RESUMO
The COVID-19 was declared a pandemic by WHO on 03/2020 has claimed millions of lives worldwide. The US leads all countries in COVID-19-related deaths. Individual level (preexisting conditions and demographics) and county-level (availability of resources) factors have been attributed to increased risk of COVID-19-related deaths. This study builds on previous studies to assess the relationship between county-level resources and COVID-19 mortality among 2,438 US counties. We merged 2019 data from AHA, AHRF, and USA FACTS. The dependent variable was the total number of COVID-19-related deaths. Independent variables included county-level resources: (1) hospital staffing levels (FTE RNs, hospitalists, and intensivists) per 10,000 population; (2) hospital capacity (occupancy rate, proportion of teaching hospitals, and number of airborne infection control rooms per 10,000 population); and (3) macroeconomic resources [per capita income and location (urban/rural)]. We controlled for population 65+, racial/ethnic minority, and COVID-19 deaths per 1,000 population. A negative binomial regression was used. Hospital staffing per 10,000 population {FTE RN [IRR = 0.997; CI (0.995-0.999)], FTE hospitalists [IRR = 0.936; CI (0.897-0.978)], and FTE intensivists [IRR = 0.606; CI (0.516-0.712)]} was associated with lower COVID-19-related deaths. Hospital occupancy rate, proportion of teaching hospitals, and total number of airborne infection control rooms per 10,000 population were positively associated with COVID-19-related deaths. Per capita income and being in an urban county were positively associated with COVID-19-related deaths. Finally, the proportion of 65+, racial/ethnic minorities, and the number of cases were positively associated with COVID-19-related deaths. Our findings suggest that focusing on maintaining adequate hospital staffing could improve COVID-19 mortality.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Etnicidade , Grupos Minoritários , Renda , População RuralRESUMO
PURPOSE: Cancer incidence in the USA remains higher among certain groups, regions, and communities, and there are variations based on nativity. Research has primarily focused on specific groups and types of cancer. This study expands on previous studies to explore the relationship between country of birth (nativity) and all cancer site incidences among USA and foreign-born residents using a nationally representative sample. METHODS: This is a cross-sectional study of (unweighted n = 22,554; weighted n = 231,175,933) participants between the ages of 20 and 80 from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Using weighted logistic regressions, we analyzed the impact of nativity on self-reported cancer diagnosis controlling for routine care, smoking status, overweight, race/ethnicity, age, and gender. We ran a partial model, adjusting only for age as a covariate, a full model with all other covariates, and stratified by race/ethnicity. RESULTS: In the partial and full models, our findings indicate that US-born individuals were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.34, 95% CI [1.93; 2.84], p < 0.01) and (OR 1. 39, 95% CI [1.05; 1.84], p < 0.05), respectively. This significance persisted only among non-Hispanic Blacks when stratified by race. Non-Hispanic Blacks who were US-born were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.30, 95% [CI 1.31; 4.02], p < 0.05). CONCLUSION: A variety of factors may reflect lower self-reported cancer diagnosis in foreign-born individuals in the USA other than a healthy immigrant advantage. Future studies should consider the factors behind the differences in cancer diagnoses based on nativity status, particularly among non-Hispanic Blacks.
Assuntos
Emigrantes e Imigrantes , Neoplasias , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Inquéritos Nutricionais , Sobrepeso , Autorrelato , Adulto JovemRESUMO
This study assessed the impact of public hospitals' privatization on payer-mix. We used a national sample of nonfederal, acute care, public hospitals in 1997 and followed them through 2013, resulting in a cohort of 492 hospitals (8,335 hospital-year observations). Privatization to for-profit (FP) status was associated with a greater increase in Medicare payer-mix (ß = 0.13; p ≤ .001), compared with a smaller increase for privatization to not-for-profit (NFP) status (ß = 0.02; p ≤ .05). FP privatization was associated with a greater decrease in Medicaid payer-mix (ß = -0.09; p ≤ .001), compared with NFP privatization (nonsignificant). There is a larger change in payer-mix after FP privatization than after NFP privatization.
Assuntos
Medicaid , Privatização , Idoso , Estudos de Coortes , Hospitais Públicos , Humanos , Medicare , Estados UnidosRESUMO
Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals' adoption of hospitalists. To fill this gap, this longitudinal study (2003-2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.
Assuntos
Médicos Hospitalares , Canadá , Hospitais , Humanos , Estudos Longitudinais , Estados Unidos , Recursos HumanosRESUMO
Asthma prevalence and asthma-related healthcare utilization differ across racial/ethnic groups and geographical areas. This study builds on previous research to examine the relationship between country of birth and asthma prevalence and healthcare utilization using a national data set. The National Health and Nutrition Examination Survey (NHANES) Demographic and Questionnaire Files from 2007 to 2012 were used for this study. We used SPSS complex sampling design to estimate the association between country of birth and asthma prevalence, wheezing and emergency department (ED) use. The sample size was 8272 children and adolescents between the ages of 5 and 19 years old. US-born children had more reported episodes of wheezing (p = 0.024) 95 % CI 1.06; 2.54. There was no association between country of birth and asthma and ED use. US-born children and adolescents compared to foreign-born children and adolescents are more likely to have episodes of wheezing.
Assuntos
Asma/etnologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Inquéritos Nutricionais , Assistência Centrada no Paciente/estatística & dados numéricos , Prevalência , Sons Respiratórios , Fatores Sexuais , Fatores Socioeconômicos , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Asthma is one of the leading causes of emergency department visits and school absenteeism among school-aged children in the United States, but there is significant local-area variation in emergency department visit rates, as well as significant differences across racial-ethnic groups. ANALYSIS: We first calculated emergency department (ED) visit rates among Medicaid-enrolled children age 5-12 with asthma using a multi-state dataset. We then performed exploratory factor analysis using over 226 variables to assess whether they clustered around three county-level conceptual factors (socioeconomic status, healthcare capacity, and air quality) thought to be associated with variation in asthma ED visit rates. Measured variables (including ED visit rate as the outcome of interest) were then standardized and tested in a simple conceptual model through confirmatory factor analysis. RESULTS: County-level (contextual) variables did cluster around factors declared a priori in the conceptual model. Structural equation models connecting the ED visit rates to socioeconomic status, air quality, and healthcare system professional capacity factors (consistent with our conceptual framework) converged on a solution and achieved a reasonable goodness of fit on confirmatory factor analysis. CONCLUSION: Confirmatory factor analysis offers an approach for quantitatively testing conceptual models of local-area variation and racial disparities in asthma-related emergency department use.
RESUMO
Asthma medication adherence is low, particularly among Medicaid enrollees. There has been much debate on the impact of direct-to-consumer advertising (DTCA) on health care use, but the impact on medication use among children with asthma has been unexamined. The study sample included 180,584 children between the ages of 5 and 18 with an asthma diagnosis from a combined dataset of Medicaid Analytic eXtract and national advertising data. We found that DTCA expenditure during the study period was significantly associated with an increase in asthma medication use. However, the effectiveness declined after a certain level.
Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Publicidade Direta ao Consumidor/métodos , Medicaid , Humanos , Adesão à Medicação/psicologia , Estados UnidosRESUMO
BACKGROUND: Although colorectal cancer (CRC) mortality rates are declining, racial-ethnic disparities in CRC mortality nationally are widening. Herein, the authors attempted to identify county-level variations in this pattern, and to characterize counties with improving disparity trends. METHODS: The authors examined 20-year trends in US county-level black-white disparities in CRC age-adjusted mortality rates during the study period between 1989 and 2010. Using a mixed linear model, counties were grouped into mutually exclusive patterns of black-white racial disparity trends in age-adjusted CRC mortality across 20 three-year rolling average data points. County-level characteristics from census data and from the Area Health Resources File were normalized and entered into a principal component analysis. Multinomial logistic regression models were used to test the relation between these factors (clusters of related contextual variables) and the disparity trend pattern group for each county. RESULTS: Counties were grouped into 4 disparity trend pattern groups: 1) persistent disparity (parallel black and white trend lines); 2) diverging (widening disparity); 3) sustained equality; and 4) converging (moving from disparate outcomes toward equality). The initial principal component analysis clustered the 82 independent variables into a smaller number of components, 6 of which explained 47% of the county-level variation in disparity trend patterns. CONCLUSIONS: County-level variation in social determinants, health care workforce, and health systems all were found to contribute to variations in cancer mortality disparity trend patterns from 1990 through 2010. Counties sustaining equality over time or moving from disparities to equality in cancer mortality suggest that disparities are not inevitable, and provide hope that more communities can achieve optimal and equitable cancer outcomes for all. Cancer 2016;122:1735-48. © 2016 American Cancer Society.
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População Negra/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/mortalidade , População Branca/estatística & dados numéricos , Fatores Etários , Geografia Médica/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Modelos Lineares , Mortalidade/tendências , Análise de Componente Principal , Análise de Regressão , Fatores Socioeconômicos , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Many asthma-related exacerbations could be prevented by consistent use of daily inhaled corticosteroid therapy (ICS-Rx). OBJECTIVES: We sought to measure the potential cost savings that could accrue from increasing ICS-Rx adherence in children. STUDY DESIGN: We measured observed costs for a cohort of 43,156 Medicaid-enrolled children in 14 southern states whose initial ICS-Rx was prescribed in 2007. METHODS: Adherence rates and associated costs were calculated from Medicaid claims. Children were categorized as high or low adherence based on the ratio of ICS-Rx claims filled to total asthma drug claims. Branching tree simulation was used to project the potential cost savings achieved by increasing the proportion of children with ICS-Rx to total asthma Rx ratios greater than 0.5 to 20%, 40%, 60%, 80%, and 100%. RESULTS: Increasing the proportion of children who maintain higher adherence after initial ICS-Rx to 40% would generate savings of $95 per child per year. An intervention costing $10 per member per month that resulted in even half of the children maintaining high adherence would generate a 98% return on investment for managed care plans or state Medicaid programs. Net costs decreased incrementally at each level of increase in ICS-Rx adherence. The projected Medicaid cost savings for these 14 states in 2007 ranged from $8.2 million if 40% of the children achieved high adherence, to $57.5 million if 80% achieved high adherence. CONCLUSIONS: If effective large-scale interventions can be found, there are substantial cost savings to be gained from even modest increases in real-world adherence to ICS-Rx among Medicaid-enrolled children with asthma.
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Asma/tratamento farmacológico , Glucocorticoides/uso terapêutico , Adesão à Medicação , Criança , Pré-Escolar , Redução de Custos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Medicaid , Estados UnidosRESUMO
BACKGROUND: US breast cancer deaths have been declining since 1989, but African American women are still more likely than white women to die of breast cancer. Black/white disparities in breast cancer mortality rate ratios have actually been increasing. METHODS: Across 762 US counties with enough deaths to generate reliable rates, county-level, age-adjusted breast cancer mortality rates were examined for women who were 35 to 74 years old during the period of 1989-2010. Twenty-two years of mortality data generated twenty 3-year rolling average data points, each centered on a specific year from 1990 to 2009. Mixed linear models were used to group each county into 1 of 4 mutually exclusive trend patterns. The most recent 3-year average black breast cancer mortality rate for each county was also categorized as being worse or not worse than the breast cancer mortality rate for the total US population. RESULTS: More than half of the counties (54%) showed persistent, unchanging disparities. Roughly 1 in 4 (24%) had a divergent pattern of worsening black/white disparities. However, 10.5% of the counties sustained racial equality over the 20-year period, and 11.7% of the counties actually showed a converging pattern from high disparities to greater equality. Twenty-three counties had 2008-2010 black mortality rates better than the US average mortality rate. CONCLUSIONS: Disparities are not inevitable. Four US counties have sustained both optimal and equitable black outcomes as measured by both absolute (better than the US average) and relative benchmarks (equality in the local black/white rate ratio) for decades, and 6 counties have shown a path from disparities to health equity.
Assuntos
Neoplasias da Mama/mortalidade , Disparidades nos Níveis de Saúde , População Negra , Neoplasias da Mama/etnologia , Feminino , Humanos , Fatores de Tempo , População BrancaRESUMO
BACKGROUND: Despite evidence-based prevention and practice guidelines, asthma prevalence, treatment, and outcomes vary widely at individual and community levels. Asthma disproportionate/ly affects low-income and minority children, who comprise a large segment of the Medicaid population. METHODS: 2007 Medicaid claims data from 14 southern states was mapped for 556 counties to describe the local area variation in 1-year asthma prevalence rates, emergency department (ED) visit rates, and racial disparity rate ratios. RESULTS: One-year period prevalence of asthma ranged from 2.8% in Florida to 6.4% in Alabama, with a median prevalence rate of 4.1%. At the county level, the prevalence was higher for Black children and ranged from 1.03% in Manatee County, FL, to 21.0% in Hockley County, TX. Black-White rate ratios of prevalence ranged from 0.49 in LeFlore County, MS, to 3.87 in Flagler County, FL. Adjusted asthma ED visit rates ranged from 2.2 per 1000 children in Maryland to 16.5 in Alabama, with a median Black-White ED-visit rate ratio of 2.4. Rates were higher for Black children, ranging from 0.80 per 1000 in Wicomico County, MD, to 70 per 1000 in DeSoto County, FL. Rate ratios of ED visits ranged from 0.25 in Vernon Parish, LA, to 25.28 in Nelson County, KY. CONCLUSIONS AND RELEVANCE: Low-income children with Medicaid coverage still experience substantial variation in asthma prevalence and outcomes from one community to another. The pattern of worse outcomes for Black children also varies widely across counties. Eliminating this variation could substantially improve overall outcomes and eliminate asthma disparities.
Assuntos
Asma/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Asma/etnologia , População Negra/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Disparidades nos Níveis de Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Prevalência , Fatores de Risco , Análise de Pequenas Áreas , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Asthma is a leading cause of emergency department (ED) visits. There has been much debate on the impact of direct to consumer advertising (DTCA) on healthcare. This study seeks to examine the association between DTCA expenditure and asthma-related ED use. STUDY DESIGN: In this study, we combined Medicaid administrative data and a national advertising data on asthma medications. The sample size consisted of 180,584 Medicaid-enrolled children between the ages of 5 and 18 years who had an asthma diagnosis. Twenty percent of the Medicaid-enrolled children in the sample had asthma-related ED visits. RESULTS: We found that DTCA expenditure is associated with a decrease in asthma-related ED visits (OR = 0.75; CI: 0.64-0.89). However, at higher levels of DTCA expenditure, the likelihood of asthma-related ED visits increases (OR = 1.25; CI: 1.05-1.49), indicating a decreased relationship between DTCA and asthma-related ED visits. CONCLUSIONS: Our findings suggest that DTCA may be associated with improved health outcomes for Medicaid-enrolled children with asthma.