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Pittell H, Calip GS, Pierre A, Ryals CA, Guadamuz JS. Racialized economic segregation and inequities in treatment initiation and survival among patients with metastatic breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07319-5. [PMID: 38702585 DOI: 10.1007/s10549-024-07319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Racialized economic segregation, a form of structural racism, may drive persistent inequities among patients with breast cancer. We examined whether a composite area-level index of racialized economic segregation was associated with real-world treatment and survival in metastatic breast cancer (mBC). METHODS We conducted a retrospective cohort study among adult women with mBC using a US nationwide electronic health record-derived de-identified database (2011-2022). Population-weighted quintiles of the index of concentration at the extremes were estimated using census tract data. To identify inequities in time to treatment initiation (TTI) and overall survival (OS), we employed Kaplan-Meier methods and estimated hazard ratios (HR) adjusted for clinical factors. RESULTS The cohort included 27,459 patients. Compared with patients from the most privileged areas, those from the least privileged areas were disproportionately Black (36.9% vs. 2.6%) or Latinx (13.2% vs. 2.6%) and increasingly diagnosed with de novo mBC (33.6% vs. 28.9%). Those from the least privileged areas had longer median TTI than those from the most privileged areas (38 vs 31 days) and shorter median OS (29.7 vs 39.2 months). Multivariable-adjusted HR indicated less timely treatment initiation (HR 0.87, 95% CI 0.83, 0.91, p < 0.01) and worse OS (HR 1.19, 95% CI 1.13, 1.25, p < 0.01) among those from the least privileged areas compared to the most privileged areas. CONCLUSION Racialized economic segregation is a social determinant of health associated with treatment and survival inequities in mBC. Public investments directly addressing racialized economic segregation and other forms of structural racism are needed to reduce inequities in cancer care and outcomes.
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Affiliation(s)
- Harlan Pittell
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA.
| | - Gregory S Calip
- Program on Medicines and Public Health, University of Southern California School of Pharmacy, Los Angeles, USA
| | - Amy Pierre
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cleo A Ryals
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA
| | - Jenny S Guadamuz
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA
- Division of Health Policy and Management, Berkeley School of Public Health, University of California, Berkeley, USA
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Thunell JA, Joyce GF, Ferido PM, Chen Y, Guadamuz JS, Qato DM, Zissimopoulos JM. Diagnoses and Treatment of Behavioral and Psychological Symptoms of Dementia Among Racially and Ethnically Diverse Persons Living with Dementia. J Alzheimers Dis 2024:JAD231266. [PMID: 38669535 DOI: 10.3233/jad-231266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background Behavioral and psychological symptoms of dementia (BPSD) and prescribed central nervous system (CNS) active drugs to treat them are prevalent among persons living with Alzheimer's disease and related dementias (PLWD) and lead to negative outcomes for PLWD and their caregivers. Yet, little is known about racial/ethnic disparities in diagnosis and use of drugs to treat BPSD. Objective Quantify racial/ethnic disparities in BPSD diagnoses and CNS-active drug use among community-dwelling PLWD. Methods We used a retrospective cohort of community-dwelling Medicare Fee-for-Service beneficiaries with dementia, continuously enrolled in Parts A, B and D, 2017-2019. Multivariate logistic models estimated rates of BPSD diagnosis and, conditional on diagnosis, CNS-active drug use. Results Among PLWD, 67.1% had diagnoses of an affective, psychosis or hyperactivity symptom. White (68.3%) and Hispanic (63.9%) PLWD were most likely, Blacks (56.6%) and Asians (52.7%) least likely, to have diagnoses. Among PLWD with BPSD diagnoses, 78.6% took a CNS-active drug. Use was highest among whites (79.3%) and Hispanics (76.2%) and lowest among Blacks (70.8%) and Asians (69.3%). Racial/ethnic differences in affective disorders were pronounced, 56.8% of white PLWD diagnosed; Asians had the lowest rates (37.8%). Similar differences were found in use of antidepressants. Conclusions BPSD diagnoses and CNS-active drug use were common in our study. Lower rates of BPSD diagnoses in non-white compared to white populations may indicate underdiagnosis in clinical settings of treatable conditions. Clinicians' review of prescriptions in this population to reduce poor outcomes is important as is informing care partners on the risks/benefits of using CNS-active drugs.
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Affiliation(s)
- Johanna A Thunell
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Geoffrey F Joyce
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Patricia M Ferido
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Yi Chen
- Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Jenny S Guadamuz
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Dima M Qato
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Julie M Zissimopoulos
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
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Zheutlin AR, Sharareh N, Guadamuz JS, Berchie RO, Derington CG, Jacobs JA, Mondesir FL, Alexander GC, Levitan EB, Safford M, Vos RO, Qato DM, Bress AP. Association Between Pharmacy Proximity With Cardiovascular Medication Use and Risk Factor Control in the United States. J Am Heart Assoc 2024; 13:e031717. [PMID: 38390820 PMCID: PMC10944071 DOI: 10.1161/jaha.123.031717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Poor neighborhood-level access to health care, including community pharmacies, contributes to cardiovascular disparities in the United States. The authors quantified the association between pharmacy proximity, antihypertensive and statin use, and blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) among a large, diverse US cohort. METHODS AND RESULTS A cross-sectional analysis of Black and White participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study during 2013 to 2016 was conducted. The authors designated pharmacy proximity by census tract using road network analysis with population-weighted centroids within a 10-minute drive time, with 5- and 20-minute sensitivity analyses. Pill bottle review measured medication use, and BP and LDL-C were assessed using standard methods. Poisson regression was used to quantify the association between pharmacy proximity with medication use and BP control, and linear regression for LDL-C. Among 16 150 REGARDS participants between 2013 and 2016, 8319 (51.5%) and 8569 (53.1%) had an indication for antihypertensive and statin medication, respectively, and pharmacy proximity data. The authors did not find a consistent association between living in a census tract with higher pharmacy proximity and antihypertensive medication use, BP control, or statin medication use and LDL-C levels, regardless of whether the area was rural, suburban, or urban. Results were similar among the 5- and 20-minute drive-time analyses. CONCLUSIONS Living in a low pharmacy proximity census tract may be associated with antihypertensive and statin medication use, or with BP control and LDL-C levels. Although, in this US cohort, outcomes were similar for adults living in high or low pharmacy proximity census tracts.
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Affiliation(s)
- Alexander R. Zheutlin
- Division of Cardiology, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Nasser Sharareh
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Jenny S. Guadamuz
- Division of Health Policy and ManagementUniversity of California, Berkeley, School of Public HealthBerkeleyCAUSA
| | - Ransmond O. Berchie
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Catherine G. Derington
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Joshua A. Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Favel L. Mondesir
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - G. Caleb Alexander
- Department of EpidemiologyCenter for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of MedicineJohns Hopkins MedicineBaltimoreMDUSA
| | - Emily B. Levitan
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical CollegeCornell UniversityNew YorkNYUSA
| | - Robert O. Vos
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Dima M. Qato
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern CaliforniaLos AngelesCAUSA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Alfred Mann School of Pharmacy and Pharmaceutical SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Adam P. Bress
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
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Guadamuz JS. Sociodemographic inequities in COVID-19 vaccination among adults in the United States, 2022. J Am Pharm Assoc (2003) 2024:102064. [PMID: 38432482 DOI: 10.1016/j.japh.2024.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Despite the availability of COVID-19 vaccines since December 2020, sociodemographic inequities in vaccination and preventable COVID-related deaths persist. To inform efforts for equitable COVID-19 vaccination campaigns, a comprehensive national evaluation of existing inequities is necessary. OBJECTIVE To examine sociodemographic inequities in COVID-19 vaccination receipt using data from the 2022 National Health Interview Survey (NHIS). METHODS This secondary data analysis used cross-sectional nationally-representative data from the 2022 NHIS to assess vaccination inequities among 27,126 adults. Separate Poisson regressions adjusted for clinical factors (e.g., age, sex, high-risk health conditions) were used to evaluate vaccination inequities across sociographic factors (e.g., race/ethnicity, poverty, health insurance). RESULTS In 2022, 79.6% of adults received at ≥ 1 vaccine dose, 75.0% received ≥ 2 doses ("fully vaccinated"), 45.7% received ≥ 3 doses (≥ 1 booster), and 17.2% received ≥ 4 doses (≥ 2 boosters). Marked inequities were evident in COVID-19 vaccination across primary and booster doses, especially receipt of at least 1 booster dose (≥ 3 doses). Black (35.7%, prevalence ratio [PR] 0.78 [95% CI 0.74-0.83]) and Latinx (35.5%, PR 0.82 [CI 0.78-0.86]) adults were less likely to receive ≥ 3 doses than Asian (66.5%, PR 1.41 [CI 1.35-1.48]) and White (48.8%) adults. Poverty (31.1% [PR 0.65 {CI 0.61-0.69}] vs. 50.7%) and food insecurity (27.1% [PR 0.63 {CI 0.58-0.68}] vs. 47.3%) were negatively associated with receipt of ≥ 3 vaccine doses. Adults without usual source of care (24.9%, PR 0.61 [CI 0.57-0.65]) or health insurance (17.4%, PR 0.40 [CI 0.36-0.45]) had much lower rates of ≥ 3 doses than those with appropriate health care access (48.7% and 51.9%, respectively). CONCLUSION As of 2022, 1-in-5 U.S. adults remain unvaccinated, and more than half have not received any recommended booster doses. Economically/socially marginalized populations-including Black and Latinx adults and those with structural barriers such as poverty, food insecurity, and poor health care access-were less likely to receive a booster. Addressing these vaccination inequities is crucial to achieve equitable COVID-19 protection and reduce preventable deaths among economically/socially marginalized populations.
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Fallahi M, Guadamuz JS, Shooshtari A, Qato DM. Changes in HIV Pre-exposure Prophylaxis (PrEP) Coverage at State and County Level During the COVID-19 Pandemic in the United States. AIDS Behav 2024; 28:799-804. [PMID: 37751110 PMCID: PMC10896812 DOI: 10.1007/s10461-023-04180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
This study quantifies the prevalence and trends in weekly PrEP coverage at the national, state and county-level, before and during the COVID-19 pandemic in the United States.We estimated weekly PrEP coverage using longitudinal individual-level pharmacy claims from IQVIA LRx for a cohort of PrEP users (N = 287,493) ages 16 to 85 years between December 29th, 2019 and November 8th, 2020. Weekly PrEP coverage was defined as PrEP use among individuals at high risk for HIV. We conducted an interrupted time series analysis to quantify changes in weekly PrEP coverage before (December 29th, 2019 - March 8th, 2020) and during (March 29th - November 8th, 2020) the COVID-19 pandemic at the national, state and county-level by county characteristics, specifically by EHE priority jurisdiction, racial/ethnic composition, and urbanity. Nationally, weekly PrEP coverage among individuals ages 16 to 85 at high risk for HIV declined by 11.5% (from 11.0% before to 9.5% during the pandemic; t = 8.02,p < 0.01). Weekly PrEP coverage declined in all states and most counties yet varied substantially across states and counties. Geographic disparities in weekly PrEP coverage were also observed between urban EHE priority counties with significantly lower rates in counties with ≥ 50% Black/Latinx population when compared to their counterparts (7.9% vs. 11.2%; t = 18.91,p < 0.01);these disparities were most pronounced in California and New York. Weekly PrEP coverage was much lower than the 25% annual coverage reported by the Centers for Disease Control and geographic disparities observed within states likely contribute to the persistent racial/ethnic disparities in new HIV diagnoses observed within those states.
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Affiliation(s)
- Mahdi Fallahi
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
- Division of Health Policy and Management, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Andrew Shooshtari
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA.
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA.
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Huang HC, Guadamuz JS, Hoskins KF, Ko NY, Calip GS. Risk of contralateral breast cancer among Asian/Pacific Islander women in the United States. Breast Cancer Res Treat 2024; 203:533-542. [PMID: 37897647 DOI: 10.1007/s10549-023-07140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer. METHODS We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. RESULTS From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks. CONCLUSION Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer health equity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.
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Affiliation(s)
- Hsiao-Ching Huang
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Jenny S Guadamuz
- School of Public Health, University of California, Berkeley, CA, USA
| | - Kent F Hoskins
- Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Naomi Y Ko
- Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gregory S Calip
- Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, 1985 Zonal Ave, Los Angeles, 90089, CA, USA.
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Guadamuz JS, Wang X, Royce TJ, Calip GS. Sociodemographic Inequities in Telemedicine Use Among US Patients Initiating Treatment in Community Cancer Centers During the Ongoing COVID-19 Pandemic, 2020-2022. JCO Oncol Pract 2023; 19:1206-1214. [PMID: 37748113 PMCID: PMC10732501 DOI: 10.1200/op.23.00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Although telemedicine was seen as a way to improve cancer care during the coronavirus disease (COVID-19) pandemic, there is limited information regarding inequities in its uptake. This study assessed sociodemographic factors associated with telemedicine use among patients initiating treatment for 20 common cancers. METHODS This retrospective cohort study used deidentified electronic health record-derived patient data from a nationwide network of community cancer practices, linked to area-level Census information. We included adults (age 18 years and older) who initiated first-line systemic cancer treatment between March 2020 and December 2022 (follow-up through March 2023). Exposures include race/ethnicity, insurance status, and area-level social determinants of health (eg, block group socioeconomic status [SES]). The outcome was telemedicine use within 90 days after treatment initiation. Associations were examined using logistic regression models adjusted for age, sex, performance status, stage, and cancer type. RESULTS This study included 36,993 patients (48.6% women; median age, 69 years), of whom 15.1% used telemedicine services. Black (12.2%; odds ratio [OR], 0.78 [95% CI, 0.70 to 0.88]) and uninsured (9.2%; OR, 0.59 [95% CI, 0.48 to 0.73]) patients were less likely to use telemedicine services than their White and well-insured counterparts (14.5% and 15.0%, respectively). Patients in rural (9.7%; OR, 0.54 [95% CI, 0.46 to 0.57]), suburban (11.8%; OR, 0.67 [95% CI, 0.61 to 0.74]), and low SES areas (9.9%; OR, 0.39 [95% CI, 0.35 to 0.43]) were less also likely to use telemedicine than their counterparts in urban (16.6%) or high SES (21.6%) areas. CONCLUSION Nearly one sixth of patients initiating cancer treatment during the pandemic used telemedicine, but there were substantial inequities. The proliferation of telemedicine may perpetuate cancer care inequities if marginalized populations do not have equitable access.
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Affiliation(s)
- Jenny S. Guadamuz
- Flatiron Health, New York, NY
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, CA
- School of Pharmacy, University of Southern California, Los Angeles, CA
| | | | - Trevor J. Royce
- Flatiron Health, New York, NY
- Wake Forest School of Medicine, Winston-Salem, NC
| | - Gregory S. Calip
- Flatiron Health, New York, NY
- School of Pharmacy, University of Southern California, Los Angeles, CA
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Vatavuk-Serrati G, Kershaw KN, Sotres-Alvarez D, Perreira KM, Guadamuz JS, Isasi CR, Hirsch JA, Van Horn LV, Daviglus ML, Albrecht SS. Residence in Hispanic/Latino Immigrant Neighborhoods, Away-From-Home Food Consumption, and Diet Quality: The Hispanic Community Health Study/Study of Latinos. J Acad Nutr Diet 2023; 123:1596-1605.e2. [PMID: 37355040 PMCID: PMC10592543 DOI: 10.1016/j.jand.2023.06.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Hispanics/Latinos are disproportionately burdened by nutrition-related diseases but immigrants appear healthier than their US-born counterparts. Neighborhoods characterized by high Hispanic/Latino immigrant segregation may provide environments to support healthier diets. OBJECTIVE To examine whether or not Hispanic/Latino immigrant segregation is associated with frequency of away-from-home food consumption and diet quality in a large, diverse sample of Hispanic/Latino adults. DESIGN Cross-sectional baseline data from the Hispanic Community Health Study/Study of Latinos were analyzed (2008-2011). Residential addresses were geocoded and linked to census tract-level 2008-2012 American Community Survey data. Hispanic/Latino immigrant segregation was characterized using the local Getis-Ord Gi∗ statistic, a spatial clustering measure that quantifies the extent to which demographically similar neighborhoods group together. PARTICIPANTS/SETTING Participants were 15,661 adults in the Hispanic Community Health Study/Study of Latinos, a population-based study of Hispanic/Latinos aged 18 to 74 years from 4 US regions (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA). MAIN OUTCOME MEASURES Away-from-home food consumption was assessed using a modified dietary behavior questionnaire. Diet quality was assessed using the Alternate Healthy Eating Index 2010 (range = 0 to 110) from two 24-hour recalls. STATISTICAL ANALYSIS Multilevel linear and logistic regression with multilevel weights were used to estimate associations between Hispanic/Latino immigrant segregation (low, medium, or high) with Alternate Healthy Eating Index 2010 score, and away-from-home food consumption (≥3 vs <3 times/week) in separate models, respectively. The mediating role of neighborhood poverty and whether or not associations differed by nativity were also assessed. RESULTS Higher levels of segregation were associated with higher adjusted mean Alternate Healthy Eating Index 2010 scores; estimates were further magnified after accounting for neighborhood poverty (low segregation: reference category; medium segregation: β = 2.43, 95% CI 1.10 to 3.77; and high segregation: β = 1.63, 95% CI .43 to 2.82). Associations were strongest among the foreign-born compared with the US-born. There was no association between segregation and away-from-home food consumption. CONCLUSIONS These results highlight the potential role of Hispanic/Latino immigrant neighborhoods in supporting healthy diets among residents, especially immigrants.
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Affiliation(s)
- Gabriela Vatavuk-Serrati
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jenny S Guadamuz
- University of Southern California School of Pharmacy, Los Angeles, California
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jana A Hirsch
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago, Illinois
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
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Guadamuz JS, Wang X, Ryals CA, Miksad RA, Snider J, Walters J, Calip GS. Socioeconomic status and inequities in treatment initiation and survival among patients with cancer, 2011-2022. JNCI Cancer Spectr 2023; 7:pkad058. [PMID: 37707536 PMCID: PMC10582690 DOI: 10.1093/jncics/pkad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. Most studies examining cancer inequities across area-level socioeconomic status tend to use less granular or unidimensional measures and pre-date the COVID-19 pandemic. Here, we examined the association of area-level socioeconomic status on real-world treatment initiation and overall survival among adults with 20 common cancers. METHODS This retrospective cohort study used electronic health record-derived deidentified data (Flatiron Health Research Database, 2011-2022) linked to US Census Bureau data from the American Community Survey (2015-2019). Area-level socioeconomic status quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their mailing address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type. RESULTS This cohort included 291 419 patients (47.7% female; median age = 68 years). Patients from low-SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) than those in high-SES areas. Living in low-SES areas (vs high) was associated with lower treatment rates (hazard ratio = 0.94 [95% confidence interval = 0.93 to 0.95]) and reduced survival (median real-world overall survival = 21.4 vs 29.5 months, hazard ratio = 1.20 [95% confidence interval = 1.18 to 1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-level socioeconomic inequities in treatment and survival remained statistically significant in the COVID-19 era (after March 2020). CONCLUSION To reduce inequities in cancer outcomes, efforts that target marginalized, low-socioeconomic status neighborhoods are necessary.
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Affiliation(s)
- Jenny S Guadamuz
- Flatiron Health, New York, NY, USA
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, CA, USA
- Program on Medicines and Public Health, University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | | | | | - Rebecca A Miksad
- Flatiron Health, New York, NY, USA
- Department of Hematology and Oncology, Boston University School of Medicine, Boston, MA, USA
| | | | | | - Gregory S Calip
- Flatiron Health, New York, NY, USA
- Program on Medicines and Public Health, University of Southern California School of Pharmacy, Los Angeles, CA, USA
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Pittell H, Calip GS, Pierre A, Ryals CA, Altomare I, Royce TJ, Guadamuz JS. Racial and Ethnic Inequities in US Oncology Clinical Trial Participation From 2017 to 2022. JAMA Netw Open 2023; 6:e2322515. [PMID: 37477920 PMCID: PMC10362465 DOI: 10.1001/jamanetworkopen.2023.22515] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023] Open
Abstract
Importance There is increasing recognition from regulatory agencies that racial and ethnic representation in clinical trials is inadequate and linked to health inequities. The extent of racial inequities in clinical trial participation is unclear because prior studies have synthesized enrollment data from published trials, which often do not report participant race and ethnicity. Objective To evaluate racial and ethnic inequities in oncology clinical trial participation in a contemporary cohort of patients with cancer before and during the COVID-19 pandemic. Design, Setting, and Participants This cohort study used a nationwide electronic health record-derived deidentified database, which includes data for approximately 280 US cancer clinics (approximately 800 sites of care). The study included Latinx, non-Latinx Black (hereinafter, Black), and non-Latinx White (reference; hereinafter, White) patients aged 18 years or older who had been diagnosed with advanced non-small cell lung cancer, metastatic colorectal cancer, metastatic breast cancer, multiple myeloma, or metastatic pancreatic cancer between January 1, 2017, and June 30, 2022 (follow-up through December 31, 2022). Data analysis was performed between August 1, 2022, and February 7, 2023. Exposures Electronic health record-documented race and ethnicity. Main Outcomes and Measures The main outcome was oncology trial participation (ie, receipt of a clinical study drug). Stratified cause-specific hazard models were used to estimate adjusted hazard ratios (HRs) and 95% CIs for likelihood of participation. Participation was assessed overall, by cancer type, and by period of diagnosis (2017-2019 vs 2020-2022). Results Of the 50 411 patients in this study, 28 878 (57.3%) were women and 21 533 (42.7%) were men. Black and Latinx patients were younger than White patients, with a median age of 65 (IQR, 57-72), 64 (IQR, 54-73), and 68 (IQR, 60-76) years, respectively. Oncology trial participation was lower among Black patients (307 of 6912 [4.4%]) and Latinx patients (166 of 3973 [4.2%]) relative to White patients (2858 of 39 526 [7.2%]) over the entire study period. Inequities in participation were observed across the 5 cancer types studied, with notably large inequities observed among Black patients (HR, 0.54 [95% CI, 0.36-0.81]) and Latinx patients (HR, 0.46 [95% CI, 0.27-0.77]) with metastatic pancreatic cancer. Moreover, inequities between Black and White patients in terms of participation widened among those diagnosed in the COVID-19 era (2020-2022: HR, 0.49 [95% CI, 0.40-0.60] vs 1.00 [95% CI, 0.93-1.09]) relative to those diagnosed before the pandemic (2017-2019: HR, 0.61 [95% CI, 0.53-0.70] vs 1 [reference]). Conclusions and Relevance The findings of this cohort study suggest that oncology trial participation was lower among Black and Latinx patients relative to White patients across all 5 cancer types examined. These findings, including potentially widening inequities in the COVID-19 era, support the need for regulatory guidance to improve enrollment of participants from historically excluded racial and ethnic populations in clinical trials.
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Affiliation(s)
| | - Gregory S. Calip
- Flatiron Health Inc, New York, New York
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois Chicago, Chicago
| | - Amy Pierre
- Flatiron Health Inc, New York, New York
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Trevor J. Royce
- Flatiron Health Inc, New York, New York
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jenny S. Guadamuz
- Flatiron Health Inc, New York, New York
- Program on Medicines and Public Health, School of Pharmacy, University of Southern California, Los Angeles
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Guadamuz JS, Qato DM. Citizenship status and cost-related nonadherence in the United States, 2017-2021. Health Serv Res 2023. [PMID: 37259490 DOI: 10.1111/1475-6773.14185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To assess inequities in prescription medication use and subsequent cost-related nonadherence (CRN) and cost-saving strategies by citizenship status in the United States. DATA SOURCES/STUDY SETTING National Health Interview Survey (2017-2021). STUDY DESIGN This cross-sectional study examined noncitizen (n = 8596), naturalized citizen (n = 12,800), and US-born citizen (n = 120,195) adults. We also examined older adults (≥65 years) separately, including noncitizens without Medicare (a group of importance given their immigration-related barriers to health care access). Multiple mediation analysis was used to examine differences in CRN and determine whether economic, health care, and immigration factors explain observed inequities. PRINCIPAL FINDINGS Noncitizens (41.9%) were less likely to use prescription medications than naturalized (60.5%) and US-born citizens (68.2%). Among prescription medication users, noncitizens (13.8%) were more likely to report CRN than naturalized (9.5%) and US-born citizens (11.0%). CRN differences between noncitizens and naturalized citizens (OR 1.38, 95% CI 1.21-1.44) and between noncitizens and US-born citizens (OR 1.23, 95% CI 1.07-1.35) were explained by insurance status and food insecurity. Only 4.9% of medication users turned to alternative therapies to lower their drug costs, but there were no substantial differences across citizenship status. More medication users requested lower-cost prescriptions (19.0%); however, noncitizens were less likely to make these requests. Older noncitizens without Medicare, of whom 23.9% requested lower-cost drugs, were an exception. Noncitizens (5.8%), particularly older noncitizens without Medicare (21.8%), were more likely to import their drugs than naturalized (3.5%) and US-born citizens (1.2%). CONCLUSIONS Noncitizens experience a high burden of cost-related barriers to prescription medications. Efforts to reduce these inequities should focus on dismantling health care and food access barriers, regardless of citizenship status.
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Affiliation(s)
- Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
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Kaur M, Parrinello CM, Guadamuz JS, Royce TJ, Calip GS. Abstract 805: Association of state-level COVID-19 mortality rates with real-world progression and real-world overall survival among patients with advanced non-small cell lung cancer, 2020-2022. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: The COVID-19 pandemic impacted the delivery of cancer care and outcomes in the United States (US). We examined the association between time-varying state-level weekly COVID-19 mortality and progression-free survival (rwPFS), time to progression (rwTTP), and survival (rwOS) among pts with advanced non-small cell lung cancer (advNSCLC).
Methods: This retrospective study used the nationwide Flatiron Health electronic health record-derived de-identified database. The cohort included community oncology pts diagnosed with advNSCLC between March 1, 2020 and December 31, 2021 (follow-up through March 30, 2022). We extracted US data on COVID-19 deaths from the COVID-19 Data Repository by the Center for Systems Science and Engineering at Johns Hopkins University. We calculated state-level weekly COVID-19 death rates as weekly COVID-19 deaths per state population size from the 2019 American Community Survey. We categorized rates into quintiles based on all weekly rates during the observation period. Analyses were restricted to treated pts and indexed to start of first-line therapy. For rwPFS analyses, first occurrence of progression or death was considered an event, and pts were censored at last clinic note date. For rwTTP, only progression (not death) was considered an event, and pts with no event were censored at last clinic note date. For rwOS analyses, pts who did not die were censored at last structured activity. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between weekly time-varying state-level COVID-19 mortality rates and outcomes of rwPFS, rwTTP, and rwOS, adjusted for age at diagnosis, race/ethnicity, and state.
Results: Among 7,813 advNSCLC pts, the median age at diagnosis was 70 years, the majority of the cohort was non-Hispanic White (59%), had non-squamous cell histology (68%) and a history of smoking (87%). Compared to pts living in states with the lowest quintile of COVID-19 mortality rates (Q1), pts living in states with the highest COVID-19 mortality (Q5) had worse rwOS (Q5 vs. Q1: HR 1.46, 95% CI 1.26-1.69) and rwPFS (Q5 vs. Q1: HR 1.18, 95% CI 1.05-1.33). No association was observed with rwTTP (Q5 vs. Q1: HR 1.05, 95% CI 0.90-1.22).
Conclusion: In this study of real-world oncology data, we demonstrated the use of publicly-available COVID-19 mortality data to measure the time-varying impact of COVID-19 severity on outcomes in pts with advNSCLC. Higher state-level COVID-19 mortality rates were associated with worse rwOS and rwPFS among advNSCLC pts. The association with increased mortality among pts with advNSCLC may be related to COVID-19-related mortality or other factors such as pre-existing comorbidities which were not explored in this study.
Citation Format: Maneet Kaur, Christina M. Parrinello, Jenny S. Guadamuz, Trevor J. Royce, Gregory S. Calip. Association of state-level COVID-19 mortality rates with real-world progression and real-world overall survival among patients with advanced non-small cell lung cancer, 2020-2022 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 805.
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Calip GS, Altomare IP, Guadamuz JS. Evaluating External Validity of Oncology Biosimilar Safety Studies. JAMA Netw Open 2023; 6:e235776. [PMID: 37022693 DOI: 10.1001/jamanetworkopen.2023.5776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Gregory S Calip
- Flatiron Health, New York, New York
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois Chicago, Chicago
| | | | - Jenny S Guadamuz
- Flatiron Health, New York, New York
- School of Pharmacy, Program on Medicines and Public Health, University of Southern California, Los Angeles
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Holt HK, Peterson CE, MacLaughlan David S, Abdelaziz A, Sawaya GF, Guadamuz JS, Calip GS. Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status. JAMA Netw Open 2023; 6:e232985. [PMID: 36897588 PMCID: PMC10726717 DOI: 10.1001/jamanetworkopen.2023.2985] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Importance Black and Hispanic or Latina women are more likely than White women to receive a diagnosis of and to die of cervical cancer. Health insurance coverage is associated with diagnosis at an earlier stage of cervical cancer. Objective To evaluate the extent to which racial and ethnic differences in the diagnosis of advanced-stage cervical cancer are mediated by insurance status. Design, Setting, and Participants This retrospective, cross-sectional population-based study used data from the Surveillance, Epidemiology, and End Results (SEER) program on an analytic cohort of 23 942 women aged 21 to 64 years who received a diagnosis of cervical cancer between January 1, 2007, and December 31, 2016. Statistical analysis was performed from February 24, 2022, to January 18, 2023. Exposures Health inusurance status (private or Medicare insurance vs Medicaid or uninsured). Main Outcomes and Measures The primary outcome was a diagnosis of advanced-stage cervical cancer (regional or distant stage). Mediation analyses were performed to assess the proportion of observed racial and ethnic differences in the stage at diagnosis that were mediated by health insurance status. Results A total of 23 942 women (median age at diagnosis, 45 years [IQR, 37-54 years]; 12.9% were Black, 24.5% were Hispanic or Latina, and 52.9% were White) were included in the study. A total of 59.4% of the cohort had private or Medicare insurance. Compared with White women, patients of all other racial and ethnic groups had a lower proportion with a diagnosis of early-stage cervical cancer (localized) (American Indian or Alaska Native, 48.7%; Asian or Pacific Islander, 49.9%; Black, 41.7%; Hispanic or Latina, 51.6%; and White, 53.3%). A larger proportion of women with private or Medicare insurance compared with women with Medicaid or uninsured received a diagnosis of an early-stage cancer (57.8% [8082 of 13 964] vs 41.1% [3916 of 9528]). In models adjusting for age, year of diagnosis, histologic type, area-level socioeconomic status, and insurance status, Black women had higher odds of receiving a diagnosis of advanced-stage cervical cancer compared with White women (odds ratio, 1.18 [95% CI, 1.08-1.29]). Health insurance was associated with mediation of more than half (ranging from 51.3% [95% CI, 51.0%-51.6%] for Black women to 55.1% [95% CI, 53.9%-56.3%] for Hispanic or Latina women) the racial and ethnic inequities in the diagnosis of advanced-stage cervical cancer across all racial and ethnic minority groups compared with White women. Conclusions and Relevance This cross-sectional study of SEER data suggests that insurance status was a substantial mediator of racial and ethnic inequities in advanced-stage cervical cancer diagnoses. Expanding access to care and improving the quality of services rendered for uninsured patients and those covered by Medicaid may mitigate the known inequities in cervical cancer diagnosis and related outcomes.
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Affiliation(s)
- Hunter K Holt
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago
| | - Caryn E Peterson
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago
| | | | - Abdullah Abdelaziz
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago
| | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Jenny S Guadamuz
- Flatiron Health, New York, New York
- Program on Medicines and Public Health, University of Southern California, Los Angeles
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago
- Flatiron Health, New York, New York
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Haakenstad A, Yearwood JA, Fullman N, Bintz C, Bienhoff K, Weaver MR, Nandakumar V, LeGrand KE, Knight M, Abbafati C, Abbasi-Kangevari M, Abdoli A, Abeldaño Zuñiga RA, Adedeji IA, Adekanmbi V, Adetokunboh OO, Afzal MS, Afzal S, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmadi A, Ahmadi S, Ahmed A, Ahmed Rashid T, Aji B, Akande-Sholabi W, Alam K, Al Hamad H, Alhassan RK, Ali L, Alipour V, Aljunid SM, Ameyaw EK, Amin TT, Amu H, Amugsi DA, Ancuceanu R, Andrade PP, Anjum A, Arabloo J, Arab-Zozani M, Ariffin H, Arulappan J, Aryan Z, Ashraf T, Atnafu DD, Atreya A, Ausloos M, Avila-Burgos L, Ayano G, Ayanore MA, Azari S, Badiye AD, Baig AA, Bairwa M, Bakkannavar SM, Baliga S, Banik PC, Bärnighausen TW, Barra F, Barrow A, Basu S, Bayati M, Belete R, Bell AW, Bhagat DS, Bhagavathula AS, Bhardwaj P, Bhardwaj N, Bhaskar S, Bhattacharyya K, Bhurtyal A, Bhutta ZA, Bibi S, Bijani A, Bikbov B, Biondi A, Bolarinwa OA, Bonny A, Brenner H, Buonsenso D, Burkart K, Busse R, Butt ZA, Butt NS, Caetano dos Santos FL, Cahuana-Hurtado L, Cámera LA, Cárdenas R, Carneiro VLA, Catalá-López F, Chandan JS, Charan J, Chavan PP, Chen S, Chen S, Choudhari SG, Chowdhury EK, Chowdhury MAK, Cirillo M, Corso B, Dadras O, Dahlawi SMA, Dai X, Dandona L, Dandona R, Dangel WJ, Dávila-Cervantes CA, Davletov K, Deuba K, Dhimal M, Dhimal ML, Djalalinia S, Do HP, Doshmangir L, Duncan BB, Effiong A, Ehsani-Chimeh E, Elgendy IY, Elhadi M, El Sayed I, El Tantawi M, Erku DA, Eskandarieh S, Fares J, Farzadfar F, Ferrero S, Ferro Desideri L, Fischer F, Foigt NA, Foroutan M, Fukumoto T, Gaal PA, Gaihre S, Gardner WM, Garg T, Getachew Obsa A, Ghafourifard M, Ghashghaee A, Ghith N, Gilani SA, Gill PS, Goharinezhad S, Golechha M, Guadamuz JS, Guo Y, Gupta RD, Gupta R, Gupta VK, Gupta VB, Hamiduzzaman M, Hanif A, Haro JM, Hasaballah AI, Hasan MM, Hasan MT, Hashi A, Hay SI, Hayat K, Heidari M, Heidari G, Henry NJ, Herteliu C, Holla R, Hossain S, Hossain SJ, Hossain MBH, Hosseinzadeh M, Hostiuc S, Hoveidamanesh S, Hsieh VCR, Hu G, Huang J, Huda MM, Ifeagwu SC, Ikuta KS, Ilesanmi OS, Irvani SSN, Islam RM, Islam SMS, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Jahani MA, Jahanmehr N, Jain R, Jakovljevic M, Janodia MD, Jayapal SK, Jayaram S, Jha RP, Jonas JB, Joo T, Joseph N, Jürisson M, Kabir A, Kalankesh LR, Kalhor R, Kamath AM, Kamenov K, Kandel H, Kantar RS, Kapoor N, Karanikolos M, Katikireddi SV, Kavetskyy T, Kawakami N, Kayode GA, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khalilov R, Khammarnia M, Khan MN, Khan MAB, Khan M, Khezeli M, Kim MS, Kim YJ, Kisa S, Kisa A, Klymchuk V, Koly KN, Korzh O, Kosen S, Koul PA, Kuate Defo B, Kumar GA, Kusuma D, Kyu HH, Larsson AO, Lasrado S, Lee WC, Lee YH, Lee CB, Li S, Lucchetti G, Mahajan PB, Majeed A, Makki A, Malekzadeh R, Malik AA, Malta DC, Mansournia MA, Mantovani LG, Martinez-Valle A, Martins-Melo FR, Masoumi SZ, Mathur MR, Maude RJ, Maulik PK, McKee M, Mendoza W, Menezes RG, Mensah GA, Meretoja A, Meretoja TJ, Mestrovic T, Michalek IM, Mirrakhimov EM, Misganaw A, Misra S, Moazen B, Mohammadi M, Mohammed S, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moradi G, Moreira RS, Mosser JF, Mostafavi E, Mouodi S, Nagarajan AJ, Nagata C, Naghavi M, Nangia V, Narasimha Swamy S, Narayana AI, Nascimento BR, Nassereldine H, Nayak BP, Nazari J, Negoi I, Nepal S, Neupane Kandel S, Ngunjiri JW, Nguyen HLT, Nguyen CT, Ningrum DNA, Noubiap JJ, Oancea B, Oghenetega OB, Oh IH, Olagunju AT, Olakunde BO, Omar Bali A, Omer E, Onwujekwe OE, Otoiu A, Padubidri JR, Palladino R, Pana A, Panda-Jonas S, Pandi-Perumal SR, Pardhan S, Pasupula DK, Pathak PK, Patton GC, Pawar S, Pereira J, Pilania M, Piroozi B, Podder V, Pokhrel KN, Postma MJ, Prada SI, Quazi Syed Z, Rabiee N, Radhakrishnan RA, Rahman MM, Rahman M, Rahman M, Rahman MHU, Rahmani AM, Ranabhat CL, Rao CR, Rao SJ, Rasella D, Rawaf S, Rawaf DL, Rawal L, Renzaho AM, Reshmi B, Resnikoff S, Rezapour A, Riahi SM, Ripon RK, Sacco S, Sadeghi M, Saeed U, Sahebkar A, Sahiledengle B, Sahoo H, Sahu M, Salama JS, Salamati P, Samy AM, Sanabria J, Santric-Milicevic MM, Sathian B, Sawhney M, Schmidt MI, Seidu AA, Sepanlou SG, Seylani A, Shaikh MA, Sheikh A, Shetty A, Shigematsu M, Shiri R, Shivakumar KM, Shokri A, Singh JA, Sinha DN, Skryabin VY, Skryabina AA, Sofi-Mahmudi A, Sousa RARC, Stephens JH, Sun J, Szócska M, Tabarés-Seisdedos R, Tadbiri H, Tamiru AT, Thankappan KR, Topor-Madry R, Tovani-Palone MR, Tran MTN, Tran BX, Tripathi N, Tripathy JP, Troeger CE, Uezono DR, Ullah S, Ullah A, Unnikrishnan B, Vacante M, Valadan Tahbaz S, Valdez PR, Vasic M, Veroux M, Vervoort D, Violante FS, Vladimirov SK, Vlassov V, Vo B, Waheed Y, Wamai RG, Wang YP, Wang Y, Ward P, Wiangkham T, Yadav L, Yahyazadeh Jabbari SH, Yamagishi K, Yaya S, Yazdi-Feyzabadi V, Yi S, Yiğit V, Yonemoto N, Younis MZ, Yu C, Yunusa I, Zaman SB, Zastrozhin MS, Zhang ZJ, Zhong C, Zuniga YMH, Lim SS, Murray CJL, Lozano R. Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Glob Health 2022; 10:e1715-e1743. [PMID: 36209761 PMCID: PMC9666426 DOI: 10.1016/s2214-109x(22)00429-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/13/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. METHODS We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. FINDINGS Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9-21·3), as well as among the young (22·5, 19·9-24·7), working (17·2, 15·2-19·1), and post-working (15·1, 13·2-17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6-33·0) on average in low-SDI countries to 83·4 (82·4-84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4-89·0), working (33·8-82·8), and post-working (30·4-79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. INTERPRETATION Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. FUNDING Bill & Melinda Gates Foundation.
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Guadamuz JS, Shooshtari A, Qato DM. Global, regional and national trends in statin utilisation in high-income and low/middle-income countries, 2015-2020. BMJ Open 2022; 12:e061350. [PMID: 36691204 PMCID: PMC9462115 DOI: 10.1136/bmjopen-2022-061350] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Prior studies have reported inequitable global access to essential medicines for cardiovascular disease (CVD) prevention, especially statins. Here we examine recent trends and disparities in statin utilisation at the income group, regional and country levels. DESIGN Ecological study. Pharmaceutical sales data were used to examine statin utilisation in high-income counties (HICs) and low/middle-income countries (LMICs) from 2015 to 2020. Population estimates were obtained from the Global Burden of Disease. Fixed-effects panel regression analysis was used to examine associations between statin utilisation and country-level factors. SETTING Global, including 41 HICs and 50 LMICs. PARTICIPANTS Population older than 40 years of age. PRIMARY AND SECONDARY OUTCOME MEASURES Statin utilisation was measured using defined daily doses (DDDs) per 1000 population ≥40 years per day (TPD). RESULTS Globally, statin utilisation increased 24.7% from 54.7 DDDs/TPD in 2015 to 68.3 DDDs/TPD in 2020. However, regional and income group disparities persisted during this period. In 2020, statin utilisation was more than six times higher in HICs than LMICs (192.4 vs 28.4 DDDs/TPD, p<0.01). Substantial disparities were also observed between LMICs, ranging from 3.1 DDDs/TPD in West African nations to 225.0 DDDs/TPD in Lebanon in 2020. While statin utilisation increased in most LMICs between 2015 and 2020, several experienced declines in utilisation, most notably Venezuela (-85.1%, from 92.3 to 14.0 DDDs/TPD). In LMICs, every $100 increase in per capita health spending was associated with a 17% increase in statin utilisation, while every 10% increase in out-of-pocket health spending was associated with a 11% decline (both p<0.05). CONCLUSIONS Despite global increases in statin utilisation, there are substantial regional and country-level disparities between HICs and LMICs. To address global CVD disparities, policymakers should promote increased and equitable access to statins in LMICs.
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Affiliation(s)
- Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Andrew Shooshtari
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
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Guadamuz JS, Rohrer R, Mohyuddin GR, Chiu BCH, Patel PR, Sweiss K, Seymour E, Sborov D, Calip GS. Abstract 3669: Racial/ethnic disparities in treatment with bone-modifying agents among newly diagnosed multiple myeloma patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: There are racial/ethnic disparities in multiple myeloma (MM) treatment, including differences in the use of novel agents, stem cell transplantation, and supportive therapies such as bone-modifying agents (BMAs). BMAs reduce the frequency of fractures and skeletal-related pain, and some evidence suggests that more recently approved agents (i.e., denosumab) confer greater progression-free survival benefits than older agents (i.e., bisphosphonates). Here we describe disparities in the initiation of BMA use and uptake of denosumab among newly diagnosed MM patients by race/ethnicity.
Methods: We conducted a retrospective cohort study using the nationwide Flatiron Health electronic health record-derived de-identified database. This analysis included adults (≥ 18 years) newly diagnosed with MM between January 2018 and September 2021 who initiated first-line therapy. Patient demographics and clinical characteristics were determined using structured and unstructured data, curated via technology-enabled abstraction. Cumulative incidence functions accounting for competing risks were used to estimate the initiation of BMA use within 90 days before the start of first-line MM therapy and 30 days post. We used multivariable logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI) for differences in the receipt of denosumab versus bisphosphonates alone (zoledronic acid or pamidronate) among patients who initiated BMA use.
Results: Among 4460 newly diagnosed MM patients, 52% were White, 17% were Black, 7% were Latinx, and 2% were Asian. Overall, 2208 (50%) initiated BMA treatment, and utilization differed across racial/ethnic groups with higher rates observed among Asian (55%), White (51%), and Latinx (50%) patients compared to Black patients (44%) (P=0.023). Among patients that initiated BMAs, 53% received denosumab and 47% received bisphosphonates alone. Compared to White patients, Black (OR 1.06, 95% CI 0.83-1.36) and Asian (OR 0.82, 95% CI 0.44-1.53) patients had similar odds of receiving denosumab, whereas Latinx patients had significantly lower odds of receiving denosumab (OR 0.56, 95% CI 0.40-0.79).
Conclusion: Among newly diagnosed MM patients, approximately half initiated BMAs. Substantial racial/ethnic disparities exist. For example, Black patients were less likely to receive any BMAs, and, even when treated, Latinx patients were less likely to receive denosumab. Future research should determine whether these treatment disparities impact progression-free and overall survival in real-world MM data.
Citation Format: Jenny S. Guadamuz, Rebecca Rohrer, Ghulam Rehman Mohyuddin, Brian C.-H. Chiu, Pritesh R. Patel, Karen Sweiss, Erlene Seymour, Douglas Sborov, Gregory S. Calip. Racial/ethnic disparities in treatment with bone-modifying agents among newly diagnosed multiple myeloma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3669.
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Affiliation(s)
| | | | | | | | | | | | | | - Douglas Sborov
- 3University of Utah School of Medicine, Salt Lake City, UT
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Guadamuz JS, Wang X, Snider J, Walters J, Miksad RA, Calip GS. Abstract 3668: Socioeconomic disparities in healthcare utilization and overall survival among patients with cancer: Application of area-level socioeconomic status in a nationwide electronic health record-derived database. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: While lower socioeconomic status (SES) is associated with worse cancer outcomes, most electronic health records (EHRs) lack documentation of SES. Here we apply an area-level SES measure to an EHR-derived database to evaluate representativeness according to SES. We then examine socioeconomic disparities in the timeliness of healthcare utilization (biomarker testing and systemic treatment) and overall survival (OS) in 3 common cancers.
Methods: This retrospective study uses the nationwide Flatiron Health EHR-derived de-identified database of cancer patients who have clinical activity between January 2011-August 2021. Census block group data from the American Community Survey (2015-2019) was used to measure SES per the Yost Index (incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information). SES quintiles were determined from the US population and then applied to patients based on their residential addresses. Our database included 2,067,644 cancer patients from community practices. Patients with advanced non-small-cell lung cancer (aNSCLC, n=51,596), metastatic breast cancer (mBC, n=18,268), and multiple myeloma (MM, n=8,246) were sampled and followed from advanced, metastatic, or initial diagnosis date, respectively. Differences were evaluated using Χ2 tests for categorical variables and log-rank tests for Kaplan-Meier survivor functions.
Results: Compared to the US population, our database of cancer patients has a similar SES distribution (differences <3%), capturing cancer patients living in the most (Q1) and least affluent areas (Q5) of the country. Yet, among the 1.5% of cancer patients who participated in clinical trials, only 15.2% lived in the least affluent areas. aNSCLC and mBC patients living in the least affluent areas were less likely to receive biomarker testing within 30 days of index diagnosis than those in the most affluent areas (59.4% vs. 68.7%; 74.9% vs. 81.0%, both p<.01). Similar patterns were observed in receipt of systemic treatment within 60 days of index diagnosis (aNSCLC: 58.9% vs. 64.9%; mBC: 76.0% vs. 80.1%, both p<.01). No differences in healthcare utilization were observed among MM patients. Patients in the least affluent areas had lower median OS (months) than those in the most affluent areas (aNSCLC: 10.8 [95% CI: 10.4-11.3] vs. 12.2 [95% CI: 11.8-12.7]; mBC: 28.0 [95% CI: 26.6-29.5] vs. 34.5 [95% CI: 33.1-36.9], MM: 57.4 [95% CI: 53.5-61.5] vs. 67.5 [95% CI: 62.5-76.4]; all p<.01).
Conclusion: Lower SES was associated with reduced clinical trial participation, less timely healthcare utilization, and worse OS. Making SES available in real-world data can support the development of inclusive clinical trials and inform interventions to reduce cancer care disparities.
Citation Format: Jenny S. Guadamuz, Xiaoliang Wang, Jeremy Snider, James Walters, Rebecca A. Miksad, Gregory S. Calip. Socioeconomic disparities in healthcare utilization and overall survival among patients with cancer: Application of area-level socioeconomic status in a nationwide electronic health record-derived database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3668.
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Huang HC, Guadamuz JS, Hoskins KF, Ko NY, Calip GS. Abstract 3630: Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Breast cancer survivors have an increased risk of contralateral breast cancer (CBC), among whom minority breast cancer patients are at increased risk of this adverse outcome. Studies evaluating CBC risk by race/ethnicity frequently aggregate Asian/Pacific Islanders (API) into a single group or exclude them. The purpose of this study was to determine the impact of socioeconomic status (SES) on the risk of CBC among subgroups of API breast cancer survivors.
Method: We conducted a population-based retrospective cohort study of women ages 18+ years diagnosed with unilateral Stage I-III breast cancer using the Surveillance, Epidemiology and End Results Census Tract-level SES and Rurality Database (2000-2016). Women included in the study received cancer-directed surgery and the primary outcome of interest was asynchronous CBC occurring. SES was classified using the Yost index, a validated time-dependent composite score with the 1st quintile representing the lowest and 5th quintile being the highest SES. API women were categorized into Chinese, Japanese, Filipina, Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other Asian/Pacific Islanders. We determined overall associations between SES and the risk of CBC using Fine and Gray regression models accounting for competing risks comparing API women to Non-Hispanic White (NHW) women. Multivariable adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups.
Results: From a cohort of 44,362 API female breast cancer patients included, one quarter of the cohort were Filipina (25%), 18% were Chinese, 14% were Japanese, 8% were Indian/Pakistani, and 17% were other API. API women living in the lowest SES areas were more likely to be uninsured or have Medicaid coverage (21% vs. 6%) and have Stage lll first primary breast cancer (14% vs. 10%) compared to API women living in the highest SES areas. Overall, API breast cancer patients as an aggregate group did not have significantly increased risk of CBC compared to NHW patients. In stratified subgroups, risk estimates for CBC were higher among Chinese women (SHR 1.24, 95% CI 1.08-1.41), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Hawaiian women (SHR 1.67, 95% CI 1.37-2.08) when compared to NHW women after adjusting for demographics and baseline clinical characteristics. Lower SES was not associated with increased CBC risk among API women overall. However, the risk of CBC is significantly lower among Chinese and Vietnamese women and higher among Filipina women who lived in areas lower SES quintile compared to women who lived in area with the highest SES quintile when examining impact of SES within API subgroups.
Conclusion: Chinese, Filipina, and Hawaiian women have higher risk of CBC when compared to NHW. When disaggregated API women into subgroups, the impact of SES on the risk of CBC differs significantly across API subgroups.
Citation Format: Hsiao- Ching Huang, Jenny S. Guadamuz, Kent F. Hoskins, Naomi Y. Ko, Gregory S. Calip. Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3630.
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Huang HC, Smart MH, Zolekar A, Deng H, Hubbard CC, Hoskins KF, Ko NY, Guadamuz JS, Calip GS. Impact of socioeconomic status and rurality on cancer-specific survival among women with de novo metastatic breast cancer by race/ethnicity. Breast Cancer Res Treat 2022; 193:707-716. [PMID: 35460499 PMCID: PMC10224670 DOI: 10.1007/s10549-022-06603-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE There are approximately 150,000 women living with metastatic breast cancer (mBC) in the United States. Disparities in de novo mBC incidence and mortality exist across race/ethnicity, socioeconomic status (SES), and rurality. However, how SES and rurality independently impact mBC outcomes across different racial/ethnic groups is not fully understood. The purpose of this study was to determine the impact of SES and rurality on cancer-specific mortality among women with mBC by race/ethnicity. METHODS We conducted a large, population-based retrospective cohort study in women aged 18 + years diagnosed with de novo mBC using the Surveillance, Epidemiology and End Results Census Tract-level SES and Rurality Database (2000-2015). Associations between SES/rurality and cancer-specific mortality were determined using Fine and Gray regression models. Subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) by race/ethnicity and hormone receptor (HR) status were calculated. RESULTS A cohort of 33,976 women were included with the majority being White (67%), 17% Black, 0.4% American Indian/Alaskan Native, 6% Asian/Pacific Islander, and 10% Latina/Hispanic. We observed the greatest increased risk of BC mortality among Black women with HR-negative mBC residing in neighborhoods with lower SES (lowest versus highest quintile: SHR 1.38, 95% CI 1.00-1.90) and in rural areas compared to urban areas (SHR 1.27, 95% CI 1.01-1.59). CONCLUSION Overall, BC-specific survival among women with de novo mBC differs by race/ethnicity, with the greatest adverse impacts of SES and rurality affecting Black women with HR-negative disease.
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Affiliation(s)
- Hsiao-Ching Huang
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Mary H Smart
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Ashwini Zolekar
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Huiwen Deng
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Colin C Hubbard
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kent F Hoskins
- Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL, USA
| | - Naomi Y Ko
- Section of Hematology Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA.
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois Chicago, 833 South Wood Street, MC 871, Chicago, IL, 60612, USA.
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Guadamuz JS, Durazo-Arvizu RA, Morales JF, Qato DM. Citizenship Status and Mortality Among Young Latino Adults in the U.S., 1998‒2015. Am J Prev Med 2022; 62:777-781. [PMID: 35459453 DOI: 10.1016/j.amepre.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Although Latino immigrants, especially noncitizens, endure structural factors that may increase their risk of death at younger ages, little is known about their risk of death in young adulthood. This study evaluates mortality differences across citizenship status among young Latino adults (aged 18-44 years) in the U.S. METHODS This study used the National Health Interview Survey (1998-2014) with mortality follow-up through 2015. Cox regression models adjusted for age and sex were used to determine baseline differences in mortality. Models adjusted for socioeconomic factors (i.e., English proficiency, education, poverty, and health insurance) were used to determine whether socioeconomic conditions attenuate mortality differences. RESULTS Participants included noncitizens (n=48,388), naturalized citizens (n=16,241), and U.S.-born citizens (n=63,388). Noncitizens (hazard ratio [HR]=1.40, 95% CI=1.31, 1.51), but not naturalized citizens (HR=1.04, 95% CI=0.94, 1.16), were at greater risk of all-cause death than U.S.-born citizens. Both noncitizens (HR=2.46, 95% CI=2.07, 2.92) and naturalized citizens (HR=1.76, 95% CI=1.40, 2.21) were more likely to die of cancer. Noncitizens were also at a greater risk of death because of cardiometabolic diseases (HR=1.46, 95% CI=1.20, 1.78) and accidents (HR=1.33, 95% CI=1.14, 1.55). Socioeconomic factors attenuated differences in all-cause, cardiometabolic, and accidental deaths, but not differences in cancer mortality. CONCLUSIONS Contrary to the long-held notion of the healthy migrant, young Latino immigrants, especially noncitizens, are at increased risk of death than their U.S.-born counterparts. Efforts to reduce these disparities should focus on improving their socioeconomic conditions and healthcare access early in adulthood.
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Affiliation(s)
- Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California.
| | - Ramon A Durazo-Arvizu
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Josefina Flores Morales
- California Center for Population Research, University of California, Los Angeles, Los Angeles, California
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
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22
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Calip GS, Wadé NB, Guadamuz JS, Wang X, Miksad RA, Whitaker KD. Disparities in cardiovascular disease mortality after breast cancer treatment: Methodological considerations using real-world data. Cancer 2021; 128:647-650. [PMID: 34873685 DOI: 10.1002/cncr.34045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory S Calip
- Flatiron Health, New York, New York.,Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Niquelle Brown Wadé
- Flatiron Health, New York, New York.,Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jenny S Guadamuz
- Flatiron Health, New York, New York.,Program on Medicines and Public Health, School of Pharmacy, University of Southern California, Los Angeles, California
| | | | - Rebecca A Miksad
- Flatiron Health, New York, New York.,Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts
| | - Kristen D Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Guadamuz JS, Durazo R, Morales JF, Qato DM. Citizenship Status and Mortality Among Latinos: Analyses of the
US
National Health Interview Survey Linked Mortality Files. Health Serv Res 2021. [DOI: 10.1111/1475-6773.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | | | - Dima M. Qato
- University of Southern California Los Angeles USA
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Guadamuz JS, Alexander GC, Zenk SN, Kanter GP, Wilder JR, Qato DM. Access to pharmacies and pharmacy services in New York City, Los Angeles, Chicago, and Houston, 2015-2020. J Am Pharm Assoc (2003) 2021; 61:e32-e41. [PMID: 34366287 DOI: 10.1016/j.japh.2021.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the importance of pharmacies in ensuring medications and health care needs are met, there is limited up-to-date information regarding access to pharmacies or their services in the United States. OBJECTIVES To evaluate trends and disparities in access to pharmacies in 4 largest cities in the United States, New York City, Los Angeles, Houston, and Chicago, by neighborhood racial and ethnic composition from 2015 to 2020. METHODS Data from the National Council for Prescription Drug Programs (2015-2020) and the American Community Survey (2015-2019) were used. We examined neighborhoods (i.e., census tracts) and evaluated disparities in "pharmacy deserts" (low-income neighborhoods (1) whose average distance to the nearest pharmacy was at least 1 mile or (2) whose average distance to the nearest pharmacy was at least 0.5 mile and at least 100 households had no vehicle access). We also evaluated the differences in pharmacy closures and the availability of pharmacy services. RESULTS From 2015 to 2020, the percent of neighborhoods with pharmacy deserts declined in New York City (from 1.6% to 0.9% of neighborhoods, P < 0.01), remained stable in Los Angeles (13.7% to 13.4%, P = 0.58) and Houston (27.0% to 28.5%, P = 0.18), and increased in Chicago (15.0% to 19.9%, P < 0.01). Pharmacy deserts were persistently more common in Black and Latino neighborhoods in all 4 cities. As of 2020, pharmacies in Black and Latino neighborhoods were also more likely to close and less likely to offer immunization, 24-hour, and drive-through services than pharmacies in other neighborhoods. CONCLUSION To reduce disparities in access to medications and health care services, including those in response to the coronavirus disease 2019 pandemic (e.g., testing and vaccinations), policies that improve pharmacy access and expand the provision of pharmacy services in minority neighborhoods are critical.
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Guadamuz JS, Wilder JR, Mouslim MC, Zenk SN, Alexander GC, Qato DM. Fewer Pharmacies In Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007-15. Health Aff (Millwood) 2021; 40:802-811. [PMID: 33939507 DOI: 10.1377/hlthaff.2020.01699] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The accessibility of pharmacies may be an overlooked contributor to persistent racial and ethnic disparities in the use of prescription medications and essential health care services within urban areas in the US. We examined the availability and geographic accessibility of pharmacies across neighborhoods based on their racial/ethnic composition in the thirty most populous US cities. In all cities examined, we found persistently fewer pharmacies located in Black and Hispanic/Latino neighborhoods than White or diverse neighborhoods throughout 2007-15. In 2015 there were disproportionately more pharmacy deserts in Black or Hispanic/Latino neighborhoods than in White or diverse neighborhoods, including those that are not federally designated Medically Underserved Areas. These disparities were most pronounced in Chicago, Illinois; Los Angeles, California; Baltimore, Maryland; Philadelphia, Pennsylvania; Milwaukee, Wisconsin; Dallas, Texas; Boston, Massachusetts; and Albuquerque, New Mexico. We also found that Black and Hispanic/Latino neighborhoods were more likely to experience pharmacy closures compared with other neighborhoods. Our findings suggest that efforts to increase access to medications and essential health care services, including in response to COVID-19, should consider policies that ensure equitable pharmacy accessibility across neighborhoods in US cities. Such efforts could include policies that encourage pharmacies to locate in pharmacy deserts, including increases to Medicaid and Medicare reimbursement rates for pharmacies most at risk for closure.
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Affiliation(s)
- Jenny S Guadamuz
- Jenny S. Guadamuz is a postdoctoral fellow in the Program on Medicines and Public Health in the Titus Family Department of Clinical Pharmacy and the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California School of Pharmacy, in Los Angeles, California
| | - Jocelyn R Wilder
- Jocelyn R. Wilder is a PhD candidate in the Department of Epidemiology, University of Illinois at Chicago, in Chicago, Illinois
| | - Morgane C Mouslim
- Morgane C. Mouslim is a policy analyst at the Hilltop Insititute, University of Maryland Baltimore County, in Baltimore, Maryland
| | - Shannon N Zenk
- Shannon N. Zenk is director of the National Institute of Nursing Research, National Institutes of Health, in Bethesda, Maryland. She was a professor in the Department of Population Health Nursing Science, University of Illinois at Chicago, when this work was conducted
| | - G Caleb Alexander
- G. Caleb Alexander is a professor in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and codirector of the school's Center for Drug Safety and Effectiveness, in Baltimore, Maryland
| | - Dima Mazen Qato
- Dima Mazen Qato is an associate professor at the University of Southern California School of Pharmacy, senior fellow at the Leonard D. Schaeffer Center for Health Policy and Economics, and director of the school's Program on Medicines and Public Health
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Guadamuz JS, Kapoor K, Lazo M, Eleazar A, Yahya T, Kanaya AM, Cainzos-Achirica M, Bilal U. Understanding Immigration as a Social Determinant of Health: Cardiovascular Disease in Hispanics/Latinos and South Asians in the United States. Curr Atheroscler Rep 2021; 23:25. [PMID: 33772650 PMCID: PMC8164823 DOI: 10.1007/s11883-021-00920-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The main purpose of this review is to summarize the epidemiology of cardiovascular disease and its risk factors among two of the largest and most diverse immigrant groups in the United States (Hispanics/Latinos and South Asians). RECENT FINDINGS While the migration process generates unique challenges for individuals, there is a wide heterogeneity in the characteristics of immigrant populations, both between and within regions of origin. Hispanic/Latino immigrants to the United States have lower levels of cardiovascular risk factors, prevalence, and mortality, but this assessment is limited by issues related to the "salmon bias." South Asian immigrants to the United States generally have higher levels of risk factors and higher mortality. In both cases, levels of risk factors and mortality generally increase with time of living in the United States (US). While immigration acts as a social determinant of health, associations between immigration and cardiovascular disease and its risk factors are complex and vary across subpopulations.
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Affiliation(s)
- Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
- Centre de Recherche Politiques et Systèmes de Santé, Université Libre de Bruxelles Ecole de Santé Publique, Brussels, Belgium
| | - Karan Kapoor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mariana Lazo
- Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea Eleazar
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
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Guadamuz JS, McCormick CD, Choi S, Urick B, Alexander GC, Qato DM. Telepharmacy and medication adherence in urban areas. J Am Pharm Assoc (2003) 2021; 61:e100-e113. [DOI: 10.1016/j.japh.2020.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 01/16/2023]
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Affiliation(s)
- Jenny S Guadamuz
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy
| | - Dima M Qato
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Guadamuz JS, Durazo-Arvizu RA, Daviglus ML, Perreira KM, Calip GS, Nutescu EA, Gallo LC, Castaneda SF, Gonzalez F, Qato DM. Immigration Status and Disparities in the Treatment of Cardiovascular Disease Risk Factors in the Hispanic Community Health Study/Study of Latinos (Visit 2, 2014-2017). Am J Public Health 2020; 110:1397-1404. [PMID: 32673107 DOI: 10.2105/ajph.2020.305745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate treatment rates of high cholesterol, hypertension, and diabetes among Hispanic/Latino immigrants by immigration status (i.e., naturalized citizens, documented immigrants, or undocumented immigrants).Methods. We performed a cross-sectional analyses of the Hispanic Community Health Study/Study of Latinos (visit 2, 2014-2017). We restricted our analysis to Hispanic/Latino immigrants with high cholesterol (n = 3974), hypertension (n = 3353), or diabetes (n = 2406); treatment was defined as use of statins, antihypertensives, and antidiabetics, respectively.Results. When compared with naturalized citizens, undocumented and documented immigrants were less likely to receive treatment for high cholesterol (38.4% vs 14.1%; prevalence ratio [PR] = 0.37 [95% confidence interval [CI] = 0.27, 0.51] and 25.7%; PR = 0.67 [95% CI = 0.58, 0.76]), hypertension (77.7% vs 57.7%; PR = 0.74 [95% CI = 0.62, 0.89] and 68.1%; PR = 0.88 [95% CI = 0.82, 0.94]), and diabetes (60.3% vs. 50.4%; PR = 0.84 [95% CI = 0.68, 1.02] and 55.8%; PR = 0.93 [95% CI = 0.83, 1.03]); the latter did not reach statistical significance. Undocumented and documented immigrants had less access to health care, including insurance coverage or a usual health care provider, than naturalized citizens. Therefore, adjusting for health care access largely explained treatment disparities across immigration status.Conclusions. Preventing cardiovascular disease among Hispanic/Latino immigrants should focus on undertreatment of high cholesterol, hypertension, and diabetes by increasing health care access, especially among undocumented immigrants.
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Affiliation(s)
- Jenny S Guadamuz
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Ramon A Durazo-Arvizu
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Martha L Daviglus
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Krista M Perreira
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Gregory S Calip
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Edith A Nutescu
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Linda C Gallo
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Sheila F Castaneda
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Franklyn Gonzalez
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
| | - Dima M Qato
- Jenny S. Guadamuz and Martha L. Daviglus are with the Institute for Minority Health Research at the University of Illinois at Chicago. Gregory S. Calip, Edith A. Nutescu, and Dima M. Qato are with the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago. Ramon A. Durazo-Arvizu is with the Department of Public Health Sciences, Loyola University Chicago, Chicago, IL. Krista M. Perreira is with the Department of Social Medicine at the University of North Carolina at Chapel Hill. Linda C. Gallo and Sheila F. Castaneda are with the Department of Psychology, San Diego State University, San Diego, CA. Franklyn Gonzalez II is with the Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill
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Qato DM, Alexander GC, Guadamuz JS, Choi S, Trotzky-Sirr R, Lindau ST. Pharmacist-Prescribed And Over-The-Counter Hormonal Contraception In Los Angeles County Retail Pharmacies. Health Aff (Millwood) 2020; 39:1219-1228. [DOI: 10.1377/hlthaff.2019.01686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dima Mazen Qato
- Dima Mazen Qato is an associate professor in the Department of Pharmacy Systems, Outcomes, and Policy at the University of Illinois at Chicago, in Chicago, Illinois
| | - G. Caleb Alexander
- G. Caleb Alexander is a professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health and codirector of the school’s Center for Drug Safety and Effectiveness, in Baltimore, Maryland
| | - Jenny S. Guadamuz
- Jenny S. Guadamuz is a research fellow in the Institute for Minority Health Research at the University of Illinois at Chicago
| | - Sun Choi
- Sun Choi is a pharmacy student at the University of Illinois at Chicago
| | - Rebecca Trotzky-Sirr
- Rebecca Trotzky-Sirr is an assistant professor in the Department of Emergency Medicine at the University of Southern California, in Los Angeles, California
| | - Stacy Tessler Lindau
- Stacy Tessler Lindau is a professor in the Departments of Obstetrics and Gynecology and of Medicine-Geriatrics and director of the Program in Integrative Sexual Medicine at the University of Chicago, in Chicago, Illinois
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Guadamuz JS, Durazo-Arvizu RA, Daviglus ML, Calip GS, Nutescu EA, Qato DM. Citizenship Status and the Prevalence, Treatment, and Control of Cardiovascular Disease Risk Factors Among Adults in the United States, 2011-2016. Circ Cardiovasc Qual Outcomes 2020; 13:e006215. [PMID: 32151148 PMCID: PMC7100997 DOI: 10.1161/circoutcomes.119.006215] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jenny S. Guadamuz
- Department of Pharmacy Systems, Outcomes and Policy,
University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
- Institute of Minority Health Research, University of
Illinois at Chicago College of Medicine, Chicago, Illinois
- Centre de Recherche Politiques et Systèmes de
Santé, Université Libre de Bruxelles Ecole de Santé Publique,
Brussels, Belgium
| | | | - Martha L. Daviglus
- Institute of Minority Health Research, University of
Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes and Policy,
University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic
Research, University of Illinois at Chicago College of Pharmacy, Chicago,
Illinois
- Division of Public Health Sciences, Epidemiology Program,
Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Edith A. Nutescu
- Department of Pharmacy Systems, Outcomes and Policy,
University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic
Research, University of Illinois at Chicago College of Pharmacy, Chicago,
Illinois
- Department of Pharmacy Practice, University of Illinois at
Chicago College of Pharmacy, Chicago, Illinois
| | - Dima M Qato
- Department of Pharmacy Systems, Outcomes and Policy,
University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
- Division of Epidemiology and Biostatistics, University of
Illinois at Chicago School of Public Health, Chicago, Illinois
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32
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Abstract
This quality improvement study examines trends in pharmacy closures in the United States between 2009 and 2015, as well as pharmacy, community, and market factors that might be associated with such closures.
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Affiliation(s)
- Jenny S Guadamuz
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shannon N Zenk
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago
| | - Dima M Qato
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago
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Guadamuz JS, Ozenberger K, Qato DM, Ko NY, Saffore CD, Adimadhyam S, Cha AS, Moran KM, Sweiss K, Patel PR, Chiu BCH, Calip GS. Mediation analyses of socioeconomic factors determining racial differences in the treatment of diffuse large B-cell lymphoma in a cohort of older adults. Medicine (Baltimore) 2019; 98:e17960. [PMID: 31725657 PMCID: PMC6867777 DOI: 10.1097/md.0000000000017960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Despite near universal health coverage under Medicare, racial disparities persist in the treatment of diffuse large B-cell lymphoma (DLBCL) among older patients in the United States. Studies evaluating DLBCL outcomes often treat socioeconomic status (SES) measures as confounders, potentially introducing biases when SES factors are mediators of disparities in cancer treatment.To examine differences in DLBCL treatment, we performed causal mediation analyses of SES measures, including: metropolitan statistical area (MSA) of residence; census-tract poverty level; and private Medicare supplementation using the Surveillance, Epidemiology and End Results-Medicare linked database between 2001 and 2011. In this retrospective cohort study of DLBCL patients ages 66+ years, we conducted a series of multivariable logistic regression analyses estimating odds ratios (OR) and 95% confidence intervals (CI) relating chemo- and/or immuno-therapy treatment and each SES measure, comparing non-Hispanic (NH)-black, Hispanic/Latino, and Asian/Pacific Islander (API) to NH-white patients.Compared to NH-white patients, racial/ethnic minority patients had lower odds of receiving chemo- and/or immuno-therapy treatment (NH-black: OR 0.84, 95% CI 0.65, 1.08; API: OR 0.80, 95% CI 0.64, 1.01; Hispanic/Latino: OR 0.78, 95% CI 0.64, 0.96) and higher odds of lacking private Medicare supplementation and residence within an urban MSA and poor census tracts. Adjustment for SES measures as confounders nullified observed racial differences. In causal mediation analyses, between 31% and 38% of race/ethnicity differences were mediated by having private Medicare supplementation.Providing equitable access to Medicare supplementation may reduce disparities in receipt of chemo- and/or immuno-therapy treatment in older DLBCL patients.
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Affiliation(s)
- Jenny S. Guadamuz
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
- Institute of Minority of Health Research, University of Illinois at Chicago
| | - Katharine Ozenberger
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
| | - Dima M. Qato
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
- Division of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL
| | - Naomi Y. Ko
- Section of Hematology Oncology, Boston University School of Medicine, Boston, MA
| | | | - Sruthi Adimadhyam
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
| | - Ashley S. Cha
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
| | - Kellyn M. Moran
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
| | - Karen Sweiss
- Department of Pharmacy Practice, University of Illinois at Chicago
| | - Pritesh R. Patel
- Division of Hematology Oncology, University of Illinois at Chicago
| | - Brian C.-H. Chiu
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
- Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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Abstract
IMPORTANCE Despite the increasingly important role of pharmacies in the implementation of naloxone access laws, there is limited information on the impact of such laws at the local level. OBJECTIVE To evaluate the availability (with or without a prescription) and cost of naloxone nasal spray at pharmacies in Philadelphia, Pennsylvania, following a statewide standing order enacted in Pennsylvania in August 2015 to allow pharmacies to dispense naloxone without a prescription. DESIGN, SETTING, AND PARTICIPANTS A survey study was conducted by telephone of all pharmacies in Philadelphia between February and August 2017. Pharmacies were geocoded and linked with the American Community Survey (2011-2015) to obtain information on the demographic characteristics of census tracts and the Medical Examiner's Office of the Philadelphia Department of Public Health to derive information on the number of opioid overdose deaths per 100 000 people for each planning district. Data were analyzed from March 2018 to February 2019. MAIN OUTCOMES AND MEASURES Availability and out-of-pocket cost of naloxone nasal spray (with or without a prescription) at Philadelphia pharmacies overall and by pharmacy and neighborhood characteristics. RESULTS Of 454 eligible pharmacies, 418 were surveyed (92.1% response rate). One in 3 pharmacies (34.2%) had naloxone nasal spray in stock; of these, 61.5% indicated it was available without a prescription. There were significant differences in the availability of naloxone by pharmacy type and neighborhood characteristics. Naloxone was both more likely to be in stock (45.9% vs 27.8%; difference, 18.0%; 95% CI, 8.3%-27.8%; P < .001) and available without a prescription (80.6% vs 42.2%; difference, 38.4%; 95% CI, 23.0%-53.8%; P < .001) in chain stores than in independent stores. Naloxone was also less likely to be available in planning districts with very elevated rates of opioid overdose death (≥50 per 100 000 people) compared with those with lower rates (31.1% vs 38.5%). The median (interquartile range) out-of-pocket cost among pharmacies offering naloxone without a prescription was $145 ($119-$150); costs were greatest in independent pharmacies and planning districts with elevated rates of opioid overdose death. CONCLUSIONS AND RELEVANCE Despite the implementation of a statewide standing order in Pennsylvania more than 3 years prior to this study, only one-third of Philadelphia pharmacies carried naloxone nasal spray and many also required a physician's prescription. Efforts to strengthen the implementation of naloxone access laws and better ensure naloxone supply at local pharmacies are warranted, especially in localities with the highest rates of overdose death.
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Affiliation(s)
- Jenny S. Guadamuz
- Institute of Minority Health Research, College of Medicine, University of Illinois at Chicago
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
| | - G. Caleb Alexander
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Center for Drug Safety and Effectiveness, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Tanya Chaudhri
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
| | - Rebecca Trotzky-Sirr
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Los Angeles County Department of Health Services, Los Angeles, California
| | - Dima M. Qato
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
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Abstract
IMPORTANCE It is unknown whether and how pharmacy closures alter medication adherence. OBJECTIVE To examine the association between pharmacy closures and adherence to statins, β-blockers, and oral anticoagulants among adults 50 years or older in the United States. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, comparative interrupted time series analyses were performed using a nationally representative 5% random sample of anonymized, longitudinal, individual-level pharmacy claims from IQVIA LRx LifeLink. Analyses included all prescription claims for individuals followed up between January 1, 2011, and December 31, 2016. Separate cohorts were derived for users of statins, β-blockers, and oral anticoagulants. The differential association of pharmacy closure was examined as a function of baseline adherence, pharmacy, and individual characteristics. MAIN OUTCOMES AND MEASURES Difference in monthly adherence, measured as proportion of days covered, during 12-month baseline and follow-up periods among patients using a pharmacy that subsequently closed (closure cohort) compared with their counterparts (control cohort). RESULTS Among 3 089 803 individuals filling at least 1 statin prescription between January 1, 2011, and December 31, 2016 (mean [SD] age, 66.3 [9.3] years; 52.0% female), 3.0% (n = 92 287) filled at a pharmacy that subsequently closed. Before closure, monthly adherence was similar in the closure and control cohorts (mean [SD], 70.5% [26.7%] vs 70.7% [26.5%]). In multivariable models, individuals filling at pharmacies that closed experienced an immediate and significant decline (on average, an absolute change of -5.90%; 95% CI, -6.12% to -5.69%) in statin adherence during the first 3 months after closure compared with their counterparts. This difference persisted over 12 months of follow-up. A similar decline in adherence was observed when examining cohorts using β-blockers (-5.71%; 95% CI, -5.96% to -5.46%) or oral anticoagulants (-5.63%; 95% CI, -6.24% to -5.01%). The mean association of pharmacy closure with adherence was greater among individuals using independent pharmacies (-7.89%; 95% CI, -8.32% to -7.47%) or living in neighborhoods with fewer pharmacies (-7.98%; 95% CI, -8.50% to -7.47%) compared with their counterparts. CONCLUSIONS AND RELEVANCE Pharmacy closures are associated with persistent, clinically significant declines in adherence to cardiovascular medications among older adults in the United States. Efforts to reduce nonadherence to prescription medications should consider the role of pharmacy closures, especially among patients at highest risk.
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Affiliation(s)
- Dima M. Qato
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
| | - G. Caleb Alexander
- Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Apurba Chakraborty
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
| | - Jenny S. Guadamuz
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
- Institute of Minority Health Research, College of Medicine, University of Illinois at Chicago
| | - John W. Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Qato DM, Alexander GC, Guadamuz JS, Lindau ST. Prescription Medication Use Among Children and Adolescents in the United States. Pediatrics 2018; 142:peds.2018-1042. [PMID: 30150214 DOI: 10.1542/peds.2018-1042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Information on the use of prescription medications among children and adolescents in the United States is lacking. We estimate the prevalence of prescription medication use, concurrent use, and potential major drug-drug interactions (DDIs) in this population. METHODS We conducted descriptive analyses using nationally representative data for people ≤19 years old from NHANES. Data were derived from a medication log administered by direct observation during in-home interviews. Acute medications were used for ≤30 days. Concurrent use was defined as use of ≥2 prescription medications. Micromedex was used to identify potentially major DDIs. RESULTS During 2013-2014, 19.8% of children and adolescents used at least 1 prescription medication, and 7.1% used acute medications. Concurrent use of prescription medications was 7.5% overall and was highest among boys 6 to 12 years old (12%) and among boys and girls ages 13 to 19 years old (10% for both). Using pooled 2009-2014 data, we found that 8.2% of concurrent users of prescription medications were at risk for a potentially major DDI. The vast majority of interacting regimens involved antidepressants and were more common among adolescent girls than boys (18.1% vs 6.6%; P < .05), driven largely by greater rates of use of acute medications. CONCLUSIONS Many US children and adolescents use prescription medications with nearly 1 in 12 concurrent users of prescription medications potentially at risk for a major DDI. Efforts to prevent adverse drug events in children and adolescents should consider the role of interacting drug combinations, especially among adolescent girls.
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Affiliation(s)
- Dima M Qato
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy and .,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - G Caleb Alexander
- Department of Epidemiology and.,Center for Drug Safety and Effectiveness, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
| | - Jenny S Guadamuz
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy and
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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Abstract
This study uses NHANES data to estimate the prevalence of dietary supplement use, including both nutritional products and alternative medicines, among US children and adolescents between 2003 and 2014.
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Affiliation(s)
- Dima M. Qato
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago,Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago
| | - G. Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jenny S. Guadamuz
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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