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Article ; Online: Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk

Neeru Gupta / Samuel R. Cookson

Healthcare, Vol 11, Iss 21, p

A Secondary Analysis Using Linked Population-Based Data

2023 Volume 2854

Abstract: Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national ... ...

Abstract	Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5–11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3–24.4) but not among lesbian and bisexual women (3.5; CI: 0.9–13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.
Keywords	health services research ; rural health ; sexual minorities ; healthcare inequalities ; preventable hospitalization ; data linkage ; Medicine ; R
Subject code	360
Language	English
Publishing date	2023-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of Survey Nonresponse in Measuring Cardiometabolic Health Risk Factors and Outcomes among Sexual Minority Populations

Neeru Gupta / Samuel R. Cookson

International Journal of Environmental Research and Public Health, Vol 20, Iss 5346, p

A National Data Linkage Analysis

2023 Volume 5346

Abstract: Understanding cardiometabolic health among lesbian, gay, and bisexual (LGB) people is challenged by methodological constraints, as most studies are either based on nonprobability samples or assume that missing values in population-based samples occur at ... ...

Abstract	Understanding cardiometabolic health among lesbian, gay, and bisexual (LGB) people is challenged by methodological constraints, as most studies are either based on nonprobability samples or assume that missing values in population-based samples occur at random. Linking multiple years of nationally representative surveys, hospital records, and geocoded data, we analyzed selection biases and health disparities by self-identified sexual orientation in Canada. The results from 202,560 survey respondents of working age identified 2.6% as LGB, 96.4% as heterosexual, and <1.0% with nonresponse to the sexual identity question. Those who did not disclose their sexual identity were older, less highly educated, less often working for pay, and less often residing in rural and remote communities; they also had a diagnosed cardiometabolic condition or experienced a cardiometabolic-related hospitalization more often. Among those reporting their sexual identity, LGB individuals were younger, more likely to smoke tobacco or drink alcohol regularly, more likely to have heart disease, and less likely to have a regular medical provider than heterosexual persons. This investigation highlighted the potential of leveraging linked population datasets to advance measurements of sexual minority health disparities. Our findings indicated that population health survey questions on sexual identity are not generally problematic, but cautioned that those who prefer not to state their sexual identity should neither be routinely omitted from analysis nor assumed to have been randomly distributed.
Keywords	sexual orientation ; sexual minorities ; health surveys ; data linkage ; health measurement ; Medicine ; R
Subject code	360
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Research to support evidence-informed decisions on optimizing gender equity in health workforce policy and planning

Neeru Gupta

Human Resources for Health, Vol 17, Iss 1, Pp 1-

2019 Volume 3

Abstract: Abstract Women constitute 70% of the global health and social care workforce, but important knowledge gaps persist to effectively support decision making to optimize gender equity. In this Editorial introducing a new thematic series on ‘Research to ... ...

Abstract	Abstract Women constitute 70% of the global health and social care workforce, but important knowledge gaps persist to effectively support decision making to optimize gender equity. In this Editorial introducing a new thematic series on ‘Research to support evidence-informed decisions on optimizing gender equity in health workforce policy and planning,’ we are calling for submissions focusing on research concerning the monitoring, evaluation and accountability of human resources for health policy options through a gender equity lens. We are particularly interested to receive manuscripts advancing the innovative use of data and methodologies in the areas of occupational segregation, decent work, gender pay gap and gendered leadership in the health workforce that could be reproducible across different country contexts.
Keywords	Health workforce ; Human resources for health ; Gender equality ; Occupational segregation ; Leadership ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2019-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Relative remoteness and wage differentials in the Canadian allied health professional workforce

Neeru Gupta / Adrienne Gulliver / Paramdeep Singh

Rural and Remote Health, Vol

2023 Volume 23

Abstract: Introduction: Health workforces around the world are characterized with geographic maldistribution, often leading to inequalities in rural health outcomes. Monetary incentives are frequently raised as a policy option to bolster recruitment of healthcare ... ...

Abstract	Introduction: Health workforces around the world are characterized with geographic maldistribution, often leading to inequalities in rural health outcomes. Monetary incentives are frequently raised as a policy option to bolster recruitment of healthcare practitioners to rural and underserved communities; however, few rural health workforce studies focus on allied health professionals (AHPs), include urban comparators, integrate gender considerations, or measure rural diversity. This population-based observational study examines trends in the geographic and gender distribution and earnings of AHPs in Canada across the rural-urban continuum. Methods: Nationally representative data from the 2006 and 2016 Canadian population censuses were pooled and linked with the geocoded Index of Remoteness for all inhabited communities. Five groups of university-educated AHPs providing prevention, diagnostic evaluation, therapy, and rehabilitation services were identified by occupation. Multiple linear regression models were used to estimate the associations between relative remoteness and annual earnings of AHPs aged 25-54 years, controlling for gender and other personal and professional characteristics. Results: The density of AHPs was found to be 15 times higher in more urbanized and accessible parts of the country (23.6-25.6 per 10 000 population in 2016) compared to the most rural and remote areas (1.6 per 10 000 population), a pattern that changed little over the previous decade. A positive correlation was seen across occupations in terms of the degree of feminization and their geographic dispersion by relative remoteness. While pharmacists residing in more rural and remote communities earned 9% (95% confidence interval 4-15%) more than those in core urban centers, relative remoteness contributed little to wage differentials among dentists, physiotherapists and occupational therapists, or other AHPs in therapy and assessment (no significant difference at p<0.05). Women earned significantly less than men in dentistry, ...
Keywords	allied health occupations ; Canada ; health workforce ; medically underserved areas ; rural health services ; spatial analysis ; Special situations and conditions ; RC952-1245 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	James Cook University
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Beyond weight

Neeru Gupta / Zihao Sheng

BMC Health Services Research, Vol 21, Iss 1, Pp 1-

examining the association of obesity with cardiometabolic related inpatient costs among Canadian adults using linked population based survey and hospital administrative data

2021 Volume 9

Abstract: Abstract Background The global population has transitioned to one where more adults are living with obesity than are underweight. Obesity is associated with the development of cardiometabolic diseases and widely attributed to increased hospital resource ... ...

Abstract	Abstract Background The global population has transitioned to one where more adults are living with obesity than are underweight. Obesity is associated with the development of cardiometabolic diseases and widely attributed to increased hospital resource use; however, empirical evidence is limited regarding obesity prevention to support hospital cost containment. This study aims to test for obesity in predicting hospitalization costs for cardiometabolic conditions among the Canadian population aged 45 and over. Methods Data from the 2007−2011 Canadian Community Health Survey were linked to eight years of hospital discharge records. A cohort was identified of inpatients admitted for diabetes, hypertension, and other cardiometabolic diseases. Multiple linear regressions were used to investigate the association between obesity status and inpatient costs, controlling for sociodemographic and behavioural factors. Results The target cohort included 23,295 admissions for cardiometabolic diseases. Although inflation-adjusted inpatient costs generally increased over time, compared with the non-obese group, living with obesity was not a significant predictor of differences in cardiometabolic-related resource use (0.972 [95% CI: 0.926–1.021]). Being female and rural residence were found to be protective factors. Conclusions Obesity was not found in this study to be independently linked to higher cardiometabolic hospitalization costs, suggesting that actions to mitigate disease progression in the population may be more beneficial than simply promoting weight loss. Results amplified the need to consider gender and urbanization when formulating which levers are most amenable to adoption of healthy lifestyles to reduce impacts of obesogenic environments to the healthcare system.
Keywords	Obesity ; Cardiometabolic health ; Hospital costs ; Demographic and health surveys ; National hospital discharge surveys ; Data linkage ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Reduced Risk of Hospitalization With Stronger Community Belonging Among Aging Canadians Living With Diabetes

Neeru Gupta / Zihao Sheng

Frontiers in Public Health, Vol

Findings From Linked Survey and Administrative Data

2021 Volume 9

Abstract: Background: Social isolation has been identified as a substantial health concern in aging populations, associated with adverse chronic disease outcomes and health inequalities; however, little is known about the interconnections between social capital, ... ...

Abstract	Background: Social isolation has been identified as a substantial health concern in aging populations, associated with adverse chronic disease outcomes and health inequalities; however, little is known about the interconnections between social capital, diabetes management, and hospital burdens. This study aimed to assess the role of community belonging with the risk of potentially avoidable hospitalization among aging adults living with diabetes in Canada.Methods: The study leveraged a novel resource available through Statistics Canada's Social Data Linkage Environment: the Canadian Community Health Survey linked to administrative health records from the hospital Discharge Abstract Database. A population-representative sample of 13,580 community-dwelling adults aged 45 and over with diabetes was identified. Multiple logistic regression was used to assess the association of individuals' sense of community belonging with the risk of diabetes-related hospitalization over the period 2006–2012.Results: Most (69.9%) adults with diabetes reported a strong sense of belonging to their local community. Those who reported weak community belonging were significantly more likely to have been hospitalized for diabetes (χ2 = 13.82; p < 0.05). The association between weak community attachment and increased risk of diabetes hospitalization remained significant [adjusted OR: 1.80 (95%CI: 1.12–2.90)] after controlling for age, education, and other sociodemographic and behavioral factors.Conclusion: The COVID-19 pandemic has resurfaced attention to the need to better address social capital and diabetes care in public health strategies. While the causal pathways are unclear, this national study highlighted that deficits in social attachments may place adults with diabetes at greater risk of acute complications leading to hospitalization.
Keywords	hospitalization - statistics and numerical data ; diabetes mellitus ; data linkage analysis ; community belonging ; aging adults ; Public aspects of medicine ; RA1-1270
Subject code	306
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Individual physical activity, neighbourhood active living environment and mental illness hospitalisation among adults with cardiometabolic disease

Neeru Gupta / Dan Lawson Crouse / Pablo Miah / Tim Takaro

BMJ Open, Vol 13, Iss

a Canadian population-based cohort analysis

2023 Volume 2

Abstract: Objectives This population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic ... ...

Abstract	Objectives This population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic condition.Design and setting Data from the 2013–2014 Canadian Community Health Survey were linked longitudinally to hospital records from the 2013/2014‒2017/2018 Discharge Abstract Database and to a geocoded measure of active living environments (ALE). Relationships between individuals’ leisure-time physical activity and neighbourhood ALE with risk of hospital admission for mental health disorders were assessed using multivariable Cox regressions.Participants A national cohort was identified from the survey data of 24 960 respondents aged 35 years and above reporting having been diagnosed with diabetes, hypertension and/or heart disease.Outcome measure Potentially avoidable hospitalisation for a mood, anxiety or substance use disorder over a 5-year period.Results More than half (52%) of adults aged 35 years and above with a cardiometabolic disease were physically inactive in their daily lives, and one-third (34%) resided in the least activity-friendly neighbourhoods. The rate of being hospitalised at least once for a comorbid mental disorder averaged 8.1 (95% CI: 7.0 to 9.3) per 1000 person-years of exposure. Individuals who were at least moderately active were half as likely to be hospitalised for a comorbid mental health problem compared with those who were inactive (HR: 0.50 (95% CI: 0.38 to 0.65)). No statistically discernible associations between neighbourhood ALE and hospitalisation risks were found after controlling for individuals’ behaviours and characteristics, including in separate models stratified by age group and by sex.Conclusions The evidence base to support prioritisation of interventions focusing on the built environment favouring mental health-promoting physical activity among higher-risk adults at the population level, independently of ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Gender composition and wage gaps in the Canadian health policy research workforce in comparative perspective

Neeru Gupta / Sarah Ann Balcom / Paramdeep Singh

Human Resources for Health, Vol 20, Iss 1, Pp 1-

2022 Volume 14

Abstract: Abstract Background Gendered challenges have been shown to persist among health practitioners in countries at all levels of development. Less is known about non-clinical professionals, that is, those who do not deliver services directly but are essential ...

Abstract	Abstract Background Gendered challenges have been shown to persist among health practitioners in countries at all levels of development. Less is known about non-clinical professionals, that is, those who do not deliver services directly but are essential to health systems performance, such as health policy researchers. This national observational study examined gender occupational segregation and wage gaps in the Canadian health policy research workforce using a cross-domain comparative labour market analysis approach. Methods Sourcing data from the 2016 population census, we applied linear regression and Oaxaca–Blinder decomposition techniques to assess wage differentials by sex, traditional human capital measures (e.g., age, education, place of work), and social identity variables intersecting with gender (household head, childcare, migrant status) among health policy researchers aged 25–54. We compared the gender composition and wage gap with seven non-health policy and programme domains, as mapped under the national occupational classification by similarity in the types of work performed. Results The health policy research workforce (N = 19 955) was characterized by gender segregation: 74% women, compared with 58% women among non-health policy research occupations (N = 102 555). Women health policy researchers earned on average 4.8% (95% CI 1.5‒8.0%) less than men after adjusting for other professional and personal variables. This gap was wider than among education policy researchers with similar gender composition (75% women; adjusted wage gap of 2.6%). Wages among health policy researchers were 21.1% (95% CI 19.4‒22.8%) lower than their counterparts in the male-dominated economics policy domain, all else being equal. Overall, women’s earnings averaged 3.2% lower than men’s due to factors that remained unexplained by policy domain or other measured predictors. Conclusions This investigation found that the gender inequalities already widely seen among clinical practitioners are replicated among health policy ...
Keywords	Health workforce ; Health occupations ; Health policy research ; Professional labour markets ; Wage differentials ; Gender inequality ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Neighbourhood characteristics related to mental health service use among adults with diabetes

Neeru Gupta / Dan Lawson Crouse / Ismael Foroughi

BMC Research Notes, Vol 15, Iss 1, Pp 1-

a population-based cohort study in New Brunswick, Canada

2022 Volume 8

Abstract: Abstract Objective It has been postulated that social and economic inequalities may shape the distributions of comorbid diabetes and mental illness. This observational cohort study using linked population-based administrative and geospatial datasets ... ...

Abstract	Abstract Objective It has been postulated that social and economic inequalities may shape the distributions of comorbid diabetes and mental illness. This observational cohort study using linked population-based administrative and geospatial datasets aimed to describe associations between neighbourhood socioenvironments and disorder-specific mental health service use among adults with diabetes in the province of New Brunswick, Canada. Results A baseline cohort of 66,275 persons aged 19 and over living with diabetes was identified. One-quarter (26.3%) had used healthcare services for mood and anxiety disorders at least once during the six-year follow-up period 2012/2013–2017/2018. Based on Cox proportional hazards models, the risk of mental health service contacts was significantly higher among those residing in the most materially deprived neighbourhoods [HR: 1.07 (95% CI: 1.01–1.14)] compared to those in the least so, and those in areas characterized with the highest residential instability [HR: 1.13 (95% CI: 1.05–1.22)] compared to those in areas with the lowest instability. Among adults with incident diabetes (N = 4410), age and sex but not neighbourhood factors were related to differential help-seeking behaviours for mental health problems. These findings underscored the gap between theoretical postulations and population-based observations in delineating the syndemics of neighbourhood socioenvironments and mental health outcomes in populations with high diabetes prevalence.
Keywords	Diabetes mellitus ; Mental disorders ; Social determinants of health ; Population health ; Environment design ; Residence characteristics ; Medicine ; R ; Biology (General) ; QH301-705.5 ; Science (General) ; Q1-390
Subject code	360
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The evidence gap on gendered impacts of performance-based financing among family physicians for chronic disease care

Neeru Gupta / Holly M. Ayles

Human Resources for Health, Vol 18, Iss 1, Pp 1-

a systematic review reanalysis in contexts of single-payer universal coverage

2020 Volume 15

Abstract: Abstract Background Although pay-for-performance (P4P) among primary care physicians for enhanced chronic disease management is increasingly common, the evidence base is fragmented in terms of socially equitable impacts in achieving the quadruple aim for ...

Abstract	Abstract Background Although pay-for-performance (P4P) among primary care physicians for enhanced chronic disease management is increasingly common, the evidence base is fragmented in terms of socially equitable impacts in achieving the quadruple aim for healthcare improvement: better population health, reduced healthcare costs, and enhanced patient and provider experiences. This study aimed to assess the literature from a systematic review on how P4P for diabetes services impacts on gender equity in patient outcomes and the physician workforce. Methods A gender-based analysis was performed of studies retrieved through a systematic search of 10 abstract and citation databases plus grey literature sources for P4P impact assessments in multiple languages over the period January 2000 to April 2018, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study was restricted to single-payer national health systems to minimize the risk of physicians sorting out of health organizations with a strong performance pay component. Two reviewers scored and synthesized the integration of sex and gender in assessing patient- and provider-oriented outcomes as well as the quality of the evidence. Findings Of the 2218 identified records, 39 studies covering eight P4P interventions in seven countries were included for analysis. Most (79%) of the studies reported having considered sex/gender in the design, but only 28% presented sex-disaggregated patient data in the results of the P4P assessment models, and none (0%) assessed the interaction of patients’ sex with the policy intervention. Few (15%) of the studies controlled for the provider’s sex, and none (0%) discussed impacts of P4P on the work life of providers from a gender perspective (e.g., pay equity). Conclusions There is a dearth of evidence on gender-based outcomes of publicly funded incentivizing physician payment schemes for chronic disease care. As the popularity of P4P to achieve health system goals continues to grow, so does the risk of unintended consequences. There is a critical need for research integrating gender concerns to help inform performance-based health workforce financing policy options in the era of the Sustainable Development Goals.
Keywords	Physician reimbursement ; Gender-based analysis ; Health workforce financing ; Pay-for-performance ; Systematic review ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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