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[PMID]:29297077
[Au] Autor:Purnell TS; Luo X; Cooper LA; Massie AB; Kucirka LM; Henderson ML; Gordon EJ; Crews DC; Boulware LE; Segev DL
[Ad] Endereço:Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
[Ti] Título:Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014.
[So] Source:JAMA;319(1):49-61, 2018 01 02.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Over the past 2 decades, there has been increased attention and effort to reduce disparities in live donor kidney transplantation (LDKT) for black, Hispanic, and Asian patients with end-stage kidney disease. The goal of this study was to investigate whether these efforts have been successful. Objective: To estimate changes over time in racial/ethnic disparities in LDKT in the United States, accounting for differences in death and deceased donor kidney transplantation. Design, Setting, and Participants: A secondary analysis of a prospectively maintained cohort study conducted in the United States of 453 162 adult first-time kidney transplantation candidates included in the Scientific Registry of Transplant Recipients between January 1, 1995, and December 31, 2014, with follow-up through December 31, 2016. Exposures: Race/ethnicity. Main Outcomes and Measures: The primary study outcome was time to LDKT. Multivariable Cox proportional hazards and competing risk models were constructed to assess changes in racial/ethnic disparities in LDKT among adults on the deceased donor kidney transplantation waiting list and interaction terms were used to test the statistical significance of temporal changes in racial/ethnic differences in receipt of LDKT. The adjusted subhazard ratios are estimates derived from the multivariable competing risk models. Data were categorized into 5-year increments (1995-1999, 2000-2004, 2005-2009, 2010-2014) to allow for an adequate sample size in each analytical cell. Results: Among 453 162 adult kidney transplantation candidates (mean [SD] age, 50.9 [13.1] years; 39% were women; 48% were white; 30%, black; 16%, Hispanic; and 6%, Asian), 59 516 (13.1%) received LDKT. Overall, there were 39 509 LDKTs among white patients, 8926 among black patients, 8357 among Hispanic patients, and 2724 among Asian patients. In 1995, the cumulative incidence of LDKT at 2 years after appearing on the waiting list was 7.0% among white patients, 3.4% among black patients, 6.8% among Hispanic patients, and 5.1% among Asian patients. In 2014, the cumulative incidence of LDKT was 11.4% among white patients, 2.9% among black patients, 5.9% among Hispanic patients, and 5.6% among Asian patients. From 1995-1999 to 2010-2014, racial/ethnic disparities in the receipt of LDKT increased (P < .001 for all statistical interaction terms in adjusted models comparing white patients vs black, Hispanic, and Asian patients). In 1995-1999, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.45 (95% CI, 0.42-0.48) among black patients, 0.83 (95% CI, 0.77-0.88) among Hispanic patients, and 0.56 (95% CI, 0.50-0.63) among Asian patients. In 2010-2014, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.27 (95% CI, 0.26-0.28) among black patients, 0.52 (95% CI, 0.50-0.54) among Hispanic patients, and 0.42 (95% CI, 0.39-0.45) among Asian patients. Conclusions and Relevance: Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014. These findings suggest that national strategies for addressing disparities in receipt of live donor kidney transplantation should be revisited.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde/etnologia
Falência Renal Crônica/etnologia
Transplante de Rim/tendências
Doadores Vivos
[Mh] Termos MeSH secundário: Adulto
Afroamericanos
Americanos Asiáticos
Estudos de Coortes
Grupo com Ancestrais do Continente Europeu
Feminino
Disparidades em Assistência à Saúde/tendências
Hispano-Americanos
Seres Humanos
Estimativa de Kaplan-Meier
Falência Renal Crônica/cirurgia
Transplante de Rim/mortalidade
Masculino
Meia-Idade
Estados Unidos/epidemiologia
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19152


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[PMID]:28467238
[Au] Autor:Charlton BM; Reisner SL; Agénor M; Gordon AR; Sarda V; Austin SB
[Ad] Endereço:1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.
[Ti] Título:Sexual Orientation Disparities in Human Papillomavirus Vaccination in a Longitudinal Cohort of U.S. Males and Females.
[So] Source:LGBT Health;4(3):202-209, 2017 Jun.
[Is] ISSN:2325-8306
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: This study sought to examine how human papillomavirus (HPV) vaccination may differ across sexual orientation groups (e.g., bisexuals compared to heterosexuals)-particularly in boys and men, about whom little is known. METHODS: Data were from a prospective cohort of 10,663 U.S. females and males enrolled in the Growing Up Today Study followed from 1996 to 2014. Participants were aged 11-24 years when the vaccine was approved for females in 2006 and 14-27 years when approved for males in 2009. In addition to reporting sexual orientation identity/attractions, participants reported sex of lifetime sexual partners. Log-binominal models were used to examine HPV vaccination across sexual orientation groups. RESULTS: Among females, 56% received ≥1 dose. In contrast, 8% of males obtained ≥1 dose; HPV vaccination initiation was especially low among completely heterosexual males. After adjusting for potential confounders, completely heterosexual (risk ratio [RR]; 95% confidence interval [CI]: 0.45 [0.30-0.68]) and mostly heterosexual (RR; 95% CI: 0.44 [0.25-0.78]) males were half as likely to have received even a single dose compared to gay males. Compared to lesbians, no differences were observed for completely heterosexual or bisexual females, but mostly heterosexual females were 20% more likely to have received at least one dose. CONCLUSIONS: HPV vaccination rates in the U.S. are strikingly low and special attention is needed for boys and men, especially those who do not identify as gay. Vaccinating everyone, regardless of sex/gender and/or sexual orientation, will not only lower that individual's susceptibility but also decrease transmission to partners, females and/or males, to help eradicate HPV through herd immunity.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde
Vacinas contra Papillomavirus/uso terapêutico
Comportamento Sexual
Minorias Sexuais e de Gênero
[Mh] Termos MeSH secundário: Adolescente
Criança
Feminino
Seres Humanos
Estudos Longitudinais
Masculino
Infecções por Papillomavirus/epidemiologia
Infecções por Papillomavirus/prevenção & controle
Estudos Prospectivos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Papillomavirus Vaccines)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1089/lgbt.2016.0103


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[PMID]:28468575
[Au] Autor:Cannon SM; Shukla V; Vanderbilt AA
[Ad] Endereço:a College of Medicine and Life Sciences , University of Toledo , Toledo , OH , USA.
[Ti] Título:Addressing the healthcare needs of older Lesbian, Gay, Bisexual, and Transgender patients in medical school curricula: a call to action.
[So] Source:Med Educ Online;22(1):1320933, 2017.
[Is] ISSN:1087-2981
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Medical students matriculating in the coming years will be faced with treating an expansive increase in the population of older lesbian, gay, bisexual, and transgender (LGBT) patients. While these patients face healthcare concerns similar to their non-LGBT aging peers, the older LGBT community has distinct healthcare needs and faces well-documented healthcare disparities. In order to reduce these healthcare barriers, medical school curricula must prepare and educate future physicians to treat this population while providing high quality, culturally-competent care. This article addresses some of the unique healthcare needs of the aging LGBT population with an emphasis on social concerns and healthcare disparities. It provides additional curricular recommendations to aid in the progressive augmentation of medical school curricula. ABBREVIATIONS: Liaison Committee on Medical Education (LCME); LGBT: Lesbian, gay, bisexual, transgender.
[Mh] Termos MeSH primário: Educação de Graduação em Medicina/métodos
Necessidades e Demandas de Serviços de Saúde
Minorias Sexuais e de Gênero
[Mh] Termos MeSH secundário: Fatores Etários
Currículo
Disparidades em Assistência à Saúde
Seres Humanos
Estudantes de Medicina
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1080/10872981.2017.1320933


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[PMID]:28459618
[Au] Autor:Celedón JC; Burchard EG; Schraufnagel D; Castillo-Salgado C; Schenker M; Balmes J; Neptune E; Cummings KJ; Holguin F; Riekert KA; Wisnivesky JP; Garcia JGN; Roman J; Kittles R; Ortega VE; Redline S; Mathias R; Thomas A; Samet J; Ford JG; American Thoracic Society and the National Heart, Lung, and Blood Institute
[Ti] Título:An American Thoracic Society/National Heart, Lung, and Blood Institute Workshop Report: Addressing Respiratory Health Equality in the United States.
[So] Source:Ann Am Thorac Soc;14(5):814-826, 2017 May.
[Is] ISSN:2325-6621
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Health disparities related to race, ethnicity, and socioeconomic status persist and are commonly encountered by practitioners of pediatric and adult pulmonary, critical care, and sleep medicine in the United States. To address such disparities and thus progress toward equality in respiratory health, the American Thoracic Society and the National Heart, Lung, and Blood Institute convened a workshop in May of 2015. The workshop participants addressed health disparities by focusing on six topics, each of which concluded with a panel discussion that proposed recommendations for research on racial, ethnic, and socioeconomic disparities in pulmonary, critical care, and sleep medicine. Such recommendations address best practices to advance research on respiratory health disparities (e.g., characterize broad ethnic groups into subgroups known to differ with regard to a disease of interest), risk factors for respiratory health disparities (e.g., study the impact of new tobacco or nicotine products on respiratory diseases in minority populations), addressing equity in access to healthcare and quality of care (e.g., conduct longitudinal studies of the impact of the Affordable Care Act on respiratory and sleep disorders), the impact of personalized medicine on disparities research (e.g., implement large studies of pharmacogenetics in minority populations), improving design and methodology for research studies in respiratory health disparities (e.g., use study designs that reduce participants' burden and foster trust by engaging participants as decision-makers), and achieving equity in the pulmonary, critical care, and sleep medicine workforce (e.g., develop and maintain robust mentoring programs for junior faculty, including local and external mentors). Addressing these research needs should advance efforts to reduce, and potentially eliminate, respiratory, sleep, and critical care disparities in the United States.
[Mh] Termos MeSH primário: Grupos Étnicos/estatística & dados numéricos
Acesso aos Serviços de Saúde/estatística & dados numéricos
Disparidades nos Níveis de Saúde
Disparidades em Assistência à Saúde
Grupos Minoritários/estatística & dados numéricos
Doenças Respiratórias/epidemiologia
[Mh] Termos MeSH secundário: Política de Saúde
Seres Humanos
National Heart, Lung, and Blood Institute (U.S.)
Pneumologia
Classe Social
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:CONSENSUS DEVELOPMENT CONFERENCE, NIH; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1513/AnnalsATS.201702-167WS


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[PMID]:28453715
[Au] Autor:Pan B; Towne SD; Chen Y; Yuan Z
[Ad] Endereço:Department of Health Statistics, School of Public Health, Nanchang University, Nanchang, People' Republic of China.
[Ti] Título:The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis.
[So] Source:Health Policy Plan;32(5):634-646, 2017 Jun 01.
[Is] ISSN:1460-2237
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective : The main aim of the New-type Rural Cooperative Medical System (NRCMS) put into effect in 2003 was to reduce financial barriers in accessing health care services among vulnerable populations. The aim of this study was to assess the association between NRCMS and income related inequality in hospital utilization among rural inhabitants in Jiangxi Province, China. Methods : A multistage stratified random cluster sampling method was adopted to select 1838, 1879, and 1890 households as participants in 2003/2004, 2008 and 2014, respectively. The Erreygers Concentration index (EI) of two measures of hospital inpatient care including admission to hospital and hospital avoidance, were calculated to measure income-related inequality. The decomposition of the EI was performed to characterize the contributions of socioeconomic and need factors to the measured inequality. Results : An affluent-focused (pro-rich) inequity was observed for hospital admission adjusting for need factors over time. The level of inequity for hospital admission decreased dramatically, while hospital avoidance decreased marginally, and with a high value (EI, -0.0176) in 2008. The implementation of the NRCMS was associated with decreased inequity in 2008 and in 2014, but the associations were limited. Income contributed the most to the inequality of hospital utilization each year. Conclusion : The coverage of the NRCMS expanded to cover nearly all rural inhabitants in Jiangxi province by 2014 and was associated with a very small reduction in inequalities in admission to hospital. In order to increase equitable access to health care, additional financial protections for vulnerable populations are needed. Improving the relatively low level of medical services in township hospitals, and low rate of reimbursement and financial assistance with the NRCMS is recommended.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde/estatística & dados numéricos
Hospitais/utilização
Serviços de Saúde Rural/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
China/epidemiologia
Estudos Transversais
Disparidades em Assistência à Saúde/economia
Seres Humanos
Seguro Saúde
Serviços de Saúde Rural/economia
População Rural/estatística & dados numéricos
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/heapol/czw175


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[PMID]:28453693
[Au] Autor:Mahal BA; Chen YW; Muralidhar V; Mahal AR; Choueiri TK; Hoffman KE; Hu JC; Sweeney CJ; Yu JB; Feng FY; Kim SP; Beard CJ; Martin NE; Trinh QD; Nguyen PL
[Ad] Endereço:Harvard Radiation Oncology Program, Boston, USA.
[Ti] Título:Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States.
[So] Source:Ann Oncol;28(5):1098-1104, 2017 05 01.
[Is] ISSN:1569-8041
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: In 2012, the United States Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA) screening, despite evidence that Black men are at a higher risk of prostate cancer-specific mortality (PCSM). We evaluated whether Black men of potentially screening-eligible age (55-69 years) are at a disproportionally high risk of poor outcomes. Patients and methods: The SEER database was used to study 390 259 men diagnosed with prostate cancer in the United States between 2004 and 2011. Multivariable logistic regression modeled the association between Black race and stage of presentation, while Fine-Gray competing risks regression modeled the association between Black race and PCSM, both as a function of screening eligibility (age 55-69 years versus not). Results: Black men were more likely to present with metastatic disease (adjusted odds ratio [AOR] 1.65; 1.58-1.72; P < 0.001) and were at a higher risk of PCSM (adjusted hazard ratio [AHR] 1.36; 1.27-1.46; P < 0.001) compared to non-Black men. There were significant interactions between race and PSA-screening eligibility such that Black patients experienced more disproportionate rates of metastatic disease (AOR 1.76; 1.65-1.87 versus 1.55; 1.47-1.65; Pinteraction < 0.001) and PCSM (AHR 1.53; 1.37-1.70 versus 1.25; 1.14-1.37; Pinteraction = 0.01) in the potentially PSA-screening eligible group than in the group not eligible for screening. Conclusions: Racial disparities in prostate cancer outcome among Black men are significantly worse in PSA-screening eligible populations. These results raise the possibility that Black men could be disproportionately impacted by recommendations to end PSA screening in the United States and suggest that Black race should be included in the updated USPSTF PSA screening guidelines.
[Mh] Termos MeSH primário: Neoplasias da Próstata/diagnóstico
[Mh] Termos MeSH secundário: Afroamericanos
Idoso
Detecção Precoce de Câncer
Disparidades em Assistência à Saúde
Seres Humanos
Calicreínas/metabolismo
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Antígeno Prostático Específico/metabolismo
Neoplasias da Próstata/metabolismo
Neoplasias da Próstata/mortalidade
Neoplasias da Próstata/terapia
Fatores de Risco
Programa de SEER
Resultado do Tratamento
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
EC 3.4.21.- (Kallikreins); EC 3.4.21.- (kallikrein-related peptidase 3, human); EC 3.4.21.77 (Prostate-Specific Antigen)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/annonc/mdx041


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[PMID]:29367432
[Au] Autor:Boatin AA; Schlotheuber A; Betran AP; Moller AB; Barros AJD; Boerma T; Torloni MR; Victora CG; Hosseinpoor AR
[Ad] Endereço:Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
[Ti] Título:Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries.
[So] Source:BMJ;360:k55, 2018 01 24.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To provide an update on economic related inequalities in caesarean section rates within countries. DESIGN: Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. SETTING: 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. PARTICIPANTS: Women aged 15-49 years with a live birth during the two or three years preceding the survey. MAIN OUTCOME MEASURES: Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. RESULTS: National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. CONCLUSIONS: Substantial within country economic inequalities in caesarean deliveries remain. These inequalities might be due to a combination of inadequate access to emergency obstetric care among the poorest subgroups and high levels of caesarean use without medical indication in the richest subgroups, especially in middle income countries. Country specific strategies should address these inequalities to improve maternal and newborn health.
[Mh] Termos MeSH primário: Cesárea/estatística & dados numéricos
Países em Desenvolvimento
Disparidades em Assistência à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Seres Humanos
Meia-Idade
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k55


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[PMID]:29390313
[Au] Autor:Parikh-Patel A; Morris CR; Kizer KW
[Ad] Endereço:California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health.
[Ti] Título:Disparities in quality of cancer care: The role of health insurance and population demographics.
[So] Source:Medicine (Baltimore);96(50):e9125, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance.
[Mh] Termos MeSH primário: Demografia
Disparidades em Assistência à Saúde
Cobertura do Seguro
Seguro Saúde
Neoplasias/economia
Neoplasias/terapia
Qualidade da Assistência à Saúde
[Mh] Termos MeSH secundário: California
Estudos Transversais
Feminino
Seres Humanos
Masculino
Sistema de Registros
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009125


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[PMID]:29206952
[Au] Autor:MacDougall H
[Ad] Endereço:3144 Chowen Avenue South #211, Minneapolis, MN 55416.
[Ti] Título:Dental Disparities among Low-Income American Adults: A Social Work Perspective.
[So] Source:Health Soc Work;41(3):208-210, 2016 Aug 01.
[Is] ISSN:0360-7283
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência Odontológica
Disparidades em Assistência à Saúde
Renda/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Pobreza
Serviço Social
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1093/hsw/hlw026


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[PMID]:27775395
[Au] Autor:Patterson-Lomba O; Safan M; Towers S; Taylor J
[Ad] Endereço:Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States. email: oskkypatterson@yahoo.es.
[Ti] Título:Modeling the role of healthcare access inequalities in epidemic outcomes.
[So] Source:Math Biosci Eng;13(5):1011-1041, 2016 10 01.
[Is] ISSN:1551-0018
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Urban areas, with large and dense populations, offer conditions that favor the emergence and spread of certain infectious diseases. One common feature of urban populations is the existence of large socioeconomic inequalities which are often mirrored by disparities in access to healthcare. Recent empirical evidence suggests that higher levels of socioeconomic inequalities are associated with worsened public health outcomes, including higher rates of sexually transmitted diseases (STD's) and lower life expectancy. However, the reasons for these associations are still speculative. Here we formulate a mathematical model to study the effect of healthcare disparities on the spread of an infectious disease that does not confer lasting immunity, such as is true of certain STD's. Using a simple epidemic model of a population divided into two groups that differ in their recovery rates due to different levels of access to healthcare, we find that both the basic reproductive number (R0) of the disease and its endemic prevalence are increasing functions of the disparity between the two groups, in agreement with empirical evidence. Unexpectedly, this can be true even when the fraction of the population with better access to healthcare is increased if this is offset by reduced access within the disadvantaged group. Extending our model to more than two groups with different levels of access to healthcare, we find that increasing the variance of recovery rates among groups, while keeping the mean recovery rate constant, also increases R0 and disease prevalence. In addition, we show that these conclusions are sensitive to how we quantify the inequalities in our model, underscoring the importance of basing analyses on appropriate measures of inequalities. These insights shed light on the possible impact that increasing levels of inequalities in healthcare access can have on epidemic outcomes, while offering plausible explanations for the observed empirical patterns.
[Mh] Termos MeSH primário: Doenças Transmissíveis/epidemiologia
Epidemias/estatística & dados numéricos
Acesso aos Serviços de Saúde/estatística & dados numéricos
Disparidades em Assistência à Saúde/estatística & dados numéricos
Modelos Biológicos
[Mh] Termos MeSH secundário: Seres Humanos
Fatores Socioeconômicos
População Urbana
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.3934/mbe.2016028



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