1
|
Lemons J, Saravanan M, Tumin D, Anyigbo C. Caregiver Report of Adverse Childhood Events: Comparison of Self-Administered and Telephone Questionnaires. CHILDREN AND YOUTH SERVICES REVIEW 2024; 163:107758. [PMID: 39157649 PMCID: PMC11326482 DOI: 10.1016/j.childyouth.2024.107758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Adverse childhood experiences (ACEs) are traumatic experiences that increase people's susceptibility to adverse physical health, mental health, and social consequences in adulthood. Screening for ACEs in primary care settings is complicated by a lack of consensus on appropriate methods for identifying exposure to ACEs. It is unclear whether self-report methods could increase disclosure of ACEs as compared to interview-based methods. This study compares data on the prevalence of ACEs from two publicly available surveys conducted on the same population of children's caregivers: the 2019 Ohio subsample of the web/mail-based National Survey of Children's Health and the telephone-based 2019 Ohio Medicaid Assessment Survey. We find higher disclosure of caregiver-reported child exposure to ACEs in the telephone interview survey, highlighting the importance of the role of verbal communication in developing a safe and trusting relationship in the disclosure of trauma.
Collapse
Affiliation(s)
- Jamie Lemons
- Brody School of Medicine at East Carolina University, Greenville, NC; 600 Moye Blvd Greenville NC 27834
| | - Madhumitha Saravanan
- Georgetown University School of Medicine, Washington DC; 3900 Reservoir Rd NW, Washington, DC 20007
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville NC; 600 Moye Blvd Greenville NC 27834
| | - Chidiogo Anyigbo
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati OH; 3333 Burnet Ave, MLC 7035, Cincinnati, OH 45229
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati OH
| |
Collapse
|
2
|
Kodali S, He CH, Patel S, Tao A, Szlechter M, Parsikia A, Mbekeani JN. Characteristics of ocular injuries associated with mortality in patients admitted with major trauma. BMC Ophthalmol 2024; 24:125. [PMID: 38504178 PMCID: PMC10949718 DOI: 10.1186/s12886-024-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries. METHODS A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05. RESULTS Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity. CONCLUSIONS Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.
Collapse
Affiliation(s)
- Sruthi Kodali
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Catherine H He
- Department of Ophthalmology & Visual Sciences, Yale School of Medicine, New Haven, Conn, USA
| | - Sheel Patel
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Alice Tao
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Queens, NY, USA
| | - Moshe Szlechter
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA
| | - Afshin Parsikia
- Department of Research Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce N Mbekeani
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA.
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
3
|
Ahiarakwe U, Zachary Pearson, Ochuba A, Kim W, Pressman Z, Haft M, Srikumaran U, Best MJ. Trends in total elbow arthroplasty in patients with rheumatoid arthritis receiving disease-modifying antirheumatic drug therapy based on payer status. J Shoulder Elbow Surg 2023; 32:2132-2139. [PMID: 37348781 DOI: 10.1016/j.jse.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Total elbow arthroplasty (TEA) is often used to manage advanced arthropathies of the elbow caused by inflammatory conditions such as rheumatoid arthritis (RA). Recent literature has shown that use of TEA is decreasing in patients with RA, part of which can be attributed to early medical management involving disease-modifying antirheumatic drugs (DMARDs). However, there is a significant economic barrier to accessing DMARD therapy. The purpose of this study was to compare the use of TEA between patients with and without DMARD therapy from 2010 to 2020. METHODS A retrospective cohort analysis was performed using a national insurance claim database to investigate the trends of patients with RA undergoing TEA from 2010-2020. Patients who underwent TEA and had a diagnosis of RA were identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD)-9 and ICD-10 codes between 2010 and 2020. These patients were then stratified into 2 cohorts: those with DMARD prescription claims and those without. A linear regression, compound annual growth rate (CAGR) analysis, and χ2 analysis were conducted to compare trends and demographic variables, including insurance type, between cohorts. Additionally, a multivariable logistic regression was subsequently performed to observe odds ratios (ORs) and 95% confidence intervals. RESULTS From 2010 to 2020, there has been no significant change in the incidence of TEA in RA patients without DMARD prescriptions, whereas there has been a statistically significantly decreasing rate of TEA observed in RA patients with DMARD prescription claims. The analysis showed that there was a CAGR of -4%. For patients with a diagnosis of RA and DMARD prescription claims, the highest incidence of undergoing TEA was seen in the age group of 60-69 years, whereas patients with a diagnosis of RA and no DMARD prescription claims had the highest incidence of undergoing TEA in the age group of 70-79 years. CONCLUSION The incidence of patients undergoing TEA with a diagnosis of RA and DMARD prescription claims has shown a statistically significant decrease from 2010 to 2020, whereas no significant difference was observed for patients without DMARD prescription claims. There were no statistically significant differences in the insurance plans between cohorts.
Collapse
Affiliation(s)
- Uzoma Ahiarakwe
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA; Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Zachary Pearson
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Arinze Ochuba
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - William Kim
- Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Zachary Pressman
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Mark Haft
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, MD, USA
| |
Collapse
|
4
|
Arrué AM, Hökerberg YHM, Jantsch LB, da Gama SGN, de Oliveira RDVC, Okido ACC, Cabral IE, de Lima RAG, Neves ET. Prevalence of children with special healthcare needs: An epidemiological survey in Brazil. J Pediatr Nurs 2022; 67:95-101. [PMID: 36058190 DOI: 10.1016/j.pedn.2022.08.013] [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: 05/25/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to estimate the prevalence and delineate the profile of children with special healthcare needs (CSHCN) in the three municipalities of Brazil's southern and southeastern regions from 2015 to 2017. DESIGN AND METHODS This cross-sectional study included 6853 children aged 0-11 years. Participants were selected through complex sampling in 32 primary healthcare units. The Brazilian version of the Children with Special Healthcare Needs Screener© and a questionnaire were used to identify sociodemographic and family characteristics, health status, and health services utilization. Simple and multiple logistic regression models were used to evaluate the association between family and child characteristics and prevalence (P < 0.05). RESULTS The prevalence of CSHCN was 25.3% (95% confidence interval: 21.0-30.0). Most participants required health services or were on long-term medication for a current chronic condition; approximately 53% of CSHCN had no formally recorded diagnoses. The most frequent health problems were respiratory conditions, asthma, and allergies. Approximately 60% of the CSHCN patients underwent follow-up examinations of the specialties pneumology, pediatrics, otorhinolaryngology, speech therapy, neurology, and psychology. Children of school age, of male sex, with premature birth, with a history of recurrent hospitalization, from non-nuclear families, and from underprivileged social classes were identified as risk factors for classification as CSHCN. PRACTICE IMPLICATION These results contribute to the unprecedented mapping of these children in healthcare networks in Brazil. CONCLUSION The high prevalence of CSHCN in medium and large municipalities in the southern and southeastern regions was associated with the child's previous health conditions and family structure.
Collapse
Affiliation(s)
- Andrea Moreira Arrué
- Sergio Arouca National School of Public Health, Fiocruz and Federal Institute of Paraná, Paraná, Brazil.
| | - Yara Hahr Marques Hökerberg
- Sergio Arouca National School of Public Health, Fiocruz and Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
| | | | | | | | | | - Ivone Evangelista Cabral
- Anna Nery School of Nursing, Federal University of Rio de Janeiro and State University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | | |
Collapse
|
5
|
Molino AR, Minnick MLG, Jerry-Fluker J, Karita Muiru J, Boynton SA, Furth SL, Warady BA, Ng DK. Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort Study. Kidney Med 2022; 4:100455. [PMID: 35518833 PMCID: PMC9062328 DOI: 10.1016/j.xkme.2022.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Rationale & Objective To understand the association between health and dental insurance status and health and dental care utilization, and their relationship with disease severity in a population with childhood-onset chronic kidney disease (CKD). Study Design Observational cohort study. Settings & Participants Nine hundred fifty-three participants contributing 4,369 person-visits (unit of analysis) in the United States enrolled in the Chronic Kidney Disease in Children (CKiD) Study from 2005 to 2019. Exposures Health insurance (private vs public vs none) and dental insurance (presence vs absence) self-reported at annual visits. Outcomes Self-reported suboptimal health care utilization in the past year, defined separately as not visiting a private physician, visiting the emergency room, visiting the emergency room at least twice, being hospitalized, and self-reported suboptimal dental care utilization over the past year, defined as not receiving dental care. Analytical Approach Repeated measures Poisson regression models were fit to estimate and compare utilization by insurance type and disease severity at the prior visit. Additional unadjusted and adjusted models were fit, as well as models including interactions between insurance and Black race, maternal education, and income. Results Those with public health insurance were more likely to report suboptimal health care utilization across the CKD severity spectrum, and lack of dental insurance was strongly associated with lack of dental care. These relationships varied depending on strata of socioeconomic status and race but the effect measure modification was not significant. Limitations Details of insurance coverage were unavailable; reasons for emergency care or type of private physician visited were unknown. Conclusions Pediatric nephrology programs may consider interventions to help direct supportive resources to families with public insurance who are at higher risk for suboptimal utilization of care. Insurance providers should identify areas to expand access for families of children with CKD.
Collapse
Affiliation(s)
- Andrea R. Molino
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria Lourdes G. Minnick
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Judith Jerry-Fluker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline Karita Muiru
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sara A. Boynton
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan L. Furth
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Bradley A. Warady
- Department of Pediatrics, Division of Nephrology, Children’s Mercy Kansas City, Kansas City, MO
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chronic Kidney Disease in Children Study
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Division of Nephrology, Children’s Mercy Kansas City, Kansas City, MO
| |
Collapse
|
6
|
Obeidat R, Noureldin A, Bitouni A, Abdellatif H, Lewis-Miranda S, Liu S, Badner V, Timothé P. Oral health needs of U.S. children with developmental disorders: a population-based study. BMC Public Health 2022; 22:861. [PMID: 35488224 PMCID: PMC9055681 DOI: 10.1186/s12889-022-13237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Children with Special Health Care Needs (CSHCN) have higher rates of oral diseases and tooth decay compared with the general population. Children with developmental disorders/ disabilities (DD) are a subset of CSHCN whose oral health has not been specifically addressed. Therefore, this study had two objectives: to describe the oral health needs (OHN) of children with DD compared with children without DD; and to assess barriers to access to care, utilization of dental services, and their association with oral health needs for children with DD. Methods This cross-sectional study utilized a sample of 30,530 noninstitutionalized children from the 2018 National Survey of Children’s Health (NSCH). Analysis was conducted using descriptive and inferential statistics. Results The analysis identified 6501 children with DD and 24,029 children without DD. Children with DD had significantly higher prevalence of OHN (20.3% vs. 12.2%, respectively), unmet dental needs (3.5% vs 1.2%), and utilization of any dental visits (86.1% vs 76.1%), (P-value < . 001). The adjusted logistic model identified four factors that contributed to the higher odds of OHN among children with DD: poverty (< 100% of the Federal Poverty Level (AOR = 2.27, CI: 1.46–3.51), being uninsured (AOR = 2.12, 95% CI: 1.14–3.95), a high level of disability (AOR = 1.89, CI: 1.23–2.78), and living in the western United States (AOR = 1.61, CI: 1.09–2.37. Conclusion Despite higher utilization of dental services, children with DD had poorer oral health and more unmet dental needs than children without DD. Advocacy efforts and policy changes are needed to develop affordable access that assesses, as early as possible, children with DD whose conditions impact their ability a great deal so that their potential OHN may be alleviated more effectively.
Collapse
Affiliation(s)
- Raghad Obeidat
- Public Health Sciences Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA.
| | - Amal Noureldin
- Public Health Sciences Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Anneta Bitouni
- Department of Comprehensive Dentistry, Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Hoda Abdellatif
- Princess Nourah Bint, Abdulrahman University, Riyadh, Saudi Arabia
| | - Shirley Lewis-Miranda
- Department of Comprehensive Dentistry, Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Shuling Liu
- Statistical Collaboration Center, Texas A&M University, 155 Ireland Street, College Station, TX, 77843, USA
| | - Victor Badner
- Depts. of Dentistry and Epidemiology and Population Health, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, New York City, NY, 10461, USA
| | - Peggy Timothé
- Public Health Sciences Texas A&M University College of Dentistry, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| |
Collapse
|
7
|
Bastani P, Mohammadpour M, Ghanbarzadegan A, Rossi-Fedele G, Peres MA. Provision of dental services for vulnerable groups: a scoping review on children with special health care needs. BMC Health Serv Res 2021; 21:1302. [PMID: 34863174 PMCID: PMC8642970 DOI: 10.1186/s12913-021-07293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/15/2021] [Indexed: 01/18/2023] Open
Abstract
Background The provision of dental services for children with special health care needs (CSHCN) needs to be considered by policymakers. This study is aimed to explore the determinant factors affecting dental and oral services provision for this vulnerable group. Methods A review was conducted applying the 9-steps approach. Five scientific databases of PUBMED, SCOPUS, Web of Science and PROQUEST and EMBASE were searched up to 10.07.2021, applying appropriate keywords. Thematic analysis was used to analyse the extracted data, and a conceptual map was developed according to JBI manual for evidence synthesis. Results From the abstracts of the 136 articles that fulfilled the inclusion criteria, 56 articles were included. Five main themes were identified as determinants affecting the provision of dentistry services for CSHCN, including needs assessment, policy advice, oral health interventions, providers’ perception and access barriers. According to the developed conceptual map, assessing the needs of CSHCN can lead to particular policy advice. Regarding the policies, appropriate oral health interventions can be presented. These interventions, along with providers’ perception about service delivery to CSHCN and the barriers to access them, determine the provision of dentistry services for CSHCN. Conclusions An effective needs assessment of CSHCN and their parents/carers can lead to evidence-informed policymaking and applicable policy advice according to the needs. Then policymakers should develop interventions to improve the community’s health literacy, as well as support the seeking behaviours for appropriate services. Policymakers should also consider how to limit the barriers to accessing oral and dental health by CSHCN to decrease disparities. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07293-4.
Collapse
Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Ghasrdasht street, Shiraz, Iran.
| | - Mohammadtaghi Mohammadpour
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Ghanbarzadegan
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Giampiero Rossi-Fedele
- Faculty of Health and Medical Sciences, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Marco A Peres
- National Dental Research Institute, Singapore, 5 Second Hospital Ave, Singapore, 168938, Singapore
| |
Collapse
|
8
|
Zhao J, Han X, Zheng Z, Nogueira L, Lu AD, Nathan PC, Yabroff KR. Racial/Ethnic Disparities in Childhood Cancer Survival in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:2010-2017. [PMID: 34593561 DOI: 10.1158/1055-9965.epi-21-0117] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/17/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-white patients with childhood cancer have worse survival than Non-Hispanic (NH) White patients for many childhood cancers in the United States. We examined the contribution of socioeconomic status (SES) and health insurance on racial/ethnic disparities in childhood cancer survival. METHODS We used the National Cancer Database to identify NH White, NH Black, Hispanic, and children of other race/ethnicities (<18 years) diagnosed with cancer between 2004 and 2015. SES was measured by the area-level social deprivation index (SDI) at patient residence and categorized into tertiles. Health insurance coverage at diagnosis was categorized as private, Medicaid, and uninsured. Cox proportional hazard models were used to compare survival by race/ethnicity. We examined the contribution of health insurance and SES by sequentially adjusting for demographic and clinical characteristics (age group, sex, region, metropolitan statistical area, year of diagnosis, and number of conditions other than cancer), health insurance, and SDI. RESULTS Compared with NH Whites, NH Blacks and Hispanics had worse survival for all cancers combined, leukemias and lymphomas, brain tumors, and solid tumors (all P < 0.05). Survival differences were attenuated after adjusting for health insurance and SDI separately; and further attenuated after adjusting for insurance and SDI together. CONCLUSIONS Both SES and health insurance contributed to racial/ethnic disparities in childhood cancer survival. IMPACT Improving health insurance coverage and access to care for children, especially those with low SES, may mitigate racial/ethnic survival disparities.
Collapse
Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Amy D Lu
- The University of Toronto, Toronto, Ontario, Canada
| | - Paul C Nathan
- The University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Division of Hematology/Oncology, Toronto, Ontario, Canada
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
9
|
Wray CM, Khare M, Keyhani S. Access to Care, Cost of Care, and Satisfaction With Care Among Adults With Private and Public Health Insurance in the US. JAMA Netw Open 2021; 4:e2110275. [PMID: 34061204 PMCID: PMC8170543 DOI: 10.1001/jamanetworkopen.2021.10275] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/24/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Contemporary data directly comparing experiences between individuals with public and private health insurance among the 5 major forms of coverage in the US are limited. Objective To compare individual experiences related to access to care, costs of care, and reported satisfaction with care among the 5 major forms of health insurance coverage in the US. Design, Setting, and Participants This survey study used data from the 2016-2018 Behavioral Risk Factor Surveillance System on 149 290 individuals residing in 17 states and the District of Columbia, representing the experiences of more than 61 million US adults. Exposure Private (individually purchased and employer-sponsored coverage) or public health insurance (Medicare, Medicaid, and Veterans Health Administration [VHA] or military coverage). Main Outcomes and Measures A pairwise multivariable analysis was performed, controlling for underlying health status of US adults covered by private and public health insurance plans, and responses to survey questions on access to care, costs of care, and reported satisfaction with care were compared. Estimates are weighted. Results A total of 149 290 individuals responded to the survey (mean [SD] age, 50.7 [0.2] years; 52.8% female). Among the respondents, most were covered by private insurance (95 396 [63.9%]), followed by Medicare (35 531 [23.8%]), Medicaid (13 286 [8.9%]), and VHA or military (5074 [3.4%]) coverage. Among those with private insurance, most (117 939 [79.0%]) had employer-sponsored coverage. Compared with those covered by Medicare, individuals with employer-sponsored insurance were less likely to report having a personal physician (odds ratio [OR], 0.52; 95% CI, 0.48-0.57) and were more likely to report instability in insurance coverage (OR, 1.54; 95% CI, 1.30-1.83), difficulty seeing a physician because of costs (OR, 2.00; 95% CI, 1.77-2.27), not taking medication because of costs (OR, 1.44; 95% CI, 1.27-1.62), and having medical debt (OR, 2.92; 95% CI, 2.69-3.17). Compared with those covered by Medicare, individuals with employer-sponsored insurance were less satisfied with their care (OR, 0.60; 95% CI, 0.56-0.64). Compared with individuals covered by Medicaid, those with employer-sponsored insurance were more likely to report having medical debt (OR, 2.06; 95% CI, 1.83-2.32) and were less likely to report difficulty seeing a physician because of costs (OR, 0.83; 95% CI, 0.73-0.95) and not taking medications because of costs (OR, 0.78; 95% CI, 0.66-0.92). No difference in satisfaction with care (OR, 0.96; 95% CI, 0.87-1.06) was found between individuals with employer-sponsored private health insurance and those with Medicaid coverage. Conclusions and Relevance In this survey study, individuals with private insurance were more likely to report poor access to care, higher costs of care, and less satisfaction with care compared with individuals covered by publicly sponsored insurance programs. These findings suggest that public health insurance options may provide more cost-effective care than private options.
Collapse
Affiliation(s)
- Charlie M. Wray
- Department of Medicine, University of California, San Francisco
- Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Meena Khare
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco
- Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| |
Collapse
|
10
|
Zhang C, Fu C, Song Y, Feng R, Wu X, Li Y. Utilization of public health care by people with private health insurance: a systematic review and meta-analysis. BMC Public Health 2020; 20:1153. [PMID: 32703180 PMCID: PMC7376853 DOI: 10.1186/s12889-020-08861-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this systematic review was to explore the association between private health insurance and health care utilization. Methods We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases for relevant articles since 2010. Studies were eligible if they described original empirical research on the utilization of public health care by individuals with private health insurance, compared with individuals without private insurance. A pooled measure of association between insurance status with health care utilization was assessed through meta-analysis. Results Twenty-six articles were included in the final analysis. We found that patients with private insurance did not use more public health care than people without private insurance (P < 0.05). According to the subgroup analysis, people with private insurance were more likely to be hospitalized than people with no insurance (OR 1.67; 95% CI, 1.18 to 2.36). Conclusions People with private insurance did not increase their use of health care (outpatient services), compared to those without private insurance. Private health insurance coverage may ease the financial burden on patients and on the public health insurance system.
Collapse
Affiliation(s)
- Congcong Zhang
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Chenwei Fu
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yimin Song
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Rong Feng
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Yongning Li
- Department of International Medical Servicers, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
11
|
Developing Future Clinical Pharmacy Leaders in the Interprofessional Care of Children with Special Health Care Needs and Medical Complexity (CSHCN-CMC) in a Pediatric Pulmonary Center. CHILDREN-BASEL 2019; 6:children6120135. [PMID: 31818043 PMCID: PMC6955724 DOI: 10.3390/children6120135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022]
Abstract
The health care needs of children with special health care needs and medical complexity (CSHCN-CMC) are multifaceted and often require the expertise of various disciplines. The medication-related needs of this population can be further complicated with off-label medication use, polypharmacy, and vulnerability to medication errors. Although clinical pharmacists are increasingly becoming a common part of inpatient, pediatric interprofessional patient care teams, their presence remains lacking in the outpatient or ambulatory care realm. Pediatric clinical pharmacists in the ambulatory care setting have the potential to help optimize medication use and safety through collaborative efforts as part of the interprofessional team. Since the late 1960s, Pediatric Pulmonary Centers (PPCs) provide training programs designed to develop interprofessional leaders who will improve the health status of CSHCN-CMC, specifically those with chronic respiratory and sleep-related conditions. The addition of pharmacists not only provides a more comprehensive care model for CSHCN-CMC, it creates an avenue to encourage the career paths of pediatric pharmacists in the ambulatory care setting. Here, we describe the addition of clinical pharmacy as part of an interprofessional patient care team and the development and implementation of a maternal child health (MCH) pharmacy discipline training model designed to mentor future pharmacist leaders in the care of CSHCN-CMC.
Collapse
|
12
|
Mandell DS, Candon MK, Xie M, Marcus SC, Kennedy-Hendricks A, Epstein AJ, Barry CL. Effect of Outpatient Service Utilization on Hospitalizations and Emergency Visits Among Youths With Autism Spectrum Disorder. Psychiatr Serv 2019; 70:888-893. [PMID: 31215353 PMCID: PMC6773491 DOI: 10.1176/appi.ps.201800290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Psychiatric hospitalizations and emergency department (ED) visits occur more frequently for youths with autism spectrum disorder (ASD). One mechanism that may reduce the likelihood of these events is utilization of home and community-based care. Using commercial claims data and a rigorous analytical framework, this retrospective study examined whether spending on outpatient services for ASD, including occupational, physical, and speech therapies and other behavioral interventions, reduced the likelihood of psychiatric hospitalizations and ED visits. METHODS The study sample was composed of >100,000 children and young adults with ASD and commercial insurance from every state between 2008 and 2012. The authors estimated maximum-likelihood complementary log-log link survival models with robust standard errors. The outcomes of interest were a hospitalization or an ED visit with an associated psychiatric diagnosis code (ICD-9-CM 290 through 319) in a given week. RESULTS An increase of $125 in weekly spending on ASD-specific outpatient services in the 7 to 14 weeks prior to a given week reduced the likelihood of a psychiatric hospitalization in that week by 2%. ASD-specific outpatient spending during the 6 weeks prior to a psychiatric hospitalization did not decrease risk of hospitalization. Spending on ASD-specific outpatient services did not reduce the likelihood of a psychiatric ED visit. CONCLUSIONS The financial burden associated with ASD is extensive, and psychiatric hospitalizations remain the most expensive type of care, costing more than $4,000 per week on average. Identifying the mechanisms by which psychiatric hospitalizations occur may reduce the likelihood of these events.
Collapse
Affiliation(s)
- David S Mandell
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry)
| | - Molly K Candon
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry)
| | - Ming Xie
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry)
| | - Steven C Marcus
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry)
| | - Alene Kennedy-Hendricks
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry)
| | - Andrew J Epstein
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry)
| | - Colleen L Barry
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry)
| |
Collapse
|
13
|
Abstract
Children with special health care needs (CSHCN) are a vulnerable population subgroup, but little is known about their oral health, particularly regarding the prevalence and cause of tooth decay. This lack of knowledge is a barrier to progress in terms of developing evidence-based clinical interventions and policies aimed at promoting oral health in CSHCN. This article reviews the oral health literature pertaining to CSHCN, identifies critical knowledge gaps, highlights future research opportunities, and extends clinical recommendations to pediatric health care providers.
Collapse
|
14
|
Miller LS, Wu M, Schettine AM, Cogan LW. Identifying Children with Special Health Care Needs Using Medicaid Data in New York State Medicaid Managed Care. Health Serv Res 2018; 53:4157-4177. [PMID: 30238977 DOI: 10.1111/1475-6773.13047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The ability to identify children with special health care needs (CSHCN) is crucial to evaluate disparities in the quality of health care for children in Medicaid Managed Care. We developed and assessed the accuracy of a new method to classify CSHCN. DATA SOURCES Secondary data analysis was conducted using NYS Medicaid administrative data and the Children with Chronic Conditions Screener (CCC Screener). STUDY DESIGN This study included 5,907 NYS Medicaid beneficiaries (17 years old or younger) whose parents completed the CCC Screener in 2014. Medicaid administrative data were used to create a risk score to assess the risk of special needs, and a cut point was identified to differentiate between children with versus without special needs. Diagnostic accuracy of the method was assessed using sensitivity and specificity analyses. PRINCIPAL FINDINGS Applying the CCC Screener as the "gold standard," the risk score correctly classified the majority of CSHCN as positive (sensitivity = 75 percent) and the majority of the children without special needs as negative (specificity = 79 percent). This method demonstrated decent diagnostic ability (AUC = 0.77). CONCLUSIONS Our method can identify CSHCN in the NYS Medicaid Managed Care population and will help the State monitor the quality of care for this vulnerable population.
Collapse
Affiliation(s)
- Lauren S Miller
- New York State Department of Health, Office of Quality and Patient Safety, Albany, NY
| | - Meng Wu
- New York State Department of Health, Office of Quality and Patient Safety, Albany, NY
| | - Anne M Schettine
- New York State Department of Health, Office of Quality and Patient Safety, Albany, NY
| | - Lindsay W Cogan
- New York State Department of Health, Office of Quality and Patient Safety, Albany, NY.,Department of Health Policy Management & Behavior, School of Public Health, University at Albany, Albany, NY
| |
Collapse
|
15
|
Insurance Coverage and Well-Child Visits Improved for Youth Under the Affordable Care Act, but Latino Youth Still Lag Behind. Acad Pediatr 2018; 18:35-42. [PMID: 28739534 DOI: 10.1016/j.acap.2017.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine whether there have been changes in insurance coverage and health care utilization for youth before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) and to assess whether racial and ethnic inequities have improved. METHODS Data are from 64,565 youth (ages 0-17 years) participants in the 2011 to 2015 National Health Interview Survey. We conducted multivariate logistic regression analyses to determine how the period after national implementation of the ACA (years 2011-2013 vs years 2014-2015) was associated with health insurance coverage and utilization of health care services (well-child visits, having visited an emergency department, and having visited a physician, all in the past 12 months), and whether changes over the pre- and post-ACA periods varied according to race and Latino ethnicity. RESULTS The post-ACA period was associated with improvements in insurance coverage and well-child visits for all youth. Latino youth had the largest absolute gain in insurance coverage; however, they continued to have the highest proportion of uninsurance post national ACA implementation. With regard to health care equity, non-Latino black youth were less likely to be uninsured and Latino youth had no significant improvements in insurance coverage relative to non-Latino white youth after national ACA implementation. Inequities in health care utilization for non-Latino black and Latino youth relative to non-Latino white youth did not improve. CONCLUSIONS Insurance coverage and well-child visits have significantly improved for all youth since passage of the ACA, but inequities persist, especially for Latino youth.
Collapse
|
16
|
Glassgow AE, Van Voorhees B. Behavioral Health Disparities Among Children and Youth with Special Health Care Needs. Pediatr Ann 2017; 46:e382-e386. [PMID: 29019633 DOI: 10.3928/19382359-20170920-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The burden of mental health morbidity, disability, and mortality in children is not equally distributed across populations in the United States. The consequence is widespread differences in health status between certain groups of children that result in systematic behavioral health disparities. In the US, an estimated 12.8% of children (9.4 million) have a special health care need. Mental, emotional, and behavioral problems and disorders are widespread among children and youth with special health care needs (CYSHCN), but are often undetected and untreated despite the adverse consequences to children throughout the life course. CYSHCN experience behavioral health disparities in the prevalence of behavioral health problems and conditions, and in the access to needed services. Further investigation is required to fully identify behavioral health needs, the mechanisms contributing to the disparities, and effective strategies to prevent and provide interventions for CYSHCN. Investing in research and interventions is vital to reducing behavioral health disparities. [Pediatr Ann. 2017;46(10):e382-e386.].
Collapse
|
17
|
Lee JM, Wang X, Ojha RP, Johnson KJ. The effect of health insurance on childhood cancer survival in the
U
nited
S
tates. Cancer 2017; 123:4878-4885. [DOI: 10.1002/cncr.30925] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Jong Min Lee
- Brown School, Washington University in St. LouisSt. Louis Missouri
| | - Xiaoyan Wang
- Brown School, Washington University in St. LouisSt. Louis Missouri
| | - Rohit P. Ojha
- Center for Outcomes ResearchJPS Health NetworkFort Worth Texas
- Department of Biostatistics and EpidemiologySchool of Public Health, University of North Texas Health Science CenterFort Worth Texas
| | - Kimberly J. Johnson
- Brown School, Washington University in St. LouisSt. Louis Missouri
- Department of PediatricsWashington University School of Medicine, Washington University in St. LouisSt. Louis Missouri
| |
Collapse
|