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Health and Health Care Access of Vulnerable Populations

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (15 May 2020) | Viewed by 40895

Special Issue Editors


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Guest Editor
Department of social epidemiology, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Inserm, F75012 Paris, France
Interests: environmental health; social epidemiology; vulnerable populations; outbreaks; epidemiology; children
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
IRDES—Institut de Recherche et Documentation en Economie de la Santé, 117bis rue Manin, 75019 Paris, France
Interests: health economies; equity; access to health care services; immigrant health; survey sciences

Special Issue Information

Dear Colleagues,

We are delighted to organize a Special Issue on the health and health care of vulnerable populations in the International Journal of Environmental Research and Public Health.

Vulnerability is a multidimensional concept which definition varies across research fields and between authors, and is related to adjacent concepts such as fragility, poverty or insecurity. Vulnerable individuals are more likely to experience deleterious consequences of adverse events, which can be economic (unemployment, working poors…), medical (disease, accident), familial (divorce, widowhood. Vulnerability includes physiological, psychological, socio-economic and environmental dimensions. Vulnerable population may be identified according to physical fragilities or impairments (children, disabled, elderly); psychological fragility (victims of violence, drug users), social and economic status (homeless, unemployed), isolation (undocumented immigrants, oldest old, marginalized individuals), stigmatization (ethnicity, sexual orientation). Vulnerability plays a pivotal role in life course detrimental dynamics where poverty and economic fragility contribute to worsen health, and the reverse.

Vulnerability is characterized by complex interactions between several individual, socio-environmental and economic dimensions. These dimensions are often combined, inscribed in life paths that determine both health status and access to the health care system. Improving health and healthcare of vulnerable populations requires understanding the mechanisms that generate vulnerability. Understanding the mechanisms then allow to design policies to reduce risks and to improve coping.

Vulnerable individuals are also lees likely to access to universal welfare policies, for reasons of non-take up (due to lack of administrative literacy, language proficiency, access to information, or distrust), lack of inclusiveness/responsiveness of social services, or simply lack of rights. Within the health system, welfare policies mostly consist in Social health insurance and the provision of health care services.

Access to health care services results from an interaction between the individual and the health care system in a process where health needs are perceived, health care is sought, health care services are used, and have an outcome on health. While individual, social and contextual factors may play a role in patients’ demand, access, use and outcomes of health care, health care services may in turn respond differently to identical needs. Health service inclusiveness, responsiveness and discrimination may therefore contribute to disparities in outcomes.

Vulnerable populations are often invisible to policymakers and are changing rapidly. Health policies need to take these populations into consideration in order to better tackle inequalities and keep up with their social objectives. Recent innovations such as information technologies and related techniques (big data, artificial intelligence), may represent a new opportunity to identify and access vulnerable populations and also to provide more appropriate care.

This Special Issue is open to any subject area related to better understanding the health and healthcare of vulnerable populations, and the policies aiming at tackling vulnerabilities in health and their consequences. The listed keywords suggest just a few of the many possibilities.

Dr. Stéphanie Vandentorren
Dr. Paul Dourgnon
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly 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 2500 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

  • Health care
  • Social Inequalities
  • Vulnerability, fragility
  • Inclusiveness, responsiveness
  • Elderly – children
  • Chronically ill and disabled
  • Minorities – migrants
  • Discrimination
  • Low –income – homeless population
  • Social support
  • Health literacy
  • Big data – Information technologies

Published Papers (13 papers)

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Research

20 pages, 903 KiB  
Article
Employment Legal Framework for Persons with Disabilities in China: Effectiveness and Reasons
by Yuling Hao and Peng Li
Int. J. Environ. Res. Public Health 2020, 17(14), 4976; https://doi.org/10.3390/ijerph17144976 - 10 Jul 2020
Cited by 4 | Viewed by 3354
Abstract
In order to promote the employment of persons with disabilities, two dominant legal approaches—anti-discrimination legislation based on the social model of disability and an employment quota scheme based on the medical model—are usually employed on a nation-state basis in disability policies. This article [...] Read more.
In order to promote the employment of persons with disabilities, two dominant legal approaches—anti-discrimination legislation based on the social model of disability and an employment quota scheme based on the medical model—are usually employed on a nation-state basis in disability policies. This article systematically examines the reasons why both the anti-discrimination and employment quota scheme legal frameworks have limited effectiveness in promoting employment of persons with disabilities in China. We found that the lack of a definition of disability, the lack of a definition of discrimination, and the absence of effective enforcement mechanisms are the reasons for poor outcomes of the anti-discrimination legal framework. For the employment quota scheme, conflicts between the mainstream labor market legal framework and the quota scheme legal framework have prompted employers to pay penalties rather than hire persons with disabilities. China should address these issues in the current legal system in the short term. Meanwhile, the CRPD should be more strongly emphasized in China. This article argues for the human rights model espoused by the CRPD, instead of the medical model, to develop a coherent and sustainable disability legal framework for promoting participation of persons with disabilities, rather than focusing on viewing them as recipients of care. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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13 pages, 844 KiB  
Article
Post-Traumatic Stress Disorder in Homeless Migrant Mothers of the Paris Region Shelters
by Mathilde Roze, Maria Melchior, Cécile Vuillermoz, Dalila Rezzoug, Thierry Baubet and Stéphanie Vandentorren
Int. J. Environ. Res. Public Health 2020, 17(13), 4908; https://doi.org/10.3390/ijerph17134908 - 07 Jul 2020
Cited by 5 | Viewed by 3346
Abstract
Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in [...] Read more.
Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study’s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03; 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20; 2.76), and residential instability (PR = 1.93 95% CI 1.27; 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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11 pages, 907 KiB  
Article
Investigation of Measles Outbreak among Thai and Migrant Workers in Two Factories in Nakhon Pathom, Thailand, 2019
by Suphanat Wongsanuphat, Phanthanee Thitichai, Rungrot Jaiyong, Patchanee Plernprom, Kanthika Thintip, Charuttaporn Jitpeera and Rapeepong Suphanchaimat
Int. J. Environ. Res. Public Health 2020, 17(13), 4627; https://doi.org/10.3390/ijerph17134627 - 27 Jun 2020
Cited by 3 | Viewed by 2489
Abstract
On 22 March 2019 the Thai Department of Disease Control (DDC) was notified that 16 workers, including Thai and Myanmar migrant workers, from two factories located in Nakhon Phathom Province, had presented with a fever with rash during the previous 2 weeks. Active [...] Read more.
On 22 March 2019 the Thai Department of Disease Control (DDC) was notified that 16 workers, including Thai and Myanmar migrant workers, from two factories located in Nakhon Phathom Province, had presented with a fever with rash during the previous 2 weeks. Active case finding was conducted among workers in both factories using face-to-face interviews. Suspected cases were defined as a worker who developed fever with rash with one of the following symptoms: cough, coryza or conjunctivitis. Testing for measles IgM antibodies and viral identification through throat swabs by polymerase chain reaction (PCR) were performed to confirm diagnosis. Vaccination history among cases was reviewed. Nationality and age-specific attack rates (AR) were calculated. An environmental study and a social network analysis were conducted to better understand the transmission process. A total 56 cases (AR = 0.97%) were identified. Of 21 serum measles IgM collected, 8 (38.0%) were positive. Of 8 throat swabs collected, 5 (62.5%) were positive for measles genotype D8. The disease attack rate in migrant employees was twice as large as the rate in Thai counterparts (AR = 0.7 and 1.4%). The first case was identified as a Myanmar worker who arrived in Thailand two weeks prior to his illness. The Myanmar workers’ accommodation was more crowded than that for Thai workers. The hot spots of transmission were found at a drinking water tank which had shared glasses. Among the cases, 62.5% could not recall their vaccination history, and 25% had never had an injection containing a measles vaccination. The majority of migrant cases had never completed a two-dose measles vaccination. To halt the outbreak, measles vaccines were administered to the employees, particularly those working in the same sections with the cases and shared glasses were removed. For future policy action, a vaccination program should be incorporated into the work permit issuance process. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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10 pages, 1015 KiB  
Article
Association between Participation in Annual Physical Examinations and Risk Factors for Noncommunicable Diseases in Adults with Disabilities: Evidence from Shanghai, China
by Yugang Li, Qi Zhang, Xiaohong Li, Mei Sun, Jun Lu and Gang Chen
Int. J. Environ. Res. Public Health 2020, 17(11), 3822; https://doi.org/10.3390/ijerph17113822 - 28 May 2020
Cited by 3 | Viewed by 2042
Abstract
The relationships between regular participation in annual physical examinations and the risk factors for noncommunicable diseases (NCDs) among adults with disabilities remains unclear. To address this gap, we used data from 130,899 individuals with disabilities in Shanghai (2014–2016) and evaluated four risk factors [...] Read more.
The relationships between regular participation in annual physical examinations and the risk factors for noncommunicable diseases (NCDs) among adults with disabilities remains unclear. To address this gap, we used data from 130,899 individuals with disabilities in Shanghai (2014–2016) and evaluated four risk factors for NCDs: hypertension, hyperglycemia, hyperlipidemia, and being overweight. Overall, 4540 individuals participated in annual physical examinations across all three years and 11,388 missed examinations in 2015 (group without regular participation). Chi-squared tests and binary logistic regression were used to assess differences in patient characteristics and explore correlations between variables. Significant differences in age (χ2 = 102.620, p < 0.01), place of residence (χ2 = 94.308, p < 0.01), educational level (χ2 = 59.884, p < 0.01), marital status (χ2 = 16.414, p < 0.01) and disability type (χ2 = 56.499, p < 0.01) and severity (χ2 = 45.464, p < 0.01) were found between those who participated in regular physical examinations and those who did not. Regular participation was associated with reduced incidences of hypertension (odds ratio 0.799, 95% confidence interval (CI): 0.733–0.871) and hyperlipidemia (0.347, 95% CI: 0.307–0.392), but not with the incidence of diabetes (1.049, 95% CI: 0.944–1.166) or being overweight (0.907, 95% CI: 0.812–1.014). Hence, regular participation in annual physical examinations had different associations with risk factors for NCDs. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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16 pages, 1310 KiB  
Article
Disparities in the Use of General Somatic Care among Individuals Treated for Severe Mental Disorders and the General Population in France
by Coralie Gandré and Magali Coldefy
Int. J. Environ. Res. Public Health 2020, 17(10), 3367; https://doi.org/10.3390/ijerph17103367 - 12 May 2020
Cited by 15 | Viewed by 3217
Abstract
Individuals with severe mental illnesses (SMI) face a striking excess and premature mortality which has been demonstrated in several national contexts. This phenomenon, which constitutes a red-flag indicator of public health inequities, can be hypothesized to result from healthcare access issues which have [...] Read more.
Individuals with severe mental illnesses (SMI) face a striking excess and premature mortality which has been demonstrated in several national contexts. This phenomenon, which constitutes a red-flag indicator of public health inequities, can be hypothesized to result from healthcare access issues which have been insufficiently documented so far. In this context, our objective was to explore patterns of general somatic healthcare use of individuals treated for SMI in comparison to those of the general population in France using national health administrative data and a matched case-control study. Differences in the use of general and specific somatic preventive care services, primary care, routine specialized somatic care and admissions to non-psychiatric hospital departments for somatic causes were described between cases and controls after adjustment on differing clinical needs, socio-economic status, and living environment. Our results show a lower use of general preventive care services and of routine specialized somatic care in the SMI population, despite more frequent comorbidities, and a higher occurrence of avoidable hospitalizations, despite higher contacts with primary care physicians. These findings suggest that the health system fails to address the specific needs of this vulnerable population and support the development of measures aimed at reducing this gap. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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17 pages, 873 KiB  
Article
Diphtheria-Tetanus-Polio, Measles-Mumps-Rubella, and Hepatitis B Vaccination Coverage and Associated Factors among Homeless Children in the Paris Region in 2013: Results from the ENFAMS Survey
by Samreen Mansor-Lefebvre, Yann Le Strat, Anne Bernadou, Nicolas Vignier, Jean-Paul Guthmann, Amandine Arnaud, Daniel Lévy-Bruhl and Stéphanie Vandentorren
Int. J. Environ. Res. Public Health 2020, 17(8), 2854; https://doi.org/10.3390/ijerph17082854 - 21 Apr 2020
Cited by 6 | Viewed by 2177
Abstract
Background: The number of homeless families has increased considerably since the 1990s in France. We aimed to estimate the homeless children vaccination coverage (VC) for diphtheria, tetanus, polio, measles–mumps–rubella and hepatitis B and identify factors associated with insufficient VC according to birthplace. [...] Read more.
Background: The number of homeless families has increased considerably since the 1990s in France. We aimed to estimate the homeless children vaccination coverage (VC) for diphtheria, tetanus, polio, measles–mumps–rubella and hepatitis B and identify factors associated with insufficient VC according to birthplace. Methods: A cross-sectional survey was conducted among homeless shelter families in the greater Paris area. A nurse conducted face-to-face interviews and collected vaccination records. We analyzed factors associated with insufficient VC, stratified by birthplace and vaccine, using robust Poisson regression. Results: The study included 214 children born in France and 236 born outside France. VC in French-born homeless children was high (>90% at 24 months for most vaccinations) and similar to levels observed in the general population, whereas VC in those born outside France was low (<50% at 24 months for all vaccines). Factors significantly associated with insufficient VC among children born outside France were age, parents with French-language difficulties, and changing residence at least twice in the previous year. Children in contact with the healthcare system at least once in the previous year had significantly higher VC, irrespective of vaccine and birthplace. Conclusion: Special attention should be paid to homeless children born outside France, with recent European and French recommendations confirming the need for catch-up vaccination in children with undocumented VC. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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12 pages, 335 KiB  
Article
Effect of Health Education on Healthcare-Seeking Behavior of Migrant Workers in China
by Xuefeng Li, Han Yang, Hui Wang and Xujun Liu
Int. J. Environ. Res. Public Health 2020, 17(7), 2344; https://doi.org/10.3390/ijerph17072344 - 30 Mar 2020
Cited by 21 | Viewed by 4705
Abstract
Health education is considered to be an effective way to improve the healthcare-seeking behavior of migrant workers. This study examined the impact of health education on healthcare-seeking behavior of migrant workers in China and explored the differences in different health education methods. This [...] Read more.
Health education is considered to be an effective way to improve the healthcare-seeking behavior of migrant workers. This study examined the impact of health education on healthcare-seeking behavior of migrant workers in China and explored the differences in different health education methods. This paper used the 2017 China Migrants Dynamic Survey (CMDS) to analyze the relationship between health education and healthcare-seeking behavior. Our results indicated that health education could significantly improve the healthcare-seeking behavior of migrant workers, but there was still ample space for improvement. From the perspective of different health education methods, lectures, public consultation, and online education were positively correlated to healthcare-seeking behavior, while publicity materials and bulletin boards were not. Although the effects of publicity materials and bulletins were limited, these two health education methods were still the most widely used. Our results emphasized the necessity of increasing investment in lectures, public consultation, online education, and other similar health education methods. This change in health education methods can play an effective role in the spread of health education to improve the healthcare-seeking behavior of migrant workers. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
11 pages, 306 KiB  
Article
Obesity and Obesogenic Behaviors in Asian American Children with Immigrant and US-Born Mothers
by Bianca R. Argueza, Karen Sokal-Gutierrez and Kristine A. Madsen
Int. J. Environ. Res. Public Health 2020, 17(5), 1786; https://doi.org/10.3390/ijerph17051786 - 10 Mar 2020
Cited by 5 | Viewed by 2904
Abstract
Child obesity is understudied in Asian Americans, which include a growing population of recent immigrants. We examined the relationship between maternal nativity and time in the US, and obesity and obesogenic behaviors among Asian American children. We analyzed public-use data from the 2013–2016 [...] Read more.
Child obesity is understudied in Asian Americans, which include a growing population of recent immigrants. We examined the relationship between maternal nativity and time in the US, and obesity and obesogenic behaviors among Asian American children. We analyzed public-use data from the 2013–2016 California Health Interview Survey for Asian American children ages 2 to 11 years. We used logistic regression to determine the odds of obesity and obesogenic behaviors associated with maternal nativity and time in the US. This study included n = 609 children. Children of US-born mothers had lower odds of obesity (adjusted odds ratio, AOR, 0.12; 95% CI 0.02 to 0.91) and lower fruit intake (AOR 0.15, 95% CI 0.03 to 0.81) than children of recent immigrants (< 5 years in the US). Asian American children with recent immigrant mothers are more likely to be obese and eat less fruit than children with US-born mothers. Efforts to prevent obesity and increase fruit consumption are particularly important for this vulnerable population of children of recent immigrants. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
10 pages, 416 KiB  
Article
Is Raising Your Grandchild Bad for Your Health? The Association Between Custodial Grandparent Status and Health Biomarkers in Taiwanese Grandparents
by Zoe N. Fokakis, Danielle K. Nadorff and Ian T. McKay
Int. J. Environ. Res. Public Health 2020, 17(5), 1753; https://doi.org/10.3390/ijerph17051753 - 07 Mar 2020
Cited by 6 | Viewed by 2884
Abstract
Data from two waves of the Social Environment and Biomarkers of Aging Study in Taiwan were analyzed to determine the effects of custodial grandparenting on health in a longitudinal sample. Self-reported measures on respondents’ perception of their health, six health biomarkers, the presence [...] Read more.
Data from two waves of the Social Environment and Biomarkers of Aging Study in Taiwan were analyzed to determine the effects of custodial grandparenting on health in a longitudinal sample. Self-reported measures on respondents’ perception of their health, six health biomarkers, the presence of twelve diseases, and a measure of stress were included. Custodial Grandparents (CGPs) were significantly more likely to report worse health than their peers. However, there were no significant differences in biomarkers, and CGPs were only significantly different from non-custodial grandparents (nCGPs) regarding lower respiratory disease. Results suggest that CGPs do not have significantly worse health than nCGPs, but report feeling less healthy. This disparity is suspected to be due to energy levels or stress sources not assessed by the variables in the original study. These results and their implications based upon the stress-coping model elucidate the need to design interventions that incorporate the East Asian cultural values and practices in order to promote better health outcomes for CGP populations overall. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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20 pages, 1267 KiB  
Article
Factors Influencing the Application of Connected Health in Remote Areas, Taiwan: A Qualitative Pilot Study
by Sonia Chien-I. Chen and Chenglian Liu
Int. J. Environ. Res. Public Health 2020, 17(4), 1282; https://doi.org/10.3390/ijerph17041282 - 17 Feb 2020
Cited by 8 | Viewed by 2739
Abstract
This pilot study investigated factors influencing the application of connected health (CH) in Taiwanese remote areas. These factors cover issues of cost, infrastructure, technology, business sustainability, business model, collaboration, and communication. It aimed to explore the significance and to assess the feasibility of [...] Read more.
This pilot study investigated factors influencing the application of connected health (CH) in Taiwanese remote areas. These factors cover issues of cost, infrastructure, technology, business sustainability, business model, collaboration, and communication. It aimed to explore the significance and to assess the feasibility of researching CH in Taiwan. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 18). The majority were healthcare providers as most of them are the CH end users. Their feedback was essential in reflecting the effectiveness of CH products and services. Therefore, understanding their views is significant in the design of a successful and user-friendly interactive system. A theoretical framework on the introduction of innovations in healthcare was employed to guide data collection and thematic analysis. Additionally, stakeholders proposed strategies for enhancing the implementation of CH in remote areas. This pilot study also contributed to identifying future directions and information for conducting the multi-stage interviews for collecting the data more effectively. Although the results reveal that the study of CH is meaningful, there is an issue of business sustainability which is obscured by some barriers that need to be addressed. These barriers will be further investigated in the first-stage interview and second-stage interview in future research. The research findings also suggest that strategies and sustainability for CH implementation should be included from the planning phase to benefit all the stakeholders in the CH ecosystem. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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18 pages, 3073 KiB  
Article
Cost Effectiveness and Budget Impact Analyses of Influenza Vaccination for Prisoners in Thailand: An Application of System Dynamic Modelling
by Rapeepong Suphanchaimat, Pawinee Doung-ngern, Kritchavat Ploddi, Suthanun Suthachana, Mathudara Phaiyarom, Kumaree Pachanee, Walairat Chaifoo and Sopon Iamsirithaworn
Int. J. Environ. Res. Public Health 2020, 17(4), 1247; https://doi.org/10.3390/ijerph17041247 - 14 Feb 2020
Cited by 7 | Viewed by 3555
Abstract
Influenza outbreaks in Thai prisons were increasing in number every year and to address this, the Thai Ministry of Public Health (MOPH) initiated a policy to promote vaccination for prisoners. The objective of this study was to assess the cost effectiveness and budget [...] Read more.
Influenza outbreaks in Thai prisons were increasing in number every year and to address this, the Thai Ministry of Public Health (MOPH) initiated a policy to promote vaccination for prisoners. The objective of this study was to assess the cost effectiveness and budget impact of the influenza vaccination policy for prisoners in Thailand. The study obtained data from the Division of Epidemiology, Department of Disease Control (DDC), MOPH. Deterministic system dynamic modelling was exercised to estimate the financial implication of the vaccination programme in comparison with routine outbreak control. The incremental cost-effectiveness ratio (ICER) was calculated via a DDC perspective. The reproductive number was estimated at 1.4. A total of 143 prisons across the country (375,763 prisoners) were analysed. In non-vaccination circumstances, the total healthcare cost amounted to 174.8 million Baht (US$ 5.6 million). Should all prisoners be vaccinated, the total healthcare cost would reduce to 90.9 million Baht (US$ 2.9 million), and 46.8 million Baht (US$ 1.5 million) of this is related to the vaccination. The ICER of vaccination (compared with routine outbreak control) varied between 39,738.0 to 61,688.3 Baht per disability-adjusted life year (DALY) averted (US$ 1281.9–1989.9). Should the vaccination cover 30% of the prisoners, the ICER would be equal to 46,866.8 Baht (US$ 1511.8) per DALY averted with the budget burden amounted to Baht (US$ 4.8 million). The vaccination programme would become more cost-effective if the routine outbreak control was intensified. In summary, the vaccination programme was a cost-effective measure to halt influenza outbreak amongst prisoners. Further primary studies that aim to assess the actual impact of the programme are recommended. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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15 pages, 785 KiB  
Article
Trajectories of Outpatient Service Utilisation of Hypertensive Patients in Tertiary Hospitals in China
by Zijing Pan, Wanchun Xu, Zhong Li, Chengzhong Xu, Fangfang Lu, Pei Zhang, Liang Zhang and Ting Ye
Int. J. Environ. Res. Public Health 2020, 17(3), 852; https://doi.org/10.3390/ijerph17030852 - 29 Jan 2020
Cited by 3 | Viewed by 2499
Abstract
This study aims to identify the characteristics and trajectories of outpatient service utilisation for hypertensive patients in tertiary hospitals. This study also attempts to investigate the determinants of the trajectories of outpatient service utilisation. A total of 9822 patients with hypertension and hypertension-related [...] Read more.
This study aims to identify the characteristics and trajectories of outpatient service utilisation for hypertensive patients in tertiary hospitals. This study also attempts to investigate the determinants of the trajectories of outpatient service utilisation. A total of 9822 patients with hypertension and hypertension-related medical utilisation were recruited in Yichang, China from January 1 to December 31 in 2016. The latent trajectories of outpatient service utilisation were identified through latent class growth analysis. Differences in the demographic characteristics and medical utilisation among patients in different trajectories were tested by one-way ANOVA and chi-square analysis. The predictors of the trajectory groups of outpatient service utilisation were identified through multinomial logistic regression. Four trajectory groups were determined as stable-low (34.7%), low-fluctuating (13.4%), high-fluctuating (22.5%), and stable-high (29.4%). Significant differences were observed in all demographic characteristics (p < 0.001) and medical service utilisation variables (p < 0.001) among the four trajectories except for inpatient cost (p = 0.072). Determinants for outpatient service utilisation patterns include the place of residence, education level, outpatient visit times, inpatient service utilisation, and outpatient cost. Overall, hypertensive patients visiting outpatient units in the tertiary hospital were middle-aged, elderly, and well-educated, and they received poor follow-up services. The four identified latent trajectories have different characteristics and medical utilisation patterns. Trajectory group-based measurements are necessary for hypertension management and economic burden reduction. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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13 pages, 703 KiB  
Article
Trends and Inequalities in the Health Care and Hypertension Outcomes in China, 2011 to 2015
by Yang Zhao, Ajay Singh Mahal, Tilahun Nigatu Haregu, Ameera Katar, Brian Oldenburg and Luwen Zhang
Int. J. Environ. Res. Public Health 2019, 16(22), 4578; https://doi.org/10.3390/ijerph16224578 - 19 Nov 2019
Cited by 13 | Viewed by 2820
Abstract
Background: Hypertension is one of the most significant and common risk factors for cardiovascular disease, yet it remains poorly controlled in China. This study aims to examine trends and socioeconomic inequalities in the management of hypertension between 2011 and 2015 in China and [...] Read more.
Background: Hypertension is one of the most significant and common risk factors for cardiovascular disease, yet it remains poorly controlled in China. This study aims to examine trends and socioeconomic inequalities in the management of hypertension between 2011 and 2015 in China and to investigate the association between antihypertensive medication treatment and reduction of blood pressure, using nationally representative data. Methods: Concentration curve and concentration index were used to assess socioeconomic-related inequalities in hypertension care and health service utilisation. The fixed-effects analysis was performed to measure the impact of medication treatment on reduction of blood pressure among people with hypertension by using linear regression models. Results: Among hypertensive individuals, there were growing trends in the rates of awareness and treatment from 55.87% and 48.44% in 2011, to 68.31% in 2013 and 61.97% in 2015, respectively. The proportion of hypertension control was still below 30%. The fixed-effects models indicated that medication treatment was statistically significant and associated with the patients’ systolic blood pressure (β: −13.483; 95% CI: −15.672, −11.293) and diastolic blood pressure (β: −5.367; 95% CI: −6.390, −4.344). Conclusions: China has made good progress in the hypertension diagnosis, medication treatment and coverage of health services over the last 10 years; however, pro-rich inequalities in hypertension care still exist, and there is considerable progress to be made in the prevention, treatment and effective control of hypertension. Full article
(This article belongs to the Special Issue Health and Health Care Access of Vulnerable Populations)
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