Measures of Social Deprivation That Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery
The Australian National University, Canberra, ACT. Health Services Research
(Impact Factor: 2.78).
07/2012; 48(2). DOI: 10.1111/j.1475-6773.2012.01449.x
OBJECTIVE: To develop a measure of social deprivation that is associated with health care access and health outcomes at a novel geographic level, primary care service area. DATA SOURCES/STUDY SETTING: Secondary analysis of data from the Dartmouth Atlas, AMA Masterfile, National Provider Identifier data, Small Area Health Insurance Estimates, American Community Survey, Area Resource File, and Behavioural Risk Factor Surveillance System. Data were aggregated to primary care service areas (PCSAs). STUDY DESIGN: Social deprivation variables were selected from literature review and international examples. Factor analysis was used. Correlation and multivariate analyses were conducted between index, health outcomes, and measures of health care access. The derived index was compared with poverty as a predictor of health outcomes. DATA COLLECTION/EXTRACTION METHODS: Variables not available at the PCSA level were estimated at block level, then aggregated to PCSA level. PRINCIPAL FINDINGS: Our social deprivation index is positively associated with poor access and poor health outcomes. This pattern holds in multivariate analyses controlling for other measures of access. A multidimensional measure of deprivation is more strongly associated with health outcomes than a measure of poverty alone. CONCLUSIONS: This geographic index has utility for identifying areas in need of assistance and is timely for revision of 35-year-old provider shortage and geographic underservice designation criteria used to allocate federal resources.
Available from: Danielle C Butler
- "Physician Masterfile. These datasets have been used in multiple analyses of relationships with outcomes [1,10-12]. Occasionally, surveys are also used to assess the geographical distribution of physicians . In Canada, the Canadian Institute for Health Information (CIHI) aggregates physician benefits information from provincial government into a comprehensive database called the National Physician Database. "
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ABSTRACT: Good quality spatial data on Family Physicians or General Practitioners (GPs) are key to accurately measuring geographic access to primary health care. The validity of computed associations between health outcomes and measures of GP access such as GP density is contingent on geographical data quality. This is especially true in rural and remote areas, where GPs are often small in number and geographically dispersed. However, there has been limited effort in assessing the quality of nationally comprehensive, geographically explicit, GP datasets in Australia or elsewhere.Our objective is to assess the extent of association or agreement between different spatially explicit nationwide GP workforce datasets in Australia. This is important since disagreement would imply differential relationships with primary healthcare relevant outcomes with different datasets. We also seek to enumerate these associations across categories of rurality or remoteness.
We compute correlations of GP headcounts and workload contributions between four different datasets at two different geographical scales, across varying levels of rurality and remoteness.
The datasets are in general agreement with each other at two different scales. Small numbers of absolute headcounts, with relatively larger fractions of locum GPs in rural areas cause unstable statistical estimates and divergences between datasets.
In the Australian context, many of the available geographic GP workforce datasets may be used for evaluating valid associations with health outcomes. However, caution must be exercised in interpreting associations between GP headcounts or workloads and outcomes in rural and remote areas. The methods used in these analyses may be replicated in other locales with multiple GP or physician datasets.
Available from: Maruí Weber Corseuil
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ABSTRACT: The aim of this study was to describe prevalence, awareness, and treatment of high blood pressure (HBP) and associated factors among the elderly in Florianópolis, Santa Catarina State, Brazil. This cross-sectional population-based study used a complex sampling design. HBP was defined as elevated blood pressure (by direct measurement), use of antihypertensive medication, or prior diagnosis. The association of outcomes with independent variables was assessed by Poisson regression. One-thousand seven hundred and five participants were interviewed. Of these, 84.6% presented HBP, 77.5% were aware of their condition, and 79.1% were on antihypertensive medication. Prevalence of HBP was associated with age, functional capacity, and body mass index (BMI). Awareness of the condition was associated with age, gender, BMI, self-rated health, and recent medical consultation. Treatment was associated with gender, functional capacity, self-rated health, and recent medical consultation. Although public health policies should include everyone, unequal distribution of HBP in the population should be addressed through targeted preventive, diagnostic, and therapeutic measures.
Available from: scielo.br
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ABSTRACT: To verify social inequalities in hospital admissions due to respiratory diseases in Salvador, Bahia State, Brazil, 2001-2007, an ecological study was conducted with information zones as the units of analysis. Information zones were stratified according to living conditions and analyzed by Poisson regression. Spatial distribution of hospitalization rates due to respiratory diseases ranged from 3.3 to 80.5/10,000. Asthma, pneumonia, and chronic obstructive pulmonary disease (COPD) showed heterogeneous spatial patterns, in which strata with the worst living conditions showed higher hospitalizations rates. The hospitalization rate for respiratory diseases was 2.4 times higher in zones with very low living conditions as compared to the wealthiest zone. There was a reduction in inequalities in hospital admissions for pneumonia and an increase for asthma and COPD. The sharp social gradient supports the hypothesis that socioeconomic factors are determinants of hospitalizations for respiratory diseases.
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