Phase-Specific and Lifetime Costs of Multiple Myeloma Among Older Adults in the US.

Importance: Health care costs associated with diagnosis and care among older adults with multiple myeloma (MM) are substantial, with cost of care and the factors involved differing across various phases of the disease care continuum, yet little is known about cost of care attributable to MM from a Medicare perspective. Objective: To estimate incremental phase-specific and lifetime costs and cost drivers among older adults with MM enrolled in fee-for-service Medicare. Design, Setting, and Participants: A retrospective cohort study was conducted using population-based registry data from the 2007-2015 Surveillance, Epidemiology, and End Results database linked with 2006-2016 Medicare administrative claims data. Data analysis included 4533 patients with newly diagnosed MM and 4533 matched noncancer Medicare beneficiaries from a 5% sample of Medicare to assess incremental MM lifetime and phase-specific costs (prediagnosis, initial care, continuing care, and terminal care) and factors associated with phase-specific incremental MM costs. The study was conducted from June 1, 2019, to April 30, 2021. Main Outcomes and Measures: Incremental MM costs were calculated for the disease lifetime and the following 4 phases of care: prediagnosis, initial, continuing care, and terminal. Results: Of the 4533 patients with MM included in the study, 2374 were women (52.4%), 3418 (75.4%) were White, and mean (SD) age was 75.8 (6.8) years (2313 [51.0%] aged ≥75 years). The characteristics of the control group were similar; however, mean (SD) age was 74.2 (8.8) years (2839 [62.6%] aged ≤74 years). Mean adjusted incremental MM lifetime costs were $184 495 (95% CI, $183 099-$185 968). Mean per member per month phase-specific incremental MM costs were estimated to be $1244 (95% CI, $1216-$1272) for the prediagnosis phase, $11 181 (95% CI, $11 052-$11 309) for the initial phase, $5634 (95% CI, $5577-$5694) for the continuing care phase, and $6280 (95% CI, $6248-$6314) for the terminal phase. Although inpatient and outpatient costs were estimated as the major cost drivers for the prediagnosis (inpatient, 55.8%; outpatient, 40.2%), initial care (inpatient, 38.1%; outpatient, 35.5%), and terminal (inpatient, 33.0%; outpatient, 34.6%) care phases, prescription drugs (44.9%) were the largest cost drivers in the continuing care phase. Conclusions and Relevance: The findings of this study suggest that there is substantial burden to Medicare associated with diagnosis and care among older adults with MM, and the cost of care and cost drivers vary across different phases of the cancer care continuum. The study findings might aid policy discussions regarding MM care and coverage and help further the development of alternative payment models for MM, accounting for differential costs across various phases of the disease continuum and their drivers.

The Association Between Consumer Competency and Supplemental Nutrition Assistance Program Participation on Food Insecurity.

OBJECTIVE: To examine whether Supplemental Nutrition Assistance Program (SNAP) participants exhibited lower food insecurity when they also demonstrated desirable behaviors in the areas of financial management, nutrition literacy, and conscientious food shopping. DESIGN: Using data from the US Department of Agriculture's newly launched National Household Food Acquisition and Purchase Survey, this study examined whether consumer competency is a factor that affects food insecurity. PARTICIPANTS: A total of 4,158 participants were included. Sampling weights were applied to represent the population better. MAIN OUTCOME MEASURE(S): Very low food insecurity was the dependent variable. Important independent variables were participants' financial management skills, nutrition literacy, and conscientious shopping. ANALYSIS: Logit and 2-staged least-squares models were used for empirical analyses. The significance of models was tested at .05, .01, and .001. RESULTS: Consumer competency-related factors such as financial management ability, not defaulting on bill payments within the previous 6 months, and using the nutrition panel frequently when shopping were negatively associated with food insecurity and very low food security after controlling for a number of other demographic, socioeconomic, and behavioral characteristics. CONCLUSIONS AND IMPLICATIONS: Policies that focus solely on consumer competency programs such as SNAP-Education might marginally achieve program goals but the effect would be modest owing to the unique challenges that SNAP participants may face. Further investigations are needed to understand better why SNAP participants do not benefit successfully from competent consumer practices.

Geographic Disparity in Funding for School Nutrition Environments: Evidence from Mississippi Schools.

BACKGROUND: Despite the federal initiatives on equitable provision of school nutrition programs, geographic disparity in childhood obesity persists. It may be partly because built-in school nutrition environments rely on each school's efficient use of existing operational funds or its ability to obtain expanded financial support. This study explores how funding acquisition by schools is determined by local community characteristics and how it relates to healthy school meal offerings. METHODS: Information about food preparation technology and funding in 811 schools in Mississippi was obtained by in-depth phone interviews of district child nutrition directors and school foodservice managers, which was matched to socioeconomic indicators of schools and communities. Probit models were estimated. RESULTS: About 56% of schools in the sample received some funds toward combination oven/steamers in the last few years. Small schools, schools in non-metro counties, and those in low-income minority areas were significantly less likely to be funded. Obtainment of funds was associated with a 45 percentage-point reduction in the probability of serving fried foods. CONCLUSIONS: Funds obtained by schools for advanced food preparation technology contributes to creation of healthier nutrition environments for children. However, fund availability is associated with community characteristics, possibly contributing to geographic disparity of child health.

Assessment of forearm and plantar foot load in the elderly using a four-wheeled walker with armrest and the effect of armrest height.

BACKGROUND: Patients with hand and/or wrist pathology are recommended to have a four-wheeled walker with an arm rest (FWW-AR) rather than a standard walker or a standard four-wheeled walker (FWW). However, only a few quantitative studies have been performed to compare upper and lower extremity weight bearing. The aim of this study was to evaluate forearm and foot weight bearing using a FWW-AR and the effect of the armrest height. METHODS: Eleven elderly women (mean age 80.1±5.3 years; mean height 148.5±4.0 cm; mean weight 51.2±9.0 kg) were enrolled. The subjects walked with an FWW-AR, with the elbow in either 90 degree (D90) or 130 degree (D130) flexion, for a distance of 10 m. Surface electromyographic signals were recorded for the upper, middle, and lower trapezius, anterior deltoid, and erector spinae muscles; walking velocity was measured with the subjects weight bearing on their feet and forearms while walking. Simultaneously, the maximum plantar and forearm loads during walking with an FWW-AR were measured. RESULTS: The normalized foot plantar loads were lower at D90 than at D130, while the normalized forearm load was higher at D90 than at D130 (all P<0.05; left foot, 7.9±0.1 N/kg versus 8.8±0.1 N/kg; right foot, 8.6±0.2 N/kg versus. 9.6±0.1 N/kg; left forearm, 1.8±0.5 N/kg versus 0.8±0.2 N/kg; and right forearm, 2.0±0.5 N/kg versus 1.0±0.2 N/kg, respectively). The surface electromyographic activity of the muscles involved in shoulder elevation and the walking velocity were both lower with the elbow at D90 than at D130 (all P<0.05; left upper trapezius, 98.7%±19.5% versus 132.6%±16.9%; right upper trapezius, 83.4%±10.6% versus 108.1%±10.5%; left anterior deltoid, 94.1%±12.8% versus 158.6%±40.4%; right anterior deltoid, 99.1%±15.0% versus 151.9%±19.4%; and velocity, 0.6±0.1 m/sec versus 0.7±0.1 m/sec, respectively). CONCLUSION: Weight bearing on the lower extremities is significantly reduced when the upper extremities are supported during walking with an FWW-AR. Furthermore, the weight bearing profile is dependent on the armrest height.