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2 "Health services accessibility"
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Regional disparities in the availability of cancer clinical trials in Korea
Jieun Jang, Wonyoung Choi, Sung Hoon Sim, Sokbom Kang
Epidemiol Health. 2024;46:e2024006.   Published online December 11, 2023
DOI: https://doi.org/10.4178/epih.e2024006
  • 1,960 View
  • 55 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Unequal access to cancer clinical trials is an important issue, given the potential benefits of participation for cancer patients. We evaluated regional disparities in access to cancer clinical trials in Korea.
METHODS
From the Ministry of Food and Drug Safety database, we extracted 2,465 records of all cancer clinical trials approved between January 2012 and April 2023. To measure disparities in cancer clinical trial access, we calculated the ratio of clinical trials open to non-capital areas relative to those open to capital areas. We then analyzed temporal trends in this ratio, which we termed the trial geographical equity index (TGEI).
RESULTS
Disparities in access to cancer clinical trials, as indicated by the TGEI, did not significantly improve during the study period (regression coefficient, 0.002; p=0.59). However, for phase II/III trials sponsored by global pharmaceutical companies, the TGEI improved significantly (regression coefficient, 0.021; p<0.01). In contrast, the TGEI deteriorated for trials initiated by investigators or those testing domestically developed therapeutics (regression coefficient, -0.015; p=0.05). Furthermore, the increasing trend of TGEI for phase II/III trials sponsored by global companies began to reverse after 2019, coinciding with the outbreak of coronavirus disease 2019 (COVID-19).
CONCLUSIONS
Over the past decade, access to cancer clinical trials has improved in Korea, particularly for phase II/III trials evaluating therapeutics from global companies. However, this increase in accessibility has not extended to trials initiated by investigators or those assessing domestically developed therapeutics. Additionally, the impact of COVID-19 on disparities in clinical trial access should be closely monitored.
Summary
Korean summary
본 연구는 개시된 암 임상시험 수가 국내 수도권에 비해 비수도권에서 절대적으로 부족하고, 이러한 부족이 지난 10년간 개선되지 않았음을 보여줍니다. 다만, 글로벌 제약회사의 치료제를 검증하는 2상/3상 암 임상시험의 경우 임상시험 접근성에 대한 이러한 지역적 격차가 의미 있게 감소했으나 이러한 개선 또한 2019년 이후로는 정체되었을 수 있습니다. 상기 결과들은 임상시험 가용성의 형평성을 향상시키기 위해서는 국내 임상시험 개시 규모가 지역적 불균형을 이루고 있음에 대한 인식이 높아져야 하고, 비수도권 지역에서 임상시험 개시를 방해하는 장벽을 식별하는 데 추가적인 노력이 필요함을 강조합니다.
Key Message
The findings in this study indicate scarcity of cancer clinical trials in non-capital areas compared to that in capital areas of Korea, which has not improved over the past decade. However, this regional disparity in the access to clinical trials meaningfully decreased for phase II/III trials testing therapeutics from global pharmaceutical companies, though this progress may have stalled after 2019. This study highlights that increasing awareness of the regional imbalance in clinical trial access is vital and further efforts are needed to identify the barriers impeding the initiation of clinical trials in non-capital areas to improve the equity of availability.
Prevalence and factors associated with non-use of health services in the Peruvian population with COVID-19 symptomatology: a secondary analysis of the 2020 National Household Survey
Akram Hernández-Vásquez, Fabriccio J. Visconti-Lopez, Diego Azañedo
Epidemiol Health. 2021;43:e2021084.   Published online October 18, 2021
DOI: https://doi.org/10.4178/epih.e2021084
  • 7,609 View
  • 148 Download
  • 1 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19).
METHODS
A secondary analysis of the 2020 National Household Survey (ENAHO) was carried out. Participants over 18 years of age with any COVID-19 symptom (fever, cough, sensation of shortness of breath) in the last 4 weeks who did not visit health services were defined as exhibiting NUHS. Adjusted prevalence ratios (aPRs) were estimated to determine the factors associated with NUHS.
RESULTS
Data from 1,856 participants were analyzed; the prevalence of NUHS was 52.2% (95% confidence interval [CI], 48.0 to 56.5). Living in urban areas of the jungle (aPR, 1.61; 95% CI, 1.32 to 1.98; p<0.001) and rural areas of the jungle (aPR, 1.48; 95% CI, 1.15 to 1.90; p=0.002) was associated with a higher probability of NUHS than living in urban coastal areas. The factors associated with a lower probability of NUHS were being 50-59 years old (aPR, 0.72; 95% CI, 0.58 to 0.90) and 60 years and over (aPR, 0.74; 95% CI, 0.59 to 0.95), having a secondary educational level (aPR, 0.67; 95% CI, 0.48 to 0.93) or superior educational level (aPR, 0.67; 95% CI, 0.48 to 0.96), and having health insurance (aPR, 0.79; 95% CI, 0.68 to 0.92).
CONCLUSIONS
More than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms.
Summary
Key Message
The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19) in 2020. In the study, more than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms, in the country with the highest mortality rate by this disease.

Citations

Citations to this article as recorded by  
  • Staying in or out? COVID-19-induced healthcare utilization avoidance and associated socio-demographic factors in rural India
    Michael Safo Oduro, Prince Peprah, Anthony Kwame Morgan, Williams Agyemang-Duah
    BMC Public Health.2023;[Epub]     CrossRef
  • Chronic disease relapses: A cross-sectional study of the associated factors and socioeconomic inequalities during the COVID-19 pandemic in Peru
    Fabriccio J. Visconti-Lopez, Akram Hernández-Vásquez, Dustin M. Solorzano-Salazar, Diego Azañedo, Ramune Jacobsen
    PLOS ONE.2022; 17(9): e0274697.     CrossRef
  • COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study
    Kim N. Cajachagua-Torres, Hugo G. Quezada-Pinedo, Carlos A. Huayanay-Espinoza, Jordan A. Obeso-Manrique, Víctor A. Peña-Rodríguez, Elisa Vidal, Luis Huicho
    Heliyon.2022; 8(12): e11948.     CrossRef

Epidemiol Health : Epidemiology and Health