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Background: Socioeconomic inequalities in the population influence access to health services and constitute a challenge for health systems, especially in low- and middle-income countries. In Peru, an increase in the use of medical services has been estimated; however, the study of inequalities in the use of medical services is limited. Therefore, the objective of this research was to analyze and decompose socioeconomic inequalities in the use of medical consultation services in Peru. Methods: A cross-sectional analytical study was conducted using data from the National Household Survey 2019. The outcome variable was the use of a consultation attended by a physician in the last 4 weeks in persons who presented symptom or discomfort, illness, relapse of chronic disease and/or accident. Concentration curves and Erreygers concentration indices were used to determine socioeconomic inequalities, and a generalized linear regression model was used for the decomposition analysis of inequalities. Results: A total of 52,715 persons were included in the study. The frequency of medical consultation was 25.4% (95% confidence interval: 24.8 − 26.1%). In the inequality analysis, it was found that the use of medical consultations was concentrated among the wealthiest individuals. The main contributing factors were having another type of health insurance (social health insurance [EsSalud], private health insurance, health provider, the Armed Forces, and the Police), residing in an urban area, belonging to the richest wealth quintile, having a chronic disease, and residing in the highlands of Peru. Conclusions: Based on our findings, government institutions seeking to achieve equitable access to health services should consider the main factors contributing to this inequality in the formulation of strategies to lessen the negative impact of inadequate disease control in the population. [ABSTRACT FROM AUTHOR]

Despite the fact that vaccination coverage against COVID-19 has made great progress in Peru, there is still a quarter of the population that has not been fully vaccinated. This study aims to determine the factors associated with complete vaccination in Peruvian adults. An analysis of the National Household Survey 2022 in Peru was performed. Prevalence ratios with their 95% confidence intervals (95% CI) were estimated to assess the factors associated with vaccination with three or more doses of the COVID-19 vaccine. A total of 58,471 participants were included in the study and 75.8% of the surveyed population were found to have received full vaccination. Significant differences in complete coverage were observed according to sex, age, educational level, ethnicity, poverty status, and geographic location. In the adjusted analysis, individuals aged 60 years or older, those with higher educational attainment, the non-poor, and those living in urban areas were more likely to be fully vaccinated. Native individuals and people who live in households without media are less likely to be fully covered. These results highlight the importance of considering demographic and socioeconomic factors when analyzing COVID-19 vaccination coverage. Additional strategies are needed to address vaccination gaps and ensure better vaccination coverage. [ABSTRACT FROM AUTHOR]

Background: Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. Methods: This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions (ENAHO) from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were (i) the proportion of individuals who incurred OOP expenditures and (ii) the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic. Results: ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (P = .916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (P = .073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups. Conclusion: The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures. [ABSTRACT FROM AUTHOR]

Objectives: Abdominal obesity (AO) has become a public health issue due to its impact on health, society and the economy. The relationship between socioeconomic disparities and the prevalence of AO has yet to be studied in Peru. Thus, our aim was to analyze the socioeconomic inequalities in AO distribution defined using the International Diabetes Federation (IDF) cut-off points in Peruvian adults in 2018–2019. Methods: This was a cross-sectional study using data from the 2018–2019 Demographic and Family Health Survey (ENDES) of Peru. We analyzed a representative sample of 62,138 adults over 18 years of age of both sexes from urban and rural areas. Subjects were grouped into quintiles of the wealth to calculate a concentration curve and the Erreygers Concentration Index (ECI) in order to measure the inequality of AO distribution. Finally, we performed a decomposition analysis to evaluate the major determinants of inequalities. Results: The prevalence of AO among Peruvian adults was 73.8%, being higher among women than men (85.1% and 61.1% respectively, p < 0.001). Socioeconomic inequality in AO was more prominent among men (ECI = 0.342, standard error (SE) = 0.0065 vs. ECI = 0.082, SE = 0.0043). The factors that contributed most to inequality in the prevalence of AO for both sexes were having the highest wealth index (men 37.2%, women 45.6%, p < 0.001), a higher education (men 34.4%, women 41.4%, p < 0.001) and living in an urban setting (men 22.0%, women 57.5%, p < 0.001). Conclusions: In Peru the wealthy concentrate a greater percentage of AO. The inequality gap is greater among men, although AO is more prevalent among women. The variables that most contributed to inequality were the wealth index, educational level and area of residence. There is a need for effective individual and community interventions to reduce these inequalities. [ABSTRACT FROM AUTHOR]

Background: Peru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018. Methods: Secondary analysis of cross-sectional data using data from the 2008–2018 ENAHO survey. Access to safe drinking water, determined based on the presence of chlorinated water supplied by the public network, as well as socioeconomic variables were analyzed. A trend analysis from 2008 to 2018, and comparisons between 2008 versus 2018 were performed to understand and describe changes in access to safe drinking water, according to city size. Concentration curves and Erreygers concentration index (ECI) were estimated to measure inequalities in access to safe drinking water. Results: In 2008, 47% of Peruvian households had access to safe drinking water, increasing to 52% by 2018 (p for trend < 0.001). For small cities, access to safe drinking water did not show changes between 2018 and 2008 (difference in proportions − 0.2 percentage points, p = 0.741); however, there was an increase in access to safe drinking water in medium (difference in proportions 3.3 percentage points, p < 0.001) and large cities (difference in proportions 12.8 percentage points, p < 0.001). The poorest households showed a decreasing trend in access to safe drinking water, while the wealthiest households showed an increasing trend. In small cities, socioeconomic inequalities showed an increase between 2008 and 2018 (ECI 0.045 and 0.140, p < 0.001), while in larger cities, socioeconomic inequality reduced in the same period (ECI: 0.087 and 0.018, p = 0.036). Conclusions: We report a widening gap in the access to safe drinking water between the wealthiest and the poorest households over the study period. Progress in access to safe drinking water has not been equally distributed throughout the Peruvian population. Promoting and supporting effective implementation of policies and strategies to safe drinking water, including equity-oriented infrastructure development and resource allocation for most vulnerable settings, including emerging small cities, is a priority. [ABSTRACT FROM AUTHOR]

• Previous studies have established that in high-altitude regions there is a higher prevalence of depression. • An increase in meters above sea level of residence was positively and significantly associated with the depressive symptoms score. • This relationship is also observed according to the sex, age, number of comorbidities, marital status, area of residence, current smoking status, and pattern of alcohol consumption. • For the sensitivity analysis, altitude having no significant effect on the low scores (p10) of depressive symptoms, and the high scores of depressive symptoms are associated with the high altitude. In high altitude regions, people experience biological, inflammatory and brain structure changes that increase the risk of depressive symptoms. The aim of this study was to determine the association between altitude and depressive symptoms in the Peruvian population, adjusting by demographic, socioeconomic and exposure to health risk factors. We performed a cross-sectional analytical study of data collected annually by the Demographic and Family Health Survey during the period 2013–2020. The presence of depressive symptoms during the last 14 days prior to the survey were measured using scores obtained from the Patient Health Questionnaire-9 (PHQ-9). A generalized linear model (GLM) of gamma family and log link function was used to report the crude and adjusted β coefficients. A quantile regression model was performed as a sensitivity analysis. Data from a total of 215,409 participants were included. After adjusting for demographic, socioeconomic and health risk exposures, the GLM showed that an increase in every 100 m of altitude of residence was positively and significantly associated with the depressive symptoms score (β=0•01 [95% confidence interval: 0•01–0•01]). The length of residence in high altitude areas of the population included cannot be established, requiring future research to determine if the results of the present study are similar in native people or permanent residents of high altitude regions. Altitude was positively associated with depressive symptom scores. Our results will allow the development of mental health interventions based on factors that increase the likelihood of depressive symptoms in high-altitudes. [ABSTRACT FROM AUTHOR]

Objectives: Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017., Methods: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index., Results: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05)., Conclusions: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

Objectives.: To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults., Materials and Methods.: Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated., Results.: The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care., Conclusions.: Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru.

Objective.: To estimate the prevalence and determine the factors associated with the non-utilization of healthcare facilities (NUHCF) among adult Venezuelan migrants in Peru., Materials and Methods.: An analytical cross-sectional study of the "Survey of the Venezuelan Population Residing in Peru" 2018. We calculated the proportion of immigrants with NUHCF (immigrants with some symptom or malaise, illness, relapse of chronic illness, accident and discomfort, or other problem such as depression, fear, anger, anxiety, and stress, and who did not consider that it was serious or that they needed to visit a healthcare facility). Raw and adjusted (PRa) prevalence ratios (PR) for presenting NUHCF were estimated using generalized linear models., Results.: The study included 2,144 Venezuelan migrants: 57.2% presented NUHCF, reporting reasons such as: not having money (64.5%), lack of health insurance (24.3%), self-medication (12.8%), and not having time (8.4%). Living in Arequipa (PRa: 0.69; 95% CI: 0.57-0.83) or Trujillo (PRa: 0.87; 95% CI: 0.76-0.99), suffering from a chronic disease (PRa: 0.83; 95% CI: 0.71-0.97), and being enrolled in the Seguro Integral de Salud (SIS) insurance (PRa: 0.28; 95% CI: 0.13-0.61) was associated with a lower probability of NUHCF. Belonging to an age group under 60 years was associated with a higher probability of NUHCF., Conclusions.: One out of two Venezuelan migrants in Peru presents NUHCF. Having SIS increases the likelihood of Venezuelan migrants in Peruvian territory seeking medical attention. Increasing public health insurance for this population, which is currently low, could increase the utilization of health services.

Objectives: : To identify the prevalence and factors associated with the use of oral health services in Peruvian older adults (OA) during 2018., Materials and Methods: . Secondary analysis of data on 4,874 Peruvian OAs from the Demographic and Family Health Survey (ENDES) carried out in 2018. The use of oral health services was considered (yes/no) based on the six months prior to the application of the survey as a dependent variable. The independent variables were sex, age, area of residence, educational level, marital status, geographical domain, physical limitation, health insurance, spoken language, and welfare index quintile. A descriptive analysis was performed using absolute frequencies and weighted proportions, and a multivariate analysis using generalized linear models (Poisson regression)., Results: . From the total of OAs, 52.6% were women, 52.9% belonged to the 60-69 age group, 77% belonged to the urban area, and 81.1% had a health insurance. The prevalence of the use of dental care services in the last six months was 24.9%. Multivariate analysis found association with area of residence (p<0.001), higher educational level (p=0.001), health insurance affiliation (p<0.001), geographic domain (p=0.019), and all welfare index quintiles (p<0.001)., Conclusions: . The prevalence of the use of dental care services in OAs was low, and its associated factors were the area of residence, educational level, health insurance, geographic domain, and welfare index quintiles.

Introduction and Objective: There is little evidence in Latin America about the impact of the ACC/AHA 2017 guideline. Taking as reference the JNC 7 guideline, the objective of our study is to estimate changes in the prevalence of arterial hypertension (HBP) according to socio-demographic characteristics and geographic regions, applying the criteria of the new ACC / AHA guide 2017., Methods: Cross-sectional study of the Demographic and Family Health Survey conducted in Peru in 2017. Standardized weighted hypertension prevalence's were estimated for the WHO population according to both guidelines, and absolute differences with 95% CI., Results: We included 30,682 people aged 18 years and over, with an average age of 42.3 years, 51.1% women. The standardized prevalence of HBP for 2017 according to JNC 7 was 14.4% (95% CI: 13.8-15.1) and according to ACC / AHA 2017 it was 32.9% (95% CI: 32.0-33.7), so the prevalence increase is 18.5 percentage points, being higher in males than females (24.2 vs 12.9 respectively). In people with obesity and / or who consume tobacco, the increases were higher (24.3 and 24.1 percentage points respectively). In the regions of Tacna, Ica and Metropolitan Lima, the increase, in comparison with the JNC 7 guidelines, overcome the national average (22.4, 20.7 and 20.4, percentage points, respectively)., Conclusions: Considering the context of a Latin American country and knowing the epidemiology of hypertension in Peru, the potential adoption of the ACC/AHA 2017 guidelines for the prevention, detection, evaluation, and management of hypertension should be accompanied by an evaluation of the impact at the individual, system and social level.

Objectives: . To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults., Materials and Methods.: Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method., Results: . Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance., Conclusions: . Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system.