Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults

2021 ◽  
pp. ASN.2020101511
Author(s):  
Rebecca Thorsness ◽  
Shailender Swaminathan ◽  
Yoojin Lee ◽  
Benjamin D. Sommers ◽  
Rajnish Mehrotra ◽  
...  
Keyword(s):  
United States ◽  
Incidence Rate ◽  
Kidney Failure ◽  
The United States ◽  
Early Years ◽  
Relative Reduction ◽  
Medicaid Expansion ◽  
Expansion Time ◽  
Incident Cases ◽  
Medicaid Expansions

BackgroundLow-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to chronic disease care.MethodsUsing a difference-in-differences analysis, we examined the association between Medicaid expansion status under the Affordable Care Act (ACA) and the kidney failure incidence rate among all nonelderly adults, aged 19–64 years, in the United States, from 2012 through 2018. We compared changes in kidney failure incidence in states that implemented Medicaid expansions with concurrent changes in nonexpansion states during pre-expansion, early postexpansion (years 2 and 3 postexpansion), and later postexpansion (years 4 and 5 postexpansion).ResultsThe unadjusted kidney failure incidence rate increased in the early years of the study period in both expansion and nonexpansion states before stabilizing. After adjustment for population sociodemographic characteristics, Medicaid expansion status was associated with 2.20 fewer incident cases of kidney failure per million adults per quarter in the early postexpansion period (95% CI, −3.89 to −0.51) compared with nonexpansion status, a 3.07% relative reduction (95% CI, −5.43% to −0.72%). In the later postexpansion period, Medicaid expansion status was not associated with a statistically significant change in kidney failure incidence (−0.56 cases per million per quarter; 95% CI, −2.71 to 1.58) compared with nonexpansion status and the pre-expansion time period.ConclusionsThe ACA Medicaid expansion was associated with an initial reduction in kidney failure incidence among the entire, nonelderly, adult population in the United States; but the changes did not persist in the later postexpansion period. Further study is needed to determine the long-term association between Medicaid expansion and changes in kidney failure incidence.

Abstract 392: Incidence Of Paroxysmal Supraventricular Tachycardia In The United States

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Michael Rehorn ◽  
Naomi Sacks ◽  
Madison Preib ◽  
Philip Cyr ◽  
Maia Emden ◽  
...  
Keyword(s):  
United States ◽  
Incidence Rate ◽  
Supraventricular Tachycardia ◽  
Older Patients ◽  
The United States ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Research Database ◽  
Heart Rhythm Disorders ◽  
Us Census ◽  
Incident Cases

Background: Paroxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythm disorders that lead to abrupt increases in heart rate. Given its episodic nature, PSVT can be difficult to capture in a clinical setting. Therefore, estimating incidence of PSVT is challenging and thus limited data is available on the incidence of this disease. Objective: Estimate the incidence of PSVT within the United States in contemporary practice. Methods: Using claims, enrollment, and demographic data from the IBM Marketscan® Commercial Research Database (<65y) and the Medicare Limited Dataset (≥65y), individuals enrolled in health plans for at least 5 continuous years from 2008-2016 were identified. Patients having claims with a PSVT diagnosis (ICD-9: 427.0; ICD-10 I47.1) on 2+ outpatient visits, 1+ ED visit, or 1+ inpatient admission were included in the analysis. Only patients receiving an initial diagnosis of PSVT in year 5 of continuous enrollment were included in the incidence calculation in order to avoid including prevalent cases. Incidence was projected to the US population based on the 2018 US census data. Results: Among 18,057,297 patients, 86,614 met PSVT criteria. Incidence rates were higher in female and older patients. Within the 18-44y group, the incidence rate was 1.9-fold higher for females as compared to males. Overall incidence rate per 100,000 was 79.1 and 107.2 for males and females respectively (Table). Projected to the 2018 US Census, there were 305,548 incident PSVT cases in 2018. Conclusion: There were over 305,000 incident cases of PSVT in 2018 with higher rates in female and older patients. Further studies are needed to understand practice patterns in management of PSVT, given the high incidence of this disease.

1488-P: Closing the Racial/Ethnic Disparity Gap in Kidney Failure from Diabetes in the United States, 2000-2016

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1488-P
Author(s):  
NILKA RIOS BURROWS ◽  
YAN ZHANG ◽  
ISRAEL A. HORA ◽  
MEDA E. PAVKOV ◽  
GIUSEPPINA IMPERATORE
Keyword(s):  
United States ◽  
Kidney Failure ◽  
The United States ◽  
Ethnic Disparity ◽  
Racial Ethnic

scholarly journals Monetizing the Burden of Childhood Asthma Due to Traffic Related Air Pollution in the Contiguous United States in 2010

2021 ◽  
Vol 18 (15) ◽  
pp. 7864
Author(s):  
Minaal Farrukh ◽  
Haneen Khreis
Keyword(s):  
United States ◽  
Air Pollution ◽  
Economic Impact ◽  
Childhood Asthma ◽  
Ambient Air ◽  
The United States ◽  
The State ◽  
Cost Calculation ◽  
Cost Burden ◽  
Incident Cases

Background: Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. Objective: The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. Methods: We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. Results: The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95% CI: $101,019,728.20–$256,980,126.65). The state with the highest cost burden is California with $24,501,859.84 (95% CI: $10,020,182.62–$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95% CI: $33,491.06–$144,269.18). Conclusion: This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP’s impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population’s exposure.

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

Trends in Federally Mandated Warning Labels for Consumer Products

2001 ◽  
Vol 45 (11) ◽  
pp. 838-842 ◽  
Author(s):  
Frederick J. Diedrich ◽  
Christine T. Wood ◽  
Thomas J. Ayres
Keyword(s):  
United States ◽  
Safety Information ◽  
The United States ◽  
Consumer Products ◽  
Early Years ◽  
Warning Labels ◽  
Labeling Requirements ◽  
Hazard Warning

Consumer products currently sold in the United States often come with extensive safety information, but the presentation of large amounts of such material was not always the case. We reviewed federally mandated hazard labeling as it evolved during the 20th century by documenting changes in labeling requirements for home-use products prescribed by federal statutes. Our review indicated that during the course of the 20th century, there was a dramatic change in the presence, prevalence and specificity of hazard warning requirements. In the early years, Congress concentrated on truth in labeling of contents and quality. This labeling identified hazardous agents in some products. However, as the century progressed, Congress gradually added requirements that could include descriptions of the mechanisms, consequences, and means for avoidance of such hazards. Moreover, the 1960's and especially the 1970's brought a dramatic expansion in the number and types of products required to bear hazard labels.

Anglo-american policy in Greece (1946-50)

2013 ◽  
Author(s):  
Spero Simeon Zachary Paravantes
Keyword(s):  
United States ◽  
Foreign Policy ◽  
American Foreign Policy ◽  
The United States ◽  
Early Years ◽  
United States Government ◽  
Anglo American ◽  
Dramatic Shift ◽  
Current Financial Crisis ◽  
Post War

While trying to understand and explain the origins and dynamics of Anglo-American foreign policy in the pre and early years of the Cold War, the role thatperception played in the design and implementation of foreign policy became acentral focus. From this point came the realization of a general lack of emphasisand research into the ways in which the British government managed to convincethe United States government to assume support for worldwide British strategicobjectives. How this support was achieved is the central theme of this dissertation.This work attempts to provide a new analysis of the role that the British played in the dramatic shift in American foreign policy from 1946 to 1950. Toachieve this shift (which also included support of British strategic interests in theEastern Mediterranean) this dissertation argues that the British used Greece, first asa way to draw the United States further into European affairs, and then as a way toanchor the United States in Europe, achieving a guarantee of security of theEastern Mediterranean and of Western Europe.To support these hypotheses, this work uses mainly the British andAmerican documents relating to Greece from 1946 to 1950 in an attempt to clearlyexplain how these nations made and implemented policy towards Greece duringthis crucial period in history. In so doing it also tries to explain how Americanforeign policy in general changed from its pre-war focus on non-intervention, to the American foreign policy to which the world has become accustomed since 1950. To answer these questions, I, like the occupying (and later intervening)powers did, must use Greece as an example. In this, I hope that I may be forgivensince unlike them, I intend not to make of it one. My objectives for doing so lie notin justifying policy, but rather in explaining it. This study would appear to havespecial relevance now, not only for the current financial crisis which has placedGreece once again in world headlines, but also for the legacy of the Second WorldWar and the post-war strife the country experienced which is still playing out todaywith examples like the Distomo massacre, German war reparations and on-goingsocial, academic and political strife over the legacy of the Greek Civil War.

scholarly journals Mapping a Nation: Daniel Carter Beard’s Time as a Surveyor for the Sanborn Map Company

2019 ◽  
Vol 1 ◽  
pp. 1-1
Author(s):  
John J. Swab
Keyword(s):  
United States ◽  
Lived Experience ◽  
The United States ◽  
Early Years ◽  
Urban America ◽  
Fire Insurance ◽  
History Of ◽  
The 19Th Century ◽  
The City ◽  
Eastern Half

<p><strong>Abstract.</strong> Fire insurance maps produced by the American firm the Sanborn Map Company have long served as cartographic guides to understanding the history of urban America. Primarily used by cultural and historical geographers, historians, historic preservationists, and environmental consultants; historians of cartography have little explored the history of this company. While this scholarship has addressed various facets of Sanborn’s history (Ristow, 1968), no scholarly piece has explored the lived experience of being a Sanborn surveyor. This lack of scholarship comes not from any significant oversight but rather from the fact that the contributions of most Sanborn surveyors were anonymous and little recorded on the maps themselves. Moreover, the company itself has done little to save its own history, thus little is known of their individual stories and experiences. The exception to this is perhaps the most famous Sanborn surveyor of all: Daniel Carter Beard.</p><p>Over the course of his nine-decade life, Daniel Carter Beard held several prominent positions including the co-founder of the Boy Scouts of America and the lead illustrator for many of Mark Twain’s novels. However, he got his start as a surveyor for the Sanborn Map Company in the 1870s, just a few years after its founding. His papers, housed at the Manuscript Division of the Library of Congress, includes a variety of ephemera from his time with the Sanborn Map Company.</p><p>Trained in civil engineering, Beard got his start as a surveyor for the Cincinnati (Ohio) Office of Platting Commission, creating the first official plat map for the city. He was hired by Sanborn in 1874 and served as a surveyor until 1878, traveling extensively over the eastern half of the United States, parlaying his skills into creating fire insurance maps for Sanborn. Thus, this paper speaks to two main themes. The first theme traces the route of Beard during his early years with the company across the eastern half of the United States, documenting both the places he visited and the challenges he faced as a Sanborn surveyor. The second theme, interwoven through the paper, is an analysis of the innerworkings of Sanborn’s administrative structure and its relationship with the larger fire insurance market during the 1870s. Altogether, these documents present unique insight into the organization of the Sanborn Map Company and how it produced its maps during the second-half of the 19th century.</p>

Insurance coverage and care affordability in cancer survivors in 2016-2019.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1520-1520
Author(s):  
Justin Michael Barnes ◽  
Eric Adjei Boakye ◽  
Mario Schootman ◽  
Evan Michael Graboyes ◽  
Nosayaba Osazuwa-Peters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Low Socioeconomic Status ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Mediating Effect ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Linear Probability

1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.

“Pride Comes in Many Colors”

Pride Parades ◽  
2016 ◽  
Author(s):  
Katherine McFarland Bruce
Keyword(s):  
United States ◽  
Cultural Change ◽  
The United States ◽  
Early Years ◽  
Cultural Contexts ◽  
Sense Of Purpose ◽  
Pride Parades ◽  
Cultural Code

Chapter Four continues the comparison of contemporary Pride parades from the previous chapter, focusing on the differences between the various expressions of Pride across the United States. While pursuing a common model of cultural change, each parade promotes visibility, support, and celebration using symbols and messages adapted to their local cultural contexts. When the level of tolerance varies, so too does the expression of identities defying the heteronormative cultural code. Additionally, through their variation Pride parades deal differently with the three identified issues – visibility, support, celebration - that began in the phenomenon’s early years. With still unsettled debates, Pride parades wrestle with provocative displays, commercialization, and maintaining a sense of purpose amid the festivity.

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