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PubMed2000

The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful?

Central venous catheters (CVCs) are essential for many hospitalized patients, but they are associated with important infectious complications. Recent studies have indicated that CVCs coated with antimicrobial agents reduce the incidence of catheter-related bloodstream infection (CR BSI). To estimate the clinical and economic consequences of short-term central venous catheter-related infection and the potential usefulness of antimicrobial-coated catheters, we reviewed and synthesized the available relevant literature. Statistical pooling was used to estimate the incidence of both catheter colonization and CR BSI. The attributable mortality of CR BSI was also evaluated. In addition, the economic consequences of both local and systemic catheter-related infection was estimated from literature reports that used micro-costing and other techniques. Among patients in whom standard, noncoated CVCs are in place for an average of 8 days, 24.7% are expected to develop catheter colonization (95% confidence interval [CI(95)], 22.0%-27.5%). Approximately 5.2% (CI(95), 3.9%-6.5%) will develop CR BSI. The attributable mortality of CR BSI remains unclear, but recent studies are consistent with a range from 4% to 20%. An episode of local catheter-related infection leads to an additional cost of approximately $400, whereas the additional cost of CR BSI ranges from approximately $6,005 to $9,738. Formal economic analyses indicate that CVCs coated with antibacterial agents (such as chlorhexidine-silver sulfadiazine or minocycline-rifampin) likely reduce infectious complications, yielding economic advantages. In light of the substantial clinical and economic burden of catheter-related infection, hospital personnel should adopt proven cost-effective methods to reduce this common and important nosocomial complication.

Anti-Infective Agents↗
PubMed2006

How do we evaluate the economics of health care?

Economic evaluation has become an integral component of health service research in recent years and will no doubt become more influential. As resources are reduced in health services, more questions are likely to be asked on the costs and benefits of new treatments. Questions are also likely to be aimed at treatments that are currently provided. Economics related to health care is complex and numerous methods of economic evaluation exist. Full economic evaluation involves the assessment of both costs and outcomes and is ideal for comparing the efficiency of treatments. Partial evaluations can also provide useful information on the contribution of component costs to treatment costs as a whole. The aim of this review is to assess the various methods available to evaluate the economics of health care and to place in context how these methods may be used within dentistry.

Cost Control↗
PubMed2001

Socio-economic position and coronary heart disease risk factors in youth. Findings from the Young Hearts Project in Northern Ireland.

BACKGROUND: This study investigates the existence of socioeconomic differentials in behavioural and biological risk factors for coronary heart disease in young people from Northern Ireland, taking into account differences in biological maturation. METHODS: A school-based prospective study, with measurements in 1989/1990 and 1992/1993. Socio-economic position was based on occupational level of the main family breadwinner. Behavioural risk factors included were physical inactivity, the intake of total energy, dietary fat and a number of micronutrients. Biological risk factors included were blood pressure, body fatness, lipoproteins and cardio-pulmonary fitness. Biological maturation was based on Tanner's stages. PARTICIPANTS: 251 boys and 258 girls who were measured at the age of 12 years and re-examined at the age of 15 years. RESULTS: Cross-sectional analyses showed that socio-economic differences in cholesterol intake (in boys) and physical inactivity and total energy intake (in girls) were present at 12 and 15 years of age, while differences in fat and fruit intake and smoking behaviour (in boys and girls) became established at the age of 15 years, with unfavourable levels in subjects in the manual group. Longitudinal analyses confirmed that differences in behavioural risk factors exist or develop during adolescence. No clear pattern of differences in biological risk factors was found by socio-economic position. Adjustment for biological maturation did not materially alter the results. CONCLUSION: Differences in lifestyle by socio-economic position seem to become established in adolescence. These differences however, are not (yet) reflected in differences in biological risk factors by socio-economic position.

Adolescent↗
PubMed2001

The association between socio-economic status and chest pain, focusing on self-rated health in a primary health care area of Sweden.

STUDY OBJECTIVE: The study objective was to determine, first, the association between men's and women's chest pain and their socio-economic status (occupation, smoking) and, secondly, the association between their socio-economic status and self-rated health, in a primary health care area. DESIGN AND SETTING: A population-based cross-sectional survey was made in a primary health care area of Sweden. Primarily based on occupation according to Swedish standards, 4,238 men and women were divided into two socio-economic groups; blue-collar and white-collar workers. METHODS: Odds ratios with 95% CI were calculated by multivariate logistic regression, controlling for the variable age as confounding factor. Student's t-test was used to compare self-rated health, and the chi 2-test to determine any difference in smoking habits between the two groups. MAIN RESULTS: Both male and female blue-collar workers showed significantly more chest pain when excited than white-collar workers. In six of eight health indices, they also reported significantly worse self-rated health than the white-collar workers. CONCLUSIONS: These findings show that there are socio-economic inequalities in self-reported chest pain. Furthermore, socio-economic status has a major influence on self-rated health, acting across the working life of both sexes.

Adult↗
PubMed2003

Health measures: differentiating associations with gender and socio-economic status.

BACKGROUND: In a cohort survey on health-related lifestyles, four different measures of health were analysed with regard to their associations with gender, socio-economic and psychosocial factors. METHODS: The survey was carried out in Berne, Switzerland. Response rate was 64% in the initial interview and 83% in the second interview, from which the data presented were derived, resulting in 923 participants aged 56 to 66 years. Along with socio-economic and psychosocial parameters, four self-report health measures were obtained, namely self-rated health, physical fitness, number of medical conditions and restrictions caused by medical conditions. Regression analysis was used to investigate and compare their associations with gender, socio-economic and psychosocial factors and relevant interaction terms. RESULTS: Gender was statistically significantly associated with physical fitness, number of medical conditions and subsequent restrictions. Education and income showed statistically significant associations with self-rated health and fitness. Psychological factors were statistically significantly associated with all health measures. Gender showed to interact with education, income interacted with internal health locus of control. Analyses with separated genders showed that the association of socio-economic status with self-rated health and fitness was statistically significant in women only. CONCLUSION: The different health measures showed considerable variation in strengths of association with health-related factors, most noticeably so with gender and socio-economic status. The choice of health measures in population studies should comply with the intention to analyse its associations with any of those related factors, or, in reverse, with the wish to prevent their confounding properties.

Activities of Daily Living↗
PubMed2005

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe.

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.

Adolescent↗
PubMed2005

Can large relative mortality differences between socio-economic groups among Swedish men be explained by risk indicator-associated social mobility?

BACKGROUND: The Nordic countries, profiled as welfare states, are shown to have comparatively large relative socio-economic differences in mortality and comparatively high intergenerational mobility. The aim of this study was to analyse the role of risk indicator-associated social mobility (from childhood through to adulthood) in socio-economic mortality differences among Swedish men aged 35-50 years. METHODS: We used data on risk indicators for adult mortality (risk use of alcohol, smoking, low emotional control, psychiatric diagnosis, medication for nervous problems, contact with police and child care, experience of unemployment, low body height, low education) collected at compulsory conscription for military training among Swedish men at aged 18-20, fathers' socio-economic status at subjects' ages 9-11 years, data on subjects' socio-economic status at ages 34-36 years, and follow-up data on mortality during 1986-1999 (at ages 35-50 years). RESULTS: Persons in manual occupations in 1985 showed an elevated relative risk (RR) of mortality compared with stable non-manual employees regardless of the social position of their father (RR 1.75 among stable manual workers, and RR 1.74 among the downwardly mobile). In multivariate analyses, taking into account the risk indicators first operating in late adolescence, the increased mortality risk among stable manual workers and also among the downwardly mobile diminished considerably (RR 1.32 and 1.39, respectively). CONCLUSIONS: These results suggest that a substantial part of the socio-economic differences in mortality among middle-aged men had their origin in childhood circumstances. Risk indicator-associated social mobility was found to contribute substantially to an increase in the relative difference in mortality between male manual workers and non-manual employees.

Adolescent↗
PubMed2006

School-related risk factors for drunkenness among adolescents: risk factors differ between socio-economic groups.

PURPOSE: To examine, separately for boys and girls, whether socio-economic differences in drunkenness exist in adolescence, whether the level of exposure to school-related risk factors differ between socio-economic groups, and whether the relative contribution of school-related risk factors to drunkenness differ between socio-economic groups. METHODS: The study population was a random sample of 1453 Danish 15-year-old students. The outcome measure was drunkenness 10 times or more, as a lifetime measure. Predictor variables comprised five aspects of well-being at school. Socio-economic position (SEP) was measured by parental occupation. RESULTS: Among girls, exposures to school-related risk factors were more prevalent in lower socio-economic groups. Poor school satisfaction was associated with drunkenness among girls from high SEP, odds ratio (OR) = 2.98 (0.73-12.16). Among boys from high SEP autonomy in decision-making was associated with drunkenness, OR = 2.74 (1.06-7.08), whereas poor school satisfaction was associated with drunkenness among boys from intermediate SEP, OR = 2.26 (0.98-5.22). Weak Parental Support in school-related matters, OR = 3.92 (1.16-13.24), and disliking school, OR = 9.12 (1.77-47.09), were associated with drunkenness among boys from low SEP. These associations were also seen among girls although not significant. CONCLUSION: We found that well-being at school had socially differential impact on drunkenness in adolescence.

Adaptation, Psychological↗
PubMed2002

Economic transition and maternal health care for internal migrants in Shanghai, China.

Economic migration and growth in informal employment in many of the major cities of developing countries, combined with health sector reforms that are increasingly relying on insurance and out-of-pocket payment, are raising concerns about equity and sustainability of economic and social development. In China, the number of internal migrants has dramatically grown since economic transition started in 1980, and maternal health care for these is a pressing issue to be addressed. To provide information for policy-makers and health administrators, a medical records review, a questionnaire survey and qualitative interviews were carried out in Minhang District, Shanghai. This paper describes important inequities in main maternal health outcomes and utilization indicators relating to economic and social transformation of the Chinese society. Analysis of the data collected clarifies that insufficient antenatal care is one of the main determinants for poor maternal health outcomes and that migrants are using antenatal care services significantly less than permanent residents. The data suggest that there is no single explanatory factor, but that migrants are faced with a package of obstacles to accessing health care services, and that health systems may need to rethink and redesign their delivery approaches to specifically target those groups that are faced with such multi-faceted packages of obstacles to service-access. Although the study addresses a specific Chinese phenomenon related to internal migration and registration of residency, parallels can be drawn to other settings where a combination of economic and social transitions of the society and a reform of health care financing are potentially creating the same conditions of significant inequalities.

Adult↗
PubMed2002

Economic implications of assisted reproductive techniques: a systematic review.

BACKGROUND: Approximately one in six couples experiences problems with their fertility at some point in their reproductive lives. The economic implications of the use of assisted reproductive techniques require consideration. Herein, the health economics research in this area are critically appraised. METHODS: Multiple strategies were used to identify relevant studies. Each title and abstract was independently reviewed by two members of the study team and categorized according to perceived relevance. The selected papers were then assessed for quality and data were extracted, converted to UK pounds sterling at 1999/2000 prices, tabulated and critically appraised. RESULTS: A total of 2547 papers was identified through the searches; this resulted in 30 economic evaluations, 22 cost studies and five economic benefit studies that met the selection criteria. The quality of these studies was mixed; many failed to disaggregate costs, discount future costs or conduct sensitivity analyses. Consistent findings included the following: initiating treatment with intrauterine insemination appeared to be more cost-effective than IVF; vasectomy reversal appeared to be more cost-effective than ICSI; factors associated with poor prognosis decreased the cost-effectiveness of interventions. CONCLUSIONS: The cost-effectiveness of different interventions should be considered when making decisions about treatment. Future economic appraisals of assisted reproductive techniques would benefit from more robust methodology than is evident in much of the published literature to date.

Adult↗
PubMed2005

Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study.

BACKGROUND: Numerous studies have demonstrated social inequalities in coronary heart disease using a variety of measures of social position. In this study we examine associations between persistent economic difficulties and serious coronary events. Our aim is to assess whether these associations are (i) explained by other measures of socioeconomic status, and (ii) mediated by psychosocial, behavioural and biological factors. METHODS: The data come from 5021 middle-aged, white-collar men in the Whitehall II study. Self-reported household financial problems, measured at baseline (1985-88) and Phase 3 (1991-93), were used to construct a five-category score of persistent economic difficulties. Associations between economic difficulties and incident coronary events were determined over an average follow-up of 7 years. Other socioeconomic, psychosocial, behavioural and biological explanatory variables were obtained from the Phase 3 questionnaire and clinical examination. RESULTS: Age-adjusted Cox regression analyses demonstrated steep gradients in the incidence of coronary events with economic difficulties. The relative hazard between the bottom and the top of the difficulties hierarchy was 2.5 (95% confidence intervals (CI) 1.2-5.2) for fatal and non-fatal myocardial infarction (MI), 2.1 (1.3-3.6) for MI plus definite angina and 2.8 (1.9-4.2) for total coronary events. Adjustment for other markers of socioeconomic position, early life factors, psychosocial work environment characteristics and health-related behaviours had little effect, while adjustment for the biological factors reduced the association between difficulties and coronary events by 16-24%. CONCLUSION: We have demonstrated an economic difficulties gradient in coronary events in men that is independent of other markers of socioeconomic position and appears to be only partially mediated by well-known risk factors in mid-life.

Alcohol Drinking↗
PubMed2003

Low income Russian families adopt effective behavioral strategies to maintain dietary stability in times of economic crisis.

The social, political and economic reforms of 1992 in Russia led to a decade of rising income inequality, unemployment and economic crises, the most severe of which occurred in 1998. This study assesses dietary trends for children in low and high income households during this politically and economically unstable period from 1994 to 2000. Several possible food-related behaviors were also assessed to evaluate coping strategies adopted in the face of decreasing economic stability. Low income children maintained a steady energy intake per kilogram weight throughout the study period (251.0-259.4 kJ/kg), whereas intake for high income children increased significantly to a per capital average of 297.1 kJ/kg by 2000. At the food group level, the trend in per capita intake for all food groups was maintained for low income children except for a 22% decrease in meat and poultry consumption (P < 0.01). Per capita intake increased over time for dairy products and eggs in the high income group (P < 0.01). A decrease in cost per kJ (rubles/kJ) was observed for both low and high income families (P < 0.01). These data suggest that Russian households were able to conserve the diet structure for children by using what appear to be food-related behavioral mechanisms during periods of economic crisis.

Child↗
PubMed1995

Help or hindrance? The role of economics in rationing health care.

The economic evaluation of alternative diagnostic and therapeutic interventions is not merely a help to the processes by which decision makers allocate scarce economic resources, it is an essential ingredient into those rationing processes. Clinicians and other decision makers who advocate the use of effectiveness data alone to determine who will be treated and who will be left in pain and discomfort may perpetuate the inefficient use of resources. Rationing, or resource allocation, in health care must be informed by knowledge of the costs and consequences (effects) or alternative interventions. To ignore the economic element in clinical choices, generates inefficiency, and therefore unethical practice. The great advantage of the economic approach to rationing is that it requires an explicit framework which identifies the costs and benefits of alternative actions in all domains of human action. The combination of explicitness and precision inherent in good economic evaluation can only help in the difficult task of producing further health benefits for patients from the limited resources of the NHS.

Health Care Rationing↗
PubMed2003

Socio-economic position and health: what you observe depends on how you measure it.

BACKGROUND: A number of different socio-economic classifications have been used in relation to health in the United Kingdom. The aim of this study was to compare the predictive power of different socio-economic classifications in relation to a range of health measures. METHODS: A postal questionnaire was sent to a random sample of adults in the West of Scotland (sampling from 1997 electoral roll, response rate 50 percent achieved sample 2,867). RESULTS: Associations between social position and health vary by socio-economic classification, health measure and gender. Limiting long-standing illness is more socially patterned than recent illness; income, Registrar General Social Class, housing tenure and car access are more predictive of health than the new National Statistics Socio Economic Classification; and men show steeper socio-economic gradients than women. CONCLUSION: Although there is a consistent picture of poorer health among more disadvantaged groups, however measured, in seeking to explain and reduce social inequalities in health we need to take a more differentiated approach that does not assume equivalence among social classifications and health measures.

Female↗
PubMed1999

Socio-economic consequences of rheumatoid arthritis in the first years of the disease.

OBJECTIVE: Few data have been presented to document the impact of rheumatoid arthritis (RA) on socio-economic well-being. In this study, exact figures on socio-economic consequences were assessed. METHODS: The socio-economic consequences were studied in an inception cohort (186 early RA patients, mean disease duration 3 yr) by measuring the change in work capability, income, rest during the daytime, leisure time activity, transport mobility, housing and social support occurring in the first years of the disease. RESULTS: For 89% of the patients, RA had an impact on one of the socio-economic items; for 58%, at least three of these items were affected simultaneously. Work disability appeared to be 4-15 times higher than in the general population. After 3 yr, 42% of the patients were registered as work disabled. Nearly a quarter of the patients experienced income reduction. Over 40% of the patients claimed extra rest during the daytime. Leisure activity changed towards activities with a lower joint load. There was a decline in transport mobility for 52% of the patients. Social support increased strongly. CONCLUSIONS: Socio-economic change already presents in the first years of RA and appears to be influenced by age, gender, marital status and work disability. Furthermore, physical limitation appeared to be predictive for work-related income reduction, reduced transport mobility and development of social dependency.

Activities of Daily Living↗
PubMed1997

Economic considerations in the care of patients with head and neck malignancies.

In an era of cost-consciousness and managed care, quality concerns practice variability attributed to nonmedical factors, and growing attention to outcomes research, there is increasing interest in the economics of malignant disease. This review explores economic issues pertinent to the management of patients with head and neck malignancies. Using economic principles to evaluate medical practice does not uniformly mean that less money should be spent; rather, the intention is to optimize efficiency in the use of limited resources. Accordingly costs are best evaluated in the context of other outcomes of interest. The available economic literature for head and neck tumors is limited; it is often compromised by the use of facility charges as a proxy for true costs and the adoption of a truncated economic perspective. Given the potential health policy implications of such studies, their methodologies and results warrant careful scrutiny. Many opportunities exist for further research.

Cost Control↗
PubMed1998

Economic evaluation of cancer treatments: methodological and practical issues.

Economic evaluation is a comparative analysis of alternatives in terms of both their costs and consequences. Therefore, the basic task of economic evaluation is to identify, measure, value and compare the costs and effects of the alternatives being considered. In this paper, the methodology of economic evaluation in general and in cancer in particular is reviewed and practical issues are illuminated. In the treatment of cancer patients not only survival and disease-free survival are important outcome parameters, but also quality of years alive. Hence, specific attention is given to the measurement and valuation of quality of life. Economic evaluation is intended to support health policy at different levels of decision making. In cancer treatment, health policy concerns both preventive, curative and palliative strategies, and decisions are often made at the micro and macro level. Economic evaluation can provide essential information on the costs and benefits of each option, and consequently on the optimal policy mix, and thus support decisions on the adoption and utilization of new treatments. Such information may assist policy makers in formulating regulatory policies and legislation, industry in developing products, health professionals in treating and serving patients, and consumers in making personal health decisions.

Cost-Benefit Analysis↗
PubMed1997

Medical costs and economic production losses due to injuries in the Netherlands.

BACKGROUND: To support injury control, we assessed the direct medical costs and indirect costs of injuries in the Netherlands, making use of recent advances in health economics. METHODS: We estimated the direct medical costs with the help of available data on health care utilization as a consequence of injuries. In our calculations of indirect costs, we used two alternative approaches. We used the traditional human-capital approach, which estimates the potential economic production losses caused by diseases or injuries. In addition, we applied the friction-costs method, which was recently developed as an attempt to measure the actual economic production losses to society. RESULTS: Injuries are an important source of medical costs and economic production losses. Almost two-thirds of the medical costs are the result of injuries among females (mainly domestic injuries of elderly women). On the contrary, independent of the method used, more than 80% of the indirect costs are the result of injuries among males (mainly caused by a high frequency of traffic injuries, occupational injuries, and sports injuries among young males). The application of the friction-costs method confirms the importance of injuries as a source of production losses in comparison with other diseases, showing that they belong to the main three causes of indirect costs to society. CONCLUSIONS: Estimates of the medical costs and both the potential and actual economic production losses to society clearly demonstrate that injuries should be a major concern for health policy makers and the medical profession.

Accidents, Occupational↗