جستجوی مقالات مرتبط با کلیدواژه « health status disparities » در نشریات گروه « پزشکی »

Mental health is integral to public health in adolescents. Although previous studies have shown that low socioeconomic status (SES) is associated with mental disorders (MD), it is unclear which mental health domains are most important. Thus, our study aimed to investigate the associations between 5 domains of mental disorder and SES inequality in adolescents. 

We conducted a cross-sectional study among adolescents (N = 1724). Associations between SES inequality with mental disorders, such as emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and prosocial behavior, were examined. We used the concentration index (CI) to determine inequality. The gap between the low and high socioeconomic groups was decomposed into its determinants using the Blinder-Oaxaca decomposition method.  

Mental health's overall CI was –0.085 (P ˂ 0.001). The emotional problem was primarily caused by SES inequality (–0.094 [P = 0.004]). Decomposition of the gap between the 2 economic groups showed that physical activity, school performance, exercise, parents' smoking status, and gender were the most important determinants of inequality.  

SES inequality plays a vital role in adolescents' mental health. It seems that the emotional problem domain of mental health might be more amenable to interventions than other domains.

Universities of medical sciences (UMSs) in Iran have geographic catchment areas (normally a province) in which they are responsible for public health services as well as provision of care by public providers. The present study strived to analyze and rank the performance of the medical sciences universities in improving the public health and primary healthcare.

Data on 41 indicators on the output (16 indicators), outcome (16 indicators), and impact (9 indicators) levels were extracted from various data sources. Principal component analysis (PCA) was used to calculate the weight for each of the indicators. The score range for each level of performance is between 0 and 1. A score of 1 indicates the highest and a score of 0 indicates the lowest level of performance. Finally, the UMSs were ranked by their scores.

The national mean performance scores of the UMSs on the output, outcome, impact, and the composite indicator levels were 0.756, 0.641, 0.561, and 0.563, respectively. The results show that the changes in performance scores at different levels of the results chain are remarkable.

The national mean performance of the UMSs of Iran is not satisfactory. However, there is considerable dispersion in their performance. Designing effective interventions in proportion to the conditions of universities on different levels of the results chain, developing a robust information system, conducting continuous monitoring and evaluation of public health are recommended for balanced improvements in public health and primary healthcare indicators in the country.

Early recognition of autism is important, but diagnosis age varies among children. Recent studies have aimed to identify factors affecting age of diagnosis and several studies have attempted to explore geographic variation in age at diagnosis of autism. However, there is a lack of research examining geographic variations with multiple models to find whether geographic differences can be explained by risk factors such as socioeconomic status and differences in child characteristics. This study aimed to address this gap of knowledge by comparing age at diagnosis of autism between the group of people living in the center of the province and the group of people living in the rest of the province, considering potential medical and socioeconomic confounders.

The study population consisted of 50 autistic children born in East Azerbaijan Province between 2004 and 2016. Initially, univariate testing by ANOVA was performed to identify family and individual factors contributing to differences in age at autism diagnosis. Following this, the association between living in the center of the province and age at diagnosis in univariate and multivariate analyses was examined.

Results from the initial univariate analysis indicate a significant association between living in the center of province and early diagnosis. However, inclusion of possible confounders in multiple model illustrates that these geographical disparities in age at diagnosis can be explained by differences in socioeconomic and medical status.

Although geographic variation in age at diagnosis of autism was observed, analyses show that differences in individual and family-level factors may contribute to geographic differences. In this study, most of the observed variation was accounted for by family-level factors rather than geographic policies. Findings prove that multiple strategies are required to identify targeted interventions and strategies.

Young breast cancer survivors (YBCS) face greater needs than their older counterparts. These needs require characterization for success of breast cancer assistance programs because needs vary by survivor race and where they are in their survivorship journey. This study evaluated quality of life (QOL) for YBCS in three states with poorer survivorship outcomes and identified differences in QOL for white and African American (AA) YBCS.

A survey identifying QOL needs was sent to YBCS in Louisiana, Mississippi, and Alabama. It assessed domains including relationships, women’s health, employment, fertility, and menopause. The survey was resent to participants after one-year completion of the first survey to identify QOL changes.

Overall, 371 baseline surveys and 127 follow-up surveys were collected. At baseline, AA YBCS faced more problems in five QOL domains and were less likely to have spoken with healthcare providers about genetic testing for breast cancer than white YBCS. After one year, all YBCS showed improvement in five different QOL domains, but indicated an increase in memory problems.

Survey results reflect existing literature that AA YBCS face greater QOL issues as well as disparities in the provision of genetic counseling. Additionally, all YBCS require more counseling from providers related to various physical and psychological symptoms. This survey identified QOL deficiencies faced by YBCS and differences based on survivor race. Defining and understanding these features allows for the development of culturally appropriate programming for survivors, while adapting to YBCS’ QOL changes as they move further from treatment.

Many COVID-19 cases and deaths have been reported from the United States (US). This study aimed to assess the health system inequalities as a determinant of COVID-19 case morbidity and mortality in the US. This study collected data on US COVID-19 cases and deaths as of the 27th of January 2021 from the Worldometer and COVID-19 Community Vulnerability Index. The strength of association between the social vulnerability index (SVI), total COVID-19 deaths and tests, and regional population in the US were determined using Pearson’s correlation. P values < 0.05 were statistically significant. New York has the highest SVI (0.94) in the North-Eastern region and the highest percentage of non-Whites. California has the highest SVI (0.90) in the Western region and the highest proportion of Asians. In the mid-Western region of the US, Illinois has the highest SVI (0.88) and the highest proportion of African Americans and Asians. North Carolina has the highest SVI of (1.00) in the Southern region and the highest proportion of African Americans. A strong positive correlation exists between the SVI and total COVID-19 tests (P = 0.001) in the North-eastern and Southern regions (P = 0.025). In addition, a positive correlation (P < 0.039) exists between SVI and the total population in the Western and mid-Western regions (P < 0.003). Multi-sectoral collaboration should be encouraged to promote equity in accessing COVID-19 healthcare in the US, especially in States with high COVID-19 SVI.

Health literacy is a major factor for health promotion and well‑being. In spite of several researches on health literacy, information on the subject of the status of health literacy in
Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors.

In this cross‑sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset‑based approach, and principal component analysis (PCA) was performed to estimate the families’ SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software.

The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168–0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor.

The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.

Provider perceptions about patient candidacy for kidney transplant (KT) are potentially significant contributors to disparities in KT. To examine nephrologists’ perceptions about factors that are important in excluding patients from KT referral, and to analyze the association between these perceptions and nephrologists’ demographic and practice characteristics. Invitations were sent to 3180 nephrologists. Among those who consented, 822 fulfilled the inclusion criteria, and 250 were randomly invited to complete a questionnaire about perceptions of factors essential in deciding not to refer patients for KT. Responses from 216 participants with complete responses were analyzed. The 3 most common reasons for excluding patients were “patient’s inadequate social support” (44%), “limited understanding of the process due to patient’s inadequate education” (32%), and “patient’s age above 65” (26%). Nephrologists practicing in rural settings were more likely to consider inadequate support and limited education of patients as reasons not to refer for KT. In multivariate analysis, physicians with 2 or fewer transplant centers within 50 miles were more likely to report inadequate social support (OR: 3.15, 95% CI: 1.59–6.24) and age greater than 65 years (OR: 1.88, 95% CI: 1.01–3.49) as reasons to exclude patients from KT referral. Nephrologists whose practice included patients majority of whom had not completed high school were more likely to consider limited understanding due to inadequate education as an important reason to exclude patients from KT (OR: 3.31, 95% CI: 1.60–6.86). Patient’s social support, understanding, and age were the most common factors regarded by nephrologists as important in not referring patients for KT evaluation. Practice location, particularly rural setting, proximity to a transplant center, and the education level of a nephrologist’s patient population were important determinants of referral for KT.

It is not well understood whether the self-reported experience of substance abuse-related problems differs by socioeconomic status. We conducted a secondary analysis using the 2013 National Survey on Drug Use and Health (NSDUH) on participants who reported ever using illicit drugs or used illicit drugs in the past year. Among those reporting ever using illicit drugs (n = 4701), 71% were Non-Hispanic White, 37% had a family income ≥ $75000, and 3% reported having substance abuse-related problems in the past year. After adjustment for age, race, marital status, and education, individuals in the lowest income group were more likely to report having problems related to their substance abuse compared to individuals in the highest income group [odds ratio (OR) = 1.36, 95% confidence interval (CI): 1.08-1.72] among those who reported ever using illicit drugs. There was no evidence of interaction with race or gender. Our findings suggest that poverty may be associated with self-identification of substance abuse-related problems among those who report ever using illicit drugs. Appropriate intervention should be targeted toward the low-income group to address identified substance abuse-related problems.

Studies addressing ethnic disparities and trends in liver transplantation for Asian population are scant.
To examine the impact of Share 35 policy on Asian patients’ access to liver transplantation and outcomes since its implementation in June 2013.
A total of 11,910 adult white and Asian patients who were registered for deceased donor liver transplantation between 2012 and 2015, was identified from the United Network for Organ Sharing database. Logistic regression and proportional hazard models with adjustment for demographic, clinical and geographic factors were used to model the access to liver transplantation and patient survival. Stratification on pre- and post-Share 35 periods was performed to compare the first 18 months of Share 35 policy to an equivalent period.
Comparison of the pre- and post-Share 35 periods showed a significant decrease in time on waiting list and higher proportions of patients receiving liver transplantation for Asian patients. Asians shared similar transplant rates as whites (OR: 1.15, 95% CI: 0.80–1.67) but experienced significantly longer waiting time (HR: 0.56, 95% CI: 0.34–0.92) before they received liver transplantation after Share 35 policy took effect. No significant post-transplantation survival difference was observed between Asians and whites at the 18-month outcome.
Although benefited from the Share 35 policy, Asian patients are still at greater risk of disparities in access to liver transplantation.

The aging population of Hong Kong is rapidly growing. Although older adults enjoy a relatively long life expectancy, their psychological health is ranked near the bottom in the world.
This study assessed the psychological health of older women in Hong Kong and compared it with that of older men. It also aimed to examine if demographic characteristics have similar effects on the psychological health of older women and men.
A standardized questionnaire was administered in face-to-face interviews with 554 participants (288 women and 266 men), aged 70 years or above. Psychological health was measured by the general health questionnaire-30 (GHQ-30), center for epidemiologic studies-depression (CES-D) scale, and life satisfaction index (LSI). Chi square test was performed to examine gender differences in psychological health and determine the relationship between demographic characteristics and psychological health of the elderly.
Compared with older men, a greater proportion of older women were at risk of mild psychiatric problems (22.1% vs. 12.3%, P Health promotion programs should be implemented to reduce health inequalities among men and women. Effectiveness of programs can be enhanced by targeting the elderly whose psychological health is most vulnerable.

The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31–17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69–32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51–2.14], the low-economic group (OR= 2.33, 95% CI= 1.90–2.87), the visually impaired (OR= 1.41, 95% CI= 1.05–1.90), and the uninsured (OR= 1.93, 95% CI= 1.45–2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93–0.96) and education (OR= 0.94, 95% CI= 0.92–0.96). In this study, 24.72% (95% CI= 22.30–27.14) of the low-economic group and 9.94% (95% CI= 8.75–11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause.