the prevalence of pairs of stunted children and overweight mothers. The prevalence of this phenomenon is generally below 10%, except in four countries, three of them in Latin America. The phenomenon is generally more prevalent in Latin America than in Africa, though not necessarily more prevalent in urban than in rural areas. The analysis finds that the phenomenon is associated with economic development, but not urbanization, and that it does differ between urban and rural areas and regions. The association with GDP per capita supports the hypothesis that SCOWT increases with economic development, up to a point. SCOWT appears to be most prevalent, as expected, in those countries in the midst of the nutrition transition. Recognizing this phenomenon is important for delineating strategies that respond to the differential needs of individuals within the household and do not just affect the household as a whole. This may become especially important with future economic development and, potentially, urbanization.

Adult↗
PubMedDate not supplied

The economic evaluation of health care.

Economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Economic evaluation can also be called economic appraisal or the cost-benefit approach. The basis of economic evaluation lies in comparing costs and benefits of an intervention, program or service. The most important reasons for undertaking an economic evaluation are that resources (e.g., money, time, staff, equipment) are scarce compared with the demands made on them, and that such resource constraints require choices to be made. In this paper, four types of economic evaluations (cost-minimisation, cost-effectiveness, cost-utility and cost-benefit analyses) are described.

Australia↗