The socioeconomic inequity in healthcare utilization among individuals with cardiovascular diseases in India.

We assess the effects of socioeconomic inequity on healthcare utilization among individuals with cardiovascular diseases (CVDs) in India using the indirect standardization method with Erreygers' corrected concentration index. We analyze both horizontal and vertical inequities and linearly decompose the respective inequities to identify the major factors driving both kinds of inequities. Our findings show that actual healthcare utilization is highly concentrated among rich CVD individuals. After controlling for the confounding effects of health needs, horizontal inequity is found to be significantly pro-rich, and income and urban concentration are found to be the major factors driving this inequity. However, the direction and magnitude of vertical inequity vary, depending on the selection of the target group. When we use healthcare utilization of the richest 20 percent as the target, we find no significant vertical inequity among CVD individuals. However, when we take the richest 10 percent as the target, we observe a significant pro-rich differential effect of health needs on healthcare utilization between all individuals and the target group. Decomposition reveals an inappropriate differential effect of health needs and age in driving vertical inequity. Hence, the presence of vertical inequity may trigger further pro-rich socioeconomic inequity in healthcare utilization if not supported by any targeted healthcare coverage.

Inequities in curative health-care utilization among the adult population (20-59 years) in India: A comparative analysis of NSS 71st (2014) and 75th (2017-18) rounds.

OBJECTIVE: The study attempts (a) to compute the degree of socio-economic inequity in health care utilization and (b) to decompose and analyze the drivers of socio-economic inequity in health care utilization among adults (20-59 years) in India during the periods 2014 and 2017-18. DATA SOURCE: The analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0), of National sample Survey (NSS), corresponding to the 71st and 75th rounds. METHODS: Odds ratios were computed through logistic regression analysis to examine the effect of the socio-economic status on the health seeking behaviour of the ailing adult population in India. Concentration Indices (CIs) were calculated to quantify the magnitude of socio-economic inequity in health care utilization. Further, the CIs were decomposed to find out the share of the major contributory factors in the overall inequity. RESULTS: The regression results revealed that socio-economic status continues to show a strong association with treatment seeking behavior among the adults in India. The positive estimates of CIs across both the rounds of NSS suggested that health care utilization among the adults continues to be concentrated within the higher socio-economic status, although the magnitude of inequity in health care utilization has shrunk from 0.0336 in 2014 to 0.0230 in 2017-18. However, the relative contribution of poor economic status to the overall explained inequities in health care utilisation observed a rise in its share from 31% in 2014 to 45% in 2017-18. CONCLUSION: To reduce inequities in health care utilization, policies should address issues related to both supply and demand sides. Revamping the public health infrastructure is the foremost necessary condition from the supply side to ensure equitable health care access to the poor. Therefore, it is warranted that India ramps up investments and raises the budgetary allocation in the health care infrastructure and human resources, much beyond the current spending of 1.28% of its GDP as public expenditure on health. Further, to reduce the existing socio-economic inequities from the demand side, there is an urgent need to strengthen the redistributive mechanisms by tightening the various social security networks through efficient targeting and broadening the outreach capacity to the vulnerable and marginalized sections of the population.

Chironomid midges as allergens: evidence from two species from West Bengal, Kolkata, India.

BACKGROUND & OBJECTIVES: Arthropods of different taxonomic identity including chironomid midges are known to induce allergic response in humans. The present study was done to access two common chironomid species Chironomus circumdatus and Polypedilum nubifer for their sensitizing potential as an allergen in atopic patients and controls. METHODS: Following preparation of allergenic extracts of the two chironomid species separately, 198 atopic patients attending an allergy clinic and 50 age matched controls were tested along with a routine panel of allergens to assess sensitization. RESULTS: The skin prick test (SPT) results revealed that 189 of the 198 patients (95.4%) demonstrated sensitization to both the chironomid species. Higher levels of total IgE was observed in atopic subjects than in the control group. INTERPRETATION & CONCLUSIONS: The results suggest that the chironomid midges Chironomus circumdatus and Polypedilum nubifer can elicit sensitization in humans. A potential risk for allergic reactions by susceptible individuals exists due to these chironomid species, owing to their abundance and chances of contact with human beings. Further studies may be initiated to characterize the nature of the allergens and to assess their clinical relevance.

Clinico-immunochemical studies on airborne Areca catechu L. Pollen, a probable risk factor in emergency asthma hospitalization from Eastern India.

BACKGROUND: The pollen grain of the Areca catechu L. tree is airborne and allergenic. This study aimed to know the role of this pollen as a source of aeroallergen with effect on emergency asthma hospitalization, to isolate its important allergic fraction and to check its cross-reaction with betel nut. METHODS: Areca pollen was monitored with a Burkard sampler. Determination of allergenic activities was studied by in vivo and in vitro analyses. Asthma hospitalization data were collected from two nearby hospitals. The pollen extract was fractionated by a combination of DEAE-Sephadex and Sephacryl S-200 column. The protein components were observed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Cross-reactivity of Areca pollen and betel nut was shown by IgE enzyme-linked immunosorbent assay (ELISA) inhibition. RESULTS: The Areca pollen was perennially airborne. Skin test results of respiratory allergic patients showed 38.6% positivity. The detected aeroallergen spots in particle immunoblotting correlated significantly with airborne pollen count. Areca pollen showed a significant positive correlation with asthma hospitalization. There are 6 IgE-reactive protein components in the whole-pollen extract. IgE-reactive fraction 1 was resolved into 4 subfractions. Subfraction 1a showing IgE reactivity contained 3 protein components, among which 2 of 48 and 118 kDa were IgE reactive. The 48-kDa component was reported to be cross-reactive with other palm pollen types. In IgE ELISA inhibition, the betel nut extract showed 50% inhibition with about 110 ng/ml concentration. CONCLUSION: A. catechu pollen is a significant contributor to the aeroallergen load in India. Its partially purified IgE-reactive fraction may be useful in therapeutics. The betel nut extract showed remarkable cross-reactivity with Areca pollen.