Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions

Authors: Diego A. Martinez, Haoxiang Zhang, Magdalena Bastias, Felipe Feijoo, Jeremiah Hinson, Rodrigo Martinez, Jocelyn Dunstan, Scott Levin, Diana Prieto

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

Most data on mortality and prognostic factors of universal healthcare waiting lists come from North America, Australasia, and Europe, with little information from South America. We aimed to determine the relationship between medical center-specific waiting time and waiting list mortality in Chile.

Method

Using data from all new patients listed in medical specialist waitlists for non-prioritized health problems from 2008 to 2015 in three geographically distant regions of Chile, we constructed hierarchical multivariate survival models to predict mortality risk at two years after registration for each medical center. Kendall rank correlation analysis was used to measure the association between medical center-specific mortality hazard ratio and waiting times.

Result

There were 987,497 patients waiting for care at 77 medical centers, including 33,546 (3.40%) who died within two years after registration. Male gender (hazard ratio [HR] = 1.17, 95% confidence interval [CI] 1.1–1.24), older age (HR = 2.88, 95% CI 2.72–3.05), urban residence (HR = 1.19, 95% CI 1.09–1.31), tertiary care (HR = 2.2, 95% CI 2.14–2.26), oncology (HR = 3.57, 95% CI 3.4–3.76), and hematology (HR = 1.6, 95% CI 1.49–1.73) were associated with higher risk of mortality at each medical center with large region-to-region variations. There was a statistically significant association between waiting time variability and death (Z = 2.16, P = 0.0308).

Conclusion

Patient wait time for non-prioritized health conditions was associated with increased mortality in Chilean hospitals.
Appendix
Available only for authorised users
Literature
1.
World Health Organization. The world health report: health systems financing: the path to universal coverage: executive summary (No. WHO/IER/WHR/10.1). Geneva: World Health Organization; 2010.
2.
3.
4.
5.
Willcox S, Seddon M, Dunn S, Edwards RT, Pearse J, Tu JV. Measuring and reducing waiting times: a cross-national comparison of strategies. Health Aff (Millwood). 26:1078–87.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Letelier LM, Bedregal P. Health reform in Chile. Lancet. 2006;368:2197–8.CrossRef
16.
17.
Bastías G, Pantoja T, Leisewitz T, Zárate V. Health care reform in Chile. CMAJ. 2008;179:1289–92.CrossRef
18.
Vargas V, Poblete S. Health prioritization: the case of Chile. Health Aff (Millwood). 27:782–92.
19.
20.
21.
22.
23.
24.
25.
26.
Begg M, Parides M. Separation of individual-level and cluster-level covariate effects in regression analysis of correlated data. Stat Med. 2003;22:2591–602.CrossRef
27.
Enders C, Tofighi D. Centering predictor variables in cross-sectional multilevel models: a new look at an old issue. Psychol Methods. 2007;12:121–38.CrossRef
28.
29.
Therneau T. coxme: mixed effects Cox models. R package version 2.2-3. Vienna: R Foundation for Statistical Computing; 2012.
30.
31.
Rondeau V, Gonzalez J. frailtypack: A computer program for the analysis of correlated failure time data using penalized likelihood estimation. Comput Methods Programs Biomed. 2005;80:154–64.CrossRef
32.
33.
Develpment CM of S. Sintesis de Resultados en Salud CASEN. 2015.
34.
de la Jimenez Jara J, Bastias G, Ferreccio C, Moscoso C, Sagues S, Cid C, et al. A snapshot of cancer in Chile: analytical frameworks for developing a cancer policy. Biol Res. 2015;48:10.CrossRef
35.
Izarzugaza MI, Fernández L, Forman D, Sierra MS. Burden of gallbladder cancer in central and South America. Cancer Epidemiol. 2016;44(Suppl 1):S82–9.CrossRef
36.
Andia ME, Hsing AW, Andreotti G, Ferreccio C. Geographic variation of gallbladder cancer mortality and risk factors in Chile: a population-based ecologic study. Int J Cancer. 2008;123:1411–6.CrossRef
37.
Del Castillo SC, Cabrera CME, Derio PL, Gaete VF, Cavada CG. Impact of the Chilean Explicit Guaranties Health System (GES) on breast cancer treatment. Rev Med Chil. 2017;145:1507–13.CrossRef
38.
39.
Juan Carlos Roa S, Catterina Ferreccio R, Juan Francisco Miquel P. Cáncer de la vesícula biliar: estudios necesarios para el diseño de estrategias de prevención y diagnóstico precoz. Rev Médica Clínica Las Condes. 2011;22:486–91.CrossRef
40.
Bitrán R, Escobar L, Gassibe P. After Chile’s health reform: increase in coverage and access, decline in hospitalization and death rates. Health Aff (Millwood). 2010;29:2161–70.CrossRef
41.
Nazzal NC, Campos TP, Corbalán HR, Lanas ZF, Bartolucci JJ, Sanhueza CP, et al. The impact of Chilean health reform in the management and mortality of ST elevation myocardial infarction (STEMI) in Chilean hospitals. Rev Med Chil. 2008;136:1231–9.CrossRef
42.
Wang Y, Álvarez G, Salinas R, Ramírez G, Catalán M, Díaz C. Compliance with Chilean diagnostic guidelines among patients with ischemic stroke admitted to a public hospital. Rev Med Chil. 2011;139:697–703.CrossRef
43.
44.
Concha DF, Pastén VN, Espinosa FV, López AF. Impacto de la implementación del Plan AUGE en la detección antenatal de cardiopatías congénitas. Rev Chil Obstet Ginecol. 2008;73.
45.
Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Health Policy Plan. 2014;29:717–31.CrossRef
46.
González F. Implementation of AUGE plan for chronic renal failure patients. The implementation of universal access and explicit guaranties plan (AUGE), generates longer waiting lists among patients with chronic renal failure. Rev Med Chil. 2003;131:545–51.PubMed
47.
VEGA J, HOLLSTEIN RD, DELGADO I, PEREZ JC, CARRASCO S, MARSHALL G, et al. Chile: socioeconomic differentials and mortality in a middle-income nation. In: Challenging Inequities in Health. Oxford University Press; 2001. p. 122–137.
48.
Burrows J. Inequalities and healthcare reform in Chile: equity of what? J Med Ethics. 2008;34:e13.CrossRef
49.
Román O, Muñoz F. A critical appraisal to “AUGE” health plan in Chile. Rev Med Chil. 2008;136:1599–603.PubMed
50.
Nazzal C, Lanas F, Garmendia ML, Bugueño C, Mercadal E, Garcés E, et al. Universal health coverage and accomplishment of secondary prevention goals among patients with acute myocardial infarction. Rev Med Chil. 2013;141:977–86.CrossRef
51.
Sánchez H, Albala C, Dangour AD, Uauy R. Compliance with guidelines for the management of community acquired pneumonia at primary health care centers. Rev Med Chil. 2009;137:1575–82.PubMed
52.
Vega J, Bedregal P, Jadue L, Delgado I. Gender inequity in the access to health care in Chile. Rev Med Chil. 2003;131:669–78.PubMed
53.
54.
Siciliani L, Borowitz M, Moran V. Waiting Time Policies in the Health Sector: OECD Publishing; 2013.
55.
Guillou M, Carabantes CJ, Bustos FV. Availability of physicians and specialists in Chile. Rev Med Chil. 2011;139:559–70.CrossRef
56.
Román AO. Evolution of the availability of physicians in Chile. Rev Med Chil. 2010;138:22–8.
57.
Román O, Acuña M, Señoret M. Availability of physicians in Chile at the year 2004. Rev Med Chil. 2006;134:1057–64 doi:/S0034–98872006000800017.PubMed
58.
Banks J, Muriel A, Smith JP. Attrition and health in ageing studies: evidence from ELSA and HRS. Longit Life Course Stud. 2011;2.
Metadata
Title
Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions
Authors
Diego A. Martinez
Haoxiang Zhang
Magdalena Bastias
Felipe Feijoo
Jeremiah Hinson
Rodrigo Martinez
Jocelyn Dunstan
Scott Levin
Diana Prieto
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-6526-6

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

Factors associated with relevant knowledge of intestinal schistosomiasis and intention to participate in treatment campaigns: a cross sectional survey among school children at Ijinga Island on Lake Victoria, North-Western Tanzania

Research article

Impact of problematic mobile phone use and insufficient physical activity on depression symptoms: a college-based follow-up study

Research article

Women’s freedom of movement and participation in psychosocial support groups: qualitative study in northern India

Research article

An exploratory model for the non-fatal drowning risks in children in Guangdong, China

Research article

Increasing socioeconomic disparities in sedentary behaviors in Chinese children

Research article

Participant retention in follow-up studies of prematurely born children