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Healthcare
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Inequalities in Environmental Exposure and in Health Care
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Inequalities in Environmental Exposure and in Health Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Environmental Factors and Global Health".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 20327

Special Issue Editor

Andrea Tittarelli

E-Mail Website
Guest Editor
Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Interests: epidemiology; cancer registries; health data treatment; database management; environment; risk assessment; statistics

Special Issue Information

Dear Colleagues,

In the last months, most of the energy of health operators and policy makers was surely (and rightly) absorbed by the emergency due to the worldwide spread of Covid-19 virus. And this situation unfortunately is still going on, as the pandemic is not over at the moment.

But this dramatic circumstances we are now facing do not have to make us forget other important issues in Public Health, some of them also partially related to the presence and the consequences of a pandemic virus. We can think about environmental pollution and its effects on human health. But also about inequalities in the access to health care, both inter- and intra-countries, or in the possibility of limiting personal exposure, and consequently the potential adverse outcomes associated. Socio-economical status (SES) is a variable not simple to assess and manage in epidemiological studies. But it is surely an important topic to consider, as it could affect many relationships found between risk factors and health effects.

For this reason, the aim of this Special Issue is mainly to collect paper considering the role of SES in epidemiological studies, the methods that are used to assess it at the smallest possible level (as an approximation of the personal socio-economical status), its influence in the association between risk factors (mainly environmental factors, but not only) and any health outcomes. The papers could be original studies or reviews of scientific literature; they could describe an epidemiological study in which this topic is addressed or they could be methodological articles or also commentaries. Finally, papers considering inequalities in the access to health care are also welcome.

Mr. Andrea Tittarelli
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Public Health
  • Environmental pollution
  • Epidemiology
  • Personal exposure
  • Risk assessment
  • Confounders
  • SES
  • Inequalities
  • Health care

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Published Papers (7 papers)

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Research

18 pages, 2050 KiB  
Article
The Influence of Socioeconomic Status on the Prognosis and Profile of Patients Admitted for Acute Heart Failure during COVID-19 Pandemic: Overestimated Aspects or a Multifaceted Hydra of Cardiovascular Risk Factors?
by Radu-Stefan Miftode, Irina-Iuliana Costache, Petru Cianga, Antoniu Octavian Petris, Corina-Maria Cianga, Minela-Aida Maranduca, Ionela-Larisa Miftode, Daniela Constantinescu, Amalia-Stefana Timpau, Adrian Crisan, Ovidiu Mitu, Mihai Stefan Cristian Haba, Celina-Silvia Stafie and Ionela-Lacramioara Șerban
Healthcare 2021, 9(12), 1700; https://doi.org/10.3390/healthcare9121700 - 8 Dec 2021
Cited by 12 | Viewed by 3128
Abstract
Background: Heart failure (HF) is a complex clinical syndrome that represents a great burden on public health systems due to its increased prevalence, disability and mortality rates. There are multiple triggers that can induce or aggravate a preexisting HF, socioeconomic status (SES) [...] Read more.
Background: Heart failure (HF) is a complex clinical syndrome that represents a great burden on public health systems due to its increased prevalence, disability and mortality rates. There are multiple triggers that can induce or aggravate a preexisting HF, socioeconomic status (SES) emerging as one of the most common modifiable risk factors. Our study aimed to analyze the influence of certain SES indicators on the outcome, clinical aspects and laboratory parameters of patients with HF in North-Eastern Romania, as well as their relationship with other traditional cardiovascular risk factors. Methods: We conducted a prospective, single-center study comprising 120 consecutively enrolled patients admitted for acute HF. The evaluation of individual SES was based upon a standard questionnaire and evidence from official documents. Results: the patients’ age ranged between 18 and 94 years; Out of 120 patients, 49 (40.8%) were women and 71 (59.2%) were men, residing in rural 59 (49.2%) or urban 61 (50.8%) areas. 14.2% were university graduates, while 15.8% had only attended primary school. The majority of the patients are or were employed in the service sector (54.5%), followed by industry (29.2%) and agriculture (20%). The mean monthly income was 306.1 ± 177.4 euro, while the mean hospitalization cost was 2471.8 ± 2073.8 euro per patient. The individual income level was positively correlated with urban area of residence, adequate household sanitation facilities and healthcare access, and negatively associated with advanced age and previous hospitalizations due to HF. However, the individual financial situation was also positively correlated with the increased prevalence of certain cardiovascular risk factors, such as arterial hypertension, anemia or obesity, but not with total cholesterol or male gender. Concerning the direct impact of a poor economic status upon prognosis in the setting of acute HF, our results showed no statistically significant differences concerning the in-hospital or at 1-month follow-up mortality rates. Rather than inducing a direct impact on the short-term outcome, these findings concerning SES indicators are meant to enhance the implementation of policies aimed to provide adequate healthcare for people from all social layers, with a primary focus on modifiable cardiovascular risk factors. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
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21 pages, 3505 KiB  
Article
The Regionalization Process for Universal Health Coverage in Brazil (2008–2015)
by Rafael da Silva Barbosa and Eduardo Fagnani
Healthcare 2021, 9(10), 1380; https://doi.org/10.3390/healthcare9101380 - 15 Oct 2021
Cited by 1 | Viewed by 1771
Abstract
The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable [...] Read more.
The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable economic growth and expansion of private health insurance and an unprecedented historical period with economic growth and reduction of social inequality. Across 5570 municipalities, the multivariate analysis model was used to estimate the level of concentration and the imbalance (heterogeneity) of installed health capacity of the network of health care services. Public spending on investment and human resources showed positive variation in all regions and in almost all population strata. The offer by the Unified Health System (public) of primary health care increased by 8000 new establishments in all regions, especially in previously uncovered cities and cities that had shortages of public health services. Public universalization almost reached its maximum, with about 70% of municipalities. The only setback was the significant reduction of 50% in the number of private establishments in primary health care services. The data suggest a positive movement toward the universalization of health services in Brazil, with the concentration of high-complexity care and the heterogeneity of the installed capacity being points for improvement. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
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20 pages, 287 KiB  
Article
Impact of Education, Medical Services, and Living Conditions on Health: Evidence from China Health and Nutrition Survey
by Xianhua Dai and Wenchao Li
Healthcare 2021, 9(9), 1122; https://doi.org/10.3390/healthcare9091122 - 30 Aug 2021
Cited by 4 | Viewed by 2174
Abstract
Education, medical services, and living conditions can influence individual health and health literacy. We used the 2015 China Health and Nutrition Survey data to analyze the impact of education, medical services, and living conditions on individual health by extending the Grossman model. As [...] Read more.
Education, medical services, and living conditions can influence individual health and health literacy. We used the 2015 China Health and Nutrition Survey data to analyze the impact of education, medical services, and living conditions on individual health by extending the Grossman model. As a result, using the instrumental variable (read, write, and draw) two-stage least square method, we found that education, medical services, and living conditions have a positive impact on individual health, both physical health and psychological health. Among them, medical services have the largest influence, followed by living conditions and education. In addition, the results are robust. However, individual characteristics, family income, and working status also affect individual health. Moreover, we observed heterogeneity in age, sex, and residence in the impact of education, medical services, and living conditions on individual health. In particular, the health of the rural elderly and elderly women is more sensitive to education, the medical services of middle-aged women and young men have a greater impact on their health, and the living conditions of the rural elderly and youth have a greater impact on their health. All the findings are helpful for optimizing the path of the Healthy China program. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
10 pages, 235 KiB  
Article
Digital and Economic Determinants of Healthcare in the Crisis-Affected Population in Afghanistan: Access to Mobile Phone and Socioeconomic Barriers
by Jin-Won Noh, Yu-Mi Im, Kyoung-Beom Kim, Min Hee Kim, Young Dae Kwon and Jiho Cha
Healthcare 2021, 9(5), 506; https://doi.org/10.3390/healthcare9050506 - 27 Apr 2021
Cited by 8 | Viewed by 3228
Abstract
Despite recent progress in Afghanistan’s health system from the support of international donors and NGOs, protracted conflicts combined with a series of natural disasters have continued to present substantial health risks. Extreme poverty has still aggravated social determinants of health and financial barriers [...] Read more.
Despite recent progress in Afghanistan’s health system from the support of international donors and NGOs, protracted conflicts combined with a series of natural disasters have continued to present substantial health risks. Extreme poverty has still aggravated social determinants of health and financial barriers to healthcare. Little is known about the context-specific factors influencing access to healthcare in the crisis-affected population. Using a subset of data from ‘Whole of Afghanistan Assessment (WoAA) 2019’, this study analyzed 31,343 households’ data, which was collected between 17 July and 19 September 2019 throughout all 34 provinces in Afghanistan. The outcome measured was access to care in the healthcare facility, and multivariable binary logistic regression models were used to identify the specific factors associated with access to healthcare. Of 31,343 households exposed to complex emergencies in Afghanistan, 10,057 (32.1%) could not access healthcare facilities when one was needed in last three months. The access to healthcare was significantly associated with displacement status, economic factors such as employment status or total monthly income, and the distance to healthcare facilities. Significant increase in healthcare access was associated with factors related to communication and access to information, such as awareness of humanitarian assistance availability and mobile phone with a SIM card, while disability in cognitive function, such as memory or concentration, was associated with poorer healthcare access. Our findings indicate that the crisis-affected population remains vulnerable in access to healthcare, despite the recent improvements in health sectors. Digital determinants, such as access to mobile phone, need to be addressed along with the healthcare barriers related to poverty and household vulnerabilities. The innovative humanitarian financing system using mobile communication and cash transfer programs would be considerable for the conflict-affected but digitally connected population in Afghanistan. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
14 pages, 541 KiB  
Article
Inequality in Health: The Correlation between Poverty and Injury—A Comprehensive Analysis Based on Income Level in Taiwan: A Cross-Sectional Study
by Shi-Hao Huang, Shih-Chun Hsing, Chien-An Sun, Chi-Hsiang Chung, Chang-Huei Tsao, Ren-Jei Chung, Bing-Long Wang, Yao-Ching Huang and Wu-Chien Chien
Healthcare 2021, 9(3), 349; https://doi.org/10.3390/healthcare9030349 - 18 Mar 2021
Cited by 2 | Viewed by 3212
Abstract
Is income still an obstacle that influences health in Taiwan, the National Health Insurance system was instituted in 1995? After collecting injured inpatient data from the health insurance information of nearly the whole population, we categorized the cases as either low-income or nonlow-income [...] Read more.
Is income still an obstacle that influences health in Taiwan, the National Health Insurance system was instituted in 1995? After collecting injured inpatient data from the health insurance information of nearly the whole population, we categorized the cases as either low-income or nonlow-income and tried to determine the correlation between poverty and injury. Chi-square tests, Fisher’s exact tests, an independent-samples t-test, and percentages were used to identify differences in demographics, causes for hospitalization, and other hospital care variables. Between 1998 and 2015, there were 74,337 inpatients with low-income injuries, which represented 1.6% of all inpatients with injury events. The hospitalization mortality rate for the low-income group was 1.9 times higher than that of the nonlow-income group. Furthermore, the average length of hospital stay (9.9 days), average medical expenses (1681 USD), and mortality rate (3.6%) values for the low-income inpatients were higher than those of the nonlow-income group (7.6 days, 1573 USD, and 2.1%, respectively). Among the injury causes, the percentages of “fall,” “suicide,” and “homicide” incidences were higher for the low-income group than for the nonlow-income group. These findings support our hypothesis that there is a correlation between poverty and injury level, which results in health inequality. Achieving healthcare equality may require collaboration between the government and private and nonprofit organizations to increase the awareness of this phenomenon. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
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15 pages, 2264 KiB  
Article
Uptake of Health Care Services by Refugees: Modelling a Country Response to a Western Balkan Refugee Crisis
by Milena Santric-Milicevic, Milena Vasic, Vladimir Vasic, Mirjana Zivkovic-Sulovic, Dragana Cirovic, Milan Lackovic and Nikolina Boskovic
Healthcare 2020, 8(4), 560; https://doi.org/10.3390/healthcare8040560 - 14 Dec 2020
Cited by 1 | Viewed by 2384
Abstract
Planning and adjusting health capacities to meet the needs of refugees is a constant issue for transit and destination countries following the 2015/2016 Western Balkans refugee crisis. Understanding this crisis is important for taking the right steps in the future. The study informs [...] Read more.
Planning and adjusting health capacities to meet the needs of refugees is a constant issue for transit and destination countries following the 2015/2016 Western Balkans refugee crisis. Understanding this crisis is important for taking the right steps in the future. The study informs about the prediction of the refugees’ health needs and demands for services in correspondence to political decision-making during 2015/2016 Western Balkan Refugee Crisis. Time series analysis, linear regression, and correlation analyses modelled the weekly flux of arrivals of more than half a million refugees to Serbia and the European Union, changes in the utilization of health care services, and disease diagnoses. With strategic planning, in the event of a recurrence of the refugee crises, the demand for health care services in the transit country could increase by 63 (95% CI: 21–105) for every additional 1000 refugees. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
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13 pages, 260 KiB  
Article
Psychological Distress and Somatization in Immigrants in Primary Health Care Practices
by Rosa García-Sierra, María Isabel Fernández-Cano, Josep María Manresa-Domínguez, María Feijoo-Cid, Eduard Moreno Gabriel, Antonia Arreciado Marañón, Francesc Ramos-Roure, Jordi Segura-Bernal and Pere Torán-Monserrat
Healthcare 2020, 8(4), 557; https://doi.org/10.3390/healthcare8040557 - 13 Dec 2020
Cited by 5 | Viewed by 3303
Abstract
The process of international migration causes a situation of vulnerability in people’s health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies [...] Read more.
The process of international migration causes a situation of vulnerability in people’s health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from four communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the primary care centers of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the Sub-Saharan community. Psychological distress showed a mean value of 0.66, with the Sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the Sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
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