RESUMEN
OBJECTIVES: Although there is well-established evidence for the existence of socio-economic inequalities in virtually all dimensions of health, little is known about the implications of these socio-economic disparities for healthcare costs from a cumulative life course perspective. Accounting for differentials in healthcare use patterns and mortality, we assess how lifetime costs differ between socio-economic groups. STUDY DESIGN: This study used dynamic microsimulation modelling. METHODS: Combining price weights for healthcare services with information on healthcare consumption from the 2014 Austrian Health Interview Survey (n = 15,771), we calculated average cost profiles by gender, age and education consistent with aggregate System of Health Accounts. A dynamic microsimulation model was used to project cumulative healthcare costs over the entire lifecycle for the 2019 birth cohort in four different scenarios to illustrate the influence of the different cost determinants on lifetime costs. RESULTS: Before considering social inequalities in mortality, men with compulsory education have close to 66% higher lifetime costs than men with tertiary education; for women, the difference is close to 20%. Accounting for longevity differentials reduces this gap to approximately 40% for men and 10% for women. Closing the gap in healthcare use and in longevity between socio-economic groups would reduce lifetime healthcare expenditure by 4.1% in the 2019 birth cohort and by 19% in the whole population. CONCLUSIONS: Accounting for mortality differentials between socio-economic groups has a large impact on estimated lifetime healthcare costs. Reducing social inequalities in health can contribute to containing healthcare expenditures against the backdrop of rising life expectancy.
Asunto(s)
Costos de la Atención en Salud , Acontecimientos que Cambian la Vida , Masculino , Humanos , Femenino , Factores Socioeconómicos , Escolaridad , Gastos en SaludRESUMEN
This study reports the toxicity of sediments from rivers and canals collected at two six-month intervals from 19 sampling points of the province of Naples in Southern Italy. The toxicity of the pore-water from sediments was determined with a battery composed of different freshwater microbiotests. The toxicity varied substantially from station to station, but none of the Toxkit tests was either the most or the least sensitive for all stations. Chemical analyses were accomplished on some heavy metals. Furthermore, the in situ biological communities of macroinvertebrates were assessed. Most of tested sediments were found to be very toxic for several if not all the microbiotests as well as the biological communities (EBI). Comparison between toxicological data and heavy metals revealed a positive correlation for zinc and copper. This study confirms that only an integrated approach is suitable for the evaluation of contaminated sediments and that single parameters are not always able to define a situation of environmental deterioration.