scholarly journals Socio-economic and rural-urban differences in healthcare and catastrophic health expenditures among cancer patients in China: analysis of the China Health and Retirement Longitudinal Study

2021 ◽  
Author(s):  
Yang Zhao ◽  
Shenglan Tang ◽  
Wenhui Mao ◽  
Tomi F Akinyemiju
Keyword(s):  
Longitudinal Study ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Service Utilization ◽  
Rural Areas ◽  
Urban Areas ◽  
Healthcare Service ◽  
Service Use ◽  
Increased Risk ◽  
Chinese Cancer Patients

Abstract Background In China, cancer deaths account for one-fifth of all deaths and exert a heavy toll on patients, families, healthcare systems, and society as a whole. This study aims to examine socio-economic and rural-urban differences in treatment, healthcare service utilization and catastrophic health expenditure (CHE) among Chinese cancer patients, and to investigate the relationship between different treatment types and healthcare service use as well as incidence of CHE. Methods We analyzed a nationally representative sample from the China Health and Retirement Longitudinal Study including 17,224 participants in 2011 and 19,569 participants in 2015. Multivariable regression models were performed to investigate the association of cancer treatments with healthcare service utilization and CHE. Results The age-adjusted prevalence of cancer is 1.37% for 2011 and 1.84% for 2015. Approximately half of the cancer patients utilized treatment for their disease, with a higher proportion of urban residents (54%) than rural residents (46%) receiving cancer treatment in 2015. CHE declined by 22% in urban areas (25% in 2011 and 19% in 2015) but increased by 31% in rural areas (25% in 2011 to 33% in 2015). There was a positive relationship between cancer treatment and outpatient visit (OR = 2.098, 95% CI = 1.453, 3.029), admission to hospital (OR = 1.961, 95% CI = 1.346, 2.857) and CHE (OR = 1.796, 95% CI = 1.231, 2.620). Chemotherapy and surgery were each associated with a 2-fold increased risk of CHE. Conclusions Meaningful changes to improve health insurance benefit packages are needed to ensure universal, affordable and patient-centered health coverage for the Chinese cancer patients.

scholarly journals Socio-Economic and Rural-Urban Differences in Healthcare and Catastrophic Health Expenditure Among Cancer Patients in China: Analysis of the China Health and Retirement Longitudinal Study

2022 ◽  
Vol 9 ◽  
Author(s):  
Yang Zhao ◽  
Shenglan Tang ◽  
Wenhui Mao ◽  
Tomi Akinyemiju
Keyword(s):  
Longitudinal Study ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Service Utilization ◽  
Health Expenditure ◽  
Healthcare Service ◽  
Catastrophic Health Expenditure ◽  
Cancer Treatments ◽  
Increased Risk ◽  
Different Types

Objective: In China, cancer accounts for one-fifth of all deaths, and exerts a heavy toll on patients, families, healthcare systems, and society as a whole. This study aims to examine the temporal trends in socio-economic and rural-urban differences in treatment, healthcare service utilization and catastrophic health expenditure (CHE) among adult cancer patients in China. We also investigate the relationship between different types of treatment and healthcare service utilization, as well as the incidence of CHE.Materials and Methods: We analyzed data from the 2011 and 2015 China Health and Retirement Longitudinal Study, a nationally representative survey including 17,224 participants (234 individuals with cancer) in 2011 and 19,569 participants (368 individuals with cancer) in 2015. The study includes six different types of cancer treatments: Chinese traditional medication (TCM); western modern medication (excluding TCM and chemotherapy medications); a combination of TCM & western medication; surgery; chemotherapy; and radiation therapy. Multivariable regression models were performed to investigate the association between cancer treatments and healthcare service utilization and CHE.Results: The age-adjusted prevalence of cancer increased from 1.37% to 1.84% between 2011 and 2015. More urban patients (54%) received cancer treatment than rural patients (46%) in 2015. Patients with high socio-economic status (SES) received a higher proportion of surgical and chemotherapy treatments compared to patients with low SES in 2015. Incidence of CHE declined by 22% in urban areas but increased by 31% in rural areas. We found a positive relationship between cancer treatment and outpatient visits (OR = 2.098, 95% CI = 1.453, 3.029), hospital admission (OR = 1.961, 95% CI = 1.346, 2.857) and CHE (OR = 1.796, 95% CI = 1.231, 2.620). Chemotherapy and surgery were each associated with a 2-fold increased risk of CHE.Conclusions: Significant improvements in health insurance benefit packages are necessary to ensure universal, affordable and patient-centered health coverage for cancer patients in China.

scholarly journals Cancer Cases Referral system in Nepal

2018 ◽  
Vol 8 (4) ◽  
pp. 748-752 ◽  
Author(s):  
Krishna Kanta Poudel ◽  
Deborah Sims ◽  
Dianne Morris ◽  
Prakash Raj Neupane ◽  
Anjani Kumar Jha ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Rural Areas ◽  
Urban Areas ◽  
Care Delivery ◽  
Health Centre ◽  
Medical Doctor ◽  
Primary Health ◽  
Treatment Centre

The burden of cancer is estimated to be increasing in Nepal, whilst the country lacks national established guidelines or protocols for referral of cancer cases. Cancer patients are presenting many different health facilities throughout the country. In rural areas almost all cancer patients have their first diagnosis when visiting a health assistant or nurse at their nearest primary health care delivery service.  If cancer is suspected, health care assistants or nurses will refer the patient to a medical doctor at the primary health centre, or refer the patient directly to the cancer treatment centre or oncology department of the closest hospital.  Patients from urban areas will usually be seen for the first time by a medical doctor initially and then referred to either the cancer treatment centre or oncology department of the hospital.  Both in rural and urban areas the referral for treatment is determined by both the patients’ capacity to pay for treatment own healthcare, as well as their geographical location (i.e. availability and accessibility of cancer treatment services. 

scholarly journals Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

2020 ◽  
Vol 17 (4) ◽  
pp. 1327 ◽  
Author(s):  
Yang Zhao ◽  
Lin Zhang ◽  
Yu Fu ◽  
Minyu Wang ◽  
Luwen Zhang
Keyword(s):  
Health Service ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Service Utilization ◽  
Health Expenditure ◽  
Health Service Utilization ◽  
Service Use ◽  
Catastrophic Health Expenditure ◽  
Socioeconomic Disparities ◽  
Health Service Use

Background: This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. Methods: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. Results: The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. Conclusion: Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.

The Prevalence of Frailty in Cancer Patients and Mortality Prediction With a Novel Frailty Index Based Clinical Algorithm-A Multicenter, Prospective, Observational Study

2020 ◽  
Author(s):  
Xi Jin ◽  
Yue Ren ◽  
Li Shao ◽  
Zengqing Guo ◽  
Chang Wang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Frailty Index ◽  
National Level ◽  
Laboratory Data ◽  
Mortality Prediction ◽  
Prediction Algorithm ◽  
Tumor Type ◽  
Risk Of Death ◽  
Increased Risk ◽  
Chinese Cancer Patients

Abstract Purpose To investigate the prediction capacity and status of frailty in Chinese cancer patients in national level, through establishing a novel prediction algorithm. Methods The percentage of frailty in different ages, provinces and tumor type groups of Chinese cancer patients were revealed. The predictioncapacity of frailty on mortality of Chinese cancer patients was analyzed by FI-LAB that is composed of routine laboratory data from accessible blood test and calculated as the ratio of abnormal factors in 22 variables. Establishment of a novel algorithm MCP(mortality of cancer patients)to predict the five-year mortality in Chinese cancer patients was accomplished and its prediction capacity was tested in the training and validation sets using ROC analysis. ResultsWe found that the increased risk of death in cancer patients can be successfully identified through FI-LAB. The univariable and multivariable Cox regression were used to evaluate the effect of frailty on death. In the 5-year follow-up, 20.6% of the 2959 participants (age = 55.8 ± 11.7 years; 43.5% female) were dead while the mean FI-LAB score in baseline was 0.23 (standard deviation = 0.13; range = 0 to 0.73).Frailty (after adjusting for gender, age, and other confounders) could be directly correlated with increased risk of death, with a hazard ratio of 12.67 (95% confidence interval CI: 7.19, 22.31) in comparison with those without frailty. In addition, MCP algorithm presented an area under the ROC (AUC) of 0.691 (95% CI: 0.659-0.684) and 0.648 (95% CI: 0.613-0.684) in the training and validation set, respectively. Conclusion Frailty is common in cancer patients and FI-LAB has high prediction capacity on mortality. The MCP algorithm is a good supplement for frailty evaluation and mortality prediction in cancer patients.

scholarly journals Health and work disability outcomes in parents of patients with schizophrenia associated with antipsychotic exposure by the offspring

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Heidi Taipale ◽  
Syed Rahman ◽  
Antti Tanskanen ◽  
Juha Mehtälä ◽  
Fabian Hoti ◽  
...  
Keyword(s):  
Sickness Absence ◽  
Work Disability ◽  
Healthcare Service ◽  
Service Use ◽  
Antipsychotic Treatment ◽  
Healthcare Use ◽  
Swedish Population ◽  
Increased Risk ◽  
Healthcare Service Use

AbstractThis study aimed to identify if antipsychotic exposure in offspring is associated with psychiatric and non-psychiatric healthcare service use and work disability of their parents. This Swedish population-based cohort study was based on data comprising 10,883 individuals with schizophrenia, who had at least one identifiable parent in the nationwide registers, and their parents (N = 18,215). The register-based follow-up during 2006–2013 considered the level of antipsychotic exposure and persistence of use of the offspring, further categorized into first (FG) and second generation (SG) antipsychotics, and orals versus long-acting injections (LAIs). The main outcome measure was parental psychiatric healthcare service use, secondary outcomes were non-psychiatric healthcare use and long-term sickness absence. SG-LAI use was associated with a decreased risk (relative risks [RR] 0.81-0.85) of parental psychiatric healthcare use compared with not using SG-LAI, whereas oral antipsychotics were associated with an increased risk (RRs 1.10–1.29). Both FG- and SG-LAI use by the offspring were associated with a lower risk of long-term sickness absence (range of odds ratios 0.34–0.47) for the parents, compared with non-use of these drugs. The choice of antipsychotic treatment for the offspring may have an impact on work disability and healthcare service use of their parents.

scholarly journals The impact of the COVID-19 pandemic on the wellbeing of Irish Men’s Shed members

2020 ◽  
Author(s):  
Aisling McGrath ◽  
Niamh Murphy ◽  
Noel Richardson
Keyword(s):  
Physical Activity ◽  
Life Satisfaction ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Promotion Program ◽  
Activity Levels ◽  
Health And Wellbeing ◽  
Self Rated Health ◽  
Increased Risk ◽  
The Impact

Summary COVID-19 disproportionately affects males especially those who are older and more socio-economically disadvantaged. This study assessed wellbeing outcomes among men’s shed members (Shedders) in Ireland at baseline (T1), 3 (T2), 6 (T3) and 12 months (T4) in response to a 10-week health promotion program ‘Sheds for Life’ (SFL). Two cohorts participated in SFL commencing in March and September 2019. This study compares the T3 findings from one cohort carried out during the COVID-19 pandemic [COVID cohort (n = 185)] with T3 findings from a comparator cohort [pre-COVID cohort (n = 195)], completed pre-COVID-19. Questionnaires assessing wellbeing [life satisfaction, mental health, loneliness, physical activity (PA), self-rated health and other lifestyle measures] were analyzed in both cohorts T1, T2 and T3. Self-rated Health and life satisfaction decreased in the COVID cohort at T3 (p < 0.001), while loneliness scores increased (p < 0.0005). Higher loneliness scores were correlated with lower health ratings, life satisfaction and PA during COVID-19 (p < 0.001). Days PA decreased in the COVID cluster at T3 from T2 (p < 0.01) with those in urban areas reporting lower activity levels than rural areas (p < 0.05). Those sufficiently active at baseline managed to maintain PA during COVID-19 while those not meeting guidelines were more likely to report decreases (p < 0.001). Shedders experiencing COVID-19 restrictions are at an increased risk of poorer wellbeing and increased levels of loneliness. Support and guidance are needed to safely encourage this cohort back into men’s sheds, settings that protect against loneliness and positively promote health and wellbeing. Lay summary The COVID-19 pandemic will have wide-reaching implications on wellbeing, particularly on those who are older and more vulnerable. Evidence also suggests that COVID-19 disproportionately affects males. This study aimed to understand the impact that COVID-19 has had on men in the setting of Men’s Sheds in Ireland. Two cohorts of men who were participating in a 10-week health and wellbeing program (Sheds for Life) at different stages were followed over time. At 6 months follow-up the first Cohort had not experienced COVID-19 whereas the second cohort was actively experiencing the COVID-19 pandemic. We measured wellbeing using questionnaires, comparing both groups of men for differences. We found that the men who were experiencing COVID-19 had lower self-rated health, physical activity and life satisfaction as well as higher rates of loneliness, with those who were more lonely reporting lower wellbeing scores. We also found that men in rural areas were more physically active during COVID-19 and that those were not active were more likely to become more inactive during COVID-19. This study suggests that support and guidance is needed to safely encourage this cohort back into Men’s Sheds, settings that protect against loneliness and positively promote health and wellbeing.

Psychosocial outcomes and care utilization among rural and nonrural cancer patients.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 79-79
Author(s):  
Angela E Usher ◽  
Janice Bell ◽  
Laurel A Beckett ◽  
Jill G Joseph ◽  
Brad J. Zebrack ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cancer Patients ◽  
Rural Areas ◽  
Urban Areas ◽  
Psychosocial Care ◽  
Psychosocial Outcomes ◽  
Psychosocial Distress ◽  
Care Utilization ◽  
Lower Odds ◽  
Independent Effects

79 Background: Approximately 20% of people diagnosed with cancer in the U.S. travel from rural areas to urban cancer centers for treatment. Rural cancer patients face unique challenges which may contribute to greater psychosocial distress when compared to urban-dwelling patients. While up to half of all cancer patients screen positive for psychosocial distress, only 25-44% of distressed patients utilize psychosocial care. Patients from rural areas may face greater barriers to utilization of psychosocial care compared to patients from urban areas. To date, few studies have focused on these concerns. Methods: Three-years of data were collected from newly diagnosed patients screened between 2015 and 2017, including the Patient Health Questionnaire-2 and the NCCN Distress Thermometer (n = 4,865). Adjusted multi-variable logistic regression, chi-square, and negative binomial regression were used to assess relationships among psychosocial outcomes and care utilization, rurality, and distance to treatment in driving miles, controlling for socio-demographic and clinical covariates. Distance to treatment based on driving miles computed in ArcGIS v10.5. Stata v15 was used for all statistical analyses, significance set at ≤.05. Results: Higher odds of depressive symptoms were detected among people living in rural areas compared to urban areas. The odds of psychosocial distress were higher in patients from rural areas and further distances from treatment compared to local distance. Patients from rural areas had lower odds of psychosocial care utilization compared to patients in urban areas. Distance to treatment had independent effects, over and above rurality, for lower odds of psychosocial care utilization. Conclusions: Distance to treatment and rurality appear to be risk factors with independent effects on depressive symptoms and psychosocial distress and appear to be associated with lower odds of psychosocial care use among cancer patients with self-reported distress when compared to patients from urban and local areas. Findings support improved detection of and response to patient reported psychosocial outcomes, and further research designed to better understand the mechanisms underlying the reported associations.

scholarly journals Determinants of Under-Five Child Mortality in Arab Countries. Are the Effects Homogeneous Across Birth Order and Among Countries?

2021 ◽  
Vol 14 (23) ◽  
pp. 34-49
Author(s):  
Chellai Fatih
Keyword(s):  
Birth Order ◽  
Child Mortality ◽  
Rural Areas ◽  
Urban Areas ◽  
Arab Countries ◽  
Policy Implications ◽  
Educational Levels ◽  
Under Five ◽  
Risk Of Death ◽  
Increased Risk

Abstract Under-five-child mortality remains a major challenge for governments in the Arab world to achieve Sustainable Development Goals. Thus, further studies are needed to analyze the determinants of child mortality. The Multiple Indicators Cluster Surveys (MICS) datasets of six Arab countries (Algeria, Egypt, Iraq, Mauritania, Sudan, and Tunisia) have been used, which are consisting of 249.000 children nested within 54.644 mothers. The study was designed in a women-parity-covered one to six birth order. Binary multivariable logistic models were used to estimate the risk ratios of death by adjusting for child sex, birth outcome (twin vs. singleton), mother’s education level, maternal age, previous birth interval, place of residence (rural vs. urban), and the family wealth index. The findings revealed that the under-five child mortality rates were 87, 70,66,35,36, and 21 per 1000 live births in Sudan, Mauritania, Egypt, Iraq, Algeria, and Tunisia, respectively). First-born infants in these six countries have a higher risk of mortality during their five years of life. Second, third-and fourth-born infants were at a decreased risk of death compared to first-born infants in all countries; in contrast, fifth-and-sixth-born infants were at an increased risk in all countries except Sudan and Mauritania. Twin children have a higher risk of death than singletons in all countries and across all birth orders. Children of mothers with higher educational levels living in urban areas are at lower risk of death than their peers across all birth orders. Regarding policy implications, decision-makers can target three main axes: first, enhancing women’s educational levels; second, increasing birth intervals (birth spacing policies); and third, improving living standards and healthcare strategies, especially in rural areas to improve child and mother health.

scholarly journals COVID-19 pandemic and Thyroid cancer treatment in perspective of Bangladesh

2021 ◽  
Vol 29 (2) ◽  
pp. 178-181
Author(s):  
Mahmud Asif Rifat ◽  
Mostafa Kamal Arefin ◽  
Abu Yusuf Fakir ◽  
SK Nurul Fattah Rumi ◽  
Husne Qumer Osmany ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Active Surveillance ◽  
Hospital Admissions ◽  
Lung Metastases ◽  
Vulnerable Groups ◽  
Severe Illness ◽  
Medical College ◽  
Increased Risk

Background: The COVID-19 pandemic in Bangladesh is part of the worldwide pandemic of coronavirus disease 2019 which has crowded out services for both covid and non-covid patients, in a country where the health care system was already under huge stress even before the pandemic. Objectives: To postpone non-urgent surgeries along with active surveillance of thyroid cancer patients to make sure the hospitals are not unnecessarily occupied. Methods: Document based categorization of thyroid cancer patients, like- low risk, high risk and clinically extremely vulnerable groups who are at greatest risk of severe illness from coronavirus are to be done accordingly. Individuals with thyroid cancer are mostly not susceptible to COVID- 19. However, patients with thyroid cancer (papillary or medullary) having lung metastases or undergoing certain types of cancer treatment might be at increased risk of viral infection or complications. Risk benefit ratio is checked and explained to the patient and their attendants. Recommendations: As COVID-19 is spreading across the Bangladesh, hospitals are being forced to reallocate resources to the care of critically ill. So it is crucial to adhere to the advice from experts to reduce the risk of infection. All non-essential surgeries and hospital admissions can be postponed to make sure that hospitals are not unnecessarily occupied. Conclusion: In the face of the COVID-19 pandemic, cancer care has had to adapt rapidly given recommendations to postpone nonurgent surgeries with active surveillance of thyroid cancer patients except thyroid tumors requiring acute airway management. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 178-181

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