scholarly journals Population-scale identification of differential adverse events before and during a pandemic

2021 ◽  
Author(s):  
Xiang Zhang ◽  
Marissa Sumathipala ◽  
Marinka Zitnik
Keyword(s):  
Adverse Events ◽  
Gender Gap ◽  
Older Patients ◽  
Medication Use ◽  
The United States ◽  
Healthcare Systems ◽  
Safe Medication ◽  
Demographic Groups ◽  
Public Health Emergencies ◽  
Population Scale

AbstractAdverse patient safety events, unintended injuries resulting from medical therapy, were associated with 110,000 deaths in the United States in 2019. A nationwide pandemic (such as COVID-19) further challenges the ability of healthcare systems to ensure safe medication use and the pandemic’s effects on safety events remain poorly understood. Here, we investigate drug safety events across demographic groups before and during a pandemic using a dataset of 1,425,371 reports involving 2,821 drugs and 7,761 adverse events. Among 64 adverse events identified by our analyses, we find 54 increased in frequency during the pandemic, despite a 4.4% decrease in the total number of reports. Out of 53 adverse events with a pre-pandemic gender gap, 33 have seen their gap increase with the pandemic onset. We find that the number of adverse events with an increased reporting ratio is higher in adults (by 16.8%) than in older patients. Our findings have implications for safe medication use and preventable healthcare inequality in public health emergencies.

scholarly journals Population-scale patient safety data reveal inequalities in adverse events before and during COVID-19 pandemic

2021 ◽  
Author(s):  
Xiang Zhang ◽  
Marissa Sumathipala ◽  
Marinka Zitnik
Keyword(s):  
Public Health ◽  
Patient Safety ◽  
Adverse Events ◽  
Drug Safety ◽  
Gender Gap ◽  
Safety Data ◽  
Medication Use ◽  
Incidence Rates ◽  
Drug Interference ◽  
Demographic Groups

Adverse patient safety events were associated with 110 thousand deaths in the U.S. alone in 2019. The COVID-19 pandemic has further challenged the ability of healthcare systems to ensure medication safety, and its effects on patient safety remain unknown. Here, we investigate negative outcomes associated with medication use before and during the pandemic. Using a dataset of 10,443,476 reports involving 3,624 drugs and 19,193 adverse events, we develop an algorithmic approach to analyze the pandemic's impact on incidence of drug safety events by evaluating disproportional reporting relative to the pre-pandemic time, quantifying unexpected trends in clinical outcomes, and adjusting for drug interference. Among 64 adverse events identified by our analyses, we find 54 have increased incidence rates during the pandemic, even though reporting of adverse events has decreased by 4.4% overall. We find clinically relevant differences in drug safety outcomes between demographic groups. Comparing to male patients, women report 47.0% more distinct adverse events whose occurrence significantly increased during the pandemic relative to pre-pandemic levels. Out of 53 adverse events with the pre-pandemic gender gap, 33 have increased gap during the pandemic more than would have been expected had the pandemic not occurred. While musculoskeletal and metabolic side effects are disproportionately enriched in women during the pandemic, immune-related adverse events are enriched only in men. We also find the number of adverse events with a higher reporting ratio during the pandemic in adults is higher (16.8%) than in older patients (adjusted for population size). Our findings have implications for safe medication use and public health policy and highlight the role of variation in adverse events for improving patient safety during a public health emergency.

Gender Differences in IT Use in the U.S. and Japan

2008 ◽  
pp. 3174-3202
Author(s):  
Hiroshi Ono ◽  
Madeline Zavodny
Keyword(s):  
United States ◽  
Gender Differences ◽  
Digital Divide ◽  
Gender Inequality ◽  
Gender Gap ◽  
The United States ◽  
It Use ◽  
Demographic Groups ◽  
Actual Usage ◽  
Nuanced Understanding

As information technology (IT) has become more common in everyday use, so too have concerns about the digital divide—unequal access to and use of IT across demographic groups and countries. Understanding the extent and causes of the digital divide is important because IT skills have become increasingly vital to individuals’ economic success. Although IT is widely available in both the United States and Japan, there are notable gender differences in its actual usage between the two countries. In the United States, the gender gap in IT use has narrowed over time, and according to some measures, women are at least as likely as men to use computers. In Japan, however, sizable gender gaps in IT use persist. The contrasting patterns of IT use in the United States and Japan reflect differences in the structure of social organizations and institutions in the two countries. Studying gender differences in IT use across countries thus requires a nuanced understanding of the institutional context under which gender inequality is generated. Using the United States and Japan as contrasting examples, this article examines how gender differences in IT use evolve from gender inequality in broader cultural settings, particularly labor market institutions.

scholarly journals The Paradox of Declining Female Happiness

2009 ◽  
Vol 1 (2) ◽  
pp. 190-225 ◽  
Author(s):  
Betsey Stevenson ◽  
Justin Wolfers
Keyword(s):  
United States ◽  
Gender Gap ◽  
Well Being ◽  
The United States ◽  
Objective Measures ◽  
Subjective Well Being ◽  
Industrialized Countries ◽  
Demographic Groups ◽  
The Past

The lives of women in the United States have improved over the past 35 years by many objective measures, yet we show that measures of subjective well-being indicate that women's happiness has declined both absolutely and relative to men. This decline in relative well-being is found across various datasets, measures of subjective well-being, demographic groups, and industrialized countries. Relative declines in female happiness have eroded a gender gap in happiness in which women in the 1970s reported higher subjective well-being than did men. These declines have continued and a new gender gap is emerging—one with higher subjective well-being for men. (JEL I31, J16, J28)

Gender Differences in IT Use in the U.S. and Japan

2011 ◽  
pp. 564-569
Author(s):  
Hiroshi Ono ◽  
Madeline Zavodny
Keyword(s):  
United States ◽  
Gender Differences ◽  
Digital Divide ◽  
Gender Inequality ◽  
Gender Gap ◽  
The United States ◽  
It Use ◽  
Demographic Groups ◽  
Actual Usage ◽  
Nuanced Understanding

As information technology (IT) has become more common in everyday use, so too have concerns about the digital divide—unequal access to and use of IT across demographic groups and countries. Understanding the extent and causes of the digital divide is important because IT skills have become increasingly vital to individuals’ economic success. Although IT is widely available in both the United States and Japan, there are notable gender differences in its actual usage between the two countries. In the United States, the gender gap in IT use has narrowed over time, and according to some measures, women are at least as likely as men to use computers. In Japan, however, sizable gender gaps in IT use persist. The contrasting patterns of IT use in the United States and Japan reflect differences in the structure of social organizations and institutions in the two countries. Studying gender differences in IT use across countries thus requires a nuanced understanding of the institutional context under which gender inequality is generated. Using the United States and Japan as contrasting examples, this article examines how gender differences in IT use evolve from gender inequality in broader cultural settings, particularly labor market institutions.

scholarly journals Comparative Toxicity and Effectiveness of Trastuzumab-Based Chemotherapy Regimens in Older Women With Early-Stage Breast Cancer

2017 ◽  
Vol 35 (29) ◽  
pp. 3298-3305 ◽  
Author(s):  
Katherine E. Reeder-Hayes ◽  
Anne Marie Meyer ◽  
Sharon Peacock Hinton ◽  
Ke Meng ◽  
Lisa A. Carey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Adverse Events ◽  
Older Patients ◽  
Early Stage ◽  
The United States ◽  
Health Care Use ◽  
Significant Shift ◽  
Serious Adverse Events ◽  
Adjuvant Trastuzumab

Purpose The combination of chemotherapy and trastuzumab is the standard of care for adjuvant treatment of human epidermal growth factor receptor 2–positive breast cancer. Two regimens have been widely adopted in the United States: doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab (ACTH) and docetaxel, carboplatin, and trastuzumab (TCH). No head-to-head comparison of these regimens has been conducted in a clinical trial, and existing trial data have limited generalizability to older patients. Methods We used SEER-Medicare data from 2005 to 2013 to compare outcomes of ACTH versus TCH among patients age older than 65 years. Propensity score matching was used to balance cohort characteristics between treatment arms. Outcomes included toxicity-related hospitalization, survival, and trastuzumab completion. Data from 1,077 patients receiving ACTH or TCH were analyzed, and the propensity-matched subsample included 416 women. Results There was a significant shift toward TCH over time, with 88% of patients receiving ACTH in 2005 compared with 15% by 2011. Among propensity score–matched patients, we found no difference between regimens in health care use overall or for chemotherapy-related adverse events (ACTH, 34% v TCH, 36.5%; P = .46). Patients receiving TCH were significantly more likely to complete trastuzumab (89% v 77%; P = .001). There was no difference in 5-year breast cancer–specific survival (ACTH, 92% v TCH, 96%; hazard ratio, 2.08; 95% CI, 0.90 to 4.82) or overall survival. Conclusion Among a matched sample of older patients, ACTH compared with TCH was not associated with a higher rate of serious adverse events or hospitalizations, but it was associated with less completion of adjuvant trastuzumab. We did not detect a difference in 5-year survival outcomes for ACTH compared with TCH. In the context of limited evidence in older patients, selection between these two regimens on the basis of concerns about differential toxicity or efficacy may not be appropriate.

scholarly journals District nurses’ use of a decision support and assessment tool to improve the quality and safety of medication use in older adults: a feasibility study

2020 ◽  
Vol 21 ◽  
Author(s):  
Annica Lagerin ◽  
Lena Lundh ◽  
Lena Törnkvist ◽  
Johan Fastbom
Keyword(s):  
Older Patients ◽  
Assessment Tool ◽  
Medication Use ◽  
Nursing Interventions ◽  
Quality And Safety ◽  
Potential Drug ◽  
Drug Related Problems ◽  
Stockholm County ◽  
Safe Medication ◽  
District Nurses

Abstract Aim: To investigate whether district nurses (DNs) can identify factors related to the quality and safety of medication use among older patients via a clinical decision support system (CDSS) for medication and an instrument for assessing the safety of drug use [the Safe Medication Assessment tool (SMA)]. A secondary aim was to describe patients’ experiences of the assessment. Background: DNs in Stockholm County have the opportunity to establish special units at primary health care centers (PHCCs) for patients aged 75 years and older. The units conduct drug utilization reviews and create care plans for older adults. Methods: Nine DNs at 7 PHCCs in Stockholm County used the tools with 45 patients aged 75 years and older who used one or more drugs. Outcome measures were the number of drugs, potential drug-related problems, nursing interventions, and patient satisfaction. Prevalences of drug-related problems and nursing interventions were calculated. Eleven patients answered a telephone questionnaire on their experiences of the assessment. Findings: DNs identified factors indicative of drug-related problems, including polypharmacy (9.8 drugs per person), potential drug–drug interactions (prevalence 40%), potential adverse drug reactions (2.7 per person), and prescribers from more than two medical units (60%). DNs used several nursing interventions to improve the safety of medication use (e.g., patient education, initiating a pharmaceutical review). The patients thought it was meaningful to receive information about their drug use and important to identify potential drug-related problems. With the support of the CDSS and the SMA tool, the DNs could identify several factors related to inappropriate or unsafe medication and initiated a number of interventions to improve medication use. The patients were positive toward the assessments. Using these tools, the DNs may help promote safe medication use in older patients.

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