Trends from 2008 to 2018 in Electricity-dependent Durable Medical Equipment Rentals and Sociodemographic Disparities.
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ABSTRACT: Background
Duration and number of power outages have increased over time, partly fueled by climate change, putting users of electricity-dependent durable medical equipment (hereafter, "durable medical equipment") at particular risk of adverse health outcomes. Given health disparities in the United States, we assessed trends in durable medical equipment rental prevalence and individual- and area-level sociodemographic inequalities.Methods
Using Kaiser Permanente South California electronic health record data, we identified durable medical equipment renters. We calculated annual prevalence of equipment rental and fit hierarchical generalized linear models with ZIP code random intercepts, stratified by rental of breast pumps or other equipment.Results
243,559 KPSC members rented durable medical equipment between 2008 and 2018. Rental prevalence increased over time across age, sex, racial-ethnic, and Medicaid categories, most by >100%. In adjusted analyses, Medicaid use was associated with increased prevalence and 108 (95% confidence interval [CI] = 99, 117) additional days of equipment rental during the study period. ZIP code-level sociodemographics were associated with increased prevalence of equipment rentals, for example, a 1 SD increase in percent unemployed and
SUBMITTER: Casey JA
PROVIDER: S-EPMC8140591 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundFragmentation in China's social health insurance schemes and income gap have been recognised as important factors for the inequitable use of healthcare. This study assessed trends in disparities in healthcare utilisation between and within health insurances in China between 2008 and 2018.MethodsWe used data from the 2008, 2013, and 2018 China National Health Services Survey. Outpatient visit, inpatient admission and foregone inpatient care were chosen to measure healthcare utilisation and underutilisation by health insurances. Absolute differences and rate ratios were generated to examine disparities between and within health insurances, and changes in disparities were analysed descriptively. Pearson χ2 tests were used to test for statistical significance of differences.ResultsThe outpatient visit rate for respondents covered by the urban resident-based basic medical insurance scheme (URBMI) more than doubled between 2008 and 2018, increasing from 10.5% (9.7-11.2) to 23.5% (23.1-23.8). Inpatient admission rates for respondents covered by URBMI and the new rural cooperative medical scheme (NRCMS) more than doubled between 2008 and 2018, increasing by 7.2 (p < 0.0001) and 7.4 (p < 0.0001) percentage points, respectively. Gaps in outpatient visits and inpatient admissions narrowed across the urban employee-based basic medical insurance scheme (UEBMI), URBMI, and NRCMS through 2008 to 2018, and by 2018 the gaps were small. The rate ratios of foregone inpatient care between NRCMS and UEBMI fell from 0.9 (p > 0.1) in 2008 to 0.8 (p < 0.0001) in 2018. Faster increases in outpatient and inpatient utilisation and greater reductions in foregone inpatient care were observed in poor groups than in wealthy groups within URBMI and NRCMS. However, the poor groups within UEBMI, URBMI, and NRCMS were always more likely to forego inpatient care in comparison with their wealthy counterparts.ConclusionsRemarkable increases in healthcare utilisation of URBMI and NRCMS, especially among the poorest groups, were accompanied by improvements in inequality in healthcare utilisation across UEBMI, URBMI, and NRCMS, and in income-based inequality in healthcare utilisation within URBMI and NRCMS. However, the poor groups were always more likely to forego admission to hospital, as recommended by doctors. We suggest further focus on the foregoing admission care of the poor groups.
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Project description:BACKGROUND:Women are currently underrepresented in academic psychiatry. As publication activity reflects both leadership and participation in academia, we examined temporal trends in women's authorship by conducting a large-scale bibliometric study of psychiatry journals. METHODS:We examined changes in proportions of women in the first, last, and overall authorship positions over time; relationship to journal impact factor and editorial board makeup; and rates of transition to senior author status using original research articles published in the 24 highest-impact psychiatry journals between January 2008 and May 2018. RESULTS:In 30,934 articles, women represented 40.0% of all authors in 2008 and 44.8% in 2018, with a significant increase in the percentage of women as first authors (2008: 43.5%, 2018: 49.5%; B = 0.64, p = .002) and last authors over time (2008: 30.0%, 2018: 35.7%; B = 0.64, p = 1 × 10-5). Articles with women as last authors were significantly more likely than those with men as last authors to have a woman as first author (?21 = 126.1, p < 2.2 × 10-16). Women exhibited slower rates of transition to the last author position (log rank p = 2 × 10-16); time to 10% transition was 5 years for men and 9 years for women. CONCLUSIONS:These results indicate continued improvement in the representation of women authors in psychiatry journals, resulting in near parity in first authors. However, slower rates of transition to the senior author position and continued underrepresentation of women as senior authors suggest ongoing challenges in achieving gender parity in academic leadership. At the present rate of change for last authors (0.64% increase per year), women would achieve parity in senior authorship in ?20 to 25 years.
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