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Systematic review: An approach to identifying health inequalities through case studies
Revisión sistemática: un enfoque para identificar desigualdades en salud a través de estudios de casos
Palabras clave:
Health Equity, Healthcare Disparities, Case reports (en)equidad en salud, Disparidades en Atención de Salud, Reportes de caso. (es)
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Introduction: Health inequalities, among other factors, reflect the wellbeing level of a population. Interventions aimed at eliminating or preventing such inequalities require an understanding of their origins.
Objective: To perform a systematic review to identify case studies reporting health inequalities worldwide.
Methodology: Case reports, case studies and case series written in English, Spanish and Portuguese reporting health inequalities were included. Databases like Medline and EMBASE, and grey literature sources such as LILACS, OpenGrey, Google, and others were included.
Results: Initially, the search produced 1272 articles. 139 articles were selected by their title, while, based on their abstract, 28 articles were chosen for full text reading. Finally, 23 articles were included. Gender difference was the most frequent factor in terms of health inequalities (23.2%), followed by socio economic condition (20%), belonging to a migrant population (13.3%), ethnic origin (13.3%), age (10%), geographic origin (3.3%), and others (16.6%).
Discussion: This approach, which is based on reviewing case reports to study health inequalities, contrasts with the majority of the studies carried out in this field. This research proposes to study inequalities specific to population groups that suffer such inequalities within communities in a particular geographic area and are not able to access to optimal health services.
Introducción: las desigualdades en salud, entre otros factores, reflejan el nivel de bienestar de una población. Para realizar intervenciones dirigidas a eliminar o prevenir estas desigualdades es necesario comprender su origen.
Objetivo: realizar una revisión sistemática para identificar estudios de casos en los que se reportan desigualdades en salud en todo el mundo.
Metodología: en este estudio se incluyeron reportes de caso, estudios de casos y series de casos, escritos en inglés, español y portugués, en los que se informan desigualdades en salud. Se utilizaron bases de datos como Medline y EMBASE, así como fuentes de literatura gris como LILACS, OpenGrey, Google, entre otras.
Resultados: la búsqueda inicial arrojó 1272 artículos; de los cuales se seleccionaron 139 por su título; luego, basándose en su resumen, se escogieron 28 para realizar una lectura completa. Finalmente se incluyeron 23 artículos. En términos de inequidad en salud, la diferencia de género fue el factor más frecuente (23.2%), seguido por condición socioeconómica (20%), pertenecer a una población migrante (13.3%), origen étnico (13.3%), edad (10%), origen geográfico (3.3%) y otros (16,6%).
Discusión: este enfoque, que se basa en la revisión de reportes de caso para estudiar las desigualdades en salud, contrasta con la mayoría de estudios que se han realizado al respecto. En esta investigación se propone analizar las desigualdades en salud que son específicas a poblaciones que viven dentro de comunidades en un área geográfica en particular y que no tienen acceso a servicios óptimos de salud.
Referencias
Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429-45. http://doi.org/fwhz5n
Aday LA, Fleming GV, Anderson RM. An overview of current access issues. In: Access to Medical Care in the U.S.: Who Have It, Who Don’t. 1:1–18. Chicago: Pluribus Press/University of Chicago; 1984. p. 229.
Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167-94. http://doi.org/dv6m6f
Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ. 2002 [cited 2016 Aug 24];80(2):97-105. Available from: http://goo.gl/GTNmTn
Angell M. Privilege and health -- What is the connection? N Engl J Med. 1993;329(2):126-7. http://doi.org/b6bjwz
Dachs JN, Ferrer M, Florez CE, Barros AJ, Narváez R, Valdivia M. Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries. Rev Panam Salud Publica. 2002;11(5-6):335-55. http://doi.org/bqh365
Ruiz-Gómez F, Zapata-Jaramillo T, Garavito-Beltrán L.. Colombian health care system: results on equity for five health dimensions, 2003-2008. Rev Panam Salud Publica. 2013;33(2):107-15. http://doi.org/bpq4
Soberón Acevedo G, Narro J. Equidad y atención de salud en América Latina. Principios y dilemas. Bol Oficina Sanit Panam. 1985;99(1):1-9.
Hattersley L. Trends in life expectancy by social class: an update. Health Statistics Quarterly. 1999;(2):17-24.
van Doorslaer E, Masseria C, Koolman X, OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. CMAJ. 2006 Jan 17;174(2):177-83. http://doi.org/bn8r3f
Cardona D, Acosta LD, Bertone CL. Inequidades en salud entre países de Latinoamérica y el Caribe (2005-2010). Gac Sanit. 2013;27(4):292-7. http://doi.org/f2f6t3
Jackson SF, Birn AE, Fawcett SB, Poland B, Schultz JA. Synergy for health equity: integrating health promotion and social determinants of health approaches in and beyond the Americas. Rev Panam Salud Publica. 2013 [Cited 2016 Aug 24];34(6):473-80. Available from: http://goo.gl/LZ681M
Marmot M, Bobak M, Smith GD. Explanations for social inequalities in health. In: Amick III BC, Levine S, Tarlov AR, Chapman D, Coord. Society & Health. Nueva York: Oxford University Press; 1995. 070 p.
Murray CJL, Michaud CM, McKenna MT, Marks JS. U.S. Patterns of Mortality by County and Race: 1965-1994. Cambridge: Harvard Burden of Disease Unit, Harvard Center for Population and Development Studies; Atlanta: National Center for Chronic Disease Prevention and Health Promotion, CDC; 1998.
Kmietowicz Z. Gap between classes in life expectancy is widening. BMJ. 2003;327(7406):68. http://doi.org/bktfpg
Tudor Hart J. The Inverse Care Law. Lancet. 1971;207(7696):405-412. http://doi.org/fwq2sv
Romaní-Romaní F. Reporte de caso y serie de casos: una aproximación para el pregrado. CIMEL. 2010 [Cited 2016 Aug 24];15(1):46-51. Available from: http://www.goo.gl/x8zlOV
Sen A. ¿Por qué la equidad en salud?. Rev Panam Salud Publica. 2002;11(5-6):302-9. http://doi.org/dbdrnx
Khalid M, editor. Human Development Report 2014. Sustaining Human Progress: Reducing Vulnerabilities and Building Resilience. New York: United Nations Development Programme; 2014.
Starfield B. The hidden inequity in health care. Int J Equity Health. 2011;10:15. http://doi.org/fgq68w
Braveman P. Monitoring equity in health: a policy-oriented approach in low-and middle-income countries. Geneva: World Health Organization; 1998 [Cited 2016 Aug 24]. Available from: http://goo.gl/FQ84sP
Eslava-Schmalbach J, Alfonso H, Oliveros H, Gaitan H, Agudelo C. A new Inequity-in-Health Index based on Millenium Development Goals: methodology and validation. J Clin Epidemiol. 2008;61(2):142-50. http://doi.org/cwg8v3
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9. http://doi.org/bpq5
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10. http://doi.org/dcqvfj
Chatty D, Mansour N, Yassin N. Bedouin in Lebanon: Social discrimination, political exclusion, and compromised health care. Soc Sci Med. 2013; 82:43-50. http://doi.org/bpsq
Abadia CE, Oviedo DG. Bureaucratic Itineraries in Colombia. A theoretical and methodological tool to assess managed-care health care systems. Soc Sci Med. 2009; 68(6):1153-60. http://doi.org/cgvgdc
Brimacombe MB, Heller DS, Zamudio S. Comparison of fetal demise case series drawn from socioeconomically distinct counties in New Jersey. Fetal Pediatr Pathol. 2007;26(5-6):213-22. http://doi.org/cv8373
Yang JS. Contextualizing immigrant access to health resources. J Immigr Minor Health. 2010;12(3):340-53. http://doi.org/cj8x2p
Sypek S, Clugston G, Phillips C. Critical health infrastructure for refugee resettlement in rural Australia: case study of four rural towns. Aust J Rural Health. 2008;16(6):349-54. http://doi.org/dqrfh8
Karam-Calderón MA, Bustamante-Montes P, Campuzano-González M, Camarena Pliego A. Aspectos sociales de la mortalidad materna. Estudio de caso en el Estado de México. Medicina Social. 2007 [cited 2016 Aug 24]; 2(4):205-11. Available from: http://goo.gl/MGEG1R
Bogenschutz M. “We Find a Way”: Challenges and facilitators for health care access among immigrants and refugees with intellectual and developmental disabilities. Med Care. 2014;52(10 Suppl 3):S64-70. http://doi.org/bpsr
Källander K, Hildenwall H, Waiswa P, Galwango E, Peterson S, Pariyo G. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ. 2008;86(5):332-8. http://doi.org/dh88xd
Hacker J, Stanistreet D. Equity in waiting times for two surgical specialties: a case study at a hospital in the North West of England. J Public Health (Oxf). 2004;26(1):56-60. http://doi.org/bckjqv
Harrington BE, Smith KE, Hunter DJ, Marks L, Blackman TJ, McKee L, et al. Health inequalities in England, Scotland and Wales: stakeholders´ accounts and policy compared. Public Health. 2009;123 (1):24-8. http://doi.org/bg844z
Furler J, Harris E, Harris M, Naccarella L, Young D, Snowdon T. Health inequalities, physician citizens and professional medical associations: an Australian case study. BMC Med. 2007;5:23. http://doi.org/fh2trs
Oosterhoff P, Anh NT, Yen PN, Wright P, Hardon A. HIV-positive mothers in Viet Nam: using their status to build support groups and access essential services. Reprod Health Matters. 2008;16(32):162-70. http://doi.org/dt4k8d
Campbell J, Buchan J, Cometto G, David B, Dussault G, Fogstad H, et al. Human resources for health and universal health coverage: fostering equity and effective coverage. Bull World Health Organ. 2013;91: 853-63. http://doi.org/bptc
Mumtaz Z, Salway S, Shanner L, Bhatti A, Laing L. Maternal deaths in Pakistan: intersection of gender, caste and social exclusion. BMC Int Health Hum Rights. 2011;11(Suppl 2):S4. http://doi.org/dxpm5d
El Arifeen S, Hill K, Ahsan KZ, Jamil K, Nahar Q, Streatfield PK. Maternal mortality in Bangladesh: a Countdown to 2015 country case study. Lancet. 2014;384(9951):1366-74. http://doi.org/f2vkct
Crawley J, Kane D, Atkinson-Plato L, Hamilton M, Dobson K, Watson J. Needs of the hidden homeless -No longer hidden: a pilot study. Public Health. 2013;127(7):674-80. http://doi.org/bptd
Zoidze A, Rukhazde N, Chkhatarashvili K, Gotsadze G. Promoting universal financial protection: health insurance for the poor in Georgia - a case study. Health Res Policy Syst. 2013;11:45. http://doi.org/bptj
Mumtaz Z, Levay A , Bhatti A, Salway S. Signalling, status and inequities in maternal healthcare use in Punjab, Pakistan. Soc Sci Med. 2013;94:98-105. http://doi.org/bptk
Harper-Bulman K; McCourt C. Somali refugee women’s experiences of maternity care in west London: a case study. Critical Public Health. 2002;12(4):365-80. http://doi.org/d47mcp
Feng Y, Xiong X, Xue Q, Yao L, Luo F, Xiang L. The impact of medical insurance policies on the hospitalization services utilization of people with schizophrenia: A case study in Changsha, China. Pak J Med Sci. 2013;29(3):793-8. http://doi.org/bptm
van Beurden E, Lefevbre C, James R. Transferring community-based interventions to new settings: a case study in heart health cholesterol testing from urban USA to rural Australia. Health Promotion International. 1991;6(3):181-90. http://doi.org/dtnqzv
Türkkan A, Aytekin H. Socioeconomic and health inequality in two regions of Turkey. J Community Health. 2009;34(4):346-52. http://doi.org/dmfk9w
de Andrade LO, Pellegrini Filho A, Solar O, Rígoli F, de Salazar LM, Serrate PC, et al. Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. Universal health coverage in Latin America. Lancet. 2015;385(9975):1343-51. http://doi.org/f265fw
De Brouwere V, Richard F, Witter S. Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn. Trop Med Int Health. 2010;15(8):901-9. http://doi.org/djfwf7
Padhi BK, Padhy PK, Jain VK. Impact of indoor air pollution on maternal and child health: A case study in India. Epidemiology. 2011;22(1):s118. http://doi.org/d9dh8c
Stolt R, Winblad U. Mechanisms behind privatization: a case study of private growth in Swedish elderly care. Soc Sci Med. 2009;68(5):903-11. http://doi.org/btvrqs
Maberley D, Hollands H, Chang A, Adilman S, Chakraborti B, Kliever G. The prevalence of low vision and blindness in a Canadian inner city. Eye (Lond). 2007;21(4):528-33. http://doi.org/d76brr
Carmichael A, Williams HE. Use of health care services for an infant population in a poor socio-economic status, multi-ethnic municipality in Melbourne. Aust. Paediatr. J. 1983;19(4):225-9. http://doi.org/d2mrr4
Bernal R, Cárdenas M. Race and Ethnic Inequality in Health and Health Care in Colombia. Bogotá: Fedesarrollo; 2005 [Cited 2016 Aug 24]. Available from: http://goo.gl/EYf1jC
Teerawichitchainan B, Phillips JF. Ethnic differentials in parental health seeking for childhood illness in Vietnam. Soc Sci Med. 2008;66(5):1118-30. http://doi.org/bch8gf
Macleod MR, Andrews PJ. Effect of deprivation and gender on the incidence and management of acute brain disorders. Intensive Care Med. 2002;28(12):1729-34. http://doi.org/cvrf9d
Eslava-Schmalbach JH, Rincón CJ, Guarnizo-Herreño CC. 'Inequidad' de la expectativa de vida al nacer por sexo y 'departamentos' de Colombia. Biomedica. 2013;33(3):383-92. http://doi.org/bptn
Sandoval-Vargas YG, Eslava-Schmalbach JH. Inequidades en mortalidad materna por departamentos en Colombia para los años (2000-2001), (2005-2006) y (2008-2009). Rev Salud Publica (Bogota). 2013 [cited 2016 Aug 24];15(4):529-41. Available from: http://goo.gl/o9UogY
Pinilla A, Cano N, Granados C, Páez-Canro C, Eslava-Schmalbach J. Inequalities in prescription of hydrochlorothiazide for diabetic hypertensive patients in Colombia. Rev Salud Publica (Bogota). 2011 [cited 2016 Aug 24];13(1):27-40. Available from: http://goo.gl/tmWiXg
Herrera Gómez PJ, Medina PA. Los problemas de la analgesia obstétrica. Rev. colomb. anestesiol. 2014;42(1):37-9. http://doi.org/f2n8tk
Duarte Ortiz G, Navarro-Vargas JR, Eslava-Schmalbach J. Inequidad en el sistema de salud: el panorama de la analgesia obstétrica. Rev colomb. anestesiol. 2013;41(03):215-7. http://doi.org/f2hmz5
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