Racial/Ethnic Disparities in Health and Life Insurance Denial Due to Cancer among Cancer Survivors.

This study examined racial/ethnic differences in health/life insurance denial due to cancer among cancer survivors after the passage of the Affordable Care Act (ACA). Behavioral Risk Factor Surveillance System data were obtained from 2012-2020. The dependent variable asked: "Were you ever denied health insurance or life insurance coverage because of your cancer?" Cancer survivors were included if they were diagnosed with cancer after the Affordable Care Act (N = 14,815). Unadjusted and adjusted logistic regressions for age, sex, income, and employment provided odds ratios of insurance denial due to cancer across racial/ethnic groups: Non-Hispanic White, Black, and Other/mixed race; and Hispanic. Statistically significant differences (p < 0.05) were found between those who were denied or not denied insurance across sex, age, race/ethnicity, income, and employment. Adjusted regressions found significantly higher odds ratios of insurance denial for Blacks (OR: 3.00, 95% CI: 1.77, 5.08), Other/mixed race (OR: 2.16, 95% CI: 1.16, 4.02), and Hispanics (OR: 2.13, 95% CI: 1.02, 4.42) compared to Whites. Differences were observed across sex, income, and employment. Cancer survivors report racial/ethnic disparities in health and life insurance denial due to their cancer despite policy changes. This may be harmful for those who are already financially vulnerable due to their cancer diagnosis and exacerbate racial/ethnic cancer disparities.

Use of cervical cancer preventive services among US women aged 21-29: an assessment of the 2010 Affordable Care Act rollout through 2018.

PURPOSE: The 2010 Affordable Care Act (ACA) provided millions of people with health insurance coverage and facilitated routine cancer screening by requiring insurers to cover preventive services without cost-sharing. Despite greater access to affordable cancer screening, Pap testing has declined over time. The aim of this study is to assess participation in Pap test and HPV vaccination, and adherence to guidelines as outlined by the American Cancer Society (ACS) from the 2010 ACA provision eliminating cost-sharing for preventive services. METHODS: Using multi-year responses from the Behavioral Risk Factor Surveillance System, we examined the association between the ACA and participation in and adherence to Pap testing and HPV vaccination behaviors as set by the ACS. The sample included women aged 21-29 who completed the survey between 2008 and 2018 (every other year) and who live in 24 US States (N = 37,893). RESULTS: Results showed significant decreases in Pap testing rates but increases in the uptake of the HPV vaccine series for all age groups and across all demographics. Post-ACA year significantly predicted increases in HPV + Pap co-testing participation and adherence. Women with health insurance coverage were more likely to engage in both behaviors. CONCLUSION: Findings raise concerns around declines in the proportion of women receiving and adhering to Pap testing guidelines. A need exists for research to examine the role of increases in HPV vaccination uptake on decreases in Pap testing. Moreover, effective strategies should target increases in cervical cancer screening uptake among women vaccinated against HPV.

Economic impact of epilepsy and the cost of nonadherence to antiepileptic drugs in older Medicare beneficiaries.

Epilepsy is most prevalent among older individuals, and its economic impact is substantial. The development of economic burden estimates that account for known confounders, and using percent incremental costs may provide meaningful comparison across time and different health systems. The first objective of the current study was to estimate the percent incremental healthcare costs and the odds ratio (OR) for inpatient utilization for older Medicare beneficiaries with epilepsy and without epilepsy. The second objective was to estimate the percent incremental healthcare costs and the OR for inpatient utilization associated with antiepileptic drug (AED) nonadherence among Medicare beneficiaries with epilepsy. The OR of inpatient utilization for cases compared with controls (i.e., non-cases) were 2.4 (95% CI 2.3 to 2.6, p-value<0.0001) for prevalent epilepsy and 3.6 (95% CI 3.2 to 4.0, p-value<0.0001) for incident epilepsy. With respect to total health care costs, prevalent cases incurred 61.8% (95% CI 56.6 to 67.1%, p-value<0.0001) higher costs than controls while incident cases incurred 71.2% (95% CI 63.2 to 79.5%, p-value <0.0001) higher costs than controls. The nonadherence rates were 33.6 and 32.9% for prevalent and incident cases, respectively. Compared to nonadherent cases, the OR of inpatient utilization for adherent prevalent cases was 0.66 (95% CI 0.55 to 0.81, p-value <0.0001). The cost saving for a prevalent case adherent to AEDs was 13.2% (95% CI 6.6 to 19.4%, p-value=0.0001) compared to a nonadherent case. An incident case adherent to AEDs spent 16.4% (95% CI 6.5 to 25.2%, p-value=0.002) less than a nonadherent incident case on health care. Epilepsy is associated with higher health care costs and utilization. Older Medicare beneficiaries with epilepsy incur higher total health care spending and have higher inpatient utilization than those without epilepsy. Total health care spending is less for older Medicare beneficiaries who have prevalent or incident epilepsy if they are adherent to AEDs.

An update on the prevalence and incidence of epilepsy among older adults.

OBJECTIVE: To estimate the prevalence and incidence of epilepsy among beneficiaries of Arizona Medicare aged 65 and over. METHODS: An analysis of Medicare administrative claims data for 2009-2011 for the State of Arizona was conducted. Epilepsy was defined as a beneficiary who had either≥one claim with diagnostic code of 345.xx (epilepsy) or at least two claims with diagnosis code of 780.3x (seizure) ≥30days apart. Stroke-related and psychiatric comorbidities were determined by diagnostic codes. Average annual prevalence and incidence were calculated and stratified by demographic characteristics and comorbidities. Odds ratios (OR) and 95% confidence intervals (CI) were calculated as measures of effect for prevalence and incidence and the chi-square statistic was calculated to compare the proportions of epilepsy cases with and without comorbidities (alpha=0.05). RESULTS: The overall average annual prevalence and incidence over the study period was 15.2/1000 and 6.1/1000, respectively. Relative to the 65-69 age group and White beneficiaries, the highest prevalence was observed for beneficiaries 85 years or older (19.8/1000, OR 1.66, 95% CI 1.53-1.81) and Native Americans (21.2/1000, OR 1.42, 95% CI 1.25-1.62). In contrast, the highest incidence rates were observed for beneficiaries 85 years and older (8.5/1000, OR 1.82, 95% CI 1.60-2.07) and for Black beneficiaries (8.7/1000, OR 1.44, 95% CI 1.12-1.86). The incidence rate for Native Americans was not significantly different from that for White beneficiaries (6.2/1000, OR 1.02, 95% CI 0.81-1.29). More than one quarter of all cases (25.7%) and 31% of incident cases had either stroke-related and/or psychiatric comorbidities (all p-values < 0.001). CONCLUSIONS: Epilepsy is a significant neurological disease among Medicare beneficiaries 65 years and older. Beneficiaries aged 85 and older and Black and Native Americans experienced higher rates of epilepsy than other demographic subgroups compared to White beneficiaries.

Self-reported depression and perceived financial burden among long-term rectal cancer survivors.

OBJECTIVES: Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among long-term survivors (≥5 years post-diagnosis). METHODS: A mailed survey with 576 long-term RC survivors who were members of Kaiser Permanente was conducted in 2010-2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form-12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. RESULTS: The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI95% 0.20-0.89) and 0.59 (CI95% 0.37-0.93), respectively. Twenty-two percent perceived moderate-to-high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self-reported depression was associated with higher perceived financial burden (p < 0.001); surgical procedure history did not modify this relationship. CONCLUSIONS: Depression was reported frequently among these long-term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well-being might improve care among long-term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd.

Test-retest reliability and predictors of unreliable reporting for a sexual behavior questionnaire for U.S. men.

Accurate knowledge about human sexual behaviors is important for increasing our understanding of human sexuality; however, there have been few studies assessing the reliability of sexual behavior questionnaires designed for community samples of adult men. A test-retest reliability study was conducted on a questionnaire completed by 334 men who had been recruited in Tucson, Arizona. Reliability coefficients and refusal rates were calculated for 39 non-sexual and sexual behavior questionnaire items. Predictors of unreliable reporting for lifetime number of female sexual partners were also assessed. Refusal rates were generally low, with slightly higher refusal rates for questions related to immigration, income, the frequency of sexual intercourse with women, lifetime number of female sexual partners, and the lifetime number of male anal sex partners. Kappa and intraclass correlation coefficients were substantial or almost perfect for all non-sexual and sexual behavior items. Reliability dropped somewhat, but was still substantial, for items that asked about household income and the men's knowledge of their sexual partners' health, including abnormal Pap tests and prior sexually transmitted diseases (STD). Age and lifetime number of female sexual partners were independent predictors of unreliable reporting while years of education was inversely associated with unreliable reporting. These findings among a community sample of adult men are consistent with other test-retest reliability studies with populations of women and adolescents.

Factors associated with acquisition and clearance of human papillomavirus infection in a cohort of US men: a prospective study.

BACKGROUND: Our understanding of factors associated with acquisition and clearance of human papillomavirus (HPV) in men has been limited. This study sought to determine factors associated with those aspects of HPV infection in a cohort of US men. METHODS: A total of 285 men aged 18-44 years were monitored every 6 months for approximately 18 months. Risk-factor information was obtained at each visit by use of a self-administered questionnaire. A continuous-time 2-state Markov model was applied. RESULTS: Lifetime number of sex partners reported at enrollment was the most significant risk factor for acquisition of all types of HPV. Men reporting >16 lifetime sex partners were at significantly elevated risk of any HPV infection (adjusted hazard ratio [AHR], 2.8 [95% confidence interval {CI}, 1.1-7.1]), oncogenic HPV infection (AHR, 9.6 [95% CI, 2.4-37.8]), and nononcogenic HPV infection (AHR, 3.6 [95% CI, 1.3-9.9]), compared with those reporting 0-4 partners. Circumcised men were 3 and 6 times more likely to clear infection with any and oncogenic HPV types, respectively. In addition, having had >16 lifetime sex partners was associated with greater likelihood of clearance of oncogenic HPV infection (AHR, 4.9 [95% CI, 1.2-19.8]). CONCLUSION: The key factor associated with acquisition of HPV was lifetime number of sex partners, whereas circumcision was the most significant determinant for clearance of any HPV infection and oncogenic HPV infection.