Precision Medicine implies a deep understanding of inter-individual differences in health and disease that are due to genetic and environmental factors. To acquire such understanding there is a need for the implementation of different types of technologies based on artificial intelligence (AI) that enable the identification of biomedically relevant patterns, facilitating progress towards individually tailored preventative and therapeutic interventions. Despite the significant scientific advances achieved so far, most of the currently used biomedical AI technologies do not account for bias detection. Furthermore, the design of the majority of algorithms ignore the sex and gender dimension and its contribution to health and disease differences among individuals. Failure in accounting for these differences will generate sub-optimal results and produce mistakes as well as discriminatory outcomes. In this review we examine the current sex and gender gaps in a subset of biomedical technologies used in relation to Precision Medicine. In addition, we provide recommendations to optimize their utilization to improve the global health and disease landscape and decrease inequalities.

/pdf/sex-and-gender-differences-and-biases-in-artificial-180x64qu0t.pdf

Sex and gender differences and biases in artificial intelligence for biomedicine and healthcare.

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

https://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040119-094318

Disparities in Access to Oral Health Care.

BACKGROUND Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. OBJECTIVES To understand whether sociodemographic differences in patient portal use for secure messaging can be explained by differences in internet access and care preferences. RESEARCH DESIGN Cross-sectional survey to examine the association between patient sociodemographic characteristics and internet access and care preferences; then, the association between sociodemographic characteristics and secure message use with and without adjusting for internet access and care preference. SUBJECTS One thousand forty-one patients with chronic conditions in a large integrated health care delivery system (76% response rate). MEASURES Internet access, portal use for secure messaging, preference for in-person or online care, and sociodemographic and health characteristics. RESULTS Internet access and preference mediated some of the differences in secure message use by age, race, and income. For example, using own computer to access the internet explained 52% of the association between race and secure message use and 60% of the association between income and use (Sobel-Goodman mediation test, P<0.001 for both). Education and sex-related differences in portal use remained statistically significant when controlling for internet access and preference. CONCLUSIONS As the availability and use of patient portals increase, it is important to understand which patients have limited access and the barriers they may face. Improving internet access and making portals available across multiple platforms, including mobile, may reduce some disparities in secure message use.

The Digital Divide and Patient Portals: Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income.

Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020.

Background: Since 1976, federal Medicaid has excluded abortion care except in a small number of circumstances; 17 states provide this coverage using state Medicaid dollars. Since 2010, federal and state restrictions on insurance coverage for abortion have increased. This paper describes payment for abortion care before new restrictions among a sample of women receiving first and second trimester abortions. Methods: Data are from the Turnaway Study, a study of women seeking abortion care at 30 facilities across the United States. Findings: Two thirds received financial assistance, with those with pregnancies at later gestations more likely to receive assistance. Seven percent received funding from private insurance, 34% state Medicaid, and 29% other organizations. Median out-of-pocket costs when private insurance or Medicaid paid were $18 and $0. Median out-of-pocket cost for women for whom insurance or Medicaid did not pay was $575. For more than half, out-of-pocket costs were equivalent to more than one-third of monthly personal income; this was closer to two thirds among those receiving later abortions. One quarter who had private insurance had their abortion covered through insurance. Among women possibly eligible for Medicaid based on income and residence, more than one third received Medicaid coverage for the abortion. More than half reported cost as a reason for delay in obtaining an abortion. In a multivariate analysis, living in a state where Medicaid for abortion was available, having Medicaid or private insurance, being at a lower gestational age, and higher income were associated with lower odds of reporting cost as a reason for delay. Conclusions: Out-of-pocket costs for abortion care are substantial for many women, especially at later gestations. There are significant gaps in public and private insurance coverage for abortion. Copyright 2014 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc.

Out-of-pocket costs and insurance coverage for abortion in the United States.

Objective To examine the effects of health insurance coverage and other factors on access to prescription medicines for non-elderly women ages 18–64. Methods Based on a nationally representative telephone survey of adult women in the United States, this study uses multiple logistic regression to determine the factors significantly associated with cost barriers among non-elderly women. The sample for the study includes 1,177 women ages 18–64 who use ≥1 prescription drug on a regular basis. Cost barriers are defined as not filling a prescription or skipping or splitting doses owing to cost. A composite variable of income and health insurance was created to examine the role of insurance in mitigating barriers for women of different income levels. Descriptive analyses report the share of subgroups of women who have faced any of these cost barriers, and logistic regression analyses were used to examine the role of health insurance, income, and other factors in predicting financial access to prescribed medications. Key Findings Over half (54%) of non-elderly women reported that they were taking a prescription medicine on a regular basis, and nearly one third (32%) of these women reported experiencing ≥1 affordability barrier in the prior year and had to either forgo or delay a prescription and/or reduce dosages to make medicines last longer because of costs. Uninsured women had the highest odds of facing a cost barrier, regardless of income level. Low-income, uninsured women were nearly 7 times as likely to face a cost barrier to prescription drugs, compared with higher income women with insurance. Even uninsured women with incomes ≥200% of the federal poverty level had 5 times the odds of facing a prescription medicine cost barrier, and low-income, insured women experienced 2 times the odds of a prescription medicine cost barrier, compared with their higher income, insured counterparts. Conclusion Lack of health insurance coverage was significantly associated with experiencing cost barriers, regardless of income level, underscoring the critical role that insurance coverage plays in protecting women from out-of-pocket costs and for accessing prescription medicines. Limiting out-of-pocket spending is also important for low-income women who have insurance, because even minimal costs can act as barriers for this group.

Role of health insurance coverage in women's access to prescription medicines.

/pdf/state-medicaid-coverage-of-perinatal-services-summary-of-4gmqd9wrlz.pdf

State Medicaid Coverage of Perinatal Services: Summary of State Survey Findings

The health issues women face over the course of their lives, as well as policies that shape Medicare, Medicaid, and other supplemental coverage can affect retired women's economic well‐being. This study uses a nationally representative sample of Medicare beneficiaries aged 65 and older in 2002 to explore gender‐based differences in health and long‐term care use, spending patterns, and the financial burden of health and long‐term care out‐of‐pocket health expenses. Women's health care expenses were higher than men's; older women paid for a greater share of their total spending out of pocket and they faced a greater financial burden by shouldering these out‐of‐pocket costs with less income at their disposal. Low‐income women, those with Medigap or no supplemental coverage, and white women, who are less likely to qualify for Medicaid which covers long term care, faced the greatest financial burdens associated with health and long‐term care costs. The implications of these findings for women in the context of...

Health Coverage and Expenses: Impact on Older Women's Economic Well-Being

/pdf/barriers-to-care-experienced-by-women-in-the-united-states-2reqg6qs60.pdf

Barriers to Care Experienced by Women in the United States.

As Medicaid marks its 50th year, the program has unquestionably become the mainstay of health coverage for lowincome women in the nation. Since its inception, its role for women has continued to evolve and expand, but the passage of the Affordable Care Act (ACA) swung open the doors for Medicaid to serve even more low-income women who lack access to private or employer-based insurance. This is because the ACA enabled states to finally eliminate Medicaid’s historical “categorical” requirements, which had essentially shut out women and men without dependent children. The vision of the ACA’s proponents was that eligibility would be extended to all individuals with incomes up to 138% of the federal poverty level (FPL), creating a pathway to coverage for millions who previously could not qualify for the program, regardless of how poor they were. In 2012, a Supreme Court decision effectively made this expansion a state option (Supreme Court of the United States, 2012). As a result, 30 states plus the District of Columbia have opted to broaden eligibility, but 20 states have chosen to maintain historical eligibility categories with income thresholds that are far below the poverty level in many states. Despite this ACA implementation setback, millions of low-income women (and men) have gained coverage since the law was enacted (Office of the Assistant Secretary for Planning and Evaluation, 2015). Nearly 21% of nonelderly adult women and 16% of men now have public coverage, primarily Medicaid. Additionally, 4.8 million women and 3.7 million men have purchased a marketplace plan, with the majority qualifying for premium subsidies (Centers for Disease Control and Prevention, 2015). Considerable questions remain, however, about how to maximize the ACA’s potential to reduce the uninsured count, improve access to care, and how elements of coverage can be strengthened to better serve the needs of lowincome women.

Medicaid and Women's Health Coverage Two Years into the Affordable Care Act

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