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An ecological study of publicly funded elective hip arthroplasties in Brazil and Scotland: do access inequalities reinforce the inverse care law?
Filippon, Jonathan; Bremner, Stephen; Giovanella, Ligia; Pollock, Allyson.
Afiliação
  • Filippon J; Institute of Population Health Sciences, Queen Mary University of London, London E1 2AB, UK.
  • Bremner S; Brighton and Sussex Medical School, Brighton BN1 9PX, UK.
  • Giovanella L; National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21031-210, Brazil.
  • Pollock A; Institute of Population Health Sciences, Centre for Regulatory Sciences, Newcastle University, Newcastle NE1 7RU, UK.
JRSM Open ; 11(5): 2054270420920772, 2020 May.
Article em En | MEDLINE | ID: mdl-32523706
OBJECTIVES: To compare elective hip arthroplasty rates funded by the public sector in Brazil and Scotland. DESIGN: Ecological study, 2009-13, of crude and directly standardised rates of elective primary hip arthroplasty rates (per 100,000) funded by the public sector at national and regional level for age (30 + years) and gender in Brazil and Scotland. SETTING: National Health Service Scotland and Unified Health System in Brazil. PARTICIPANTS: Over 30 s who had undergone an elective hip arthroplasty funded by the public sector. MAIN OUTCOME MEASURES: Publicly funded standardised elective hip arthroplasty rates in Brazil and Scotland. RESULTS: Between 2009 and 2013, there was a seven-fold difference in treatment rates between Brazil and Scotland, and an eight-fold regional difference in Brazil; Brazil (7.8-8.3/100,000, increase of 0.5 per 100,000, 95% confidence interval (CI) (0.3, 0.7) from 2009/10 to 2012/13) and Scotland (from 61.1 to 57.7/100,000, decrease of 3.4 per 100,000, 95% confidence interval (1.4, 5.8) per 100,000); a two-fold difference in number of public beds per head of population (Brazil 158.3/100,000 vs. Scotland 305.1/100,000) and general medical workforce (Brazil 198.8/100,000 vs. Scotland 327.4/100,000); numbers of orthopaedic surgeons per head of population in the two countries were similar in 2013 (Brazil 5.2/100,000 vs. Scotland 4.3/100,000). CONCLUSION: Although the 'inverse care law' is seen in both countries, access to publicly funded hip arthroplasties in Brazil is worse than in Scotland; the distribution of specialists and higher treatment rates in Brazil is highly skewed towards wealthier areas, perpetuating historical regional inequalities.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Aspecto: Determinantes_sociais_saude / Equity_inequality País/Região como assunto: America do sul / Brasil Idioma: En Revista: JRSM Open Ano de publicação: 2020 Tipo de documento: Article País de publicação: Reino Unido
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Aspecto: Determinantes_sociais_saude / Equity_inequality País/Região como assunto: America do sul / Brasil Idioma: En Revista: JRSM Open Ano de publicação: 2020 Tipo de documento: Article País de publicação: Reino Unido