Associations Between Physician Supply Levels and Amenable Mortality Rates: An Analysis of Taiwan Over Nearly 4 Decades

Access to health care is an important determinant of health, but it remains unclear whether having more physicians reduces mortality. In this study, we used Taiwan’s population-level National Death Certification Registry data to investigate whether a greater supply of physicians is associated with lower rates of amenable mortality, defined as deaths that can be delayed with appropriate and timely medical treatment. Our baseline regression analysis adjusting only for age and sex shows that an increase in the number of physicians per 1000 is associated with a reduction of 1.7 ( P < .01) and 0.97 ( P < .01) age-standardized deaths per 100 000 for men and women, respectively. However, in our full analyses that control for socioeconomic factors and Taiwan’s health insurance expansion, we find that physician supply is no longer statistically associated with amenable mortality rates. Nevertheless, we found that greater physician supply levels are associated with a reduction in deaths from ischemic heart disease (−0.13 ( P < .05) for men, and −0.066 ( P < .05) for women). These findings suggest that overall, physician supply is not associated with amenable mortality rates after controlling for socioeconomic factors but may help reduce amenable mortality rates in specific causes of death.

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Abstract P264: Cardiovascular and Cardiometabolic Post-hospitalization Mortality Rates are Not Associated With Traditional Risk Factors and Socioeconomic Status at the Population Level in Canada

Circulation ◽

10.1161/circ.141.suppl_1.p264 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Sarah Singh ◽

Saverio Stranges ◽

Piotr Wilk ◽

Stephanie J Frisbee

Keyword(s):

Risk Factors ◽

Socioeconomic Factors ◽

Hospital Discharge ◽

Population Level ◽

Mortality Rates ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Census Division ◽

Traditional Risk Factors ◽

Over Time

Background: While existing literature has established individual risk factors for early death post-hospitalization in patients with cardiovascular and cardiometabolic disease (CVD/CMD), few studies to date have examined whether the known effects of these risk factors are maintained at the population level. The aim of this study was to determine whether traditional CVD risk factors and socioeconomic factors at the population level impacted CVD/CMD post-hospitalization mortality rates in Canada over time. Methodology: We conducted an ecological, cross-sectional analysis using merged data from two sources: 1) the Canadian Community Health Survey 2000-2011 and, 2) the Canadian Vital Statistics Death Database linked to the Discharge Abstract Database 2000-2012. The study outcome was 1-year mortality rate after hospital discharge for CVD/CMD, calculated by census division (CD) using ICD-9-CA codes for hospitalizations and deaths. The first stage of the statistical analysis reported age- and sex-standardized 1-year mortality rates after hospital discharge for CVD/CMD, across CDs in Canada. The second stage utilized Poisson regression to model associations between traditional CVD risk factors and socioeconomic factors at the CD level and CVD/CMD post-hospitalization mortality rates in Canada over time. Results: National 1-year mortality rates in patients with CVD/CMD increased from 146.5 per 100,000 in 2000 to 150.4 in 2012, peaking at 202.4 in 2006, with no significant trend observed over time. Maps of average 1-year mortality rates over the time period (2000-2012) show wide variations in rates across census divisions (CDs) in Canada. Nova Scotia and Ontario had the highest proportion of CDs with worsening rates of mortality over time (3% and 7% respectively) that remained below the national average. Traditional CVD risk factors, demographic factors and socioeconomic factors at the census division level were not associated with 1-year mortality rates after hospital discharge for CVD/CMD over time. Potential implication: Reductions in the CVD/CMD post-hospitalization mortality burden at the individual level may benefit from treatment targeted towards traditional risk factors and socioeconomic factors however; reduction in post-hospitalization burden at the population level can benefit from policy focused towards other societal elements such as healthcare and community care resources.

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Breast cancer mortality rates trends by race in São Paulo, Brazil

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1162 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D B Vale ◽

B Gozzi ◽

A C Marcelino ◽

J F Oliveira ◽

C Cardoso-Filho ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Mortality ◽

Access To Health Care ◽

White Women ◽

Breast Cancer Mortality ◽

Age Groups ◽

Mortality Rates ◽

Sao Paulo ◽

São Paulo ◽

Access To Health

Abstract Background Breast cancer is the main cause of female death by neoplasia in Brazil. Although half of the Brazilian population is black/brown (BB), socio-economic disparities translate in a vulnerable situation to those women. Access to health care is an important barrier to improve the health of BB women. This study aims to investigate trends in breast cancer mortality rates regarding race and age. Methods This is a population-based study of trends evaluation on breast cancer mortality in São Paulo state, Brazil, from 2000 to 2017. The absolute number of deaths and population figures (including race) by age-groups and years were available online from government data. Data on race were not available by ten-year age-groups, so the figures were projected according to the female age structure by year. Total rates by year and race were age-adjusted to the 'World Population (2000)'. For trend analysis, linear regression was used, with 5% level of significance. Results In the period were observed 60,940 breast cancer deaths, 76.7% in white and 17.5% in BB women. The absolute number of deaths in white and BB women was respectively 2,095 and 333 in 2000, and 3,076 and 999 in 2017. The total age-adjusted mortality rates per 100,000 women of white and BB in 2000 were respectively 16.4, 17.2 and 7.5. In 2017 rates were 14.6, 16.6 and 16.1. There was a trend towards reducing the mortality rates of white women (P = 0.002) and in their age-groups from 40 to 79 years (P < 0.03). There was a trend towards increasing the mortality rates of BB women (P < 0.001) and in all their age-groups (P < 0.02). Conclusions Although breast cancer figures of death and mortality rates in BB women have more than doubled in 18 years, rates reached almost the same figures of white women in the period. Changes in behaviour risk factors may explain this result. However, it is very likely that access to health care to these women has been improved, reducing the disparities in the health system. Key messages Breast cancer mortality rates in black/brown women have reached almost the same figures as white women from 2000 to 2017 in São Paulo, Brazil. Access to health care in black women may have improved in São Paulo, Brazil.

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Lupus Nephritis: A Different Disease in European Patients?

Kidney Diseases ◽

10.1159/000438844 ◽

2015 ◽

Vol 1 (2) ◽

pp. 110-118 ◽

Cited By ~ 11

Author(s):

Vladimir Tesar ◽

Zdenka Hruskova

Keyword(s):

Health Care ◽

High Risk ◽

African Americans ◽

Lupus Nephritis ◽

Socioeconomic Factors ◽

Access To Health Care ◽

Response To Treatment ◽

Renal Outcome ◽

Access To Health ◽

High Risk Populations

Background: Lupus nephritis (LN) is still associated with significant mortality and substantial risk of progression to end-stage renal failure. Its outcome is related to the class and severity of LN and response to treatment, and it is poorer in patients with renal relapses. Ethnicity has a relatively well-defined impact on the outcome of the patients and their response to treatment and must always be taken into consideration in treatment decisions. Summary: In this article, we provide a review of the impact of ethnicity on the prevalence of systemic lupus erythematosus (SLE), the proportion of patients with SLE developing LN, outcomes of SLE and LN and response of LN to treatment. In European patients, the prevalence of SLE and the proportion of SLE patients with LN are lower and the outcome of LN is better than in nonwhite populations. European patients may respond better to some modes of treatment [e.g. cyclophosphamide (CYC) or rituximab] and may be less frequently refractory to treatment compared to black patients with LN. Although these differences may be largely genetically driven, socioeconomic factors (poverty, education, insurance, access to health care and adherence to treatment) may also play a significant role in some disadvantaged patients. Key Message: Treatment of LN may be different in patients with different ethnicity. Less aggressive disease in European patients may better respond to less aggressive treatment. Treatment of LN in nonwhite patients may require newer (more effective) therapeutic approaches, but targeting negative socioeconomic factors might be even more effective. Facts from East and West: (1) The prevalence of SLE is lower among Caucasians than other ethnicities. A higher prevalence is observed among Asians and African Americans, while the highest prevalence is found in Caribbean people. The prevalence of LN in Asian SLE patients is much higher than in Caucasians as well. However, the 10-year renal outcome and renal survival rate appear to be better in Asians. (2) Polymorphisms of genes involved in the immune response, such as Fcγ receptor, integrin alpha M, TNF superfamily 4, myotubularin-related protein 3 and many others, might be partly responsible for the differences in prevalence between the different ethnic groups. European ancestry was shown to be associated with a decrease in the risk of LN even after adjustment for genes most associated with renal disease. (3) Access to health care is a key determinant of disease progression, treatment outcome and the management of complications such as infections, particularly in South Asia, and might also explain disparities between clinical outcomes. (4) The efficacy of low-dose CYC combined with corticosteroids for induction treatment of LN was proved in European Caucasian patients. This treatment is also used in Asia, although no formal evaluation of efficacy and safety in comparison with other treatment regimens exists in this population. The efficacy of mycophenolate mofetil (MMF) is similar to that of CYC, and similar between Asians and Caucasians. MMF may be more effective than CYC in inducing response in high-risk populations such as African American or Hispanic patients. MMF might cause less infection-related events in Asians, but its high cost prevents broader usage at present. (5) For maintenance therapy, corticosteroid combined with azathioprine (AZA) or MMF is used worldwide, with a broadly similar efficacy of both treatments, although there are data suggesting that in high-risk populations (e.g. African Americans) MMF may be more effective in preventing renal flares. AZA is often preferred in Asia due to economic constraints and because of its safety in pregnancy. (6) Alternative therapies under investigation include rituximab, which might be more efficient in Caucasians, as well as belimumab. Recent Japanese and Chinese studies have indicated a potential benefit of tacrolimus as a substitute for or in addition to CYC or MMF (dual or triple immunosuppression). Mizoribine is used in Japan exclusively.

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Health Care Resources and 24,910 Deaths Due to Traffic Accidents: An Ecological Mortality Study in Poland

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115561 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5561

Author(s):

Agnieszka Genowska ◽

Jacek Jamiołkowski ◽

Krystyna Szafraniec ◽

Justyna Fryc ◽

Andrzej Pająk

Keyword(s):

Health Care ◽

Access To Health Care ◽

Traffic Accidents ◽

Case Fatality ◽

Population Level ◽

Health Care Resources ◽

Car Accidents ◽

Access To Health ◽

Territorial Differentiation ◽

Hospital Deaths

Background: Deaths due to traffic accidents are preventable and the access to health care is an important determinant of traffic accident case fatality. This study aimed to assess the relation between mortality due to traffic accidents and health care resources (HCR), at the population level, in 66 sub-regions of Poland. Methods: An area-based HCR index was delivered from the rates of physicians, nurses, and hospital beds. Associations between mortality from traffic accidents and the HCR index were tested using multivariate Poisson regression models. Results: In the sub-regions studied, the average mortality from traffic accidents was 11.7 in 2010 and 9.3/100.000 in 2015. After adjusting for sex, age and over time trends in mortality, out-of-hospital deaths were more frequently compared to hospitalized fatal cases (incidence rate ratio (IRR) = 1.68, 95% CI 1.45–1.93). Compared to sub-regions with high HCR, mortality from traffic accidents was higher in sub-regions with low and moderate HCR (IRR = 1.25, 95% CI 1.11–1.42 and IRR = 1.19, 95% CI 1.02–1.38, respectively), which reflected the differences in out-of-hospital mortality most pronounced in car accidents. Conclusions: Poor HCR is an important factor that explains the territorial differentiation of mortality due to traffic accidents in Poland. The high percentage of out-of-hospital deaths indicates the importance of preventive measures and the need for improvement in access to health care to reduce mortality due to traffic accidents.

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Associations between physician supply levels and amenable mortality rates: A descriptive and panel data analysis of Taiwan over nearly four decades

10.21203/rs.2.18884/v1 ◽

2019 ◽

Author(s):

Brian Chen ◽

Dakshu Jindal ◽

Y. Tony Yang ◽

Nicole Hair ◽

Chun-Yuh Yang

Keyword(s):

Health Care ◽

Panel Data ◽

Population Health ◽

Household Income ◽

Mortality Rates ◽

Regression Analyses ◽

Physician Supply ◽

Amenable Mortality ◽

Panel Data Regression ◽

Data Regression

Abstract Background. Access to health care is an important determinant of health, but despite years of research, it remains unclear whether having more physicians reduces mortality. In this study, we investigate whether a greater supply of physicians in given administrative areas is associated with lowers rates of amenable mortality, defined as deaths that can be delayed with appropriate and timely medical treatment or public health measures.Methods. We use Taiwan’s population-level National Death Certification Registry data spanning nearly four decades to study the trend in age-standardized amenable mortality rates by area physician supply quartiles. We also conducted multivariate panel data regression analyses of the association between age-standardized amenable mortality rates and physician supply, controlling for mean household income, education attainment, urbanization levels, decade fixed effects, and the implementation of universal health care.Results. The trend analyses (adjusted for age and sex only) show that Taiwanese townships in the top quartile of physician supply consistently had the lowest age-standardized amenable mortality rates. However, in the panel data regression analyses, after controlling for at least mean household income, the negative association between physician supply and overall amenable mortality loses statistical significance, although it remains statistically significant for ischemic heart disease.Conclusions. These findings suggest that physician supply, while important, is but one input that contributes to population health and is likely confounded with other socioeconomic factors correlated with better health. Physician supply levels are not randomly distributed, and doctors likely choose to practice in higher income areas and areas with demonstrated medical need. More research is needed, but policy makers should consider broader social policies, not just healthcare resources, as means to promote population health once a critical mass of physicians is achieved.

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Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations ◽

10.1044/cds19.3.71 ◽

2012 ◽

Vol 19 (3) ◽

pp. 71-76 ◽

Cited By ~ 1

Author(s):

Pauline A. Mashima

Keyword(s):

Health Care ◽

Health Care Providers ◽

Access To Health Care ◽

Underserved Populations ◽

Linguistically Diverse ◽

Care Providers ◽

Department Of Health ◽

Use Of Technology ◽

Access To Health ◽

Improve Access

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

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