International Journal for Equity in Health最新文献

{"title":"Geographic disparities in hospital readmissions: a retrospective cohort study among patients with chronic disease in rural China.","authors":"Mingyue Li, Haoqing Tang, Huixian Zheng, Baisong Zhang, Haozhe Cheng, Yanshang Wang, Yuxun Zhou, Xiaotian Zhang, Pascal Geldsetzer, Xiaoyun Liu","doi":"10.1186/s12939-025-02443-0","DOIUrl":"10.1186/s12939-025-02443-0","url":null,"abstract":"<p><strong>Background: </strong>Frequent hospital readmissions place a significant burden on patients, families, and society. Many high-income countries have implemented financial incentives to reduce readmissions. In China, readmission metrics have also been introduced as part of the performance evaluation for secondary hospitals. However, the understanding of hospital readmissions, particularly in rural and remote areas of China, remains limited. This study aims to analyze geographic disparities in hospital readmissions among high-need patients.</p><p><strong>Methods: </strong>This retrospective cohort study used anonymized hospital discharge data from January 1, 2017, to December 31, 2021, from three public secondary county hospitals. We included rural patients aged 15 and older with hypertension or type 2 diabetes. The outcomes were 30-day, 90-day, and annual readmissions. The explanatory variable was the travel distance to county hospitals, calculated based on the longitude and latitude of registered addresses. Covariates included patient demographics (gender, age, marital status, and ethnicity); health status (Charlson comorbidity score, types of chronic diseases, surgery, and length of stay); and other factors (health insurance and admitted departments). We first reported unweighted readmissions stratified by travel distances (< 40 km versus ≥ 40 km). Multiple logistic regression models were then used to examine the relationship between travel distances and readmissions.</p><p><strong>Results: </strong>The 30-day, 90-day and annual readmission rates for hypertension or type 2 diabetes were 8.5%, 19.1%, and 39.7%, respectively. Patients living far away were more vulnerable - older (aged 65 and older 59.1% versus 58.5%, P < 0.001), predominantly minorities (Minority 55.6% versus 29.4%, P < 0.001), and having more hypertension and diabetes-related complications, as well as undergoing more surgeries (surgery 29.4% versus 23.3%, P < 0.001) compared to those living nearby. After adjusting covariates and weights, patients living 40 km away had 11% decrease in the odds of being readmitted within 30 days (OR = 0.89, 95%CI = 0.83-0.96), 10% decrease in the odds of 90-day readmissions (OR = 0.90, 95%CI = 0.85-0.94), and 13% decrease in the odds of annual readmissions (OR = 0.87, 95%CI = 0.84-0.91) compared to those living within 40 km.</p><p><strong>Conclusion: </strong>We found significant geographic disparities in hospital readmissions among high-need patients. Patients living farther from hospitals had significantly lower odds of readmissions. Readmission rates reflect patients' healthcare utilization patterns in rural and remote areas. Policymakers should address the geographic access barriers and be cautious when using readmission rates as a measure of hospital performance.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"83"},"PeriodicalIF":4.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718724","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":"Communication practices with patients using a language other than French: a cross-sectional survey in a university hospital in France.","authors":"Johann Cailhol, Bouamrane Larbi-Benhadjar, Ando Rajaonah, Anais Anthonioz, Vincent Kaufmann, Claire Peloso, Sanjeev Bista","doi":"10.1186/s12939-025-02422-5","DOIUrl":"10.1186/s12939-025-02422-5","url":null,"abstract":"<p><strong>Aims: </strong>This paper aims to shed light on routine communication practices between all types of hospital workers- medical, administrative and psycho-social -, and patients using a language other than French.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted at a University Hospital, located in a Parisian suburb, where the proportion of immigrants is high. The survey targeted any type of hospital employee, provided that the employee was in contact with patients. The survey items included: routine communication practices with patients using a language other than French; perceived quality of communication; issues experienced when communicating with non-French speaking patients; main languages raising communications difficulties; ways to improve communication with patients using a language other that French. Descriptive and bivariate analysis were conducted with R software. Survey findings were cross-analyzed with 2-year records of professional interpreter services at the University hospital.</p><p><strong>Results: </strong>A total of 362 participants responded in June 2022 to the online survey, of which 353 had no missing value. All types of hospital staff were represented, the majority being paramedics and medical doctors. \"The use of a professional interpreter\" was ranked as third most used practice, behind \"getting by\" and \"use of an accompanying adult\". South Asian languages were those fueling the most important communication issues. Medical doctors and psychologists had significantly more access to professional interpreters, whereas paramedics and administrative staff made more use of application software. Several negative consequences on everyday care, significantly impacting its perceived quality, were raised.</p><p><strong>Conclusions: </strong>Our findings showed the importance of alleviating communication difficulties with patients using a language other than French, in order to achieve health equity, and means to achieve this are discussed.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"82"},"PeriodicalIF":4.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700152","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":"Colonial shadows - a systematic review of the Xavante health transformation.","authors":"Katarzyna Górka","doi":"10.1186/s12939-025-02430-5","DOIUrl":"10.1186/s12939-025-02430-5","url":null,"abstract":"<p><strong>Background: </strong>From a biocultural perspective, health is a multifaceted concept shaped not only by biomedical factors but also by social, cultural, political, and economic forces. In Indigenous contexts, health is particularly vulnerable, as it is profoundly influenced by external socioeconomic and cultural changes, often introduced or imposed by the broader society. The Xavante Indigenous community, located in the Central-Western region of Brazil, is one of the most extensively studied Indigenous groups in the country in terms of health. Despite a rich body of literature addressing various aspects of their health, there has been a notable absence of comprehensive studies that trace the historical evolution of their health status through bibliographic analysis. This article seeks to fill this gap by providing an in-depth examination of the historical transformation of the Xavante health, positioning this issue within the broader discourse of Indigenous health as a public health concern, while applying a decolonial perspective.</p><p><strong>Methods: </strong>A systematic bibliographic analysis was conducted to trace the historical trajectory of health among the Xavante people from Mato Grosso, Brazil.</p><p><strong>Results: </strong>A total of 109 academic publications meeting the inclusion criteria were identified. The analysis revealed sustained scholarly interest in the health of the Xavante community, particularly since their first sustained contact with the urbanized society. A comparative examination of the earliest and most recent, comprehensive studies on this topic highlighted a marked decline in the health status of the Xavante people over time.</p><p><strong>Conclusions: </strong>Despite periodic shifts in the administrative frameworks governing Indigenous healthcare in Brazil, including reductions in mortality rates and increased utilization of hospital services, the overall health status of the Xavante has significantly deteriorated. This article critically analyzes this trend through a decolonial lens, highlighting the limitations and shortcomings of existing health policies and interventions. It argues that the prevailing colonial approach to healthcare, compounded by the denial of culturally appropriate services, represents a clear violation of human rights. Furthermore, the article underscores the substantial impact of social determinants-such as historical trauma, cultural disruption, and systemic inequality-on the health outcomes of this community.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"81"},"PeriodicalIF":4.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676565","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":"Applications of equity frameworks in theory-based health behavior interventions: a scoping review.","authors":"Katherine S Gallagher, Kristefer Stojanovski, Kristen Ogarrio, Laura Wright, Melissa Fuster, Caryn N Bell","doi":"10.1186/s12939-025-02438-x","DOIUrl":"10.1186/s12939-025-02438-x","url":null,"abstract":"<p><strong>Background: </strong>Health behavior theories are scientific frameworks used to inform health behavior interventions to address health-related issues, given their use in understanding and modifying behavior change.</p><p><strong>Purpose: </strong>We aimed to assess how theory-informed health behavior interventions utilize health equity frameworks and methods.</p><p><strong>Methods: </strong>Using the PRISMA guidelines, we conducted a scoping review of ten often taught health behavior theories found in health behavior textbooks. We identified 656 intervention papers, and after the title and abstract screening and full-text review, we extracted data from 26 studies. We conducted a thematic analysis to examine 1) the prevalence and quality of behavior interventions informed by health equity frameworks and 2) the application of health equity frameworks in the design and implementation of health behavior interventions.</p><p><strong>Results: </strong>Theory-informed health behavior interventions incorporating equity frameworks predominately focused on two strategies. First, by incorporating multilevel frameworks via the socioecological model to influence behavior at multiple levels of risk. The second was utilizing community-based participatory methods to integrate the community's cultural, social, and lived experiences into the interventions. Creating practices and policies rooted in lived experiences, such as recording meetings, having childcare, and processes for inclusion of feedback served to embed equity into the intervention design and implementation. Studies that were more dedicated to community involvement showed greater community acceptance and improved intervention outcomes.</p><p><strong>Conclusions: </strong>Our scoping review identified that incorporating equity into health behavior interventions is essential yet not widely practiced and poorly understood regarding how to \"bake in equity.\" Enhanced training on incorporating equity into theory-informed behavioral interventions could improve health behavior and health education training, research, and practice.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"79"},"PeriodicalIF":4.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663355","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":"Dying of starvation if not from bombs: assessing measurement properties of the Food Insecurity Experiences Scale (FIES) in Gaza's civilian population experiencing the world's worst hunger crisis.","authors":"Feten Fekih-Romdhane, Kamel Jebreen, Tasnim Swaitti, Mohammed Jebreen, Eqbal Radwan, Wafa Kammoun-Rebai, Inad Nawajah, Omar Shamsti, Sahar Obeid, Souheil Hallit","doi":"10.1186/s12939-024-02365-3","DOIUrl":"10.1186/s12939-024-02365-3","url":null,"abstract":"<p><strong>Background: </strong>Since October 2023, the humanitarian crisis in Gaza has dramatically escalated and food insecurity (FI) has rapidly deteriorated. In the face of such situation, it has been recommended that accurate information on FI should be integrated in emergency reporting systems in order to better target and assess the impact of humanitarian aid. To achieve this, field practitioners, researchers and decision-makers should be equipped with user-friendly and psychometrically sound measures tailored to real-life war situations and the Palestinian context. Therefore, the present study aimed to test the psychometric properties of the Food Insecurity Experiences Scale (FIES) in a sample of Arabic-speaking community adults currently living in the Gaza Strip during the war.</p><p><strong>Methods: </strong>This study used a cross-sectional design, snowball sampling as a recruiting strategy, and a self-administered online questionnaire to collect data from participants. It was performed during the period from September 1st to 30th, 2024. A total of 534 valid responses were received and were included in the final analysis.</p><p><strong>Results: </strong>Approximately one out of two people in Gaza were experiencing any FI. Fit indices in confirmatory factor analysis indicated that a one-factor solution fit the data with acceptable factor loadings. Furthermore, our findings indicated that the Arabic version of the FIES presented an excellent level of reliability, with both Cronbach's alpha and McDonald omega coefficients of 0.94. Cross-sex measurement invariance in the FIES was established at scalar and metric levels. Finaly, concurrent validity was evidenced by FIES's positive correlations with water insecurity experiences, post-traumatic stress, depression and anxiety symptoms.</p><p><strong>Conclusion: </strong>Altogether, our findings showed that the FIES fulfils requirements of validity and reliability. It may thus be considered as appropriate tool for assessing FI in Gazan war-affected populations currently suffering from acute FI emergency and requiring urgent action to meet their food needs. The FIES is simple, short, economic and time-effective. As a FI indicator, the Arabic FIES is useful in providing information that enables actions by policy makers and guides humanitarian-aid actors' efforts aimed at decreasing, mitigating, or preventing severe FI, and saving lives or livelihoods.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"80"},"PeriodicalIF":4.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669829","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":"Impact of an innovative case-based payment reform on hospital cost variation: insights from cerebral infarction inpatients in China.","authors":"Yining Wang, Shiting Liu, Xinyu Zhang, Haifeng Ma, Xiaohua Ying","doi":"10.1186/s12939-025-02447-w","DOIUrl":"10.1186/s12939-025-02447-w","url":null,"abstract":"<p><strong>Background: </strong>Variations in hospital costs often indicate deficiency in efficient and standardised care. Case-based provider payment systems are utilised globally to address these issues. In China, an innovative case-based payment scheme called the Diagnosis-Intervention Packet (DIP) under the global budget framework has been progressively implemented. However, evidence regarding its effectiveness and potential mechanisms underlying its impact is limited. This study aimed to investigate the impact of DIP reform on hospital cost variations among patients with cerebral infarction (CI) and to explore potential pathways through quality-cost trade-offs.</p><p><strong>Methods: </strong>This cross-sectional study analysed de-identified discharge records of patients from City G, China, between January 2018 and December 2022. The study included 293,255 cases discharged with CI from 185 hospitals. Interrupted time series models were used to assess the overall and heterogeneous impacts on hospital cost variations, measured by the coefficient of variation (CV) and interquartile range (IQR) of the hospital-level average cost per case. The contribution of each itemised cost was quantified using grey relational analysis. Quality measures were compared across hospital groups organised based on the hospitals' relative cost rankings.</p><p><strong>Results: </strong>Following the DIP reform, a significant immediate decline of 0.137 (p = 0.031) was observed in the CV. The quarterly trends in CV decreased by 0.001 (p = 0.954) and IQR by 103.40 RMB ($14.48; p = 0.389). Subgroup analyses found significant reductions in secondary hospitals, surgical groups, and medication costs, with medication costs aligning the most with the total change. Given hospital convergence toward the average cost level, no association between costs and quality was observed. Hospitals transitioning from the high-cost category experienced a reduction in in-hospital mortality (-0.5%). Similarly, those moving from the average- to low-cost category demonstrated decreased mortality (-0.7%) and complications (-0.5%).</p><p><strong>Conclusions: </strong>Our findings revealed a concentrated distribution of post-reform hospital costs without compromising quality. These findings suggest the effectiveness of case-based payment systems in reducing hospital cost variations and improving healthcare efficiency, potentially because providers adopt more standardised behaviours in response to incentive changes. This study offers insights to other countries on payment systems as leverage to achieve efficient, equitable, and high-value care.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"78"},"PeriodicalIF":4.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663362","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":"Breaking the cycle: how Spain's dependency care system creates occupational inequalities in geriatric nursing assistants and the need for reform.","authors":"Mireia Campoy-Vila, Albert Espelt, Júlia Jubany, Olga Borao, Anna Canet-Torres, Carles Muntaner","doi":"10.1186/s12939-025-02426-1","DOIUrl":"10.1186/s12939-025-02426-1","url":null,"abstract":"<p><strong>Background: </strong>The implementation of Spain's Dependency Law aimed to enhance care for those with dependency needs. However, its focus on privatized service provision has raised concerns about potential inequalities in working conditions for geriatric nursing assistants working in long-term care, particularly regarding resources, workload, and labour protections between public and private ownership. This study aims to explore the employment conditions, working conditions and health status of geriatric nursing assistants in Spanish nursing homes, specifically examining the potential impact of facility ownership type.</p><p><strong>Methods: </strong>We conducted a descriptive cross-sectional study including geriatric nursing assistants working in nursing homes in Spain in the year 2022. The final sample consisted of 344 nursing assistants recruited using the snowball and self-selection sampling methods. Data were collected using a computerized, self-administered questionnaire. The variables studied encompassed employment and working conditions and health-related factors, including physical and mental health status assessed using 12-Item Short Form Health Survey (SF-12v1), physical activity levels, and characteristics of back pain. To examine the association between the descriptive variables and facility ownership, Poisson regression models with robust variance were fitted.</p><p><strong>Results: </strong>Nursing assistants in private nursing homes were significantly more likely to report worse working and health-related conditions (aPR = 1.19, 95% CI: 1.07-1.32) compared to those in public facilities. For example, only 22.6% of public workers felt they lacked time for tasks, compared to 48.2% in private nursing homes. Similarly, emotional exhaustion was more prevalent among private staff (86.6% vs. 71.7%).</p><p><strong>Conclusions: </strong>The results highlight the negative impact of neoliberal policies, particularly the privatization of nursing homes, on the working conditions of geriatric nursing assistants, exacerbating health inequalities. A shift towards a community-based care model with increased public investment is essential to improve working conditions, promote healthy aging, and enhance the quality of care provided by nursing assistants.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"77"},"PeriodicalIF":4.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657274","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":"Does the charitable medical assistance program impact catastrophic medical expenditures for families of children with leukemia? An evidence-based study in China.","authors":"Jun Su, Yu-Qing Zhang, Di Shao, Jia-Min Wang, Wei Hao, Yan-Xiu Liu, Long Wang, Xiao-Jie Sun","doi":"10.1186/s12939-025-02442-1","DOIUrl":"10.1186/s12939-025-02442-1","url":null,"abstract":"<p><strong>Background: </strong>Pediatric leukemia is the most prevalent childhood cancer in China, exerting a considerable financial impact on affected families. Despite the mandatory participation of all Chinese children in the Resident Basic Medical Insurance, out-of-pocket (OOP) expenses remain substantial for families of children with leukemia. However, charity assistance has been shown to help mitigate these financial burdens. The \"Love Union Project\" is a comprehensive charitable medical assistance program designed to support families of children with leukemia within China's multi-tiered healthcare security system. This study was designed to evaluate the impact of the \"Love Union Project\" on reducing the incidence of catastrophic health expenditure (CHE) among families of children with leukemia in China.</p><p><strong>Methods: </strong>The study involved 85 children in the intervention group from H city and 36 matched control children from S and Y cities. Data on demographics, medical expenses, and assistance were collected. Non-normally distributed costs were reported as medians. Multivariate logistic regression analyzed the impact of the \"Love Union Project\" on CHE.</p><p><strong>Results: </strong>Thanks to the program's intervention, the CHE rate among the intervention group decreased from 75.3% to 65.9%, while the incidence of CHE in the control group was 75.0%. Compared to families with children aged 0-6 years, those aged 7-12 were more likely to incur CHE (OR 5.224; 95% confidence intervals 1.412-19.322). Families with five or more members were also at higher risk of CHE than those with four members or fewer (OR 2.847; 95% confidence intervals 1.056-7.676). Additionally, families with a monthly income of CNY8000($1,120) or more were less likely to experience CHE than those with a monthly income of CNY4000($560) or less (OR 0.257; 95% confidence intervals 0.072-0.923). Lastly, families receiving assistance from the \"Love Union Project\" reported significantly lower CHE rates than those who didn't receive such support (OR 0.151; 95% confidence intervals 0.044-0.524).</p><p><strong>Conclusion: </strong>While medical insurance provides limited relief, the \"Love Union Project\" enhances economic resilience for families of children with leukemia. Attention should focus on younger patients, larger households, lower-income families, and those not receiving charity support.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"75"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648523","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 the magnitude of inequality and inequity in use of healthcare resources among older Australians with cognitive decline.","authors":"Brenda Gannon, Phyo Myat Aung, Aarushi Dhingra, Yaying Zhou","doi":"10.1186/s12939-025-02432-3","DOIUrl":"10.1186/s12939-025-02432-3","url":null,"abstract":"<p><strong>Background: </strong>This study investigates whether healthcare utilisation among older Australians is equitable, particularly focusing on people with cognitive decline from age 50. It investigates the economic concept of horizontal inequity in various types of healthcare use among older Australians and compares inequity among three groups: a representative sample of all individuals aged 50 and above, those with cognitive impairment, and individuals with a disability. Additionally, we examine changes in these patterns over time.</p><p><strong>Methods and data: </strong>This study utilizes cross-sectional data for 2013 and 2017 from the Household, Income and Labour Dynamics in Australia (HILDA) survey to investigate four types of healthcare utilisation-general practitioner (GP), specialist, dental, and hospital admissions. We calculate the concentration index to measure the inequality and inequity in use. To quantify inequity, we correct for differences in needs and health status, following the indirect standardisation approach.</p><p><strong>Results: </strong>Our findings suggest that among the three samples, the inequity faced by older Australians with cognitive impairment is the most pronounced. Individuals with higher socioeconomic status used dental care more, while GP visits were concentrated among the lower socioeconomic groups in 2013. By 2017, all types of healthcare except GP visits favour the better-off people (pro-rich). Among those with disabilities, we find a pro-rich distribution of dental care in both 2013 and 2017, and pro-rich inequity in the usage of specialist visits, even after adjusting for needs.</p><p><strong>Conclusion: </strong>Pronounced disparities are observed among older people with cognitive impairment. Further targeting of policies to improve access to healthcare for older vulnerable Australians is recommended, to help achieve equitable and universal coverage in Australia.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"76"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648468","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":"Equity of access in rural and metropolitan dementia diagnosis, management, and care experiences: an exploratory qualitative study.","authors":"Hannah Gulline, Sarah Carmody, Mark Yates, Amelia Bevins, Amy Brodtmann, Samantha M Loi, Yen Ying Lim, Heather Macklin, Karen Glennen, Michael Woodward, Scott Ayton, Darshini Ayton","doi":"10.1186/s12939-025-02434-1","DOIUrl":"10.1186/s12939-025-02434-1","url":null,"abstract":"<p><strong>Background: </strong>The limited allocation of resources to rural and regional communities is a major contributor to healthcare inequities in Australia. Distribution of health service resources between metropolitan and rural communities commonly sees highly populated areas prioritised over more sparsely populated and geographically vast areas. As such, challenges impacting dementia diagnosis, management, and care in metropolitan areas are experienced more acutely in rural areas. This study aimed to examine equity of access to dementia diagnosis, management, and care services amongst people who experienced the process of dementia diagnosis as a patient or significant other (partner/spouse, adult children, siblings, and friends) throughout rural and metropolitan Australia.</p><p><strong>Methods: </strong>This exploratory qualitative study consisted of thirty-three online semi-structured interviews with thirty-seven people with experience of the dementia diagnosis process as a patient and/or significant other. Interviews explored symptoms of dementia, health professionals consulted, tests conducted, and challenges faced throughout the diagnosis and post-diagnosis process. Rurality was defined by the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) and the Modified Monash Model (MMM). Thematic analysis was conducted, with Russell's (2013) Dimensions of Access framework (geography, affordability, availability, acceptability, accommodation, awareness, and timeliness) guiding data analysis.</p><p><strong>Results: </strong>Participants were distributed across various regions of Australia: seven interviews from inner regional Australia, five interviews from outer regional Australia, and twenty-one interviews from metropolitan areas. Disparities in access between metropolitan and rural areas emerged in five key dimensions: 1) geography impeding ability to access services; 2) affordability of travel expenses; 3) availability of healthcare and support services; 4) acceptability of available health professionals and services; and 5) awareness of local services and resources. The dimensions of accommodation and timeliness of care were experienced as challenges irrespective of location, with lengthy appointment wait times and difficulty navigating complex systems. However, rurality often compounded the challenges in dementia diagnosis, management, and care.</p><p><strong>Conclusions: </strong>Significant health inequities persist between rural and metropolitan communities that must be prioritised in endeavours to promote equitable dementia diagnosis, management, and care. Targeted action to address disparities is vital to mitigate the impact of rurality, particularly as clinical practice evolves with research advancements.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"74"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648467","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}