Health Equity: A Challenging Outcome Measure in Rheumatic Global Health
Bibliographic record
Abstract
In this issue of The Journal of Rheumatology , Wiens et al1 describe how Indigenous people with rheumatoid arthritis (RA) and their unaffected first-degree relatives perceive access to healthcare services in Canada. This was a cohort study with individuals from remote communities and urbanized centers, representatives of which participated in the construction of a questionnaire to explore health accessibility. Data were obtained from a total of 831 complete surveys comprising 7 items among 3 domains (wait, travel, and medications). The authors analyzed a binary outcome (overall access difficulty), defined as a perceived moderate/big problem in one or more items of a specific domain. These are main results of this study: A higher overall access difficulty in patients with RA from remote areas was found compared to those from urban areas; this difference was present in all 3 domains. The length of disease had no effect on access difficulty, whereas disability showed a trend toward more problems with healthcare access. Meanwhile, older age, female sex, and living in a rural community were important factors for access difficulty, these being more related to the domains of wait and travel. With these results, the authors concluded that healthcare equity is still a problem in Canadian remote communities, especially for First Nations female individuals. Health equity has increasingly become a topic of interest in research and action, shown for example by the surge in articles related to health equity recorded in PubMed, from around 5000 in the mid-1960s to over 130,000 in recent years. The coronavirus disease 2019 (COVID-19) pandemic has also contributed to this boom through calls for research and action that specifically integrate this perspective.2 Since health equity was first formally defined by Whitehead in 1992, … Address correspondence to Dr. I. Peláez-Ballestas, Dr. Balmis 148, Col. Doctores, Cuahtémoc 06720, Mexico City, Mexico. Email: pelaezin{at}gmail.com.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.041 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".