Trends from 2008 to 2018 in Electricity-dependent Durable Medical Equipment Rentals and Sociodemographic Disparities.
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ABSTRACT: Background
Duration and number of power outages have increased over time, partly fueled by climate change, putting users of electricity-dependent durable medical equipment (hereafter, "durable medical equipment") at particular risk of adverse health outcomes. Given health disparities in the United States, we assessed trends in durable medical equipment rental prevalence and individual- and area-level sociodemographic inequalities.Methods
Using Kaiser Permanente South California electronic health record data, we identified durable medical equipment renters. We calculated annual prevalence of equipment rental and fit hierarchical generalized linear models with ZIP code random intercepts, stratified by rental of breast pumps or other equipment.Results
243,559 KPSC members rented durable medical equipment between 2008 and 2018. Rental prevalence increased over time across age, sex, racial-ethnic, and Medicaid categories, most by >100%. In adjusted analyses, Medicaid use was associated with increased prevalence and 108 (95% confidence interval [CI] = 99, 117) additional days of equipment rental during the study period. ZIP code-level sociodemographics were associated with increased prevalence of equipment rentals, for example, a 1 SD increase in percent unemployed and
SUBMITTER: Casey JA
PROVIDER: S-EPMC8140591 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundFragmentation in China's social health insurance schemes and income gap have been recognised as important factors for the inequitable use of healthcare. This study assessed trends in disparities in healthcare utilisation between and within health insurances in China between 2008 and 2018.MethodsWe used data from the 2008, 2013, and 2018 China National Health Services Survey. Outpatient visit, inpatient admission and foregone inpatient care were chosen to measure healthcare utilisation and underutilisation by health insurances. Absolute differences and rate ratios were generated to examine disparities between and within health insurances, and changes in disparities were analysed descriptively. Pearson χ2 tests were used to test for statistical significance of differences.ResultsThe outpatient visit rate for respondents covered by the urban resident-based basic medical insurance scheme (URBMI) more than doubled between 2008 and 2018, increasing from 10.5% (9.7-11.2) to 23.5% (23.1-23.8). Inpatient admission rates for respondents covered by URBMI and the new rural cooperative medical scheme (NRCMS) more than doubled between 2008 and 2018, increasing by 7.2 (p < 0.0001) and 7.4 (p < 0.0001) percentage points, respectively. Gaps in outpatient visits and inpatient admissions narrowed across the urban employee-based basic medical insurance scheme (UEBMI), URBMI, and NRCMS through 2008 to 2018, and by 2018 the gaps were small. The rate ratios of foregone inpatient care between NRCMS and UEBMI fell from 0.9 (p > 0.1) in 2008 to 0.8 (p < 0.0001) in 2018. Faster increases in outpatient and inpatient utilisation and greater reductions in foregone inpatient care were observed in poor groups than in wealthy groups within URBMI and NRCMS. However, the poor groups within UEBMI, URBMI, and NRCMS were always more likely to forego inpatient care in comparison with their wealthy counterparts.ConclusionsRemarkable increases in healthcare utilisation of URBMI and NRCMS, especially among the poorest groups, were accompanied by improvements in inequality in healthcare utilisation across UEBMI, URBMI, and NRCMS, and in income-based inequality in healthcare utilisation within URBMI and NRCMS. However, the poor groups were always more likely to forego admission to hospital, as recommended by doctors. We suggest further focus on the foregoing admission care of the poor groups.
| S-EPMC8876177 | biostudies-literature
Project description:BACKGROUND:Women are currently underrepresented in academic psychiatry. As publication activity reflects both leadership and participation in academia, we examined temporal trends in women's authorship by conducting a large-scale bibliometric study of psychiatry journals. METHODS:We examined changes in proportions of women in the first, last, and overall authorship positions over time; relationship to journal impact factor and editorial board makeup; and rates of transition to senior author status using original research articles published in the 24 highest-impact psychiatry journals between January 2008 and May 2018. RESULTS:In 30,934 articles, women represented 40.0% of all authors in 2008 and 44.8% in 2018, with a significant increase in the percentage of women as first authors (2008: 43.5%, 2018: 49.5%; B = 0.64, p = .002) and last authors over time (2008: 30.0%, 2018: 35.7%; B = 0.64, p = 1 × 10-5). Articles with women as last authors were significantly more likely than those with men as last authors to have a woman as first author (?21 = 126.1, p < 2.2 × 10-16). Women exhibited slower rates of transition to the last author position (log rank p = 2 × 10-16); time to 10% transition was 5 years for men and 9 years for women. CONCLUSIONS:These results indicate continued improvement in the representation of women authors in psychiatry journals, resulting in near parity in first authors. However, slower rates of transition to the senior author position and continued underrepresentation of women as senior authors suggest ongoing challenges in achieving gender parity in academic leadership. At the present rate of change for last authors (0.64% increase per year), women would achieve parity in senior authorship in ?20 to 25 years.
| S-EPMC6699930 | biostudies-literature
Project description:PurposePrior studies have been inconclusive in documenting whether the prevalence of adolescent anxiety is increasing, given sampling and measurement limitations. This study adds new information on recent time trends in anxiety prevalence, specifically investigating trends among previously unexamined sociodemographic subgroups.MethodsWeighted data of 37,360 youth respondents (51.1% female, 71.8% White, 91.3% heterosexual, 99.2% cisgender) from the 2012-2018 Dane County Youth Assessment, a county-wide survey administered to youth in participating school districts, were analyzed to estimate time trends in anxiety prevalence among the whole sample and by sociodemographic subgroups.ResultsThe prevalence of youth meeting anxiety-screening criteria increased from 34.1% (95% CI 33.4-34.9) in 2012 to 44% (95% CI 43.2-44.7) in 2018 (OR for trend = 1.07, P for trend < 0.001). The trend remained significant after adjusting for known confounds (AOR for trend = 1.07, P for trend < 0.001). Anxiety increased significantly for several subgroups and widening disparities were documented among females relative to males (P < 0.001), and sexual minority youth relative to heterosexual youth (P = 0.003). In addition, Black youth did not increase at the same swift rate as White youth over the study period (P < 0.001).ConclusionThis study reports recent data on anxiety time trends and finds that among a geographically representative sample of adolescents, anxiety prevalence is rising. Findings provide new evidence documenting increased anxiety prevalence among sexual minority youth relative to their peers. Results highlight the need to bolster public health interventions focused on adolescent mental health, with tailored interventions for vulnerable groups.
| S-EPMC8183580 | biostudies-literature
Project description:ImportanceRacial and ethnic disparities in delayed medical care for reasons that are not directly associated with the cost of care remain understudied.ObjectiveTo describe trends in racial and ethnic disparities in barriers to timely medical care among adults during a recent 20-year period.Design, setting, and participantsThis was a serial cross-sectional study of 590 603 noninstitutionalized adults in the US using data from the National Health Interview Survey from 1999 to 2018. Data analyses were performed from December 2021 through August 2022.ExposuresSelf-reported race, ethnicity, household income, and sex.Main outcomes and measuresTemporal trends in disparities regarding 5 specific barriers to timely medical care: inability to get through by telephone, no appointment available soon enough, long waiting times, inconvenient office or clinic hours, and lack of transportation.ResultsThe study cohort comprised 590 603 adult respondents (mean [SE] age, 46.00 [0.07] years; 329 638 [51.9%] female; 27 447 [4.7%] Asian, 83 929 [11.8%] Black, 98 692 [13.8%] Hispanic/Latino, and 380 535 [69.7%] White). In 1999, the proportion of each race and ethnicity group reporting any of the 5 barriers to timely medical care was 7.3% among the Asian group; 6.9%, Black; 7.9%, Hispanic/Latino; and 7.0%, White (P > .05 for each difference compared with White individuals). From 1999 to 2018, this proportion increased across all 4 race and ethnicity groups (by 5.7, 8.0, 8.1, and 5.9 percentage points [pp] among Asian, Black, Hispanic/Latino, and White individuals, respectively; P < .001 for each), slightly increasing the disparities between groups. In 2018, compared with White individuals, the proportion reporting any barrier was 2.1 and 3.1 pp higher among Black and Hispanic/Latino individuals (P = .03 and P = .001, respectively). There was no significant difference in prevalence between Asian and White individuals. There was a significant increase in the difference in prevalence between Black individuals and White individuals who reported delaying care because of long waiting times at the clinic or medical office and because of a lack of transportation (1.5 pp and 1.8 pp; P = .03 and P = .01, respectively). In addition, the difference in prevalence between Hispanic/Latino and White individuals who reported delaying care because of long waiting times increased significantly (2.6 pp; P < .001).Conclusions and relevanceThe findings of this serial cross-sectional study of data from the National Health Interview Survey suggest that barriers to timely medical care in the US increased for all population groups from 1999 to 2018, with associated increases in disparities among race and ethnicity groups. Interventions beyond those currently implemented are needed to improve access to medical care and to eliminate disparities among race and ethnicity groups.
| S-EPMC9617175 | biostudies-literature
Project description:Studies reporting trends and disparities of osteoarthritis (OA) in the United States are limited. We aimed to examine trends and disparities of OA prevalence among US adults, from 2005 to 2018. Continuous National Health and Nutrition Examination Survey (NHANES) data from 2005-2006 to 2017-2018 were analyzed. Age-adjusted and self-reported OA prevalence, stratified by race/ethnicity and socioeconomic status (SES), was calculated separately for men and women. The linear trend and the association between the survey cycles and OA prevalence were assessed. Age-adjusted and self-reported OA prevalence linearly increased in the seven survey cycles (both Plinear trend ≤ 0.0002) in men and women. Non-Hispanic Caucasians (both Plinear trend ≤ 0.0001) in both genders and Non-Hispanic African Americans women (Plinear trend ≤ 0.0001) had significantly increasing linear trends in OA prevalence. In addition, people with lower SES had a lower age-adjusted prevalence of self-reported OA when compared to those with higher SES. The increasing linear trends still existed among both men and women after adjusting for multiple confounders (both Plinear trend ≤ 0.002). There were significant rising trends and disparities in self-reported OA prevalence among US men and women between 2005 and 2018.
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Project description:Determining long-term trends in chronic pain prevalence is critical for evaluating and shaping U.S. health policies, but little research has examined such trends. This study (1) provides estimates of pain trends among U.S. adults across major population groups; (2) tests whether sociodemographic disparities in pain have widened or narrowed over time; and (3) examines socioeconomic, behavioral, psychological, and medical correlates of pain trends. Regression and decomposition analyses of joint, low back, neck, facial/jaw pain, and headache/migraine using the 2002-2018 National Health Interview Survey for adults aged 25-84 (N = 441,707) assess the trends and their correlates. We find extensive escalation of pain prevalence in all population subgroups: overall, reports of pain in at least one site increased by 10%, representing an additional 10.5 million adults experiencing pain. Socioeconomic disparities in pain are widening over time, and psychological distress and health behaviors are among the salient correlates of the trends. This study thus comprehensively documents rising pain prevalence among Americans across the adult life span and highlights socioeconomic, behavioral, and psychological factors as important correlates of the trends. Chronic pain is an important dimension of population health, and demographic research should include it when studying health and health disparities.
| S-EPMC8035485 | biostudies-literature
Project description:BackgroundPeople using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.MethodsWe obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.ResultsAmong 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.ConclusionsOur results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group.
| S-EPMC10524711 | biostudies-literature
Project description:IntroductionHIV treatment recommendations have evolved over time, reflecting both growing availability of new antiretrovirals and accumulating evidence on their safe and effective use. We analysed patterns of antiretroviral use among diagnosed pregnant women living with HIV delivering in the UK and Ireland between 2008 and 2018 using national surveillance data.MethodsAll singleton pregnancies with known outcomes and known timing of antiretroviral initiation reported to the National Surveillance of HIV in Pregnancy and Childhood were included. Every individual instance of specific antiretroviral use was the unit of analysis in generating a snapshot of antiretroviral use overall and over calendar time. The final analysis was restricted to the 14 most frequently prescribed antiretrovirals.ResultsThere were 12 099 singleton pregnancies reported during 2008-2018 and a total of 38 214 individual uses of the 14 most commonly prescribed antiretrovirals, the majority of which were started before conception (70.9%). In 2008, 37.7% (482/1279) of pregnancies were conceived under treatment, reaching 80.9% (509/629) by 2018. Patterns of antiretroviral use have changed over time, particularly for third agents. Between 2008 and 2018 the most frequently used protease inhibitor shifted from lopinavir to darunavir, whereas use of integrase inhibitors increased steadily over time.ConclusionsThese national surveillance data enable investigation of the 'real-world' use of antiretrovirals in pregnancy on a population level. Findings demonstrate mixed responsiveness of antiretroviral prescription to changes in pregnancy guideline recommendations and may also reflect changes in commissioning and in the characteristics of pregnant women living with HIV.
| S-EPMC9306524 | biostudies-literature
Project description:IntroductionRace, ethnicity, and socioeconomic status are known to influence staging and survival in colorectal cancer (CRC). It is unclear how these relationships are affected by geographic factors and changes in insurance coverage for CRC screening. We examined the temporal trends in the association between sociodemographic and geographic factors and staging and survival among Medicare beneficiaries.MethodsWe identified patients 65 years or older with CRC using the 1991-2010 Surveillance, Epidemiology, and End Results-Medicare database and extracted area-level sociogeographic data. We constructed multinomial logistic regression models and the Cox proportional hazards models to assess factors associated with CRC stage and survival in 4 periods with evolving reimbursement and screening practices: (i) 1991-1997, (ii) 1998-June 2001, (iii) July 2001-2005, and (iv) 2006-2010.ResultsWe observed 327,504 cases and 102,421 CRC deaths. Blacks were 24%-39% more likely to present with distant disease than whites. High-income areas had 7%-12% reduction in distant disease. Compared with whites, blacks had 16%-21% increased mortality, Asians had 32% lower mortality from 1991 to 1997 but only 13% lower mortality from 2006 to 2010, and Hispanics had 20% reduced mortality only from 1991 to 1997. High-education areas had 9%-12% lower mortality, and high-income areas had 5%-6% lower mortality after Medicare began coverage for screening colonoscopy. No consistent temporal trends were observed for the associations between geographic factors and CRC survival.DiscussionDisparities in CRC staging and survival persisted over time for blacks and residents from areas of low socioeconomic status. Over time, staging and survival benefits have decreased for Asians and disappeared for Hispanics.
| S-EPMC7145046 | biostudies-literature
Project description:BackgroundIn an effort to improve stroke quality of care and patient outcomes, quality of care metrics are monitored to assess utilization of evidence-based stroke care processes as part of the Paul Coverdell National Acute Stroke Program (PCNASP). We aimed to assess temporal trends in defect-free care (DFC) received by stroke patients in the PCNASP between 2008 and 2018.MethodsQuality of care data for 10 performance measures were available for 849,793 patients aged ≥18 years who were admitted to a participating hospital with a clinical diagnosis of stroke between 2008 and 2018. A patient who receives care according to all performance measures for which they are eligible, receives "defect-free care" (DFC) (eg, appropriate medications, assessments, and education). Generalized estimating equations were used to examine the factors associated with receipt of DFC.ResultsDFC among ischemic stroke patients increased from 38.0% in 2008 to 80.8% in 2018 (P < .0001), with the largest improvement seen in receipt of stroke education (relative percent change, RPC = 64%). Similarly, DFC for hemorrhagic stroke and transient ischemic attack patients increased from 46.7% to 82.6% (RPC = 76.9%) and 39.9% to 85.0% (RPC = 113.0%) (P < .001), respectively. Among ischemic stroke patients, the adjusted odds for receiving DFC were lower for women, patients aged 18 to 54 years, Medicaid or Medicare participants, and patients with atrial fibrillation (P < .05).ConclusionsFrom 2008 to 2018, receipt of DFC by ischemic stroke patients significantly increased in the PCNASP; however certain subgroups were less likely to receive this level of care. Targeted quality improvement initiatives could result in even further improvements among all stroke patients and help reduce disparities in care.
| S-EPMC8114176 | biostudies-literature