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1.
BMC Public Health ; 22(1): 811, 2022 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-35459200

RESUMO

BACKGROUND: Nearly one-half of Americans have been exposed to at least one adverse childhood experience (ACE) before turning 18, contributing to a broad array of problems spanning physical health, mental and behavioral health, and psychosocial functioning. METHODS: This was a cross-sectional, survey research study, using 2018 data from a state adolescent health surveillance system, i.e., Maryland Youth Risk Behavior Survey/Youth Tobacco Survey. The population-based sample of Maryland high school students (n = 41,091) is representative at the state and county levels. The outcome variables included five binary measures of ACEs (i.e., food insecurity, parental substance use/gambling, parental mental illness, family member in jail/prison, and caregiver verbal abuse), and number of ACEs. The main exposure variable, area-level socioeconomic disadvantage, was assessed at the county level using a continuous measure of the area deprivation index (ADI). Additional covariates included: rural county status, age, race/ethnicity, sex, and sexual or gender minority (SGM) status. We used mixed-effect multivariate logistic regression to estimate the odds of ACEs in association with socioeconomic deprivation. Models were adjusted for all covariates. RESULTS: County-level ADI was associated with 3 of the 5 ACES [i.e., food insecurity (OR = 1.10, 95% CI: 1.07-1.13), parental substance use/gambling (OR = 1.05, 95% CI: 1.02-1.07), and incarceration of a family member (OR = 1.14, 95% CI: 1.09-1.19)]; and with having at least one ACE (i.e., OR = 1.08, 95% CI: 1.05-1.10). Odds of reporting at least one ACE were higher among girls, older adolescents (i.e., aged 16 and ≥ 17 relative to those aged ≤ 14 years), and among SGM, Black, and Latinx students (all ORs > 1.20). CONCLUSIONS: ACEs greatly increase risk for adolescent risk behaviors. We observed an increased likelihood of adversity among youth in more deprived counties and among Black, Latinx, or SGM youth, suggesting that social and structural factors play a role in determining the adversity that youth face. Therefore, efforts to address structural factors (e.g., food access, family financial support, imprisonment as a sanction for criminal behavior) could be a critical strategy for primary prevention of ACEs and promoting adolescent health.


Assuntos
Experiências Adversas da Infância , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Maryland/epidemiologia , Estudantes , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
3.
PLoS One ; 17(3): e0263893, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35263326

RESUMO

BACKGROUND: The Covid-19 pandemic and its accompanying public-health orders (PHOs) have led to (potentially countervailing) changes in various risk factors for overdose. To assess whether the net effects of these factors varied geographically, we examined regional variation in the impact of the PHOs on counts of nonfatal overdoses, which have received less attention than fatal overdoses, despite their public health significance. METHODS: Data were collected from the Overdose Detection Mapping Application Program (ODMAP), which recorded suspected overdoses between July 1, 2018 and October 25, 2020. We used segmented regression models to assess the impact of PHOs on nonfatal-overdose trends in Washington DC and the five geographical regions of Maryland, using a historical control time series to adjust for normative changes in overdoses that occurred around mid-March (when the PHOs were issued). RESULTS: The mean level change in nonfatal opioid overdoses immediately after mid-March was not reliably different in the Covid-19 year versus the preceding control time series for any region. However, the rate of increase in nonfatal overdose was steeper after mid-March in the Covid-19 year versus the preceding year for Maryland as a whole (B = 2.36; 95% CI, 0.65 to 4.06; p = .007) and for certain subregions. No differences were observed for Washington DC. CONCLUSIONS: The pandemic and its accompanying PHOs were associated with steeper increases in nonfatal opioid overdoses in most but not all of the regions we assessed, with a net effect that was deleterious for the Maryland region as a whole.


Assuntos
COVID-19/epidemiologia , Overdose de Opiáceos/epidemiologia , COVID-19/virologia , District of Columbia/epidemiologia , Humanos , Maryland/epidemiologia , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Pandemias , Saúde Pública/tendências , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Fatores de Tempo
4.
J Sch Health ; 92(5): 429-435, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35253227

RESUMO

BACKGROUND: The Summer Food Service Program (SFSP) provides free and nutritious meals to children under age 18 during out-of-school times. During the COVID-19 pandemic, Maryland sponsors served over 9.5 million meals to children through an expanded version of the SFSP. This study aimed to explore and compare the factors that enabled 2 SFSP sponsors in Maryland to dramatically increase meals distribution during the pandemic. METHODS: Sponsors were selected based on their responses in the larger study and demographic characteristics of the area in which they served. Semi-structured in-depth interviews were conducted over Zoom-4 interviews with Sponsor A (3 interviews with the sponsor, 1 interview with their vendor) and 1 interview with Sponsor B. Qualitative data were analyzed inductively and deductively. Participation data from 2019 and 2020 were obtained from the Maryland State Department of Education and analyzed. RESULTS: Despite their differences in organization type and geographic region, they identified similar facilitators to their success-communication with the community and utilization of the United States Department of Agriculture-issued waivers. CONCLUSIONS: Strengthening community communication networks and permanently integrating more flexibility into regulation of the SFSP may increase meals participation during future out-of-school times.


Assuntos
COVID-19 , Serviços de Alimentação , Adolescente , COVID-19/epidemiologia , Criança , Humanos , Maryland/epidemiologia , Refeições , Pandemias , Instituições Acadêmicas , Estados Unidos
5.
Emerg Infect Dis ; 28(5): 1002-1005, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35263559

RESUMO

A case of monkeypox was diagnosed in a returning traveler from Nigeria to Maryland, USA. Prompt infection control measures led to no secondary cases in 40 exposed healthcare workers. Given the global health implications, public health systems should be aware of effective strategies to mitigate the potential spread of monkeypox.


Assuntos
Monkeypox , Animais , Pessoal de Saúde , Humanos , Controle de Infecções , Maryland , Monkeypox/diagnóstico , Monkeypox/epidemiologia , Vírus da Varíola dos Macacos
6.
Matern Child Health J ; 26(5): 1153-1159, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35334026

RESUMO

OBJECTIVES: The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about its impact on participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The purpose of this study was to evaluate whether Baby Friendly Hospital (BFH) designation in Maryland improved breastfeeding practices among Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants. METHODS: Breastfeeding practices of WIC participants (22,543 mother-infant dyads) were analyzed utilizing WIC management information system de-identified data from four Maryland WIC agencies during 2010-12 and 2017-19. Participants lived in areas served by a hospital that became BFH in 2016 or remained non-BFH. Pre-post implementation breastfeeding practices (breastfeeding initiation, at 3 months and 6 months) of women associated with a BFH were compared to women associated with a non-BFH using propensity score weighting and a difference-in-difference modeling. RESULTS: From pre to post intervention no differences in breastfeeding initiation or any breastfeeding at 6 months were attributable to BFH status. There was some evidence that BFH designation in 2016 was associated with an absolute percent change of 2.4% (P = 0.09) for any breastfeeding at 3 months. DISCUSSION: Few differences in breastfeeding outcomes among WIC participants were attributable to delivery in a BFH. Results from this study inform policy about maternity practices impacting WIC breastfeeding outcomes. More study needed to determine the impact of BFH delivery on differences in breastfeeding outcomes between sub-groups of women.


Assuntos
Aleitamento Materno , Promoção da Saúde , Criança , Feminino , Promoção da Saúde/métodos , Hospitais , Humanos , Lactente , Maryland , Mães , Gravidez
7.
PLoS One ; 17(2): e0263820, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35176031

RESUMO

Many factors play a role in outcomes of an emerging highly contagious disease such as COVID-19. Identification and better understanding of these factors are critical in planning and implementation of effective response strategies during such public health crises. The objective of this study is to examine the impact of factors related to social distancing, human mobility, enforcement strategies, hospital capacity, and testing capacity on COVID-19 outcomes within counties located in District of Columbia as well as the states of Maryland and Virginia. Longitudinal data have been used in the analysis to model county-level COVID-19 infection and mortality rates. These data include big location-based service data, which were collected from anonymized mobile devices and characterize various social distancing and human mobility measures within the study area during the pandemic. The results provide empirical evidence that lower rates of COVID-19 infection and mortality are linked with increased levels of social distancing and reduced levels of travel-particularly by public transit modes. Other preventive strategies and polices also prove to be influential in COVID-19 outcomes. Most notably, lower COVID-19 infection and mortality rates are linked with stricter enforcement policies and more severe penalties for violating stay-at-home orders. Further, policies that allow gradual relaxation of social distancing measures and travel restrictions as well as those requiring usage of a face mask are related to lower rates of COVID-19 infections and deaths. Additionally, increased access to ventilators and Intensive Care Unit (ICU) beds, which represent hospital capacity, are linked with lower COVID-19 mortality rates. On the other hand, gaps in testing capacity are related to higher rates of COVID-19 infection. The results also provide empirical evidence for reports suggesting that certain minority groups such as African Americans and Hispanics are disproportionately affected by the COVID-19 pandemic.


Assuntos
Big Data , COVID-19/prevenção & controle , Distanciamento Físico , Saúde Pública , Viagem/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/virologia , District of Columbia/epidemiologia , Feminino , Humanos , Masculino , Maryland/epidemiologia , Máscaras/estatística & dados numéricos , Pessoa de Meia-Idade , Quarentena , SARS-CoV-2/isolamento & purificação , Virginia/epidemiologia
8.
PLoS One ; 17(1): e0261687, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35061736

RESUMO

Although African Americans have lower rates of anxiety in childhood than other racial and ethnic minority groups, they seem to experience escalating rates during emerging adulthood. Despite this, few studies have examined factors associated with anxiety during emerging adulthood among African American populations. The current study investigated the extent to which late adolescent family relationships affect anxiety problems among African American emerging adults. Informed by family development theory, family cohesion was hypothesized to indirectly effect anxiety problems through self-regulation. This model was tested with three waves of data (ages 17, 19, 21) from African Americans participating in the Maryland Adolescent Development in Context Study. Study findings were consistent with the hypothesized model: family cohesion forecasted decreased anxiety problems, indirectly, via increased self-regulation. This finding suggests that families may be an important promotive process for anxiety problems during emerging adulthood. Prevention programs that target family processes may be able to reduce anxiety problems in emerging adult African Americans.


Assuntos
Afro-Americanos , Transtornos de Ansiedade , Relações Familiares , Autocontrole/psicologia , Adolescente , Adulto , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Feminino , Humanos , Masculino , Maryland/epidemiologia
9.
Med Care ; 60(3): 248-255, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34984989

RESUMO

BACKGROUND: Health care systems in the United States are increasingly interested in measuring and addressing social determinants of health (SDoH). Advances in electronic health record systems and Natural Language Processing (NLP) create a unique opportunity to systematically document patient SDoH from digitized free-text provider notes. METHODS: Patient SDoH status [recorded by Your Current Life Situation (YCLS) Survey] and associated provider notes recorded between March 2017 and June 2020 were extracted (32,261 beneficiaries; 50,722 YCLS surveys; 485,425 provider notes).NLP patterns were generated using a machine learning test statistic (Term Frequency-Inverse Document Frequency). Patterns were developed and assessed in a training, training validation, and final validation dataset (64%, 16%, and 20% of total data, respectively).NLP models analyzed SDoH-specific categories (housing, medical care, and transportation needs) and a combined SDoH metric. Model performance was assessed using sensitivity, specificity, and Cohen κ statistic, assuming the YCLS Survey to be the gold standard. RESULTS: Within the training validation dataset, NLP models showed strong sensitivity and specificity, with moderate agreement with the YCLS Survey (Housing: sensitivity=0.67, specificity=0.89, κ=0.51; Medical care: sensitivity=0.55, specificity=0.73, κ=0.20; Transportation: sensitivity=0.79, specificity=0.87, κ=0.58). Model performance in the training and training validation datasets were comparable.In the final validation dataset, a combined SDoH prediction metric showed sensitivity=0.77, specificity=0.69, κ=0.45. CONCLUSION: This NLP algorithm demonstrated moderate performance in identification of unmet patient social needs. This novel approach may enable improved targeting of interventions, allocation of limited resources and monitoring a health care system's addressing its patients' SDoH needs.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Processamento de Linguagem Natural , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Algoritmos , Estudos de Coortes , Atenção à Saúde , District of Columbia , Feminino , Habitação/estatística & dados numéricos , Humanos , Aprendizado de Máquina , Masculino , Maryland , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
10.
Contraception ; 106: 45-48, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34587503

RESUMO

OBJECTIVE: In the United States, restrictive abortion policies are concentrated in a subset of states. Little research has examined how people who consider abortion make sense of abortion obtainability and the extent of regulation of abortion care in their state. STUDY DESIGN: We conducted in-depth interviews with 30 pregnant women in Maryland, a state with high abortion service availability and few policies restricting abortion, and 28 pregnant women in Louisiana, a state with low service availability and numerous restrictions, who had considered but not obtained an abortion for their pregnancy. We analyzed findings using inductive qualitative analytic techniques. RESULTS: All participants were financially struggling. Most participants in Maryland considered abortion easy to get, while a plurality of participants in Louisiana considered abortion difficult to get. Yet, despite their measurable differences in access, participants in both states considered abortion generally obtainable. Participants in Louisiana who thought abortion difficult to get, but nonetheless obtainable, cited strategies that they already employed for other challenges in their lives as options for overcoming abortion barriers. CONCLUSIONS: Pregnant women who consider abortion and are subject to restrictions do not necessarily perceive restrictions as barriers. Their accounts illustrate how those impacted by restrictions adapt to constraints on their reproductive autonomy just as they manage many other challenges that restrict their freedom to live self-determined lives. IMPLICATIONS: Financially struggling pregnant people who considered abortion in Louisiana did not perceive restrictions as barriers to abortion, illustrating the broader adoption of strategies to deal with constraints among women living on low incomes.


Assuntos
Aborto Induzido , Aborto Espontâneo , Feminino , Acesso aos Serviços de Saúde , Humanos , Maryland , Gravidez , Gestantes , Estados Unidos
11.
Health Serv Res ; 57(1): 192-199, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34648179

RESUMO

OBJECTIVE: To develop and validate a prediction model of avoidable hospital events among Medicare fee-for-service (FFS) beneficiaries in Maryland. DATA SOURCES: Medicare FFS claims from Maryland from 2017 to 2020 and other publicly available ZIP code-level data sets. STUDY DESIGN: Multivariable logistic regression models were used to estimate the relationship between a variety of risk factors and future avoidable hospital events. The predictive power of the resulting risk scores was gauged using a concentration curve. DATA COLLECTION/EXTRACTION METHODS: One hundred and ninety-eight individual- and ZIP code-level risk factors were used to create an analytic person-month data set of over 11.6 million person-month observations. PRINCIPAL FINDINGS: We included 198 risk factors for the model based on the results of a targeted literature review, both at the individual and neighborhood levels. These risk factors span six domains as follows: diagnoses, pharmacy utilization, procedure history, prior utilization, social determinants of health, and demographic information. Feature selection retained 73 highly statistically significant risk factors (p < 0.0012) in the primary model. Risk scores were estimated for each individual in the cohort, and, for scores released in April 2020, the top 10% riskiest individuals in the cohort account for 48.7% of avoidable hospital events in the following month. These scores significantly outperform the Centers for Medicare & Medicaid Services hierarchical condition category risk scores in terms of predictive power. CONCLUSIONS: A risk prediction model based on standard administrative claims data can identify individuals at risk of incurring a future avoidable hospital event with good accuracy.


Assuntos
Definição da Elegibilidade/tendências , Planos de Pagamento por Serviço Prestado/tendências , Hospitalização/tendências , Idoso , Idoso de 80 Anos ou mais , Hospitalização/estatística & dados numéricos , Humanos , Maryland
12.
Health Serv Res ; 57(2): 411-421, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34657287

RESUMO

OBJECTIVE: To operationalize an intersectionality framework using a novel statistical approach and with these efforts, improve the estimation of disparities in access (i.e., wait time to treatment entry) to opioid use disorder (OUD) treatment beyond race. DATA SOURCE: Sample of 941,286 treatment episodes collected in 2015-2017 in the United States from the Treatment Episodes Data Survey (TEDS-A) and a subset from California (n = 188,637) and Maryland (n = 184,276), states with the largest sample of episodes. STUDY DESIGN: This retrospective subgroup analysis used a two-step approach called virtual twins. In Step 1, we trained a classification model that gives the probability of waiting (1 day or more). In Step 2, we identified subgroups with a higher probability of differences due to race. We tested three classification models for Step 1 and identified the model with the best estimation. DATA COLLECTION: Client data were collected by states during personal interviews at admission and discharge. PRINCIPAL FINDINGS: Random forest was the most accurate model for the first step of subgroup analysis. We found large variation across states in racial disparities. Stratified analysis of two states with the largest samples showed critical factors that augmented disparities beyond race. In California, factors such as service setting, referral source, and homelessness defined the subgroup most vulnerable to racial disparities. In Maryland, service setting, prior episodes, receipt of medication-assisted opioid treatment, and primary drug use frequency augmented disparities beyond race. The identified subgroups had significantly larger racial disparities. CONCLUSIONS: The methodology used in this study enabled a nuanced understanding of the complexities in disparities research. We found state and service factors that intersected with race and augmented disparities in wait time. Findings can help decision makers target modifiable factors that make subgroups vulnerable to waiting longer to enter treatment.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Substâncias , Analgésicos Opioides/uso terapêutico , Disparidades em Assistência à Saúde , Humanos , Aprendizado de Máquina , Maryland , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Estados Unidos
13.
Am J Emerg Med ; 51: 64-68, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34678575

RESUMO

OBJECTIVE: A decline in OHCA performance metrics during the pandemic has been reported in the literature but the cause is still not known. The Montgomery County Fire and Rescue Service (MCFRS) observed a decline in both the rate of return of spontaneous circulation (ROSC) and the proportion of resuscitations that resulted in cerebral performance category (CPC) 1 or 2 discharge of the patient beginning in March of 2020. This study examines whether the decline in these performance metrics persists when known COVID positive patients are excluded from the analysis. METHODS: Two samples of OHCA patients for similar time periods (one year apart) before and after the start of the COVID pandemic were developed. A database of known COVID positive patients among EMS encounters was used to identify and exclude COVID positive patients. OHCA outcomes in these two groups were then compared using a Chi-square test and Fisher's exact test for difference in proportions and Analysis of Variance (ANOVA) for difference in means. A two-stage multivariable logistic regression model was used to develop odds ratios for achieving ROSC and CPC 1 or 2 discharge in each period. RESULTS: After excluding known COVID patients, 32.5% of the patients in the pre-COVID period achieved ROSC compared to 25.1% in the COVID period (p = 0.007). 6% of patients in the pre-COVID period were discharged with CPC 1 or 2 compared to 3.2% from the COVID era (p = 0.026). Controlling for all available patient characteristics, patients undergoing OHCA resuscitation prior to be beginning of the pandemic were 1.2 times more likely to achieve ROSC and 1.6 times more likely to be discharged with CPC 1 or 2 than non-COVID patients in the pandemic era sample. CONCLUSIONS: When known COVID patients are excluded, pre-pandemic OHCA resuscitation patients were more likely to achieve ROSC and CPC 1 or 2 discharge. The prevalence of known COVID positive patients among all OHCA resuscitations during the pandemic was not sufficient to fully account for the marked decrease in both ROSC and CPC 1 or 2 discharges. Other causative factors must be sought.


Assuntos
Benchmarking , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , COVID-19 , Distribuição de Qui-Quadrado , Feminino , Humanos , Modelos Logísticos , Masculino , Maryland , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Ressuscitação , Estudos Retrospectivos , Retorno da Circulação Espontânea
14.
J Am Acad Orthop Surg ; 30(2): e264-e271, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34678850

RESUMO

BACKGROUND: When treating Medicare beneficiaries, orthopaedic surgeons must follow Centers for Medicare & Medicaid Services (CMS) policies regarding whether to perform surgical treatments under inpatient or outpatient status. Recently, most orthopaedic and spinal procedures were removed from the CMS's "inpatient-only" list (IPOL). We investigated differences in hospital payments under the Diagnosis Related Group (DRG)/Ambulatory Payment Classification (APC) system when common orthopaedic/spinal procedures are done under outpatient rather than inpatient status. We compared these differences under the DRG/APC model with differences in payments to Maryland hospitals, which are paid under the alternative Global Budget Revenue model. METHODS: We used the CMS Inpatient Pricer and CMS Addendum B to retrieve the mean duration-of-stay data, estimated DRG (inpatient) payment, and APC (outpatient) payment for eight common orthopaedic/spinal procedures for four non-Maryland hospitals (2 urban academic hospitals and 2 neighboring community hospitals). We retrieved Maryland's Health Services Cost Review Commission hospital rates for the same eight procedures done under inpatient or outpatient status to estimate hospital charges for a Maryland urban academic hospital and a neighboring community hospital. RESULTS: Among the four non-Maryland hospitals, estimated differences in payment for hospitalizations under inpatient versus outpatient status for common orthopaedic/spinal procedures with a mean duration of stay of <2 days, whose status would be most subject to change from inpatient to outpatient by its removal from the IPOL, ranged from $19 to $13,042. For the two Maryland hospitals, differences in outpatient versus inpatient payment for these same procedures ranged from $182 to $1,273. DISCUSSION: Non-Maryland hospitals receive widely different CMS payments for common orthopaedic/spinal procedures based on a change in hospitalization status (inpatient to outpatient) prompted by the procedure being removed from the IPOL. The Maryland global budget revenue mitigates most of the effect of hospitalization status on hospital payment and may serve as a guide toward DRG/APC payment reassessment. LEVEL OF EVIDENCE: N/A.


Assuntos
Pacientes Internados , Ortopedia , Idoso , Hospitais , Humanos , Maryland , Medicare , Estados Unidos
15.
J Pediatr ; 241: 48-53.e1, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34624317

RESUMO

OBJECTIVES: To study the demographic and clinical characteristics of preterm infants with bronchopulmonary dysplasia (BPD) to identify the factors most strongly predictive of outpatient mortality, with the goal of identifying those individuals at greatest risk. STUDY DESIGN: Demographic and clinical characteristics were retrospectively reviewed for 862 subjects recruited from an outpatient BPD clinic. Characteristics of the deceased and living participants were compared using nonparametric analysis. Regression analysis was performed to identify factors associated with mortality. RESULTS: Of the 862 subjects, 13 (1.5%) died during follow-up, for an overall mortality rate of approximately 15.1 deaths per 1000 subjects. Two patients died in the postneonatal period (annual mortality incidence, 369.9 per 100 000), 9 died between age 1 and 4 years (annual mortality incidence, 310.2 per 100 000), and 2 died between age of 5 and 14 years (annual mortality incidence, 71.4 per 100 000). After adjusting for gestational age and BPD severity, mortality was found to be associated with the amount of supplemental oxygen required at discharge from the neonatal intensive care unit (adjusted hazard ratio [aHR], 4.10; P = .001), presence of a gastrostomy tube (aHR, 8.13; P = .012), and presence of a cerebrospinal fluid (CSF) shunt (aHR, 4.31; P = .021). CONCLUSIONS: The incidence of mortality among preterm infants with BPD is substantially higher than that seen in the general population. The need for greater amounts of home supplemental oxygen and the presence of a gastrostomy tube or CSF shunt were associated with an increased risk of postdischarge mortality. Future studies should focus on clarifying risk factors for the development of severe disease to allow for early identification and treatment of those at highest risk.


Assuntos
Displasia Broncopulmonar/mortalidade , Recém-Nascido Prematuro , Adolescente , Derivações do Líquido Cefalorraquidiano , Criança , Pré-Escolar , Feminino , Seguimentos , Gastrostomia , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Maryland/epidemiologia , Oxigenoterapia , Estudos Retrospectivos
16.
Womens Health Issues ; 32(1): 33-40, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34556399

RESUMO

BACKGROUND: Widespread underreporting of abortion persists in survey data. The list experiment, a measurement tool designed to elicit truthful responses to sensitive questions, may alleviate underreporting. METHODS: Using The Statewide Survey of Women of Reproductive Age in Delaware and Maryland (n = 2,747), we estimate the prevalence of abortion in Maryland and Delaware using a double list experiment. RESULTS: We find 21% (95% confidence interval [CI]: 16.8%-25.3%) of respondents aged 18 to 44 ever had an abortion and we identify disparities in abortion prevalence by age, race, education, income, marital status, and insurance status. Respondents who were Black (37.0%; 95% CI: 27.1%-46.8%), had less than a college degree (24.8%; 95% CI: 18.3%-31.3%), were in a cohabiting relationship (39.0%; 95% CI: 29.1%-48.9%), were living in households with incomes less than $50,000 (28.6%; 95% CI: 19.7%-37.5%), and were currently covered by Medicaid (42.8%; 95% CI: 27.6%-58.0%) were more likely than their counterparts to have ever had an abortion. CONCLUSIONS: List experiments yield estimates of abortion substantially higher than those obtained from direct questions. Findings demonstrate external validity through consistency with estimates from administrative data sources and gold standard abortion provider survey data.


Assuntos
Aborto Induzido , Adolescente , Adulto , Delaware , Feminino , Humanos , Maryland/epidemiologia , Gravidez , Prevalência , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
17.
J Trauma Acute Care Surg ; 92(3): 567-573, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34610619

RESUMO

BACKGROUND: Intentional injury (both self-harm and interpersonal) is a major cause of morbidity and mortality, yet there are little data on the per-person cost of caring for these patients. Extant data focus on hospital charges related to the initial admission but does not include actual dollars spent or follow-up outpatient care. The Affordable Care Act has made Medicaid the primary payor of intentional injury care (39%) in the United States and the ideal source of cost data for these patients. We sought to determine the total and per-person long-term cost (initial event and following 24 months) of intentional injury among Maryland Medicaid recipients. METHODS: Retrospective cohort study of Maryland Medicaid claims was performed. Recipients who submitted claims after receiving an intentional injury, as defined by the International Classification of Diseases, Tenth Revision, between October 2015 and October 2017, were included in this study. Subjects were followed for 24 months (last participant enrolled October 2017 and followed to October 2019). Our primary outcome was the dollars paid by Medicaid. We examined subgroups of patients who harmed themselves and those who received repeated intentional injury. RESULTS: Maryland Medicaid paid $11,757,083 for the care of 12,172 recipients of intentional injuries between 2015 and 2019. The per-person, 2-year health care cost of an intentional injury was a median of $183 (SD, $5,284). These costs were highly skewed: min, $2.56; Q1 = 117.60, median, $182.80; Q3 = $480.82; and max, $332,394.20. The top 5% (≥95% percentile) required $3,000 (SD, $6,973) during the initial event and $8,403 (SD, $22,024) per served month thereafter, or 55% of the overall costs in this study. CONCLUSION: The long-term, per-person cost of intentional injury can be high. Private insurers were not included and may experience different costs in other states. LEVEL OF EVIDENCE: Economic and Value Based Evaluations; level III.


Assuntos
Medicaid/economia , Comportamento Autodestrutivo/economia , Comportamento Autodestrutivo/terapia , Violência , Ferimentos e Lesões/economia , Ferimentos e Lesões/terapia , Feminino , Humanos , Masculino , Maryland/epidemiologia , Patient Protection and Affordable Care Act , Estudos Retrospectivos , Comportamento Autodestrutivo/epidemiologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia
18.
Cancer Epidemiol Biomarkers Prev ; 31(2): 413-421, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34862211

RESUMO

BACKGROUND: Our objective was to determine the association between racialized economic segregation and the hazard of breast cancer mortality in Maryland. METHODS: Among 35,066 women (24,540 White; 10,526 Black) diagnosed with incident invasive breast cancer in Maryland during 2007 to 2017, exposure to racialized economic segregation was measured at the census tract level using Index of Concentration at the Extremes metrics. HRs and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression for the association between racialized economic segregation and the hazard of breast cancer mortality, accounting for clustering at the census tract level. Models were adjusted for age and stratified by race, median age (<60 years, ≥60 years), and clinical characteristics. RESULTS: Overall, the hazard of breast cancer mortality was 1.84 times as high (95% CI, 1.64-2.06) for the least privileged quintile of racialized economic segregation compared with the most privileged quintile. This association differed significantly (P interaction< 0.05) by race and age, with 1.20 (95% CI, 0.90-1.60) times the hazard of breast cancer mortality for Black women versus 1.66 (95% CI, 1.41-1.95) times the hazard for White women, and with greater hazards for younger women (HR, 2.17; 95% CI, 1.83-2.57) than older women (HR, 1.62; 95% CI, 1.40-1.88). CONCLUSIONS: Our results suggest that breast cancer survival disparities exist in Maryland among women residing in the least privileged census tracts with lower income households and higher proportions of Black residents. IMPACT: Our findings provide new insights into the breast cancer mortality disparities observed among women in Maryland.


Assuntos
Neoplasias da Mama/mortalidade , Disparidades nos Níveis de Saúde , Características de Residência , Idoso , Feminino , Humanos , Maryland/epidemiologia , Pessoa de Meia-Idade , Pobreza , Modelos de Riscos Proporcionais , Sistema de Registros , /estatística & dados numéricos
19.
Cancer ; 128(4): 727-736, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-34873682

RESUMO

BACKGROUND: Although racial disparities in breast cancer (BC) mortality have been well documented in the United States, little is known about the impact of coexisting cardiovascular disease (CVD) and other clinical factors on Black-White survival disparities after the diagnosis of BC. This study examined the associations of race, CVD, and clinical factors at diagnosis with the hazard of BC and CVD-related mortality among patients with BC identified from the Maryland Cancer Registry. METHODS: A total of 36,088 women (25,181 Whites and 10,907 Blacks) diagnosed with incident invasive BC between 2007 and 2017 were included. Subdistribution hazard ratios (sdHRs) for CVD-related and BC mortality were estimated with Fine and Gray regression models, which accounted for the influence of competing events. RESULTS: After a median follow-up of 5.8 years, 8019 deaths occurred; 3896 were BC deaths, and 1167 deaths were CVD-related. Black women had a higher hazard of BC mortality (sdHR, 1.66; 95% confidence interval [CI], 1.55-1.77) and CVD mortality (sdHR, 1.33; 95% CI, 1.17-1.51) in comparison with White women. Associations with CVD mortality were significantly stronger among Black women aged 50 to 59 years (sdHR, 2.86; 95% CI, 1.84-4.44; P for interaction < .001). Among Black women with CVD, the hazard of BC death was 41% higher in comparison with White women. By treatment, a significant association with CVD mortality was observed only among Black women undergoing surgery and radiation (sdHR, 1.61; 95% CI, 1.22-2.13). CONCLUSIONS: Clinicians should consider the impact of younger age, preexisting CVD, and BC treatments among Black patients. Early identification of those at risk for worse survival may improve surveillance and outcomes.


Assuntos
Neoplasias da Mama , Doenças Cardiovasculares , Disparidades em Assistência à Saúde/etnologia , Neoplasias da Mama/etnologia , Neoplasias da Mama/mortalidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Feminino , Humanos , Maryland/epidemiologia , Pessoa de Meia-Idade
20.
Am Surg ; 88(3): 439-446, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34732080

RESUMO

BACKGROUND: Older adults (OAs) ≥ 65 years of age, representing the fastest growing segment in the United States, are anticipated to require a greater percentage of emergency general surgery procedures (EGSPs) with an associated increase in health care costs. The aims of this study were to identify the frequency of EGSP and charges incurred by OA compared to their younger counterparts in the state of Maryland. METHODS: A retrospective review of the Maryland Health Services Cost Review Commission from 2009 to 2018 was undertaken. Patients undergoing urgent or emergent ESGP were divided into 2 groups (18-64 years and ≥65 years). Data collected included demographics, APR-severity of illness (SOI), APR-risk of mortality (ROM), the EGSP (partial colectomy [PC], small bowel resection [SBR], cholecystectomy, operative management of peptic ulcer disease, lysis of adhesions, appendectomy, and laparotomy), length of stay (LOS), and hospital charges. P-values (P < .05) were significant. RESULTS: Of the 181,283 patients included in the study, 55,401 (38.1%) were ≥65 years of age. Older adults presented with greater APR-SOI (major 37.7% vs 21.3%, extreme 5.2% vs 9.3%), greater APR-ROM (major 25.3% vs 8.7%, extreme 22.3% vs 5.3%), underwent PC (24.5% vs 10.9%) and SBR (12.8% vs 7.0%) more frequently, and incurred significantly higher median hospital charges for every EGSP, consistently between 2009 and 2018 due to increased LOS and complications when compared to those ≤65 years of age. CONCLUSION: These findings stress the need for validated frailty indices and quality improvement initiatives focused on the care of OAs in emergency general surgery to maximize outcomes and optimize cost.


Assuntos
Procedimentos Cirúrgicos Operatórios/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/economia , Apendicectomia/estatística & dados numéricos , Colecistectomia/economia , Colecistectomia/estatística & dados numéricos , Colectomia/métodos , Emergências/economia , Emergências/epidemiologia , Feminino , Custos de Cuidados de Saúde , Preços Hospitalares , Humanos , Intestino Delgado/cirurgia , Laparotomia/economia , Laparotomia/estatística & dados numéricos , Tempo de Internação/economia , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Úlcera Péptica/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Aderências Teciduais/cirurgia , Adulto Jovem
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