The socioeconomic statuses of Asian countries are diverse, and government reimbursement policies for renal replacement programs vary greatly from one country to another. Both factors affect not only the availability of treatment, but also the choice of dialysis modality. A close correlation is demonstrated between the dialysis treatment rate for end-stage renal disease (ESRD) and the gross domestic product (GDP) per capita income. A biphasic relationship with the GDP per capita income and the peritoneal dialysis (PD) utilization rate is observed, in that the countries with the highest and lowest treatment rates tend to have lower PD utilization rates, whereas countries with modest treatment rates tend to have higher PD utilization rates. In contrast, countries with high continuous ambulatory peritoneal dialysis (CAPD) utilization rates have the lowest automated peritoneal dialysis (APD) utilization rates. The low APD utilization rates are due to fact that, in most instances, patients themselves must purchase the APD machine, and the machines are relatively more expensive in Asian Pacific countries. Continuous cycling peritoneal dialysis (CCPD) is most frequently practiced. Generally, convenience for employment is the main indication for the utilization of APD. Other important indications are the convenience of treatment in young or elderly uremic patients. Contrary to the practice in CAPD treatment, detailed documentation of dialysis adequacy and nutritional status is not routinely done in patients undergoing APD treatment in most Asian Pacific countries. In conclusion, APD is an underdeveloped treatment modality in the renal replacement programs of Asian Pacific countries. The low utilization of APD is clearly influenced by non medical factors including government reimbursement policy and the cost of PD machines. (+info)
Relations between individual and neighborhood-based measures of socioeconomic position and bone lead concentrations among community-exposed men: the Normative Aging Study.
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To examine the association between lead exposure and both individual and geographic area indicators of socioeconomic position, the authors measured tibia lead concentration, a biomarker of cumulative lead exposure, using K x-ray fluorescence in a cross-sectional survey of 538 white males aged 50-92 years who were healthy when enrolled in the Normative Aging Study (Boston, Massachusetts) in the 1960s. Data on individual risk factors, education, occupation, and income were collected by questionnaire. Using subjects' residential addresses at the time of the tibia lead measurements, the authors obtained geographic area-specific measures of education, social class, and poverty by linking records to 1990 US Census block group data. In multivariate linear regression analysis controlling for age and cumulative smoking, tibia lead concentrations were 10.39 microg/g (95% confidence interval (CI) 7.80-12.97) higher in men who did not graduate from high school than in men with > or =4 years of college. Among the former men (non-high school graduates), living in an undereducated area was associated with a 9.28 microg/g (95% CI 1.59-16.97) increase in tibia lead level compared with living in a non-undereducated area; among the latter men (college graduates), no difference existed by residential area education (beta = 0.72, 95% CI -5.35 to 6.78). The authors conclude that the influence of individual socioeconomic position on cumulative lead exposure is modified by geographic area conditions. (+info)
Income levels of bad-debt and free-care patients in Massachusetts hospitals.
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This study disputes the common notion that many hospitalized patients whose expenses are written off to bad debt are able to pay their bills. By matching 1996 state tax returns to more than 350,000 bad-debt and free-care claims at seven Massachusetts hospitals, we found that most patients involved had incomes below the federal poverty level and thus were presumably eligible for either public programs or hospital-based free care. This suggests that hospitals and public officials need to investigate further why low-income, uninsured patients are not receiving benefits for which they are eligible. Our results also suggest that measurements of indigent care levels in hospitals for purposes of research or regulation should include some portion of bad debt. (+info)
Increased effects of smoking and obesity on asthma among female Canadians: the National Population Health Survey, 1994-1995.
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To assess smoking, obesity, and other risk factors for asthma, the authors examined 17,605 subjects aged 12 years or more who participated in the National Population Health Survey in 1994-1995. Asthma was considered present if an affirmative response was given to the question, "Do you have asthma diagnosed by a health professional?" The authors used analytic weights incorporating a design effect to take the complex survey design into account. The prevalence of asthma was 10.4% for males and 11.2% for females aged 12-24 years. Among the subjects aged 25 years or more, the prevalence varied from 4.1% to 5.8% for men and from 4.9% to 6.4% for women. Female smokers demonstrated a 1.7-fold increase in the prevalence of asthma compared with female nonsmokers, with the smoking effect more pronounced among female children and young adults. In contrast, there was no significant relation between smoking and asthma in males. The prevalence of asthma increased with increasing body mass index in females, but not in males. Immigrant status, history of allergy, and household income were significant predictors for both genders. Low household income was associated with a higher prevalence of asthma in men and women. (+info)
Income inequality and mortality in England.
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BACKGROUND: Despite the increasing evidence that income inequality causes reductions in life expectancy in developed countries, this relationship has not been explored in the United Kingdom, where local income data are not routinely available. We have surmounted this problem by employing an ecological design which applies national income data to local mortality and occupational data. METHODS: This ecological, cross-sectional study used 1991 mortality and Census data on the 366 English local government districts, and 1991 New Earnings Survey data for England, to determine the independent effect of income inequalities within English local authorities on the variation in all cause mortality between them. The subjects were all men and women recorded as economically active in the 1991 Census. We carried out linear regression analyses between all cause, all ages standardized mortality ratios, income inequality indexes and mean income levels of the local government districts. Results Both income inequality and mean income were independently associated with mortality. CONCLUSIONS: It is likely that income inequality makes an independent contribution to life expectancy in English local authorities. This finding adds further to the international evidence supporting the potentially positive health impact of increasing the scale of redistributive fiscal policies. (+info)
Who has screening mammography? Results from the 1994-1995 National Population Health Survey.
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OBJECTIVE: To determine the characteristics of Canadian women aged 35 to 49 who receive screening mammograms not recommended by the Canadian Task Force on the Periodic Health Examination. DESIGN: Secondary data analysis of the 1994-1995 National Population Health Survey. SETTING: Patients' homes. PARTICIPANTS: From a full national representative sample of 17,626 Canadian residents, we selected 2053 women aged 35 to 49 with no breast problems. MAIN OUTCOME MEASURES: Age, education, employment status, marital status, immigrant status, region of residence, self-reported health status, having a regular doctor, smoking status, alcohol consumption, and having a confidant. RESULTS: Of the 2053 women in the sample, 825 (40.2%) had had a screening mammogram as part of a regular medical checkup; 1228 (59.8%) had never had one. Logistic analysis showed that respondents who were approaching age 50, had higher incomes, lived in Quebec, and had regular medical doctors were more likely to have screening mammograms. Statistical trends indicated that heavy drinkers were less likely and immigrants more likely to have mammograms (not significant at P < .01: P = .012 and P = .02, respectively). CONCLUSIONS: Most of these findings are consistent with those of other studies of women 50 and younger. The findings suggest that the patient variables associated with having mammograms in those younger than 50 might be similar to those in women older than 50. An important next step is to determine whether this pattern of use has more to do with younger patients' demand for screening or with physicians' ordering of tests. Further research is also needed to understand the dynamics of the doctor-patient relationship in this situation. (+info)
Race and differences in breast cancer survival in a managed care population.
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BACKGROUND: African-American women with breast cancer have poorer survival than European-American women. After adjustment for socioeconomic variables, survival differences diminish but do not disappear, possibly because of residual differences in health care access, biology, or behavior. This study compared breast cancer survival in African-American and European-American women with similar health care access. METHODS: We measured survival in women with breast cancer who are served by a large medical group and a metropolitan Detroit health maintenance organization where screening, diagnosis, treatment, and follow-up are based on standard practices and mammography is a covered benefit. We abstracted data on African-American and European-American women who had been diagnosed with breast cancer from January 1986 through April 1996 (n = 886) and followed these women for survival through April 1997 (137 deaths). RESULTS: African-American women were diagnosed at a later stage than were European-American women. Median follow-up was 50 months. Five-year survival was 77% for African-American and 84% for European-American women. The crude hazard ratio for African-American women relative to European-American women was 1.6 (95% confidence interval [CI] = 1.1-2.2). Adjusting only for stage, the hazard ratio was 1.3 (95% CI = 0.9-1.9). Adjusting only for sociodemographic factors (age, marital status, and income), the hazard ratio was 1.2 (95% CI = 0.8-1.9). After adjusting for age, marital status, income, and stage, the hazard ratio was 1.0 (95% CI = 0.7-1.5). CONCLUSION: Among women with similar medical care access since before their diagnoses, we found ethnic differences in stage of breast cancer at diagnosis. Adjustment for this difference and for income, age, and marital status resulted in a negligible effect of race on survival. (+info)
Trends in perceived cost as a barrier to medical care, 1991-1996.
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OBJECTIVES: This study examined trends in perceived cost as a barrier to medical care. METHODS: The Behavioral Risk Factor Surveillance System was used to analyze monthly telephone survey data from 45 states. RESULTS: Overall, the percentage of persons perceiving cost as a barrier to medical care increased from 1991 until early 1993 and then declined to baseline values in late 1996. Perceived cost was a greater barrier in 1996 than in 1991 for persons with low incomes and for those who were unemployed and uninsured. For self-employed persons, percentages increased until mid-1993 and then remained constant. CONCLUSIONS: Further efforts are needed to improve access to medical care for socially disadvantaged populations. (+info)