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2.
Medicine (Baltimore) ; 100(29): e26476, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398003

RESUMO

ABSTRACT: Several viral infections are known to increase the risk of dementia through brain cell damage and systemic infection. The association between hepatitis B and C virus (HBV and HCV) infections and dementia was evaluated using a national sample cohort from South Korea. Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with HBV or HCV infection and for matched control participants. The controls were matched to the patients according to age, sex, income, region of residence, and past medical histories. The incidence of HCV infection was higher in the dementia group (1.0% [113/11,228]) than in the control group (0.8% [364/44,912], P = .043). However, there was no difference in the incidence of HBV infection in the dementia and control groups. The adjusted odds ratio (OR) for HCV infection was 1.25 (95% confidence interval [CI] = 1.01-1.54, P = .043) in the dementia group. According to the subgroup analysis by sex, the adjusted ORs for HCV infection were 1.04 (95% CI = 072-1.49, P = .851) in men and 1.38 (95% CI = 1.06-1.79, P = .016) in women. We concluded that the incidence of HCV infection was higher (with a higher OR) in women with dementia than in matched control participants in South Korea.


Assuntos
Demência/diagnóstico , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Adulto , Idoso , Distribuição de Qui-Quadrado , Correlação de Dados , Mineração de Dados , Demência/epidemiologia , Feminino , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Incidência , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Fatores de Risco
3.
Cancer Epidemiol ; 73: 101974, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34243048

RESUMO

PURPOSE: Multiple Myeloma (MM), the second leading blood malignancy, has complex and costly disease management. We studied patterns of treatment disparities and unplanned interruptions among the MM patients after the Affordable Care Act to assess their prevalence and effect on survival. MATERIALS AND METHODS: This retrospective study of 1002 MM patients at a tertiary referral center used standard guidelines as a reference to identify underuse of effective treatments. We used multivariate logistic regression and Cox proportionate hazard to study the prognostic effect on survival. RESULTS: Median age in the cohort was 63.0 [IQR: 14] years. Non-Hispanic White (NHW) patients were older (p = 0.007) and more likely to present with stage I disease (p = 0.02). Underuse of maintenance therapy (aOR = 1.98; 95 % CI 1.12-3.48) and interruptions in treatment were associated with race/ethnicity and insurance (aOR = 4.14; 95 % CI: 1.78-9.74). Only underuse of induction therapy was associated with overall patient survival. CONCLUSION: Age, race, ethnicity and primary insurance contribute to the underuse of treatment and in unplanned interruptions in MM treatment. Addressing underuse causes in such patients is warranted.


Assuntos
Disparidades em Assistência à Saúde , Mieloma Múltiplo , Idoso , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Mieloma Múltiplo/epidemiologia , Mieloma Múltiplo/etnologia , Mieloma Múltiplo/terapia , Patient Protection and Affordable Care Act , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
MMWR Morb Mortal Wkly Rep ; 70(28): 985-990, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34264911

RESUMO

COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19-associated morbidity and mortality (1); however, COVID-19 vaccination coverage is lower in these groups (2). CDC used data from CDC's Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020-May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson & Johnson]) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020-May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18-24 years had the lowest ≥1-dose coverage (28.7%) among all age groups. Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19.


Assuntos
Vacinas contra COVID-19/administração & dosagem , Seguro Saúde/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/prevenção & controle , Grupos de Populações Continentais/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
5.
West J Emerg Med ; 22(3): 552-560, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-34125026

RESUMO

INTRODUCTION: In March 2020, shelter-in-place orders were enacted to attenuate the spread of coronavirus 2019 (COVID-19). Emergency departments (EDs) experienced unexpected and dramatic decreases in patient volume, raising concerns about exacerbating health disparities. METHODS: We queried our electronic health record to describe the overall change in visits to a two-ED healthcare system in Northern California from March-June 2020 compared to 2019. We compared weekly absolute numbers and proportional change in visits focusing on race/ethnicity, insurance, household income, and acuity. We calculated the z-score to identify whether there was a statistically significant difference in proportions between 2020 and 2019. RESULTS: Overall ED volume declined 28% during the study period. The nadir of volume was 52% of 2019 levels and occurred five weeks after a shelter-in-place order was enacted. Patient demographics also shifted. By week 4 (April 5), the proportion of Hispanic patients decreased by 3.3 percentage points (pp) (P = 0.0053) compared to a 6.2 pp increase in White patients (P = 0.000005). The proportion of patients with commercial insurance increased by 11.6 pp, while Medicaid visits decreased by 9.5 pp (P < 0.00001) at the initiation of shelter-in-place orders. For patients from neighborhoods <300% federal poverty levels (FPL), visits were -3.8 pp (P = 0.000046) of baseline compared to +2.9 pp (P = 0.0044) for patients from ZIP codes at >400% FPL the week of the shelter-in-place order. Overall, 2020 evidenced a consistently elevated proportion of high-acuity Emergency Severity Index (ESI) level 1 patients compared to 2019. Increased acuity was also demonstrated by an increase in the admission rate, with a 10.8 pp increase from 2019. Although there was an increased proportion of high-acuity patients, the overall census was decreased. CONCLUSION: Our results demonstrate changing ED utilization patterns circa the shelter-in-place orders. Those from historically vulnerable populations such as Hispanics, those from lower socioeconomic areas, and Medicaid users presented at disproportionately lower rates and numbers than other groups. As the pandemic continues, hospitals should use operations data to monitor utilization patterns by demographic, in addition to clinical indicators. Messaging about availability of emergency care and other services should include vulnerable populations to avoid exacerbating healthcare disparities.


Assuntos
COVID-19/etnologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Status Econômico/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Seguro Saúde/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto Jovem
6.
MMWR Morb Mortal Wkly Rep ; 70(25): 905-909, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34166332

RESUMO

HIV testing is a critical component of effective HIV prevention and care. CDC recommends routine opt-out HIV testing in health care settings for all sexually active persons aged 13-64 years at least once in their lifetime and risk-based testing regardless of age for those who report behaviors associated with HIV acquisition (1). However, recent studies show low HIV testing rates in clinical settings; HIV testing rates at visits to physician offices did not increase during 2009-2016 (2). The objective of the current study is to estimate temporal trends in HIV testing among persons with commercial insurance or Medicaid from 2014 through 2019 and describe their demographic characteristics in 2019. Weighted data from the IBM MarketScan Commercial Claims and Encounters database* (commercial insurance) and from the Centers for Medicare & Medicaid Services (CMS) claims database† (Medicaid) were analyzed to estimate the proportions of persons with commercial insurance or Medicaid who received testing for HIV. Testing rates increased among male and nonpregnant female persons aged ≥13 years with either type of coverage. In 2019, only 4.0% of those with commercial insurance and 5.5% of those with Medicaid received testing for HIV. Testing rates were higher among non-Hispanic Black or African American (Black) persons and Hispanic or Latino (Hispanic) persons. Based on mathematical modeling studies, these annual testing rates would need to increase at least threefold and be sustained over several years (3,4) to achieve the Ending the HIV Epidemic (EHE) in the U.S. initiative goal of ≥95% of persons with HIV being aware of their infection by 2025.§ Interventions need to be implemented to increase routine and risk-based HIV testing in clinical settings to higher levels that can help reduce disparities in HIV diagnoses between Black and Hispanic persons compared with non-Hispanic White (White) persons (5). Increased HIV testing is essential to achieve the goals of the EHE initiative and reduce disparities in HIV diagnoses; public health should partner with health care systems to implement interventions that support increased testing.


Assuntos
Teste de HIV/tendências , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Adolescente , Adulto , Idoso , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
7.
Postgrad Med ; 133(7): 798-806, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34139934

RESUMO

OBJECTIVES: Evidence on physician patient-sharing relationships from developing countries is limited. This study aimed to identify patient-sharing networks among physicians in China and explore the effect of attributes of physician networks on healthcare utilization and costs. METHODS: Retrospective analysis was undertaken based on healthcare claims from Urban Employee Basic Medical Insurance Data spanning the years 2015 to 2018. We identified patients with hypertension and modeled physician patient-sharing networks using social network analysis. Relationships among physicians were further quantified using network measures. We fitted a log-linear model to examine the association between networks and healthcare at the physician level. RESULTS: 29,321 patients, seen by 3,429 physicians from 57 hospitals in one eastern city of China were included. Physicians were connected to 21 other physicians (threshold = 1 shared patients) or 7 other physicians (threshold = 4, 6, or 8 shared patients). Degree and centrality measures of physicians at primary care facilities were significantly lower than those at secondary or tertiary hospitals (p < 0.001). The links between physicians at different hospital grades were weak and patients tended to flow among physicians at the same hospital grade. Compared with a low closeness centrality, a medium level was associated with fewer hospitalization costs and days, and high closeness centrality was accompanied by a sharper decrease (all P < 0.001). CONCLUSIONS: Primary care physicians were located in peripheral positions in China, and the links between primary care facilities and higher-grade hospitals were still weak. Characteristics of physicians' networks and the position of physicians in the network were associated with spending and utilization of services, but not all associations were in the same direction.


Assuntos
Hipertensão/epidemiologia , Seguro Saúde/estatística & dados numéricos , Pacientes/estatística & dados numéricos , Médicos/estatística & dados numéricos , Análise de Rede Social , Idoso , China/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos
8.
Plast Reconstr Surg ; 148(1): 1e-11e, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181599

RESUMO

BACKGROUND: The impact of breast reconstruction on financial toxicity remains poorly understood despite growing awareness. The authors sought to illustrate the relationship between breast reconstruction subtypes and the risk of financial toxicity. METHODS: The authors conducted a single-institution cross-sectional survey of all female breast cancer patients undergoing any form of breast reconstruction between January of 2018 and June of 2019. Financial toxicity was measured by means of the validated Comprehensive Score for Financial Toxicity instrument. Demographics, clinical course, and coping strategies were abstracted from a purpose-built survey and electronic medical records. Multivariable linear regression was performed to identify associations with financial toxicity. RESULTS: The authors' analytical sample was 350 patients. One hundred eighty-four (52.6 percent) underwent oncoplastic reconstruction, 126 (36 percent) underwent implant-based reconstruction, and 40 (11.4 percent) underwent autologous reconstruction. Oncoplastic reconstruction recipients were older, had a higher body mass index, and were more likely to have supplemental insurance and receive adjuvant hormonal therapy. No significant differences in the risk of financial toxicity were uncovered across breast reconstruction subtypes (p = 0.53). Protective factors against financial toxicity were use of supplemental insurance (p = 0.0003) and escalating annual household income greater than $40,000 (p < 0.0001). Receipt of radiation therapy was positively associated with worsening financial toxicity (-2.69; 95 CI percent, -5.22 to -0.15). Financial coping strategies were prevalent across breast reconstruction subtypes. CONCLUSIONS: Breast reconstruction subtype does not differentially impact the risk of financial toxicity. Increasing income and supplemental insurance were found to be protective, whereas receipt of radiation therapy was positively associated with financial toxicity. Prospective, multicenter studies are needed to identify the main drivers of out-of-pocket costs and financial toxicity in breast cancer care.


Assuntos
Neoplasias da Mama/cirurgia , Efeitos Psicossociais da Doença , Estresse Financeiro/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Mamoplastia/economia , Adulto , Idoso , Neoplasias da Mama/economia , Estudos Transversais , Feminino , Estresse Financeiro/diagnóstico , Estresse Financeiro/economia , Humanos , Renda/estatística & dados numéricos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos
9.
J Prev Med Public Health ; 54(3): 161-165, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34092061

RESUMO

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

Assuntos
COVID-19/etnologia , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Americanos Asiáticos/estatística & dados numéricos , COVID-19/epidemiologia , Teste para COVID-19/estatística & dados numéricos , Estudos Transversais , Emprego/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Adulto Jovem
10.
BMC Infect Dis ; 21(1): 571, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34126937

RESUMO

BACKGROUND: Antibiotic resistance is increasing among urinary pathogens, resulting in worse clinical and economic outcomes. We analysed factors associated with antibiotic-resistant bacteria (ARB) in patients hospitalized for urinary tract infection, using the comprehensive French national claims database. METHODS: Hospitalized urinary tract infections were identified from 2015 to 2017. Cases (due to ARB) were matched to controls (without ARB) according to year, age, sex, infection, and bacterium. Healthcare-associated (HCAI) and community-acquired (CAI) infections were analysed separately; logistic regressions were stratified by sex. RESULTS: From 9460 cases identified, 6468 CAIs and 2855 HCAIs were matched with controls. Over a 12-months window, the risk increased when exposure occurred within the last 3 months. The following risk factors were identified: antibiotic exposure, with an OR reaching 3.6 [2.8-4.5] for men with CAI, mostly associated with broad-spectrum antibiotics; surgical procedure on urinary tract (OR 2.0 [1.5-2.6] for women with HCAI and 1.3 [1.1-1.6] for men with CAI); stay in intensive care unit > 7 days (OR 1.7 [1.2-2.6] for men with HCAI). Studied co-morbidities had no impact on ARB. CONCLUSIONS: This study points out the critical window of 3 months for antibiotic exposure, confirms the impact of broad-spectrum antibiotic consumption on ARB, and supports the importance of prevention during urological procedures, and long intensive care unit stays.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Seguro Saúde/estatística & dados numéricos , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , França/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecções Urinárias/microbiologia
11.
World Neurosurg ; 151: e630-e651, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33940276

RESUMO

OBJECTIVE: Financial toxicity associated with cancer treatment has a deleterious impact on patient outcomes but has not been well characterized among patients with metastatic cancers. We characterize the extent of financial toxicity among this population and identify factors associated with financial toxicity. METHODS: We prospectively surveyed adult patients with brain and spine metastases who received radiosurgery at a large academic medical center between January 2018 and December 2019. Financial toxicity was measured with the Personal Financial Wellness (PFW) scale. RESULTS: In total, 93 patients were included, with a median survival of 17.7 months. Most patients had private insurance (47%) or Medicare with supplementary insurance (42%), whereas 11% of patients were uninsured or insured by Medicaid/Medicare/Veterans Affairs. Of patients, 60% were primary income earners, of whom 52% had dependents. The median PFW score was 7.0 (interquartile range, 5.1-9.1), with financial toxicity reported in 23 patients (25%). After adjusting for age and education level, private insurance (odds ratio [OR], 0.28; P = 0.080) was associated with a lower likelihood of financial toxicity. Having ≥1 emergency department visit (OR, 3.87; P = 0.024) and a cancer-related change in employment status (OR, 3.63; P = 0.036) were associated with greater likelihood of reporting financial toxicity. CONCLUSIONS: Most patients with cancer with brain and spine metastases with a poor prognosis treated at a tertiary center are primary income earners and experience financial toxicity. Further studies are warranted to assess the longitudinal impact of financial toxicity in patients with metastatic cancer, particularly those with ≥1 emergency department visit and a cancer-related change in employment status.


Assuntos
Neoplasias Encefálicas/economia , Neoplasias Encefálicas/secundário , Estresse Financeiro/etiologia , Neoplasias da Coluna Vertebral/economia , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Neoplasias Encefálicas/terapia , Estudos de Coortes , Feminino , Humanos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/terapia , Inquéritos e Questionários , Estados Unidos
12.
Public Health ; 194: 176-181, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33962093

RESUMO

OBJECTIVES: Analyze the association between health insurance coverage and the use of health care services, dentist visits, and self-medication in a national sample of Mexican adults aged ≥50 years with diabetes. METHODS: Participants with diabetes taken from a subsample of the Mexican Health and Aging Study (MHAS-2018) (n = 3667) were examined, with data pertaining to the frequency of their doctor and dentist visits, residence, years of education, self-medication, and health insurance coverage (insured/uninsured) also collected. A logistic regression model was used to identify the association between independent variables and health insurance coverage, whereas Poisson regression models were also estimated to ascertain whether health insurance coverage was associated with the number of doctor and dentist visits. RESULTS: The prevalence of self-reported diabetes was 24.6%, whereas approximately 93.3% of subjects had visited a doctor, 40.6% had visited a dentist, and 20.3% self-medicated. Individuals with insurance coverage were 75% (Odds ratio [OR] = 1.75 [95% confidence interval {CI}1.32-2.31]; P < 0.001) more likely to have visited a doctor and 57% more likely to have visited a dentist (OR = 1.57 [95% CI 1.35-1.83]; P < 0.001) than uninsured adult subjects, while adults living in rural areas were 77% less likely to be insured than adults living in urban areas. Doctor and dentist visits [rate ratio {RR} = 1.32 (95% CI 1.28-1.35); P < 0.001] and [RR = 1.47 (95% CI 1.37-1.58); P < 0.001, respectively] were found to be positively associated with the insured members of the study population. CONCLUSION: A positive association was found between doctor and dentist visits in the population insured with diabetes. A major public health challenge is the population of diabetics who report being uninsured, wherein this population requires coverage to access the necessary clinical follow-up and control to prevent complications.


Assuntos
Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos
14.
J Occup Health ; 63(1): e12231, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33974321

RESUMO

OBJECTIVES: Prevention of and early treatment for noncommunicable diseases such as hypertension, hyperglycemia, and dyslipidemia are important, as these diseases are asymptomatic in early stages but can lead to critical conditions such as macro- and microvascular disorders later on. While screening is conducted worldwide, low rates of hospital visits after screening is a common issue. We aimed to investigate the effect of reminder letters on the consultation behavior of screened participants. METHODS: We used administrative claims data from a database managed by JMDC Inc for participants of health checkups in 2014, 2015, 2016, and 2017, who belonged to a health insurance society. Reminder letters were sent regularly 6 months after checkups to improve participant consultation behavior. Participants who screened positive for hypertension, hyperglycemia, and dyslipidemia, and who were not taking medication for any of these diseases at the time of health checkups, were included in the analyses. RESULTS: A total of 1739 participants in 2014, 1693 in 2015, 2002 in 2016, and 2144 in 2017 were included in the analysis for hypertension. The cumulative proportion of hospital visits gradually increased over the course of 12 months after checkups in all years. After 2015, spikes, albeit very small ones, were observed at 6 months after checkups in accordance with the timing of reminder letters. Similar trends were observed for hyperglycemia and dyslipidemia. CONCLUSIONS: Sending reminder letters is a potentially effective approach to increase hospital visits, but further improvements (ie, multiple reminders) may be necessary to affect enhancements in participant consultation behavior.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Sistemas de Alerta/estatística & dados numéricos , Adulto , Bases de Dados Factuais , Dislipidemias/diagnóstico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hiperglicemia/diagnóstico , Hipertensão/diagnóstico , Seguro Saúde/estatística & dados numéricos , Japão , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Estudos Retrospectivos
15.
Eur J Vasc Endovasc Surg ; 62(1): 119-125, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33824066

RESUMO

OBJECTIVE: A previous study revealed a preliminary trend towards higher in hospital mortality in patients admitted as an emergency with acute stroke during the COVID-19 pandemic in Germany. The current study aimed to further examine the possible impact of a confirmed SARS-CoV-2 infection on in hospital mortality. METHODS: This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalised for ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, acute limb ischaemia (ALI), aortic rupture, acute stroke, or transient ischaemic attack (TIA) between 1 January 2017, and 31 October 2020, were included. Admission rates per 10 000 insured and mortality were compared between March - June 2017 - 2019 (pre-COVID) and March - June 2020 (COVID). Mortality rates were determined by the occurrence of a confirmed SARS-CoV-2 infection. RESULTS: A total of 316 718 hospitalisations were included (48.7% female, mean 72.5 years), and 21 191 (6.7%, 95% CI 6.6% - 6.8%) deaths occurred. In hospital mortality increased during the COVID-19 pandemic when compared with the three previous years for patients with acute stroke from 8.3% (95% CI 8.0 - 8.5) to 9.6% (95% CI 9.1 - 10.2), while no statistically significant changes were observed for STEMI, NSTEMI, ALI, aortic rupture, and TIA. When comparing patients with confirmed SARS-CoV-2 infection (2.4%, 95% CI 2.3 - 2.5) vs. non-infected patients, a higher in hospital mortality was observed for acute stroke (12.4% vs. 9.0%), ALI (14.3% vs. 5.0%), and TIA (2.7% vs. 0.3%), while no statistically significant differences were observed for STEMI, NSTEMI, and aortic rupture. CONCLUSION: This retrospective analysis of claims data has provided hints of an association between the COVID-19 pandemic and increased in hospital mortality in patients with acute stroke. Furthermore, confirmed SARS-CoV-2 infection was associated with increased mortality in patients with stroke, TIA, and ALI. Future studies are urgently needed to better understand the underlying mechanism and relationship between the new coronavirus and acute stroke.


Assuntos
COVID-19/complicações , Ataque Isquêmico Transitório/mortalidade , Doença Arterial Periférica/mortalidade , Acidente Vascular Cerebral/mortalidade , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Idoso , COVID-19/diagnóstico , COVID-19/epidemiologia , Emergências/epidemiologia , Extremidades/irrigação sanguínea , Feminino , Alemanha/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Seguro Saúde/estatística & dados numéricos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/terapia , Masculino , Pandemias/estatística & dados numéricos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/terapia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia
16.
Am J Emerg Med ; 47: 154-157, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33812332

RESUMO

OBJECTIVE: To determine the rate at which commercially-insured patients fill prescriptions for naloxone after an opioid-related ED encounter as well as patient characteristics associated with obtaining naloxone. METHODS: This is a retrospective cohort study of adult patients discharged from the ED following treatment for an opioid-related condition from 2016 to 2018 using a commercial insurance claims database (Optum Clinformatics® Data Mart). The primary outcome was a pharmacy claim for naloxone in the 30 days following the ED encounter. A multivariable logistic regression model examined the association of patient characteristics with filled naloxone prescriptions, and predictive margins were used to report adjusted probabilities with 95% confidence intervals. RESULTS: 21,700 patients had opioid-related ED encounters during the study period, of which 1743 (8.0%) had encounters for heroin overdose, 8825 (40.7%) for overdose due to other opioids, 5400 (24.9%) for withdrawal, and 5732 (26.4%) for other opioid use disorder conditions. 230 patients (1.1%) filled a prescription for naloxone within 30 days. Patients with heroin overdose (2.6%; 95%CI 1.7 to 3.4), recent prescriptions for opioid analgesics (1.4%; 95%CI 1.1 to 1.7), recent prescriptions for buprenorphine (1.9%; 95%CI 1.0 to 2.9), and naloxone prescriptions in the prior year (3.3%; 95%CI 1.8 to 4.8) were more likely to obtain naloxone. The rate was significantly higher in 2018 [1.9% (95%CI 1.5 to 2.2)] as compared to 0.4% (95%CI 0.3 to 0.6) in 2016. CONCLUSIONS: Few patients use insurance to obtain naloxone by prescription following opioid-related ED encounters. Clinical and policy interventions should expand distribution of this life-saving medication in the ED.


Assuntos
Overdose de Drogas/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Síndrome de Abstinência a Substâncias/epidemiologia , Adulto , Bases de Dados Factuais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Int J Equity Health ; 20(1): 96, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827600

RESUMO

OBJECTIVE: This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. DATA SOURCE: The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. STUDY DESIGN: Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. DATA COLLECTION/EXTRACTION METHODS: We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. PRINCIPAL FINDINGS: While income was a significant predictor of health insurance coverage (a difference of 6.1-7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. CONCLUSION: Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.


Assuntos
Renda , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/etnologia , Idoso , Criança , Feminino , Gastos em Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Estados Unidos
18.
Vet Rec ; 189(1): e243, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33870521

RESUMO

BACKGROUND: Although cost is often a barrier to providing optimal veterinary care, only a minority of pet owners use insurance to help cover veterinary costs. We sought to estimate consumer demand and preferences for pet insurance and how educating owners on treatment costs and disease risk affects pet insurance uptake. METHODS: We surveyed 306 dog owners across the United States without pet insurance, including a choice experiment, used ordinary least squares regression to estimate the demand for pet insurance, and conjoint analysis to estimate the pet insurance feature preferences. RESULTS: Pet insurance uptake increased by 12.3% after veterinary treatment cost and canine cancer risk information was presented to participants. We found that, on average, pet owners were willing to pay $24 more per month for a preventive care service in pet insurance. Forty-four percent of participants were willing to spend up to $1000 to prolong their pet's life a year, while 46% of the sample were willing to spend $3000 or more. CONCLUSIONS: Our results suggest that providing pet owners' information about the costs and likelihood of disease can increase their willingness to pay for pet insurance. Coverage of preventive care was the most valuable feature in pet insurance among those presented to dog owners.


Assuntos
Seguro Saúde/estatística & dados numéricos , Propriedade , Animais de Estimação , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Gatos , Cães , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
19.
JAMA Netw Open ; 4(4): e215503, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33847752

RESUMO

Importance: Rehospitalization after major surgery is common and represents a significant cost to the health care system. Little is known regarding the causes of these readmissions and the degree to which they may be preventable. Objective: To evaluate the degree to which readmissions after major surgery are potentially preventable. Design, Setting, and Participants: This retrospective cohort study used a weighted sample of 1 937 354 patients from the 2017 National Readmissions Database to evaluate all adult inpatient hospitalizations for 1 of 7 common major surgical procedures. Statistical analysis was performed from January 14 to November 30, 2020. Main Outcomes and Measures: The study calculated 90-day readmission rates as well as rates of readmissions that were considered potentially preventable. Potentially preventable readmissions (PPRs) were defined as those with a primary diagnosis code for superficial surgical site infection, acute kidney injury, aspiration pneumonitis, or any of the Agency for Healthcare Research and Quality-defined ambulatory care sensitive conditions. Multivariable logistic regression was used to identify factors associated with PPRs. Results: A total weighted sample of 1 937 354 patients (1 048 046 women [54.1%]; mean age, 66.1 years [95% CI, 66.0-66.3 years]) underwent surgical procedures; 164 755 (8.5%) experienced a readmission within 90 days. Potentially preventable readmissions accounted for 29 321 (17.8%) of all 90-day readmissions, for an estimated total cost to the US health care system of approximately $296 million. The most common reasons for PPRs were congestive heart failure exacerbation (34.6%), pneumonia (12.0%), and acute kidney injury (22.5%). In a multivariable model of adults aged 18 to 64 years, patients with public health insurance (Medicare or Medicaid) had more than twice the odds of PPR compared with those with private insurance (adjusted odds ratio, 2.09; 95% CI, 1.94-2.25). Among patients aged 65 years or older, patients with private insured had 18% lower odds of PPR compared with patients with Medicare as the primary payer (adjusted odds ratio, 0.82; 95% CI, 0.74-0.90). Conclusions and Relevance: This study suggests that nearly 1 in 5 readmissions after surgery are potentially preventable and account for nearly $300 million in costs. In addition to better inpatient care, improved access to ambulatory care may represent an opportunity to reduce costly readmissions among surgical patients.


Assuntos
Seguro Saúde/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Estudos Transversais , Bases de Dados Factuais , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Seguro Saúde/classificação , Masculino , Medicaid , Readmissão do Paciente/economia , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Estados Unidos/epidemiologia
20.
Public Health ; 194: 89-95, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33866150

RESUMO

OBJECTIVE: Given that the presence of insurance may affect the risk of suicide mortality in cancer patients, we aimed to examine the association in a population-based study using the Surveillance, Epidemiologic, and End Results (SEER) database. STUDY DESIGN: A retrospective analysis of data from the SEER database. METHODS: We conducted a retrospective study using the SEER database. Hazard ratios (HRs), adjusted HRs (aHRs), and 95% confidence intervals (95% CIs) of suicide death were calculated using Cox proportional hazard models to evaluate the risk of suicide mortality among the cohorts. RESULTS: Multivariable analysis revealed that cancer patients without insurance had an increased risk of suicide death compared with patients with private insurance (aHR, 1.37; 95% CI, 1.01-1.72), whereas no significant result was observed in patients with any Medicaid (aHR, 1.10; 95% CI, 0.93-1.30; P = 0.27). In addition, the stratified analysis indicated that the risk of suicide death in patients in the uninsured and Medicaid groups presented with localized stage of disease (aHR, 1.32; 95% CI, 1.02, 1.69), White (aHR, 1.34; 95% CI, 1.05, 1.71), and American Indian/Alaska Native and Asian/Pacific Islander (aHR, 1.89; 95% CI, 1.08, 3.30) were greater than insured patients. CONCLUSION: Overall, our results indicated that insurance status was a statistically significant predictor of suicide death in patients with cancer. Healthcare providers should identify those patients at high risk of suicide and provide appropriate mental health and psychosocial oncology services in time.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Neoplasias/terapia , Suicídio Consumado/estatística & dados numéricos , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Programa de SEER , Estados Unidos/epidemiologia , Adulto Jovem
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