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PubMed1998

Does dental service utilization drop during economic recession? The example of Finland, 1991-94.

UNLABELLED: After enjoying rapid economic growth in the 1980s, Finland suffered a deep economic recession that began in 1990. It has been claimed that recession and uneven subsidies influence the use of dental services negatively. Finnish adults born after 1956 and world war veterans are entitled to subsidized dental care either in the Public Dental Service (PDS) or in the private sector. Other adults pay their treatment costs. OBJECTIVES: The purpose of this paper is to determine whether the economic recession in Finland during the early 1990s affected the use of dental services. METHODS: The data were collected by the National Research and Development Centre for Welfare and Health using a method called CATI (Computer Assisted Telephone Interview). The target population was non-institutionalized persons aged 25-79 years. RESULTS: About one-third of those interviewed had visited a dentist during the previous 6 months and this proportion was stable during the years studied. Number of teeth, length of education, income and sex had the highest predictive values for use of dental services as analyzed by multiple logistic regression. Two-thirds had visited a private practitioner, one-third a PDS clinic and a small percentage some other dentist or denturist. CONCLUSIONS: The results showed that the dental service utilization by Finns was stable during this period of economic downturn and only minor changes occurred in the mean number of visits. The most prominent change was seen in the youngest age group, among whom dental utilization decreased by almost 10%. The study indicated that subsidies do not strongly affect dental utilization today.

Adult↗
PubMed2001

Self-reported dental health, treatment need and attendance among older adults in two areas of Finland.

OBJECTIVE: The purpose of the study was to assess differences in dental health, need for care and attendance among older adults in two areas of Finland with contrasting socio-cultural and economic backgrounds. A further aim was to analyse and compare the determinants of oral health and dental visiting patterns. BASIC RESEARCH DESIGN AND PARTICIPANTS: FINRISK senior survey was conducted by the National Public Health Institute in the two areas in 1997. Data were collected through a postal questionnaire, a health examination and an interview, which included questions of number of extracted teeth, dental treatment need and utilisation. The sample consisted of 1,500 persons, 250 women and 500 men aged 65-74 years in both areas; the response rate was 86%. RESULTS: Forty-one per cent of the respondents reported having lost all their teeth and 44% had visited a dentist during the past year. Differences between the areas concerning both dental health and attendance were considerable. Respondents living in North Karelia had lost more teeth and visited a dentist more seldom than respondents in the Helsinki region. Risk indicators for the number of extracted teeth differed between the areas, while determinants for the dental attendance during the previous year were almost identical. The major predictors for a dental visit during the previous year were number of teeth and household income. Self-perceived need for dental care was minor. Functional capacity, medically compromising diagnoses or medication did not play any apparent role in dental attendance. CONCLUSIONS: The number of teeth together with income are the principal determinants for dental visits among older persons in Finland.

Activities of Daily Living↗
PubMed2004

Confidence in the ability to communicate with physicians among low-income patients with prostate cancer.

OBJECTIVES: To describe the confidence of low-income patients with prostate cancer in interacting with physicians. Men with prostate cancer need to communicate easily with their physicians when facing treatment decisions and symptom management; however, little is known about whether low-income men are confident in these interactions. METHODS: We used validated instruments to measure self-efficacy in patient-physician interactions, emotional well-being, symptom distress, satisfaction with care, and health-related quality of life among low-income men receiving prostate cancer treatment through a statewide public assistance program. We abstracted clinical variables from medical records. We dichotomized self-efficacy scores empirically on the basis of the sample distribution and conducted univariate and multivariate analyses. RESULTS: The self-efficacy scores were skewed toward the high scores, with 77% in the high range. Those (23%) with low self-efficacy were more likely to have poor emotional well-being, symptom distress, role limitations--emotional, low social function, and poor urinary, sexual, and bowel outcomes. In multivariate analysis, low-income men were more likely to have low self-efficacy if they were less satisfied with their care, did not have confidence in their provider, or had more symptom distress. CONCLUSIONS: Among low-income patients with prostate cancer, low self-efficacy for interacting with physicians was best predicted by diminished overall satisfaction with care, low confidence in providers, and worse symptom distress. Men with low self-efficacy fared worse over a range of psychosocial outcomes and both general and disease-specific health-related quality of life.

Adenocarcinoma↗
PubMed1981

Demographic factors associated with physician staffing in rural areas: the experience of the National Health Service Corps.

To determine which demographic factors favor rural communities obtaining physicians, county characteristics of National Health Service Corps sites are analyzed. Through the use of a difference of means test, sites which were staffed at least once are compared with sites which were never able to obtain physicians. Since a major portion of the sites never staffed were located in the Southeast, the effect of "southeast location" as a separate, binary variable is considered. Five factors related to income, employment and education significantly (p less than 0.01) distinguish the staffed from the "never-staffed" sites. A function derived from discriminant analysis correctly classifies more than 70 per cent of the sites as staffed or never-staffed; inclusion of the southeast variable increases the number of correctly classified sites by 6 per cent. Given the presence of both socioeconomic and nondemographic constraints on rural communities, significant improvements in physician distribution may require that programmatic interventions be intensified.

Demography↗
PubMed2006

[The individual's status in the labor market and health inequity in Brazil].

OBJECTIVE: To investigate inequalities in personal health conditions and in the utilization of healthcare services according in relation to the individual's status in the labor market. METHODS: This study was based on 39,925 males aged 15 to 64 years living in 10 Brazilian metropolitan regions, who took part in the 1998 National Household Survey. They were classified as formal labor, informal labor, unemployed or outside of the labor market. Each category was compared with formal labor regarding sociodemographic characteristics, health status indicators and healthcare utilization. This analysis was by means of Pearson's Chi-square test. Multinomial logistic regression was used to investigate independent associations between labor market status, health status indicators and healthcare utilization. RESULTS: The classification of the participants' status was that 52.2% were formal labor, 27.7% informal labor, 10% unemployed and 10.2% were outside of the labor market. There were significant differences between these categories with respect to age, schooling, household income, household status and region of residence. Independent of the sociodemographic characteristics, unemployment, informal labor status and, especially, exclusion from the labor market remained associated with poor health status. CONCLUSIONS: The individual's status in the labor market is expressed through a gradient of inequality in health conditions. These findings reinforce the need to also consider the individual's status in the labor market in studies on healthcare inequalities.

Adolescent↗
PubMed1993

Comparison of the dental health status of six-year-old children in Manitoba.

The caries rates of six-year-old Manitoba children from a non-fluoridated Northern community were compared with those of a representative group of southern Manitoba children from non-fluoridated areas. All of the surveyed children became eligible for dental treatment coverage under Manitoba Health's Children's Dental Program approximately two months prior to the survey. Access to dental care was equivalent for all children. Screening (data collection) was completed by Manitoba Dental Health staff and was based on standard World Health Organization (WHO) criteria. The initial assessment of the data indicated that the Northern Manitoba children experienced an average of 82 per cent more decay per child than the southern group. Caries treatment requirements in the north were 59 per cent greater than in the south. The southern Manitoba children were almost twice as likely to be caries free than the Northern children. Closer examination of the Northern data, based on a socioeconomic delineation, indicated that the Northern middle- to high-income group experienced 24 per cent more decay per child than the southern group. The Northern middle- to low-income group experienced 124 per cent more decay per child than the southern group. In this study, it was demonstrated that although increased dental caries experience was closely related to geographic location, socioeconomic factors may play an even greater role in dental caries experience.

Analysis of Variance↗
PubMed2005

Longitudinal patterns and predictors of alcohol consumption in the United States.

OBJECTIVES: We examined demographic predictors of longitudinal patterns in alcohol consumption. METHODS: We used mixed-effects models to describe individual alcohol consumption and change in consumption with age, as well as the associations between consumption and birth year, national alcohol consumption, and demographic factors, among 14 105 adults from the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study. RESULTS: Alcohol consumption declined with increasing age, and individual consumption mirrored national consumption. Higher consumption was associated with male gender, being White, being married, having a higher educational level, having a higher income, being employed, and being a smoker. Faster age-related decline in consumption was associated with earlier cohorts, being male, being married, having a lower educational level, and being a smoker. CONCLUSIONS: Compared with alcohol consumption among earlier cohorts, that among recent cohorts declined more slowly with increasing age, suggesting that negative health effects of alcohol could increase in the future.

Adult↗
PubMed1993

Sources of health insurance for the self employed: does differential taxation make a difference?

Health insurance obtained through employment has enabled many workers to take advantage of the favorable tax treatment of employer contributions to these benefits. However, the full deductibility of such employer payments as a business expense and their exemption from income taxation are not available to self-employed owners of unincorporated businesses. We identify the sources of health insurance for the self employed and examine how this disparity in tax treatment is associated with health insurance status. Analyses of data from the 1987 National Medical Expenditure Survey reveal that the differential taxation of the unincorporated self employed is associated with lower rates of employment-related coverage for themselves and their workers.

Chi-Square Distribution↗
PubMed2001

Elevated incidence of type 2 diabetes in San Antonio, Texas, compared with that of Mexico City, Mexico.

OBJECTIVE: To compare the incidence of type 2 diabetes between low-income Mexican-Americans residing in San Antonio, Texas, and low-income residents in Mexico City, Mexico. RESEARCH DESIGN AND METHODS: Using data from the San Antonio Heart Study and the Mexico City Diabetes Study, we compared the incidence of type 2 diabetes in 35- to 64-year-old low-income Mexican-American residents of San Antonio with similarly aged low-income residents of Mexico City. Because of the different follow-up times in the two studies, Poisson regression was used to compare the rates of diabetes. Potential risk factors for diabetes were also analyzed to determine whether they explained or contributed to a difference in incidence. RESULTS: The age- and sex-adjusted incidence of type 2 diabetes was significantly higher in San Antonio (RR 2.01) compared with Mexico City. This difference was seen primarily in the oldest age group (55-64 years of age) and remained statistically significant after adjusting for a number of diabetes risk factors, including demographic, anthropometric, and metabolic variables. Follow-up rates were similar in both cities. CONCLUSIONS: We conclude that there was a higher incidence of type 2 diabetes in San Antonio than in Mexico City, and that difference occurred primarily in individuals in the oldest age group. The potential mediating factors we examined did not account for this difference. Other factors, such as exercise and diet, which were not available for analysis in this study, in addition to a cohort effect, may have contributed to the difference in incidence of type 2 diabetes in the two cities. In addition, there was no evidence of a higher case fatality among diabetic individuals from Mexico City compared with San Antonio.

Adult↗
PubMed2006

Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem?

OBJECTIVE: Significant racial, ethnic, and socioeconomic disparities have been observed in the rates of perforated appendicitis among children, by using large administrative databases. This study evaluated whether these factors had an impact on the care of patients with appendicitis at a major children's hospital with a well-established, comprehensive, primary referral system. METHODS: A retrospective analysis was performed for all children between the ages of 2 and 20 years who were treated for appendicitis between January 1, 2001, and December 31, 2003. Demographic variables included patient age, gender, race, insurance status, parental educational status, and income level. Coding data were used to identify patients with perforated appendicitis. The use of radiologic imaging was also analyzed. RESULTS: During the 3-year period, 788 patients were treated for appendicitis. The racial distribution (white: 81%; black: 12%; other: 7%) was consistent with the demographic composition of the local population. The overall perforation rate was 25%, and the rate was significantly greater in the age group of <6 years, compared with older children. However, there were no significant differences in the perforation rate with respect to race, insurance status, educational level, or income status. Rates of radiologic imaging use were similar among all racial and socioeconomic groups. CONCLUSIONS: Although racial and socioeconomic disparities in the rates of perforated appendicitis among children have been reported, we found no significant evidence for such inequality at our institution. This may reflect improved access, early diagnosis, and referral by primary care physicians in the community. Pooled national and multiple-state administrative databases have been used to highlight persistent disparities in health care. This study illustrates how single-institution data sources can be used to test a local hypothesis generated by national data, with surprisingly different results.

Acute Disease↗
PubMed2005

Pediatric Gastroenterology Workforce Survey, 2003-2004.

BACKGROUND: The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) performed a workforce survey to determine the number, distribution, and work-related activities of pediatric gastroenterologists in the United States of America (USA) and Canada, and compared these findings with the first workforce survey completed in 1996. METHODS: The survey queried pediatric gastroenterologists in the USA and Canada between November, 2003 and June 2004. To permit the optimal comparison to the 1996 survey data, the original survey was used as a template for development of the current instrument and, when possible, the questions were left unchanged. Additional questions were added to address important contemporary issues not present in the initial survey. Limited income information was also collected. The survey was posted on the NASPGHAN website, and the NASPGHAN membership was notified of the survey by electronic mail via its electronic mail distribution list. This was followed by a three-part postal mail survey to all non-respondents. After the Internet and postal mail requests, all non-respondent physicians were telephoned a minimum of three times. If unsuccessful in contacting the physicians directly, office personnel were queried to facilitate survey completion regarding the provision of pediatric gastroenterology, nutrition or hepatology services in either clinical care or research. RESULTS: The response rate based on the potential contact list for Part I of the survey was 69%. The final phone call or electronic mail contact of an office staff member with questions regarding gender and delivery of pediatric gastroenterology services yielded a total contact rate of 88%. There were 699 pediatric gastroenterologists identified in North America, as compared with 672 in 1996. If known non-respondents are included, there could be as many as 794 pediatric gastroenterologists. Time spent in clinical activities increased from 60% to 66% in the USA and from 43% to 53% in Canada. The use of nurse practitioners and physician assistants has increased considerably over the past 7 years. Fifty-three percent of respondents feel there are too few pediatric gastroenterologists. Fifty percent of section and practice heads report that they are currently recruiting partners. Limited income information is presented. CONCLUSIONS: There is currently a self-perceived shortage of pediatric gastroenterologists as compared with 7 years ago, despite a constant proportion of pediatric gastroenterologists per million children. In the USA, nurse practitioners and physician assistants are being increasingly used to fill this need, and physicians in both Canada and the USA have increased the time they spend in clinical care.

Adult↗
PubMed2006

Trends in absolute socioeconomic inequalities in mortality in Sweden and New Zealand. A 20-year gender perspective.

BACKGROUND: Both trends in socioeconomic inequalities in mortality, and cross-country comparisons, may give more information about the causes of health inequalities. We analysed trends in socioeconomic differentials by mortality from early 1980s to late 1990s, comparing Sweden with New Zealand. METHODS: The New Zealand Census Mortality Study (NZCMS) consisting of over 2 million individuals and the Swedish Survey of Living Conditions (ULF) comprising over 100, 000 individuals were used for analyses. Education and household income were used as measures of socioeconomic position (SEP). The slope index of inequality (SII) was calculated to estimate absolute inequalities in mortality. Analyses were based on 3-5 year follow-up and limited to individuals aged 25-77 years. Age standardised mortality rates were calculated using the European population standard. RESULTS: Absolute inequalities in mortality on average over the 1980s and 1990s for both men and women by education were similar in Sweden and New Zealand, but by income were greater in Sweden. Comparing trends in absolute inequalities over the 1980s and 1990s, men's absolute inequalities by education decreased by 66% in Sweden and by 17% in New Zealand (p for trend <0.01 in both countries). Women's absolute inequalities by education decreased by 19% in Sweden (p = 0.03) and by 8% in New Zealand (p = 0.53). Men's absolute inequalities by income decreased by 51% in Sweden (p for trend = 0.06), but increased by 16% in New Zealand (p = 0.13). Women's absolute inequalities by income increased in both countries: 12% in Sweden (p = 0.03) and 21% in New Zealand (p = 0.04). CONCLUSION: Trends in socioeconomic inequalities in mortality were clearly most favourable for men in Sweden. Trends also seemed to be more favourable for men than women in New Zealand. Assuming the trends in male inequalities in Sweden were not a statistical chance finding, it is not clear what the substantive reason(s) was for the pronounced decrease. Further gender comparisons are required.

Adult↗
PubMed2006

Increasingly conflicted: an analysis of conflicts of interest reported at the annual meetings of the Orthopaedic Trauma Association.

PURPOSE: To identify trends in industry sponsorship of orthopaedic trauma research presented at the annual meetings of the Orthopaedic Trauma Association since the establishment of conflict of interest (COI) reporting policies in 1993. BACKGROUND: Industry plays a large role in funding orthopaedic basic science and clinical research. The purpose of this study was to analyze the role of industrial support in orthopaedic research as documented in the final programs of the annual meetings of the Orthopaedic Trauma Association (OTA), determine the incidence and nature of COI in the papers and posters accepted for OTA presentation, and report any changes in the frequency of reporting since disclosure policies were enacted in 1993. METHODS: This paper analyzes COI for all years since the adoption of the reporting policies 1993-2002. From 1993-1998, presenters of posters and papers presented at the Orthopaedic Trauma Association annual meetings were required to disclose COI greater than dollar 500, the type of monetary distribution was not recorded. From 1999-2002, presenters of posters and papers were required to acknowledge the type of COI: 1. research grant, 2. miscellaneous non-income support, 3. royalties, 4. stock, and 5. consultant fees. All COI categories were recorded for each year Linear regression was used to determine significance of trends in the pooled data. RESULTS: There was an increase in the percentage of papers accepted and presented at the OTA between 1993 and 2002 with COI. The number of papers reporting COI rose from 7.6% in 1993 to 12.6% in 2002 (p = 0.0129). There was no significant increase in posters with COI over that same time period. No changes were observed in the nature of industrial involvement since the change in reporting enacted in 1999. There were no observed trends in NIH or OTA grant distribution between 1993 and 2002. DISCUSSION AND CONCLUSION: Industry is playing an increasing role in the funding oforthopaedic research. The majority of industrial support is in the form of research grants. The increasing industrial support of scientific research in the public sector is to be applauded as long as it does not lead to the sequestering and suppression of information that may be disadvantageous to the industrial sponsor.

Authorship↗
PubMed2002

Body mass index and morbidity in adult males of the War Khasi in Northeast India.

OBJECTIVE: Data on the relationship between obesity, or high body mass index (BMI), and morbidity in adult individuals are frequently reported, but little is known about the relationship between morbidity and low BMI especially in developing countries. The present study was therefore an attempt to evaluate the relationship between BMI and morbidity in adult individuals. DESIGN: The analyses were derived from the data based on self-reported morbidity and anthropometric measurements taken on adult males. The results were presented according to age and income groups for individuals of reporting and non-reporting illness. SUBJECTS: The total sample size was 575 adult males (18-59 y) of the War Khasi population. SETTING: Rural area of the state of Meghalaya in Northeast India. RESULTS: : The prevalence of chronic energy deficiency (CED) was found to be 35%, although the mean BMI (20.06+/-2.65 kg/m(2)) in individuals of non-reporting illness was higher than in those reported for many populations of Northeast India. The relationship between BMI and reported illness was not significant, although the morbidity curve tended to be U-shaped, and the prevalence of reported illness (32%) was highest in the individuals with BMI below 17.0 kg/m(2). Moreover, the suggested cut-off 18.5 of BMI for screening the prevalence of CED did not correspond with the rise in morbidity, but both BMI and morbidity were significantly associated with age and income of the household. CONCLUSION: In view of the present analysis and other related literature, BMI is likely to be a better indicator of standards of living than a predictor of illness as the latter may also predispose individuals to the former. Thus, morbidity and low BMI may be considered parts of ill health, which are influenced by a number of biological and environmental factors especially age, economic conditions, undernutrition, safe water sanitation, community pathogens, prevention and control measures of locally endemic diseases and infections.

Adolescent↗
PubMed2002

Trends in infant mortality inequalities in the Americas: 1955-1995.

STUDY OBJECTIVE: s: To describe overall and income related trends in infant mortality inequalities in the Region of the Americas from 1955 to 1995. DESIGN: Infant mortality rates (IMRs) were computed and their trends assessed by ordinary least squares. Overall trends in IMR inequalities among countries were analysed by comparing 10 year period IMRs, Gini coefficients, and Lorenz curves. Income related trends in IMR inequalities were assessed using 10 year period IMR ratios between the highest and the lowest quintiles of the per capita gross national product (GNP) distributions (adjusted for purchasing power). SETTING: Aggregated country data were used for all countries with over 200 thousand inhabitants (33 geopolitical units). The 10 year period midpoint IMR estimates used for the 1955-1995 time series were those published by the United Nations in 1997. MAIN RESULTS: IMRs decreased from 90.34 to 31.31 per 1000 live births between 1955 and 1995 at an average of 15.3 every 10 years. In contrast, Lorenz curves and Gini coefficients were similar for the five 10 year periods. After grouping by adjusted GNP distribution, a similar decreasing trend of IMR was observed in all groups. The rate ratio between the group at the lowest quintile and that at the highest quintile ranged from 4 to 5. The analysis of variance for repeated observations showed that there is a significant reduction in the IMR (F=130.18; p<0.01), that trends did not differ significantly among groups (F=1.16; p=0.32), and that they were approximately linear (F=155.83; p<0.01). CONCLUSIONS: Despite a sizable reduction in the infant mortality, whether or not income related, levels of IMR inequality among countries have remained almost constant between 1955 and 1995 in the Region of the Americas. Further analysis and focused interventions are needed to tackle the challenges of reducing these persistent mortality inequalities.

Americas↗
PubMed1979

Ecological factors underlying protein-calorie malnutrition in an irrigated area of the Sudan.

A community survey was undertaken in 14 villages in the Gezira farming region of the Sudan to determine the causes of malnutrition which is prevalent in the area. Low expenditure on food, poor housing conditions, and poor hygiene were found to result from low income. While the ultimate goal should be improvement of income, quicker results will accrue from tackling the equally important dietary causes which result from ignorance about child feeding. In the Sudan, the decline of breastfeeding, the rise in bottlefeeding, the lack of supplementary feeding, and inequitable intrafamily distribution of food are particularly important causative factors. The low levels of immunization against communicable diseases is a contributory factor which could be corrected immediately. Family size and birth rank were not important in the etiology of malnutrition.

Africa↗
PubMedDate not supplied

Using a population-based health information system to study child health.

OBJECTIVE: This paper describes the population-based analyses of measures of child health status used throughout this supplement. METHODS: The articles in this supplement examine health-related data for children 0 to 19 years. Most analyses cover the period from April 1, 1994 to March 31, 1999. Administrative and survey data were used to assess child health and well-being. For regional comparisons, data were broken down by subregions of Manitoba, called Regional Health Authorities (RHAs), and neighbourhoods of Winnipeg, called Winnipeg Community Areas (Winnipeg CAs). The premature mortality rate (PMR) was used as a proxy of the overall health of the population. All graphs comparing rates among RHAs and Winnipeg CAs rank these subregions in the same order, from lowest to highest PMR. Income was operationalized by dividing the province's population into urban and rural quintiles based upon household income. Other aspects of methodology are discussed. RESULTS: Results are presented in the articles that follow this one. CONCLUSION: The relationships between key child health indicators and geographic and socioeconomic factors for Manitoba children are discussed in the articles following this one.

Adolescent↗