Search Results (144)

The population dynamics of high-altitude mountainous areas are shaped by a complex interplay of socioeconomic and environmental drivers. Despite their significance, such regions have received limited scholarly attention. This research identifies and examines the principal determinants of population changes in the high-altitude mountainous zones of Sichuan Province, China. Utilizing a robust quantitative framework, we introduce the Sustainable Population Migration Index (SPMI) to systematically analyze the migration potential over two decades. The findings indicate healthcare accessibility as the most significant determinant influencing resident and rural population changes, while economic factors notably impact urban populations. The SPMI reveals a pronounced deterioration in migration attractiveness, decreasing by 0.27 units on average from 2010 to 2020. Furthermore, a fixed-effects panel regression confirmed the predictive capability of SPMI regarding population trends, emphasizing its value for demographic forecasting. We also develop a Digital Twin-based Simulation and Decision-support Platform (DTSDP) to visualize policy impacts effectively. Scenario simulations suggest that targeted enhancements in healthcare and infrastructure could significantly alleviate demographic pressures. This research contributes critical insights for sustainable regional development strategies and provides an effective tool for informed policymaking. Full article

Background/Objectives: Access to health services is often limited due to socio-economic and organizational determinants of health systems, which lead to increased unmet healthcare needs. This study aimed to identify access barriers for the general population in Greece, including those that may have emerged following the COVID-19 pandemic. Methods: This was a cross-sectional survey of 1002 Greek citizens. A questionnaire regarding socio-demographics, healthcare utilization, and access to health services was used. Interviews took place between October and November 2022. Results: Of 837 participants who used health services in 2022, 82.6% had a medical consultation, 80.6% took diagnostic tests, and 63.6% visited a pharmacy for pharmaceuticals. Of those having a medical consultation, 33.1% did so at an NHS health unit, while 75% of the participants taking diagnostic tests visited a contracted private laboratory. Out of the 135 participants requiring hospitalization, 62% were hospitalized in a public hospital, while 85% of the participants requiring pharmaceuticals visited a private pharmacy. Access barriers in the past year were reported by 48% of the participants requiring a medical consultation, 34% of the participants requiring diagnostic tests, and 40% of the participants requiring hospitalization. The most common barriers were long waiting times and financial constraints. The main barrier to accessing pharmaceuticals was the availability and administration of the product. Conclusions: The identified healthcare access barriers highlight the vulnerabilities of the current health system in Greece, which were further exposed during the COVID-19 pandemic crisis. Addressing socioeconomic factors that are considered key access indicators should be the focus of future health policy initiatives. Full article

Background/Objectives: Laboratory tests conducted in community settings are occasionally repeated within hours of presentation to pediatric emergency departments (PEDs). Reducing unnecessary repetitions can ease child discomfort and alleviate the healthcare burden without compromising the diagnostic process or quality of care. The aim of this study was to develop a decision tree (DT) model to guide physicians in minimizing unnecessary repeat blood tests in PEDs. The minimal decision tree (MDT) algorithm was selected for its interpretability and capacity to generate optimally pruned classification trees. Methods: Children aged 3 months to 18 years with community-based complete blood count (CBC), electrolyte (ELE), and C-reactive protein (CRP) measurements obtained between 2016 and 2023 were included. Repeat tests performed in the pediatric emergency department within 12 h were evaluated by comparing paired measurements, with tests considered justified when values transitioned from normal to abnormal ranges or changed by ≥20%. Additionally, sensitivity analyses were conducted for absolute change thresholds of 10% and 30% and for repeat intervals of 6, 18, and 24 h. Results: Among 7813 children visits in this study, 6044, 1941, and 2771 underwent repeated CBC, ELE, and CRP tests, respectively. The mean ages of patients undergoing CRP, ELE, and CBC testing were 6.33 ± 5.38, 7.91 ± 5.71, and 5.08 ± 5.28 years, respectively. The majority were of middle socio-economic class, with 66.61–71.24% living in urban areas. Pain was the predominant presented complaint (83.69–85.99%), and in most cases (83.69–85.99%), the examination was conducted by a pediatrician. The DT model was developed and evaluated on training and validation cohorts, and it demonstrated high accuracy in predicting the need for repeat CBC and ELE tests but not CRP. Performance of the DT model significantly exceeded that of the logistic regression model. Conclusions: The data-driven guide derived from the DT model provides clinicians with a practical, interpretable tool to minimize unnecessary repeat laboratory testing, thereby enhancing patient care and optimizing healthcare resource utilization. Full article

Background: Childhood hearing loss is a public health problem of critical importance associated with speech development, academic achievement, and quality of life. Parents’ awareness and knowledge about risk factors contribute to early detection and timely intervention.  Objective: This study aims to examine Jordanian mothers’ knowledge of childhood hearing loss risk factors and investigate the impact of education level and socioeconomic status (SES) on the accuracy and comprehensiveness of this knowledge with the moderating effect of health literacy. Material and Methods: The approach employed an embedded mixed-methods design with a dominant quantitative strand supported by qualitative data, utilizing quantitative surveys (n = 250), analyzed using structural equation modeling (SEM) in SmartPLS, and qualitative interviews (n = 10), analyzed thematically to expand upon the quantitative findings by exploring barriers to awareness and healthcare-seeking behaviors. Results: The accuracy and comprehensiveness of knowledge of hearing loss risk factors were also positively influenced by maternal knowledge of hearing loss risk factors. Maternal knowledge was significantly associated with both education level and socioeconomic status (SES). Furthermore, maternal knowledge and accuracy were significantly moderated by health literacy, such that mothers with higher health literacy exhibited a stronger relationship between knowledge and accuracy. Qualitative findings revealed that individuals encountered barriers to accessing reliable information and comprehending medical advice and faced financial difficulties due to limited options for healthcare services. Conclusions: These results underscore the need for maternal education programs that address specific issues, provide simplified healthcare communication, and enhance access to pediatric audiology services. Future research should explore longitudinal assessments and intervention-based strategies to enhance mothers’ awareness and detect early childhood hearing loss. Full article

Radiotherapy, a critical component of cancer treatment, faces significant challenges in Gauteng, South Africa. These disparities hinder the achievement of Sustainable Development Goal 3, primarily due to systemic issues, socioeconomic barriers, and limitations within the health system. This article presents the House framework, designed to enhance access to radiotherapy services by integrating the WHO Health Systems framework with the dimensions of access proposed by Penchansky and Thomas. The framework is visually represented as a house, with Policy & Governance as the foundation, WHO building blocks as pillars, and Equitable Cancer Care and Improved Outcomes as the roof. A mixed-methods approach was utilized, combining quantitative data from radiotherapy facilities and qualitative insights from healthcare professionals to identify barriers and potential solutions. Findings indicate significant disparities in resource distribution and accessibility between public and private institutions, compounded by socioeconomic factors like transport costs and lack of awareness. The article discusses innovative proposed framework using the 5As of access as potential solutions. The House framework serves as a valuable tool for policymakers and healthcare providers aiming to improve radiotherapy access and promote equitable cancer care in Gauteng, ultimately working towards reducing disparities in cancer outcomes. Full article

Background Socioeconomic factors significantly influence access to kidney transplantation, with socially vulnerable populations experiencing delays in receiving transplants, resulting in prolonged dialysis duration and poorer post-transplant outcomes. This study evaluates the relationship between social vulnerability and disparities in preemptive kidney transplantation using the Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC). Methods Utilizing data from the Scientific Registry of Transplant Recipients (SRTR) from 2012 to 2020, we analyzed 155,424 adult kidney transplant recipients. The primary exposure was SVI, categorized into quartiles, while primary outcomes included preemptive transplant status and dialysis vintage. Multivariable regression models were adjusted for clinical covariates such as age, gender, BMI, diabetes, and peripheral vascular disease. Result Findings indicate that higher social vulnerability is significantly associated with a reduced likelihood of preemptive kidney transplantation (p < 0.0001) and an increased duration of dialysis prior to transplantation. Patients in the highest SVI quartile (0.75–1.00) were more than twice as likely to undergo dialysis before transplantation compared to those in the lowest quartile (OR = 2.21, 95% CI: 1.89–2.57). Similarly, increased SVI was strongly correlated with prolonged dialysis duration (OR = 3.43, 95% CI: 3.31–3.55, p < 0.0001). Conclusions These results highlight the impact of socioeconomic disparities on access to timely kidney transplantation. Addressing social vulnerability factors—such as poverty, education, and healthcare access—may help reduce inequities and improve transplantation outcomes. Future interventions should target high-SVI communities to facilitate earlier transplant access and reduce reliance on prolonged dialysis. Full article

This paper investigates the ultimate socioeconomic causes underlying the termination of parental investment in humans by analyzing the relationship between socioeconomic status and various forms of child mortality, including live births, stillbirths, infant deaths, and infanticide. Utilizing theoretical foundations from human behavioral ecology, the study illustrates how different forms of termination of parental investment can be viewed as points along a continuum of adaptive strategies aimed at optimizing reproductive fitness. The research emphasizes that technical and cognitive limitations lead to many instances of infanticide being concealed as natural child deaths, such as Sudden Infant Death Syndrome (SIDS), thus complicating the accurate detection of true causes of death. However, addressing common ultimate causes—specifically socioeconomic factors such as healthcare accessibility, nutritional quality, social support, and stress reduction—can simultaneously prevent or reduce all forms of investment termination. The paper further analyzes demographic data from Zagreb and surrounding municipalities. Ultimately, the study advocates a holistic approach to public health interventions and policies aimed at improving socioeconomic conditions as a crucial step toward reducing all forms of child mortality. Full article

Immunization coverage is a key public health indicator reflecting healthcare accessibility and socio-economic conditions. This study employs Principal Component Analysis (PCA) to construct composite development scores and analyze their relationship with immunization coverage for measles and diphtheria-tetanus-pertussis (DTP) vaccines across 195 countries (2000–2021). The analysis comprises a training period (2000–2015) for score development and a test period (2016–2021) for validation. Variables were selected based on correlation with immunization coverage and standardized before PCA extraction. PC1, the principal component explaining the largest variance, was identified as a key indicator of development disparities. Findings reveal that higher PC1 scores (lower socio-economic development) are associated with reduced immunization rates, while lower PC1 scores (higher socio-economic development) correspond to greater coverage, a trend consistent across both periods. Geospatial analysis highlights stark disparities, particularly in sub-Saharan Africa and South Asia, whereas North America, Europe, and East Asia maintain significantly higher coverage. These results provide policy-relevant insights, demonstrating the utility of PCA-derived scores for resource allocation and targeted interventions. Full article

Background: Sudden Infant Death Syndrome (SIDS) remains an important global health concern despite its decline in recent decades. This research assesses the global, regional, and national tendencies in SIDS mortality and DALYs from 1991 to 2021, highlighting the differences across various sociodemographic indexes (SDIs). Methods: Utilizing data from the Global Burden of Disease (GBD) study 2021, SIDS mortality and DALYs were evaluated across different global regions, SDI categories, and age groups. The trends over the study period were determined by conducting estimated annual percentage change (EAPC) analyses. Results: Between 1991 and 2021, the global SIDS mortality rate reduced greatly from 74,782 deaths (58.72 per 100,000 infants) to 30,608 deaths (24.16 per 100,000 infants), showing an EAPC of −3.01%. Similarly, the global DALYs decreased from 6,710,608 to 2,746,174. The biggest decline (EAPC: −5.25%) occurred in the high-SDI regions, whereas the low-SDI regions displayed a minimal decline (EAPC: −2.74%). Infants who were 1–5 months old uniformly had the highest mortality and DALY rates. Gender differences persisted, with larger rates discovered among males. The regional differences remained prominent, with the low-SDI states experiencing a much higher burden. Conclusions: Although there have been remarkable global advancements, great differences in the SIDS burden persist, mainly boosted by socioeconomic unfairness and healthcare access. Improved targeted interventions mitigating these modifiable risks and enhancing healthcare infrastructure in low-SDI regions are the keys to further reducing the global SIDS burden. Full article

Background: Liver transplantation has become the standard of care for patients with end-stage liver disease. Despite advances in surgical techniques, immunosuppression, and perioperative care, disparities in access and outcomes persist across demographic and socioeconomic lines. Objective: To assess trends and disparities in liver transplant admissions in the United States from 2016 to 2021, examining demographic patterns, in-hospital mortality, hospital charges, length of stay, and socioeconomic factors. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2021, we identified liver transplant admissions using ICD-10 PCS codes 0FY00Z1 and 0FY00Z2. Demographic characteristics (age, sex, race, insurance status, and income quartile), clinical outcomes, and resource utilization metrics were analyzed. One-way ANOVA and Hensel’s test were used to assess variance and distribution homogeneity, with a significance threshold of p < 0.05. Results: A total of 9677 liver transplant admissions were analyzed. The mean recipient age remained stable (51–52 years), with males comprising ~62% of transplants. White patients constituted the largest group of recipients (~66–68%), followed by Hispanic (~14–17%) and Black patients (~7–10%). The proportion of transplants relative to liver failure admissions remained stable across racial groups, indicating no widening racial gap during the study period. In-hospital mortality post-transplant remained low (2.37–3.52%) and did not differ significantly by race (p = 0.23), sex (p = 0.24), or income quartile (p = 0.13). Similarly, Charlson Comorbidity Index > 5 did not predict inpatient mortality (p = 0.154). Hospital charges ranged from $578,000 to $766,000, with an average stay of ~21 days. Conclusions: Liver transplantation outcomes, including in-hospital mortality, appear consistent across demographic and socioeconomic groups once patients are admitted for transplant. However, broader disparities in access persist, necessitating further research into pre-transplant barriers and long-term outcomes. These findings support the need for equitable healthcare strategies aimed at optimizing transplant candidacy and survival across all populations. Full article

Hospital length of stay (HLOS) is a critical healthcare metric influencing patient outcomes, resource utilization, and healthcare costs. While reducing HLOS can improve hospital efficiency and patient throughput, it also poses risks such as premature discharge, increased readmission rates, and potential compromise of patient safety. This literature review synthesizes current evidence on the determinants of HLOS, including patient-specific factors such as demographics, comorbidities, and socioeconomic status, as well as hospital-related factors like admission route, resource allocation, and institutional policies. We also examine the relationship between HLOS and key clinical outcomes, including mortality, readmission rates, and healthcare-associated infections. Additionally, we evaluate predictive modeling approaches, including artificial intelligence and machine learning, for forecasting HLOS and guiding early intervention strategies. While interventions such as enhanced recovery after surgery (ERAS) protocols, multidisciplinary care teams, and structured discharge planning have demonstrated efficacy in reducing HLOS, their success varies based on healthcare setting, patient complexity, and resource availability. Predictive analytics, incorporating clinical and non-clinical variables, offer promising avenues for improving hospital efficiency, yet may carry risks related to data quality and model bias. Given the impact of HLOS on clinical and economic outcomes, targeted interventions and predictive models should be applied cautiously, with future research focusing on refining personalized discharge strategies and addressing disparities across diverse patient populations. Full article

Background/Objectives: Randomized controlled trials demonstrate comparable survival among early-stage breast cancer patients undergoing breast-conserving therapy or patient preference mastectomy. Many factors affect the choice of treatment like the availability of radiation centers, socioeconomic status, and insurance status. This study aimed to identify the determinants of surgical breast cancer treatments in a rural community. Methods: Retrospective data were obtained from the medical records of breast cancer patients between 2015 and 2022 at a single rural healthcare system. Demographics, barriers to care, support services offered, pre-treatment services, and the type and stage of cancer were analyzed to identify trends among patients who received breast-conserving therapy and mastectomy. Results: Among the 162 patients who underwent a mastectomy, 16.1% chose this procedure based on patient preference. The patient preference mastectomy group was younger with a median age of 58 years compared to 65 years in the breast conservation group. Additionally, they were 2.7 times more likely to choose a mastectomy when reporting no financial support. When receiving lymphedema management or psychosocial services, they were also more likely to be in the patient preference mastectomy group, 58.3% versus 5.2% and 100% versus 83.5%, respectively. Genetic screening, however, was more common among the breast conservation therapy group (61.9% vs. 26.9%). Conclusions: Our findings indicate an increase in the utilization of breast conservation therapy in a rural healthcare system. These patients were generally older, had financial support, and received genetic screening. Having a multidisciplinary approach to treating breast cancer contributes to our ability to pursue breast-conserving therapy measures in rural communities. Full article

Background and Objectives: Low back pain (LBP) is a highly prevalent musculoskeletal condition that frequently recurs, leading to increased healthcare utilization and socioeconomic burden. While short-term management strategies are well-documented, long-term recurrence patterns remain insufficiently studied. This study aims to describe the long-term recurrence patterns and healthcare utilization associated with LBP in a nationwide cohort over a 17-year period. Materials and Methods: This descriptive, retrospective longitudinal cohort study utilized data from the Korean National Health Insurance Service (NHIS) database (2002–2018). We included 3,086,665 patients who sought medical care for LBP (ICD-10 code M54.5) at least once in 2010. Patients with a history of disability rating assessments were excluded. The primary outcomes included the number of LBP episodes, episode duration, recurrence patterns, and changes in healthcare utilization. We assessed the number of healthcare visits per episode and the interval between episodes over time. Results: Among the study population, 79.4% experienced recurrent LBP, with an average of 5.0 ± 4.9 episodes per patient. Recurrence rates increased with each episode. In addition, episode duration lengthened, and intervals between episodes shortened. Healthcare utilization also increased, with patients requiring more visits per episode over time. The demographic and socioeconomic characteristics of the LBP patients in our sample were also described. Conclusions: In this population-based sample, LBP follows a progressive course, with increasing episode frequency, prolonged duration, and escalating healthcare utilization over time. These findings highlight the need for early intensive management and long-term follow-up strategies to mitigate the growing burden of recurrent LBP on individuals and healthcare systems. Full article

Objective: To explore the impact of ethnic and socioeconomic disparities on diabetic foot ulcer (DFU) care and outcomes, emphasizing the need for personalized treatment approaches tailored to diverse patient populations. Methods: This retrospective observational study analyzed 1409 patients hospitalized with DFUs between 2016 and 2023 at a tertiary medical center. Data extracted from electronic medical records included demographics, socioeconomic status (SES), clinical variables, and healthcare utilization. Statistical analyses included descriptive statistics, Chi-Square and Kruskal–Wallis tests, and a regularized logistic regression model to identify predictors of mortality and disparities in treatment access. Results: Arab patients had significantly lower SES (median score: 3.00) compared to Jewish patients (median score: 8.00), resulting in reduced healthcare access and worse clinical outcomes. Arab patients were diagnosed with diabetes at a younger age (57 years vs. 68 years for Jewish patients) and exhibited a higher body mass index (30.36 vs. 28.68, p < 0.05). Despite similar mortality rates between groups (21.52% vs. 22.83%, p = 0.65), differences in healthcare utilization were evident, particularly in younger patients (18–59 years) within the internal medicine department (p = 0.017). Conclusions: Our findings underscore the need for a personalized approach to diabetic foot care, integrating socioeconomic and demographic factors into treatment plans. Ethnic minorities with lower SES, earlier diabetes onset, and higher BMI may require tailored intervention strategies to optimize prevention, access to specialized care, and adherence to treatment. Addressing individualized patient needs through precision medicine and culturally adapted healthcare models can improve outcomes and reduce disparities in DFU management. Full article

This paper examines the societal, demographic, and health-related determinants of online stress management information-seeking (OSMIS) behavior in Hungary. We processed the International Social Survey Program: Health and Healthcare (n = 1008) dataset of 2021. Relationships between variables were assessed using weighted multiple logistic regression. The bootstrapping method was applied to gauge the robustness and reliability of the estimates. Subgroup analyses were also utilized to explore potential confounding effects between OSMIS behavior and various socioeconomic and health-related lifestyle factors. Empirical findings indicate that socially excluded strata were the most likely to seek online stress management information to cope with stressful situations. OSMIS behavior was significantly associated with divorced marital status (OR = 3.13; 95% CI: [1.92–5.17]), unemployment (OR = 2.22 [1.64–2.99]), living in a rural village (OR = 1.39 [1.12–1.93]), and distrust in the healthcare system (OR = 2.03 [1.33–3.11]). During the COVID-19 pandemic, the concept of techquity played a pivotal role in Hungary, bridging gaps in health access. Policymakers, healthcare practitioners, and digital health developers may harness our results to enhance digital health tools within integrated healthcare systems, prioritizing equitable access to ensure that marginalized populations can fully benefit from the advantages of techquity and digital inclusion. Full article