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1.
J Prev Med Public Health ; 54(3): 161-165, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34092061

RESUMEN

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood. METHODS: We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code. RESULTS: We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income

Asunto(s)
COVID-19/etnología , Pobreza/estadística & datos numéricos , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Anciano , Americanos Asiáticos/estadística & datos numéricos , COVID-19/epidemiología , Prueba de COVID-19/estadística & datos numéricos , Estudios Transversales , Empleo/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Adulto Joven
2.
Medicine (Baltimore) ; 100(20): e25998, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34011094

RESUMEN

ABSTRACT: To examine the impact of inadequate health insurance coverage on physician utilization among older adults using a novel quasi-experimental design in the time period following the elimination of cost sharing for most preventative services under the US Affordable Care Act of 2010.The Medical Expenditure Panel Survey full year consolidated data files for the period 2010 to 2017 were used to construct a pooled cross-sectional dataset of adults aged 60 to 70. Regression discontinuity design was used to estimate the impact of transitioning between non-Medicare and Medicare plans on use of routine office-based physician visits and emergency room visits.For the overall population, gaining access to Medicare at age 65 is associated with a higher propensity to make routine office-based visits (2.94 percentage points [pp]; P < .01) and lower out-of-pocket costs (-23.86 pp; P < .01) Similarly, disenrollment from non-Medicare insurance plans at age 66 was associated with more routine office-based visits (3.01 pp; P < .01) and less out-of-pocket costs (-8.09 pp; P < .10). However, some minority groups reported no changes in visits and out-of-pocket costs or reported an increased propensity to make emergency department visits.Enrollment into Medicare from non-Medicare insurance plans was associated with increased use of routine office-based services and lower out-of-pocket costs. However, some subgroups reported no changes in routine visits or costs or an increased propensity to make emergency department visits. These findings suggest other nonfinancial, structural barriers may exist that limit patient's ability to access routine services.


Asunto(s)
Cobertura del Seguro/estadística & datos numéricos , Medicare/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Anciano , Seguro de Costos Compartidos/economía , Seguro de Costos Compartidos/legislación & jurisprudencia , Seguro de Costos Compartidos/estadística & datos numéricos , Femenino , Gastos en Salud/estadística & datos numéricos , Humanos , Cobertura del Seguro/economía , Masculino , Medicare/economía , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Ensayos Clínicos Controlados no Aleatorios como Asunto , Visita a Consultorio Médico/economía , Visita a Consultorio Médico/estadística & datos numéricos , Patient Protection and Affordable Care Act/economía , Estados Unidos
3.
MMWR Morb Mortal Wkly Rep ; 70(13): 461-466, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33793461

RESUMEN

Clinical preventive services play an important role in preventing deaths, and Healthy People 2020 has set national goals for using clinical preventive services to improve population health (1). The Patient Protection and Affordable Care Act (ACA) requires many health plans to cover certain recommended clinical preventive services without cost-sharing when provided in-network (covered clinical preventive services).* To ascertain prevalence of the use of selected recommended clinical preventive services among persons aged ≥18 years, CDC analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), a state-based annual nationwide survey conducted via landline and mobile phones in the United States, for 10 clinical preventive services covered in-network with no cost-sharing pursuant to the ACA. The weighted prevalence of colon, cervical, and breast cancer screening, pneumococcal and tetanus vaccination, and diabetes screening ranged from 66.0% to 79.2%; the prevalence of the other four clinical preventive services were <50%: 16.5% for human papillomavirus (HPV) vaccination, 26.6% for zoster (shingles) vaccination, 33.2% for influenza vaccination, and 45.8% for HIV testing. Prevalence of HIV testing had the widest variation (3.1-fold differences) across states among the 10 services included in this report. The prevalence of use of clinical preventive services varied by insurance status, income level, and rurality, findings that are consistent with previous studies (2-6). The use of nine of the 10 services examined was lower among the uninsured, those with lower income, and those living in rural communities. Among those factors examined, insurance status was the dominant factor strongly associated with use of clinical preventive services, followed by income-level and rurality. Understanding factors influencing use of recommended clinical preventive services can potentially help decision makers better identify policies to increase their use including strategies to increase insurance coverage.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Servicios Preventivos de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Reforma de la Atención de Salud , Humanos , Cobertura del Seguro/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act , Factores Socioeconómicos , Estados Unidos , Adulto Joven
4.
Medicine (Baltimore) ; 100(7): e24838, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607853

RESUMEN

ABSTRACT: More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.


Asunto(s)
Atención a la Salud/economía , Emigrantes e Inmigrantes/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Tuberculosis Latente/epidemiología , Adolescente , Adulto , Anciano , Niño , Estudios Transversales , Atención a la Salud/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Cobertura del Seguro/tendencias , Ensayos de Liberación de Interferón gamma/métodos , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/prevención & control , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Mycobacterium tuberculosis/inmunología , Encuestas Nutricionales/métodos , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
5.
Biomed Res Int ; 2021: 8843390, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33604386

RESUMEN

This study is aimed at examining the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetric and gynecology hospital in Vietnam. This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. The utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia. A total of 417 women had vaginal deliveries during the study period. 207 women utilized epidural analgesia for pain relief during labor, and 210 did not. Parturients older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous women (OR 2.8 95% CI 1.85-4.25), women living from an urban area, women with higher income (OR 6.47, 95% CI 2.59-19.23), and women with higher level of education were more likely to utilize labor epidurals. Factors related to a parturient request for epidural analgesia during labor at our tertiary obstetric hospital included age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographic characteristics.


Asunto(s)
Analgesia Epidural/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Embarazo/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Paridad , Factores Socioeconómicos , Vietnam/epidemiología , Adulto Joven
6.
Am J Public Health ; 111(4): 743-751, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33476242

RESUMEN

Objectives. To compare health care coverage and utilization between men who have sex with men (MSM) in Medicaid expansion versus nonexpansion states.Methods. We used cross-sectional weighted data from the National HIV Behavioral Surveillance system, which used venue-based methods to interview and test MSM in 22 US cities from June through December, 2017 (n = 8857). We compared MSM in Medicaid expansion versus nonexpansion states by using the Rao-Scott χ2 test stratified by HIV status. We used multivariable logistic regression to model the relationship between Medicaid expansion, coverage, and preexposure prophylaxis (PrEP) use.Results. MSM in expansion states were more likely to have insurance (87.9% vs 71.6%), have Medicaid (21.3% vs 3.8%), discuss PrEP with a provider (58.8% vs 44.3%), or use PrEP (31.1% vs 17.5%).Conclusions. Medicaid expansion is associated with higher coverage and care, including PrEP.Public Health Implications. States may consider expanding Medicaid to help end the HIV epidemic.


Asunto(s)
Infecciones por VIH/prevención & control , Medicaid/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Aceptación de la Atención de Salud , Profilaxis Pre-Exposición/economía , Minorías Sexuales y de Género/estadística & datos numéricos , Adulto , Ciudades , Estudios Transversales , Humanos , Cobertura del Seguro/estadística & datos numéricos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto Joven
9.
J Trauma Acute Care Surg ; 90(3): 544-549, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33492108

RESUMEN

BACKGROUND: The beneficial effects of acute rehabilitation for trauma patients are well documented but can be limited because of insurance coverage. The Patient Protection and Affordable Care Act (ACA) went into effect on March 23, 2010. The ACA allowed patients who previously did not have insurance to be fully incorporated into the health system. We sought to analyze the likelihood of discharge to rehab for trauma patients before and after the implementation of the ACA. We hypothesized that there would be a higher rate of inpatient rehabilitation hospital (IRH) admission after the ACA was put into effect. METHODS: The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried from 2003 to 2017 for all trauma patients admitted to accredited trauma centers in Pennsylvania, who also had a functional status at discharge (FSD). Admission to an IRH was determined using discharge destination. Two categories were created to represent periods before and after ACA was implemented, 2003 to 2009 (pre-ACA) and 2010-2017 (post-ACA). A multilevel mixed-effects logistic regression model controlling for demographics, injury severity, and FSD assessed the adjusted impact of ACA implementation on IRH admissions. RESULTS: From the Pennsylvania Trauma Outcome Study query, 341,252 patients had FSD scores and of these patients, 47,522 (13.9%) were admitted to IRH. Patients who were severely injured were more likely to be admitted to IRH. Compared with FSD scores signifying complete independence at discharge, those with lower FSD had significantly increased odds of IRH admission. The odds of IRH admission post-ACA implementation significantly increased when compared with pre-ACA years (adjusted odds ratio, 1.14; 95% confidence interval, 1.12-1.17; p < 0.001; area under the receiver operating curve, 0.818). CONCLUSION: The implementation of the ACA significantly increased the likelihood of discharge to IRH for trauma patients. LEVEL OF EVIDENCE: Care management, level III.


Asunto(s)
Hospitalización/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Patient Protection and Affordable Care Act , Centros de Rehabilitación/estadística & datos numéricos , Heridas y Lesiones/rehabilitación , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Pennsylvania , Adulto Joven
10.
J Urol ; 205(1): 115-121, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32658588

RESUMEN

PURPOSE: Optimal treatment of intermediate risk prostate cancer remains unclear. National Comprehensive Cancer Network® guidelines recommend active surveillance, prostatectomy or radiotherapy. Recent trials demonstrated no difference in prostate cancer specific mortality for men undergoing active surveillance for low risk prostate cancer compared to prostatectomy or radiotherapy. The use of active surveillance for intermediate risk prostate cancer is less clear. In this study we characterize U.S. national trends for demographic, clinical and socioeconomic factors associated with active surveillance for men with intermediate risk prostate cancer. MATERIALS AND METHODS: This retrospective cohort study examined 176,122 men diagnosed with intermediate risk prostate cancer from 2010 to 2016 in the National Cancer Database. Temporal trends in demographic, clinical and socioeconomic factors among men with intermediate risk prostate cancer and association with the use of active surveillance were characterized. The analysis was performed in April 2020. RESULTS: In total, 176,122 men were identified with intermediate risk prostate cancer from 2010 to 2016. Of these men 57.3% underwent prostatectomy, 36.4% underwent radiotherapy and 3.2% underwent active surveillance. Active surveillance nearly tripled from 1.6% in 2010 to 4.6% in 2016 (p <0.001). On multivariate analysis use of active surveillance was associated with older age, diagnosis in recent years, lower Gleason score and tumor stage, type of insurance, treatment at an academic center and proximity to facility, and attaining higher education (p <0.05). Race and comorbidities were not associated with active surveillance. CONCLUSIONS: Our findings highlight increasing active surveillance use for men with intermediate risk prostate cancer demonstrating clinical and socioeconomic disparities. Prospective data and improved risk stratification are needed to guide optimal treatment for men with intermediate risk prostate cancer.


Asunto(s)
Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Neoplasias de la Próstata/terapia , Espera Vigilante/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Disparidades en Atención de Salud/economía , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Calicreínas/sangre , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Próstata/patología , Antígeno Prostático Específico/sangre , Prostatectomía/economía , Prostatectomía/estadística & datos numéricos , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Radioterapia/economía , Radioterapia/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Espera Vigilante/economía
11.
J Urol ; 205(1): 257-263, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32716676

RESUMEN

PURPOSE: Among some populations access to neonatal circumcision has become increasingly limited despite evidence of its benefits. This study examines national neonatal circumcision trends before and after the 2012 American Academy of Pediatrics recommendation for neonatal circumcision reimbursement. MATERIALS AND METHODS: A retrospective cohort study of boys aged 28 days or less was conducted using data from the Kids' Inpatient Database (2003 to 2016). Boys who underwent neonatal circumcision prior to discharge were compared to boys who did not. Boys with coagulopathies, penile anomalies or a history of prematurity were excluded. RESULTS: An estimated 8,038,289 boys comprised the final cohort. Boys were primarily White (53.7%), privately insured (49.1%) and cared for at large (60.8%) teaching (49.4%) hospitals in metropolitan areas (84.1%). While 55.0% underwent circumcision prior to discharge, neonatal circumcision rates decreased significantly over time (p <0.0001). Black (68.0%) or White (66.0%) boys, boys in the highest income quartile (60.7%) and Midwestern boys (75.0%) were most likely to be circumcised. Neonatal circumcision was significantly more common among privately (64.9%) than publicly (44.6%) insured boys after controlling for demographics, region, hospital characteristics and year (p <0.0001). The odds of circumcision over time were not significantly different in the years before vs after 2012 (p=0.28). CONCLUSIONS: Among approximately 8 million boys sampled over a 13-year period 55.0% underwent neonatal circumcision. The rate of neonatal circumcision varied widely by region, race and socioeconomic status. The finding that boys with public insurance have lower circumcision rates in all years may be related to lack of circumcision access for boys with public insurance.


Asunto(s)
Circuncisión Masculina/tendencias , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Afroamericanos/estadística & datos numéricos , Circuncisión Masculina/economía , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Geografía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Humanos , Recién Nacido , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Clase Social , Estados Unidos
12.
J Urol ; 205(1): 213-218, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856985

RESUMEN

PURPOSE: Neurogenic lower urinary tract dysfunction is a significant source of morbidity for individuals with spinal cord injury and is managed with a range of treatment options that differ in efficacy, tolerability and cost. The effect of insurance coverage on bladder management, symptoms and quality of life is not known. We hypothesized that private insurance is associated with fewer bladder symptoms and better quality of life. MATERIALS AND METHODS: This is a cross-sectional, retrospective analysis of 1,226 surveys collected as part of the prospective Neurogenic Bladder Research Group SCI Registry. We included patients with complete insurance information, which was classified as private or public insurance. The relationship between insurance and bladder management, bladder symptoms and quality of life was modeled using multinomial logistic regression analysis. Spinal cord injury quality of life was measured by the Neurogenic Bladder Symptom Score. RESULTS: We identified 654 privately insured and 572 publicly insured individuals. The demographics of these groups differed by race, education, prevalence of chronic pain and bladder management. Publicly insured patients were more likely to be treated with indwelling catheters or spontaneous voiding and less likely to take bladder medication compared to those with private insurance. On multivariate analysis insurance type was not associated with differences in bladder symptoms (total Neurogenic Bladder Symptom Score) or in urinary quality of life. CONCLUSIONS: There is an association between insurance coverage and the type of bladder management used following spinal cord injury, as publicly insured patients are more likely to be treated with indwelling catheters. However, insurance status, controlling for bladder management, did not impact bladder symptoms or quality of life.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Traumatismos de la Médula Espinal/complicaciones , Vejiga Urinaria Neurogénica/terapia , Adulto , Catéteres de Permanencia/economía , Catéteres de Permanencia/estadística & datos numéricos , Estudios Transversales , Femenino , Disparidades en Atención de Salud/economía , Humanos , Cobertura del Seguro/economía , Seguro de Salud/economía , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente/economía , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/terapia , Resultado del Tratamiento , Vejiga Urinaria/inervación , Vejiga Urinaria/fisiopatología , Vejiga Urinaria Neurogénica/diagnóstico , Vejiga Urinaria Neurogénica/economía , Vejiga Urinaria Neurogénica/etiología , Cateterismo Urinario/economía , Cateterismo Urinario/estadística & datos numéricos
13.
Plast Reconstr Surg ; 147(1): 135e-153e, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33370073

RESUMEN

SUMMARY: The Affordable Care Act's provisions have affected and will continue to affect plastic surgeons and their patients, and an understanding of its influence on the current American health care system is essential. The law's impact on pediatric plastic surgery, craniofacial surgery, and breast reconstruction is well documented. In addition, gender-affirmation surgery has seen exponential growth, largely because of expanded insurance coverage through the protections afforded to transgender individuals by the Affordable Care Act. As gender-affirming surgery continues to grow, plastic surgeons have the opportunity to adapt and diversify their practices.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Procedimientos Quirúrgicos Reconstructivos/estadística & datos numéricos , Cirugía de Reasignación de Sexo/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/tendencias , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/tendencias , Masculino , Medicaid/economía , Medicaid/estadística & datos numéricos , Patient Protection and Affordable Care Act/economía , Procedimientos Quirúrgicos Reconstructivos/economía , Procedimientos Quirúrgicos Reconstructivos/tendencias , Cirugía de Reasignación de Sexo/economía , Cirugía de Reasignación de Sexo/tendencias , Factores Socioeconómicos , Estados Unidos , Seguro de Salud Basado en Valor/economía , Seguro de Salud Basado en Valor/estadística & datos numéricos
14.
Lancet Child Adolesc Health ; 5(2): 103-112, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33333071

RESUMEN

BACKGROUND: Disparities in outcomes of adult sepsis are well described by insurance status and race and ethnicity. There is a paucity of data looking at disparities in sepsis outcomes in children. We aimed to determine whether hospital outcomes in childhood severe sepsis were influenced by race or ethnicity and insurance status, a proxy for socioeconomic position. METHODS: This population-based, retrospective cohort study used data from the 2016 database release from the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). The 2016 KID included 3 117 413 discharges, accounting for 80% of national paediatric discharges from 4200 US hospitals across 47 states. Using multilevel logistic regression, clustered by hospital, we tested the association between race or ethnicity and insurance status and hospital mortality, adjusting for individual-level and hospital-level characteristics, in children with severe sepsis. The secondary outcome of length of hospital stay was examined through multilevel time to event (hospital discharge) regression, with death as a competing risk. FINDINGS: 12 297 children (aged 0-21 years) with severe sepsis with or without shock were admitted to 1253 hospitals in the 2016 KID dataset. 1265 (10·3%) of 12 297 patients did not have race or ethnicity data recorded, 15 (0·1%) were missing data on insurance, and 1324 (10·8%) were transferred out of hospital, resulting in a final cohort of 9816 children. Black children had higher odds of death than did White children (adjusted odds ratio [OR] 1·19, 95 % CI 1·02-1·38; p=0·028), driven by higher Black mortality in the south (1·30, 1·04-1·62; p=0·019) and west (1·58, 1·05-2·38; p=0·027) of the USA. We found evidence of longer hospital stays for Hispanic children (adjusted hazard ratio 0·94, 95% CI 0·88-1·00; p=0·049) and Black children (0·88, 0·82-0·94; p=0·0002), particularly Black neonates (0·53, 95% CI 0·36-0·77; p=0·0011). We observed no difference in survival between publicly and privately insured children; however, other insurance status (self-pay, no charge, and other) was associated with increased mortality (adjusted OR 1·30, 95% CI 1·04-1·61; p=0·021). INTERPRETATION: In this large, representative analysis of paediatric severe sepsis in the USA, we found evidence of outcome disparities by race or ethnicity and insurance status. Our findings suggest that there might be differential sepsis recognition, approaches to treatment, access to health-care services, and provider bias that contribute to poorer sepsis outcomes for racial and ethnic minority patients and those of lower socioeconomic position. Studies are warranted to investigate the mechanisms of poorer sepsis outcomes in Black and Hispanic children. FUNDING: None.


Asunto(s)
Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Sepsis/etnología , Sepsis/mortalidad , Adolescente , Adulto , Niño , Preescolar , Bases de Datos Factuales , Femenino , Disparidades en Atención de Salud , Mortalidad Hospitalaria/etnología , Humanos , Lactante , Recién Nacido , Masculino , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Factores Socioeconómicos , Estados Unidos , Adulto Joven
15.
Public Health Rep ; 136(1): 70-78, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33108960

RESUMEN

OBJECTIVES: Having health insurance is associated with improvements in health care access and use, health behaviors, and outcomes. We examined changes in health insurance coverage for California women before, during, and after pregnancy after implementation of the Affordable Care Act (ACA). METHODS: We used data from the 2011-2017 California Maternal and Infant Health Assessment, an annual representative survey of women sampled from birth certificates (n = 47 487). We examined health insurance coverage at baseline before ACA implementation (2011-2013) and in each survey year from 2014 to 2017 for 3 periods (before, during, and after pregnancy). We calculated prevalence ratios to evaluate changes in health insurance coverage, adjusting for changes in demographic characteristics. Few women were uninsured during pregnancy before implementation of the ACA; therefore, analyses focused on health insurance before pregnancy and postpartum. RESULTS: Before ACA implementation, 24.4% of women reported being uninsured before pregnancy, which decreased to 10.1% in 2017. About 17% of women reported being uninsured postpartum before ACA implementation, and this percentage decreased to 7.5% in 2017. ACA implementation resulted in a >50% adjusted decline in the likelihood of being uninsured before pregnancy or postpartum, primarily because of substantial increases in Medicaid coverage. CONCLUSIONS: ACA implementation resulted in a dramatic reduction in mothers in California who were uninsured before and after pregnancy. Medicaid expansion played a major role in this improvement.


Asunto(s)
Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/legislación & jurisprudencia , Pacientes no Asegurados/estadística & datos numéricos , Patient Protection and Affordable Care Act , Adolescente , Adulto , California , Femenino , Encuestas Epidemiológicas , Humanos , Medicaid/legislación & jurisprudencia , Embarazo , Estados Unidos , Adulto Joven
16.
Int J Cancer ; 148(1): 28-37, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32621751

RESUMEN

Little is known about how health insurance policies, particularly in developing countries, influence breast cancer prognosis. Here, we examined the association between individual health insurance and breast cancer-specific mortality in China. We included 7436 women diagnosed with invasive breast cancer between 2009 and 2016, at West China Hospital, Sichuan University. The health insurance plan of patient was classified as either urban or rural schemes and was also categorized as reimbursement rate (ie, the covered/total charge) below or above the median. Breast cancer-specific mortality was the primary outcome. Using Cox proportional hazards models, we calculated hazard ratios (HRs) for cancer-specific mortality, contrasting rates among patients with a rural insurance scheme or low reimbursement rate to that of those with an urban insurance scheme or high reimbursement rate, respectively. During a median follow-up of 3.1 years, we identified 326 deaths due to breast cancer. Compared to patients covered by urban insurance schemes, patients covered by rural insurance schemes had a 29% increased cancer-specific mortality (95% CI 0%-65%) after adjusting for demographics, tumor characteristics and treatment modes. Reimbursement rate below the median was associated with a 42% increased rate of cancer-specific mortality (95% CI 11%-82%). Every 10% increase in the reimbursement rate is associated with a 7% (95% CI 2%-12%) reduction in cancer-specific mortality risk, particularly in patients covered by rural insurance schemes (26%, 95% CI 9%-39%). Our findings suggest that underinsured patients face a higher risk of breast cancer-specific mortality in developing countries.


Asunto(s)
Neoplasias de la Mama/mortalidad , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Adolescente , Adulto , Neoplasias de la Mama/economía , China/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Cobertura del Seguro/economía , Seguro de Salud/economía , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/estadística & datos numéricos , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Pronóstico , Estudios Prospectivos , Medición de Riesgo/estadística & datos numéricos , Servicios de Salud Rural/economía , Servicios de Salud Rural/estadística & datos numéricos , Clase Social , Servicios Urbanos de Salud/economía , Servicios Urbanos de Salud/estadística & datos numéricos , Adulto Joven
18.
N C Med J ; 81(6): 370-376, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33139466

RESUMEN

Prior to the passage of the Affordable Care Act, many individuals across the state and country faced numerous barriers to accessing affordable and quality health care. This paper provides a review of health coverage in North Carolina before the ACA, the impact the ACA has had on access to health care, and how North Carolina could continue to benefit from "complete" implementation of the ACA.


Asunto(s)
Patient Protection and Affordable Care Act , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , North Carolina , Estados Unidos
20.
PLoS One ; 15(10): e0240151, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052932

RESUMEN

As of August 2020, the United States is the global epicenter of the COVID-19 pandemic. Emerging data suggests that "essential" workers, who are disproportionately more likely to be racial/ethnic minorities and immigrants, bear a disproportionate degree of risk. We used publicly available data to build a series of spatial autoregressive models assessing county level associations between COVID-19 mortality and (1) percentage of individuals engaged in farm work, (2) percentage of households without a fluent, adult English-speaker, (3) percentage of uninsured individuals under the age of 65, and (4) percentage of individuals living at or below the federal poverty line. We further adjusted these models for total population, population density, and number of days since the first reported case in a given county. We found that across all counties that had reported a case of COVID-19 as of July 12, 2020 (n = 3024), a higher percentage of farmworkers, a higher percentage of residents living in poverty, higher density, higher population, and a higher percentage of residents over the age of 65 were all independently and significantly associated with a higher number of deaths in a county. In urban counties (n = 115), a higher percentage of farmworkers, higher density, and larger population were all associated with a higher number of deaths, while lower rates of insurance coverage in a county was independently associated with fewer deaths. In non-urban counties (n = 2909), these same patterns held true, with higher percentages of residents living in poverty and senior residents also significantly associated with more deaths. Taken together, our findings suggest that farm workers may face unique risks of contracting and dying from COVID-19, and that these risks are independent of poverty, insurance, or linguistic accessibility of COVID-19 health campaigns.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Factores Socioeconómicos , Infecciones por Coronavirus/mortalidad , Demografía/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Agricultores/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Pandemias , Neumonía Viral/mortalidad , Estados Unidos
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