Unobserved Heterogeneity of Frailty in the Analysis of Socioeconomic Differences in Health and Mortality

Zarulli, Virginia

doi:10.1007/s10680-015-9361-1

Cited by 20 publications

(7 citation statements)

References 105 publications

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“…These studies focused on regional differences, or changes in health levels, and found significant associations between regional differences in health levels, particularly in regional mortality. Many studies have shown that socio-economic factors, rather than natural environment, play an important role in contributing to regional differences in mortality (6,8,(12)(13)(14)(15)(16). Their findings empirically proved the influence of medical resource on individual health level.…”

Section: Literature Reviewmentioning

confidence: 98%

Regional Disparity of Medical Resources and Its Effect on Mortality Rates in China

Chai

Zhang

Chang

2020

Front. Public Health

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The purpose of this study was twofold. First, to empirically study the effects that medical resources (i.e., hospital, doctors, beds) have on the mortality rate in China. Second, to divide China into east, middle, and west regions, and empirically study the regional disparity of medical resources and its effect on mortality rates in China. Methodology and Data: This study utilized a panel data regression model to explore the effect medical resources have on the age-standardized mortality rate in China. The data came from the 2003-2017 China Statistical Yearbook compiled by the National Bureau of Statistics of China. Results: Nationwide, hospitals, doctors, and beds had a significant negative correlation with the mortality rate. In the western region, hospitals, beds, and doctors had a significant negative correlation with the mortality rate. In China's middle and eastern regions, hospitals, beds, and doctors had no significant effect on the mortality rate. In China, increased hospitals, doctors, and beds significantly reduced the mortality rate. The distribution of medical resources in eastern, middle, and western China was unequal. More hospitals, beds, and doctors in the less developed western regions can more effectively alleviate the local mortality rate. In the middle and east regions, hospitals, beds, and doctors had no significant impact on the local mortality rate. Conclusion: First, China's overall medical resources are still inadequate and improving medical resources throughout the country could reduce the mortality rate. Second, due to the imbalanced distribution of medical resources in China, the Chinese government should implement more supportive policies for medical resources in the western region. At the same time, we should also actively develop the western region by improving local per capita GDP and reducing unemployment, so as to fundamentally reduce the local mortality rate.

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Section: Literature Reviewmentioning

confidence: 98%

Regional Disparity of Medical Resources and Its Effect on Mortality Rates in China

Chai

Zhang

Chang

2020

Front. Public Health

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“…Some frailty measures, such as the Frailty Index from the Canadian Study of Health and Aging take into account factors such as comorbidity, whereas others, such as the Edmonton Frail Scale do not [12,14]. Finally, another contributing factor is the heterogeneity among frail patients [31,32]. Even published studies on frailty often identify frailty without objective measures [16].…”

Section: Discussionmentioning

confidence: 99%

Variability in clinicians’ understanding and reported methods of identifying high-risk surgical patients: a qualitative study

Selwood

Blakely

Senthuran

et al. 2020

BMC Health Serv Res

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Background: High-risk patients presenting for surgery require complex decision-making and perioperative management. However, given there is no gold standard for identifying high-risk patients, doing so may be challenging for clinicians in practice. Before a gold standard can be established, the state of current practice must be determined. This study aimed to understand how working clinicians define and identify high-risk surgical patients. Methods: Clinicians involved in the care of high-risk surgical patients at a public hospital in regional Australia were interviewed as part of an ongoing study evaluating a new shared decision-making process for high-risk patients. The new process, Patient-Centred Advanced Care Planning (PC-ACP) engages patients, families, and clinicians from all relevant specialties in shared decision-making in line with the patient's goals and values. The semi-structured interviews were conducted before the implementation of the new process and were coded using a modified form of the 'constant comparative method' to reveal key themes. Themes concerning patient risk, clinician's understanding of high risk, and methods for identifying high-risk surgical patients were extricated for close examination. Results: Thirteen staff involved in high-risk surgery at the hospital at which PC-ACP was to be implemented were interviewed. Analysis revealed six sub-themes within the major theme of factors related to patient risk: (1) increase in high-risk patients, (2) recognising frailty, (3) risk-benefit balance, (4) suitability and readiness for surgery, (5) avoiding negative outcomes, and (6) methods in use for identifying high-risk patients. There was considerable variability in clinicians' methods of identifying high-risk patients and regarding their definition of high risk. This variability occurred even among clinicians within the same disciplines and specialties. Conclusions: Although clinicians were confident in their own ability to identify high-risk patients, they acknowledged limitations in recognising frail, high-risk patients and predicting and articulating possible outcomes when consenting these patients. Importantly, little consistency in clinicians' reported methods for identifying high-risk patients was found. Consensus regarding the definition of high-risk surgical patients is necessary to ensure rigorous decision-making.

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“…In an environment where mortality forces are harsher for one subpopulation than another, the frailer members of the disadvantaged subpopulation will die earlier and in greater numbers than those from the more advantaged subpopulation. The resulting old-age population composition of each of the two subpopulations will differ such that the disadvantaged subgroup will be homogenously robust and the advantaged subgroup will be heterogeneously frail, resulting in the mortality crossover (Vaupel et al 1979;Lynch et al 2003;Zarulli 2016).…”

Section: The Selection Hypothesismentioning

confidence: 99%

Race Crossover in Longevity

Arias

2019

Encyclopedia of Gerontology and Population Aging

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Unobserved Heterogeneity of Frailty in the Analysis of Socioeconomic Differences in Health and Mortality

Cited by 20 publications

References 105 publications

Regional Disparity of Medical Resources and Its Effect on Mortality Rates in China

Regional Disparity of Medical Resources and Its Effect on Mortality Rates in China

Variability in clinicians’ understanding and reported methods of identifying high-risk surgical patients: a qualitative study

Race Crossover in Longevity

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