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Missing female patients: an observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India
  1. Mudit Kapoor1,
  2. Deepak Agrawal2,
  3. Shamika Ravi3,8,
  4. Ambuj Roy4,
  5. S V Subramanian5,7,
  6. Randeep Guleria6
  1. 1 Economics and Planning Unit, Indian Statistical Institute, Delhi Centre, New Delhi, India
  2. 2 Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center , All India Institute of Medical Sciences, New Delhi, Delhi, India
  3. 3 Brookings Institution India Centre, New Delhi, Delhi, India
  4. 4 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  5. 5 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  6. 6 Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, Delhi, India
  7. 7 Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
  8. 8 Prime Minister’s Economic Advisory Council, Government of India., New Delhi, Delhi, India
  1. Correspondence to Professor Ambuj Roy; drambujroy{at}gmail.com

Abstract

Objective To investigate gender discrimination in access to healthcare and its relationship with the patient’s age and distance from the healthcare facility.

Design and setting An observational study based on outpatient data from a large referral public hospital in Delhi, India.

Participants Confirmed clinical appointments.

Primary and secondary outcome measures Estimates from the logistic regression are used to compute sex ratios (male/female) of patient visits with respect to distance from the hospital and age. Missing female patients for each state—a measure of the extent of gender discrimination—is computed as the difference in the actual number of female patients who came from each state and the number of female patients that should have visited the hospital had male and female patients come in the same proportion as the sex ratio of the overall population from the 2011 census.

Results Of 2377028 outpatient visits, excluding obstetrics and gynaecology patients, the overall sex ratio was 1.69 male to one female visit. Sex ratios, adjusted for age and hospital department, increased with distance. The ratio was 1.41 for Delhi, where the facility is located; 1.70 for Haryana, an adjoining state; 1.98 for Uttar Pradesh, a state further away; and 2.37 for Bihar, the state furthest from Delhi. The sex ratios had a U-shaped relationship with age: 1.93 for 0–18 years, 2.01 for 19–30 years, and 1.75 for 60 years or over compared with 1.43 and 1.40 for the age groups 31–44 and 45–59 years, respectively. We estimate there were 402 722 missing female outpatient visits from these four states, which is 49% of the total female outpatient visits for these four states.

Conclusion We found gender discrimination in access to healthcare, which was worse for female patients who were in the younger and older age groups, and for those who lived at increasing distances from the hospital.

  • gender discrimination
  • access to public health

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Footnotes

  • MK and DA contributed equally.

  • Contributors DA: Substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work. MK: Substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work. SR: Substantial contributions to the conception of the work; interpretation of data for the work. AR: Substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work. SVS: Substantial contributions to the design of the work; the interpretation of data for the work. RG: Substantial contributions to the design of the work; the interpretation of data for the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethical approval for this study was received from All India Institute of Medical Sciences (AIIMS) ethical review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The hospital information system was queried for all confirmed clinical appointments in the year 2016. The data were made available from the Hospital Administration System for this study and are not publicly available.

  • Patient consent for publication Not required.

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