Financial Hardship Among Pregnant and Postpartum Women in the United States, 2013 to 2018
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ABSTRACT:
SUBMITTER: Taylor K
PROVIDER: S-EPMC8556621 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:CONTEXT:Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of these conditions in this population is lacking. OBJECTIVE:To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking among past-year pregnant and postpartum women in the United States. DESIGN:National survey. SETTING:Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. PARTICIPANTS:A total of 43 093 respondents were interviewed, of whom 14 549 were women 18 to 50 years old with known past-year pregnancy status. MAIN OUTCOME MEASURES:Prevalence of 12-month DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking. RESULTS:Past-year pregnant and postpartum women had significantly lower rates of alcohol use disorders and any substance use, except illicit drug use, than nonpregnant women. In addition, currently pregnant women had a lower risk of having any mood disorder than nonpregnant women. The only exception was the significantly higher prevalence of major depressive disorder in postpartum than in nonpregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women. Lifetime and past-year treatment-seeking rates for any psychiatric disorder were significantly lower among past-year pregnant than nonpregnant women with psychiatric disorders. Most women with a current psychiatric disorder did not receive any mental health care in the 12 months prior to the survey regardless of pregnancy status. CONCLUSIONS:Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period. Groups of pregnant women with particularly high prevalence of psychiatric disorders were identified. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period.
| S-EPMC2669282 | biostudies-literature
Project description:BackgroundWith rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States.MethodsWe identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey - Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18-64 or 65+ years).ResultsAmong cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P < 0.001). Factors significantly associated with hardship intensity in multivariable analyses included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices.ConclusionsMedical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors.ImpactEfforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.
| S-EPMC7007367 | biostudies-literature
Project description:BackgroundCancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States.MethodsWe identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress], and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately.ResultsA total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P < .001) and behavioral (28.4% vs 21.2%, P < .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P < .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior.ConclusionsAdult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors' health, and multifaceted interventions are necessary to address underlying causes.
| S-EPMC8328985 | biostudies-literature
Project description:Hepatitis A virus (HAV) is primarily transmitted fecal-orally after close contact with an infected person (1); it is the most common cause of viral hepatitis worldwide, typically causing acute and self-limited symptoms, although rarely liver failure and death can occur (1). Rates of hepatitis A had declined by approximately 95% during 1996-2011; however, during 2016-2018, CDC received approximately 15,000 reports of HAV infections from U.S. states and territories, indicating a recent increase in transmission (2,3). Since 2017, the vast majority of these reports were related to multiple outbreaks of infections among persons reporting drug use or homelessness (4). In addition, increases of HAV infections have also occurred among men who have sex with men (MSM) and, to a much lesser degree, in association with consumption of imported HAV-contaminated food (5,6). Overall, reports of hepatitis A cases increased 294% during 2016-2018 compared with 2013-2015. During 2016-2018, CDC tested 4,282 specimens, of which 3,877 (91%) had detectable HAV RNA; 565 (15%), 3,255 (84%), and 57 (<1%) of these specimens were genotype IA, IB, or IIIA, respectively. Adherence to the Advisory Committee on Immunization Practices (ACIP) recommendations to vaccinate populations at risk can help control the current increases and prevent future outbreaks of hepatitis A in the United States (7).
| S-EPMC6542191 | biostudies-literature
Project description:OBJECTIVES:The COVID-19 pandemic has led to unprecedented levels of unemployment and financial strain for many Americans. Among the individuals impacted by financial strain are pregnant women, for whom added financial stress may be particularly impactful due to the costs associated with prenatal care and providing for a newborn. Financial stress has been previously associated with elevated depression symptoms among pregnant women, which could have significant impacts on birth outcomes and long-term offspring health. However, the impacts of COVID-19-associated financial stress on maternal depression in pregnancy has not been investigated. METHODS:Here, we evaluated whether COVID-19-associated financial stress was associated with increased likelihood of a clinically significant depression score (Edinburgh Postnatal Depression Score???15) among pregnant women living in the United States during the COVID-19 pandemic. Data come from an online survey administered to a convenience sample in April 2020 (N = 2099). RESULTS:Forty-three percent of participants reported experiencing financial stress as a result of the pandemic, while 24% of participants had a clinically significant depression score. COVID-19-related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjustment for covariates including participant education and income (adjusted Odds Ratio: 2.23, 95% CI = 1.80, 2.77, P?<?.001). CONCLUSIONS:Financial stress caused by the COVID-19 pandemic is associated with more than two times the likelihood of depression during pregnancy, which could impact birth outcomes and long-term offspring health.
| S-EPMC7536992 | biostudies-literature
Project description:In response to the US opioid epidemic, the Centers for Disease Control and Prevention updated their guideline on prescription opioids for chronic pain management in March 2016. The aim of this study was to provide detailed analysis of trends in opioid claims among cancer patients in the United States during 2013-2018. We analyzed pharmaceutical dispensing data from Symphony Health's Integrated Dataverse database, which covers approximately 80% of the US population. We examined annual trends in dispensed opioids in cancer patients during 2013-2018. We examined quarterly trends of the prevalence, mean number of days, and dose (stated as morphine milligram equivalents) of opioid dispensing in cancer patients. Dispensing records of an average of over 3.7 million cancer patients contributed to the study annually in 2013-2018. The annual prevalence of opioid dispensing claims declined from 40.2% in 2013 to 34.5% in 2018. Annual declines occurred across cancer sites, and particularly among patients with metastatic cancer (decline of 19.8%), breast cancer (18.2%), and lung cancer (13.8%). By quarter, the prevalence of opioid claims declined statistically significantly from 26.6% in Q1 2013 to 21.2% in Q4 2018; this decline was more pronounced after Q3 2016 (2-sided P = .004). Both quarterly trends in mean days and morphine milligram equivalents of opioids supplied showed a gradual decline from 2013 to 2018, with a slightly larger decline after 2016. We observed a decline in opioid use among cancer patients, particularly after 2016, coinciding with the publication of the Centers for Disease Control and Prevention's guideline on prescription opioids for chronic pain management.
| S-EPMC8793171 | biostudies-literature
Project description:P2Y12 inhibitors (i.e., clopidogrel, prasugrel, or ticagrelor) are effective at reducing adverse cardiovascular outcomes post-revascularization in coronary artery disease (CAD). However, the choice of a specific P2Y12 inhibitor may vary according to the patient's characteristics, and trends in the use of different P2Y12 inhibitors are not well studied in real-world settings. The objective of this study is to determine trends in the prescription patterns of P2Y12 inhibitors in patients with CAD. We studied 137,073 patients with CAD cross-sectionally using the IBM MarketScan database (2013-2018). Patients with CAD prescribed P2Y12 inhibitors within 14 days of index revascularization were included to compare the utilization of P2Y12 inhibitors based on age and clinical characteristics. There were differences in prescription patterns by age. Among patients aged less than or equal to 65 years (N = 92,734), a continuously increased utilization of ticagrelor was observed from 13.7% to 45.6% replacing clopidogrel as the most prescribed medication by 2018. Similarly, ticagrelor was the choice of drug among patients undergoing percutaneous coronary intervention. Among the patients at high bleeding risk, clopidogrel remained the most prescribed medication with use in 50.6% of patients in 2018 in patients aged less than or equal to 65 years. Contrarily, among the older adults with age 65 or above (N = 44,339), although ticagrelor use increased with time, clopidogrel remained the most utilized drug and was used by 66.2% of patients in 2018. Additionally, clopidogrel was the preferred medication among patients with stroke history. With the increasing use of ticagrelor in real-world practice, further research is needed to observe its impact on cardiovascular outcomes.
| S-EPMC10582679 | biostudies-literature
Project description:PurposeTo estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship.MethodsWe identified 1,202 adult cancer survivors diagnosed or treated at ? 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ? 65 years).ResultsMaterial financial hardship was more common in cancer survivors age 18 to 64 years than in those ? 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ? 65 years of age, those who were younger were more likely to report any financial hardship.ConclusionCancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.
| S-EPMC4872019 | biostudies-literature
Project description:INTRODUCTION:Perinatal depression is a complication of pregnancy that can result in adverse maternal and infant outcomes. Screening to identify pregnant and postpartum women with depressive symptoms is recommended to provide diagnosis, treatment, and follow-up care to reduce poor outcomes. METHODS:CDC analyzed 2018 data from the Pregnancy Risk Assessment Monitoring System to describe postpartum depressive symptoms (PDS) among women with a recent live birth and to assess whether health care providers asked women about depression during prenatal and postpartum health care visits, by site and maternal and infant characteristics. RESULTS:Among respondents from 31 sites, the prevalence of PDS was 13.2%, ranging from 9.7% in Illinois to 23.5% in Mississippi. The prevalence of PDS exceeded 20% among women who were aged ?19 years, were American Indian/Alaska Native, smoked during or after pregnancy, experienced intimate partner violence before or during pregnancy, self-reported depression before or during pregnancy, or whose infant had died since birth. The prevalence of women reporting that a health care provider asked about depression during prenatal care visits was 79.1% overall, ranging from 51.3% in Puerto Rico to 90.7% in Alaska. The prevalence of women reporting that a provider asked about depression during postpartum visits was 87.4% overall, ranging from 50.7% in Puerto Rico to 96.2% in Vermont. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE:The prevalence of self-reported PDS varied by site and maternal and infant characteristics. Whether providers asked women about perinatal depression was not consistent across sites. Provision of recommended screenings and appropriate referrals for diagnosis, treatment, and follow-up care can ensure early and effective management of depression to reduce adverse maternal and infant outcomes.
| S-EPMC7238954 | biostudies-literature
Project description:Little is known about the association between health insurance literacy and financial hardship among cancer survivors. Using the 2016 Medical Expenditure Panel Survey Experiences with Cancer self-administered questionnaire, we evaluated the associations between health insurance literacy and medical financial hardship and nonmedical financial sacrifices among adult cancer survivors in the United States. Of the survivors, 18.9% aged 18-64 years and 14.6% aged 65 years and older reported health insurance literacy problems. In both age groups (18-64 and ≥65 years), from multivariable logistic regressions, survivors with health insurance literacy problems were more likely to report any material (adjusted odds ratio [AOR] = 3.02, 95% confidence interval [CI] = 1.53 to 5.96; AOR = 3.33, 95% CI = 1.69 to 6.57, respectively) or psychological (AOR = 5.53, 95% CI = 2.35 to 13.01; AOR = 8.79, 95% CI = 4.55 to 16.97, respectively) hardship, as well as all types of nonmedical financial sacrifices than those without these problems. Future longitudinal studies are warranted to test causality and assess whether improving health insurance literacy can mitigate financial hardship.
| S-EPMC7050003 | biostudies-literature