29 research outputs found
Explorations of structure and choice in taxing capital gains: New Zealand tax experts' perspectives
No full textThis study explores the key issues, aspects, and attributes concerning capital gains tax (CGT) to enable the formulation of policy guidelines that might be used if a CGT were considered in New Zealand. It contends that the development of the New Zealand’s policy on taxing capital gains has continued in a somewhat ad hoc and inconsistent fashion. The lack of a uniform approach to capital gains taxation has resulted in detailed, but complex, legislation which leads to “policy inconsistencies and unintended incentives built into the tax structure” (Oliver, 2001, pp. 80 – 81). The study bridges the divide between theoretical analysis of CGT and implementation issues on operating a CGT. It attempts to address one primary research question and an associated secondary question. The primary research question is: should capital gains be taxed more comprehensively than at present? As a start, it examines the two important issues surrounding income definition and the capital/income distinction. In this regard, the research first attempts to identify the definition(s) of capital gains from the New Zealand perspective(s). This is followed by investigating the key areas of the tax system in order to seek the best way of taxing capital gains. This study also attempts to address the secondary research question, i.e., why (or why not) do the tax experts favour (or oppose) a comprehensive CGT? In this respect, this study identifies 23 factors/issues that are related to the tax experts’ attitudes towards a particular form of a CGT model (i.e., current hybrid approach, a realisation-based CGT or an accrual-based CGT). A mixed-methods design has been adopted in this study involving both a quantitative (survey) and a qualitative (interview) method in analysing the data to determine the tax experts’ overall perceptions of a CGT in New Zealand and the CGT adoption factors which influenced them. One important finding of the comparative analyses was that all tax experts generally agreed that the lack of a comprehensive CGT could provide more significant tax planning opportunities. However, many tax experts did not support the comprehensive income concept as they disagreed with the benefits derived from the gains in horizontal equity through adopting a CGT. This study has identified several important policy issues and reviewed their implication for the adoption of a CGT in New Zealand. The finding of the study revealed that the tax experts strongly supported the exemption of the gains on disposal of a taxpayer’s main residence and the tax preference for inflation adjustment. Another important policy issue is the implementation of an accrual-based CGT. Most tax experts considered a realisation-based CGT would be better than an accrual one. In particular, they were concerned about the liquidity problems and the compliance costs involved in an accrual-based CGT regime i.e., the annual valuation of all assets. These findings represent a first step towards a theoretical CGT framework. It is hoped that the knowledge gained in this study would give a greater understanding into the practical decision-making process that could result in a better public acceptance for a tax reform
Impact of HIV Infection on Overall Survival among Women with Stage IV Breast Cancer in South Africa
No full textPURPOSE: Advanced breast cancer (BC) at diagnosis is common in sub-Saharan Africa (SSA), including among women living with HIV (WLWH). In public hospitals across South Africa (SA), 10–15% of women present with stage IV BC, compared to <5% in the United States (US); 20% of new BC diagnoses in SA are in WLWH. We evaluated the impact of HIV on overall survival (OS) among women with stage IV BC. METHODS: We conducted a prospective cohort study of women diagnosed with stage IV BC between February 2, 2015 and September 18, 2019 at six public hospitals in SA. Multivariate Cox regression models were used to estimate the association of HIV status on OS. RESULTS: Among 550 eligible women, 147 (26.7%) were WLWH. Compared to HIV-negative BC patients, WLWH were younger (median age 45 vs. 60 years, p<0.001), predominantly black (95.9% vs. 77.9%, p<0.001), and more likely to have hormone receptor-negative (hormone-negative) BC (32.7% vs. 22.6%, p=0.016). Most women received systemic cancer-directed therapy (80.1%). HIV status was not associated with treatment or OS (Hazard Ratio (HR) 1.13 [95%CI 0.89–1.44]). On exploratory subgroup analysis, WLWH and hormone-negative BC had shorter OS compared to HIV-uninfected women (1-year OS: 27.1% vs. 48.8%, p=0.003; HR 1.94 [95%CI 1.27–2.94]; p=0.002), which was not observed for hormone receptor positive BC. CONCLUSION: HIV-status was not associated with worse OS in women with stage IV BC in SA and cannot account for the poor survival in this cohort. Subgroup analysis revealed that WLWH with hormone-negative BC had worse OS, which warrants further investigation
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Multimorbidity and overall survival among women with breast cancer: results from the South African Breast Cancer and HIV Outcomes Study
No full textBACKGROUND: Breast cancer survival in South Africa is low, but when diagnosed with breast cancer, many women in South Africa also have other chronic conditions. We investigated the impact of multimorbidity (≥ 2 other chronic conditions) on overall survival among women with breast cancer in South Africa. METHODS: Between 1 July 2015 and 31 December 2019, we enrolled women newly diagnosed with breast cancer at six public hospitals participating in the South African Breast Cancer and HIV Outcomes (SABCHO) Study. We examined seven chronic conditions (obesity, hypertension, diabetes, HIV, cerebrovascular diseases (CVD), asthma/chronic obstructive pulmonary disease, and tuberculosis), and we compared socio-demographic, clinical, and treatment factors between patients with and without each condition, and with and without multimorbidity. We investigated the association of multimorbidity with overall survival using multivariable Cox proportional hazard models. RESULTS: Of 3,261 women included in the analysis, 45% had multimorbidity; obesity (53%), hypertension (41%), HIV (22%), and diabetes (13%) were the most common individual conditions. Women with multimorbidity had poorer overall survival at 3 years than women without multimorbidity in both the full cohort (60.8% vs. 64.3%, p = 0.036) and stage groups: stages I–II, 80.7% vs. 86.3% (p = 0.005), and stage III, 53.0% vs. 59.4% (p = 0.024). In an adjusted model, women with diabetes (hazard ratio (HR) = 1.20, 95% confidence interval (CI) = 1.03–1.41), CVD (HR = 1.43, 95% CI = 1.17–1.76), HIV (HR = 1.21, 95% CI = 1.06–1.38), obesity + HIV (HR = 1.24 95% CI = 1.04–1.48), and multimorbidity (HR = 1.26, 95% CI = 1.13–1.40) had poorer overall survival than women without these conditions. CONCLUSIONS: Irrespective of the stage, multimorbidity at breast cancer diagnosis was an important prognostic factor for survival in our SABCHO cohort. The high prevalence of multimorbidity in our cohort calls for more comprehensive care to improve outcomes for South African women with breast cancer. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13058-023-01603-w
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Neoadjuvant Chemotherapy Use for Nonmetastatic Breast Cancer at Five Public South African Hospitals and Impact on Time to Initial Cancer Therapy
No full textIn sub‐Saharan Africa, clinical decisions can be affected by resource constraints. This article analyzes the clinical and sociodemographic factors associated with receiving neoadjuvant chemotherapy among patients from a previously existing cohort: women enrolled in the prospective South African Breast Cancer and HIV Outcomes study
South African Breast Cancer and HIV Outcomes Study: Methods and Baseline Assessment
No full textPurpose: In low- and middle-income, HIV-endemic regions of sub-Saharan Africa, morbidity and mortality from the common epithelial cancers of the developed world are rising. Even among HIV-infected individuals, access to antiretroviral therapy has enhanced life expectancy, shifting the distribution of cancer diagnoses toward non–AIDS-defining malignancies, including breast cancer. Building on our prior research, we recently initiated the South African Breast Cancer and HIV Outcomes study. Methods: We will recruit a cohort of 3,000 women newly diagnosed with breast cancer at hospitals in high (average, 20%) HIV prevalence areas, in Johannesburg, Durban, Pietermaritzburg, and Empangeni. At baseline, we will collect information on demographic, behavioral, clinical, and other factors related to access to health care. Every 3 months in year 1 and every 6 months thereafter, we will collect interview and chart data on treatment, symptoms, cancer progression, comorbidities, and other factors. We will compare survival rates of HIV-infected and uninfected women with newly diagnosed breast cancer and their likelihood of receiving suboptimal anticancer therapy. We will identify determinants of suboptimal therapy and context-specific modifiable factors that future interventions can target to improve outcomes. We will explore molecular mechanisms underlying potentially aggressive breast cancer in both HIV-infected and uninfected patients, as well as the roles of pathogens, states of immune activation, and inflammation in disease progression. Conclusion: Our goals are to contribute to development of evidence-based guidelines for the management of breast cancer in HIV-positive women and to improve outcomes for all patients with breast cancer in resource-constrained settings
Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort.
No full textObjectiveIn low- and middle-income countries (LMICs), advanced-stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. Understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve survival from BC in LMICs.MethodsWithin the South African Breast Cancers and HIV Outcomes (SABCHO) cohort, we examined factors affecting the stage at diagnosis of histologically confirmed invasive breast cancer at five tertiary hospitals in South Africa (SA). The stage was assessed clinically. To examine the associations of the modifiable health system, socio-economic/household and non-modifiable individual factors, hierarchical multivariable logistic regression with odds of late-stage at diagnosis (stage III-IV), was used.ResultsThe majority (59%) of the included 3497 women were diagnosed with late-stage BC disease. The effect of health system-level factors on late-stage BC diagnosis was consistent and significant even when adjusted for both socio-economic- and individual-level factors. Women diagnosed in a tertiary hospital that predominantly serves a rural population were 3 times (OR = 2.89 (95% CI: 1.40-5.97) as likely to be associated with late-stage BC diagnosis when compared to those diagnosed at a hospital that predominantly serves an urban population. Taking more than 3 months from identifying the BC problem to the first health system entry (OR = 1.66 (95% CI: 1.38-2.00)), and having luminal B (OR = 1.49 (95% CI: 1.19-1.87)) or HER2-enriched (OR = 1.64 (95% CI: 1.16-2.32)) molecular subtype as compared to luminal A, were associated with a late-stage diagnosis. Whilst having a higher socio-economic level (a wealth index of 5) reduced the probability of late-stage BC at diagnosis, (OR = 0.64 (95% CI: 0.47-0.85)).ConclusionAdvanced-stage diagnosis of BC among women in SA who access health services through the public health system was associated with both modifiable health system-level factors and non-modifiable individual-level factors. These may be considered as elements in interventions to reduce the time to diagnosis of breast cancer in women
The Impact of HIV Infection on Neoadjuvant and Adjuvant Chemotherapy Relative Dose Intensity in South African Patients with Breast Cancer
No full textResults of the South African Breast Cancer and HIV Outcomes (SABCHO) study showed that patients with breast cancer living with HIV and treated with neoadjuvant chemotherapy achieve lower rates of complete pathologic response than patients without HIV. This article assesses the impact of comorbid HIV on receipt of timely and complete neoadjuvant and adjuvant chemotherapy
outcomes study
No full textIn some countries of sub-Saharan Africa, the prevalence of HIV exceeds 20%; in South Africa, 20.4% of people are living with HIV. We examined the impact of HIV infection on the overall survival (OS) of women with nonmetastatic breast cancer (BC) enrolled in the South African Breast Cancer and HIV Outcomes (SABCHO) study. We recruited women with newly diagnosed BC at six public hospitals from 1 July 2015 to 30 June 2019. Among women with stages I-III BC, we compared those with and without HIV infection on sociodemographic, clinical, and treatment factors. We analyzed the impact of HIV on OS using multivariable Cox proportional hazard models. Of 2367 women with stages I-III BC, 499 (21.1%) had HIV and 1868 (78.9%) did not. With a median follow-up of 29 months, 2-year OS was poorer among women living with HIV (WLWH) than among HIV-uninfected women (72.4% vs 80.1%, P = 45 years and = 50 viral load copies/mL had poorer survival than HIV-uninfected BC patients [aHR: 1.35 (1.09-1.66) and 1.54 (1.20-2.00), respectively], as did WLWH who had >= 200 CD4+ cells/mL at diagnosis [aHR: 1.39 (1.15-1.67)]. Because receipt of antiretroviral therapy has become widespread, WLWH is surviving long enough to develop BC; more research is needed on the causes of their poor survival
Hospitals participating in the SABCHO study.
No full textThe source of the original map is D-Maps on https://d-maps.com/carte.php?num_car=4413&lang=en.</p
Breast cancer knowledge and self-delay period following symptom recognition.
No full textBreast cancer knowledge and self-delay period following symptom recognition.</p
