Social prevalence of knowledge about ectopic pregnancy – tip of the ‘health inequalities’ iceberg?

We aimed to assess the social and demographic factors determining the level of awareness of the signs and symptoms of ectopic pregnancy (EP) in an East London female population and determine if awareness was related to adverse outcomes. This was a prospective, observational study using a structured questionnaire to assess awareness of EP. A retrospective analysis of a database of EP patients was used to assess the association between adverse clinical outcomes and knowledge about EP. A younger age (500 ml of blood loss were higher in the ethnic minorities. RR of >500 ml of blood loss if Asian compared to white is 1.1034 and if black compared to white is 1.1201. Blacks are more likely than whites and Asians to have blood loss >1000 ml (p = .019). An ethnic minority, a lower education level, the older age groups, those with a lower income and with non-professional careers are linked to a lower level of knowledge about EP. Ethnic minority communities have a higher risk of adverse clinical outcomes.Impact Statement What is already known on this subject? Research has identified demographic and social factors which prove that victims of health inequalities are usually the poor and the marginalised. What the results of this study add? To-date, our study is the only one to establish that the level of knowledge about ectopic pregnancy (EP) is influenced by demographic and socioeconomic factors and that lower levels of knowledge are significantly associated with adverse clinical outcomes. Our findings show that ethnic minority women are more likely to suffer morbidity from EP than their Caucasian counterparts. We have also established that women of poorer backgrounds, women with lesser levels of education and in non-professional jobs are least likely to be aware of signs and symptoms and consequences of EP. What the implications are of these findings for clinical practice and/or further research? The health service has a responsibility to identify these populations and target them for interventions to correct these health inequalities. We propose a multifaceted plan to increase the level of knowledge of these identified sections of the local community

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research