1,720,979 research outputs found
Inequality aversion in income, health, and income-related health
No full textBased on a survey of a sample of the general public, we estimate inequality aversion across income, health, and bivariate income-health. Inequality aversion is domain specific: mean inequality aversion is greater for income than for health, but the underlying distributions of aversion attitudes differ, with a highly bi-modal distribution of inequality-aversion values for health in which nearly half the participants display very low aversion and nearly half display very high aversion. Aversion to income-related health inequality is greater than that to income or health alone. Consistent with previous literature, we find only weak associations between aversion attitudes and individual characteristics. The magnitude of the estimates implies potentially large gains in welfare from reducing inequality in these domains
Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study
No full textEssays on Health, Inequality and Fairness
Full text linkGovernments, international agencies, and researchers routinely assess health and income inequalities and inequities so as to better communicate the evidence of their levels and trends to both policy-makers and the general public. Measuring the extent to which differences in health or income are unequal or unfair is, however, complex. This thesis contains three chapters centrally concerned with inequalities, though the focus differs across chapters. Chapter 2 helps address the gap between the requirements of indices often used for measuring income-related health inequality and current research practice by providing a non-technical review and critical assessment of the recent literature. This chapter should function as a guide for policy researchers and analysts to help them be more critical consumers of studies that use these indices while also helping applied researchers in choosing inequality measures that have the normative properties they seek. Most measures of inequality make assumptions about the extent to which society is averse to inequality. Moreover, analysts often assume that attitudes toward inequalities in health or income are the same. Chapter 3 is the first study using a mixed-methods approach to assess public attitudes toward inequalities in income, health, and income-related health inequality to determine preferences and how attitudes toward inequalities in these domains differ. Chapter 2 and 3 contribute to a greater understanding of the measurement and interpretation of inequalities.
While chapters 2 and 3 focus on inequalities among individuals within a society, chapter 4 focuses on inequalities globally among societies. Chapter 4 examines global health inequalities that result from medical care use using the example of long-standing drug technologies for treating hypertension. The study links availability and affordability of blood-pressure-lowering medicines with individual use and health outcomes. Chapter 4, therefore, provides an empirical illustration on how country-specific policies can play an important role in either countering or exacerbating health differences.ThesisDoctor of Philosophy (PhD)This thesis concerns itself with different aspects of inequality related to health and income, though the focus differs across chapters. The second and third chapters of this thesis contribute to a greater understanding of the measurement and interpretation of inequalities. Whereas the fourth chapter provides empirical evidence on how country-specific policies can counteract or exacerbate health differences. Chapter 2 comprehensively reviews and critically assesses the literature on the technical and normative properties of indices commonly used for measuring income-related health inequality thereby addressing the gap between the requirements of these indices and current research practice. Chapter 3 investigates public attitudes toward inequalities in income, health, and income-related health inequality to determine preferences and where attitudes toward these inequalities differ. Chapter 4 examines global health inequalities that result from medical care use using the example of long-standing drug technologies for treating hypertension and links availability and affordability of medicines with individual use and health outcomes
Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study
No full textHealth-related quality of life and healthcare costs of symptoms and cardiovascular disease events in patients with atrial fibrillation: a longitudinal analysis of 27 countries from the EURObservational Research Programme on Atrial Fibrillation general long-term registry
Full text linkAims: We examine the effects of symptoms and cardiovascular disease (CVD) events on health-related quality of life (HRQOL) and healthcare costs in a European population with atrial fibrillation (AF). Methods and results: In the EURObservational Research Programme on AF long-term general registry, AF patients from 250 centres in 27 European countries were enrolled and followed for 2 years. We used fixed effects models to estimate the association of symptoms and CVD events on HRQOL and annual healthcare costs. We found significant decrements in HRQOL in AF patients in whom ST-segment elevation myocardial infarction (STEMI) [−0.075 (95% confidence interval −0.144, −0.006)], angina or non-ST-elevation myocardial infarction (NSTEMI) [−0.037 (−0.071, −0.003)], new-onset/worsening heart failure [−0.064 (−0.088, −0.039)], bleeding events [−0.031 (−0.059, −0.003)], thromboembolic events [−0.071 (−0.115, −0.027)], mild symptoms [0.037 (−0.048, −0.026)], or severe/disabling symptoms [−0.090 (−0.108, −0.072)] occurred during the follow-up. During follow-up, annual healthcare costs were associated with an increase of €11 718 (€8497, €14 939) in patients with STEMI, €5823 (€4757, €6889) in patients with angina/NSTEMI, €3689 (€3219, €4158) in patients with new-onset or worsening heart failure, €3792 (€3315, €4270) in patients with bleeding events, and €3182 (€2483, €3881) in patients with thromboembolic events, compared with AF patients without these events. Healthcare costs were primarily driven by inpatient costs. There were no significant differences in HRQOL or healthcare resource use between EU regions or by sex. Conclusion: Symptoms and CVD events are associated with a high burden on AF patients and healthcare systems throughout Europe
The capital importance of lifestyle and diet in cardiovascular disease
Full text linkInternational audienceThis issue of the European Journal of Preventative Cardiology focuses on Lifestyle and Cardiovascular Diseases.In 2022, the American Heart Association (AHA) revised its widely used Life’s Simple 7 framework, incorporating new insights—such as the critical role of sleep in cardiovascular health—and refining components including diet, nicotine exposure, blood lipids, and blood glucose to create the Life’s Essential 8 (LE8). While LE8 offers an updated approach to promoting cardiovascular health, its ability to predict key clinical outcomes has lacked comprehensive evaluation. In ‘Life’s Essential 8 and the risk of cardiovascular disease: a systematic review and meta-analysis’,Sebastian et al.1 address this gap with a systematic review and meta-analysis of observational studies to examine the associations of LE8 with cardiovascular disease (CVD) outcomes and mortality. Their review identified 34 studies involving 1.8 million participants aged 18–80, followed for an average of 12 years. The findings are compelling: higher LE8 scores (80–100 out of 100 points) were associated with a 53% reduction in CVD risk, including a 56% reduction in coronary heart disease and a 48% reduction in stroke. All-cause mortality was also significantly reduced by 46%. Bloomfield,2 in an accompanying editorial, highlights opportunities for improvement, noting that standardizing the assessment of key components, such as diet and physical activity, could enhance the comparability of LE8 across studies. While these improvements could further strengthen the evidence base, the current findings, based on diverse populations from China, Finland, Spain, UK, and USA, suggest that LE8 is a useful and relevant framework for improving cardiovascular health worldwide
The cardiometabolic consequences of workplace sexual harassment
No full textThis editorial refers to ‘Exposure to workplace sexual harassment and risk of cardiometabolic disease: a prospective cohort study of 88 904 Swedish men and women’, by P. KC et al., https://doi.org/10.1093/eurjpc/zwae178
When the technical is also normative: a critical assessment of measuring health inequalities using the concentration index-based indices
Full text linkBACKGROUND: Concentration index-based measures are one of the most popular tools for estimating socioeconomic-status-related health inequalities. In recent years, several variants of the concentration index have been developed that are designed to correct for deficiencies of the standard concentration index and which are increasingly being used. These variants, which include the Wagstaff index and the Erreygers index, have important technical and normative differences. MAIN BODY: In this study, we provide a non-technical review and critical assessment of these indices. We (i) discuss the difficulties that arise when measurement tools intended for income are applied in a health context, (ii) describe and illustrate the interrelationship between the technical and normative properties of these indices, (iii) discuss challenges that arise when determining whether index estimates are large or of policy significance, and (iv) evaluate the alignment of research practice with the properties of the indices used. Issues discussed in parts (i) and (ii) include the different conceptions of inequality that underpin the indices, the types of changes to a distribution which leave inequality unchanged and the importance of the measurement scale and range of the outcome variable. These concepts are illustrated using hypothetical examples. For parts (iii) and (iv), we reviewed 44 empirical studies published between 2015 and 2017 and find that researchers often fail to provide meaningful interpretations of the index estimates. CONCLUSION: We propose a series of questions to facilitate further sensitivity analyses and provide a better understanding of the index estimates. We also provide a guide for researchers and policy analysts to facilitate the critical assessment of studies using these indices, while helping applied researchers to choose inequality measures that have the normative properties they seek. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12963-022-00299-y
Cost-effectiveness of digitally enabled cardiac rehabilitation: progress, promise, and persisting questions
Full text linkIncome-related inequality in health systems: a multi-country study on access, utilisation, and vaccination during the covid-19 pandemic
Full text linkIntroduction The COVID-19 pandemic placed unprecedented strain on global health systems, however, income-related health inequalities during the period remain underexplored. This thesis investigates income-related inequality in healthcare access, healthcare utilisation, and vaccination in 16 socioeconomically diverse countries during the pandemic. This thesis aims to: (1) situate the research in the literature, (2) assess income-related inequality in healthcare, (3) compare inequality across countries, (4) examine variation within countries, and (5) explore novel equality and efficiency approaches in healthcare. This thesis contributes to understanding inequalities during disruptions, offering insights to promote equitable access. Methods I conduct a replicable literature review on quantitative assessment of inequality in access, utilisation of health services, and vaccination, and apply variants of the concentration index to estimate income-related inequality in these areas. I then assess inequality-efficiency trade-offs in a financial incentives vaccination case study, and investigate sociodemographic characteristics associated with vaccine sentiment consistency. Finally, I conduct a synthesis of inequalities in health systems considering the estimates produced in this thesis. Results Significant pro-rich inequalities were identified in each country, particularly in lower and middle-income settings. Access and utilisation of appointments exhibited pro-rich inequality. Hospitalisation was utilised pro-poorly after overcoming access barriers. Vaccine sentiment was initially pro-rich, though inequality reduced over time. Financial incentives did not alter inequality in vaccination, but illustrate the importance of inequality measurement, while stated intention was the strongest predictor of vaccine uptake. Conclusion This thesis contextualises and quantifies income-related health inequality in several settings, finding a degree of inequality in each country. To address income-related inequality in healthcare, equality-sensitive policy makers need to adopt measures that focus on the vulnerable, and are based on recent and reliable evidence. This thesis sets out several considerations and implications to address inequality in healthcare
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