Bias-corrected estimates for logistic regression models for complex surveys with application to the United States’ Nationwide Inpatient Sample

As the rate of HIV infection continues to rise among men who have sex with men (MSM) in the United States, a focus of current prevention efforts is to encourage frequent HIV testing. Although levels of lifetime testing are high, low levels of routine testing among MSM are concerning. Using data from an online sample of 768 MSM, this article explores how perceptions of HIV prevalence are associated with HIV testing behavior. Ordinal logistic regression models were fitted to examine correlates of perceived prevalence, and binary logistic regression models were fitted to assess associations between perceived prevalence and HIV testing. The results indicate that perceptions of higher prevalence among more proximal reference groups such as friends and sex partners are associated with greater odds of HIV testing. Perceptions of HIV prevalence were nonuniform across the sample; these variations point to groups to target with strategic messaging and interventions to increase HIV testing among MSM.

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Serious Psychological Distress and Emergency Room Use among Adults with Multimorbidity in the United States

Psychiatry Journal ◽

10.1155/2017/8565186 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Khalid Alhussain ◽

Abdulkarim M. Meraya ◽

Usha Sambamoorthi

Keyword(s):

United States ◽

Logistic Regression ◽

Psychological Distress ◽

Emergency Room ◽

Regression Models ◽

The United States ◽

Serious Psychological Distress ◽

Cross Sectional ◽

Logistic Regression Models ◽

Adjusted Logistic Regression

Objectives. (1) To examine the association between serious psychological distress (SPD) and emergency room (ER) use in the past 12 months among adults with multimorbidity in the United States (US) and (2) to investigate the association between SPD and the reasons for ER use. Methods. The current study used a cross-sectional design with retrospective data from the 2015 National Health Interview Survey. Logistic regression models were used to assess the association between SPD and ER use among adults with multimorbidity. Among ER users, adjusted logistic regression models were conducted to examine the association between SPD and the reasons for the ER use. Results. After controlling for other variables, adults with multimorbidity and SPD were more likely to use ER than those with multimorbidity and no SPD (AOR = 1.61, 95% CI = 1.26, 2.04). Among ER users, there were no significant associations between SPD and the reasons for ER use after controlling for other variables. Conclusion. Adults with multimorbidity and SPD were more likely to use ER as compared to those with multimorbidity and no SPD. Among adults with multimorbidity, routine screening for SPD may be needed to reduce the ER use.

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Youth Access to School Salad Bars in the United States—2011 to 2014

American Journal of Health Promotion ◽

10.1177/0890117116671645 ◽

2016 ◽

Vol 32 (1) ◽

pp. 84-88 ◽

Cited By ~ 1

Author(s):

Brenna K. VanFrank ◽

Stephen Onufrak ◽

Diane M. Harris

Keyword(s):

United States ◽

Logistic Regression ◽

Regression Models ◽

The United States ◽

Logistic Regression Models ◽

Multivariable Logistic Regression ◽

Let's Move ◽

Race Ethnicity ◽

Nationally Representative ◽

Over Time

Purpose: To examine differences in students’ access to school salad bars across sociodemographic groups and changes in availability over time. Design: Nonexperimental. Setting: Nationally representative 2011 and 2014 YouthStyles surveys. Participants: A total of 833 (2011) and 994 (2014) US youth aged 12 to 17 years. Measures: Youth-reported availability of school salad bars. Analysis: Multivariable logistic regression models were used to assess differences in school salad bar availability by sociodemographics and changes in availability from 2011 to 2014. Results: Youth-reported salad bar availability differed by age in 2011 and race/ethnicity in 2014, but not by sex, income, metropolitan residence, or region in either year. Salad bars were reported by 62% of youth in 2011 and 67% in 2014; the increase was not statistically significant ( P = .07). Significant increases from 2011 to 2014 were noted among youth aged 12 to 14 years (56%-69%; P < .01), youth of non-Hispanic other races (60%-85%; P < .01), and youth in the Midwest (58%-72%; P = .01). Conclusion: These results suggest that youth-reported access to school salad bars does not differ significantly across most sociodemographic groups. Although overall salad bar availability did not increase significantly from 2011 to 2014, some increases were observed among subgroups. Continued efforts to promote school salad bars through initiatives such as Let’s Move Salad Bars to Schools could help increase access for the nearly one-third of US youth reporting no access.

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Sociodemographic Characteristics and Health Status of Mindfulness Users in the United States

Mindfulness ◽

10.1007/s12671-020-01486-4 ◽

2020 ◽

Vol 11 (12) ◽

pp. 2725-2729 ◽

Cited By ~ 1

Author(s):

Otto Simonsson ◽

Maryanne Martin ◽

Stephen Fisher

Keyword(s):

United States ◽

Mental Illness ◽

Logistic Regression ◽

Regression Models ◽

The United States ◽

Access Barriers ◽

Physical Pain ◽

Unequal Distribution ◽

Logistic Regression Models ◽

Barriers To Healthcare

Abstract Objectives The aims of the present study are to provide population estimates for the prevalence of mindfulness use in the United States and to identify which groups are more likely to self-report mindfulness use. Methods Using data from the 2017 National Health Interview Survey (NHIS), the current study analyzed 26,742 responses from adults in the United States and estimated patterns in the likelihood of self-reported mindfulness use across groups using logistic regression models. Results The results suggest that 5% of adults in the United States in 2017 had used mindfulness over the prior year, which is significantly more than the finding that 2% of adults in the United States had used mindfulness during the 12 months prior to the 2012 NHIS interview. The logistic regression models show that self-reported mindfulness use was less likely among married adults and more likely among women, sexual minorities, young and middle-aged adults, white adults, employed adults, adults without minor children in the family, adults from the West of the United States, adults with access barriers to healthcare, adults with cost barriers to healthcare, adults with mental illness, and adults with physical pain. Most notably, mindfulness use was reported by substantial numbers of respondents with access barriers to healthcare (10%), cost barriers to healthcare (9%), mental illness (15%), or physical pain (7%). Conclusions The results of the present study suggest an unequal distribution of mindfulness use across groups in the United States.

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Rise in Use of Digital Mental Health Tools and Technologies in the United States During the COVID-19 Pandemic: Survey Study (Preprint)

10.2196/preprints.26994 ◽

2021 ◽

Author(s):

Dara H Sorkin ◽

Emily A Janio ◽

Elizabeth V Eikey ◽

Margaret Schneider ◽

Katelyn Davis ◽

...

Keyword(s):

Mental Health ◽

United States ◽

Logistic Regression ◽

Regression Models ◽

The United States ◽

Clinical Depression ◽

Depression And Anxiety ◽

Logistic Regression Models ◽

Symptoms Of Depression ◽

Time Point

BACKGROUND Accompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically. OBJECTIVE The objective of this study was to systematically examine whether there was a COVID-19 pandemic–related increase in the self-reported use of digital mental health tools and other technologies to manage mental health. METHODS We analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one’s mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. RESULTS Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. CONCLUSIONS Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy.

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Vision Impairment, Poor Diet, and Food Insecurity in the United States

Current Developments in Nutrition ◽

10.1093/cdn/nzab033_030 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 30-30

Author(s):

Ajay Kolli ◽

Rebecca Mozaffarian ◽

Erica Kenney

Keyword(s):

United States ◽

Logistic Regression ◽

Food Security ◽

Food Insecurity ◽

Diet Quality ◽

Regression Models ◽

The United States ◽

Vision Impairment ◽

Logistic Regression Models ◽

Poor Diet

Abstract Objectives To test the hypotheses that poor diet and food insecurity are associated with both measured and self-reported vision impairment (VI). Methods We analyzed data from adults age ≥50 years in the National Health and Nutrition Examination Survey (NHANES) between 1999–2008 in the United States (US). To assess diet quality, Healthy Eating Index 2015 scores (HEI-2015) were applied to participants’ 24-hour recall dietary intake. Participants were categorized as having full, marginal, low, or very low food security using the US Food Security Survey Module. Presenting VI (PVI) was defined as presenting distance visual acuity worse than 20/40 in the better-seeing eye. Self-reported VI (SRVI) was defined as vision reported as fair, poor, or very poor. Accounting for NHANES’ complex survey design, separate logistic regression models were constructed to assess the associations between HEI-2015 quintile and PVI, HEI-2015 quintile and SRVI, food insecurity category and PVI, and food insecurity category and SRVI. Models were adjusted for age, gender, race, education, income, cigarette use, alcohol use, body mass index, and physical activity. Results Of the 10078 adults in this analysis, mean age was 63.4 years, 54% were women, and 80% were white. Mean HEI-2015 score (from 0–100) was 52.5. The prevalence of full food security was 89.9%, that of PVI was 7.2%, and that of SRVI was 20.1%. In adjusted logistic regression models, those with HEI-2015 scores in the lowest quintile (poor diet) had significantly higher odds of SRVI (OR: 1.29; 95% confidence interval [CI]: 1.04–1.61), but not PVI (OR: 1.13; CI: 0.86–1.49) compared to those in the fifth quintile. Compared to full food security, marginal (OR: 1.31; CI: 0.97–1.76), low (OR: 1.61; CI: 1.17–2.23), and very low (OR: 2.71; CI: 1.75, 4.20) food security was associated with increased odds of PVI. Similarly, marginal (OR: 1.58; CI: 1.23–2.02), low (OR: 1.46; CI: 1.11–2.92), and very low (OR: 1.85; CI: 1.41, 2.41) food security were associated with increased odds of SRVI compared to full security. Conclusions In this nationally representative sample of US adults age 50 years and older, poorer overall diet quality was associated with greater prevalence of SRVI. In a dose-response pattern, increasingly severe food insecurity was associated with greater prevalence of both PVI and SRVI. Funding Sources None

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HPV Vaccine Initiation and Completion Among Native Hawaiian and Pacific Islander Adults, United States, 2014

Asia Pacific Journal of Public Health ◽

10.1177/10105395211027467 ◽

2021 ◽

pp. 101053952110274

Author(s):

Sameer Vali Gopalani ◽

Amanda E. Janitz ◽

Sydney A. Martinez ◽

Janis E. Campbell ◽

Sixia Chen

Keyword(s):

United States ◽

Logistic Regression ◽

Vaccination Coverage ◽

Hpv Vaccine ◽

Regression Models ◽

Insurance Coverage ◽

Hpv Vaccination ◽

Pacific Islander ◽

Logistic Regression Models ◽

Vaccine Initiation

Native Hawaiian and Pacific Islander (NHPI) adults bear a disproportionate burden of certain human papillomavirus (HPV)-associated cancers. In 2015, data from the National Health Interview Survey (NHIS) showed vaccination coverage among adults by racial and ethnic groups; however, coverage data for NHPI adults were unavailable. In this study, we estimated the initiation and completion of HPV vaccination and assessed the factors associated with vaccination among NHPI adults aged 18 to 26 years in the United States. We analyzed public data files from the 2014 NHPI NHIS (n = 1204). We specified sampling design parameters and fitted weighted logistic regression models to calculate the odds of HPV vaccine initiation. We developed a directed acyclic graph to identify a minimally sufficient set for adjustment and adjusted for insurance coverage (for education and ethnicity) and doctor visit (for insurance coverage, earnings, ethnicity, and sex). Overall, 24.9% and 11.5% of NHPI adults had initiated and completed the HPV vaccination series, respectively. Weighted logistic regression models elucidated that the odds of HPV vaccine initiation were higher for females (weighted odds ratio = 5.4; 95% confidence interval = 2.8-10.4) compared with males. Low vaccination coverage found among NHPI adults provides an opportunity for targeted programs to reduce the burden of HPV-associated cancers.

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Trends in Peritoneal Dialysis Use in the United States after Medicare Payment Reform

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.05910519 ◽

2019 ◽

Vol 14 (12) ◽

pp. 1763-1772 ◽

Cited By ~ 12

Author(s):

Caroline E. Sloan ◽

Cynthia J. Coffman ◽

Linda L. Sanders ◽

Matthew L. Maciejewski ◽

Shoou-Yih D. Lee ◽

...

Keyword(s):

United States ◽

Peritoneal Dialysis ◽

Regression Models ◽

Prospective Payment System ◽

The United States ◽

Payment Reform ◽

Logistic Regression Models ◽

Medicare Data ◽

Dialysis Facility

Background and objectivesPeritoneal dialysis (PD) for ESKD is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis (HD), but has historically been underused. We assessed the effect of the 2011 Medicare prospective payment system (PPS) for dialysis on PD initiation, modality switches, and stable PD use.Design, setting, participants, & measurementsUsing US Renal Data System and Medicare data, we identified all United States patients with ESKD initiating dialysis before (2006–2010) and after (2011–2013) PPS implementation, and observed their modality for up to 2 years after dialysis initiation. Using logistic regression models, we examined the associations between PPS and early PD experience (any PD 1–90 days after initiation), late PD use (any PD 91–730 days after initiation), and modality switches (PD-to-HD or HD-to-PD 91–730 days after initiation). We adjusted for patient, dialysis facility, and regional characteristics.ResultsOverall, 619,126 patients with incident ESKD received dialysis at Medicare-certified facilities, 2006–2013. Observed early PD experience increased from 9.4% before PPS to 12.6% after PPS. Observed late PD use increased from 12.1% to 16.1%. In adjusted analyses, PPS was associated with increased early PD experience (odds ratio [OR], 1.51; 95% confidence interval [95% CI], 1.47 to 1.55; P<0.001) and late PD use (OR, 1.47; 95% CI, 1.45 to 1.50; P<0.001). In subgroup analyses, late PD use increased in part due to an increase in HD-to-PD switches among those without early PD experience (OR, 1.59; 95% CI, 1.52 to 1.66; P<0.001) and a decrease in PD-to-HD switches among those with early PD experience (OR, 0.92; 95% CI, 0.87 to 0.98; P=0.004).ConclusionsMore patients started, stayed on, and switched to PD after dialysis payment reform. This occurred without a substantial increase in transfers to HD.

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Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes

The Scientific World JOURNAL ◽

10.1155/2014/623460 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 16

Author(s):

Thomas Danninger ◽

Rehana Rasul ◽

Jashvant Poeran ◽

Ottokar Stundner ◽

Madhu Mazumdar ◽

...

Keyword(s):

Logistic Regression ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Regression Models ◽

The United States ◽

Perioperative Outcomes ◽

Blood Transfusions ◽

Logistic Regression Models ◽

Total Hip ◽

Major Complications

Background.Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion.Methods.Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors.Results.Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12–9.90) of all major complications.Conclusions.Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions.

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The Financial Burden of Cancer on Families in the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073790 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3790

Author(s):

Patrick Richard ◽

Nilam Patel ◽

Yuan-Chiao Lu ◽

Regine Walker ◽

Mustafa Younis

Keyword(s):

United States ◽

Logistic Regression ◽

Linear Models ◽

Financial Burden ◽

Panel Study ◽

The United States ◽

Logistic Regression Models ◽

Household Level ◽

Medical Debt ◽

Diagnosis Of Cancer

This study examined the relationship between a diagnosis of cancer and the likelihood of having any out-of-pocket costs (OOPC) and medical debt, and the amounts of OOPC and medical debt, at the household level. We used the 2013 Panel Study of Income Dynamics, a continuous, representative panel survey that collects demographic, economic, and social data in the United States. The analytic sample included head of households and their spouse (if married), 18–64 years old. Two-part models were used. The first part consisted of logistic regression models and the second part consisted of generalized linear models with logarithmic link and a gamma distribution. Logistic regression results showed odds of 2.13 (CI: 1.27, 3.57, p < 0.01) for any OOPC and odds of 1.55 (CI: 0.93, 2.58, p < 0.1) for any medical debt for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to those that did not report a diagnosis of cancer. Likewise, results from the second part of the model for households with a positive amount of OOPC showed an exponentiated coefficient of 1.73 (CI: 1.33, 2.25, p < 0.01) for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to households without a diagnosis of cancer. This study shows that a diagnosis of cancer places a financial burden on families, particularly with all types of debt, in the United States even after controlling for differences between households with a diagnosis of cancer and those without a diagnosis of cancer.

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