Older adults with disability in extreme poverty in Peru: How is their access to health care?

Abstract

BackgroundDisability rates increase with age. In 2012, Peruvian older adults (≥ 65 years) represented 9% of the population. Additionally, older population reported disabilities at about 5 times the rate of Peruvians between 36 and 64 years old, and 30% of older population lived in poverty. Peruvian seniors living in extreme poverty experience disabilities and the extent of their access to healthcare is unknown.ObjectiveThis study assesses associations between disability and access to healthcare among Peruvians older individuals living in extreme poverty.MethodsSecondary analysis of a national representative population based survey that utilizes information from Peru’s 2012 survey Health and Wellbeing in Older Adults (ESBAM), which includes older adults living in extreme poverty. We define disability in terms of the Activities of Daily Living (ADL disability) framework. Healthcare access was assessed as having any of Peru’s available health insurance schemes combined with preventive health services (vision assessment, influenza vaccination, blood pressure assessment, diabetes screening, and cholesterol assessment). Poisson robust regression models were used to evaluate the associations among relevant variables. Prevalence Ratios and 95% confidence intervals (95%CI) were reported.ResultsData from 3869 individuals (65 to 80 years old), of whom 1760 (45.5%) were females, were analyzed. The prevalence of ADL disability was 17.3% (95%CI: 16.0%-18.4%). In addition, more than 60% had never received any of the preventive measures evaluated, except for the blood pressure assessment. In the adjusted model, people with ADL disability had 63% less probability of having extensive insurance, compared to those without disability (p<0.05).ConclusionsThis study shows that this Peruvian older population living in extreme poverty has limited access to healthcare services. Although there was no consistent association between ADL disability and the healthcare access, there is an urgent need to reduce the inequitable access to healthcare of this poor Peruvian older population.

Multimorbidity analysis and hospitalizations for diabetes before and after lockdown due to the COVID-19 pandemic in Peru

“…We then perform a network analysis to evaluate the frequency of co-occurrence of diagnosis for hospital admissions according to demographic characteristics and before and after the mandatory lockdown in response to the COVID-19 pandemic. To do this, CIE-10 codes from E100 to E149 were grouped just as diabetes, and the dataset was split according to various criteria: whether the hospitalization was before (from January 2017 to March 2020) or after the pandemic lockdown (from March to December 2020), whether the patient lived or died after admission to a hospital, and by sex and age group [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , and 60+ years) of the patient. In each study interest group a network analysis was carried out, in which pairs of diagnoses that were repeated in a frequency greater than 10% of the total records were selected; the most frequent admission codes were chosen in cases in which the number of admission code pairs was greater than 20.…”

“…The demographic variables included sex (male or female) and age (18-39 years / 40-59 years / 60 years or more). We chose these cut-off points to: better characterize early-onset adult type 2 diabetic patients [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , specify the largest group of working people with diabetes [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , and include the definition of an elderly person in Peru (≥ 60) [24] , [25] , [26] , [27] . Clinical characteristics were the presence of other comorbidities of the individual.…”

“…The elderly experience more barriers to access health care during the pandemic due to greater disability, low availability of routine care, limited access to home visits, lower digital literacy and economic dependence [45] . In Peru, adults over the age of 65 who live in poverty have limited access to health care irrespective of their physical capacities, and those who are insured seldom have access to preventive health services [46] . Indeed, insurance does not guarantee access to care due to structural deficiencies of the healthcare system, which has failed to expand its supply of services despite the growing number of individuals with insurance [21] , [47] .…”

Use of rehabilitation services by persons with disabilities in Brazil: A multivariate analysis from Andersen’s behavioral model

“…Health insurance is a facilitating factor for the use of health services [ 1 ], is directly related to socioeconomic level [ 29 ], is an important indicator of access, and in this study, the effect on the greater use of rehabilitation services, considering that the coverage of health insurance implies reducing financial barriers to the use of health services [ 30 ].…”

Sustainable Development Goal 1.2

“…A number of previous health studies have found that poverty affects the accessibility of regular sources of primary care. People of low income cannot receive equal health care in some societies ( Chung et al, 2019 ;Flores-Flores et al, 2018 ;Fujita et al, 2016 ). Affordability is one of the main determinants of healthcare access ( Peters et al, 2008 ).…”