Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil.

BACKGROUND: Evidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil. METHODS: This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package. RESULTS: 2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest. CONCLUSIONS: There are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population's right to health.

Occupational health: the role of demographic factors in the condition of increased risk.

OBJECTIVES: The paper analyses the impact of socio-demographic characteristics of the employees in conditions of uncertainty in the organizations. MATERIAL AND METHODS: The study was conducted on a sample of 210 employees using the Mental Health Inventory - 38 (MHI-38), Satisfaction with life scale (SWLS), and the Center for Epidemiological Studies - Depression (CES-D). RESULTS: The results showed that female respondents had significantly higher scores on ANX (t = 2,278, p < 0.05), while male employees had higher scores on life satisfaction (t = 2.103, p < 0.05). Older employees have a higher tendency for loss of emotional-behavioral control (F = 4.427, p < 0.05). Respondents who have satisfying living standards have also higher scores on SWLS (t = 2.257, p < 0.05). Respondents who have dissatisfying living standard have higher scores on generally positive affect (t = 3.152, p < 0.01), life satisfaction (t = 3.571, p < 0.01), psychological distress (t = 2.929, p < 0.01) and loss of emotional- behavioral control (t = 2.361, p < 0.05). Employees with different levels of educational background have similar tendencies in life satisfaction, mental health, and depressive symptoms (p > 0.05). CONCLUSIONS: The study showed that the specific socio-demographic profile of the employees is related to higher levels of mental health issues. Specifically, the mental health of female and older employees have been especially affected and disturbed by uncertain conditions. The results can be potentially used both in the terms of designing activities that support the mental health of the population, as well as in relation to the mental health of employees. Int J Occup Med Environ Health. 2023;36(2):250-62.

Neighborhood Characteristics and COVID-19 Incidence and Mortality in Southeastern Pennsylvania.

The COVID-19 pandemic has differentially impacted people according to their race/ethnicity, socioeconomic status, and preexisting conditions. Public health surveillance efforts, especially those occurring early in the pandemic, did not gather nor report adequate individual-level demographic information to identify these differences, and thus, neighborhood-level characteristics were used to note striking disparities in the US. We sought to determine whether risk factors associated with COVID-19 incidence and mortality in five Southeastern Pennsylvania counties could be better understood by using neighborhood-level demographic data augmented with health, socioeconomic, and environmental characteristics derived from publicly available sources. Although we found that education level and age of residents were the most salient predictors of COVID-19 incidence and mortality, respectively, neighborhoods exhibited a high degree of segregation with multiple correlated factors, which limits the ability of neighborhood-level analysis to identify actionable factors underlying COVID-19 disparities.

Inequalities in the receipt of healthcare practitioner counseling for adults after COVID-19 in southern Brazil.

Health counseling is a prevention and health promotion action, especially in the context of a pandemic, for both preventing disease and maintaining health. Inequalities may affect receipt of health counseling. The aim was to provide an overview of the prevalence of receiving counseling and to analyze income inequality in the receipt of health counseling. METHODS: This was a cross-sectional telephone survey study with individuals aged 18 years or older with diagnosis of symptomatic COVID-19 using RT-PCR testing between December 2020 and March 2021. They were asked about receipt of health counseling. Inequalities were assessed using the Slope Index of Inequality (SII) and Concentration Index (CIX) measures. We used the Chi-square test to assess the distribution of outcomes according to income. Adjusted analyses were performed using Poisson regression with robust variance adjustment. RESULTS: A total of 2919 individuals were interviewed. Low prevalence of health counseling by healthcare practitioner was found. Participants with higher incomes were 30% more likely to receive more counseling. CONCLUSIONS: These results serve as a basis for aggregating public health promotion policies, in addition to reinforcing health counseling as a multidisciplinary team mission to promote greater health equity.

Relationships between the COVID-19 lockdown, socioeconomic factors and acute coronary syndrome hospitalisations in France.

INTRODUCTION: Worldwide, the COVID-19 pandemic has been associated with an overall drop in acute coronary syndrome (ACS) hospitalizations. Additionally, there is a well-known association between ACS and socioeconomic status. This study aims to assess the COVID-19 effect on ACS admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. MATERIALS AND METHODS: In this retrospective study, we used the French hospital discharge database (PMSI) to estimate ACS admission rates in all public and private hospitals in 2019 and 2020. A negative binomial regression explored the nationwide change in ACS admissions during lockdown compared with 2019. A multivariate analysis explored the factors associated with the ACS admission incidence rate ratio (IRR, 2020 incidence rate/2019 incidence rate) variation at the county level. RESULTS: We found a significant but geographically heterogeneous nationwide reduction in ACS admissions during lockdown (IRR 0·70 [0·64-0·76]). After adjustment for cumulative COVID-19 admissions and the ageing index, a higher share of people on short-term working arrangements during lockdown at the county level was associated with a lower IRR, while a higher share of individuals with a high school degree and a higher density of acute care beds were associated with a higher ratio. CONCLUSIONS: During the first national lockdown, there was an overall decrease in ACS admissions. Local provision of inpatient care and socioeconomic determinants linked to occupation were independently associated with the variation in hospitalizations.

Socioeconomic disparities and concentration of the spread of the COVID-19 pandemic in the province of Quebec, Canada.

BACKGROUND: Recent studies suggest that the risk of SARS-CoV-2 infection may be greater in more densely populated areas and in cities with a higher proportion of persons who are poor, immigrant, or essential workers. This study examines spatial inequalities in SARS-CoV-2 exposure in a health region of the province of Quebec in Canada. METHODS: The study was conducted on the 1206 Canadian census dissemination areas in the Capitale-Nationale region of the province of Quebec. The observation period was 21 months (March 2020 to November 2021). The number of cases reported daily in each dissemination area was identified from available administrative databases. The magnitude of inequalities was estimated using Gini and Foster-Greer-Thorbecke (FGT) indices. The association between transmission and socioeconomic deprivation was identified based on the concentration of transmission in socially disadvantaged areas and on nonparametric regressions relating the cumulative incidence rate by area to ecological indicators of spatial disadvantage. Quantification of the association between median family income and degree of exposure of dissemination areas was supplemented by an ordered probit multiple regression model. RESULTS: Spatial disparities were elevated (Gini = 0.265; 95% CI [0.251, 0.279]). The spread was more limited in the less densely populated areas of the Quebec City agglomeration and outlying municipalities. The mean cumulative incidence in the subsample made up of the areas most exposed to the pandemic was 0.093. The spread of the epidemic was concentrated in the most disadvantaged areas, especially in the densely populated areas. Socioeconomic inequality appeared early and increased with each successive pandemic wave. The models showed that areas with economically disadvantaged populations were three times more likely to be among the areas at highest risk for COVID-19 (RR = 3.55; 95% CI [2.02, 5.08]). In contrast, areas with a higher income population (fifth quintile) were two times less likely to be among the most exposed areas (RR = 0.52; 95% CI [0.32, 0.72]). CONCLUSION: As with the H1N1 pandemics of 1918 and 2009, the SARS-CoV-2 pandemic revealed social vulnerabilities. Further research is needed to explore the various manifestations of social inequality in relation to the pandemic.

Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020.

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Are we equally at risk of changing smoking behavior during a public health crisis? Impact of educational level on smoking from the TEMPO cohort.

BACKGROUND: The COVID-19 pandemic as a public health crisis has led to a significant increase in mental health difficulties. Smoking is strongly associated with mental health conditions, which is why the pandemic might have influenced the otherwise decline in smoking rates. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic has exacerbated existing social inequalities and because this group was more likely to smoke before the pandemic. We examined smoking prevalence in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between interpersonal changes in tobacco consumption and educational level from 2018 to 2021. METHODS: Using four assessments of smoking status available from 2009 to 2021, we estimated smoking prevalence over time, stratified by highest educational level in the TEMPO cohort and the difference was tested using chi2 test. We studied the association between interpersonal change in smoking status between 2018 and 2021 and educational attainment among 148 smokers, using multinomial logistic regression. RESULTS: Smoking prevalence was higher among those with low education. The difference between the two groups increased from 2020 to 2021 (4.8-9.4%, p < 0.001). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018 to 2021 compared to low educated smokers (aOR = 2.72 [1.26;5.89]). CONCLUSION: Current findings showed a widening of the social inequality gap in relation to smoking rates, underscoring the increased vulnerability of persons with low educational level to smoking and the likely inadequate focus on social inequalities in relation to tobacco control policies during the pandemic.

Health inequalities in Brazil: proposed prioritization to achieve the Sustainable Development Goals. / Desigualdades de saúde no Brasil: proposta de priorização para alcance dos Objetivos do Desenvolvimento Sustentável.

This study aimed to develop a prioritization index to speed up the achievement of national health targets proposed in the 2030 Agenda. This is an ecological study that addressed the Health Regions in Brazil. The index incorporated 25 indicators with analytical proximity to the official indicators of the 2030 Agenda whose data are available from public municipal sources for the period of 2015-2019. According to our study, the index was a powerful method to support health management decisions. The results showed the most vulnerable territories are located in the North Region of the country, and therefore, these are priority areas for resource allocation. The analysis of subindices highlighted local health bottlenecks, reinforcing the need for municipalities in each region to set their own priorities while making decisions for health resource allocation. By indicating Health Regions and priority themes for more investments, this investigation shows paths to support the implementation of the 2030 Agenda, from the local to the national level, in addition to providing elements that can be used by policy makers to minimize the effects of social inequalities on health, prioritizing territories with worse indices.

O objetivo deste artigo é desenvolver um índice de priorização para aceleração do cumprimento das metas nacionais de saúde propostas pela Agenda 2030. Trata-se de estudo ecológico que abordou as Regiões de Saúde do Brasil. O índice incorporou 25 indicadores com proximidade analítica aos indicadores oficiais da Agenda 2030, para os quais existem dados de fontes públicas no nível municipal para o período de 2015 a 2019. O índice apresentou-se como potente método para apoiar a decisão da gestão em saúde. Os resultados permitiram identificar que a Região Norte do país apresenta os territórios mais vulneráveis e, portanto, prioritários para a alocação de recursos. Além disso, a análise dos subíndices permitiu destacar os gargalos locais de saúde, reforçando a necessidade de os municípios de cada região estabelecerem suas próprias prioridades na decisão de alocação dos recursos da saúde. Ao indicar as Regiões de Saúde e os temas prioritários para maiores investimentos, esta investigação aponta caminhos que podem apoiar a implementação da Agenda 2030 do nível local ao nacional, além de fornecer elementos por meio dos quais os formuladores de políticas podem minimizar os efeitos das iniquidades sociais sobre a saúde, priorizando os territórios com piores índices.

El objetivo fue desarrollar un índice de priorización para acelerar el cumplimiento de las metas nacionales de salud propuestas por la Agenda 2030. Se trata de un estudio ecológico que abordó las Regiones de Salud de Brasil. El índice incorporó 25 indicadores con proximidad analítica a los indicadores oficiales de la Agenda 2030 para los cuales existen datos de fuentes públicas a nivel municipal para el período 2015-2019. El índice se presentó como potente método para apoyar la decisión de la gestión en salud. Los resultados permitieron identificar que la Región Norte del país cuenta con los territorios más vulnerables y, por tanto, áreas prioritarias para la asignación de recursos. Además, el análisis de los subíndices permitió resaltar cuellos de botella locales en salud, reforzando la necesidad de que los municipios de cada región establezcan sus propias prioridades en la decisión de asignación de recursos en salud. Al indicar las Regiones de Salud y los temas prioritarios para mayores inversiones, esta investigación apunta caminos que pueden apoyar la implementación de la Agenda 2030 desde el nivel local al nacional, además de proporcionar elementos a través de los cuales los formuladores de políticas pueden minimizar los efectos de las inequidades sociales sobre la salud, priorizando los territorios con peores índices.

[Assessment of food insecurity in the context of COVID-19: association with emergency aid and collecting food donations among the socially vulnerable population of a capital in Northeastern Brazil]. / Avaliação da insegurança alimentar no contexto da COVID-19: associação com o auxílio emergencial e recebimento de doação de alimentos na população em vulnerabilidade social de uma capital do Nordeste do Brasil.

The scope of this study was to investigate the prevalence of food insecurity in the context of COVID-19 and its association with the emergency aid income-transfer program and the collecting of food donations by the population in a situation of social vulnerability. A cross-sectional study was carried out with socially vulnerable families eight months after confirming the first case of COVID-19 in Brazil. A total of 903 families, living in 22 underprivileged communities of Maceió, in the state of Alagoas, were included. Sociodemographic characteristics were evaluated, and the Brazilian Food Insecurity Scale was applied. The association of food insecurity with the variables studied was performed using Poisson regression with robust variance estimation, considering α = 5%. Of the total sample, 71.1% were food insecure, a situation associated with receiving food donations (PR = 1.14; 95%CI: 1.02; 1.27) and being a beneficiary of emergency aid (PR =1.23; 95%CI: 1.01; 1.49). The results show that the population in a situation of social vulnerability was strongly affected by food insecurity. On the other hand, the population group in question benefited from actions implemented at the outset of the pandemic.

O estudo objetivou investigar a prevalência de insegurança alimentar no contexto da COVID-19 e sua associação com o programa de transferência de renda Auxílio Emergencial e o recebimento de doação de alimentos na população em vulnerabilidade social. Estudo transversal, realizado com famílias em vulnerabilidade social, oito meses após a confirmação do primeiro caso de COVID-19 no Brasil. Foram incluídas 903 famílias, residentes em 22 aglomerados subnormais de Maceió, em Alagoas. Avaliaram-se características sociodemográficas e foi aplicada a Escala Brasileira de Insegurança Alimentar. A associação da insegurança alimentar com as variáveis estudadas foi realizada por meio de regressão de Poisson com estimativa robusta das variâncias, considerando α = 5%. Do total da amostra, 71,1% estavma em insegurança alimentar, situação que se associou com o recebimento de doação de alimentos (RP = 1,14, IC95%: 1,02; 1,27) e ser beneficiário do Auxílio Emergencial (RP = 1,23, IC95%: 1,01; 1,49). Os resultados mostram que a população em vulnerabilidade social foi fortemente afetada pela insegurança alimentar. Em contrapartida, essa população foi beneficiada por ações que foram implementadas no início da pandemia.

Socioeconomic Risk Factors for Pediatric Out-of-hospital Cardiac Arrest: A Statewide Analysis.

INTRODUCTION: Economic hardship is a major threat to children's health, implying that pediatric out-of-hospital cardiac arrest (pOHCA) might be promoted by lower incomes and child poverty. To target resources, it is helpful to identify geographical hotspots. Rhode Island is the smallest state by area in the United States of America. It has one million inhabitants and is comparable to many larger cities worldwide. We aimed to investigate the possible associations of pOHCA with economic factors and the coronavirus 2019 (COVID-19) pandemic. Our goal was to identify high-risk areas and evaluate whether the COVID-19 pandemic had an influence on delays in prehospital care. METHODS: We analyzed all pOHCA cases (patients <18 years of age) in Rhode Island between March 1, 2018-February 28, 2022. We performed Poisson regression with pOHCA as dependent and economic risk factors (median household income [MHI] and child poverty rate from the US Census Bureau) as well as the COVID-19 pandemic as independent variables. Hotspots were identified using local indicators of spatial association (LISA) statistics. We used linear regression to assess the association of emergency nedical services-related times with economic risk factors and COVID-19. RESULTS: A total of 51 cases met our inclusion criteria. Lower MHIs (incidence-rate ratio [IRR]) 0.99 per $1,000 MHI; P=0.01) and higher child poverty rates (IRR 1.02 per percent; P=0.02) were significantly associated with higher numbers of ambulance calls due to pOHCA. The pandemic did not have a significant influence (IRR 1.1; P=0.7). LISA identified 12 census tracts as hotspots (P<0.01). The pandemic was not associated with delays in prehospital care. CONCLUSION: Lower median household income and higher child poverty rate are associated with higher numbers of pediatric out-of-hospital cardiac arrest.

The Legal and Socioeconomic Considerations in Spine Telemedicine.

Telemedicine has become indispensable in today's health care because of the recent ongoing COVID-19 crisis. Although it has been beneficial in coping with the pandemic, there is still much uncertainty as to whether it will have a permanent role in treating spine patients. Some of the ongoing legal challenges include patient confidentiality, liability coverage for treating healthcare workers, and financial reimbursements by insurance companies. One of the impediments of telemedicine is its lack of a standard legal framework. Telehealth is currently regulated through a state-based system with each state having its own policy regarding this practice. In addition, each of the components of a virtual visit represent a potential area for legal concerns. Nonetheless, telemedicine has the ability to provide convenient and effective health care to patients. However, the spine surgeon, as well as other physicians, must consider the legal issues along with some socioeconomic factors identified herein. Moreover, without parity and uniformity, the incentive to offer telehealth services decreases. There may be a need for modifications in the law, insurance policies, and medical malpractice coverage to strengthen their support to telemedicine usage. As spine surgeons become more familiarized with the telemedicine framework, its role in patient care will likely expand.

Marginalization, Vulnerability and Economic Dynamics in COVID-19

Abstract COVID-19, caused by the coronavirus family SARS-CoV-2 and declared a pandemic in March 2020, continues to spread. Its enormous and unprecedented impact on our society has evidenced the huge social inequity of our modern society, in which the most vulnerable individuals have been pushed into even worse socioeconomic situations, struggling to survive. As the pandemic continues, we witness the huge suffering of the most marginalized populations around the globe, even in developed, high-income latitudes, such as North America and Europe. That is even worse in low-income regions, such as Brazil, where the public healthcare infrastructure had already been struggling before the pandemic. Cities with even more evident social inequity have been impacted the most, leaving the most socioeconomically disadvantaged ones, such as slum residents and black people, continuously inflating the statistics of COVID-19 sufferers. Poverty, marginalization, and inequity have been well-known risk factors for morbidity and mortality from other diseases. However, COVID-19 has deepened our society's wound. It is up to us to heal it up. If we really care for the others and want to survive as a species, we must fight social inequity.