Abstract
Background
During the COVID-19 pandemic, reductions in healthcare utilization are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities in ...access to healthcare in the context of COVID-19.
Methods
To evaluate gender disparities in access to medical in Chile we conducted an interrupted time series analysis using segmented regression. The outcome variable was the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. The series contained data from weeks 1 to 39 for 2017 to 2020. The intervention period started at week 12. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. We estimated the level effect using a dummy variable indicating the intervention period and slope effect using a continuous variable from weeks 12 to 39. To test heterogeneity by gender and age group, we conducted a stratified analysis.
Results
We observed a sizable reduction in access to care with a slowly recovery for oncologic (level effect 0.323; 95% CI 0.291–0.359; slope effect 1.022; 95% CI 1.016–1.028) and cardiovascular diseases (level effect 0.586; 95% CI 0.564–0.609; slope effect 1.009; 95% CI 1.007–1.011). Greater reduction occurred in women compared to men, particularly marked on myocardial infarction (level effect 0.595; 95% CI 0.566–0.627 versus 0.532; 95% CI 0.502–0.564) and colorectal cancer (level effect 0.295; 95% CI 0.248–0.35 versus 0.19; 95% CI 0.159–0.228). Compared to men, a greater absolute reduction was observed in women for oncologic diseases, excluding sex-specific cancer, (1352; 95% CI 743–1961) and cardiovascular diseases (1268; 95% CI 946–1590).
Conclusion
We confirmed a large drop in new diagnoses for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender perspective into the pandemic response.
Chile is one of several countries that recently implemented a fiscal policy to reduce soft drink (SD) intake and obesity. In 2014 the government increased the existing ad-valorem tax on high-sugar SD ...by 5% and decreased by 3% the tax on low-sugar SD, based on a 6.25gr/100 ml sugar threshold. This study aims to evaluate the tax modification passed-on to consumers through prices, and to calculate changes in affordability of SDs. We analysed nationally representative consumer price index data of 41 soft drinks within 6 beverage categories between 2009 and 2016. Price change post-tax implementation was estimated for different categories (carbonates, juices, concentrates, waters and energy-sport drinks), using time-series analyses. In addition, changes in affordability were evaluated by estimating the changes in prices relative to wages. The price of carbonates increased by 5.60% (CI 95% 3.18–8.03%) immediately after the tax was implemented. A sustained increase in the prices of concentrates was observed after the implementation. Unexpectedly, a smaller increase was also seen for the price of bottled water – a category that saw no tax change. There were no effects for juices and energy-sports drinks. There was a reduction in affordability for carbonates, concentrates and waters. Overall, the fiscal policy was effective in increasing prices and there are some signs of reduced affordability. Results varied substantially among categories directly affected by the tax policy. While for carbonates the price increase exceeded the tax change (‘over-shifting’), in other categories subject to a tax cut, a price reduction was expected but the opposite occurred. As the effect of the tax on prices differed between categories, the effects of the tax policy on consumption patterns are likely to be mixed. Our findings underline the need to better understand and anticipate price setting behaviour of firms in response to a tax.
•Chile implemented a tax policy on soft drinks (SD) to promote healthier diets in 2014.•It consists in a 5% tax increase on high-sugar SD and 3% reduction on low-sugar SD.•Using consumer price index data we estimate policy impact on SD price/affordability.•Overall, the policy was effective to increase prices and reduce affordability.•Results varied substantially among SD categories, with some counterintuitive effects.
Respiratory diseases, including influenza and coronaviruses, pose recurrent global threats. This study delves into the respiratory surveillance systems, focusing on the effectiveness of SARI sentinel ...surveillance for total and severe cases incidence estimation. Leveraging data from the COVID-19 pandemic in Chile, we examined 2020-2023 data (a 159-week period) comparing census surveillance results of confirmed cases and hospitalizations, with sentinel surveillance. Our analyses revealed a consistent underestimation of total cases and an overestimation of severe cases of sentinel surveillance. To address these limitations, we introduce a nowcasting model, improving the precision and accuracy of incidence estimates. Furthermore, the integration of genomic surveillance data significantly enhances model predictions. While our findings are primarily focused on COVID-19, they have implications for respiratory virus surveillance and early detection of respiratory epidemics. The nowcasting model offers real-time insights into an outbreak for public health decision-making, using the same surveillance data that is routinely collected. This approach enhances preparedness for emerging respiratory diseases by the development of practical solutions with applications in public health.
Abstract
While there is a broad literature analysing the effects of migration on health, important knowledge gaps persist particularly on the causal effects of forced displacement on health outcomes. ...We undertake a scoping review of applied epidemiological, statistical and econometric studies examining causal health impacts of forced displacement, which initially identified 1454 studies from the health and social sciences disciplines published up to May 2021. Our study makes two key contributions. First, we offer a comprehensive overview of the evidence generated, methodologies adopted and analytical challenges faced by current research examining the causal relationship between forced displacement and health. Second, we present concrete examples of how key challenges around study design and estimation approaches influence the strength of the evidence-base on the topic, using as a case study the broad domain of reproductive health. We find that, beyond the increased mortality risk that can be attributed to forced displacement, most of the available empirical evidence for a wide range of health outcomes is prone to substantial bias, making it difficult to draw firm conclusions. Our synthesis of credible studies conducted in different settings indicates that current research practice in the field could be strengthened through selection of valid control groups and application of more appropriate causal inference methods. Our findings are useful to promote the generation of further evidence on the topic that can reliably inform the design of policies to protect the health of displaced populations.
Gender plays a well-recognized role in shaping health inequities. However, the population-level health consequences of gender inequalities have not been measured comprehensively. The goal of this ...study was to evaluate the association between gender inequality and health indicators in organization for Economic Co-operation and Development (OECD) countries.
Ecological study based on 1990–2017 panel data for OECD member countries. Gender inequality was measured using the Gender Inequality Index (GII). The population health parameters evaluated were life expectancy (LE), healthy life expectancy (HALE), years of life lost (YLL), years lived with disability (YLD), disability-adjusted life years (DALYs), and specific-cause mortality. Two-way fixed-effects linear models were used to assess the relationship between gender inequality and health outcomes. Models included potential mediating and confounding factors such as health spending, political model, and income inequalities.
Greater gender inequality was associated with lower LE (-0·49%; CI95 -0·63%– -0·31%; p-value < 0·0001), HALE (-0·47%; CI95 -0·63%– -0·31%; p-value < 0·0001) and with increased premature mortality YLL (6·82%; CI95 3·63%–10·75%; p-value < 0·0001) and morbidity measured in DALYs (1·50%; CI95 0·48%–2·46%; p-value = 0·0028) and YLD (2·59%; CI95 0·67%–4·77%; p-value = 0·0063) for each 0·1 increments on the GII. The sensitivity analysis indicated that the results were robust to the various specifications of the causal models.
Our results suggest that gender inequality pose a sizable impact on population health outcomes. Promoting gender equality as part of public policies is vital for optimizing health on a population scale.
Agencia Nacional de Investigación y Desarrollo (ANID)/Programa Becas/Magister Becas Chile/2017- 22,170,332
In April 2016, Chile enacted the Law 20,900, which restricted electoral publicity on public roads. It established two important regulations: first, candidates were allowed, 30 days before any ...election, to publicize their campaigns in specific street locations. Second, roadside publicity must follow strict size standards to avoid visual contamination. This article examines the impact of this regulation in reducing road traffic crashes.
We obtained a number of traffic injuries and fatalities per population from public records. A time-series difference-in-difference study, using generalized linear models with an interaction between time-period and intervention, compared a municipal election period before the introduction of Law 20,900 (2012) to the first municipal election affected by the law (2016). We adjusted for precipitation and temperature, and applied models to three cities: Santiago, Gran-Valparaíso, and Concepción. We assessed the overall impact of the intervention using random effects meta-analyses.
The law was associated with a decrease of 0.01 (95% confidence interval CI: -0.02, -0.00) in Santiago, a decrease of 0.01 (95% CI: -0.03, -0.00) in Valparaíso and an increase of 0.09 (95% CI: 0.06, 0.13) in Concepción, in all daily injuries and fatalities per 100,000 population. After 40 days of its implementation, the intervention was associated with a mild absolute reduction of 34 (95% reduction interval: -270, 67) traffic injuries and fatalities.
This study estimates that the regulation of public road publicity had an overall mild effect on reducing traffic injuries and fatalities in three large cities in Chile.
To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the ...health care system.
We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2.
After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region).
Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.
The problem of estimation and forecasting of population nutritional status has been addressed in the literature, showing successful results when the data are available and frequently collected over ...time. However, most low and middle-income countries collect nutritional status data sparsely, and consequently, the uncertainty/absence of information may negatively affect decisions from policymakers. In this context, the problem of estimation and forecasting of obesity prevalence using sparsely collected cross-sectional data is formally stated and a novel sequential approach to address it is proposed. Specifically, this work describes the nutritional status dynamics using a system of nonlinear difference equations, where the set of transition probabilities are unknown parameters due to the sparsely collected cross-sectional data. Then, an artificial neural network alike model is proposed through its equivalent nonlinear programming model, considering the difference equations system as constraints as well as bounds for the transition probabilities based on literature data. In addition, comprehensive data collection and information analysis processes to compute demographic parameters are defined. As the model is non-convex, an optimal solution is characterized and coined as stable; and thereafter assessed in terms of its goodness-of-fit. Computational experiments and a resolution scheme using a rolling-horizon forecasting/back-casting approach and divergence metrics is proposed. To illustrate the usefulness of this novel approach, Chile is used as a case study. Results show an accuracy up to 90%, forecasting the men and women obese population (BMI ≥ 30.0 kg/m2) for 2024, reaching 30.6% (95% CI: 28.4-32.8%) and 32.6% (95% CI: 29.1-36.0%), respectively.
Display omitted
•The problem of estimation and forecasting the obesity prevalence is addressed.•A novel approach is proposed to handle sparsely collected data using an artificial neural network.•Transition probabilities according to the combination of sex, body mass index and age are computed.•Several computational experiments based on Chilean case are carried out.
In the context of the COVID‐19 pandemic, personal protective measures (e.g., social distancing, handwashing, and mask wearing) have been adopted as a cornerstone to limit the spread of the disease. ...Yet, the effectiveness of these measures depends on people's levels of adherence. In this article, we apply social‐psychological research to the study of compliance with personal protective measures during the COVID‐19 pandemic in Chile. We consider three possible models underlying adherence: (1) sociodemographic and socioeconomic factors, (2) instrumental factors, and (3) normative factors. We draw on data from a longitudinal nonrepresentative panel study (Study 1, n = 32,304) and a cross‐sectional representative survey (Study 2, n = 1,078) to explore the impact of these different factors on personal protective measures compliance. Findings show the strongest support for the role of instrumental and normative factors, in that people who comply with protective measures report to a greater extent that relatives and friends comply too and tend to perceive high risk of COVID‐19. We finish by proposing policy recommendations to promote effective strategies to contain the spread of the virus.
Abstract
This article examines the policy change process that resulted in the current sugar-sweetened beverages taxes in Mexico and Chile, using the Kaleidoscope Model for Policy Change, a framework ...developed for nutrition and food policy change analysis. We used a qualitative study design, including 24 key informant (KI) interviews (16 researchers, 5 civil society representatives and 3 food/beverage industry representatives), encompassing global and in-country perspectives. The analysis shows concurrence with the Kaleidoscope Model, highlighting commonalities in the policy change process. These included the importance of focusing events and coalitions for agenda-setting. Both top-down executive leadership and bottom-up pressure from civil society coalitions were important for the policy adoption as were flexible framing of the tax, and taking advantage of windows of opportunity. In both countries, the tax resulted from national, revenue-seeking fiscal reforms and in sub-optimal tax rates, as a result of the industry influence. KIs also discussed emerging evaluation results, highlighting differences in interpretation concerning the magnitude of change from the tax, and shared potential modifications to the current policies. This analysis contributes to a greater understanding of the policy change process focused on obesity prevention, using an innovative theoretical framework developed specifically for food and nutrition policy.
PDF
