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JAMA Health Forum May 2024
Topics: Humans; Centers for Medicare and Medicaid Services, U.S.; United States; Access to Information
PubMed: 38819799
DOI: 10.1001/jamahealthforum.2024.1328 -
JAMA Health Forum May 2024
Topics: Humans; Research Personnel; United States; Centers for Medicare and Medicaid Services, U.S.; Access to Information
PubMed: 38819796
DOI: 10.1001/jamahealthforum.2024.1281 -
JAMA Health Forum May 2024
Topics: Humans; Centers for Medicare and Medicaid Services, U.S.; United States; Health Services Research; Access to Information
PubMed: 38819795
DOI: 10.1001/jamahealthforum.2024.1284 -
Journal of Primary Care & Community... 2024Healthcare screening identifies factors that impact patient health and well-being. Hunger as a Vital Sign (HVS) is widely applied as a screening tool to assess food...
Screening for Food and Nutrition Insecurity in the Healthcare Setting: A Cross-Sectional Survey of Non-Medicaid Insured Adults in an Integrated Healthcare Delivery System.
OBJECTIVES
Healthcare screening identifies factors that impact patient health and well-being. Hunger as a Vital Sign (HVS) is widely applied as a screening tool to assess food security. However, there are no common practice screening questions to identify patients who are nutrition insecure or acquire free food from community-based organizations. This study used self-reported survey data from a non-Medicaid insured adult population approximately one year after the start of the COVID-19 pandemic (2021). The survey examined the extent to which the HVS measure might have under-estimated population-level food insecurity and/or nutrition insecurity, as well as under-identified food and nutrition insecurity among patients being screened for social risks in the healthcare setting.
METHODS
Data from a 2021 English-only mailed/online survey were analyzed for 2791 Kaiser Permanente Northern California (KPNC) non-Medicaid insured members ages 35-85 years. Sociodemographics, financial strain, food insecurity, acquiring free food from community-based organizations, and nutrition insecurity were assessed. Data from respondents' electronic health records were abstracted to identify adults with diet-related chronic health conditions. Data were weighted to the age × sex × racial/ethnic composition of the 2019 KPNC adult membership. Differences between groups were evaluated for statistical significance using adjusted prevalence ratios (aPRs) derived from modified log Poisson regression models.
RESULTS
Overall, 8.5% of participants reported moderate or high food insecurity, 7.7% had acquired free food from community-based organizations, and 13% had nutrition insecurity. Black and Latino adults were significantly more likely than White adults to have food insecurity (17.4% and 13.1% vs 5.6%, aPRs = 2.97 and 2.19), acquired free food from community-based organizations (15.1% and 15.3% vs 4.1%, aPRs = 3.74 and 3.93), nutrition insecurity (22.1% and 23.9% vs 7.9%, aPRs = 2.65 and 2.64), and food and nutrition insecurity (32.4% and 32.5% vs 12.3%, aPRs = 2.54 and 2.44). Almost 20% of adults who had been diagnosed with diabetes, prediabetes, ischemic CAD, or heart failure were food insecure and 14% were nutrition insecure.
CONCLUSIONS
Expanding food-related healthcare screening to identify and assess food insecurity, nutrition insecurity, and use of community-based emergency food resources together is essential for supporting referrals that will help patients achieve optimal health.
Topics: Humans; Food Insecurity; Female; Male; Adult; Cross-Sectional Studies; Middle Aged; Aged; COVID-19; Delivery of Health Care, Integrated; Aged, 80 and over; California; Mass Screening
PubMed: 38818953
DOI: 10.1177/21501319241258948 -
Plastic and Reconstructive Surgery.... May 2024Delay in care secondary to socioeconomic status (SES) and demographic factors represents an area for potential improvement. Reducing time to surgery in distal radius...
BACKGROUND
Delay in care secondary to socioeconomic status (SES) and demographic factors represents an area for potential improvement. Reducing time to surgery in distal radius fracture (DRF) fixation may improve outcomes while reducing cost. The purpose of this study is to investigate the effect of SES on time to surgery in our study population.
METHODS
Patients undergoing outpatient DRF surgery within an academic healthcare system during a 4-year period were reviewed. Time to surgery and demographic factors were analyzed. The US Census Bureau was used to determine median household income (MHI) for a patient's ZIP code; patients were stratified into three groups based on MHI.
RESULTS
A total of 413 patients met inclusion criteria. SES (14.7 d in the low-SES group, 14.0 d in the mid-SES group, and 11.1 d in the high-SES group, = 0.00063), insurance (11.7 d for insured versus 16.3 d for Medicaid/uninsured, < 0.0001), race (non-White group: 15.2 d versus White group: 10.9 d, < 0.0001), and treatment facility (16.2 d at county hospital versus 10.9 d at university hospital, < 0.0001) were associated with time to surgery in univariate analysis. Multivariate analysis found that only treatment facility was associated with time to surgery.
CONCLUSIONS
Non-White, uninsured/Medicaid individuals residing in low-SES areas may be more likely to receive care at a safety-net facility and are at greatest risk for delay in time to surgery. Measures aimed to reduce barriers to care, increase healthcare coverage, and improve patient education should be initiated to mitigate these disparities.
PubMed: 38818232
DOI: 10.1097/GOX.0000000000005838 -
Health Affairs Scholar May 2024We investigated unfair treatment among 1863 Medicare Advantage (MA) enrollees from 21 MA plans using 2022 survey data (40% response rate) in which respondents indicated...
We investigated unfair treatment among 1863 Medicare Advantage (MA) enrollees from 21 MA plans using 2022 survey data (40% response rate) in which respondents indicated whether they were treated unfairly in a health care setting based on any of 10 personal characteristics. We calculated reported unfair treatment rates overall and by enrollee characteristics. Nine percent of respondents reported any unfair treatment, most often based on health condition (6%), disability (3%), or age (2%). Approximately 40% of those reporting any unfair treatment endorsed multiple categories. People who qualified for Medicare via disability reported unfair treatment by disability, age, income, race and ethnicity, sex, sexual orientation, and gender/gender identity more often than those who qualified via age. Enrollees dually eligible for Medicare and Medicaid or eligible for a Low-Income Subsidy (DE/LIS) reported unfair treatment by disability, income, language/accent, race and ethnicity, culture/religion, and sex more often than non-DE/LIS enrollees. Compared with White respondents, racial and ethnic minority respondents more often reported unfair treatment by race and ethnicity, language/accent, culture/religion, and income. Female respondents were more likely than male respondents to report unfair treatment based on age and sex.
PubMed: 38812985
DOI: 10.1093/haschl/qxae063 -
American Journal of Perinatology Jul 2024This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI).
OBJECTIVE
This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI).
STUDY DESIGN
A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity.
RESULTS
Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, -value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06).
CONCLUSION
Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery.
KEY POINTS
· Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..
PubMed: 38810963
DOI: 10.1055/a-2335-2951 -
Dermatology Practical & Conceptual Apr 2024Onychomycosis, a fungal nail infection, is associated with significant morbidity and negative impact on quality of life. Therefore, understanding associated risk factors...
INTRODUCTION
Onychomycosis, a fungal nail infection, is associated with significant morbidity and negative impact on quality of life. Therefore, understanding associated risk factors may inform onychomycosis screening guidelines.
OBJECTIVES
This retrospective study investigated common demographic and comorbidity risk factors among hospitalized patients using the National Inpatient Sample.
METHODS
The 2003-2014 National Inpatient Sample (NIS) database was used to identify onychomycosis cases and age and sex matched controls in a 1:2 ratio. Chi-square tests and T-tests for independent samples were utilized to compare categorical and continuous patient factors. Demographic and comorbidity variables significant (P < 0.05) on univariate analysis were analyzed via a multivariate regression model with Bonferroni correction (P < 0.0029).
RESULTS
119,662 onychomycosis cases and 239,324 controls were identified. Compared to controls, onychomycosis patients frequently were White (69.0% versus 68.0%; P < 0.001), Black (17.9% versus 5.8%; P < 0.0001), and insured by Medicare or Medicaid (80.1% versus 71.1%; P < 0.0001). Patients had greater hospital stays (9.69 versus 5.39 days; P < 0.0001) and costs ($39,925 versus $36,720; P < 0.001) compared to controls. On multivariate analysis, onychomycosis was commonly associated with tinea pedis (odds ratio [OR]: 111.993; P < 0.0001), human immunodeficiency virus (OR: 4.372; P < 0.001), venous insufficiency (OR: 6.916; P < 0.0001), and psoriasis (OR: 3.668; P < 0.001).
CONCLUSIONS
Onychomycosis patients had longer hospital stays and greater costs compared to controls. Black patients were disproportionately represented among cases compared to controls. Onychomycosis was associated with tinea pedis, venous insufficiency, human immunodeficiency virus, psoriasis, obesity (body mass index [BMI] ≥ 30 kg/m), peripheral vascular disease, and diabetes with chronic complications, suggesting that inpatients with onychomycosis should be screened for these conditions.
PubMed: 38810060
DOI: 10.5826/dpc.1402a74 -
Rhode Island Medical Journal (2013) Jun 2024Disparities in contraceptive counseling are well documented in the United States. People of color, those of lower socio-economic status, and Medicaid insurance are more...
INTRODUCTION
Disparities in contraceptive counseling are well documented in the United States. People of color, those of lower socio-economic status, and Medicaid insurance are more likely to receive contraception/sterilization counseling than White patients. Postpartum contraceptive choice is an important aspect for pregnant people, especially for those who plan to breastfeed. This study assessed postpartum contraception/sterilization prescription among breastfeeding people in Rhode Island insured under Medicaid compared to other insurance carriers.
METHODS
Secondary analysis of data from the Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016-2019. Participants who answered yes to 'having ever breastfed' were included and dichotomized based on insurance into 'Medicaid' or 'other insurance'. Primary outcome was postpartum contraception/sterilization prescription. Stata software version 15 was used to perform multivariable logistic regression accounting for complex survey design and weighting.
RESULTS
Of 3686 participants, 868 (24.4%) were insured under Medicaid. Medicaid participants were younger, had higher BMIs and were more likely to identify as Black or mixed race or Hispanic ethnicity than those with other insurers. Those insured under Medicaid were 1.5 times more likely to be prescribed postpartum contraception than those with other insurers (95% CI 1.26,1.78). After adjusting for race/ethnicity, education level, marital status and preterm delivery, those with Medicaid were 1.28 times more likely to be prescribed contraception (95% CI 1.05,1.57).
CONCLUSION
In this study, breastfeeding participants with Medicaid were more likely to be prescribed postpartum contraception than those with other insurances. Future research should be focused on assessing provider bias, contraception coercion, and initiatives to provide equitable and patient-centered counseling in this population.
Topics: Humans; Rhode Island; Medicaid; Female; Breast Feeding; Adult; Contraception; United States; Postpartum Period; Young Adult; Pregnancy; Adolescent; Practice Patterns, Physicians'
PubMed: 38810012
DOI: No ID Found -
Heliyon May 2024To perform a geospatial analysis of food insecurity in a rural county known to have poor health outcomes and assess the effect of the COVID-19 pandemic.
OBJECTIVE
To perform a geospatial analysis of food insecurity in a rural county known to have poor health outcomes and assess the effect of the COVID-19 pandemic.
METHODS
In 2020, we mailed a comprehensive cross-sectional survey to all households in Sullivan County, a rural county with the second-worst health outcomes among all counties in New York State. Surveys of households included validated food insecurity screening questions. Questions were asked in reference to 2019, prior to the pandemic, and for 2020, in the first year of the pandemic. Respondents also responded to demographic questions. Raking adjustments were performed using age, sex, race/ethnicity, and health insurance strata to mitigate non-response bias. To identify significant hotspots of food insecurity within the county, we also performed geospatial analysis.
FINDINGS
From the 28,284 households surveyed, 20% of households responded. Of 4725 survey respondents, 26% of households reported experiencing food insecurity in 2019, and in 2020, this proportion increased to 35%. In 2020, 58% of Black and Hispanic households reported experiencing food insecurity. Food insecurity in 2020 was also present in 58% of unmarried households with children and in 64% of households insured by Medicaid. The geospatial analyses revealed that hotspots of food insecurity were primarily located in or near more urban areas of the rural county.
CONCLUSIONS
Our countywide health survey in a high-risk rural county identified significant increases of food insecurity in the first year of the COVID-19 pandemic, despite national statistics reporting a stable rate. Responses to future crises should include targeted interventions to bolster food security among vulnerable rural populations.
PubMed: 38807877
DOI: 10.1016/j.heliyon.2024.e31354