Dataset Information

Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010).

ABSTRACT: OBJECTIVES: We measured gender differences in "Quality of Care" (QOC) during the first year after initiation of antiretroviral therapy and investigated factors associated with poorer QOC among women. DESIGN: QOC was estimated using the Programmatic Compliance Score (PCS), a validated metric associated with all-cause mortality, among all patients (?19 years) who initiated ART in British Columbia, Canada (2000-2010). METHODS: PCS includes six indicators of non-compliance with treatment initiation guidelines at baseline (not having drug resistance testing before treatment; starting on a non-recommended regimen; starting therapy at CD4<200 cells/mm3) and during first-year follow-up (receiving <3 CD4 tests; receiving <3 viral load tests; not achieving viral suppression within six months). Summary scores range from 0-6; higher scores indicate poorer QOC. Multivariable ordinal logistic regression was used to measure if female gender was an independent predictor of poorer QOC and factors associated with poorer QOC among women. RESULTS: QOC was determined for 3,642 patients (20% women). At baseline: 42% of women (34% men) did not have resistance testing before treatment; 17% of women (9% men) started on a non-recommended regimen (all p<0.001). At follow-up: 17% of women (11% men) received <3 CD4; 17% of women (11% men) received <3 VL; 50% of women (41% men) did not achieve viral suppression (all p<0.001). Overall, QOC was better among men (mean PSC?=?1.54 (SD?=?1.30)) compared with women (mean?=?1.89 (SD?=?1.37); p<0.001). In the multivariable model, female gender (AOR?=?1.16 [95% CI: 0.99-1.35]; p?=?0.062) remained associated with poorer QOC after covariate adjustment. Among women, those with injection drug use history, of Aboriginal ancestry, from Vancouver Island, and who initiated ART in earlier years were more likely to have poorer QOC. CONCLUSIONS: Poorer QOC among women, especially from marginalized communities, demands that barriers undermining women's access to high-quality care be addressed to improve treatment and health for women with HIV.

SUBMITTER: Carter A

PROVIDER: S-EPMC3958538 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010).

Carter Allison A Min Jeong Eun JE Chau William W Lima Viviane D VD Kestler Mary M Pick Neora N Money Deborah D Montaner Julio S G JS Hogg Robert S RS Kaida Angela A

PloS one 20140318 3

<h4>Objectives</h4>We measured gender differences in "Quality of Care" (QOC) during the first year after initiation of antiretroviral therapy and investigated factors associated with poorer QOC among women.<h4>Design</h4>QOC was estimated using the Programmatic Compliance Score (PCS), a validated metric associated with all-cause mortality, among all patients (≥19 years) who initiated ART in British Columbia, Canada (2000-2010).<h4>Methods</h4>PCS includes six indicators of non-compliance with tr ...[more]

PMID: 24642949

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Project description:BackgroundThis study aimed to measure the income-related inequalities and inequities - the inequalities that remain after accounting for differences in health need - in expenditure on fully publicly covered (hospital and ambulatory) and partially publicly covered (prescription drugs) services for those in their last year of life in the province of British Columbia (B.C.), Canada. We focused on a decedent population for three reasons: to minimize unmeasured need differences among our cohort and therefore isolate income effects; to explore inequities for a high-spending window of health care use; and, because previous studies have found conflicting relationships between income and decedent health care spending, to further quantify this relationship.MethodsWe used linked administrative databases to describe spending on health services by income for all 58,820 deaths of B.C. residents 65 and older from 2004 to 2006. Regression analyses examined the association between income and health care spending, adjusting for age, sex, health status, cause of death, and other relevant factors. We then used concentration indexes to measure both inequalities and inequities separately for three key types of services. Analyses were also run separately for men and women.ResultsOn average, per capita expenditure on acute health care in the last year of life was $20,705 (CDN2006). In need-adjusted regression analyses, we found decedents in the highest income quintile had 11% lower hospital expenditures, 15% higher specialist expenditures and 23% higher prescription drug expenditures than decedents in the lowest income quintile. Concentration index analysis suggested that spending for all types of care was concentrated among those with higher income before adjusting for need. Need-adjusted equity results mirrored regression findings and suggested patterns of inequities that were more pronounced among male decedents than females.ConclusionsDespite the universal health care system in B.C., we found patterns of inequity in spending by income in the last year of life, even for fully publicly covered services. These results, parallel to relationships between income and spending from previous studies of the B.C. population, suggest persistent income-related inequities in the health care Canadians receive throughout their lives.

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Dataset Information

Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010).

Publications

Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010).

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