Health insurance coverage among women in Indonesia's major cities: A multilevel analysis

We examined women's access to health insurance in Indonesia. We analyzed IFLS-4 data of 1,400 adult women residing in four major cities. Among this population, the health insurance coverage was 24%. Women who were older, involved in paid work, and with higher education had greater access to health insurance (p < .05). We also found there were disparities in the probability of having health insurance across community levels (Median Odds Ratios = 3.40). Given the importance of health insurance for women's health, strategies should be developed to expand health insurance coverage among women in Indonesia, including the disparities across community levels. Such problems might also be encountered in other developing countries with low health insurance coverage.     

Factors associated with hysterectomy among women in Australia

This study was to identify hysterectomy prevalence across urban, rural and remote areas of Australia and across states, to separate geographic variation from the effect of sociodemographic influences, and also to compare the quality of life of women who have and have not had hysterectomy. Data were collected from 14,072 women aged 45-50 years participating in the baseline survey of the Australian Longitudinal Study on Women's Health. The estimated prevalence of hysterectomy was 22%. Factors significantly associated with hysterectomy included living in a rural or remote area, state of residence, having private health insurance, lower levels of education, being married and having more than two children, having had other gynaecological and non-gynaecological surgical procedures, and more visits to general practitioners. Compared with women who had not had hysterectomy, women who had had hysterectomy had significantly poorer physical and mental health as measured by the SF-36 quality of life profile (adjusted mean PCS=45.7 vs 49.3, p<0.0001; adjusted mean MCS=46.9 vs 48.2, p<0.0001).     

Factors Influencing Breast Cancer Screening in Low-Income African Americans in Tennessee

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 334) were selected from the Meharry CNP community survey database. There were several predictors of breast cancer screening such as marital status and having health insurance (P < .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and not having enough information about screenings (P < .05). Educational interventions aimed at improving breast cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.     

Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey

BACKGROUND: Cervical cancer screening is not fully utilized among all groups of women in the United States, especially women without access to health care and older women. METHODS: Papanicolaou (Pap) test use among U.S. women age 18 and older is examined using data from the 2000 National Health Interview Survey (NHIS). RESULTS: Among women who had not had a hysterectomy (n = 13,745), 83% reported having had a Pap test within the past 3 years. Logistic regression analyses showed that women with no contact with a primary care provider in the past year were very unlikely to have reported a recent Pap test. Other characteristics associated with lower rates of Pap test use included lacking a usual source of care, low family income, low educational attainment, and being unmarried. Having no health insurance coverage was associated with lower Pap test use among women under 65. Despite higher insurance coverage, being age 65 and older was associated with low use. Rates of recent Pap test were higher among African-American women. CONCLUSIONS: Policies to generalize insurance coverage and a usual source of health care would likely increase use of Pap testing. Also needed are health system changes such as automated reminders to assist health care providers implement appropriate screening. Renewed efforts by physicians and targeted public health messages are needed to improve screening among older women without a prior Pap test.     

The importance of health insurance as a determinant of cancer screening: evidence from the Women's Health Initiative

BACKGROUND: Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort. METHODS: Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. RESULTS: Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. CONCLUSIONS: In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.     

Health insurance coverage among persons with AIDS: results from a multistate surveillance project.

To determine factors associated with health insurance coverage among persons with acquired immunodeficiency syndrome (AIDS), we interviewed 1958 persons 18 years of age or older who were reported to have AIDS in 11 states and cities. Overall, 25% had no insurance, 55% had public insurance, and 20% had private insurance. Factors associated with lack of insurance varied by current employment status. Employed persons with an annual household income of less than $10,000 were 3.6 times more likely to lack insurance than employed persons with a higher income. Unemployed persons diagnosed with AIDS for less than 1 year were two times more likely to lack health insurance than unemployed persons diagnosed for a longer time. Making insurance available to persons identified as most likely to lack insurance should improve access to care for persons with AIDS.     

Complications following hysterectomy in women with intellectual and developmental disabilities

BackgroundLimited data exist on complications following hysterectomy among women with intellectual and developmental disabilities (IDD).ObjectiveThe objective was to assess the frequencies of postoperative complications in women with IDD following hysterectomy.MethodsThe National Inpatient Sample from 2014 to 2017 was queried using codes from the International Classification of Disease 9th and 10th revisions to identify women over 15 years of age with a diagnosis of an IDD undergoing hysterectomy. Comparisons were made to women without IDD undergoing the same procedure. Logistic regression analysis was performed to examine between group differences in the frequency of clinical post-surgical complications while adjusting for potential confounding variables.ResultsOf eligible women undergoing hysterectomy, 1,370 were identified as having IDD and 624,700 did not. Compared to controls, women with IDD were significantly younger (45 vs. 50 years, p < 0.001). Women with IDD were also more likely to have had governmental health insurance (83% vs. 34%, p < 0.001), an open hysterectomy approach (78% vs. 69%, p = 0.002), and longer hospital stays (4 vs. 3 days, p < 0.001). After adjusting for potential confounders, women with IDD had greater odds of postoperative urinary complications (OR 3.74, 95% CI 1.18–11.83) and complications related to decubitus ulcer formation (OR 8.97, 95% CI 2.10–38.36).ConclusionsWomen with IDD have increased odds having urinary and decubitus ulcer complications following hysterectomy, compared to women without IDD. These results inform surgical decision-making and anticipatory guidance for these women and their caregivers.     

Health characteristics of adults 55 years of age and over: United States, 2000-2003

OBJECTIVE: This report highlights the health characteristics of four age groups of older adults-55-64 years, 65-74 years, 75-84 years, and 85 years and over-providing estimates by sex, race and Hispanic origin, poverty status, health insurance status, and marital status. METHODS: The estimates in this report were derived from the 2000-2003--National Health Interview Surveys' Family and Sample Adult questionnaires. Estimates are based on interviews with 39,990 sample adults aged 55 years and over. RESULTS: Overall, prevalence rates for fair or poor health, chronic health conditions (with the exception of diabetes), sensory impairments, and difficulties with physical and social activities increased with advancing age, doubling or even tripling between the age groups 55-64 and 85 years and over. About one in five adults aged 55-64 years were in fair or poor health, rising to about one-third of adults aged 85 years and over. Men and women were about equally likely to be in fair or poor health across the age groups studied, but women were more likely to have difficulty in physical or social activities. Sociodemographic variations in health were noted across the age groups studied, with the most consistent and striking results found for poverty status and health insurance coverage. Poor and near poor adults and those with public health insurance were, by far, the most disadvantaged groups of older adults in terms of health status, health care utilization, and health behaviors. CONCLUSIONS: Health status, health care utilization, and health-promoting behaviors among adults aged 55 and over vary considerably by age and other sociodemographic characteristics. Identifying these variations can help government and private agencies pinpoint areas of greatest need and greatest opportunity for extending years of healthy life among the Nation's seniors.     

Hysterectomy: variations in rates across small areas and across physicians' practices.

This analysis focuses on the practice of hysterectomy across 33 hospital catchment areas of one Canadian province, using claims data from the Manitoba health insurance system. Hysterectomy rates varied five-fold across hospital areas. The availability of hospitals and physicians was unrelated to area rates, and there appeared to be no access barriers in the low-rate areas. High-rate areas were characterized by women who visited large numbers of different physicians and by having larger proportions of French, Polish, and Italian residents (ethnic groups which are largely Catholic in Manitoba). Although women residents of high rate areas made somewhat more visits for gynecologic problems and had many more D&Cs (dilation and curretage of the uterus), it is concluded that this may be due as much to the practice style of physicians treating patients from these areas as to gynecologic need. Residents of high and medium-high rate areas are more likely to have hysterectomy-prone surgeons as their primary physicians. Such physicians appear both more likely to "label" their patients' conditions as gynecologic in origin and more likely to advise surgical intervention (both D&C and hysterectomy) once such conditions are diagnosed. Thus, a combination of patient and physician characteristics may explain much of the variation in small area hysterectomy rates, rather than narrowly defined medical need.     

Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse

The purpose of this study is to examine the relationship between food security and cost-related medication underuse among older adults (persons aged 65 years and older) in the United States; and to determine if this relationship differs by sex, chronic disease status, and type of health insurance. Data are from a combined sample of older adults in the 2011 and 2012 National Health Interview Survey (N = 10,401). Both bivariate and multivariate analyses show a dose-response relationship between food insecurity and cost-related medication underuse among the elderly—increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < 0.001). This association is not conditional on sex, chronic disease status, or type of health insurance. However, females and those with a chronic condition are more likely to report cost-related medication underuse than males and those without a chronic condition respectively; and older adults with Medicare and Medicaid or other public insurance are less likely to report cost-related medication underuse than older adults with only Medicare.     

Assessment of recent HIV testing among older adults in the United States

Older adults are the fastest growing segment of people living with HIV, and unfortunately many are unaware of their HIV status. Many providers are reluctant to ask older adults about their sexual histories, evaluate their risk factors, and test for HIV, and older adults have low perception of HIV risk. Using data from the 2013 to 2014 National Health and Nutrition Examination Survey, this study assessed the prevalence of recent HIV testing among older adults in the United States (n = 1,056) and identified predictors and barriers to recent HIV testing. The prevalence of recent HIV testing was 28%. Recent HIV testing was associated positively with male gender, education level, having public insurance, having same sex sexual behavior, African, and Hispanic ethnicity, whereas age, income-to-poverty ratio, and Asian ethnicity were associated negatively with recent HIV testing. Public health social workers are advised that targeted HIV testing for Asian, economically disadvantaged, female older adults is needed to increase HIV awareness and detection and to decrease late diagnosis of HIV. Provided public insurance was identified as a predictor of recent HIV testing, facilitating economically disadvantaged older adults’ eligibility for public insurance that will likely improve access to HIV testing services and increase HIV testing rates.     

Prevalence and associated factors of cancer screening: why are so many older Mexican American women never screened?

OBJECTIVES: The aim of this study was to identify patterns of mammogram and Papanicolaou (Pap) screenings among Mexican American women ages 67 and over. METHODS: Data on 1,403 Mexican American women from the Hispanic Established Population for the Epidemiological Study of the Elderly, a cohort study of community-dwelling Mexican Americans ages 65 years or over from the southwestern United States, were analyzed. RESULTS: Mexican American women age 75 or older were less likely to ever have had breast or cervical screening than women ages 67 to 74, even controlling for sociodemographic, cultural, and selected health factors. Overall, fewer medical conditions and never having had a hysterectomy were found to be associated with a decreased chance of ever having had a mammogram or a Pap test. Women who lacked insurance coverage and had fewer doctor visits were less likely to ever have had a mammogram, whereas women with low education, low acculturation, and lower cognitive status scores were less likely to ever have had a Pap test. CONCLUSIONS: If these results withstand more detailed studies (e.g., with the addition of important variables such as awareness), better communication with health professional doctors and improvement of access to heath care services should increase rates of both mammogram and Pap screenings.     

Disability benefits as an incentive for hysterectomy: Uterine fibroid patients in Taiwan

Worker compensation insurance in Taiwan ensures that a woman under the age of 45 years who has her uterus removed can receive disability compensation benefits. The present study investigated whether such a compensation policy was related to a woman’s inclination to have a hysterectomy. We extracted the records of 16,030 women diagnosed with uterine fibroids (UF) between 2000 and 2010 from the Longitudinal Taiwan Health Insurance Database. Each younger and older age group had a significantly lower hysterectomy rate compared to that of the 44-year-old age group. Moreover, significantly more patients with lower monthly wages had had hysterectomies than those with higher monthly wages. Policy makers should be aware that worker compensation regulations in Taiwan might encourage women with economic need to undergo hysterectomy surgery when approaching the age of 45 years.     

Evaluating Iowa Severe Maternal Morbidity Trends and Maternal Risk Factors: 2009–2014

Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009–2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N?=?196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa’s 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women <20 years and >34 years compared to women 25–34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus.     

“My mama told me it would happen”: menarche and menstruation experiences across generations

ABSTRACT

The purpose of this study was to understand women’s menarche and menstruation-related knowledge, attitudes, and behaviors across generations. Women ages 18 years and older (Mean = 49.13 ± 14.76 years; Range = 19–78 years) living in South Carolina were recruited to participate in semi-structured interviews during May-November 2016. A total of 70 interviews were conducted, which were audio-recorded and transcribed verbatim. Thematic analysis using open and axial coding techniques from grounded theory provided the framework for data interpretation. Women described vivid menarche memories; however, most women had not received proper education or preparation for what to expect prior to onset. Participants discussed their experiences with menstrual products, oral contraceptives, and medical procedures to suppress, manipulate, or manage menstruation. Findings provide practical recommendations for health professionals to develop further effective and timely messaging related to menarche and menstruation across the lifespan. Messaging should inform women about what to expect with menarche, menstruation management, and health-related impacts, as well as methods to reduce menses-related myths and stigmas.     

Mammography use among older women of seven Latin American and Caribbean cities

BACKGROUND: To describe the prevalence of mammography use, and to estimate its association with sociodemographics. METHODS: A sample of 6207 women aged 60 and older from the first interview of Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE) in seven cities (Buenos Aires, Bridgetown, Havana, Mexico, Montevideo, Santiago, and Sao Paulo). The outcome was reporting a mammogram within the last 2 years. RESULTS: Prevalence of mammography use ranged from 9.8% in Havana to 34.4% in Sao Paulo. Independent predictors of mammography use across cities were older age (lowest odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.89-0.95), higher education (highest OR = 1.14, 95% CI 1.08-1.20), public health insurance (lowest OR = 0.28, 95% CI 0.11-0.76), or no insurance (lowest OR = 0.08, 95% CI 0.02-0.34) compared with private insurance. In a combined sample of six cities, higher education was associated with higher mammography use, but older age and insurance (public: OR = 0.54, 95% CI 0.45-0.65; no insurance: OR = 0.30, 95% CI 0.23-0.40; compared with private insurance) were associated with lower mammography use. CONCLUSIONS: Prevalence of mammography use across cities was lower than that reported for Hispanic populations in the US. In the overall sample, mammography use was increased in highly educated people and decreased in people without insurance.     

What Factors Explain Disparities in Mammography Rates Among Asian-American Immigrant Women? A Population-Based Study in California

BackgroundThe purpose of this study was to compare rates of screening mammography among immigrant women in five Asian-American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening.MethodsUsing 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, sociodemographic characteristics, access to health care, and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors.FindingsParticipation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past 2 years) screening. These differences decreased substantially after adjusting for acculturation, sociodemographic factors, and risk factors of breast cancer, but differences remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors.ConclusionsThis analysis draws attention to low mammography screening rates among Asian-American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is important to increase regular mammography screening in these groups.     

Predictors of having heard about human papillomavirus vaccination: Critical aspects for cervical cancer prevention among Colombian women

ObjectivesTo determine whether the probability of having heard about human papillomavirus (HPV) vaccination differs by socio-demographic characteristics among Colombian women; and whether the effect of predictors of having heard about HPV vaccination varies by educational levels and rural/urban area of residence.MethodsData of 53,521 women aged 13–49 years were drawn from the 2010 Colombian National Demographic and Health Survey. Women were asked about aspects of their health and their socio-demographic characteristics. A logistic regression model was used to identify factors associated with having heard about HPV vaccination. Educational level and rural/urban area of residence of the women were tested as modifier effects of predictors.Results26.8% of the women had heard about HPV vaccination. The odds of having heard about HPV vaccination were lower among women: in low wealth quintiles, without health insurance, with subsidized health insurance, and those who had children (p < 0.001). Although women in older age groups and with better education had higher probabilities of having heard about HPV vaccination, differences in these probabilities by age group were more evident among educated women compared to non-educated ones. Probability gaps between non-educated and highly educated women were wider in the Eastern region. Living in rural areas decreased the probability of having heard about HPV vaccination, although narrower rural/urban gaps were observed in the Atlantic and Amazon-Orinoquía regions.ConclusionsAlmost three quarters of the Colombian women had not heard about HPV vaccination, with variations by socio-demographic characteristics. Women in disadvantaged groups were less likely to have heard about HPV vaccination.