Sex Diversity in the Cardiothoracic Anesthesiology Fellowship: The Influence of Geographic Region.

OBJECTIVES: To investigate if the lack of sex diversity in adult cardiothoracic anesthesiology fellowships is a result of few female applicants or low acceptance rate. DESIGN: Retrospective review of adult cardiothoracic anesthesiology applicants and fellows by sex and geographic regions across the United States. SETTING: Accreditation Council for Graduate Medical Education's adult cardiothoracic anesthesiology fellowship programs across the United States. PARTICIPANTS: Applicants to adult cardiothoracic anesthesiology fellowship programs and fellows. INTERVENTIONS: No intervention. MEASUREMENTS AND MAIN RESULTS: Numerical comparison of male and female applicants by percentage and acceptance rates into adult cardiothoracic anesthesiology fellowship programs in each geographic region. Women comprised between 27% and 35% of applicants from 2013 to 2018. Acceptance rates for men completing residency in the Midwest region ranged between 67% and 84%, and 67% and 87% for women from the Midwest (p = 0.1-0.9). Men from Northeast residencies had acceptance rate of 71% to 86% and women had rate of 69% to 83% (p = 0.2-0.8). Male and female residents from the Southeast had acceptance rates of 65% to 94% and 71% to 93%, respectively (p = 0.3-0.8). The male residents from the Southwest had acceptance rates of 73% to 85%, and female residents had rates between 44% and 100% (p = 0.02-0.8). The male residents from the West had rates of 59% to 88%, female residents had rates between 64% and 100% (p = 0.1-0.7). CONCLUSIONS: There is an absence of clear identification of the barriers preventing women from entering cardiac anesthesiology. The reasons leading to a male-dominated field of cardiac anesthesiologists stem from fewer female anesthesiology residents applying to cardiothoracic anesthesiology fellowships. No bias against acceptance of women into cardiothoracic anesthesiology fellowships was found.

Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, 2013.

BACKGROUND: The demographic shift and epidemiologic transition in Brazil have drawn attention to ways of measuring population health that complement studies of mortality. In this paper, we investigate regional differences in healthy life expectancy based on information from the National Health Survey (PNS), 2013. METHODS: In the survey, a three-stage cluster sampling (census tracts, households and individuals) with stratification of the primary sampling units and random selection in all stages was used to select 60,202 Brazilian adults (18 years and over). Healthy life expectancies (HLE) were estimated by Sullivan's method according to sex, age and geographic region, using poor self-rated health for defining unhealthy status. Logistic regression models were used to investigate socioeconomic and regional inequalities in poor self-rated health, after controlling by sex and age. RESULTS: Wide disparities by geographic region were found with the worst indicators in the North and Northeast regions, whether considering educational attainment, material deprivation, or health care utilization. Life expectancy at birth for women and men living in the richest regions was 5 years longer than for those living in the less wealthy regions. Modeling the variation across regions for poor self-rated health, statistically significant effects (p < 0.001) were found for the North and Northeast when compared to the Southeast, even after controlling for age, sex, diagnosis of at least one non-communicable chronic disease, and schooling or socioeconomic class. Marked regional inequalities in HLE were found, with the loss of healthy life much higher among residents of the poorest regions, especially among the elderly. CONCLUSIONS: By combining data on self-rated health status and mortality in a single indicator, Healthy Life Expectancy, this study demonstrated the excess burden of poor health experienced by populations in the less wealthy regions of Brazil. To mitigate the effects of social exclusion, the development of strategies at the regional level is essential to provide health care to all persons in need, reduce risk exposures, support prevention policies for adoption of healthy behaviors. Such strategies should prioritize population groups that will experience the greatest impact from such interventions.