RACIAL/ETHNIC DIFFERENCES IN CARDIOVASCULAR OUTCOMES IN A UNIVERSAL HEALTHCARE SYSTEM: INSIGHTS FROM THE CARTAGENE COHORT

2021 ◽  
Vol 37 (10) ◽  
pp. S23-S24
Author(s):  
M d'Entremont ◽  
M Nguyen ◽  
E Couture ◽  
J Ni ◽  
A Yan ◽  
...  
Keyword(s):  
Healthcare System ◽  
Ethnic Differences ◽  
Cardiovascular Outcomes ◽  
Universal Healthcare ◽  
Universal Healthcare System ◽  
Racial Ethnic

scholarly journals Racial/ethnic differences in cardiovascular outcomes in a universal healthcare system: insights from the CARTaGENE cohort

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M D'Entremont ◽  
E L Couture ◽  
M Nguyen ◽  
J Ni ◽  
A Yan ◽  
...  
Keyword(s):  
Health Care ◽  
Ethnic Differences ◽  
Cardiovascular Outcomes ◽  
Universal Health Care ◽  
Universal Healthcare ◽  
Single Payer ◽  
Racial Ethnic ◽  
Universal Health

Abstract Background While prior studies have shown racial/ethnic differences in cardiovascular (CV) outcomes within private or mixed health care systems, it remains uncertain whether inequalities in cardiovascular outcomes exist between different races and ethnicities in universal health care contexts. We aimed to determine whether there are racial/ethnicity disparities in long-term CV outcomes within a single-payer universal health care system. Methods The CARTaGENE study is a population-based prospective cohort study with enrollment of 19,996 individuals between 40–69 years in 2009, in the province of Quebec, Canada. Participants residing in four large metropolitan areas were randomly chosen from the provincial health insurance registry by strata of age, sex, and postal codes. Follow-up was available up to 2016. For this analysis, we retained only participants without prior known CV disease. The primary composite endpoint was time to the first CV event or intervention (CV death, acute coronary syndrome, heart failure, coronary revascularization, ischemic stroke, or peripheral vascular event or revascularization). We used unadjusted and adjusted Cox proportional hazard models to evaluate the association of self-defined race/ethnicity with the primary endpoint. Results There were 17,802 eligible participants with a mean age of 51 years (52.5% females) with 111,312 person-years of follow-up (median follow-up of 6.6 years). South Asian (SA) participants had the highest prevalence of diabetes mellitus (29%) and hypertension (32%). After adjustment for age and sex, SA ethnicity was associated with a 95% relative increase in risk for CV events, while East/Southeast Asian (ESA) ethnicity was associated with a 42% relative decrease in risk for CV events compared to White participants. After further adjustment for socioeconomic status and CV risk factors, ESA ethnicity remained associated with a similar decreased CV risk. In contrast, the association of SA ethnicity with increased CV risk was attenuated after full adjustment for baseline characteristics (Table 1). Conclusions Racial/ethnic disparities in long-term CV outcomes are present in a single-payer universal healthcare setting. ESA ethnicity was associated with a lower risk of long-term CV outcomes. Future studies are needed to corroborate the reduced risk of long-term major CV events associated with ESA ethnicity. Understanding the reasons related to potential CV protection with ESA ethnicity could facilitate endeavors to reduce long-term CV outcomes in other races/ethnicities. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): McGill Health University Center

scholarly journals Molecular Sovereignty: Building a Blood Screening Test for the Brazilian Nation

2021 ◽  
Vol 8 (2) ◽  
pp. 1-25
Author(s):  
Koichi Kameda
Keyword(s):  
Healthcare System ◽  
Transition To Democracy ◽  
Universal Healthcare ◽  
National Imaginary ◽  
Constitutional Right ◽  
National Boundaries ◽  
Acid Test ◽  
Diagnostic Technologies ◽  
Universal Healthcare System ◽  
Blood Screening

This article interrogates the relationship between the development of national diagnostic technologies and the exercise of sovereignty, by analysing a Brazilian project to produce a nucleic acid test (NAT) for the country’s blood screening programme. The concept of ‘molecular sovereignty’ is proposed to demonstrate that exercising sovereignty demands not only technological resources but also a sufficiently powerful and national imaginary to support local knowledge production as a means of advancing national healthcare priorities. First, this research article contextualises the political importance of blood safety for Brazil during its transition to democracy in the 1980s and the creation of its universal healthcare system. Then, it investigates how adopting the NAT led the state to invest in the production of a national technology. Third, the article unpacks the diagnostic test to consider how certain aspects of the project might ultimately strengthen the ability of global capital to cross national boundaries and create new markets. Lastly, it discusses how the project ended up creating a centralised and ‘closed’ system to avoid leaving the country vulnerable to the entry of global diagnostic companies. This case demonstrates how the molecularisation of blood, through the construction of a unified healthcare system driven by the constitutional right to health, can be deployed to construct imagined communities on the scale of a nation.

Evaluation of disparity in care for perforated appendicitis in a universal healthcare system

2019 ◽  
Vol 36 (2) ◽  
pp. 219-225 ◽  
Author(s):  
Laura M. Fluke ◽  
Christian S. McEvoy ◽  
Anne H. Peruski ◽  
Christina A. Shibley ◽  
Brian T. Adams ◽  
...  
Keyword(s):  
Healthcare System ◽  
Perforated Appendicitis ◽  
Universal Healthcare ◽  
Universal Healthcare System

scholarly journals Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

2020 ◽  
Vol 7 (5) ◽  
pp. 3095-3108
Author(s):  
Inge Schjødt ◽  
Søren P. Johnsen ◽  
Anna Strömberg ◽  
Jan B. Valentin ◽  
Brian B. Løgstrup
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Healthcare System ◽  
Population Based ◽  
Heart Failure Care ◽  
Universal Healthcare ◽  
System A ◽  
Universal Healthcare System

Racial/Ethnic Differences in Influenza Vaccination in the Veterans Affairs Healthcare System

2006 ◽  
Vol 31 (5) ◽  
pp. 375-382 ◽  
Author(s):  
Kristy A. Straits-Tröster ◽  
Leila C. Kahwati ◽  
Linda S. Kinsinger ◽  
Jean Orelien ◽  
Mary B. Burdick ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Healthcare System ◽  
Ethnic Differences ◽  
Veterans Affairs ◽  
Racial Ethnic

scholarly journals Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

2016 ◽  
Vol 17 (2) ◽  
pp. 222-229 ◽  
Author(s):  
Christopher J. Coroneos ◽  
Sophocles H. Voineskos ◽  
Marie K. Coroneos ◽  
Noor Alolabi ◽  
Serge R. Goekjian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Brachial Plexus ◽  
Healthcare System ◽  
Quality Indicators ◽  
Brachial Plexus Injury ◽  
Shoulder Dystocia ◽  
Publicly Funded ◽  
Universal Healthcare ◽  
Universal Healthcare System

OBJECT The aim of this study was to determine the volume and timing of referrals for obstetrical brachial plexus injury (OBPI) to multidisciplinary centers in a national demographic sample. Secondarily, we aimed to measure the incidence and risk factors for OBPI in the sample. The burden of OBPI has not been investigated in a publicly funded system, and the timing and volume of referrals to multidisciplinary centers are unknown. The incidence and risk factors for OBPI have not been established in Canada. METHODS This is a retrospective cohort study. The authors used a demographic sample of all infants born in Canada, capturing all children born in a publicly funded, universal healthcare system. OBPI diagnoses and corresponding risk factors from 2004 to 2012 were identified and correlated with referrals to Canada’s 10 multidisciplinary OBPI centers. Quality indicators were approved by the Canadian OBPI Working Group’s guideline consensus group. The primary outcome was the timing of initial assessment at a multidisciplinary center, “good” if assessed by the time the patient was 1 month of age, “satisfactory” if by 3 months of age, and “poor” if thereafter. Joinpoint regression analysis was used to determine the OBPI incidence over the study period. Odds ratios were calculated to determine the strength of association for risk factors. RESULTS OBPI incidence was 1.24 per 1000 live births, and was consistent from 2004 to 2012. Potential biases underestimate the level of injury identification. The factors associated with a very strong risk for OBPI were humerus fracture, shoulder dystocia, and clavicle fracture. The majority (55%–60%) of OBPI patients identified at birth were not referred. Among those who were referred, the timing of assessment was “good” in 28%, “satisfactory” in 66%, and “poor” in 34%. CONCLUSIONS Shoulder dystocia was the strongest modifiable risk factor for OBPI. Most children with OBPI were not referred to multidisciplinary care. Of those who were referred, 72% were assessed later than the target quality indicator of 1 month that was established by the national guideline consensus group. A referral gap has been identified using quality indicators at clinically relevant time points; this gap should be addressed with the use of knowledge tools (e.g., a clinical practice guideline) to target variations in referral rates and clinical practice. Interventions should guide the referral process.

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