Prenatal exposure to the 2009 pandemic H1N1 influenza vaccine on health outcomes in children

IntroductionDuring the 2009 H1N1 pandemic, less than half of pregnant women in Ontario received the recommended influenza vaccine. Commonly-cited reasons for low vaccine uptake include misconceptions about the possible impact of maternal influenza infection and vaccine safety. Providing data on previously understudied pediatric health outcomes may help increase vaccine uptake. Objectives and ApproachWe conducted a retrospective cohort study of all live births from November 2nd, 2009 to October 31st, 2010 using the BORN Ontario province-wide birth registry containing information on H1N1 vaccination. These data were deterministically/probabilistically linked with several health administrative databases held at the Institute for Clinical Evaluative Sciences to ascertain specific immune-related pediatric health outcomes and health services utilization over 5 years of follow-up. Negative binomial regression models were used to evaluate the association between prenatal H1N1 vaccination and outcomes. Stabilized inverse probability of treatment weights (sIPTW) derived from the propensity scores were used to adjust for potential confounding. ResultsThe study cohort included 104,310 eligible infants, 31,310 (30%) of whom were born to H1N1-vaccinated women. Median follow-up time was 5 years. Using sIPTWs we were able to achieve good balance of baseline measured covariates across exposure groups, with no absolute standardized differences larger than 7%. The sIPTW-adjusted analyses indicated no significant associations between prenatal exposure to H1N1 vaccination and upper respiratory infections (adjusted rate ratio [aRR] 1.01; 95% confidence interval [CI] 0.98-1.03), lower respiratory infections (aRR 1.00; 95%CI 0.96-1.04), otitis media (aRR 1.04; 95%CI 1.00-1.07), all infections (aRR 1.00; 95%CI 0.98-1.03), and rates of urgent and in-patient health services utilization (aRR 1.00; 95%CI 0.98-1.02). Conclusion/ImplicationsOur primary findings suggest there are no associations between prenatal exposure to H1N1 vaccination and (1) the development of several immune-related health outcomes in children; (2) rates of health services utilization. Furthermore, our study provides new evidence on the long-term safety of influenza vaccination during pregnancy, which is currently lacking.

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Health outcomes and services in children with sickle cell trait, sickle cell anemia, and normal hemoglobin

Blood Advances ◽

10.1182/bloodadvances.2018028043 ◽

2019 ◽

Vol 3 (10) ◽

pp. 1574-1580 ◽

Cited By ~ 3

Author(s):

Sarah L. Reeves ◽

Hannah K. Jary ◽

Jennifer P. Gondhi ◽

Mary Kleyn ◽

Kevin J. Dombkowski

Keyword(s):

Health Outcome ◽

Health Services ◽

Health Outcomes ◽

Sickle Cell ◽

Health Services Utilization ◽

Sickle Cell Trait ◽

Respiratory Infections ◽

Acute Otitis Media ◽

Acute Respiratory Infections ◽

Services Utilization

AbstractThe health effects of sickle cell trait among children are unknown. We compared select health outcomes and health services utilization among children with sickle cell trait, sickle cell anemia (SCA), and normal hemoglobin. Newborn screening records were used to identify children with sickle cell trait and SCA born in Michigan (1997-2014) who were enrolled in Michigan Medicaid for ≥1 year from 2012 to 2014. Each select health outcome (acute otitis media, acute respiratory infections, fever, invasive pneumococcal disease, pneumonia and influenza, renal complications, spleen problems, stroke) was defined as ≥1 claim with a diagnosis code for the respective outcome within a study year. Health services utilization was summarized as counts of emergency department, inpatient, and outpatient encounters. The relationship between hemoglobin status and each health outcome or utilization was assessed by logistic or negative binomial regression with generalized estimating equations. The study population consisted of 18 257 children with sickle cell trait, 368 with SCA, and 74 523 with normal hemoglobin (227 188 total person-years). Compared with those with normal hemoglobin, children with sickle cell trait had lower odds of acute otitis media (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.84-0.91), acute respiratory infections (OR, 0.94; 95% CI, 0.92-0.97), pneumonia and influenza (OR, 0.93; 95% CI, 0.87-0.99), and outpatient visits (incidence rate ratio, 0.95; 95% CI, 0.93-0.97). Children with SCA had higher or nonsignificant odds of all outcomes and types of health services utilization. These results indicate that children with sickle cell trait may not be at additional health risk for these outcomes. However, additional case-control studies may be necessary to identify rare events.

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The impact of health insurance on health services utilization and health outcomes in Vietnam

Health Economics Policy and Law ◽

10.1017/s174413311400005x ◽

2014 ◽

Vol 9 (4) ◽

pp. 359-382 ◽

Cited By ~ 12

Author(s):

G. Emmanuel Guindon

Keyword(s):

Health Insurance ◽

Health Services ◽

Health Outcomes ◽

Health Services Utilization ◽

Living Standard ◽

Outpatient Services ◽

Services Utilization ◽

The Poor ◽

Inpatient Services ◽

The Impact

AbstractIn recent years, a number of low- and middle-income country governments have introduced health insurance schemes. Yet not a great deal is known about the impact of such policy shifts. Vietnam’s recent health insurance experience including a health insurance scheme for the poor in 2003 and a compulsory scheme that provides health insurance to all children under six years of age combined with Vietnam’s commitment to universal coverage calls for research that examines the impact of health insurance. Taking advantage of Vietnam’s unique policy environment, data from the 2002, 2004 and 2006 waves of the Vietnam Household Living Standard Survey and single-difference and difference-in-differences approaches are used to assess whether access to health insurance – for the poor, for children and for students – impacts on health services utilization and health outcomes in Vietnam. For the poor and for students, results suggest health insurance increased the use of inpatient services but not of outpatient services or health outcomes. For young children, results suggest health insurance increased the use of outpatient services (including the use of preventive health services such as vaccination and check-up) but not of inpatient services.

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Health services utilization of Chinese patients with Huntington’s disease: a cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06826-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huiyi Ke ◽

Xi Cao ◽

Yanyan Song ◽

Li Cao

Keyword(s):

Logistic Regression ◽

Health Insurance ◽

Health Services ◽

Huntington's Disease ◽

Huntington’S Disease ◽

Influencing Factors ◽

Health Services Utilization ◽

Services Utilization ◽

Medical Visits

Abstract Background Huntington’s disease (HD) is a hereditary disease which could have a large impact on patients’ quality of life. As the neurodegenerative disorders progress, HD patients are expected to regularly take follow-up medical visits for proper treatment. This study aimed to analyze the general situation of health services utilization of Chinese HD patients and factors associated with their adherence to follow-up medical visits. Methods We collected data from a questionnaire-based investigation conducted by the Chinese Huntington’s Disease Association. Data from 232 respondents were included to investigate whether they adhered to regular follow-up medical visits and the influencing factors. Based on Andersen’s behavioral model, the independent variables were categorized into predisposing, enabling and need factors. The variables were analyzed by chi-square test and stepwise logistic regression analysis. Results Thirty-one point nine percent of the respondents had regular follow-up medical visits over the past year. Univariate analysis showed that there were significant differences with 6 factors (P < 0.05), among which, according to logistic regression, 2 enabling factors (reimbursement of health insurance, need for accompanying family members to follow-up visits) and 3 need factors (perceived stage of disease, perceived effectiveness of drugs, self-care ability) were independent influencing factors of follow-up medical behaviors of Chinese HD patients. The predisposing factors investigated here did not play a part in determining patients’ adherence to follow-up visits. Conclusions Poor adherence to medical visits among Chinese HD patients is derived from multiple factors, including reimbursement of health insurance, perceived stage of disease and effectiveness of drugs, need for accompanying family members and self-care ability. To promote HD patients’ health services utilization, the improvement of the health insurance system, the enhancement of social support and the development of therapeutic approaches still have a long way to go.

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Health services utilization and payments in patients with cancer pain: A comparison of intrathecal drug delivery versus conventional medical management.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.125 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 125-125

Author(s):

Lisa Stearns ◽

Nora Anita Janjan ◽

Jennifer A. Hinnenthal

Keyword(s):

Drug Delivery ◽

Health Services ◽

Cancer Pain ◽

Health Outcomes ◽

Medical Management ◽

Hospital Costs ◽

Matched Pairs ◽

Services Utilization ◽

Ed Visits

125 Background: The financial costs of cancer care are a burden to people diagnosed with cancer, their families, and society. This analysis compared health services utilization and cost in patients receiving either intrathecal drug delivery (IDD) or conventional medical management (CMM) for the treatment of cancer pain. Methods: Using retrospective administrative claims data, patients receiving either IDD or CMM were propensity score-matched 1:1 based on characteristics including, but not limited to, age, gender, cancer type, comorbid conditions, and health care utilization and cost during a six-month baseline period. Follow-up cost and utilization were subsequently compared for up to 12 months. Results: From a sample of 142 IDD patients and 3,188 CMM patients that met all inclusion/exclusion criteria, 73 matched pairs were obtained. Among the matched pairs, the average age was 52.6 years and 70.5% were female. The three most common cancers were leukemia/lymphoma (54.8%), digestive system cancer (40.4%) and breast cancer (24.0%). All patients were continuously enrolled at 2 months, 61% at 6 months, and 35.6% at 12 months; enrollment was not significantly different between groups. At two, six and twelve months follow-up, compared to CMM, IDD patients had a lower average number of inpatient (IP) hospitalizations (two months: 1.12 vs. 1.74 (p=0.0010); six months: 1.72 vs. 2.69 (p=0.0358); twelve months: 2.14 vs. 3.13 (p=0.1476)), and emergency department (ED) visits (two months: 0.47 vs. 1.36 (p<0.0001); six months: 0.98 vs. 2.38 (p=0.0049); 12 months: 1.59 vs. 3.17 (p=0.0611)). Including the cost of the IDD implant procedure, IDD still provided overall savings of $4,123 in IP hospital costs, $6,144 in outpatient hospital costs and $1,902 in ED costs at 12 months. Once all sites of services were considered, IDD saved $3,195 at 12 months relative to CMM. Conclusions: The goal of healthcare reform is to improve health outcomes through more effective therapies and avoid futile care. Through reduced hospital and ED visits, IDD improves health outcomes, and assists healthcare entities to meet current hospital readmission rate criteria and other quality standards.

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Health services utilization of Chinese patients with Huntington's disease: A cross-sectional study

10.21203/rs.3.rs-215224/v1 ◽

2021 ◽

Author(s):

Huiyi Ke ◽

Xi Cao ◽

Yanyan Song ◽

Li Cao

Keyword(s):

Logistic Regression ◽

Health Insurance ◽

Health Services ◽

Huntington's Disease ◽

Huntington’S Disease ◽

Health Services Utilization ◽

Self Care ◽

Services Utilization ◽

Medical Visits

Abstract Background Huntington’s disease (HD) is a hereditary disease which could have a large impact on patients’ quality of life. As the neurodegenerative disorders progress, HD patients are expected to regularly take follow-up medical visits for proper treatment. This study aimed to analyze the general situation of health services utilization of Chinese HD patients and factors associated with their adherence to follow-up medical visits. Methods We collected data from a questionnaire-based investigation conducted by Chinese Huntington's Disease Association. Data from 232 respondents were included to investigate whether they adhered to regular follow-up medical visits and the cause and correlates. Based on Andersen’s behavioral model, the independent variables were categorized into predisposing, enabling and need factors. The variables were analyzed by chi-square test and stepwise logistic regression analysis. Results 31.9% of the respondents had regular follow-up medical visits over the past year. Univariate analysis showed there were significant differences with 6 factors (P < 0.05), among which, according to logistic regression, 2 enabling factors (reimbursement of health insurance, need for accompanying family members to follow-up visits) and 3 need factors (perceived stage of disease, perceived effectiveness of drugs, self-care ability) were independent influencing factors of follow-up medical behaviors of Chinese HD patients. The predisposing factors investigated here did not play a part in determining patients’ adherence to follow-up visits. Conclusions Poor adherence to medical visits among Chinese HD patients is derived from multiple factors, including reimbursement of health insurance, perceived stage of disease and effectiveness of drugs, need for accompanying family members and self-care ability. To promote HD patients’ health services utilization, the improvement of health insurance system, the enhancement of social support and the development of therapeutic approaches still have a way to go.

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Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population‐based study

Epilepsia ◽

10.1111/epi.16642 ◽

2020 ◽

Vol 61 (9) ◽

pp. 1969-1978

Author(s):

Churl‐Su Kwon ◽

Bonnie Wong ◽

Parul Agarwal ◽

Jung‐Yi Lin ◽

Madhu Mazumdar ◽

...

Keyword(s):

Health Services ◽

Hospital Admissions ◽

Health Services Utilization ◽

Population Based ◽

Population Based Study ◽

Services Utilization ◽

Discharge Disposition

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Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience

BMC Public Health ◽

10.1186/s12889-021-10586-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maria Helena Rodrigues Galvão ◽

Angelo Giuseppe Roncalli

Keyword(s):

Health Policy ◽

Oral Health ◽

Health Services ◽

Health Services Utilization ◽

Age Groups ◽

Public Access ◽

Services Utilization ◽

Index Of Inequality ◽

Oral Health Services ◽

Oral Health Policy

Abstract Background This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy. Methods The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII). Results There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied. Conclusions The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.

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