International Journal for Equity in Health最新文献

{"title":"Barriers to health equity in the United States of America: can they be overcome?","authors":"Allen M Chen","doi":"10.1186/s12939-025-02401-w","DOIUrl":"10.1186/s12939-025-02401-w","url":null,"abstract":"<p><p>Health equity-defined by the Centers for Disease Control and Prevention as \" the state in which everyone has a fair and just opportunity to attain their highest level of health-\" represents one of the most critical issues facing modern societies. While seemingly an increasing focus of policymakers in recent years, this concept is hardly a novel one. In 1948, the inaugural Constitution of the newly founded World Health Organization clearly stated that \"the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.\" Yet nearly a century later, it is arguable how much progress society has made in achieving health equity, particularly in the United States of America where numerous factors at both the level of the individual and population contribute to significant complexity with respect to healthcare access and delivery. The purpose of this review is to thus outline the barriers to health equity so that thoughtful discourse can be promoted to create a more even playing field for the lives of the disadvantaged and underserved in the future.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"39"},"PeriodicalIF":4.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the WHO building blocks to examine cross-border public health surveillance in MENA.","authors":"Laura Buback, Shayanne Martin, Esbeydy Pardo, Farah Massoud, Jesus Formigo, Atousa Bonyani, Noha H Farag, Zayid K Almayahi, Kenta Ishii, Susie Welty, Dana Schneider","doi":"10.1186/s12939-025-02393-7","DOIUrl":"10.1186/s12939-025-02393-7","url":null,"abstract":"<p><p>The introduction of the Sustainable Development Goals by the United Nations has set a global target for achieving Universal Health Coverage, requiring resilient health systems capable of addressing public health emergencies and ensuring health security. Public health surveillance, crucial for detecting and responding to infectious disease outbreaks, is key to building health system resilience. Due to the high levels of mobility and political instability in the Middle East and North Africa (MENA) region, unique challenges arise in cross-border health surveillance. This review aims to highlight the importance of cross-border public health surveillance in strengthening health systems across MENA to achieve equitable health outcomes.A mixed-methods approach was utilized, combining a systematic literature review with semi-structured in-depth interviews (IDIs) involving 28 stakeholders from seven MENA countries. The literature review adhered to PRISMA guidelines, while the IDIs provided qualitative insights into current surveillance practices and challenges. Findings from the literature review and IDIs were triangulated and analyzed using the WHO Health Systems Strengthening (HSS) Building Blocks Framework to identify key challenges and recommendations for improving cross-border surveillance.Results indicate that existing cross-border surveillance systems in MENA face challenges in data collection, analysis, and sharing, with disparities across countries based on income levels and political contexts. Key challenges include delayed and incomplete data sharing, insufficient funding across sectors, inadequate training, inconsistent data definitions, and limited integration of health data for mobile populations. Recommendations emphasize strengthened governance and leadership to facilitate regional cooperation and information sharing, sustainable financing for implementing a One Health approach, utilizing innovative information systems, workforce development to enhance data collection and analysis, and secure supply chains for medicines and vaccines and equitable service delivery for all mobile populations.In conclusion, the WHO HSS Building Block Framework provides a comprehensive approach to assessing and improving cross-border public health surveillance and enhancing health security and equity in MENA. Strengthening cross-border surveillance systems may help MENA countries meet IHR requirements, achieve greater health security, and advance health equity among all types of mobile populations. Despite limitations, the study offers critical insights for improving cross-border surveillance strategies in the region.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"38"},"PeriodicalIF":4.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining general, physical, and mental health disparities between transgender and cisgender adults in the U.S.","authors":"Sunday Azagba, Galappaththige S R de Silva, Todd Ebling","doi":"10.1186/s12939-024-02364-4","DOIUrl":"10.1186/s12939-024-02364-4","url":null,"abstract":"<p><strong>Background: </strong>With the proliferation of anti-transgender policies in some U.S. jurisdictions, this study examines the general, mental, and physical health of transgender and cisgender populations.</p><p><strong>Methods: </strong>Data from the 2020-2023 Behavioral Risk Factor Surveillance System were analyzed to examine associations between gender identity and health outcomes. Propensity score weighting was used to address potential imbalances among group characteristics. We conducted logistic regression for the binary outcome of self-rated health and quasi-Poisson regression for the number of days reporting poor mental and physical health.</p><p><strong>Results: </strong>Results reveal significant disparities in health outcomes, with transgender individuals reporting lower proportions of good general health and more days of poor mental and physical health compared to cisgender individuals. In the adjusted analyses, transgender individuals were significantly less likely to report good general health compared to cisgender peers (OR = 0.60, 95% CI = 0.52-0.69). Gender nonconforming (GNC), male-to-female (MTF), and female-to-male (FTM) individuals had lower odds of reporting good general health compared to cisgender individuals (GNC, OR = 0.46, 95% CI = 0.35-0.61; MTF, OR = 0.67, 95% CI = 0.53-0.85; FTM, OR = 0.71, 95% CI = 0.57-0.87). GNC individuals had an 86% higher frequency of poor mental health days (IRR = 1.86, 95% CI = 1.57-2.21) and a 37% higher frequency of poor physical health days (IRR = 1.37, 95% CI = 1.15-1.63) compared to cisgender counterparts. Similarly, MTF and FTM individuals had significantly higher frequencies of poor mental and physical health days.</p><p><strong>Conclusions: </strong>The study highlights significant health disparities faced by transgender individuals, who report poorer general, mental, and physical health. These findings underscore the need to address the unique challenges and improve health outcomes within the transgender community.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"37"},"PeriodicalIF":4.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of National Reimbursement Drug Price Negotiation on drug accessibility, utilization, and cost in China: a systematic review.","authors":"Zheng Zhu, Jiawei Zhang, Zhihu Xu, Quan Wang, Yu Qi, Li Yang","doi":"10.1186/s12939-025-02390-w","DOIUrl":"10.1186/s12939-025-02390-w","url":null,"abstract":"<p><strong>Objective: </strong>National Reimbursement Drug Price Negotiation (NRDPN) refers to a government-led process of negotiating with pharmaceutical companies to reach reasonable prices for exclusive drugs covered by national reimbursement. Since 2016, the Chinese government has regularly implemented eight rounds of NRDPN. This systematic review aimed to determine the effects of NRDPN on drug price, availability, affordability, utilization, cost, and health outcomes in China in the years 2016-2023.</p><p><strong>Methods: </strong>We searched the electronic databases PubMed (which includes MEDLINE), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP for all associated studies published in English or Chinese between January 2016 and December 2023. One of the following outcomes had to be reported: drug price, availability, affordability, utilization, cost, or health outcomes. The study design had to be a randomized or non-randomized trial, an interrupted time series (ITS) analysis, a repeated measures study, or a controlled before-after (CBA) study. Two reviewers independently extracted data and assessed the studies according to Cochrane Effective Practice, Organization of Care (EPOC) guidelines.</p><p><strong>Results: </strong>From a total of 2628 studies, we identified 20 studies that met the inclusion criteria (16 interrupted time-series studies and 4 controlled before-after studies). Most of the studies (66%, n = 12) have some limitations (unclear risk of bias). The published studies indicated the implementation of the NRDPN policy decreased drug prices, ranging from 24 to 72%, which increased the affordability of success-negotiated drugs (refer to those medications that have undergone a successful price negotiation process between pharmaceutical companies and healthcare authorities) and decreased out-of-pocket expenditures. The availability rate increased form 27% to 47%. It has been suggested that the NRDPN was conducive to narrowing disparities in availability and affordability across regions, hospital levels, and types of health insurance. In addition, it was associated with the increased drug expenditure by 61% due to the increased use of successful-negotiated drugs. However, there is insufficient evidence to explore the health outcome changes after the NRDPN policy.</p><p><strong>Conclusion: </strong>Evidence to date generally suggests the NRDPN policy is an effective way to decrease drug prices, improve access to innovative medicines, and improve fairness. It provides useful experience and lessons in improving access to innovative medicines for other low-and middle-income countries.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"36"},"PeriodicalIF":4.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Political economy analysis of health financing reforms in times of crisis: findings from three case studies in south-east Asia.","authors":"Sophie Witter, Maria Paola Bertone, Sushil Baral, Ghanshyam Gautam, Saugat K C Pratap, Aungsumalee Pholpark, Nurmala Selly Saputri, Arif Budi Darmawan, Nina Toyamah, Rizki Fillaili, Valeria de Oliveira Cruz, Susan Sparkes","doi":"10.1186/s12939-025-02395-5","DOIUrl":"10.1186/s12939-025-02395-5","url":null,"abstract":"<p><strong>Background: </strong>Over the last decades, universal health coverage (UHC) has been promoted in south-east Asia (SEA), where many countries still need to ensure adequate financial protection to their populations. However, successful health financing reforms involve complex interactions among a range of stakeholders, as well as with context factors, including shocks and crises of different nature. In this article, we examine recent health financing reforms in Nepal, Thailand and Indonesia, using a political economy lens. The objective is to understand whether and how crises can be utilised to progress UHC and to analyse the strategies used by reformers to benefit from potential windows of opportunity.</p><p><strong>Methods: </strong>The study adopted a retrospective, comparative case study design, using a shared framework and tools. The case studies mapped the contexts, including economic, political, social trends and any shocks which had recently occurred. A focal health financing reform was chosen in each setting to examine, probing the role of crisis in relation to it, through the key elements of the reform process, content and actors. Data sources were largely qualitative and included literature and document review (144 documents included across the three cases) and key informant interviews (26 in total).</p><p><strong>Results: </strong>The findings, which bring out similarities and differences in the roles played by change teams across the settings, highlight the importance of working closely with political leaders and using a wide range of strategies to build coalitions and engage or block opponents. Changing decision rules to block veto points was significant in one case, and all three cases used participation and dialogue strategically to further reforms. More broadly, the links with context emerged as important, with prior conflicts and economic crises creating a sense of urgency about addressing health inequities, while in all countries appeal was made to underlying values to enhance the legitimacy of the reforms.</p><p><strong>Conclusion: </strong>The lessons from these case studies include that technical teams can and should engage in Political Economy Analysis (PEA) thinking and strategizing, including being aware of and adaptable to the changing PEA landscape and prepared to take advantage of windows of opportunity, including, but not limited to, those emerging from crisis. There is a need for more empirical studies in this area and sharing of lessons to support future reforms to increase health coverage and financial protection, including in the face of likely shocks.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"34"},"PeriodicalIF":4.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran.","authors":"Ahmad Raeesi, Soheil Hashtarkhani, Mahmood Tara, Narjes Sargolzaei, Behzad Kiani","doi":"10.1186/s12939-025-02399-1","DOIUrl":"10.1186/s12939-025-02399-1","url":null,"abstract":"<p><strong>Background: </strong>Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluchestan Province in southeast Iran.</p><p><strong>Methods: </strong>This study employed the enhanced two-step floating catchment area (E2SFCA) method to create an overall composite spatial accessibility index for healthcare facilities and services in Sistan and Baluchestan Province, southeast Iran. Spatial accessibility for general practitioners, nursing, dentistry, midwifery, pharmacy, medical laboratory, nutrition, public health, radiology, psychology, environmental health, rural health workers, inpatient hospital beds, and five medical specialty services were calculated. Spatial accessibility scores were normalized from 0 to 1 (no access = 0, low = 0.01 to 0.33, moderate = 0.331 to 0.66, high = 0.661 to 1) and aggregated into overall indices of primary, secondary, and overall healthcare accessibility for each district. Inequality was assessed using the Lorenz curve and Gini coefficient analysis.</p><p><strong>Results: </strong>Low geographic accessibility was found across Sistan and Baluchestan Province, especially in rural areas. Almost 75% of the population had low/no access to overall primary care services within a 30-minute drive time. For secondary care, nearly 45% had low/no access to hospital inpatient beds within a 30-minute drive time, and around 40% had low/no access to specialists within a 60-minute drive time. Just 11.6% of the population had high overall healthcare access. The calculated Gini coefficient of 0.517 for the overall spatial accessibility index to healthcare services in Sistan and Baluchestan Province highlights a highly unequal distribution of healthcare services.</p><p><strong>Conclusions: </strong>This study demonstrates a useful replicable methodology that combines individual service accessibility metrics into an overall spatial healthcare access index. Furthermore, this study provides evidence of major shortfalls in healthcare access across Sistan and Baluchestan Province. Targeted strategies are required to increase the availability and capacity of services in underserved communities. Improving geographic access is key for progressing towards universal coverage and better population health.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"35"},"PeriodicalIF":4.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the determinants of out-of-pocket health expenditures among Cambodian households in informal employment using survey data.","authors":"Andrea Hannah Kaiser, Sovathiro Mao, Jesper Sundewall, Marlaina Ross, Sokunthea Koy, Searivoth Vorn, Pichenda Koeut, Bjoern Ekman","doi":"10.1186/s12939-025-02394-6","DOIUrl":"10.1186/s12939-025-02394-6","url":null,"abstract":"<p><strong>Background: </strong>As the deadline for the Sustainable Development Goals approaches, financial protection in Cambodia remains inadequate, especially for nonpoor informal workers lacking formal social health protection coverage or access to other prepayment schemes. This exposes them to high out-of-pocket health expenditures (OOPE) and related financial hardship. To better understand the drivers behind these expenditures, our study aims to model their healthcare, health, and social determinants and to assess their relative importance.</p><p><strong>Methods: </strong>In 2023, we conducted a cross-sectional multistage clustered sampling survey across seven Cambodian provinces, surveying 3,254 households engaged in informal employment and not covered by any formal social health protection scheme. The survey gathered information on households' use of outpatient and inpatient care and associated OOPE. We employed generalized linear models (GLMs) to analyse the healthcare, health, and social determinants of OOPE and the OOPE budget share (the proportion of total annual household consumption expenditure spent on OOPE) and applied Shapley decomposition analysis to quantify the relative contributions of these determinants to the explained variance in our outcomes.</p><p><strong>Results: </strong>Healthcare variables were the dominant contributors to the explained variance in all outcomes (41.36-50.73%), followed by health factors. While several social variables were significant, only the wealth quintile made notable contributions to explaining variance in our outcomes. The key healthcare contributors included the sector type and level of care, and the number of outpatient medications. Important health contributors included illness severity and the presence of chronic illnesses or noncommunicable diseases.</p><p><strong>Conclusions: </strong>Our findings emphasize the necessity of integrating nonpoor informal workers and their dependents into formal prepayment schemes to reduce OOPE and enhance financial protection on Cambodia's path toward universal health coverage. Strategically engaging with private providers and pharmacies to improve access to essential services and medicines, coupled with the implementation of an effective referral system are important policy considerations to this end. Further research is needed on how health determinants are modifiable with policy interventions. Our findings can assist the Cambodian government in advancing its universal health coverage goals and offer insights for other countries aiming to extend coverage to similar population groups.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"33"},"PeriodicalIF":4.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health system financing fragmentation and maternal mortality transition in Mexico, 2000-2022.","authors":"Edson Serván-Mori, Carlos Pineda-Antúnez, Diego Cerecero-García, Laura Flamand, Alejandro Mohar-Betancourt, Christopher Millett, Thomas Hone, Rodrigo Moreno-Serra, Octavio Gómez-Dantés","doi":"10.1186/s12939-024-02357-3","DOIUrl":"10.1186/s12939-024-02357-3","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the temporal and territorial relationship between health system financing fragmentation and maternal mortality in the last two decades in Mexico.</p><p><strong>Methods: </strong>We conducted an ecological-longitudinal study of the maternal mortality ratio (MMR) in the 32 states of Mexico during the period 2000-2022. Annual MMRs were estimated at the national and state levels according to health insurance. We compared the distribution of individual attributes and place of residence between deceased women with and without social security to identify overrepresented demographic profiles. Finally, we mapped state disparities in MMR by health insurance for the last four political administrations.</p><p><strong>Findings: </strong>MMR in Mexico decreased from 59.3 maternal deaths per hundred thousand live births in 2000 to 47.3 in 2018. However, from 2019 onwards, MMR increased from 48.7 in 2019 to 72.4 in 2022. Seven out of ten maternal deaths occurred in the population without social security from 2000 to 2018, then decreasing to six out of ten from 2020. Maternal deaths in the population without social security were more frequent among younger women, with less schooling, unmarried, and residing in rural areas, with higher Indigenous presence and greater social marginalization. From 2019 onwards, the MMR was higher in the population with social security.</p><p><strong>Conclusion: </strong>The results of this study confirm the close relationship between maternal mortality and social inequalities, and suggest that affiliation with social security has ceased to be a differentiating factor in recent years. Understanding the evolution of maternal mortality between the population with and without social security in Mexico allows us to quantify the gap in maternal deaths attributed to inequalities in access to maternal health services, which can contribute to the design of policies that mitigate these gaps.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"32"},"PeriodicalIF":4.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health economics assessment of statin therapy initiation thresholds for atherosclerosis prevention in China: a cost-effectiveness analysis.","authors":"Tianyu Feng, Xiaolin Zhang, Jiaying Xu, Shang Gao, Xihe Yu","doi":"10.1186/s12939-025-02391-9","DOIUrl":"10.1186/s12939-025-02391-9","url":null,"abstract":"<p><strong>Background: </strong>Recent updates to the Chinese guidelines for dyslipidemia management have reduced the 10-year risk threshold for starting statins in the primary prevention of atherosclerotic heart disease. This study aims to evaluate the potential negative effects of different statin initiation thresholds on diabetes risk in the Chinese population, while also analyzing their health economic implications.</p><p><strong>Methods: </strong>I We developed a microsimulation model based on event probabilities to assess the cost-effectiveness of statin therapy. The model utilized the China-PAR prediction tool for ASCVD risk and incorporated data from a nationally representative survey and published meta-analyses of middle-aged and elderly Chinese populations. Four strategies were evaluated: a 7.5% 10-year risk threshold, the current guideline strategy, and a 15% threshold. For each strategy, we calculated the incremental cost per quality-adjusted life year (QALY) to gain insights into the economic impact of each approach.</p><p><strong>Result: </strong>The incremental cost per QALY for the 10% 10-year risk threshold strategy, compared to the untreated, was $52,218.75. The incremental cost per QALY for the guideline strategy, compared to the 7.5% 10-year risk threshold strategy, was $464,614.36. These results were robust in most sensitivity analyses.</p><p><strong>Conclusion: </strong>Maintaining the recommended thresholds outlined in the current guidelines for the management of dyslipidemia may represent a cost-effective option for China at present. Variations in statin prices and the risk of statin-induced diabetes have significant impacts on the cost-effectiveness outcomes.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"31"},"PeriodicalIF":4.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual well-being and national determinants of screening mammography among women over fifty.","authors":"Boaz Hovav, Shuli Brammli-Greenberg","doi":"10.1186/s12939-025-02389-3","DOIUrl":"10.1186/s12939-025-02389-3","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most prevalent cancer among women worldwide, causing over 400,000 cases of premature death annually. Timely screening mammography (SM) could have prevented most death. Although SM utilization varies across countries, few studies have examined country-level factors, and fewer explored their interaction with individual-level factors. The study aims to analyze individual and country-level variables and their interaction that determines SM utilization and variation between countries.</p><p><strong>Methods: </strong>Individual, country, and cross-level models are used to analyze the cross-sectional data from the SHARE database for 26,672 women aged 50 or over, from 27 countries. Key individual variables investigated include quality-of-life (QOL), psychological, and subjective-health status. Country-level variable included government health expenditure (GHE) percentage of GDP, and organized screening programs. Models were adjusted for individual variables such as age and education.</p><p><strong>Results: </strong>Self-reported SM utilization varied from 5 to 67% in the countries examined. On the individual level, higher QOL, psychological, and subjective health status positively correlated with SM utilization, as did GHE and organized programs on the country-level. Surprisingly, the interaction between individual and country-level variables shows that while SM utilization positively correlates with higher psychological and subjective health status in high-GHE countries, it negatively correlates in low-GHE countries, and only weakly positive correlates in mid-level GHE countries.</p><p><strong>Conclusions: </strong>Better individual well-being, both physical and psychological, increased SM utilization, as did higher GHE and countrywide SM programs. The negative correlations in low-GHE countries and positive correlations in high-GHE countries underscores disparities that need to be addressed.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"30"},"PeriodicalIF":4.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}