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Author: search.filters.author.Marcela OyarteSubject: search.filters.subject.chile

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    Breast cancer diagnosis and staging in Chile: A non-randomized survey-based study to assess frequency and delays
    (2024)
    CAMPAÑA, CARLA  
    ;
    Marcela Oyarte
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    OBACH KING, ALEXANDRA ALICE  
    <jats:p>Introduction Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.</jats:p>
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    Unequal Access and Use of Health Care Services among Settled Immigrants, Recent Immigrants, and Locals: A Comparative Analysis of a Nationally Representative Survey in Chile
    (2022)
    Marcela Oyarte
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    Isabel Rada
    ;
    Alice Blukacz
    ;
    Manuel Espinoza
    <jats:p>Globally, and particularly in the Latin American region, international migration continues to grow. Access and use of health care services by migrants vary according to their country of origin and residence time. We aimed to compare the access and use of health care services between international migrants (including settled migrants from Peru, Argentina, Bolivia, Ecuador; Emerging migrants from Venezuela, Dominican Republic, Colombia, Haiti; and migrants from other countries) and the Chilean population. After performing a secondary data analysis of population-based nationally representative surveys (CASEN 2011–2017), access and use patterns (insurance, complementary insurance, non-consultation, and non-treatment coverage) were described and compared among settled immigrants, recent emerging immigrants, others, and locals. Immigrants had a significantly higher uninsured population compared to locals. Specifically, in CASEN 2017, 19.27% of emerging (95% CI: 15.3–24.1%), 11.79% of settled (95% CI: 10.1–13.7%), and 2.25% of locals (95% CI: 2.1–2.4%) were uninsured. After 2013, settled and recent emerging migrants showed higher percentages of non-consultation. Collaborative and interculturally relevant strategies from human rights and equity perspectives are needed. Initiatives with a particular focus on recent immigrants can contribute to reducing the existing disparities in health care access and use with locals due to lack of insurance and treatment coverage.</jats:p>
      9Scopus© Citations 10
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    Percepción de discriminación en inmigrantes comparados a nacidos en Chile y su relación con acceso a servicios y resultados de salud
    (2022)
    Marcela Oyarte
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    Manuel Espinoza
    ;
    María Teresa Valenzuela
    ;
    DELGADO BECERRA, OROZIMBA IRIS  
    <jats:p>OBJETIVOS: Comparar la autopercepción de discriminación entre inmigrantes y locales en Chile y analizar la relación entre inmigración y discriminación percibida e inmigración, discriminación y resultados de salud, ajustando por características sociodemográficas y capital social. MÉTODOS: Estudio transversal, utilizando encuesta poblacional (CASEN2017). Se seleccionaron 2.409 inmigrantes (representativos de N = 291.270) y 67.857 locales (representativos de N = 5.438.036) mayores de 18 años encuestados. Se estimaron modelos de regresión logística, considerando la muestra compleja, con discriminación, salud autoevaluada, tratamiento médico, pertenencia al sistema de salud, seguros complementarios de salud, consulta médica y problemas al consultar como variables dependientes, inmigración y discriminación como variables de exposición principal, y capital social y variables sociodemográficas como covariables de los modelos. RESULTADOS: Inmigrantes tuvieron mayor posibilidad de percibir discriminación en general comparado con locales (OR = 2,31; IC95%:1,9–2,9). Sin embargo, esto no ocurre para todos los motivos específicos de discriminación; color de piel y apariencia física fueron las causas de discriminación más frecuentes en inmigrantes. La interacción entre inmigración y discriminación se relacionó significativamente con peores resultados de salud autoevaluada y tratamiento por patologías, en desfavor de los inmigrantes discriminados. Tanto en locales como en inmigrantes la discriminación no se asoció con resultados de acceso a atención en salud, excepto problemas durante la consulta en locales (OR = 1,61; IC95% 1,4–1,8). CONCLUSIONES: En Chile, las experiencias de discriminación se entrelazan con otras formas de rechazo y exclusión social, por lo cual es urgente concientizar a la población para prevenir estas prácticas discriminatorias, sobre todo en la atención en salud y lugares de uso cotidiano. Abordar la discriminación es indispensable para lograr impactar en variables intermedias y resultados de salud. La extensión de los resultados a toda la población inmigrante podría ser de amplia utilidad para profundizar la problemática y mejorar las estimaciones realizadas.</jats:p>
    Scopus© Citations 11  13
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    Scopus© Citations 8  3
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      30  3Scopus© Citations 9
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    A comparative analysis of health status of international migrants and local population in Chile: a population-based, cross-sectional analysis from a social determinants of health perspective
    (2022)
    Isabel Rada
    ;
    Marcela Oyarte
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>During recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean).</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>International migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44–0.84; <jats:italic>P</jats:italic> = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Testing the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.</jats:p> </jats:sec>
      2Scopus© Citations 12  3