National household data suggest that more than four million women in India have experienced nonspousal rape. Fewer than 1.5% of victims of sexual violence in India report their assaults to police, though there is some indication of increased rape reporting to police following a very high-profile fatal gang rape in Delhi in December 2012. This study examines effects of the Delhi gang rape on rape reporting to police in India, and assesses the roles played by geography, media access, and women’s status and protection factors in that reporting. Triangulated data from Indian crime, census, and police bureau records were used to assess trends in rape reporting to police at national and district levels from 2005 to 2016, using regressions, spatial mapping, and graphical trend analyses. Nationally, there was a 33% increase in annual rapes reported to police after 2012. Subnationally, there was substantial variation in trends; these district-level changes were particularly affected by distance from Delhi (0.2 fewer rapes reported to police/100,000 women for each 100 km from Delhi), literacy sex ratio (0.6 more rapes for every increase of 0.1 in male: female literacy ratio), and the presence of a women’s police station (1.0 fewer rapes reported to police/100,000 women relative to districts with no women’s police station). The 2012 Delhi gang rape significantly affected rape reporting to police in India, with greater increases seen closer to Delhi and in districts with compromised gender equity. Further work to support the rights and safety of women is needed, including bolstering an enabling environment for reporting, legal protections, and responsive criminal justice.
Objective. To characterize hospitals based on patterns of their combined financial and clinical outcomes for heart failure hospitalizations longitudinally. Data Source. Detailed cost and administrative data on hospitalizations for heart failure from 424 hospitals in the 2005-2011 Premier database. Study Design. Using a mixture modeling approach, we identified groups of hospitals with distinct joint trajectories of risk-standardized cost (RSC) per hospitalization and risk-standardized in-hospital mortality rate (RSMR), and assessed hospital characteristics associated with the distinct patterns using multinomial logistic regression. Principal Findings. During 2005-2011, mean hospital RSC decreased from $12,003 to $10,782, while mean hospital RSMR declined from 3.9 to 3.2 percent. We identified five distinct hospital patterns: highest cost and low mortality (3.2 percent of the hospitals), high cost and low mortality (20.4 percent), medium cost and low mortality (34.6 percent), medium cost and high mortality (6.2 percent), and low cost and low mortality (35.6 percent). Longer hospital stay and greater use of intensive care unit and surgical procedures were associated with phenotypes with higher costs or greater mortality. Conclusions. Hospitals vary substantially in the joint longitudinal patterns of cost and mortality, suggesting marked difference in value of care. Understanding determinants of the variation will inform strategies for improving the value of hospital care.
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