Are some QALYs more equal than others?

Including societal preferences in allocation decisions is an important challenge for the health care sector. Here, we present results of a phased discrete choice experiment investigating the impact of various attributes on respondents’ preferences for distribution of health and health care. In addition to the renowned equity principles severity of illness (operationalized as initial health) and fair innings (operationalized as age), some characteristics of beneficiaries (culpability and having dependents) and the disease (rarity) were included in the choice experiment. We used a nested logit model to analyse the data. We found that all selected attributes significantly influenced respondents’ choices. The phased inclusion showed that additional attributes affected respondents’ preferences for previously-included attributes and reduced unobserved variance. Although not all these attributes may be considered relevant for decision making from a normative perspective, including them in choice experiments contributes to our understanding of societal preferences for each single attribute.     

Are persons with diabetes practicing healthier behaviors in the year 2001? Results from the Behavioral Risk Factor Surveillance System

BACKGROUND: To examine changes in modifiable health-risk behaviors of diabetic persons in the United States. METHODS: A cross-sectional study was conducted of noninstitutionalized adults aged 18 years or older, in states that participated in the Behavioral Risk Factor Surveillance System in 1995 and 2001. Changes in self-reported health-risk behaviors among persons with diabetes are examined for those years (5,218 in 1995 and 13,733 in 2001 for the core instrument; 3,227 in 1995 and 9,304 in 2001 for the diabetes module). RESULTS: From 1995 to 2001, the percentage of persons with diabetes who were obese, had ever been told their blood pressure or blood cholesterol was high, or had their blood cholesterol checked in the past year increased significantly. Significant increases were also reported among diabetic persons who were former smokers, received an annual influenza vaccination, ever received a pneumococcal vaccination, performed daily self-monitoring of blood glucose, received annual foot examination, and received annual dilated eye exam. CONCLUSIONS: Continued emphasis needs to be placed on a multirisk factor approach to prevent, delay, and reduce the complications of diabetes.     

Are women more sensitive to smoking than men? Findings from the Renfrew and Paisley study

BACKGROUND: Prescott et al. found that the relative risks associated with smoking for respiratory and vascular deaths were higher for women who inhale than for inhaling men, and found no gender differences in relative risks of smoking-related cancers. The purpose of the present study was to assess whether these findings are reproducible, using data from the Renfrew and Paisley study. METHODS: Age-standardized mortality rate differences and age-adjusted mortality rate ratios (using Cox's proportional hazard model) were calculated for male and female smokers by amount smoked compared with never smokers. These analyses were repeated after excluding non-inhalers. RESULTS: The all-cause mortality rate ratio was higher for men than for women in all categories of amount smoked, although this difference was only statistically significant in the light smokers (1.83 [95% CI : 1.61-2.07] for men and 1.41 [95% CI : 1.28-1.56] for women, P = 0.001). The cause-specific mortality rate ratios tended to be higher for men than for women, and this difference was most substantial for neoplasms (2.57 [95% CI : 2.01-3.29] for male light smokers and 1.35 [95% CI : 1.14-1.61] for female light smokers, P < 0.001) and, in particular, for lung cancer (11.10 [95% CI : 5.89-20.92] for male light smokers and 4.73 [95% CI : 2.99-7.50] for female light smokers, P = 0.03). Furthermore, looking at the rate differences the effects of smoking were uniformly greater in men than in women. These results were virtually unchanged after excluding non-inhalers. CONCLUSION: We found similar results to Prescott et al. when all smokers were considered, but could not reproduce their findings when non-inhalers were excluded. Given the fact that we showed greater rate differences in men than in women, we think that it is too early to conclude that women may be more sensitive than men to some of the deleterious effects of smoking.     

Are urban children really healthier? Evidence from 47 developing countries

On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural-urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. Using micro-data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries, the purpose of this paper is threefold. First, we document the magnitude of rural-urban disparities in child nutritional status and under-5 mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural-urban differences in the degree of socioeconomic inequality in these health outcomes. The results demonstrate that there are considerable rural-urban differences in mean child health outcomes in the entire developing world. The rural-urban gap in stunting does not entirely mirror the gap in under-5 mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in growth stunting is more than 1.5 times higher than that in mortality. On average, the rural-urban risk ratios of stunting and under-5 mortality fall by, respectively, 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. We confirm earlier findings of higher socioeconomic inequality in stunting in urban areas and demonstrate that this also holds for under-5 mortality. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows.     

Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada

Objectives: Immigrants are typically healthier than the native-born population in the receiving country and also tend to be healthier than non-migrants in the countries of origin. This foreign-born health advantage has been referred to as the healthy immigrant effect (HIE). We examined evidence for the HIE in Canada.

Design: We employed a systematic search of the literature on immigration and health and identified 78 eligible studies. We used a narrative method to synthesize the HIE across different stages of the life-course and different health outcomes within each stage. We also examined the empirical evidence for positive selection and duration effects – two common explanations of migrants’ health advantage and deterioration, respectively.

Results: We find that the HIE appears to be strongest during adulthood but less so during childhood/adolescence and late life. A foreign-born health advantage is also more robust for mortality but less so for morbidity. The HIE is also stronger for more recent immigrants but further research is needed to determine the critical threshold for when migrants’ advantage disappears. Positive selection as an explanation for the HIE remains underdeveloped.

Conclusions: There is an absence of a uniform foreign-born health advantage across different life-course stages and health outcomes in Canada. Nonetheless, it remains the case that the HIE characterizes the majority of contemporary migrants since Canada’s foreign-born population consists mostly of core working age adults.     

Are atrial fibrillation guidelines altering management? A community based study

BACKGROUND AND AIMS: We wanted to determine the prevalence of atrial fibrillation (AF) in a community based cross sectional study in greater Glasgow and how current anti-thrombotic management compares to published guidelines. METHODS: 1466 patients with AF were identified in General Practices in our community and 1008 consented to take part. Their demographic details and medical history were recorded. RESULTS: 1466 patients (mean age 73.4; 55% female) with AF were identified, in our community, giving a prevalence of 1%. 53% of patients were on warfarin therapy. Of those not receiving warfarin, only one third had a putative contra-indication. The proportion ofAF patients on warfarin increased with increasing stroke risk, and over the period of the study. CONCLUSIONS: Prevalence of AF was in keeping with previous estimates. The proportion of patients with AF receiving warfarin therapy appears to be increasing. In the moderate risk group, there was a tendency to use more warfarin in the younger age groups compared to the elderly. It was in the moderate and low risk groups that there was still evidence of deviation from published guidelines.     

Are Current Dietary Habits in Mediterranean Islands a Reflection of the Past? Results from the MEDIS Study

In the 1960s, the recorded dietary pattern of Southern European populations was typical of the traditional Mediterranean diet. However, diets have been rapidly changing. The aim of the current work was to examine the extent by which present food habits of inhabitants residing in various Mediterranean islands uphold past dietary traditions of the Mediterranean diet. A population-based, multi-stage sampling method was used to voluntarily enroll 876 men and 936 women (aged > 65 years) from 12 Mediterranean islands. Demographic, behavioral, clinical, and dietary data were collected. Principal component analysis derived fruits, vegetables, and greens as part of the main dietary pattern across most Mediterranean regions. Surprisingly, Crete had the highest frequency of fast-food and sweets consumption. Malta had the lowest frequency of fish and vegetable consumption and the lowest MedDietScore. As Mediterranean populations gradually move away from traditional dietary patterns, public-health efforts to preserve these diets are needed.     

Are immigrants living in France more reluctant to receive vaccines than native-born French citizens? findings from the national health Barometer study

BackgroundFrance is one of the world's most vaccine hesitant countries and vaccine hesitancy (VH) is considered one of the world's leading threats to global health. However, little is known about VH in immigrant populations in France. Using data from the 2016 Health Barometer, we examined VH among newcomers, more established immigrants, and the native-born population in France.MethodsData was collected from French speaking individuals aged from 15 to 75 years old, residing in France. Individuals were selected through randomly generated landline and mobile phone numbers. Vaccine hesitancy was assessed through four questions and a “time spent in France” variable was created, using the year of arrival in France. Associations were studied using logistic regression.ResultsA sample of 15,216 participants residing in France included 1,524 foreign-born immigrants and 13,692 native-born individuals, with a mean age of 46-years. Most participants (75.7%) reported being favorable to vaccination regardless of country of origin but immigrants were less hesitant toward vaccinations than the host population. Foreign-born immigrants from North Africa had the most favorable views whereas those from sub-Saharan Africa held most unfavorable views on vaccination. With time spent in France, the opinions towards vaccination became more negative (aOR = 0.57, 95 %CI [0.40–0.79], p = 0.001) and the risk of vaccine refusal (aOR = 2.34, 95 %CI [1.45 – 3.78] p = 0.001) and reluctant acceptance of vaccines increased (aOR = 1.89 95 %CI [1.20 – 2.99], p = 0.006).Foreign-born individuals with the longest residency in France had more negative opinions than native-born individuals, regardless of region of origin.ConclusionImmigrants were less hesitant toward vaccinations than the host population, but vaccine hesitancy increased with time spent in France. The provision of appropriate information and awareness to facilitate critical thinking towards antivaccine theories is necessary for immigrants in France.     

Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study

The objective of the study was to examine the predictive effect of prospectively registered falls on survival within a randomly selected group of elderly women. A longitudinal study, with 9 years follows up after 1 year prospective fall registration was designed. Persons age 75 or more living in the community. A total of 300 Norwegian women; mean age was 80.8 participated in the study. Base-line registrations of health, functioning and medication were made. Falls which occurred during a 1-year period after baseline were registered as well as the date of death within a 9-year period after the end of the fall registration period. Half of the women reported one or more falls (1–11). Eighty-six women (28.7%) experienced only one fall and 65 (21.7%) had at least two. During the 9-year follow-up period, 41.7% died. Cox regression analyzes demonstrated that frequent falling, old age and a self-reported worsening of health were significantly associated with mortality during the follow-up period. Their relative risks of death when experiencing at least two falls was 1.6 (95% CI 1.1–2.4), P = 0.04, when compared with no falls. Older fallers appear to have markedly increased mortality. Since falls are common among elderly people, this is a relevant fact for public health policy. Increasing age, poor self-rated health and high frequency of falls predict independently mortality in our 9 years follow up study. Because women represent the largest proportion of the elderly and falls are amendable, fall preventive may have the potential for significant impact on increasing year of life.     

Osteoporosis detection in the community. Are patients adequately managed?

In conclusion, osteoporosis remains underdiagnosed in the South Eastern Sydney area. A public awareness campaign, highlighting the need for bone densitometry in men and women 45 years and older who sustain minimal trauma fractures in order to diagnose osteoporosis, is required. Proven therapies for patients presenting with osteoporotic fractures, including men, are now available and should be considered.     

Are oral nutritional supplements of benefit to patients in the community? Findings from a systematic review

Although the use of oral nutritional supplements has increased in the community setting, no consensus exists about the benefits of their use in patients with different diseases and conditions. This article highlights new findings from a critical, systematic review of 84 trials, which has led to a rationale for the use of supplements in patients with chronic conditions in the community and has identified key areas for future research.     

Are people being screened for colorectal cancer as recommended? Results from the National Health Interview Survey

BACKGROUND: The evidence is now compelling that colorectal cancer incidence and mortality can be reduced by screening, and medical organizations recommend regular screening among persons of average risk aged 50 years or older. We sought to determine whether appropriate screening has become more widespread now that consensus over its value has been achieved. METHODS: We analyzed data from the 1992 and 1998 National Health Interview Survey, an in-person survey of a nationally representative sample of the U.S. population. Persons aged > or =50 years (4428 in 1992, 12,629 in 1998) were questioned about their use of colorectal cancer screening. RESULTS: Self-reported use of fecal occult blood testing and proctoscopy increased slightly from 1992 to 1998. In 1998, however, only an estimated 22.9% of Americans aged > or =50 years had been screened with either the home-administered fecal occult blood testing in the past year or proctoscopy within 5 years. Nearly half of fecal occult blood testings were performed with a sample taken during an in-office physical examination rather than with the recommended home kit. CONCLUSION: Most eligible persons are still not meeting the screening recommendations for colorectal cancer. Education is needed for both the public and health care providers to increase their compliance with current guidelines.     

Does the Integrated Management of Childhood Illness cost more than routine care? Results from the United Republic of Tanzania.

OBJECTIVE: The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. METHODS: Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. We also included administrative and support costs incurred by national and district administrations. The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. FINDINGS: The annual cost per child of caring for children less than five years old in districts with IMCI was USD 11.19, 44% lower than the cost in the districts without IMCI (USD 16.09). Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. CONCLUSION:IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI.     

Gaining weight through retirement? Results from the SHARE survey

This paper estimates the causal impact of retirement on the Body Mass Index (BMI) of adults aged 50–69 years old, on the probability of being either overweight or obese and on the probability of being obese. Based on the 2004, 2006 and 2010–2011 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), our identification strategy exploits variation in European Early Retirement Ages (ERAs) and stepwise increases in ERAs in Austria and Italy between 2004 and 2011 to examine an exogenous shock to retirement behavior. Our results show that retirement induced by discontinuous incentives in early retirement schemes causes a 12-percentage point increase in the probability of being obese among men within a two- to four-year period. We find that the impact of retirement is highly non-linear and mostly affects the right-hand side of the male BMI distribution. Additional results show that this pattern is driven by men retiring from strenuous jobs and by those who were already at risk of obesity. In contrast, no significant results are found among women.