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Berkowitz SA, Basu S. Unemployment Insurance, Health-Related Social Needs, Health Care Access, and Mental Health During the COVID-19 Pandemic. JAMA Intern Med 2021; 181:699-702. [PMID: 33252615 PMCID: PMC8094006 DOI: 10.1001/jamainternmed.2020.7048] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional study assesses whether receiving unemployment insurance is associated with lower health-related social needs, better health care access, and better mental health during the COVID-19 pandemic.
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Bress AP, Greene T, Derington CG, Shen J, Xu Y, Zhang Y, Ying J, Bellows BK, Cushman WC, Whelton PK, Pajewski NM, Reboussin D, Beddu S, Hess R, Herrick JS, Zhang Z, Kolm P, Yeh RW, Basu S, Weintraub WS, Moran AE. Patient Selection for Intensive Blood Pressure Management Based on Benefit and Adverse Events. J Am Coll Cardiol 2021; 77:1977-1990. [PMID: 33888247 PMCID: PMC8068761 DOI: 10.1016/j.jacc.2021.02.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intensive systolic blood pressure (SBP) treatment prevents cardiovascular disease (CVD) events in patients with high CVD risk on average, though benefits likely vary among patients. OBJECTIVES The aim of this study was to predict the magnitude of benefit (reduced CVD and all-cause mortality risk) along with adverse event (AE) risk from intensive versus standard SBP treatment. METHODS This was a secondary analysis of SPRINT (Systolic Blood Pressure Intervention Trial). Separate benefit outcomes were the first occurrence of: 1) a CVD composite of acute myocardial infarction or other acute coronary syndrome, stroke, heart failure, or CVD death; and 2) all-cause mortality. Treatment-related AEs of interest included hypotension, syncope, bradycardia, electrolyte abnormalities, injurious falls, and acute kidney injury. Modified elastic net Cox regression was used to predict absolute risk for each outcome and absolute risk differences on the basis of 36 baseline variables available at the point of care with intensive versus standard treatment. RESULTS Among 8,828 SPRINT participants (mean age 67.9 years, 35% women), 600 CVD composite events, 363 all-cause deaths, and 481 treatment-related AEs occurred over a median follow-up period of 3.26 years. Individual participant risks were predicted for the CVD composite (C index = 0.71), all-cause mortality (C index = 0.75), and treatment-related AEs (C index = 0.69). Higher baseline CVD risk was associated with greater benefit (i.e., larger absolute CVD risk reduction). Predicted CVD benefit and predicted increased treatment-related AE risk were correlated (Spearman correlation coefficient = -0.72), and 95% of participants who fell into the highest tertile of predicted benefit also had high or moderate predicted increases in treatment-related AE risk. Few were predicted as high benefit with low AE risk (1.8%) or low benefit with high AE risk (1.5%). Similar results were obtained for all-cause mortality. CONCLUSIONS SPRINT participants with higher baseline predicted CVD risk gained greater absolute benefit from intensive treatment. Participants with high predicted benefit were also most likely to experience treatment-related AEs, but AEs were generally mild and transient. Patients should be prioritized for intensive SBP treatment on the basis of higher predicted benefit. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).
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Acharya S, Adamová D, Adler A, Adolfsson J, Aggarwal MM, Aglieri Rinella G, Agnello M, Agrawal N, Ahammed Z, Ahmad S, Ahn SU, Akbar Z, Akindinov A, Al-Turany M, Alam SN, Albuquerque DSD, Aleksandrov D, Alessandro B, Alfanda HM, Alfaro Molina R, Ali B, Ali Y, Alici A, Alizadehvandchali N, Alkin A, Alme J, Alt T, Altenkamper L, Altsybeev I, Anaam MN, Andrei C, Andreou D, Andronic A, Angeletti M, Anguelov V, Anson C, Antičić T, Antinori F, Antonioli P, Apadula N, Aphecetche L, Appelshäuser H, Arcelli S, Arnaldi R, Arratia M, Arsene IC, Arslandok M, Augustinus A, Averbeck R, Aziz S, Azmi MD, Badalà A, Baek YW, Bagnasco S, Bai X, Bailhache R, Bala R, Balbino A, Baldisseri A, Ball M, Balouza S, Banerjee D, Barbera R, Barioglio L, Barnaföldi GG, Barnby LS, Barret V, Bartalini P, Bartels C, Barth K, Bartsch E, Baruffaldi F, Bastid N, Basu S, Batigne G, Batyunya B, Bauri D, Bazo Alba JL, Bearden IG, Beattie C, Bedda C, Behera NK, Belikov I, Bell Hechavarria ADC, Bellini F, Bellwied R, Belyaev V, Bencedi G, Beole S, Bercuci A, Berdnikov Y, Berenyi D, Bertens RA, Berzano D, Besoiu MG, Betev L, Bhasin A, Bhat IR, Bhat MA, Bhatt H, Bhattacharjee B, Bianchi A, Bianchi L, Bianchi N, Bielčík J, Bielčíková J, Bilandzic A, Biro G, Biswas R, Biswas S, Blair JT, Blau D, Blume C, Boca G, Bock F, Bogdanov A, Boi S, Bok J, Boldizsár L, Bolozdynya A, Bombara M, Bonomi G, Borel H, Borissov A, Bossi H, Botta E, Bratrud L, Braun-Munzinger P, Bregant M, Broz M, Bruna E, Bruno GE, Buckland MD, Budnikov D, Buesching H, Bufalino S, Bugnon O, Buhler P, Buncic P, Buthelezi Z, Butt JB, Bysiak SA, Caffarri D, Caliva A, Calvo Villar E, Camacho JMM, Camacho RS, Camerini P, Canedo FDM, Capon AA, Carnesecchi F, Caron R, Castillo Castellanos J, Castro AJ, Casula EAR, Catalano F, Ceballos Sanchez C, Chakraborty P, Chandra S, Chang W, Chapeland S, Chartier M, Chattopadhyay S, Chattopadhyay S, Chauvin A, Cheshkov C, Cheynis B, Chibante Barroso V, Chinellato DD, Cho S, Chochula P, Chowdhury T, Christakoglou P, Christensen CH, Christiansen P, Chujo T, Cicalo C, Cifarelli L, Cilladi LD, Cindolo F, Ciupek MR, Clai G, Cleymans J, Colamaria F, Colella D, Collu A, Colocci M, Concas M, Conesa Balbastre G, Conesa Del Valle Z, Contin G, Contreras JG, Cormier TM, Corrales Morales Y, Cortese P, Cosentino MR, Costa F, Costanza S, Crochet P, Cuautle E, Cui P, Cunqueiro L, Dabrowski D, Dahms T, Dainese A, Damas FPA, Danisch MC, Danu A, Das D, Das I, Das P, Das P, Das S, Dash A, Dash S, De S, De Caro A, de Cataldo G, de Cuveland J, De Falco A, De Gruttola D, De Marco N, De Pasquale S, Deb S, Degenhardt HF, Deja KR, Deloff A, Delsanto S, Deng W, Dhankher P, Di Bari D, Di Mauro A, Diaz RA, Dietel T, Dillenseger P, Ding Y, Divià R, Dixit DU, Djuvsland Ø, Dmitrieva U, Dobrin A, Dönigus B, Dordic O, Dubey AK, Dubla A, Dudi S, Dukhishyam M, Dupieux P, Ehlers RJ, Eikeland VN, Elia D, Erazmus B, Erhardt F, Erokhin A, Ersdal MR, Espagnon B, Eulisse G, Evans D, Evdokimov S, Fabbietti L, Faggin M, Faivre J, Fan F, Fantoni A, Fasel M, Fecchio P, Feliciello A, Feofilov G, Fernández Téllez A, Ferrero A, Ferretti A, Festanti A, Feuillard VJG, Figiel J, Filchagin S, Finogeev D, Fionda FM, Fiorenza G, Flor F, Flores AN, Foertsch S, Foka P, Fokin S, Fragiacomo E, Frankenfeld U, Fuchs U, Furget C, Furs A, Fusco Girard M, Gaardhøje JJ, Gagliardi M, Gago AM, Gal A, Galvan CD, Ganoti P, Garabatos C, Garcia JRA, Garcia-Solis E, Garg K, Gargiulo C, Garibli A, Garner K, Gasik P, Gauger EF, Gay Ducati MB, Germain M, Ghosh J, Ghosh P, Ghosh SK, Giacalone M, Gianotti P, Giubellino P, Giubilato P, Glaenzer AMC, Glässel P, Gomez Ramirez A, Gonzalez V, González-Trueba LH, Gorbunov S, Görlich L, Goswami A, Gotovac S, Grabski V, Graczykowski LK, Graham KL, Greiner L, Grelli A, Grigoras C, Grigoriev V, Grigoryan A, Grigoryan S, Groettvik OS, Grosa F, Grosse-Oetringhaus JF, Grosso R, Guernane R, Guittiere M, Gulbrandsen K, Gunji T, Gupta A, Gupta R, Guzman IB, Haake R, Habib MK, Hadjidakis C, Hamagaki H, Hamar G, Hamid M, Hannigan R, Haque MR, Harlenderova A, Harris JW, Harton A, Hasenbichler JA, Hassan H, Hassan QU, Hatzifotiadou D, Hauer P, Havener LB, Hayashi S, Heckel ST, Hellbär E, Helstrup H, Herghelegiu A, Herman T, Hernandez EG, Herrera Corral G, Herrmann F, Hetland KF, Hillemanns H, Hills C, Hippolyte B, Hohlweger B, Honermann J, Horak D, Hornung A, Hornung S, Hosokawa R, Hristov P, Huang C, Hughes C, Huhn P, Humanic TJ, Hushnud H, Husova LA, Hussain N, Hussain SA, Hutter D, Iddon JP, Ilkaev R, Ilyas H, Inaba M, Innocenti GM, Ippolitov M, Isakov A, Islam MS, Ivanov M, Ivanov V, Izucheev V, Jacak B, Jacazio N, Jacobs PM, Jadlovska S, Jadlovsky J, Jaelani S, Jahnke C, Jakubowska MJ, Janik MA, Janson T, Jercic M, Jevons O, Jin M, Jonas F, Jones PG, Jung J, Jung M, Jusko A, Kalinak P, Kalweit A, Kaplin V, Kar S, Karasu Uysal A, Karatovic D, Karavichev O, Karavicheva T, Karczmarczyk P, Karpechev E, Kazantsev A, Kebschull U, Keidel R, Keil M, Ketzer B, Khabanova Z, Khan AM, Khan S, Khanzadeev A, Kharlov Y, Khatun A, Khuntia A, Kileng B, Kim B, Kim B, Kim D, Kim DJ, Kim EJ, Kim H, Kim J, Kim JS, Kim J, Kim J, Kim J, Kim M, Kim S, Kim T, Kim T, Kirsch S, Kisel I, Kiselev S, Kisiel A, Klay JL, Klein C, Klein J, Klein S, Klein-Bösing C, Kleiner M, Kluge A, Knichel ML, Knospe AG, Kobdaj C, Köhler MK, Kollegger T, Kondratyev A, Kondratyeva N, Kondratyuk E, Konig J, Konigstorfer SA, Konopka PJ, Kornakov G, Koska L, Kovalenko O, Kovalenko V, Kowalski M, Králik I, Kravčáková A, Kreis L, Krivda M, Krizek F, Krizkova Gajdosova K, Krüger M, Kryshen E, Krzewicki M, Kubera AM, Kučera V, Kuhn C, Kuijer PG, Kumar L, Kundu S, Kurashvili P, Kurepin A, Kurepin AB, Kuryakin A, Kushpil S, Kvapil J, Kweon MJ, Kwon JY, Kwon Y, La Pointe SL, La Rocca P, Lai YS, Lamanna M, Langoy R, Lapidus K, Lardeux A, Larionov P, Laudi E, Lavicka R, Lazareva T, Lea R, Leardini L, Lee J, Lee S, Lehner S, Lehrbach J, Lemmon RC, León Monzón I, Lesser ED, Lettrich M, Lévai P, Li X, Li XL, Lien J, Lietava R, Lim B, Lindenstruth V, Lindner A, Lippmann C, Lisa MA, Liu A, Liu J, Liu S, Llope WJ, Lofnes IM, Loginov V, Loizides C, Loncar P, Lopez JA, Lopez X, López Torres E, Luhder JR, Lunardon M, Luparello G, Ma YG, Maevskaya A, Mager M, Mahmood SM, Mahmoud T, Maire A, Majka RD, Malaev M, Malik QW, Malinina L, Mal'Kevich D, Malzacher P, Mandaglio G, Manko V, Manso F, Manzari V, Mao Y, Marchisone M, Mareš J, Margagliotti GV, Margotti A, Marín A, Markert C, Marquard M, Martin CD, Martin NA, Martinengo P, Martinez JL, Martínez MI, Martínez García G, Masciocchi S, Masera M, Masoni A, Massacrier L, Masson E, Mastroserio A, Mathis AM, Matonoha O, Matuoka PFT, Matyja A, Mayer C, Mazzaschi F, Mazzilli M, Mazzoni MA, Mechler AF, Meddi F, Melikyan Y, Menchaca-Rocha A, Mengke C, Meninno E, Menon AS, Meres M, Mhlanga S, Miake Y, Micheletti L, Migliorin LC, Mihaylov DL, Mikhaylov K, Mishra AN, Miśkowiec D, Modak A, Mohammadi N, Mohanty AP, Mohanty B, Khan MM, Moravcova Z, Mordasini C, Moreira De Godoy DA, Moreno LAP, Morozov I, Morsch A, Mrnjavac T, Muccifora V, Mudnic E, Mühlheim D, Muhuri S, Mulligan JD, Mulliri A, Munhoz MG, Munzer RH, Murakami H, Murray S, Musa L, Musinsky J, Myers CJ, Myrcha JW, Naik B, Nair R, Nandi BK, Nania R, Nappi E, Naru MU, Nassirpour AF, Nattrass C, Nayak R, Nayak TK, Nazarenko S, Neagu A, Negrao De Oliveira RA, Nellen L, Nesbo SV, Neskovic G, Nesterov D, Neumann LT, Nielsen BS, Nikolaev S, Nikulin S, Nikulin V, Noferini F, Nomokonov P, Norman J, Novitzky N, Nowakowski P, Nyanin A, Nystrand J, Ogino M, Ohlson A, Oleniacz J, Oliveira Da Silva AC, Oliver MH, Oppedisano C, Ortiz Velasquez A, Oskarsson A, Otwinowski J, Oyama K, Pachmayer Y, Pacik V, Padhan S, Pagano D, Paić G, Pan J, Panebianco S, Pareek P, Park J, Parkkila JE, Parmar S, Pathak SP, Paul B, Pazzini J, Pei H, Peitzmann T, Peng X, Pereira LG, Pereira Da Costa H, Peresunko D, Perez GM, Perrin S, Pestov Y, Petráček V, Petrovici M, Pezzi RP, Piano S, Pikna M, Pillot P, Pinazza O, Pinsky L, Pinto C, Pisano S, Pistone D, Płoskoń M, Planinic M, Pliquett F, Poghosyan MG, Polichtchouk B, Poljak N, Pop A, Porteboeuf-Houssais S, Pozdniakov V, Prasad SK, Preghenella R, Prino F, Pruneau CA, Pshenichnov I, Puccio M, Putschke J, Qiu S, Quaglia L, Quishpe RE, Ragoni S, Raha S, Rajput S, Rak J, Rakotozafindrabe A, Ramello L, Rami F, Ramirez SAR, Raniwala R, Raniwala S, Räsänen SS, Rath R, Ratza V, Ravasenga I, Read KF, Redelbach AR, Redlich K, Rehman A, Reichelt P, Reidt F, Ren X, Renfordt R, Rescakova Z, Reygers K, Riabov A, Riabov V, Richert T, Richter M, Riedler P, Riegler W, Riggi F, Ristea C, Rode SP, Rodríguez Cahuantzi M, Røed K, Rogalev R, Rogochaya E, Rohr D, Röhrich D, Rojas PF, Rokita PS, Ronchetti F, Rosano A, Rosas ED, Roslon K, Rossi A, Rotondi A, Roy A, Roy P, Rueda OV, Rui R, Rumyantsev B, Rustamov A, Ryabinkin E, Ryabov Y, Rybicki A, Rytkonen H, Saarimaki OAM, Sadek R, Sadhu S, Sadovsky S, Šafařík K, Saha SK, Sahoo B, Sahoo P, Sahoo R, Sahoo S, Sahu PK, Saini J, Sakai S, Sambyal S, Samsonov V, Sarkar D, Sarkar N, Sarma P, Sarti VM, Sas MHP, Scapparone E, Schambach J, Scheid HS, Schiaua C, Schicker R, Schmah A, Schmidt C, Schmidt HR, Schmidt MO, Schmidt M, Schmidt NV, Schmier AR, Schukraft J, Schutz Y, Schwarz K, Schweda K, Scioli G, Scomparin E, Seger JE, Sekiguchi Y, Sekihata D, Selyuzhenkov I, Senyukov S, Serebryakov D, Sevcenco A, Shabanov A, Shabetai A, Shahoyan R, Shaikh W, Shangaraev A, Sharma A, Sharma A, Sharma H, Sharma M, Sharma N, Sharma S, Sheibani O, Shigaki K, Shimomura M, Shirinkin S, Shou Q, Sibiriak Y, Siddhanta S, Siemiarczuk T, Silvermyr D, Simatovic G, Simonetti G, Singh B, Singh R, Singh R, Singh R, Singh VK, Singhal V, Sinha T, Sitar B, Sitta M, Skaali TB, Slupecki M, Smirnov N, Snellings RJM, Soncco C, Song J, Songmoolnak A, Soramel F, Sorensen S, Sputowska I, Stachel J, Stan I, Steffanic PJ, Stenlund E, Stiefelmaier SF, Stocco D, Storetvedt MM, Stritto LD, Suaide AAP, Sugitate T, Suire C, Suleymanov M, Suljic M, Sultanov R, Šumbera M, Sumberia V, Sumowidagdo S, Swain S, Szabo A, Szarka I, Tabassam U, Taghavi SF, Taillepied G, Takahashi J, Tambave GJ, Tang S, Tarhini M, Tarzila MG, Tauro A, Tejeda Muñoz G, Telesca A, Terlizzi L, Terrevoli C, Thakur D, Thakur S, Thomas D, Thoresen F, Tieulent R, Tikhonov A, Timmins AR, Toia A, Topilskaya N, Toppi M, Torales-Acosta F, Torres SR, Trifiró A, Tripathy S, Tripathy T, Trogolo S, Trombetta G, Tropp L, Trubnikov V, Trzaska WH, Trzcinski TP, Trzeciak BA, Tumkin A, Turrisi R, Tveter TS, Ullaland K, Umaka EN, Uras A, Usai GL, Vala M, Valle N, Vallero S, van der Kolk N, van Doremalen LVR, van Leeuwen M, Vande Vyvre P, Varga D, Varga Z, Varga-Kofarago M, Vargas A, Vasileiou M, Vasiliev A, Vázquez Doce O, Vechernin V, Vercellin E, Vergara Limón S, Vermunt L, Vernet R, Vértesi R, Vickovic L, Vilakazi Z, Villalobos Baillie O, Vino G, Vinogradov A, Virgili T, Vislavicius V, Vodopyanov A, Volkel B, Völkl MA, Voloshin K, Voloshin SA, Volpe G, von Haller B, Vorobyev I, Voscek D, Vrláková J, Wagner B, Weber M, Weber SG, Wegrzynek A, Wenzel SC, Wessels JP, Wiechula J, Wikne J, Wilk G, Wilkinson J, Willems GA, Willsher E, Windelband B, Winn M, Witt WE, Wright JR, Wu Y, Xu R, Yalcin S, Yamaguchi Y, Yamakawa K, Yang S, Yano S, Yin Z, Yokoyama H, Yoo IK, Yoon JH, Yuan S, Yuncu A, Yurchenko V, Zaccolo V, Zaman A, Zampolli C, Zanoli HJC, Zardoshti N, Zarochentsev A, Závada P, Zaviyalov N, Zbroszczyk H, Zhalov M, Zhang S, Zhang X, Zhang Z, Zherebchevskii V, Zhi Y, Zhou D, Zhou Y, Zhou Z, Zhu J, Zhu Y, Zichichi A, Zinovjev G, Zurlo N. Elliptic Flow of Electrons from Beauty-Hadron Decays in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV. PHYSICAL REVIEW LETTERS 2021; 126:162001. [PMID: 33961482 DOI: 10.1103/physrevlett.126.162001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
The elliptic flow of electrons from beauty hadron decays at midrapidity (|y|<0.8) is measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02 TeV with the ALICE detector at the LHC. The azimuthal distribution of the particles produced in the collisions can be parametrized with a Fourier expansion, in which the second harmonic coefficient represents the elliptic flow, v_{2}. The v_{2} coefficient of electrons from beauty hadron decays is measured for the first time in the transverse momentum (p_{T}) range 1.3-6 GeV/c in the centrality class 30%-50%. The measurement of electrons from beauty-hadron decays exploits their larger mean proper decay length cτ≈500 μm compared to that of charm hadrons and most of the other background sources. The v_{2} of electrons from beauty hadron decays at midrapidity is found to be positive with a significance of 3.75 σ. The results provide insights into the degree of thermalization of beauty quarks in the medium. A model assuming full thermalization of beauty quarks is strongly disfavored by the measurement at high p_{T}, but is in agreement with the results at low p_{T}. Transport models including substantial interactions of beauty quarks with an expanding strongly interacting medium describe the measurement within uncertainties.
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Basu S, Shao H, Luo J, Lipska K, Suda KJ, Yudkin JS. Estimates of insulin needs and dispensation given wastage, alternative glycemic targets, and non-insulin therapies in US populations with type 2 diabetes mellitus: A microsimulation study. J Diabetes Complications 2021; 35:107839. [PMID: 33455873 DOI: 10.1016/j.jdiacomp.2020.107839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
AIMS Registries and health plans estimate insulin need for population health metrics. We sought to identify how such estimates affect population- and individual-level estimates of over- and under-treatment. METHODS We developed a microsimulation comparing estimated insulin need to dispensation using the National Health and Nutrition Examination Survey (NHANES, 2005-2016, N= 2832) and Medical Expenditure Panel Survey (MEPS, 2005-2016, N = 29,615). RESULTS From NHANES, ~21.6% of people with type 2 diabetes would require insulin to achieve a HbA1c target of 7% after maximum titration of two non-insulins (60.7 IU/person/day, or 84,629,833 vials of 1000 IU in the US). From MEPS, we observed 57.4 IU/person/day of insulin dispensed (81,585,842 vials). About 29% of people were dispensed at least two standard deviations less than their estimated need, and 22% at least two standard deviations more than estimated need. Population-level need estimates reduced 39.4% if liberalizing HbA1c targets to 8% for people ≥75 years old. CONCLUSIONS Estimated insulin needs of people with type 2 diabetes in the U.S. are consistent with their dispensed insulin at the population level, but are sensitive to HbA1c targets for older adults, and conceal under- and over-treated subpopulations.
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Kiang MV, Chin ET, Huynh BQ, Chapman LAC, Rodríguez-Barraquer I, Greenhouse B, Rutherford GW, Bibbins-Domingo K, Havlir D, Basu S, Lo NC. Routine asymptomatic testing strategies for airline travel during the COVID-19 pandemic: a simulation study. THE LANCET. INFECTIOUS DISEASES 2021; 21:929-938. [PMID: 33765417 PMCID: PMC7984872 DOI: 10.1016/s1473-3099(21)00134-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Routine viral testing strategies for SARS-CoV-2 infection might facilitate safe airline travel during the COVID-19 pandemic and mitigate global spread of the virus. However, the effectiveness of these test-and-travel strategies to reduce passenger risk of SARS-CoV-2 infection and population-level transmission remains unknown. METHODS In this simulation study, we developed a microsimulation of SARS-CoV-2 transmission in a cohort of 100 000 US domestic airline travellers using publicly available data on COVID-19 clinical cases and published natural history parameters to assign individuals one of five health states of susceptible to infection, latent period, early infection, late infection, or recovered. We estimated a per-day risk of infection with SARS-CoV-2 corresponding to a daily incidence of 150 infections per 100 000 people. We assessed five testing strategies: (1) anterior nasal PCR test within 3 days of departure, (2) PCR within 3 days of departure and 5 days after arrival, (3) rapid antigen test on the day of travel (assuming 90% of the sensitivity of PCR during active infection), (4) rapid antigen test on the day of travel and PCR test 5 days after arrival, and (5) PCR test 5 days after arrival. Strategies 2 and 4 included a 5-day quarantine after arrival. The travel period was defined as 3 days before travel to 2 weeks after travel. Under each scenario, individuals who tested positive before travel were not permitted to travel. The primary study outcome was cumulative number of infectious days in the cohort over the travel period without isolation or quarantine (population-level transmission risk), and the key secondary outcome was the number of infectious people detected on the day of travel (passenger risk of infection). FINDINGS We estimated that in a cohort of 100 000 airline travellers, in a scenario with no testing or screening, there would be 8357 (95% uncertainty interval 6144-12831) infectious days with 649 (505-950) actively infectious passengers on the day of travel. The pre-travel PCR test reduced the number of infectious days from 8357 to 5401 (3917-8677), a reduction of 36% (29-41) compared with the base case, and identified 569 (88% [76-92]) of 649 actively infectious travellers on the day of flight; the addition of post-travel quarantine and PCR reduced the number of infectious days to 2520 days (1849-4158), a reduction of 70% (64-75) compared with the base case. The rapid antigen test on the day of travel reduced the number of infectious days to 5674 (4126-9081), a reduction of 32% (26-38) compared with the base case, and identified 560 (86% [83-89]) actively infectious travellers; the addition of post-travel quarantine and PCR reduced the number of infectious days to 3124 (2356-495), a reduction of 63% (58-66) compared with the base case. The post-travel PCR alone reduced the number of infectious days to 4851 (3714-7679), a reduction of 42% (35-49) compared with the base case. INTERPRETATION Routine asymptomatic testing for SARS-CoV-2 before travel can be an effective strategy to reduce passenger risk of infection during travel, although abbreviated quarantine with post-travel testing is probably needed to reduce population-level transmission due to importation of infection when travelling from a high to low incidence setting. FUNDING University of California, San Francisco.
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Basu S. Workplace Bans On Sugar-Sweetened Beverages: The Authors Reply. Health Aff (Millwood) 2021; 40:543. [PMID: 33646871 DOI: 10.1377/hlthaff.2021.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Basu S, Akers M, Berkowitz SA, Josey K, Schillinger D, Seligman H. Comparison of Fruit and Vegetable Intake Among Urban Low-Income US Adults Receiving a Produce Voucher in 2 Cities. JAMA Netw Open 2021; 4:e211757. [PMID: 33749765 PMCID: PMC7985725 DOI: 10.1001/jamanetworkopen.2021.1757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022] Open
Abstract
Importance Fruit and vegetable vouchers have been implemented by cities and counties across the US to increase fruit and vegetable intake and thereby improve overall nutritional quality. Objective To determine whether and why use of fruit and vegetable vouchers are associated with varied nutritional intake across different populations and environments. Design, Setting, and Participants In a population-based pre-post cohort study of 671 adult participants with low income before and during (6 months after initiation) participation in a 6-month program, fruit and vegetable vouchers were distributed for redemption at local San Francisco and Los Angeles neighborhood grocery and corner stores between 2017 and 2019. A transportability analysis was performed to identify factors that may explain variation in voucher use between cities. Exposure Receipt of $20 per month in produce vouchers for 6 months from 2017 to 2019. Main Outcomes and Measures Change in total fruits and vegetables (as defined by the US Department of Agriculture) consumed per person per day (change in cup-equivalents between month 6 and month 0). Results A total of 671 adults (median age, 54.9 years [interquartile range, 45.0-65.0 years]; 61.7% female; 30.9% Black; 19.7% Hispanic) were enrolled. An increase in fruit and vegetable intake of 0.22 cup-equivalents per day overall (95% CI, 0.14-0.31 cup-equivalents; P < .001) was observed. However, the observed increase was larger in Los Angeles compared with San Francisco (0.64 cup-equivalents per day; 95% CI, 0.41-0.88 cup-equivalents vs 0.10 cup-equivalents per day; 95% CI, 0.01-0.19 cup-equivalents). When the concurrently sampled San Francisco group (n = 157) was weighted in transportability analysis to demographically match the Los Angeles group (n = 155) in observed covariates, the weighted San Francisco group had an estimated increase of 0.53 fruit and vegetable cup-equivalents per day (95% CI, 0.27- 0.79 cup-equivalents, P = .03), with income being the variable needed to allow the 95% confidence intervals to overlap between the weighted San Francisco and unweighted Los Angeles populations. Conclusions and Relevance In this study, the use of fruit and vegetable vouchers appeared to be associated with greater benefit among those with lower incomes, suggesting that further investigation of flat-rate rather than income-scaled benefits is warranted.
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Berkowitz SA, Basu S. Unmet Social Needs And Worse Mental Health After Expiration Of COVID-19 Federal Pandemic Unemployment Compensation. Health Aff (Millwood) 2021; 40:426-434. [PMID: 33600235 PMCID: PMC8053426 DOI: 10.1377/hlthaff.2020.01990] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Federal Pandemic Unemployment Compensation (FPUC) provided unemployment insurance beneficiaries an extra $600 a week during the unprecedented economic downturn during the coronavirus disease 2019 (COVID-19) pandemic, but it initially expired in July 2020. We applied difference-in-differences models to nationally representative data from the Census Bureau's Household Pulse Survey to examine changes in unmet health-related social needs and mental health among unemployment insurance beneficiaries before and after initial expiration of FPUC. The initial expiration was associated with a 10.79-percentage-point increase in risk for self-reported missed housing payments. Further, risk for food insufficiency, depressive symptoms, and anxiety symptoms also increased among households that reported receiving unemployment insurance benefits, relative to the period when FPUC was in effect. As further unemployment insurance reform is debated, policy makers should recognize the potential health impact of unemployment insurance.
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Johnson KT, Palakshappa D, Basu S, Seligman H, Berkowitz SA. Examining the bidirectional relationship between food insecurity and healthcare spending. Health Serv Res 2021; 56:864-873. [PMID: 33598952 PMCID: PMC8522574 DOI: 10.1111/1475-6773.13641] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To improve food insecurity interventions, we sought to better understand the hypothesized bidirectional relationship between food insecurity and health care expenditures. DATA SOURCE Nationally representative sample of the civilian noninstitutionalized population of the United States (2016-2017 Medical Expenditure Panel Survey [MEPS]). STUDY DESIGN In a retrospective longitudinal cohort, we conducted two sets of analyses: (a) two-part models to examine the association between food insecurity in 2016 and health care expenditures in 2017; and (b) logistic regression models to examine the association between health care expenditures in 2016 and food insecurity in 2017. We adjusted for demographic and socioeconomic variables as well as 2016 health care expenditures and food insecurity. DATA COLLECTION Health care expenditures, food insecurity, and medical condition data from 10 886 adults who were included in 2016-2017 MEPS. PRINCIPAL FINDINGS Food insecurity in 2016, compared with being food secure, was associated with both a higher odds of having any health care expenditures in 2017 (OR 1.29, 95% CI: 1.04 to 1.60) and greater total expenditures ($1738.88 greater, 95% CI: $354.10 to $3123.57), which represents approximately 25% greater expenditures. Greater 2016 health care expenditures were associated with slightly higher odds of being food insecure in 2017 (OR 1.007 per $1000 in expenditures, 95% CI: 1.002 to 1.012, P =0.01). Exploratory analyses suggested that poor health status may underlie the relationship between food insecurity and health care expenditures. CONCLUSIONS A bidirectional relationship exists between food insecurity and health care expenditures, but the strength of either direction appears unequal. Higher health care expenditures are associated with a slightly greater risk of being food insecure (adjusted for baseline food insecurity status) but being food insecure is associated with substantially greater subsequent health care expenditures (adjusted for baseline health care expenditures). Interventions to address food insecurity and poor health may be helpful to break this cycle.
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Van Metre Baum L, Bruzelius E, Kiang M, Humphreys K, Basu S, Baum A. Analysis of unused prescription opioids and benzodiazepines remaining after death among Medicare decedents. Drug Alcohol Depend 2021; 219:108502. [PMID: 33421803 PMCID: PMC7914112 DOI: 10.1016/j.drugalcdep.2020.108502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Millions of opioid and benzodiazepine prescriptions are dispensed near end-of-life. After death, patients' unused prescription pills belong to family members, who often save rather than dispose of them. We sought to quantify this exposure in Medicare beneficiaries. METHODS We estimated the share of decedent Medicare beneficiaries who potentially left behind opioid or benzodiazepine pills at the time of death using Part D claims of a 20 % national sample of Medicare beneficiaries between 2006-2015 linked to the National Death Index. RESULTS We estimated that 1 in 6 Medicare beneficiaries who died between 2006-2015 potentially left behind opioid pills, and 1 in 10 who died between 2013-2015 potentially left benzodiazepines as well. Leftover pills were more common among younger, dually enrolled, and lower-income beneficiaries, as well as beneficiaries living in non-urban areas and those with a history of mental illness, drug use disorders, and chronic pain. North American Natives and Non-Hispanic Whites had higher proportions than Black, Hispanic, and Asian decedents. CONCLUSIONS Opioids and benzodiazepines are commonly left behind at death. Policies and interventions that encourage comprehensive and safe medication disposal after death may reduce risk for intra-household diversion and misuse of prescription opioids and benzodiazepines.
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Kiang MV, Chin ET, Huynh BQ, Chapman LAC, Rodríguez-Barraquer I, Greenhouse B, Rutherford GW, Bibbins-Domingo K, Havlir D, Basu S, Lo NC. Routine asymptomatic testing strategies for airline travel during the COVID-19 pandemic: a simulation analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.12.08.20246132. [PMID: 33330886 PMCID: PMC7743095 DOI: 10.1101/2020.12.08.20246132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Airline travel has been significantly reduced during the COVID-19 pandemic due to concern for individual risk of SARS-CoV-2 infection and population-level transmission risk from importation. Routine viral testing strategies for COVID-19 may facilitate safe airline travel through reduction of individual and/or population-level risk, although the effectiveness and optimal design of these "test-and-travel" strategies remain unclear. METHODS We developed a microsimulation of SARS-CoV-2 transmission in a cohort of airline travelers to evaluate the effectiveness of various testing strategies to reduce individual risk of infection and population-level risk of transmission. We evaluated five testing strategies in asymptomatic passengers: i) anterior nasal polymerase chain reaction (PCR) within 3 days of departure; ii) PCR within 3 days of departure and PCR 5 days after arrival; iii) rapid antigen test on the day of travel (assuming 90% of the sensitivity of PCR during active infection); iv) rapid antigen test on the day of travel and PCR 5 days after arrival; and v) PCR within 3 days of arrival alone. The travel period was defined as three days prior to the day of travel and two weeks following the day of travel, and we assumed passengers followed guidance on mask wearing during this period. The primary study outcome was cumulative number of infectious days in the cohort over the travel period (population-level transmission risk); the secondary outcome was the proportion of infectious persons detected on the day of travel (individual-level risk of infection). Sensitivity analyses were conducted. FINDINGS Assuming a community SARS-CoV-2 incidence of 50 daily infections, we estimated that in a cohort of 100,000 airline travelers followed over the travel period, there would be a total of 2,796 (95% UI: 2,031, 4,336) infectious days with 229 (95% UI: 170, 336) actively infectious passengers on the day of travel. The pre-travel PCR test (within 3 days prior to departure) reduced the number of infectious days by 35% (95% UI: 27, 42) and identified 88% (95% UI: 76, 94) of the actively infectious travelers on the day of flight; the addition of PCR 5 days after arrival reduced the number of infectious days by 79% (95% UI: 71, 84). The rapid antigen test on the day of travel reduced the number of infectious days by 32% (95% UI: 25, 39) and identified 87% (95% UI: 81, 92) of the actively infectious travelers; the addition of PCR 5 days after arrival reduced the number of infectious days by 70% (95% UI: 65, 75). The post-travel PCR test alone (within 3 days of landing) reduced the number of infectious days by 42% (95% UI: 31, 51). The ratio of true positives to false positives varied with the incidence of infection. The overall study conclusions were robust in sensitivity analysis. INTERPRETATION Routine asymptomatic testing for COVID-19 prior to travel can be an effective strategy to reduce individual risk of COVID-19 infection during travel, although post-travel testing with abbreviated quarantine is likely needed to reduce population-level transmission due to importation of infection when traveling from a high to low incidence setting.
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Basu S, Johnson KT, Berkowitz SA. Use of Machine Learning Approaches in Clinical Epidemiological Research of Diabetes. Curr Diab Rep 2020; 20:80. [PMID: 33270183 DOI: 10.1007/s11892-020-01353-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Machine learning approaches-which seek to predict outcomes or classify patient features by recognizing patterns in large datasets-are increasingly applied to clinical epidemiology research on diabetes. Given its novelty and emergence in fields outside of biomedical research, machine learning terminology, techniques, and research findings may be unfamiliar to diabetes researchers. Our aim was to present the use of machine learning approaches in an approachable way, drawing from clinical epidemiological research in diabetes published from 1 Jan 2017 to 1 June 2020. RECENT FINDINGS Machine learning approaches using tree-based learners-which produce decision trees to help guide clinical interventions-frequently have higher sensitivity and specificity than traditional regression models for risk prediction. Machine learning approaches using neural networking and "deep learning" can be applied to medical image data, particularly for the identification and staging of diabetic retinopathy and skin ulcers. Among the machine learning approaches reviewed, researchers identified new strategies to develop standard datasets for rigorous comparisons across older and newer approaches, methods to illustrate how a machine learner was treating underlying data, and approaches to improve the transparency of the machine learning process. Machine learning approaches have the potential to improve risk stratification and outcome prediction for clinical epidemiology applications. Achieving this potential would be facilitated by use of universal open-source datasets for fair comparisons. More work remains in the application of strategies to communicate how the machine learners are generating their predictions.
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Sharma N, Khanna A, Chandra S, Basu S, Chopra K, Singla N. Epidemiological correlates and treatment outcomes of MULTIDRUG-RESISTANT Tuberculosis in Delhi, India: A record-based operational research study. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Navarro-Payá D, Flis I, Anderson MAE, Hawes P, Li M, Akbari OS, Basu S, Alphey L. Targeting female flight for genetic control of mosquitoes. PLoS Negl Trop Dis 2020; 14:e0008876. [PMID: 33270627 PMCID: PMC7714197 DOI: 10.1371/journal.pntd.0008876] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023] Open
Abstract
Aedes aegypti Act4 is a paralog of the Drosophila melanogaster indirect flight muscle actin gene Act88F. Act88F has been shown to be haploinsufficient for flight in both males and females (amorphic mutants are dominant). Whereas Act88F is expressed in indirect flight muscles of both males and females, expression of Act4 is substantially female-specific. We therefore used CRISPR/Cas9 and homology directed repair to examine the phenotype of Act4 mutants in two Culicine mosquitoes, Aedes aegypti and Culex quinquefasciatus. A screen for dominant female-flightless mutants in Cx. quinquefasciatus identified one such mutant associated with a six base pair deletion in the CxAct4 coding region. A similar screen in Ae. aegypti identified no dominant mutants. Disruption of the AeAct4 gene by homology-dependent insertion of a fluorescent protein marker cassette gave a recessive female-flightless phenotype in Ae. aegypti. Reproducing the six-base deletion from Cx. quinquefasciatus in Ae. aegypti using oligo-directed mutagenesis generated dominant female-flightless mutants and identified additional dominant female-flightless mutants with other in-frame insertions or deletions. Our data indicate that loss of function mutations in the AeAct4 gene are recessive but that short in-frame deletions produce dominant-negative versions of the AeAct4 protein that interfere with flight muscle function. This makes Act4 an interesting candidate for genetic control methods, particularly population-suppression gene drives targeting female viability/fertility.
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Roy S, Basu S. Multiple mechanisms contributing fluoroquinolone (ciprofloxacin, levofloxacin,moxifloxacin) resistance in neonatal septicaemic A. baumannii from India. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Basu S, Bhatnagar N. The determinants of presumptive antibiotic prescribing behavior among early career physicians in Delhi, India. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Aggarwal N, Ahmed M, Basu S, Curtin JJ, Evans BJ, Matheny ME, Nundy S, Sendak MP, Shachar C, Shah RU, Thadaney-Israni S. Advancing Artificial Intelligence in Health Settings Outside the Hospital and Clinic. NAM Perspect 2020; 2020:202011f. [PMID: 35291747 PMCID: PMC8916812 DOI: 10.31478/202011f] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Berkowitz SA, Gold R, Domino ME, Basu S. Health insurance coverage and self-employment. Health Serv Res 2020; 56:247-255. [PMID: 33146406 DOI: 10.1111/1475-6773.13598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Self-employed workers are 10% of the US labor force, with growth projected over the next decade. Whether existing policy mechanisms are sufficient to ensure health insurance coverage for self-employed workers, who do not have access to employer-sponsored coverage, is unclear. OBJECTIVE To determine whether self-employment is associated with lack of health insurance coverage. DATA SOURCES Secondary analysis of Medical Expenditure Panel Survey (MEPS) data collected 2014-2017. STUDY DESIGN Participants were working age (18-64 years), employed, civilian noninstitutionalized US adults with two years of Medical Expenditure Panel Survey (MEPS) participation in 2014-2017. We compared those who were employees vs those who were self-employed. Key outcomes were self-report of health insurance coverage, and of delaying needed medical care. DATA EXTRACTION METHODS Longitudinal design among individuals who were employees during study year 1, comparing health insurance coverage among those who did vs did not transition to self-employment in year 2. PRINCIPAL FINDINGS 16 335 individuals, representing 121 473 345 working-age adults, met inclusion criteria; of these, 147, representing 1 097 582 individuals, transitioned to self-employment. In unadjusted analyses, 25.7% of those who became self-employed were uninsured in year 2, vs 8.1% of those who remained employees (P < .0001). In adjusted models, self-employment was associated with greater risk of being uninsured (26.1% vs 8.0%, risk difference 18.0%, 95% confidence interval [CI] 9.2% to 26.9%, P = .0001). A time-by-employment type product term suggests that 10.0 percentage points (95%CI 0.3 to 19.7 percentage points, P = .04) of the risk difference may be attributable to the change to self-employment. Self-employment was also associated with delaying needed medical care (12.0% vs 3.1%, risk difference: 8.9%, 95% CI 3.1% to 14.6%, P = .003). CONCLUSIONS One in four self-employed workers lack health insurance coverage. Given the rise in self-employment, it is imperative to identify ways to improve health care insurance access for self-employed working-age US adults.
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Treat S, Ebert Jr. C, Farzal Z, Basu S, Zanation A, Thorp B, Kimbell J, Senior B, Kimple A. Intranasal corticosteroids: patient administration angles and impact of education. RHINOLOGY ONLINE 2020; 3:160-166. [DOI: 10.4193/rhinol/20.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION: Intranasal corticosteroids sprays (INCS) are first line treatment for allergic rhinitis and are frequently used for chronic rhinosinusitis. Improperly aiming INCS increases the risk of epistaxis and may decrease the efficacy of the medication. The goal of this study was to determine how patients position INCS for drug delivery and if verbal or written instructions improve their positioning. METHODS: Patients in rhinology clinics were photographed while administering a generic spray bottle. The angle of the spray bot- tle relative to the patients’ head and a fixed background was determined. RESULTS: A total of 46 participants were included. The average spray angle for the right naris was 10.1o towards the septum and 67.2o below the Frankfurt Horizontal plane. The average spray angle for the left naris was 4.5o towards the septum and 62.2o below the Frankfurt horizontal plane. The angle of the spray bottle ranged from 50o toward the septum to 43o away from the sep- tum. Only 8 patients aimed away from the septum for both nares. Patients who recalled receiving verbal and written instructions aimed the INCS bottle at the lateral wall and inferior turbinate in contrast to patients who only received one form of instruction or no instructions. CONCLUSIONS: Most patients (83%) incorrectly aim INCS when compared to current guidelines. There was statistically significant improvement in the positioning of patients who reported receiving both verbal and written instruction; however, this study high- lights a greater need for patient education.
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Fried JE, Basu S, Phillips RS, Landon BE. Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model. Ann Fam Med 2020; 18:535-544. [PMID: 33168682 PMCID: PMC7708288 DOI: 10.1370/afm.2587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/19/2020] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We sought to determine the financial impact to primary care practices of alternative strategies for offering buprenorphine-based treatment for opioid use disorder. METHODS We interviewed 20 practice managers and identified 4 approaches to delivering buprenorphine-based treatment via primary care practice that differed in physician and nurse responsibilities. We used a microsimulation model to estimate how practice variations in patient type, payer, revenue, and cost across primary care practices nationwide would affect cost and revenue implications for each approach for the following types of practices: federally qualified health centers (FQHCs), non-FQHCs in urban high-poverty areas, non-FQHCs in rural high-poverty areas, and practices outside of high-poverty areas. RESULTS The 4 approaches to buprenorphine-based treatment included physician-led visits with nurse-led logistical support; nurse-led visits with physician oversight; shared visits; and solo prescribing by physician alone. Net practice revenues would be expected to increase after introduction of any of the 4 approaches by $18,000 to $70,000 per full-time physician in the first year across practice type. Yet physician-led visits and shared medical appointments, both of which relied on nurse care managers, consistently produced the greatest net revenues ($29,000-$70,000 per physician in the first year). To ensure positive net revenues with any approach, providers would need to maintain at least 9 patients in treatment, with a no-show rate of <34%. CONCLUSIONS Using a simulation model, we estimate that many types of primary care practices could financially sustain buprenorphine-based treatment if demand and no-show rate requirements are met, but a nurse care manager-based approach might be the most sustainable.
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Ghosh S, Das M, Basu S, Adhikari J. Gluconeogenic fructose-1,6-bisphosphatase from the mature sporocarps of common aquatic ferns: partial purification and basic characterization of this enzyme from Marsilea minuta (Polypodiopsida). UKRAINIAN BOTANICAL JOURNAL 2020. [DOI: 10.15407/ukrbotj77.05.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present communication reports substantial activity of gluconeogenic fructose-1,6-bisphosphatase (FBPase; EC 3.1.3.11) in three common heterosporous aquatic ferns (Marsilea minuta, Salvinia natans, and Azolla pinnata) and also describes a protocol for its partial purification from mature sporocarps of Marsilea minuta. The cytosolic FBPase, obtained from Marsilea minuta, Salvinia natans, and Azolla pinnata was recognized as gluconeogenic enzyme due to its drastic catabolic inactivation in presence of externally administered glucose and its insensitivity towards photosynthetic light illumination. Cytosolic gluconeogenic FBPase was partially purified from mature sporocarps of Marsilea minuta to about 22-fold over homogenate following low-speed centrifugation (11, 400 × g), 30–80% ammonium sulfate fractionation followed by subsequent chromatography using matrices like CM-Cellulose, Sephadex G-200, and Ultrogel AcA 34. The profile of partially purified FBPase in PAGE under non-denaturing condition was recorded. The enzyme activity increased linearly with respect to protein concentration to about 100 µg and with respect to time up to 75 minutes. Temperature optimum was found at 35 °C. The effect of substrate concentration and kinetic analyses for FBPase were carried out using D-fructose-1,6-bisphosphate (D-FBP, the substrate) in the range of 0.0 to 1.0 mM at an interval of 0.1 mM concentration. The Km value for D-FBP of FBPase was 0.06129 mM and Vmax was 4525 nmole Pi released (mg)-1 protein h-1 as determined by nonlinear regression kinetics using Prism 8 software (Graph Pad). The enzyme was functional in a constricted pH range of 7.0 to 8.0, giving maxima at pH 7.5. This cytosolic enzyme was significantly stimulated by Mg2+ and strongly inhibited by Hg2+, Cu2+ and Zn2+.
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Chin ET, Huynh BQ, Chapman LAC, Murrill M, Basu S, Lo NC. Frequency of Routine Testing for Coronavirus Disease 2019 (COVID-19) in High-risk Healthcare Environments to Reduce Outbreaks. Clin Infect Dis 2020; 73:e3127-e3129. [PMID: 33570097 PMCID: PMC7797732 DOI: 10.1093/cid/ciaa1383] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/06/2020] [Indexed: 01/12/2023] Open
Abstract
Routine asymptomatic testing strategies for COVID-19 have been proposed to prevent outbreaks in high-risk healthcare environments. We used simulation modeling to evaluate the optimal frequency of viral testing. We found that routine testing substantially reduces risk of outbreaks, but may need to be as frequent as twice weekly.
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, 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Zandian H, Zastrozhin MS, Zhang Y, Zhang ZJ, Zhao JT, Zhao XJG, Zhao Y, Zhou M, Ziapour A, Zimsen SRM, Brauer M, Afshin A, Lim SS. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 3570] [Impact Index Per Article: 892.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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Kharlov Y, Khatun A, Khuntia A, Kileng B, Kim B, Kim B, Kim D, Kim DJ, Kim EJ, Kim H, Kim J, Kim JS, Kim J, Kim J, Kim J, Kim M, Kim S, Kim T, Kim T, Kirsch S, Kisel I, Kiselev S, Kisiel A, Klay JL, Klein C, Klein J, Klein S, Klein-Bösing C, Kleiner M, Kluge A, Knichel ML, Knospe AG, Kobdaj C, Köhler MK, Kollegger T, Kondratyev A, Kondratyeva N, Kondratyuk E, Konig J, Konigstorfer SA, Konopka PJ, Kornakov G, Koska L, Kovalenko O, Kovalenko V, Kowalski M, Králik I, Kravčáková A, Kreis L, Krivda M, Krizek F, Krizkova Gajdosova K, Krüger M, Kryshen E, Krzewicki M, Kubera AM, Kučera V, Kuhn C, Kuijer PG, Kumar L, Kundu S, Kurashvili P, Kurepin A, Kurepin AB, Kuryakin A, Kushpil S, Kvapil J, Kweon MJ, Kwon JY, Kwon Y, La Pointe SL, La Rocca P, Lai YS, Lamanna M, Langoy R, Lapidus K, Lardeux A, Larionov P, Laudi E, Lavicka R, Lazareva T, Lea R, Leardini L, Lee J, Lee S, Lehner S, Lehrbach J, Lemmon RC, León Monzón I, Lesser ED, Lettrich M, Lévai P, Li X, Li XL, Lien J, Lietava R, Lim B, Lindenstruth V, Lindner A, Lippmann C, Lisa MA, Liu A, Liu J, Liu S, Llope WJ, Lofnes IM, Loginov V, Loizides C, Loncar P, Lopez JA, Lopez X, López Torres E, Luhder JR, Lunardon M, Luparello G, Ma YG, Maevskaya A, Mager M, Mahmood SM, Mahmoud T, Maire A, Majka RD, Malaev M, Malik QW, Malinina L, Mal'Kevich D, Malzacher P, Mandaglio G, Manko V, Manso F, Manzari V, Mao Y, Marchisone M, Mareš J, Margagliotti GV, Margotti A, Marín A, Markert C, Marquard M, Martin CD, Martin NA, Martinengo P, Martinez JL, Martínez MI, Martínez García G, Masciocchi S, Masera M, Masoni A, Massacrier L, Masson E, Mastroserio A, Mathis AM, Matonoha O, Matuoka PFT, Matyja A, Mayer C, Mazzaschi F, Mazzilli M, Mazzoni MA, Mechler AF, Meddi F, Melikyan Y, Menchaca-Rocha A, Mengke C, Meninno E, Menon AS, Meres M, Mhlanga S, Miake Y, Micheletti L, Migliorin LC, Mihaylov DL, Mikhaylov K, Mishra AN, Miśkowiec D, Modak A, Mohammadi N, Mohanty AP, Mohanty B, Mohisin Khan M, Moravcova Z, Mordasini C, Moreira De Godoy DA, Moreno LAP, Morozov I, Morsch A, Mrnjavac T, Muccifora V, Mudnic E, Mühlheim D, Muhuri S, Mulligan JD, Mulliri A, Munhoz MG, Munzer RH, Murakami H, Murray S, Musa L, Musinsky J, Myers CJ, Myrcha JW, Naik B, Nair R, Nandi BK, Nania R, Nappi E, Naru MU, Nassirpour AF, Nattrass C, Nayak R, Nayak TK, Nazarenko S, Neagu A, Negrao De Oliveira RA, Nellen L, Nesbo SV, Neskovic G, Nesterov D, Neumann LT, Nielsen BS, Nikolaev S, Nikulin S, Nikulin V, Noferini F, Nomokonov P, Norman J, Novitzky N, Nowakowski P, Nyanin A, Nystrand J, Ogino M, Ohlson A, Oleniacz J, Oliveira Da Silva AC, Oliver MH, Oppedisano C, Ortiz Velasquez A, Oskarsson A, Otwinowski J, Oyama K, Pachmayer Y, Pacik V, Padhan S, Pagano D, Paić G, Pan J, Panebianco S, Pareek P, Park J, Parkkila JE, Parmar S, Pathak SP, Paul B, Pazzini J, Pei H, Peitzmann T, Peng X, Pereira LG, Pereira Da Costa H, Peresunko D, Perez GM, Perrin S, Pestov Y, Petráček V, Petrovici M, Pezzi RP, Piano S, Pikna M, Pillot P, Pinazza O, Pinsky L, Pinto C, 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D, Vrláková J, Wagner B, Weber M, Weber SG, Wegrzynek A, Wenzel SC, Wessels JP, Wiechula J, Wikne J, Wilk G, Wilkinson J, Willems GA, Willsher E, Windelband B, Winn M, Witt WE, Wright JR, Wu Y, Xu R, Yalcin S, Yamaguchi Y, Yamakawa K, Yang S, Yano S, Yin Z, Yokoyama H, Yoo IK, Yoon JH, Yuan S, Yuncu A, Yurchenko V, Zaccolo V, Zaman A, Zampolli C, Zanoli HJC, Zardoshti N, Zarochentsev A, Závada P, Zaviyalov N, Zbroszczyk H, Zhalov M, Zhang S, Zhang X, Zhang Z, Zherebchevskii V, Zhi Y, Zhou D, Zhou Y, Zhou Z, Zhu J, Zhu Y, Zichichi A, Zinovjev G, Zurlo N. Measurement of the Low-Energy Antideuteron Inelastic Cross Section. PHYSICAL REVIEW LETTERS 2020; 125:162001. [PMID: 33124836 DOI: 10.1103/physrevlett.125.162001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
In this Letter, we report the first measurement of the inelastic cross section for antideuteron-nucleus interactions at low particle momenta, covering a range of 0.3≤p<4 GeV/c. The measurement is carried out using p-Pb collisions at a center-of-mass energy per nucleon-nucleon pair of sqrt[s_{NN}]=5.02 TeV, recorded with the ALICE detector at the CERN LHC and utilizing the detector material as an absorber for antideuterons and antiprotons. The extracted raw primary antiparticle-to-particle ratios are compared to the results from detailed ALICE simulations based on the geant4 toolkit for the propagation of (anti)particles through the detector material. The analysis of the raw primary (anti)proton spectra serves as a benchmark for this study, since their hadronic interaction cross sections are well constrained experimentally. The first measurement of the inelastic cross section for antideuteron-nucleus interactions averaged over the ALICE detector material with atomic mass numbers ⟨A⟩=17.4 and 31.8 is obtained. The measured inelastic cross section points to a possible excess with respect to the Glauber model parametrization used in geant4 in the lowest momentum interval of 0.3≤p<0.47 GeV/c up to a factor 2.1. This result is relevant for the understanding of antimatter propagation and the contributions to antinuclei production from cosmic ray interactions within the interstellar medium. In addition, the momentum range covered by this measurement is of particular importance to evaluate signal predictions for indirect dark-matter searches.
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Baum A, Wisnivesky J, Basu S, Siu AL, Schwartz MD. Association of Geographic Differences in Prevalence of Uncontrolled Chronic Conditions With Changes in Individuals' Likelihood of Uncontrolled Chronic Conditions. JAMA 2020; 324:1429-1438. [PMID: 33048153 PMCID: PMC8094427 DOI: 10.1001/jama.2020.14381] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. OBJECTIVE To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. EXPOSURES The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). MAIN OUTCOMES AND MEASURES Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. RESULTS The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. CONCLUSIONS AND RELEVANCE In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.
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