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Background: Understanding older people's health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people's health-seeking activities., Objective: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs., Methods: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ≥50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors., Results: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults' well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants' observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype., Conclusions: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults' health seeking. Our findings have implications for the design and implementation of health services and policies., (©Yichi Zhang, Edmund W J Lee, Wei-Peng Teo. Originally published in JMIR Aging (https://aging.jmir.org), 04.05.2023.)

Timely sexual health exams are important healthcare behaviours that contribute to the early detection of cancer and health promotion. Sexual and gender minorities have been shown in past research to be significantly less likely to access healthcare services. Consequently, the current study included participants of diverse sexual and gender identities in order to gain greater insight into their concerns and potential reasons for avoiding healthcare services. The current study asked participants to describe their greatest concerns about visiting the doctor for a sexual health exam. Sexual and gender minorities were more likely to mention their identities as being central to their concerns about visiting the doctor. In contrast, the primary concerns mentioned by non-minority participants were related to their actual health, such as the potential diagnosis of cancer or STIs. The current study presents the self-reported reasons that individuals avoid visiting their doctors for sexual health exams as a function of sexual and gender identity. Through understanding how sexual and gender identity are related to the prevalence of specific concerns related to sexual health exams, it becomes possible to determine areas of improvement for increasing healthcare utilisation among marginalised populations. Implications for minority health and recommendations on improving healthcare support for sexual and gender minorities are discussed. [ABSTRACT FROM PUBLISHER]

Medical residents, as part of their job to balance the demands of their work with caring for themselves so as to be mentally, emotionally, and physically sound to stay clinically competent. While regulatory and legislative attempts at limiting medical resident work hours have materialized but have yet to attain passage, there are fairly little data looking into how residents cope up with their demands and yet attend to their own personal health.Anonymous mailed survey.Three hundred and thirty-seven residents from all internal medicine residency programs within United States.We conducted a survey in the form of a questionnaire that was sent by e-mail to the program directors of various internal medicine residency programs within the United States, and responses were collected between May 19 and June 21, 2009. Response was well appreciated with total number of participants of 337 with even demographical distribution in gender, residency year, AMG/IMG, age group. Seventy-one percent of the residents felt that they would prefer getting admitted to their own hospital for any acute medical or surgical condition. Of the 216 residents who have had received health care in the past, almost half of them chose their own hospital because of the proximity, while 45% did not choose their own hospital despite proximity. Two out of three residents missed their doctors appointments or cancelled them due to demands of medical training. Only half of the residents have a primary care physician and almost 80% of them did not have their yearly health checkup. Close to 30% held back information regarding their social and sexual history from their provider because of privacy and confidentiality concerns. Eighty percent of residents never received information about barriers that physicians may face in obtaining care for their socially embarrassing conditions. Seventy percent felt that their performance then was suboptimal because of that health condition and also felt sick but did not drop the call. Half of the residents had concerns that they might be having a psychiatric illness, but only 5% of them received a formal evaluation at their own hospital and 23 (12.4%) at an outside hospital.It is very important to have more studies to emphasize on resident's physical and mental health and encourage them to have a primary care physician. There are several reasons preventing residents from getting a formal evaluation, confidentiality reasons, lack of time – schedule constraints, fear of being labeled, and social repercussions are few of them. Program directors should encourage the residents to not only care of the health of their patients but also be enthusiastic about their personal health issues for upgraded, revised patient care, and ultimately for their overall well-being.

Rural Healthy People is a companion piece to the federal Healthy People initiative released once a decade to identify the most important Healthy People priorities for rural America, as identified by rural stakeholders, for the current decade. This study reports on the findings of Rural Healthy People 2030. The study relied on a survey of rural health stakeholders collected from July 12, 2021, to February 14, 2022, and: 1) identified the 20 Healthy People priorities most frequently selected as priorities for rural America, 2) studied the priorities that were most frequently selected as a "top 3" priority within each Healthy People 2030 category, and 3) investigated Healthy People 2030 priorities in terms of ranked importance for rural Americans. The analysis finds that for the first time across 3 decades of Rural Healthy People, a greater proportion of respondents selected "Mental Health and Mental Disorders" and "Addiction" as Healthy People priorities for rural America, than did "Health Care Access and Quality". Even still, respondents ranked "Health Care Access and Quality" as the single-most important rural priority. "Economic Stability," a new priority within the Social Determinant of Health category, debuted within the 10 most frequently selected priorities for rural America for the coming decade. As public health practitioners, researchers, and policymakers work toward closing the urban-rural divide, the most important rural priorities to address in the coming decade are mental health and substance use disorders, access to high quality health care services, and social determinants of health, such as economic stability., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Canadian population-based surveys report comparable access to health care services between immigrant and non-immigrant populations, yet other research reports immigrant-specific access barriers. A scoping review was conducted to explore research regarding Canadian immigrants' unique experiences in accessing health care, and was guided by the research question: 'What is currently known about the barriers that adult immigrants face when accessing Canadian health care services?' The findings of this study suggest that there are unmet health care access needs specific to immigrants to Canada. In reviewing research of immigrants' health care experiences, the most common access barriers were found to be language barriers, barriers to information, and cultural differences. These findings, in addition to low cultural competency reported by interviewed health care workers in the reviewed articles, indicate inequities in access to Canadian health care services for immigrant populations. Suggestions for future research and programming are discussed. [ABSTRACT FROM AUTHOR]

In France in 2012, of the total population of 65.2 million, 8.7 % were migrants. After being the third principal host country, France is now the 6th highest host country in the OECD. Since the 1980's numerous Acts have been passed by parliament on immigration issues. In 2000 the Universal Health Cover (Couverture Maladie Universelle) was created as health coverage for all residents of France. At the same time the State Medical Assistance (Aide Médicale de l'Etat) was created as health protection for undocumented migrants. Since the creation of this scheme, it has been the object of many political debates which call it into question, on account of its cost, perceived fraud, and the legitimacy of a social protection for undocumented migrants. Recently, access to State Medical Assistance has been made difficult by introducing conditions of residence and financial contributions. After a reports' analysis on institutional, associative, research studies and European recommendations, we note that all reports converge on the necessity of health protection for undocumented migrants. The major reasons are humanitarian, respect of European and International conventions, for public health, and financial. Moreover, fraud allegations have proved to be unfounded. Finally, State Medical Assistance is underused: in 2014 data from Médecins du Monde shows that only 10.2 % of undocumented migrant patients in their health facilities have access to this scheme. We conclude that the political debate concerning the State Medical Assistance should be about its under-utilisation, its improvement, its merger with the Universal Health Cover, and not its elimination. Moreover, the current debates regarding this scheme stigmatize this population, which is already precarious, making it more difficult for migrants to access healthcare, and generally, weaken national social cohesion. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers residing in the UK face multiple barriers to accessing healthcare. A Health Access Card information resource was launched in Newcastle upon Tyne in 2019 by Newcastle City Council, intended to guide refugees and asylum seekers living in the city, and the professional organisations that support them, to appropriate healthcare services provided locally. The aim of this qualitative evaluation was to explore service user and professional experiences of healthcare access and utilisation in Newcastle and perspectives on the Health Access Card . Eleven semi-structured interviews took place between February 2020 and March 2021. Participants provided diverse and compelling accounts of healthcare experiences and described cultural, financial and institutional barriers to care. Opportunities to improve healthcare access for these population groups included offering more bespoke support, additional language support, delivering training and education to healthcare professionals and reviewing the local support landscape to maximise the impact of collaboration and cross-sector working. Opportunities to improve the Health Access Card were also described, and these included providing translated versions and exploring the possibility of developing an accompanying digital resource.

Throughout its history, leprosy has been much feared and misunderstood. Today, we have the best knowledge, expertise, therapies, and surgical and physiotherapeutic skills to virtually cure and eradicate the disease, but the continuing high levels of stigma pose insurmountable obstacles in our efforts to remove the scourges of leprosy. In this review, the medical, social, and political aspects related to the impact of stigma on leprosy are elaborated, and strategies for providing access to equitable and effective care are described. Leprosy is a biosocial disease, and experience has shown that both the medical and social dimensions must be aggressively confronted. Stigma in leprosy is based on religious, sociocultural, psychological, and demographic experience over centuries of human existence. Therefore, any attempt to eradicate or reduce stigma will require strong multifaceted approaches that will permeate psychological, social, and mental layers of the human mind and result in necessary health-seeking behaviors. What then is needed is a social multidrug therapy similar to the medical multidrug therapy, where there would be one arm for curing the medical problems of leprosy, a second arm focusing on empowering the people, especially affected persons, through appropriate education, awareness, especially for early detection and treatment, encouraging positive attitudes and perceptions, and a third arm for advocacy, attacking derogatory and discriminatory laws, enabling opportunities for persons with leprosy disabilities to be profitably employed, and providing necessary rehabilitation facilities. Health can never be adequately protected by health services without the active understanding and involvement of communities whose health is at stake. The review cautions that without a social multidisciplinary approach using communitybased participatory techniques, we cannot provide access to effective and acceptable health care to leprosy-affected persons. [ABSTRACT FROM AUTHOR]

Background: Measurement of healthcare spatial access over a network involves accounting for demand, supply, and network structure. Popular approaches are based on floating catchment areas; however the methods can overestimate demand over the network and fail to capture cascading effects across the system. Methods: Optimization is presented as a framework to measure spatial access. Questions related to when and why optimization should be used are addressed. The accuracy of the optimization models compared to the two-step floating catchment area method and its variations is analytically demonstrated, and a case study of specialty care for Cystic Fibrosis over the continental United States is used to compare these approaches. Results: The optimization models capture a patient's experience rather than their opportunities and avoid overestimating patient demand. They can also capture system effects due to change based on congestion. Furthermore, the optimization models provide more elements of access than traditional catchment methods. Conclusions: Optimization models can incorporate user choice and other variations, and they can be useful towards targeting interventions to improve access. They can be easily adapted to measure access for different types of patients, over different provider types, or with capacity constraints in the network. Moreover, optimization models allow differences in access in rural and urban areas. [ABSTRACT FROM AUTHOR]

Objective To longitudinally examine female sex workers’ (FSWs’) uptake of a women-only, sex-work-specific drop-in service and its impact on their access to sexual and reproductive health (SRH) services. Methods For the present longitudinal analysis, data were drawn from the AESHA (An Evaluation of Sex Workers’ Health Access) study, a community-based, open, prospective cohort of FSWs from Vancouver, BC, Canada. Data obtained between January 2010 and February 2013 were analyzed. Participants are followed up on a semi-annual basis. Multivariable logistic regression using generalized estimating equations was used to identify correlates of service uptake. Results Of 547 FSWs included in the present analysis, 330 (60.3%) utilized the services during the 3-year study period. Service use was independently associated with age (adjusted odds ratio [AOR] 1.04; 95% confidence interval [CI] 1.03–1.06), Aboriginal ancestry (AOR 2.18; 95% CI 1.61–2.95), injection drug use (AOR 1.67; 95% CI 1.29–2.17), exchange of sex for drugs (AOR 1.40; 95%CI 1.15–1.71), and accessing SRH services (AOR 1.65; 95% CI 1.35–2.02). Conclusion A sex-work-specific drop-in space for marginalized FSWs had high uptake. Women-centered and low-threshold drop-in services can effectively link marginalized women with SRH services. [ABSTRACT FROM AUTHOR]

Little research has been conducted on the prevalence of physical health problems in Cambodian refugees and the relationship between their mental and physical health. We identified the relationship between mental and physical health problems and barriers to healthcare access in Cambodian refugee adults. We used a cross-sectional survey design with a snowball sample of 136 Cambodian refugee adult residents of Connecticut and Western Massachusetts. 61 % reported being diagnosed with three or more physical conditions and 73 % with depression, posttraumatic stress disorder (PTSD) or both. Language and transportation problems were the primary barriers to accessing care. Participants with probable comorbid PTSD and depression had 1.850 times more physical health problems than those without either condition ( p > .001; CI 1.334-2.566). Age moderated this relationship. Participants who had been diagnosed with both depression and PTSD reported a consistent number of health conditions across the age span while those who had no mental health conditions or only one of the two reported fewer health conditions when they were younger and more when they were older. These two groups were significantly different from the group reporting both. There is a significant relationship between chronic comorbid mental and physical health diseases affecting Cambodian refugees resettled in the US Having comorbid depression and PTSD puts Cambodian refugees at risk for physical health problems no matter their age. It is vital that those treating Cambodian genocide survivors identify and treat their prevalent comorbid health conditions. Language and transportation barriers must be addressed to improve access to mental and physical health care in this population. [ABSTRACT FROM AUTHOR]

The Coronavirus disease 19 (COVID-19) pandemic has profoundly affected economic and health systems around the world. This paper aims to assess household access to basic foods and health care and food security attainment during the COVID-19 pandemic in Burkina Faso. We use the COVID-19 High-Frequency Phone Survey 2020 panel data supported by the World Bank and conducted by Institut National de la Statistique et de la Démographie (INSD). The pooled multinomial logistic, the panel logistic, and the panel ordered logistic regressions are used to analyse the access to basic foods, the access to health care and the food security of the households, respectively. The results show that during COVID-19, female-headed households, poor households and farm households remain the most vulnerable in terms of access to basic foods, health services and food insecurity. Furthermore, the results indicate that households living outside the capital, particularly in the other urbans, experience fewer difficulties obtaining basic foods than those residing in the capital and are also unlikely to experience food insecurity. For more effective policy responses to the COVID-19 or similar shocks, the interventions should focus on household socioeconomic conditions and distinguish between urban and rural areas., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Background: To describe the relationship between longevity and local access to preventive healthcare at the county level., Methods: We used Medicare outpatient reimbursement data from the 2010 Dartmouth Health Atlas and longevity data from Chetty et al. (2016) to identify the cross-sectional associations between county longevity, access to outpatient care, and the quality of primary care., Results: We find that the cost of outpatient care is inversely correlated with area life expectancy for individuals in the bottom income quartile. Much of this correlation is driven by men in the bottom income quartile. We also find that disaggregating a preventive care index produces significant relationships between components of the index and longevity where none were previously found., Conclusions: These results counter prior assertions that local health costs are not associated with life expectancy. Additionally, the results also suggest that the local cost of outpatient care and the quality of that care may influence the longevity of low-income populations, especially for low-income men., (© 2022. The Author(s).)

Background: During COVID-19, anti-Asian discrimination increased in attention. Hate and unfair treatment are related but do not completely overlap. We expect those who report a hate incident would also report race-based unfair treatment, yet feelings of social desirability or self-blame may lead to under-reporting of unfair treatment., Objectives: To describe reporting of an experience of race-based hate but not an experience of race-based unfair treatment among Asians in California and explore the association between this reporting discordance with (1) serious psychological distress, (2) forgoing needed medical care, (3) increased household interpersonal conflict, and (4) feeling unsafe in their neighborhood., Methods: We used the 2020 California Health Interview Survey's AANHPI COVID Module, conducted weighted descriptive and multivariate analyses, and computed adjusted relative risks (RR). The multivariate models controlled for Asian subgroup, age, gender, immigrant status, education level, poverty, and English proficiency., Results: Among Asians who reported race-based hate (6.9% overall), 62.4% reported not experiencing race-based unfair treatment. Compared to Asians not reporting a hate incident, this "discordant" group was more likely to experience serious psychological distress (RR = 6.9), forgo necessary medical care (RR = 2.4), increased household interpersonal conflicts (RR = 2.7), and feel unsafe in their neighborhoods (RR = 3.0). The "concordant" group did not post significant effects for severe psychological distress nor forgoing necessary medical care., Discussion: Most Asians reporting hate did not report race-based unfair treatment, and this group is most affected by the consequences of a hate incident. We indicate future directions for research and policy., Competing Interests: At time of submission, AA was employed by Precision Advisors, a for-profit healthcare consulting firm. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ponce, Adia, Banawa, Tan and Sabado-Liwag.)

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The Healthy Howard Health Plan (HHHP) is an innovative health access plan providing healthcare and health coaching to previously uninsured adults in Howard County, Maryland. HHHP members who enrolled in HHHP between January 2009 to June 2010 are followed over time using a variety of self-reported data collection tools including a health risk assessment (HRA), the SF-12, a measure of health status, and the PAM, patient activation measure. We describe their unmet health needs, demographics, health status and behaviors at baseline and we describe changes in health-related behaviors over time. Demographic and baseline HRA results for 700 individuals who enrolled over the first 18 months reveal HHHP members generally were racially diverse (white: 37 %; African American: 23 %, and Asian: 30 %), married (50 %) females (59 %). Most (62 %) have a family income between 121 and 200 % of the federal poverty level, and were without health insurance for more than 1 year (56 %). Self-reported health and behaviors for 163 plan members who completed initial and follow up HRAs revealed increases in physical activity, fruit and vegetable consumption, and health status. Statistically significant differences were found in patient activation from baseline to follow up (44 vs 58 %, p value 0.0005). Patient demographics, health status, and health behaviors of these newly insured Americans may help policy makers and care providers prepare to meet their needs. We noted improvements in certain self-reported health behaviors and health status, suggesting participation in the Plan is associated with positive health impacts for some Plan members. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic exacerbated longstanding inequities in resources and healthcare, stacked on top of historical systems that exploit immigrants and communities of color. The range of relief, mutual aid, and advocacy responses to the pandemic highlights the role of social movement organizations in addressing the ways that immigration status creates systemic barriers to adequate health and wellbeing. This paper conceptualizes what I call, "movement pandemic adaptability," drawing from a decolonial-inspired study including participant-observation (September 2018-September 2020), interviews ( n = 31), and focus groups ( n = 12) with community members and health advocates. Data collection began before the COVID-19 pandemic (September 2018-February 2019) and continued during its emergence and the initial shelter-in-place orders (March 2019-September 2020). Movement pandemic adaptability emerged as a strategy of drawing from pre-existing networks and solidarities to provide culturally relevant resources for resilience that addressed vulnerabilities created by restrictions against undocumented people and language barriers for communities that speak Spanish and a range of Indigenous languages. This paper presents how the relationship between immigration status and health is influenced by the local context, as well as the decisions of advocates, policymakers, and community members.

Evidence of doulas' positive impacts on maternal health outcomes, particularly among underserved populations, supports expanding access. Health workforce-related barriers challenge the development of robust doula services in the United States. We investigated organizations' barriers regarding training, recruitment, and employment of doulas. We conducted literature and policy reviews and 16 semi-structured interviews with key informants who contribute to state policymaking and from organizations involved in training, certifying, advocating for, and employing doulas. Our study shows barriers to more robust doula services, including varying roles and practices, prohibitive costs of training and certification, and insufficient funding. This study underscores the importance of doulas in providing support to clients from underserved populations. Health workforce-related challenges remain, especially for community-based organizations seeking to serve underserved communities., (© Copyright 2022 Lamaze International.)

Introduction: The 2014 Medicaid expansion was intended to improve access to care. We hypothesized that Medicaid expansion would be associated with improved gastric cancer (GC) outcomes., Methods: We selected patients with a new primary diagnosis of GC from the National Cancer Database. We compared states that expanded Medicaid in 2014 to those that did not. We compared pre-and post-expansion intervals 2012-2013 and 2015-2016., Results: There was an increase in patients diagnosed with stage 0-2 GC from 38% to 41.5% [p < 0.01] in expansion states (ES), but no change at 38.9% in non-expansion states (NES). Uninsured and Medicaid patients diagnosed with stages 0-2 GC increased in ES from 32.4% to 37.8% [p = 0.01] and decreased in NES from 29.7% to 27.3% [p = n.s.]. Uninsured and Medicaid patients receiving treatment rose from 87.0% to 90.3% in ES [p < 0.01] and in NES 83.9%-84.9% [p = n.s.]. Twelve-month survival for ES rose from 68.1% to 70.6% [p = 0.03] and in NES decreased 65.2%-65.1% [p = n.s.]., Conclusion: Increased healthcare access may be related to earlier diagnosis and improved outcomes in GC., (Copyright © 2022 Elsevier Inc. All rights reserved.)

South Africa has long grappled with one of the highest HIV and tuberculosis (TB) burdens in the world. The COVID-19 pandemic poses challenges to the country's already strained health system. Measures to contain COVID-19 virus may have further hampered the containment of HIV and TB in the country and further widened the socioeconomic gap. South Africa's handling of the pandemic has led to disruptions to HIV/TB testing and treatment. It has, furthermore, influenced social risk factors associated with increased transmission of these diseases. Individuals living with HIV and/or TB also face higher risk of developing severe COVID-19 disease. In this case study, we contextualize the HIV/TB landscape in South Africa and analyze the direct and indirect impact of the COVID-19 pandemic on the country's efforts to combat these ongoing epidemics.

Stroke can be a life altering event that necessitates considerable amounts of formal and informal care. The impacts of stroke often persist over time requiring ongoing support for stroke survivors. Family members provide the majority of care and experience many life changes as a result of their caregiving role including social, financial, employment and health impacts. Formal supports such as counselling, respite, and health promotion initiatives that directly benefit caregivers or benefit them indirectly through supporting the stroke survivor, are well-placed to help caregivers manage their caregiving role. However, to date little is known about formal service use by stroke caregivers and the factors that influence their service use. This scoping review provides a critique and synthesis of what is known about stroke caregivers' access and use of formal services intended to support them. Findings suggest that while services are available, caregivers' ability to use them are impacted by both facilitators and barriers. Facilitators included: sex, age, and having a higher household income (depending on services used). Barriers included: high cost, poor service quality and deficient knowledge/communication regarding service availability. This review highlights a significant gap in our knowledge of caregivers' experience in accessing and using formal services.

Aims: The objectives of this research protocol are as follows: to examine the influence of the COVID-19 pandemic on health and social care for migrant women in the Son Gotleu district of Palma de Mallorca, Spain, and to develop outreach tools to target this specific group., Design: This is a qualitative study that uses content analysis to obtain in-depth knowledge of personal experience (manifest content) and contextual experience (latent content) in a specific social setting., Methods: The study population are migrant women living in Son Gotleu district, who are segmented by their age and experience of COVID-19, defined as positive or negative according to whether or not they have been infected with the disease., Results: The shortcomings and needs relating to communication and health care that affect this group's current and future quality of life will be identified., Conclusion: The study of migrant women offers a gateway allowing vulnerability in health care to be detected. An awareness of their needs will allow prototype tools to be developed to facilitate communication and care for general and acute health needs between the scientific community and the vulnerable population., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aims: Total hip arthroplasty (THA) is one of the most successful surgical procedures. The objectives of this study were to define whether there is a correlation between socioeconomic status (SES) and surgical complications after elective primary unilateral THA, and investigate whether access to elective THA differs within SES groups., Methods: We conducted a retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, over a 17-year period. Patients were divided into income quintiles based on postal codes as a proxy for personal economic status. Multivariable logistic regression models were then used to primarily assess the relationship between SES and surgical complications within one year of index THA., Results: Of 111,359 patients who underwent elective primary THA, those in the lower SES groups had statistically significantly more comorbidities and statistically significantly more postoperative complications. While there was no increase in readmission rates within 90 days, there was a statistically significant difference in the primary and secondary outcomes including all revisions due (with a subset of deep wound infection and dislocation). Results showed that those in the higher SES groups had proportionally more cases performed than those in lower groups. Compared to the highest SES quintile, the lower groups had 61% of the number of hip arthroplasties performed., Conclusion: Patients in lower socioeconomic groups have more comorbidities, fewer absolute number of cases performed, have their procedures performed in lower-volume centres, and ultimately have higher rates of complications. This lack of access and higher rates of complications is a "double hit" to those in lower SES groups, and indicates that we should be concentrating efforts to improve access to surgeons and hospitals where arthroplasty is routinely performed in high numbers. Even in a universal healthcare system where there are no penalties for complications such as readmission, there seems to be an inequality in the access to THA. Cite this article: Bone Joint J  2022;104-B(5):589-597.