Evelina Pappa

Assessing the socio-economic and demographic impact on health-related quality of life: evidence from Greece

Objectives:The impact of socioeconomic status on health has been extensively studied and studies have shown that low socio-economic status is related to lower values of various health and quality-of-health measures. The aim of this study was to assess the influence of demographic and socio-economic factors on health- related quality of life (HRQoL).Methods:A cross-sectional study was carried out in 2003 using a representative sample of a Greek general population (n = 1007, 18+ years old), living in Athens area. Multivariate stepwise linear regression analyses were performed to investigate the influence of socio-demographic and economic variables on HRQoL, measured by eight scales of the SF-36. Interaction effects between socioeconomic status (SES) and demographic variables were also performedResults:Females and elderly people were associated with impaired HRQoL in all SF-36 scales. Disadvantaged SES i. e. primary education and low total household income was related to important decline in HRQoL and a similar relation was identified among men and women. Only the interaction effects between age and SES was statistically significant for some SF-36 scales. Multiple regression analyses produced models explaining significant portions of the variance in SF-36 scales, especially physical functioning.Conclusions:The analysis presented here gives evidence of a relationship existing between SES and HRQoL similar to what has been found elsewhere. In order to protect people from the damaging effects of poverty in health it is important to formulate health promotion educational programs or to direct policies to empower the disposable income etc. Helping people in disadvantaged SES to achieve the good health that people in more advantaged SES attained would help to prevent the widening of health inequalities.

Construct Validation of the Greek SF-36 Health Survey

Objective: To test the construct validity of the Short-Form 36 (SF-36) Health Survey, using structural equation modeling (SEM). Methods: Cross -sectional survey was conducted. Data were collected from 1007 participants in a stratified sample of adult general population, interviewed face-to-face by trained interviewers. Results: SEM analyses supported the superiority of the eight first-order factor model of health. Higher -order analyses suggested that a model with three correlated second-order factors (physical health, general well-being, general mental health) and one third-order factor (health) provided a satisfactory fit to the data. Conclusions: These results confirm the multidimensional structure of the SF-36 and underscore the feasibility of multinational comparisons of health status using this instrument. They also support the use of eight subscale scores in parallel with three second -order summary scores rather than one overall score.

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area

BackgroundGiven the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors.MethodsData was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models.ResultsHealth care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care.ConclusionThis study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

Validity of the EuroQoL (EQ-5D) Instrument in a Greek General Population

OBJECTIVES The main purpose of this study was to assess the construct validity of the Greek EQ-5D instrument in measuring health-related quality of life, as well as to address the issues of concurrent validity, internal consistency reliability, and sensitivity. METHODS A stratified, representative sample (n = 1388) of the Greek general population was approached for interview (response rate 72.4%). The survey included the EQ-5D, the SF-36, and questions on sociodemographic and clinical characteristics of the sample. RESULTS The EQ-5D dimensions, the EQ visual analog scale, and the UK-based utility index were capable of distinguishing between groups of respondents, in the expected manner, on the basis of sex, age, education, socioeconomic status, self-reported health problems, and health services utilization, thus providing evidence of construct validity. Convergent and divergent validity of the EQ-5D descriptive system were supported by expected relationships with SF-36 scale and summary scores. Additionally, reporting a problem in a given EQ dimension was generally associated with lower SF-36 scores, supporting concurrent validity. Internal consistency reliability and sensitivity were also satisfactorily demonstrated. CONCLUSIONS The results provide initial support for the construct validity of the EQ-5D in Greece, and, in conjunction to future studies addressing test-retest reliability and responsiveness, they support administering the instrument in health status studies, which in turn can contribute to transnational comparisons.

Investigating Unmet Health Needs in Primary Health Care Services in a Representative Sample of the Greek Population

Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access.

Sociodemographic and socioeconomic determinants of health services utilization in Greece: the Hellas Health I study.

The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34–44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors. The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.

Do place of residence and ethnicity affect health services utilization? evidence from greece

BackgroundEqual utilization of health services for equal need, is one of the main targets for public health systems. Given the public-private structure of the Greek NHS, the main aim of the study was to investigate the impact of underlying factors, such as health care needs, socio-demographic characteristics and ethnicity, on the utilization of primary and hospital health care in an urban and rural population of the Greek region, Thessaly.MethodsA cross-sectional study was carried out in 2006 in Thessaly, a Greek region of Central Greece, in a representative sample of 1372 individuals (18+ years old, response rate 91.4%) via face-to-face interview. Health care needs were determined by self-perceived health status estimated by the SF-36 Health Survey, using the summary scores of physical and mental health. The utilization of primary care was measured by last month visits to 1) primary public services and 2) private practitioners visits and utilization of secondary care was measured by past year visits to 3) public hospital emergency departments and 4) admissions to public hospitals. Multivariable stepwise logistic regression analysis was applied in the whole sample and separately for the urban and rural population, in order to determine the predictors of health services utilization. Statistical significance was determined with a p value < 0.05.ResultsHealth care needs were the most significant determinants of primary and secondary health services utilization in both the urban and rural areas. Poor physical and mental health was associated with higher likelihood of use. In the urban areas middle-aged, elderly and Greeks were more likely to use primary health services, whereas primary education was associated with more visits to the emergency departments. Wealthier individuals were two times more likely to be admitted to hospitals. Individuals from the rural areas with university education visited more the public primary services, while wealthier individuals visited more the private practitioners. Immigrants had a higher likelihood of visiting emergency departments.ConclusionsAlthough health care needs were the main determinant of health services utilization in both the urban and rural population, socio-economic and ethnic differences also seem to contribute to the inequities observed in some types of health services use, favouring the better-off. Such findings provide important information to policy makers, which attempt to reduce inequalities in health care according to place of residence and ethnicity.

Gender- and age-related benefit of renal replacement therapy on health-related quality of life.

OBJECTIVES The aim of this study was to compare the health-related quality of life (HRQOL) of end-stage renal disease patients on renal replacement therapy with that of subjects of the same gender and similar age from the general population, in an attempt to determine patient subgroup that benefits more from the treatment. METHODS A cross-sectional study involving haemodialysis, peritoneal dialysis and renal transplant patients (n = 874) was conducted with subjects providing socio-demographic and disease-related data, and completing the validated Greek Short Form-36 (SF-36) Health Survey. Patient-specific z-scores were calculated using mean SF-36 scores and SD of age- and gender-matched subgroups from the Greek norms. RESULTS Males and younger patients generally reported better HRQOL. However, z-scores in these groups generally showed a larger health deficit, i.e. an increased divergence from the HRQOL of their age- and gender-matched counterparts of the general population, compared with the health deficit observed in female and younger patients. CONCLUSIONS Health-related quality of life studies involving disease groups may sometimes be inconclusive if results are not compared with population norms, and particularly with subgroups matched for important demographic variables. Otherwise, as this study has shown, it is possible that important information may remain unrevealed.

Depression, quality of life and primary care: a cross-sectional study.

Objective: To estimate the presence of depression and impairment of quality of life in primary care and identify correlations with demographics and chronic diseases. Materials and methods: 500 people (220 men) that visited the Gytheio Health Center, Greece, participated in the study answering a study questionnaire that included demographic and somatometric data, medical history, the Zung self-rating depression scale (SDS-Zung) and the Short Form 12 (SF-12) scale for quality of life evaluation with a mental component scale (MCS) and a physical component scale (PCS). Results: 163 persons (32.6% of the study population) had SDS-Zung scores over 50 indicating depressive symptomatology. Of those 22% of the study population (70% women) had no awareness of their problem and were under no treatment; 80 (16% of the study population) had mild depressive symptoms (SDS-Zung: 53.12 ± 0.6 [95% CI]) and physical impairment: MCS12: 44.32 ± 1.9 (95% CI), PCS: 39.16 ± 2.2 (95% CI) (p < 0.005) and 23 (4.6% of study population) had moderate symptoms (SDS-Zung: 63.82 ± 1.34 [95% CI]), with mental and physical impairment: MCS12: 36.99 ± 1.88 (95% CI), PCS: 34.83 ± 5.12 (95% CI) (p < 0.005) adjusted for age, sex and co-morbidities. Arthritis and COPD were associated with depressive symptomatology and physical impairment (p < 0.05) and coronary heart disease and congestive heart failure with physical impairment (p < 0.005). Patients under anti-depressive medication had significant depressive symptomatology and decreased quality of life (p < 0.0005). Conclusion: The prevalence of both depressive symptomatology and impairment of quality of life is significant and primary care with simple, validated tools can be the setting for identifying and helping such patients.

Factors Affecting Use of Preventive Tests for Cardiovascular Risk among Greeks

Data from a Greek national representative sample was used to investigate socio-demographic, self-perceived health, and health risk factors that determine the use of cardiovascular preventive tests (blood pressure, cholesterol and blood glucose). Chi-square and logistic regression analyses were used (p < 0.05). Older age, marriage, regular family doctor and chronic diseases increased the likelihood of receiving preventive tests, whereas low education and alcohol consumption reduced the likelihood of having these tests. The effect of obesity varied. Interventions which improve the knowledge of the poorly educated and empower the preventive role of the physicians may redress the inequalities and improve the effectiveness of preventive services utilization.