OBJECTIVES
Decline in physical function is associated with older age. Healthcare utilization and expenditures related to physical functioning declines will likely increase as the proportion of the ...population of older adults rises. This study evaluated resource utilization associated with differences in physical functioning in a nationally representative sample of older adults.
DESIGN
A retrospective panel study nationally representative for 26 809 552 older adults in the United States.
SETTING
Medical Expenditure Panel Survey (MEPS) data from 2013 to 2014.
PARTICIPANTS
Adults aged 70 years or older who completed both rounds of the Self‐Administered Questionnaire in MEPS.
MEASUREMENTS
Physical Component Score (PCS) from the Short‐Form Health Survey as a measure of physical functioning was stratified into quartiles. Healthcare utilization (count of medical visits by setting) and total expenditures were assessed during and after the PCS measurements. Generalized linear mixed models, adjusted for demographic and clinical covariates, estimated the relationship between healthcare utilization and physical functioning.
RESULTS
The lowest functional status (Q1) was associated with significantly increased healthcare utilization of emergency department, inpatient, home health, outpatient, and total medical visits compared with the three higher quartiles groups (P < .001, all). When compared with the lowest functioning group (Q1), the percentage savings for direct healthcare expenditures were 26.7% (95% confidence interval CI = 7.8‐41.7) in Q2, 50.1% (95% CI = 35.6‐61.4) in Q3, and 65.2% (95% CI = 54.7‐73.2) in Q4. Similarly, there were 10.4% (95% CI = 9.2‐11.7), 11.9% (95% CI = 10.5‐13.6), and 14.0% (95% CI = 2.2%‐15.9%) reductions in total medical visits, respectively.
CONCLUSION
Lower physical functioning was associated with higher healthcare utilization and expenditures. These estimates are conservative because they do not capture long‐term care utilization due to the nature of MEPS. These results can be used to benchmark other healthcare resource benefits of interventions to maintain or improve physical functioning in older adults in noninstitutionalized settings. J Am Geriatr Soc 68:266–271, 2020
See related editorial by Resnick et al. in this issue.
Several factors, including the lack of a systematic cannabis use assessment within healthcare systems, have led to significant under-documentation of cannabis use and its correlates in medical ...records, the unpreparedness of clinicians, and poor quality of cannabis-related electronic health record data, limiting its utilization in research. Multiple steps are required to overcome the existing knowledge gaps and accommodate the health needs implied by the increasing cannabis use prevalence. These steps include (1) enhancing clinician and patient education on the importance of cannabis use assessment and documentation, (2) implementing a standardized approach for comprehensive cannabis use assessment within and across healthcare systems, (3) improving documentation of cannabis use and its correlates in medical records and electronic health records by building in prompts, (4) developing and validating reliable computable phenotypes of cannabis use, (5) conducting research utilizing electronic health data to study a wide array of related health outcomes, (6) and establishing evidence-based guidelines to inform clinical practices and policies. Integrating comprehensive cannabis use assessment and documentation within healthcare systems is necessary to enhance patient care and improve the quality of electronic health databases. Employing electronic health record data in cannabis-related research is crucial to accelerate research in light of the existing knowledge gaps on a wide array of health outcomes. Thus, improving and modernizing cannabis use assessment and documentation in healthcare is an integral step on which research conduct and evidence generation primarily rely.
We Cannot Treat the Dead Goodin, Amie J
American journal of public health (1971),
10/2018, Letnik:
108, Številka:
10
Journal Article
Recenzirano
Odprti dostop
...from 2016 to the present, 28 states have enacted limitations on daily supply of opioid prescriptions per patient or total morphine milligram equivalents of new opioid prescriptions,3 with more ...states considering similar proposals. ...legislative supply limitations coupled with payer-driven restrictions placed by Medicare and other major payers, along with the ongoing confusion regarding the Centers for Disease Control and Prevention's 2016 opioid prescribing guidelines,4 may leave pain patients high and dry (or, perhaps, low and dry). Downstream opioid problems include spread of infectious diseases resulting from shared needles, increased burden on child welfare services resulting from incarcerated parents with opioid possession or diversion convictions, the increased rate ofinfants born with neonatal abstinence syndrome, an overwhelmed legal and judicial system dealing with the rapidly evolving circumstances of opioids and analog products, and even decreases in US labor force participation.6 We cannot treat the dead, and so public health practitioners must make harm reduction and public health- focused policies more palatable to policymakers and the public by clarifying policy intent.
To evaluate the association between mass casualty shooting venues, types of firearms, and the age of perpetrators in the United States.
We analyzed data on mass casualty (≥ 3 fatalities) shootings ...for August 1982 through February 14, 2018. We describe data overall, specifically by school venues and the weapons used. We categorized perpetrators by ages of younger than 18 years, 18 to 20 years, and 21 years and older. We described the number of victims (fatalities plus injuries) by medians and average per event.
Of 97 events, the median perpetrator age was 35 years and 21 years for school shootings. Four of 16 school events were committed by those aged 18 to 20 years, and all of those events included long guns. Victims of perpetrators aged 18 to 20 years made up 9.0% of all victims and 31.1% of victims of school shootings.
Persons aged 18 to 20 years perpetrated about 1 in 8 shootings, accounting for about 1 in 3 victims of school shootings. Public Health Implications. Legislation to prevent mass casualty events must be multifaceted, including age restrictions, restrictions on certain types of firearms, and improved resources for mental health, with particular emphasis on mental health and firearm restrictions for young adults.
Prescription Drug Monitoring Programs (PDMPs) document the dispensing of prescription medications that are designated as controlled substances by federal and state authorities. Previous research ...using state-operated PDMPs have typically evaluated epidemiological and/or health-related outcomes associated with use of controlled substances; however, PDMPs are accessed, used and impact on a variety of law enforcement applications. As such, there is potential for PDMPs as a research vehicle for the evaluation of programs and policies to capture controlled substance trends and outcomes that are more relevant for criminology. We propose extensions of the epidemiological-criminology framework to identify and classify potential PDMP research opportunities into five non-mutually exclusive categories: 1) effects on public health and safety outcomes, 2) data use for evaluation of criminology-explicit outcomes, 3) data use for emerging epidemiological-criminology applications, 4) data triangulation and integration, and 5) surveillance of “ecosystem” interactions. Applications and a review of relevant published literature are discussed for each of these categories in the context of highlighting opportunities for criminologists to increase research on PDMPs. Multi-disciplinary research partnerships are recommended to develop more robust study designs and to rigorously interpret and apply findings as reported from studies that use PDMP data.
Background Menthol can mask the harshness and taste of tobacco, making menthol cigarettes easier to use and increasing their appeal among vulnerable populations. The tobacco industry has targeted ...youth, women, and racial minorities with menthol cigarettes, and these groups smoke menthol cigarettes at higher rates. The tobacco industry has also targeted the lesbian, gay, bisexual, and transgender (LGBT) communities with tobacco product marketing. Purpose To assess current menthol cigarette smoking by sexual orientation among a nationally representative sample of U.S. adults. Methods Data were obtained from the 2009–2010 National Adult Tobacco Survey, a national landline and cellular telephone survey of non-institutionalized U.S. adults aged ≥18 years, to compare current menthol cigarette smoking between LGBT ( n =2,431) and heterosexual/straight ( n =110,841) adults. Data were analyzed during January–April 2014 using descriptive statistics and logistic regression adjusted for sex, age, race, and educational attainment. Results Among all current cigarette smokers, 29.6% reported usually smoking menthol cigarettes in the past 30 days. Menthol use was significantly higher among LGBT smokers, with 36.3% reporting that the cigarettes they usually smoked were menthol compared to 29.3% of heterosexual/straight smokers ( p <0.05); this difference was particularly prominent among LGBT females (42.9%) compared to heterosexual/straight women (32.4%) ( p <0.05). Following adjustment, LGBT smokers had greater odds of usually smoking menthol cigarettes than heterosexual/straight smokers (OR=1.31, 95% CI=1.09, 1.57). Conclusions These findings suggest that efforts to reduce menthol cigarette use may have the potential to reduce tobacco use and tobacco-related disease and death among LGBT adults.
Objective
Incidence of neonatal abstinence syndrome (NAS) is increasing due to the rise in opioid use. Rural states like Kentucky have been disproportionally impacted by opioid abuse, and this study ...determines NAS burden nationally and in Kentucky while quantifying differences in access to care between Appalachian and non‐Appalachian counties.
Methods
NAS rates were calculated using National (2013) and Kentucky (2008‐2014) National Inpatient Sample discharge data. Births were identified using International Classification of Diseases v9 code 779.5 and live birth codes V30.x‐V38.x. Counties were classified as rural, micropolitan, or metropolitan using census data. Proximity analysis was conducted via mapping from ZIP code centroid to nearest opioid treatment facility. Distance to treatment facilities was calculated and then compared using nonparametric testing for counties by rural and Appalachian status.
Results
NAS cases tripled from 2008 to 2014 in Kentucky counties, with a 2013 NAS rate more than double the national NAS rate. Rural and Appalachian counties experienced an NAS increase per 1,000 births that was 2‐2.5 times higher than urban/non‐Appalachian counties, with a greater number of NAS births overall in Appalachian counties. All opioid treatment facility types were further from rural patients than micropolitan/metropolitan patients (P < .001), as well as further for Appalachians versus non‐Appalachians (P < .001, all facility types).
Conclusions
NAS burden disparately affects rural and Appalachian Kentucky counties, while treatment options are disproportionately further away for these residents. Policy efforts to increase NAS prevention and encourage opioid abuse treatment uptake in pregnant women should address rural and Appalachian disparities.
•Three-fourths of newly diagnosed RLS patients were initiated on a dopamine agonist.•Gabapentinoids are a first-line treatment alternative but were initiated less often.•Gabapentinoid initiators had ...more emergency department and inpatient encounters.•A significant risk of the primary outcome with gabapentinoids was not detected.•A significant risk of substance use disorders with gabapentinoids was detected.
Limited long-term safety information exists for gabapentinoid treatment of idiopathic restless legs syndrome (RLS). We estimated incident mental health-related emergency department visits and hospitalizations with a primary mental health diagnosis (primary outcome) among early-onset idiopathic RLS patients following first-line treatment initiation and examined outcome risk with gabapentinoids compared with dopamine agonists (DAs). A retrospective cohort study was conducted using administrative claims data from 2012 to 2019. Adults with early-onset (18–44 years) idiopathic RLS initiating either gabapentinoids or DAs within 60 days of new diagnosis were followed up to two years. Incidence rates were calculated and a log-binomial regression model with propensity score weighting estimated relative risk of the outcome and of substance use disorders (SUDs) as a secondary analysis with gabapentinoids. Among a cohort of 6,672 patients, 4,986 (74.7%) initiated DAs and 1,686 (25.3%) gabapentinoids. Incidence of the primary outcome (49.8 95% CI 40.8–69.3 per 1,000 person-years) and SUDs (49.5 95% CI 40.6–59.9 per 1,000 person-years) were higher in the gabapentinoid group compared with the DA group. A statistically significant risk of mental health diagnoses with gabapentinoids was not detected, but SUD risk was significant after covariate adjustment. High-risk mental health comorbidities (i.e., SUDs) should be considered when initiating RLS treatments.
Background
The Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile International Normalized Ratio (INR), Elderly, Drugs or alcohol use (HAS‐BLED) score has strong predictive ...validity for major bleeding complications, but limited validation has been conducted in venous thromboembolism (VTE). This study evaluates the HAS‐BLED score in a large cohort of VTE patients.
Methods and Results
A retrospective cohort of adults ≥18 years with primary diagnosis of VTE between January 1, 2010 and November 31, 2013 were identified in an insurance claims database. Patients were tracked until death, any bleed event, or end of study period. HAS‐BLED score and components were evaluated via proportional hazard models. Cumulative incidence functions were reported at 30, 60, 90, and 180 days. N=132 280 patients with a VTE were identified, with 73.8% having HAS‐BLED scores of 0 to 2, 3.6% score ≥4, and 4789 bleeding events (3.6% all patients). A 1‐point HAS‐BLED score increase was associated with 20% to 30% bleeding rate increase overall, but in a cancer cohort only the increase from 3‐ to 4‐points was significant for all bleeds (csHR=1.41, 95% CI: 1.17–1.69; sdHR=1.40, 95% CI: 1.17–1.69) and major bleeds (csHR=1.66, 95% CI: 1.26–2.20; sdHR=1.66, 95% CI: 1.25–2.19). Adding cancer to the model as an independent covariate provided the strongest association among all covariates, with csHR=2.25 (95% CI: 1.98–2.56) and sdHR=2.11 (95% CI: 1.85–2.41) in the model for major bleeds.
Conclusions
The HAS‐BLED score has good predictive validity for bleeding risks in patients with VTE. The addition of cancer as an independent bleeding risk factor merits consideration, possibly as part of the “B” criterion (“bleeding tendency or predisposition”).
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