Browsing by Author "Gupta, Neeru"
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Item Decomposition analysis of gender pay gaps among psychologists in Canada(University of New Brunswick, 2022-08) Gulliver, Adrienne; Gupta, Neeru; Balcom, SarahFemale healthcare practitioners worldwide face multiple gender-related challenges, including pay gaps. Early research on the Canadian psychologist workforce highlights differences in earnings between women and men, which may reflect undervaluing of female-dominated work like counselling and psychosocial support. However, much of the existing research on gender wage gaps to inform gender-responsive health workforce financing policy focuses on physicians and nurses, and timely evidence on the psychologist workforce is inadequate. This research evaluates and decomposes the gender pay gap among psychologists using the latest available national data. Microdata from the 2016 Canadian Population Census, accessed from the New Brunswick Research Data Centre, are analyzed with linear regression models and the Oaxaca-Blinder decomposition method to evaluate wage differences by sex (male/female), traditional human capital measures (e.g., education, hours worked) and components of socially institutionalized gender roles (e.g., children in the household). A significant adjusted wage gap of 35% was found between male and female psychologists. After adjusting for both professional and personal characteristics, 33% of the gap remained unexplained. Among parents, a much wider gender wage gap of 49% was found, consistent with the Motherhood Earnings Penalty theoretical framework. The results highlight the need for greater focus on gender equity in the psychologist workforce, ultimately resulting in a better performing mental health services system.Item Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data(MDPI, 2023-10-30) Gupta, Neeru; Cookson, Samuel R.Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5–11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3–24.4) but not among lesbian and bisexual women (3.5; CI: 0.9–13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.Item Exploring the impact of the New Brunswick pediatric insulin pump program on type 1 diabetes health outcomes(University of New Brunswick, 2020) Higgins, Heather; Gupta, NeeruThe purpose of this study is to evaluate the effect of the New Brunswick Pediatric Insulin Pump Program (PIPP) on health outcomes for patients with type 1 diabetes (T1D), by analyzing acute-care hospitalization length of stay (LOS) as measure of outcome relative to non-PIPP participants. The current study uses a retrospective population-based cohort design using administrative health and geospatial databases from 2012/13 to 2014/15. The population includes all New Brunswick inpatients 0-18 years with primary diagnosis of diabetes as the reason for the hospital stay. It was hypothesized a significantly shorter mean LOS among PIPP participants would be observed. To examine the research question, multiple linear regressions were conducted to investigate the hypothesis. Results showed that inpatients supported by the PIPP had significantly shorter hospital stays relative to non-participants (mean of 1.3 days less, p<0.05), after adjusting for age, sex, health region and neighbourhood deprivation level. These results have the potential to inform evidence-based future policy on insulin pump programs.Item Health system responses to changes in the supply and demand for healthcare workers during and after a viral respiratory infection pandemic: protocol for a systematic review of the evidence to inform post-pandemic preparedness(2020) Gupta, Neeru; Witherspoon, RichelleHealthcare systems need comprehensive, policy-actionable evidence to mitigate not just the immediate risk of infectious exposures from the current Coronavirus disease (COVID-19) outbreak, but also longer-term impacts of pandemic responses. Infectious disease outbreaks are associated with surges in the supply of and demand for healthcare workers (HCWs). How these surges impact health systems’ abilities to manage chronic noncommunicable diseases (NCDs) during the pandemic and post-pandemic periods are less well known.Item Self-perceived mental health and its gendered and immigration associations(2018) Aspinall, Mary; Gupta, NeeruBackground: Many research designs have analyzed various socioeconomic factors that influence a person’s physical health, such as diabetes. Whether or not these same factors are associated with a person’s mental health have received less attention. Some studies indicate that gender disparities and the migration process may be associated with differential mental health outcomes. Objective: This research examines the relationship between gender, immigrant status, and self-perceived mental health (SPMH) in the Canadian population aged 18 and over. Method: The analysis draws on the latest available Canadian Community Health Survey (CCHS) public use microdata file, which captured information from a nationally representative sample of 58,574 adults. Multivariate logistic regression was used to explore interactions of gender and immigrant status on SPMH, controlling for a range of socioeconomic variables including education and income. Survey weights were applied to allow for generalization of the results to the Canadian population. Results: The relationships between gender, immigrant status, and SPMH were significant, with females more likely to report good SPMH than men (odds ratio=1.16, p<0.05), and immigrants more likely to report good SPMH than non-immigrants (odds ratio=1.05). Discussion: Results indicate that the “healthy immigrant effect” often reported for diabetes and other physical health measures may also be protective for mental health. Women are more likely to rate their mental health as good. However, our examination did not account for clinical diagnosis of mental illness. More research is needed to inform evidence-based policy and practice guidelines in addressing potential gendered and immigration differences in both measured and perceived mental health.Item Sexual minority status and the hospital burden of cardiometabolic diseases: protocol for an observational study using linked survey and hospital data(2019) Gupta, Neeru; Seng, ZihaoThis paper outlines a protocol for a national observational study examining the association between sexual identity and potentially avoidable hospital costs for diabetes and other cardiometabolic diseases. Our aim is to strengthen the evidence base on sexual minority status as a social determinant of health. We will use data from the Canadian Community Health Survey (CCHS) linked to multiple years of acute-care inpatient records from the Discharge Abstract Database (DAD), representing all provinces except Quebec. Sexual identity is captured in the CCHS among respondents ages 18 to 59. Hospital costs measured from DAD data are considered as an aggregate reflection of the frequency and intensity of use of hospital resources to meet essential medical needs. The study falls within a wider program of research with funding from Diabetes Canada, the New Brunswick Health Research Foundation, the Heart and Stroke Foundation of New Brunswick, and Diabetes Action Canada to conduct policy-actionable population health and health services research using existing databases from official statistical sources.Item Systematic review protocol: Examining the effects of introducing pay-for-performance for primary care physicians on diabetes outcomes in single-payer healthcare systems(2017) Gupta, Neeru; Ayles, Holly M.Background: Although pay-for-performance (P4P) for diabetes care is increasingly common across health organizations, evidence of its effectiveness in improving population health and service delivery is deficient. This information gap is attributable in part to the heterogeneity of healthcare financing, covered medical conditions, care settings, and provider remuneration arrangements within and across countries. Objective: This paper outlines a protocol for a systematic review examining the effects of introducing P4P for physicians in primary care and community settings to support guideline- based diabetes care. Our aim is to reduce the heterogeneity of evidence presented that has deterred conclusiveness of previous reviews by narrowing the focus to disease-specific P4P schemes in single-payer healthcare insurance systems. This approach enables us to minimize the risk of unintended consequences of P4P such as physicians’ gaming the payment system. Methods: Our review systematically searches, appraises, and synthesizes the literature concentrating on whether P4P for primary care physicians leads to better diabetes outcomes in single-payer health systems. We search 10 electronic databases and manually scan the reference lists of review articles and other global health literature. We include primary studies evaluating the effects of introducing P4P for diabetes care among primary care physicians in countries of universal health coverage. Outcomes of interest include patient morbidity, avoidable hospitalization, premature death, and healthcare costs. Results: We have received funding from Diabetes Canada and the New Brunswick Health Research Foundation to conduct policy-actionable diabetes health services research. Database searches were conducted and full-texts screened by two reviewers in 2017. We aim to submit the review for publication in 2018. Conclusions: We are narratively synthesizing the data. Because of the wide range of outcomes considered, we do not expect to perform a meta-analysis.