scholarly journals Avoidable hospitalization in Milan’s metropolitan area: inequalities and comparison with OECD cities

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
B Pongiglione ◽  
A Torbica ◽  
M Gusmano
Keyword(s):  
Risk Factors ◽  
Population Health ◽  
Metropolitan Area ◽  
Access To Healthcare ◽  
World City ◽  
Avoidable Hospitalization ◽  
Individual Level ◽  
Hospitalization Rates ◽  
Health And Social Care ◽  
Hospitalization Costs

Abstract Background The largest cities on the world face the unprecedented challenge of meeting the needs of a population that lives longer, has declining birthrates, and is altering the demographic profile on which social welfare programs have long been premised. This work is part of an international project aimed at comparing health and social care systems in megacities worldwide. We study access to healthcare in the metropolitan area of Milan to quantify avoidable hospital care and social inequalities within this world city, and compare Milan with other OECD megacities. Methods Two sources of data are combined: individual-level hospital discharge data to measure hospitalization for ambulatory-care sensitive conditions (ACSC), and municipality-level data collected from the national office for statistics. First, we performed an ecological analysis using a linear model for ACSC hospitalization rates to detect the risk factors in the municipality where the patient resides. Then, to identify both individual and area-level variations in population health, we use multilevel logistic regression model. Results Age-adjusted ACSC hospitalization rates continuously declined from 2005 to 2016, from 16% to 10.7%. Municipality-level risk factors include proportion of residents aged 65+ and proportion of foreigner residents. The individual-level predictors of ACSC hospitalization include being male, being single, having co-morbidities and low education. This association is only modestly attenuated when patient’s area-level characteristics are accounted. Conclusions We observed declining trends in ACSC hospitalizations and identified some patient’s as well as area-level characteristics related to avoidable hospitalization. Understanding whether ACSC hospitalization has dropped due to improvements in population health and access to healthcare or as part of the overall reduction in hospitalization rates needs to be further explored. Key messages Effective primary care can reduce hospitalization for preventable and chronic conditions. This work identifies individual and ecological factors related to avoidable hospitalization in urban settings. Policies to improve access to healthcare, tackle inequalities and reduce hospitalization costs may be more effective if targeted on individuals considering and the environment in which they live.

scholarly journals Geographical variation and clustering are found in atrial fibrillation beyond socioeconomic differences: a Danish cohort study, 1987–2015

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kirstine Wodschow ◽  
Kristine Bihrmann ◽  
Mogens Lytken Larsen ◽  
Gunnar Gislason ◽  
Annette Kjær Ersbøll
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cohort Study ◽  
Incidence Rate ◽  
Socioeconomic Position ◽  
Geographical Variation ◽  
Incidence Rates ◽  
Socioeconomic Differences ◽  
Individual Level ◽  
Geographical Variations

Abstract Background The prevalence and incidence rate of atrial fibrillation (AF) increase worldwide and AF is a risk factor for more adverse cardiovascular diseases including stroke. Approximately 44% of AF cases cannot be explained by common individual risk factors and risk might therefore also be related to the environment. By studying geographical variation and clustering in risk of incident AF adjusted for socioeconomic position at an individual level, potential neighbourhood risk factors could be revealed. Methods Initially, yearly AF incidence rates 1987–2015 were estimated overall and stratified by income in a register-based cohort study. To examine geographical variation and clustering in AF, we used both spatial scan statistics and a hierarchical Bayesian Poisson regression analysis of AF incidence rates with random effect of municipalities (n = 98) in Denmark in 2011–2015. Results The 1987–2015 cohort included 5,453,639 individuals whereof 369,800 were diagnosed with an incident AF. AF incidence rate increased from 174 to 576 per 100,000 person-years from 1987 to 2015. Inequality in AF incidence rate ratio between highest and lowest income groups increased from 23% in 1987 to 38% in 2015. We found clustering and geographical variation in AF incidence rates, with incidence rates at municipality level being up to 34% higher than the country mean after adjusting for socioeconomic position. Conclusions Geographical variations and clustering in AF incidence rates exist. Compared to previous studies from Alberta, Canada and the United States, we show that geographical variations exist in a country with free access to healthcare and even when accounting for socioeconomic differences at an individual level. An increasing social inequality in AF was seen from 1987 to 2015. Therefore, when planning prevention strategies, attention to individuals with low income should be given. Further studies focusing on identification of neighbourhood risk factors for AF are needed.

scholarly journals Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Eleonora RO Ribeiro ◽  
Alzira Maria DN Guimarães ◽  
Heloísa Bettiol ◽  
Danilo DF Lima ◽  
Maria Luiza D Almeida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prenatal Care ◽  
Metropolitan Area ◽  
Northeast Brazil ◽  
Inadequate Prenatal Care ◽  
Prenatal Care Use

scholarly journals The Impact of Risk Factors for Coronary Heart Disease on Related Disability in Older Irish Adults

2017 ◽  
Vol 31 (1) ◽  
pp. 165-184 ◽  
Author(s):  
Sharon M. Cruise ◽  
John Hughes ◽  
Kathleen Bennett ◽  
Anne Kouvonen ◽  
Frank Kee
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Northern Ireland ◽  
Physical Inactivity ◽  
Relative Risks ◽  
Chd Risk ◽  
Health And Social Care ◽  
Chd Risk Factors ◽  
The Impact

Objective: The aim of this study is to examine the prevalence of coronary heart disease (CHD)–related disability (hereafter also “disability”) and the impact of CHD risk factors on disability in older adults in the Republic of Ireland (ROI) and Northern Ireland (NI). Method: Population attributable fractions were calculated using risk factor relative risks and disability prevalence derived from The Irish Longitudinal Study on Ageing and the Northern Ireland Health Survey. Results: Disability was significantly lower in ROI (4.1% vs. 8.8%). Smoking and diabetes prevalence rates, and the fraction of disability that could be attributed to smoking (ROI: 6.6%; NI: 6.1%), obesity (ROI: 13.8%; NI: 11.3%), and diabetes (ROI: 6.2%; NI: 7.2%), were comparable in both countries. Physical inactivity (31.3% vs. 54.8%) and depression (10.2% vs. 17.6%) were lower in ROI. Disability attributable to depression (ROI: 16.3%; NI: 25.2%) and physical inactivity (ROI: 27.5%; NI: 39.9%) was lower in ROI. Discussion: Country-specific similarities and differences in the prevalence of disability and associated risk factors will inform public health and social care policy in both countries.

scholarly journals Risk factors and hospitalization costs of Dementia patients: Examining race and gender variations

2015 ◽  
Vol 40 (4) ◽  
pp. 258 ◽  
Author(s):  
Baqar Husaini ◽  
AashraiS V Gudlavalleti ◽  
Van Cain ◽  
Robert Levine ◽  
Majaz Moonis
Keyword(s):  
Risk Factors ◽  
Race And Gender ◽  
Dementia Patients ◽  
Hospitalization Costs ◽  
And Gender ◽  
Gender Variations

scholarly journals Personalized Models of Internalizing Symptoms for Women with Social Anxiety Disorder and Depression

2020 ◽  
Author(s):  
Marilyn Piccirillo ◽  
Thomas Rodebaugh
Keyword(s):  
Risk Factors ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Internalizing Symptoms ◽  
Emotional Experience ◽  
Group Level ◽  
Major Depressive ◽  
Individual Level ◽  
Depressive Episodes

Social anxiety disorder (SAD) constitutes an important risk factor for major depressive disorder (MDD) and women are at greater risk for both disorders and their comorbidity. Despite much research examining risk factors for MDD specifically, there is limited research evaluating how individuals with SAD transition into depressive episodes. Clinical and theoretical evidence suggests that each individual may exhibit a unique personalized pattern of risk factors. These idiographic patterns may contradict group-level findings. In this study, women (N = 35) with SAD and a current or past major depressive episode completed ecological sampling of their mood and emotional experience five times a day for a month via a smartphone application. These data were analyzed using idiographic analyses to construct individual-level models of each woman’s mood. A multilevel model was constructed to determine risk factors for group-level intra-daily sadness (i.e., depressed mood). Some group-level relationships were consistent with previous research; however, most women’s models demonstrated few, and differing, risk factors for intra-daily sadness. We also examined the spread of individual-level estimates taken from group and idiographic models to determine the extent to which multilevel models can estimate individual-level effects. Implications for integrating results from idiographic methodology into existing theoretical models of psychopathology and clinical practice are discussed.

scholarly journals Association between area-level education and the co-occurrence of behavior-related risk factors: a multilevel analysis

2019 ◽  
Vol 22 ◽  
Author(s):  
Antonio Fernando Boing ◽  
SV Subramanian ◽  
Alexandra Crispim Boing
Keyword(s):  
Risk Factors ◽  
Chronic Diseases ◽  
Educational Level ◽  
Physical Inactivity ◽  
Eating Habits ◽  
Significant Proportion ◽  
Simultaneous Occurrence ◽  
Cross Sectional ◽  
Individual Level ◽  
Unhealthy Eating

ABSTRACT: Introduction: This study aimed to investigate the association of four different risk factors for chronic diseases and accumulation of these health behaviors with area-level education, regardless of individual-level characteristics in Brazil. Methods: A population-based cross-sectional study was carried out in Southern Brazil including 1,720 adults in 2009/2010. The simultaneous occurrence of tobacco smoking, abusive drinking, unhealthy eating habits, and physical inactivity was investigated. Using multilevel models, we tested whether area-level education was associated with each risk factor and with the co-occurrence of them after controlling sociodemographic individual-level variables. Results: We observed a between-group variance of 7.79, 7.11, 6.84 and 1.08% for physical inactivity, problematic use of alcohol, unhealthy eating habits, and smoking, respectively. The between-group variance for the combination of four behaviors was 14.2%. Area-level education explained a significant proportion of the variance observed in physical inactivity and unhealthy eating habits. Residents of low educational level neighborhoods showed a 2.40 (95%CI 1.58 - 3.66) times higher chance of unhealthy eating and 1.78 (95%CI 1.19 - 2.67) times higher chance of physical inactivity. The likelihood of individuals with two or three/four risk factors was simultaneously higher among residents of low educational level neighborhoods. Conclusion: Public policies should consider the area-level characteristics, including education to control risk factors for chronic diseases.

scholarly journals COVID-19 risk factors amongst 14,786 care home residents: An observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays, and vaccination status in Wales (UK) between 1st September 2020 and 1st May 2021.

2021 ◽  
Author(s):  
Joe Hollinghurst ◽  
Robyn Hollinghurst ◽  
Laura North ◽  
Amy Mizen ◽  
Ashley Akbari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admissions ◽  
Care Home ◽  
Vaccination Status ◽  
Care Homes ◽  
Positive Test ◽  
Care Providers ◽  
Specialist Care ◽  
Individual Level

Objectives: Determine individual level risk factors for care home residents testing positive for SARS-CoV-2. Study Design: Longitudinal observational cohort study using individual-level linked data. Setting: Care home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021. Participants: 14,786 older care home residents (aged 65+). Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. Methods: We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 polymerase chain reaction (PCR) test. We included time dependent covariates for the estimated community positive test rate of COVID-19, hospital admissions, and vaccination status. Additional covariates were included for age, positive PCR tests prior to the study, sex, frailty (using the hospital frailty risk score), and specialist care home services. Results: The multivariable logistic regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year of age), community positive test rate (OR 1.13 [1.12,1.13] per percent increase in positive test rate), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09] respectively) were associated with a decreased odds of a positive test. Conclusions: Our findings suggest care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Furthermore, minimising potential COVID-19 infection for care home residents admitted to hospital should be prioritised.

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