1
|
Levine G, Bielicki J, Fink G. Cumulative Antibiotic Exposure in the First Five Years of Life: Estimates for 45 Low- and Middle-income Countries from Demographic and Health Survey Data. Clin Infect Dis 2022; 75:1537-1547. [PMID: 35325088 DOI: 10.1093/cid/ciac225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Estimates of the total cumulative exposure to antibiotics of children in low-resource settings, and the source of these treatments, are limited. METHODS We estimated the average number of antibiotic treatments children received in the first five years of life in 45 low- and middle-income countries (LMICs) using Demographic and Health Survey (DHS) data. The two-week point prevalence of fever, diarrhea or cough and antibiotic treatment for these illnesses were estimated for ages 0-59 months and aggregated to estimate cumulative illness and antibiotic treatment for each country. We estimated treatment rates and contribution to total antibiotic use attributable to medical care, informal care, and self-medication. RESULTS Forty-five countries contributed 438,140 child-observations. The proportion of illness episodes treated with antibiotics ranged from 10% (95% CI: 9-12) (Niger) to 72% (95% CI: 69-75) (Jordan). A mean of 42·7% (95% CI: 42.1-43.3) of febrile and 32.9% of non-febrile illness (95% CI: 32.4-33.5) episodes received antibiotics. In their first five years, we estimate children received 18.5 antibiotics treatments on average (IQR: 11.6-24.6) in LMICs. Cumulative antibiotic exposure ranged from 3.7 treatments in Niger (95% CI: 2.8-4.6) to 38·6 treatments in DR Congo (95% CI: 34.7-42.4). A median of 9.0% of antibiotic treatment was attributable to informal care (IQR: 5.9-21.2), and 16.9% to self-medication (IQR: 9.5-26.2). CONCLUSIONS Childhood antibiotic exposure is high in some LMICs, with considerable variability. While access to antibiotics for children is still not universal, important opportunities for reducing excess use also exist, particularly with respect to the informal care sector and self-medication.
Collapse
Affiliation(s)
- Gillian Levine
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse, Allschwil, Switzerland.,University of Basel, Petersplatz, Basel, Switzerland
| | - Julia Bielicki
- Pediatric Infectious Disease Research Group, St George's University of London, Cranmer Terrace, Tooting, London, United Kingdom.,Infection Prevention and Control, University Children's Hospital, Basel, Spitalstrasse, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse, Allschwil, Switzerland.,University of Basel, Petersplatz, Basel, Switzerland
| |
Collapse
|
2
|
Ji X, Marchak JG, Mertens AC, Curseen KA, Zarrabi AJ, Cummings JR. National estimates of mental health service use and unmet needs among adult cancer survivors. Cancer 2021; 127:4296-4305. [PMID: 34378803 DOI: 10.1002/cncr.33827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/17/2021] [Revised: 06/07/2021] [Accepted: 06/24/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer survivors are at elevated risk for developing mental health (MH) disorders. This study assessed MH service use and unmet service needs among a nationally representative sample of cancer survivors. METHODS Respondents aged 18 to 64 years were identified from the 2015-2018 National Survey of Drug Use and Health data. Outcomes assessed past-year MH service use and self-reported unmet MH needs. Outcomes were compared between respondents who reported a cancer history (survivors) and those who did not (controls), descriptively and in adjusted analyses controlling for sociodemographic factors and health status. Analyses were stratified by age groups (18-34, 35-49, and 50-64 years). RESULTS Comparing 3540 survivors with 149,843 controls, within each age group, a higher proportion of survivors than controls received any MH service (P values < .05); this difference persisted among those aged 35 to 49 years (P = .004) in fully adjusted models. Moreover, a higher proportion of survivors than controls reported an unmet need for MH care; this difference was larger among young adults aged 18 to 34 years (20.8% vs 9.0%; P < .001) than those aged 35 to 49 years (9.4% vs 5.3%; P < .001) and 50 to 64 years (4.8% vs 3.4%; P = .029). In fully adjusted models, the survivor-control difference in self-reported unmet MH needs persisted among young adults (24% relative increase; P = .023). Among cancer survivors, young adult survivors had the highest likelihood of reporting unmet MH needs. CONCLUSIONS This nationally representative study found an increased perception of unmet needs for MH care among cancer survivors, particularly among young adult survivors, compared with the general population without cancer.
Collapse
Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ann C Mertens
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia
| | | | - Ali J Zarrabi
- Department of Medicine, Emory School of Medicine, Atlanta, Georgia
| | - Janet R Cummings
- Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, Georgia
| |
Collapse
|
3
|
Ji X, Cummings JR, Mertens AC, Wen H, Effinger KE. Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors-Results from a national survey. Cancer 2021; 127:3223-3231. [PMID: 33974717 DOI: 10.1002/cncr.33634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/13/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Substance use can exacerbate cancer-related morbidity and mortality in adolescent/young adult (AYA) cancer survivors and place them at increased risk for adverse health outcomes. The objective of this study was to assess substance use, misuse, and substance use disorders [SUDs], as well as receipt of treatment for SUDs, among AYA cancer survivors. METHODS The authors used data from the National Survey of Drug Use and Health (2015-2018) to identify a nationally representative sample of AYAs aged 12 to 34 years. Outcomes assessed past-year tobacco, alcohol, marijuana, and illicit drug use; misuse of prescription opioids; SUDs; and SUD treatment. Multiple logistic regression was estimated to compare outcomes between 832 AYAs who reported a cancer history (survivors) and 140,826 AYAs who did not, adjusting sequentially for sociodemographic characteristics and health status. RESULTS In regressions adjusting for sociodemographic characteristics, survivors were more likely than a noncancer comparison group of peers to use alcohol (6% relative increase; P = .048) and illicit drugs (34% relative increase; P = .012), to misuse prescription opioids (59% relative increase; P < .001), and to have a marijuana (67% relative increase; P = .011), illicit drug (77% relative increase; P < .001), or prescription opioid (67% relative increase; P = .048) SUD. When further adjusting for health status, survivors were still 41% more likely (P < .001) to misuse prescription opioids than noncancer peers. Among those with SUDs, survivors were more likely than peers to receive treatment (unadjusted, 21.5% vs 8.0%; adjusted, P < .05). CONCLUSIONS AYA survivors were as likely as or more likely than noncancer peers to report substance use problems. These findings underscore the importance of interventions to reduce substance use and improve SUD treatment among AYA cancer survivors. LAY SUMMARY The authors assessed substance use, misuse, and substance use disorders, as well as the receipt of treatment for substance use disorders, among adolescent and young adult (AYA) cancer survivors. In a nationally representative AYA sample, cancer survivors, despite their increased risk for morbidity and early mortality, were as likely as or more likely than peers without cancer to experience substance use problems. In particular, survivors had a significantly higher rate of prescription opioid misuse than peers. However, only 1 in 5 AYA survivors who experienced substance use disorders received treatment. These findings underscore the importance of interventions toward reducing substance use and improving access to treatment among AYA survivors.
Collapse
Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Janet R Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Hefei Wen
- Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Karen E Effinger
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| |
Collapse
|
4
|
Aslam MV, Owusu-Edusei K, Nesheim SR, Gray KM, Lampe MA, Dietz PM. Trends in Women With an HIV Diagnosis at Delivery Hospitalization in the United States, 2006-2014. Public Health Rep 2020; 135:524-533. [PMID: 32649273 DOI: 10.1177/0033354920935074] [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: 11/16/2022] Open
Abstract
OBJECTIVES The risk of mother-to-child HIV transmission can be reduced to ≤0.5% if the mother's HIV status is known before delivery. This study describes 2006-2014 trends in diagnosed HIV infection documented on delivery discharge records and associated sociodemographic characteristics among women who gave birth in US hospitals. METHODS We analyzed data from the 2006-2014 National Inpatient Sample and identified delivery discharges and women with diagnosed HIV infection by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We used a generalized linear model with log link and binomial distribution to assess trends and the association of sociodemographic characteristics with an HIV diagnosis on delivery discharge records. RESULTS During 2006-2014, an HIV diagnosis was documented on approximately 3900-4400 delivery discharge records annually. The probability of having an HIV diagnosis on delivery discharge records decreased 3% per year (adjusted relative risk [aRR] = 0.97; 95% CI, 0.94-0.99), with significant declines identified among white women aged 25-34 (aRR = 0.93; 95% CI, 0.88-0.97) or those using Medicaid (aRR = 0.93; 95% CI, 0.90-0.97); among black women aged 25-34 (aRR = 0.95; 95% CI, 0.92-0.99); and among privately insured women who were black (aRR = 0.96; 95% CI, 0.92-0.99), Hispanic (aRR = 0.92; 95% CI, 0.86-0.98), or aged 25-34 (aRR = 0.96; 95% CI, 0.92-0.99). The probability of having an HIV diagnosis on delivery discharge records was greater for women who were black (aRR = 8.45; 95% CI, 7.56-9.44) or Hispanic (aRR = 1.56; 95% CI, 1.33-1.83) than white; for women aged 25-34 (aRR = 2.33; 95% CI, 2.12-2.55) or aged ≥35 (aRR = 3.04; 95% CI, 2.79-3.31) than for women aged 13-24; and for Medicaid recipients (aRR = 2.70; 95% CI, 2.45-2.98) or the uninsured (aRR = 1.87; 95% CI, 1.60-2.19) than for privately insured patients. CONCLUSION During 2006-2014, the probability of having an HIV diagnosis declined among select sociodemographic groups of women delivering neonates. High-impact prevention efforts tailored to women remaining at higher risk for HIV infection can reduce the risk of mother-to-child HIV transmission.
Collapse
Affiliation(s)
- Maria Vyshnya Aslam
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kwame Owusu-Edusei
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven R Nesheim
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Mahle Gray
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret A Lampe
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Marie Dietz
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
5
|
Ji X, Cummings JR, Gilleland Marchak J, Han X, Mertens AC. Mental health among nonelderly adult cancer survivors: A national estimate. Cancer 2020; 126:3768-3776. [PMID: 32538481 DOI: 10.1002/cncr.32988] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/16/2020] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study assessed mental health (MH) outcomes across age groups in a nationally representative US sample of adult cancer survivors. METHODS The 2015 to 2017 National Survey on Drug Use and Health was used to identify respondents aged 18 to 64 years. The authors compared MH outcomes between respondents with a cancer history and respondents without a cancer history in adjusted analyses controlling for demographics and socioeconomic status. Outcomes included past-year major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness. All analyses were stratified by age group (18-34, 35-49, or 50-64 years). RESULTS In a comparison of 2656 survivors and 112,952 individuals without cancer, within each age group, survivors had an elevated prevalence of MH problems in 5 of the 7 outcome measures. Among young adults (aged 18-34 years), survivors were more likely than noncancer counterparts to experience major depressive episodes (18.1% vs 9.6%), serious psychological distress (34.2% vs 17.9%), suicidal thoughts (10.5% vs 7.0%), any mental illness (41.1% vs 23.3%), and serious mental illness (13.2% vs 5.9%) in the past year (P values <.05). These differences persisted in adjusted analyses (P values <.01). Similar survivor-comparison differences were observed among older groups but with a smaller magnitude. Among survivors, young adult survivors had the highest likelihood of experiencing MH problems across all outcomes (P values <.05). CONCLUSIONS This population-based study shows an elevated prevalence of MH problems among adult cancer survivors in comparison with the general population. This finding highlights the importance of developing strategies to ensure the early detection of mental illness and to improve access to MH treatment for cancer survivors.
Collapse
Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Janet R Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle-Colarusso T, Cho SJ, Aggarwal D, Kirby RS. National population-based estimates for major birth defects, 2010-2014. Birth Defects Res 2019; 111:1420-1435. [PMID: 31580536 PMCID: PMC7203968 DOI: 10.1002/bdr2.1589] [Citation(s) in RCA: 412] [Impact Index Per Article: 82.4] [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: 07/14/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Using the National Birth Defects Prevention Network (NBDPN) annual data report, U.S. national prevalence estimates for major birth defects are developed based on birth cohort 2010-2014. METHODS Data from 39 U.S. population-based birth defects surveillance programs (16 active case-finding, 10 passive case-finding with case confirmation, and 13 passive without case confirmation) were used to calculate pooled prevalence estimates for major defects by case-finding approach. Fourteen active case-finding programs including at least live birth and stillbirth pregnancy outcomes monitoring approximately one million births annually were used to develop national prevalence estimates, adjusted for maternal race/ethnicity (for all conditions examined) and maternal age (trisomies and gastroschisis). These calculations used a similar methodology to the previous estimates to examine changes over time. RESULTS The adjusted national birth prevalence estimates per 10,000 live births ranged from 0.62 for interrupted aortic arch to 16.87 for clubfoot, and 19.93 for the 12 critical congenital heart defects combined. While the birth prevalence of most birth defects studied remained relatively stable over 15 years, an increasing prevalence was observed for gastroschisis and Down syndrome. Additionally, the prevalence for atrioventricular septal defect, tetralogy of Fallot, omphalocele, and trisomy 18 increased in this period compared to the previous periods. Active case-finding programs generally had higher prevalence rates for most defects examined, most notably for anencephaly, anophthalmia/microphthalmia, trisomy 13, and trisomy 18. CONCLUSION National estimates of birth defects prevalence provide data for monitoring trends and understanding the impact of these conditions. Increasing prevalence rates observed for selected conditions warrant further examination.
Collapse
Affiliation(s)
- Cara T. Mai
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L. Isenburg
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Robert E. Meyer
- North Carolina Birth Defects Monitoring Program, State Center for Health Statistics, Raleigh, North Carolina
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adolfo Correa
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Clinton J. Alverson
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Tiffany Riehle-Colarusso
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sook Ja Cho
- Birth Defects Monitoring & Analysis Unit, Minnesota Department of Health, St. Paul, Minnesota
| | - Deepa Aggarwal
- California Birth Defects Monitoring Program, California Department of Public Health, Richmond, California
| | - Russell S. Kirby
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
| | | |
Collapse
|
7
|
Gulbrandsen M, Hartigan DE, Patel KA, Makovicka JL, Tummala SV, Chhabra A. Ten-Year Epidemiology of Ankle Injuries in Men's and Women's Collegiate Soccer Players. J Athl Train 2019; 54:881-888. [PMID: 31390272 DOI: 10.4085/1062-6050-144-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 01/31/2023]
Abstract
CONTEXT Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players. OBJECTIVE To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis. DESIGN Descriptive epidemiology study. SETTING Online injury surveillance. MAIN OUTCOME MEASURE(S) The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. RESULTS When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98). CONCLUSIONS Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.
Collapse
|
8
|
Torio CM, Encinosa W, Berdahl T, McCormick MC, Simpson LA. Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions. Acad Pediatr 2015; 15:19-35. [PMID: 25444653 DOI: 10.1016/j.acap.2014.07.007] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine national trends in hospital utilization, costs, and expenditures for children with mental health conditions. METHODS The analyses of children aged 1 to 17 are based on AHRQ's 2006 and 2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases, and on AHRQ's pooled 2006 to 2011 Medical Expenditure Panel Survey (MEPS). All estimates are nationally representative, and standard errors account for the complex survey designs. RESULTS Although overall all-cause children's hospitalizations did not increase between 2006 and 2011, hospitalizations for all listed mental health conditions increased by nearly 50% among children aged 10 to 14 years, and by 21% for emergency department (ED) visits. Behavioral disorders experienced a shift in underlying patterns between 2006 and 2011: inpatient stays for alcohol-related disorders declined by 44%, but ED visits increased by 34% for substance-related disorders and by 71% for impulse control disorders. Inpatient visits for suicide, suicidal ideation, and self-injury increased by 104% for children ages 1 to 17 years, and by 151% for children ages 10 to 14 years during this period. A total of $11.6 billion was spent on hospital visits for mental health during this period. Medicaid covered half of the inpatient visits, but with 50% to 30% longer length of stays in 2006 and 2011, respectively, than private payers. Medicaid's overall share of the ED visits increased from 45% in 2006 to 53% in 2011. CONCLUSIONS These alarming trends highlight the renewed need for research on mental health care for children. This study also provides a baseline for evaluating the impact of the Affordable Care Act and the mental health parity legislation on mental health utilization and expenditures for children.
Collapse
Affiliation(s)
- Celeste Marie Torio
- Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, Md.
| | - William Encinosa
- Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, Md
| | - Terceira Berdahl
- Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, Md
| | - Marie C McCormick
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Mass
| | | |
Collapse
|
9
|
Taxman FS, Young DW, Wiersema B, Rhodes A, Mitchell S. The National Criminal Justice Treatment Practices survey: multilevel survey methods and procedures. J Subst Abuse Treat 2007; 32:225-38. [PMID: 17383548 PMCID: PMC2266083 DOI: 10.1016/j.jsat.2007.01.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [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: 09/26/2006] [Revised: 12/24/2006] [Accepted: 01/08/2007] [Indexed: 11/19/2022]
Abstract
The National Criminal Justice Treatment Practices (NCJTP) survey provides a comprehensive inquiry into the nature of programs and services provided to adult and juvenile offenders involved in the justice system in the United States. The multilevel survey design covers topics such as the mission and goals of correctional and treatment programs; organizational climate and culture for providing services; organizational capacity and needs; opinions of administrators and staff regarding rehabilitation, punishment, and services provided to offenders; treatment policies and procedures; and working relationships between correctional and other agencies. The methodology generates national estimates of the availability of programs and services for offenders. This article details the methodology and sampling frame for the NCJTP survey, response rates, and survey procedures. Prevalence estimates of juvenile and adult offenders under correctional control are provided with externally validated comparisons to illustrate the veracity of the methodology. Limitations of the survey methods are also discussed.
Collapse
Affiliation(s)
- Faye S Taxman
- Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA 23220, USA.
| | | | | | | | | |
Collapse
|