The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: Analysis of large sub populations

<p>Abstract</p> <p>Background</p> <p>Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer.</p> <p>The objective</p> <p>To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer.</p> <p>Methods</p> <p>The study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI).</p> <p>Results</p> <p>Data on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p < 0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant.</p> <p>Conclusion</p> <p>Patients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation.</p

Disparities in diabetes care: role of the patient's socio-demographic characteristics

<p>Abstract</p> <p>Background</p> <p>The commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. However, disparities in health care are well-documented. The objectives were to explore disparities in diabetes prevalence, care and control among diabetic patients. The study was conducted by Maccabi Healthcare Services (MHS), an Israeli HMO (health care plan).</p> <p>Methods</p> <p>Retrospective study. The dependent variables were diabetes prevalence, uptake of follow-up examinations, and disease control. The independent variables were socio-economic rank (SER), ethnicity (Arab vs non Arab), supplementary voluntary health insurance (SVHI), and immigration from Former Soviet Union (FSU) countries. Chi Square and Logistic Regression Models were estimated.</p> <p>Results</p> <p>We analyzed 74,953 diabetes patients. Diabetes was more prevalent in males, lower SER patients, Arabs, immigrants and owners of SVHI. Optimal follow up was more frequent among females, lower SERs patients, non Arabs, immigrants and SVHI owners. Patients who were female, had higher SERs, non Arabs, immigrants and SVHI owners achieved better control of the disease. The multivariate analysis revealed significant associations between <it>optimal follow up </it>and age, gender (males), SER (Ranks 1-10), Arabs and SVHI (OR 1.02, 0.95, 1.15, 0.85 and 1.31, respectively); <it>poor diabetes control </it>(HbA1C > 9 gr%) was significantly associated with age, gender (males), Arabs, immigrants, SER (Ranks1-10) and SVHI (OR 0.96, 1.26, 1.38, 0.72, 1.37 and 0.57, respectively); significant associations with <it>LDL control </it>(< 100 gr%) were revealed for age, gender (males) and SVHI (OR 1.02, 1.30 and 1.44, respectively).</p> <p>Conclusion</p> <p>Disparities in diabetes prevalence, care and control were revealed according to population sub-group. MHS has recently established a comprehensive strategy and action plan, aimed to reduce disparities among members of low socioeconomic rank and Arab ethnicity, sub-groups identified in our study as being at risk for less favorable health outcomes.</p

Persistence with Statins and Onset of Rheumatoid Arthritis: A Population-Based Cohort Study

In a retrospective cohort study, Gabriel Chodick and colleagues find a significant association between persistence with statin therapy and reduced risk of developing rheumatoid arthritis, but only a modest decrease in risk of osteoarthritis

C-C4-04: Trends in Breast Cancer Incidence in a Setting of Increased Mammography Screening and Decreased Use of Oral Estrogen Replacement Therapy

Background: Utilization of estrogen hormone replacement therapy (HRT) has dropped dramatically since the publication of the Women’s Health Initiative findings questioning its use for prevention of chronic conditions. Recent publications have suggested a link between this drop in HRT use and a parallel drop in breast cancer

C-D2-04: Persistence With Statins and All-Cause Mortality: A Population-based Cohort Study

Background: The beneficial effects of statins in secondary-prevention on cardiovascular mortality have been established in several long-term placebo-controlled trials; however, the value of statin therapy in reducing overall mortality in patients without coronary heart disease (CHD) is questionable. The study objective was to evaluate the effect of statin therapy in an unselected cohort of subjects with no indication of a cardiovascular-disease (primary-prevention) and patients with known CHD (secondary-prevention)

PS2-18: The Maccabi Healthcare Services Cardiovascular Information System: Integration of Patient Care Data, Registries, and Gui

Abstract Background: The present study describes a registry of cardiovascular disease (CVD) patients in a large health maintenance organization in Israel aimed to be used by health professionals to identify CVD patients and follow the courses of their illnesses and risk factors

Proportional effects of persistence with statins on reduction of risk for RA per 10% of follow-up days covered with statins.

<p>Squares indicate adjusted HRs, horizontal lines, 95% CIs. Mutually adjusted for all covariates listed in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000336#pmed-1000336-t004" target="_blank">Table 4</a>.</p

Study population characteristics, according to PDC with statins, patients eligible for the RA analysis (<i>n</i> = 211,627).

a<p>Kruskal-Wallis test for continuous data; χ² test for categorical data.</p>b<p>In the year prior to Index date.</p><p>GP, general practitioner; SD, standard deviation.</p

Adjusted HR and 95% CI for RA and OA, according to PDC with statins in patients with at least 5 y of follow-up.

<p>Adjusted for baseline values of age, sex, socioeconomic level, utilization of healthcare services in the year prior to index date, chronic comorbidity (cardiovascular diseases, diabetes mellitus, cancer, morbid obesity), LDL level, and statin efficacy.</p

Incidence density rates (IDR) of RA and OA according to the PDC with statins, MHS 1998–2007.

a<p>Excluding first year of follow-up.</p><p>SD, standard deviation.</p