scholarly journals AB0142 SOCIOECONOMIC STATUS (SES) AND MEDICATION USE IN RHEUMATOID ARTHRITIS (RA): A SCOPING REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1098.2-1099
Author(s):  
O. Russell ◽  
S. Lester ◽  
R. Black ◽  
C. Hill
Keyword(s):  
Rheumatoid Arthritis ◽  
Socioeconomic Status ◽  
Scoping Review ◽  
Research Training ◽  
Medication Use ◽  
Study Group ◽  
Knowledge Gaps ◽  
Coverage Area ◽  
Race Ethnicity ◽  
The Impact

Background:Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain.Objectives:To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain.Methods:MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable.SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables.Results:1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA.Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded.Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded.96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.)Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates.70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies.Conclusion:Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use.References:[1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73.[2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9.[3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2.[4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64.Acknowledgements:This research was supported by an Australian Government Research Training Program Scholarship.Disclosure of Interests:None declared

scholarly journals Understanding the Intersection of Race/Ethnicity, Socioeconomic Status, and Geographic Location: A Scoping Review of U.S. Consumer Food Purchasing

2020 ◽  
Vol 17 (20) ◽  
pp. 7677 ◽  
Author(s):  
Chelsea Singleton ◽  
Megan Winkler ◽  
Bailey Houghtaling ◽  
Oluwafikayo Adeyemi ◽  
Alexandra Roehll ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Scoping Review ◽  
Low Income ◽  
Geographic Location ◽  
Healthy Eating Index ◽  
Food Purchasing ◽  
Food Purchases ◽  
Sweetened Beverages ◽  
Food And Beverage ◽  
Race Ethnicity

Disparities in diet quality persist in the U.S. Examining consumer food purchasing can provide unique insight into the nutritional inequities documented by race/ethnicity, socioeconomic status (SES), and geographic location (i.e., urban vs. rural). There remains limited understanding of how these three factors intersect to influence consumer food purchasing. This study aimed to summarize peer-reviewed scientific studies that provided an intersectional perspective on U.S. consumer food purchasing. Thirty-four studies were examined that presented objectively measured data on purchasing outcomes of interest (e.g., fruits, vegetables, salty snacks, sugar-sweetened beverages, Healthy Eating Index, etc.). All studies were of acceptable or high quality. Only six studies (17.6%) assessed consumer food purchases at the intersection of race/ethnicity, SES, or geographic location. Other studies evaluated racial/ethnic or SES differences in food purchasing or described the food and/or beverage purchases of a targeted population (example: low-income non-Hispanic Black households). No study assessed geographic differences in food or beverage purchases or examined purchases at the intersection of all three factors. Overall, this scoping review highlights the scarcity of literature on the role of intersectionality in consumer food and beverage purchasing and provides recommendations for future studies to grow this important area of research.

Exploring the Effect of Disability, Race-Ethnicity, and Socioeconomic Status on Scores on the Self-Determination Inventory: Student Report

2018 ◽  
Vol 85 (1) ◽  
pp. 10-27 ◽  
Author(s):  
Karrie A. Shogren ◽  
Leslie A. Shaw ◽  
Sheida K. Raley ◽  
Michael L. Wehmeyer
Keyword(s):  
Socioeconomic Status ◽  
Best Practices ◽  
Interactive Effect ◽  
Autism Spectrum ◽  
The Self ◽  
Self Determination ◽  
Future Research ◽  
Assessment Development ◽  
Race Ethnicity ◽  
The Impact

The Self-Determination Inventory: Student Report (SDI:SR) was developed to address a need in the field for tools to assess self-determination that are aligned with current best practices in assessment development and administration, and emerging research and best practices in promoting self-determination. The present study explored patterns of differences in self-determination scores across students with and without disabilities (i.e., no disability, learning disabilities, intellectual disability, autism spectrum disorder, and other health impairments) of varying racial-ethnic backgrounds (i.e., White, African American or Black, Hispanic or Latino[a], and Other) as well as the impact of receiving free and reduced price lunch (as a proxy for socioeconomic status) on self-determination scores in these groups. Findings suggest an interactive effect of disability, race-ethnicity, and free and reduced price lunch status on self-determination scores. Implications for future research and practice are discussed.

The Impact of Socioeconomic Status and Race-Ethnicity on Dental Health

2007 ◽  
Vol 50 (1) ◽  
pp. 7-25 ◽  
Author(s):  
Kenneth Hudson ◽  
Jean Stockard ◽  
Zach Ramberg
Keyword(s):  
Socioeconomic Status ◽  
Dental Health ◽  
Race Ethnicity ◽  
The Impact

scholarly journals Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

2021 ◽  
Author(s):  
Arnab K Ghosh ◽  
Orysya Soroka ◽  
Mark A Unruh ◽  
Martin Shapiro
Keyword(s):  
Socioeconomic Status ◽  
Length Of Stay ◽  
Median Income ◽  
Adverse Health Outcomes ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic ◽  
Fourth Quartile ◽  
Zip Code ◽  
Surgical Admission

Length of stay, a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES). Longer LOS is associated with adverse health outcomes. We assessed differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Using the 2009-2014 State Inpatient Datasets from three states, we examined trends in aALOS differences by race/ethnicity, and SES (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. For those discharged home, racial/ethnic and SES aALOS differences remained stable. Notably, for those discharged to non-home destinations, Black vs White, and low vs high SES aALOS differences increased significantly from 2009 to 2013, more sharply after Q3 2011, the introduction of the Affordable Care Act (ACA). Further research to understand the impact of the ACA on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

scholarly journals A Scoping Review of Enterovirus D-68

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Ashley Weeks ◽  
Lisa Waddell ◽  
Andrea Nwosu ◽  
Christina Bancej ◽  
Shalini Desai ◽  
...  
Keyword(s):  
Public Health ◽  
Scoping Review ◽  
Prevention And Control ◽  
Grey Literature ◽  
Infection Prevention And Control ◽  
Future Research ◽  
Surveillance Systems ◽  
Knowledge Gaps ◽  
And Control ◽  
The Impact

Objective: To create a scoping review on enterovirus D-68 (EV-D68) that will serve as a useful tool to guide future research with the aim of filling critical information gaps and supporting the development of public health preparedness activities.Introduction: EV-D68 is a non-polio enterovirus, primarily resulting in respiratory illness, with clinical symptoms ranging from mild to severe. Infection has also been associated with severe neurological conditions like acute flaccid myelitis (AFM). EV-D68 was first discovered in 1962, with infrequent case reports until 2014 at which point a widespread multi-national outbreak mostly affecting the pediatric population occurred across North America, Europe, Southeast Asia and Africa. This outbreak was associated with an increase in AFM, with cases being reported in Canada, the United States, Norway, and France. With this new and emerging threat, public health and other organizations were called upon to implement response measures such as establishment of case definitions, surveillance mechanisms, and recommendations for clinical and public health management. The response to the 2014 outbreak in Canada highlighted several important EV-D68 evidence gaps including a lack of risk factor and clinical information available for non-severe cases, and uncertainty around seasonal, cyclical and secular trends. Given the increased reporting of EV-D68 cases associated with severe outcomes, it's critical that public health establishes what is known about EV-D68 in order to support decision-making, education and other preparedness activities and to highlight priority areas for future research to fill critical knowledge gaps. Scoping reviews provide a reproducible and updateable synthesis research methodology to identify and characterise all the literature on a broad topic as a means to highlight where evidence exists and where there are knowledge gaps. In order to systematically characterise the EV-D68 knowledge base, a scoping review was conducted to map the current body of evidence.Methods: A literature search of published and grey literature on EV-D68 was conducted on May 1, 2017. A standardized search algorithm was implemented in four bibliographic databases: Medline, Embase, Global Health and Scopus. Relevant grey literature was sought from a prioriidentified sources: the World Health Organization, United States Centers for Disease Control and Prevention, the Public Health Agency of Canada, the European Centre for Disease Prevention and Control, and thesis registries. Two-level relevance screening (title/abstract followed by full-text) was performed in duplicate by two independent reviewers using pretested screening forms. Conflicts between the reviewers were reconciled following group discussion with the study team. English and French articles were included if they reported on EV-D68 as an outcome. There were no limitations by date, publication type, geography or study design. Conference abstracts were excluded if they did not provide sufficient outcome information to characterize. The articles were then characterized by two independent reviewers using a pretested study characterization form. The descriptive characteristics of each article were extracted and categorized into one of the following broad topic categories: 1) Epidemiology and Public Health, 2) Clinical and Infection Prevention and Control (IPC), 3) Guidance Products, 4) Public Health Surveillance, 5) Laboratory, and 6) Impact. The Epidemiology and Public Health category contained citations describing prevalence, epidemiological distribution, outbreak data and public health mitigation strategies. Clinical and IPC citations included details regarding symptoms of EV-D68 infection, patient outcomes, clinical investigation processes, treatment options and infection prevention and control strategies. The Guidance category included citations that assess risk, provide knowledge translation or provide practice guidelines. Public Health Surveillance citations provided details on surveillance systems. Citations in the laboratory category included studies that assessed the genetic characteristics of circulating EV-D68 (phylogeny, taxonomy) and viral characteristics (proteins, viral properties). Lastly, the Impact category contained citations describing the social, economic and resource burden of EV-D68 infection. Each broad topic category was subsequently characterised further into subtopics.Results: The search yielded a total of 384 citations, of which 300 met the inclusion criteria. Twenty-six of forty-three potentially relevant grey literature sources were also included. Preliminary literature characterization suggests that the majority of the published literature fell under the topic categories of Epidemiology, Clinical, and Laboratory. There were limited published articles on public health guidance, IPC, surveillance systems and the impact of EV-D68. The grey literature primarily consisted of webpages directed towards the public (what EV-D68 is, how to prevent it, what to do if ill, etc.). This scoping review work is presently underway and a summary of the full results will be presented at the 2018 Annual Conference.Conclusions: The body of literature on EV-D68 has increased since the 2014 outbreak, but overall remains small and contains knowledge gaps in some areas. To our knowledge, this scoping review is the first to classify the entirety of literature relating to EV-D68. It will serve as a useful tool to guide future research with the aim of filling critical information gaps, and supporting development of public health preparedness activities.

Impact of Socioeconomic Status & Race/Ethnicity On Survival in Diffuse Large B-Cell Lymphoma (DLBCL): A Population-Based Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1954-1954
Author(s):  
James M. Foran ◽  
Laura A. McClure ◽  
Christina A. Clarke ◽  
Theresa H. M. Keegan
Keyword(s):  
Socioeconomic Status ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Block Group ◽  
Census Block ◽  
Census Block Group ◽  
Risk Of Death ◽  
Race Ethnicity ◽  
The Impact ◽  
Neighborhood Ses

Abstract Abstract 1954 Poster Board I-977 Introduction: Despite advances in treatment and a well-characterized prognostic index, significant heterogeneity remains in DLBCL survival. Preliminary data suggest a potential survival disparity based on race/ethnicity or socioeconomic status (SES). To evaluate the impact of these and other variables on survival we performed an analysis in the ethnically diverse population-based California Cancer Registry (CCR). We utilized Neighborhood SES, an index of 7 census measures of education, income, occupation & cost of living, based on the residential census-block group at diagnosis. Each census-block group comprises ∼1500 residents. Neighborhood SES has been shown to be significantly associated with survival after Follicular Lymphoma (JCO 27:3044, 2009). Methods: All pts with DLBCL (ICD-O-3 codes 9680 & 9684) diagnosed from Jan 1988 to Dec 2007 and reported to CCR were included in the analysis, including n=16,892 diagnosed from 1988-2000, and n=11,916 from 2001-2007 (total study pop'n =28,808). HIV/AIDS pts were excluded, as were n=63 with Mediastinal LBCL & n=10 with primary effusion lymphoma. The mean age was 63 yrs, and the cohort was 53% male. Between time periods, there was a relative increase in Hispanic pts [15.4% (1988-2000) to 20.8% (2001-2007), p<0.001], and a 4% increase in advanced stage from 42% (1988-2000) to 46% (2001-2007) (p<0.001). Neighborhood SES was stratified into quintiles from lowest (SES-1) to highest (SES-5), the pt distribution was: SES-1, 14%; SES-2, 18%; SES-3, 21%; SES-4, 23%; and SES-5, 24%. To evaluate the impact of prognostic factors (particularly diagnosis period, SES, and race/ethnicity) on overall survival (OS) & disease-specific survival (DSS) we used Cox proportional hazards regression to calculate hazard ratios (HR) for death with 95% CI's. Multivariate regression models included variables significant at p<0.15 in univariate models or with a priori hypotheses for inclusion. Results are presented by stage at diagnosis [Localized/Regional (LocReg) vs. Advanced (ADV)]. Results: There was a significant improvement in OS in patients diagnosed after 2001 for both LocReg (HR 0.87, 95%CI 0.82-0.91, p<0.001) and ADV stage (HR 0.69, 95%CI 0.66-0.72, p<0.001), which correlates with the introduction of rituximab into therapy for DLBCL. As expected, age >60 years was associated with a significantly worse OS for LocReg (HR 3.06, 95%CI 2.90-3.24) and ADV stage (2.02, 95%CI 1.93-2.12). Females also had significantly better OS compared with males (Loc-Reg - HR 0.90, 95%CI 0.86-0.94; ADV - HR 0.89, 95%CI 0.85-0.93). There was no significant impact of race/ethnicity on survival with the exception of non-Hispanic Asian/Pacific Islanders (NH A/PI) with ADV stage, for whom OS was significantly inferior compared with whites (HR 1.18, 95%CI 1.09-1.27, p<0.001). Compared with the highest quintile (SES-5), there was a significant effect of lower neighborhood SES on OS and DSS (see Table). Conclusion: There has been a significant improvement in survival after DLBCL since 2001, but patients in the lowest SES-1 quintile have a 34% higher risk of death from any cause and 20% higher risk for death from lymphoma than those in the highest SES-5. In this model, race/ethnicity did not have a significant impact on survival with the exception of NH A/PI with ADV stage. Studies to understand and address these socioeconomic disparities are urgently required in order to extend the improvements in DLBCL survival more effectively. Disclosures: Foran: Genentech: Honoraria, Research Funding.

scholarly journals Association of Hospitalised Infection With Socioeconomic Status in Patients With Rheumatoid Arthritis Receiving Biologics or Tofacitinib: A Population-Based Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Hsin-Hua Chen ◽  
Ching-Heng Lin ◽  
Chen-Yu Wang ◽  
Wen-Cheng Chao
Keyword(s):  
Rheumatoid Arthritis ◽  
Socioeconomic Status ◽  
Risk Factor ◽  
Cox Regression ◽  
Population Based ◽  
Research Database ◽  
Inverse Association ◽  
Cox Regression Analysis ◽  
High Income Category ◽  
The Impact

Objectives: Use of biologics or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) is associated with infection in patients with rheumatoid arthritis (RA). Socioeconomic status is substantial in infectious diseases; however, the impact of socioeconomic status on risk for infection in patients with RA receiving b/tsDMARD remains unclear.Methods: We used the 2003–2017 Taiwanese National Health Insurance Research Database to identify patients with RA receiving b/tsDMARDs. A Cox regression analysis was used to estimate the associations of covariates with the risk of hospitalised infection shown as hazard ratios (HRs) with 95% confidence interval (CIs).Results: We identified 7,647 RA patients who started their first bDMARD/tsDMARD treatment. Log-rank analyses demonstrated the association between age (p &lt; 0.001), urbanisation (p = 0.001), the insured amount (p = 0.021), and the hospitalisation. Cox proportional regression analyses showed that age was independently associated with hospitalised infection in a dose–response manner, whereas a high-income category had an inverse association (HR 0.48, 95% CI 0.23–0.96). Hospitalisation for infection within 5 years was a strong risk factor (HR 5.63, 95% CI 1.91–16.62), and living in a rural area tended to be a risk factor (HR 1.76, 95% CI 0.98–3.14) for incident hospitalised infection.Conclusions: This study showed the crucial impacts of age, socioeconomic status, and history of infection on hospitalised infection in patients with RA receiving b/tsDMARDs. These findings highlight the largely ignored role of socioeconomic status in risk stratification among patients receiving b/tsDMARDs for RA.

scholarly journals The impact of low-dose glucocorticoids on disease activity, bone mineral density, fragility fractures, and 10-year probability of fractures in patients with rheumatoid arthritis

2018 ◽  
Vol 66 (6) ◽  
pp. 1004-1007 ◽  
Author(s):  
Tien-Tsai Cheng ◽  
Han-Ming Lai ◽  
Shan-Fu Yu ◽  
Wen-Chan Chiu ◽  
Chung-Yuan Hsu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Disease Activity ◽  
Bone Mineral ◽  
Clinical Characteristics ◽  
Low Dose ◽  
Control Group ◽  
Study Group ◽  
Mineral Density ◽  
The Impact

This study aimed to investigate the effect of low-dose glucocorticoids (LDGs) on disease activity, bone density, and fractures in patients with rheumatoid arthritis (RA). This was an interim analysis of the RA Registry. Demographic data and clinical characteristics, including fracture risk assessment tool, were collected. 25(OH) Vitamin D, bone mineral density (BMD), and intact parathyroid hormone were measured at enrollment. The study group were those who took LDGs (2.5–7.5 mg/day prednisolone or equivalent dose), and the others were included as the control group. A total of 425 participants were enrolled, including 85 (20%) in the control group and 340 (80%) in the study group. The demographics and clinical characteristics were comparable between the two groups. Compared with the control group, the LDGs group had a significantly lower vertebral BMD (L 1–4) (g/cm2), (0.854 vs 0.896, p=0.046), significantly higher rate of previous fractures (103 (30.3%) vs 13 (15.3%), p=0.006), higher 10-year probability of major fractures (14 (15.5) vs 8 (8.6), p<0.0001), and higher 10-year probability of hip fractures (4.4 (8.4) vs 2 (3.9), p<0.0001). Disease activity appeared to be similar in the patients with RA regardless of whether or not they received LDG treatment. However, the patients with RA who received LDG treatment had a lower BMD at the spine (L1–4) and a higher rate of previous fractures that was associated with a significantly higher 10-year probability of fractures than those who did not receive LDG treatment.

The Role of Psychosocial Processes in Explaining the Gradient Between Socioeconomic Status and Health

2003 ◽  
Vol 12 (4) ◽  
pp. 119-123 ◽  
Author(s):  
Nancy E. Adler ◽  
Alana Conner Snibbe
Keyword(s):  
Socioeconomic Status ◽  
Allostatic Load ◽  
Direction Of Causation ◽  
Race Ethnicity ◽  
And Gender ◽  
Psychosocial Processes ◽  
The Life Course ◽  
Ethnicity And Gender ◽  
The Impact

The gradient between socioeconomic status (SES) and health is well established: Many measures of health show that health increases as SES increases. However, the mechanisms underlying this association are not well understood. Behavioral, cognitive, and affective tendencies that develop in response to the greater psychosocial stress encountered in low-SES environments may partially mediate the impact of SES on health. Although these tendencies might be helpful for coping in the short term, over time they may contribute to the development of allostatic load, which increases vulnerability to disease. Debate remains regarding the direction of causation between SES and health, the impact of income inequality, the interaction of SES with race-ethnicity and gender, and the effects of SES over the life course.

A scoping review of acupuncture insurance coverage in the United States

2020 ◽  
pp. 096452842096421
Author(s):  
Roselle Bleck ◽  
Emma Marquez ◽  
Melanie A Gold ◽  
Carolyn L Westhoff
Keyword(s):  
United States ◽  
Scoping Review ◽  
Insurance Coverage ◽  
Research Priorities ◽  
The United States ◽  
Subject Area ◽  
Published Data ◽  
Opioid Use ◽  
Knowledge Gaps ◽  
The Impact

Background: Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods: We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results: We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion: We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.

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