The occurrence of bone and joint cancers and their association with rural living and radon exposure in Iowa.

Primary bone and joint cancers are rare and understudied, yet these neoplasms are difficult to treat and impact all age groups. To explore the long-term changes in the occurrence of bone and joint cancers, patients diagnosed with these neoplasms between 1975 and 2016 were identified in the Surveillance Epidemiology and End Results of the National Cancer Institute of the USA. The age-adjusted incidence (AAIR) and mortality (AAMR) rates were calculated for three decades and compared to AAIR and AAMR in years 1975-1984. By using the population-based cancer registries of the USA, Iowa was identified as a state with increased cases of bone and joint malignancies. The bone and joint cancer cases in Iowa were correlated with the percentage of rural population, the average farmland size, or the residential radon levels. Results demonstrated that the mean AAIR of bone and joint cancers for US female and male patients (< 50 years of age) increased from 0.57 (95% C.I. 0.55-0.63) and 0.76 (95% C.I. 0.69-0.82) for years 1975-1984 to 0.71 (95% C.I. 0.66-0.76) and 0.94 (95% C.I. 0.87-1.07) for years 2005-2014, respectively. The increase in bone and joint cancer cases in Iowa positively correlated with the percentage rural population (R = 0.222, P < 0.02), and the average farmland size (R = 0.236, P < 0.02) but not the radon levels (R = - 0.038, P < 0.7). The findings revealed that patients younger than 50 years of age and those who resided in rural areas and engaged in farming were more likely to be diagnosed with primary bone and joint cancers.

Prevalence and patterns of catastrophic spending for antidiabetic medication in 2020.

BACKGROUND: Medication costs for antidiabetic drugs have risen significantly in the United States, causing concerns about the affordability of these essential treatments. OBJECTIVE: To examine out-of-pocket spending for antidiabetic medication and evaluate what proportion of Americans reach catastrophic spending levels during the year. METHODS: This retrospective cohort analysis of nationally representative data from the 2020 Medical Expenditure Panel Survey (MEPS) was analyzed for respondents that reported a diabetes diagnosis. Prescription drug costs were identified from the MEPS Prescribed Medicines File, which included both total prescription payment and out-of-pocket payment for each medication fill. Catastrophic spending thresholds were evaluated based on the World Health Organization's definition, which is spending greater than 40% of a household's nonsubsistence income on health care payments. Statistical analysis was performed with Stata 17 and sample weights were applied adjusting for the MEPS complex survey design to produce national estimates. Descriptive statistics were reported as weighted counts and percentages for categorical variables and as medians with interquartile range for continuous variables. Comparisons of reaching catastrophic spending thresholds across study variables were evaluated with Pearson chi-square tests. A P value less than 0.05 was considered statistically significant in this study. RESULTS: The study included data from a weighted US population of 29.5 million Americans with diabetes. Among this group, 23.8 million (81%) reported use of a prescription medication to treat diabetes. Total reported out-of-pocket payments paid by the patient for antidiabetic medication surpassed $5.2 billion with the largest portion attributable to the insulin subclass, which accounted for 42% or $2.2 billion. The data suggest an estimated 3 million Americans (10.3%) experienced out-of-pocket spending for antidiabetic drugs that reached catastrophic spending thresholds in 2020. CONCLUSIONS: Affordability of prescribed medication in community-dwelling persons with diabetes remains a significant challenge for many Americans.

Racial-Ethnic Variations in Potentially Inappropriate Psychotropic Medication Use Among the Elderly.

OBJECTIVE: Psychotropic drugs are among the most frequently prescribed medications to the elderly in the USA. Yet, many of those drugs have been used inappropriately. Increased risks of potentially inappropriate psychotropic medication (PIPM) utilization are associated with several patient and provider characteristics. However, little is known whether and to what extent patient race and ethnicity is related to PIPM use patterns among the elderly. METHODS: We used multiyear (2012-2015) Medical Expenditure Panel Survey (MEPS) data. Among elderly psychotropic drug users (N = 7616), we identified PIPM prescription fills based on a Beers criterion, a list of drugs (by generic names) that should be avoided at any circumstances among the elderly. Logistic regression was used for the likelihood analysis. RESULTS: The likelihood of filling PIPMs was higher among Hispanics than among Whites (adjusted odds ratio [AOR] = 1.22; 95% confidence interval [CI] = 1.02-1.46). No differences were found between Whites and Blacks. The prevalence of PIPM use is high in all racial groups (43-52%). CONCLUSION: We found differences in the use of PIPMs by patient race and ethnicity between 2012 and 2015: among elderly psychotropic medication users, Hispanics were more likely than Whites to receive PIPMs. More clinical and policy efforts should aim to reduce PIPM use in all groups, particularly among Hispanic, given potentially negative health consequences related with the use of inappropriate medications.

Racial-Ethnic Differences in Off-Label Antidepressant Use, by Insurance Type.

OBJECTIVE: The objective of this study was to examine whether and to what extent racial-ethnic differences exist in off-label use of antidepressant drugs by insurance type (Medicare, Medicaid, private coverage, and uninsured). METHODS: Multiyear data (2000-2010) from Medical Expenditure Panel Surveys were used. Logistic and negative binomial regressions were used for the likelihood and frequency analyses, respectively. RESULTS: The likelihood of filling prescriptions for off-label use of antidepressants was greater among blacks than among whites in all insurance groups (Medicare [N=6,470], adjusted odds ratio [AOR]=1.68; Medicaid [N=3,076], AOR=1.76; private coverage [N=9,918], AOR=2.10; and uninsured [N=1,826], AOR=1.88). Only in the uninsured group were Hispanics more likely than whites to use antidepressants off label (AOR=1.58). Among off-label antidepressant users, blacks and Hispanics with private coverage filled significantly fewer off-label antidepressant prescriptions than whites (blacks, incidence rate ratio [IRR]=.81; Hispanics, IRR=.88). CONCLUSIONS: Off-label use of antidepressants was more likely among blacks than among whites in all insurance groups; however, once whites initiated off-label use of antidepressants, they tended to fill off-label antidepressant prescriptions more frequently than blacks or Hispanics. Because off-label use may be inappropriate, clinical and policy efforts should aim to reduce off-label antidepressant use, with particular attention to racial-ethnic differences.

Racial-ethnic disparities in use of antidepressants in private coverage: implications for the Affordable Care Act.

OBJECTIVE: The objective of this study was to examine racial-ethnic disparities in the use of antidepressants among people with private coverage and people with public insurance or no coverage. METHODS: Data were from Medical Expenditure Panel Surveys (2006-2010), and logistic regression was used for the analysis. RESULTS: Among persons with depression and private coverage, racial-ethnic minority groups were significantly less likely than non-Hispanic whites to use antidepressants (N=4,468; adjusted odds ratio [AOR]=.50, 95% confidence interval [CI]=.33-.66 for non-Hispanic blacks; AOR=.70, CI=.55-.89 for Hispanics). No significant racial-ethnic disparity in the use of antidepressants was found in Medicare (N=1,944), Medicaid (N=2,125), and uninsured populations (N=1,679). For all racial-ethnic groups, persons with no insurance coverage had much lower rates of antidepressant use than their insured counterparts. CONCLUSIONS: A wide racial-ethnic gap in the use of antidepressants existed in private coverage. As the nation continues to implement the Affordable Care Act, which will increase the number of enrollees from racial-ethnic minority groups in private plans, continuing efforts will be needed to reduce racial-ethnic disparities in the use of antidepressants.

National trends in the use of antidepressants between 1997 and 2009 and the role of Medicare Part D implementation.

OBJECTIVES: This study examined national trends in antidepressant use before and after implementation of Medicare Part D and compared utilization among individuals with different types of insurance. METHODS: The data source was the Medical Expenditure Panel Survey Household Component (1997-2009), and logistic regression was used for the analysis. RESULTS: The odds of antidepressant use among people with depression increased between 1997 and 2009 in each insurance group (Medicare: adjusted odds ratio [AOR]=3.30, 95% confidence interval [CI]=1.84-5.92; Medicaid: AOR=2.97, CI=2.01-4.40; dually eligible for Medicare and Medicaid: AOR=2.24, CI=1.11-4.54; and private coverage: AOR=6.63, CI=5.23-8.42). The odds of antidepressant use after implementation of Part D increased more among Medicare beneficiaries than among Medicaid beneficiaries (AOR=1.35, CI=1.05-1.72). CONCLUSIONS: The use of antidepressants among people with depression increased in all insurance groups up to 2009; however, the patterns of utilization and the degree of increase over time differed by insurance type.