Decline and Pronounced Regional Disparities in Medical Cocaine Usage in the United States.
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ABSTRACT:
SUBMITTER: Armbuster YC
PROVIDER: S-EPMC8592245 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:There have been increasing concerns about adverse effects and drug interactions with meperidine. The goal of this study was to characterize meperidine use in the United States. Meperidine distribution data were obtained from the Drug Enforcement Administration's Automated of Reports and Consolidated Orders System. The Medicare Part D Prescriber Public Use File was utilized to capture overall trends in national prescriptions in this observational report. Nationally, meperidine distribution decreased by 94.6% from 2001 to 2019. In 2019, Arkansas, Alabama, Oklahoma, and Mississippi saw significantly greater distribution when compared with the US state average of 9.27 mg per 10 persons (SD = 6.82). Meperidine distribution showed an 18-fold difference between the highest state (Arkansas = 36.8 mg) and lowest state (Minnesota = 2.1 mg). Five of the six states with the lowest distribution were in the Northeast. Meperidine distribution per state was correlated with the prevalence of adult obesity (r(48) = +0.48, p < .001). Family medicine and internal medicine physicians accounted for 28.9% and 20.5%, respectively, of meperidine total daily supply (TDS) in 2017. Interventional pain management (5.66) and pain management (3.48) physicians accounted for the longest TDS per provider. The use of meperidine declined over the last two decades. Meperidine varied by geographic region with south-central states, and those with more obesity, showing greater distribution. Primary care doctors continue to account for the majority of meperidine daily supply. Increasing knowledge of meperidine's undesirable adverse effects like seizures and serious drug-drug interactions is likely responsible for these pronounced reductions.
| S-EPMC8204095 | biostudies-literature
Project description:BackgroundThe prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine are sympathomimetic drugs with therapeutic use. They are designated in the United States as Schedule II substances, defined by the 1970 Controlled Substances Act as having a "high potential for abuse". Changing criteria for the diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and the approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns. This report compared the pharmacoepidemiology of these stimulants in the United States from 2010-2017.MethodsDistribution of amphetamine, methylphenidate, lisdexamfetamine were examined via weights extracted from the Drug Enforcement Administration's (DEA) Automated Reports and Consolidated Ordering System (ARCOS). Median stimulant Daily Dosage per patient was determined for a regional analysis. The percent of cost and prescriptions attributable to each stimulant and atomoxetine in Medicaid from the "Drug Utilization 2018 - National Total" from the Centers for Medicare and Medicaid was determined.ResultsThere was a rise in amphetamine (+67.5%) and lisdexamfetamine (+76.7%) from 2010-2017. The change in methylphenidate (-3.0%) was modest. Persons/day stimulant usage was lower in the West than in other US regions from 2014-2017. There was a negative correlation (r(48) = -0.43 to -0.65, p < .05) between the percent Hispanic population per state and the Daily Dosage/population per stimulant. Methylphenidate formulations accounted for over half (51.7%) of the $3.8 billion reimbursed by Medicaid and the plurality (45.4%) of the 22.0 million prescriptions. Amphetamine was responsible for less than one-fifth (18.4%) of cost but one-third of prescriptions (33.6%). Lisdexamfetamine's cost (26.0%) exceeded prescriptions (16.3%).ConclusionThe rising amphetamine and lisdexamfetamine distribution may correspond with a rise in adult ADHD diagnoses. Regional analysis indicates that stimulant distribution in the West may be distinct from that in other regions. The lower stimulant distribution in areas with greater Hispanic populations may warrant further study.
| S-EPMC8706327 | biostudies-literature
Project description:Chat Generative Pretrained Transformer (ChatGPT) is a large language model developed by OpenAI that has gained widespread interest. It has been cited for its potential impact on health care and its beneficial role in medical education. However, there is limited investigation into its use among medical students. In this study, we evaluated the frequency of ChatGPT use, motivations for use, and preference for ChatGPT over existing resources among medical students in the United States. Data was collected from an original survey consisting of 14 questions assessing the frequency and usage of ChatGPT in various contexts within medical education. The survey was distributed via email lists, group messaging applications, and classroom lectures to medical students across the United States. Responses were collected between August and October 2023. One hundred thirty-one participants completed the survey and were included in the analysis. Of the total, 48.9% respondents responded that they have used ChatGPT in medical studies. Among ChatGPT users, 43.7% of respondents report using ChatGPT weekly, several times per week, or daily. ChatGPT is most used for writing, revising, editing, and summarizing purposes. 37.5% and 41.3% of respondents reported using ChatGPT more than 25% of the working time for these tasks respectively. Among respondents who have not used ChatGPT, more than 50% of respondents reported they were extremely unlikely or unlikely to use ChatGPT across all surveyed scenarios. ChatGPT users report they are more likely to use ChatGPT over directly asking professors or attendings (45.3%), textbooks (42.2%), and lectures (31.7%), and least likely to be used over popular flashcard application Anki (11.1%) and medical education videos (9.5%). ChatGPT is an increasingly popular resource among medical students, with many preferring ChatGPT over other traditional resources such as professors, textbooks, and lectures. Its impact on medical education will only continue to grow as its capabilities improve.
| S-EPMC11292693 | biostudies-literature
Project description:Significant clusters of high- and low-obesity counties have been demonstrated across the United States (US). This study examined regional disparities in obesity prevalence and differences in the related structural characteristics across regions of the US.Drawing on model-based estimates from the Centers for Disease Control and Prevention, regional differences in county-level adult obesity prevalence (percent of the adult population [? 20 years] that was obese [BMI ? 30 kg/m(2) ] within a county, 2009) were assessed with a LISA (Local Indicators of Spatial Association) analysis to identify geographic concentrations of high and low obesity levels. Regional regime analysis was utilized to identify factors that were differentially associated with obesity prevalence between regions of the US.High- and low-obesity county clusters and the effect of a number of county-level characteristics on obesity prevalence differed significantly by region. These included the positive effect of African American populations in the South, the negative effect of Hispanic populations in the Northeast, and the positive effect of unemployed workers in the Midwest and West.Our findings suggest the need for public health policies and interventions that account for different regional characteristics underlying obesity prevalence variation across the US.
| S-EPMC4310761 | biostudies-literature
Project description:BackgroundAlthough regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability.MethodsA national sample of 59 360 workers' compensation (WC) cases to evaluate impact of regional SE factors on medical costs and length of disability (LOD) in occupational low back pain (LBP).ResultsLower neighborhood median household incomes (MHI) and higher state unemployment rates were associated with longer LOD. Medical costs were lower in states with more workers receiving Social Security Disability, and in areas with lower MHI, but this varied in magnitude and direction among neighborhoods. Medical costs were higher in more urban, more racially diverse, and lower education neighborhoods.ConclusionsRegional SE disparities in medical costs and LOD occur even when health insurance, health care availability, and indemnity benefits are similar. Results suggest opportunities to improve care and disability outcomes through targeted health care and disability interventions.
| S-EPMC5413850 | biostudies-literature
Project description:BackgroundAlthough black women experienced greater cervical cancer incidence and mortality rate reduction in recent years, they continue to have higher incidence rates than whites. Great variations also exist among geographic regions of the US, with the South having both the highest incidence and mortality rates compared to other regions. The present study explores the question of whether living in the South is associated with greater racial disparity in cervical cancer incidence and mortality by examining race- and region-specific rates and the trend between 2000 and 2012.MethodsThe Surveillance, Epidemiology, and End Results (SEER) 18 Program data was used. Cervical cancer incidence and mortality rates, annual percent changes, and disparity ratios were calculated using SEER*Stat software and Joinpoint regression for four groups: US14-Non-Hispanic White (NHW), US14-Non-Hispanic Black (NHB), South-NHW, and South-NHB, where South included 4 registries from Georgia and Louisiana and US14 were 14 US registries except the four South registries.ResultsThe average age-adjusted cervical cancer incidence rate was the highest among South-NHBs (11.1) and mortality rate was the highest among US14-NHBs (5.4). In 2012, the degree of racial disparities between South-NHBs and South-NHWs was greater in terms of mortality rates (NHB:NHW = 1.80:1.35) than incidence rates (NHB:NHW = 1.45:1.15). While mortality disparity ratios decreased from 2000-2012 for US14-NHB (APC: -1.9(-2.3,-1.4), mortality disparity ratios for South-NHWs (although lower than NHBs) increased compared to US14-NHW. Incidence rates for NHBs continued to increase with increasing age, whereas rates for NHWs decreased after age 40. Mortality rates for NHBs dramatically increased at age 65 compared to a relatively stable trend for NHWs. The increasing racial disparity with increasing age in terms of cervical cancer incidence rates became more pronounced when corrected for hysterectomy prevalence.ConclusionsBlack race and South region were associated with higher cervical cancer incidence and mortality. Cervical cancer rates uncorrected for hysterectomy may underestimate regional and racial disparities. Increasing incidence rates for older NHBs compared to NHWs warrant further research to determine whether screening should continue for NHBs over age 65.
| S-EPMC5325259 | biostudies-literature
Project description:Bystander cardiopulmonary resuscitation (CPR) is associated with increased survival from cardiac arrest, yet bystander CPR rates are low in many communities. The overall prevalence of CPR training in the United States and associated individual-level disparities are unknown. We sought to measure the national prevalence of CPR training and hypothesized that older age and lower socioeconomic status would be independently associated with a lower likelihood of CPR training. We administered a cross-sectional telephone survey to a nationally representative adult sample. We assessed the demographics of individuals trained in CPR within 2 years (currently trained) and those who had been trained in CPR at some point in time (ever trained). The association of CPR training and demographic variables were tested using survey weighted logistic regression. Between September 2015 and November 2015, 9022 individuals completed the survey; 18% reported being currently trained in CPR, and 65% reported training at some point previously. For each year of increased age, the likelihood of being currently CPR trained or ever trained decreased (currently trained: odds ratio, 0.98; 95% CI, 0.97-0.99; P<0.01; ever trained: OR, 0.99; 95% CI, 0.98-0.99; P=0.04). Furthermore, there was a greater then 4-fold difference in odds of being currently CPR trained from the 30-39 to 70-79 year old age groups (95% CI, 0.10-0.23). Factors associated with a lower likelihood of CPR training were lesser educational attainment and lower household income (P<0.01 for each of these variables). A minority of respondents reported current training in CPR. Older age, lesser education, and lower income were associated with reduced likelihood of CPR training. These findings illustrate important gaps in US CPR education and suggest the need to develop tailored CPR training efforts to address this variability.
| S-EPMC5524119 | biostudies-literature
Project description:PurposeWe identified clinical and regional factors associated with the use of urethroplasty vs repeat endoscopic management for urethral stricture disease.Materials and methodsWe analyzed claims for patients 18 to 65 years old in the 2007 to 2011 MarketScan® Commercial Claims and Encounters Database with a diagnosis of urethral stricture. The primary outcome was treatment with urethroplasty vs repeat endoscopic management, defined as more than 2 dilations or direct vision internal urethrotomies. The likelihood of urethroplasty vs repeat endoscopic management was determined for each major metropolitan area in the United States. Multivariate logistic regression was done to identify factors associated with urethroplasty.ResultsWe identified 41,056 patients with urethral stricture, yielding a diagnosis rate of 296/100,000 men in MarketScan. Repeat endoscopic management and urethroplasty were performed in 2,700 and 1,444 patients, respectively. Compared to patients treated with repeat endoscopic management those with urethroplasty were younger (median age 44 vs 54 years) and more likely to have a Charlson comorbidity score of 0 (84% vs 77%), have traveled out of a metropolitan area for care (34% vs 17%) and have a reconstructive urologist in the treatment metropolitan area (76% and 62%, each p <0.001). When controlling for age and Charlson comorbidity score, travel out of a metropolitan area (OR 2.7, 95% CI 2.2-3.3) and a reconstructive urologist in the treatment metropolitan area (OR 2.0, 95% CI 1.7-2.5) were associated with a greater likelihood of urethroplasty vs repeat endoscopic management.ConclusionsDespite the well established benefits of urethroplasty compared to repeat endoscopic management a strong bias for repeat endoscopic management exists in many regions in the United States.
| S-EPMC4359508 | biostudies-literature
Project description:OBJECTIVES:To determine the distribution of influenza vaccine coverage in the United States in 2008. DESIGN:Cross-sectional analysis. SETTING:The 2008 Behavioral Risk Factor Surveillance Survey, which employs random-digit dialing to interview noninstitutionalized adults in the United States and territories. PARTICIPANTS:Two hundred forty-nine thousand seven hundred twenty-three persons aged 50 and older. MEASUREMENTS:Participants were asked whether they had had an influenza vaccination during the previous 12 months. RESULTS:In 2008, 42.0% of adults aged 50 to 64 and 69.5% of adults aged 65 and older reported receiving an influenza vaccination in the past 12 months. Vaccine coverage generally increased with advancing age (P<.001), higher levels of education (P<.001) and total household income (P<.001), and greater morbidity (P<.001). In participants aged 50 to 64, vaccine prevalence was lower in men (39.9%) than in women (44.1%; P<.001), although no significant differences were observed in older adults. Within each 5-year interval of age, non-Hispanic blacks and Hispanics had significantly lower vaccine prevalence than non-Hispanic whites (P<.001 for all comparisons). For participants aged 65 and older, non-Hispanic blacks and Hispanics were 56% (adjusted prevalence ratio (PR)=1.56, 95% confidence interval (CI)=1.48, 1.64) and 44% (adjusted PR=1.44, 95% CI=1.35, 1.54) more likely, respectively, to be unvaccinated than non-Hispanic whites, adjusting for age and sex. Racial and ethnic disparities in vaccine coverage narrowed with increasing number of diseases, although these disparities remained significant in older adults with two or more diseases (P<.05). CONCLUSION:There were large disparities in influenza vaccine coverage in 2008, particularly across race and ethnicity and socioeconomic position. Accordingly, more targeted interventions are needed to improve vaccine delivery to disadvantaged segments of the U.S. population.
| S-EPMC3249761 | biostudies-literature
Project description:Tertiary to home and work, "third places" serve as opportunity structures that transmit information and facilitate social capital and upward mobility. However, third places may be inequitably distributed, thereby exacerbating disparities in social capital and mobility. The authors use tract-level data from the National Neighborhood Data Archive to examine the distribution of third places across the United States. There were significant disparities in the availability of third places. Higher poverty rates were associated with fewer third places. Tracts with the smallest shares of Black and Hispanic populations had comparatively more third places. However, this racial disadvantage was not linear, suggesting potential buffering effects in places with the largest shares of Black and Hispanic populations. There was also a rural disadvantage, except in the most isolated rural tracts. This study demonstrates the value of conceptualizing and measuring third places to understand sociospatial disparities in the availability of these understudied opportunity structures.
| S-EPMC10634631 | biostudies-literature