The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: analysis of large sub populations.

BACKGROUND: Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer. THE OBJECTIVE: To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer. METHODS: The study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI). RESULTS: Data on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p < 0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. CONCLUSION: Patients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation.

Disparities in diabetes care: role of the patient's socio-demographic characteristics.

BACKGROUND: The commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. However, disparities in health care are well-documented. The objectives were to explore disparities in diabetes prevalence, care and control among diabetic patients. The study was conducted by Maccabi Healthcare Services (MHS), an Israeli HMO (health care plan). METHODS: Retrospective study. The dependent variables were diabetes prevalence, uptake of follow-up examinations, and disease control. The independent variables were socio-economic rank (SER), ethnicity (Arab vs non Arab), supplementary voluntary health insurance (SVHI), and immigration from Former Soviet Union (FSU) countries. Chi Square and Logistic Regression Models were estimated. RESULTS: We analyzed 74,953 diabetes patients. Diabetes was more prevalent in males, lower SER patients, Arabs, immigrants and owners of SVHI. Optimal follow up was more frequent among females, lower SERs patients, non Arabs, immigrants and SVHI owners. Patients who were female, had higher SERs, non Arabs, immigrants and SVHI owners achieved better control of the disease. The multivariate analysis revealed significant associations between optimal follow up and age, gender (males), SER (Ranks 1-10), Arabs and SVHI (OR 1.02, 0.95, 1.15, 0.85 and 1.31, respectively); poor diabetes control (HbA1C > 9 gr%) was significantly associated with age, gender (males), Arabs, immigrants, SER (Ranks1-10) and SVHI (OR 0.96, 1.26, 1.38, 0.72, 1.37 and 0.57, respectively); significant associations with LDL control (< 100 gr%) were revealed for age, gender (males) and SVHI (OR 1.02, 1.30 and 1.44, respectively). CONCLUSION: Disparities in diabetes prevalence, care and control were revealed according to population sub-group. MHS has recently established a comprehensive strategy and action plan, aimed to reduce disparities among members of low socioeconomic rank and Arab ethnicity, sub-groups identified in our study as being at risk for less favorable health outcomes.

[Equity promotion in Maccabi Healthcare Services: from the Equality Report to an organizational action plan].

Maccabi Healthcare Services (MHS), the second largest HMO in Israel, has chosen to implement a multi-annual strategy to promote equality and equity in healthcare. Within the strategy's framework, MHS will maintain an ongoing process of studying the variability of its members characteristics for the purpose of adjusting service provision and improving health outcomes. MHS has recently published its first Equality Report, dedicated to defining the observed associations between its members demographic and socioeconomic characteristics and their health measures. The report identifies those sub-groups belonging to Israel's geographic and social peripheries that require focused interventions. Based on the report's recommendations, MHS has decided to designate promotion of equality as its strategic objective, a filter through which every policy decision will be reviewed. In addition it was decided to: 1. develop an organizational methodology to produce an index to assess reductions in disparities over time; 2. adjust MHS services to member's ethnic and cultural needs; 3. strengthen perceptions of community orientation based in primary care; 4. target resources to "social peripheries", beginning in 2010; 5. improve service accessibility and availability in geographically peripheral areas; 6. reduce economic barriers to healthcare. This article details the disparities as analyzed in the report in addition to the specific policy decisions made in their wake.

Genetic-environmental interactions in asthma and allergy: a study in a closed population exposed to different environments.

BACKGROUND: Asthma and allergy are common chronic diseases caused by genetic and environmental factors. OBJECTIVE: To study the effect of different environments on the prevalence of both diseases in an isolated founder population that resettled in different geographic and environmental areas (namely, the genetically homogeneous population that immigrated to Israel from Cochin, India, 50 years ago). METHODS: Respiratory and allergy symptoms were recorded by a questionnaire. The relative contribution of genetic factors on asthma and allergy was established by comparing Cochin with non-Cochin Jews living in the Jerusalem mountains; the relative contribution of the environment was determined by comparing mountain Cochin Jews with those living in the desert. The study was conducted from January to October 2004. RESULTS: A total of 983 individuals (481 mountain Cochins, 353 desert Cochins, and 149 non-Cochins) were studied. The overall prevalence of asthma in Cochins was 23.7%; and of allergy, 29.5%. The rate of asthma and/or allergy in Cochins in the mountains was significantly higher than in control non-Cochins. The rates of both asthma and allergy among Cochin Jews in the mountains were significantly higher than those among Cochin Jews in the desert, the former because of a higher prevalence of allergic asthma. The rates of nonallergic asthma and allergy without asthma were similar in both environments. CONCLUSIONS: Two different asthma and allergy phenotypes were detected that share a distinct genetic background but differ in the environmental influences. Allergic asthma is strongly determined by both genetic and environmental factors, whereas nonallergic asthma or atopy without asthma is determined mainly by genetic factors and is less influenced by environmental factors.