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4 "Healthcare disparities"
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Original Articles
Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study
Dal-Lae Jin, Kyoung-Hoon Kim, Euy Suk Chung, Seok-Jun Yoon
J Prev Med Public Health. 2024;57(3):260-268.   Published online May 30, 2024
DOI: https://doi.org/10.3961/jpmph.24.057
  • 509 View
  • 20 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival.
Methods
A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed.
Results
The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91).
Conclusions
Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.
Summary
Korean summary
심혈관 관련 수술을 대상으로 지역적 불균형을 분석한 결과, 관상동맥우회술, 경피적 관상동맥중재술, 스텐트 삽입술은 전국적으로 광범위하게 분포되었다. 반면에 대동맥류 절제술은 지역적 불균형이 발생하였고, 사망률 또한 유의한 차이가 있었다. 따라서 의료 격차 해소를 위해 병원 간 협력체계 구축, 지역 균형적 의료자원 확충 등 정책적 노력이 필요하다
Key Message
An analysis of regional disparities in cardiovascular surgeries revealed that coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and stent insertion procedures were widely distributed nationwide. However, there was a regional imbalance in aortic aneurysm resection (AAR) surgeries, which also showed significant differences in mortality rates. Therefore, policy efforts are needed to bridge the healthcare gap, such as establishing collaborative systems among hospitals and ensuring a balanced distribution of medical resources across regions.
Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households
Ehsan Aghapour, Mehdi Basakha, Seyed Hossein Mohaqeqi Kamal, Abolghasem Pourreza
J Prev Med Public Health. 2022;55(4):379-388.   Published online June 27, 2022
DOI: https://doi.org/10.3961/jpmph.22.123
  • 2,487 View
  • 80 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
Methods
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Results
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
Conclusions
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.
Summary

Citations

Citations to this article as recorded by  
  • Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics
    Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Salah Eddin Karimi, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh Forouzan
    INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2024;[Epub]     CrossRef
Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017
Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli
J Prev Med Public Health. 2020;53(4):266-274.   Published online June 10, 2020
DOI: https://doi.org/10.3961/jpmph.20.035
  • 4,498 View
  • 190 Download
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.
Methods
We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.
Results
The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).
Conclusions
Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.
Summary

Citations

Citations to this article as recorded by  
  • Causes of death among international travellers in Peru, 2017 to 2021
    Kasim Allel, Miguel M Cabada, Collen Lau, Deborah Mills, Richard C Franklin, Yan Zhu, Luis Furuya-Kanamori
    Journal of Travel Medicine.2024;[Epub]     CrossRef
  • Informal payments in health facilities in Peru in 2018: Analysis of a cross-sectional survey
    Laura Espinoza-Pajuelo, Patricia Mallma, Hannah Hogan Leslie, Patricia Jannet García, Sarthak Gaurav
    PLOS Global Public Health.2024; 4(1): e0001837.     CrossRef
  • An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India
    Aashima, Rajesh Sharma
    International Journal of Social Determinants of Health and Health Services.2024;[Epub]     CrossRef
  • Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
    Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
    Journal of Preventive Medicine and Public Health.2024; 57(1): 65.     CrossRef
  • High cost drugs in Latin America: access and barriers
    Diego Rosselli
    Expert Review of Pharmacoeconomics & Outcomes Research.2023; 23(6): 619.     CrossRef
  • Determinants of Eye Care Service Utilization among Peruvian Adults: Evidence from a Nationwide Household Survey
    Antonio Barrenechea-Pulache, Andres Portocarrero-Bonifaz, Akram Hernández-Vásquez, Carlos Portocarrero-Ramos, Jenny Moscoso-Carrasco
    Ophthalmic Epidemiology.2022; 29(3): 339.     CrossRef
  • Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature
    Taslima Rahman, Dominic Gasbarro, Khurshid Alam
    Health Research Policy and Systems.2022;[Epub]     CrossRef
  • THE IGNORED PANDEMIC OF PUBLIC HEALTH CORRUPTION: A CALL FOR ACTION AMID AND BEYOND SARS-COV-2/COVID-19
    Jorge A. Sánchez-Duque, Zhaohui Su, Diego Rosselli, Maria Camila Chica-Ocampo, Maria Isabel Lotero-Puentes, Ana M. Bolaños-Portilla, Manish Dhawan, Alfonso J. Rodríguez-Morales, Kuldeep Dhama
    Journal of Experimental Biology and Agricultural Sciences.2021; 9(2): 108.     CrossRef
Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea
Youngsoo Kim, Saerom Kim, Seungmin Jeong, Sang Guen Cho, Seung-sik Hwang
J Prev Med Public Health. 2019;52(1):51-59.   Published online January 23, 2019
DOI: https://doi.org/10.3961/jpmph.18.162
  • 6,388 View
  • 191 Download
  • 11 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated.
Methods
Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables.
Results
The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and selfrated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model.
Conclusions
The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.
Summary
Korean summary
이 연구에서는 2011년부터 2015년까지의 한국의료패널 자료를 이용하여 미충족의료과 불건강의 관련성을 살펴보고, 불건강을 매개하는 미충족의료의 크기를 추정했다. 미충족의료는 개인고정효과를 보정하였을 때 불건강에 유의한 영향 준다는 것을 확인할 수 있었고, 미충족의료가 매개하는 저소득의 건강 효과는 저소득이 불건강에 미치는 전체 효과 중 일부에 지나지 않았으며, 효과의 크기는 분석 연도 별로 일정하지 않게 나타났다. 이는 건강불평등을 줄이기 위한 정책 개입에서 미충족의료 해소가 유의미한 정책 목표로 가치가 있지만 그 한계 또한 명확하다는 것을 의미한다.

Citations

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  • How did unmet care needs during the pandemic affect health outcomes of older European individuals?
    Julien Bergeot, Florence Jusot
    Economics & Human Biology.2024; 52: 101317.     CrossRef
  • Unmet healthcare needs among the population aged 50+ and their association with health outcomes during the COVID-19 pandemic
    Carlota Quintal, Luis Moura Ramos, Micaela Antunes, Óscar Lourenço
    European Journal of Ageing.2023;[Epub]     CrossRef
  • Factors and at-risk group associated with hypertension self-management patterns among people with physical disabilities: a latent class analysis
    Hye Jin Nam, Ju Young Yoon
    BMC Public Health.2022;[Epub]     CrossRef
  • Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data
    Woojin Chung
    Healthcare.2022; 10(11): 2243.     CrossRef
  • Intergenerational Differences in Factors Affecting Unmet Health Care Needs in South Korea: Comparison of Middle-aged and Older Adults
    Eunjeong Noh
    Journal of Intergenerational Relationships.2021; 19(1): 144.     CrossRef
  • Identification of Unmet Healthcare Needs: A National Survey in Thailand
    Sukanya Chongthawonsatid
    Journal of Preventive Medicine and Public Health.2021; 54(2): 129.     CrossRef
  • Factors affecting unmet healthcare needs of low-income overweight and obese women in Korea: analysis of the Korean National Health and Nutrition Examination Survey 2017
    Ju-Hee Nho, Sook Kyoung Park
    Korean Journal of Women Health Nursing.2021; 27(2): 93.     CrossRef
  • Factors Affecting Unmet Healthcare Needs among Adults with Chronic Diseases
    Ji-Young Han, Hyeon-Sook Park
    Journal of Korean Academy of Community Health Nursing.2021; 32(2): 131.     CrossRef
  • Association between osteoarthritis and unmet medical needs in Korea: limitations in activities as a mediator
    Hooin Jo, Eun-san Kim, Boyoung Jung, Soo-Hyun Sung, In-Hyuk Ha
    BMC Public Health.2020;[Epub]     CrossRef
  • Unmet Healthcare Needs and Associated Factors in Rural and Suburban Vietnam: A Cross-Sectional Study
    Ju Young Kim, Dae In Kim, Hwa Yeon Park, Yuliya Pak, Phap Ngoc Hoang Tran, Truc Thanh Thai, Mai Thi Thanh Thuy, Do Van Dung
    International Journal of Environmental Research and Public Health.2020; 17(17): 6320.     CrossRef
  • Factors Underlying Unmet Medical Needs: A Cross-Sectional Study
    Young Suk Yoon, Boyoung Jung, Dongsu Kim, In-Hyuk Ha
    International Journal of Environmental Research and Public Health.2019; 16(13): 2391.     CrossRef

JPMPH : Journal of Preventive Medicine and Public Health